Abnormal psy Ch.3
Clinical assessment
Clinical assessment is used to determine whether, how, and why a person is behaving abnormally and how that person may be helped. It also enables clinicians to evaluate people's progress after they have been in treatment for a while and decide whether the treatment should be changed
3.2 Diagnosis: Does the Client's Syndrome Match a Known Disorder?
Clinicians use the information from interviews, tests, and observations to construct an integrated picture of the factors that are causing and maintaining a client's disturbance, a construction sometimes known as a clinical picture Clinical pictures also may be influenced to a degree by the clinician's theoretical orientation "model" ex: cognitive or behavioral type.
Conducting the Interview
The interview is often the first contact between client and clinician. Clinicians use it to collect detailed information about the person's problems and feelings, lifestyle and relationships, and other personal history. They may also ask about the person's expectations of therapy and motives for seeking it.
types of interviews used by certain models
Unstructured interviews typically appeal to psychodynamic and humanistic clinicians, while structured formats are widely used by behavioral and cognitive clinicians, who need to pinpoint behaviors, attitudes, or thinking processes that may underlie abnormal behavior
To be useful, these tools must be..
be standardized and must have clear reliability and validity
flaws of iq test
intelligence tests have some key shortcomings. Factors that have nothing to do with intelligence, such as low motivation or high anxiety, can greatly influence test performance). In addition, IQ tests may contain cultural biases in their language or tasks that place people of one background at an advantage over those of another ). Similarly, members of some minority groups may have little experience with this kind of test, or they may be uncomfortable with test examiners of a majority ethnic background. Either way, their performances may suffer
Assessment
Assessment: The process of collecting and interpreting relevant information about a client or research participant
Categorical Information
First, the clinician must decide whether the person is displaying one of the hundreds of psychological disorders listed in the manual. Some of the most frequently diagnosed disorders are the anxiety disorders and depressive disorders
SENTENCE-COMPLETION TEST( Projective test)
In the sentence-completion test, first developed in the 1920s, the test-taker completes a series of unfinished sentences, such as "I wish ..." or "My father...." The test is considered a good springboard for discussion and a quick and easy way to pinpoint topics to explore.
Neuroimaging techniques:/brain scans
Neurological tests that provide images of brain structure or activity, such as CT scans, PET scans, and MRIs. Also called brain scans
ANXIETY DISORDERS
People with anxiety disorders may experience general feelings of anxiety and worry (generalized anxiety disorder); fears of specific situations, objects, or activities (phobias); anxiety about social situations (social anxiety disorder); repeated outbreaks of panic (panic disorder); or anxiety about being separated from one's parents or other key individuals (separation anxiety disorder).
DEPRESSIVE DISORDERS
People with depressive disorders may experience an episode of extreme sadness and related symptoms (major depressive disorder), persistent and chronic sadness (persistent depressive disorder), or severe premenstrual sadness and related symptoms (premenstrual dysphoric disorder).
To gather such individual information, clinicians use the procedures of:
assessment and diagnosis. Then they are in a position to offer treatment.
The hundreds of clinical assessment techniques and tools that have been developed fall into three categories:
clinical interviews, tests, and observations
Robert hare psychopathy test (video) 1980's psycothopy checklist revised ( for a more standardized test) 20 item rating scale. possible scales range from 0-40 average person typical score is 5 score of 30 or above is a psychopath 1% of population may have the disorder 3x more liely to re offend 4x morelikely toviolent offend 20% of violent offenders in jail score high on checklist
psychopathy (sociopathy) and demonstrates a leading tool for assessing this antisocial pattern. The video focuses on the work of Robert Hare and shows the "Hare Psychopathy Checklist.. to check for predicted criminal or violent behavior.
limitations of clinical interviews (problems)
+One problem is that they sometimes lack validity, or accuracy (Sommers-Flanagan & Sommers-Flanagan, 2013). Individuals may intentionally mislead in order to present themselves in a positive light or to avoid discussing embarrassing +Or people may be unable to give an accurate report in their interviews. Individuals who suffer from depression, for example, take a pessimistic view of themselves and may describe themselves as poor workers or inadequate parents when that isn't the case at all. +Interviewers too may make mistakes in judgments that slant the information they gather. They usually rely too heavily on first impressions, for example, and give too much weight to unfavorable information about a client. Interviewer biases, including gender, race, and age biases, may also influence the interviewers' interpretations of what a client say. +Interviews, particularly unstructured ones, may also lack reliability (Sommers-Flanagan & Sommers-Flanagan, 2013). People respond differently to different interviewers, providing, for example, less information to a cold interviewer than to a warm and supportive one (Quas et al., 2007). Similarly, a clinician's race, gender, age, and appearance may influence a client's responses +Because different clinicians can obtain different answers and draw different conclusions even when they ask the same questions of the same person, some researchers believe that interviewing should be discarded as a tool of clinical assessment
Interviews can be either unstructured or structured
-unstructured interview, the clinician asks mostly open-ended questions, perhaps as simple as "Would you tell me about yourself?" The lack of structure allows the interviewer to follow leads and explore relevant topics that could not be anticipated before the interview. -In a structured interview, clinicians ask prepared—mostly specific—questions. Sometimes they use a published interview schedule—a standard set of questions designed for all interviews. Many structured interviews include a mental status exam, a set of questions and observations that systematically evaluate the client's awareness, orientation with regard to time and place, attention span, memory, judgment and insight, thought content and processes, mood, and appearance (Sommers-Flanagan & Sommers-Flanagan, 2013). A structured format ensures that clinicians will cover the same kinds of important issues in all of their interviews and enables them to compare the responses of different individuals.
