Transcript Advanced Psychopathology

Advanced
Psychopathology
Defining the Phenomena
Example






30 y/o male
Experiences depressed mood every day for 1 month
(sad, cries for no reason)
Wakes up two hours before his alarm goes off and can’t
get back to sleep
Has lost 12 pounds because he doesn’t eat consistently
Has forgotten three meetings at work and can’t
concentrate
Reports that he would be better off dead
Psychopathology

Statistical Deviance


Maladaptive Behavior




Conceptual Definition? How Deviant?
Context
Distress/Dysfunction
Social Deviance
Harmful Dysfunction
Harmful according to culture
 Failure of a mental mechanism

Psychopathology

What is real when it comes to psychopathology?
Suffering
 Is suffering pathological?


The problem of subjectivity

Theory vs. Conception

Explanation vs. A Description of that to be explained
Psych Disorders

The accepted descriptions of our society
representing agreed-upon abstractions of
psychopathology
Social Constructionism vs. Essentialism
 Why do we diagnose?

Professional/Client Communication
 Sick role
 Research
 Reimbursement

Psychopathology vs. Disorder

DSM-5 Mental Disorder

… a syndrome characterized by clinically significant disturbance in
an individual’s cognition, emotion regulation or behavior that
reflects a dysfunction in psychological, biological or developmental
processes underlying mental functioning. Mental disorders are
usually associated with significant distress or disability in social,
occupational or other important activities. An expectable or
culturally approved response to a common stressor or loss such as
death of a loved one is not a mental disorder. Socially deviant
behavior (e.g., political, religious, or sexual) and conflicts that are
primarily between the individual and society are not mental
disorders unless the deviance or conflict results from a dysfunction
in the individual as described above.
DSM-5

A list and description that we believe to fit the
proposed definition of a mental disorder.

DSM IV is a “prototypical” system
Categorical vs. Dimensional
 Many manifestations of disorders

Diagnosis

How do we come by a diagnosis?
ASSESSMENT
Diagnostic Assessment

Structured vs. Unstructured
Inventories
 Structured Interviews


Almost always done w/a clinical interview
Clinical Interview

Presenting Problem



History of Presenting Problem







When did it start, how severe, what is the functional impact?
Developmental History


What is their perception of why they have come in?
What’s the problem behavior, thoughts, or emotions
Family of origin
Academic
Employment
Personal relationships
Alcohol/Drug
Medical History – Major or recent medical issues/illnesses
Treatment History – Therapy, medication, hospitalizations
Clinical Interview



Within each content area your job is not only to
get the info put to ask questions that allow you
to differentiate “symptoms” so that a diagnosis
emerges
Addressing these areas paints a picture of that
person.
From that picture you abstract a diagnosis
Bias in Diagnosis





Biased Constructs
 Ethnocentric Construction of Idealized Self
 Self- Control (Very Western)
Biased Application
 Based on race, class, gender
Biased Sampling
 Influence of bias factors on presentation to
assessment/treatment
 The importance and the problem of BASE RATES
Biased Instruments
 DIF
Biased Criteria
 Why don’t we have “delusional dominating PD?”
Your goal


To learn the system well enough so that during
an interview you will hear info that will allow
you to generate a list of possible disorders
With that list you then ask questions to rule out
disorders until you come to the one that best
describes their suffering.