Reliability and Validity of the DSM and ICD

Question 1

Reliability and Validity of the DSM and ICD

Dofferemce between Neurosis and Psychosis

Answer 1

Neurosis

Mental health issues that fall just off normal functioning but the individual is so in touch with reality and know they r ill

e.g. overly self-conscious or struggling with phobias

Psychosis

Mental health issues when the individual has lost touch with reality

this is not on a Continuum with normal mental health

e.g.
Trouble thinking clearly or logically

Question 2

Reliability and Validity of the DSM and ICD

DSM

Answer 2

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Society (APA) and provides criteria for which a mental disorder can be diagnosed. It was fist published in 1952 and is used around the world. Since then, there has been 6 revisions of the DSM; the current being DSM-V which was published in May 2013.

The DSM was developed in response to the need for a census of mental health disorders; the US army had developed a system to diagnose mental disorders using mainly descriptions and classifications, such as neuroses and psychoses. From such, classifications and descriptions, list of symptoms gradually developed and were refined, and the DSM evolved.

Question 3

Reliability and Validity of the DSM and ICD

Y change to DSM v

Answer 3

To keep up with modern science and to increase the accuracy of diagnosis

Question 4

Reliability and Validity of the DSM and ICD

critisisms of Dsm V

Answer 4

It is said that the DSM pathologises normal behaviour for example Sadness

that’s diagnosed by the DSM as something it is not really

because it’s just a normal behavior

just because it fits the description of the disorder they are looking for

Question 5

Reliability and Validity of the DSM and ICD

Why DSM V better than DSM IV TR

Answer 5

In the dsmv they changed to be definitions to make diagnosis more precise

Question 6

Reliability and Validity of the DSM and ICD

CHANGES FROM DSM IV TR TO DSM V

Answer 6

ABOLISHING THE ASIXS

• The axes from DSM-IV are gone.

• Critics said these were artificial and made it hard to draw links between different symptoms.

• The whole aim of DSM-5 is the links made between different symptoms and conditions

REMOVING UNNECESSARY (AND OVER-USED) DIAGNOSES

• Autistic spectrum disorder has become just one category.

• The old categories of autism Asperger’s, childhood disintegrative disorder, and pervasive developmental disorder have been merged together.

• The same has been done with schizophrenia spectrum disorder, which is just one category

• The old sub-types of paranoid, catatonic, disorganised, undifferentiated and residual schizophrenia have been merged together

REFLECTING SOCIAL CHANGE

• Some changes to DSM-5 reflect changes in society.

• The wars in Iraq and Afghanistan have given us a lot more insight into Post-Traumatic Stress Disorder (PTSD) and DSM-5 covers more symptoms of this, such as flashbacks

• Dementia is a growing problem now that people live longer and DSM-5 reclassifies this as a neurocognitive disorder and separates major dementia and mild dementia to encourage doctors to diagnose it early

• In a multicultural society, there is more awareness of cultural differences in mental health DSM-5 gets rid of the list of “culture-bound syndromes” and replaces it with advice on “Cultural Concepts of Distress”

REFLECTING TOLERANT ATTITUDES

• The offensive phrase “mental retardation” is finally out of the DSM. The new phrase is “Intellectual disability” or Intellectual Development Disorder (IDD)

GRIEF

• The DSM-5 removed what was known as the bereavement exclusion for major depressive episodes

• in the past, depression symptoms lasting less than two months following the death of a loved one would not have been classified as a major depressive episode

Question 7

Reliability and Validity of the DSM and ICD

DSM 3 sections

and how lists Dissorders

and example of Section III Dissorder

Answer 7

Section I:

Explains how DSM V is organised and introduces some of the changes from the DSM IV TR (such as no more multi Axis system)

Section II:

Diagnostic Criteria and Codes

This section is used to make a diagnosis clinicians often gather information about a patient

via one of these methods: Observation, Unstructured interviews, Structured interviews based on the symptoms list EG Beck Depression inventory

Disorders are organised criminologically, those that manifest early in life are listed first and those which become apparent in adolescence and adulthood are listed later on

Section III:

emerging measures and models regarding the future of diagnosis

diagnostic categories that need more research before they included in section II

e.g. internet gaming dissorder:

need 5/9 symptoms to be ID b4 diagnosed

Symptoms: pre-oplication with gains, psychological withdrawal, irritability, deceiving family or therapist, using gaming to escape a bad nude, jeopardizing a job or relationship over gaming, lack of success in controlling their game participation, loss of interest in previous hobbies, carrying on in spite of knowing the problems