Some of the key changes in DSM-5 are the following (2013)
1.Adding a new category, "autism spectrum disorder," that combines certain past categories such as "autistic disorder" and "Asperger's syndrome" . 2.Viewing "obsessive-compulsive disorder" as a problem that is different from the anxiety disorders and grouping it instead along with other obsessive-compulsive-like disorders such as "hoarding disorder," "body dysmorphic disorder," "trichotillomania" (hair-pulling disorder), and "excoriation (skin-picking) disorder" (see Chapter 4). 3.Viewing "posttraumatic stress disorder" as a problem that is distinct from the anxiety disorders (see Chapter 5). 4.Adding new categories, "disruptive mood dysregulation disorder," "persistent depressive disorder," and "premenstrual dysphoric disorder," and grouping them with other kinds of depressive disorders (see Chapter 6). 5.Adding a new category, "somatic symptom disorder" (see Chapter 8). 6.Replacing the term "hypochondriasis" with the new term "illness anxiety disorder" (see Chapter 8). 7.Adding a new category, "binge eating disorder" (see Chapter 9). 8.Adding a new category, "substance use disorder," that combines past categories "substance abuse" and "substance dependence" (see Chapter 10). 9.Viewing "gambling disorder" as a problem that should be grouped as an addictive disorder alongside the substance use disorders (see Chapter 10). 10.Replacing the term "gender identity disorder" with the new term "gender dysphoria" (see Chapter 11). 11.Replacing the term "mental retardation" with the new term "intellectual disability" (see Chapter 14). 12.Adding a new category, "specific learning disorder," that combines past categories "reading disorder," "mathematics disorder," and "disorder of written expression" (see Chapter 14). 13.Replacing the term "dementia" with the new term "neurocognitive disorder" (see Chapter 15). 14.Adding a new category, "mild neurocognitive disorder" (see Chapter 15).
The 10 scales on the MMPI measure the following
1.Hypochondriasis Items showing abnormal concern with bodily functions ("I have chest pains several times a week.") 2.Depression Items showing extreme pessimism and hopelessness ("I often feel hopeless about the future.") 3.Hysteria Items suggesting that the person may use physical or mental symptoms as a way of unconsciously avoiding conflicts and responsibilities ("My heart frequently pounds so hard I can feel it.") 4.Psychopathic deviate Items showing a repeated and gross disregard for social customs and an emotional shallowness ("My activities and interests are often criticized by others.") 5.Masculinity-femininity Items that are thought to separate male and female respondents ("I like to arrange flowers.") 6.Paranoia Items that show abnormal suspiciousness and delusions of grandeur or persecution ("There are evil people trying to influence my mind.") 7.Psychasthenia Items that show obsessions, compulsions, abnormal fears, and guilt and indecisiveness ("I save nearly everything I buy, even after I have no use for it.") 8.Schizophrenia Items that show bizarre or unusual thoughts or behavior ("Things around me do not seem real.") 9.Hypomania Items that show emotional excitement, overactivity, and flight of ideas ("At times I feel very 'high' or very 'low' for no apparent reason.") 10.Social introversion Items that show shyness, little interest in people, and insecurity ("I am easily embarrassed.")
RORSCHACH TEST ( type of projective test) (inkblot test)
1911 Hermann Rorschach, a Swiss psychiatrist.Rorschach found that everyone saw images in these blots. In addition, the images a viewer saw seemed to correspond in important ways with his or her psychological condition. People diagnosed with schizophrenia, for example, tended to see images that differed from those described by people experiencing depression. Rorschach selected 10 inkblots and published them in 1921 with instructions for their use in assessment. This set was called the Rorschach Psychodynamic Inkblot Test. Rorschach died just 8 months later, at the age of 37 In the early years, Rorschach testers paid special attention to the themes and images that the inkblots brought to (Butcher, 2010). Testers now also pay attention to the style of the responses: Do the clients view the design as a whole or see specific details? Do they focus on the blots or on the white spaces between them?
