1. A2 unit 4 Clinical Psychology
4) Content
Reliability of the diagnosis of mental disorders
Validity of the diagnosis of mental disorders
Cultural issues

2. Pre-reading check By now you should have read pages 234-245 (Brain)
You should be thinking about the use of the DSM and how reliable and valid it is, as well as the influence of cultural & gender issues in the diagnosis of mental disorders.

3. Learning outcomes:
a) To be able to describe and evaluate the reliability of the diagnosis of mental disorders.
b) To be able to describe and evaluate the validity of the diagnosis of mental disorders.
c) To be able to describe and evaluate cultural issues in the diagnosis of mental disorders. (in all three cases using the findings of studies).

4. DSM- IV
The Diagnostic and Statistical Manual of Mental Disorder (Edition 5), was last published in 2013.
The DSM is produced by the American Psychiatric Association.
It is the most widely used diagnostic tool in psychiatric institutions around the world

5. ICD - 10
There is also the International Statistical Classification of Diseases (known as ICD).
It is produced by the World Health Organisation (WHO) and is currently in it’s 10th edition.

6. Identification
Prognosis
Investigate causes
Treatment

7. We are now on DSM V but the exam will allow you to discuss / use / refer to DSM IV – see Blog

8. 4 types of assessment
Observation
Interview
Psych tests
Physio tests

9. Ensure this is in your packs

10. Overview of DSM
Using hand out, highlight key points and complete table in pg. 5 in packs
Use text books if there is anything you are unsure about
Thought shower in your
groups, strengths and
weaknesses of the DSM

11. Evaluation of the DSM Strengths
1. Allows for common diagnosis (although many revisions) because it has stood the test of time
When 2 or more doctors use the DSM, they should come close to the same diagnosis.
2. Evidence suggests that it is reliable ~Goldstein looked at the reliability between DSM-II and DSM-III is (1988)
She found there was evidence of reliability within the DSM-III (but less so between DSM-II and DSM-III)

12. Evaluation of the DSM Weaknesses
The DSM is seen as a confirmation of the medical state of mental disorder, as suffers are ‘patients’ and ‘treatment’ is suggested.
Mental health issues are ‘disorders’ and ‘illnesses’ so ‘cures’ are looked for.
However, it might be said that some mental disorders are simply ways of living …. who is to say whether it is ‘illness’ or not. (e.g. schizophrenics may be trying to get back to their normal self)

13. Reliability and the diagnosis of mental disorders
The DSM’s reliability rests on the question of
whether one person’s set of symptoms would lead to a common diagnosis by different physicians
If different doctors give different diagnosis for the same set of symptoms (e.g. for the same person), then the diagnosis are not reliable and the treatment may not work

14. Rationale: Why study Goldstein? – so many reasons!!
Goldstein (1988) study!
Rationale: Why study Goldstein? – so many reasons!!
Schizophrenia
Gender differences
Validity and Reliability of DSM
Primary and Secondary data
Levels of significance
Longitudinal study

15. Research Questions
Do males and females experience schizophrenia in different ways?
What part do premorbid factors play?
Premorbid factors are those present before onset of the disease
Are there differences between the DSM-II and DSM-III?

16. Studies looking at the reliability of the DSM
Goldstein (1988)
tested DMS-III for reliability and found that there was reliability
looked at the effect of gender on the experience of schizophrenia
she re-diagnosed 199 patients, originally diagnosed using DSM–II; some differences
she asked two other experts to re-diagnoses (single blind) a random sample of 8 of the patients using the case histories with all indication of previous diagnoses removed
high level of agreement/consistency of diagnosis

17. Goldstein (1988)
As she realised that she was aware of her hypothesis it was important that she asked two experts to re-diagnose a random sample of 8 patients
She found a high level of agreement and inter-rater reliability.
This suggests that DSM-III is a reliable tool

18. Other research exploring Reliability
Using text books and hand out, research other studies that have explored the reliability of the DSM
What have these studies shown?
look at the information about Kirk and Kutchin’s (1992) study…this is on the handout and on this PP which will be on the Blog

19. Kirk and Kutchins (K&K) (1992)
In their review paper Kirk and Kutchins argued that there are methodological problems with the studies used to test the reliability of the DSM up until 1992… these then limit the generalisability of the findings.
The studies outlined used interviews and questionnaires to gather data; K&K argued that training and supervision of interviews was insufficient and that they lacked the commitment and skills to be accurate.
They also pointed out that the studies they looked at tended to take place in specialised research settings… meaning that their findings might not relate to clinicians in normal clinical settings.
Generally speaking, an unreliable diagnostic tool would lack validity…. K&K suggested the DSM could also lack validity.

20. Evaluation of K&K (1992) points
Points about interviewing - such as that different interviewers may affect the situation and lead to different data – might be important when considering generalising findings from studies
Goldstein (1988) did not, however, use interviewing to test reliability – she used re-diagnosis using secondary data, and also found reliability

21. Evaluation of K&K (1992) points
The patients in the studies looked at were not all from research settings
The ‘gamblers’ in Stinchfield’s study were on a gambling treatment program, not in a research situation.
The patients in Brown et al.’s study were out patients in a hospital
= possible ecological validity?

22. Evaluation of K&K (1992) points
K&K’s study took place before Brown et al. and Stinchfield’s studies which showed that DSM-IV-TR could be regarded as reliable.
Possible to therefore conclud that further work has been done since DSM-II and reliability has improved.
Goldstein (1988), Brown et al. (2003) and Stinchfield (2003) all provide evidence that diagnosis is reliable.

23. Questions: you also have questions in your pack ~ page 5 that need to be completed
1) What do these studies tell us about the reliability of the DSM in diagnosing mental disorders?
2) How are Kirk and Kutchin’s findings different from the majority of the other studies? What does this tell us about the reliability of the DSM?
3) How can the reliability of the DSM be improved?