How To Explain Abnormal Behavior

 

Medical Model

·        Specific causes, symptoms, disease

·        Abnormal behavior is biogenic

·        Results from malfunction within the body

 

Psychodynamic Perspective

·        Unconscious psychological conflicts originating in childhood

·        Behavioral Perspective

·        Inappropriate learning

·        Maladaptive behaviors are rewarded

·        Adaptive behaviors are not rewarded

 

Cognitive Perspective

·        Maladaptive ways of perceiving or thinking about oneself or the environment

·        Sociocultural Perspective

·        Broad social forces

·        Examines the biases that can influence diagnosis

 

Diagnosis

·        “The Classification of Psychopathology Has a Long Past but a Very Recent History”

·        using very old, detailed descriptions of patients, we can make a dx today

 

Kraepelin-1898:  2 Varieties of Psychopathology

·        Dementia praecox (schizophrenia) and affective disorders

·        Emphasized the biological bases of psychiatric disorders

 

1917-APiA With Census Bureau

·        Developed classification of mental disease

·        Uniform statistics in hospitals

·        But not useful for diagnosis

 

APiA and NY Medical Center

·        Developed new nomenclature

·        Mostly for chronic inpatients

·        Not useful to WWII vets, who had  psychophysiological, personality, and acute disorders

 

Armed Forces and VA developed their own system

 

1948 - World Health Organization

Added section on mental disorders to the international classification of diseases and health related problems (ICD)

Excluded dementia, adjustment disorders, and many personality disorders

 

In 1948 There Were 3 Different Systems Being Used in the USA:

1)  APiA and NY Medical Center

2)  Armed Forces and VA

3)  ICD

·        As late as 1970, France and Russia had their own classification systems

 

Diagnostic and Statistical Manual

 

DSM-I

·        Published in 1952

·        Little influence on dx practice

 

DSM-II in 1968

·        Relied heavily on unproven theories of etiology

·        Not widely accepted

·        System had very little reliability

 

DSM-III

  • 1980, directed by Spitzer
  • 3 Major Changes in DSM-III: 
    • Took atheoretical approach to dx
    • Specificity and detail of criteria-could study reliability and validity
    • Created axes

 

Axes

  • Axis I:  disorder itself
  • Axis II:  chronic, personality disorders
  • Axis III:  physical disorders and conditions
  • Axis IV:  psychosocial stress
  • Axis V:  current level of adaptive functioning

 

DSM-III-R

  • 1987
  • Minor adjustments to some criteria
  • Problems With DSM-IIIs
  • Low reliability of some dx categories remained
  • Many criteria
  • Empirically based and potentially measurable
  • Were derived by committee consensus

 

DSM-IV

  • Realized need for consistent, worldwide system
  • Out in 1993 concurrently worked on with DSM
  • Task force of experts created for DSM-iv-reviewed literature
  • Independent Studies or Field Trials
    • Examined reliability and validity of alternative sets of definitions or criteria
    • Created new diagnoses, if needed

 

Changes From DSM-IIIR

  • Organically-based vs. Psychologically-based disorders
  • Only personality and MR coded on axis II
  • Axis IV psychosocial and environmental problems
  • Axis V with estimate of highest level of functioning in the past year

 

DSM-IV-TR

  • Corrected factual errrors identified in DSM-IV
  • Ensured up-to-date information
  • Added new information
  • Enhanced educational value of test
  • Updated ICD-9-CM codes

 

CRITICISMS OF DSM-IV

 

(see Carson article)

 

1)  Problem With Multiple dxs:

  • Not same as “disease”
  • No markers
  • No definitive criteria, etc.

 

2)  Disorders Are Interactions of Multiple Factors: 

  • Biological
  • Psychosocial
  • sociocultural
  • Historic/current
  • Hardware and software
  • Bad luck

 

3)  Excessive Focus on Reliability

  • Usefulness?
  • Predictiveness?
  • Construct validity?

 

Other DSM Issues Raised by Carson

  • DSM-II to DSM-III, 50% of pp. Previously dx’d as schizophrenic moved to other categories
  • Poor predictive validity for schizophrenia just 6-25 months in the future
  • Changes in dx criteria may render past research unusable

 

Carson Recommends

  • Prototypal-dimensional-profile (hybrid) approach

 

Disadvantages of DX:

  • Misdiagnosis
  • Assumption of discontinuity
  • Embodiment of medical model
  • Questionable reliability
  • Labeling
  • Illusion of explanation (“he is hallucinating because he is schizophrenic”)

 

Benefits of DX:

  • Communication
  • Etiology
  • Treatment
  • Prognosis