Describe the key features of the DSM system of diagnostic classification Show
The DSM, now in its fifth edition (the DSM-5), classifies a wide range of abnormal behavior patterns in terms of categories of mental disorders and identifies specific types of disorders within each category that are diagnosed on the basis of applying specified criteria. Describe the concept of culture bound syndromes and identify some examples Culture-bound syndromes are abnormal behavior patterns found exclusively or predominantly in particular cultures. Explain why the new edition of the DSM, the DSM-5, is controversial Many concerns have been raised about the DSM-5, including concerns over the expansion of diagnosable disorders, changes in classification of mental disorders, changes in diagnostic criteria for particular disorders, and lack of research evidence during the process of development. Evaluate the DSM system in terms of its strengths and weaknesses. The major strength of the DSM system is the use of specified diagnostic criteria for each disorder. Weaknesses include questions about reliability and validity of certain diagnostic categories and, to some, the adoption of a medical model framework for classifying abnormal behavior patterns. Describe the major methods used in clinical assessment: the clinical interview The clinical interview involves the use of a set of questions designed to elicit relevant information from people seeking treatment. -three major types of clinical interviews are unstructured interviews (clinicians use their own style of questioning rather than follow a particular script), semistructured interviews (clinicians follow a preset outline in directing their questioning but are free to branch off in other directions), and structured interviews (clinicians strictly follow a preset order of questions). Describe the major methods used in clinical assessment: Psychological tests Psychological tests are structured methods of assessment used to evaluate reasonably stable traits such as intelligence and personality. Tests of intelligence, such as the Wechsler scales, are used for various purposes in clinical assessment, including determining evidence of intellectual disability or cognitive impairment, and assessing strengths and weaknesses.
Describe the major methods used in clinical assessment: Neuropsychological assessment Neuropsychological assessment involves the use of psychological tests to indicate possible neurological impairment or brain defects. The Halstead-Reitan Neuropsychological Battery uncovers skill deficits that are suggestive of underlying brain damage. Describe the major methods used in clinical assessment: Behavioral assessment Methods of behavioral assessment include behavioral interviewing, self-monitoring, use of analogue or contrived measures, direct observation, and behavioral rating scales. The behavioral examiner may conduct a functional analysis, which relates the problem behavior to its antecedents and consequences. Describe the major methods used in clinical assessment: Cognitive assessment Cognitive assessment focuses on the measurement of thoughts, beliefs, and attitudes to help identify distorted thinking patterns. Specific methods of assessment include the use of a thought record or diary and the use of rating scales such as the Automatic Thoughts Questionnaire and the Dysfunctional Attitudes Scale Describe the major methods used in clinical assessment: Physiological measurement Measures of physiological functioning include heart rate, blood pressure, galvanic skin response, muscle tension, and brain wave activity. Brain-imaging and recording techniques such as EEG, CT scans, PET scans, and MRI and fMRI, probe the inner workings and structures of the brain. Describe objective and projective personality tests and evaluate their usefulness Objective personality tests, such as the MMPI, use structured items to measure psychological characteristics or traits, such as anxiety, depression, and masculinity-femininity. These tests are considered objective in the sense that they make use of a limited range of possible responses to items and are based on an empirical, or objective, method of test construction. Objective tests are easy to administer and have high reliability because the limited response options permit objective scoring. However, they may be limited by underlying response biases. Describe objective and projective personality tests and evaluate their usefulness Projective personality tests, such as the Rorschach and TAT, require subjects to interpret ambiguous stimuli in the belief their answers may shed light on their unconscious processes. However, the reliability and validity of projective techniques continue to be debated. Sociocultural Factors of Psychological Assessment Tests that are reliable and valid in one culture may not be so when used with members of another culture, even when they are translated accurately. Examiners also need to protect against cultural biases when evaluating people from other ethnic or cultural backgrounds. For example, they need to ensure they do not label behaviors as abnormal that are normative within the person’s own cultural or ethnic group.
