I.
Diagnosis and Classification
Issues
Defining Abnormality
1. Personal or Subjective Distress –
people with poor sense of well-being or
high level of subjective distress
considered psychologically abnormal
(severe depression or panic disorder).
Advantage of this definition:
- Reasonable to expect that adults and
some children can assess whether
they are experiencing problems and
can share this information.
Problems with this definition:
- There are obvious pitfalls in asking a
person to know whether they are
maladjusted.
2. Statistical Infrequency (Rarity) and
Violation of Social Norms (Deviance) –
deviant, outrageous, nonconforming
behavior considered psychologically
abnormal (dissociative identity disorder
and schizophrenia, respectively).
Advantages of this definition:
- Test authors designate cutoff point,
based on statistical deviance from
the mean score obtained by normal
sample of test takers.
o Frequently used
interpretation
psychological test scores.
o Scores at or beyond cutoff =
clinically significant.
- Intuitive appeal – those behaviors
we consider abnormal would be
evaluated similarly by others.
Problems with this definition:
- Difficulty in establishing agreed-
upon cutoff points.
- Cultural and Developmental
Relativity – judgements can vary
depending on whether family, school
officials, or peers are making them.
3. Impaired Social Functioning –
behavior creating some degree of
social/interpersonal
occupational/educational problems for
the individual considered
psychologically abnormal (social
phobia or antisocial personality
disorder).
Advantages of this definition:
- Little inference required.
- Problem in this sphere often prompt
individuals to get treatment.
Problems with this definition:
- Judgements about social and
occupational functioning are relative,
involving a value-oriented standard.
Defining Abnormality (cont.)
- 1990s, Jerome Wakefield offered a
simplified definition of mental
disorders.
- Harmful Dysfunction Theory
o Harmful – value term based
on social norms.
o Dysfunction – scientific
term referring to failure of a
mental mechanism to
perform its natural function.
- Wakefield proposes that we consider
both scientific (evolutionary) data
and social values in a cultural
in context to determine what is
of abnormal.
Defining Abnormality (cont.)
- Diagnostic and Statistical Manual
of Mental Disorders (DSM) – the
prevailing diagnostic guide; the
medical model of psychopathology.
o Disorder = entity; defined
categorically and features a
list of specific symptoms.
o Defined mental disorder as a
clinically significant
disturbance in cognition,
emotion, regulation, or
behavior that indicates a
dysfunction in mental
or functioning that is usually
 associated with significant
distress or disability in
work, relationships, or other
areas of functioning.
- Not all deviant behaviors or conflicts
with society are signs of mental
disorder.
Importance of Diagnosis
- Diagnosis – a type of expert-level
categorization (enable us to make
distinctions)
- For Professionals
o Facilitate study of specific
disorders by researchers and
its consideration by clinicians
(professional vocabulary).
o People will be diagnosed
with specific mental disorders
and conceptualized as having
this form of mental illness.
- For Clients
o Help clients identify and
demystify a nameless
experience.
o Gain access to treatment that
might have been unavailable
without a diagnosis.
Diagnosis and Classification of Mental
Disorders: A Brief History
Hippocrates
- He did not offer supernatural
explanations like possession.
- Emphasized natural causes like
imbalance of bodily fluids (blood,
phlegm, black, and yellow bile) for
mental illnesses
19 Century
th
- Cities in Europe and United States
establish asylums for the treatment
of mentally ill.
- Categorization and organization of
clients: Philippe Pinel’s melancholia,
mania, and dementia.
1900
- Emil Kraepelin (father of current
diagnostic system) labeled manic-
depressive psychosis and dementia
praecox.
- Military categorization system to
facilitate diagnosis and treatment for
soldiers returning from World War II.
Medical Model of Psychopathology
DSM – Earlier Editions (I and II)
- DSM I – 1952 (American
Psychological Association)
- DSM II – 1968, as a revision.
- Contained 3 broad categories of
disorders: psychoses (equivalent to
schizophrenia), neuroses (equivalent
to major depression, bipolar
disorder, and anxiety disorders), and
character disorders (equivalent to
personality disorders).
- Not scientifically nor empirically
based – rather, it represented the
accumulated clinical wisdom of
senior academic psychiatrists.
