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.
- 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.
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.
- Subjective: Only looks at mental disorders
- Ethnocentric: Was made in America
- reliability/validity: It was compiled by over 1000 people and is constantly updated
- 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)
- 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
- 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?
DSM/ICD Simularities and Differences
- Both systems catagories DB in a systematic way
- Both sytsems high in validity
- Both complex systems
- Both reliable
- ICD 10 looks at physiological illnesses whereas DSM-IV doesn’t
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.
Definitions of DB Evaluations
Evaluation of Rosenhan & Seligman
-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
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
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: