Ch 3 Abnormal Pysch
What are the major criticisms of the DSM 5?
*challenge the utility of particular symptoms or features associated with a particular syndrome ex: you have to have major depression for 2 weeks before diagnosis *DSM 5 has a heavy reliance on the medical model, sometimes behavior is too complex to only be treated via symptoms and through physical means *the medical model focuses on categorizing psychological disorders rather than describing a person's behavioral strengths and weaknesses *the DSM aims to determine what disorders people have not how well they can function in particular settings; does not have a high emphasis on behavior *the DSM might stigmatize people and label them which can create discrimination and sanism
Structured Interviews (standardized interviews)
*highest level of reliability follows -includes both close ended and open ended questions
What is the major advantage of the DSM 5?
*its designation of specific diagnostic criteria- it permits the clinician to readily match a client's complaints and associated features with specific standards to see which diagnosis best fits the symptoms
Evaluation of Projective Techniques
-Rorschach may not be reliable -an individuals response to the TAT may say more about the drawing than the person
Computerized Interviews
-becoming more widely used but probably won't replace human interviews anytime soon -may help a person admit things they would be embarrassed to admit to a person -computers lack human sensitive concerns to know when to dive deeper into a person's deepest fears, relationship problems, and sexual matters; also can't detect facial expressions *most resistance comes from clinicians not clients *computer assessments should be combined with clinical findings
self monitoring disadvantages
-clients are unreliable and do not keep accurate records -with client's consent, clinican can also get help from family members -reporting undesirable behaviors can make people see their need to change
Thematic Apperception test
-consists of cards that depict an ambiguous scene -clients reponses reflect their experiences and outlooks on lie -they are asked to describe what is happening, what led up to it, and how it ends
Minnesota Multiphasic Peronality Inventory (MMPI)
-contains more than 567 true-false statements that assess interests, habits, family relationshps, phsycial health complaints, atttidues, beliefs, and behaviors -a score of 65 or higher is clinically significant -includes validity scales to see if a client is "faking good" -many clinicians use the MMPI to gain general information about respondents' personality traits and attributes that may underlie their psychological problems, rather than to make a diagnosis
Million Clinical Multiaxial Inventory (MCMI)
-developed to help clinicians formulate diagnoses, especially for personality disorders -has a more questionable validity than MMPI
Rorschach Test
-inkblot interpretation -clinicians make interpretations on the basis of the content and the form of responses
Wechsler's Scale
-intelligence test -verbal skills, perceptual reasoning, working memory, processing speed -IQ scores based on how respondents answers deviate from those of the same age -whole test score at any age is 100
Bender Visual Motor Gestalt Test
-one of the first and most widely used neuropsychological testss -consists of geometrical figures- client is asked to copy geometric designs from memory because neurological damage can impair memory functioning *not as sophisticated as Halstead-Reitan Neuropsychological Battery
Intelligence tests
-originally made by Binet -expressed as a number IQ -Wechsler's are used most widely, different versions for different age groups, has subgroups that measure diferent intellectual abilities --> designed to show strengths and weaknesses
Evaluation of Objective Tests
-relatively easy to administer -can give insight for clinicians that they might not get from a review disadvantage: rely on individuals themselves as the source of information; they may not reflect the client's actualy feelings, because the client might say what they think is socially appropriate- this is why the tests contain validity scales; it may be limited to relatively high-functioning individuals who can read well, respond to verbal material, and focus on a potentially tedious tasks
Behavioral Assessment
-treats test results as samples of behavior that occur in specific situations rather than as signs of underlying personality traits -behavior is primarily determined by environmental and situational factors such as stimulus cues and reinforcement, not by underlying traits -focuses on clincal or behavioral observation of behavior in a particular setting -may conduct a functional analysis of problem behavior -may conduct a behavioral interview by asking history questions -direct observation* hallmark of behavioral assessment -self monitoring
Sociocultural factors in psychological assessment
-when assessing other cultures, careful translations are important to capture the meanings of the original items -assessment techniques that may be reliable and valid in one culture may not be in another, even when they are translated accurately -examiners need to ensure they are not labeling cultural differences in beliefs or practices as evidence of abnormal behaviors
4 points of controversy about the DSM 5
1. Expansion of diagnosable disorders 2. Changes in classification of mental disorders 3. Changes in diagnostic criteria for particular disorders 4. Process of Development
What 5 topics do interviewers usually cover?
1. Identifying data- sociodemographic status 2.Description of presenting problems- how does the client view the problem 3. Psychosocial history-developmental history 4. Medical/psychiatric history- is the presenting problem recurrent? 5. Medical problems/medication- current problems and treatments
What things does the client identify when they journal during a cognitive assessment?
1. The situation in which the emotional state occured 2. the automatic or disruptive thought that passed through the client's mind 3. the type or category of disordered thinking that the automatic thoughts represented 4. a rational response to the troublesome thought 5. the emotional outcome or final emotional response
3 Types of clinicals interviews
1. unstructured interview 2. semistructured interview 3. structured interview
How many categories is the DSM organized into?
