GGZ2030 – PSYCHODIAGNOSTICS
CO M P A C T S U M M A R Y O F A L L L I T ER A T U R E
A LL TA SKS
, GGZ2030 – TASK 1
The diagnostic process:
5 basic questions form the basis for most of the questions posed by clients, referrers and
diagnosticians.
1 Recognition: = Identifying both complaints and adequate behavior of the client and/or his
environment. What are the problems; what works and what doesn’t?
All-or-nothing principle DSM categories
More-or-less principle dimensions of a test or questionnaire
Diagnostic formulation focuses on the individual and his own unique clinical picture (holistic theory).
Allows for the uniqueness of individual, this helps the therapy planning, but lacks empirical evidence.
2 Explanation: = Why there is a problem or a behavioral problem. Why do certain problems exist and
what perpetuates them?
1. The locus = the person or the situation:
o Person-oriented = explanatory factor lies in person himself (behavior is viewed
separately from context)
o Situation-oriented = in the event of a well-known context.
2. The nature of control:
o Cause determines and explain behavior; determined by previous conditions (how
someone acts after a certain event)
o Reason = determined by a voluntary or intentional choice. Causes explain behavior
while reasons make behavior understandable.
3. Synchronous and diachronous explanatory conditions:
o Synchronous explanatory conditions = coincide with the behavior that is to be
explained at the time (addiction, addicted friends)
o Diachronous explanatory conditions = precede this behavior (prior to the behavior,
like attachment)
4. Induced and persistent conditions:
o nduced conditions give rise to a behavioral problem produce
o Persistent conditions perpetuate the behavioral problem (maintain)
3 Prediction: = Prediction involves making a statement about the problem behavior in the future.
The predictor is the present behavior, and the criterion is the future behavior.
In the case of prediction, the margins of error are often so large that high expectations of legal and
other societal contexts cannot be met.
4 Indication: = Whether the client requires treatment and, if so, which (caregiver) most suitable
The indication is a search process. Before the indication can start, the steps for explanation and
prediction must be completed.
- Knowledge of treatments and therapists
- Knowledge of the relative usefulness of treatments
- Knowledge of the client’s acceptance of the indication
5 Evaluation: = Evaluation of the therapeutic process and the results of the treatment:
- whether the therapy took account of the diagnosis and treatment proposal
- whether the process and the treatment have brought about change in the client’s behavior
and experience.
,The diagnostic/empirical cycle:
1. Observation = collecting and classifying empirical materials, which provide the basis for
forming thoughts
2. Induction = the formulation of theory and hypotheses about the behavior
3. Deduction = testable predictions are derived from these hypotheses
4. Testing = new materials are used to determine whether the predictions are correct or
incorrect
5. Evaluation.
Diagnostic examination:
1. Hypothesis formulation
2. Selection of examination tools
3. Formulation of testable predictors
4. Administration and scoring
5. Argumentation
6. Report
The diagnostician’s reflections: = The diagnostician should be aware of his potential biases in both
general clinical judgement and towards clients.
The diagnostic scenario: = The diagnostician organizes all of the requester’s and client’s questions
from the application phase, then he proposes an initial theory about the client’s problematic
behavior.
Source: Luteijn & Barelds (2019) Psychological diagnostics in health care
Current understanding of narcissism and narcissistic personality disorder
- Kohut’s self-psychology approach = The deficit model of narcissism pathological
narcissism originates in childhood as a result of failure of parents to empathize with their
child.
, - Kernberg’s object relations = emphasizes aggression and conflict in the psychological
development of narcissism, focusing on the patient’s aggression towards and envy of others
conflict model.
- Social critical theory (Wolfe) = narcissism was a result of the collective ego’s defensive
response to industrialization and the changing economic and social structure of society.
