Diagnosis of mental disorders AO1
Key terms -Diagnosis Prognosis
-To diagnose open ended ?? clinical interview
Diagnosis- matching person’s
(no biometric tools)
thoughts, feelings and desires to
symptoms of a recognised mental Assessment of abnormality (4D’s) some mental disorders common and getting
health disorder. -all down to judgement of more frequent. Wittchen et al. (2011), every
Prognosis- Predict how the problem therapist year 165 million Europeans - 38.2% of
will develop over time w/o *Deviance Europe's population - suffer form of mental
treatment. -behaviour viewed unacceptable illness, top 3 anxiety, insomnia
2 ways to measure: and depression.
Deviance- Behaviours, cognition,
feelings and desires which differ
from social & statistical norms. Statistically Social norms
-Extremely rare occurrence seen as -Unwritten rule about behaviour
Dysfunction- Inability to conduct deviant -Differ in cultures & time
everyday activity. -Violate norms = abnormal
Distress- Subjective feeling of being behaviour
anxious/upset. Culture
History
Danger- At risk of causing Situation
psychological or physical harm to Gender
themselves or others. Middle 68% seen as normal (within Age
1s.d.) (diff. expectations.)
2s.d. either side of normal
Abnormal after
Rosenhan & Seligman (1989) How WE feel about abnormality SUBJECTIVE
characteristics that define failure to
function: *Dysfunction
-Unpredictable/loss control -Abnormal behaviour interfering with life
-irrationality -cannot live healthy life
-cause discomfort to observers (statistical definition of deviance ignores)
-suffering -Abnormal behaviour may help
-unconventionality
e.g. taking drugs for stress
-violate moral standards
*Distress
-abnormality involves being unhappy (pain/anxiety)
-appear inappropriately/longer than normal
(all subjective) e.g. how long to grieve a loved one
-some people who do NOT feel distress abnormal
-Quan data Kessler Psychological distress scale (K10) self-report questionnaire focusing
on month.
*Danger
-based on harm principle (act however as long as you don’t cause harm)
,-harmful driving a car
BUT excessive risk e.g. drunk driving
-liberal view everyone should be left to own devices if harmless
AO2 Application
-serious application if false diagnosis
Type 1 error: False positive diagnosing mental health when
healthy
(adding something)
Type 2 error: False negative diagnosing healthy but ill
(taking away something)
e.g. in DSM-5 looking Schizophrenia
delusions/hallucinations e.c.t.
Client must have TWO symptoms // previous editions ONE symptom was necessary
(false posi less likely may cause false negative)
Cultural problems Taijan Kyofusho
-psychology has a western outlook (DSM is American) -Japenese social anxiety disorder
-psychiatrists diagnosing non-wester backgrounds -10/20% of Japanese people
*”unofficial” mental disorders considered folk illness -due to pressure of making wrong move
*people from other cultures may describe symptom Latah ‘ticklish/jumpy’
differently -Malaysia
(e.g. African-Caribbean usual to talk to dead relative) -uncontrollable startle reaction
-female condition
‘Medicalising’ normal experiences
e.g. sadness/anger/laziness
Lisa Appignanesi (2008)
-latest edition DSM criticised -we trust doctor and accept
’new’ disorders include shyness/loneliness diagnosis
-doctors want believe all can be
Nick Craddock-people believing they have mental illness
treated
when normal experience may do more harm than good
-‘Big Pharma’ want to sell cures
Others say it removes stigma.
,AO3 Evaluation
C -Reliability can be improved through talking to other clinicians (inter-rater reliability)
+avoid errors in diagnosis
Spitzer & Fleiss (’74) diagnostic systems = more communications among clinicians
-DCM & ICD always reviewed (up-to-date)
-DCM focuses on 4D’s
e.g. schizophrenia wouldn’t be diagnosed just on deviance
O -Labelling e.g. using ‘danger’ to describe illness gives connotation
-therapist needs to use ‘professional judgement’ ((Dissociative identity disorder recognised
in US not UK))
Fazel el al. (2009) Most ppl w/ Schizophrenia are not more dangerous than ppl w/o
+self-fulfilling prophecy
-Spitzer & Fleiss (’74) meta-analysis 6 studies
reliability not high for diagnosis of any mental health disorder ((Before DSM-III)
Wilson (’93) new DSM to tackle unreliability
D -Timothy Davies proposes 5th (Duration)
e.g. Greif, it is important to know how long
+Schizophrenia diagnosis requires a month of symptoms
-Radical approach Recovery model ((ppl feel the need))
rejects focusing on symptoms & fitting into categories
idea humans are no ‘illnesses’
Arenella (2015) medical model too expensive // people turning to recovery model
A (AO2)
-60s & 70s Soviet Union condemned for declaring political opponents ‘Mad’
put in mental asylums
Wanting democratic freedom = paranoid schizophrenia
, Diagnostic classification systems AO1
-contains: -classifications of disorders into diff types
-symptoms of disorders which can be recognised (phys/cog/affective change)
-doesn’t speculate causes of disorder
-based on observes statistical patterns
DSM- The diagnostic & statistical manual.
