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Starter:
Reflecting upon previous work
• Read through the work I have given back
and read my comments
• Complete the feedback sheet and put
your work with it
• We will then discuss common errors
SORT THE FOLLOWING BEHAVIOUR INTO TWO
COLUMNS:
(FILL IN TABLE ON NEXT SLIDE)
‘Normal’
‘Abnormal’
Activity 1: Reflecting on Task 1

What made this exercise either easier or harder to complete?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

How do you think this relates to the diagnosis of dysfunctional behaviour?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

How would you define dysfunctional behaviour?
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____________________________________________________________________
____________________________________________________________________
DYSFUNCTIONAL
BEHAVIOUR
•
•
•
Diagnosis (1), Definition (2), Bias
(3)
Explanations
Treatments
G543
HEALTH & CLINICAL PSYCHOLOGY
EXAM STYLE QUESTIONS (ESQ)
Diagnosis
CATEGORISING
June 2010
a.
Describe one way (eg. classification system) in which dysfunctional behaviour can be
categorised. (10)
b.
Discuss the limitations of diagnosing dysfunctional behaviour (15)
January 2013
a.
How has dysfunctional behaviour been categorised (e.g. a classification system)? (10)
b.
Evaluate the validity of diagnosis of dysfunctional behaviour (15)
BIAS
June 2012
a.
How has dysfunctional behaviour been defined [10]
b.
To what extent may diagnosis of dysfunctional behaviour be considered ethnocentric? [15]
DEFINITIONS
January 2012
a.
Describe research into biases in diagnosis [10]
b.
Evaluate the reliability of diagnosis of dysfunctional behaviour [15]
1. Diagnosis, Definitions & Bias
1- Diagnosis: DSM & ICD
2a - Definitions of Abnormality:
Rosenhan & Seligman)
2b - Evaluation of definitions
3 - Bias: Ford & Widiger
1. Recapping the DSM and ICD-10
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
What is the aim of a classification system?
Why are the two classification systems under review?
What are the current diagnostic manuals used in the
USA and the UK?
Who published the ICD?
What is the major difference between ICD-10 and
DSM-IV?
Name and advantage and disadvantage to giving an
individual a diagnosis?
When using these is the diagnosis reliable?
1. Summary Information: DIAGNOSIS
Aim
To find a way of categorising mental illness
that could be applied by any psychiatrist
Background
Two main classification systems are used to
diagnose mental illness in most of the
world. Both systems are now under revision
and both are very controversial. As yet
there are no biological tests for mental
illness, although some are in development.
Why is it important to have a ‘universal’ measurement of
dysfunctional or disordered behaviour?
1. Summary Information: DIAGNOSIS
DSM-IV
ICD-10
Axis 1: Clinical disorders, e.g. Alcohol
abuse

Axis 2: Personality disorders, e.g.
Histrionic

Axis 3: General medical conditions,
e.g. Cancer or diabetes

Axis 4: Psychosocial and
environmental problems e.g.
Stressful events like divorce
Axis 5: Global assessment of
functioning, e.g. How well is the
patient working?


Each disorder is listed in one
of 11 categories
Personality disorders are
category 9
Medical conditions are
covered in the first category
Built into the groupings of the
disorders are the causal
factors such as organic cause,
substance abuse and stress
There is no global assessment
of functioning separately
1. Summary Information
Requirements for a valid classification system



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It should provide an exhaustive system (including all
types of dysfunctional behaviour)
The categories used to classify a disorder should be
mutually exclusive
It should be reliable (consistency and inter-rater
reliability)
It should be valid



