Defining and Diagnosing Disorder

Mood (depression)anxiety (phobia) food (anorexia) impulse control (kleptomania,

pyromania, gambling).personality (paranoid)

Objectives

• Describe and summarize what a disorder is AND why it is so hard to diagnose

• Describe the DSM (disorder book) • Describe the advantages and disadvantages of

the DSM ( T chart)• Compare and contrast projective and

objective tests

Dilemmas of definitionPossible models for defining disordersAs the violation of cultural standards

As emotional distress

As behavior harmful to oneself or others

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Basic definition- level 1

• Mental disorder is any behavior or emotional state that causes a person great suffering, is self-destructive, seriously impairs the persons ability to work or get along with others, or endangers others or the community

Mental disorderAny behavior or emotional state that causes a person to suffer, is self-destructive; seriously impairs the person’s ability to work or get along with others; or endangers others or the community

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Your turnPsychopaths are often happy, functional people, but they manipulate and harm others without conscience. On what basis are psychopaths said to have a mental disorder?A mental disorder is any behavior or mental state that(1) causes a person to suffer, is self-destructive;(2) seriously impairs the person’s ability to work or get along with others;(3) or endangers others or the community.

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Your turnPsychopaths are often happy, functional people, but they manipulate and harm others without conscience. On what basis are psychopaths said to have a mental disorder?A mental disorder is any behavior or mental state that(1) causes a person to suffer, is self-destructive;(2) seriously impairs the person’s ability to work or get along with others;(3) or endangers others or the community.

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Dilemmas of Diagnosis

• Classifying is not an easy task• DSM standard reference manual to diagnose

disorders• Categorizes by behavior • Diagnostic and statistical manual of mental

disorders• Referenced by judges, attorneys• 1952- 86 pages long• DSM-IV 1994-2000, 900 pages long, 400 diagnosis

Diagnostic and Statistical Manual

Axis I: Primary clinical problem

Axis II: Personality disordersAxis III: General medical conditionsAxis IV: Social and environmental stressorsAxis V: Global assessment of overall functioning

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DSM

• Disorders usually first diagnosed in infancy, childhood, or adolescence

• Delirium, dementia, amnesia, and other cognitive disorders

• Substance-related disorders• Schizophrenia and other psychotic disorders

DSM

• Mood disorders• Anxiety disorders• Eating disorders• Dissociative disorders- 2 or more identities

DSM

• Sexual and gender identity disorders= transsexualism(want to be other sex, erformance, premature ejaculation, lack of Orgasim, paraphilias (unusual or bisare imagry)

• Impulse control disorders• Personality disorders• Additional conditions that may be a focus of

clinical attention

Explosion of mental disorders

Supporters of new categories answer that it is important to distinguish disorders precisely.

Critics point to economics: diagnoses are needed for insurance reasons for therapists to be compensated.

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Problems with the DSM=objective 3

• The danger of over diagnosis • “give a small boy a hammer, everything needs

pounding” • ADHD- impulsive, restless, easily frustrated • Since added to DSM= Fastest growing disorder

in America• 10 x’s more than in Europe

problems

• The power of diagnostic labels• Reassuring emotional symptoms, problems• “ whew that’s what I got”• Also label sticks to person• Oppositional defiant disorder

problems

• The confusion of serious mental disorders with normal problems

• “disorder of written expression” (can’t write clearly)

• “ mathematics disorder” (not doing well in math)

• “ caffeine induced sleep disorder” (switch to decafe)

problems

• The illusion of objectivity and universality• Not empirical evidence but group consensus• Samuel Cartwright- drapetomania (urge to

escape from slavery)

Concerns about diagnostic system

The danger of over-diagnosis

The power of diagnostic labels

Confusion of serious mental disorders with normal problems

The illusion of objectivity and universality

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advantages

• Mild to severe• When used correctly, with tests, ultra effective• Culture-bound syndromes- specific to cultures

Advantages of the DSM

When the manual is used correctly and diagnoses are made with valid objective tests, the DSM improves the reliability of and agreement between clinicians.

The DSM-IV included for the first time a list of culture-bound syndromes.

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Objective 4

• Projective tests are psychological tests used to infer a persons motives, conflicts, and unconscious dynamics on the basis of the persons interpretations of ambiguous stimuli.

• Rorschach Inkblot test is a projective personality test that requires respondents to interpret abstract, symmetrical inkblots

• Objective tests (inventories) are standardized objective questionnaires requiring written responses; they typically include scales on which people are asked to rate themselves.

• Minnesota Multiphase Personality Inventory (MMPI) is a widely used objective personality test.

Projective testsProjective testsPsychological tests used to infer a person’s motives, conflicts, and unconscious dynamics on the basis of the person’s interpretation of ambiguous stimuli

Rorschach inkblot testA projective personality test that asks respondents to interpret abstract, symmetrical inkblots

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What do you see?

What does this appear to be?

Objective testsInventoriesStandardized objective questionnaires requiring written responses

Typically include scales on which people are asked to rate themselves

MMPIMost widely used personality instrument

Clinical and employment settings

Measures aspects of personality that, if extreme, suggest a problem

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Summary

• DSM• Positives/negatives• Tests