Features of the DSM
- DSM-IV contains over 200 mental disorders arranged in various categories. Most of these categories are very wide-ranging.
- The disorders are defined by symptoms rather than by features believed to caused each disorder.
- Each diagnostic category is based on prototypes - sets of features that are believed to be characteristic of that category. Some of these symptoms are essential for a diagnosis, others often occur but are not always present.
- Some categories are controversial e.g. dissociative identity disorders and dissociative amnesia.
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Summary of the DSM
- DSM stands for 'Diagnostic and Statistical Manual of Mental Disorders'.
- Published by American Psychiatric Association (APA).
- Used aroun the world.
- First published in 1952 and has been revised 5 times. DMS-IV was published in 2000 and DSM-V was published in May 2012.
- Developed in response to the need for a consus of mental health disorders.
- US army developed a system to diagnose mental disorders using descrptions and classification, such as neuroses and psychoses.
- Lists of symptoms developed and were refined.
- Most utilised.
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- The DSM has five axies: each diagnosis of a disorder is split into five levels called aces that relate to different aspects of a disorder.
- A patient is put into a category using symptoms.
- Axis I considers clinical disorders, major mental disorders, developmental disorders and learning disorders.
- Axs II looks at underlying personality conditions.
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Reliability of the Diagnosis of Mental Disorders
- The DSM's reliability rests on the question of whether one person's set of symptoms would lead to a common diagnosis by different physicians.
- If different doctors give different diagnosis for the same set of symptoms (e.g. fot the same person), then the diagnosis aren't reliable and the treatment may not work.
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- Tested DSM-III for reliability and found that there was reliabikity.
- Looked at effect of gender on the experience of schizophrenia.
- Re0diagnosed 199 oatients using DSM-III when they had originally been diagnosed using DSM-II.
- Goldstein asked other experts to carry out the re-diagnosis seperately, using a single blind technique.
- She asked 2 experts to re-diagnose a random sample of eight patients bevaise she was aware of the hypothesis.
- The experts were given copies of case histories with any reference to the original diagnosis removed.
- Found a high level of agreement and inter-rater reliability.
- Suggests that DSM-III is a reliable tool.
- As later versions of the DSM have focused o improving validity and reliability, it's likely that DSM-IV-TR is also reliable.
- (more detailed version in own revision card stack).
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Brown et al (2001)
- Studied anxiety and mood disorders in 362 out-patients from Boston.
- Went to 2 independent interviews and used the DSM-IV.
- They found high reliability and high intrt-rater reliability.
- Disagreements weren't over symtpoms but over quality of symptoms.
- Problems for major depressive and anxiety disorders with boundaries - harder to diagnose.
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- Tested reliability and validity.
- Looked at diagnosis of pathological gambling.
- 803 males and females.
- 250 on treatment programmes
- Found DSM criteria reliable and valid.
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Kirk and Kutchins (1992)
- Formulated a review paper - methodological issues with stuides on reliability of DSM to 1992.
- Suggested generalisability limited.
- Other studies used interviews and questionnaires, Kirk and Kutchins argued training and skills of interviewers insufficient.
- Many participants took part in specialised research settings rather than clinical settings.
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Validity and the Diagnosis of Mental Disorders
- If the DSM weren't reliable it wouldn't be valid either.
- If a diagnosis was done again and the DSM provided a different one, then it wouldn't be a valid diagnosis.
- Validity in diagnosis means that it would be measuring what it claimed to measure so therefore reliability and validity go together.
- Does it do what it says it does? i.e. identify people who need help and name the illness. Do all people who have those symptoms have that illness? Do all the people labelled as having the illness ave the care symtpoms.
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- For a disgnosis to have concurrent validity symptoms that form part of the disorder but aren't part of the actual diagnosis, should be found in those diagnosed.
- E.g. Schizophrenics often have problems with personal relationships, but this isn't a characteristic that's looked at when diagnosing them according to the classification system.
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- Convergent validity is when a test results converges on another test result that measures the same thing.
- A correctional test result that measures the same thing.
- If two scales measure the same construct, for example, then a person's score on one should converge with (correlate with) their score on the other.
- The difference between convergent valicity and predictive/concurrent validity is that in convergent validity the two measures should be measuring exactly the same thing, whereas in the other two types of validity there can be a different way of measuring each case.
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- Predictive validity is present if diagnosis can lead to a predicition of future behaviours caused by the disorder.
- If a diagnosis has predicitive validity we should be able to say whether the person is likely to recover or whether the symptoms will continue, it should also be possible to predict how someone with a specific disorder will respond to specific treatments.
- E.g. the drug lithium corbonate is effective for bipolar disorder, but not effective for other mental disorders. If a classification system has good predictive validity and diagnoses someone with bipolar disorder, they should respond to lithium carbonate.
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- If the DSM is to define mental disorders, then mental disorders need to be operationalised.
- List of symptoms and behaviour are the result of making a mental disorder measurable.
- It has been argued that in operationalising a concept such as depression, something is lost from the understanding of the nature of the whole experience of depression, which means that the DSM isn't a valid tool.
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- Once diagnosed the treatments should work. If you have diagnosed correctly and the treatment has worked then this is a good sign for the validity of your diagnostic tool.
- There are very conflicting views; certainly treatments don't work all the time which we would expect it truly valid. But doctors claim a high success in controlling symptoms from anti psychotic drugs and in helping with clinical depression.
- If the drugs work on the illness that has been named then it's likely that you have correctly named and diagnosed the illness/problem.
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- If an illness exists as such then we would expect it to run in families.
- Psychiatrists/doctors are the amin users of DSM, with their medical background they tend to lean towards a biological explanation.
- They view the fact that specific mental illnesses such as depression and schizophrenia runs in families as clear evidnece for validity for their tools.
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Cultural Bias in the DSM
- DSM-IV has made modest attempts to address cultural issues by reffering to culture-bound syndromes in its Appendix. At present it's unclear whether all of the culture-cound syndromes listed are specific to one or a very few cultures. It's also unlikely that this list includes more than a small percentage of such syndromes.
- Most of the classification system are based on the Western view of what is abnormal, and therefore can be considered to represent 'psychiatric imperalism'. Paniagua (2000) argues that we can't use a Western classification syste (i.e. DSM) to accurately calssify from other cultures.
- Littlewood and Lipsedge (1997) have suggested that the reason why black and Irish people in Britain are more likely than others to receive a diagnosis of serious mental disorder has more to do with bias in the system than a genuine greater vulnerability in those groups. They describe the case od Calvin, a Jamacian man arrested following an argument with the police when a post office clerk believed he was cashing a stolen postal order.
- It's been argued that male-based assumptions influence what is included in the DSM. Ford and Widger (1989) presented the same profiles labelled with either a make or a female name to therapists and found that those labelled as men were more likely than those considered female to be diagnosed with anti-social personality disorders. Conversely, those labelled as female were more likely than those regarded as male to be diagnosed as histrionic personality disorder.
- However, Funtowicz and Widiger (1999) found no evidence of sec bias when diagnosing personality disorders - they found no difference in the level of impairment suggested in the personality disorder (PD) diagnosis of male-typed PDs than female-typed PDs.
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