Content validity (ask the right questions)
Criterion validity (ensuring one criterion is associated with
another criterion)
Construct validity
1b. Evaluation Questions: DIAGNOSIS
Do psychiatrists always agree when using the same
system?
Diagnosis is dependent on the clinical interview, are selfreports reliable?
Is it problematic that both the ICD & DSM have ‘misc’
categories?
Do you think cultural changes affect symptom listings?
Are mental illness inherited or learnt?
At what point does a mentally ill person loose free will?
Where is the science in diagnosis?
Is the DSM/ICD useful?
1b. Debate Questions: DIAGNOSIS
Are mental illness inherited or learnt?
At what point does a mentally ill person loose
free will?
 Where is the science in diagnosis?
 Is the DSM/ICD useful?
1b. Evaluation & Debates: DIAGNOSIS
 Psychiatrists do not always agree on a diagnosis using the same systems. This
is because symptoms overlap and occur in clusters with no clear boundaries.
 Diagnosis depended on the clinical interview and this in turns depends on
how honest and open the patient is about their symptoms.
 A high proportion of mental illness are diagnosed ‘unspecified’ in ICD-10 or
not otherwise specified in DSM IV. This suggest that the criteria are not
working well.
 Cultural changes affect inclusion of symptoms, e.g homosexuality has been
removed.
Nature-Nurture: Are mental illness inherited or learned?
 Free Will Vs Determinism: at what point does a mentally ill person loose free
will?
Psychology as a science: where is the science in diagnosis? Why no hard and
fast tests?
 Usefulness: New categories are being discussed globally
2a. DEFINITIONS
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What is the aim of defining dysfunctional behaviour?
What are the four definitions of abnormality according to
Rosenhan and Seligman?
What does Jahoda suggest you should have for ideal mental
health?
How might a person be considered to function inadequately?
Which culture is more likely to be diagnosed with dysfunctional
behaviour according to The Mental Health Act Commission’s
‘Count Me In Census’ (2005)?
What factors affect the reliability and validity of defining
dysfunctional behaviour?
2a. Summary Information: DEFINITIONS
Aim
To try to define what we mean by someone
who is abnormal generally
Background
Rosenhan has attempted to define what we
mean by abnormality using the following
terms:
• Statistical Infrequency
• Violation of social norms
• Failure to function adequately
• Deviation from ideal mental heath
2a. Summary Information: DEFINITIONS
KEY TERM
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Statistical infrequency/deviation from statistical
norms: Certain behaviours are statistically rare
Violation from social norms: Behaviour that is
socially deviant is regarded as abnormal
Failure to function adequately: Psychological distress
or discomfort
Deviation from ideal mental health: Lack of a
“contented existence”
Think back to the starter activity – can you find any that would be deemed
abnormal according to one definition, but not another?
Under this definition, a person’s trait,
thinking or behaviour is classified as
abnormal if it is rare or statistically
unusual.
 With this definition it is necessary to be
clear about how rare a trait or behaviour
needs to be before we class it as
abnormal

www.psychlotron.org.uk
Statistical Infrequency
Average IQ in the
population is 100pts.
frequency
The further from 100
you look, the fewer
people you find
70
100
IQ Scores
130
www.psychlotron.org.uk
Statistical Infrequency
www.psychlotron.org.uk
Statistical Infrequency
frequency
A very small subset of the
population (<2.25%) have
an IQ below 70pts. Such
people are statistically
rare. We regard them as
having abnormally low IQs
70
100
IQ Scores
130
2a. Summary Information: DEFINITIONS
Deviation from Social Norms
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Standards are set by society
A norm is an accepted set of behaviours constructed
by a social group
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Behaviour which is anti-social or undesirable
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Socially deviant behaviour
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Under this definition, a person’s thinking or
behaviour is classified as abnormal if it violates the
(unwritten) rules about what is expected or
acceptable behaviour in a particular social group.
Their behaviour may:
 Be
incomprehensible to others
 Make others feel threatened or uncomfortable
www.psychlotron.org.uk
Deviation from Social Norms

With this definition, it is necessary to consider:
 The
degree to which a norm is violated, the importance
of that norm and the value attached by the social
group to different sorts of violation.
 E.g. is the violation rude, eccentric, abnormal or
criminal?
www.psychlotron.org.uk
Deviation from Social Norms
2a.Summary Information: DEFINITIONS
Failure to Function Adequately
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Abnormality can be judged in terms of not being
able to cope. For example, if you are feeling
depressed this is acceptable as long as you can
continue to go to work, eat meals, wash your
clothes, and generally go about day-to-day living.
Rosenhan & Seligman: suffering, danger to self,
stands out, loss of control, irrational, violates moral
social standard.


Under this definition, a person is considered
abnormal if they are unable to cope with the
demands of everyday life.
They may be unable to perform the behaviours
necessary for day-to-day living e.g. self-care, hold
down a job, interact meaningfully with others, make
themselves understood etc.
www.psychlotron.org.uk
Failure to Function Adequately
2a. Summary Information: DEFINITIONS
KEY TERM
Rosenhan & Seligman
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Suffering: distress or
discomfort?
Maladaptivness: Engage
in behaviours that make it
difficult to get on.
Irrationality
Unpredictability
Unconventionality
Observer discomfort
Violation of moral/ideal
standards.
Any issues that may arise with these definitions
or criteria?
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‘normal’ people suffer distress and
discomfort
Those with personality disorders may not
experience distress or discomfort
Where to we draw the line with
‘unconventionality’? Often seen as
desirable/cultural variations
Some behaviours will make some feel
uncomfortable e.g. in different
cultures/times – does this make the
behaviour dysfunctional?

Doesn’t take into account different morals

Too broad?
2a. Summary Information: DEFINITIONS
Deviation from Ideal Mental Health
We define physical illness in part by looking at
the absence of signs of physical health.