Question 8

Reliability and Validity of the DSM and ICD

The ICD

Answer 8

The international statistical classification of diseases in related health problems ICD is used more frequently than the DSM in some parts of the world

the ICD includes a look at the general health of the population and is used to monitor incidents and prevalence

the ICD provides mortality numbers for the world Health Organization

all WHO member states use the ICD for such figures

the WHO was established in 1948 and its Goal is to achieve the highest level of health including mental health for all people

Diagnoses other diseases as well as MENTAL HEALTH

Question 9

Reliability and Validity of the DSM and ICD

ICD 10 and how it works

Answer 9

• The icd-10 was published in May 1990 and includes both physical and mental disorders the icd is a multilingual freely available resource used by clinicians researchers policymakers and client organizations Internationaly

• Reed et al 2011 did a study of 4887 psychiatrists around the world, 70% used the ICD 10

• Within each section of the icd 10 it categorizes each Disorder into family for example schizophrenia, schizotypal and delusional disorders are In F20-29.

• F20 = SZ

• F20.0 is Parinoid SZ and F20.1 is Hebephrenic SZ ect.

• Each section has left over codes so new disorders can be added

• allowing for clinicians to go from the general to the specific diagnosis in an easy and systematic way

ICD-10 (2015)

has 22 catagorys in roman Numerals

V is Mental and Behavioural Dissorders

Question 10

Reliability and Validity of the DSM and ICD

Comparing The ICD 10 and DSM V

Sim and Diff

Answer 10

SIMULARITYS

• both are diagnostic manuals

• both diagnose mental health disorders based on symptoms

• they’re both developed closely so there are limited differences

• they both use code to organise disorders within the manual

• both introduced dimensional assessments (which are measures to evaluate the extent which symptoms exist)

DIFFERENCES

• DSM is used in the US the ICD is used worldwide

• the DSM is only diagnosing mental disorders whereas the ICD has a wide range of applications including also diseases

• they have differing duration criteria which is how long a person has to show symptoms before a diagnosis can be made

• for the dsm-5 for PTSD it is one month of disturbances (delayed reaction is with symptoms atleast 6 months after insident)

• whereas the icd-10 it must be within six months of the stressful event

• the role of functional impairments is mandatory the DSM V but not in the ICD 11

(functional impairments is a person’s day today functioning has been limited due to the illness)

Question 11

Reliability and Validity of the DSM and ICD

How assess lvls of agreement ( reliability)

Cohen Kappa statistic

Answer 11

Robert Spitzer the chairman of the dsm3 introduced a formula known as the cohen kappa statistic

• which is used to assess a degree of agreement this is a decimal

• in which the higher the number out of one the more agreement between practitioners

• When used to measure for test retest reliability it is the agreement between the original diagnosis and the rediagnosis of a patient by the same practitioner

• when used to test for interrat reliability it is the agreement between the diagnoses of two or more separate practitioners

Question 12

Reliability and Validity of the DSM and ICD

Reliability

Answer 12

Reliability is the consistency or replicability of results

• in clinical psychology base would take the form of lots of patients with the same symptoms getting the same diagnosis by a clinician

• for example in Rosenhan’s 1973 study 11 out of 12 patients showing auditory hallucinations as a fake symptom would diagnosed with SZ

Question 13

Reliability and Validity of the DSM and ICD

Inter rater reliability

Answer 13

Inter rater reliability is the degree of agreement between multiple experimenters

• an example within clinical psychology IS when a patient with the same set of symptoms goes to a different clinician and gets the same diagnosis from both of them

Question 14

Reliability and Validity of the DSM and ICD

test retest reliability

Answer 14

• Test retest reliability is the ability to find the same results by using the same procedure on different occasions usually with the same practitioners

• an example of in clinical psychology would be when a patient is Rediagnosed with the same diagnosis when showing the same symptoms when they went to the same clinician again

Question 15

Reliability and Validity of the DSM and ICD

Validity

Answer 15

Validity is the accuracy of results

• an example in clinical psychology would be one of clinician gives a patient with set symptoms of the correct diagnosis

