1. Dysfunctional Behaviour G543

3. –Categories: DSM and ICD –Definitions by Rosenhan & Seligman –Diagnostic bias (gender) Ford & Widiger

4. 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

5. Task Students discuss both diagnostic tools

6. ICD 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.

7. DSM 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.

8. Task Explain the advantages of categorising

9. 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.

10. Explain the disadvantages of categorising

11. 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

12. Disadvantages of categorisation –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.

13. Disadvantages of categorisation –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.

14. Rosenhan and Seligman Where do you see signs of failure to function normally but without indicating mental health problems?

15. Rosenhan and Seligman Criteria for diagnosis Students outline on A3 paper and evaluate

16. Biases 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 pathologised 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,). (Discuss)

17. Sex Biases 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

18. If clinicians apply the criteria differentially to men and women, then whatever biases occur must be within the clinicians rather than the criteria sets.

19. 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

20. 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 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.

21. Task Students to research both disorders and develop a mind map for group discussion

22. 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.

23. Conclusions Can you write out the conclusions and evaluation points of the study

24. –Examination Question: –Outline one way of diagnosing mental health problems(10) –Evaluate biases that may be present in the diagnosis of mental health (15)