Chapter 4 Classification and Assessment of Abnormal Behaviour Copyright © 2006 Pearson Education Canada Inc.

2 Assessment Assessment is the process of gathering information. Diagnosis refers to the identification or recognition of a disorder based on the characteristics of symptoms. Does not mean we know the etiology What information should we collect and how?

Copyright © 2006 Pearson Education Canada Inc. 3 Why a Classification Scheme for Mental Disorders? Three Cs: – Communication: between mental health professionals – Control: prevention and treatment of disorders – Comprehension: studying underlying causes

Copyright © 2006 Pearson Education Canada Inc. 4 Classification Systems Is used to subdivide or organize a set of objects There are many ways to subdivide information any class of objects (i.e., vehicle) There are not right or wrong ways to classify objects, just ones that are useful and one that are not

Copyright © 2006 Pearson Education Canada Inc. 5 Classification Systems Categorical approach – distinctions among members of different categories are qualitative (taxonomy) – “all or none” Dimensional approach – focus on level of the characteristics – place a specific characteristic along an ordered sequence

Copyright © 2006 Pearson Education Canada Inc. 6 History of Classifying Abnormal Behaviour Emil Kraepelin ( ) – dementia praecox – manic-depressive psychosis Diagnostic and Statistical Manual (DSM) International Classification of Diseases (ICD) 1960s classification criticized for self-fulfilling prophesies

Copyright © 2006 Pearson Education Canada Inc. 7 Diagnostic and Statistical Manual Criteria – inclusion criterion – exclusion criterion Multiaxial classification system – each concerned with a different domain of information

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10 Multiaxial Classification System

Copyright © 2006 Pearson Education Canada Inc. 11 Culture & Classification Manual encourages clinicians to consider: – cultural influences on behaviour – cultural context in which the problems appeared glossary of culture-bound syndromes – i.e., amok found in people in Malaysia & Philippines

Copyright © 2006 Pearson Education Canada Inc. 12 Pibloktoq: Culture-Bound Syndrome abrupt, dissociative, episodes accompanied by confusion & extreme excitement (e.g., tearing off clothing, rolling in snow) 5-60 minutes dissociative disorder? etiology: – culturally sanctioned way of showing distress and the desire to be cared for – diet?

Copyright © 2006 Pearson Education Canada Inc. 13 Evaluating Classification Systems reliability – cross-diagnostic consistency validity – concurrent – predictive

Copyright © 2006 Pearson Education Canada Inc. 14 Limitations of DSM-IV-TR comorbidity failure to make better use of information regarding course of mental disorders

Copyright © 2006 Pearson Education Canada Inc. 15 Basic Issues in Assessment:  purpose of clinical assessment – collect/interpret information on person  consistency of behaviour – corroboration  levels of analysis – micro- vs macro-analysis

Copyright © 2006 Pearson Education Canada Inc. 16 Assessment Procedures interviews – structured, semi-structured & unstructured observation – mental status exam – rating scales (e.g., Personality Tests) – Behavioural coding systems

Copyright © 2006 Pearson Education Canada Inc. 17 Mental Status Exam Provides a simple way of organizing interview observations about a client’s mental functioning in 5 categories: 1) Appearance & Behaviour 2) Thought Processes 3) Mood & Affect 4) Intellectual Function 5) Sensation & Perception

Copyright © 2006 Pearson Education Canada Inc. 18 The Clinical Interview Unstructured Interview - open ended, places few constraints on what the client can discuss - guided by the clinician’s implicit theory of personality which provides some structure - low inter-rater reliability Structured Interview - clinician asks a series of prepared questions - higher inter-rater reliability

Copyright © 2006 Pearson Education Canada Inc. 19 Structured Clinical Interview For DSM (SCID) The interview takes 45 to 90 minutes to complete It is divided into six self-contained modules that can be administered in sequence that include:  mood episodes  psychotic symptoms  psychotic disorders  mood disorders  substance use disorders  anxiety disorders.

