Abnormal Paper 2 Flashcards
theories of normality
Jahoda (1958)
Rosenhan & Seligman (1989)
normality discussion point (cultural deviations)
DSM
normality study (social expectations)
Swami (2012)
normality study
Rosenhan (1973)
clinical biases
Swami (2012) - gender bias
Rosenhan (1973) - labelling bias
Lipton & Simon (1985) - confirmation bias
Jenkins-Halls & Sacco (1991) - racial bias
classification system(s) theory
DSM
classification system(s) studies
Lobbestael, Leurgans & Arntz (2011) - DSM-IV
Lipton & Simon (1985) - DSM-III
Rosenhan (1973) - DSM-II
validity & reliability studies
Rosenhan (1973) - validity
Lipton & Simon (1985) - reliability
Lobbestael, Leurgans & Arntz (2011) - reliability
Swami (2012) - validity
validity & reliability discussion point
DSM
method
Jenkins-Halls & Sacco (1991)
Lipton & Simon (1985)
Rosenhan (1973)
ethics
Rosenhan (1973)
Lipton & Simon (1985)
Jahoda (1958)
AIM
- determine criteria for ideal mental health
STUDY
- field survey
PARTICIPANTS
- 740 adults responded to survey
METHOD
- Jahoda synthesised answers to model ideal mental health
RESULTS
- CHEAAP
- capacity for growth
- health relationships
- environmental mastery (good daily functioning)
- autonomy/independence
- accurate perception if reality
- positive self perception
IMPLICATIONS
- abnormality is defined as a 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)
Clinical Biases Definition
- any cognitive bias that affects the validity of a diagnosis
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
DSM-I year & characteristics
- 1952
- based on psychoanalytic traditions
- finding causes to abnormal behaviour (reliant on interpretation)
DSM-II 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 & Homosexuality
- disorder from 1952-1973
- quietly removed
- psychological disorders are cultural deviations
- DSM is ethnocentric social norms
- pathologising deviant behaviour as mental illnesses
DSM-IV year & characteristics
-1994
- post Lipton&Simon
- reduce overdiagnosis from prior DSM
- included clinical significance criteria
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
DSM , countries , publisher , full name
- diagnostic and statistical manual
- American Psychiatric Association
- USA, UK, Australia
ICD , countries , publisher , full name
- international classifications of diseases
- world health organisation
- europe
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
validity definition
- accurately measuring (objectivity)
- classifying symptoms that lead to an effective treatment as this would mean the diagnosis is true
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)
AIM
- To investigate the role of gender bias in diagnosis
STUDY
- ??
PARTICIPANTS
- 1218 british adults
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
RESULTS
- participants were more likely to indicate the male did NOT suffer a disorder
- whereas women were more likely to be indicated as suffering
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
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
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)
reliability definition
- multiple people agree & come to same conclusion
- multiple psychiatrists agree to diagnosis in accordance to same symptoms
Rosenhan (1973)
AIM
- To determine psychiatry hospital’s ability to detect sanity
STUDY
- Naturalistic Observational Study
PARTICIPANTS
- 8 sane people
- 3 psychologists, 2 doctors
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
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
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)
AIM
- investigate reliability of diagnoses
STUDY
- field experiment
PARTICIPANTS
- 131 PATIENTS
- 7 external clinicians to reevaluate their diagnoses
METHOD
- 7 clinicians re-evaluated and diagnosed the patients from a different psychiatric hospital to determine the reliability
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
IMPLICATIONS
- same symptoms do not correspond with same diagnosis from another psychiatrist
- questioning reliability of DSM & of defining abnormalities
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
METHOD
- pseudo students approached faculty members at standford who appeared busy
- asking for directions to parts on the campus
RESULTS
- all questions were answered & never ignored
IMPLICATIONS
- psychiatric hospital’s dehumanising culture which devalues patients resulting in lack of care
Lobbestael, Leurgans & Arntz (2011)
AIM
- To investigate the reliability of diagnosis using the DSM IV
STUDY
- Single double blind procedure
PARTICIPANTS
- 151 participants which underwent clinical interviews for mental health diagnoses
METHOD
- Clinical interviews between a psychiatrist and participant were audio-taped, and the participant was given a diagnosis based off this interview.
- A second psychiatrist which did not know the diagnosis of the first psychiatrist listened to the audio of the clinical interview to then form their own diagnosis
RESULTS
- Personality disorders were more likely, than other mental illnesses, to be diagnosed reliability across the first and second psychiatrist
- 71% reliability in diagnosis of MDD
- 84% reliability in diagnosis of personality disorders
IMPLICATIONS
- High rate of consistent diagnosis indicates the DSM IV is reliable across clinicians as there is more agreement on diagnosis.
- however reliable diagnoses does not necessarily mean the diagnoses are valid
Jenkins-Halls & Sacco (1991)
AIM
- To investigate the influence of racial bias in the diagnosis of MDD
STUDY
- True experiment
- Independent measures design (only exposed to 1 variation of IV)
- data triangulation (multiple rating systems , increasing validity)
PARTICIPANTS
- 62 White psychotherapists from USA
- Mean age of 36
- Even male / female split
METHOD
- Participants watched a 3-minute pseudo-consultation between a client and a therapist (the participant thought the consultation was real)
- 4 various of the pseudo-consultation: white acting depressed, black acting depressed, white acting non-depressed, black acting non-depressed—(scripted answers based on symptoms from standardised depression inventory and DSM)
- After watching the video, the participants answered a questionnaire to rate the depressive symptoms, social skills, and psychological state of the pseudo-client
RESULTS
- The participants correctly diagnosed/rated the depressed condition corresponding to their symptoms, and in non-depressive condition to a similar degree regardless of race
- However, the participants gave significantly lower ratings for social skills, and likeability to black depressed pseudo-clients than white depressed pseudo-clients
IMPLICATIONS
- Therapists susceptible to racial bias in diagnosis as the depressed Black clients were viewed more negatively which would result in adverse and unfairly harmful treatment
- Good contrast to Swami (2012) because yes therapists may be able to avoid societal stereotypes in diagnosis, however, may still impact the treatment of minority groups by health professionals, as these societal stereotypes lead to different treatment of clients