19th-century German physician Emil Kraepelin was the first modern theorist to develop a comprehensive model of classification on the basis of distinctive features, or symptoms, associated with abnormal behavior patterns The most commonly used classification system today is largely an outgrowth and extension of Kraepelin’s work: the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. Why is it important to classify abnormal behavior? -helps researchers communicate their findings to one another DSM is used widely in the United States the most widely used diagnostic manual worldwide is the
International Statistical Classification of Diseases and Related Health Problems (ICD) involve: The DSM and Models of abnormal behaviour -treats abnormal behaviours as signs or symptoms underlying disorders or pathologies -descriptive, not explanatory -limitation of the categorical model is that it does not directly provide a means of evaluating the severity of a disorder DSM 5 - categories of mental disorders: Autism spectrum disorder Specific learning disorder Communication disorders DSM 5 - categories of mental disorders: Schizophrenia Schizophreniform disorder Schizoaffective disorder Delusional disorder Schizotypal personality disorder DSM 5 - categories of mental disorders: Bipolar disorder Cyclothymic disorder DSM 5 - categories of mental disorders: Major depressive disorder Persistent depressive disorder (Dysthymia) Premenstrual dysphoric disorder DSM 5 - categories of mental disorders: Panic disorder Phobic disorders Generalized anxiety disorder DSM 5 - categories of mental
disorders: Obsessive–compulsive disorder Body dysmorphic disorder Hoarding disorder Trichotillomania (Hair-pulling disorder) DSM 5 - categories of mental disorders: Adjustment disorder Acute stress disorder Posttraumatic stress disorder DSM 5 - categories of mental disorders: Dissociative amnesia Depersonalization/derealization disorder Dissociative identity disorder DSM 5 - categories of mental
disorders: Somatic symptom disorder Illness anxiety disorder Factitious disorder DSM 5 - categories of mental disorders: Anorexia nervosa Bulimia nervosa Binge-eating disorder DSM 5 - categories of mental disorders: Enuresis (bed wetting) Encopresis (soiling) DSM 5 - categories of mental disorders: Insomnia disorder Hypersomnolence disorder Narcolepsy breathing-related sleep disorders Circadian rhythm sleep-wake disorders Nightmare disorder DSM 5 - categories of mental disorders: Male hypoactive sexual desire disorder Erectile disorder Female sexual interest/arousal disorder Female orgasmic disorder Delayed ejaculation Premature (early) ejaculation DSM 5 - categories of mental disorders: DSM 5 - categories of mental disorders: Conduct disorder Oppositional defiant disorder Intermittent explosive disorder DSM 5 - categories of mental disorders: Alcohol use disorder Stimulant use disorder Gambling disorder DSM 5 - categories of mental disorders: Delirium Mild neurocognitive disorder Major neurocognitive disorder DSM 5 - categories of mental disorders: Paranoid personality disorder Schizoid personality disorder Histrionic personality disorder Antisocial personality disorder Borderline personality disorder Dependent personality disorder Avoidant personality disorder Obsessive–compulsive personality disorder DSM 5 - categories of mental disorders: Exhibitionistic disorder Fetishistic disorder Transvestic disorder Voyeuristic disorder Pedophilic disorder Sexual masochism disorder Sexual sadism disorder Determining level of care The assessment of a person’s functioning takes into account the individual’s ability to manage the responsibilities of daily living. -occur in some cultures but are rare or unknown in others Examples of Culture Bound Syndromes from Other Cultures: Amok: Men in Southeastern Asian/traditional Puerto Rican and Navajo Cultures in the
West. Examples of Culture Bound Syndromes from Other Cultures: -Emotional distress in Latin American/Mediterranean groups Examples of Culture Bound Syndromes from Other Cultures: -Disorder affecting males, found principally in India, that involves intense fear or anxiety over the loss of semen through nocturnal emissions, ejaculations, or excretion with urine (in fact, semen doesn’t mix with urine). In Indian culture, there is a popular belief that loss of semen depletes a man of his vital natural energy. Examples of Culture Bound Syndromes from Other Cultures: Occurring principally among southern U.S. and Caribbean groups, the disorder involves an episode of sudden collapsing or fainting. The attack may ccur without warning or be preceded by dizziness or feelings of “swimming” in the head. Although the eyes remain open, the individual reports an inability to see. The person can hear what others are saying and understand what is occurring but feels powerless to move. Examples of Culture Bound Syndromes from Other Cultures: A disorder occurring among American Indian groups, it involves a preoccupation with death and with the “spirits” of the deceased. Symptoms include bad dreams, feelings of weakness, loss of appetite, fear, anxiety, and a sense of foreboding. Hallucinations, loss of consciousness, and states of confusion may also be present, among other symptoms. Examples of
