1. Defining Abnormality and Diagnosing Psychological Disorders

2. 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’…. ▫No diagnosis, no treatment

3. 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.

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

5. 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 Symptoms different in different cultures Possible misdiagnosis! Legal implications ▫NGRIs!

6. Diagnosis Process Process ▫Interviews!! ▫Behavior observation ▫Psychological Testing Weaknesses ▫Based on patient’s subjective descriptions of symptoms (Reductionist!) ▫Relationship with counselor  unequal relationship?  A clinician’s unique style, experience, and theoretical orientation

7. RELIABLE Classification Systems: Multiple psychiatrists agree on diagnosis. ▫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.

8. Problems with the DSM 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/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.

9. Rosenhan (1973) 8 researchers tried to get admission to psychiatric clinics complaining they heard a voice saying ‘empty,’ ‘hollow,’ ‘thud.’ All other questions answered truthfully. Results: ▫Kept for 7-52 days (M = 19), 7 were diagnosed with schizophrenia.  Once in, they acted normally.  Genuine patients could tell the difference, while staff couldn’t. ▫Normal behaviors (writing in journal, waiting for lunch, pacing out of boredom) seen as symptoms ▫Participants reported a lack of privacy, depersonalization, and powerlessness  7 min/day with personnel- nurses and doctors ignored questions ▫Discharged with ‘schizophrenia in remission’ Significance: ▫Diagnosis/treatment of patients determined by confirmation bias. ▫Stigma affects how the patient feels!

10. 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?

11. EVALUATE the DSM-IV diagnosis system. Your response should include: ▫What is the DSM-IV? ▫What are the advantages to this system? ▫What are the disadvantages to this system? ▫Should we continue to use it?  If yes, then why?  If no, what should be used instead?  Or how could it be improved?