The 4D's, Classification Systems & Diagnosis (Clinical Psychology)

Question 1

What are the 4 D’s of Diagnosis?

Answer 1

Deviance Dysfunction Distress Danger

Question 2

What is meant by Deviance (when discussing diagnosis)?

Answer 2

How rare/ infrequent the behaviour is within society Does it break social norms?

Question 3

What is meant by Dysfunction (when discussing diagnosis)?

Answer 3

If their behaviour interferes with their life

Question 4

What is meant by Distress (when discussing diagnosis)?

Answer 4

Does it cause the individual to become upset?

Question 5

What is meant by Danger (when discussing diagnosis)?

Answer 5

Does it cause danger to themselves/others?

Question 6

Is Diagnosis reliable?

Answer 6

Everything is self-reported by the patient: The patient’s recall may be biased Everything is interpreted by the clinician, which may have a biased perspective on the patient’s symptoms.problems The subjectivity weakens reliability

Question 7

What are the Strengths + Weaknesses of the 4Ds of Diagnosis?

Answer 7

The 4D’s of diagnosis is a standardised procedure Therapists will have to cover all 4D’s, which is a long + difficult process that leads to different views

Question 8

What are the Issues + Debates surrounding Diagnosis?

Answer 8

Social Control: Some argue that clinicians have a lot/too much power in making diagnoses. Once a person is labelled as ‘mentally ill’ there are serious implications + it can be difficult for them to lose that label. Many individuals who have been sectioned under the mental health act find it to be a distressing + dehumanising process, as their power to make decisions is removed, and some are treated badly in care

Practical Issues: Research into mental health often involves data form the diagnosis of real patients. The diagnosis method of clinical interviews is subjective; due to relying on self report, ad clinician bias. This leads to inaccurate/inconsistent diagnosis between clinicians

Question 9

What are Classification Systems?

Answer 9

Comprehensive and standardised lists of known mental disorders and their symptoms.

Question 10

What 2 Classification Systems are looked at in Clinical Psychology?

Answer 10

DSM ICD

Question 11

When was the ICD first written?

Answer 11

1948

Question 12

When was the DSM first written?

Answer 12

1952

Question 13

What does the DSM stand for?

Answer 13

Diagnostic and Statistical Manual

Question 14

What is the DSM?

Answer 14

The DSM is a multiaxial tool as it examines 5 different aspects of the patient’s behaviour and health. It is an American system.

Question 15

How many Axes does the DSM have?

Answer 15

The DSM is multiaxial - 5

Axis I: The main clinical syndrome/mental disorder

Axis II: Personality disorder and retardation- anything wrong with the personality that may influence the main disorder

Axis III: Medical conditions that may affect the main disorder

Axis IV: Psychosocial stressors - any events in a person’s life that may affect mental disorders + stress

Axis V: Global assessment of functioning- a test assessing social + occupational functioning, seeing how well they can carry out everyday activities (e.g. washing)

Question 16

What does the ICD stand for?

Answer 16

International Classification of Diseases

Question 17

What is the ICD?

Answer 17

The ICD-10 lists and categorises all diseases including mental and physical ones. This is a European system.

Question 18

How does the ICD work?

Answer 18

Section F deals with mental health disorders. Each mental health diagnosis is given a code the describes: the family of the disease, the particular disorder, the severity of the disorder, the severity of the disorder and any specific symptoms seen. (This doesn’t have to be learnt)

Question 19

What did Ward et al (1962) find about the diagnostic systems?

Answer 19

Disagreement between psychiatrists is due to inconsistent interpretation and inadequacy of the DSM / ICD-10

Question 20

What is meant by (inter-rater) Reliability of Diagnosis?

Answer 20

The extent to which clinicians agree on the same diagnosis for each patient

Question 21

What is Test-Retest Reliability?

Answer 21

When the same clinician makes the same diagnosis on different occasions.

Question 22

What evidence Supports that Diagnosis is Reliable?

Answer 22

Brown (2001) Hoffmaan (2002) Rosenhan (1973)

Question 23

How does Rosenhan’s (1972) study support the Reliability of Diagnosis?

