Download Slide 1

ESQ Diagnosis
CATEGORISING
June 2010
• Describe one way (eg. classification system) in which dysfunctional behaviour can be
categorised. (10)
• Discuss the limitations of diagnosing dysfunctional behaviour (15)
January 2013
• How has dysfunctional behaviour been categorised (e.g. a classification system)? (10)
• Evaluate the validity of diagnosis of dysfunctional behaviour (15)
DEFINING
June 2012
• How has dysfunctional behaviour been defined [10]
• To what extent may diagnosis of dysfunctional behaviour be considered ethnocentric? [15]
BIAS
January 2012
• Describe research into biases in diagnosis [10]
• Evaluate the reliability of diagnosis of dysfunctional behaviour [15]
PLANS FOR 10 MARK QUESTIONS
• Classification
• Definitions
• Bias
Describe (IW) ways (e.g. classification system) in which dysfunctional behaviour (CW) can be categorised
(TW). (10)
Introduction: There are two classificatory systems that are used to diagnose dysfunctional behaviour, ICD 10
& DSM-IV.
DSM
Diagnosis
(ICD/DSM)
1. Published by the American
Psychiatric Association
2. Specific to MHD.
3. Comprehensive; stats, prog etc
4. Multi-axal classificatory system:
•AXIS 1: Main disorder presented
•AXIS 2: Personality/Developmental
•AXIS 3: Relevant physical disorders
•AXIS 4: Psychosocial or environmental
factors
•AXIS 5: Global Assessment of
functioning - level of functioning on a
scale 1-100.
ICD
1. The International Classification of Diseases
(ICD) is the standard diagnostic tool for
epidemiology, health management and
clinical purposes.
2. Published by WHO
3. Includes the analysis of the general health
situation of population groups.
4. General: Used to monitor the incidence and
prevalence of diseases and other health
problems (mental and physical)
5. 9 Categories of MHD, for example:
- Organic
- Substance related
- Schizophrenia, delusional
- Mood disorder
- Neurotic, stress-related
- Behaviour syndromes
- Disorders of adult personality
Conclusion:
There are two well know classificatory systems for diagnosing mental health. They offer slightly different
purposes. The ICD provides a resource that lists key information related to disorders such as age of onset,
How (IW) has dysfunctional behaviour (CW) been defined (TW) [10]
Introduction: Dysfunctional behaviour is very difficult to define "behaviour which disrupts normal functioning such
as social interaction and sustaining employment", Rosenhan & Seligman attempted to create a robust criteria that
would identify dysfunctional/abnormal behaviour.
Statistical Infrequency
If a behaviour falls outside the statistical mean of a
population the rare behaviour could be dysfunctional
e.g. Purging after eating associated with bulimia
nervosa would be statistical infrequent (2SD).
Failure to function adequately
Deviation from Social Norm
Behaviours that break the codes of acceptable behaviour
would be seen as dysfunctional e.g. an individual who
believes they are being controlled by a higher being
(symptomatic of schizophrenia) could be deemed
dysfunctional.
Deviation from Ideal Mental Health
This is measuring criteria of normal functioning and
Jahoda, took a slightly different approach. She felt that in
Sheofcame
up with
criteria
assessing how well an individual is capable
fulfilling
order7to
decide if> something were atypical it would be
these tasks. For example an person who does not
essential to define normal or ideal She came up with 7
wash/dress themselves appropriately could be seen as criteria >
dysfunctional. Behaviours that are distressing for the
1. have a positive view of yourself
individual and the observer, unpredictable and
2. be capable of some personal growth
irrational behaviour.
3. be independent and self-regulating
4. have an accurate view of reality
5. be resistant to stress
6. be able to adapt to your environment.MH.
Conclusion:
Although there are a number of definitions of abnormality non of them are fully suitable.. FTF and DFIMH are more
robust., however they rely on subjective assessment by an observer which is not a reliable measurement tool.
Describe (IW) research into biases (CW) in diagnosis (TW) [10]
Introduction: Bias occurs in diagnosis because practitioners who are making diagnosis have their own
cultural, social and personal beliefs that could influence the way in which they diagnose and individual. Bias
beliefs could be related to age, gender, socio-economic status and ethnicity.
Ford & Widiger Study
Aim To find out if clinicians were stereotyping genders when diagnosing disorders.
Methodology A self-report, where health practitioners were given scenarios and asked to make diagnoses based on
the information. The independent variable was the gender of the patient in the case study and the dependent
variable was the diagnosis made by the
clinician.
Participants A final sample of 354 clinical psychologists from 1127 randomly selected from the National Register in
1983, with a mean of 15.6 years’ clinical experience; 266 psychologists responded to the case histories. Design An
independent design as each participant was given a male, female or sex-unspecified case study.
Findings Sex-unspecified case histories were diagnosed most often with borderline personality Disorder. ASPD was
correctly diagnosed 42 per cent of the time in males and 15 per cent in females. Females with ASPD were
misdiagnosed with HPD 46 per cent of the time, whereas males were only misdiagnosed with HPD 15 per cent of
the time.
HPD was correctly diagnosed in 76 per cent of females and 44 per cent of males.
Conclusion: Practitioners are biased by stereotypical views of genders, as there was a clear tendency to diagnose
females with HPD even when their case histories were of ASPD. There was also a tendency not to diagnose males
with HPD, although this was not as
great as the misdiagnosis of women. The characteristics of HPD (a pattern of excessive emotional behaviour and
attention-seeking,
together with a need for approval and inappropriate seductiveness) might be considered by some clinicians to be
gender specific, and so any behaviour that fits these criteria leads more readily to a diagnosis of a ‘female typical’
disorder.
