Advanced Psychopathology

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Advanced Psychopathology

• Defining the Phenomena

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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
  cant get back to sleep
• Has lost 12 pounds because he doesnt eat
  consistently
• Has forgotten three meetings at work and cant
  concentrate
• Reports that he would be better off dead

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Psychopathology

• Statistical Deviance
• Conceptual Definition? How Deviant?
• Maladaptive Behavior
• Context
• Distress/Dysfunction
• Social Deviance
• Harmful Dysfunction
• Harmful according to culture
• Failure of a mental mechanism

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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

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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

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Psychopathology vs. Disorder

• DSM-5 Mental Disorder
• a syndrome characterized by clinically
  significant disturbance in an individuals
  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.

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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

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Diagnosis

• How do we come by a diagnosis?
• ASSESSMENT

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Diagnostic Assessment

• Structured vs. Unstructured
• Inventories
• Structured Interviews
• Almost always done w/a clinical interview

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Clinical Interview

• Presenting Problem
• What is their perception of why they have come
  in?
• Whats the problem behavior, thoughts, or
  emotions
• History of Presenting Problem
• When did it start, how severe, what is the
  functional impact?
• Developmental History
• Family of origin
• Academic
• Employment
• Personal relationships
• Alcohol/Drug
• Medical History Major or recent medical
  issues/illnesses
• Treatment History Therapy, medication,
  hospitalizations

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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

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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 dont we have delusional dominating PD?

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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.