Assessment, Classification, and Diagnosis

Question 1

Our current system has its origins in ___________ with the concept of _______.

Answer 1

medical models; syndromes

Question 2

Who are the 2 researchers who rly contributed to today’s vision of psychopathology?

Answer 2

Thomas Sydenham & Emil Kraepelin

Question 3

Thomas Sydenham core ideas (2)

Answer 3

British physician from the 1600s. Tried to identify physical syndromes or diseases to better treat physical ailments.
(1) To him, Disease/syndrome = measurable entity.
(2) Expresses itself as clusters of symptoms that present together. => All symptoms hang together in some way, present at the same time, predictable course, go together.

Question 4

Emil Kraepelin core ideas (2)

Answer 4

Psychiatrist from the 19th century. Among the first to try to apply Sydenham’s ideas to mental health.
(1) Distinct forms of mental illness are defined as a syndrome. I.e. With clusters of correlated symptoms all/largely present together
(2) Mental disorders are TAXONIC in nature. I.e. mental disorders are CATEGORIES that exist in the real world (either you have it or you don’t).
=> Differentiated psychological conditions based on their signs, symptoms, and natural histories.

Question 5

Wakefield’s Harmful dysfunction

Answer 5

Looks at natural selection as a basis to define psychopathology.
Disorders have both a biological/evolutionary component & a social component.

Question 6

What is “Dysfunction” in Harmful dysfunction?

Answer 6

“An organ system performing contrary to its design.” Importantly,notat the peak of its design.

Question 7

What is “Harmful” in Harmful dysfunction?

Answer 7

[Subjective] Has to cause problems within the environmental context in which the individual is situated.
-> What is adaptive varies across contexts. What’s adaptive will look different. Bound by societal norms (in part).

Question 8

In the concept of “Harmful dysfunction”, is it still harmful if the person is NOT suffering from the dysfunction?

Answer 8

A person doesn’t THEMSELVES need to perceive that they are suffering from this dysfunction. Can be that dysfunction causes harm to other people

Question 9

Lillienfeld critique of harmful dysfunction (2)

Answer 9

(1) It’s really hard to differentiate between adaptations (math/arts) & secondary adaptations (feathers). If can’t do math doesn’t mean that something’s wrong
(2) So what are the core features of this organ system that we’re looking at to define psychopathology?
=> Some disorders may represent adaptations, not maladaptations.

Question 10

Widiger Proposal core idea (2)

Answer 10

(1) Forms of pathologies are constructs.
=> Because mental disorders are constructs, there’s not going to be any single definitions that entirely captures it. Constantly evolving.
(2) We need to consider all of these different ways of thinking (e.g. statistical, harmful dysfunction…) to understand the whole construct of mental illness/psychopathology.

Question 11

Construct def

Answer 11

Things that we think exist that we cannot measure directly. Way of organizing the world.
=> Idea or theory containing various conceptual elements, typically one considered to be subjective and not based on empirical evidence.

Question 12

Purposes of a Classification System (4)

Answer 12

(1) Description: Highlight critical features of a diagnoses.
(2) Prediction:May tell you something about course, treatment response, etiology.
(3) Theory: Provides a set of postulates about relationships of different elements to one another. How/why do some symptoms hang together?
(4) Communication:e.g., between clinicians. You want every clinician to have the same definitions.

Question 13

5criteria (Robins & Guze) proposed for valid classification of disorders

Answer 13

(1) Clinical Description:The disorder has to be characterized by a common set of symptoms that cluster together and are characteristic of the disorder.
(2) Course:People with the disorder should follow a common trajectory, and have a similar onset.
(3) Treatment Response:If a disorder is valid, most people with that disorder will respond similarly to similar treatments.
(4) Family/Natural History:Does the disorder run in families? Considers the course and outcome of the disorder. People with the disorder should follow a common trajectory, and have a similar onset.
(5) Laboratory Studies:Involves data from psychological, biological, and laboratory tests. Look for biological and psychophysiological associations

Question 14

Limitations of a Classification System (2)

Answer 14

(1) Loss of Uniqueness: common features are more important
(2) Difficulty of boundary cases

Question 15

Categorical model def

Answer 15

Presence/absence of a disorder. You have the disorder or not.

