Diagnosis Flashcards
What is abnormal psychology
The studies of psychological disorders
Diagnosis and Abnormal Psychology
- Difficult to define abnormal behaviour -> therefore it is difficult to diagnose (based on the symptoms people exhibit or report)
- Making a correct diagnosis is extremely important because this determines the treatment people receive.
How are diagnoses carried out
- using a standardised system (diagnostic manual)
- clinicians rely on self reported data, physiological testing, clinical observation etc
- standardised clinical interview
Affective symptoms (emotional elements)
Behavioural symptoms
Cognitive symptoms (ways of thinking)
Somatic symptoms (physical symptoms)
limitations to relying on a clinical interview for diagnosis
- sick role bias
- reactivity (increase in anxiety -> changed behaviour)
- Clinician’s style, degree of experience
limitations on diagnoses
- Has no clear definition of normality or abnormality
- symptoms vary between individuals and social and cultural groups
- diagnoses an be biased or wrong - definitions of abnormality/normality can change over time
- HOWEVER can use data triangulation to increase validity of data (obtains data from two or more sources)
what is a classification system
they identify patterns of behavioural or mental symptoms that consistently occur together to form a disorder EX: DSM-5 (standardised system for diagnosis) [mainly in USA]
Focuses on symptoms rather than etiology or cause
Evaluation of DSM
- widely used (gives professionals common diagnostic criteria to communicate with and about patients)
- non-diverse samples (minorities’ experience with mental health in not well represented - very Western view of mental health [individualistic society - self sufficiency, self actualisation, independence])
issue with classification systems
- difference between classification systems
- updated and change over time
- level of reliability
What is validity of a diagnosis
Whether a diagnosis is correct and leads to successful treatment
What is reliability of a diagnosis
Whether two or more psychiatrists using the same classification system make the same diagnosis.
Many symptoms are difficult to measure (feelings of helplessness, or hearing voices).
Psychiatrists are heavily dependent on self-reported data and this is known to result in some bias.
Individuals may suffer from two or more psychological disorders simultaneously. This is known as comorbidity
Lobbestael, Leurgans & Arntz (2011)
Aim : To investigate the reliability of diagnosis using the DSM IV
Sample: 151 (Patients and non-patients)
Method: Single blind procedure
Procedure:
1. Original clinical interview (~2 hr) were audiotaped
2. Interviews were assessed by a second psychiatrist who didn’t know initial diagnosis
Results:
- Generally higher reliability for personality disorders compared to other disorders
- high rate of consistency
- doesn’t mean results are valid
Conclusion: High consistency in diagnosis, suggesting DSM IV aids agreement among clinicians.
Evaluation of Lobbestael, Leurgans & Arntz (2011)
Strengths:
- Single blind
- using audiotapes : non-verbal behaviour/appearance of patient did not affect diagnosis process
Limitations:
- using audiotapes : difficult to know which non-verbal behaviour may have played a role in the first diagnosis
- the second diagnosis may be too controlled and could have missed important non-verbal data which may have changed the diagnosis.
Rosenhan (1973)
Aim: to test the validity of psychiatric diagnoses as well as determine the negative consequences of institutionalization
Sample: 8 healthy participants
Method: Field experiment
Procedure
1. Participants tried to gain admission to 12 different psychiatric hospitals
2. Complained they were hearing unfamiliar voices (same sex), said words like “thud” and “empty”
3. Once they were admitted they stopped reporting symptoms and began acting “normally”
Results
- 7 pseudo-patients were diagnosed with schizophrenia
- took an average of 19 days before they were discharged (“schizophrenia in remission” )
- experienced very little contact with doctors and “a lack of normal interaction” with the staff (no eye-contact and personal connection)
- staff interpreted patients’ normal behaviour (note-taking) as abnormal
Conclusion
- cannot distinguish the sane from the insane in psychiatric hospitals.
- The hospital itself imposes a special environment in which the meaning of behavior can easily be misunderstood.
- The consequences to patients hospitalized in such an environment – the powerlessness, depersonalization, segregation, mortification, and self-labeling (counter-therapeutic)
Rosenhan (1973) Evaluation
Strengths
- highly influential in promoting change in hospital practice and protecting rights of patient (better admissions procedures and follow-up care in mental hospitals)
- field study : high ecological validity
Limitations
- unethical (no consent given by staff, deception, no debrief, can’t withdraw from study)
- can’t verify validity of claims made by the “patients”
- only studies a single diagnosis
Di Nardo et al (1993)
Aim: To investigate the reliability of the DSM-III for anxiety disorders
Procedure
Two clinicians separately diagnosed each of 267 people seeking treatment for anxiety and stress disorders
Results
- high reliability for obsessive-compulsive disorder (.80) - very low reliability for assessing generalized anxiety disorder (.57)
Conclusion: Seems that DSM 3 is unreliable to treat anxiety disorders
