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Homework answers / question archive / UNIT II STUDY GUIDE Diagnoses and the Role of Culture in Psychopathology Course Learning Outcomes for Unit II Upon completion of this unit, students should be able to: 1

UNIT II STUDY GUIDE Diagnoses and the Role of Culture in Psychopathology Course Learning Outcomes for Unit II Upon completion of this unit, students should be able to: 1


UNIT II STUDY GUIDE Diagnoses and the Role of Culture in Psychopathology Course Learning Outcomes for Unit II Upon completion of this unit, students should be able to: 1. Distinguish the diagnostic nature in abnormal psychology from other areas of psychological study. 1.1 Explain how to use Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in relation to abnormal psychological diagnostics. 2. Explain the importance of recognizing cultural bias in psychopathology treatment. 2.1 Indicate specific considerations that account for cultural competency within the realm of psychological assessment. Course/Unit Learning Outcomes 1.1 2.1 Learning Activity Unit Lesson Chapter 3, pp. 56–88 Unit II Essay Unit Lesson Chapter 3, pp. 56–88 Unit II Essay Reading Assignment Chapter 3: Diagnosis and Assessment, pp. 56–88 Unit Lesson Introduction This unit focuses specifically on the diagnostic process for determining mental illness. This area sets abnormal psychology apart from other areas within the field because others are not tasked (or licensed) to diagnose psychopathologies. For example, a school psychologist may not be licensed through the laws of his or her state to determine a specific diagnosis or an industrial/organizational psychologist may be primarily concerned with workplace recruitment and organizational motivation and not diagnoses. It is the professionals working in and around the field of mental health that deal specifically with psychopathologies and the diagnoses of a particular mental illness. Some things you will want to keep in mind while reading the lesson are the professional and academic use of the vocabulary terms presented in the readings. When you hear things like, “She’s so schizo” or “My brother is totally manic” used in everyday language, you should be aware that these terms have very deep meanings in the study of abnormal psychology, and the meanings are not as simple as they are conveyed in those comments. As a student in this course, you should question what those comments really mean. By doing so, you are opening the door to understanding the true meaning of these words in the scientific community. How do mental health professionals know how to accurately assess and treat conditions like schizophrenia, depression, and learning disorders? If medication is recommended, how do we know the correct classifications of drugs to treat the particular set of symptoms? In working to answer these questions, it is useful to follow a guide compiled by experts in the field. PSY 2010, Abnormal Psychology 1 DSM-5 UNIT x STUDY GUIDE Title The Diagnostic and Statistical Manual of Mental Disorders (DSM) is in its fifth and current edition, which is also known as DSM-5. DSM-5 could be likened to a sort of bible for the clinical psychology profession. While there have been previous versions and there are even a few alternative approaches out there, DSM-5 is the standard tool used to describe and diagnose more than three hundred identified psychological maladies. This newest iteration of the manual, published in 2013, contains a nuanced, categorical system and several individual psychological diagnoses. As you may imagine, much of the science and vocabulary relating to mental illness has grown over time. The first edition of the DSM came out in 1952 and was significantly shorter than the one used today. This stands to reason that as a field in a constant state of growth, we must acknowledge that there is always room for improvement. There are valid considerations and criticisms that must be acknowledged. While streamlining some areas, DSM-5 currently contains 347 individual diagnoses. Some diagnoses are thought to be too particular and could be streamlined further, while there is professional feedback that perhaps Figure 1. Image of DSM-5 (Walter, 2010) DSM-5 over-pathologizes (e.g., to diagnose too much). As previously discussed, we cannot see psychopathology disorders through an x-ray because they are not tangible or obvious through visual testing. This means that diagnosing and treating these types of disorders is tricky. Pause for a moment to consider a condition with which you may be familiar, post-traumatic stress disorder (PTSD). If we cannot see it in a person like a broken finger, then it makes sense that professionals in the field need a uniform guide for deciding what PTSD is and how we arrive at a clinical diagnosis for someone suffering from the condition. DSM-5 provides a wealth of information on epidemiology, or the estimated prevalence and distribution of a condition (Kring & Johnson, 2018). One example of this is that the average risk for developing PTSD in the United States before age 75 is 8.7% (American Psychiatric Association, 2013). Does that figure surprise you? Can you think of certain populations that might be more apt to develop this particular disorder as opposed to others? While etiology, or the cause of a condition, can be hard to pin down, many of us might suppose at this point that those who have served in the military are at a higher risk to develop PTSD (Kring & Johnson, 2018). DSM-5 discusses other considerations, such as potential environmental and genetic factors contributing to PTSD. Now, take all of those considerations and detailed, systematic, diagnostic criteria to consider and rule out every other diagnosis in the book, then multiply the process by a few hundred conditions, and you will start to see how much information is contained within the pages of DSM-5! A concerted effort was made in the design of DSM-5 for disorders to be grouped together by their causes (Kring & Johnson, 2018). Continuing our example about PTSD, does it make sense to group something called acute stress disorder, a related but shorter-lived version of PTSD, in the same chapter as PTSD? Chapters in DSM-5 are called diagnostic categories. The chapter for acute stress disorder and PTSD is formally called Trauma- and Stressor-Related Disorders. Most clinicians freely admit that exact causation is difficult to pinpoint in the majority of mental illnesses, but this order of grouping aims to make some sense of the many and varied psychological disorders described. Quite often this also results in an overlap of symptomology, where symptoms experienced by sufferers that are very similar to other symptoms are found within the same category. An example of this is having two diagnoses, like major depressive disorder and depressive disorder due to another medical condition, included in the Depressive Disorders diagnostic category (American Psychiatric Association, 2013). Tools for Diagnoses Modes of assessment abound, and depending on the background and experience of a practitioner, a client may undergo