Un enfant angoissé face à ses parents qui se disputent

Assessing mental health

Question Modern mental health classifications
AnswerDuring World War II, American psychiatrists in an army recruitment centre on the West Coast declared 10 times more enlisted men unfit for service due to mental disorders than in an East Coast centre. Research was undertaken to minimize practitioner interpretation in order to correct this anomaly. During the 1950s, a relationship between the number of symptoms and the severity of mental disorders was established.  Finally, in 1979, a new version of the American classification of mental disorders was published: the DSM-III (Diagnostic and Statistical Manual for Mental Disorders, 3nd version).

Since the advent of the DSM-III, mental disorders are defined by a specific number of symptoms and diagnostic criteria, making mental health measurable and mental health assessment reliable. The WHO followed suit with the ICD-10 (International Classification of Diseases, 10th version).  Later versions sought to improve over the DSM-III. The current version is the DSM-V.

Question Limitations
AnswerModern classifications lack theoretical underpinnings. Because of the complexity of the brain and the range of individual situations, no theoretical construct is involved.   Theories, however, have an explanatory function.  Most of the important medical therapeutic advances came on the heels of an understanding of the disease causal mechanisms. But the causes of mental disorders remain little understood.  As a result, improvements brought about by the DSM-III in the assessment area were not accompanied by comparable therapeutic advances.

The efficacy of treatments is advancing only slowly.  Therefore, the measure-based, reliable approach to mental health is criticized and questioned by supporters of approaches focused on individual experience.  They champion psychotherapies and psychosocial methods and are generally opposed to medication, although studies show that both treatments are often complementary.

Question Diagnostics
AnswerToday, a diagnosis of mental disorder is based on a minimum number of diagnostic criteria.
Question Diagnostic criteria
AnswerClassifications establish a list of symptoms for each diagnosis. All children have symptoms. They all are disturbed, agitated or overexcited at times. But for a symptom to be a diagnostic criterion, it must be frequent, lasting and have an impact on daily life (distress, functional impairment). For a diagnosis (e.g. depression) to be made, a minimum number of diagnostic criteria must be met.  Once defined by a number of criteria mental health is measurable.  That is the method currently used (WHO, etc.) to evaluate mental health.
Question Dominic ‘Tendencies’
AnswerDominic does not make diagnoses, but establishes ‘Tendencies’ based on a minimum number of more or less appropriate reactions.  An inappropriate reaction is considered to be a symptom.  Children and most adolescents cannot reliably estimate the frequency and duration of their symptoms, nor the distress or impairment they cause.  Dominic ‘Tendencies’ provide quantitative information, and flag problems early, because they are based on symptoms that do not necessarily have the frequency, duration or severity of diagnostic criteria.
Question Categorical and dimensional classifications
AnswerMedical classifications are said to be categorical because they define two categories of people: normal and pathological.  Psychological classifications are called dimensional because they categorize people on dimensions ranging from 0% to 100%.

Tendencies evaluated by Dominic

Question Attention deficit/hyperactivity
AnswerChildren with a tendency toward attention deficit/hyperactivity have a hard time sustaining attention, make careless mistakes, seem not to listen when spoken to, do not follow instructions, are disorganized and easily distracted. They fidget and squirm in their seat, run and climb everywhere and have a hard time staying quiet. They have difficulty waiting for their turn, interrupt others and butt into conversations and games.
Question Borderline personality
AnswerBorderline personality is characterized by marked recklessness and instability in interpersonal relations, self-image and emotions.  Excessive, shifting emotions generate aggressive or self-destructive behavior. Relationships are unstable and intense. Threats to commit suicide and suicide attempts reflect both distress and manipulation. Risky behaviors are aimed at feeling alive and fighting an impression of emptiness. Borderline teenagers often are alcohol and drugs users. Stress can bring in depersonalization and short-term hallucinations.
Question Conduct Disorder
AnswerConduct disorder is a set of repeated, persistent behaviors that involve violating the basic rights of others or age-appropriate social norms and rules.

These kids show little empathy. They interpret others’ intentions as hostile and threatening, and respond with aggression they feel reasonable and justified. They don’t feel guilt or remorse.  They show poor tolerance towards frustration, irritability, temper outbursts, and recklessness.

Boys are prone to fighting, stealing, vandalism and behavior problems at school; girls are more likely to lie, skip school, run away, use alcohol and drugs, and prostitute themselves.

Question Depression
AnswerDepressive disorders are characterized by a depressive or irritable mood, a loss of interest or pleasure, and a number of other symptoms like sadness, thoughts of death, trouble sleeping, etc. Children and adolescents describe themselves negatively and think no one loves them. Parents notice irritability, mood swings, endless complaints about minor things, and a lack of interest in favored activities. Depressed children and adolescents cry easily.
Question Generalized Anxiety
AnswerGeneralized anxiety is a tendency toward anxiety in general. It involves disproportionate worries about events or activities like school performance.  Worries may concern almost anything and are difficult to control.
Question Opposition and Defiance
AnswerOpposition involves a set of negative, hostile or provocative behaviors. It manifests itself through stubbornness, resistance to following instructions and a refusal to compromise, yield or deal with adults. Provocation involves deliberately and permanently testing limits, ignoring or challenging orders and refusing criticism. Hostility is expressed through verbal aggressiveness and the desire to annoy others. The child or teen is in constant conflict with parents, teachers and classmates and justifies this behavior as a response to unreasonable demands or unfair circumstances.
Question Separation Anxiety
AnswerSeparation anxiety is excessive anxiety over separation from home or from people the child is attached to, generally her/his parents. Reactions to separation are excessive and inappropriate, beyond what is expected based on the child’s developmental level.  Separation anxiety is normal in young children, but it tapers off before they go to school.
Question Social phobia
AnswerThe fear or intense anxiety that characterizes social phobia is based on the fear of being negatively judged (crazy, stupid, boring, unlikeable, etc.). The adolescent fears blushing, sweating, hands trembling, stuttering, offending others, etc.
Question Specific phobia
AnswerPhobias are persistent, intense, unreasonable or excessive fears, triggered by a specific object or situation (e.g., flying, heights, animals, injection, seeing blood).

Because it is normal for children to have fears, for a phobia to exist, the child or adolescent has to feel a pronounced, persistent and unreasonable fear in the presence of, or when anticipating a confrontation with a specific object or situation.

Question Strengths and Competencies
AnswerThe strengths and competencies of a child are a set of personal abilities and skills that are important to keep balanced behaviors in various social situations and environments (home, peer, school). This includes a positive impression of one’s personal skills and an ability to establish and sustain good relations. These skills protect children/adolescents against mental health problems and create ‘resilience ‘.
Question Substance Abuse
AnswerPsychoactive substances use often starts during adolescence. Cannabis, alcohol and tobacco are generally the first substances they try. Potentially addictive substances stimulate the pleasure inducing brain reward system.
Question Suicidality
AnswerSuicidality refers to the whole range of behaviors and thoughts related to suicide, i.e. a continuum from suicidal ideation (thoughts about the desire to die) to threats of committing suicide, suicide attempt and completed suicide. The intentionality of the desire to die takes the form of a plan.