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DSM-IV-TR
z Diagnostic and Statistical Manual, Fourth Edition, Text Revision z Taxonomy of behavioral, mental, and psychiatric disorders
{Atheoretical {Nomothetical
History of DSM-IV
z Based on work of Emil Kraepelin
{ Late 1800s to early 1900s
z DSM published in 1945 at 120 pages z DSM-IV-TR is the sixth revision at over 900 pages z While there are problems with DSM-IV, it still has had a great impact on the field. z DSM-IV has engendered a lot of research
DSM-IV
z Definition of mental disorder:
{Clinically significant behavior or psychological syndrome or pattern which is associated with 1) present distress or 2) disability {Must be associated with a significantly increased risk of suffering, death, pain, disability, or loss of freedom {Must not be an expected response to a particular event
DSM-IV Disorders
z No sharp dividing line between one disorder and another z No sharp dividing line between having a disorder and not
z Diagnostic Criteria
Diagnostic Criteria
z Diagnostic Criteria for 307.1 Anorexia Nervosa
{ A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
Diagnostic Criteria
{B. Intense fear of gaining weight or becoming fat, even though underweight. {C. Disturbance in the way in which ones body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. {D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen administration.)
z Axis I
Multi-Axial System
{Clinical syndromes and V-Codes
z Axis II
{Developmental and Personality Disorders
z Axis III
{Physical disorders
z Axis IV
{Severity of Psychosocial Stressors
z Axis V
{Global Assessment of Functioning
Appendices
z Appendix A
{Controversial new disorders
z Appendix B
{Decision Trees
z Appendix C
{Glossary of Technical Terms
DSM-V
z Changes to expect:
{Conform with ICD {Maybe change diagnosis {Maybe change theoretical orientation {Maybe increased emphasis on testing and assessment
{Contextual Factors
z Environmental Factors z Personal Factors
Diagnoses
z Practice comes from medicine z Diagnosis is the assignment of a label that serves as shorthand for a cluster of related behavioral features which may or may not be related to demonstrable organic varibles z Psychological diagnoses arent yet to the level of medical diagnoses
(A) Dichotomy There are only two levels, and all people are at one of those two levels
60 Frequency 40 20 0 1 3 5 7 9 11 13 15 17 19 Scores
z Self-fulfilling prophesy z Distorting diagnoses to get insurance coverage z Label viewed as immutable z Circular use of label z Disagreement of diagnoses z Inconsistency in the definition of the label
z Careless assignment of labels z Potentially harmful effects on a person z Political and economic exploitation z confidentiality
Methods of Assessment
z Clinical Interview
{Most widely used method {Covers:
z Identifying data z Presenting Problem z Psychosocial History z Psychiatric History z Medical History
Methods of Assessment
{Interview Formats:
Structured Increased reliability and validity Decreased flexibility May miss idiosyncratic info May increase defensiveness and resistance Allows comparability Used in research & clinical settings Computer admin & scoring Unstructured Decreased reliability and validity Increased flexibility Picks up idiosyncratic info Increases rapport Creates favorable changes
Methods of Assessment
{Interview vs. Conversation
z Interview designed to achieve certain goals z Interview may require discussion of unpleasant things z Interviewer directs and controls the flow of the interview z One-sided z Time Limited
Methods of Assessment
z Mental Status Exam
{Appearance and behavior {Thought processes {Mood and affect {Intellectual functioning {Sensorium
z Physical Exam
Methods of Assessment
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Methods of Assessment
z Psychological Tests
{Used to evaluate reasonably stable traits such as intelligence and personality {Standardized {Two important concepts:
z Validity
The extent to which a test measures what it purports to measure
z Reliability
The extent to which a test obtains comparable scores across time
Methods of Assessment
{Intelligence Tests
z Stanford Binet z Wechsler Scale z Deviation IQ score
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Methods of Assessment
Methods of Assessment
This inkblot resembles the ambiguous figures presented in the Rorschach test
Methods of Assessment
{Projective Personality Tests
z Rationale for these z Validity z Rorschach Inkblot Test z Thematic Apperception Test
{Neuropsychological Assessment
z Bender Visual Motor Gestalt Test z Halstead-Reitan Neuropsychological Battery z Luria Nebraska Battery
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Methods of Assessment
{Behavioral Assessment
z Functional analysis z Self-monitoring
Reactivity
Methods of Assessment
z EEG z EMG z Brain Imaging
CT Scan PET Scan MRI fMRI BEAM
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z Research Design
{ A method to test hypotheses { Independent variable The variable that causes or influences behavior { Dependent variable The behavior influenced by the independent variable
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Types of Research
z Case Study z Correlational Study z Experimental Study
{Single Case Experimental Design {Genetic Studies {Studying Behavior Across Time {Studying Behavior Across Cultures
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