Clinical test- are more than 500 Clinicians use six kinds most often: projective tests, personality inventories, response inventories, psychophysiological tests, neurological and neuropsychological tests, and intelligence tests.
A device for gathering information about a few aspects of a person's psychological functioning from which broader information about the person can be inferred (magazine personality tests) Such tests might sound convincing, but most of them lack reliability, validity, and standardization. That is, they do not yield consistent, accurate information or say where we stand in comparison with others.
face validity
A given assessment tool may appear to be valid simply because it makes sense and seems reasonable.. ex:A test for depression, for example, might include questions about how often a person cries. Because it makes sense that depressed people would cry, these test questions have face validity. but...It turns out, however, that many people cry a great deal for reasons other than depression, and some extremely depressed people do not cry at all. Thus an assessment tool should not be used unless it has high predictive validity or concurrent validity
Reliability:
A measure of the consistency of test or research results. A good assessment tool will always yield similar results in the same situation). An assessment tool has high test-retest reliability, one kind of reliability, if it yields similar results every time it is given to the same people.
SUMMING UP DIAGNOSIS:
After collecting assessment information, clinicians form a clinical picture and decide upon a diagnosis. The diagnosis is chosen from a classification system. The system used most widely in North America is the Diagnostic and Statistical Manual of Mental Disorders (DSM). The most recent version of the DSM, known as DSM-5, lists more than 500 disorders. DSM-5 contains numerous additions and changes to the diagnostic categories, criteria, and organization found in past editions of the DSM. The reliability and validity of this revised diagnostic and classification system are currently receiving clinical review and, in some circles, criticism. Even with trustworthy assessment data and reliable and valid classification categories, clinicians will not always arrive at the correct conclusion. They are human and so fall prey to various biases, misconceptions, and expectations. Another problem related to diagnosis is the prejudice that labels arouse, which may be damaging to the person who is diagnosed
The Effectiveness of Treatment problems with defining effectiveness of treatment
Altogether, more than 400 forms of therapy are currently practiced in the clinical field. Naturally, the most important question to ask about each of them is whether it does what it is supposed to do. Does a particular treatment really help people overcome their psychological problems? The first problem is how to define "success." If, as Franco's therapist implies, he still has much progress to make at the conclusion of therapy, should his recovery be considered successful? The second problem is how to measure improvement ). Should researchers give equal weight to the reports of clients, friends, relatives, therapists, and teachers? Should they use rating scales, inventories, therapy insights, observations, or some other measure Perhaps the biggest problem in determining the effectiveness of treatment is the variety and complexity of the treatments currently in use. People differ in their problems, personal styles, and motivations for therapy. Therapists differ in skill, experience, orientation, and personality. And therapies differ in theory, format, and setting. Because an individual's progress is influenced by all these factors and more, the findings of a particular study will not always apply to other clients and therapists
intellengence tests for mental retardation used in court by laywers to reduce sentences for low iq people.
An early definition of intelligence described it as "the capacity to judge well, to reason well, and to comprehend well" Because intelligence is an inferred quality rather than a specific physical process, it can be measured only indirectly. In 1905, French psychologist Alfred Binet and his associate Théodore Simon produced an intelligence test consisting of a series of tasks requiring people to use various verbal and nonverbal skills. The general score derived from this and later intelligence tests is termed an intelligence quotient (IQ). There are now more than 100 intelligence tests available.
Rapprochement movement:
An effort to identify a set of common strategies that run through the work of all effective therapists. have tried to identify a set of common factors, or common strategies, that may run through all effective therapies, regardless of the clinicians' particular orientations
summing up 3.1 section
CLINICAL ASSESSMENT Clinical practitioners are interested primarily in gathering individual information about each client. They seek an understanding of the specific nature and origins of a client's problems through clinical assessment. To be useful, assessment tools must be standardized, reliable, and valid. Most clinical assessment methods fall into three general categories: clinical interviews, tests, and observations. A clinical interview may be either unstructured or structured. Types of clinical tests include projective, personality, response, psychophysiological, neurological, neuropsychological, and intelligence tests. Types of observation include naturalistic observation, analog observation, and self-monitoring
DSM-5 requires clinicians to provide both categorical and dimensional information as part of a proper diagnosis. people often get diagnosed more than one disorder
Categorical information refers to the name of the particular category (disorder) indicated by the client's symptoms. Dimensional information is a rating of how severe a client's symptoms are and how dysfunctional the client is across various dimensions of personality
DSM-5
DSM-5 lists more than 500 mental disorders (see Figure 3.3). Each entry describes the criteria for diagnosing the disorder and the key clinical features of the disorder. The system also describes features that are often but not always related to the disorder. The classification system is further accompanied by background information such as research findings; age, culture, or gender trends; and each disorder's prevalence, risk, course, complications, predisposing factors, and family patterns.