Culture Bound Syndromes from Other Cultures: Found primarily in China and some other south and east Asian countries, the syndrome refers to an episode of acute anxiety involving the fear that one’s genitals (the penis in men and the vulva and nipples in women) are shrinking and retracting into the body and that death may result. Examples
of Culture Bound Syndromes from Other Cultures: A term used in a number of countries in North Africa and the Middle East to describe the experience of spirit possession. Possession by spirits is often used in these cultures to explain dissociative episodes (sudden changes in consciousness or identity) that may be characterized by periods of shouting, banging the head against a wall, laughing, singing, or crying. Affected people may seem apathetic or withdrawn or refuse to eat or carry out their usual responsibilities. T/F Dhat syndrome is a culturebound syndrome found in India in which men develop intense fears over loss of semen. True The DSM may be considered reliable, or consistent, if different evaluators using the system are likely to arrive at the same diagnoses when they evaluate the same people. The system may be considered valid if diagnostic judgments correspond with observed behavior. For example, people diagnosed with social phobia should show abnormal levels of anxiety in social situations -Needs to be more sensitive to the importance of cultural and ethnic factors in diagnostic assessment (determined by a consensus of mostly US trained psychologists/psychiatrists) points of controversy about the DSM-5: 1. Expansion of diagnosable disorders points of controversy about the DSM-5: 3. Changes in diagnostic criteria for particular disorders Greater emphasis on dimensional assessment across most categories and disorders -By conceptualizing disorders more broadly as representing dimensions of dysfunctional behavior rather than simply as “present or absent” diagnostic categories allows clinicians to make judgments about the relative severity of disorders, such as by indicating the frequency of symptoms or the level of suicide risk or anxiety. Examples of new disorders in the DSM-5: -Compulsive need to accumulate things, such as books, clothing, household items, and even junk mail Diagnostic Classification:
Examples of new disorders in the DSM-5: -Frequent, excessive temper tantrums in children Doagnostic Classification: -Depressive Disorders Examples of new disorders in the DSM-5: Significant
declines in mental functioning involving thinking, memory, and attention Diagnostic Classification: Why are these changes and controversies important to anyone other than psychologists and psychiatrists? the diagnostic manual affects how clinicians identify, conceptualize, classify, and ultimately treat mental or
psychological disorders. Advantages of the DSM System -designation of specific diagnostic criteria Disadvantages of the DSM System -challenge the reliance of the medical model (problem behaviours viewed as symptoms of underlying mental disorders - same way
physical symptoms are seen as signs of underlying physical disorders) -society is biased
against people who are labeled mentally ill Standards of clinical assessment: Reliability -refers to consistency of a method of assessment -assessment techniques in different parts of the test yield consistent results if it yields similar results on separate occasions - raters must show a high level of agreement in their ratings Standards of clinical assessment: -Assessment techniques must also be valid of an assessment technique is the degree to which its content represents the behaviors associated with the trait in question. represents the degree to which the assessment technique correlates with an independent, external criterion (standard) of what the technique is intended to assess. Predictive validity is a form of criterion validity. A test or assessment
technique shows good predictive validity if it can be used to predict future performance or behavior. -see if it is able to identify people who meet diagnostic criteria for the disorder refers to the degree to which a test correctly identifies people who have the disorder the test is intended to detect. Tests that lack sensitivity produce a high number of false negative individuals identified as not having the disorder who truly do have the disorder. Specificity refers to the degree to which the test avoids classifying people as having a particular disorder who truly do not have the disorder. Tests that lack specificity produce a high number of false positives—people identified as having the disorder who truly do not have the disorder. By taking into account the sensitivity and specificity of a given test, clinicians can determine the ability of a test to classify individuals correctly. Construct validity: is the degree to which a test corresponds to the theoretical model of the underlying construct or trait it purports to measure e.g. anxiety not concrete - theoretical construct helps explain phenomena: a pounding heart T/F A psychological test can indeed be highly reliable yet also invalid. A test of musical aptitude may have superb reliability but be invalid as a measure of personality or intelligence T/F Beliefs in phrenology have long been discredited 6 Major methods used in clinical assessment:
