Classification and Assessment of Abnormal Behavior  Classification System is used to subdivide or organize a set of objects. It is a list of various types of problems and their associated symptoms.  Assessment is the process of gathering information from a new patient.

Diagnosis Identification or recognition of a disorder on the basis of its characteristics. Enables the clinician to refer to the base of knowledge that has accumulated with regard to the disorder. Assigning a diagnosis does not mean that the etiology is known. Diagnoses are made based on behaviors and thought patterns.

Diagnosis Advantages: Diagnosis can facilitate communication, research, treatment Clinicians use it to match their client’s problems with the form of intervention that is most effective Must be used in the search for new knowledge Disadvantages: Diagnosis can dehumanize and stigmatize/label people (see page 79) accuracy/consistency questionable

BASIC ISSUES IN CLASSIFICAITON Categories Versus Dimensions Categorical Approach to Classification Assumes that distinctions among members of different categories are qualitative. Quality not quantity – represents differences in “kind” not amount Either yes no

BASIC ISSUES IN CLASSIFICAITON NOS—Not otherwise specified 0eating%20disorder%20doesn't%20meet%20our%20criteria.htm

BASIC ISSUES IN CLASSIFICAITON Dimensional Approach Describes the objects of classification in terms of continuous dimensions. How much of a characteristic does that object exhibit? This process allows scientists to record subtle distinctions that would be lost if they were forced to make all-or-none decisions.

CLASSIFYING ABNORMAL BEHAVIOR  Currently, two diagnostic systems for mental disorders are widely recognized.  One—the Diagnostic and Statistical Manual (DSM)— is published by the American Psychiatric Association.  The other—the International Statistical Classification of Diseases & Related Health Problems (ICD)—is published by the World Health Organization.

CLASSIFYING ABNORMAL BEHAVIOR  Brief Historical Perspective  1840 census: single category, "idiocy/insanity".  1880 census seven categories: Mania, melancholia, monomania, paresis, dementia, dipsomania, and epilepsy.  1917, APA developed "Statistical Manual for the Use of Institutions for the Insane" 22 diagnoses.  Revised several times by APA over the years and called: "Standard Classified Nomenclature of Disease", referred to as the "Standard".

CLASSIFYING ABNORMAL BEHAVIOR  DSM I (1952) 108 disorders  DSM II (1968) 182 disorders  Highly psychoanalytic  Little emphasis on description  Doubtful validity and reliability  DSM III (1980) 265 disorders  DSM III- R (1987)  DSM IV (1994) & DSM IV-TR (2000) 297 disorders

CLASSIFYING ABNORMAL BEHAVIOR The DSM-IV-TR 18 primary headings Lists specific criteria for each diagnostic category Duration of the problem is considered Inclusion criteria Employs multiaxial classification: 5 axes

CLASSIFYING ABNORMAL BEHAVIOR  The DSM-IV-TR (continued)  Axis I: Clinical Syndromes  Axis II: Personality Disorders and MR  Axis III: General Medical Conditions  Axis IV: Psychosocial and Environmental Problems  Axis V: Global Assessment of Functioning (0-100)

EVALUATING CLASSIFICATION SYSTEMS The DSM is an evolving document produced by the American Psychiatric Association. DSM-V is due to appear in May, 2013 Task force of 28 experts

EVALUATING CLASSIFICATION SYSTEMS Each time the DSM-IV-TR is revised, new categories are added and old categories are dropped, presumably because they are not sufficiently useful. Up to the present time, clinicians have been more willing to include new categories than to drop old ones.

BIID—Body Identity Integration Disorder

EVALUATING CLASSIFICATION SYSTEMS  Reliability  The consistency of measurements, including diagnostic decisions  Interrater reliability: agreement among raters or judges  Test-retest reliability - consistency or agreement between multiple administrations of the same test

EVALUATING CLASSIFICATION SYSTEMS  Validity  Refers to the meaning or importance of a measurement. Measures the test, measurement, or category’s accuracy of diagnosis.

