© Cengage Learning 2016 Assessment and Classification of Mental Disorders 3

© Cengage Learning 2016 Degree to which a test or procedure yields the same results repeatedly under the same circumstances Test-retest reliability –Same results when given at two different points in time Internal consistency –Various parts of measure yield similar or consistent results Reliability

© Cengage Learning 2016 Interrater reliability –Consistency of responses when scored by different test administrators Reliability (cont’d.)

© Cengage Learning 2016 Extent to which a procedure actually performs its designed function Predictive validity –How well a test predicts a person’s behavior or response Construct validity –How well a test or measure relates to the characteristics or disorder in question Validity

© Cengage Learning 2016 Content validity –How well a test measures what it is intended to measure –Assesses all areas known to be associated with a particular disorder Validity (cont’d.)

© Cengage Learning 2016 Standard administration Professionals administering a test must follow common rules or procedures Standardization sample –Group of people who initially took the measure Performance is used as standard or norm –Test-takers should be similar to the standardization sample for test to be valid Standardization

© Cengage Learning 2016 Psychological assessment –Gathering information and drawing conclusions Traits, abilities, emotional function, and more Four main assessment methods –Observations –Interviews –Psychological tests and inventories –Neurological tests Assessment and Classification of Mental Disorders

© Cengage Learning 2016 Controlled (analogue) observations –Made in laboratory, clinic, or other contrived setting Naturalistic observations –Informal observations made in a natural setting (schoolroom, office, hospital ward, home) –Usually in conjunction with an interview Observe appearance and behavior Observations

© Cengage Learning 2016 Observe client and collect data about the person’s life history, current situation, and personality Analyze –Verbal behavior –Nonverbal behavior –Content –Process of communication Interviews

© Cengage Learning 2016 Interviews vary in degree of structure and formality Structured interviews –Common rules and procedures –Standard series of questions –Disadvantage: limit conversation –Advantage: collect consistent and comprehensive information Types of Interviews

© Cengage Learning 2016 Objective: evaluate client’s cognitive, psychological, and behavioral functioning Uses questions, observations, and tasks Clinician considers the appropriateness and quality of the client’s responses –Forms tentative opinion of diagnosis and treatment needs Mental Status Examination

© Cengage Learning 2016 Standardized tools Measure characteristics such as personality, social skills, and more Projective personality tests –Test taker presented with ambiguous stimuli and asked to respond in some way Rorschach Technique Thematic Apperception Test (TAT) Sentence-completion test Draw-a-person test Psychological Tests and Inventories

© Cengage Learning 2016 Do not meet reliability and validity standards Analysis and interpretation of responses subject to wide variation May have limited cultural relevance Problems with Projective Personality Tests

© Cengage Learning 2016 Used to assess depression, anxiety, or emotional reactivity May involve completion of open-ended sentences Minnesota Multiphasic Personality Inventory (MMPI and MMPI-2) –Interpretation is complicated Beck Depression Inventory (BDI) Self-Report Inventories

© Cengage Learning 2016 The Ten MMPI-2 Clinical Scales and Sample MMPI-2 Tests (Partial)

© Cengage Learning 2016 Primary functions –Obtain intelligence quotient (IQ), or estimate of current level of cognitive functioning –Provide clinical data Wechsler scales –Used for ages 16 and older Stanford-Binet scales –Used for ages 2 to 85 Intelligence Tests

© Cengage Learning 2016 Fail to consider the effects of culture, poverty, discrimination, and oppression Do not consider multidimensional attributes of intelligence Have a poor level of predictive validity –Do not accurately predict future behaviors or achievement –Motivation and work ethic may matter more Criticisms of Intelligence Tests

© Cengage Learning 2016 Bender-Gestalt Visual-Motor Test –Involves copying geometric designs Halstead-Reitan Neuropsychological Test Battery –Differentiates patients with brain damage Can provide valuable information about the type and location of the damage Tests for Cognitive Impairment

© Cengage Learning 2016 The Nine Bender Designs

© Cengage Learning 2016 Allows noninvasive visualizations of brain structures Electroencephalograph (EEG) Computerized axial tomography (CT) Magnetic resonance imaging (MRI) –Functional MRI (fMRI) –Diffusion tensor imaging (DTI) Magnetoencephalography (MEG) Positron emission tomography (PET) Neurological Tests

© Cengage Learning 2016 Psychiatric classification system –Similar to a catalogue, with detailed descriptions of each disorder Patterns of behavior are distinctly different –Each category accommodates symptom variations Diagnosing Mental Disorders

© Cengage Learning 2016 Widely used classification system –DSM-I (1952): Identified 106 mental disorders –DSM-II (1968): Identified 182 disorders –Revisions (DSM-II, DSM-III, DSM-III-R, DSM- IV, DSM-5) increase reliability and validity Diagnostic and Statistical Manual of Mental Disorders (DSM)

© Cengage Learning 2016 DSM-5 Disorders – Categories and Features

© Cengage Learning 2016 DSM-5 Disorders – Categories and Features (cont’d.)

© Cengage Learning 2016 Interrater Reliability of DSM-5 Diagnostic Categories

© Cengage Learning 2016 Interrater Reliability of DSM-5 Diagnostic Categories (cont’d.)

© Cengage Learning 2016 DSM-5 is a categorical model –Some professionals believe ineffective for diagnosis Dimensional classification system –Disorders reside on a continuum from normal to severe forms of a disorder Dimensional Perspective

© Cengage Learning 2016 Remains a categorical system with exceptions Exceptions to DSM-5 categorical system –Autism spectrum disorder –Risk syndromes Indicate milder forms of well-established disorders –Enhanced assessment procedures Allowing more than a “yes or no” answer Final Version of the DSM-5

© Cengage Learning 2016 Subtypes Specifiers Remission Cost-cutting measures Comorbidity –Presence of two or more disorders in the same person Other Attributes of the DSM-5

© Cengage Learning 2016 Determining whether a behavior is consistent with cultural norms –Responsibility of the clinician Bias DSM-5 includes guidelines for conducting a cultural assessment –16 questions Cultural Factors in Assessment

© Cengage Learning 2016 Changes in the criteria for some disorders –May increase the number of individuals receiving a diagnosis Addition of some disorders –Example: gambling disorder Bereavement removed as an exclusionary criteria when diagnosing depression Changes in the DSM-5 Classification System

© Cengage Learning 2016 Labeling a person can lead to overgeneralization, stigma, and stereotypes Labeling may lead a person to believe they possess characteristics associated with the label Label are required by social systems –Do not provide precise information required by health care organizations Objections to Classification and Labeling

© Cengage Learning 2016 Current trends –Increased reliance on the biological model Advances based on biological and neurological research –Effort to discover specific biomarkers associated with different conditions –Increased consideration of psychological, social, and sociocultural factors –Growing consensus that mental health professionals not merely objective observers Contemporary Trends and Future Directions

© Cengage Learning 2016 How do we know if psychological tests and evaluation procedures are accurate? How do mental health professionals evaluate a client’s mental health? How do professionals make a psychiatric diagnosis? What changes are occurring that will affect assessment? Review