Copyright © 2006 Pearson Education Canada Inc. 20 Pros & Cons of Clinical Interviews advantages – interviewer control – non-verbal assessment – rich information in short time disadvantages – lack of comprehensive reporting – selective reporting – distorted recall – suggestibility

Copyright © 2006 Pearson Education Canada Inc. 21 Personality Inventories Minnesota Multiphasic Personality Inventory MMPI-II – most widely used psychological test actuarial interpretation 567 True/False items large, culturally diverse standardized sample

Copyright © 2006 Pearson Education Canada Inc. 22 MMPI-II 10 clinical scales and several Auxiliary scales Mean score of 50, score > 70 = deviant look for elevations and profiles

MMPI Copyright © 2006 Pearson Education Canada Inc. Table 4-6

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25 MMPI-II 3 validity scales  Lie Scale (L) - high score = faking good, a blatant attempt to appear socially desirable  Frequency Scale (F) - high score = faking bad, cry for help  Defensiveness Scale (K) - may be a reluctance to admit problems

Copyright © 2006 Pearson Education Canada Inc. 26 Advantages of MMPI-II  test-taking attitude/honesty  wide range of problems  objective ratings  excellent norms

Copyright © 2006 Pearson Education Canada Inc. 27 Disadvantages of MMPI-II  lack of sensitivity to certain conditions  literacy requirement  actuarial interpretation not always possible  reliability of profiles?

Copyright © 2006 Pearson Education Canada Inc. 28 Projective Personality Tests psychoanalytic tradition show client ambiguous stimuli responses indicate unconscious conflicts popular projectives include the Rorschach, T.A.T. strength: allow person to communicate difficult themes weakness: reliability problem, validity problem

Copyright © 2006 Pearson Education Canada Inc. 29 The Rorschach Inkblot Test The Rorschach Inkblot Test is the most commonly used projective test – It is one of the most widely used tests that exists – It is widely cited in research

Copyright © 2006 Pearson Education Canada Inc. 30 History Herman Rorschach, a Swiss psychiatrist, was the first to suggest (1911) the use of inkblot responses as a diagnostic instrument – In 1921 he published his book on the test, Psychodiagnostik (and soon thereafter died, age 38)

Copyright © 2006 Pearson Education Canada Inc. 31 History Rorschach's test was not well-received, attracting little notice – David Levy brought it to the United States - thought it was scientifically unsound. – His student, Samuel Beck, popularized its use here, writing several papers and books on it starting with Configurational Tendencies in Rorschach Responses (1933) Several other early users also published work on he Rorschach – Several offered their own system of administration, scoring, and interpretation, leading to later problems in standardization

Copyright © 2006 Pearson Education Canada Inc. 32 What is the Rorschach? The stimuli were generated by dropping ink onto a card and folding it – They are not, however, random: the ten cards in the current test were hand-selected out of thousands that Rorschach generated Ten blots – 5 black/white, 2 red/gray (II & III) and 3 color (VIII – X) Thought to tap into the deep layers of personality and bring out what is not conscious to the test taker The following are the inkblots

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Copyright © 2006 Pearson Education Canada Inc. 37 Administering the Rorschach The test is usually administered with as little instruction and information as possible – The tester asks 'What might this be? and gives no clues or restrictions on what is expected as a response – Anxious subjects often do ask questions, and vague answers are offered – Some advocate sitting beside the subject to avoid giving clues by facial expression – If only one response is given, some hint to find more may be offered: "Some people see more than one thing.“

Copyright © 2006 Pearson Education Canada Inc. 38 Administering the Rorschach The cards are shown twice: – The first time responses are obtained - free association phase – The second time they are elaborated – inquiry phase

Copyright © 2006 Pearson Education Canada Inc. 39 Rorschach (cont.) Exner’s Comprehensive Scoring System 1. Location - W = whole (intellectual potential) - D = subdivisions (common sense) - Dd = details (compulsive tendencies) - DW (confabulated detail) 2. Content (i.e., general class to where response belongs) - people, part of a person, clothing, animal, part of an animal, nature, anatomical

Copyright © 2006 Pearson Education Canada Inc. 40 Rorschach (cont.) 3. Determinants (i.e., specific property of the blot) - F = shape/outline (rational approach) - M = movement (imagination) - C = color (emotional reactions) - Y = shades of grey (depression) 4. Form Quality 5. typical vs. unusual response 6. time

Copyright © 2006 Pearson Education Canada Inc. 41 Rorschach (cont.)  norms = unrepresentative  inter-rater reliability  test-retest reliability  construct validity  criterion validity

Copyright © 2006 Pearson Education Canada Inc. 42 Psychometric Properties of the Rorschach The Rorschach is a popular test, however, it has been plagued by low reliability and validity. Obviously, it is difficult to measure any of the usual psychometric properties in the usual way – Validity and reliability are usually low because of the open-ended multiplicity of possibility that is allowed and by the lack of universally-accepted standardized instructions, administration protocol, and scoring procedure