-regularly updated as understanding changes
-to help psychiatrists communicate using common system of diagnosis
DSM-I DSM-II DSM-III DSM-IV
-1952 -1968 (rev 1974) -1980 (rev 1987) -1994 (rev 2000 IV-TR)
-Began for military -Homosexuality no -based observation & -297 diagnostic
-split two types ‘sociopathic biology categories
Psychoses (brought on disturbance’ ‘sexual -boom mental health - mental disorders by
by brain damage) deviance’ research putting on 5 “axes”
Neuroses (formed from -Revision caused -Spitzer caused 1. Psych diagnosis
early experience.) homosexuality ‘medicalisation of 20- 2.Personality prob
-Freud removed 30% pop who may not 3.Medical condition
have serious mental 4.Environmental stress
health problems’ 5.“Global functioning”
-less reductionist
-inc. ‘culture-bound’
syndromes
DSM-5 -2013 (continually adapting) Making diagnosis:
-observation & interviews
-axes have gone & diagnostic categories down to 157
-ruling out disorders which do not
Sect 1 guidance on new system
match
Sect 2 detail disorders (based current understanding) -some cases weeks/months
Sect 3 suggestions for new disorder (e.g. internet gaming
disorder) emerging measures & models
Abolishing 5 “axes” Removed unnecessary Reflecting social change Reflecting tolerant
diagnosis attitudes
-from DSM-IV gone -Autism spectrum -wars in -offensive phrase
-Critics said artificial & disorder become 1 Iraq/Afghanistan more “mental retardation”
hard to draw links category insight into PTSD out “intellectual
-need links between (used to be Asperger’s DSM covers more development disorder”
symptoms & condition e.c.t,) symptoms -IQ scores not used for
-making diagnosis -Dementia is a growing IDD fail to function
much easier (more problem, major/mild
valid???) dementia to encourage
early diagnosis
-rid of ‘Culture-bound
syndromes’ instead
advice on cultural
Key terms -Diagnosis Prognosis
-To diagnose open ended ?? clinical interview
Diagnosis- matching person’s
(no biometric tools)
thoughts, feelings and desires to
symptoms of a recognised mental Assessment of abnormality (4D’s) some mental disorders common and getting
health disorder. -all down to judgement of more frequent. Wittchen et al. (2011), every
Prognosis- Predict how the problem therapist year 165 million Europeans - 38.2% of
will develop over time w/o *Deviance Europe's population - suffer form of mental
treatment. -behaviour viewed unacceptable illness, top 3 anxiety, insomnia
2 ways to measure: and depression.
Deviance- Behaviours, cognition,
feelings and desires which differ
from social & statistical norms. Statistically Social norms
-Extremely rare occurrence seen as -Unwritten rule about behaviour
Dysfunction- Inability to conduct deviant -Differ in cultures & time
everyday activity. -Violate norms = abnormal
Distress- Subjective feeling of being behaviour
anxious/upset. Culture
History
Danger- At risk of causing Situation
psychological or physical harm to Gender
themselves or others. Middle 68% seen as normal (within Age
1s.d.) (diff. expectations.)
2s.d. either side of normal
Abnormal after
Rosenhan & Seligman (1989) How WE feel about abnormality SUBJECTIVE
characteristics that define failure to
function: *Dysfunction
-Unpredictable/loss control -Abnormal behaviour interfering with life
-irrationality -cannot live healthy life
-cause discomfort to observers (statistical definition of deviance ignores)
-suffering -Abnormal behaviour may help
-unconventionality
e.g. taking drugs for stress
-violate moral standards
*Distress
-abnormality involves being unhappy (pain/anxiety)
-appear inappropriately/longer than normal
(all subjective) e.g. how long to grieve a loved one
-some people who do NOT feel distress abnormal
-Quan data Kessler Psychological distress scale (K10) self-report questionnaire focusing
on month.
*Danger
-based on harm principle (act however as long as you don’t cause harm)
,-harmful driving a car
BUT excessive risk e.g. drunk driving
-liberal view everyone should be left to own devices if harmless
AO2 Application
-serious application if false diagnosis
Type 1 error: False positive diagnosing mental health when
healthy
(adding something)
Type 2 error: False negative diagnosing healthy but ill
(taking away something)
e.g. in DSM-5 looking Schizophrenia
delusions/hallucinations e.c.t.
