Defining Abnormality and Diagnosing Psychological Disorders

Defining ‘abnormal’ behavior can be controversial No set definition of normal/abnormal ▫symptoms vary between individuals, social groups, and cultural groups But we need to identify what is ‘abnormal’ so that we can make a diagnosis! ▫No diagnosis, no treatment

Defining Abnormality 1.Statistics… ▫But how rare does it have to be? ▫But some disorders are common…. ▫But sometimes deviation is a good thing! 2.Deviation from social norms… ▫But since it’s socially defined, it must always be changing!  Different times, cultures, places = different definitions 3.Failure to function in society.. ▫But applied by others so it could be biased.

What is the DSM-V? Diagnostic Statistical Manual, APA handbook to identify and classify symptoms of psychiatric disorders based on: ▫Clinical and medical conditions ▫Psychosocial stressors ▫Extent that a person’s mental state interferes with life

Diagnosis AdvantagesDisadvantages Relief to know WHY ▫Knowing something is ‘causing’ it = hope for prognosis! Can begin treatment! Opportunity to develop treatments LABELING! ▫Self-fulfilling prophecy ▫Confirmation bias Legal implications ▫NGRIs!

Diagnosis Process Process ▫Interviews!! ▫Brain scans ▫Behavior observation ▫Psychological Testing (personality or IQ tests, etc) Weaknesses ▫Based on patient’s subjective descriptions of symptoms ▫Reductionist! ▫Limitations of standardized diagnostic interview process (Klienmutz, 1967)  If there is an unequal relationship between patient/clinician  Intense anxiety/preoccupation of the patient  A clinician’s unique style, degree of experience, and theoretical orientation

RELIABLE Classification Systems: Different psychiatrists agree on a patient’s diagnosis when using the same diagnostic system. ▫inter-rater reliability VALID Classification Systems: The extent to which the diagnosis is accurate. Difficult to assess in psychological disorders! ▫ Some symptoms may appear in different disorders.

Problems with the DSM Can overpathologize! Beck et al. (1962) ▫agreement on diagnosis of 153 patients between 2 psychiatrists was only 54%! DiNardo (1993) ▫Two clinicians separately diagnosed 267 individuals seeking treatment for anxiety and stress disorders ▫Results: high reliability for OCD (.80), but very low reliability for assessing GAD (.57) ▫So… there are problems interpreting how excessive a person’s worries were.

More Research! Cooper et al. (1972) ▫NY and London psychiatrists shown the same videotaped clinical interviews and asked to diagnose the patients ▫NY psychiatrists were 2x as likely to diagnose schizophrenia than London psychiatrists. ▫London psychiatrists were 2x as likely to diagnose mania or depression Lipton and Simon (1985) ▫131 randomly selected patients in a NY hospital were given various assessments for diagnosis. This diagnosis was compared to the original diagnosis. ▫Of the original 89 diagnoses of schizophrenia, only 16 received the same diagnosis on re-evaluation; 50 were diagnosed with a mood disorder, even though only 15 had been originally diagnosed with one.

Ethical Questions? Who decides when you need treatment? Do benefits of treatment outweigh drawbacks? ▫Possible misdiagnosis, loss of self-responsibility, labeling effects? Should treatment be given if exact cause is not known?

Related Learning Outcomes: Examine the concepts of normality and abnormality. ▫Explicitly link ONE study Discuss validity of diagnosis. ▫Explicitly link ONE study Discuss reliability of diagnosis. ▫Explicitly link ONE study Discuss cultural considerations in diagnosis (cultural variation). ▫Explicitly link ONE study Discuss ethical considerations in diagnosis (stigmatization). ▫Explicitly link ONE study