Clinical Psychology Notes
5.1.1 Diagnosis of mental disorders, including deviance,
dysfunction and distress
Deviance – Deviance is when behaviour is considered abnormal in society.
How unusual a behaviour is can be decided statistically. Extremely rare
people can be considered deviant – and when people violate social norms,
this is abnormal
-Risk of subjectivity
Deviance - who decides what is normal? Distress - everyone has a
different level of upset by different things
This is a weakness because… we must look at how the patient is coping
not just the symptoms being discussed, as everyone experiences
symptoms differently
Dysfunction – when abnormal behaviour is interfering with daily tasks and
life. Can’t cope with the demands of every-day life – looking after yourself,
making yourself understood etc
-The use of interviews for sensitive data
This is a weakness because… practical issues arise. In clinical interviews -
unstructured/semi-structured questions lead to issues of reliability and
validity, as they are open to subjectivity. Furthermore, the interviews
would be based on self-report data - some patients also withhold or
change their data, which leads to a misdiagnosis
Distress – Abnormality involves being unhappy, leads to negative feelings
such as anxiety, isolation, fear – especially when they exist over a long
period of time
+Trying to be objective
This is a strength because… clinicians must explore all 4D's - some of
these are based on standardised measures – specifically distress and
danger
Danger – consists of two broad themes – danger to selves and danger to
others – lost of psychologically healthy people engage in dangerous
activities such as sports, so diagnosis must be required if the danger is
excessively risky
+Connecting diagnoses to everyday life
This is a strength because it means we can protect society and the
individual from danger. If the individual gets treatment, then level of
distress can be addressed and quality of life improves.
,However, there are issues of social control - clinicians are given a lot of
power over diagnoses... Some patients could be sectioned against their
will according to the Mental Health Act
(Duration - this is important because all behaviours can exist in the short
term/and merit a different diagnosis)
5.1.2 Classification systems (DSM IVR or DSM V and ICD) for
mental health, including reliability and validity of diagnoses
Diagnostic manuals allow clinicians to make objective, reliable diagnoses
DSM and ICD are most popular – they contain the classifications of
disorders into different types and symptoms of disorders (E.g. physical or
behavioural changes)
The DSM – Diagnostic and statistical manual of mental disorders
- The DSM is a diagnostics manual of mental health conditions
collated by the APA
- First DSM was published in 1952 for the diagnosis of WW2 men. Lots
of updates – for example homosexuality used to be labelled as a
sociopathic personality disorder
- It contains different sections and chapters organised around the
common symptoms of the disorders
- Section 2 lists and categorises disorders and how they manifest over
a lifespan is also taken into consideration
- Now the DSM uses a symptom-based approach that doesn’t put
disorders into sub types but has a multi-dimensional assessment
- Clinicians would use the DSM to aid a clinical interview to rule
out/consider specific disorders
+ There is evidence to suggest that diagnosis using the DSM V is reliable.
Brown 2001 found that the reliability of mood disorders and anxiety were
found to be excellent. This is a strength as it shows that the DSM can help
clinicians give an accurate diagnosis
+Looking at the DSM, Kim-Cohen et al 2005 demonstrated the
concurrent validity of conduct disorder by interviewing children and their
mothers and observing anti-social behaviour. Predictive validity was also
measured… 5 y/o children with CD would show difficulties at age 7, too.
This is a strength as it shows that the DSM can accurately diagnose
disorders for the long term too, and this means that adult mental health
problems could reduce as they are frequently preceded by the symptoms
of CD
-There is evidence that suggests the DSM is not reliable for all disorders.
Regier 2013 found that major depressive disorder had a poor reliability
, score. This is a weakness because it means for some disorders patients
may not be diagnosed or misdiagnosed.
The ICD – international statistical classification of disease
The ICD is a diagnostic system that includes all diseases, physical and
mental used by clinicians to diagnose service users (1).
If the service user presents with a possible mental health disorder the
clinician would use the section that focuses on mental and behavioural
disorders (1).
For each mental health disorder, it gives a clinician the main features and
the symptoms needed to make a diagnosis (1),
for example, the ICD 10 states that paranoid schizophrenia is dominated
by relatively stable, paranoid delusions, often with hallucinations (1).
- In multiple languages so data can be collected and compared by
clinicans around the world
- Clinician selects key words from an interview with the patient that
describes their symptoms, to use these words and locate correct sub
category
+ Longitudinal studies on the ICD found that people who retain the same
diagnosis when reassessed increased 26% for schiz. This is a strength
because it shows clear reliability for diagnosis over a number of
months/years
+ Galeazzi et al 2004 found high inter-rater reliability for clinicians using
the ICD to conduct a joint interview. This is a strength as it encourages the
reliability of clinicians coming to the same decision based on the ICD
+Mason (1997) shows that the diagnosis of schiz using the ICD showed
good predictive validity of future disability. This is a strength as it shows
good ability to predict future outcomes
Similarities and differences between the DSM and ICD:
Both are regularly updated, both are now symptom based
DSM has used a multi axial system, ICD has always been
symptom based
DSM only contains mental disorders whereas ICD contains all
medical conditions
5.1.1 Diagnosis of mental disorders, including deviance,
dysfunction and distress
Deviance – Deviance is when behaviour is considered abnormal in society.
