Diagnosis Flashcards
What is clinical psychology?
Clinical psychology deals with diagnosing, explaining, and treating mental illness.
What is diagnosis?
Diagnosis involves a clinician assessing a patient, deciding whether they show evidence of mental disorder, and if so, whether their symptoms match those in a checklist of the features and symptoms of a mental disorder.
Why is it often difficult to decide whether someone actually has a mental disorder or not?
- There is no clear dividing line separating normal and abnormal behavior.
- The concept of abnormality can change over time.
- The concept of abnormality can change between societies/cultures.
- Many different types of behaviour can be considered abnormal.
What are the four Ds?
•Deviance
•Distress
•Dysfunction
•Danger
Define deviance
Deviance refers to behaviours or emotions that are unusual in society. To be described as deviant, a behaviour must not only be statistically rare, but also disapproved of by most in society. So extreme bravery (running into a burning building to save a child) would be unusual, but would not be classed as deviant because people in society would view it positively rather than negatively.
Define distress
Distress refers to the extent to which the individual finds their behaviour and/or emotions upsetting.
Define dysfunction
Dysfunction refers to the extent to which the behaviour interferes with the person’s day-to-day life.
Define danger
Danger refers to behavior which could harm others, or which could harm the individual themselves.
Give two strengths of the four Ds of diagnosis
•The four D are useful because they have a practical application in helping professionals decide whether a patient’s symptoms warrants a clinical diagnosis.
•They also provide a holistic way to assess someone’s mental health, as they cover a wide range of symptoms.
Describe weaknesses of the four D’s of diagnosis
•However, there is likely to be subjectivity in the application of the four Ds. For example, assessment of dysfunction can be quite subjective as to how much these behaviours inhibit someone’s life. The individual themselves may not think they have a problem, and their unusual behaviour may suit them as it provides them with a way of coping with their difficulties in life.
•Similarly, distress is subjective and difficult to measure. Also, not all mental disorders are’ distressing to the person; for example, a sociopath may be perfectly content with their
mental functioning. And the same applies to danger: the assessment of how much danger a person poses to themselves or others may be subjective.
•Because of this subjectivity, the four Ds may lack Validity. This is because diagnosis may not
be accurate.
•Subjectivity may also mean that the four Ds may lack reliability. This is because if they are used by two different professionals, they may not arrive at the same diagnosis. This reduces the scientific status of diagnosis.
•The model can also be criticised for being incomplete; Davis (2009] suggests that a fifth “D” needs to be added to the list: duration. This refers to how long the symptoms have lasted for. For example, a diagnosis of depression requires the symptoms to have lasted for at least two weeks.
Identify two key debates and explain why they are relevant to the four Ds.
•Social control. This is seen where defining behaviours as deviance could be used to discriminate against people whom the majority disapprove of and want removed from society
•Psychology as a science: subjectivity means that the four Ds will not be applied in a reliable and consistent way.
What is the aim of classification systems?
Classification systems are used by practitioners to help them make diagnoses and establish appropriate treatment regimens. Their aim is to provide clear and measurable criteria for diagnosis, which can be used in the same way by all practitioners. This should increase the reliability of diagnosis.
Define reliability
When the same results are found when the study is repeated
Describe what is meant by the medical model of abnormality.
• It is a biological approach which assumes that abnormal behaviour is caused by a physical illness.
•It also therefore also believes that the most appropriate treatment for mental disorders is biological (e.g. drug treatment).
Describe one strength of the medical model of abnormality
The medical model groups symptoms together and classifies them into syndromes, so that their cause can be discovered and appropriately treated. This is a strength because it takes scientific, obiective approach to diagnosis.
Describe one limitation of the
medical model of abnormality
Whereas the classification of physical illnesses involves observation and measurement of objective symptoms such as broken bones, fever, blood pressure etc., with mental illnesses, the symptoms are much more subjective - e.g., feelings of despair, lack of energy or hearing voices.
These cannot be easily measured, so the clinician must make a judgement based largely on experience, reducing validity.
What are the two major classification systems?
•ICD 10
•DSM 5
Describe the purpose of the DSM 5 and the ICD.
•To provide a standardised, criterion based system
•to allow for accurate diagnosis of mental disorders.
Give two reasons why the DSM and the ICD are regularly reviewed and updated. [2]
• To take account of new research
• To take account of people’s changing cultural views.
Identify similarities between the DSM and the ICD
•Both regularly updated
•Both try to take account of different cultural views
•Both include categories of mental disorder based on patterns of symptoms
•Both use similar coding systems
•Both use the medical model
•Both can be considered to be reductionist as they rely on checklists of symptoms
Identify three differences between
the DSM and the ICD
•The DSM is published by the American Psychiatric Association and must be paid for whereas the ICD is published by the World Health Organisation and is free.
•The DSM only deals with mental conditions whereas the ICD also diagnoses physical illnesses.
•The DSM is considered to be more holistic than the ICD because it uses four ways to assess people: type of disorder; factors such as mental retardation and general medical conditions; psychosocial and contextual factors; and disability - whereas the ICD is purely criterion based.
Identify two strengths of using a
classification system for diagnosis. [2]
•Classification systems are regularly updated. This is a strength because it means that they take account of new research. It also means that any inconsistencies will be removed.
• Using a classification system increases reliability of diagnosis, as clinicians will be using the same clear set of criteria, meaning that they should arrive at similar diagnoses.
Identify two weaknesses of using a
classification system for diagnosis. [2]
•Even where clear criteria for a disorder are set out, clinicians must use their subjective judgement at times, reducing reliability and validity of diagnosis.
• Classification systems use the medical model, suggesting that mental disorders are caused by physical illness. However, this may not be appropriate in psychology, where, because, unlike with many physical disorders, the causes of mental illnesses are often unknown, which leads to a focus only on symptoms.
Provide one argument in favour of the idea that classification systems are scientific, and one argument supporting the idea that classification systems are not scientific. [2]
•Classification systems can be considered to be scientific because they rely on standardised checklists of observable behaviour, which are reliable because they can be used in the same way by all clinicians.
•On the other hand, they may be considered to be unscientific because there will always be an element of subjectivity when interpreting the diagnostic criteria.
What possible factors can impact reliability of diagnosis?
•Patient factors: the patient may give
different psychiatrists different information.
• Clinician factors: the practitioner may not be objective. The practitioner may not gather enough information or may use the classification system incorrectly.
•Classification systems: the new ICD-11 coding system correlates well with the DSM-5 increasing reliability.
One piece of evidence that suggests that diagnosis may be HIGH in reliability
Brown (2002) tested the reliability and validity of DSM IV diagnoses for anxiety and mood disorders and found them to be good to excellent.
One piece of evidence that suggests that diagnosis may be LOW in reliability
Spitzer and Williams (1985) reviewed the process of diagnosis and suggested that experienced psychiatrists only
agree on diagnosis about 50% of
the time.
define concurrent validity
Compares evidence from different diagnostic tests to see if they agree. The DSM and the ICD seem to have good concurrent validity.
