Abnormal Psychology, Twelfth Edition by Ann M. Kring, Sheri L. Johnson, Gerald C. Davison, & John M. Neale & John M. Neale Copyright © 2012 John Wiley & Sons, Inc. All rights reserved.

 Chapter 3: Diagnosis and Assessment I. Cornerstones of Diagnosis and Assessment II. Classification and Diagnosis III. Psychological Assessment IV. Neurobiological Assessment V. Cultural and Ethnic Diversity and Assessment © 2012 John Wiley & Sons, Inc. All rights reserved.

 Diagnosis The classification of disorders by symptoms and signs. The classification of disorders by symptoms and signs.  Advantages of diagnosis: Facilitates communication among professionals Facilitates communication among professionals Advances the search for causes and treatments Advances the search for causes and treatments Cornerstone of clinical care Cornerstone of clinical care © 2012 John Wiley & Sons, Inc. All rights reserved.

 Consistency of measurement Inter-rater Inter-rater  Observer agreement Test-retest Test-retest  Similarity of scores across repeated test administrations or observations Alternate Forms Alternate Forms  Similarity of scores on tests that are similar but not identical Internal Consistency Internal Consistency  Extent to which test items are related to one another © 2012 John Wiley & Sons, Inc. All rights reserved.

 How well does a test measure 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 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) Extent to which a measure is associated with another measure (the criterion)  Concurrent  Two measures administered at the same point in time  Predictive  Ability of the measure to predict another variable measured at some future point in time © 2012 John Wiley & Sons, Inc. All rights reserved.

 Construct validity (Cronbach & Meehl, 1955) A construct is an abstract concept or inferred attribute A construct is an abstract concept or inferred attribute Involves correlating multiple indirect measures of the attribute Involves correlating multiple indirect measures of the attribute  e.g., self-report of anxiety correlated with increased HR, shallow breathing, racing thoughts Important for validating our theoretical understanding of psychopathology Important for validating our theoretical understanding of psychopathology Method for evaluating diagnostic categories Method for evaluating diagnostic categories © 2012 John Wiley & Sons, Inc. All rights reserved.

 Diagnostic and Statistical Manual of Mental Disorders (DSM) published by American Psychiatric Association First edition published in 1952 First edition published in 1952  Current edition: DSM-IV-TR (fourth edition, revised) Published in 1994, text revised in 2000 Published in 1994, text revised in 2000  New edition expected in 2013: DSM-5 © 2012 John Wiley & Sons, Inc. All rights reserved.

 Changes in multiaxial system Five axes in DSM-IV-TR changed to two axes in DSM-5 Five axes in DSM-IV-TR changed to two axes in DSM-5  Clinical Syndromes  Psychosocial and Environmental Problems  Changes in organization of diagnoses DSM-IV-TR clusters diagnoses on similarity of symptoms DSM-IV-TR clusters diagnoses on similarity of symptoms DSM-5 diagnoses are reorganized to reflect new knowledge of comorbidity and shared etiology DSM-5 diagnoses are reorganized to reflect new knowledge of comorbidity and shared etiology  OCD moved from anxiety cluster to new cluster that also includes hoarding and body dysmorphic disorder © 2012 John Wiley & Sons, Inc. All rights reserved.

 DSM-IV-TR based on categorical classification If you have minimum number of symptoms, you are diagnosed with disorder. If one short, you are not. If you have minimum number of symptoms, you are diagnosed with disorder. If one short, you are not.  Little research support for this diagnosable threshold DSM-5 preserves categorical approach DSM-5 preserves categorical approach  NOS (“Not Otherwise Specified”) likely to remain in use for subthreshold cases  DSM-5 adds a Continuous Severity Rating Dimensional system describes degree of severity of disorder Dimensional system describes degree of severity of disorder © 2012 John Wiley & Sons, Inc. All rights reserved.

 Categorical Presence/absence of a disorder Presence/absence of a disorder  Either you are anxious or you are not anxious.  Dimensional Rank on a continuous quantitative dimension Rank on a continuous quantitative dimension  Degree to which a symptom is present  How anxious are you on a scale of 1 to 10? © 2012 John Wiley & Sons, Inc. All rights reserved.

 Personality Disorder Diagnoses DSM-IV-TR’s 10 different personality disorders will likely be reduced to 5 types in DSM-5 DSM-IV-TR’s 10 different personality disorders will likely be reduced to 5 types in DSM-5  New Diagnoses Disruptive mood dysregulation, mixed anxiety depressive disorder, language impairment disorder, etc. Disruptive mood dysregulation, mixed anxiety depressive disorder, language impairment disorder, etc.  Combining Diagnoses Substance use disorder replaces substance abuse and substance dependence, etc. Substance use disorder replaces substance abuse and substance dependence, etc.  Clearer Criteria © 2012 John Wiley & Sons, Inc. All rights reserved.

