Transcript Abnormal Psychology Fifth Edition

Classification and Assessment of
Abnormal Behavior
Classification System is used to subdivide
or organize a set of objects. It is a list of
various types of problems and their
associated symptoms.
 Assessment is the process of gathering
information from a new patient.
 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.
 Diagnoses are made based on behaviors and thought
patterns.
Diagnosis
 Advantages:



Diagnosis can facilitate communication, research,
treatment
Clinicians use it to match their client’s problems with the
form of intervention that is most effective
Must be used in the search for new knowledge
 Disadvantages:


Diagnosis can dehumanize and stigmatize/label people
(see page 79)
accuracy/consistency questionable
BASIC ISSUES IN CLASSIFICAITON
 Categories Versus Dimensions
 Categorical Approach to Classification
 Assumes that distinctions among members of different
categories are qualitative.


Quality not quantity – represents differences
in “kind” not amount
Either
yes
no
BASIC ISSUES IN CLASSIFICAITON
 NOS—Not otherwise specified
http://www2.sunysuffolk.edu/hanauej/Abnormal/Web%20pages/Sorry,%20Your%2
0eating%20disorder%20doesn't%20meet%20our%20criteria.htm
BASIC ISSUES IN CLASSIFICAITON
 Dimensional Approach

Describes the objects of classification in terms
of continuous dimensions.
 How much of a characteristic does that
object exhibit?

This process allows scientists to record
subtle distinctions that would be lost if they
were forced to make all-or-none decisions.
CLASSIFYING ABNORMAL BEHAVIOR
Currently, two diagnostic systems for mental disorders
are widely recognized.
One—the Diagnostic and Statistical Manual (DSM)—
is published by the American Psychiatric Association.
The other—the International Statistical Classification
of Diseases & Related Health Problems (ICD)—is
published by the World Health Organization.
CLASSIFYING ABNORMAL BEHAVIOR
 Brief Historical Perspective
 1840 census: single category, "idiocy/insanity".
 1880 census seven categories: Mania, melancholia,
monomania, paresis, dementia, dipsomania, and epilepsy.
 1917, APA developed "Statistical Manual for the Use of
Institutions for the Insane" 22 diagnoses.
 Revised several times by APA over the years and called:
"Standard Classified Nomenclature of Disease", referred to
as the "Standard".
CLASSIFYING ABNORMAL BEHAVIOR
DSM I (1952) 108 disorders
DSM II (1968) 182 disorders
 Highly psychoanalytic
 Little emphasis on description
 Doubtful validity and reliability
DSM III (1980) 265 disorders
 DSM III- R (1987)
DSM IV (1994) & DSM IV-TR (2000) 297 disorders
CLASSIFYING ABNORMAL BEHAVIOR
 The DSM-IV-TR
 18 primary headings
 Lists specific criteria for each diagnostic category
 Duration of the problem is considered
 Inclusion criteria
 Employs multiaxial classification: 5 axes
CLASSIFYING ABNORMAL BEHAVIOR
 The DSM-IV-TR (continued)
 Axis I: Clinical Syndromes
 Axis II: Personality Disorders and MR
 Axis III: General Medical Conditions
 Axis IV: Psychosocial and Environmental
Problems
 Axis V: Global Assessment of Functioning
(0-100)
EVALUATING CLASSIFICATION SYSTEMS
 The DSM is an evolving document produced by the
American Psychiatric Association.
 DSM-V is due to appear in May, 2013
 Task force of 28 experts
EVALUATING CLASSIFICATION SYSTEMS
 Each time the DSM-IV-TR is revised, new categories
are added and old categories are dropped, presumably
because they are not sufficiently useful.
 Up to the present time, clinicians have been more
willing to include new categories than to drop old
ones.
BIID—Body Identity Integration Disorder
EVALUATING CLASSIFICATION SYSTEMS
 Reliability
 The consistency of measurements, including
diagnostic decisions
 Interrater reliability: agreement among raters or
judges
 Test-retest reliability - consistency or agreement
between multiple administrations of the same test
EVALUATING CLASSIFICATION SYSTEMS
 Validity
 Refers to the meaning or importance of a
measurement. Measures the test, measurement, or
category’s accuracy of diagnosis.
EVALUATING CLASSIFICATION SYSTEMS
 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
disorder.
EVALUATING CLASSIFICATION SYSTEMS
 Problems and Limitations of the DSM-IV-TR System
 Widespread acceptance of DSM-IV-TR may hinder the
consideration of promising alternative classification
systems.
 Does not classify clinical problems into syndromes in
the simplest and most beneficial way
 Comorbidity: Simultaneous appearance of two or
more disorders in the same person.
BASIC ISSUES IN ASSESSMENT
 Purposes of Clinical Assessment
 Process of collecting and interpreting information that
will be used to understand another person.
 Assessor must adopt a theoretical perspective
regarding the nature of the disorder.
 Used for several purposes