Copyright © 2006 Pearson Education Canada Inc. 43 Interpreting the Rorschach Uses norms for five groups: nonpatient, outpatient nonpsychotic, inpatient character problem, inpatient depressive, inpatient schizophrenics one Deviation from norms can mean an invalid protocol, or brain damage, or emotional problems, or a low mental age (or just an original person)

Copyright © 2006 Pearson Education Canada Inc. 44 Thematic Apperception Test (TAT) Construct a story about what you see on the following picture Describe: - what led up to the scene - what is happening - what the characters in the story might think or feel - how the story will end

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Copyright © 2006 Pearson Education Canada Inc. 47 Thematic Apperception Test The Thematic Apperception Test (TAT): 30 grayscale pictures + one blank for elicitation of stories – each contain a dramatic event or critical situation Most subjects see cards, over two sessions Based on Murray's (1938) theory of 28 social needs (sex, affiliation, dominance, achievement, attitudes etc.) People would project into their story their needs Attention is paid to the protagonist in each story and his/her environmental stressors Many variations on this 'story-telling' test exist

Copyright © 2006 Pearson Education Canada Inc. 48 TAT (cont.) Administration: not standardized - Not the same 20 cards - Not the same order - Seldom 2 sessions - Instructions differ Scoring is Minimal Low Reliability & Validity

Copyright © 2006 Pearson Education Canada Inc. 49 TAT – scoring/interpretation Scoring Congruence with picture stimuli Conformity with directions Conflict Psychometric properties: internal consistency is low; high reliability but diminishes with time, 2 months, r =.80; 10 months r =.50; Inter-rater reliability vary with studies: range.3 to.9

Copyright © 2006 Pearson Education Canada Inc. 50 Draw-a-Person Test - Originally to assess children’s intelligence - Now: a screening procedure for emotional disturbance - Cannot constitute a diagnosis - The administration: Draw a person Draw a person of the opposite sex Draw yourself

Copyright © 2006 Pearson Education Canada Inc. 51 Draw-a-Person Test Administrator Asks: - Can you please draw a person? - Draw whatever you like in any way you like? Administrator Then Asks: - Draw a person of the opposite sex?

Copyright © 2006 Pearson Education Canada Inc. 52 Draw-a-Person Test (cont.) Subjective vs. quantitative scoring system Clinician looks for: – Sequence of body parts – Verbalizations during the drawing process – Size & placement of figures on the page – Number of erasures – Shading – Gender of picture – Over attention to certain body parts

Copyright © 2006 Pearson Education Canada Inc. 53 Draw-a-Person Test (cont..) Among the plausible but empirically untrue relations that have been claimed: - Large size = Emotional expansiveness or acting out - Small size = emotional constriction; withdrawal, or timidity - Overworked lines = tension, aggression - Distorted or omitted features = Conflicts related to that feature - Large or elaborate eyes = Paranoia

Copyright © 2006 Pearson Education Canada Inc. 54 Sources of Inaccuracy in Personality Self-Report Testing Personality assessment largely depends on self-report Response sets may affect personality results

Copyright © 2006 Pearson Education Canada Inc. 55 Social Desirability Some test takers choose socially acceptable answers or present themselves in a favourable light People often do not attend as much to the trait being measured as to the social acceptability of the statement This represents unwanted variance

Copyright © 2006 Pearson Education Canada Inc. 56 Social Desirability (cont.) Example items: – People I know can count on me to finish what I start. – I would rather work in a group than by myself. – I often get stressed-out in many situations.

Copyright © 2006 Pearson Education Canada Inc. 57 Faking Faking -- some test takers may respond in a particular way to cause a desired outcome – may “fake good” (e.g., in employment settings) to create a favourable impression – may “fake bad” (e.g., in clinical or forensic settings) as a cry for help or to appear mentally disturbed – may use some subtle questions that are difficult to fake because they aren’t clearly face valid

Copyright © 2006 Pearson Education Canada Inc. 58 Assessing for Depression Beck Depression Inventory – 21 item self report rating inventory measuring supposed manifestations of depression – Take approximately 10 minutes to complete

Copyright © 2006 Pearson Education Canada Inc. 59 Assessing for Depression Beck Depression Inventory Scoring considered normal mild to moderate depression moderate to severe depression severe depression

Copyright © 2006 Pearson Education Canada Inc. 60 Assessing Social Systems Family Environment Scale – relationships – personal growth

Copyright © 2006 Pearson Education Canada Inc. 61 Assessing Biological Systems Psychophysiological assessment Brain imaging techniques – CT scan – PET scan – MRI – fMRI