Clinical Psychology- Theories and applied studies
*Diagnosis*
A01
o Deviance- the extent that behaviour and emotions are unusual and deviate from social
norms/ statistical norms
o Dysfunction- when the individual has a reduced chance of survival due to MHD
o Distress- the extent that the individual experiences negative feelings
o Danger- how dangerous the individual is to themselves or others
o [Duration]- how long the individual has experienced the symptoms (Davis 2009)
A03
o Consideration of all 4 Ds is more likely to increase validity
o Highly subjective interpretation- affecting validity and reliability (interviews-
semi/unstructured) =Patients may lie/abstain from full truth
o Deviation- Social norms vary between cultures/over time shown with homosexuality –
criminals often deviate yet don’t label them all as mentally ill
o Thomas Szasz and ‘symbolic recapture’- like to label those with unpredictable behaviours
o RD laing- mental health issues is normal response to modern pressures
o Distress- Subjective interpretation of distress/what it is to suffer- some exaggerate/show
non at all e.g psychopathy
o Dysfunction/danger- some behaviours seen as self-expression yet wouldn’t label as mentally
ill e.g bungee jumping/boxing
o
A03CA
o Some standardised tests e.g eat-26 which creates quantitative data
o Jahoda- measure of ideal mental health- free from MHD, ability to be rational and
introspective, self-actualisation, realistic view of world, self-esteem and autonomy
o Hard to diagnose as no physical measure
*Classification systems*
A01
o ICD- European/international system, free, categorised according to similarities in symptoms
(f), digit represents family of MHD e.g F32- depression F31- bipolar. Decimal place
determines type of depression
o DSM IVR- American based system, paid for, multi axial system(5)
o DSM V 2013 - groups disorders to go from general diagnosis to specific one. Section2-
diagnostic criteria and codes. Section3- possible diagnosis’ that aren’t medicalised e.g
caffeine use disorder. Made to harmonise more with ICD (increased standardisation) greater
sensitivity to cultures
A03
, o ICD- allows clinicians to move from general diagnoses to specific ones with a focus on
symptoms in a standardised way. Subjective interviews (symptoms may overlap between
disorders).
o DSM5- self assesment which may cause lack of truth due to stigmas in cultures. More
specific diagnoses e.g eating disorder=> binge eating than DSM4. Does not link to biological
influences. Interpretation of social norms from clinician and subjectivity.
o Interviews- subjective, doesn’t represent symptoms experienced all the time, may lack
insight from patient
o Co-morbidity- overlap of symptoms and diagnosis- if manifest in similar ways
o Andrews 1999- only 68% agreement between ICD and DSM on 1500 pps
A03CA
o DSM5- US bias, culture dominated
o ICD-.assumptions about aetiology (causes) are made (unlike DSM)
o Evans 2013- 51% used ICD compared to 44% for DSM
o Allen Frances- chair of DSM4- argued DSM5 will create many type 1 errors (false positive)
Clinical reliability and validity
A01
o Interrater reliability- different researchers come to the same conclusion
o Test/retest reliability- if repeating the experiment would result in the same conclusion
(same symptoms=same diagnosis)
o Aetiological validity- if you know the cause you can make a more valid conclusion
o Concurrent validity- same diagnosis with different diagnostic tools (ICD/DSM)
o Predictive validity- if diagnosis can accurately make prognosis (treatments work with same
disorder)
o Patient factors- different information/lack of insight/minor symptoms at time of interview
o Clinician factors- subjective interpretation based on background/training/expertise.