 Mental illness universal  Culture can influence: Risk factors Risk factors Types of symptoms experienced Types of symptoms experienced Willingness to seek help Willingness to seek help Availability of treatments Availability of treatments  DSM-IV-TR includes: Enhanced cultural sensitivity Enhanced cultural sensitivity Appendix of 25 culture-bound syndromes Appendix of 25 culture-bound syndromes  Amok, Drat, Koru, Taijin kyofusho, Hikikomori, etc. © 2012 John Wiley & Sons, Inc. All rights reserved.

 Too many diagnoses? Should relatively common reactions be pathologized? Should relatively common reactions be pathologized? Comorbidity Comorbidity  Presence of a second diagnosis  45% of people diagnosed with one disorder will meet criteria for a second disorder  Reliability in everyday practice © 2012 John Wiley & Sons, Inc. All rights reserved.

 Extent to which clinicians agree on the diagnosis © 2012 John Wiley & Sons, Inc. All rights reserved.

 Construct validity of highest concern  Diagnoses are constructs For most disorders, no lab test available to diagnose with certainty For most disorders, no lab test available to diagnose with certainty  Strong construct validity predicts wide range of characteristics Possible etiological causes (past) Possible etiological causes (past) Clinical characteristics (current) Clinical characteristics (current) Predict treatment response (future) Predict treatment response (future) © 2012 John Wiley & Sons, Inc. All rights reserved.

 Stigma against mental illness. Treated differently by others Treated differently by others Difficulty finding a job Difficulty finding a job  Categories do not capture the uniqueness of a person. The disorder does not define the 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. Relevant information may be overlooked. © 2012 John Wiley & Sons, Inc. All rights reserved.

 Techniques employed to: Describe client’s problem Describe client’s problem Determine causes of problem Determine causes of problem Arrive at a diagnosis Arrive at a diagnosis Develop a treatment strategy Develop a treatment strategy Monitor treatment progress Monitor treatment progress Conducting valid research Conducting valid research  Ideal assessment involves multiple measures and methods Interviews, personality inventories, intelligence tests, etc. Interviews, personality inventories, intelligence tests, etc. © 2012 John Wiley & Sons, Inc. All rights reserved.

 Informal/less structured interviews Interviewer attends to how questions are answered Interviewer attends to how questions are answered Is response accompanied by appropriate emotion? Is response accompanied by appropriate emotion? Does client fail to answer question? Does client fail to answer question? Good rapport essential to earn trust Good rapport essential to earn trust Empathy and accepting attitude necessary Empathy and accepting attitude necessary Reliability lower than for structured interviews Reliability lower than for structured interviews  Structured interviews All interviewers ask the same questions in a predetermined order All interviewers ask the same questions in a predetermined order Structured Clinical Interview for Axis I of DSM (SCID) Structured Clinical Interview for Axis I of DSM (SCID)  Good interrater reliability for most diagnostic categories © 2012 John Wiley & Sons, Inc. All rights reserved.

 Stress Subjective experience of distress in response to perceived environmental problems Subjective experience of distress in response to perceived environmental problems  Bedford College Life Events and Difficulties Schedule (LEDS) Semi-structured interview Semi-structured interview Evaluates stressors within the context of each individual’s circumstances Evaluates stressors within the context of each individual’s circumstances  Self-Report Stress Checklists Faster way to assess stress Faster way to assess stress Test-retest reliability low Test-retest reliability low © 2012 John Wiley & Sons, Inc. All rights reserved.

 Personality Tests Self-reported Personality Inventories Self-reported Personality Inventories  Minnesota Multiphasic Personality Inventory (MMPI)  Yields profile of psychological functioning  Specific subscales to detect lying and faking “good” or “bad” Projective Tests Projective Tests  Rorshach Inkblot Test and Thematic Apperception Test (TAT)  Projective hypothesis  Responses to ambiguous stimuli reflect unconscious processes © 2012 John Wiley & Sons, Inc. All rights reserved.

 Intelligence tests (IQ tests) Assess current mental ability Assess current mental ability Wechsler Scales Wechsler Scales  Wechsler Adult Intelligence Scale, 4 th ed. (WAIS-IV)  Wechsler Intelligence Scale for Children, 4 th ed. (WISC-IV)  Wechsler Preschool and Primary Scale for Children, 3 rd ed. (WPPSI-III) Stanford-Binet, 5 th ed. (SB5) Stanford-Binet, 5 th ed. (SB5) Used to predict school performance, diagnose learning disabilities or intellectual developmental disorder (mental retardation), identify gifted children, as part of a neuropsychological examination Used to predict school performance, diagnose learning disabilities or intellectual developmental disorder (mental retardation), identify gifted children, as part of a neuropsychological examination Mean IQ = 100, SD = 15 (Wechsler) or SD = 16 (SB) Mean IQ = 100, SD = 15 (Wechsler) or SD = 16 (SB) Lower IQs associated with higher psychopathology and mortality Lower IQs associated with higher psychopathology and mortality Performance on IQ tests impacted by Stereotype Threat Performance on IQ tests impacted by Stereotype Threat © 2012 John Wiley & Sons, Inc. All rights reserved.