-Clinicians use different methods of assessment to arrive at a diagnoses Clinical interview Clinical Interview: Form of assessment -is the most widely used means of assessment Clinical Interview: Topics usually covered 1. Identifying data: sociodemographic characteristics: address, phone #, gender, ethnicity : How do they perceive the problem? Where, When, what Q's 3. Psychological history: Clients developmental history: school, occupation, family relationships 4. Medical/Psychiatric history: Clients history. Is this a recurring problem? How did they handle in the past? 5. Medical problems/medication:description of present medical problems and present treatment Three types of clinical interviews Unstructured interview the clinician adopts his or her own style of questioning rather than following a standard format the clinician follows a general outline of questions designed to gather essential information but is free to ask the questions in any particular order and to branch off into other directions to follow up on important information Structured interview (standardized interviews) the interview
follows a preset series of questions in a particular order. The 19th-century belief in phrenology held that personality and mental faculties were based on the size of certain parts of the brain and could be assessed by measuring the pattern of bumps on a person’s head. Computerized clinical interviews have been used for more than 25 years, and some research suggests that the computer may be more effective than its human counterpart in teasing out problems. Psychological Tests -is a structured method of assessment used to evaluate reasonably stable traits, such as intelligence and personality Intelligence Tests -assessment of abnormal behavior often includes an
evaluation of the client’s intelligence : Capacity, understand the world, resourcefulness to cope with its challenges -Stanford-Binet Intelligence scale: measure intelligence in children and young adults (memory) two major types of tests used to assess personality: and the Millon Clinical Multiaxial Inventory (MCMI). -are self-report personality inventories that use items to measure personality traits such as emotional
instability, masculinity/femininity, and introversion. People are asked to respond to specific questions or statements about their feelings, thoughts, concerns, attitudes, interests, beliefs, and the like Minnesota Multiphasic Personality Inventory -cannot be expected to provide diagnostic judgments consistent with the current version of the DSM system, but is used to gain information about personality traits and attributes that may underlie their psychological problems -more than 567 true–false statements that assess interests, habits, family relationships, physical health complaints, attitudes, etc. The Millon Clinical Multiaxial Inventory (MCMI) on third edition -developed
to help clinicians formulate diagnoses, especially for personality disorders -easy to administer two major types of tests used to assess personality: and the T hematic Apperception Test (TAT).-offers no clear, specified response options (inkblots - respond to them) The Rorschach Inkblot Test -believed their “percepts” reflected their personalities as well as the stimulus cues provided by the blot T/F True The Thematic Apperception Test -Apperception = Interpreting on the basis of existing ideas & past excperinces Evaluation of Projective techniques -reliability and validity of projective techniques continue to be a subject of extensive research and debate -interpretation of a person’s responses depends to some degree on subjective judgment of the examiner -interpretation of the response—what it means—remains an open question Neu ropsychological assessment -involves the use of tests to help determine whether psychological problems reflect underlying neurological
impairment or brain damage Neu ropsychological assessment: The Bender Visual Motor Gesta lt Test -the first neuropsychological tests to be developed and still one of the most widely used neuropsychological tests -consists of geometric figures that illustrate various Gestalt principles of perception -client is asked to copy geometric designs. Neuropsychological assessment: The Halstead-Reitan Neuropsychological Battery -study brain–behavior relationships among organically impaired individuals Neuropsychological assessment: The Halstead-Reitan Neuropsychological Battery 1. The Category test: Reflect functioning in frontal lobe Neuropsychological assessment: The Halstead-Reitan Neuropsychological Battery 3. The Tactual Performance Test: Blindfolded subject. fit wooden blocks into shapes corresponding to depressions on a foam board. Draws the board from memory as a measure of visual memory
-treats test results as samples of behavior that occur in specific situations rather than as signs of underlying personality traits -functional analysis: analysis