Question 16

Reliability and Validity of the DSM and ICD

construct validity

Answer 16

Constructive validity is how much the method used to measure something (The IV), can accurately represent it (can measure it)

• an example of in clinical psychology would be if the DSM and ICD as diagnosis systems are effective and accurate at accurately diagnosing disorders based off symptoms

Question 17

Reliability and Validity of the DSM and ICD

Concurrent validity

Answer 17

Concurrent validity
is when a new test/ method for measuring something is compared with a previously established and deemed valid test/ method for measuring the same thing

and finds the same results then the new test/ method would be considered to be valid

• An example in clinical psychology would be if the DSM is accurate than the similarly developed and functioning ICD will also have an accurate diagnosis based off similar symptoms

Question 18

Reliability and Validity of the DSM and ICD

Predictive validity

Answer 18

Predictive valency is the ability of results to accurately predict future results based on that result

• an example within clinical psychology would be if the DSM diagnos SZ on the basis of certain symptoms then the ICD should diagnose SZ on the same or similar symptoms

Question 19

Reliability and Validity of the DSM and ICD

Reliability

The same symptoms leading to the same diagnosis by a different clinician using the same classification system would be consistent diagnosis and therefore reliable

+ (1*)

rosenhan 1973

Answer 19

For example in Rosenhan’s 1973 study

11 out of 12 hospitals diagnosed pseudo patients with the same symptoms (hearings some same-sex voices saying: empty, hollow and thud)
This therefore makes diagnosis using the dsm-2 reliable

And there was consistent diagnosis from different clinicians in different hospitals using the same classification system leading to the same diagnosis by looking at the same symptoms

Therefore showing consistency in results which is why the DSM is considered to be reliable

Question 20

Reliability and Validity of the DSM and ICD

Reliability

Inter rater reliability is when multiple clinicians reach and agreement of the diagnosis of the same patient

(-) Andrews
(2)

Answer 20

• Andrews

1500 ppts assessed w/ dsm-iv and icd

Found agreement for the diagnosis of depression, substance dependence and anxiety

• but it was only a 68% agreement

• meaning there was still a large amount of disagreement

• they had a poor agreement over PTSD w/ ICD

• this shows that both the dsm-iv and the ICD do not have high agreement over the diagnosis of many disorders

• possibly due to dispute over adequate number of symptoms for a diagnosis to be made

• nevertheless this shows them to have poor consistency in diagnosis agreements a

• this is therefore evidence pointing towards them having poor inter rater reliability

Question 21

Reliability and Validity of the DSM and ICD

Reliability

(High) Test retest reliability is when the same patient is tested over different time periods to receive the same diagnosis

+ Poinzovsky et al 2006
(3)

Answer 21

Poinzovsky et al 2006

Did a large scale longitudinal study, found that PPV scores (proportion of people who retained the same diagnosis when reassessed)

• increased by 26% for SZ

• 16% for mood disorders

• 8% for eating disorders
for the icd-9

• showing that reassessing diagnosis in icd-9 improves the number of people given the same diagnosis

• Thus Poinzovsky et al 2006 is showing the icd-9 has good test retest reliability as reassessed patients got the same diagnosis when it was used on them.

Question 22

Reliability and Validity of the DSM and ICD

Reliability

Cohen’s Kappa
A formula for measuring reliability (based on agreement of an alternative practitioner or the proportion of who gets the same diagnosis when reassessed at a later time)

score 1 = perfect 0.8 = good 0 = Bad

+ Reigers 2013 (4)

Answer 22

Reigers 2013

Reported that in 3 disorders including PTSD had KAPPA-values ranging from 0.6 – 0.79 (very good)

while 7 more including SZ had values of 0.4-0.59 (good)

Reigers 2013 is showing how the DSM being used identify disorders from syndromes is largely reliable and it’s scores at least good reliability in 10 disorders

Question 23

Reliability and Validity of the DSM and ICD

Reliability

(4 part 2) ( as a weakness to that paragraph)

Weakness of Cohen’s Kappa as a formula for measuring reliability

(-) Cooper 2014

Answer 23

Cooper 2014

Shows the acceptable level of agreement has decreased over the past 35 years within the cohen’s kappa

with DSM V classifying as low as 0.2 – 0.4 as exceptible levels of agreements

For example major depressive disorder has a KAPPA value of 0.28 which is considered an acceptable level of agreement despite being out of one whereas in the DSM III 0.7 is classed as good

