Clinical Psychology - Reliability, validity and culture issues regarding diagnosing mental disorders

Description and evaluation of the reliability, validity and cultural issues of the DSM and other diagnostic classification systems for mental disorders using studies to support or conflict with each factor. 

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The DSM is the American system used to
diagnose and classify mental disorders.
There are 14 major categories and it is based
on five axes.
The british classification system is called the
International classification of diseases (ICD).…read more

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1. Disorders usually diagnosed in infancy, childhood or
2. Delirium, dementia amnestic and other cognitive disorders
3. Substance related disorders
4. Schizophrenia and other psychotic disorders
5. Mood disorders
6. Anxiety disorders
7. Somatoform disorders
8. Factitious disorders
9. Dissociative disorders
10. Sexual and gender identity disorders
11. Eating disorders
12. Sleep disorders
13. Impulse control disorders not elsewhere classified
14. Adjustment disorders…read more

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Axis 1 and 2 concern the diagnosis of mental disorders ­ axis
1 looks at all disorders apart from personality disorders and
mental retardation which are in axis 2.
The other three axes look at factors that may affect the
mental disorder or it's treatment:
Axis 3 looks at general medical conditions as the symptoms
of some conditions are similar to mental disorders.
Axis 4 looks at psychosocial and environmental problems
which may have an effect on the disorder. Such as family
problems, problems with employment and social problems.
Axis 5 is called the global assessment of functioning (GAF)
scale which ranges from 100 to 0. The patient has to assess
how able the patient is to cope with everyday life and
how urgent their need for treatment is. Someone with a
score of 100 has perfect functioning but someone with a
score of 40 can have serious problems in particular areas
such as family relationships, ability to hold down a job and
ability to think rationally.…read more

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Several studies have looked at the inter-rata reliability of the
DSM with varying results:
Brown et al (1996) found that there was a 67% agreement
rate for major depression ­ good reliability.
Davison and Neale (1994) found variable reliability rate for
different disorders, with 92% for psychosexual disorders
but just 54% for somatoform disorders.
Willemse, Van Ypreen and Rispens (2003) tested the
reliability of ICD 10 for childrens disorders and they found
that unless the category was objective the reliability was
poor, especially when the diagnosis was based on
observations of the children.
However it has been argued that the reliability of
classification systems is as good as the reliability for medical
disorders. This was shown by Falek and Moser (1975) who
found a 66% agreement rate between what doctors indicated
was the cause of death without aid of tests and post mortem
findings.…read more

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A classification system needs to be valid so that it can correctly diagnose
the mental disorder and accurate predictions can be made about
development and treatments.
A diagnosis can have three types of validity:
1. Etiological validity ­ a group of people who have been diagnosed with
the same disorder will have the same factors causing it e.g. is
schizophrenia is caused by too much of the neurotransmitter
dopamine, then to have etiological validity, people diagnosed with
schizophrenia should all have an excess of dopamine in their brain.
2. Concurrent validity ­ symptoms that form part of the disorder but
are not part of the actual diagnosis should be found in those
diagnosed. E.g. schizophrenics often have problems with personal
relationships but this is not a characteristic that is looked at when
diagnosing the disorder.
3. Predictive validity ­ if a diagnosis can lead to a prediction of future
behaviours caused by the disorder. If a diagnosis has predictive
validity we should be able to say whether a person is likely to
recover or whether the symptoms will continue. It should also be
possible to predict how patients will respond to treatment.…read more

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A very useful presentation, many thanks!

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