Health - Dysfunctional Behaviour - Diagnosing

Sub topic: Diagnoses of Dysfunctional behaviour

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DSM/ICD

DSM

Set up in the USA by a team of mental health professionals.

Wanted to improve the reliability of mental health diagnosis.

A multi-axial tool, with info on symptoms of 297 metal disorders, grouped into 5 axes.

  • Axis I: Clinical disorders (e.g. Depression; Schizophrenia)
  • Axis II: Personality disorders (e.g. Paranoid Personality Disorder)
  • Axis III: Physical conditions (e.g. Brain injuries)
  • Axis IV: Environmental factors contributing to the disorder
  • Axis V: Numeric scale - to rate how well an individual is coping.
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DSM

Reliability:

  • Inter-rater reliability of DSM was 'fair to good', and test-retest reliability is 'fair at best'. This shows the DSM isn't a very reliable source for diagnosis of depression.
  • Keller et al – suggested the reason why low reliability for diagnosing depression is you need 5 out of 9 symptoms to be diagnosed. So because someone believes you don’t have the fifth symptom, could stand between being diagnosed with depression or another less serious illness.

Validity:

  • Some patients with major depressive disorder or dysthymia, had overlap of symptoms between the different types of depression, making it hard to justify which type the patient had.

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DSM Evaluation

Evaluation Issues:

  • Subjective: Only looks at mental disorders
  • Ethnocentric: Was made in America
  • reliability/validity: It was compiled by over 1000 people and is constantly updated

Debates:

  • Holistic vs. Reductionism:Only looks at mental disorders

Useful when diagnosing mental disorders 

Positives and Negatives:

  • +Generally accepted to be valid classifications system
  • +Explicit criteria for diagnosis
  • +Axes are specific
  • +holism- looks at 5 different axes so doesn’t just focus on one thing
  • - Not straightforward to use (complex system)
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DSM/ICD

ICD:

  • manual published by World Health Organisation (WHO)
  • used to diagnose physical and mental conditions
  • each disorder has description of main features + important associated features
  • diagnostic section - how many of each feature + balance between dif types needed
  • gives more possible categories
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ICD

Evaluation Issues:

  • Its useful to use ICD to diagnose DB as it enables people to obtain a formal diagnosis so that help and support can be obtained
  • Reliability- Do all psychiatirists use the same systems and get the same diagnosis?
  • Validity- Does the system allow for correct doagnosis
  • Usefullness- Gives us a base. What if we didn't have the systems? How would we diagnose?
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DSM/ICD Simularities and Differences

Simularities:

  • Both systems catagories DB in a systematic way
  • Both sytsems high in validity
  • Both complex systems
  • Both reliable

Diferences:

  • ICD 10 looks at physiological illnesses whereas DSM-IV doesn’t
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Definitions of DB

Rosenhan and Seligman (1989): Elements of abnormal behaviour; suffering, loss of control, violation of moral and ideal standards, irationality maladaptiveness.

Deviation from statistical norm: Deviating from the average. Anyone at either end of the normal distribution curve is 'abnormal'. e.g. Tall/short, high IQ/low IQ. (bell graph) 

Deviation from social norm: Commonly held norms of society, how people think others should behave. i.e. Culture. These norms can vary over time.

Deviation from ideal mental health: If characteristics could be determined for ideal mental health, people who do not possess those are seen as 'abnormal'. 

Failure to function adequately: People who experiance personal distress and seek help from health care proff's adopt the 'sick role' that goes with it.  

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Definitions of DB Evaluations

Evaluation of Rosenhan & Seligman

Issues:

-Deviation from social norms definition: Social norms vary across cultures, e.g. in some Greek villages, fire walking is a normal thing to do, but in the UK it would be seen as abnormal It’s era-dependent as social norms vary through time, e.g. until 1967, homosexuality was illegal in the UK, now its widely accepted -Failure to function adequately definition: They might not be functioning adequately due to social/economic conditions Some people may appear to function adequately but in fact have a psychological abnormality

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Biases in Diagnosing

Ford and Widiger (1989) -looked at sex bias in diagnosis 

Aim - to investigate if health professionals introduced gender bias in their diagnosis

sample - 266 clinical psychologists (randomly assigned a case history of a patient, some had ASPD and some HPD or both)

procedure - they had to diagnose the illness of them. 7 point scale. cases rated on how much they had each symptom.

findings - unspeicified cases were mostly diagnosed with borderline personality disorder

-ASPD correctly identified in males 42% of the time whereas women 15% 

-ASPD misdiagnosed in males 46% of time and females 15% of time

-HPD correctly diagnosed in females 76% of the time 

 

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Biases in Diagnosing Evaluation

Evaluation: Issues: Ethnocentrism- done in America using American psychologists- might not get the same results with British psychologists for example. E.V.- they only read case histories, and didn’t actually meet the patients. Generalisabilty- the sample was made up of keen psychologists with 15 years of experience, so it cant be generalised to newer psychologists who have seen less cases of the disorders.  Debates:

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