diagnosing abnormality

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  • DIAGNOSING ABNORMAL BEHAVIOUR
    • AO1
      • BASICS
        • Diagnosis is proposing a cause for a medical problem
          • Is followed by prognosis - prediction about how the problem will develop with or without treatment
        • Mental disorders diagnosed in clinical interview
          • Therapist
            • Open ended qs
            • Observations
            • Bio-metric tools
          • Complicated
            • Poor description form client
            • Difficult observations
            • No bio-metric tools
      • 4 D's
        • Basics
          • assessment tool - decide if behavior is abnormal
            • Situation/cont-ext must be considered
          • No clear diff. between normal/abnor-mal
            • Therapist judgement needed
          • Just because 4 D's present doesn't mean psychiatric diagnosis is correct
        • Deviance
          • behaviours and emotions that are viewed as unacceptable
          • Statistical deviance
            • how unusual is a behaviour
              • Extremely rare = deviant
            • Some behavior can be measured on quantitative scale
              • e.g. extroversion via psychometric tests
            • Distribution curve
              • scores cluster round mean
              • Normal = 68% in middle (1 SD = 34.1 either side of mean)
                • Odd = 2SD from mean (13.6% either side of normal)
                  • Truly abnormal = 2.1% at top or bottom of scale
            • Advantage -mathematicall-y objective
              • However ignores feelings about behaviours
                • Mental disorders becoming more common
                  • Wittchen et al. (2011)
          • Social deviance
            • social norm is an unwritten rule about acceptable behaviour
              • people stick to them
                • can differ based on culture, gender, time period, situation, age
              • violating social norm seen as abnormal
                • those people seen as eccentric/rebel-lious
                • extremely abnormal behavior - conflict with whole society
            • Advantage : define abnormality in terms of how we feel and our values
              • however its subjective
                • therapist may be influenced by own feelings rather than society's
                • can be difficult to find out social norms
        • Dysfunction
          • when the abnormal behaviour is significantly interfering with everyday tasks and living your life
            • unable to cope with the demands of everyday life
          • Rosenhan & Seligman (1989) suggest the characteristics that define failure to function adequately
            • Unpredictabilit-y, irrationality, cause discomfort to others, suffering, maladaptivene-s, vividness, violate moral standards
        • Distress
          • simple view that abnormality involves being unhappy: experiencing negative feelings like anxiety, isolation, confusion and fear
            • when these feelings become too common or persist too long
              • e.g.When Prince Albert died in 1861, Queen Victoria went into mourning for the remaining 40 years of her life
          • Problem - judging it is subjective
        • Danger
          • when the behaviour harms, or put at risk, the individual or others around them.
          • based on the harm principle
            • states that you have a right to behave in any way you like so long as you don't cause harm
              • abnormal behaviour puts yourself or other people at excessive risk
    • AO2
      • Basics
        • Mental disorders are classified into groups of symptoms
          • to provide effective treatment of a disorder, the condition needs to be accurately diagnosed
            • Diagnosis depends on a comprehensive classification system
              • DSM
              • ICD
      • Types of error
        • Type 1/False positive
          • diagnosing someone with a mental disorder when they are healthy
          • come from "reading too much" into the client's behaviour
            • also come from the fear of the consequences of a False Negative
        • Type 2/False Negative
          • diagnosing someone as healthy when in reality they are ill
            • can come from the suspicion that the client is faking their illness
        • DSM-5
          • diagnosing sc-hizophrenia
            • Two symptoms needed for diagnosis
              • has made False Positives less likely but may have caused False Negatives
      • Cultural Problems in Diagnosis
        • Psychology and psychiatry is very Western
          • psychiatrists have to diagnose mental disorders in patients from non-Western background
            • People from other cultures presenting their symptoms to a Western doctor may express themselves in unfamiliar ways
              • African-Caribbeans it is not abnormal to talk to dead relatives while grieving
                • false positive diagnosis of schizo
          • Disorders, classifications and symptoms that are recognised by Western psychiatry become "official"
            • "unofficial" mental disorders are considered to be folk illnesses and are not taken seriously. This can lead to false negative diagnosis
      • Medicalising Normal Experiences
        • concern that clinical psychologists are 'medicalising' normal experiences like sadness, anger, laziness and bad habits
          • False positives
          • Lisa Appignanesi (2008) argues there are a number of reasons for this
            • We trust doctors - accept diagnosis
            • Doctors want to help
            • We are lazy and believe that medical problems are for Doctor to fix - not for us to change
            • Companies want to sell cures
          • latest edition of DSM has been criticised for this, because it contains a lot of "new" mental disorders that include shyness and loneliness
          • Advantage - makes mental disorders more normal = people more likely to open up
    • AO3
      • Credibility
        • use of diagnostic systems means more communication between clinicians
          • increased reliability
            • Spitzer & Fleiss, 1974
          • inter-rater reliability
        • DSM and ICD always being updated
          • ensure that it is possible to make more valid diagnoses based on up-to-date evidenc
        • The DSM focuses on the Four Ds, showing each has validit
      • Objections
        • diagnosis depends on which system is used, the validity of diagnosis is in doubt of diagnosis
        • There has been found to be only a 68% agreement (Andrews et al, 1999) between the ICD and DSM
        • Rosenhan (1973) provides evidence that diagnoses are flawed
        • Since there are no objective measures of each of the four Ds, the therapist has to use their professional judgement
          • subjective

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