20
Is the DSM descriptive or explanatory?
Descriptive, it describes the diagnostic features, it does not explain them *a diagnosis is given when a person meets the minimum description for a disorder
Brain Imaging and Recording techniques
EEG (electroenceophalograph) examines brain wave patterns associated with psychological disorders CT (computed tomography/CAT scan)- looks at brain shape positron emission tomography (PET) studies the functioning of various parts of the brain, positrons show the glucose metabolized parts of the brain magnetic resonance imaging (MRI)- donut shaped tunnel, brain can then be measured at several angles fMRI- identifies parts of the brain that become active when people engage in particular tasks such as seeing, recalling from memory, or speaking, this reveals oxygen demands in different parts of the brain
Halstead-Reitan Neuropsychological Battery
Includes subtests: 1. Category Test- measures abstract thinking, people are asked to categorize and relate words and things to each other 2. The Rhythm Test- concentration and attention, says whether the beats in each pair are the same or different 3. The Tactual Performance Test- blindfolded subject fits wooden blocks of different shapes into corresponding depressions on a form board and then they draw the board from memory
what is a second major change in the DSM 5?
It adopted a dimensional component; it expanded the categorical model that gives the evaluator the opportunity to identify gray areas
What is a change in the DSM 5 that has been well-received?
It placed a greater emphasis on dimensional assessment, this changes an assessment from describing the disorder as being just present or absent, but it also places an emphasis on the severity of the disorder
Is the DSM sensitive to cultural and ethnic factors?
Many think it needs to be more sensitive because the problem behaviors are identified via a consensus of mostly US-trained psychiatrists, psychologists, and social workers; there would probably be different responses from professionals from other countries *however the DSM 5 does place more emphasis than the other DSMs on cultural emphasis
Although researchers tend to think of medical tests as a gold standard of testing, evidence shows that psychological tests are actually on par with many medical tests in their ability to predict criterion variables such as underlying conditions of future outcomes
TRUE
The DSM recognizes that abnormal behaviors may take different forms in different cultures and that some abnormal behavior patterns are cultural-specific
TRUE
The DSM aims to determine what "disorders" people "have"-- not how well they can function in particular settings. The behavioral model, alternatively, focuses more on behaviors than on underlying processes--more on what people do than on what they "are" or "have"
TRUE *although behavioralists still use the DSM
The DSM classifies disorders people have, not the people themselves
TRUE- good quality; to label someone carries an unfortunate and stigmatizing implication that a person's identity is defined by the disorder they have
What is a major difference between the DSM 5 and DSM 4?
The DSM 4 had a multiaxial version, but it was hard to use, the DSM 5 has a simpler system that clinicians can use to render diagnostic judgements as well as identify stressful factors
What is the DSM based on?
a categorical model of classification- the clinician needs to make a categorical yes or no type of judgement about whether the disorder is present in a iven case
Automatic Thought Questionaire
a type of cognitive assessment; asks people to rate the frequency and occurance and the strength of belief associated with 30 automatic negative thoughts -higher scores are suggestive of depressive thought patterns
Dysfunctional Attitudes Scale
a type of cognitive assessment; clients rate statement associated with depression on a 1-7 scale
advantages and disadvantages to direct observation
advantage: does not rely on client's self reports -can suggest strategies for intervention disadvantages: lack of consensus in defining problems in behavioral terms -ex: clinicians must agree on what represents hyperactivity -this reduces reliability -observers may show response bias (observers need to be kept uniformed and blinded) -reactivity- people may change their behavior because they know they are being observed -observer drift- observers or raters deviate from the coding system they were trained to use -limited to measuring overt behaviors
Semistructured interview
advantage: provides more structure and uniformity; general outline of questions disadvantage: loose some spontaneity
Unstructured Interview
advantage: spontaneity and conversational style; interviewer not bound to a set of questions disadvantage: lack of standardization
Beck Depression Inventory and sociocultural perspective
an inventory of depressive symptoms used widely in the US, has good validity when used with ethnic minority groups in the US and in other cultures distinguishing between depressed and nondepressed people
What are culture bound syndromes in the US?
anorexia nervosa and dissociative identity disorder (multiple personality disorder)- these are unknown in less-developed countries
How does the DSM treat abnormal behavior?
as signs or symptoms of underlying disorders or pathologies *it does not assume that abnormal behaviors necessarily stem from biological causes or defects
Explain the critique of the expansion of diagnosable disorders for the DSM 5
called diagnostic inflation, it added more disorders to the DSM and moved them to a higher ranking disorder; this expands the number of people labeled as suffering from a mental disorder or mental illness
Explain the critique in the DSM of "changes in the diagnostic criteria for particular disorders"
changes in the clinical definitions or diagnostic criteria for various disorders, this changes the number of people that have the disorder, and critics say that some of the changes have not been sufficiently validated
sensitivity
degree to which a test correctly identifies the people that have the disorder lacking sensitivity false negatives
Define reliable
if different evaluators using the system are likely to arrive at the same diagnoses when they evaluate the same people
test-retest reliability
if it yields similar results on separate occasions
Define valid
if the diagnostic judgements correspond with observed behavior
analogue measures
intended to stimulate the setting in which the behavior naturally takes place but are carried out in laboratory or controlled settings -role playing is common -often used with phobias
define mental disorder
involve emotional distress (typically depression or anxiety), significantly impaired functioning (difficulty meeting responsibilitites at work, in the family or in society at large) or behavior that places people at risk for personal suffering, pain, disability, or death (suicide attempts, repeated use of harmful drugs)
What is a limitation of the categorical model?
