Dysfunctional Behaviour Diagnosis, Definition, Bias Explanations Treatments HEALTH & CLINICAL PSYCHOLOGY G543

1. Diagnosis, Definitions & Bias Diagnosis: DSM & ICD Definitions of Abnormality: Rosenhan & Seligman) Bias: Ford & Widiger

EXAM STYLE QUESTIONS (ESQ) Diagnosis Categorising June 2010 Describe one way (eg. classification system) in which dysfunctional behaviour can be categorised. (10) Discuss the limitations of diagnosing dysfunctional behaviour (15) January 2013 How has dysfunctional behaviour been categorised (e.g. a classification system)? (10) Evaluate the validity of diagnosis of dysfunctional behaviour (15) bias June 2012 How has dysfunctional behaviour been defined [10] To what extent may diagnosis of dysfunctional behaviour be considered ethnocentric? [15] definitions January 2012 Describe research into biases in diagnosis [10] Evaluate the reliability of diagnosis of dysfunctional behaviour [15]

Resources: Diagnosis, Definitions, Bias Information Booklet Powerpoint Essay Help Booklet Exam Style Questions (ESQ)

Activity 1 Worksheet 1: KEY WORDS Complete the key terms related to this topic You can use the resources and internet to help Each definition should be at least two sentences long You should use these terms where appropriate in your essays

Diagnosing Dysfunctional Behaviour Key Words: Diagnosing Dysfunctional Behaviour Term Definition dIAGNOSIS DSM-iv icd-10 sTATISTICAL INFREQUENCY DEVIATION FROM SOCIAL NORMS FAILURE TO FUNCTION DEVIATION FROM IDEAL MENTAL HEALTH BIAS ETHNOCENTRICISM HISTRIONIC PERSONALITY DISORDER ANTISOICAL PERSONALITY DISORDER

Worksheet 2: Summary Notes Activity 2 Worksheet 2: Summary Notes Complete summary notes for each section Diagnosis Definitions Bias You can use the resources and internet to help

2a. QUESTIONS: Diagnosis What is the aim of a classification system? Why are the two classification systems under review? What are the current diagnostic manuals used in the USA and the UK? Who published the ICD? What is the major difference between ICD-10 and DSM-IV? Name and advantage and disadvantage to giving an individual diagnosis? When using these is the diagnosis reliable?

2a. Summary Information: DIAGNOSIS Aim To find a way of categorising mental illness that could be applied by any psychiatrist Background Two main classification systems are used to diagnose mental illness in most of the world. Both systems are now under revision and both are very controversial. As yet there are no biological tests for mental illness, although some are in development.

2a. Summary Information: Diagnosis DSM-IV ICD-10 Axis 1: Clinical disorders, e.g. Alcohol abuse Axis 2: Personality disorders, e.g. Histrionic Axis 3: General medical conditions, e.g. Cancer or diabetes Axis 4: Psychosocial and environmental problems e.g. Stressful events like divorce Axis 5: Global assessment of functioning, e.g. How well is the patient working? Each disorder is listed in one of 11 categories Personality disorders are category 9 Medical conditions are covered in the first category Built into the groupings of the disorders are the causal factors such as organic cause, substance abuse and stress There is no global assessment of functioning separately

2a. Summary Information Requirements for a valid classification system It should provide an exhaustive system (including all types of dysfunctional behaviour) The classificatory categories should be mutually exclusive It should be reliable (consistency and inter-rater reliability) It should be valid Content validity (ask the right questions) Criterion validity (ensuring one criterion is associated with another criterion) Construct validity

2b.Summary Questions: Definitions What is the aim of defining dysfunctional behaviour? What are the four definitions of abnormality according to Rosenhan and Seligman? What does Jahoda suggest you should have for ideal mental health? How might a person be considered to function inadequately? Which culture is more likely to be diagnosed with dysfunctional behaviour according to The Mental Health Act Commission’s ‘Count Me In Census’ (2005)? What factors affect the reliability and validity of defining dysfunctional behaviour?