Making predictions, planning treatments,
and evaluating treatments
PSYCHOLOGICAL ASSESSMENT
PROCEDURES
 Interviews
 Most commonly used procedure in psychological
assessment.
 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.
PSYCHOLOGICAL ASSESSMENT
PROCEDURES
 Structured: a question-answer format with a specific
list of detailed questions.
 Examples:
SCID (Structured Clinical Interview for DSM disorders)
 See page 91, Table 4-4 (Assessment of Schizotypal PD)

PSYCHOLOGICAL ASSESSMENT
PROCEDURES
 Unstructured Interview
 Less standardized
 More exploratory
 Lack reliability and validity
 Semi-structured Interview
PSYCHOLOGICAL ASSESSMENT
PROCEDURES
 Personality Tests and Self-Report Inventories
 Tests designed to measure symptoms or personality
traits based on clients’ responses to structured questions
PSYCHOLOGICAL ASSESSMENT
PROCEDURES
 Personality Inventories


Sometimes called “objective tests”
MMPI-2



Straightforward questions
Validity scales
Actuarial interpretation
TABLE 4-5 Clinical Scales for the MMPI
SCALE #
1
2
3
SCALE NAME
Hypochondriasis
Depression
Hysteria
4
Psychopathic
5
Masculinity–Femininity
6
Paranoia
7
Psychasthenia
8
Schizophrenia
9
Hypomania
0
Social-Introversion
INTERPRETATION OF HIGH SCORES
Excessive bodily concern; somatic symptoms
Depressed; pessimistic; irritable; demanding
Physical symptoms that cannot be traced to a
medical illness; self-centered;
demands attention
Deviate Asocial or antisocial; rebellious;
impulsive, poor judgment
For men: aesthetic interests
For women: assertive; competitive; selfconfident
Suspicious, sensitive; resentful; rigid; may be
frankly psychotic
Anxious ;worried; obsessive; lacks selfconfidence; problems in decision making
May have thinking disturbance, withdrawn; feels
alienated and unaccepted
Excessive activity; lacks direction; low frustration
tolerance; friendly
Socially introverted; shy; sensitive;
overcontrolled; conforming
PSYCHOLOGICAL ASSESSMENT
PROCEDURES

Beck Depression Inventory (BDI-II)
 0) I do not feel sad.
 (1) I feel sad.
 (2) I am sad all the time and I can't snap out of it.
 (3) I am so sad or unhappy that I can't stand it.
 Measures: changes in sleep patterns, appetite, feelings of being
punished, thoughts about suicide, interest in sex
 21 questions
 0–13: minimal to no depression
 14–19: mild depression
 20–28: moderate depression
 29–63: severe depression.
 Higher total scores indicate more severe depressive symptoms.
PSYCHOLOGICAL ASSESSMENT
PROCEDURES
 Projective Personality Tests
 The person is presented with a series of ambiguous
stimuli.

The Rorschach Test
PSYCHOLOGICAL ASSESSMENT
PROCEDURES
 Thematic Apperception Test (TAT)