Diagnosis & Classification

Zoltan Kovary PhD

ELTE PPK
Department of Clinical Psychology and Addictology
2015/16 Autumn Semester

Sketch for todays lecture

Normality & pathology

The theoretical
questions of taxonomy
Nosologic systems

Histrorical background
Contemporary systems

Diagnostic work & tools

in clinical psychology

The questions of normality

& pathology

Normality and pathology.

has different interpretations

Medical
Juristic
Statistical
Moral

.are relative

In time
In space

The criteria for

psychological normality

Abillity to adapt
Ability to enjoy
Interpersonal
competence
Intellect
Emotional and
motivational control
and stress tolerance

Social attitudes:
empathy, intimity
Productivity
Autonomy and self
confidence
Positive self image
Integrity

Criteria for abnormal mental

functioning & behavior: the 4 Ds

Mental functioning and

behavior are abnormal
if its

Deviant
Causing Distress
Disfunctional
Dangerous

What is dysfunctional in the cases of

disorders?
Etiological models of mental disorders

Organic/biological/medical
model

Dynamic model

Behavior

Cognitive model

Personality/character

Behaviorist model

Brain functioning

Information processing

Phenomenological model

Symbolization of experiences

What kind of illneses are mental

disorders?
Small disease
categories

Classic /big disease

categories

Specific etiology
Well outlined
symptomatology
Typical clinical course
Outlined prognosis
Reportable changes
Somatic illnesses

Diverse etiology
Similar symptomatology
Similar clinical course
More or less predictable
prognosis
Detectable changes are
not always
Mental illneses/disorders

Taxonomy:
the questions of
classification

Classification of mental
disorders

Paradigms

Clinical testability

Explicit criteria for disorders

Concentration of informations

Great professor
Expert consesnus

Education, research, statistics

Principles

Classifiable
Mutually exclusive categories
Separated Families and
subsystems of Diseases
Openness, felixibility

Historical development of
diagnostic categories

Hippocrat
Mania, hysteria
Neurosis
William Cullen (18.th cent.)
Freud (20th century)
Actual neuroses
Psychoneuroses
Psychosis
Emil Kraepelin (19th cent.)
Dementia praecox, PMD
Eugene Bleuler (20th cent.)
Schizophrenia
Personality disorder
Kurt Schneider
Characteropathia
Franz Alexander
Characterneuroses

Freuds contribution

Actual neuroses
Neurasthenia
Anxiety neuroses
Hipochondria
Psychoneuroses
Hysteria
Obsessional neuroses
Anxiety hysteria (phobia)
Narcissistic neuroses (paraphrenia)
Paranoia
Dementia praecox (sch.)
Traumatic neuroses
Characterneuroses (F. Alexander)
Pathoneuroses (Ferenczi)

Contemporary nosologic
systems

ICD 10
International Classification of
Diseases

ICD 8: 1968
A brief description of mental
disturbances
ICD 10: 1992
Number of categories increased
Tighter criteria
Coding system based on
numbers
More precise differentiation of
subgroups
Classzic categories
Neurosis
Neurasthenia
No itemized diagnostic
criteria!!!
ICD 11 is coming in 2018

Categories of mental and

behavior disorders in ICD 10

DSM - IV

DSM I: 1952
DSM III: 1980

Descriptive clinical categories

Itemized, explicit, operational
criteria
Neurosis rejected

DSM IV: 1994

Multiaxial diagnostics:
I. Clinical disorder
II. Personality disorders/mental
retardation
III. Somatic state
IV. Psychosocial and environmental
problems
V. Global Assessment of Functioning
(GAF %)

DSM V: 2013 update

Categories of DSM IV

New diagnostic categories

in DSM V

Complex posttraumatic stress

disorder
Depressive personality
disorder
Negativistic (passiveagressive) personality
disorder
Olfactory Reference Syndrome
Relational Disorder
Skin Picking Disorder
Binge Eating Disorder

Groups of disorders in DSM V

Contradictions in psychiatric
diagnosing and their handling

Multiple diagnoses?

Multiaxial diagnosis

DSM IV

Comorbidity theory
Spectrum & continuum
approaches

The mood spectrum & disorders

The continuum hypothesis of eating

disorders according to Vandereycken

Hiperoxi
a

Anorexia

Dietingstarving
Anorexia
Nervosa

Extreme leanness

Self-induced
vomiting
Using prgative

Bulimia
nervosa

lean-fat
persons

Stable
extreme
obesity

Bulimarexia

Normal weight

Extreme
obesity

Psychodynamic approach to clinical diagnosis.

Kernbergs personality organization model

Temperament

Personality organization

Introversion vs extraversion
Psychotic: psychotic disorders
Borderline: severe personality disorders,
perversions, addictions
(Intermediate): mild personality disorders
Neurotic: symptomatic neuroses

Criteria of personality organization

Matureness of object relations

Stability of self/identity
Personality structure & functions

Superego-functions
Ego-functions
Id: sympotoms

Levels of personality
organizations and personality
disorders

The diagnostic work in

clinical psychology

Diagnosis and diagnostics

Diagnosis

Diagnostics

The identification of the nature

and cause of a certain
phenomenon
Scientific discipline

The process of diagnosing

Diagnosis and
differentialdiagnosis
Prognosis
Indication and contraindication

The differences between psychaitric and

psychological/psychotherapeutic diagnosis
Psychiatric diagnosis
Diagnostic classification

Psychological/psychotherapeutic diagnosis

1st level

Psychiatric diagnosis

Treatment plan

2nd level

Prognosis - Indication

3rd level

Process of treatment

Personality structure & dynamics

Indication

Rating suitability for

psychotherapy

Motivational, relationship,
suitabilty, matching, environmental
etc. diagnoses

The process of diagnosing in

clinical/psychoterapeutic work

Usually the first phase of the therapeutic

process (1-5 occ.)
The unity of diagnosis, prognosis and
indication
The role of the psychologist/therapist
The role of the relationship
The role of time
The question of depth
The therapeutic effects of the diagnostic
phase

Psychoeducation
Building relationship
Specific/nonspecific effects

The tools of clinical

psychodiagnostics

What can we use?

Depends on the

Tools of diagnostics

Institutional background
Diagnostic targets
Clinical question(s) !!!
Interview/exploration
Behavioral diagnostics
Psychological tests

Plan of diagnostic process

Interview/exploration
Test battery

Performance tests
THEN personality tests

Exploration/interview

Basic tool of assessment

Contains the story of
the disease (cross section)
The whole life (longitudinal
section)
Basic forms
Unstructured
Semi-structured
Structured
Versions

First interview (psychotherapy)

Survey interview

Psychodynamic
Cognitive etc.

Behavioral diagnostics

Objectively observeable behavior

Observations
Identifing well-defined units
problem behaviors

What does he/she do?

What doesnt he/she do?

Doesnt identify personality traits

or inner structure & dynamics
Importance of relationship with
the environment
Time dynamics of formation
R = f (S, O, C, C)

Tesztvizsglatok
Performance tests

Focusing on particular
functions

Memory

Attention

Intelligence tests

IQ

Raven Progressive Matrix

Intelligence structure
Wechsler test

Personality tests

Objective tests

Scales, simple inventories

Complex tests

BDI
MMPI

Projective tests

Associative (Rorschach)
Choice (Szondi)
Completion (PFT)
Constructive (TAT)
Expressive (Drawing tests)