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’….▫No diagnosis, no

treatment

Defining Abnormality1. 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 diagnose psychiatric disorders based on:▫Clinical and medical

conditions▫Psychosocial stressors▫Extent that a person’s

mental state interferes with life

DiagnosisAdvantages Disadvantages

• 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!

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

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.

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.

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!

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?

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?