any number of assessment measures outside of utilizing DSM-5. Interviews: Clinical interviews are frequently the first step in beginning to understand what a client is experiencing (Kring & Johnson, 2018). In clinical interviews, how something is expressed can be just as important as the words said. Structured interviews are frequently employed to cover a variety of topics that PSY 2010, Abnormal Psychology 2 may be related to the problem(s) the client is presenting. There, perhaps the therapist prefers GUIDE to let his or her UNIT x STUDY new client drive the conversation and see where it leads. Title Checklists and assessments: Checklists and assessments for a particular area of difficulty are often employed early in the diagnostic process (Kring & Johnson, 2018). The Beck Anxiety Inventory assesses levels of anxiety with a relatively quick self-check questionnaire. Perhaps a therapist wants to begin with a good understanding of the client’s personality and how they function in the world. They might be given a projective test designed to see where their mind goes and what kind of story they have to tell. If a more structured, empirical assessment is preferred, they may be given something called the Minnesota Multiphasic Personality Inventory, which assesses for multiple psychological conditions with a very comprehensive set of questions (approximately 500). Answers to these questions can be compared to scales designed to recognize patterns of depression, paranoia, or a host of other symptomologies (Kring & Johnson, 2018). When it comes to education, you may have completed one or more intelligence tests administered by a school counselor. Especially when dealing with younger children, direct observation might be chosen as a method of assessing their social development or other areas of interest. Neurobiological tests: Where available, neurobiological tests may be used to assess for certain conditions. Computerized axial tomography (CAT) scans are used to construct a cross section of the brain to assess for tumors, blood clots, and other abnormalities (Kring & Johnson, 2018). You most likely have heard of an MRI, magnetic resonance imaging, a more precise method of viewing the Figure 2. MRI of brain brain’s interior. A positron emission tomography or PET scan can assess for (Igokapil, 2015) Alzheimer’s disease by measuring the activity of neurotransmitters. There are also several neuropsychological tests that do not require multi-million dollar testing equipment that may be used. Have you ever been asked to draw a clock or to remember three simple words over a period of a few minutes? Looking back, can you see how these seemingly benign activities gave an indication of your level of spatial orientation and working memory? Cultural Considerations Cultural considerations play a very important role in the development and implementation of diagnostic criteria in the mental health field (Kring & Johnson, 2018). What countries experience a greater prevalence of anxiety disorders? Would you be surprised to know that the United States leads in this diagnosis (Kring & Johnson, 2018)? The United States also leads in overall diagnoses of mental illness, but, obviously, many factors could impact this finding. Specific cultures can play a part in the prevalence of many disorders. In fact, some disorders can appear exclusively within one culture. DSM-5’s appendix describes ghost sickness in some Native American tribes, which manifests as a severe preoccupation with death and the deceased (Kring & Johnson, 2018). Another example is taijin kyofusho in Japan, which describes a fear of offending others through inappropriate eye contact or other social inaptness (Kring & Johnson, 2018). These rare mental disorders are psychiatric diagnoses with their own descriptions, criteria, etiology, and epidemiology. Another vital aspect of cultural competency to recognize, particularly in standardized methods of testing, is errors. To truly measure the intelligence or social functioning of a person, a multicultural understanding is always necessary. Perhaps, you have heard of criticisms that many psychological tests are geared toward the White, middle or upper-middle classes. That is something that good science must always examine. If a student is given a test that is not written in their primary language, it stands to reason their familiarity with instructions and vocabulary may be different and the result of the test may be negatively affected. Researchers and assessment specialists continually work to address and accommodate for these issues, but it would be remiss not to point out that ethnic bias can exist (Kring & Johnson, 2018). Sometimes, even a stereotype, such as women not performing in a sport as well as men, can alter results! Now, consider a new client who mentions upon their intake that they communicate with spirits inhabiting their home. To many clinicians, this person may be experiencing psychotic symptoms; perhaps they need inpatient therapy, a brain scan, or even antipsychotic medication. On the other hand, if this client’s culture has a PSY 2010, Abnormal Psychology 3 history of engaging with spiritual entities, that fact must play into the therapist’s assessment. UNIT x STUDYPerhaps, GUIDE the reported spiritual phenomenon has no bearing on the client’s visit, and they were Titleonly seeking help dealing with a difficult coworker. Summary If all of this sounds like a lot, it is. Professionals working in the mental health field often take years of advanced training and oftentimes hold master’s and doctoral degrees. A psychiatrist (a physician with psychiatric training) is not likely to approach a situation the same way as a psychoanalyst (someone who studied Freud and Jung for years after completing their doctoral degrees). At this point, you are not expected to be an expert in any of these tools or methodologies; perhaps, like many psychotherapists, your job is simply to listen and learn. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. Igokapil. (2015). Mri brain stroke. Movements, consciousness (ID 52527973) [Photograph]. Dreamstime. Kring, A. M., & Johnson, S. L. (2018). Abnormal psychology: The science and treatment of psychological disorders (14th ed.). Wiley. Walter, R. (2010). dsm-5-cover-050213-marg1 [Photograph]. Flickr. Suggested Reading To reinforce the concepts from this unit, click here to review the Chapter 3 Presentation. Click here for the same presentation in PDF form. Chapter 4, in the textbook, discusses research methods involved with psychopathy. While this chapter is not a required reading item, it will give you additional insight into how psychological research is conducted. Chapter 4: Research Methods in Psychopathology Learning Activities (Nongraded) Nongraded Learning Activities are provided to aid students in their course of study. You do not have to submit them. If you have questions, contact your instructor for further guidance and information. Please review and complete this interactive presentation on key terminology from Chapter 3 by clicking here.

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