- Reflected psychoanalytic approach.
- Limited generalizability or utility
(one paragraph description per
disorder).
- Presented 106 and 182 disorders,
respectively.
DSM – Recent Editions (III, III-R, IV, and
IV-TR)
- DSM-III – 1980
o Relied more on empirical
data.
o Presented 265 disorders.
o Used specific diagnostic
criteria (checklist) to define
disorders.
o Dropped allegiance to a
particular theory.
o Introduced multiaxial
assessment system.
Multiaxial Assessment System
 Axis I. Episodic disorders (have - Scientific review committee –
beginning and end points), all assure that there was sufficient
psychological diagnostic scientific evidence to support
categories except personality changes by work groups.
disorders and mental - New disorders in DSM 5:
retardation. o Premenstrual dysphoric
Axis II. Long-lasting disorders disorder (PMDD)
like personality disorders and o Disruptive mood
mental retardation. Note dysregulation disorder
maladaptive personality features (DMDD)
and defense mechanisms. o Binge eating disorder (BED)
Axis III. Report general medical o Mild neurocognitive disorder
conditions relevant to the (Mild NCD)
individual’s mental disorder. o Somatic symptom disorder
Axis IV. Report psychosocial
(SSD)
and environmental problems
o Hoarding disorder
affecting the mental disorder.
Axis V. Global Assessment of - Revised disorders in DSM 5:
Functioning Scale (GAF) – o Major Depression – dropped
place client on a 100-point bereavement exclusion.
continuum describing overall o Autistic disorder to autism
level of functioning. spectrum disorder.
GAF = score (current); o ADHD – age where
(highest level in the past year); symptoms must first appear
(at discharge). was changed from 7 to 12
Anxiety Neurosis years old.
DSM-II o Mental retardation to
- Characterized by anxious over- intellectual disability
concern extending to panic and (intellectual development
frequently associated with somatic disorder)
symptoms. o Learning disabilities
- Anxiety may occur under any combined with new name:
circumstances and is not restricted specific learning disorder.
to specific situations or objects - Possible changes in the future:
(unlike phobic neurosis). o Expanded “biological
- Must be distinguished from normal markers” – to emphasize
apprehension or fear. neuropsychology or
DSM – The Current Edition biological roots of mental
- DSM 5 – May 2013 disorders.
- David Kupfer and Darrel Regier o View disorders along a
- 300 disorders continuum (overly
- Work groups – reviewed disorders complicated, thus, rejected).
listed in previous DSMs. Each o Dimensional approach to
focused on a particular area of personality disorders.
mental disorders. o Remove 5 out of 10
personality disorders:
 paranoid, schizoid, - According to a dimensional
histrionic, dependent, and approach, the issue isn’t the presence
narcissistic. or absence of a disorder; instead, the
- Criticisms on DSM 5: issue is where on a continuum a
o Diagnostic overexpansion: client’s symptoms fall.
diagnoses cover too much of - Proponents of this approach share
normal life. that all of us share the same
o Transparency of revision fundamental characteristics but we
process: vague and selective differ in the amounts of these
about what was shared in the characteristics we possess.
website. Five-Factor Model of Personality (Big
o Membership of work Five Model)
groups: some researchers do - According to the dimensional
not practice at all. approach to abnormality, each of our
o Field trial problems: some personalities contains the same five
reliability ratings were too basic factors—neuroticism,
low. extraversion, openness to
o Price: costly. experience, agreeableness, and
o Improvements over their conscientiousness.
predecessors: rapid - These five factors could constitute
expansion of diagnoses; the dimensions on which clinical
many newer disorders are not psychologists describe clients with
entirely mental disorders. personality problems.
o Controversial cutoffs: some
cutoffs have been
subjectively chosen by DSM
authors.
o Cultural issues: may not
reflect minority experiences.
o Gender bias: some
categories are biased toward
pathologizing one gender
more than the other.
o Nonempirical influences:
political wrangling and
public opinion may have
influenced authors.
o Limitations on objectivity:
decisions were results of
experts’ consensus.
Alternative Directions in Diagnosis and
Classifications
Dimensional Approach
- In replacement of categorical
approach (has or does not have; yes
or no).