Can Diagnosis and Labeling/classifying Cause Harm?
Even with trustworthy assessment data and reliable and valid classification cate.gories, clinicians will sometimes arrive at a wrong conclusion Like all human beings, they are flawed information processors. Studies show that they may be overly influenced by information gathered early in the assessment process. In addition, they may pay too much attention to certain sources of information, such as a parent's report about a child, and too little to others, such as the child's point of view. Finally, their judgments can be distorted by any number of personal biases—gender, age, race, and socioeconomic status, to name just a few. Given the limitations of assessment tools, assessors, and classification systems, it is small wonder that studies sometimes uncover shocking errors in diagnosis, especially in hospitals classifying- the very act of classifying people can lead to unintended results., for example, many family-social theorists believe that diagnostic labels can become self-fulfilling prophecies. When people are diagnosed as mentally disturbed, they may be perceived and reacted to correspondingly. If others expect them to take on a sick role, they may begin to consider themselves sick as well and act that way. Furthermore, our society attaches a stigma to abnormality. People labeled mentally ill may find it difficult to get a job, especially a position of responsibility, or to be welcomed into social relationships. Once a label has been applied, it may stick for a long time. Because of these problems, some clinicians would like to do away with diagnoses. Others disagree. They believe we must simply work to increase what is known about psychological disorders and improve diagnostic techniques. They hold that classification and diagnosis are critical to understanding and treating people in distress.
clinical observations have certain disadvantages.
For one thing, they are not always reliable. It is possible for various clinicians who observe the same person to focus on different aspects of behavior, assess the person differently, and arrive at different conclusions. Careful training of observers and the use of observer checklists can help reduce this problem Similarly, observers may make errors that affect the validity, or accuracy, of their observations ). The observer may suffer from overload= and be unable to see or record all of the important behaviors and events. Or the observer may experience observer drif+t, a steady decline in accuracy as a result of fatigue or of a gradual unintentional change in the standards used when an observation continues for a long period of time. Another possible problem is observer bias—the observer's judgments may be influenced by information and expectations he or she already has about the person An ideal observation Using a one-way mirror, a clinical observer is able to view a mother interacting with her child without distracting the duo or influencing their behaviors. A client's reactivity may also limit the validity of clinical observations; that is, his or her behavior may be affected by the very presence of the observer ). If schoolchildren are aware that someone special is watching them, for example, they may change their usual classroom behavior, perhaps in the hope of creating a good impression. Finally, clinical observations may lack cross-situational validity. A child who behaves aggressively in school is not necessarily aggressive at home or with friends after school. Because behavior is often specific to particular situations, observations in one setting cannot always be applied to other settings
types of inventories for the different models
For social skills inventories, used particularly by behavioral and family-social clinicians, respondents indicate how they would react in a variety of social situations. Cognitive inventories reveal a person's typical thoughts and assumptions and can help uncover counterproductive patterns of thinking. They are, not surprisingly, often used by cognitive therapists and researchers.
Treatment Decisions/plans
Franco's therapist began, like all therapists, with assessment information and diagnostic decisions. Knowing the specific details and background of Franco's problem (idiographic data) and combining this individual information with broad information about the nature and treatment of depression, the clinician arrived at a treatment plan for him. Yet therapists may be influenced by additional factors when they make treatment decisions. Their treatment plans typically reflect their theoretical orientations and how they have learned to conduct therapy (Sharf, 2015). As therapists apply a favored model in case after case, they become more and more familiar with its principles and treatment techniques and tend to use them in work with still other clients. according to surveys, therapists gather much of their information about the latest developments in the field from colleagues, professional newsletters, workshops, conferences, Web sites, books, and the like . not all read research articles.
Are Particular Therapies Effective for Particular Problems Behavioral therapies, for example, appear to be the most effective of all in treating phobias (Antony, 2014), whereas drug therapy is the single most effective treatment for schizophrenia
Gordon Paul said decades ago that the most appropriate question regarding the effectiveness of therapy may be "What specific treatment, by whom, is most effective for this individual with that specific problem, and under which set of circumstances?" Drug therapy is sometimes combined with certain forms of psychotherapy, for example, to treat depression. In fact, it is now common for clients to be seen by two therapists—one of them a psychopharmacologist, a psychiatrist who primarily prescribes medications, and the other a psychologist, social worker, or other therapist who conducts psychotherapy .
