Diagnostic and Statistical Manual

Diagnostic Criteria

1. Violation of Norms

2. Personal Suffering or Distress

3. Disability or Dysfunction

4. Statistical Infrequency

Deviance

The behavior is highly unusual, many psychological disorders break social norms.

What do proponents argue about the view of Personal Suffering or Distress as a definition of abnormality?

What do some therapists also take into account when looking at Personal Suffering or Distress as a definition of abnormality?

Proponents of this view argue that a behavior is only abnormal if the individual suffers as a result of the behavior(s) and wishes to be rid of them.

Some therapists object to the subjective discomfort criterion because people are not always aware of problems that their behavior may create for themselves or others. For example, someone may not be suffering directly from their disorder, but someone else may be suffering because of that person's disorder.

When the behavior prevents normal daily functioning.

Think of the case of Tom (man who was afraid of riding the escalator). If this behavior makes him have to climb 5 flights of stairs everyday to work, subsequently making him late and stressed out, this would prevent normal daily functioning.

What does Statistical Infrequency depend on?

What are some arguments against Statistical Infrequency?

The norms for that behavior in a culture. For example, urinating in your house in a tribal culture might not be against social norms and therefore not considered to be abnormal.

Statistical Infrequency cannot be the only criterion because there are people who are on the other end of the spectrum (i.e. IQ scores and the Bell Curve) who are not considered to have a mental disorder.

Also, you can display traits of a disorder without having the disorder (i.e. being depressed because you got a bad test grade). Therefore, in these cases, Statistical Infrequency does not matter.

1. Psychiatrists

2. Clinical Psychologists

3. Social Workers

4. Professional Counselors

5. Marriage and family therapy (MFT)

6. Psychiatric Nurses

7. Psychosocial rehabilitation (PSR) professionals

1. What is Psychiatry?

2. What level of education must a Psychiatrist receive?

3. What is something specific about Psychiatrists?

1. The branch of medicine that is concerned with the study and treatment of mental disorders.

2. M.D. (Medical Doctorate)

3. Psychiatrists are licensed to practice medicine and therefore are able to prescribe medication.

1. What is Clinical Psychology?

2. What level of education must you earn to be a Clinical Psychologist?

3. What is something specific about Clinical Psychology?

1. The psychology concerned with the application of psychological science to the assessment and treatment of mental disorders.

2. Ph.D or Psy.D.

3. One can also obtain a Ph.D. degree in counseling psychology, a more applied field that focuses on training, assessment, and therapy. Sometimes they can prescribe a prescription, but cannot claim to be a psychologist until licensed.

1. What is Social Work

2. What level of education must one have to become a Social Worker?

3. What is something specific about Social Workers?

1. Social work is a third profession that is concerned with helping people to achieve an effective level of psychosocial functioning.

2. Master's Degree

3. Social Work is state dependent, requires supervision in which the supervisor will read and review notes. They work on placing individuals where they need to be (i.e. children in foster care).

1. What do Professional Counselors do?

2. What level of education must you have to become a professional counselor?

1. Work in a many different settings, ranging from schools and government agencies to mental health centers and private practice.

2. Master's Degree

1. What is Marriage and Family Therapy (MFT)?

2. What level of education must you have to participate in MFT?

1. It is a multidisciplinary field in which professionals are trained to provide psychotherapy.

2. Master's Degree

What is the highest occupation in terms of clinically trained professionals providing mental health services in the U.S.?

What is one of the occupations most in need?

Social Workers have the highest number.

Psychiatrists are one of the occupations most in need.

Clinical Description

Causation (etiology)

Treatment and Outcome

Distinguish clinically significant dysfunction from common human experience.

For example, if you forget why you came into a room, this may be a normal human experience. If it happens more often than usual, it may be abnormal.

Describe the prevalence and incidence of disorders

Describe prevalence and incidence of disorders

Describe onset of disorders

Describe course of disorders

Determine a Prognosis

What is the onset of a disorder?

What is acute onset?

What is insidious onset?

How the disorder starts.

Sudden onset

Gradual or Slow onset

What is the course of a disorder?

What is an episodic course?

What is a time-limited course?