How unusual a behaviour is can be decided statistically. Extremely rare
people can be considered deviant – and when people violate social norms,
this is abnormal
-Risk of subjectivity
Deviance - who decides what is normal? Distress - everyone has a
different level of upset by different things
This is a weakness because… we must look at how the patient is coping
not just the symptoms being discussed, as everyone experiences
symptoms differently
Dysfunction – when abnormal behaviour is interfering with daily tasks and
life. Can’t cope with the demands of every-day life – looking after yourself,
making yourself understood etc
-The use of interviews for sensitive data
This is a weakness because… practical issues arise. In clinical interviews -
unstructured/semi-structured questions lead to issues of reliability and
validity, as they are open to subjectivity. Furthermore, the interviews
would be based on self-report data - some patients also withhold or
change their data, which leads to a misdiagnosis
Distress – Abnormality involves being unhappy, leads to negative feelings
such as anxiety, isolation, fear – especially when they exist over a long
period of time
+Trying to be objective
This is a strength because… clinicians must explore all 4D's - some of
these are based on standardised measures – specifically distress and
danger
Danger – consists of two broad themes – danger to selves and danger to
others – lost of psychologically healthy people engage in dangerous
activities such as sports, so diagnosis must be required if the danger is
excessively risky
+Connecting diagnoses to everyday life
This is a strength because it means we can protect society and the
individual from danger. If the individual gets treatment, then level of
distress can be addressed and quality of life improves.
,However, there are issues of social control - clinicians are given a lot of
power over diagnoses... Some patients could be sectioned against their
will according to the Mental Health Act
(Duration - this is important because all behaviours can exist in the short
term/and merit a different diagnosis)
5.1.2 Classification systems (DSM IVR or DSM V and ICD) for
mental health, including reliability and validity of diagnoses
Diagnostic manuals allow clinicians to make objective, reliable diagnoses
DSM and ICD are most popular – they contain the classifications of
disorders into different types and symptoms of disorders (E.g. physical or
behavioural changes)
The DSM – Diagnostic and statistical manual of mental disorders
- The DSM is a diagnostics manual of mental health conditions
collated by the APA
- First DSM was published in 1952 for the diagnosis of WW2 men. Lots
of updates – for example homosexuality used to be labelled as a
sociopathic personality disorder
- It contains different sections and chapters organised around the
common symptoms of the disorders
- Section 2 lists and categorises disorders and how they manifest over
a lifespan is also taken into consideration
- Now the DSM uses a symptom-based approach that doesn’t put
disorders into sub types but has a multi-dimensional assessment
- Clinicians would use the DSM to aid a clinical interview to rule
out/consider specific disorders
+ There is evidence to suggest that diagnosis using the DSM V is reliable.
Brown 2001 found that the reliability of mood disorders and anxiety were
found to be excellent. This is a strength as it shows that the DSM can help
clinicians give an accurate diagnosis
+Looking at the DSM, Kim-Cohen et al 2005 demonstrated the
concurrent validity of conduct disorder by interviewing children and their
mothers and observing anti-social behaviour. Predictive validity was also
measured… 5 y/o children with CD would show difficulties at age 7, too.
This is a strength as it shows that the DSM can accurately diagnose
disorders for the long term too, and this means that adult mental health
problems could reduce as they are frequently preceded by the symptoms
of CD
-There is evidence that suggests the DSM is not reliable for all disorders.
Regier 2013 found that major depressive disorder had a poor reliability
, score. This is a weakness because it means for some disorders patients
may not be diagnosed or misdiagnosed.
The ICD – international statistical classification of disease
The ICD is a diagnostic system that includes all diseases, physical and
mental used by clinicians to diagnose service users (1).
If the service user presents with a possible mental health disorder the
clinician would use the section that focuses on mental and behavioural
disorders (1).
For each mental health disorder, it gives a clinician the main features and
the symptoms needed to make a diagnosis (1),
for example, the ICD 10 states that paranoid schizophrenia is dominated
by relatively stable, paranoid delusions, often with hallucinations (1).
- In multiple languages so data can be collected and compared by
clinicans around the world
- Clinician selects key words from an interview with the patient that
describes their symptoms, to use these words and locate correct sub
category
+ Longitudinal studies on the ICD found that people who retain the same
diagnosis when reassessed increased 26% for schiz. This is a strength
because it shows clear reliability for diagnosis over a number of
months/years
+ Galeazzi et al 2004 found high inter-rater reliability for clinicians using
the ICD to conduct a joint interview. This is a strength as it encourages the
reliability of clinicians coming to the same decision based on the ICD
+Mason (1997) shows that the diagnosis of schiz using the ICD showed
good predictive validity of future disability. This is a strength as it shows
good ability to predict future outcomes
Similarities and differences between the DSM and ICD:
Both are regularly updated, both are now symptom based
DSM has used a multi axial system, ICD has always been
symptom based
DSM only contains mental disorders whereas ICD contains all
medical conditions
