Discuss the validity and reliability of diagnosis Classification of mental disorders involves the identification of groups or patterns of behavioral

or mental symptoms that reliably occur together to form a type of disorder. This allows: I. II. III. IV. Psychiatrists, doctors and psychologists to more easily identify groups of similar sufferers Allows a prognosis to be made Researchers to investigate these groups of people to determine what the aetiology of the disorders are A suitable treatment to developed and administered to all those showing similar symptoms

The major systems of diagnosis include the DSM and ICD. DSM The Diagnostic and Statistical Manual of Mental Disorder (DSM) defines mental disorders clinically significant syndrome associated with distress, a loss of functioning, an increased risk of death/pain, or an important loss of freedom. The manual attempts to describe any disorder in such terms that two clinicians referring to The system would probably agree with the diagnosis it suggests. The DSM groups disorders into categories and then offers specific guidance to psychiatrists by listing the symptoms required for a diagnosis to be given. The DSM consists of a multiracial approach, where diagnosing clinician considers the individual under investigation under 5 axis. I. Axis 1: Clinical syndromes refers to the major diagnostic classification arrived by the clinician Axis 2: Developmental and personality disorders consists of additional diagnostic classifications that may contribute to an understanding of the Axis 1 Syndrome. III. Axis 3: Medical conditions

IV. Axis 4: Psychosocial stressors, all potentially stressful events or enduring circumstances that might be relevant to the disorder are rated for severity on a scale ranging from 1(none) to 6 (catastrophic) for the past year. V. Axis 5: Global assessment of functioning, rates the highest level of social, occupation a land psychological function on a scale of 1 (persistent danger) to 90 (good in all areas) currently and during the past year The strength of the DSM is that it utilizes multi-axial diagnosis and it encourages a diagnosing clinician to use a more holistic approach to understanding the person. The DSM also undergoes constant revisions and it adapts to changes in thinking overtime. ICD The International Classification of Diseases (ICD) is more commonly used internationally than the DSM and it covers a wide range of diseases and conditions for the sake of classification rather than diagnosis. There is a chapter in the ICD that categorizes mental disorders that is very similar to the DSM and the ICD has fewer categories than the DSM because each category tends to be slightly broader. The biggest difference between the two systems is that the ICD is intended primarily as a classification system but includes details of what symptoms are required for diagnosis. Conversely, the DSM is intended as a fully comprehensive manual for diagnosis and so includes precise details of how to conduct diagnostic interviews, precise diagnostic details and other tests. Validity and reliability In order for a diagnostic system to be reliable, those using it must consistently make the same diagnoses. For it to be the valid, the diagnoses must identify a real pattern of symptoms and therefore apply appropriate treatment. Reliability A major way of assessing reliability of psychiatric diagnosis is by inter-rater reliability, which is by assessing the agreement with which different clinicians diagnose conditions in the same patients. Studies of inter-rater reliability show that some diagnostic categories are much more reliable than others and that procedures are more reliable for some types of patients than others. Studies: Beck et al. (1962) found that agreement on diagnosis for 153 patients between two psychiatrist was only 54%.

Di Nardo et al (1993) studied the reliability of DSM-3 for anxiety disorders where two clinicians separately diagnosed each of 267 people seeking for treatment for anxiety and stress disorders. They found high reliability for OCD but very low for assessing generalized anxiety disorder mainly due to problems with interpreting how excessive a person worries are. This study used the DSM-III and has already undergone two revisions and is on the DSM-IV already and so issues may have already been resolved. But even then, this study shows the unreliability for certain disorders. Lipton and Simon (1985) randomly selected 131 patients in a hospital in New York and conducted various assessment procedures to arrive at a diagnosis for each patient. This diagnosis was compared with the original diagnosis and found that of the original 89diagnosis of schizophrenia; only 16 received this on reevaluation. Fifty were diagnosed with a mood disorder even though only 15 had been initially diagnosed with it in the first place. But I could be argued that being misdiagnosed caused the mood disorder to develop. Rosenhan et al. (1973) Aim: To test the reliability of diagnosis Method and Results: - Rosenhan and a group of colleagues and people with various occupations presented themselves at 12 different hospitals across the USA complaining of hearing a voice. - All but one was admitted with a diagnosis of schizophrenia. - All of the pseudo-patients could do this but were diagnosed with a case of schizophrenia. - It took between 7-52 days for the pseudopatients to be released. This time was used by the patients to conduct a participant observation of life in the hospital - The staff noticed about this but categorized it as a symptom. - Rosenhan found that truly abnormal people can be mistakenly assumed to be healthy aswell, cause in a follow up study, Rosenhan told a hospital that they should expect pseudo-patients over a 3 months period, but none were sent instead 41 real patients were released. - Shows the general inability and the lack of reliability in telling the difference between normal and abnormal behavior - Good reliability and poor validity ; that the environment heavily affects the process of diagnosis and therefore affected its validity. - Took place 30 years ago - Used the DSM II