EVALUATING CLASSIFICATION SYSTEMS Unresolved Questions The boundary between normal and abnormal behavior. Clinicians must rely on their own subjective judgment Cutoff points required for a diagnosis Specific time periods used in the definition of various disorder.

EVALUATING CLASSIFICATION SYSTEMS  Problems and Limitations of the DSM-IV-TR System  Widespread acceptance of DSM-IV-TR may hinder the consideration of promising alternative classification systems.  Does not classify clinical problems into syndromes in the simplest and most beneficial way  Comorbidity: Simultaneous appearance of two or more disorders in the same person.

BASIC ISSUES IN ASSESSMENT  Purposes of Clinical Assessment  Process of collecting and interpreting information that will be used to understand another person.  Assessor must adopt a theoretical perspective regarding the nature of the disorder.  Used for several purposes  Making predictions, planning treatments, and evaluating treatments

PSYCHOLOGICAL ASSESSMENT PROCEDURES  Interviews  Most commonly used procedure in psychological assessment.  Provide an opportunity to obtain people’s own description of their problems.  Allow clinicians to observe important features of a person’s appearance and nonverbal behavior.

PSYCHOLOGICAL ASSESSMENT PROCEDURES  Structured: a question-answer format with a specific list of detailed questions.  Examples:  SCID (Structured Clinical Interview for DSM disorders)  See page 91, Table 4-4 ( Assessment of Schizotypal PD)

PSYCHOLOGICAL ASSESSMENT PROCEDURES Unstructured Interview Less standardized More exploratory Lack reliability and validity Semi-structured Interview

PSYCHOLOGICAL ASSESSMENT PROCEDURES Personality Tests and Self-Report Inventories Tests designed to measure symptoms or personality traits based on clients’ responses to structured questions

PSYCHOLOGICAL ASSESSMENT PROCEDURES Personality Inventories Sometimes called “objective tests” MMPI-2 Straightforward questions Validity scales Actuarial interpretation

TABLE 4-5 Clinical Scales for the MMPI SCALE # SCALE NAME INTERPRETATION OF HIGH SCORES 1HypochondriasisExcessive bodily concern; somatic symptoms 2Depression Depressed; pessimistic; irritable; demanding 3 HysteriaPhysical symptoms that cannot be traced to a medical illness; self-centered; demands attention 4 Psychopathic Deviate Asocial or antisocial; rebellious; impulsive, poor judgment 5 Masculinity–Femininity For men: aesthetic interests For women: assertive; competitive; self- confident 6 Paranoia Suspicious, sensitive; resentful; rigid; may be frankly psychotic 7 Psychasthenia Anxious ;worried; obsessive; lacks self- confidence; problems in decision making 8 Schizophrenia May have thinking disturbance, withdrawn; feels alienated and unaccepted 9 Hypomania Excessive activity; lacks direction; low frustration tolerance; friendly 0 Social-Introversion Socially introverted; shy; sensitive; overcontrolled; conforming

PSYCHOLOGICAL ASSESSMENT PROCEDURES  Beck Depression Inventory (BDI-II)  0) I do not feel sad.  (1) I feel sad.  (2) I am sad all the time and I can't snap out of it.  (3) I am so sad or unhappy that I can't stand it.  Measures: changes in sleep patterns, appetite, feelings of being punished, thoughts about suicide, interest in sex  21 questions  0–13: minimal to no depression  14–19: mild depression  20–28: moderate depression  29–63: severe depression.  Higher total scores indicate more severe depressive symptoms.

PSYCHOLOGICAL ASSESSMENT PROCEDURES Projective Personality Tests The person is presented with a series of ambiguous stimuli. The Rorschach Test

PSYCHOLOGICAL ASSESSMENT PROCEDURES Thematic Apperception Test (TAT)