Question 16

Categorical model Pros (3)

Answer 16

(1) Advantages for research and understanding.
(2) Simplifies communication. Natural preference among humans to employ categories in speech (not: they’re 3/10 on mood).
(3) Categories better-suited for clinical decision-making: Hospitalize or don’t? Treat or don’t? (3)

Question 17

Dimensional model def

Answer 17

Rank on a continuous quantitative dimension. Everybody falls SOMEWHERE on the dimension.

Question 18

Dimensional model Advantages (4)

Answer 18

(1) Better capture an individual’sfunctioning
(2) Give more info about the person
(3) Preserves more information
(4) Greater reliability–inter-rater, test re-test

Question 19

Cons of Categorical (1)

Answer 19

Cutoffs in categorical system tend to magnify small differences

Question 20

Cons of Dimensional

Answer 20

Taking a dimensional approach: Would need a threshold. Cut tend to be arbitrary. Looks a lot like categorical model.

Question 21

When was the DSM-1introduced?

Answer 21

1952. Not that long ago. Shows how young the science of clinical psychology is.

Question 22

DSM-II Characteristics (4)

Answer 22

1968.
(1) Few categories (I and II). Broad descriptions of the disorder.
(2) No requirements for number of symptoms.
(3) Psychoanalysis was the dominant paradigm
(4) Problem for epidemiological research bc no standardized definition. =→ If you care about how frequently things occur in the world across countries, you want to have a standardized definition.

Question 23

DSM-III Changes (7)

Answer 23

1980.
(1) Define many more forms of psychopathology
(2) Inclusion Criteria:What symptoms do you need to have, and how many?
(3) Duration Criteria:Howlongdo you need to exhibit these symptoms?
(4) Exclusion Criteria:What symptomsrule outa diagnosis?
(5) Multi-Axial Classification
(6) Structured interviews
(7) Theoretical agnosticism

Question 24

Multi-Axial Classification in DSM-III

Answer 24

Axis I: Presence/Absence - Major Clinical Disorders(e.g., MDD, PTSD)
Axis II: Presence/Absence - Personality Disorders(e.g., BPD, NPD)
Axis III: Medical conditions that might contribute or be relevant to treatment
Axis IV: Psychosocial Stressors (environment)
Axis V: Global Assessment of Functioning (GAF)

Question 25

What’s the core idea behind the Multi-Axial Classification?

Answer 25

The primary presenting problem would always be the Axis I and that Axis 2 is a secondary consideration that might interfere w the treatment.

Question 26

Global Assessment of Functioning (GAF) def

Answer 26

A simple rating (0-100) of function/summary score for severity. How well the person is functioning in the world. Very arbitrary.

Question 27

2 Assumptions introduced in DSM-III

Answer 27

(1) Symptoms are the MOST USEFUL basis for assessment (not based on etiology - freud).
(2) Locus of pathology is IN the individual (disregard environment).

Question 28

DSM-IV Characteristics (2)

Answer 28

Did not made a lot of massive changes.
(1) Revision process much more public and research based.
(2) Efforts to rely more on the body of research around these forms of psychopathology.

Question 29

DSM-IV-TR Characteristics (2)

Answer 29

2000. Did not introduce new diagnoses or specific criteria.
      (1) Provided more information on each diagnosis. Narrowing on the constructs they’re talking about.
      (2) Provided for the first time in the DSM a broad definition of mental illness.

Question 30

What’s the definition of psychopathology introduced in the DSM-IV-TR?

Answer 30

Clinically significantbehavioral/psychological syndrome that occurs in an individual which is associated with distress/ disability or significantly increased risk of suffering.
Also: No definition adequately specifies precise boundaries for the concept of mental disorder.
There is NO assumption that each category of mental disorder is a completely discreet entity with absolute boundaries.

