Abnormal Flashcards
Reliability & Validity of diagnoses
Rosenhan 1973
Lipton & Simon 1985
Rosenhan (1973) Aim
To determine psychiatry hospital’s ability to detect sanity
Rosenhan (1973) Experiment
Naturalistic Observational Study
Rosenhan (1973) Participants
- 8 sane people
- 3 psychologists, 2 doctors
Rosenhan (1937) Method
- each participant called various psychiatric hospitals
- they claimed they were hearing voice with negative commands
- they answered every question honestly except name and address
- once admitted to hospital they stopped their ‘symptoms’ acting normal/sane
Rosenhan (1973) Results
- all admitted to hospital
- 7 diagnosed SZ, 1 bipolar
- never discovered
- all classified as “in remission” not sane
- oral acquisitive syndrome
- average 19 days stay 7-52 range
- over 70% of psychiatrists & nurses ignored the participants when asked for request
Lipton & Simon (1985) Aim
- investigate reliability of diagnoses
Lipton & Simon (1985) Participants & Experiment
- 131 PATIENTS
- 7 external clinicians to reevaluate their diagnoses
- field experiment
Lipton & Simon (1985) Method
- 7 clinicians re-evaluated and diagnosed the patients from a different psychiatric hospital to determine the reliability
Lipton & Simon (1985) Results
- only 18% of patients originally had SZ had been re-diagnosed
- 50 patients diagnosed w/ mood disorder after reevaluation
- only 15 had originally received a mood disorder prior
DSM-I year & characteristics
- 1952
- based on psychoanalytic traditions
- finding causes to abnormal behaviour (reliant on interpretation)
DSM-II year & characteristics
- 1968
- still heavily psychoanalytical
- but moving towards objectivity
- pre Rosenhan (1973)
DSM-III year & characteristics
- 1980
- post Rosenhan
- shift towards objectivity
- describing psychological disorders through observable symptoms
- hardcore medical and biological approach to classifying mental illness through ‘medical checklist’
- 265 disorders
DSM-IV year & characteristics
-1994
- post Lipton&Simon
- reduce overdiagnosis from prior DSM
- included clinical significance criteria
DSM & Homosexuality
- disorder from 1952-1973
- quietly removed
- psychological disorders are cultural deviations
- DSM is ethnocentric social norms
- pathologising deviant behaviour as mental illnesses
DSM Expansion
- ADD in 1980
- ADHD in 1987
- to include women
- expansion NOT born from observed and unaccounted abnormality
- further diagnoses otherwise ‘normal’
people - invalid diagnoses of mental abnormality
ICD , countries , publisher , full name
- international classifications of diseases
- world health organisation
- europe
DSM , countries , publisher , full name
- diagnostic and statistical manual
- American Psychiatric Association
- USA, UK, Australia
CCMD , countries , publisher , full name
- chinese classification of mental disorders
- china
Purpose of classification systems
- reliable & valid method of diagnosing psychological disorders
- range of psychiatrists arrive at the same diagnosis with same symptoms
- minimising cultural, clinical, biases & subjectivity
- psychological experience of patient corresponds to diagnosis received
Challenges for classification systems
- cross-cultural reliability
- validity & reliability
- minimising clinical biases & subjectivity
- lack of biological evidence (still marketed as such for treatments)
- expansion of DSM (more abnormality according to DSM)
- comorbidity (polypharmacy, difficult treatments & reduced efficacy)
- ethnocentrism (conforming to white Christian cultural norms vs deviation)
Swami (2012) Participants & Experiment
- 1218 british adults
Swami (2012) Aim
To investigate the role of gender bias in diagnosis
What is Gender Bias
- males and females are associated more with different disorders due to gendered expectations
- and so more likely to be diagnosed w mental illness which matches gender stereotype
- than other gender w same symptoms
Swami (2012) Method
- participants given a description of a persons symptoms which corresponded to depression of DSM IV
- the only difference was that half got the name of a female & other name of male
- asked to determine whether description had mental health disorder
Swami (2012) Results
- participants were more likely to indicate the male did NOT suffer a disorder
- whereas women were more likely to be indicated as suffering
Clinical Biases Stuides
- gender bias Swami (2012)
- labelling bias Rosenhan (1973)
- confirmation bias Lipton & Simon (1985)
Reliability & Validity Studies
- Rosenhan (1973)