Symptom overlap with diagnoses (high comorbidity)
A03
o Big pharma- funded by pharmacological industry, more likely to diagnose= 87% of MHD
treated by medication in 2014
o Circular argument- hearing voices due to schizophrenia yet schizophrenia causing person to
hear voices- overly reductionist
o Labelling- may lower distress as gives reason for behaviour yet individuals may act
accordingly to it based on stereotypes
o Kupfer- biomarkers= biological signs that aren’t related just be chance, depression cant fully
be caused by genes
o ‘Shopping list’ of ticking off symptoms
o Culture bound syndrome- MHD not recognised universally across cultures
e.g KORO- mainly in men, fear of sexual organs disappearing inside body causing death
JINN- spiritual belief in Islam causing schizophrenic symptoms
- may cause overcompensation for certain cultures
*Diagnosis*
A01
o Deviance- the extent that behaviour and emotions are unusual and deviate from social
norms/ statistical norms
o Dysfunction- when the individual has a reduced chance of survival due to MHD
o Distress- the extent that the individual experiences negative feelings
o Danger- how dangerous the individual is to themselves or others
o [Duration]- how long the individual has experienced the symptoms (Davis 2009)
A03
o Consideration of all 4 Ds is more likely to increase validity
o Highly subjective interpretation- affecting validity and reliability (interviews-
semi/unstructured) =Patients may lie/abstain from full truth
o Deviation- Social norms vary between cultures/over time shown with homosexuality –
criminals often deviate yet don’t label them all as mentally ill
o Thomas Szasz and ‘symbolic recapture’- like to label those with unpredictable behaviours
o RD laing- mental health issues is normal response to modern pressures
o Distress- Subjective interpretation of distress/what it is to suffer- some exaggerate/show
non at all e.g psychopathy
o Dysfunction/danger- some behaviours seen as self-expression yet wouldn’t label as mentally
ill e.g bungee jumping/boxing
o
A03CA
o Some standardised tests e.g eat-26 which creates quantitative data
o Jahoda- measure of ideal mental health- free from MHD, ability to be rational and
introspective, self-actualisation, realistic view of world, self-esteem and autonomy
o Hard to diagnose as no physical measure
*Classification systems*
A01
o ICD- European/international system, free, categorised according to similarities in symptoms
(f), digit represents family of MHD e.g F32- depression F31- bipolar. Decimal place
determines type of depression
o DSM IVR- American based system, paid for, multi axial system(5)
o DSM V 2013 - groups disorders to go from general diagnosis to specific one. Section2-
diagnostic criteria and codes. Section3- possible diagnosis’ that aren’t medicalised e.g
caffeine use disorder. Made to harmonise more with ICD (increased standardisation) greater
sensitivity to cultures
A03
, o ICD- allows clinicians to move from general diagnoses to specific ones with a focus on
symptoms in a standardised way. Subjective interviews (symptoms may overlap between
disorders).
o DSM5- self assesment which may cause lack of truth due to stigmas in cultures. More
specific diagnoses e.g eating disorder=> binge eating than DSM4. Does not link to biological
influences. Interpretation of social norms from clinician and subjectivity.
o Interviews- subjective, doesn’t represent symptoms experienced all the time, may lack
insight from patient
o Co-morbidity- overlap of symptoms and diagnosis- if manifest in similar ways
o Andrews 1999- only 68% agreement between ICD and DSM on 1500 pps
A03CA
o DSM5- US bias, culture dominated
o ICD-.assumptions about aetiology (causes) are made (unlike DSM)
o Evans 2013- 51% used ICD compared to 44% for DSM
o Allen Frances- chair of DSM4- argued DSM5 will create many type 1 errors (false positive)
Clinical reliability and validity
A01
o Interrater reliability- different researchers come to the same conclusion
o Test/retest reliability- if repeating the experiment would result in the same conclusion
(same symptoms=same diagnosis)
o Aetiological validity- if you know the cause you can make a more valid conclusion
o Concurrent validity- same diagnosis with different diagnostic tools (ICD/DSM)
o Predictive validity- if diagnosis can accurately make prognosis (treatments work with same
disorder)
o Patient factors- different information/lack of insight/minor symptoms at time of interview
o Clinician factors- subjective interpretation based on background/training/expertise.
Symptom overlap with diagnoses (high comorbidity)
A03
o Big pharma- funded by pharmacological industry, more likely to diagnose= 87% of MHD
treated by medication in 2014
o Circular argument- hearing voices due to schizophrenia yet schizophrenia causing person to
hear voices- overly reductionist
o Labelling- may lower distress as gives reason for behaviour yet individuals may act
accordingly to it based on stereotypes
o Kupfer- biomarkers= biological signs that aren’t related just be chance, depression cant fully
be caused by genes
o ‘Shopping list’ of ticking off symptoms
o Culture bound syndrome- MHD not recognised universally across cultures
e.g KORO- mainly in men, fear of sexual organs disappearing inside body causing death
JINN- spiritual belief in Islam causing schizophrenic symptoms
- may cause overcompensation for certain cultures
