Defining Abnormality and Diagnosing Psychological Disorders.
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Transcript of 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?