OCR psychology - Diagnosis of Dysfunctional Behaviours

Dysfunctional Behaviours can be considered to be behaviours that are abnormal in society, and generally stop the individual from living an independent life within society.

Psychologists and doctors who typically are the ones to dianose such behaviours will have their own explanations to what dysfunctional behaviours are, and this can often make them difficult to diagnose accurately and consistantly.

Dysfunctional behaviours that we use in the section:

Schizophrenia - A psychotic disorder which involves individuals having a 'break' from reality. You cannot learn to be Schizophrenic and it can be passed on through genes (biological).

Depression - A mood disorder where the individual can feel very 'low' (unipolar depression) or be experiencing rapid changes in high or low mood swings (bipolar depression - alternating depression and mania). This is thought to be caused by faulty/negative cognitions or thought patterns (cognitive).

Phobias - An extreme and irrational fear of something or a particular situation. Phobias are said to be learnt through classical (association) &/or operant (reinforcement) conditioning (behavioural).

There are two main dianostic manuals that are used to help diagnose dysfunctional behaviours - The Intenational Classification of Diseases (ICD) and the Diagostic & Statistical Manual to Mental Disorders (DSM).

ICD (version 10) - This manual was published by the World Health Organisation (WHO) and is used throughout many countries worldwide, including Europe.

• The draft in 1987 was used in 40 different countries to see if this improved psychiatric diagnosis across cultures.
• It's only a snapshot of the field of dysfunctional behaviours.
• It's also largely a biomedical classification of all medical diseases.

DSM (IV) - This manual was published by the American Psychiatric Association and is the handbook used most often in diagnosing mental disorders in the USA.

• It complied over 1000 people who collaborated to produce a practical guide to clinical dianoses.
• Field trials were used before publication - this resulted in simpler classifcation using criteria sets (empirical research was used to support the criteria).

The main difference between the ICD and DSM is that the DSM has a multi-axial tool...

1. Clinician has to consider whether the disorder is from Axis 1 (clinical disorders) and/or Axis 2 (personality disorders).

2. The patient's general physical condition is also considered AND any social and environmental problems --> This is used to assess the patients functioning on a scale from 1 to 100.

This makes the DSM a much more holistic manual in comarison to the ICDs rather reductionist approach to criteria-based diagnosis.

Evaluative points:

• The contents of the DSM are determined by experts who are trying to make diagnoses replicable and meaningful as possible (RELIABLE) - follows a standardised procedure to some extent.
• Are still to some extent influenced by cultural variables - e.g. in 1973, homosexuality was listed in the DSM as a diagnosable mental illness. Some clinicians may still consider it to be, depending on the culture/country.

Rosenhan & Seligman (1995) came up with criteria that covered a range of general behaviours that might help to diagnose dysfunctional behaviours...

They also proposed seven major features of abnormality that appear in abnormal behaviour as opposed to normal behaviour - the more features that are possessed by the individual, the more likely they are to be considered abnormal. Here are some examples...

Maladaptiveness behaviour - Maladaptive behaviour is behaviours that prevent an individual from achieving their life goals/living independently, from having fullfulling relationships with others, and/or working effectively.

Unpredictability and loss of control - With most people you normally predict what they will do in known situations. In contrast, abnormal behaviours are often highly unpredictability, uncontrolled and innapropriate for the situation.

Deviation from social norms - For example,  our social behaviour is governed by many unspoken rules about behaviour such as the way we maintain eye contact or personal space. When other break these rules we experience discomfort. But this doesn't necessarily indicate abnormal behaviour because in some different cultures, they may well have different social rules about behaviour.

This study looks at one of the biases that can occur when trying to diagnose dysfunctional behaviour...

Aim: To find out if clinicians were stereotyping genders when diagnosing disorders.

Methodology: A self report using an independent design.

Health practitioners were given scenarios and asked to make diagnoses based on the info.

• IV - The gender of the patient in the case study.
• DV - Diagnosis made by the clinician

Participants:

• 354 clinical psychologists --> from the 1127 randomly selected from the from the National Register in 1983.
• Mean of 15.6 years clinical experience.
• 266 psychologyists responded to the case histories.

Each participant was given a male, female or sex-unspecified case study.

Procedure:

* Participants were randomly provided with one of the 9 case histories.

--> Case studies of patients with anti-social personality disorder (ASPD), histrionic personality disorder (HPD) or an equal balance of symptoms were given to each therapist.

Therapists were asked to diagnose the illness in each case study by rating them on a seven point scale the extent to which each patient appeared to have each of the 9 disorders...

• Dysthymic
• Adjustment
• Alcohol Abuse
• Antisocial
• Cyclothymic disorder
• Narcissistic
• Histrionic
• Passive Aggressive
• Borderline personality disorder

Findings:

Sex unspecified case histories were diagnosed most often with borderline personality disorder.

ASPD correctly diagnosed in males 42% of the time.

ASPD correctly diagnosed in females 15% of the time.

Females with ASPD were misdiagnosed with HPD 46% of the time - whereas males only 15%.

HPD was correctly diagnosed in 76% of females and 44% of males.

Conclusion: Practicioners were biased by stereotypical views of genders, as there was a clear tendancy to diagnose females with HPD even when their case histories were of ASPD.