- Lipton & Simon (1985)
Classification of Disorders
- DSM
- Rosenhan (1973) DSM-II
- Lipton & Simin (1985) DSM-III
- Swami (2012) DSM-IV
Abnormality Vs. Normality
Models
- Jahoda (1958)
- Rosenhan & Seligman (1989)
Analysis Difference
- Rosenhan (1973)
- Lipton & Simon (1985)
diagnosis of mental illnesses definition
- When psychiatrists classify abnormalities in the mind via, thinking patterns, behaviours, deviations (statistically & culturally), originating in the mind
(Not very good to be changed)
validity definition
- accurately measuring (objectivity)
- classifying symptoms that lead to an effective treatment as this would mean the diagnosis is true
reliability definition
- multiple people agree & come to same conclusion
- multiple psychiatrists agree to diagnosis in accordance to same symptoms
Rosenhan (1973) Implications
- psychiatrists unable to detect sanity
- behaviour was distorted to fit into label of abnormality
- DSM-II is not effective in identifying sanity
- depersonalisation/dehumanisation of misdiagnosis
Lipton & Simon (1985) Implications
- same symptoms do not correspond with same diagnosis from another psychiatrist
- questioning reliability of DSM & of defining abnormalities
Swami (2012) Implications
- although done on members of the public (not psychiatrists) that cultural norms impact how we interpret the same symptoms to be abnormal vs normal
Rosenhan Follow-Up Study
- psuedo patients would be sent to psychiatric hosptial
- staff were told to detect them
- Rosenhan gave none
- hospital detected 41 pseudo patients
Rosenhan Stanford University Comparison (Aim)
- ignoring of pseudo patients due to general superiority complex, or lack-of-care in hospitals
Rosenhan Standford University Comparison (Method)
- pseudo students approached faculty members at standford who appeared busy
- asking for directions to parts on the campus
Rosenhan Standford University Comparison (Results & implications)
- all questions were answered & never ignored
- psychiatric hospital’s dehumanising culture which devalues patients resulting in lack of care
Abnormality Definitions
Jahoda (1958)
Abnormality is a deviation from ideal mental health
Rosenhan & Seligman (1989)
Failure to function adequatley
Cannot meet demands of ones own life regularly
Jahoda (1958) Aim & Experiment & Method
- determine criteria for ideal mental health
- field survey
- 740 adults responded to survey
- Jahoda synthesised answers to model ideal mental health
Jahoda (1958) Results
CHEAAP
- capacity for growth
- health relationships
- environmental mastery (good daily functioning)
- autonomy/independence
- accurate perception if reality
- positive self perception
abnormality is deviation from this
Jahoda (1958) Limitations
- infeasible to achieve all six parameters
- most people would be classified as abnormal from this
- cannot measure degrees of abnormality as these are HARD TO QUANTIFY
- ‘realistic’, ‘accurate’ etc need further operationalisation
(turning abstract ideas into measurable)
Rosenhan & Seligman (1989) criteria
MISO-UUV
- maladaptiveness (self destructive)
- irrationality (behaviours don’t make sense to others)
- suffering (subjective experience of ones state)
- observer discomfort
- unconventional (standing out, deviations from social norms)
- unpredictability (inconsistent actions)
- violation of morality (against common moral norms)
Rosenhan & Seligman (1989) Limitations
- abnormal behaviour may become adaptive
- a lot of this measure is subjective to observer (discomfort)
- unconventional behaviour (extreme sports)
Abnormality - Statistical Infrequency (general definition)
- a behaviour is classified as abnormal if it is statistically unusual
- 1st threshold usually outside of the 95% most common in the range
- 2nd threshold 99%
- 3rd threshold 99.9% (severely abnormal)
Abnormality - Statistical Infrequency (limitations)
- statistical norms change
- IQ increases 3 per 10 years
- statistically infrequent behaviour could be advantageous
- most people are statistically infrequent in ATleast one area
Abnormality - Deviation from Social Norms (general definition)
- abnormality when falls outside boundaries of social accepted behaviour
Abnormality - Deviation from Social Norms (limitations)
- societies different globally and change over time
- this sets precedent to use abnormality as means of social control
- socially acceptable behaviour may still be maladaptive
- acceptability changes on social setting too
Clinical Biases Definition
- any cognitive bias that affects the validity of a diagnosis
