Health - Dysfunctional Behaviour - Diagnosing

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.

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.

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)

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

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?

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

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.  

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

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 

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: