© Cengage Learning 2016 Assessment and Classification of Mental Disorders 3.

© Cengage Learning 2016 © Cengage Learning 2016

Assessment and Classification of Mental Disorders

3

© Cengage Learning 2016

• Degree to which a test or procedure yields the same results repeatedly under the same circumstances

• Test-retest reliability– Same results when given at two different

points in time

• Internal consistency – Various parts of measure yield similar or

consistent results

Reliability


• Interrater reliability – Consistency of responses when scored by

different test administrators

Reliability (cont’d.)


• Extent to which a procedure actually performs its designed function

• Predictive validity– How well a test predicts a person’s behavior

or response

• Construct validity– How well a test or measure relates to the

characteristics or disorder in question

Validity


• Content validity– How well a test measures what it is intended

to measure

– Assesses all areas known to be associated with a particular disorder

Validity (cont’d.)


• Standard administration

• Professionals administering a test must follow common rules or procedures

• Standardization sample– Group of people who initially took the

measure• Performance is used as standard or norm

– Test-takers should be similar to the standardization sample for test to be valid

Standardization


• Psychological assessment – Gathering information and drawing

conclusions• Traits, abilities, emotional function, and more

• Four main assessment methods– Observations

– Interviews

– Psychological tests and inventories

– Neurological tests

Assessment and Classification of Mental Disorders


• Controlled (analogue) observations – Made in laboratory, clinic, or other contrived

setting

• Naturalistic observations – Informal observations made in a natural

setting (schoolroom, office, hospital ward, home)

– Usually in conjunction with an interview

• Observe appearance and behavior

Observations


• Observe client and collect data about the person’s life history, current situation, and personality

• Analyze– Verbal behavior

– Nonverbal behavior

– Content

– Process of communication

Interviews


• Interviews vary in degree of structure and formality

• Structured interviews– Common rules and procedures

– Standard series of questions

– Disadvantage: limit conversation

– Advantage: collect consistent and comprehensive information

Types of Interviews


• Objective: evaluate client’s cognitive, psychological, and behavioral functioning

• Uses questions, observations, and tasks

• Clinician considers the appropriateness and quality of the client’s responses– Forms tentative opinion of diagnosis and

treatment needs

Mental Status Examination


• Standardized tools

• Measure characteristics such as personality, social skills, and more

• Projective personality tests– Test taker presented with ambiguous stimuli

and asked to respond in some way• Rorschach Technique

• Thematic Apperception Test (TAT)

• Sentence-completion test

• Draw-a-person test

Psychological Tests and Inventories


• Do not meet reliability and validity standards

• Analysis and interpretation of responses subject to wide variation

• May have limited cultural relevance

Problems with Projective Personality Tests


• Used to assess depression, anxiety, or emotional reactivity

• May involve completion of open-ended sentences

• Minnesota Multiphasic Personality Inventory (MMPI and MMPI-2)– Interpretation is complicated

• Beck Depression Inventory (BDI)

Self-Report Inventories


The Ten MMPI-2 Clinical Scales and Sample MMPI-2 Tests (Partial)


• Primary functions– Obtain intelligence quotient (IQ), or estimate

of current level of cognitive functioning

– Provide clinical data

• Wechsler scales– Used for ages 16 and older

• Stanford-Binet scales– Used for ages 2 to 85

Intelligence Tests


• Fail to consider the effects of culture, poverty, discrimination, and oppression

• Do not consider multidimensional attributes of intelligence

• Have a poor level of predictive validity– Do not accurately predict future behaviors or

achievement

– Motivation and work ethic may matter more

Criticisms of Intelligence Tests


• Bender-Gestalt Visual-Motor Test– Involves copying geometric designs

• Halstead-Reitan Neuropsychological Test Battery– Differentiates patients with brain damage

• Can provide valuable information about the type and location of the damage

Tests for Cognitive Impairment


The Nine Bender Designs


• Allows noninvasive visualizations of brain structures

• Electroencephalograph (EEG)

• Computerized axial tomography (CT)

• Magnetic resonance imaging (MRI)– Functional MRI (fMRI)

– Diffusion tensor imaging (DTI)

• Magnetoencephalography (MEG)

• Positron emission tomography (PET)

Neurological Tests


• Psychiatric classification system– Similar to a catalogue, with detailed

descriptions of each disorder• Patterns of behavior are distinctly different

– Each category accommodates symptom variations

Diagnosing Mental Disorders


• Widely used classification system– DSM-I (1952): Identified 106 mental disorders– DSM-II (1968): Identified 182 disorders– Revisions (DSM-II, DSM-III, DSM-III-R, DSM-

IV, DSM-5) increase reliability and validity

Diagnostic and Statistical Manual of Mental Disorders (DSM)


DSM-5 Disorders – Categories and Features


DSM-5 Disorders – Categories and Features (cont’d.)


Interrater Reliability of DSM-5 Diagnostic Categories


Interrater Reliability of DSM-5 Diagnostic Categories (cont’d.)


• DSM-5 is a categorical model– Some professionals believe ineffective for

diagnosis

• Dimensional classification system– Disorders reside on a continuum from normal

to severe forms of a disorder

Dimensional Perspective


• Remains a categorical system with exceptions

• Exceptions to DSM-5 categorical system– Autism spectrum disorder

– Risk syndromes• Indicate milder forms of well-established disorders

– Enhanced assessment procedures• Allowing more than a “yes or no” answer

Final Version of the DSM-5


• Subtypes

• Specifiers

• Remission

• Cost-cutting measures

• Comorbidity– Presence of two or more disorders in the

same person

Other Attributes of the DSM-5


• Determining whether a behavior is consistent with cultural norms– Responsibility of the clinician

• Bias

• DSM-5 includes guidelines for conducting a cultural assessment– 16 questions

Cultural Factors in Assessment


• Changes in the criteria for some disorders– May increase the number of individuals

receiving a diagnosis

• Addition of some disorders– Example: gambling disorder

• Bereavement removed as an exclusionary criteria when diagnosing depression

Changes in the DSM-5 Classification System


• Labeling a person can lead to overgeneralization, stigma, and stereotypes

• Labeling may lead a person to believe they possess characteristics associated with the label

• Label are required by social systems– Do not provide precise information required

by health care organizations

Objections to Classification and Labeling


• Current trends– Increased reliance on the biological model

• Advances based on biological and neurological research

– Effort to discover specific biomarkers associated with different conditions

– Increased consideration of psychological, social, and sociocultural factors

– Growing consensus that mental health professionals not merely objective observers

Contemporary Trends and Future Directions


• How do we know if psychological tests and evaluation procedures are accurate?

• How do mental health professionals evaluate a client’s mental health?

• How do professionals make a psychiatric diagnosis?

• What changes are occurring that will affect assessment?

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