From Last Class

1. Defining Abnormal Behavior, Part IIIJanuary 22, 2014PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.

2. From Last Class • Distinguishing normal from abnormal behavior • Diagnosing mental disorders

3. Diagnosing Mental Disorders • Key aspects of DSM-IV definition: • Clinically significant (i.e., severe) • Associated with either distress, impairment, or interference with life • Not just a culturally accepted response

4. Diagnosing Mental Disorders • These key aspects should help us distinguish between serious and less severe problems • For example: • Social phobia vs. shyness • Major depression vs. transient sadness • Attention-deficit hyperactivity disorder vs. energetic child with high need for stimulation • Caffeine dependence vs. drinking coffee every day without associated problems

5. Diagnosing Mental Disorders • Theoretically, a problem in ANY area of psychological functioning can be a mental disorder if it meets the definition of a mental disorder • Why not: • Anger Disorders? • Internet Addiction Disorder? • Temper Tantrum Disorder? • Procrastination Disorder?

6. Diagnosing Mental Disorders • Which of the following disorders are either in the (current) DSM-IV or were seriously considered for inclusion in the DSM-5 in May of 2013?

7. Chronic Anger Disorder • Intermittent Explosive Disorder • Major Depressive Disorder • Disruptive Mood Dysregulation Disorder • Brief, Recurrent Depressive Disorder • Minor Depressive Disorder • Extremely Minor Depressive Disorder • Pre-Menstrual Dysphoric Disorder • Mixed Anxiety-Depressive Disorder • Mixed Insomnia-Irritability Disorder • Gambling Addiction Disorder • Sexual Addiction Disorder • Olfactory Reference Syndrome • Immature Personality Disorder • Dependent Personality Disorder • Chronic Normalcy Syndrome • Occasional Unhappiness Disorder Hint: 7 are fake

8. *Chronic Anger Disorder • Intermittent Explosive Disorder • Major Depressive Disorder • Disruptive Mood Dysregulation Disorder • Brief, Recurrent Depressive Disorder • Minor Depressive Disorder • *Extremely Minor Depressive Disorder • Pre-Menstrual Dysphoric Disorder • Mixed Anxiety-Depressive Disorder • *Mixed Insomnia-Irritability Disorder • Gambling Addiction Disorder • *Sexual Addiction Disorder • Olfactory Reference Syndrome • *Immature Personality Disorder • Dependent Personality Disorder • *Chronic Normalcy Syndrome • *Occasional Unhappiness Disorder *Not in DSM-IV or considered for DSM-5

9. Diagnosing Mental Disorders • Over the years, the DSM has created mental disorders describing problems experienced in nearly all domains of psychological functioning • Emotions (anxiety, depression), thought/reason, perceptual experiences, social functioning, relationships, perfectionism, substance use, eating, body image, sex, identity, physical complaints, pain, sleep, attention, activity level, memory, intelligence, conduct, etc.

10. Diagnosing Mental Disorders • In the absence of objective criteria for diagnosing mental disorders, the makers of the DSM are free to create diagnoses describing new kinds of psychological problems • Subject to cultural changes • Subject to personal biases of DSM members • Subject to third-party interests • Insurance companies • Pharmaceutical companies

11. Drug Industry Conflicts of Interest among DSM-5 Task Force Members Pilecki, Clegg, & McKay (2011)

12. Diagnosing Mental Disorders • Hypothetical effects of pharmaceutical company conflicts of interest on task force members: • Creation of new diagnoses • Bereavement = major depressive disorder • Disruptive mood dysregulation disorder • Somatic symptom disorder • Lowering threshold for diagnosing common mental disorders (adult ADHD) • How the DSM-5 handled this issue: disclosure only

13. Diagnosing Mental Disorders • Take home messages: • “Mental disorder” diagnoses should be given judiciously • Potential benefits: helping those in need • Possible problems: increased stigma (self and public), exposure to potentially harmful treatments, violation of civil rights, attention on the individual vs. external causes of problems

14. Evolution of the DSM • History of the DSM • Psychiatry’s Freudian legacy • A field under attack • Rise of the pharmacologists • Function of the modern DSM

15. Evolution of the DSM • 5 editions, I in 1952 through 5 in 2013 • Massive changes in length and content

16. Number of Diagnoses in the DSMs Across Editions (1952-1994)

17. Mental Disorders in the US • About 25% of Americans currently have a DSM-IV defined mental disorder • Lifetime prevalence of any mental disorder is about 50% • Approximately half of those with a mental disorder have 2 or more • These percentages will almost certainly increase with the new DSM-5

18. Mental Health Professions • Psychiatry (MD) • Psychiatric nursing (masters-level) • Clinical psychology (doctoral-level) • Counseling psychology (doctoral-level) • School psychology (masters- or doctoral-level) • Counseling (masters-level) • Social work (masters-level) • Marriage and family therapy (masters-level)

19. Mental Health Professions • Distinguishing between professions: • Amount of education and training • Emphasis on science vs. practice • Theoretical approach to mental disorders • Nature of clinical practice – prescribing, therapy, testing, etc. • Degree of autonomy

20. Getting into Graduate School in Clinical Psychology • Undergraduate course work • GPA, overall, last 2 years, and in major • GRE, both general and psychology tests • Research/scholarly experience • Clinically-relevant experience • Strong letters of recommendation • Personal statement • For Ph.D. programs: Clearly articulated research interests that match well with a faculty member, combined with evidence of experience/expertise, or at least serious interest, in the faculty member’s area of research

21. Useful Resources about Graduate School • American Psychological Association (2005). Graduate study in psychology 2006. Washington, DC: Author.http://www.psichi.org/pubs/articles/article_540.asp- see also the library • Excellent links page about entire process: http://www.uni.edu/walsh/linda2.html • Difference between clinical & counseling psychology:http://www.psichi.org/pubs/articles/article_73.asp • Differences between Psy.D. and Ph.D.: http://www.psichi.org/pubs/articles/article_171.asp • Obtaining a good letter of recommendation: http://www.psichi.org/pubs/articles/article_75.asp • Great list of resources: http://www.psichi.org/pubs/search.aspx?category1=7 • Writing a good personal statement: http://www.psichi.org/pubs/articles/article_98.asp

22. Historical Conceptions of Abnormal Behavior • Mental disorders have existed in all cultures • Treatment based on how they were explained • Three dominant historical traditions: • Supernatural • Biological • Psychological

23. The Supernatural Tradition • Causes of mental illness: • External, supernatural causes (e.g., demons) • Battle of good vs. evil (e.g., sin) • Movement of moon and stars

24. The Supernatural Tradition • Treatment approaches: • Exorcism • Torture • Beatings • Crude surgeries (e.g., trephining) • Hanging patient over snake pit • “Hydrotherapy” • Witch hunts