The Narcissistic Personality Inventory is the same as the Self Confidence Test. Narcissists could
underreport on psychological tests, as they want to do good and not show that they suffer from a
disease. NPD is difficult for therapists
Narcissistic personality disorder (NPD), DSM-V criteria:
1. Grandiosity and self-importance;
2. Persistent fantasies of success, power, attractiveness, intellectual superiority or ideal love;
3. Sense of superiority and specialness;
4. Wish to be admired;
5. Strong sense of entitlement;
6. Manipulates and exploits others;
7. Lack of empathy;
8. Believes others are envious of him/her and envy of others;
9. Arrogant and contemptuous attitudes and behaviors.
5 or more symptoms are needed to diagnose
At least 2 subtypes of pathological narcissism can be differentiated:
- Grandiose/overt narcissism = may appear arrogant, pretentious, dominant, self-assured,
exhibitionist or aggressive; thick-skinned
- Vulnerable/covert narcissism = may appear overly sensitive, insecure, defensive and anxious
about an underlying sense of shame and inadequacy; Thin-skinned.
There is adaptive and maladaptive narcissism. Narcissism is not that rare.
It is generally useful to use BDI-II in this case. Don’t rely on 1 test, but use different tests to get a
differential diagnosis.
Prevalence of NPD = (6-7%): Higher rates for men than for women. Higher rates for younger adults.
High comorbidity rates of substance use, mood, anxiety, and other personality disorders.
Source: Yakeley (2018) Current understanding of narcissism and narcissisic personality disorder
Diagnosis and treatment combinations (DTCs):
The idea behind DTC = once a patient has efficiently been diagnosed, the protocol- based treatment
that then takes place is preferably evidence-based and clearly fits the diagnosis that has been made.
Because the treatment protocol dictates how long the treatment may take and the diagnostics are
also standardized to the greatest possible extent, standard rates exist for DTCs.
Critical comments:
- Many clients have more than 1 complaint/problem and feel that all of these are equally
serious
- Some clients don’t have clearly defined complaints/problems
- Within departments, there is a strong focus on the reported complaints/problems
- DTCs assume an interaction between a specific diagnosis and a type of treatment
CO M P A C T S U M M A R Y O F A L L L I T ER A T U R E
A LL TA SKS
, GGZ2030 – TASK 1
The diagnostic process:
5 basic questions form the basis for most of the questions posed by clients, referrers and
diagnosticians.
1 Recognition: = Identifying both complaints and adequate behavior of the client and/or his
environment. What are the problems; what works and what doesn’t?
All-or-nothing principle DSM categories
More-or-less principle dimensions of a test or questionnaire
Diagnostic formulation focuses on the individual and his own unique clinical picture (holistic theory).
Allows for the uniqueness of individual, this helps the therapy planning, but lacks empirical evidence.
2 Explanation: = Why there is a problem or a behavioral problem. Why do certain problems exist and
what perpetuates them?
1. The locus = the person or the situation:
o Person-oriented = explanatory factor lies in person himself (behavior is viewed
separately from context)
o Situation-oriented = in the event of a well-known context.
2. The nature of control:
o Cause determines and explain behavior; determined by previous conditions (how
someone acts after a certain event)
o Reason = determined by a voluntary or intentional choice. Causes explain behavior
while reasons make behavior understandable.
3. Synchronous and diachronous explanatory conditions:
o Synchronous explanatory conditions = coincide with the behavior that is to be
explained at the time (addiction, addicted friends)
o Diachronous explanatory conditions = precede this behavior (prior to the behavior,
like attachment)
4. Induced and persistent conditions:
o nduced conditions give rise to a behavioral problem produce
o Persistent conditions perpetuate the behavioral problem (maintain)
3 Prediction: = Prediction involves making a statement about the problem behavior in the future.
The predictor is the present behavior, and the criterion is the future behavior.
In the case of prediction, the margins of error are often so large that high expectations of legal and
other societal contexts cannot be met.
4 Indication: = Whether the client requires treatment and, if so, which (caregiver) most suitable
The indication is a search process. Before the indication can start, the steps for explanation and
prediction must be completed.
