Week 3: Classification, DSM, PDM Flashcards
1
Q
What is Classification?
A
It is a system of separation in which makes information more meaningful, accessible and easier to work with.
2
Q
Into what categories is behavior classified into in clinical psychology?
A
Abnormal and Normal.
3
Q
What are some problems with classifying behavior as either abnormal or normal?
A
The definition of abnormal is insufficient - it’s divided into subclasses as a result.
4
Q
Explain the mushroom example of classification.
A
- Appearance (observable characteristics): though something may appear to look like a mushroom, that doesn’t mean it is one!
- Poisonous vs Edible: Poisonous and edible mushrooms are incredibly diverse and are at times very difficult to tell apart.
5
Q
Paradigms of Classification: Identify Hippocrates’ Four Humors.
A
- Black Bile - Depression.
- Yellow Bile - Tension/Anxiety.
- Phelgm - Dull, Sluggishness.
- Blood - Mania/Moodswings.
6
Q
What does Phlegm represent in Hippocrates’ Four Humors?
A
Dull, sluggish behavior.
7
Q
What are the trends/philosophies in clinical psychology?
A
- Symptom as focus (Kraeplin).
2. Underlying cause as focus (Freud).
8
Q
Give a few reasons why we need classification?
A
Identification, communication, research, treatment insurance, theory development and epidemiological information are all made easier.
9
Q
What’s the difference between Diagnosis and Formulation?
A
Diagnosis: assigning diagnostic category (through a Structured Interview)
Formulation: attempt to explain the genesis of, maintenance, and process for treatment. (through an Assessment)
10
Q
How do you give a diagnosis?
A
Through a Structured Interview with a client.
11
Q
How do you make a formulation?
A
Through a Psychological Assessment - gathering information to evaluate a person’s behavior, character, strengths, and needs.
12
Q
What approach(es) does the DSM have?
A
Categorical and Descriptive approach.
13
Q
Describe key qualities of the DSM (5).
A
- Over 400 disorders.
- Categorical approach.
- Descriptive features are based on observable features.
- Descriptive information is not based on one perspective of psychology.
- There is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder (DSM IV).
14
Q
What does the DSM provide information on? (4)
A
- Diagnostic Features
- Associated Features and Disorders
- Associated Laboratory Findings
- Age related, Culture related, and Gender related Features
15
Q
What’s the difference between DSM IV and DSM V?
A
DSM IV has 5 axes of classification of disorders (multiaxiel system), while the DSM V has no axes (because they are now thought to be artificial distinctions).
16
Q
What are some pros of the DSM? (3)
A
- Reliability has improved over previous editions
- Provides information on research and reliable and valid information
- Axis IV and V very good in terms of attempting to take into account many factors:
Clinical disorders, personality disorders, and general medical conditions (formerly Axes I, II, and III) are combined into a nonaxial documentation, with separate notations for Psychosocial and Contextual factors (formerly Axis IV) and Disability (formerly Axis V).
17
Q
What are some cons of the DSM? (4)
A
- Labelling and stigma are still issues
- Only one level of description provided (only description of behaviors): e.g. Biological tests are not used.
- Psychologists make more money by diagnosing more, so some patients may be diagnosed inappropriately.
- Very subjective
18
Q
Compare the DSM and PDM.
A
- DSM provides one level of description, and some argue it doesn’t measure some of the most important things.
- PDM: there is more to people than what is described in DSM.
- PDM also attempts to describe and categorize elements not found in DSM
- and PDM attempts to provide information that will improve comprehensive treatments.
19
Q
True or False: The PDM was made to replace the DSM.
A
False, it was made to support/enhance it.
20
Q
What theoretical perspective was the PDM developed from?
A
From Current Psychodynamic Theory.
21
Q
What does current Psychodynamic theory contain + explain.
A
- Psychoanalysis:
investigating the interaction of conscious and unconscious elements in the mind and bringing repressed fears and conflicts into the conscious mind by techniques such as dream interpretation and free association. - Object Relations:
the process of developing a psyche in relation to others in the childhood environment. - Attachment Theory:
evolutionary and ethological theory concerning relationships between humans. The most important tenet is that young children need to develop a relationship with at least one primary caregiver for normal social and emotional development.
22
Q
What does the PDM provide information on? (2)
A
- A diagnostic framework
- Describes the whole person (with their individualities): Surface and deeper levels of personality, person’s emotional and social functioning.
Based on current neuroscience and treatment outcome studies.
23
Q
PDM was developed by:
A
American Psychoanalytic Association
American Academy of Psychoanalysis
International Psychoanalytic Association
American Psychological Association Division 39
National Membership Committee on Psychoanalysis in Clinical Social Work
24
Q
What are the 4 elements of the PDM?
A
- Personality patterns
- Social and emotional capacities
- Unique mental profiles
- Personal experiences of individuals
25
Which diagnostic manual views human behavior as complex, wants to direct focus on full range of affect, thought, and behavior in context of one's individual history?
The Psychodynamic Diagnostic Manual (PDM).
26
True or false. Rather than thinking of people having discrete disorders (i.e., ego dystonic, separate, outside of self), the PDM see disorders as result of some process (personality, incorporation of upbringing, etc.) and the process is what is important.
True.
27
What are the PDM Dimensions?
1. Personality Patterns and Disorders (P axis)
2. Mental Functioning (M axis)
3. Manifest Symptoms and Concerns (S axis)
28
Explain the P axis of the PDM.
The P axis represent the dimension of Personality Patterns and Disorders.
Here, a person is located on a continuum of Healthy to Disordered.
Identifies ways in which a person organizes
mental functioning and interacts with world.
