Advanced Advanced PsychopathologyPsychopathology

Defining the PhenomenaDefining the Phenomena

ExampleExample

30 y/o male30 y/o male Experiences depressed mood every day for Experiences depressed mood every day for

1 month (sad, cries for no reason)1 month (sad, cries for no reason) Wakes up two hours before his alarm goes Wakes up two hours before his alarm goes

off and can’t get back to sleepoff and can’t get back to sleep Has lost 12 pounds because he doesn’t eat Has lost 12 pounds because he doesn’t eat

consistentlyconsistently Has forgotten three meetings at work and Has forgotten three meetings at work and

can’t concentratecan’t concentrate Reports that he would be better off deadReports that he would be better off dead

PsychopathologyPsychopathology

Statistical DevianceStatistical Deviance Conceptual Definition? How Deviant?Conceptual Definition? How Deviant?

Maladaptive BehaviorMaladaptive Behavior ContextContext

Distress/DysfunctionDistress/Dysfunction Social DevianceSocial Deviance Harmful DysfunctionHarmful Dysfunction

Harmful according to cultureHarmful according to culture Failure of a mental mechanismFailure of a mental mechanism

PsychopathologyPsychopathology

What is real when it comes to What is real when it comes to psychopathology?psychopathology? SufferingSuffering Is suffering pathological?Is suffering pathological?

The problem of subjectivityThe problem of subjectivity Theory vs. ConceptionTheory vs. Conception

Explanation vs. A Description of that to be Explanation vs. A Description of that to be explained explained

Psych DisordersPsych Disorders

The accepted descriptions of our The accepted descriptions of our society representing agreed-upon society representing agreed-upon abstractions of psychopathologyabstractions of psychopathology Social Constructionism vs. EssentialismSocial Constructionism vs. Essentialism Why do we diagnose?Why do we diagnose?

Professional/Client CommunicationProfessional/Client Communication Sick roleSick role ResearchResearch Reimbursement Reimbursement

Psychopathology vs. Psychopathology vs. DisorderDisorder DSM-5 Mental DisorderDSM-5 Mental Disorder

… … a syndrome characterized by clinically significant a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion disturbance in an individual’s cognition, emotion regulation or behavior that reflects a dysfunction in regulation or behavior that reflects a dysfunction in psychological, biological or developmental processes psychological, biological or developmental processes underlying mental functioning. Mental disorders are underlying mental functioning. Mental disorders are usually associated with significant distress or disability usually associated with significant distress or disability in social, occupational or other important activities. An in social, occupational or other important activities. An expectable or culturally approved response to a common expectable or culturally approved response to a common stressor or loss such as death of a loved one is not a stressor or loss such as death of a loved one is not a mental disorder. Socially deviant behavior (e.g., mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are political, religious, or sexual) and conflicts that are primarily between the individual and society are not primarily between the individual and society are not mental disorders unless the deviance or conflict results mental disorders unless the deviance or conflict results from a dysfunction in the individual as described above.from a dysfunction in the individual as described above.

DSM-5DSM-5

A list and description that we believe A list and description that we believe to fit the proposed definition of a to fit the proposed definition of a mental disorder.mental disorder. DSM IV is a “prototypical” systemDSM IV is a “prototypical” system

Categorical vs. DimensionalCategorical vs. Dimensional Many manifestations of disordersMany manifestations of disorders

DiagnosisDiagnosis

How do we come by a diagnosis?How do we come by a diagnosis?

ASSESSMENTASSESSMENT

Diagnostic AssessmentDiagnostic Assessment

Structured vs. UnstructuredStructured vs. Unstructured InventoriesInventories Structured InterviewsStructured Interviews

Almost always done w/a clinical Almost always done w/a clinical interviewinterview

Clinical InterviewClinical Interview Presenting ProblemPresenting Problem

What is their perception of why they have come in?What is their perception of why they have come in? What’s the problem behavior, thoughts, or emotionsWhat’s the problem behavior, thoughts, or emotions

History of Presenting ProblemHistory of Presenting Problem When did it start, how severe, what is the functional impact?When did it start, how severe, what is the functional impact?

Developmental HistoryDevelopmental History Family of originFamily of origin AcademicAcademic EmploymentEmployment Personal relationshipsPersonal relationships Alcohol/DrugAlcohol/Drug

Medical History – Major or recent medical Medical History – Major or recent medical issues/illnessesissues/illnesses

Treatment History – Therapy, medication, Treatment History – Therapy, medication, hospitalizationshospitalizations

Clinical InterviewClinical Interview

Within each content area your job is Within each content area your job is not only to get the info put to ask not only to get the info put to ask questions that allow you to questions that allow you to differentiate “symptoms” so that a differentiate “symptoms” so that a diagnosis emergesdiagnosis emerges

Addressing these areas paints a Addressing these areas paints a picture of that person.picture of that person.

From that picture you abstract a From that picture you abstract a diagnosisdiagnosis

Bias in DiagnosisBias in Diagnosis Biased ConstructsBiased Constructs

Ethnocentric Construction of Idealized SelfEthnocentric Construction of Idealized Self Self- Control (Very Western)Self- Control (Very Western)

Biased ApplicationBiased Application Based on race, class, genderBased on race, class, gender

Biased SamplingBiased Sampling Influence of bias factors on presentation to Influence of bias factors on presentation to

assessment/treatmentassessment/treatment The importance and the problem of BASE The importance and the problem of BASE

RATESRATES Biased InstrumentsBiased Instruments

DIFDIF Biased CriteriaBiased Criteria

Why don’t we have “delusional dominating Why don’t we have “delusional dominating PD?”PD?”

Your goalYour goal

To learn the system well enough so To learn the system well enough so that during an interview you will that during an interview you will hear info that will allow you to hear info that will allow you to generate a list of possible disordersgenerate a list of possible disorders

With that list you then ask questions With that list you then ask questions to rule out disorders until you come to rule out disorders until you come to the one that best describes their to the one that best describes their suffering.suffering.