self monitoring flaws
Here too validity is often a problem. People do not always manage or try to record their observations accurately. Furthermore, when people monitor themselves, they may change their behaviors unintentionally. Smokers, for example, often smoke fewer cigarettes than usual when they are monitoring themselves, and teachers give more positive and fewer negative comments to their students
emil kraepelin and Diagnostic and Statistical Manual of Mental Disorders
In 1883, Emil Kraepelin developed the first modern classification system for abnormal behavior (see Chapter 1). His categories formed the foundation for the Diagnostic and Statistical Manual of Mental Disorders DSM), the classification system currently written by the American Psychiatric Association (APA, 2013). The DSM is the most widely used classification system in North America. Most other countries rely primarily on a system called the International Classification of Diseases (ICD), developed by the World Health Organization, which lists both medical and psychological disorders. The content of the DSM has been changed significantly over time. The current edition, called DSM-5, was published in 2013. It features a number of changes from the previous edition, DSM-IV-TR, and the editions prior to that.
Dsm 5 rating scale of severity (dimensional information , dsm 5 first to use.
In addition to deciding what disorder a client is displaying, diagnosticians assess the current severity of the client's disorder—that is, how much the symptoms impair the client. For each disorder, the framers of DSM-5 have suggested various rating scales that may prove useful for evaluating the severity of the particular disorder (APA, 2013). In cases of major depressive disorder, for example, two scales are suggested by DSM-5: the Cross-Cutting Symptom Measure and the Emotional Distress-Depression Scale. The former scale indicates the current frequency of general negative feelings and behaviors (for example, "I do not know what I want out of life"), and the latter indicates the frequency of depression-specific feelings and behaviors (for example, "I feel worthless"). Using scores from these scales, the diagnostician then rates the client's depression as "mild," moderate," or "severe." Based on his clinical interview, tests, and observations. DSM-5 is the first edition of the DSM to consistently seek both categorical and dimensional information as equally important parts of the diagnosis, rather than categorical information alone.
benfits of the iq test
Intelligence tests are among the most carefully produced of all clinical tests (Bowden et al., 2011). Because they have been standardized on large groups of people, clinicians have a good idea how each individual's score compares with the performance of the population at large. These tests have also shown very high reliability: people who repeat the same IQ test years later receive approximately the same score. Finally, the major IQ tests appear to have fairly high validity: children's IQ scores often correlate with their performance in school, for example
bad things about physio tests
Many require expensive equipment that must be carefully tuned and maintained. In addition, psychophysiological measurements can be inaccurate and unreliable (see PsychWatch below). The laboratory equipment itself—elaborate and sometimes frightening—may arouse a participant's nervous system and thus change his or her physical responses. Physiological responses may also change when they are measured repeatedly in a single session. Galvanic skin responses, for example, often decrease during repeated testing
Naturalistic and Analog Observations
Naturalistic clinical observations usually take place in homes, schools, institutions such as hospitals and prisons, or community settings. Most of them focus on parent-child, sibling-sibling, or teacher-child interactions and on fearful, aggressive, or disruptive behavior. Often such observations are made by participant observers—key people in the client's environment—and reported to the clinician. analog observations, often aided by special equipment such as a video camera or one-way mirror. Analog observations often have focused on children interacting with their parents, married couples attempting to settle a disagreement, speech-anxious people giving a speech, and fearful people approaching an object theyfrightening
Drawings
On the assumption that a drawing tells us something about its creator, clinicians often ask clients to draw human figures and talk about them (McGrath & Carroll, 2012). Evaluations of these drawings are based on the details and shape of the drawing, the solidity of the pencil line, the location of the drawing on the paper, the size of the figures, the features of the figures, the use of background, and comments made by the respondent during the drawing task. In the Draw-a-Person (DAP) test, the most popular of the drawing tests, individuals are first told to draw "a person" and then are instructed to draw a person of the other sex.
polygraph ( psychopsysiological test) world war 1 8 out of 100 truth called lies (flaw) used by parole probation
One psychophysiological test is the polygraph, popularly known as a lie detector. Electrodes attached to various parts of a person's body detect changes in breathing, perspiration, and heart rate while the person answers questions. The clinician observes these functions while the person answers "yes" to control questions If breathing, perspiration, and heart rate suddenly increase, the person is suspected of lying
types of interviews and the models:
Psychodynamic interviewers try to learn about the person's needs and memories of past events and relationships. Behavioral interviewers try to pinpoint information about the stimuli that trigger responses and their consequences. Cognitive interviewers try to discover assumptions and interpretations that influence the person. Humanistic clinicians ask about the person's self-evaluation, self-concept, and values. Biological clinicians look for signs of biochemical or brain dysfunction. And sociocultural interviewers ask about the family, social, and cultural environments.
Is Therapy Generally Effective?
