Chapter Three Flashcards
Classification and Assessment of Abnormal Behavior
Classifying Abnormal Behavior Patterns
Mental Disorder (DSM-5)
Clinically significant behavioral or psychological patterns, not as an acceptable response to a predictable event
1. Present distress
2. Disability in one or more areas of functioning
3. Significantly increased risk of suffering disability, pain or death
4. Important loss of freedom or personal control
“…causes clinically significant distress or impairment in social, occupational, educational, academic behavior, or other important areas of functioning”
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
- The handbook used by healthcare professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders
- Provides the minimum requirements to diagnose (dx) a particular disorder
- Descriptive, NOT explanatory
- 20 categories
- Creates a common language for professionals working with mental health assists in determining treatment path
- Often can predict behavior
- Helps identify populations with similar patterns
Diagnosis Common Format:
Descriptor A
Descriptor B
X number of symptoms, for x duration
Clinically significant
Not attributable to physiological effects of substances or a medical condition
Requirement
Specifiers (severity, duration, status)
Use in Practice
- Labeling of patterns for clinician and patient to provide attuned and up to date care for specific dxs
- Billing for insurance companies
- Involvement with other care professionals (lettre for gender affirmation surgery)
- Validation of patient experience
Critiquing the DSM
- Limitations in requirements (duration, # of symptoms sx)
- Reliance on medical model
- Individual vs the collective
- Categorical vs Dimensional (Yes/No vs. Shades of Gray)
- Stigma and Labeling (a schizophrenic vs a person with schizophrenia)
- Treatment of minority experiences (homosexuality, gender variant humans)
More!
- Expansion of diagnosable disorders
- Changes in classification of mental disorders
- Changes in diagnostic criteria for specific disorders
- Process of development
- Needs to be more sensitive to cultural and ethnic factors in diagnostic assessment and to differences among diverse cultures with respect to the types of behaviors considered normal or abnormal
Culture-bound syndromes
Patterns of abnormal behavior found predominantly in only one or a few cultures
Reliability
The consistency of a measure or diagnostic instrument or system
A reliable measure of abnormal behavior must yield the same results on different occasions
Validity
The degree to which a test or diagnostic system measures the traits or constructs it purports to measure
Diagnosis
Presumes the medical model is an appropriate basis for classifying abnormal behaviors
Categorical model of classification
Means that clinicians make a categorical or yes/no type of judgment about whether a disorder is present in a given case
Controversial aspect of the DSM
Transdiagnostic model
The understanding of abnormal behavior in terms of the common processes or features that extend across different diagnostic categories
Behavioral model
Focuses more on behaviors than on underlying processes
Sanism
The negative stereotyping of people who are identified as mentally ill
Internal consistency
An assessment technique has this if the different parts of the test yield consistent results
Test-retest reliability
An assessment method has this if it yields similar results on separate occasions
Interrater reliability
Raters must show a high level of agreement in their ratings
Content validity
The degree to which its content represents the behaviors associated with the trait in question
Criterion validity
Represents the degree to which the assessment technique correlates with an independent, external criterion (standard) of what the technique is intended to assess
Predictive validity
Predictive validity
Used to predict future performance or behavior
Construct validity
The degree to which a test corresponds to the theoretical model of the underlying construct or trait it purports to measure
Methods of Assessment
Clinical interview; Unstructured interview; Semi Structured interview; Structured interview; Mental status examination; Computerized interviews/assessments
Clinical interview
- Widely used means of assessment
- Clinicians often begin by asking clients to describe the presenting complaint in their own words, saying something like, “can you describe to me the problems you’ve been having lately?”
- Identifying data
- Description of the presenting problem(s)
- Psychosocial history
- Medical/psychiatric history
- Medical problems/medication
Unstructured interview
The clinician adopts his or her own style of questioning rather than following a standard format
Semi Structured interview
The clinician follows a general outline of questions designed to gather essential information but is free to ask the questions in any order to branch off into other directions to follow up on important information
Structured interview
The interview follows a preset series of questions in a particular order
Highest level of reliability
Computerized interviews/assessments
Clients respond to questions about their psychological symptoms and related concerns that are posed to them on a computer screen
Mental status examination
A structured clinical assessment to determine various aspects of a client’s mental functioning
Appearance, mood, levels of attention, perceptual and thinking processes, orientation, judgment - all looked at
Psychological Tests
Intelligence tests
Personality Tests
- Objective vs projective
Intelligence tests
“Capacity to understand the world and resourcefulness to cope with its challenges” - Weschelser (1975)
Wechsler Intelligence Scales
Stanford-Binet Intelligence Scales
Personality Tests
Objective vs projective
Objective tests
Self-report personality inventories that use items similar to these to measure personality traits such as emotional instability, masculinity/femininity, and introversion
“Always, sometimes, never” “Yes/No”
- MMP1 → MMPI2 (revised version) Minnesota Multiphasic Personality Inventory
- Millon Clinical Multiaxial Inventory
Minnesota Multiphasic Personality Inventory
Comprises a number of individual scales made up of items that tend to be answered differently by members of carefully selected diagnostic groups than by members of reference groups
Projective tests
Offers no clear, specified response options
Clients are presented with ambiguous stimuli, such as inkblots, and asked to respond to them
Rorschach Inkblot Test
Thematic Apperception Test (TAT)
Neuropsychological Assessments
Examines potential neurological impairment (think brain structure)
Halstead-Reitan Test Battery
Bender Visual Motor Gestalt Test
Halstead-Reitan Test Battery
comprises a number of subtests, including the following:
- The category test
Measures abstract thinking ability, indicated by an individual’s proficiency in at forming principles or categories that relate different stimuli to one another - The rhythm test
Test of concentration and attention; subject listens to 30 pairs of record rhythmic beats and indicates whether the beats in each pair are the same or different - The tactual performance test
Requires the blindfolded subject to fit wooden blocks of different shapes into corresponding depressions on a foam board; they then draw the board from memory as a measure of visual memory
Bender Visual Motor Gestalt Test
Visual copying
Behavioral Assessment
Observation in the setting
Treats test results as samples of behavior that occur in specific situations rather than as signs of underlying personality traits
- Create functional analysis
- Chain of events (what happened earlier in the day? Is there a trigger? Is there a theme?)
Ability to use self-monitoring
Analogue measures of enactment
behavioral rating scale
Self-monitoring
Clients assume the responsibility for assessing the problem behavior in the settings in which it naturally occurs
Ex: food intake, cigarette smoking, nail biting, etc
Analogue measures
Intended to stimulate the setting in which a behavior naturally takes palace but are carried out in laboratory or controlled settings
Behavioral rating scale
Checklist that provides information about the frequency, intensity, and range of problem behaviors
Cognitive Assessments
Measures cognitions:
Thoughts, beliefs, and behaviors
Automatic thought questionnaires, diaries, etc.
Presence of negative cognitions regarding abnormal behavior
Physiological Assessment
Brain imaging (CT/CAT scans, PET scans, EEG), MRIs
- Physical presence of irregularities that can explain or predict abnormal behavior
- Identifies areas of the brain associated with specific diagnoses
EEG, EMG
Electroencephalograph (EEG)
Measures brain waves by attaching electrodes to the scalp
Electromyograph (EMG)
Monitors muscle tension through sensors attached to targeted muscle groups
what do researchers have to keep in mind when testing personality traits?
Researchers and clinicians must keep sociocultural and ethnic factors of clients in mind when assessing personality traits and psychological disorders