The KEY factor is that you need to understand person to understand the problem.
29
What makes up the Spectrum of a Healthy personality? (PDM) (7) - of which are used to assess functioning on the M axis.
1. Identity: views self and others in complex, stable and accurate ways.
2. Object relations: engages in satisfying relationships.
3. Affect tolerance: experiences full range of age expected feelings.
4. Affect regulation: regulates emotions and impulses in an adaptive way; flexible defenses and coping.
5. Moral sensibility: functions according to ideals, morals and standards of society.
6. Reality testing: appreciates conventional notions of what is realistic.
7. Ego strength and resilience: responds to stress resourcefully and recovers from painful events.
30
What are the Levels of Personality Organization (PDM P axis)?
1. Healthy
2. Neurotic
3. Borderline
4. Psychotic
31
What makes up the Neurotic level of personality organization in the PDM? (4)
- Anxiety based
- No distortions in reality
- Recognizes problem
- No great personality disorganization
32
What makes up the Psychotic level of personality organization in the PDM? (3)
- Gross (lots of) distortion of reality
- Some personality disorganization
- Does not recognize problem
33
Where does the Borderline level of personality organization in the PDM sit in regards to the Neurotic level and the Psychotic level?
Right in between them.
34
What are Axes of the DSM (IV)? (5)
```
Axis I: Clinical disorders
Axis II: Personality disorders
Axis III: General medical conditions
Axis IV: Psychosocial
Axis V: Contextual factors
```
35
Which axis of the PDM includes many of the Axis II diagnoses from the DSM?
P Axis - but adds other ones too that are very important:
- Depressive Personality
- Disorder Sadistic and Sadomasochistic PD
- Masochistic (Self Defeating PD)
- Somatizing PD
- Dissociative PD
36
Explain the M axis of the PDM.
Detailed look at emotional functioning.
| E.G., Information processing, self regulation, relationships, emotional expression, learning, coping/defenses, etc.
37
Explain the S axis of the PDM.
Focus on personal experience of difficulties.
Need to be seen in context of personality and mental functioning.
Uses many of the DSM categories!
38
Who is Lorna Benjamin Smith?
an American psychologist (psychotherapist) best known for her innovative treatment of patients with personality disorders who have not responded to traditional therapies or medications.
39
True or False. DSM and ICD focus on assigning diagnosis (i.e., label) to set of problems.
True.
40
True or False. PDM, OPD focus on developing the formulation in relation to stated problems.
True.
41
What is a psychological assessment made up of?
a diagnosis and formulation (joint effort with client and psychologist to summarize difficulties).
42
What is Research Domain Criteria (RDoC)?
A research framework for new approaches to investigating mental disorders.
43
Is Research Domain Criteria (RDoC) a diagnostic guide?
No. The goal is to understand the nature of mental health and illness in terms of varying degrees of dysfunctions in general psychological/biological systems.
44
What are the 5 domains of RDoC?
1. Negative Valence Systems: primarily responsible for responses to aversive situations or context, such as fear, anxiety, and loss.
2. Positive Valence Systems: responsible for responses to positive motivational situations or contexts, such as reward seeking, consummatory behavior, and reward/habit learning.
3. Cognitive Systems: many things such as memory.
4. Systems for Social Processes: mediate responses to interpersonal settings of various types, including perception and interpretation of others' actions.
5. Arousal Regulatory Systems: responsible for generating activation of neural systems as appropriate for various contexts, and providing appropriate homeostatic regulation of such systems as energy balance and sleep.
45
How are disorders classified? 4 steps.
1. Divide disorders into Mutually Exclusive and Collectively Exhaustive Subclasses - disorders must be distinct and they must all be classified.
2. Subclasses defined by necessary and
sufficient conditions - Must be characteristics that are necessary for classification, Must also be set of sufficient conditions to belong to a subclass.
3. Reliability: Each time you (or someone else) uses the classification system, should get the same result.
( Need to identify psychological problems in a clear and reliable manner. Also need agreement among mental health professionals or can have individuals referring to same term to describe different disorders)
4. Validity: Classification system should say something about the “true world."
46
Identify some concerns with the PDM (of which the PDM-2 does better!).
1. Reliability and Validity of the Axes and Diagnoses:
Needs more empirical data on the Axes and Diagnoses!
2. Clinical Utility
How useful is it in actual clinical practice? Having assessment procedures and illustrative descriptions can help.
3. M-axis; including Executive Functioning
This is to do with specific cognitive elements, such as short- and long-term attention, sequencing, and analogical reasoning. By including attention to executive function- ing, the PDM-2 would become better integrated with related research that has not to date been extensively associated with the psychodynamic literature.
4. S-axis; addition of genetic and environmental contributors to different symptoms.
May be useful for creating and validating assessment instruments specific to the subjective experience of psychopathological symptoms.
47
Identify some benefits of the PDM.
1. Provides a holistic view of the person (including context and history) - focuses on who the person is than what they have.
2. Contains a section specific for children (and elderly in the PDM 2) - not only adult focused.
3. Works as a supplementary manual to the DSM and ICD.
48
True or false. There is NO scientific evidence that psychotherapy works.
False. In Leslie Carr's video, she talks about a specific meta analysis that finds a very large effect size for psychotherapy!
49
In Leslie Carr's TedTalk, what does she provide as scientific evidence for psychotherapy?
She talks about a specific meta analysis that finds a very large effect size for psychotherapy - both during therapy and after.
50
What does Leslie Carr say is the most important part of effective therapy?
The relationship that's built between the therapist and patient. Studies show us this again and again!
51
True or False. Psychotherapy places a lot of importance on childhood experiences to shape one's expectations of the world and thus behavior.
True.