Studies suggest that therapy often is more helpful than no treatment or than placebos. A pioneering review examined 375 controlled studies, covering a total of almost 25,000 people seen in a wide assortment of therapies. The reviewers combined the findings of these studies by using a special statistical technique called meta-analysis. According to this analysis, the average person who received treatment was better off than 75 percent of the untreated persons (see Figure 3.4). Other meta-analyses have found similar relationships between treatment and improvement
Summing up treatment
TREATMENT The treatment decisions of therapists may be influenced by assessment information, the diagnosis, the clinician's theoretical orientation and familiarity with research, and the state of knowledge in the field. Determining the effectiveness of treatment is difficult. Nevertheless, therapy outcome studies have led to three general conclusions: (1) people in therapy are usually better off than people with similar problems who receive no treatment; (2) the various therapies do not appear to differ dramatically in their general effectiveness; and (3) certain therapies or combinations of therapies do appear to be more effective than others for certain disorders. Some therapists currently advocate empirically supported treatment—the active identification, promotion, and teaching of those interventions that have received clear research support.
Multiphasic Personality Inventory
The MMPI consists of more than 500 self-statements, to be labeled "true," "false," or "cannot say." The statements cover issues ranging from physical concerns to mood, sexual behaviors, and social activities. Altogether the statements make up 10 clinical scales, on each of which an individual can score from 0 to 120. When people score above 70 on a scale, their functioning on that scale is considered deviant. When the 10 scale scores are considered side by side, a pattern called a profile takes shape, indicating the person's general personality
an assessment tool must have validity.
The accuracy of a test's or study's results; that is, the extent to which the test or study actually measures or shows what it claims. Suppose a weight scale reads 12 pounds every time a 10-pound bag of sugar is placed on it. Although the scale is reliable because its readings are consistent, those readings are not valid, or accurate.
framers of dsm 5 to ensure reliabilty
The framers of DSM-5 followed certain procedures in their development of the new manual to help ensure that DSM-5 would have greater reliability than the previous DSMs (APA, 2013). For example, they conducted extensive reviews of research to pinpoint which categories in past DSMs had been too vague and unreliable. In addition, they gathered input from a wide range of experienced clinicians and researchers. They then developed a number of new diagnostic criteria and categories, expecting that the new criteria and categories were in fact reliable. Despite such efforts, some critics continue to have concerns about the procedures used in the development of DSM-5 (Wakefield, 2015; Brown et al., 2014; Frances, 2013). They worry, for example, that the framers failed to run a sufficient number of their own studies—in particular, field studies that test the merits of the new criteria and categories. In turn, the critics fear that DSM-5 may have retained several of the reliability problems that were on display in the past DSMs.
syndrome
The principle behind diagnosis is straightforward. When certain symptoms occur together regularly—a cluster of symptoms is called a syndrome—and follow a particular course, clinicians agree that those symptoms make up a particular mental disorder
standardize:
The process in which a test is administered to a large group of people whose performance then serves as a standard or norm against which any individual's score can be measured.
validity of dsm 5 -predictive validity
The validity of a classification system is the accuracy of the information that its diagnostic categories provide. Categories are of most use to clinicians when they demonstrate predictive validity—that is, when they help predict future symptoms or events. A common symptom of major depressive disorder is either insomnia or excessive sleep. When clinicians give Franco a diagnosis of major depressive disorder, they expect that he may eventually develop sleep problems even if none are present now. In addition, they expect him to respond to treatments that are effective for other depressed persons. The more often such predictions are accurate, the greater a category's predictive validity. DSM-5's framers tried to also ensure the validity of this new edition by conducting extensive reviews of research and consulting with numerous clinical advisors. As a result, its criteria and categories may have stronger validity than those of the earlier versions of the DSM. But, again, many clinical theorists worry that at least some of the criteria and categories in DSM-5 are based on weak research and that others may reflect gender or racial bias. In fact, one important organization, the National Institute of Mental Health (NIMH), has already concluded that the validity of DSM-5 is sorely lacking and is acting accordingly). The world's largest funding agency for mental health research, NIMH has announced that it will no longer give financial support to clinical studies that rely exclusively on DSM-5 criteria.
WHAT ARE THE MERITS OF PROJECTIVE TESTS?