Client must have TWO symptoms // previous editions ONE symptom was necessary
(false posi less likely may cause false negative)
Cultural problems Taijan Kyofusho
-psychology has a western outlook (DSM is American) -Japenese social anxiety disorder
-psychiatrists diagnosing non-wester backgrounds -10/20% of Japanese people
*”unofficial” mental disorders considered folk illness -due to pressure of making wrong move
*people from other cultures may describe symptom Latah ‘ticklish/jumpy’
differently -Malaysia
(e.g. African-Caribbean usual to talk to dead relative) -uncontrollable startle reaction
-female condition
‘Medicalising’ normal experiences
e.g. sadness/anger/laziness
Lisa Appignanesi (2008)
-latest edition DSM criticised -we trust doctor and accept
’new’ disorders include shyness/loneliness diagnosis
-doctors want believe all can be
Nick Craddock-people believing they have mental illness
treated
when normal experience may do more harm than good
-‘Big Pharma’ want to sell cures
Others say it removes stigma.
,AO3 Evaluation
C -Reliability can be improved through talking to other clinicians (inter-rater reliability)
+avoid errors in diagnosis
Spitzer & Fleiss (’74) diagnostic systems = more communications among clinicians
-DCM & ICD always reviewed (up-to-date)
-DCM focuses on 4D’s
e.g. schizophrenia wouldn’t be diagnosed just on deviance
O -Labelling e.g. using ‘danger’ to describe illness gives connotation
-therapist needs to use ‘professional judgement’ ((Dissociative identity disorder recognised
in US not UK))
Fazel el al. (2009) Most ppl w/ Schizophrenia are not more dangerous than ppl w/o
+self-fulfilling prophecy
-Spitzer & Fleiss (’74) meta-analysis 6 studies
reliability not high for diagnosis of any mental health disorder ((Before DSM-III)
Wilson (’93) new DSM to tackle unreliability
D -Timothy Davies proposes 5th (Duration)
e.g. Greif, it is important to know how long
+Schizophrenia diagnosis requires a month of symptoms
-Radical approach Recovery model ((ppl feel the need))
rejects focusing on symptoms & fitting into categories
idea humans are no ‘illnesses’
Arenella (2015) medical model too expensive // people turning to recovery model
A (AO2)
-60s & 70s Soviet Union condemned for declaring political opponents ‘Mad’
put in mental asylums
Wanting democratic freedom = paranoid schizophrenia
, Diagnostic classification systems AO1
-contains: -classifications of disorders into diff types
-symptoms of disorders which can be recognised (phys/cog/affective change)
-doesn’t speculate causes of disorder
-based on observes statistical patterns
DSM- The diagnostic & statistical manual.
-regularly updated as understanding changes
-to help psychiatrists communicate using common system of diagnosis
DSM-I DSM-II DSM-III DSM-IV
-1952 -1968 (rev 1974) -1980 (rev 1987) -1994 (rev 2000 IV-TR)
-Began for military -Homosexuality no -based observation & -297 diagnostic
-split two types ‘sociopathic biology categories
Psychoses (brought on disturbance’ ‘sexual -boom mental health - mental disorders by
by brain damage) deviance’ research putting on 5 “axes”
Neuroses (formed from -Revision caused -Spitzer caused 1. Psych diagnosis
early experience.) homosexuality ‘medicalisation of 20- 2.Personality prob
-Freud removed 30% pop who may not 3.Medical condition
have serious mental 4.Environmental stress
health problems’ 5.“Global functioning”
-less reductionist
-inc. ‘culture-bound’
syndromes
DSM-5 -2013 (continually adapting) Making diagnosis:
-observation & interviews
-axes have gone & diagnostic categories down to 157
-ruling out disorders which do not
Sect 1 guidance on new system
match
Sect 2 detail disorders (based current understanding) -some cases weeks/months
Sect 3 suggestions for new disorder (e.g. internet gaming
disorder) emerging measures & models
Abolishing 5 “axes” Removed unnecessary Reflecting social change Reflecting tolerant
diagnosis attitudes
-from DSM-IV gone -Autism spectrum -wars in -offensive phrase
-Critics said artificial & disorder become 1 Iraq/Afghanistan more “mental retardation”
hard to draw links category insight into PTSD out “intellectual
-need links between (used to be Asperger’s DSM covers more development disorder”
symptoms & condition e.c.t,) symptoms -IQ scores not used for
-making diagnosis -Dementia is a growing IDD fail to function
much easier (more problem, major/mild
valid???) dementia to encourage
early diagnosis
-rid of ‘Culture-bound
syndromes’ instead
advice on cultural
