Diagnosis Diagnosis: Labeling a set of symptoms. Does the problem meet the criteria for a psychological disorder? Syndrome: a set of behavioral or psychological symptoms that tends to occur together.

Diagnostic & Statistical Manual of Mental Disorders (DSM) Compiled by the American Psychiatric Association Editions: DSM (1952), II (1968), III (1980), III-R (1987), IV (1994), IV- TR(2000) The official manual for diagnosing psychological disorders in U.S. since Provides specific, concrete criteria for each disorder.

Assumptions of the DSM Medical Model – psychological disorders as “diseases” Atheoretical Orientation – descriptive rather than explanatory Categorical Approach – disorders are grouped into discrete categories Prototypical Approach – identifies certain essential characteristics, while allowing for nonessential variations Multiaxial System – assesses 5 axes or areas of functioning

The 5 Axes Axis I: Clinical Disorders - all major disorders and adjustment disorders Axis II: Personality Disorders & Mental Retardation - lifelong, chronic conditions Axis III: General Medical Conditions - causes, consequences, or coincidental Axis IV: Psychosocial & Environmental Stressors - causes, consequences, or coincidental Axis V: Global Assessment of Functioning – rating of overall level of functioning

Axis I Developmental/Childhood Disorders Cognitive Disorders (Delirium, Dementia, Amnesia, etc.) Substance-Related Disorders Schizophrenia & Other Psychotic Disorders Mood Disorders Anxiety Disorders Disorders due to a General Medical Condition

Axis I continued Somatoform Disorders Factitious Disorders Dissociative Disorders Sexual & Gender Identity Disorders Eating Disorders Sleep Disorders Adjustment Disorders Impulse Control Disorders “V” Codes

Axis II Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Obsessive-Compulsive Mental Retardation Personality Disorders:

Axis IV: Psychosocial & Environmental Problems Primary support group Social environment Educational Occupational Housing Financial Access to health care services Legal system/ crime

Axis V: Global Assessment of Functioning no sx, superior functioning absent or minimal sx, good functioning slight, transient sx or impairment in functioning mild sx & impairment in functioning moderate sx & impairment in functioning serious sx & impairment in functioning major impairment in functioning, difficulties with reality testing or communication serious impairment in communication & judgment, psychotic sx, inability to function danger to self or others, gross impairment in communication 1-10 persistent danger to self or others, inability to maintain hygiene

Issues to Consider in Diagnosis Culture & Ethnicity Gender Age Social Class The Danger of Labeling Stigmatization

Psychological Assessment The systematic evaluation and measurement of the psychological, biological, and social factors that have the most influence on the person’s functioning. In an individual presenting with a possible psychological disorder, information is gathered about the person’s symptoms.

Clinical Interview Psychological symptoms: current & past Family history of psych problems Coping strategies Life events: recent & significant Social support and functioning Culture, ethnicity, religion, SES Medical conditions & medications Drug & alcohol use Intellectual and cognitive functioning Motivation for treatment

The Clinical Interview Unstructured Interviews Semi-Structured & Structured Interviews  Structured Clinical Interview for the DSM (SCID)  Diagnostic Interview Schedule (DIS) Limitations  Resistance to being assessed or disclosing information  Biased presentation of information – omission, distortions, outright lying

Mental Status Exam 1) Appearance & Behavior – appearance, grooming, attire, mannerisms, posture, expressiveness, activity level, bodily movements 2) Thought Processes – rate, flow, & continuity of speech, thought content, obsessions, delusions 3) Mood & Affect – expression, intensity, appropriateness, reactivity, range, & personal experience of emotion. 4) Intellectual Functioning – rough estimate of cognitive strengths & weaknesses based on vocabulary, memory, attention, insight, knowledge. 5) Sensorium – general awareness of surroundings in terms of person, place, & time.

BEHAVIORAL ASSESSMENT Purpose:  To identify & monitor target behaviors and to determine the factors that influence them. Methods:  Behavioral Observation – naturalistic vs. analogue, structured vs. unstructured  Behavioral Self-Report & Behavioral Self- Monitoring – assessing one’s thoughts, feelings & behaviors in specific situations & contexts Limitations: reactivity

Personality & Diagnostic Testing: Self-Report Inventories/Questionnaires Purpose: -to assess symptoms & diagnose disorders -to assess one’s typical ways of thinking, feeling, and behaving Examples: Beck Anxiety Inventory (BAI) Hamilton Rating Scale for Depression (HRSD) Minnesota Multiphasic Personality Inventory (MMPI-2) Millon Clinical Multiaxial Inventory (MCMI-III) Myers Briggs Type Indicator (MBTI)

Projective Tests Examples: Rorschach Inkblot Test; Thematic Apperception Test; Sentence Completion Test; Draw-A-Person Test Purpose: assesses person’s underlying concerns, conflicts, and desires Strengths: doesn’t rely on person’s level of self- insight or willingness to share Weaknesses: usefulness for diagnosis, reliability and validity, subjective interpretation

Intelligence Testing Purposes: Assess cognitive strengths and weakness Detect mental retardation or brain damage Identify special needs or gifted children Screening in occupational or military settings Examples: Wechsler Intelligence Scales (WAIS-III, WISC-III) Stanford-Binet Intelligence Test (SB-IV) Limitations: Differing conceptions of intelligence Cultural and class bias

Psychophysiological Assessment  Electroencephalogram (EEG) – measures brain wave patterns & electrical activity in the brain  Electrocardiogram (EKG) – measures cardiovascular functioning  Electromyography (EMG) – measures muscular tension  Galvanic Skin Response (GSR) – measures electrodermal response, e.g. sweat gland activity

Neuropsychological Assessment Purpose: Assess motor skills, sensory & perceptual abilities, language, attention, concentration, memory, & learning Detect brain abnormalities, damage, & deterioration Examples: Halstead-Reitan Neuropsych Battery Luria-Nebraska Neuropsych Battery

Neuroimaging Techniques Purpose: to test for brain activity, structure, & damage, e.g. injury or tumor  Computerized Tomography (CT/CAT scan) – produces an x-ray image of the structure of the brain  Magnetic Resonance Imaging (MRI) – produces high resolution pictures of brain anatomy, activity, and functioning  Positron Emission Tomography (PET) - displays brain activity & metabolism

Problems in Assessment Self-Report Issues  Lack of self-awareness  Discomfort with self-disclosure Cultural Bias  Language barriers  Cultural differences in the manifestation of disorders & presentation of symptoms