PowerPoint Lecture Notes Presentation

Chapter 3
Diagnosis and Assessment
Abnormal Psychology, Eleventh Edition
by
Ann M. Kring, Gerald C. Davison, John M. Neale,
& Sheri L. Johnson
 Diagnosis and Assessment
Diagnosis
The classification of disorders by symptoms and
signs.
Advantages of diagnosis:
Facilitates communication among professionals
Advances the search for causes and treatments
Cornerstone of clinical care

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 Reliability
Consistency of measurement
Inter-rater
Observer agreement
Test-retest
Similarity of scores across repeated test administrations or
observations
Alternate Forms
Similarity of scores on tests that are similar, but not identical
Internal Consistency
Extent to which test items are related to one another

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 Validity
How well does a test measures what it is supposed
to measure?
Content validity
Extent to which a measure adequately samples the domain
of interest e.g., all of the symptoms of a disorder.
Criterion validity
Extent to which a measure is associated with another
measure (the criterion)
Concurrent
Two measures administered at the same point in time
Hopelessness scale and diagnosis of depression
Predictive
Ability of the measure to predict another variable measured at
some future point in time
College GPA and annual salary after graduation
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 Validity
Construct validity (Cronbach & Meehl, 1955)
A construct is an abstract concept or inferred
attribute
Involves correlating multiple indirect measures of
the attribute
e.g., self-report of anxiety correlated with increased HR,
shallow breathing, racing thoughts.
Important method for evaluating diagnostic
categories
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 DSM-IV-TR
Diagnostic System
Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR)
4th edition revised
Published by American Psychiatric
Association
Multiaxial system
Diagnosis based on 5 axes or dimensions.

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 Five Axes of DSM-IV
AXIS DESCRIPTION
I All diagnostic categories except personality
disorders and mental retardation
II Personality disorders and mental retardation
III General medical conditions
IV Psychosocial and environmental problems
V Global assessment of functioning scale (GAF)

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 Selected Axis I
Diagnostic Categories
Disorders usually first diagnosed in infancy, childhood or
adolescence
Learning Disorders
Pervasive Developmental Disorders
Substance-related disorders
Alcohol-related and Amphetamine-related Disorders
Schizophrenia and other Psychotic Disorders
Anxiety disorders
Panic, Generalized Anxiety, Obsessive-Compulsive Disorders
Mood disorders
Major Depressive and Bipolar Disorders
Eating Disorders
Anorexia Nervosa and Bulimia Nervosa

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 Example: Multiaxial Diagnosis of
Carol S.
Axis I Major Depressive Disorder

Axis II Borderline Personality Disorder

Axis III Thyroid disease

Problems with primary support group: marital
Axis IV
separation
GAF = 60 Moderate difficulty in social and
Axis V
occupational functioning

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 Early Foundations: Emil Kraepelin
(1856-1926)
Pioneered classification of mental illness
based on biological causes
Published 1st psychiatry text (1883)
Mental illness as syndrome
Cluster of symptoms that co-occur
Proposed two major syndromes
Dementia praecox
Manic-depressive psychosis
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 Improvements in the
DSM-IV-TR
1. Specific diagnostic criteria
Less vague, more explicit and concrete
than DSM-II (see Table 3.2)
2. More extensive descriptions
Essential features
Associated features (e.g., lab findings)
Differential diagnosis

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 Improvements in the
DSM-IV-TR
3. Increasing number of diagnostic
categories
4. Issues and possible diagnostic
categories in need of further study
Caffeine withdrawal or Premenstrual
Dysphoric Disorder

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Table 3.2 Descriptions of Mania
in DSM-II vs. DSM-IV-TR

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 Ethnic & Cultural Considerations
Mental illness universal
Culture can influence:
Risk factors
Types of symptoms experienced
Willingness to seek help
Availability of treatments
DSM-IV-TR includes:
Enhanced cultural sensitivity
Appendix of 25 culture-bound syndromes
Koro
Amok
Some researchers endorse looking for
commonalities rather than differences across
cultures
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Table 3.4 Twelve month prevalence of the
most common diagnoses by country

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Table 3.3 Number of Diagnostic
Categories per Edition of DSM

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 Figure 3.1 Categorical vs.
Categorical
Dimensional Systems
Presence/absence of a disorder
Either you are anxious or you are not
anxious.
Dimensional
Rank on a continuous quantitative
dimension
Degree to which a symptom is present
How anxious are you on a scale of 1 to
10?

Dimensional systems may better

capture an individuals functioning
Categorical approach has advantages
for research and understanding

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 Figure 3.2 Interrater Reliability
Extent to which
clinicians agree on the
diagnosis.

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 Inter-Rater Reliability of Selected
DSM Diagnoses
Diagnosis Kappa
For most DSM
Bipolar Disorder .84
diagnostic
categories, Major Depression .80
reliability is good Schizophrenia .79
Reliability in Alcohol Abuse 1.0
everyday settings Any Eating Disorder .77
may be lower than Panic Disorder .65
in formal research
settings Avoidant PD .97
Dependent PD .86
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 Validity of Diagnostic Categories
Construct validity of
highest concern
Diagnoses are
constructs
For most disorders, no
lab test available to
diagnose with certainty
Strong construct validity
predicts wide range of
characteristics

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Table 3.5 Rates of marital distress and missed
work days among people with mental illness in
the past year

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 Criticisms of Classification
Stigma against mental illness
Treated differently by others
Difficulty finding a job
Categories do not capture the uniqueness
of a person.
The disorder does not define the person.
She is an individual with schizophrenia, not a
schizophrenic
Classification may emphasize trivial
similarities
Relevant information may be overlooked.