2b. Summary Information: DEFINITIONS Aim To try to define what we mean by someone who is abnormal generally Background Rosenhan has attempted to define what we mean by abnormality using the following terms: Statistical Infrequency Violation of social norms Failure to function adequately Deviation from ideal mental heath

2b. Summary Information: DEFINITIONS KEY TERM Statistical infrequency/deviation from statistical norms: Certain behaviours are statistically rare Violation from social norms: Behaviour that is socially deviant is regarded as abnormal Failure to function adequately: Psychological distress or discomfort Deviation from ideal mental health: Lack of a “contented existence” KEY TERM

Deviation from Social Norms 2b. Summary Information: DEFINITIONS Deviation from Social Norms Standards are set by society A norm is an accepted set of behaviours constructed by a social group Behaviour which is anti-social or undesirable Socially deviant behaviour

2b. Summary Information: DEFINITIONS Failure to Function Adequately Abnormality can be judged in terms of not being able to cope. For example, if you are feeling depressed this is acceptable as long as you can continue to go to work, eat meals, wash your clothes, and generally go about day-to-day living. Rosenhan & Seligman: suffering, danger to self, stands out, loss of control, irrational, violates moral social standard.

2b. Summary Information: DEFINITIONS Deviation from Ideal Mental Health We define physical illness in part by looking at the absence of signs of physical health. Physical health is indicated by having the correct body temperature, normal weight, normal blood pressure, and so on. This is different from how we check mental health.

2b. Summary Information: DEFINITIONS KEY TERM Deviation from ideal mental health Rosenhan & Seligman Jahoda Suffering: distress or discomfort? Maladaptivness: Engage in behaviours that make it difficult to get on. Irrationality Unpredictability Unconventionality Observer discomfort Violation of moral/ideal standards. Effective self perception Realistic self-esteem Voluntary control of behaviour True perception Sustain relationships Self-direction and productivity

2c.Summary Questions: biAS Ford & Widiger (1989) Aims Method & Procedures What was the aim of this study? What method did the researchers use? If appropriate, what was the design? If appropriate, what were the IVs? What were the DVs? How was data collected? Where there any control measures? What happened? Background What information was available from previous research/knowledge Results Sample What were the main findings? What can we conclude from this study? What are the details of the sample?

2c.Summary Questions: biAS Ford & Widiger (1989) Aims & Hypothesis Background What was the aim of this study? What information was available from previous research/knowledge Sample What are the details of the sample?

Aim What was the aim of this study? To assess whether sex bias is prevalent in diagnosis of mental disorder and if this can be minimized by the explicit criteria in the DSM-III manual.

Background What information was available from previous research/knowledge There is a difference in the number of males and females diagnosed with histrionic personality disorder (HPD) and anti social personality disorder (APD). This has been attributed to sex bias.

Sample What are the details of the sample? 354 psychologists. Of these 76% were men with an average of15.6yrs experience using a variety of therapies.

2c.QUESTIONS: biAS Ford & Widiger (1989) Method & Procedure What method did the researchers use? If appropriate, what was the design? If appropriate, what were the IVs? What were the DVs? How was data collected? Where there any control measures? What happened? Results What were the main findings? What can we conclude from this study?

Method What method did the researchers use? If appropriate, what was the design? If appropriate, what were the IVs? What were the DVs? How was data collected? Where there any control measures? This was a self report where psychologists responded to a series of case histories and made a diagnosis using DSM-III criteria

Procedure What happened? The 266 psychologists were given one of nine case histories involving a female, a male or a sex-unspecified patient each time. The case histories included the symptoms needed by the DSM-III for the unique diagnosis of APD or HPD or they were mixed together in the ‘balanced’ histories. The -psychologists used 7-point scales to say how confident they were the patient had each condition. An independent panel of 88 psychologists rated how closely the case histories were examples of a histrionic or antisocial condition.

Results What were the main findings? What can we conclude from this study? The sex-unspecified group was mostly diagnosed with borderline personality disorder and not HPD or ADP. The individual list of symptoms were found to be 80% representative of APD and HPD by the panel of 88 and there were no male/female differences found in the lists. With HPD, males were 44% and females were 76% more likely to be diagnosed with the condition. With APD, females were 15% and males 42% more likely to be diagnosed with the condition. Male & female psychologists were equally likely to make these diagnosis. This clearly shows the bias in diagnosis when all else was controlled.

Worksheet 3: Evaluation Activity 3 Worksheet 3: Evaluation Part 1: DIAGNOSIS * Write/type up your responses. Elaborate your responses fully. Part 2: EVALUATION GRID

3a. Evaluation Questions: Diagnosis Do psychiatrists always agree when using the same system? Diagnosis is dependent on the clinical interview, are self-reports reliable? Is it problematic that both the ICD & DSM have ‘misc’ categories? Do you think cultural changes affect symptom listings? Are mental illness inherited or learnt? At what point does a mentally ill person loose free will? Where is the science in diagnosis? Is the DSM/ICD useful?

3a. Debate Questions: diagnosis Are mental illness inherited or learnt? At what point does a mentally ill person loose free will? Where is the science in diagnosis? Is the DSM/ICD useful?

3a. Evaluation & Debates: DIAGNOSIS Psychiatrists do not always agree on a diagnosis using the same systems. This is because symptoms overlap and occur in clusters with no clear boundaries. Diagnosis depended on the clinical interview and this in turns depends on how honest and open the patient is about their symptoms. A high proportion of mental illness are diagnosed ‘unspecified’ in ICD-10 or not otherwise specified in DSM IV. This suggest that the criteria are not working well. Cultural changes affect inclusion of symptoms, e.g homosexuality has been removed. Nature-Nurture: Are mental illness inherited or learned? Free Will Vs Determinism: at what point does a mentally ill person loose free will? Psychology as a science: where is the science in diagnosis? Why no hard and fast tests? Usefulness: New categories are being discussed globally

3b. Evaluation Questions: definitions Are people who are extremely intelligent ‘abnormal’? Is feeling down an ‘infrequent’ behaviour? Is there any behaviour is society that was considered unacceptable and now is acceptable? Or vice versa? Is training as a marathon runner or cage fighter harming oneself? If there is no agreement on a definition of abnormality, can it be deemed scientific? Is this view of abnormality ‘westernised’? Is it useful to offer a definition of abnormality?

3b. Debate Questions: definitions If there is no agreement on a definition of abnormality, can it be deemed scientific? Is this view of abnormality ‘westernised’? Is it useful to offer a definition of abnormality?

3b. Evaluation & Debates: DEFINITIONS Many very gifted individuals could easily be classified as abnormal using this definition. Some characteristics are regarded as abnormal even though they are quite frequent. This would make it common. Many people engage in behaviour that is maladaptive/harmful or threatening to oneself, but we do not class them as abnormal. Is Psychology as a science: Why are there no agreed biological or clinical tests for abnormality yet? No definitive agreement between practitioners weakens the credibility of the subject. Ethnocentricism: is abnormality as we know it a westernised idea? Are mentally ill people seen differently in other parts of the world? Usefulness: there are problems with every definition and some people argue that we are all in the continuum for most behaviour.

3c. Evaluation Questions: BIAS Is the sample representative? Is the method ecological valid? Is this study reflective of today’s society? Is the difficulty in agreement a threat to the scientific nature of diagnosis? Does cultural beliefs about gender roles affect diagnosis? What is the bigger stereotype gender or the label of personality disorder?

3c. Debate Questions: BIAS Is the difficulty in agreement a threat to the scientific nature of diagnosis? Does cultural beliefs about gender roles affect diagnosis? What is the bigger stereotype gender or the label of personality disorder?

3c. Evaluation & Debates: BIAS The unbalanced sample of 24% female could be a problem for calculating male/female differences in clinicians themselves. Usually clinicians would diagnose a disorder from face-face interviews. The study took place 25yrs ago. It does not reflect today’s approach to abnormality. Psychology as a science: Process of diagnosis is not scientific Ethnocentricism: clearly cultural beliefs about the roles of men and women affected diagnosis in this study. Usefulness: The label of illness causes stereotyping more than gender.

Worksheet 4: Essay Plans Activity 4 Worksheet 4: Essay Plans 10 Mark Questions 15 Mark Questions

EXAM STYLE QUESTIONS (ESQ) Diagnosis Categorising June 2010 Describe one way (eg. classification system) in which dysfunctional behaviour can be categorised. (10) Discuss the limitations of diagnosing dysfunctional behaviour (15) January 2013 How has dysfunctional behaviour been categorised (e.g. a classification system)? (10) Evaluate the validity of diagnosis of dysfunctional behaviour (15) bias June 2012 How has dysfunctional behaviour been defined [10] To what extent may diagnosis of dysfunctional behaviour be considered ethnocentric? [15] definitions January 2012 Describe research into biases in diagnosis [10] Evaluate the reliability of diagnosis of dysfunctional behaviour [15]

Categorising Dysfunctional Behaviour [10] One way for 10 marks or two ways for 10 marks Introduction: DSM-IV: ICD-10: Conclusion:

How has dysfunctional behaviour been defined [10] Introduction: SI: DSN: F2F: DFIMH: Conclusion:

Describe research into biases in diagnosis [10] Introduction: Ford & Widiger Rosenhan: Conclusion: