VALIDITY OF DIAGNOSIS ABNORM – NORMS AND DIAGNOSIS #2 – LESSON #3

VALIDITY Does the diagnosis process measure a real pattern of symptoms. Does the diagnosis process measure a real pattern of symptoms. Can effective treatment be administered based on the diagnosis. Can effective treatment be administered based on the diagnosis. Are there biases in diagnostics? Are there biases in diagnostics? Confirmation bias: Psychiatrists puts emphasis on factors that hint patient’s disorders and overlooks other possible factors. Confirmation bias: Psychiatrists puts emphasis on factors that hint patient’s disorders and overlooks other possible factors. FAE: Over attributing the causes to the dispositional factors. FAE: Over attributing the causes to the dispositional factors. Self-fulfilling prophecy: Patient gets labeled as having a certain disorder and act according to the label Self-fulfilling prophecy: Patient gets labeled as having a certain disorder and act according to the label

VALIDITY OF DIAGNOSIS There is a tendency of practitioners of overemphasizing dispositional rather than situational causes of behaviour when diagnosing patients (Fundamental attribution error) There is a tendency of practitioners of overemphasizing dispositional rather than situational causes of behaviour when diagnosing patients (Fundamental attribution error) The labelling of patients with certain disorders may affect the practioners perceptions of them (compare with researcher bias), patients may act the label that has been given to them (self fulfilling prophecy). The label itself may simplify a problem that is highly complex The labelling of patients with certain disorders may affect the practioners perceptions of them (compare with researcher bias), patients may act the label that has been given to them (self fulfilling prophecy). The label itself may simplify a problem that is highly complex People may fake mental illness in order to avoid punishment (The insanity defense) People may fake mental illness in order to avoid punishment (The insanity defense) Szaz 1967: Many disorders may be culturally constructed. If the biological causes of the mental disorder are known, the individual may be diagnosed with mental disorder (the mental illness criterion). If there is no biologically underlying cause of the disorder, it is better to claim that the individual has problems with living or adapting Szaz 1967: Many disorders may be culturally constructed. If the biological causes of the mental disorder are known, the individual may be diagnosed with mental disorder (the mental illness criterion). If there is no biologically underlying cause of the disorder, it is better to claim that the individual has problems with living or adapting There are significant individual differences for mental disorders. An individual may have multiple mental disorders There are significant individual differences for mental disorders. An individual may have multiple mental disorders

VALIDITY OF DIAGNOSIS Rosenhan (1973): 8 sane people could get admitted to mental hospitals merely by claiming to hear voices. Rosenhan (1973): 8 sane people could get admitted to mental hospitals merely by claiming to hear voices. Rosenhan (1973): When a teaching hospital was told to expect pseudo- patients, they suspected 41 out of 193 genuine patients of being fakers Rosenhan (1973): When a teaching hospital was told to expect pseudo- patients, they suspected 41 out of 193 genuine patients of being fakers

VALIDITY OF DIAGNOSIS Temerline (1970): Clinically trained psychiatrists was influenced in their diagnosis by hearing the opinion of a respected authority. (expert influence). Participants watched a video-taped interview of a healthy individual. The authority claimed, even though the person only seemed to be neurotic (distress where behaviour is not outside social norms, patient has not lost touch with reality) he was actually psychotic (behaviour is outside social norms, loss of touch with reality) Temerline (1970): Clinically trained psychiatrists was influenced in their diagnosis by hearing the opinion of a respected authority. (expert influence). Participants watched a video-taped interview of a healthy individual. The authority claimed, even though the person only seemed to be neurotic (distress where behaviour is not outside social norms, patient has not lost touch with reality) he was actually psychotic (behaviour is outside social norms, loss of touch with reality)

VALIDITY OF DIAGNOSIS Chapman & Chapman (1967): Beginning clinicians observed draw-a-person test drawing randomly paired (unknowingly to participants) with symptom statements of patients. Although the relationship between symptoms and drawings were absent, participants rated a high associative strength between symptom and drawing characteristics (e.g. paranoia and drawing big eyes) Chapman & Chapman (1967): Beginning clinicians observed draw-a-person test drawing randomly paired (unknowingly to participants) with symptom statements of patients. Although the relationship between symptoms and drawings were absent, participants rated a high associative strength between symptom and drawing characteristics (e.g. paranoia and drawing big eyes)

VALIDITY OF DIAGNOSIS Lipton & Simon (1985): 131 patients were randomly chosen at a New York hospital. Initially there were 89 patients diagnosed with schizophrenia, eventually only 16. Initially, there were 15 diagnosed with depression, eventually there were 50. Lipton & Simon (1985): 131 patients were randomly chosen at a New York hospital. Initially there were 89 patients diagnosed with schizophrenia, eventually only 16. Initially, there were 15 diagnosed with depression, eventually there were 50.

VALIDITY OF DIAGNOSIS There is a large amount of research supporting the view that the reliability and validity of diagnosis are poor. This is due to many reasons, e.g. a possible social construction of mental illness, poor diagnostic tools, the possibility of faking, social influence, errors in attribution by practitioners and labeling There is a large amount of research supporting the view that the reliability and validity of diagnosis are poor. This is due to many reasons, e.g. a possible social construction of mental illness, poor diagnostic tools, the possibility of faking, social influence, errors in attribution by practitioners and labeling There are significant individual and cultural differences for the symptoms of mental disorders. An individual may have multiple mental disorders There are significant individual and cultural differences for the symptoms of mental disorders. An individual may have multiple mental disorders A wrong diagnosis may lead to a social stigma (an ethical issue) A wrong diagnosis may lead to a social stigma (an ethical issue)