What is a chronic course?

The pattern of a disorder over time

Recover and re-onset of symptoms reoccur -> Depression

Improves without treatment in a short period

Lasts a long time and may be insidious in onset -> Personality Disorders

1. Supernatural Theories

2. Biological Theories

3. Psychological Theories

1. What time frame did Supernatural Tradition take place?

2. What were some common ideas?

3. What was the Chinese Supernatural Theory?

4. How were you 'cured' of supernatural possession?

1. Stone Age (Ancient China)

2. Spritual Possession and Trephination

3. Yin and Yang

4. To get the spirits out, you would try to make the body as uncomfortable for the spirit as possible. This could be by extreme heat or cold... etc. Also, Yin and Yang was looking at the balance between 'yin' and 'yang'. You could sometimes rebalance with food.

Who is the psychiatrist associated with the Biological Tradition?

What was his ideology?

Dr. Wilhelm Griesinger

He thought all disorders could be explained by a brain disease. Some of his followers created a classification system in which the modern DSM is based off of.

1. Psychoanalytic Perspective

2. Behaviorism

Franz Anton Mesmer

Mesmer believed in animal fluids within the body that could get out of balance. His treatment involved vats of fluid (chemicals) with metal rods of different types that the patient would touch to restore balance. This process was elaborate, but the overall mood was very relaxing. Patients often described going into a trance, or becoming "mesmerized." This setting was thought to be helpful and lead to the development of a relaxing setting by psychoanalysts.

1. Conscious

2. Preconscious

3. Unconscious

1. Id

2. Ego

3. Superego

The Id is the entirely unconscious and primal part of your personality that wants gratification and doesn't care about the consequences. The Id operates on the Pleasure Principle. The Id is active when we are babies.

An example is taking yoru classmates granola bar just because you're hungry, and you don't care about the consequences.

1. Pleasure Principle

2. Reality Principle

3. Morality Principle

1. Repression

2. Denial

3. Projection

4. Reaction Formation

5. Sublimation

1. Oral 0-2

2. Anal 2-3

3. Phallic 3-7

4. Latency 7-11

5. Genital 11-Adult

The infant achieves gratification through oral activities, such as feeding, thumb sucking, and babbling.

0-2

Babies put everything in their mouths, however we must moderate how much they put in their mouth or they will develop an oral fixation. An oral fixation may manifest as an adult through habits such as nail chewing, gum chewing, drinking, smoking, or thumb sucking.

The child learns to respond to some of the demands of society (such as bowel and bladder control). The child receives gratification through bowel movements, but society is restricting when you can receive this gratification. This is leading to the development of the Ego.

2-3

Fixation (based on how potty training went) results in the person either being Anal Retentive- perfectionist, neat, OR Anal Expulsive - messy.

One disease linked with fixation (Anal Retentive) is OCD.

The child leanrs to rezlise the differences between males and females and becomes aware of sexuality.

3-7

Phallic= penis like

You model the same sex parent to get morals, values, and follow cultural standards

The Oedipal complex is based off of the story of Oedipal: a boy destined to kill his father and marry his mother. To prevent this from happening his father (the king) sent Oedipus away.

The complex states that boys are sexually attracted to their mother. They become afraid that their father will get mad and castrate them. This leads to castration anxiety. Instead, the boy decides to copy and mirror their father. They repress the attraction to their mother.

The Electra Complex also comes from a Greek mythological story that involves a love triangle. In the story a girl's father dies. She then wanted her brother to avenge her father's death by killing their mother. Freud did not develop this theory, his followers did.

The complex states that the girl is originally attracted to her mother until she learns that she doesn't have a penis. She blames and dislikes the mother. She liked her father instead and develops penis envy. Eventually she associates with her mother to viariously get to her father's penis.

Men may show that they weren't castrated, and will be very sexually active.

Women may dress seductively to get their "penis envy" taken care of.

The child continues his or her development but sexual urges are relatively quiet. 7-11.

Fixation here leads to asexuality, or no attraction to anyone.

The growing adolescent shaked off old dependencies and learns to deal maturely with the opposite sex. 11-Adult.

We're supposed to stay at this stage. We are also conscious of this stage.

