The world of the Counselor An introduction to the counseling profession 5e chapter 10

Abnormal Development, Diagnosis, &
Psychopharmacology

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

1






Read vignettes, middle of p. 323
Reasons to study abnormal developmental, diagnosis,
& medication—see 11 reasons p. 324
You can’t have one without the other (abnormal
behavior, diagnosis, and medication)
 If you believe in extreme deviations from the norm
(mental disorders and abnormal behavior), then you
are going to want to understand it—classify it
 If you classify it (diagnose disorders), then you (or the
clients) are going to want to be treated
 One form of treatment is medication

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

2




Genetic and Biological Explanations
 Genetics subset of biology
 If disorders are biologically based, it would make sense to
treat them biologically
 Treating biologically can be broad-based, such as:
▪ Medication
▪ Stress reduction
▪ Exercises
▪ Amount of light we receive
▪ Proper amount of sleep
▪ Etc.

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

3


 Born all Id
 Develop ego and superego as we pass through the psychosexual

stages
 Experiences through the stages effects personality development
 Extremely poor parenting leads to development of maladaptive
behaviors as our defense mechanism attempt to control the
impulses of our id
 Discuss how various parenting styles may affect development
▪ Parents who are obsessively strict
▪ Parents who extensively praise

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

4






Learning occurs through operant conditional, classical
conditioning, or modeling
Principles of operant conditioning explains many of the ways that
individuals develop (see p. 330)
Major factors that lead to healthy or dysfunctional personality:
 Born capable of multiple personality characteristics
 Behaviors and cognitions continually reinforced
 Reinforcements can be very complex and subtle
 Abnormal behavior result of reinforcement
 Analysis of reinforcements leads to understanding of person
 New behaviors learned by applying principles of learning

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

5






Maslow and Rogers most influential

Maslow: We exhibit characteristics based on our placement in
need hierarchy (See Figure 10.1, Page 332)
Rogers: How significant others treat us results in our
personality development (and placement on Hierarchy)
 We all need to be loved
 Conditions or worth placed on us
 To gain love, we respond to others based on conditions of
worth—leads to false self
 With empathy, genuineness, and unconditional positive
regard we can rediscover our “true” selves

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

6








Post-modernism
 Questioning of modernism
 “Truth” is a construction
Social Constructionism
 Language creates reality through discourse
 Thus, our realities are created through our discourses with
others and how “reality” is passed down through society
Conclusion

 Abnormal behavior is simply a social construction
▪ Perhaps, the mental health field plays a part in
continuing this deception

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

7




See Comparison of Models Table 10.1 Page 336
 Today, many clinicians integrate the models

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

8









Greek words: Dia (apart) and gnosis (to perceive or know)
DSM-I: 1952
DSM-IV-TR: Five Axes
 Axis I: All Disorders Except Personality Disorders or Mental

Retardation
 Axis II: Mental Retardation and Personality Disorders
 Axis III: General Medical Conditions
 Axis IV: Psychosocial/environmental Problems
 Axis V: Global Assessment of Functioning
DSM-5 to come out in 2013
Advantages and Disadvantages of DSM

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

9




Offers information on:
 Disorder’s main features
 Subtypes and variation in client presentations
 Typical pattern, course, or progression of symptoms
 How to differentiate disorders
 See Table 10.2, Page 340
 Axis I includes all disorders except personality disorders or
mental retardation (in DSM-5, to be called Intellectual
Disability).
 Axis II is personality disorders and mental retardation

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

10










*Disorders usually diagnosed
in infancy, childhood, or
adolescence
Delirium, Dementia, Amnestic,
and Other Cognitive Disorders
Mental Disorders Due to A
General Medical Condition
Substance-Related Disorders
Schizophrenia and Other
Psychotic Disorders
Mood Disorders
Anxiety Disorders

© 2007 Thomson Brooks/Cole, a division of Thomson Learning











*Factitous Disorders
Dissociatve Disorders
Sexual and Gender Identity
Disorders
Eating Disorders
Sleep Disorders
Impulse Control Disorders
Not Elsewhere Classified
Adjustment Disorders
*See pp. 339-341 for
descriptions
11




Listed on Axis II because treatment has little or no effect.
 Mental retardation: Intellectual functioning significantly below
average
 Personality Disorders: Deeply ingrained, inflexible, enduring
patterns of behavior
▪ Cluster A: odd or eccentric.
▪ Disorders: paranoid, schizoid, and schizotypal
▪ Cluster B: dramatic, emotional, overly sensitive, and erratic
▪ Disorders: antisocial, borderline, histrionic, and narcissistic
▪ Cluster C: anxious and fearful

