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Abnormality

(8-20-12)

  • I: Standards of Abnormality
    • Relative Standards
      • DISTRESS (DSM-IV): causes suffering
        • How much suffering (and how do we know)?
      • FUNCTIONAL (DSM-IV): causes impairment
        • Who gets to say?
      • MATHEMATICAL [statistical] (DSM-IV): is rare
        • The only standard that really yields “positive” abnormality: genius, artistic creativity, athletic talent
      • SOCIOLOGICAL: breaks a rule
        • formal rules: laws, codes of ethical conduct, contracts
        • informal rules: norms & mores
      • TOLERANCE
        • Kanner — “annoyance threshold of the child’s environment”
        • caretaker concerns (Achenbach, 1982)
          • enduring trait: this has always been a problem
          • perceived negative change: this has become a problem
          • developmental comparison: not keeping up–failure to change as expected
    • Absolute Standards [universal]
      • IDEALISTIC: defining mental health
        • Maslow and the fully functioning person, self-actualization as a standard, “Be the most that you can be”
      • PATHOGONOMIC: always indicated illness
  • II: Nature of the Difference
    • Qualitative [categorical]–(difference is of KIND)
    • Quantitative [dimensional]–(difference is of DEGREE or amount)
  • III: Level of Interest
    • symptom
      • symptom: verbal report of patient
      • sign: observation of clinician
    • syndrome
    • disorder
    • [disease]

DSM-IV-TM

  • DSM
  • Diagnostic Certainty
  • Differential Diagnosis
  • categorical system
    • it is a classification system of patterns of behavior
    • “The essential features of . . .”
    • multiple diagnoses allowed/encouraged
  • clinical focus
  • the judgment/perspective of the clinician is the reference point
  • definition of Mental Disorder
    • the judgment/perspective of the clinician is the reference point
      • definition of Mental Disorder
      • The first question: ‘Does this client have a Mental Disorder?’
  • multiaxial
    • more comprehensive information than acute syndromes are necessary of adequately understand a case
  • precedence of diagnosis–Diagnostic Hierarchies
    • DSM-IV encourages multiple diagnoses when the criteria for more than one diagnoses are met, there are 3 general exceptions:
    • General Medical Condition/Substance Use
      • “not due to the direct effects of a substance (e.g., drugs of abuse or medication) or a general medical condition.”
      • “symptoms due to” preempts diagnosis of other mental disorders
      • Alcohol Mood Disorder preempts Major Depression
    • Associated feature of more pervasive disorder
      • “has never met the criterion for . . .”
      • “does not meet the criterion for . . .”
      • “does not occur exclusively during the course of . . .”
      • In general, the more pervasive disorder preempts the diagnosis of the more focused disorder: Schizophrenia has depression as an “associated symptom”, so Dysthymic Disorder would not also be concurrently diagnosed, except . . .
      • if uniquely established independently of more pervasive disorder
      • or, some exceptions are made when associated symptom becomes focus of treatment: sleep disorders & depression
        • self-injurious behavior & autism
    • Boundary difficulties (clinical judgments)
      • “not better accounted for by . . .”: reminds you to consider

DSM-IV-TR Multiaxial Assessment

  • Axis I
    • Clinical Syndromes
    • Other Conditions That May Be a Focus of Clinical Attention
  • Axis II
    • Mental Retardation
    • Personality Disorders
      • personality traits
  • Axis III
    • General Medical Conditions
  • Axis IV
    • Psychosocial & Environmental Problems
  • Axis V
    • Global Assessment of Functioning (GAF) Scale
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