A New Map of Psychopathology

[Aspychata]

This current model is dimensional. A person can score low, high or somewhere in between.Internalizing includes depression. This would be training in the HiTOP that is currently being developed and would show a more nuanced and holistic picture. I presented because of the interesting schematic.( I adore schematics)

 

[Aspychata]

A lot of people are just general internalizers, so they're going to have an array of issues that could be classified as panic, phobias, depression, generalized anxiety, OCD. When that is the case, it makes sense to move up from those specific things and treatment that targets the general propensity to be internalizing.

Reality distortion and inexpressivness would be associated with Thought Disorder, whereas intimacy avoidance and suspiciousness fall under Detachment.

Some forms of psychopathology have not been integrated, but this is a ongoing revision. Sorry, it seems that the png darkened itself in the upload.

 

[Bolletje]

Schematics are sexy. And this one is also very interesting!

 

[Aspychata]

HiTOP re-envisions on how symptons cluster together and how disorders tend to co-occur. Two field trials are underway to gather data about using this. It relies on questionnaire and interviews. It's primary aim is to describe mental illness not explain what causes it.
Elements of HiTOP are widely used clinically and in research.

Can you envision this being used by a clinician? What do you think?

 

[Bolletje]

In a way, models like these are already used, although for me it’s more of a thought process because I’m quite familiar with the subject matter, so I don’t use schematics a lot.

The way we’re taught to do an interview in psychiatry is to go in with an open mind and not draw conclusions until the end.
You start with an extensive interview asking the patients what problems they are experiencing. It’s important that you ask open questions in this stage of the interview so you don’t guide the patient towards answers you’re looking for.
After this phase of the interview you make a quick list in your head of what type of psychopathology the patient’s story might point towards.

Then you start asking closed questions to differentiate and rank the possible options.

After this you obtain biographical information and ask about one’s general health, comorbidities, medication and drug/alcohol use. If this raises new questions, delve into those.

That’s pretty much the interview, but it’s not where the diagnostic process ends. During the interview you pick up a lot of information about the patient as well. The way they present themselves, the way they talk, the way they make eye contact, the way they behave during the consult. You’ll also pick up on thought disorders, disinhibited or antagonistic behavior or detachment rather quickly just through observing.

All of that information combined, you describe the broad strokes of thought and behavior patterns you’ve observed. Only then do you start talking about possible diagnoses that fit the observed patterns and the interview results best. This is also why diagnoses are often not singular and not absolute. And oftentimes persons show personality traits that are not persistent or serious enough to name it a personality disorder. Describing it as a trait instead of a disorder just indicates it’s there, it affects daily life, but it’s not severe enough to classify as personality disorder.

For instance, a diagnosis I see a lot is “depression with anxiety, expressed as agoraphobia, and some avoidant and obsessive compulsive traits” which is decidedly different from “depression, anxiety disorder, avoidant personality disorder and obsessive compulsive personality disorder” even though it looks quite alike.

Sorry for the novel!

 

[Aspychata]

Very interesting, didn't know it could overlap and intertwine like that. I remember my ex telling about a story how a male client thought his man organ was a fish and was quite convinced of this.

 

[Streetwise]

View attachment 59717

This current model is dimensional. A person can score low, high or somewhere in between.Internalizing includes depression. This would be training in the HiTOP that is currently being developed and would show a more nuanced and holistic picture. I presented because of the interesting schematic.( I adore schematics)

are putting people into little pigeonholes, they forget to mention when they call something a syndrome because they have absolutely no idea what it is and don’t want to admit it

 

[Aspychata]

Good point, l am either in a pigeonhole or called a piehole, what a pathology. Now l realised l have autistic traits that my family will be sure to deny.

 

[GadAbout]

Some forms of psychopathology have not been integrated, but this is a ongoing revision. Sorry, it seems that the png darkened itself in the upload.

Hi, would you revise the thread title? I thought this thread was going to be about psychopathy. There is a huge difference between the two terms. Psychopathology encompasses all mental illness. Psychopathy only refers to conditions where there is a lack of empathy, a lack of conscience, impaired impulse control, and a history of offenses against others; includes sociopaths and psychopaths (such as Ted Bundy).

The only "News" I have seen lately about psychopathy is a distinction between primary and secondary psychopathy, which I found interesting but I'm not really knowledgeable enough to discuss.

 

[Bolletje]

I remember my ex telling about a story how a male client thought his man organ was a fish and was quite convinced of this.

I once had a patient who was utterly convinced he was dead. This meant he refused to take his medication, refused to eat, wash, brush his teeth or engage in any other form of self-care. He still talked and walked around though.

 

[GadAbout]

This is also why diagnoses are often not singular and not absolute.

Agreed. I wish more patients understood this. They often cite two differing diagnoses by different clinicians as evidence that all psychiatrists are quacks! In reality though, responsible clinicians respect that a psychopathology diagnosis is a shifting thing, and try not to undercut confidence in the entire field.