Until the 1950s, projective tests were the most commonly used method for assessing personality . In recent years, however, clinicians and researchers have relied on them largely to gain "supplementary" insights reasons behind this: One reason for this shift is that practitioners who follow the newer models have less use for the tests than psychodynamic clinicians do. Even more important, the tests have not consistently shown much reliability or validity In reliability studies, different clinicians have tended to score the same person's projective test quite differently. Similarly, in validity studies, when clinicians try to describe a client's personality and feelings on the basis of responses to projective tests, their conclusions often fail to match the self-report of the client, the view of the psychotherapist, or the picture gathered from an extensive case history (Cherry, 2015; Bornstein, 2007). Another validity problem is that projective tests are sometimes biased against minority ethnic groups For example, people are supposed to identify with the characters in the TAT when they make up stories about them, yet no members of minority groups are in the TAT pictures. In response to this problem, some clinicians have developed other TAT-like tests with African American or Hispanic figures
problems of personality tests
When clinicians have used these tests alone, they have not regularly been able to judge a respondent's personality accurately One problem is that the personality traits that the tests seek to measure cannot be examined directly. How can we fully know a person's character, emotions, and needs from self-reports alone Another problem is that despite the use of more diverse standardization groups by the MMPI-2 designers, this and other personality tests continue to have certain cultural limitations. Responses that indicate a psychological disorder in one culture may be normal responses in another ex: Puerto Rico, for example, where it is common to practice spiritualism, it would be normal to answer "true" to the MMPI item "Evil spirits possess me at times." In other populations, that response could indicate psychopathology
diagnosis They can, for example, better predict the future course of the person's problem and the treatments that are likely to be helpful
With the assessment data and clinical picture in hand, clinicians are ready to make a diagnosis A determination that a person's problems reflect a particular disorder.
An assessment tool shows high interrater (or interjudge) reliability, another kind of reliability, if
different judges independently agree on how to score and interpret it. True-false and multiple-choice tests yield consistent scores no matter who evaluates them, but other tests require that the evaluator make a judgment. Consider a test that requires the person to draw a copy of a picture, which a judge then rates for accuracy. Different judges may give different ratings to the same drawing.
The Thematic Apperception Test (TAT) (Projective test)
is a pictorial projective test . People who take the TAT are commonly shown 30 cards with black-and-white pictures of individuals in vague situations and are asked to make up a dramatic story about each card. They must tell what is happening in the picture, what led up to it, what the characters are feeling and thinking, and what the outcome of the situation will be.
Concurrent validity
is the degree to which the measures gathered from one tool agree with the measures gathered from other assessment techniques. Participants' scores on a new test designed to measure anxiety, for example, should correlate highly with their scores on other anxiety tests or with their behavior during clinical interviews.
affective inventories -many of the tests have not been subjected to careful standardization, reliability, and validity procedures -
measure the severity of such emotions as anxiety, depression, and anger. In one of the most widely used affective inventories, the Beck Depression Inventory, people rate their level of sadness and its effect on their functioning
Clinical Observations- natural analog self -monitoring
naturalistic observation, clinicians observe clients in their everyday environments. In another, analog observation, they observe them in an artificial setting, such as a clinical office or laboratory. Finally, in self-monitoring, clients are instructed to observe themselves.
To measure test-retest reliability:
participants are tested on two occasions and the two scores are correlated . The higher the correlation .. the greater the test's reliability.
Self-Monitoring benfits
people observe themselves and carefully record the frequency of certain behaviors, feelings, or thoughts as they occur over time . helps assess infrequent behaviors. . It is also useful for behaviors that occur so frequently that any other method of observing them in detail would be impossible—for example, smoking, drinking, or other drug use. Finally, self-monitoring may be the only way to observe and measure private thoughts or perceptions
therapy outcome studies
studies that measure the effects of various treatments. The studies typically ask one of three questions: (1) Is therapy in general effective? (2) Are particular therapies generally effective? (3) Are particular therapies effective for particular problems?
Before any assessment technique can be fully useful, it must meet the requirements of :
standardization, reliability, and validity. No matter how insightful or clever a technique may be, clinicians cannot profitably use its results if they are uninterpretable, inconsistent, or inaccurate
a uniformity myth—
studies often look at things in general. a false belief that all therapies are equivalent despite differences in the therapists' training, experience, theoretical orientations, and personalities
Empirically supported treatment:
: A movement in the clinical field that seeks to identify which therapies have received clear research support for each disorder, to develop corresponding treatment guidelines, and to spread such information to clinicians. Also known as evidence-based treatment.
Is DSM-5 an Effective Classification System?
A classification system, like an assessment method, is judged by its reliability and validity. Here reliability means that different clinicians are likely to agree on the diagnosis when they use the system to diagnose the same client. Early versions of the DSM were at best moderately reliable (Regier et al., 2011). In the early 1960s, for example, four clinicians, each relying on DSM-I, the first edition of the DSM, independently interviewed 153 patients (Beck et al., 1962). Only 54 percent of their diagnoses were in agreement. Because all four clinicians were experienced diagnosticians, their failure to agree suggested deficiencies in the classification system.
"Drunkorexia"
A diet fad, particularly among young women, in which the individual restricts food intake during the day so that she can party and get drunk at night without gaining weight from the alcohol
classification system
A list of disorders, along with descriptions of symptoms and guidelines for making appropriate diagnoses
Projective test:
A test consisting of ambiguous material that people interpret or respond to require that clients interpret vague stimuli, such as inkblots or ambiguous pictures, or follow open-ended instructions such as "Draw a person." Theoretically, when clues and instructions are so general, people will "project" aspects of their personality into the task (Cherry, 2015; Hogan, 2014). Projective tests are used primarily by* Psychodynamic* clinicians to help assess the unconscious drives and conflicts they believe to be at the root of abnormal functioning (Baer & Blais, 2010). The most widely used projective tests are the Rorschach test, the Thematic Apperception Test, sentence-completion tests, and drawings
Personality inventory By far the most widely used personality inventory is: the Minnesota Multiphasic Personality Inventory Two adult versions are available—the original test, published in 1945, and the MMPI-2, a 1989 revision that was itself revised in 2001
A test designed to measure broad personality characteristics, consisting of statements about behaviors, beliefs, and feelings that people evaluate as either characteristic or uncharacteristic of them. individuals indicate whether each of a long list of statements applies to them. Clinicians then use the responses to draw conclusions about the person's personality and psychological functioning (
Neuropsychological test: Bender Visual-Motor Gestalt Test
A test that detects brain impairment by measuring a person's cognitive, perceptual, and motor performances.
Psychophysiological tests: .
A test that measures physical responses (such as heart rate and muscle tension) as possible indicators of psychological problems. ex:anxiety are regularly accompanied by physiological changes, particularly increases in heart rate, body temperature, blood pressure, skin reactions (galvanic skin response), and muscle contractions
Adding additional information to diagnosis dsm 5 Each diagnostic category also has a numerical code that clinicians must state—a code listed in ICD-10
Additional Information Clinicians also may include other useful information when making a diagnosis. They may, for example, indicate special psychosocial problems the client has. Franco's recent breakup with his girlfriend might be noted as relationship distress. Altogether, Franco might receive the following diagnosis: Diagnosis: Major depressive disorder with anxious distress Severity: Moderate Additional information: Relationship distress
Characteristics of Assessment Tools
All clinicians must follow the same procedures when they use a particular type of assessment tool.
idiographic understanding:( the main focus when faced with new clients)
Idiographic understanding: An understanding of the behavior of a particular individual.
Neurological and Neuropsychological Tests
Some problems in personality or behavior are caused primarily by damage to the brain or by changes in brain activity. Head injuries, brain tumors, brain malfunctions, alcoholism, infections, and other disorders can all cause such impairment. If a psychological dysfunction is to be treated effectively, it is important to know whether its primary cause is a physical abnormality in the brain.
Response inventories: ( measure response in one area of functioning)
Tests designed to measure a person's responses in one specific area of functioning, such as affect, social skills, or cognitive processes
"Online disinhibition effect
The tendency of people to show less restraint when on the Internet
types of neuro scans
computerized axial tomography (CAT scan or CT scan), in which X rays of the brain's structure are taken at different angles and combined; positron emission tomography (PET scan), a computer-produced motion picture of chemical activity throughout the brain; and magnetic resonance imaging (MRI), a procedure that uses the magnetic property of certain hydrogen atoms in the brain to create a detailed picture of the brain's structure.
Bender Visual-Motor Gestalt Test
consists of nine cards, each displaying a simple geometrical design. Patients look at the designs one at a time and copy each one on a piece of paper. Later they try to redraw the designs from memory. Notable errors in accuracy by individuals older than 12 are thought to reflect organic brain impairment. Clinicians often use a battery, or series, of neuropsychological tests, each targeting a specific skill area
One version of the MRI, functional magnetic resonance imaging (fMRI (unable to detect subtle brain abnormalities)
converts MRI pictures of brain structures into detailed pictures of neuron activity, thus offering a picture of the functioning brain. Partly because fMRI-produced images of brain functioning are so much clearer than PET scan images, the fMRI has produced enormous enthusiasm among brain researchers since it was first developed in 1990
benefits of personality tests over projective
don't take time to administer greater retest reliability Personality inventories also appear to have more validity, or accuracy, than projective tests
Predictive validity
is a tool's ability to predict future characteristics or behavior. Let's say that a test has been developed to identify elementary schoolchildren who are likely to take up cigarette smoking in high school. The test gathers information about the children's parents—their personal characteristics, smoking habits, and attitudes toward smoking—and on that basis identifies high-risk children. To establish the test's predictive validity, investigators could administer it to a group of elementary school students, wait until they were in high school, and then check to see which children actually did become smokers.
clinical interview
is just such a face-to-face encounter .. If during a clinical interview a man looks as happy as can be while describing his sadness over the recent death of his mother, the clinician may suspect that the man actually has conflicting emotions about this loss.
One neurological test is the electroencephalogram (EEG
which records brain waves, the electrical activity that takes place within the brain as a result of neurons firing. In an EEG, electrodes placed on the scalp send brain-wave impulses to a machine