• meaning this high reliability that was shown in Reigers 2013 (7 dissorders incl SZ having Kappa values of 0.4-0.59)

may only be considered good due to the lowering of the boundaries of acceptability rather than actually showing good consistency of diagnosis and therefore good reliability

• Cooper 2014 therefore shows the poor reliability of the dsmv as a classification system and the poor use of cohern’s kappa as a formula for measuring reliability accurately

Question 24

Reliability and Validity of the DSM and ICD

Validity

Construct validity in the Diagnosis systems is the ability for the diagnosis systems to accurately diagnose a disorder based on its symptoms

(-) Rosenhan 1973

(1)

Answer 24

Rosenhan 1973

During the study hospitals used with dsm-ii to diagnose pseudo patients

• but the reported symptoms of the pseudo patients such as hearing same sex voices say hollow, thud, empty

were both:

• rarely reported symptoms of SZ

• and all of the pseudo patients were pseudo patients and therefore did not really have the symptoms, meaning the dsmi-ii misdiagnosed the symptoms as SZ in 11/ 12 hospitals

and type 1 error diagnosed healthy ppts as mentally ill

showing what it cannot accurately diagnose disorders based on symptoms that reflect the disorder

meaning the dsm II has low construct validity

Question 25

Reliability and Validity of the DSM and ICD

Validity

(Reliability 1 counter)

Predictive validity is the ability to predict factors such as the treatment based on diagnosis from the symptoms

(-) Rosenhan 1973

(1.1)

Answer 25

Rosenhan 1973

The treatment of pseudo patients varied for example hospitals stay ranged between 7-52 days

this shows the low predictive validity of the dsm II

as treatment did not always match the diagnosis

this is shown by the variation of hospital stay length not being similar but widely different

suggesting different treatment methods

meaning that rosenhan 1973 to shows how the dsm II has low predictive validity

Question 26

Reliability and Validity of the DSM and ICD

Validity

Accurate diagnosis should lead to correct effective treatment that reduces symptoms because they identified the cause of the disorder

(2)

(-) Ketter 2005

Answer 26

Ketter 2005

Points out that misdiagnosis due to system overlap shows the low validity of the classification systems

as the symptoms of disorders are similar so their diagnosis are difficult to do accurately

therefore meaning the classification systems like the dsm V and the icd 11 are invalid
Due to having this overlap in symptoms leading to misdiagnosis

Question 27

Reliability and Validity of the DSM and ICD

Validity

The DSM is unbiased in its criteria to identify symptoms (EG in the duration frequency of symptoms from the incident in, for example PTSD before a diagnosis can be made (for PTSD It is within a Month))

(+)
(3)

Answer 27

Due to the DSM being unbiased in its criteria to identify symptoms

it means that the symptoms themselves can be easily identified

as their description/criteria cannot be easily disputed

allowing for a clearer establishment of effect (symptoms) in cause and effect

giving the DSM as a diagnosis system high internal validity

Question 28

Reliability and Validity of the DSM and ICD

Validity

(4.5)
Alternative to Classification systems

Answer 28

An alternative that is better and more valid than the classification systems methods of breaking down an identifying mental disorders based on features and symptoms

• is an approach that looks at all aspects of a patient’s life such as developmental factors

( which also allow to look at cause and effect of the disorder and Gain a more effective treatment based on this)

• as simply identifying disorders based on their features and symptoms is reductionist as the disorder/Symptoms being shown may be unrecognized/ unidentified or even hidden symptoms

• all leading to false diagnoses which is invalid and reduces the link between symptoms and diagnosis and cause an effect

• meaning that the classification systems overall are invalid and this alternative method is more valid

Question 29

Reliability and Validity of the DSM and ICD

Validity

Concurrent validity is to use one established and valid test to see if a new test comes to the same results/diagnosis (both use sim methods) yes = valid no = invalid

+ Pihlajamaa et al 2008

(5)

Answer 29

Pihlajamaa et al 2008

• Looks at the validity of SZ diagnosis using the DSM III, DSM IV and icd-10

• when icd-10 was used to diagnose SZ it matched the diagnosis of the others, but using a different system

• suggesting the icd 10 is a valid classification system for we diagnosis of SZ giving it good concurrent validity