▪ Disorders: avoidant, dependent, and obsessive-compulsive

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

12




Axis III: General Medical Conditions
 Use ICD-9-CM for diagnosis
 List on Axes I or II also if cause of disorder



Axis IV: Psychosocial and Environmental
Problems
 List on Axes I or II also if cause of disorder



Axis V: Global Assessment of Functioning Scale
 See Table 10.3, p. 343

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

13




Example of Multiaxial Diagnosis
 Axis I 309.0
 Axis II 301.82
 Axis III
 Axis IV
 Axis V

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

Adjustment Disorder with Depressed Mood
Avoidant Personality Disorder
No Diagnosis
Divorce
GAF=60 (current); 75 (highest in past year)

14




Antipsychotics (neuroleptics)
 1950s: First wave of antipsychotics
 Today: Many different kinds
 Today, three types: conventional, atypical, 2nd generation
 See Table 10.5, p. 345
 Side effects are many: anticholinergic, extrapyramidal, tardive
dyskinesia, mood disorders, other



Mood-Stabilizing Drugs (e.g., for bipolar disorder)
 1950s: Lithium
 Today: Lithium, anticonvulsant drugs, benzodiazepines, other

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

15




Antidepressants
 1930s: amphetamiens
 1950s: MAOIs and Tricyclics
 More recently: SSRIs and atypical anti-depressants



Anti-anxiety Medications
 1960s: Librium, Valium
 Later, more benzodiaspenes (Tranzene, Zanax, more
 Nonbenzodiaspeines: Buspar , Gepirone, Other
 For generalized anxiety disorder, obsessive-compulsive
disorder, other

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

16






Stimulants
 Later 1800s: Cocaine and amphetamines for diet aid,
emotional disorders
 Today: Mostly used for ADHD
 Also used for narcolepsy
 Most common: Ritalin, Cylert, and Dexedrine
Warning: All have side affects
Many different drugs today exist

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

17




Misdiagnosis of Minority Clients
 Symptomatology may vary as a function of culture
 Does DSM-IV-TR truly take into account affects of
oppressive society?
 Some say: DSM-IV-TR legitimizes the concept of
“disorder” thus making it acceptable to oppress those with
the disorder

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

18




DSM-IV-TRs attempt to address cross-cultural issues
 Much greater attention to issues of age, gender,
socioeconomic status, and culture
 Also has 25 “Culture-bound Syndromes”
▪ E.g.: “Koro”
“A term, probably of Malaysian origin, that refers to an
episode of sudden and intense anxiety that the penis (or
in females, the vulva and nipples) will recede into the
body and possibly cause death. . . .” (APA, 2000, p. 900)

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

19




Ethics Code:
 ACA’s 2005 code addresses a number of important issues
relative to diagnosis
▪ Proper diagnosis: B e careful to ensure proper diagnosis
▪ Cultural Sensitivity: Be sensitive to how cultural background
can affect the manner in which the client expresses self

▪ Historical and Social Prejudice: Counselors should
understand and recognize that some groups have been
misdiagnosed and pathologized
▪ Refraining from Making a Diagnosis: Refrain from
diagnosing if you think if making a diagnosis will harm client

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

20


DSM-5 (probably, 2013)
 May collapse Axis I and Axis II
 Other?
 Challenging Abnormality and Diagnosis
 Some say mental illness is a normal response to a stressful
situation (e.g., Laing and Szasz)
 Glasser believes psychopathology is a client’s clumsy attempt at
meeting his or her needs


© 2007 Thomson Brooks/Cole, a division of Thomson Learning

21




Challenging Abnormality and Diagnosing (Cont’d)
 Ivey and Ivey suggest diagnosis may be a normal response to

developmental issues (see Box 10.3, p. 351)
 Corey: feasons why clinicians should be careful when diagnosing
(see bottom of p. 350)


Overdiagnosis of Mental Illness
 Because we have DSM, do we naturally overly diagnose?
 See Box 10.4, p. 352: On Being Sane in Insane Places

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

22




Confinement Against One's Will
 Donaldson v. O’Connor (1975): People can’t be held
against their will unless there is danger to self or others
 Today, usually need a hearing to have people confined
against their will



Insurance Fraud
 Some diagnoses may not be paid by insurance companies
 Some clinicians give alternative diagnoses in order to get
paid
 Giving an alternative diagnosis is illegal

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

23




Dismissing Impaired Graduate Students
 Should we dismiss students at all?
 Should we view students from DSM?
 Should we take a developmental perspective and assist
students to strive toward wellness?
 ACA code suggests:
▪ Assist students in securing remedial assistance
▪ Seek professional consultation and document decision
to dismiss or refer students
▪ Ensure students have recourse in a timely manner to
address issues of referral or dismissal

© 2007 Thomson Brooks/Cole, a division of Thomson Learning

24