To what extent are the ICD and DSM valid Flashcards
Valid definition
A diagnosis is considered valid if the diagnosis is correct and a patient’s symptoms match those listed in the classification system, such as DSM. Validity refers to the extent to which a diagnosis reflects an actual disorder (and possible cause) and enables a suitable treatment to be identified. Predictive validity is present if a diagnosis can lead to an accurate prediction of the patient’s outcome and the treatment is effective.
Hoffman positive
Hoffman studied different diagnoses of alcohol abuse, and alcohol and cocaine dependence using prison inmates and found that the symptoms matched the DSM criteria. Therefore, this shows that the DSM is valid for patients who are suffering from addictive disorders, although perhaps this is because the disorders are more obvious when they are more severe as in the case of these prisoners.
Kim-Cohen
Similarly, Kim-Cohen et al studied conduct disorder in 5 year olds using a variety of different research methods, such a interviews with mothers, questionnaires to teachers and comparisons with other children’s behaviour using self report data, and found that diagnoses were consistent. Therefore, this suggests that the diagnoses are valid which means that these disorders can be better treated leading to a better outcome for children with these disorders.
Mason
Equally, Mason et al compared different ways of making a diagnosis and found that ICD-9 and ICD-10 were reasonably good at predicting disability in 99 people with SZ 13 years later, as measured by the global assessment of functioning questionnaire. Therefore, this shows that the initial diagnosis was valid in terms of its ability to accurately predict future outcomes.
However Rosenhan
However, Rosenhan found that the DSM was not able to differentiate the sane from the insane as 8 sane pseudo-patients presented at 12 different hospitals saying that they were hearing voices saying the same thing, hollow, empty and thud. All except one were diagnosed as having SZ even though none actually had a mental disorder and none were released as being sane and all were labelled as in remission. Therefore, this shows that the classification systems used did not have validity and recent additions, such as the multi axial system in DSM III and DSM IV, were needed to allow a better understanding of the patient, alongside just clinical symptoms, in order to diagnose correctly. However, Pies suggested that the DSM (including DSM 5) does not offer a ‘comprehensive understanding of the patient’ which is what clinicians want and indicates a continuing issue.
Afro Caribbean
Studies have also shown that Afro Caribbean’s who live in the UK, US and other predominantly Caucasian countries in the west are up to 7 more times likely to be diagnosed with SZ than those living in a country that has predominantly black people. Equally, this rate is far higher than in their countries of origin, where rates of SZ are around 1%, the same as the indigenous populations in the west. This suggests a validity issue as the statistics spud be similar in both types of culture if the classification and diagnosis were correct.
Casas
This is supported by other studies, such as Cases who found that a lot of African Americans do not share their personal information with those of a different race. Equally, Sue and Sue found that many Asian Americans don’t like to talk about their emotions and so are less likely to admit that they have a problem and even when they have admitted it they are less likely to talk to their therapist. Therefore, these groups are less likely to receive a valid diagnosis as they are less likely to present their symptoms either fully or accurately.
However prejudice
However, the problem may not lie with the validity of the classification systems, but with issues such as prejudice and a misunderstanding of those from a different culture which means that people of a different race may be more likely to be diagnosed with a mental health disorder or receive the wrong diagnosis if they do not present the symptoms in the same way as the Western population. Equally, it may be that there is not a diagnosis issue at all but rather people of a different race are more likely to be discriminated against, and to be socially and educationally disadvantaged, living in poorer, run down inner city areas. These factors may mean that they actually do experience a higher incidence of mental health disorders, such as SZ.
Ethnocentric
Issues with validity may occur due to the ethnocentric nature of the DSM and a cultural misunderstanding by western clinicians. For example, the BPS has expressed concern about DSM 5 as it brought in social norms to be considered when making a diagnosis and this requires the clinician to make judgements about such norms or to use their own social norms. Deviance and dysfunction (2 of the 4Ds) relate to culture and social norms as they might be different in different cultures. However, this can be difficult. For example, in some Caribbean cultures it is considered normal to talk to relatives and friends after they have died. So, for instance, a grieving widow may tell a doctor she is talking to her dead husband. Therefore, clinicians in the west may not understand the norms of her culture and may diagnose a mental disorder, such as SZ.
However DSM 5
However, DSM IV and 5 take more account of cultural issues than previous editions as they acknowledge, culture-bound syndromes and so improve the validity of diagnosis. Equally, there has been an attempt to remove focus from bizarre symptoms in SZ as it was acknowledged that such symptoms are open to interpretation and that there are cultural issues in such interpretations. Therefore, this has led to more validity when Western clinicians diagnose patients of a different cultural background.
Conclusion
In conclusion, studies have shown that more recent editions of classification systems, such as the DSM, are largely valid and criteria is seen to match symptoms across many different disorders. However, validity is not the same across all disorders and cultural issues are still problematic as the DSM and ICD remain ethnocentric meaning that there are still cultural differences in diagnosis despite more recent attempts to acknowledge cult bound syndromes.