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 Possible Changes for DSM-IV
Including a Personal Health Index
Reorganizing categories based on
overlap
Dimensional approach to diagnoses
Organizing diagnoses by causes
Defining disability

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 Psychological Assessment
Techniques employed to:
Describe clients problem
Determine causes of problem
Arrive at a diagnosis
Develop a treatment strategy
Monitor treatment progress
Ideal assessment involves multiple measures
and methods
Interviews, personality inventories, etc.
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Table 3.7 Major Psychological
Assessment Methods

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 Characteristics of Clinical
Interviews
Interviewer attends to how questions are answered
Is response accompanied by appropriate emotion?
Does client fail to answer question?
Paradigm influences information sought
CBT interviewer focuses on current, rather than early
childhood, events.
Good rapport essential
Empathy and accepting attitude
Formal (structured) vs. informal
Structured interviews
All interviewers ask the same questions in a predetermined
order
Structured Clinical Interview for Axis I of DSM (SCID)

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Figure 3.4 Sample Item
from SCID

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 Assessment of Stress
Social Readjustment Rating Scale (SSRS)
Holmes & Rahe (1967)
Relies on retrospective ratings
Stressfulness ratings fixed
Assessment of Daily Experiences (ADE)
Stone & Neale (1982)
Monitor and record thoughts and events on a daily
basis
Bedford College Life Events and Difficulties
Schedule (LEDS)
Semi-structured interview
Evaluates stressors within the context of each
individuals circumstances

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Figure 3.5 Sample of
Assessment of Daily
Experience Scale

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Figure 3.6 LEDS Life Events Timeline

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 Three Types of Psychological
Tests
Self-report personality Inventories
Minnesota Multiphasic Personality Inventory (MMPI)
Yields profile of psychological functioning
Specific subscales to detect lying and faking good or bad
Projective Tests
Rorshach Inkblot Test and Thematic Apperception Test
(TAT)
Projective hypothesis
Responses to ambiguous stimuli reflect unconscious processes
Intelligence tests
Wechsler Adult Intelligence Scale, 3rd Ed (WAIS-III);
Wechsler Intelligence Scale for Children, 3rd Ed (WISC-III)
Assesses current mental ability

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Figure 3.7 Hypothetical MMPI-2
Profile

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Figure 3.8 Rorschach Inkblot Test

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 Behavioral Observation
Observe behavior as it occurs
Sequence of behavior divided into segments
Antecedents and consequences
Observation often conducted in lab setting
e.g., romantic partners discuss relationship
problem
Interaction observed through one-way mirror or
videotaped for later coding

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 Self-Observation
Self monitoring
Individuals observe and record their own behavior
e.g., moods, stressful events, thoughts, etc.
Ecological Momentary Assessment (EMA)
Collection of data in real time using diaries or
PDAs
Reactivity
The act of observing ones behavior may alter it
Desirable behaviors tend to increase whereas
undesirable behaviors decrease
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 Self-report Inventories &
Cognitive Assessment
Format often similar to personality tests
Dysfunctional Attitude Scale (DAS)
Identifies maladaptive thought patterns
People will think less of me if I make mistakes
Articulated Thoughts in Simulated
Situations (ATSS)
Assesses immediate thoughts in specific
situations
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 Neurobiological Assessment:
Brain Imaging
Computerized Axial Tomography (CT or CAT
scan)
Reveals structural abnormalities by detecting
differences in tissue density.
e.g., enlarged ventricles
Magnetic Resonance Imaging (MRI)
Similar to CT but higher quality
fMRI (functional MRI)
Images reveal function as well as structure
Measures blood flow in the brain
(BOLD; blood oxygenation level dependent)
Positron Emission Tomography (PET scan)
Brain function
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 Neurobiological Assessment:
Neurotransmitter Assessment
Postmortem studies
Metabolite assays
Metabolite levels
By-products of neurotransmitter breakdown
found in urine, blood serum or cerebral spinal
fluid
May not reflect actual level of
neurotransmitter
Correlational studies

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 Neurobiological Assessment:
Neuropsychological Assessment
Neuropsychologist
Studies how brain abnormalities affect thinking,
feeling, and behavior
Neuropsychological Tests
Reveal performance deficits that can indicate
areas of brain malfunction
Halstead-Reitan battery
Tactile Performance Test - Time
Tactile Performance Test - Memory
Speech Sounds Perception Test
Luria-Nebraska battery
Assesses motor skills, tactile & kinesthetic skills, verbal &
spatial skills, expressive & receptive speech, etc.

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 Psychophysiological Assessment
Psychophysiology
Study of bodily changes that accompany
psychological characteristics or events
Electrocardiogram (EKG)
Heart rate measured by electrodes placed on chest
Electrodermal responding (skin conductance)
Sweat-gland activity measured by electrodes
placed on hand.
Electroencephalogram (EEG)
Brains electrical activity measured by electrodes
placed on scalp.

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 Cultural Bias in Assessment
Measures developed for one culture or
ethnic group may not be valid or reliable
for another.
Not simply a matter of language translation
Meaning may be lost
Cultural bias can lead to minimizing or
exaggerating psychological problems

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 Strategies to Avoid Bias
Increase graduate students sensitivity
to cultural issues
Insure participants understanding of
task
Establish rapport
Distinguish cultural responsiveness
from cultural stereotyping (Lopez,
1994)
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 COPYRIGHT
Copyright 2009 by John Wiley & Sons, New
York, NY. All rights reserved. No part of the
material protected by this copyright may be
reproduced or utilized in any form or by any
means, electronic or mechanical, including
photocopying, recording or by any information
storage and retrieval system, without written
permission of the copyright owner.

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