Question 31

DSM-5 Characteristics (3)

Answer 31

2013. (1) Removed multi-axial system (pple can receive a PRIMARY diagnosis of personality disorder).
      (2) Introduced (in some cases) DIMENSIONAL assessment criteria for some diagnoses.
      (3) Re-Classified some disorders - Removed others (e.g. OCD/PTSD not anxiety disorder)

Question 32

Evolution of the number of Categories in the DSM

Answer 32

Grows until DSM-IV-R, diminishes in DSM-5
DSM-I = 106
DSM-II = 182
DSM-III = 265
DSM-III-TR = 292
DSM-IV-TR = 297
DSM-5 = 157

Question 33

What are two challenges to a Categorical Classification System?

Answer 33

Diagnostic Heterogeneity & Comorbidity

Question 34

Assumptions of Categorical Classification System that makes the problem of Diagnostic Heterogeneity (2)

Answer 34

(1) We assume that a group of pple that have one disorder will look like another group with the same disorder
(2) A group of pple that have one disorder will look different from another group with another disorder

Question 35

Diagnostic Heterogeneity

Answer 35

Because of the way we do diagnosis (e.g. 5 out of 9 symptoms) different pple in the same category will have different symptom profiles (sometimes opposite of one another).

Question 36

Comorbidity def

Answer 36

Simultaneous presentation of MORE than one disease.
Major problem for both research and treatment (simultaneously? one after another?).
=> It is the NORM

Question 37

Comorbidity patients _____ (2)

Answer 37

(1) tend to have poorer outcomes
(2) shortened life course and poor quality of life.

Question 38

What are the research implications of comorbidity?

Answer 38

Anything you find to be associated with one disorder may be a result of the comorbid disorder.

Question 39

Why does comorbidity exist? (4)

Answer 39

(1) Chance
(2) Sampling Bias (Individuals with more disorders -more severe individuals - are more likely to seek treatment)
(3) Pb with diagnostic criteria: many criteria overlap
(4) Poorly-drawn diagnostic boundaries: a) Multiformity, b) Causation (one can be a risk factor for another), c) Shared Etiological risk factors
But all of this doesn’t account for all the variance

Question 40

_____ samples are more biased than ______ samples.

Answer 40

Clinical, community

Question 41

Multiformity

Answer 41

Disorders express themselves in multiple ways, some of which can mimic other disorders.

Question 42

Nosology

Answer 42

Branch of medical science that deals with the classification of diseases

Question 43

What did Thomas Achenbach to obtain a new classification of mental disorders?

Answer 43

Conducted a factor analysis to see which symptoms correlate with one another.

Question 44

How did Achenbach’s classification looked like?

Answer 44

2 underlying dimensions of psychopathology: internalizing (distress to themselves) & externalizing (distress to other pple)
=> Shared factors that underlie the expression of many more specific forms of dysfunction.

Question 45

What are the problems with Achenbach’s classification? (2)

Answer 45

(1) There are more disorders than just the one he described. Where do those fit?
(2) Some disorders do not load cleanly onto this.
(3) Internalizing & externalizing factors are also correlated to one another.

Question 46

How did Achenbach explain comorbidity?

Answer 46

Comorbid disorders share this underlying latent factor that predisposes them to any kind of internalizing disorder.
=> E.g. in the early conceptualization, MDD, GAD and panic disorder all load onto internalizing.

Question 47

How does Hierarchical Taxonomy of Psychopathology (high top) explain the association between internalizing and externalizing?

Answer 47

Above internalizing & externalizing is just some general liability to have psychopathology.
=> Some pple are more likely to have psychopathology.
=> That can manifest in multiple ways, but there’s some shared factor (P) that is a higher order dimension that underlies the more specific internalizing or externalizing.

Question 48

How does the RDoC (Research Domain Criteria) model work?

Answer 48

Transdiagnostic approach: Approach disregarding diagnosis altogether and just looking at the ways in which across diagnosis, dysfunction can be expressed.
=> Talk about dysfunction of core systems that pple/animals have evolved to have.

