Classification, Diagnosis,

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Classification, Diagnosis, Assessment

• Diagnosing Psychopathology

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A. Diagnosis

• Allows psychologists to determine if
  psychopathology is present.
• Often must rely on subtle distinctions in
  behavior.

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Diagnostic standard in psychology is the DSM-IV

• Diagnostic and Statistical Manual for mental
  disorders.
• The DSM is based on a multi-axial classification
  system.
• Each individual is rated on 5 separate dimensions
  or axes.

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Axis I Psychiatric disorders, excludes
personality disorders mental retardation.

• Axis II Personality disorders mental
  retardation.
• Axis III General medical conditions
• Axis IV Psychosocial environmental problems.
• Axis V Current level of functioning Global
  Assessment Scale

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Axes I II comprise the classification of
abnormal behavior.

• Most individuals consult a clinician for an Axis
  I condition (e.g., depression).
• Clinician must examine if Axis II disorder is
  also present.
• Axis II disorders make treating Axis I disorders
  more complicated.

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Axis I Disorders

• 1. Disorders Usually First Diagnosed in Infancy,
  Childhood, or Adolescence
• separation anxiety
• attention-deficit/hyperactivity disorder
• autism

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2. Mood disorders-disturbances in emotion and
behavior.

• Major Depression (unipolar depression)
• Mania
• Bipolar disorder (Manic Depression)
• Cyclothymia (Chronic mood disorder)
• Dysthymia

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3. Schizophrenia-disturbances of thought,
emotions, and behavior.

• Different types
• Paranoid Schizophrenia
• Catatonic Schziophrenia
• Undifferentiated Schizophrenia

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4. Anxiety disorders

• Generalized anxiety disorder (GAD)
• Phobias
• Panic Disorder
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Acute Stress Disorder

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5. Sexual disorders

• Gender Identity disorder
• Transvestism
• Pedophilia
• Voyeurism
• Exhibitionism
• Sadism/Masochism
• Rape trauma

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Axis II personality disorders

• Schizoid PDperson is aloof, has few friends,
  is indifferent to praise/criticism.
• Borderline PDerratic behavior, impulsivity, and
  instability in relationships/ mood, self-image.
• Narcissistic PDpeople who have malignant
  grandiosity of their own self-importance.

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Axis II (contd.)

• Histrionic PD- marked by an overly dramatic
  display of behavior that is for show (no real
  substance underneath).
• Antisocial PDmarked by violent acts lack of
  empathy for others.

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B. Assessment

• How do we assess abnormal behavior??
• What do you think???

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Psychological assessment

• Techniques are designed to determine cognitive,
  emotional, personality, behavior factors in
  psychopathological functioning.
• Most methods stem from paradigms used to study
  psychopathology.

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1. Issues in testing

• A. Reliabilityconsistency with which a test
  measures what it purports to measure.
• Types of reliability
• inter-rated reliability
• test-retest reliability

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B. Validity-the accuracy of a test.

• Types of validity
• content validity-does test measure content area?
• face validityon surface does test measure what
  its supposed to.

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Types contd.

• Concurrent validity-does the index being used to
  measure a type of abnormal behavior agree with
  another index used to measure the same behavior.
• Predictive validity-does measure accurately
  predict the occurrence of some event.

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2. Interviews

• A. Clinical Interviews
• Clinicians interview individuals who may have
  mental disorders.
• Setting varies (hospital, clinic, office, court).
• Clinicians observe how individuals respond
  during the interview (verbal non-verbal cues).

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Clinical interviews (contd.)

• Clinicians observe the persons emotional state
  at time of interview.
• (e.g., is person withdrawn, excitable,
  extremely talkative, communicative, beligerant).
• Paradigm of clinician will influence questions
  they ask.

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B. Structured interviews

• To make reliable and valid diagnoses, clinicians
  need to gather standardized information on
  patients.
• SCID (Structured Clinical Interview)- a
  structured interview for Axis I of the DSM.
• Questions are in prescribed order for interview
  to ask. The SCID is a branching interview, which
  means the patients response to one question,
  will determine the next question asked.

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3. Psychological Tests

• Standardized procedures designed to measure a
  persons performance on a particular task or to
  assess his/her personality.
• May provide supplemental information to a
  clinical interview.
• (E.g., schizophrenic may be guarded during
  clinical interview, but tests may pick up on
  delusions hallucinations patient may be
  withholding from the clinician.)

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Psychological tests

• Aid in assessment
• May be given to many individuals
• We have statistical norms for the tests. Allows
  for standardization.

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1. Self-Report Inventories

• A. Personality Inventories
• Minnesota Multiphasic Personality Inventory
  (MMPI) widely used to screen large groups of
  people for whom clinical interviews may not be
  feasible.
• 10 scales

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2. Projective Personality Tests

• Standard stimuli are presented to the patient
  (inkblots or drawings) ambiguous enough to allow
  for variation in responses.
• Patients responses should be based on primarily
  unconscious processes will reveal his/her true
  feelings, thoughts, motives.

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Types of Projective tests

• 1. Rorschach Inkblot test patient presented
  with 10 inkblots.
• Half of inkblots are in black, white, shades of
  gray. Two have red splotches, and 3 are in
  pastel colors.
• Patient should report what they see.

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2. Thematic Apperception Test (TAT)

• Patient is shown a series of black-and-white
  pictures one by one and asked to tell a story
  related to each.
• What is the symbolic meaning underlying the story
  the patient provides?