Diagnosis and Classification Issues: DSM-5

and More
Defining Abnormality

What is Abnormality?
Normal? Or Abnormal? Why?
Before deciding to go on a date, a woman consults
her horoscope for the day to help her make a
decision.

A person feels that everyone is constantly watching

him/her and making judgments about him/her, and
that other people's thoughts and conversations
tend to revolve around that person.

A woman gets up each morning and spends an hour

putting on elaborate makeup and styling her hair
before going to work.
 Unusualness - How unusual so we could
label it as abnormality?

Distress - only if individual suffer distress

and wishes to be rid of the behaviours?
(subjective experience)
Mental Illness
only behaviours resulting from mental illness are
abnormal
4 Ds of Abnormality

▪ Distress - Causes emotional or physical pain

▪ Deviance - Leads to judgments of abnormality

▪ Dysfunction - Interferes with a person’s ability to function in

daily life

▪ Dangerousness - Behaviors and feelings that are of potential

harm
Cultural Relativism
▪ Cultural relativism: There are no
universal standards or rules for
labeling a behavior abnormal

▪ Behaviors are labeled abnormal

relative to cultural norms
The Integrationist Approach to
Understanding Mental Health
Do you agree with the idea that a behavior can be
pathological within a particular culture even if it is
common or typical within that culture? Why or why not?
 Who defines Abnormality?

Defining DSM-5 – Mental disorder is a ”clinically

significant disturbance” in “cognition,
Normality and emotion regulation, or behavior” that
indicates a “dysfunction in ”mental
Abnormality functioning”

American Psychiatric Association – “medical

model of psychopathology”
 Why is the definition of
abnormality important?

Defining
Normality and Label; Medical Insurance

Abnormality

Stigma
 Hippocrates
Diagnosis and
Classification of
Mental
Asylums with humane
Disorders: A treatment
Brief History

Before the DSM Emil Kraepelin Diagnostic

System
 DSM I (1952)

DSM II (1968)

DSM Earlier DSM I and II : Psychoses, Neuroses, and Character Disorders

Editions (I and
II)
“accumulated clinical wisdom of the small number of senior
academic psychiatrists who staffed DSM task forces”

Psychoanalytic approach

One paragraph per disorder

 DSM More Recent
Editions (III, III-R, IV,
and IV-TR)

• DSM III – Dropped a

particular theory of therapy
or psychopathology; from
psychoanalytic to no single
psychological perspective
• Introduced Multiaxial
Assessment system (dropped
in DSM-5)
• Extended descriptions,
checklist • Axis I – Clinical Disorders
• 265 from 182 –retained until • Axis II – Personality Disorders
DSM 5 but with certain
changes of its own • Axis III – Medical Conditions
• Axis IV – Psychosocial problems
• Axis V – Global Assessment of Functioning
 DSM-5: The Current Edition

DSM-5 – published in May

WHO who publishes ICD
2013 after 20 years, 12 Changes in DSM-5 – -Neurological and
dsm5.org – public (International
years in the making, led considered but did not Biological underpinnings
communication Classification of Diseases
by David Kupfer and make not yet strong
11)
Darrel Regier

“Emerging Measures and Internet Gaming Disorder

-Continuum (dimensional) -Removing 5 of the 10
Models” – “Proposed (Condition to further
rather than dichotomous personality disorders
criteria sets” study)
 From Roman to Arabic

Dropped Multiaxial Assessment

New Features
in DSM-5 New Disorders (PreMenstrualDD, DisruptiveMoodDD, BED,
mild NCD, SomaticSymtpomD, Hoarding)

Revised Disorders (person’s own history and culture, single

DSM-5 diagnosis Autism Spectrum Disorder, substance abuse
and substance dependence to substance use disorder
(tolerance / withdrawal), ADHD from 7 to 12 y/o,
 Big Five

DIMENSIONAL MODEL CATEGORICAL MODEL

OF PSYCHOPATHOLOGY OF PSYCHOPATHOLOGY
The Clinical Interview
 Quieting yourself

The
Interviewer: Self-awareness

General Skills
Positive working relationships
(attentive listening, appropriate
empathy, genuine respect, and
cultural sensitivity)
 Eye contact

Body language
The
Interviewer: Vocal qualities
Specific
Behaviors Verbal tracking

Referring to the client by proper name

 Rapport (genuine connection and sympathy) – small
talk

1. to put client at ease; 2. recognize position and

appreciate willingness, and invite them to ask
questions; 3. speak their language
Components
of the Technique (what an interviewer does)

Interview
Directive Vs. Nondirective Styles (Symptoms vs tell me
more)

Specific Interviewer Responses (open and closed-ended

questions, clarification, confrontation, paraphrasing,
reflection of feeling, summarizing, conclusion)
 Pragmatics of the Interview

NOTE TAKING AUDIO AND VIDEO THE INTERVIEW CONFIDENTIALITY

RECORDINGS ROOM
 INTAKE INTERVIEW DIAGNOSTIC STRUCTURED VS.
INTERVIEW UNSTRUCTURED
Types of INTERVIEWS

Interviews

MENTAL STATUS CRISIS INTERVIEWS CULTURAL

EXAM COMPONENTS
Intellectual and Neuropsychological
Assessment
Intelligence Testing
• Charles Spearman

• Louis Thurstone
 Wechsler Intelligence Tests (WAIS-IV, WISC-IV,
WPPSI-III)

Intelligence
Testing Vs. -Verbal Comprehension Index,
Perceptual Reasoning Index,
Working Memory Index, Stanford-Binet

Achievement
Intelligence Scales
Processing Speed Index (verbal
and performance)

Test
-Fluid Reasoning, Knowledge,
Quantitative Reasoning, Visual-
Wechsler Individual
Spatial Processing, Working Assessment Test-III
Memory (verbal and non-
verbal)
Personality Assessment and
Behavioral Assessment
 Multimethod Assessment

Different
Approaches Evidence-Based Assessment
to Assessing
Clients
Culturally Competent
Assessment
Objective
MINNESOTA MULTIPHASIC MILLON CLINICAL MULTIAXIAL NEO PERSONALITY INVENTORY-
PERSONALITY INVENTORY-2 INVENTORY-III (PERSONALITY) REVISED (NORMAL TRAITS)
(CLINICAL)

Personality
Tests
CALIFORNIA PSYCHOLOGICAL BECK DEPRESSION INVENTORY-
INVENTORY-III (POSITIVE II (SPECIFIC)
ATTRIBUTES OF PERSONALITY)
 Projective Personality Tests

RORSCHACH INKBLOT THEMATIC SENTENCE

METHOD APPERCEPTION TEST COMPLETION TESTS
• Naturalistic Observation
• Self-Monitoring

Behavioral Assessment
General Issues in
Psychotherapy
Does Psychotherapy
Work?
Efficacy Versus
Effectiveness of
Psychotherapy
 Which Type of
Psychotherapy is Best?
What Types of Psychotherapy Do
Clinical Psychologists Practice?