2. 142 Doug has been hearing voices telling him to jump through his living room window and at other times has experienced hallucinations of stepping on broken glass with bare feet. He is quite fearful and upset but refuses to go with his sister to see a doctor. Using each of the definitions from the text, determine whether this is a description of a "mental disorder. "
Deviation from social expectation: Yes; others would find his behavior disturbing, given that his behavior is unpredictable and unsettling to observers. This also reflects a mental disorder because it is rare that people have perceptual experiences like the ones Doug has had.
What clinicians treat: No; because Doug refuses to seek help from any sort of health practitioner, this definition could not apply.
Subjective distress: Yes; Doug's hallucinations are causing him a great deal of distress, compounded by his unwillingness to see someone who might be able to help him with his disorder.
Label: Probably not; even if no one has given a label to Doug's experiences, his distressing symptoms are unlikely to go away without treatment. However, if diagnosed "schizophrenic, " mis could lead to rejection and discrimination by others who interact with Doug, resulting in potentially worsened symptoms.
Dysfunction that causes harm: Yes; clearly Doug is incapable of adaptive perception and thinking on a day-to-day basis and cannot plan effectively for the future. Because of his fears, he may engage in behaviors that cause harm to himself and, potentially, to others.
2. 143 Describe the relationship between reliability and validity in assessment.
Reliability is the extent to which an assessment procedure provides consistent outcomes across items, across time, or across raters. Validity is the extent to which an assessment procedure measures what it is intended to measure, or the meaningfulness of the outcomes. Both are assessed with correlation coefficients. However, the reliability of a procedure sets the upper limit for validity. Moreover, a test or other assessment device can be very consistent over time (or raters, etc. ), thus demonstrating high reliability, but may be essentially meaningless, thus demonstrating little or no validity.
2. 144 Lyndall has been assessed by a clinical psychologist who is attempting to decide whether Lyndall has an obsessive-compulsive disorder (OCD). Describe the 4 possible diagnostic decisions the psychologist could make and what they would mean.
True positive: Lyndall is diagnosed with OCD and actually has the disorder.
True negative: Lyndall is not diagnosed with OCD and actually does not have the disorder.
False positive: Lyndall is diagnosed with OCD when, in fact, she does not have the disorder.
False negative: Lyndall is not diagnosed with OCD when, in fact, she does have the disorder.
2. 145 Why do some clinicians prefer unstructured interviews to structured interviews?
What do they sacrifice by this choice?
Unstructured interviews are preferred due to ease of administration, increased flexibility, and economy of time. However, these interviews are typically much less reliable and less comprehensive in coverage than the published structured interviews. Current evidence also suggests that structured interviews may be the most valid assessment tool available to clinicians.
2. 146 You have an appointment with a new adult client. If you could only employ two specific assessment techniques to diagnose this person, which two would you choose and why?
Structured Clinical Interview for DSM: most reliable interview method, covers comprehensive information, probably most valid single assessment method
Objective personality test - MMPI-2: superior to projective tests, standardized scoring &
computer-based normative interpretation, clearly documented reliability and good validity, does not appear to be ethnically biased
(Could make an argument for an observational method, including self-monitoring but not naturalistic observation)
2. 147 Who proposed the first systematic classification system in the late 19th century, and what was his model of mental disorders? Who developed the most influential system of that era, and what was his nosology?
Wilhelm Griesinger proposed the first classification system, based on the medical model cf disorders. Emil Kraepelin developed the most influential nosology, including the syndromes of dementia praecox, manic-depressive psychosis, and organic brain disorders.
2. 148 Compare and contrast the current classification system represented in the DSM-IV to the DSM-III and III-R.
Like the DSM-III and III-R, the DSM-IV employs a multiaxial approach to diagnosis, incorporating clinical syndromes, medical conditions, psychosocial stressors, and general level of psychosocial functioning. The various diagnoses in each of the versions are determined by following operationally defined lists of signs and symptoms collected through careful assessment.
These manuals are essentially descriptive of disorders and thus are not reflective of any one model of psychopathology. The DSM-IV, in contrast to the earlier manuals, is based on substantially more empirical field work in addition to expert advisory input. Moreover, it explicitly acknowledges how the factors of age, gender, and culture are associated with various syndromes. Finally, it is more congruent with the ICD-10, an important characteristic in light of the U. S. treaty obligation to maintain a system consistent with WHO classification.
2. 149 Huerta has been diagnosed with major depression and a comorbid dependent personality disorder. In the past year, she has lost her full-time job and is experiencing increasing marital discord. She reports that it is increasingly difficult for her to manage her hypertension with medication alone and is worried that she will end up in the hospital if she doesn't find better ways to cope with stress. Her counselor estimated Huerta's overall level of functioning as a 59. Provide the multiaxial DSM diagnosis for Huerta.
Axis I: Major depression
Axis II: Dependent personality disorder Axis III: Hypertension
Axis IV: Loss of job, marital difficulties Axis V: GAF = 59
2. 150 In simpler terms, ones that your high school neighbor would understand, what does the following statement mean? "The DSM employs a polythetic classification approach that results in heterogeneous categories of individuals. "
For each of the categories included in the DSM, the manual that mental health workers use to determine the best description for their clients' problems, there are several characteristics listed.
Some are symptoms that the person tells you about (their feelings, thoughts) and some are descriptions of their behaviors or actions. For someone to be described with a certain label, or diagnosis, they have to show a certain number of those characteristics, but they do not have to have all of them. As a result, a group of people who have the same general diagnosis, like depression, will not all have the exact same symptoms and behaviors.
2. 151 What are the dangers or difficulties that can be associated with diagnostic labeling as practiced in the DSM?
Overemphasis on reliability without sufficient evidence of validity
Arbitrary and inconsistent distinctions between mental and physical disorders
Labeling: stereotyping leading to rejection and discrimination; self-fulfilling prophecy Potential gender-related bias in clinicians' application of diagnostic criteria
Overlooking the dimensional quality of disorders by creating artificial categories Lack of attention to sociocultural factors as a cause of disorders
Insurance reimbursement pressure toward false positive diagnoses
Failure to consider cultural differences, leading to under- and overpathologizing as well as varying definitions of "abnormality"