- Knowledge of treatments and therapists
- Knowledge of the relative usefulness of treatments
- Knowledge of the client’s acceptance of the indication
5 Evaluation: = Evaluation of the therapeutic process and the results of the treatment:
- whether the therapy took account of the diagnosis and treatment proposal
- whether the process and the treatment have brought about change in the client’s behavior
and experience.
,The diagnostic/empirical cycle:
1. Observation = collecting and classifying empirical materials, which provide the basis for
forming thoughts
2. Induction = the formulation of theory and hypotheses about the behavior
3. Deduction = testable predictions are derived from these hypotheses
4. Testing = new materials are used to determine whether the predictions are correct or
incorrect
5. Evaluation.
Diagnostic examination:
1. Hypothesis formulation
2. Selection of examination tools
3. Formulation of testable predictors
4. Administration and scoring
5. Argumentation
6. Report
The diagnostician’s reflections: = The diagnostician should be aware of his potential biases in both
general clinical judgement and towards clients.
The diagnostic scenario: = The diagnostician organizes all of the requester’s and client’s questions
from the application phase, then he proposes an initial theory about the client’s problematic
behavior.
Source: Luteijn & Barelds (2019) Psychological diagnostics in health care
Current understanding of narcissism and narcissistic personality disorder
- Kohut’s self-psychology approach = The deficit model of narcissism pathological
narcissism originates in childhood as a result of failure of parents to empathize with their
child.
, - Kernberg’s object relations = emphasizes aggression and conflict in the psychological
development of narcissism, focusing on the patient’s aggression towards and envy of others
conflict model.
- Social critical theory (Wolfe) = narcissism was a result of the collective ego’s defensive
response to industrialization and the changing economic and social structure of society.
The Narcissistic Personality Inventory is the same as the Self Confidence Test. Narcissists could
underreport on psychological tests, as they want to do good and not show that they suffer from a
disease. NPD is difficult for therapists
Narcissistic personality disorder (NPD), DSM-V criteria:
1. Grandiosity and self-importance;
2. Persistent fantasies of success, power, attractiveness, intellectual superiority or ideal love;
3. Sense of superiority and specialness;
4. Wish to be admired;
5. Strong sense of entitlement;
6. Manipulates and exploits others;
7. Lack of empathy;
8. Believes others are envious of him/her and envy of others;
9. Arrogant and contemptuous attitudes and behaviors.
5 or more symptoms are needed to diagnose
At least 2 subtypes of pathological narcissism can be differentiated:
- Grandiose/overt narcissism = may appear arrogant, pretentious, dominant, self-assured,
exhibitionist or aggressive; thick-skinned
- Vulnerable/covert narcissism = may appear overly sensitive, insecure, defensive and anxious
about an underlying sense of shame and inadequacy; Thin-skinned.
There is adaptive and maladaptive narcissism. Narcissism is not that rare.
It is generally useful to use BDI-II in this case. Don’t rely on 1 test, but use different tests to get a
differential diagnosis.
Prevalence of NPD = (6-7%): Higher rates for men than for women. Higher rates for younger adults.
High comorbidity rates of substance use, mood, anxiety, and other personality disorders.
Source: Yakeley (2018) Current understanding of narcissism and narcissisic personality disorder
Diagnosis and treatment combinations (DTCs):
The idea behind DTC = once a patient has efficiently been diagnosed, the protocol- based treatment
that then takes place is preferably evidence-based and clearly fits the diagnosis that has been made.
Because the treatment protocol dictates how long the treatment may take and the diagnostics are
also standardized to the greatest possible extent, standard rates exist for DTCs.
Critical comments:
- Many clients have more than 1 complaint/problem and feel that all of these are equally
serious
- Some clients don’t have clearly defined complaints/problems
- Within departments, there is a strong focus on the reported complaints/problems
- DTCs assume an interaction between a specific diagnosis and a type of treatment