 Focus on aspects of environment  Characteristics of the person  Frequency and form of problematic behaviors  Consequences of problem behaviors © 2012 John Wiley & Sons, Inc. All rights reserved.

 Observe behavior as it occurs  Sequence of behavior divided into segments Antecedents and consequences Antecedents and consequences  Behavioral Assessments often conducted in lab setting e.g., mother and child interact in a lab living room e.g., mother and child interact in a lab living room  Interaction observed through one-way mirror or videotaped for later coding © 2012 John Wiley & Sons, Inc. All rights reserved.

 Self-monitoring Individuals observe and record their own behavior 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 smart phones Collection of data in real time using diaries or smart phones  Reactivity The act of observing one’s behavior may alter it The act of observing one’s behavior may alter it  Desirable behaviors tend to increase whereas undesirable behaviors decrease © 2012 John Wiley & Sons, Inc. All rights reserved.

 Use to help plan treatment targets  Format often similar to personality tests  Dysfunctional Attitude Scale (DAS) Identifies maladaptive thought patterns Identifies maladaptive thought patterns  “People will think less of me if I make mistakes” © 2012 John Wiley & Sons, Inc. All rights reserved.

 Computerized Axial Tomography (CT or CAT scan) Reveals structural abnormalities by detecting differences in tissue density Reveals structural abnormalities by detecting differences in tissue density  e.g., enlarged ventricles  Magnetic Resonance Imaging (MRI) Similar to CT but higher quality Similar to CT but higher quality fMRI (functional MRI) 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 Brain function © 2012 John Wiley & Sons, Inc. All rights reserved.

 Postmortem studies  Metabolite assays Metabolite levels Metabolite levels  Byproducts of neurotransmitter breakdown found in urine, blood serum or cerebral spinal fluid May not reflect actual level of neurotransmitter May not reflect actual level of neurotransmitter Correlational studies Correlational studies © 2012 John Wiley & Sons, Inc. All rights reserved.

 Neuropsychologist Studies how brain abnormalities affect thinking, feeling, and behavior Studies how brain abnormalities affect thinking, feeling, and behavior  Neuropsychological Tests Reveal performance deficits that can indicate areas of brain malfunction Reveal performance deficits that can indicate areas of brain malfunction Halstead-Reitan battery Halstead-Reitan battery  Tactile Performance Test-Time  Tactile Performance Test-Memory  Speech Sounds Perception Test Luria-Nebraska battery Luria-Nebraska battery  Assesses motor skills, tactile and kinesthetic skills, verbal and spatial skills, expressive and receptive speech, etc. © 2012 John Wiley & Sons, Inc. All rights reserved.

 Psychophysiology Study of bodily changes that accompany psychological characteristics or events Study of bodily changes that accompany psychological characteristics or events  Electrocardiogram (EKG) Heart rate measured by electrodes placed on chest Heart rate measured by electrodes placed on chest  Electrodermal responding (skin conductance) Sweat-gland activity measured by electrodes placed on hand Sweat-gland activity measured by electrodes placed on hand  Electroencephalogram (EEG) Brain’s electrical activity measured by electrodes placed on scalp Brain’s electrical activity measured by electrodes placed on scalp © 2012 John Wiley & Sons, Inc. All rights reserved.

 Cultural Bias in Assessment Measures developed for one culture or ethnic group may not be valid or reliable for another. Measures developed for one culture or ethnic group may not be valid or reliable for another. Not simply a matter of language translation Not simply a matter of language translation  Meaning may be lost  Cultural bias can lead to minimizing or exaggerating psychological problems © 2012 John Wiley & Sons, Inc. All rights reserved.

 Increase graduate students’ sensitivity to cultural issues  Insure participants’ understanding of task  Establish rapport  Distinguish “cultural responsiveness” from “cultural stereotyping” (Lopez, 1994) Conclusions should be tentative and alternative hypotheses should be entertained Conclusions should be tentative and alternative hypotheses should be entertained © 2012 John Wiley & Sons, Inc. All rights reserved.

Copyright 2012 by John Wiley & Sons, Inc. 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. © 2012 John Wiley & Sons, Inc. All rights reserved.