Diagnosis of dysfunctional behaviour

Categorising disorders - DSM/ICD

Definitions of dysfunctional behaviour - Rosenhan and Seligman

Biases in diagnosis - Ford and Widiger

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  • Created by: Amy Leech
  • Created on: 19-03-13 09:04

Categorising mental illness - ICD/DSM

DSM-IV -American                                                       ICD-10 - World Health Organisation

Axis 1: Clinical disorders e.g. alchohol abuse              Each disorder is listed in one of 11 categories              

Axis 2: Personality disorders e.g. Histrionic                 Personality disorders are category 9

Axis 3: General medical conditions e.g. cancer           Medical conditions are covered in the first category

Axis 4: Psychosocial problems e.g. divorce                 Built into groupings of the disorders are the causal factors

Axis 5: Global assessment of functioning                    There is no global assessment of functioning seperately

The DSM-IV contains over 200 mental disorders, arrange din various categories. Most of these categories are wide-ranging. The disroders are defined by sympto,s rather than by features believed to cause each disorder. Each diagnostic category is based on prototypes - sets of features that are believed to be characteristic of that category. Some categories are still controversial, for example dissociative identity disorder and dissociative amnesia.

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Categorising mental illness - ICD/DSM

Evaluation: Psychiatrists don't always agree on a diagnosis using the same systems. This is because symptons overlap and occur in clusters with no clear boundaries. Diagnosis depends on the clinical interview and this in turn depends on how honest and open the patient is about their symptoms. Ahigh proportion of mental illnesses are diagnosed 'unspecified' in ICD-10 or 'not otherwise specified' in the DSM-IV. this suggests the criteria are not working well, Cultural changes affect inclusion of symptoms, e.g. homosexuality has been removed.

The nature/nurture debate can be applied - are mental illnesses inherited or learnt? Free will vs. determinism - at what point does a mentally ill person lose free will? Psychology as a science - where is the science in diagnosis? Why no hard and fast tests?

The new systems will be more descriptive and will increase validity because a long process of discussion is going on world-wide to agree the new categories.

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Rosenhan and Seligman; Defining abnormality

Aim: To try and define what we mean by someone who is abnormal generally.

Background: Rosenhan has attempted to define what we mean by abnormaility:  Statistical Infrequency: for instance one may say an individual who has an IQ below or above average level of IQ in society is abnormal. Violation Of Social Norms: a persons thinking or behaviour is classified as abnormal if it violates the rules about what is expected or acceptable behaviour in a particular social group. Failure To Function Adequately: an individual may be unable to perform the bahviours necessary for day-to-day living, e.g. self-care, hold down a job.

Rosenhan and Seligman suggest the following characteristics that define failure to function adequately: suffering; maladaptiveness; vividness and unconventionality; unpredictability and loss of control; irrationality/incomprehensibility; casues observer discomfort; violates moral/social standards.

Deviation from Ideal Mental Health: under this definition, we define what is normal and anything that deviates from this is regarded as abnormal. Normality is a: pozsitive view of the self; capability for growth and development; autonomy and independence; accurate perception of reality; positive friendships and relationships; environmental mastery - able to meet the varying demands of day - to day situations.

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Rosenhan and Seligman; Defining Abnormaility

Evaluation: Many very gifted individuals could be classified as 'abnormal' using this definition. Some characteristics are regarded as abnormal even though they are quite frequent e.g. depression may affect one in five of the elderly. This would make it common but that doesn't mean it is not a problem. Drink driving was once considered acceptable but its now seen as socially unacceptable whereas homosexuality has gone the opposite way. Many people engage in behaviour that is maladaptive/harmful or threatening to self, but we dont not class them as abnormal, e.g. adrenaline sports.

Is psychology a science? Why are there no agreed biological or clinical tests for abnormality yet? No definitive agreement between practitioners weakens the credibility of the subject. Ethonocentrism - is abnormality as we know it a westernised idea? Are mentally ill people seen differently in other parts of the world?

There are problems with every definition and some people argue that we are on a continuum for most behaviour.

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Ford and Widiger; Sex bias in the diagnosis of his

Aim: To assess whether sex bias is prevalent in diagnosis of mental disorders and if this can be minimised by the explicit criteria in the DSM-III manual.

Background: There is a difference in the number of males and females diagnosed with histrionic personality disorder (HPD) and antisocial personality disorders (APD). This has been attributed to sex bias.

Sample: 354 psychologists. Of these, 76% were men with an average of 15.6 years of experience using a variety of therapies.

Method: This was a self-report where psychologists responded to a series of case histories and made a diagnosis using DSM-III criteria.

Procedure: The 266 psychologists were given one of nine case histories involving a female, a male or a sex-unspecified patient each time. The case histories included the symptoms needed by the DSM-III for the unique diagnosis of APD or HPD or they were mixed together in the 'balanced' histories. The psychologists used 7-point scales to say how confident they were the patient had each condition. An independent panel of 88 psychologists rated how closely the case histories were examples of a histrionic or antisocial condition.

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Ford and Widiger; Sex bias in the diagnosis of his

Results: The sex-unspecified group was mostly diagnosed with borderline personality disorder and no particularly APD or HPD. The individual lists of symptoms were found to be 80% representative of APD and HPD by the panel of 88 and there were no male/female differences found in the lists. With HPD, males were 44% and females 76% more likely to be diagnosed with the condition. With APD, females were 15% and males 42% more likely to be diagnosed with the condition. Male and female psychologists were equally likely to make these diagnoses. This showed clearly the bias in diagnosis when all else was controlled.

Evaluation: The unbalanced sample of only 24% females could be a problem for calculating male/female differences in the clinicians themselves. Psychology as a science - difficulty of agreed diagnosis by psychologists from a variety of backgrouns suggest the process is not very scientific. Ethnocentrism - clearly cultural beliefs about the roles of men and women affected by diagnosis in this study. The fact that the individual behaviour lists did not elicit a sex bias suggest that it is the label of the illness itself which causes a stereotyped response and this is important in future labelling of illnesses in the revisions of these manuals.

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alison corob

this is categorized under history of art, which it clearly is not- better put in psychology section

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