Ch. 4-Classification & Assessment of Abnormal Behavior

History of Classification

-In the U.S., the initial reason for developing a classification of mental disorders was the need to collect statistical information now it's for clinical utility and the facilitation of research

Structured Interviews

-A question-answer format with a specific list of detailed questions -Used for collecting info that'll be used to make diagnostic decisions and rate the extent to which a person is impaired by psychopathology Advantages -Interviewer controls interaction and can probe when necessary -Nonverbal behavior can be observed, allows interviewer to detect areas of resistance -Valuable information in a short time, can cover past events and different settings Limitations -Patients may be unwilling (young children, psychotic and demented patients) -Reluctant to admit embarrassing/frightening experiences -Accounts may be distorted -Interviewers can influence clients' accounts

Categorical approach to classification

-Assumes that distinctions among members of different categories are qualitative -Differences reflect a difference of kind (quality) rather than a difference in amount (quantity)

Interviews

-Most commonly used procedure in psychological assessment -Most of DSM-5 categories are based on information that can be collected in an interview and official records -Provide an opportunity to obtain people's own description of their problems -Allow clinicians to observe important features of a person's appearance and nonverbal behavior

Brain Imaging Techniques Limitations

-Norms unavailable, not possible to use these images for diagnostic purposes -Expensive -Patient exposed to radioactivity -Localizations of brain functions not fully known

Advantages of MMPI-2

-Provides information about a person's test-taking attitude (alerts to whether they are careless, defensive, or exaggerating their problems) -Covers a wide range of problems directly and efficiently -Scored objectively (not effected by clinician's impression of client) -Can be interpreted in an actuarial fashion

Assumptions about Consistency of Behavior

-Psychologists must be concerned about the consistency of behavior across time and situations -Psychologists generally seek out more than one source of information when conducting an assessment

Historical Census Categories of Abnormal Behavior

-The first attempt was in the 1840 census recording either "idiocy" or "insanity" -By 1880, there were 7 categories: Mania, Melancholia, Monomania, Paresis, Dementia, Dipsomania, Epilepsy

Purposes of Clinical Assessment

-The need to describe the nature of a person's principal problem -To make a diagnosis -Used for making predictions, planning treatments, and evaluating treatments -Check effectiveness of treatment programs

Rating Scales (observational procedures)

-The observer is asked to make judgments that place the person somewhere along a dimension -Provide abstract descriptions of a person's behavior rather than what they have specifically done -Can also be based on info collected from an interview

Projective Personality Tests Advantages

-some people may feel more comfortable talking in an unstructured situation than in an interview or lengthy MMPI -can provide interesting source of info regarding the person's unique view of the world and useful to supplement obtained assessment tools -may provide more insight then in observational procedures

Stigma

-stamp or label that sets the person apart from others, connects the person to desirable features and leads others to reject the person

Brain Imaging Techniques Advantages

-Can be used to rule out various neurological conditions (brain tumors and vascular disease) -fMRI and PET explore relationship between brain functions and specific mental disorders

Classifying Abnormal Behavior

-Classification systems in the past have been criticized for inconsistency between clinicians Two diagnostic systems currently used: Diagnostic Statistical Manual (DSM) -Published by American Psychiatric Association -DSM-5 is the most recent version International Classification of Diseases (ICD) -Published by World Health Organization -ICD-10 currently in use

Why a diagnosis?

-Clinicians use it to match their clients' problems with the form of intervention that is most effective -Must have common nomenclature in the search for new knowledge

Etiological validity

-Concerned with factors that cause or contribute to the onset of the disorder -aka things that happened in the past

Concurrent validity

-Concerned with present time and correlations between disorder and other symptoms, circumstances, test procedures -aka is the disorder currently associated with any other types of behaviors -clinical studies that are aimed at developing a more precise description of a disorder also fall into this type of validity

Predictive validity

-Concerned with the future and with the stability of the problem over time

From Description to Theory (classifications)

-Currently mental disorders are classified on the basis of their descriptive features or symptoms -Focuses on a specific characteristic and determines how much of the characteristic the object exhibits -Explanations for mental disorders are a complex interaction of systems (psychological, biological, social) -Quantitative

Dimensional approach to classification

-Describes the objects of classification in terms of continuous dimensions -How much of a characteristic that object exhibits

Behavioral Coding Systems

-Focus on the frequency of specific behavioral events and requires fewer interferences on the part of the observer -used more in research setting than clinical setting -Self-monitoring-client keeps track of own behavior

Diagnosis

-Identification or recognition of a disorder on the basis of its characteristics -Enables the clinician to refer to the base of knowledge that has accumulated with regard to the disorder -Assigning a diagnosis does not mean that the etiology is known, simply identifies the nature of the problem not the cause

Projective Personality Tests Limitations

-Lack of standardized administration and scoring -Little information on which to base comparison to normal adults or children -Time-consuming -Mixed opinions on reliability and validity

Observational Procedures

-May be formal or informal (qualitative) -Often conducted in the natural environment, sometimes in controlled situations -Observation rooms

Validity

-Refers to the meaning or importance of a measurement in this case a diagnostic decision -Categories included in DSM-5 based on: results of research studies and clinical experience -this and psychiatric diagnosis are an evolving process

Evaluating the Usefulness of Assessment Procedures

-Reliability-various types of consistency -Test-retest-consistency of measurements over time -Split-half reliability-internal consistency of items -Cultural differences present a challenge because differences span language, religion, gender roles, beliefs on health, attitudes towards the family can impact how psych problems are experienced and expressed -Validity-meaning or importance of an assessment procedure (think: does the test/procedure actually measure what it is designed to measure?)

