Psychological Disorders a General overview
Normal vs. Abnormal
Conditions for 'Disorders'
Medical Perspective
    Hippocrates
    Freud
Psychological Perspectives
Socio-Cultural Perspectives
Review of DSM-IV
Overview of DSM-5
    NeuroDevelopmental Disorders
    Anxiety Disorders
    Somatoform Disorders
    Dissociative Disorders
    Mood Disorders
    Schizophrenic Disorders
    Personality Disorders
    Insanity Defense

Psychological Disorders General overview

Normal vs. Abnormal are often used to define disorder, however, they are difficult to delineate.

The criteria of "Abnormal" may vary across:

1) Deviance (Statistical Norm referenced) based upon averages and variance (eg, intelligence scores)

2) Maladaptive behaviour that causes harm or injury to the person or other persons .

3) Personal distress pain or psychological suffering and enduring discomfort .

4) Culture Bound - relative to the cultural framework, the experience of thoughts and actions are deemed acceptable or unacceptable.
Social and moral proscriptions are bound to our categories.

Perspectives on 'Disorders'

Medical Perspective dominates in the field, making use of concepts of illness, pathology & disease

According to Kassin, the American Psychiatric Association considers a disorder to involve:

1. significant pain or distress, inability to work or play. increased risk of death, or loss of freedom in important areas of life.

2. having a source that lies within the person, due to biological factors, learned habits, or mental processes, and is simply not a 'normal' response to specific events such as the death of a loved one.

3. not social being the result of conditions such as poverty, prejudice, government policy, or other conflicts with society. (p.606)

History of the medical Model

Hippocrates - started off the traditions with his model of four humours or fluids: blood, black bile, yellow bile and phlegm.

Freud also set the stage for the 20^th century with his psychoanalytical jargon, neurosis was dominant for much of the time.
Only in the last 30 years has 'Disorder' come along as a PC substitute .

Psychological Perspectives

Based on the assumption that the 'upbringing or environmental influences are important, such as responses to natural disasters, war, abuse, violence, marital and family disputes, bereavement, friends, loneliness,...

Also assumes that conditions or syndromes exist that are characterised by clusters of symptoms.

BPS MODEL
Blending understanding of the biological and genetic influences along with the personal psychological experiences and the social and collective demands and expectations including supports and stereotypes about mental illness.

Diagnosis: the development of DSM-5

1952 DSM (I) was established, 1968 DSM-II, 
1980 DSM-III, 1987-DSM-III-R, 1994 DSM-IV;
2013-DSM-5

DSM-5 is the new standard for disorders (particularly in the USA) in Canada and is spreading through the world.

Organizational structure of DSM-5

Following WHO International Classification of Disorders (ICD) it seeks to harmonize with the most recent Clinical Modification (CM) version (11). However, in 2013 US officially recognized ICD-9-CM but will move to ICD-10-CM in October 2014.

It recognizes heterogeneity and comorbidity of mental disorders leading to a variety of expressions of each. As such it also is expected to be "a living document" that is "adaptable to future discoveries in neurobiology, genetics, and epidemiology" (p. 13).

It is organized around neurodevelopmental disorders as well as internalizing (emotional and somatic disorders), externalizing (behavioural and substance disorders), neurocognitive disorders and "other" disorders assuming an underlying pathophysiological process as well as social and environmental determining factors.

Using DSM-5 requires clinical training in order to give a careful clinical history and summary of social, psychological, and biological factors and their contributions to the diagnosed mental disorder(s).

Each Disorder is presented with a:

Definition, Criteria for clinical symptoms, Diagnostic criteria and descriptions, subtypes and specifiers.

Clinicians are to provide: a principal diagnosis, provisional diagnoses as well identify any medically induced movement disorders and other conditions that may be a focus of clinical attention.

"Cautionary Statement" for its use in Forensic Situations:

"When DSM-5 categories, criteria, and textual descriptions are emplyed for forensic purposes, there is a risk that diagnostic information will be misused or misundertood. These dangers arise because of the imperfect fit between the questions of ultimate concern to the law and the information contained in a clinical diagnosis" (p. 25).

Additionally, "It is important to note that the DSM-5 does not provide treatment guidelines for any given disorder" (p. 25).

Developmental and Lifespan Considerations

Statement on Gender recognizing that gender may:

• determine risk for a disorder (i.e. premenstrual dysphoric disorder).
• moderate overall risk for specific disorders (prevalence and incidence rates).
• affect the likelihood of occurance of specific symptoms (e.g. ADHD - "differences in presentation" (p. 15).

Distinguishes sex differences (XX, XY-reproductive organ comlpement) from gender differences - "variations that result from biological sex as well as an individual's self-representation that includes the psychological, behavioral, and social consequences of one's perceived gender" (p. 15).

Statement on Cultural Issues

"Culture provides interpretive frameworks that shape the expereince and expression of the symptoms, signs, and behaviors that are criteria for diagnosis" (p. 14) .

"Mental disorders are defined in relation to cultural, social and familial norms and values" (p. 14).

Section III recognizes cultural formulations and the role of cultural norms and coping strategies.

"Culture Bound Syndromes" of common discourse in transcultural psychiatry are to be replaced by:

Cultural Syndrome - "a cluster or group of co-occuring, relatively invariant symptoms found in a specific cultural group, community, or context. These may not be recognized as an illness in their host culture but are recognizable to an outside observer.

Cultural idiom of Distress - refers to "shared patterns (or concepts of pathology) and ways of expressing, communicating, or naming essential features of distress." They need not be associated with "specific symptoms, syndromes, or perceived causes" (p. 14).

Cultural Explanation - or perceived cause which is an "explanitory model that provides a culturally conceived etiology or cause for symptoms, illness, or distress" and it may involve the "salient feaures of folk classifications of disease used by laypersons or healers" (p. 14).

Socio-Cultural Perspectives

List of Categories of Disorders and Mitigating Factors

NeuroDevelopmental Disorders

Schizophrenia Spectrum and other Psychotic Disorders

Bipolar and related Disorders

Depressive Disorders

Anxiety Disorders

Obsessive-Compulsive and Related Disorders

Trauma and Stressor-Related Disorder

Dissociative Disorders

Somatic Symptom and Related Disorders

Feeding and Eating Disorders

Eliminative Disorders

Sleep-Wake Disorders

Sexual Dysfunctions

Gender Dysphoria

Disruptive, impulsive-control, and conduct Disorders

Substance-Related and Addictive Disorders

Neurocognitive Disorders

Personality Disorders

Paraphilic Disorders

Other Mental Disorders

Medication-Induced Movement Disorders and other Adverse Effects of Medication

Other conditions that may be a focus of Clinical Attention (i.e. Abuse & Neglect)

Controversy about the DSM

Challenges facing psychologists are threefold:

1. Do disorders as we describe them really exist?

2. Do the categories we use make sense and are they clearly able to tell us about disorders, or are they too mixed up? 

3. Labelling and other problems with the morality of disorder

Thomas Szasz - brought attention to the 'mythical' nature of mental illness, identifying the social and cultural factors (including labeling).

Changes in moral and legal standing of people through labels, expectations and entrenched propaganda. Patient role is passive and without responsibility. ADHD
American Drug Forum  

Anti-psychiatry movement (David Rosenhan)  R.D.Laing mental illnesses like schizophrenia are adaptive responses to insane social worlds, part of the politics of experienceVideo.   Titicut Follies - A look inside a mental institution circa 1967 part 2 3