DSM Flashcards
Strengths of the dsm
The DSM allows a common diagnosis to be reached by clinicians. Through it’s revision the Dsm has stood test of time. Even with the problems outlined it is perhaps the best attempt at diagnosis in existence given the limited understanding of mental disorders. When more than 2vdoctots use the dsm they should come to the diagnosis
. Golds reins study tested the reliability between the dsm 11 and dsm 111. She was found there was evidence of reliability within the dsm 111
. The Dsm5 underwent field trials before publication which included test retest reliability where different clinancian independently evaluated the same patient
Weakness of the dsm
. The dsm is seen as a confirmation of the medical state of mental disorder s sufferers are patients and treatment is suggested. Mental health issues are disorders and illnesses and so cures are looked for. However it might be said that some mental disorders are simple ways of living and who it is say whether they are illnesses or not. Rd laing suggested that schizophrenia is another way of living where a person is trying to get back to their true self anf it isn’t therefore a medical illness. The recovery model is moving away from a medical focus on mental health issues
. There was criticism that those reviewing the dsm 5 had to sign an agreement that they wouldn’t talk about the process of reviewing this version of dsm which meant was there was no transparency. It was argued that this meant Dsm5 lacked credibility in that results of any testing couldn’t be challenged later claimed that the development of the Dsm5 was very careful and transparent more so than other version because the public were able to comment on it because there is still dispute over it’s development
. Didn’t link mental disorders to any biological underpinning. Criticism of individual diagnosis has also been made such as using the name borderline personality disorder which is said to reinforce stigma and to have no useful info in this title
. The British psychological society has expressed concern about the Dsm5 because the Dsm5 has brought in social norms to be considered when making a diagnosis and this require to make judgement about such norms or to use their social norms. Deviance and dysfunction relate to social norms and culture as they might be different in different cultures
Dsm iv tr
A multi axial system
Consisting of 5 axes each diagnosis of a disorder is split into 5 levels called axes that relate to different aspects of a disorder.
A patient assigned a category according to their symptons the nearest prototype for a mental disorder suggests d by these symptons provide diagnosis
Axis1= considers clinical disorders major mental disorders tend to be problems that need immediate attention from a clinancian
Axis 11 looks at personality condition
Axis 3 = about medical and physical condotoon6
Axis 4= focused on psychosocial anf environmental factors affect disorder
Axis 5 = assessment of global functioning the question asked us how is the patient functioning. The overall rating of someone’s ability to cope with normal life. The rating scale from low scores. To 100 which refers to a superior level of functioning with reference to a range of abilities
The dsm reliability tests on the question of whether
One person’s set of symptons would lead to a common diagnosis by different physicians. If different doctors give different diagnosis es for the same set of symptons then the diagnosis aren’t reliable and treatment may not work. A diagnosis valif if it leads to treatment that work and predicts the course of mental disorder because then it us claim to measure
If diagnosis isn’t reliable because there is no consistency of individual disorder then will not be valid because the individuals symptons will de given different diagnoses by different doctors who go will suggest varying treatment options and different predictions
Golstein 1988
Teared the dsm 111 and found that there was reliability. Looked at the effect of gender on the experience of schizophrenia. Re-diagnosed 199 patients using dsm 111 when they originally been diagnosed using dsm 11 single blind technique.
Asked two experts to ewdiafbose a sample of 8 patients. The experts were given copies of case studies without abt reference to the original diagnosis removed. She found a hihmfh level of agreement and inter rater reliability
Brown et al 2001
Set out to test the reliability of the dsm1v. They studied anxiety and mood disorders in 36 out patients in Boston, USA. The patients underwent two independent interviews using the abjxiety disorder interview schedule for the dsm known as the lifetime version. For mist of the dsm iv categories there were good to excellent reliability inter rater reliability. If there was disagreement It tended to focus not on what the symptons were but whether they were enough of them. Overall emerged as reliable
Stinchfield 2003
Tested both reliability and validity. It looked at diagnosis of pathological gambling. Study looped at 803 men and women from the general population of minnesota and 259 men and women gambling programme. A questionnaire useing 19 items was used to measure the dsm iv diagnostic criteria for pathological gambling. Found that the dsm 1v diagnostic criteria were reliable and valid
Kirk and kutcgins 1992
Argued that training and supervision of interviewers in general was insufficient and thar they lacked the commitment and skills to be accurate. Pointed that studies they looked at tended to take place in specialised research setting which means their findings might not relate to clinubans in normal clinancian setting. As an unrealistic diagnostic tool lacks validity kirk and kutcgins suggested that the dsm could lack validity
Construct validity
Refers to how the constructs that are being measured represent the mental disorder
Concurrent validity
When the result of a study or test matches a result from another study or set of data done at same time
Predictive validity
When the result of a study or test matches a result from another study dome at different time.
To find predicted validity a test would be carried out and a result collected then another or different mearyre would be done some time later that would test the same feature. If the rests matched the earlier measure then this shows predictive validity
Concergent validity
When a test converges(gets close to) another test result that measures the same thing. A correlation test would be carried out if two scales measure the same construct then a person’s score onbone should converge with their score on another. The two measures should measure the exactly same thing
Validity of dsm Hoffman et al 2002
Looked at the different diagnoses of alcohol abuse, alcholo dependence and Cocaine dependence to see if such differences showed up using structured interview that was computer promoted and to see if they corresponded to the dsm iv te criteria. Looked at prison inmates it was found that the dsm diagnosis was valid and the interview data supported the idea that dependence was a more severe syndrome than abuse the symptons from the automated interview matched the dsm diagnosis
Lee 2006 validity of the dsm
To see if the dsm 1v of adhd would be suitable for Korean children. Focused on gender differences in feature of adhd recognised in the dsm. The dsm iv tr contains 18 adhd criteria with regard to children’s behaviour
. Lees study used a questionnaire with 48 primary school teachers and asked to rate the behaviour of the children they taught. In total 1663 children were rated 904 boys and 759 girls. To compare the dsm iv te criteria for diagnosing Ahd with criteria arising from questionnaire says. If the two agreed could he whish to be valid. Teachers opinions were associated with ADHD diagnosis using the dsm iv te so it was concluded that dsm has validity
Evaluation of validity of diagnosis
. The studies described above show that the dsm particularly the later versions before the Dsm5 was valid in its diagnosis. Different mental health issues were chose in the different studies cited which reinforces this conclusion. It is likely that symptons for disorders such as alcohol abuse dependence and Cocaine abuse pathological gambling and adhd are well established given that the dsm has had many revisions to rate. Different research methods such as interviews and questionnaires yield data that for those with mental health disorders natch the dsm criteria
. The claim that the dsm is valid is supported by the claim that it is reliable as reliability and validity go together. If the dsm isn’t made reliable it will not be valid
. Great efforts have been made to make sure that the dsm iv te more valid such as adding culture bound syndromes
