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Classification and Assessment in Clinical Psychology

The document discusses various approaches to classifying and diagnosing psychopathology. It covers the historical development of classification systems including Emil Kraepelin's early work and the Diagnostic and Statistical Manual. The DSM aims to provide diagnostic criteria that can be applied systematically but it is criticized for defining disorders as discrete categories. Alternative approaches discussed include the Research Domain Criteria project, hierarchical taxonomies, network analyses, and the Power Threat Meaning framework.

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Victoria Gray
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143 views7 pages

Classification and Assessment in Clinical Psychology

The document discusses various approaches to classifying and diagnosing psychopathology. It covers the historical development of classification systems including Emil Kraepelin's early work and the Diagnostic and Statistical Manual. The DSM aims to provide diagnostic criteria that can be applied systematically but it is criticized for defining disorders as discrete categories. Alternative approaches discussed include the Research Domain Criteria project, hierarchical taxonomies, network analyses, and the Power Threat Meaning framework.

Uploaded by

Victoria Gray
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Psychopathology

Chapter 2: Classification and Assessment in Clinical Psychology

2.1 CLASSIFYING PSYCHOPATHOLOGY


2.1.1 The Development of Classification Systems
 German psychiatrist Emil Kraepelin (1883–1923)
 psychopathology, like physical illness, could be classified into different
and separate pathologies, each of which had a different cause and could
be described by a distinct set of symptoms that he called a syndrome
Diagnostic and Statistical Manual (DSM) First published in 1952 by the
American Psychiatric Association (APA), the DSM extended the World
Health Organisation’s (WHO) International List of Causes of Death (ICD)
classification system to include a more widely accepted section on mental
disorders.
2.1.2 Diagnostic and Statistical Manual (DSM)
Defining and diagnosing psychopathology
 puts the emphasis on distress and disability as important defining
characteristics
 Distress relates to the chronic experience of pain or distressing
emotions
 disability refers to the fact that distress can lead to impairment in one
or more important areas of functioning, such as education, employment,
and dealing with family and social responsibilities

 DSM has four basic objectives


1. it must provide necessary and sufficient criteria for correct
differential diagnosis
2.  it should provide a means of distinguishing ‘true’ psychopathology
from non‐disordered human conditions that are often labelled as
everyday ‘problems in living’
3. it should provide diagnostic criteria in a way that allows them to be
applied systematically by different clinicians in different settings
4. the diagnostic criteria it provides should be theoretically neutral, in
the sense that they do not favour one theoretical approach to
psychopathology over another

 DSM classification systems also provide the following information


1. essential features of the disorder
2. associated features
3. diagnostic criteria
4. information on differential diagnosis

 diagnostic categories in DSM are descriptive constructs based on groups


of symptoms that define a diagnostic category, and they are not
definitions of diseases nor do they have any explanatory significance

General problems with classification


 does not classify psychopathology according to its causes but does so
merely on the basis of symptoms. diagnosis on the basis of symptoms
gives the illusion of explanation, when it is nothing more than a re‐
description of the symptoms
 stigmatising and harmful
 tends to define disorders as discrete entities (either yes/no). may
be dimensional rather than discrete
 DSM conceptualises psychopathology as a collection of hundreds of
distinct categories of disorders, but what happens in practice provides
quite a different picture
comorbidity The co-occurrence of two or more distinct psychological
disorders.
hybrid disorders Disorders that contain elements of a number of different
disorders.
disorder spectrum The frequency of comorbidity suggests that most
disorders as defined by DSM may indeed not be independent discrete
disorders, but may represent symptoms of a disorder spectrum that
represents a higher-order categorical class of symptoms.
Mixed anxiety-depressive disorder An example of a hybrid disorder
whereby people exhibit symptoms of both anxiety and depression, yet do not
meet the threshold for either an anxiety or a depression diagnosis.
 can be conceived as a ‘hodgepodge’ collection of disorders that have
been developed and refined in a piecemeal way across a number of
revisions. makes it almost impossible to frame a definition of what a
mental health problem actually is

