ESQ Diagnosis

CATEGORISING

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June 2010

Describe one way (eg. classification system) in which dysfunctional behaviour can be categorised. (10)

Discuss the limitations of diagnosing dysfunctional behaviour (15)

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January 2013

How has dysfunctional behaviour been categorised (e.g. a classification system)? (10)

Evaluate the validity of diagnosis of dysfunctional behaviour (15)

DEFINING

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June 2012

How has dysfunctional behaviour been defined [10]

To what extent may diagnosis of dysfunctional behaviour be considered ethnocentric? [15]

BIAS

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January 2012

Describe research into biases in diagnosis [10]

Evaluate the reliability of diagnosis of dysfunctional behaviour [15]

PLANS FOR 10 MARK QUESTIONS

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Classification

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Definitions

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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. Diagnosis (ICD/DSM)

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, prevalence etc. Whereas the DSM-IV is a specific classification tool that enables clinicians to make accurate

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).

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.

Failure to function adequately Deviation from Ideal Mental Health

This is measuring criteria of normal functioning and irrational behaviour. Jahoda, took a slightly different approach. She felt that in She came up with 7 criteria > these tasks. For example an person who does not wash/dress themselves appropriately could be seen as dysfunctional. Behaviours that are distressing for the individual and the observer, unpredictable and essential to define normal or ideal She came up with 7 criteria > 1.

2.

3.

have a positive view of yourself be capable of some personal growth be independent and self-regulating 4.

5.

6.

have an accurate view of reality be resistant to stress 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

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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

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Classification

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Definitions

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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 Diagnosis (ICD/DSM)

It is VALID

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.

It is not VALID

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. Diagnosis (ICD/DSM) Definitions Bias (Ford & Widiger)

Extent to which it is ethnocentric

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. 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. P: Sample of psychiatrics limited E: The clinicians involved in this study were all from USA. C: Cultural expectations of personality disorder create bias.

Extent to which it is NOT ethnocentric

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. 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. S: However, P: There is within country agreement E: The psychiatrists were from different parts of USA. C: Therefore the DSM is not ethnocentric within USA.

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) Diagnosis (ICD/DSM) Definitions Bias (Ford & Widiger)

It is RELABILITY

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. 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. P: Has a level of external reliability E: Correct diagnosis were made more often then not. C: When different psychiatrists use the classification system they arrive at the same/similar diagnosis.

It is NOT RELIABLE

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. 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. S: Conversely, P: Lacks external reliability E: psychiatrists showed gender bias in diagnosing those cases.

C: Preconceived ideas affecting diagnosis