History of DSM • DSM-I – 1952 • DSM-II – 1968 • DSM-II 7th Printing – 1974 (Homosexuality no longer listed as a disorder • DSM-III – 1980 • DSM-III-R – 1987 • DSM-IV – 1994 • DSM-IV-TR – 2000 • DSM-V – 2013 May
DSM-IV-TRBroken up in to 5 Axis • The multi-axial system of the DSM-IV) is the way in which the DSM-IV tries to address "the whole person." It grows out of the professional conviction that, in order to intervene successfully in an emotional or psychiatric disorder, we need to consider the affected person from a variety of perspectives.
AXIS I • Axis I refers broadly to the principal disorder that needs immediate attention; e.g., a major depressive episode, an exacerbation of schizophrenia, or a flare-up of panic disorder. It is usually (though not always) the Axis I disorder that brings the person "through the office door."
AXIS II • Axis II lists any personality disorder that may be shaping the current response to the Axis I problem. Axis II also indicates any developmental disorders, such as mental retardation or a learning disability, which may be predisposing the person to the Axis I problem. For example, someone with severe mental retardation or a paranoid personality disorder may be more likely to be "bowled over" by a major life stressor, and succumb to a major depressive episode.
AXIS III • Axis III lists any medical or neurological problems that may be relevant to the individual's current or past psychiatric problems; for example, someone with severe asthma may experience respiratory symptoms that are easily confused with a panic attack, or indeed, which may precipitate a panic attack.
AXIS IV • Axis IV codes the major psychosocial stressors the individual has faced recently; e.g., recent divorce, death of spouse, job loss, etc.
AXIS V • Axis V codes the "level of function" the individual has attained at the time of assessment, and, in some cases, is used to indicate the highest level of function in the past year. This is coded on a 0-100 scale, with 100 being nearly "perfect" functioning (none of us would score that high!)
How do we classify disorders? • Why do we classify? • Creates order and unity • Helps us predict a disorder’s future course • Helps us give the appropriate treatment • Allows us to do research into causes • Diagnostic and Statistical Manual of Mental Disorders IV-TR (text revised, 2000) • Published by the American Psychiatric Association • DSM V is coming out in May! • http://www.dsm5.org/Pages/Default.aspx
DSM Cont. • Although it presents disorders in medical terminology (symptoms, diagnosing, illness) it is used by all mental health professionals • DSM diagnosis is needed by insurance companies before they pay for therapy! • Does NOT provide causes - just describes disorders • A diagnosis is made based off a series of questions centered around 5 axes (categories) • An overall number value is then assigned • There are no blood tests, scans, or other medical procedures that can be used to determine if someone has a psychological disorder
Defining a Psychological Disorder • Psychopathology, psychological disorder, mental illness, mental disorder = same thing • Definitions: • Any pattern of emotions, behaviors, or thoughts inappropriate to the situation and leading to distress or the inability to achieve important goals • Persistently harmful thoughts, feelings, or actions • When behavior is deviant (different from the norm), distressful, and dysfunctional (impairs one’s life) • Maladaptive, atypical, unjustifiable, disturbing • Experts do not always agree! • However, in order for something to be considered a disorder, it must impair your life
What is Abnormal? • What qualifies as abnormal is a judgment call • Three models from book: society, individual, mental health professional • Some think of disorders as part of a continuum ranging from the absence of a disorder to a severe disorder • Disorders are an exaggeration of normal responses • Can also be influenced by culture • Standards for deviant behavior differ from place to place • I.E. Hissing is a polite way to show respect for superiors in Japan • Time • From 1952-1973, homosexuality was classified as a disorder
French reformer Said that “madness” was a sickness of the mind Patients released from chains Believed in talking to patients, giving patients activity, and giving them clean air In U.S.: Dorthea Dix Philippe Pinel
How Should We Understand Disorders? • Through the perspectives! • There is no single factor that causes a disorder, so psychologists, psychiatrists, and other mental health professionals view disorders through the lenses of the perspectives we have discussed (and a few other models) • Medical Model: Mental disorders are diseases of the mind • Encourages dependency on a doctor; What about the role of the patient in recovery? • Puts psychologists out of business! Not supported by most clinical psychologists • Similar to the biological model: Mental disorders are a result of physiological malfunctions (often genetic) • Most psychologists do recognize the importance of biology
How Should We Understand Disorders? • Psychoanalytic model: Unconscious conflicts often traced to childhood can cause disorders • Behavioral: Influence of environment • How have rewards and punishments contributed to a disorder? • Cognitive: Thoughts, feelings, perceptions, and memories can contribute to disorders • Social: Social support system (or lack thereof) can contribute to disorders • Diathesis-Stress Model: A biological predisposition (diathesis) combines with a stressful circumstance to produce a disorder • Biopsychosoical Model: combination of biological, social, and psychological factors