DIAGNOSIS AND CLASSIFICATION problems and can share this

OF PSYCHOLOGICAL PROBLEMS information when asked to do so.”

Why is abnormal behavior hard to What are some disadvantages of

define? defining abnormal behavior in
terms of subjective distress?
No descriptive feature is shared by all
forms of abnormal behavior. No one - Not everyone that we consider to be
criterion for “abnormality” is sufficient. “disordered” reports subjective
distress.
No discrete boundary exits between
normal and abnormal. _ The amount of subjective distress
necessary to be considered abnormal.
What is abnormal behavior?
Disability or dysfunction: for
There are 3 proposed definitions of
behavior to be considered abnormal, it
abnormal behavior.
must create some degree of social or
Conformity to norms: statistical occupational problem for the individual.
infrequency or violation of social Dysfunction in these two spheres is
norms, when a person’s behavior often quite apparent to both the
becomes patently deviant, outrageous, individual and the clinician.
or otherwise nonconforming, then he
Advantages & Disadvantages of
or she is more likely to be categorized
Disability or Dysfunction
as “abnormal”.
Advantages:
Advantages:
1. Little inference is required,
> Cut-off points – quantitative in
problems in the social and
nature. This principle of statistical
occupational spheres often prompt
deviance is frequently used in the
individuals to seek out help
interpretation of psychological test
scores. Disadvantages:

> Intuitive appeal - It may seem 1. Who should judge the standard for
obvious that those behaviors we dysfunction?
ourselves consider abnormal would be
2. How to agree on what specifically
evaluated similarly by others.
constitutes an adequate level on
Disadvantages: functioning.

> The number of deviations Where does this leave us?

> Choice of cut-off points - Some key points:

Conformity-oriented definitions are
- Abnormal behavior does not
limited by the difficulty of establishing
necessarily indicate mental illness.
agreed-upon cutoff points.
- Mental illness refers to: “a large
> Cultural Relativity
class of frequently observed
Subjective distress: the subjective syndromes that are comprised of
feeling of the individual to determine if certain abnormal behaviors or
he or she is maladjusted. features.”

What are some advantages of Mental Illness, as stated in the

defining abnormal behavior in DSM-IV-TR, is conceptualized as a
terms of subjective distress? clinically significant behavior or
psychological syndrome or pattern
- The text states that “it seems
that occurs in an individual and that is
reasonable to expect that individuals
associated with present distress or
can assess whether they are
disability or with a significantly
experiencing emotional or behavioral
increased risk of suffering, death, pain, - objective tests for its confirmation
disability, or an important loss of
- specific treatment outcomes
freedom. In addition, this syndrome or
pattern must not be merely an - include inclusion and exclusion
expectable and culturally sanctioned criteria for each disease
response to a particular event, for
example, the death of a loved one. Classification. A logical scheme for
Whatever its original cause, it must the grouping of diseases in rational
currently be considered a categories that is consistent to the
manifestation of a behavior, observed commonalities in cause,
psychological, or biological dysfunction manifestation, and natural course of a
in the individual. Neither deviant disease.
behavior not conflicts that are primary Diagnosis. The determination of the
between the individual and society are grouping and nomenclature of a
mental disorders unless the deviance patient’s manifested present and past
or conflicts is a syndrome of the symptoms that guide the clinician’s
dysfunction in the individual as understanding of expected cause,
described above. course, context, and treatment
Important aspects of this prognosis of the patient’s presentation.
definition: Nomenclature. The label or term that
(a) The syndrome must be associated is used to concisely communicate the
with distress, disability or increased results of the diagnostic process and
risk of problems. the identified disease (if any)

(b) A mental disorder is considered to - This is often confused with diagnosis,

represent a dysfunction within an the diagnosis essentially presents the
individual. complete clinical picture while the
nomenclature presents a shorthand
(c) Not all deviant behavior or explanation. Nomenclature changes
conflicts with society are signs of from manual to manual, but the
mental disorder. diagnosis is your case
conceptualization.