of the problem behavior in relation to antecedents, or stimulus cues that trigger it, and consequences, or reinforcements that maintain it by posing questions to learn more about the history and situational aspects of problem behavior (what, when, why, where - reinforcement, escape etc) : clinicians can observe and quantify problem behavior Behavioral Assessment: Reactivity: refers to the tendency for the behavior being observed to be influenced by the way in which it is measured (covert observation: hidden cameras reduce reactivity) observer drift: the tendency of observers, or groups of raters, to deviate from the coding system in which they were trained as time elapses (retrain them) Behavioral Assessment: Self monitoring -Training clients to record or monitor the problem behavior in their daily lives (are trained to assess it). Can be easily counted. Behavioral Approach Task, or BAT Analogue Measuresare: intended to simulate the setting in which the behavior naturally takes place but are carried out in laboratory or controlled settings e.g. role playing checklist that provides information about the frequency, intensity, and range of problem behaviors. Behavioral rating scales differ from self-report personality inventories, in that items assess specific behaviors rather than personality characteristics, interests, or
attitudes. -involves measurement of cognitions— thoughts, beliefs, and attitudes Automatic thoughts Questionnaire : asks people to rate both frequency of occurrence and strength of belief associated with 30 automatic negative thoughts Dysfunctional Attitudes Scale:Inventory of relatively stable set of underlying attitudes or assumptions associated with depression. Uses a scale to rate the degree to which they endorse each belief. May be useful in detecting vulnerability to depression. -opens a new domain to the psychologist in understanding how disruptive thoughts are related to abnormal behavior. Physiological Measurement -is the study of people’s physiological responses (anxiety = arousal of sympathetic division of the ANS - can be measured by pulse) -electroencephalograph (EEG): measures brain waves
by attaching electrodes to the scalp monitors muscle tension through sensors attached to targeted muscle groups ): Measures sweating, amount of electricity that passes through two points on the skin Physiological Measurement: -Study the workings of the brain is the most common, is a record of the electrical activity of the brain -detects minute amounts of electrical activity in the brain (brain waves) Physiological Measurement: -Brain-imaging techniques generate images that reflect the structure and functioning of the brain -The CT scan aims a narrow X-ray beam at the head, and the resultant radiation is measured from multiple angles as it passes through. The computer enables researchers to consolidate the measurements into a threedimensional image of the brain. The CT scan reveals structural abnormalities in the brain that may be implicated in various patterns of abnormal behavior. T/F False Psysiological measurement: Imagine technique - positron emission tomography (PET) scan: used to study the functioning of various parts of the brain.
measures positrons (positively charged particles) Psysiological measurement: Imagine technique -magnetic resonance imaging (MRI) : the person is placed in a donut-shaped tunnel that Psysiological measurement: Imagine technique -A type of MRI, called functional magnetic resonance imaging (fMRI), is used to identify parts of the brain that become active when people engage in particular tasks, such as seeing, recalling from memory, or speaking T/F True T/F False T/F False Sociocultural Factors in Psychological Assessment -Need to keep sociocultural and ethnic factors of clients in mind when assessing personality traits and psychological disorders Sociocultural Factors in Psychological Assessment Therapists must recognize the importance of considering a clients language preference, when conducting assessments. Meanings can get lost in translations When a clinician wants images of structural damage to the brain which of the following is used?Magnetic Resonance Imaging or MRI provides 3D images of the brain or other body structures using magnetic fields and computers. It can detect brain and spinal cord tumors or nervous system disorders such as multiple sclerosis.
Which of the following is used by clinicians to extensively assess the functioning of individuals with multiple sclerosis?The Expanded Disability Status Scale (EDSS) is widely used in order to assess the neurological symptoms of an MS patient.
Which form of assessment is typically required to make psychological diagnoses?A psychiatric assessment is most commonly carried out for clinical and therapeutic purposes, to establish a diagnosis and formulation of the individual's problems, and to plan their care and treatment.
Which of the following about the Spect scan compared with the PET scan is true quizlet?Which of the following about the SPECT scan, compared with the PET scan, is true? It is less accurate. The Halstead-Reitan Test and the Luria-Nebraska Test have been developed to do which of the following?
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Which of the following is used by clinician who wants images of structural damage to the brain?
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