1. Object Relations

2. Four Stages

1. Undifferentiated

2. Symbiosis

3. Separation-individuation

4. Integration

Unearth the hidden intrapsychic conflicts

"The real problems"

Free Association - saying whatever you want to. They try to see a pattern

Dream Analysis

What is the theory of Behaviorism?

What are its two main facets?

Your personality consists of what you can observe. Not just whats inside us, but our environment shapes us as well.

Classical Conditioning and Operant Conditioning

The response that happens without the original US.

For example, salivation without the steak being present.

The US= being bitten by a dog

The UR= fear

The CS= dog

The CR= fear

How the consequences of a behavior effect the frequency of the behavior.

The frequency of a behavior increases in the future.

Behavior increases in the future due to addition or subtraction

The frequency of a behavior decreases in the future

Behavior decreases in the future due to addition or subtraction

A pleasant stimulus is added (positive reinforcement)

OR

An unpleasant stimulus is removed (negative reinforcement)

An unpleasant stimulus is added to the environment (Positive Punishment)

OR

A pleasant stimulus is removed from the environment (Negative Punishment)

What is Systematic Desensitization?

What is it an example of?

Slowly exposing someone to what they fear; used to treat phobias or anxiety disorders

Classical Conditioning

When you reward a behavior to increase the frequency of that behavior in the future.

An example is the old man Dr. Lowery worked with... when he would behave he would get a poker, he could save up these poker chips for prizes.

Genetic Theories- disordered genes

Structural Theories- abnormalities in the structure of the brain

Biochemical Theories- imbalances in the levels of neurotransmitters or hormones

It takes multiple genetic abnormalities to create one disorder.

We believe most things are polygenic in nature.

Identify people who clearly have the disorder in question-probands

Look at these individuals first-degree relatives to see if they may also have a disorder

It is involved in controlling five drives (5 F's):

1. Fight/Flight

2. Feeding

3. Fever (temperature regulation)

4. Falling asleep

5. Fornication (sex)

Hippocampus

Cingulate Gyrus

Amygdala

Thalamus

Hypothalamus

Frontal

Temporal

Parietal

Occipital

Acetylcholine (ACh)

Dopamine

Serotonin

Norepinephrine

GABA (gamma-aminobutyric acid)

Glutamate

Excess dopamine receptor activity is linked to schizophrenia. Starved of dopamine, the brain produces the tremors and decreased mobility of Parkinson's disease.

Too much= linked to schizophrenia

Too little= linked to Parkinson's

They can act as:

Agonists

Antagonists

Inverse Agonists

It increases the activity of a neurotransmitter. It might act like a neurotransmitter or might cause the neuron to make more of the neurotransmitter.

With Parkinson's, the medicine acts like the neurotransmitter dopamine

1. Agonistic

2. Antagonistic

Psychodynamic Theories

Behavioral Theories

Cognitive Theories

Humanistic and Existential Theories

Theories that explain how our thoughts effect our moods and emotions.

What eefect our emotions is not what happens to us, but what we thing of what happened to us.

Activating Event ------------> Emotional Consequence

(get a puppy) -------------> Excited Feeling

Activating Effect ---> Automatic Thought---> Emotional Consequence

Get a Puppy ----> Automatically get excited -----> Act excited

It shows how different individuals have different interpretation of the same events, leading to different feelings. Show that our thoughts are what makes our emotion. We can change through a process to be more positive.

Turned Down For a Date----> "that's the dating world for you" ----> Slightly Disappointed

Turned Down For a Date ---> I'm a freak and I'll die single ---> Despondent

"I should be loved by everyone for everything I do"- Dating Example

"I must have perfect self-control"- Must be perfect

"Once something affects my life, it will affect it forever" - Something goes wrong now, it will effect me forever

"I should be terribly upset by certain situations"- "right" way to feel about situations

"It is better to avoid problems than to face them"- Irrational

Where you don't feel you have control over bad stuff that happens in your life, so you just give up and become helpless. This is the example with the dogs in the cage getting shocked.

Where you develop a more positve outlook at outcomes. You gain control of the situations.

