Clinical Psychology

this dimensional perspective highlights that our ability
to react adaptively is a matter of degree.

Bases of Categorization. To classify psychiatric
patients, one must use a wide assortment of methods
and principles. In some cases, patients are classified
almost solely on the basis of their current behavior or
presenting symptoms. In other cases, the judgment is
made almost entirely on the basis of history. In the
case of major depression, for example, one individual
may be diagnosed on the basis of a diagnostic
interview conducted by a clinician; another may be
classified because of a laboratory result, such as a
“positive”dexamethasone suppression test (DST);
still another may be diagnosed as a result of scores
on a self-report measure of depression. Laboratory
results provide the basis for some diagnoses of cogni-
tive disorders (e.g., vascular dementia), whereas
other cognitive disorder diagnoses (e.g., delirium)
are determined solely by behavioral observation.
Thus, the diagnostic enterprise may be quite compli-
cated for the clinician, requiring both knowledge of

and access to a wide variety of diagnostic techniques.

A major implication is that membership in any one

diagnostic category is likely to be heterogeneous

because there are multiple bases for a diagnosis.

Pragmatics of Classification. Psychiatric classifi-

cation has always been accompanied by a certain

degree of appeal to medical authority. But there is

a concurrent democratic aspect to the system that is

quite puzzling. For example, psychiatry for many

years regarded homosexuality as a disease to be

cured through psychiatric intervention. As a result

of society’s changing attitudes and other valid psy-

chological reasons, homosexuality was dropped from

theDSMsystem and is now regarded as an alternate

lifestyle (see Spitzer, 1981). Only when homosexual

individuals are disturbed by their sexual orientation

or wish to change it do we encounter homosexuality

in theDSM-IV(as an example under the category

“sexual disorder not otherwise specified”). The issue

here is not whether this decision was valid or not.

The issue is how the decision to drop homosexuality

F I G U R E 5-3 Continuum of worry, anxiety, or fear related to the prospect of a job interview.

Thoughts Emotion Behaviors

Normal “I’m going on a job interview
today. I hope they like me. I’m
going to show them what I’ve got!”

Slight physical arousal but good

alertness.

Going to the job interview

and performing well.

Mild “I’m going on a job interview
today. I wonder if they will think
badly of me. I hope my voice
doesn’t shake.”

Mild physical arousal, perhaps

feeling a bit tingly, but with good

alertness.

Going to the job interview

but fidgeting a bit.

Moderate “Wow, I feel so nervous about that
interview today. I bet I don’t get
the job. I wonder if I should just
forget about it?”

Moderate physical arousal,

including shaking and trembling,

with a little more difficulty

concentrating.

Drafting two e-mails to cancel

the interview but not sending

them. Going to the interview

but appearing physically

nervous.

Severe “My God, that interview is today. I
feel sick. I just don’t think I can do
this. They will think I’m an idiot!”

Severe physical arousal, including

shaking, dizziness, and restless-

ness, with trouble concentrating.

Postponing the interview twice

before finally going. Appearing

quite agitated during the

interview and unable to

maintain eye contact.

Anxiety
Disorder

“No way can I do this. I’m a total

loser. I can’t get that job. Why even

bother? I don’t want to look so

foolish!”

Extreme physical arousal with

dizziness, heart palpitations,

shaking, and sweating, with

great trouble concentrating.

Cancelling the interview and

staying home all day.

SOURCE: Kearny, C. & Trull, T. (2012).

148 CHAPTER 5