Psy 275 1st Edition Exam 2 Study Guide Lectures 7 10 Chapter 7 Diagnostic Assessment Defining Normality and Abnormality Abnormality known as mental disorders psychiatric diagnoses or more broadly psychopathology What Defines Abnormality In the 1990s Jerome Wakefield a renowned scholar in the field of abnormal psychology offered a theory that put forth a more simplified definition of mental disorders The harmful dysfunction theory proposes that in our efforts to determine what is abnormal we consider both scientific data and the social values in the context of which the behavior takes place Three D s Deviance Behaviors or feelings are highly unusual Distress Cause the person or others significant distress Dysfunction Prevent the person from functioning in everyday life Who defines Abnormality Clinical psychologist use disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders DSM the prevailing diagnostic guide for mental health professionals every day as they perform assessments conduct therapy and design and execute research studies The DSM reflects a medical model of psychopathology in which each disorder is an entity defined categorically and features a list of specific symptoms History of DSM DSM 1 was published in 1952 DSM II followed as a revision in 1968 They contained only three broad categories of disorders psychoses neuroses and character disorders The definitions of disorders in the DMS I and DSM II were not scientifically or empirically based The descriptions of individual disorders were not lists of specific symptoms or criteria instead they were simply prose typically one paragraph per disorder offering relatively vague descriptions of clinical conditions DMS More Recent Editions III III R IV and IV TR DSM II was published in 1980 in comparison to DMS I and II it reflected an approach to defining mental disorders that differed substantially in some important ways 1 It relied to a much greater extent on empirical data to determine which disorders to include and how to define them 2 It used specific diagnostic criteria to define disorders 3 It dropped any allegiance to a particular theory of therapy or psychopathology 4 It introduced the multiaxial assessment system When multiaxial assessment was in place the psychiatric problems were described on each of five distinct axes Axis I included disorders thought to be more episodic likely to have a beginning and ending points and Axis II included disorders thought to be more stable or long lasting Axis III and IV offered clinicians a place to list medical conditions and psychosocial environmental problems respectively relevant to the mental health issues at hand And Axis V known as the Global Assessment of Functioning Scale provided clinicians an opportunity to place the client on a 100 point continuum describing the overall level of functioning Subsequent revisions to the DSM DSM III R DSM IV and DSM IV TR retained the major quantitative and qualitative changes instituted by DSM III in 1980 DSM 5 The Current Edition In May 2013 DSM 5 was published Led by two prominent mental health researchers David Kupfer and Darrel Regier Many steps were involved in this huge undertaking Early on a Task Force essentially a committee of prominent researchers in various areas of mental disorders was created The members of this Task Force then led Work Groups each of which focused on a particular area of mental disorders The leaders also created a Scientific Review Committee of experts whose jobs was to make sure that there was sufficient scientific evidence to support the changes proposed by the Work Groups Later in the process they conducted field trials for their proposed changes Changes DSM 5 Dint make Initially the authors of DSM 5 considered significantly overhauling the manual to emphasize neuropsychology or the biological roots of mental disorders However it became evident to the DSM authors that mental health lags behind many other specialties in this regard Another across the board change that the DSM authors considered was a shift toward a dimensional definition of mental disorders It involves viewing disorders not strictly in a categorical way by along a continuum A dimensional approach was also seriously considered for a particular subset of mental disorders personality disorders The DSM authors considered removing 5 of the 10 personality disorders The five that were on the chopping block at one point were paranoid schizoid histrionic dependent and narcissistic personality disorders There were numerous proposals for specific new disorders that were considered but rejected Many of these appear in the Emerging Measures and Models section as proposed criteria sets to enable researchers to conduct studies that will help determine whether they make the cut for future editions of DSM Chapter 8 clinical Interview Evaluating Assessment Tool Validity Does this tool measure what it claims to measure Reliability Does this tool yield consistent results Clinical Utility How useful is the information gathered to a clinician treating this client Types of Validity Content Validity Does the content match what the test is supposed to measure Convergent Validity Does the test correlate with other tests that measure similar constructs Divergent Validity Does the test correlate with other tests that measure Different constructs Types of Reliability Test retest reliability Similar results across repeat administrations Interrater reliability Similar results across different administrator Internal reliability Consists of items that are consistent with each other Only relevant for items assessing the same construct Split half reliability Score on one half should correlate highly with score on other half Cronbach s alpha Overall measure of internal consistency Reliability versus Validity Reliability Consistency Validity Hitting the Target Diagnostic Interviews Unstructured Interview o Clinician decides everything What topics to cover Screening questions Follow up probes Rating system used for symptoms Means of determining diagnosis criteria vs impressions Structured Interviews o Tied to particular sets of criteria such as DSM 5 o A manual specifies What questions to as What order to ask them How to ask them How to follow them up How to interpret code the answer Semi structured Interviews o Blend of structured and unstructured approaches o Provide Areas that need to be covered Standard for rating symptoms Sometimes starter