PEC-SLAPBACK-PEC
• Worked Example
POINT: State the main claim you are making
P: The DSM IV has historical validity
EVIDENCE: Give a contextualised example to elaborate your point
E: Classificatory systems are regularly updated and reviewed to
reflect changes e.g exclusion of homosexuality
COMMENT: State how this illustrates your claim
C: This is a strength because it shows that that classificatory
systems measure dysfunctional behaviour relevant to cultural and
social context.
SLAPBACK: State a contradictory view
S: However,
POINT: State the main claim you are making
P: This classificatory systems has low interval validity
EVIDENCE: Give a contextualised example to elaborate your point
E: Patients may feel nervous when presenting symptoms to a
clinician and may not describe the situation accurately.
COMMENT: State how this illustrates your claim
C: This is a problem because the context of making diagnosis might
increase demand characteristics meaning the real symptoms are
not being accurately reported
PLANS FOR 15 MARK QUESTIONS
• Classification
• Definitions
• Bias
Evaluate (IW) the validity of diagnosis (TW) of dysfunctional behaviour (CW) (15)
Validity: Are psychiatrics really measuring/defining DB when making diagnosis?
•Internal Validity: Mundane realism /EV e.g. situational variables, personal variables, participant affects, investigator effects, DC’s)
•External Validity; historical, population, ecological validity
It is VALID
It is not VALID
Diagnosis
(ICD/DSM)
P: Has historical validity
E: Classificatory systems are regularly updated and
reviewed to reflect changes e.g exclusion of
homosexuality
C: This is a strength because it shows that that
classificatory systems measure dysfunctional
behaviour relevant to cultural and social context.
S: However,
P: Low internal validity
E: Patients may feel nervous when presenting symptoms to
a clinician and may not describe the situation accurately.
C: This is a problem because the context of making
diagnosis might increase demand characteristics meaning
the real symptoms are not being accurately reported.
Definitions
P: F2F is a comprehensive definition of DB
E: Seligman & Rosenhan reviewed research to
ensure they covered the main features that would
signal dys-functioning.
C: This is a strength as the amount of data they
reviewed was substantial enough to highlight the
main warning flags of DB.
S: On the other hand,
P: F2F is based on a subjective judgement about DB
E: Even if someone is failing to function (using this criteria),
it does not make mental illness inevitable.
C: This is a limitation because the definition is not
measuring DB.
Bias (Ford &
Widiger)
P: Study has ecological validity
E: Patients reporting their symptoms is a method
used to assess DB.
C: This is a strength because the accounts of DB
are from report of real patients are point of
diagnosis.
S: But,
P: The study lacks mundane realism
E: Psychiatrist were asked to make a diagnosis based on a
report of the pts symptoms.
C: This is a limitations as DB would not be diagnosis in this
way. Clinicians may have over-relied on factors such as
gender.
To what extent (IW) may diagnosis of dysfunctional behaviour (TW) be considered
ethnocentric (CW)? [15]
Ethnocentricism: This is the tendency to perceive the world from your own cultural group, such as your ethnic group,
national group and so on. A consequence of this is that explanations may only work for certain cultural groups.
Extent to which it is ethnocentric
Extent to which it is NOT ethnocentric
Diagnosis
(ICD/DSM)
P: DSM created in USA
E: Based on statistics from mental
health institutions in USA.
C: Symptoms/disorders presented in
USA may not be indicative of
disorders world wide.
S: On the other hand,
P: ICD is a created by the WHO
E: More comprehensive as include MH and
PH disorders universally relevant.
C: ICD less ethnocentric classificatory
system than DSM.
Definitions
P: DFSN & SI culturally dependent
E: Both of these definitions are
based on the behaviours of a
specific group or population.
C: Acceptable/Normal/Average
behaviours occur within a
social/cultural context.
S: Conversely,
P: F2F is less subjective
E: F2F is assessing levels of functioning as
opposed to identifying DB.
C: Not being able to perform day to day
tasks is a universal indicator of functioning
behaviour.
Bias (Ford & P: Sample of psychiatrics limited
Widiger)
E: The clinicians involved in this
study were all from USA.
C: Cultural expectations of
personality disorder create bias.
S: However,
P: There is within country agreement
E: The psychiatrists were from different
parts of USA.
C: Therefore the DSM is not ethnocentric
Evaluate (IW) the reliability of diagnosis (CW) of dysfunctional behaviour (TW) [15]
Reliability:
•Internal: Consistency of measure within itself (split half)
•External: Extent to which the measure varies from one use to another (test-retest, inter-rater)
It is RELABILITY
It is NOT RELIABLE
Diagnosis
(ICD/DSM)
P: Can be used by different clinicians
and arrive at the same results.
E: Rosenhan ‘Sane in InSane’
C: Shows that there is a level of
external reliability.
S: On the other hand,
P: Classificatory systems are subjective
E: Subjective interpretation of symptoms,
they cannot be quantified accurately.
C: Therefore the classificatory systems are
low in external reliability.
Definitions
P: SI definition is more quantifiable
E: By measuring behaviours that are
extreme for that specified
population. It clearly identifies DB.
C: Therefore robust measuring
system increases internal reliability.
S: However,
P: Definition of DB is open to
interpretation.
E: DIMH – Maladaptiveness/Not reaching
goals. Cannot quantify this measure of DB.
C: Demonstrates how easily there can be
issues with external reliability.
Bias (Ford & P: Has a level of external reliability
Widiger)
E: Correct diagnosis were made
more often then not.
C: When different psychiatrists use
the classification system they arrive
S: Conversely,
P: Lacks external reliability
E: psychiatrists showed gender bias in
diagnosing those cases.
C: Preconceived ideas affecting diagnosis