Question 49

RDoC (Research Domain Criteria) is another approach to resolving issues of _________ and _________.

Answer 49

heterogeneity - comorbidity

Question 50

RDoC (Research Domain Criteria) looks at domains that are thought to be central to human functioning. E.g. (5)

Answer 50

(1) Negative Valence systems: responsible for AVERSIVE situations (acute threat = fear, potential threat = anxiety…)
(2) Positive Valence systems: responsible for POSITIVE situations (reward valuation…)
(3) Cognitive Systems (e.g. Attention)
(4) Systems for Social Processes (e.g. Attachment formation/maintenance)
(5) Arousal and Regulatory Systems

Question 51

(e.g.) How would RDoC (Research Domain Criteria) model explain MDD?

Answer 51

Difficulties/abnormalities with reward valuation in MDD

Question 52

Is RDoC (Research Domain Criteria) categorical or dimensional?

Answer 52

Ultimately agnostic about whether we need to keep categorical system.

Question 53

Epidemiology

Answer 53

Describe frequency/distribution of traits/diseases in a population. Study of the determinants, occurrence, and distribution of health and disease in a defined population.

Question 54

Prevalence

Answer 54

The % of people in a population with a disorderat a particular point in time.
e.g., past month, year, or lifetime

Question 55

Incidence

Answer 55

The % of people who develop a disorder FOR THE FIRST TIME during a specific time period.
=> 1st onset cases.
E.g. “past month incidence” = how many pple had their first episode of the disorder in the past month.

Question 56

Prevalence calculus

Answer 56

Incidence x Chronicity

Question 57

Risk Factor (epidemiology)

Answer 57

Variable/correlate associated with an increased risk of disease or infection.
=> Psychologists use this term to mean predictor, or cause.

Question 58

If I say that the 1-year-prevalence of MDD is 6.7. What does that mean in simple words?

Answer 58

6.7% of pop has had in the past year diagnosed/could be diagnosed with MDD.

Question 59

Diathesis-Stress Models def

Answer 59

Early 1960s. Rosenthal. Stop debate nature vs nurture: interaction with one another. Bring it together in this model.
=> Genetic vulnerability + stress in environment = psychopathology
=> If a no diathesis + no stress = no disorder (…).
Categorical formulation.

Question 60

Diathesis def

Answer 60

Vulnerability/predisposition to develop a disorder. e.g. genetics, attachment styles…

Question 61

Stress in Diathesis-Stress Models def

Answer 61

Exposure to experiences/factors that overwhelm an organism ability to maintain homeostasis.

Question 62

What’s a challenge with the Diathesis-Stress model?

Answer 62

Assumes that the diathesis and stress are INDEPENDENT from one another.
BUT we have a lot of evidence for gene environment correlations (no independence).

Question 63

Give an example of how Diathesis & Stress are interdependent: Stress generation

Answer 63

E.g. Stress is strongly associated w dev of depression BUT it’s not only exposure to stress.
Also people vulnerable to depression BEHAVE IN WAYS that create more stress in their lives/generate interpersonal stress which erodes their social support networks.

Question 64

What are two ways in which Diathesis & Stress are interdependent?

Answer 64

(1) Stress generation
(2) “Scars” as vulnerability

Question 65

Give an example of how Diathesis & Stress are interdependent: “Scars” as vulnerability

Answer 65

Having BEEN ALREADY ill will make you think about the world in a more negative way → may exacerbate the effects of subsequent stressors.
Vulnerability may shape perception of the stress.

Question 66

Equifinality

Answer 66

Getting to the same point via many different pathways.
Pple who get a disorder, get it from different causes.
Common idea in developmental psychology.

Question 67

Final common pathway def

Answer 67

Multiple etiological factors might converse on one final step of an etiological process.

Question 68

Multifinality

Answer 68

A single risk factor can lead to many diff outcomes.
E.g. child abuse associated w almost ALL forms of psychopathology.

Question 69

Syndromes def

Answer 69

Collections of signs and symptoms that COMMONLY CO-OCCUR across individuals.

Question 70

Disorders def

Answer 70

Syndromes that can’t be easily explained by other conditions.
E.g, obsessive-compulsive disorder (OCD) is considered a disorder when symptoms can’t be attributed to specific phobias or other causes.

Question 71

Diseases

Answer 71

Disorders where both pathology and causation are reasonably well understood.

Question 72

The approach to diagnostic validation outlined by Robins and Guze is considered a specific instance of _________.

Answer 72

construct validation

Question 73

What did Rosenthal Study about labeling theory showed?

Answer 73

Diagnosis can become self-fulfilling prophecies, where ambiguous or mild behaviors get interpreted as severe mental illness due to the diagnostic label.
E.g. Pseudopatients were admitted to psychiatric hospitals, showing no psychopathology but were diagnosed with schizophrenia in remission.
=> but Flaws in this study

Question 74

Statistical Model of mental disorder

Answer 74

Equates disorder with statistical rarity. Defines disorders as conditions that are infrequent in the general population.
=> not good (no cutoffs)

Question 75

Subjective Distress Model of mental disorder

Answer 75

The core feature distinguishing disorder from nondisorder is psychological pain or distress.
=> not good (mental disorders might be ego-syntonic, lack distress)

Question 76

Biological Model of mental disorders

Answer 76

Disorder = biological or evolutionary disadvantage to the organism.
Some mental disorders are associated with biological disadvantages, like increased suicide risk in major depression.
=> doesn’t account for e.g. frontline combat roles =/ disorder

Question 77

Need for Treatment model

Answer 77

Disorders as conditions necessitating medical intervention according to health professionals.
=> not good (e.g. pregnancy)

Question 78

What does harmful dysfunction fail to explain? (2)

Answer 78

(1) Flu: can be viewed as adaptive responses rather than failures in an evolutionarily selected system.
(2) Phobias: exhibit coordinated physiological reactions that could have been evolutionarily selected for specific threats.

Question 79

Roschian Analysis

Answer 79

Defining mental disorder explicitly is impossible due to intrinsically fuzzy boundaries and lack of defining features.
Mental disorders organized around prototypes.

Question 80

4 Weaknesses of DSM-I and DSM-II

Answer 80

(1) Interrater Reliability Issues: no clear criteria
(2) Theoretical Biases: influenced by psychoanalysis
(3) Theoretical Frameworks: considered psychopathology as reactions to life events
(4) Neglect of Contextual Factors (e.g. co-occurring medical conditions, life stressors…)

Question 81

DSM-III‐R and DSM-IV moved away from a _______ approach to a _______ approach in diagnosis.

Answer 81

monothetic, polythetic
=> Signs and symptoms are not necessarily essential or sufficient for a diagnosis.

Question 82

DSM‐III‐R (1987) and DSM‐IV (1994) main changes (4)

Answer 82

(1) Shift from Monothetic to Polythetic Approach
(2) Absence of Pathognomonic Indicators => no single symptom or sign could definitively establish or exclude the presence of a disorder
(3) Relaxation of Hierarchical Exclusion Rules (cuz difficult to apply + no robust research)
(4) Inclusion of Culture-Bound Syndromes (conditions can vary across cultures => unique or variants)

Question 83

Attenuation paradox

Answer 83

Overemphasizing reliability may sometimes sacrifice validity, limiting the accuracy of diagnoses.
=> DSM diagnoses utilizing limited items to represent broader concepts might show high internal consistency but low validity.

Question 84

Szasz’s vision of mental disorder

Answer 84

Lesion argument. Mental disorders are merely deviations from social norms WITHOUT identifiable brain or body lesions, contrasting it with physical disorders defined by recognizable anatomical deviations.

Question 85

Cons of Szasz’s view (lesion argument)

Answer 85

Inadequacy of the lesion account of physical disorder. Lesions are not always identifiable anatomical deviations, and their existence doesn’t define a disorder.

Question 86

Disorder as a Pure Value Concept

Answer 86

Sees disorder as solely based on social norms and values.