Brain Imaging Techniques

-Some of these procedures provide static pictures of various brain structures at rest -Others create dynamic images of brain function -Magnetic Resonance Imaging (MRI)-provides precise measures of brain structures though a magnet that causes specific brain regions to emit certain signals -Computed Tomography (CT)-provides static images of brain structures -Positron Emission Tomography (PET)-creates functional brain images, requires nuclear cyclotron to produce radioactive elements -Functional MRI (fMRI)-identifies changes in brain activity that last less than a second, relies on blood flow and magnetic properties

Personality inventories

-Sometimes called "objective tests" -consists of a series of straightforward statements where the person being tested is required to indicate whether a statement is true or false in regards to themselves -i.e. MMPI-2

MMPI-2

-Straightforward statements (500) -covers topics ranging from physical complaints and psychological states to occupational preferences and social attitudes -Most widely used psychological test -Person receives a numerical score on each of 10 clinical scales, and four validity scales -The L (Lie) Scale-sensitive to unsophisticated attempts to avoid answering in a frank and honest manner -Actuarial interpretation: analysis of results based on explicit rules derived from empirical research (probability statements)

Culture and Classification

-The DSM-5 encourages clinicians to consider the influence of cultural factors in both expression and recognition of symptoms of mental disorders -Also attempts to sensitize clinicians to cultural issues by including a discussion of cultural concepts of distress/culture-bound syndromes/idioms of distress -Think of ataques de nervios

Herman Rorschach (1884-1922)

-The Rorschach Test-series of 10 inkblots; no correct answers; scored by Comprehensive System (objective) or through impressionistic procedures -The Thematic Apperception Test (TAT)-series of drawings that depict human figures in various ambiguous situations

Unresolved Questions

-The boundary between normal and abnormal behavior -Clinicians must rely on their own subjective judgment -Cutoff points required for a diagnosis -Specific time periods used in the definition of various disorders

Reliability

-The consistency of measurements, including diagnostic decisions -Interrater reliability-agreement among raters using DSM-5

Projective Personality Tests

-The person is presented with a series of ambiguous stimuli -Uncover person's unconscious motivations -i.e. Rorschach Test and TAT

Observational Procedures Disadvantages

-Time-consuming, expensive, raters require extensive training -Prone to observer errors and bias, reliability of ratings and behavioral coding must be monitored -Reactivity-people may alter behavior intentionally or unintentionally, when they know it is being observed -Only tell about particular situation that was selected to be observed, we don't know how they'll act elsewhere -Some aspects of psychopathalogy cannot be observed (i.e. subjective experiences like guilt and low self-esteem)

Observational Procedures Advantages

-Useful as an overall index of symptom severity/functional impairment -Provide detailed information about a person's behavior in a particular situation

Limitations of MMPI-2

-Utility of the traditional clinical scales questioned in regards to ability to distinguish between different mental disorders -Test depends on person's ability to read and respond to written statements -Actuarial interpretation not possible for particular profiles (specific data isn't always available) -Profile types not stable over time (not sure if it's lack of reliability or as sensitivity)

Problems and Limitations of the DSM-5 System

-Vague boundaries between normal and abnormal behavior -DSM-5 is based on categorical approach to classification, while symptoms are dimensional in nature -Absence of a specific definition of social impairment -Not a simple and beneficial classification of clinical problems into syndromes -Comorbidity-simultaneous appearance of two or more disorders in the same person -Fails to make better use of information regarding the course of mental disorders over time -Disorders are defined in terms of snapshots of symptoms at particular points in time -Insufficient emphasis on questions regarding lifespan development

Labeling Theory

-a perspective of mental disorders that is primarily concerned with the negative consequences of assigning a diagnostic label (about how people think of themselves and others think of them) -concerned with social factors that determine whether a person will be given a psychiatric diagnosis rather than the psychological or biological reasons for the abnormal behavior

nondirective interview

-clinician follows the train of thought supplied by the client -helps people to clarify their feelings and to provide general empathic support for what they may decide to do about their problems

The DSM-5 System

-defines mental disorders in terms of the individual rather than relationships or family systems -more than 200 specific diagnostic categories -arranged under 22 primary headings Lists specific criteria for each diagnostic category -Inclusion criteria-symptoms that must be present -Exclusion criteria-diagnosis can be ruled out if certain conditions prevail -A person can be assigned more than one diagnosis if criteria for more than one disorder are met

open-ended interview

-question/answer format

Barnum Effect

-refers to the practice of saying things about a specific person that is true can be true of virtually all people -named after P.T. Barnum who called his circus "The Greatest Show on Earth"