Physical health is indicated by having the correct
body temperature, normal weight, normal blood
pressure, and so on.

This is different from how we check mental health.
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Under this definition, rather than defining what is
abnormal, we define what is normal/ideal and
anything that deviates from this is regarded as
abnormal
This requires us to decide on the characteristics we
consider necessary to mental health
www.psychlotron.org.uk
Deviation from Ideal Mental health

Psychologists vary, but usual characteristics include:
 Positive
view of the self
 Capability for growth and development
 Autonomy and independence
 Accurate perception of reality
 Positive friendships and relationships
 Environmental mastery – able to meet the varying
demands of day-to-day situations
www.psychlotron.org.uk
Deviation from Ideal Mental Health
2a. Summary Information: DEFINITIONS
KEY TERM
Deviation from ideal mental health
Jahoda
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Effective self perception
Realistic self-esteem
Voluntary control of
behaviour
True perception
Sustain relationships
Self-direction and
productivity
2a.Summary Information: DEFINITIONS
Failure to Function Adequately


Abnormality can be judged in terms of not being
able to cope. For example, if you are feeling
depressed this is acceptable as long as you can
continue to go to work, eat meals, wash your
clothes, and generally go about day-to-day living.
Rosenhan & Seligman: suffering, danger to self,
stands out, loss of control, irrational, violates moral
social standard.


Under this definition, a person is considered
abnormal if they are unable to cope with the
demands of everyday life.
They may be unable to perform the behaviours
necessary for day-to-day living e.g. self-care, hold
down a job, interact meaningfully with others, make
themselves understood etc.
www.psychlotron.org.uk
Failure to Function Adequately
2a. Summary Information: DEFINITIONS
KEY TERM
Rosenhan & Seligman







Suffering: distress or
discomfort?
Maladaptivness: Engage
in behaviours that make it
difficult to get on.
Irrationality
Unpredictability
Unconventionality
Observer discomfort
Violation of moral/ideal
standards.
Any issues that may arise with these definitions
or criteria?




‘normal’ people suffer distress and
discomfort
Those with personality disorders may not
experience distress or discomfort
Where to we draw the line with
‘unconventionality’? Often seen as
desirable/cultural variations
Some behaviours will make some feel
uncomfortable e.g. in different
cultures/times – does this make the
behaviour dysfunctional?

Doesn’t take into account different morals

Too broad?
2 b: Evaluation
-Activity
Definition
1.
2.
3.
4.
In pairs – think of one strength and one
weakness for each means of defining
abnormality.
Strength
Weakness
2b. Evaluation Questions: DEFINITIONS
Are people who are extremely intelligent ‘abnormal’?
Is feeling down an ‘infrequent’ behaviour?
Is there any behaviour is society that was considered
unacceptable and now is acceptable? Or vice versa?
Is training as a marathon runner or cage fighter
harming oneself?
If there is no agreement on a definition of
abnormality, can it be deemed scientific?
Is this view of abnormality ‘westernised’?
Is it useful to offer a definition of abnormality?
2b. Debate Questions: DEFINITIONS
 If there is no agreement on a definition of
abnormality, can it be deemed scientific?
 Is this view of abnormality ‘westernised’?
 Is it useful to offer a definition of
abnormality?
2b. Evaluation & Debates: DEFINITIONS
Many very gifted individuals could easily be classified as
abnormal using this definition. Some characteristics are
regarded as abnormal even though they are quite frequent.
This would make it common.
Many people engage in behaviour that is
maladaptive/harmful or threatening to oneself, but we do not
class them as abnormal.
 Is Psychology as a science: Why are there no agreed biological or clinical tests for
abnormality yet? No definitive agreement between practitioners weakens the
credibility of the subject.
Ethnocentricism: is abnormality as we know it a westernised idea? Are mentally ill
people seen differently in other parts of the world?
 Usefulness: there are problems with every definition and some people argue that
we are all in the continuum for most behaviour.
3. Bias in diagnosis and definitions of dysfunctional behaviour
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
We have covered this to an extent with disorders
Recap: what types of bias might influence our view of
‘dysfunction’?
BIAS
3. BIAS
Ford & Widiger (1989)
Aims
Method & Procedures
What was the aim of this study?
What method did the researchers use?
If appropriate, what was the design?
If appropriate, what were the IVs?
What were the DVs? How was data collected?
Where there any control measures?
What happened?
Background
What information was available from
previous research/knowledge
Sample
What are the details of the
sample?
Results
What were the main findings?
What can we conclude from
this study?
2c.Summary Questions: BIAS
Ford & Widiger (1989)
Aims & Hypothesis
What was the aim of this study?
Background
What information was available from
previous research/knowledge
Sample
What are the details of the
sample?
Aim
What was the aim of this study?
To assess whether sex bias is prevalent in diagnosis
of mental disorder and if this can be minimized by
the explicit criteria in the DSM-III manual.
Background
What information was available from previous research/knowledge
There is a difference in the number of males and
females diagnosed with histrionic personality
disorder (HPD) and anti social personality disorder
(APD). This has been attributed to sex bias.
Sample
What are the details of the sample?
354 psychologists. Of these 76% were men with an
average of15.6yrs experience using a variety of
therapies.
2c.QUESTIONS: BIAS
Ford & Widiger (1989)
Method & Procedure
What method did the researchers use?
If appropriate, what was the design?
If appropriate, what were the IVs?
What were the DVs? How was data
collected?
Where there any control measures?
What happened?
Results
What were the main findings?
What can we conclude from
this study?
Method

