of diagnosis DSM The D iagnostic and S tatistical M anual of Mental Disorder Edition 4 was last published in 1994 The DSM is produced by the American Psychiatric Association ID: 641742
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Relibility and validity of diagnosis
DSMThe Diagnostic and Statistical Manual of Mental Disorder (Edition 4), was last published in 1994. The DSM is produced by the American Psychiatric Association. It is the most widely used diagnostic tool in psychiatric institutions around the world.Slide2
Relibility and validity of diagnosis
ICDThere is also the International Statistical Classification of Diseases (known as ICD).It is produced by the World Health Organisation (WHO) and is currently in it’s 10th
edition.Slide3
Relibility and validity of diagnosis
Reliability and validity of DSM-IV and ICD-10?Diagnosing a mental disorder is almost always done using the DSM-IV and the ICD-10. However, there is a risk of using this professional jargon. (Wording in the manuals is written for specialists to understand, not laymen).The main issues surrounding the diagnosis of mental disorders centre on the reliability and
validity of the diagnoses.Reliability: clinicians
should
be
able
to
reach
the same correct diagnosis consistently if they use the same diagnostic procedure.
Validity
:
refers
to
receiving
the
correct
diagnosis
which
should
result
in the
correct
treatment
and a
decent
prognosis.
Validity
requires
relibility
of
diagnosis
. Slide4
Relibility and validity of diagnosis
Inter-rater reliability – do psychiatrists agree?Beck et al (1961) looked at the inter-rater reliability between 2 psychiatrists when considering the cases of 154 patients.
The reliability was only 54% - meaning they only agreed on a diagnoses for 54% of the 154 patients!
I wonder what the other bloke thinks?Slide5
Relibility and validity of diagnosis
Inter-rater reliability – do psychiatrists agree?A true diagnosis cannot be made until a patient is clinically interviewed.Psychiatrists are relying on retrospective data, given by a person whose ability to recall much relevant information is unpredictable. Some may be exaggerating the truth – or blatantly lying!
I really hope I agree with that other bloke!Slide6
Relibility and validity of diagnosis
Reliability of DSM and ICD: It was originally hoped that the use of diagnostic tools could provide a standardised method of recognising mental disorders.However clear the diagnostic tool, the behaviour of an individual is always open to some interpretation. The process is subjective.The most famous study testing the subjectivity, reliability and validity of diagnostic tools was Rosenhan et al (1972).Slide7
Relibility and validity of diagnosis
On Being Sane in Insane Places?Rosenhan recruited 8 people (he worked with them or knew thm in some capacity).Each of the 8 people went to a psychiatric hospital and reported only 1 symptom. That a voice said only single words, like “thud”, “empty” or “hollow”.When admitted, they began to act “normally”. All were diagnosed with suffering from schizophrenia (apart from 1).
The individuals stayed in the institutions for between 7 to 52 days.Slide8
Relibility and validity of diagnosis
On Being Sane in Insane Places?Rosenhan told the institutions about his results, and warned the hospital that they could expect other individuals to try & get themselves admitted.41 patients were suspected of being fakes, and 19 of these individuals had been diagnosed by 2 members of staff.A
good film to watch: One Flew Over the Cuckoo’s Nest (is Jack Nicholson’s character mentally ill? Is he mad, bad or sad? You decide!Slide9
Relibility and validity of diagnosis
What psychiatrists don’t understand?It is tempting to label a person as a sufferer of depression, without really knowing the extent to which they are suffering.The beliefs and biases of some might mean the unnecessary labelling of millions of people as sufferers of a mental disorder
.Sometimes a disorder must reach a particular level of severity before it can be recognised with confidence as a mental health issue.Slide10
Relibility and validity of diagnosis
Who pays for medical care? How does this affect treatment?There is limited time and resources available of many professionals working in the National Health Service.Diagnoses can be made by professionals that are rushed, and preoccupied with only admitting the most serious cases in order to safeguard the resources of the institution they are working for.Slide11
Relibility and validity of diagnosis
Meehl (1977)Suggests that mental health professionals should be able to count on the diagnostic tools if they:- Paid close attention to medical records- Were serious about the process of diagnosis- Took account of the very thorough descriptions presented by the major classificatory systems
- Considered all the evidence presented to them.Slide12
Relibility and validity of diagnosis
Validity of diagnosis?Does the system of classification and diagnosis reflect the true nature of the problems the patient is suffering; the prognosis (the course that the disorder is expected to take); and how great a positive effect the proposed treatment will actually have.Many individuals do not neatly fit into categories that have been created. Instead of acknowledging this, clinicians tend to diagnose 2 separate disorders.Slide13
Relibility and validity of diagnosis
Labelling?Someone who has suffered a mental disorder has to disclose that information in situations such as job interviews.Unlike influenza, the label of ‘bipolar disorder’ or ‘depression’ stay with a person.Schizophrenics risk carrying the stigma of their condition for the rest of their lives.Slide14
Relibility and validity of diagnosis
Cultural Relativism?Davison & Neale (1994) explain that in some Asian cultures, a person experiencing some emotional turmoil is praised & rewarded if they show no expression of their emotions.In certain Arabic cultures however, the outpouring of public emotion is understood and often encouraged.Without this knowledge, an individual displaying overt emotional behaviour may be regarded as abnormal, when it fact it is not.Slide15
Relibility and validity of diagnosis
Language difficulties?The clinician might not speak the same language as the person they are attempting to diagnose.Certain things can be ‘lost in translation’This could lead to inappropriate treatment or no treatment at all.Slide16
Relibility and validity of diagnosis
A final thought…A person cannot be diagnosed with the condition if an existing mood disorder has been diagnosed in the past or if the person is suffering from this at present.It could also be the case that such symptoms are brought about as a result of another medical condition or the abuse of illegal drugs or other medications. Slide17
Relibility and validity of diagnosis
DSM V – written by APA – last published in 2013.ICD – 10 – written by WHO.Reliability – Beck (1961) – 54% agreement
Rosenhan study – subjectivityIssues
with
strictness
– unnecessary labelling.
Validity
–
persons
don’t fit into categories
Labelling/Stigma
Cultural
relativism – Davison & Neale (1994)