Diagnosis is a type of expert-level

Nosology, Classification, &
categorization. There are 4 major
Diagnosis
ADVANTAGES of diagnosis.
Nosology (Campbell, 1989): The
- Communication
study of diseases in particular their
classification, nomenclature, and - Empirical research in
relationship to one another including psychopathology
the principles for differentiating one
disease from another (diagnosis), as - For research into etiology
well as a framework of how they are - To suggest which mode of treatment
related to each other. is most likely to be effective
An Ideal Nosology Will Describe Early classification system dates
- specific causes to remember

- its natural history The Congress of Mental Science

adopted a single classification system
- typical “textbook” clinical pictures in 1889 in Paris.
and variations (subtypes)
In 1948 the World Health Organization
- expected outcomes and sequel came out with the International
without treatment Statistical Classification of Diseases,
Injuries, and Causes of Death that
include a classification of abnormal An approach to assessment in which
behavior the basic decision is whether the
person is or is not a member of the
- In 1952 the American Psychiatric
discrete grouping.
Association published the Diagnostic
and Statistical Manual (important to Essentially, the diagnosis is yes or no
remember) decision.

The first edition was known as DSM-I, Assumption of the Categorical

it was later revised in 1968 (DSM-II) Approach

Revised again in 1980, the DSM-III 1. All human behavior can be divided
had important changes, which into pathological and normal
included the use of explicit diagnostic categories; and
criteria for mental disorders, a
2. These classes are discrete, non-
multiaxial system of diagnosis, a
overlapping classes with high
descriptive approach to diagnosis that
homogeneity (textbook presentations)
attempted to be neutral with regard to
and clear inclusion and exclusion
theories of etiology, and greater
criteria. (Butcher, Mineka, & Hooley,
emphasis on the clinical utility of the
2005)
diagnostic system, these changes
have been retained in subsequent 2. Dimensional Approach
editions.
All individuals behavior can be
- Other revision were in 1987 (DSM- classified according to defined
III-R), 1994 (DSM-IV), and the one dimensions. A person’s typical
most currently used DSM-IV-TR in behavior (personality) can be
2000. classified by different configuration of
these traits (ranging from very low to
DSM-IV-TR
very high) which represent strengths
Diagnosis is multiaxial. Evaluation is and weaknesses.
done along five axes.
Normal and abnormal is defined by
I. Axis I indicated the presence of specific normative criteria (i.e. 3rd
any of the clinical disorders or other normative percentile) on each criteria.
relevant conditions.
3. Prototypical Approach
II. Axis II evaluates for personality
Prototype. A conceptual entity
disorders and mental retardation.
depicting an idealized combination of
III. Axis III highlights any medical characteristics that more or less
condition that may be relevant to the regularly occur together in a less than
conceptualization or treatment of perfect or standard way at the level of
individual’s Axis I or Axis II clinical actual observation.
disorders.
Prototype Approach
IV. Axis IV is psychosocial and
No member of the prototype has all
environmental problems relevant to
the characteristics of the prototype;
diagnosis.
however, there is sufficient core of
V. Axis V is a quantitative estimate of symptoms to define a particular
an individual’s overall level of category.
functioning.
However, there is often vagueness as
General Issues in Classification disorders are not exclusionary and
(Categories vs Dimensions) there may be a set of comorbidities
and similarities.
Models of Classification

1. Categorical Approach
Syndromes. A collection or grouping
of disjunctive, variable signs and
symptoms whose frequency of
occurrence together suggests the
existence of a single pathological or
disease process that will explain them.
(Campbell, 1898; Eysenk, 1960)

Causes of abnormal behavior and

mental illness

The each of the different models of

psychopathology have different
explanations of abnormal behavior.
There is also a more general model of
etiology that can accommodate a
variety of theoretical models: the
diathesis-stress model.

A diathesis refers to a vulnerability or

predisposition to possibly develop the
disorder in question. A diathesis is
necessary but not sufficient to produce
a mental disorder. What is required in
addition to a diathesis is sufficient
environmental stress. Stressor can be
biological or psychological in nature.

Categorical vs. Dimensional

Systems

Categorical. Presence/absence of a
disorder. (Either you are anxious or
you are not anxious.)

DSM is categorical. Yes or No.

Dimensional. Rank on a continuous

quantitative dimension. (How anxious
are you on a scale of 1 to 10?)
Threshold for diagnosis of
hypertension.

Dimensional system may better

capture an individual’s functioning but
the categorical approach has
advantages for research and
understanding.