2.1.3 DSM‐5
 many of the diagnostic changes in DSM‐5 have reduced the number of
criteria necessary to establish a diagnosis
 DSM‐5 has introduced disorder categories that are designed to identify
populations that are at risk for future mental health problems
mild neurocognitive disorder DSM-5 has introduced disorder categories
that are designed to identify populations that are at risk for future mental
health problems, and these include mild neurocognitive disorder, which
diagnoses cognitive decline in the elderly.
attenuated psychosis syndrome DSM-5 has introduced disorder categories
that are designed to identify populations that are at risk for future mental
health problems. Attenuated psychosis syndrome is seen as a potential
precursor to psychotic episodes.
 there are concerns that changes in diagnostic criteria will result in
lowered rates of diagnosis for some particularly vulnerable populations
 DSM‐5 has continued the process of attempting to align its diagnostic
criteria with developments and knowledge from neuroscience. but
neuroscience may never be able to provide a comprehensive basis for
diagnosis because its approach is too reductionist and by its very nature
it will be unable to capture the social and cultural factors that
indisputably contribute to the symptoms of mental health problems
 most mental health problems (and psychological distress generally) are
now viewed as dimensional, so any criteria defining a diagnostic cut‐off
point will be entirely arbitrary
2.1.4 Developing Alternatives to DSM
 Both DSM and ICD take a very medically oriented approach to
diagnosing psychopathology by splitting mental health problems into
numerous discrete diagnostic categories each defined on the basis of
different clusters of symptoms.
Research domains criteria (RDoC)
 classifying psychopathologies in terms of their causes would be to start
from scratch by researching causes and then relating them to
observable symptoms
 represents an attempt to understand the causes of psychopathology in
terms of the neurological, biological, psychological, social, and cultural
structures and processes that underlie mental health problems
 conceives of psychopathologies as “disorders of brain circuits” that can
be experimentally explored using the tools of neuroscience
 two‐dimensional matrix that offers a basis for guiding research

 potential limitations to the RDoC initiative

1. based on the assumption that psychopathologies are ‘disorders of


brain circuits’
2. focuses almost entirely on intra‐individual variables to the detriment
of extra‐individual variables such as the social, developmental, or
cultural context of mental health problems
3. long‐term project requiring detailed and intensive research at many
different levels of analysis, and so a classification system based on
RDoC is still a long way off
Hierarchical Taxonomy of Psychopathology (HiTOP)
 helps to predict comorbidity and also higher‐order dimensions that
reflect associations between lower‐order dimensions
 evidence‐based consensual model of symptom taxonomy
 The model deals with comorbidity by identifying higher‐order
dimensions that predict associations between disorders and symptoms
on lower levels and can encompass both narrowly defined symptoms
(e.g., obsessions) and broader clusters of psychological conditions (such
as internalising)
 still relies on DSM/ICD diagnostic categories at the level of syndromes
and disorders.
Network analyses
 assumes that disorders emerge from the causal interactions between
symptoms themselves, and understanding the causal relationships
between symptoms will enable us to define individual clusters of
symptoms that define individual disorders. In this way, depression is
not a causal entity but merely a name for the network of symptoms that
interact to cause the syndrome we call ‘depression’.

 provides an objective measure of how symptoms are interrelated and


can identify symptoms that are centrally important in defining a
disorder and affecting other symptoms
 does not provide information on causal relationships between
symptoms that may occur over different time scales
FOCUS POINT 2.2 A NETWORK ANALYSIS OF DEPRESSION
SYMPTOMS

 Network analyses can be created by collecting data about symptoms in


a variety of ways and subjecting these data to statistical analyses that
provide information about the connectedness between symptoms
 Nodes represent symptoms, and edges represent associations between
symptoms
 The centrality of a node can then be calculated by such details as the
number of edges connected to it and the strength with which it will
activate associated nodes.

The Power Threat Meaning (PTM) framework


 takes a broad view of the causes of psychopathology and views people
as social beings whose experiences of distress and troubling behaviour
are inseparable from their material, social, environmental, socio‐
economic, and cultural contexts.

2.1.5 Conclusions

case formulation The use of clinical information to draw up a psychological


explanation of the client’s problems and to develop a plan for therapy.

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