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What is dysfunctional behaviour?
How do we define and how do we categorise dysfunctional behaviour?
What factors cause bias in this process?
Dysfunctional Behaviour
Diagnosis of dysfunctional behaviour consists of the following three areas for which you
must have a ten mark descriptive answer:
Categories: DSM and ICD
Definitions by Rosenhan & Seligman
Diagnostic bias (gender) Ford & Widiger
How did we used to define mental health?
Phrenology (bumps on the head)
Body size and shape (small head)
Categories used for mental health by health care professionals:
ICD and DSM
International Classification of Diseases
Diagnostic Statistical Manual of Mental Disorders
The ICD (mental and physical health)
Set up to help track and diagnose diseases and mental health issues world wide and is
now published by WHO (the World Health Organisation).
The ICD has descriptions of the main features of mental health disorders and each
section indicates to the health professional how many features of a disease might be required in order
to diagnose the problem.
The ICD has over 100 different categories for mental health disorders ranging from
dementia to schizophrenia.
../../ ICD.doc
The DSM (mental health only)
Set up in the USA by a team of mental health professionals specifically to help improve
the reliability of mental health diagnosis, not just in the USA but across the world.
The DSM is more complex than the ICD including a range of ‘Axis’ (variables) to be
considered alongside the features of the mental health condition such as physical illnesses, social
conditions and environmental problems.
../../ DSM.doc
YouTube - The Truth about Mental Health Disorders - Psychology
Advantages of categories for mental health
Improves reliability of diagnosis between physicians
Enables people to obtain a diagnosis so that help and support can be obtained
(disablement benefit etc)
Is regularly monitored and reviewed and updated giving a forum for psychiatrists to
come together to discuss and share new issues or problems as they arise.
Disadvantages of categorisation
May contain ethnocentric bias (is based on the American model of abnormality). The
categories reflect cultural bias for example homosexuality used to be considered an abnormality when
the categories were first discussed.
Are based on the medical model of health which assumes there is a method of reliably
and consistently measuring mental health – some people dispute this is possible
There is a wide range of individual differences in mental health and as a disease
cannot be reliably scientifically tested this has led to more and more categories making the system
more and more complex to use. An example of this is that the category ‘personality disorder unknown’
is one of the most commonly used.
Does still not avoid doctor bias in the interpretation of the symptoms presented
(Rosenhan) because of the environmental conditions in which the diagnosis takes place.
Has not led to reliable diagnosis and research shows that still different doctors will use
different categories and different drugs to treat the same patients.
You tube: YouTube - LOOKING BACK, PUSHING FORWARD
YouTube - The Diagnostic and Statistical Manual of Mental Disorders (DSM)
So how else can we do it? Other ways mental health has been defined:
Statistical infrequency
Deviation from social norms
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Failure to function
Deviation from ideal mental health
Give examples of the above behaviours which may not indicate mental health
problems!
Rosenhan and Seligman (1989)
Rosenhan and Seligman (1989) propose seven major features of abnormality that
appear in abnormal behaviour as opposed to normal behaviour. The more of these features that are
possessed by the individual, the more likely they are to be considered abnormal.
Rosenhan and Seligman’s Seven Features
Suffering : Most abnormal individuals (such as those suffering with anxiety disorders)
report that they are suffering. However normal people can suffer at times in their lives and some
abnormal individuals, such as those with personality disorders, treat others badly but do not appear to
suffer themselves
Maladaptiveness: Maladaptive behaviour is behaviour that prevents an individual from
achieving major life goals, from having fulfilling relationships with others or working effectively (for
instance an agrophobic will not venture out of the house due to fear).
Vividness and unconventionality : Vivid and unconventional behaviour is relatively
unusual. It is behaviour that differs substantially from the way in which you would expect normal
people to behave in similar situations. However there are many people who behave in this way that
are not deemed to be abnormal.
Rosenhan and Seligman
Unpredictability and loss of control: With most people, you normally predict what they
will do in known situations. In contrast, abnormal behaviour is often highly unpredictable and
uncontrolled and inappropriate for the situation.
Irrationality and incomprehensibility: One of the characteristics of abnormal behaviour
is that there appears to be no good reason why the person should choose to behave in that way.
Observer discomfort: Our social behaviour is governed by a number of unspoken rules
about behaviour, such as the way we maintain eye contact or personal space. When others break
these rules we experience discomfort. But this does not necessarily indicate abnormal behaviour, for
instance different cultures may well have different social rules about behaviour.
Violation of moral and ideal standards: When moral standards are violated, this
behaviour may be judged to be abnormal. However different cultures and different times in history
have different standards?
Gender bias and diagnosis
Kaplan (1983),argued that "diagnostic systems, are male centered" . The
authors of every edition of the DSM have been predominately male, including the membership on the
more recent personality disorder work groups: 89% for DSM-III, with only one of the 9 members
female . It might not be surprising to find that male members of these DSM committees have
pathologized stereotypic feminine traits rather than, or more so than, stereotypic masculine traits,
reflecting "masculine-biased assumptions about what behaviours are healthy and what
behaviours are crazy" (Kaplan, 1983,).
Kaplan suggested that the inclusion of gender-normative behaviours within the
histrionic and dependent diagnostic criteria ( e.g., emotionality and submissive compliance,
respectively) leads to an over diagnosis of these disorders in women. Women who display behaviour
normative for their gender would then be diagnosed more frequently with these personality disorders.
Kaplan (1983) even went so far as to assert that "via assumptions about sex roles made by
clinicians, a healthy women automatically earns the diagnosis of histrionic personality disorder" .
Gender bias and diagnosis
When provided with the same symptoms via case histories, clinicians are more likely to
provide a diagnosis of histrionic personality disorder if the patient is female than if the patient is male.
In a complementary fashion, clinicians are somewhat more likely to diagnose a male patient with
antisocial personality disorder than a female patient
If clinicians apply the criteria differentially to men and women, then whatever biases
occur must be within the clinicians rather than the criteria sets.
Ford and Widiger 1989 Sex Bias in the diagnosis of disorders
Method self report – health practitioners given scenarios and asked to make a
diagnosis. The IV was gender and the DV was the type of diagnosis
Sample of 354 clinical psychologists with a mean of 15.6 years clinical experience
selected randomly from the national register.
Procedure
Participants were randomly provided with one of nine case histories. Case studies of
patients with antisocial personality disorder or histrionic personality disorder or an equal balance of
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both were given to the clinicians. They had to make a diagnosis and rate it on a 7 point scale the
extent to which the patient displayed the symptoms of the disorders.
Findings
Sex unspecified case histories were most often diagnosed with borderline personality
disorder.
Antisocial personality disorder was diagnosed correctly 52% of the time in males but
only 15% of time in females.
Females were misdiagnosed with histionic personality disorder 46% of the time but
males on 15% of the time.
Conclusions
Practitioners are clearly biased by stereotypical views of gender.
Histrionic personality disorder (a pattern of excessive emotional behaviour and
attention seeking with a need to have approval and inappropriate seductiveness) lead more readily to
a female typical disorder diagnosis.
Diagnosis of dysfunctional behaviour
Examination Question:
Outline one way of diagnosing mental health problems(10)
Evaluate biases that may be present in the diagnosis of mental health (15)