Chapter 14:
Psychological
Diagnosis and
Disorders
Rob Cramer, M.A.
Department of Psychology &
Psychology TraineeThe Counseling Center
Psychological Diagnosis and The
Medical Model
–Medical Model categorizes behavior
as abnormal
–What is abnormal? (3 criteria)
• Deviant
• Maladaptive
• Causing personal distress
–Behavioral continuum from
abnormal-normal
• Diagnostic Schemes: The Diagnostic and
Statistical Manual
– Current version is DSM-IV-TR
– 1980: DSM-III added multi-axial assessment
scheme
Axis I: Clinical Syndromes
Axis II: Personality Disorders and Mental
Retardation
Axis III: General Medical Conditions
Axis IV: Psychosocial and Environmental
Problems
Axis V: Global Assessment of Functioning
• What do you think about diagnosis?
– Do disorders exist?
– Stigma?
“She’s depressed”
“He’s on medication”
“He was hospitalized for schizophrenia”
What comes to your mind?
• Anxiety Disorders
– Generalized anxiety disorder
– Phobic disorder
– Social Phobia
– Panic disorder and agoraphobia
– Obsessive compulsive disorder
– Post-Traumatic Stress Disorder
Causes of Anxiety Disorders
• Biological factors
– Genetic predisposition, anxiety sensitivity
– GABA circuits in the brain
• Conditioning and learning
– Acquired through classical conditioning or
observational learning
– Maintained through operant conditioning
• Cognitive factors
– Judgments of perceived threat
• Personality
– Neuroticism
• Stress
– A precipitator
• Example of Maintenance of Anxiety: Phobia
Activity Time!!!
• The good doctor is still
locked away!! Help his
patients out by
identifying the type of
anxiety they have.
Case 1
• Johnny is a 20-year-old college student who has had
recent problems with grades and friends. He has
reported feeling nervous and fearful about taking
exams, making his friends happy, and many other
areas of his life. Johnny sought therapy for his
problem. During early therapy sessions, Dr. Relax
learned that Johnny’s symptoms began several
months ago after a musical performance in which he
froze and was laughed off stage. Since that time,
Johnny avoids playing his guitar or going on stage.
He also told Dr. Relax that his grades began to drop
and friendships suffered because of trouble
concentrating, trouble sleeping, and feeling tired.
What type(s) of anxiety disorders does Johnny have?
Case 2
• Lisa was involved in a plane crash more than
six months ago. Shortly after the crash, she
began having nightmares and flashbacks about
the event. Since that time, Lisa has also
become easily startled by any loud sound and
she often wakes during the night. Lisa
presented for therapy with Dr. Relax because
her job requires her to fly to a conference in
Florida next week, but she is experiencing
tremendous anxiety and trying to avoid having
to fly. What type(s) of anxiety disorders does
Lisa have?
• Depression and Suicide
• What do you know?
• What do you want to know?
Depression Facts
1. 3rd most common disorder
2. 1 in 5 people will suffer an MDD episode across
the lifetime
3. Almost twice as common in women
4. Costs businesses an estimated $33 billion in
salary productivity per year
5. Most common in young adults and older adults
6. Expressed differently by culture and age
• E.g., Chinese – somatic complaints
• E.g, Children – anger/irritability
Major Depressive Disorder
Two weeks of 5 or more of the following:
1. Depressed mood and/or
2. Loss of interest
3. Weight loss or gain
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation (e.g.,
restless)
6. Loss of energy
7. Worthlessness/guilt
8. Concentration/indecision
9. Recurrent thoughts of death
Dysthymia
Two or more of the following are present or at
least 2 years:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy
4. Low Self-esteem
5. Poor concentration/indecision
6. Feelings of hopelessness
- MDD episode cannot be present in these 2
years
Differences between MDD and
Dysthymia
1. Intensity
2. Time requirements
3. Symptom presentation
•
•
•
Thoughts of death
Weight issues
psychomotor effects
4. Presentation for treatment
•
MDD more likely
Factors Associated with Depression
1. Cognitive Styles
•
•
•
Locus of Control
Learned Helplessness
Hopelessness Theory
2. Stress
•
•
Chronic stress
Major life events – can precipitate both types
3. Personality
•
Five-Factor- associations
4. Biological underpinnings
•
Neurotransmitter dysfunction
Treatments:
1. Cognitive/Cognitive-behavioral Therapy
•
•
Belief testing
Thought Record
2. Dynamic Therapy
•
•
Bibliotherapy
Assertiveness training
3. Psychopharmacological Therapies
•
SSRIs
Warning signs
•
•
•
•
1. Changes in activity level
2. Physical changes (e.g., weight)
3. Emotional pain
4. Mood change (e.g., irritable, down, selfcritical)
• 5. Changes in thought patterns
(concentration, decision making)
• 6. Thoughts/mention of death
Scenario:
Fred is your roommate. Lately, he has been
sleeping a lot more, feeling down, and
pulling away from others. He makes
statements like “it would be better if I
wasn’t here” and “I don’t care about
anything anymore.”
1. What is wrong with Fred?
2. How would you handle this situation?
3. What if he has a plan?
Suicide Facts
1. 8th leading cause of death overall, 3rd for
adolescents and young adults
2. Most prevalent in adolescents and older
adults
3. Twice as common in college students than
non-college counterparts
4. Accounts for 30,000 deaths annually
5. Women more likely to attempt, men more
likely to complete
6. Suicidal thoughts and attempts difficult to
count
Associated Risk Factors/Causes
•
•
•
•
•
•
•
•
1. Mood disorder
2. Gender
3. Negative Life Event
4. Neuroticism
5. Low self-esteem
6. Low social support
7. Personality Disorder
**Most likely completed when mood is
improving
Warning Signs
1. Talking about dying
2. Recent loss
3. Depressive symptoms
4. Talking about loss of control/harming self
or others
5. Withdrawal from relationships
6. Hopelessness
7. Previous attempt**
8. “Finalizing behavior” (e.g., Giving things
away, tying up relationships, making out
wills)
Suicide Assessment
• Question: Imminent risk of death vs. non-fatal
attempts?
• 1. Allow person to discuss their problem for 5-10
minutes
• 2. Assess negative psychological effects of
problem (e.g., hopeless, depressed)
• 3. Assess thoughts of suicide uninterrupted 
thoughts at the moment, plan, means
• 4. Assess thoughts of death- active or passive?
• 5. Ask about carrying out plan/taking other with
them
What should you do to help?
•
•
•
•
1. Educate yourself on warning signs
2. Be direct
3. NEVER leave the person alone
4. Assess immediacy of threat – plan and means?
Remove if needed
• 5. GET HELP!!!
– University Counseling Center
• 348-3863
– University Psychological Clinic
• 348-5000
– 1-800-SUICIDE
– 1-800-273-TALK
– DIAL 911
A helping hand for Fred…
Recall that Fred has
exhibited depressive
symptoms and talked
about death. How
might you go about
helping him?
I need a volunteer for a
role play!!! 