Answer 23

Although inaccurate, 7 out of 8 pseudopatients were given a diagnosis of schizophrenia

Question 24

How does Brown’s (2001) study support the Reliability of Diagnosis?

Answer 24

He tested the reliability and validity of DSM IV diagnosis for anxiety and mood disorders and found them to be ‘good’ to ‘excellent’.

Question 25

How does Hoffmaan’s study support the Reliability of Diagnosis?

Answer 25

Hoffmaan used a computer to give structured interviews to prison inmate patient who had been diagnosed with either alcohol abuse, alcohol dependence or cocaine dependence, using the DSM-IV. The computer diagnosis were consistent with the DSM- IV Using a computerised diagnostic system eliminates any subjectivity that might take place in a diagnostic interview, making it objective.

Question 26

What evidence Challenges the Reliability of Diagnosis?

Answer 26

Beck (1954) Stetka + Ghaemi Cooper et al Ward et al

Question 27

How does Beck’s study challenge the Reliability of Diagnosis?

Answer 27

Beck found that the same set of symptoms were only diagnosed as the same disorder 50% of times.

Question 28

How does Stetka + Ghaemi study challenge the Reliability of Diagnosis?

Answer 28

S+G suggest that under half of clinicians had started using the DSM-5 one year after its release, due to concerns that led to unreliable diagnosis.

Question 29

How does Cooper et al study challenge the Reliability of Diagnosis?

Answer 29

He reported that trials of the DSM-III showed schizophrenia had a reliability estimate of 0.81 (there’s an 81% chance another will give the same diagnosis), but for the DSM V it was 0.46

Question 30

How does Ward et al study challenge the Reliability of Diagnosis?

Answer 30

He said that disagreement between psychiatrists is due to inconsistent interpretation and inadequacy of the DSM / ICD-10

Question 31

What Patient Factors affect the Reliability of Diagnosis?

Answer 31

Issues with memory, denial and shame Symptoms- e.g. disorganised thoughts Personality disorders - e.g. psychopathy, manipulation

Question 32

What Clinician Factors affect the Reliability of Diagnosis?

Answer 32

Unstructured interview- can lead to clinicians focusing on different specific things (e.g. nightmares, past events, love life, etc); leading to different info being gathered Subjectivity due to background and training; leading to different interpretations A diagnosis may have I-R validity, bu that doesn’t mean its valid (e.g. Rosenhan)

Question 33

What is meant by the Validity of Diagnosis?

Answer 33

Whether the diagnosis given to a patient is accurate or not

Question 34

Why is the Validity of Diagnosis Important?

Answer 34

An inaccurate diagnosis leads to the wrong treatment, delayed recovery, and (in some cases) make things even worse.

Question 35

What is Concurrent Validity?

Answer 35

This could be checked by looking at another diagnostic tool (e.g. DSM with the ICD). If there is broad agreement about which symptoms constitute which disorder, there is broad concurrent validity.

Question 36

What is Aetiological Validity?

Answer 36

When the patients history matches what’s known about the causes of the disorder

Question 37

What is Predictive Validity?

Answer 37

Where the future of the course of the disorder is known, and can be applied to the person; so the diagnosis can be checked against the outcome in order to see if it’s valid. i.e. when the treatment is successful

Question 38

What is Implicit Bias?

Answer 38

A positive or negative mental attitude towards a person, thing or group that a person holds at an unconscious level. Clinicians have this, affecting the interpretation of the info given to them

Question 39

How does Hoffman’s research support the Validity of Diagnosis?

Answer 39

Hoffmaan: Hoffmaan used a computer to give structured interviews to prison inmate patient who had been diagnosed with either alcohol abuse, alcohol dependence or cocaine dependence, using the DSM-IV. The computer diagnosis were consistent with the DSM- IV; showing it has concurrent validity

Question 40

How does Aboraya’s research challenge the Validity of Diagnosis?

Answer 40

Aboraya: Clinicians focus on acute symptoms and overlook others. Also, patients’ mood, memory and shame lead to inaccuracy

Question 41

What is Comorbidity?

Answer 41

When there is a presence of more than one disorder in the same person at one time. Many disorders overlap with each other (e.g. depression and anxiety), making a valid + reliable diagnosis difficult.