This is where the animals are given some sort of way to avoid the shock, and then feel optimistic that they can avoid it.

Suggests that all humans strive to fulfill their potential for good and to self-actualize.

When the inability to fulfill one's potential arises from the pressures of society to conform to others' expectations and values, and from existential anxiety.

You have always wanted to become a veterinarian, but everyone wants you to become a medical doctor.

Interpersonal Theory

Family Systems Theory

Social Structural Theory

Prototypes or images of self; these images are based off of interactions with others:

Bad me

Good me

Not me

He also came up with the idea of scripts

The root of all disorders are within the family, not the individual.

Some cultures may support the development of certain disorders "evil eye"

Some people live in more chronically stressful circumstances than others, and these people appear to be at greater risk- dangerous or poverty stricken environment

Society influences the types of psychopathology by having rules about what types of abnormal behavior a acceptable and in what circumstances - Anxiety disorders happen more in women than men maybe because it happens more in women, or because our culture doesn't support men talking about anxiety.

A list of various types of problems and their associated symptoms

Psychological disorders are grouped together when they are similar.

The identification or recognition of a disorder on the basis of its characteristic symptoms.

We utilize a classification system to come up with a diagnosis.

1. Unstructured

2. Structured

3. Semi-structured

Doesn't have specific questions, but does have goals. You don't need to go in a certain order... let the conversation flow... just finish will all of the pieces of information.

The most common form of clinical interview used.

When assessing someone's current symptoms, what is the clinician looking for?

How much the symptoms interfere with the clients ability to function

How does he/she cope with stressfull situations

Recent Events

History of Psychological Disorders

Family History of Psychological Disorders

• Physical Condition - Any medical conditions? i.e. being diagnosed with cancer may cause depression.

• Drug and Alcohol Use- Is the client taking any drugs that could cause symptoms? Is the client taking any prescriptions that could interact negatively? Illegal drug use?
• Intellectual and Cognitive Functioning - Any cognitive deficits that could cause symptoms? i.e. held back in school, history of learning disabilities. Not an intelligence assessment.

• Social Resources- Friends and family, amount of contact, and the quality of these relationships. How close are they? What kind of support are they getting. How much social contact.
• Sociocultural Background- socioeconomic status, welfare, struggling financially, unemployed
• Acculturation- To what extent do they identify with group of origin v. the mainstream dominant culture? Minorities especially, Hmong husband, Caucasian wife example.

Appearance and behavior

Thought processes

Mood and affect

Intellectual functioning

Sensorium

Face

Content

Concurrent

Predictive

Construct

Test yield the same results as other measures of the same behavior, thoughts, or feelings.

Test gets the same results as other tests that measure the same thing. Making the comparable.

Test-Retest

Alternate Form

Interal

Interrater or Interjudge

having validity.

Activity where words flashed across screen. Most everyone got the same answer (high reliability), however it wasn't the right answer, leading to no validity.

Performance IQ

Verbal IQ

General IQ

What do personality inventories do?

What is an example of a personality inventory questionnaire?

Assess people's typical ways of thinking, feeling, and behaving

Minnesota Multiphasic Personality Inventory (MMPI)- measures problematic personality traits T OR F, has trick questions embedded.

1. A classification system is useful to clinicians, who must match their clients' problems with the form of intervention that is most likely to be effective. Helps us with figuring out a treatment.

2. A classification system must be used in the search for new knowledge. Learn more.

1. Diagnostic and Statistical Manual (DMS) -published by the American Psychiatric Association

2. International Classification of Disease (ICD)- published by the World Health Organization

DSM- just psychological disorders

ICD- same psychological disorder section, but includes all physical diseases, used by doctors

Axis I: Clinical Disorders - almost all psychological disorders fall in here

Axis II: Personality Disorders & Mental Retardation (rating scale)- long going, not treated well

Axis III: General Medical Conditions- Medical conditions, specifically those that may be linked to a psychological disorder

Axis IV: Psychosocial and Environment Problems- factors in a person's environment that may impact a person's ability to function. Poverty, divorce...

Axis V: Global Assessment of Functioning- Overall rating on the person's ability to cope with life (0-100 in ten unit increments)