DSM- IV• The Diagnostic and Statistical

Manual of Mental Disorder (Edition 4), was last published in 1994.

• The DSM is produced by the American Psychiatric Association.

• It is the most widely used diagnostic tool in psychiatric institutions around the world.

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.

Reliability and validity of DSM-IV and ICD-10

• Diagnosing a mental disorder is almost always done using the DSM-IV and the ICD-10.

• However, there is a risk of using this professional jargon. (Wording in the manuals is written for specialists to understand, not laymen).

• The main issues surrounding the diagnosis of mental disorders centre on the reliability and validity of the diagnoses.

Inter-rater reliability – do psychiatrists agree?

• Beck et al (1961) looked at the inter-rater reliability between 2 psychiatrists when considering the cases of 154 patients.

• The reliability was only 54% - meaning they only agreed on a diagnoses for 54% of the 154 patients!

I wonder what the other bloke thinks?

Inter-rater reliability – do psychiatrists agree?

• A true diagnosis cannot be made until a patient is clinically interviewed.

• Psychiatrists are relying on retrospective data, given by a person whose ability to recall much relevant information is unpredictable.

• Some may be exaggerating the truth – or blatantly lying!

I really hope I agree with that other bloke!

Reliability of DSM and ICD

On Being Sane in Insane Places

• Rosenhan recruited 8 people (he worked with them or knew thm in some capacity).

• Each of the 8 people went to a psychiatric hospital and reported only 1 symptom. That a voice said only single words, like “thud”, “empty” or “hollow”.

• When admitted, they began to act “normally”. All were diagnosed with suffering from schizophrenia (apart from 1).

• The individuals stayed in the institutions for between 7 to 52 days.

On being sane… follow up

• Rosenhan told the institutions about his results, and warned the hospital that they could expect other individuals to try & get themselves admitted.

• 41 patients were suspected of being fakes, and 19 of these individuals had been diagnosed by 2 members of staff.

• In fact, Rosenhan sent no-one at all!• A good film to watch: One Flew Over the

Cuckoo’s Nest (is Jack Nicholson’s character mentally ill? Is he mad, bad or sad? You decide!

What psychiatrists don’t understand

• It is tempting to label a person as a sufferer of depression, without really knowing the extent to which they are suffering.

• The beliefs and biases of some might mean the unnecessary labelling of millions of people as sufferers of a mental disorder.

• Sometimes a disorder must reach a particular level of severity before it can be recognised with confidence as a mental health issue.

Who pays for medical care?How does this affect

treatment?• There is limited time and resources available of many

professionals working in the National Health Service.• Diagnoses can be made by professionals that are rushed,

and preoccupied with only admitting the most serious cases in order to safeguard the resources of the institution they are working for.

Meehl (1977)

• Suggests that mental health professionals should be able to count on the diagnostic tools if they:– Paid close attention to medical records– Were serious about the process of diagnosis– Took account of the very thorough

descriptions presented by the major classificatory systems

– Considered all the evidence presented to them.

Validity of diagnosis

• Does the system of classification and diagnosis reflect the true nature of the problems the patient is suffering; the prognosis (the course that the disorder is expected to take); and how great a positive effect the proposed treatment will actually have.

• Many individuals do not neatly fit into categories that have been created. Instead of acknowledging this, clinicians tend to diagnose 2 separate disorders.

Labelling• Someone who has suffered a

mental disorder has to disclose that information in situations such as job interviews, or they could face formal action.

• Unlike influenza, the label of ‘bipolar disorder’ or ‘depression’ stay with a person.

• Schizophrenics risk carrying the stigma of their condition for the rest of their lives.

Cultural Relativism• Davison & Neale (1994) explain that in

some Asian cultures, a person experiencing some emotional turmoil is praised & rewarded if they show no expression of their emotions.

• In certain Arabic cultures however, the outpouring of public emotion is understood and often encouraged.

• Without this knowledge, an individual displaying overt emotional behaviour may be regarded as abnormal, when it fact it is not.

Language difficulties

• The clinician might not speak the same language as the person they are attempting to diagnose.

• Certain things can be ‘lost in translation’• This could lead to inappropriate treatment or no

treatment at all.

A final thought…• A person cannot be diagnosed with the

condition if an existing mood disorder has been diagnosed in the past or if the person is suffering from this at present.

• It could also be the case that such symptoms are brought about as a result of another medical condition or the abuse of illegal drugs or other medications.

How to revise this topic:• DSM IV – written by APA – last published in

1994.• ICD – 10 – written by WHO.• Reliability – Beck (1961) – 54% agreement• Rosenhan study – subjectivity• Issues with severity – unnecessary

labelling.• Validity – p’s don’t fit into categories• Labelling/Stigma• Cultural relativism – Davison & Neale

(1994)