This was a self report where
psychologists responded to a
series of case histories and
made a diagnosis using DSMIII criteria
What were the DVs? How
was data collected?
IV – gender
DV – diagnosis
What method did the
researchers use?

If appropriate, what was the
design?

If appropriate, what were
the IVs?

Where there any control
measures?

Procedure
What
happened?
The 266 psychologists were given one of nine case
histories involving a female, a male or a sexunspecified patient each time.
The case histories included the symptoms needed by
the DSM-III for the unique diagnosis of APD or HPD or
they were mixed together in the ‘balanced’ histories.
The -psychologists used 7-point scales to say how
confident they were the patient had each condition.
An independent panel of 88 psychologists rated how
closely the case histories were examples of a histrionic
or antisocial condition.
Results

What were
the main
findings?
The sex-unspecified group was mostly diagnosed with
borderline personality disorder and not HPD or ADP.

The individual list of symptoms were found to be 80%
representative of APD and HPD by the panel of 88 and
there were no male/female differences found in the lists.

With HPD, males were 44% and females were 76%
more likely to be diagnosed with the condition.

With APD, females were 15% and males 42% more
likely to be diagnosed with the condition.


What can we
conclude from
this study?
Male & female psychologists were equally likely to
make these diagnosis.

This clearly shows the bias in diagnosis when all else
was controlled.

3c. Evaluation Questions: BIAS
Is the sample representative?
Is the method ecological valid?
Is this study reflective of today’s society?
Is the difficulty in agreement a threat to the scientific
nature of diagnosis?
Do cultural beliefs about gender roles affect
diagnosis?
What is the bigger stereotype gender or the label of
personality disorder?
3c. Debate Questions: BIAS
 Is the difficulty in agreement a threat to the
scientific nature of diagnosis?
Do cultural beliefs about gender roles affect
diagnosis?
What is the bigger stereotype gender or the
label of personality disorder?
3c. Evaluation & Debates: BIAS
 The unbalanced sample of 24% female could be a problem
for calculating male/female differences in clinicians themselves.
Usually clinicians would diagnose a disorder from face-face
interviews.
The study took place 25yrs ago. It does not reflect today’s
approach to abnormality.
 Psychology as a science: Process of diagnosis is not scientific
Ethnocentricism: clearly cultural beliefs about the roles of men and
women affected diagnosis in this study.
 Usefulness: The label of illness causes stereotyping more than
gender.
Activity
Worksheet : Essay Plans

10 Mark Questions

15 Mark Questions
EXAM STYLE QUESTIONS (ESQ)
Diagnosis
CATEGORISING
June 2010
a.
Describe one way (eg. classification system) in which dysfunctional behaviour can be
categorised. (10)
b.
Discuss the limitations of diagnosing dysfunctional behaviour (15)
January 2013
a.
How has dysfunctional behaviour been categorised (e.g. a classification system)? (10)
b.
Evaluate the validity of diagnosis of dysfunctional behaviour (15)
BIAS
June 2012
a.
How has dysfunctional behaviour been defined [10]
b.
To what extent may diagnosis of dysfunctional behaviour be considered ethnocentric? [15]
DEFINITIONS
January 2012
a.
Describe research into biases in diagnosis [10]
b.
Evaluate the reliability of diagnosis of dysfunctional behaviour [15]
Categorising Dysfunctional Behaviour [10]
One way for 10 marks or two ways for 10 marks
Introduction:
DSM-IV:
Conclusion:
ICD-10:
How has dysfunctional behaviour been defined [10]
Introduction:
SI:
DSN:
F2F:
DFIMH:
Conclusion:
Describe research into biases in diagnosis [10]
Introduction:
Ford & Widiger
Rosenhan:
Conclusion: