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Assessment and Diagnosis in Abnormal Psychology Chapter 3

Objectives What are the purposes of assessment in abnormal psychology? What are important characteristics of assessment approaches? How would one use interviews and testing to assess psychological disorders? How are diagnoses made for psychological disorders?

Assessing Psychological Disorders Purposes of Clinical Assessment To understand the individual To predict behavior To plan treatment To evaluate treatment outcome Analogous to a Funnel Starts broad Narrow to specific problem areas Multidimensional in approach

Characteristics of Assessment Reliability Consistency in measurement Examples include test-retest, inter-rater reliability Validity What the test measures and how well it does so Examples include content, concurrent, discriminant, construct, and face validity Sensitivity and specificity

NegativePositive No Yes1090 What does the test say? Does the person truly have the disorder? false positives false negativestrue positives true negatives Sensitivity 90/(90+10) =.90 Specificity 800/( ) = 88.9% Sensitivity and Specificity

Characteristics of Assessment Standardization Standards and norms help ensure consistency in the use of a technique Examples include administration procedures, scoring, and evaluation of data

Domains of Assessment: The Clinical Interview Clinical Interview Most common clinical assessment method Structured or semi-structured Purposes of interview Explore presenting problem Associated problem(s), History Biopsychosocial context Diagnose

Domains of Assessment: Clinical Interview (cont.) Mental Status Exam Appearance and behavior Thought processes Mood and affect Intellectual functioning Sensorium Mini Mental State Examination (MMSE) Assesses for cognitive functioning Useful for screening for dementia or other neuropsychological deficits

Domains of Assessment: Behavioral Assessment and Observation Behavioral Assessment Focus on here and now Tends to be direct and minimally inferential Purpose is to identify problematic behaviors and situations Identify antecedents, behaviors, and consequences Behavioral Observation and Behavioral Assessment Can be either formal or informal Self-monitoring vs. others observing Problem of reactivity using direct observation methods

Domains of Assessment: Psychological Testing and Projective Tests Psychological Testing Must be reliable and valid Projective Tests Project aspects of personality onto ambiguous test stimuli Roots in psychoanalytic tradition Require high degree of clinical inference in scoring and interpretation Examples include the Rorschach Inkblot Test, Thematic Apperception Test Reliability and validity data tend to be mixed

Objective Tests Test stimuli are less ambiguous Roots in empirical or scientific tradition Require minimal clinical inference in scoring and interpretation Objective Personality Tests Minnesota Multiphasic Personality Inventory (MMPI, MMPI-2, MMPI-A) Over 549 true or false items Extensive reliability, validity, and normative database Objective Intelligence Tests Nature of intellectual functioning and IQ The deviation IQ Verbal and performance domains Domains of Assessment: Psychological Testing and Objective Tests

Diagnosing Psychological Disorders: Foundations in Classification Clinical Assessment vs. Psychiatric Diagnosis Assessment – Idiographic approach (individual) Diagnosis – Nomothetic approach (norms) Both are important in treatment planning and intervention The Nature and Forms of Classification Systems Classical (or pure) categorical approach – Strict categories Dimensional approach – Classification along dimension Prototypical approach – Combines classical and dimensional views DSM-IV and ICD-10

Purposes and Evolution of the DSM Purposes of the DSM System Aid communication, evaluate prognosis, need for treatment, and treatment planning Basic Characteristics Five axes describing full clinical presentation (person and environment) Clear inclusion and exclusion criteria for disorders, including duration Disorders are categorized under broad headings Prototypic approach to classification; one that is empirically grounded

The DSM-IV The Five DSM-IV Axes Axis I – Most major disorders Axis II – Stable, enduring problems (e.g., personality disorders, mental retardation) Axis III – Medical conditions related to abnormal behavior Axis IV – Psychosocial problems affecting functioning or treatment Axis V – Global clinician rating of adaptive functioning

Be sure to…. Read second half of Chapter 3, Research Methods