Dsm-v???

[INFERNO]

For those who have some experience with abnormal psychology, or just general knowledge, you should know what the DSM system and what the ICD system by the WHO are.

In 2000, the DSM-IV-TR (TR = text revision) was released by the APA (american psychology association) and is the most recent one to date. In 2011-2012 or so (although the date has steadily been pushed over and over), the APA said the DSM-V would be released.

If you've ever taken a look at the actual DSM-IV-TR (or DSM-IV), not some paraphrased stuff online, you can easily spot several flaws, and these flaws have been documented over and over again.

In my abnormal psychology course (2nd year university), we're given a very very small version of the DSM-IV-TR, although it does skip out things such as differential diagnosis, etc... . I've looked through the real thing in the university library and with my abnormal psychology professor.

One of the flaws, and one of the proposed changes, is that the current DSM system is categorical, meaning, either you have a disorder or you don't, so you either have bipolar or you don't. One of the proposals is to change it to a dimensional system, meaning the symptoms and syndromes are ranked on a ranking scale or hierarchy.

If you've taken a psychology course, or perhaps had a good instructor for a science or philosophy course, you should have been introduced to the concepts of reliability and validity in science. If not, then here is a quick lesson on them (they are fundamental to know for all science). Reliability is whether or not you'll get the same result of a test over again. One of the types is inter-rater reliability, so you get two or more raters to give the same person a test and you see if the results are the same. Validity is whether you measure what you think you are measuring. This may sound a little bit silly but it's crucial to know that you test isn't tapping into some other concept, and runs the risk of introducing a third variable effect, confoundation or moderator variables (you should easily know these in any high school science course). Validity is harder to measure because it's more of a conceptual measurement, whereas reliability can be measured statistically through finding the kappa value.

Anyways, to see if you understand these concepts (I'll use them throughout here, so it's good to know what is being said by myself and other users), which is worse, and why?

1) Low reliability but high validity
2) Low validity but high reliability

(This is just something to think about in your spare time or reply to this and see if you're right or not)

Anyways, there are two main proposals for the DSM-V:

1) Hybrid system, where Axis I (all disorders except personality disorders and retardation) is dimensional, whereas Axis II (personality disorders and retardation) is categorical.
2) One system for researchers, another for clinical use, in order to have one geared to being more practical.

So, which one do you think would be better?

Also, one other issue with the DSM system, is classifying something as a psychological disorder, such as premenstrual syndromes, making it seen as a psychological disorder. Thoughts on this?

One other possibility, although I'm not sure if it is likely to come through or not, probably not, is adding in a sixth axis for coping skills (Freud's defense mechanisms). I know it may seem a little odd, however, consider something like psychotic denial (different from normal denial). Clearly, it can cause a disruption, a rather severe one. So, thoughts on having defense mechanisms as a sixth diagnostic axis?

[Curthose93]

In my abnormal psychology course (2nd year university...

So... how old are you?

[theOperaGhost]

I have a basic knowledge of what you are talking about, but I don't have enough to really add to this debate. I only have an introductory level knowledge in psychology, however I believe I'm going to declare it as my minor next fall. I won't be able to get into an abnormal psychology class until the spring semester of 2010, sadly. I'm looking forward to it, as I want to study forensic psychology.

[Bobby]

So... how old are you?

That's not your business to ask. If he has it displayed, then you can know.

[INFERNO]

So... how old are you?

19 years old, soon to be in 3rd year university.

[Curthose93]

That's not your business to ask. If he has it displayed, then you can know.

If he decides not to answer, fine. If he does, fine. What's the rule against asking questions?

[theOperaGhost]

If he decides not to answer, fine. If he does, fine. What's the rule against asking questions?

You weren't contributing anything to the debate and asked something completely unrelated to the thread topic. If you wanted to know his age, you could have PMed him, or at least added something that was relevant to the debate topic. (sorry, I know I don't mod anymore, but it's just a simple explanation...I'm not doing anything wrong).

Now to add to the debate (and like I said, I am not excessively knowledgeable in this area, just have a LOT of interest)...From what I understand, you are saying they are proposing to make psychological disorders have different stages? As in severity? Instead of simply determining some has a psychological disorder, they want to break down the psychological disorders into..let's say sub-stages of severity? I think this is what you are saying...I don't know for sure. :P

If this is what you are saying, I feel defining certain stages of the severity of a psychological disorder could be a good thing. It could also prove useless. I don't want to get into that now, so I shall wait for your response (to even see if I'm on the same page as you) before posting more.

[INFERNO]

You weren't contributing anything to the debate and asked something completely unrelated to the thread topic. If you wanted to know his age, you could have PMed him, or at least added something that was relevant to the debate topic. (sorry, I know I don't mod anymore, but it's just a simple explanation...I'm not doing anything wrong).

Now to add to the debate (and like I said, I am not excessively knowledgeable in this area, just have a LOT of interest)...From what I understand, you are saying they are proposing to make psychological disorders have different stages? As in severity? Instead of simply determining some has a psychological disorder, they want to break down the psychological disorders into..let's say sub-stages of severity? I think this is what you are saying...I don't know for sure. :P

If this is what you are saying, I feel defining certain stages of the severity of a psychological disorder could be a good thing. It could also prove useless. I don't want to get into that now, so I shall wait for your response (to even see if I'm on the same page as you) before posting more.

Even though Curthouse did babble off-topic, I answered anyways, perhaps contributing to being off-topic also, however, his question was answered and there's no sense in going at it even more. No sense in beating the dead horse anymore.

Yes, one proposal is to break it into severity, and I presume stages could be an appropriate word for that also. There's a reason for doing this, and I want to say the reason not to belittle you but just so it's clear as to why so we can understand each other on the debate. Take for example, an example they use, anxiety disorders and personality disorders. Ignore how related or unrelated they may be, their relationship to one another is not important. What is important, is trying to diagnose someone then getting them the proper treatment. With these two disorders, referring back to my first post regarding validity and reliability, the kappa for these two (and some other families of disorders) is rather low. Many families of disorders range from 0.48 to 0.72 on average, with the low 0.48 being the anxiety and personality disorders. One idea to hopefully increase this kappa, is to set substages or ranks of severity. In doing so we can better identify people and create better tests. For example, take two people, both of whom have schizoid personality disorder. We know nothing else of them, not even their gender. We know that because they are diagnosed with a personality disorder, it's likely they're at least 18 years old, probably older though. We also know that they meet the criteria, however, the criteria states: (from the DSM-IV-TR small book from the abnormal psych. course):

"A pervasive pattern of detatchment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following"

We need not concern ourselves with the actual criteria, however, there are 7 of the criteria. The person needs minimum of 4/7. We don't know which 4 they have, and we don't know if they have 5,6 or all 7. Currently, stating "severe schizoid personality disorder" is a rather meaningless statement without having something to base the term "severe" off of. We'd have to write a nice detailed explanation of just what the clinician considers severe to be, however, it can still be debatable by someone else if they consider it severe or not.

So, if we have a ranking scale or stages, we first identify the stages (in doing so, you automatically diagnose the person with that disorder). Referring back to the example, what if person A met just 4 of the criteria but they weren't very disruptive to their life, it wasn't a really big issue. Person B has all 7 criteria met, it's ruining their life and they need help immediately.

But, if you only are told they have that diagnosis, then you cannot differentiate without more or prior knowledge, which one needs more intense therapy and is suffering more. Consequently, even if you do tell them to go to a certain therapy, due to their disorder, you have to ask, will they even go? Perhaps you need a certain therapy tailored for them, perhaps you need to go to their place of residence and have very long-term therapy just to break the ice.

Hopefully you haven't fallen asleep :yawn: :yawn: or hopefully you aren't :confused: :confused: . But, hopefully you do see the importance and some reasons for the need for a dimensional system, or a system involving ranking the severity. Although, I'll admit, this too has its own potential problems, hopefully though, they are not as bad as what they are currently.

[theOperaGhost]

I do agree with that. I just wrote a term paper (completely unrelated topic) that had to do with revising mandatory minimum sentencing laws to be more effective. They are currently kind of a cut and dry thing; you've done this set of crimes, so you're sentenced to life (while a murderer can be released in a few years).

I can see comparisons to this. A ranked system of severity in psychological disorders would be more effective than simply "you have it or you don't."

(Hopefully my comparison made sense...I didn't really want to get way off topic, so I didn't go too far into it.)

[Shattered Soul]

heya, i'm studying Psychology at A-level in college and am continuing at uni. I always thought different western countries had different critera for diagnosing psychological disorders, but apparently. I can see several flaws with the DSM-IV, aswell, one of which is that different psychologists may diagnose patients differently, so if one person saw one psychologist, it is likely that another would disagree and give a different diagnosis. Another issue is that it is very culture specific, it doesn't allow for cultural differences.
(sorry if any of that was phrased wrong)

[INFERNO]

heya, i'm studying Psychology at A-level in college and am continuing at uni. I always thought different western countries had different critera for diagnosing psychological disorders, but apparently. I can see several flaws with the DSM-IV, aswell, one of which is that different psychologists may diagnose patients differently, so if one person saw one psychologist, it is likely that another would disagree and give a different diagnosis. Another issue is that it is very culture specific, it doesn't allow for cultural differences.
(sorry if any of that was phrased wrong)

Ah yes, what you mentioned is known as inter-rater reliability. It is a very big issue in psychology in general, especially with the DSM-IV and DSM-IV-TR. There are other forms of reliability as well, such as test-retest reliability. I don't know if you intended to mention this, but validity in the DSM is a huge issue, which gets increasingly difficult with a patient with multiple diagnosed disorders or fits the criteria and symptoms for a variety of disorders.

Generally, all of North America adheres to the DSM-IV(-TR) and generally, European areas adhere to the WHO's ICD-10.

The cross-culture issue is something that the DSM-IV-TR has attempted to address and reduce, although there still is quite a bit of trouble in that area. Unfortunately, no matter how much the DSM system tries to cope with that, it's up to the psychologist or psychiatrist to ensure that they properly deal with the cross-cultural discrepencies.

I don't know as much about the ICD-10 because in Canada, the DSM system is used so that is what we study the most. However, I do know that the ICD-10 and DSM-IV(-TR) do class for certain disorders. Such as, dissocial and antisocial personality disorders, they have the same general criteria, however, some things, such as superficial charm are not as much in the ICD-10 whereas they're more focused on in the DSM-IV(-TR).