 

[GadAbout]

are putting people into little pigeonholes, they forget to mention when they call something a syndrome because they have absolutely no idea what it is and don’t want to admit it

Aren't you one of those with a very dim view of the psychiatry (and medical) profession? You are entitled to your view, but it would be helpful if you would state it when you issue proclamations like this, so people can "consider the source."

 

[Aspychata]

Hi, would you revise the thread title? I thought this thread was going to be about psychopathy. There is a huge difference between the two terms. Psychopathology encompasses all mental illness. Psychopathy only refers to conditions where there is a lack of empathy, a lack of conscience, impaired impulse control, and a history of offenses against others; includes sociopaths and psychopaths (such as Ted Bundy).

The only "News" I have seen lately about psychopathy is a distinction between primary and secondary psychopathy, which I found interesting but I'm not really knowledgeable enough to discuss.

Thank you so much. This was clearly my oversight, and l am sorry to have let you down.

I defintely am not knowledgeable about a lot of things but l like how this forum community steps in and tries to connect dots and engage us. This is a interesting look at *internalizing * which l had zero understanding of which encompasses sexual problems, eating pathology, fear, distress, mania and is listed under general psychopathology in my png.

 

[Streetwise]

Aren't you one of those with a very dim view of the psychiatry (and medical) profession? You are entitled to your view, but it would be helpful if you would state it when you issue proclamations like this, so people can "consider the source."

As I have said before I do not want your advice I didn't ask for it

 

[Aspychata]

This is a equal opportunity thread and everyone is entitled to their view, and l thank everyone for their participation.

 

[Bolletje]

Agreed. I wish more patients understood this. They often cite two differing diagnoses by different clinicians as evidence that all psychiatrists are quacks! In reality though, responsible clinicians respect that a psychopathology diagnosis is a shifting thing, and try not to undercut confidence in the entire field.

This is very true. And since it’s not an absolute science and diagnoses are based on personal evaluation and interpretation as well as the information a patient chooses to share, you can let five psychiatrists analyze a patient in a short time and come up with five different diagnoses. However, if you let those five psychiatrists discuss those different diagnoses among each other, most will be able to see the others’ point of view.

To name myself as an example: previously I was diagnosed as someone with recurrent depressive episodes, social anxiety and avoidant and obsessive compulsive traits.

Some time later I saw a psychologist who realized that that lengthy diagnosis could very well be explained by me being on the spectrum. After a lengthy discussion with a team of psychiatrists and psychologists they decided that I did fit the criteria for Aspergers, which explained all of the previously described diagnosis.

The fact that I’m labeled with Aspergers now doesn’t make the former diagnosis invalid or untrue, it’s just an all-encompassing diagnosis that fits better. Sometimes we don’t find a good diagnosis to explain it all, which is when people end up with multiple diagnoses or even just descriptions of traits.

I personally don’t see psychiatry as a practice that tries to pigeonhole people. It tries to describe observed and anecdotal thought patterns and behavior, if possible by using an established diagnosis. Then it seeks to treat the cause, or if no cause is found, the symptoms.

My personal view is that psychiatry is more of an art form than an exact science. While it requires a lot of medical and pharmaceutical knowledge, you need good conversational skills and sharp observational skills as well as skill at abstract thinking to do right by your patients.

 

[Bolletje]

Just to add: a lot of time psychiatrists don’t have a diagnosis after the first consult, which is a good reason to follow up. It’s perfectly acceptable to state a few possible diagnoses or one working diagnosis, where time and additional observations will finally tell what ails someone. And sometimes a diagnosis is never found, and someone will just have a descriptive list of symptoms and personality traits. Keeping an open mind and not jumping to conclusions is strongly encouraged. To me, that’s the opposite of pigeonholing.

Also: no, I am not a psychiatrist, although it’s a field I would have loved to work in if it wasn’t so stressful. However, I did a lot of psychiatry internships during med school and in my current job I see a lot of clients with psychopathology and I do a psych evaluation of all clients I see.
I’m not an absolute expert, but I feel I have enough experience in the field to share my informed opinion on it.

 

[Aspychata]

Great point @Bolletje
This is where clinical knowledge, pharma expertise, and bedside manner can make a great psychiatrist. Not all medical providers are able to hit all three from the stories l heard from a medical provider trying to serve our return hero's from the war zone. The other area of expertise is when a client goes ballistic and has to be held down for the safety of those around him or her. Then add up the laborious charts that must be updated by the end of the day. Believe it or not, some docs struggle to stay on top of that alone in a huge clinic.

 

[Bolletje]

Believe it or not, some docs struggle to stay on top of that alone in a huge clinic.

Ha, I believe it. At my last job I used to work 3 extra hours a day for administrative purposes, and on Fridays I’d stay for an extra 6 hours and I still wound up doing paperwork in the weekends because I just couldn’t keep up with the sheer quantity.

 

[Bolletje]

Oh, there’s also the fine line between personality and personality disorder. Everyone has some traits of some disorder, but that doesn’t mean it’s psychopathology.