it does not directly provide a means of evaluating the severity of a disorder' 2 people might have the same number of symptoms of a given disorder to warrant a diagnosis but differ markedly in the severity of the disorder
What is an effect of the DSM changing the definition of disorders and adding new disorders?
it may medicalize behavioral problems ex: temper tantrums and expectable life changes *this affects how clinicians identify, conceptualize, classify, and ultimately treat mental or psychological disorders
sociocultural factors and translations
meanings can get lost in translation and distorted -therapists may not acknowledge the idioms and symbolism in other languages
In the DSM, how are abnormal behavior patterns classified?
mental disorders
clinical interview
most widely used means of assessment -usually the clinician's first face to face contact with the client -attentive to client's verbal and nonverbals
Can brain scans see schizophrenia?
not yet, but they are well on their way
Culture bound syndromes
patterns of abnormal behavior that appear in some cultures but are rare or unknown in others
What 2 qualities must the diagnostic system demonstrate?
reliability and validity
Reliability definition and parts
reliability=consistency -internal consistency -test-retest reliability -interrater reliability
interrater reliability
relies on judgements from observers or raters; raters much show a high level of agreement in their ratings ex: both teachers agree when evaluating a child
What is one major criticism of the DSM?
relying too strongly on the medical model
criterion validity
represents the degree to which the assessment technique correlates with an independent external criterion predictive validity- a form of criterion validity; if i can be used to predict future performance or behavior
Explain the critique in the DSM of "changes in classification of mental disorders"
the DSM 5 changes the ways in which many disorders are classified , many diagnosises were reclassifed ex: Aspergers
predictive validity
the ability to predict the course the disorder is likely to follow or its response to treatment ex: people diagnosed with bipolar disorder typically respond to the drug lithium
specificity
the degree to which a test avoids classifying people that actually don't have the disorder lacking specificity= false positive
content validity
the degree to which the content of the assessment represents the behaviors associated with the traits in question ex: you would think sadness and refusal to participate would be in an assessment about depression
construct validity
the degree to which the test corresponds to the theoretical model of the underlying construct or trait it purports to measure; the outcomes match your theoretical definition of the behavior
internal consistency
the different parts of the test yield consistent results ex:if responses to a test are not correlated enough
Explain the critique of the process of development for the DSM 5
the processes of developing the DSM 5 was very secretive and did not incorporate input from leading researchers and scholars in the field
Why does the DMS continue to use the term mental disorder even though they understand that not everything is physical?
they can't agree on an appropriate substitute
validity definition and parts
validity= instruments used must measure what they are intended to measure -content validity -criterion validity -construct validity
Behavioral rating scales
~a checkist that provides information about the frequency, intensity, and range of problem behaviors -differs from self report in that items assess specific behaviors rather than personality characteristics, interests, or attitudes -often used by parents to asses children's problem behviors ex: checkboxes: refuses to eat is disobedient hits is uncooperative destroys own things -compare scores to norms for that age
Neuropsychological Assessment
~involves the use of tests to help determine whether psychological problems reflect underlying neurological impairment or brain damage -may be used in combo with MRI and CTs -may not only suggest that brain damage exists, but an also identify where 1. Bender Visual Motor Gestalt Test 2. Halstead-Reitan Neuropsychological Battery
Cognitive Assessment
~measures cognition (thoughts, beliefs, attitudes) -want to replace dysfunctional thinking patterns with self-enhancing, rational thought patterns -often done through a record or diary
Projective tests
~offers no clear specified response options -people project their own psychological needs, drives, and motives, much of which lie in the unconscious onto their interpretations of ambiguous stimuli 1. Rorschach Inkblot Test 2. Thematic Apperception Test (TAT)
Objective Tests
~self report personality inventories that use items similar to the ones just listed to measure personality traits such as emotion instability, masculinity/femininity, and introversion -tests are objective because they limit the range of possible responses and so can be scored objectively -Minnesota Mulitphasic Personality Inventory (MCMI) -Million Clinical Multiaxial Inventory (MCMI)
Physiological assessment
~the study of people's physiological responses -ectodermal response -galvanic skin response (measures the amount of electricity that passes through 2 points on the skin -electroencephalograph (measures brain waves by attaching electrodes to the scalp) -electromyograph (detects changes in muscle tension)
self monitoring
~training clients to record or monitor the problem behavior in their daily lives -behavioral diary or log -today many clients are using electronics and hand held devices