Chapter 3: Clinical Assessment and Diagnosis

you to begin to determine the validity

I. Assessing Psychological Disorders of the first measure.
- Predictive validity- is how well your
Clinical Assessment- is the systematic evaluation and assessment tells you what will happen
measurement of psychological, biological, and social in the future.
factors in an individual presenting with a possible ● Standardization- is the process by which a
psychological disorder. certain set of standards or norms is determined
Diagnosis- is the process of determining whether the for a technique to make its use consistent
particular problem afflicting the individual meets all across different measurements.
criteria for a psychological disorder.
The Clinical Interview
Key Concepts in Assessment Gather information on current and past behavior,
Three basic concepts that help determine the value of attitudes, and emotions, as well as a detailed history of
our assessments: the individual’s life in general and of the presenting
● Reliability problem.
- The degree to which measurement is Unstructured interviews- follow no systematic
consistent format.
- Interrater reliability- conducting Semistructured interviews- are made up of questions
research on them to ensure that two or that have been carefully phrased and tested to elicit
more raters will get the same answers. useful information in a consistent manner so that
- Test-retest reliability- conducting the clinicians can be sure they have inquired about the
test again to have a similar result most important aspects of particular disorders.
● Validity- is whether something measures what
it is designed to measure—in this case, Mental Status Exam
whether a technique assesses what it is It involves the systematic observation of an
supposed to. individual’s behavior. This type of observation occurs
- Concurrent or descriptive validity- when any one person interacts with another. The exam
comparing the results of an covers 5 categories:
assessment measure under ● Appearance and behavior
consideration with the results of ● Thought processes
others that are better known allows
 Chapter 3: Clinical Assessment and Diagnosis

● Mood and affect Informal observation- relies on the observer's

● Intellectual functioning recollection, as well as interpretation, of the events.
● Sensorium Formal Observation- involves identifying specific
Informal behavior observations- allow the clinicians behaviors that are observable and measurable.
to make a preliminary determination of which areas of Self-monitoring- people observe their own behavior
the patient's behavior and condition should be assessed to find patterns.
in more detail and perhaps more formally. Behavior rating scales- used as assessment tools
before treatment and then periodically during
Physical Examination treatment to assess changes in the person's behavior.
Toxic state could be caused by bad food, the wrong Reactivity- people change their behavior caused by a
amount or type of medicine, or onset of a medical presence of others.
condition.
Psychological Testing
Behavioral Assessment Includes specific tools to determine cognitive,
It takes this process one step further by using direct emotional, or behavioral responses that might be
observation to formally assess an individual's associated with a specific disorder and more general
thoughts, feelings, and behavior in specific situations tools that assess long-standing personality features.
or context. Projective tests- a variety of methods in which
● Target behaviors are identified and observed ambiguous stimuli, such as pictures of people or
with the goal of determining the factors that things, are presented to people who are asked to
seem to influence them. describe what they see.
● Most clinicians assume that a complete picture ● Rorschach Inkblot Test (Hermann Rorschach)
of a person's problems requires direct ● Comprehensive System (John Exner)
observation in naturalistic environments ● Thematic Apperception Test (Christiana
● Analogue or similar settings Morgan and Henry Murray, 1935)
ABC’s Observation - Children Apperception Test
● Antecedents- what happened just before the - Senior Apperception Test
behavior Personality Inventories- self-report questionnaire
● Behavior that assess personal traits
● Consequences- what happened afterward
 Chapter 3: Clinical Assessment and Diagnosis

- Minnesota Multiphasic Personality Inventory The ability to look inside the nervous system and take
(developed in the late 1930s and early 1940s increasingly accurate pictures of the structure and
and first published in 1943. It is based on an function of the brain. There are two categories:
empirical approach, that is, the collection and ● Examine the structure of the brain
evaluation of data.) - X-ray (early 1970s)
Intelligence Testing- test provided a score known as - Magnetic Resonance Imaging (MRI)
intelligence quotient (IQ) ● Examine the actual functioning of the brain by
mapping blood flow and other metabolic
Neuropsychological Testing activity
Measure abilities in areas such as receptive and - Positron Emission Tomography (PET)
expressive language, attention and concentration, Scan
memory, motor skills, perceptual abilities, and - Single Photon Emission Computed
learning and abstraction in such a way that the Tomography (SPECT)
clinician can make educated guesses about a person's
performance and the possible existence of brain Psychophysiological Assessment
impairment. It refers to measurable changes in the nervous system
● Bender Visual-Motor Gestalt Test that reflect emotional or psychological events.
● Luria-Nebraska Neuropsychological Battery ● Electroencephalogram (EEG)- measuring
● Halstead-Reitan Neuropsychological Battery electrical activity in the head related to the
- Rhythm Test firing of a specific group of neurons reveals
- Strength of Grip Test brain wave activity; brain waves come from
- Tactile Performance Test the low-voltage electrical current that runs
False positives- there will be times when the test through the neurons.
shows a problem when none exists
False negatives- when no problem is found even
though some difficulty is present II. Diagnosing Psychological Disorders

Neuroimaging: Pictures of the Brain Idiographic strategy- determine what is unique about
an individual's personality, cultural background, or
circumstances
 Chapter 3: Clinical Assessment and Diagnosis

Nomothetic strategy- determine a general class of

problems to which the presenting problem belongs Reliability
Classification- any effort to construct groups or Classification should describe specific subgroups of
categories and to assign objects or people to these symptoms that are clearly evident and can be readily
categories on the basis of their shared attributes or identified by experienced clinicians.
relations
Taxonomy- the classification of entities for scientific Validity
purposes Measures what it is designed to measure.
Nosology- taxonomic system to psychological and ● Construct validity- the signs and symptoms
medical phenomena or other clinical areas chosen as criteria for the diagnostic category
Nomenclature- describes the names or labels of the are consistently associated or “go
disorders that make up the nosology together”and what they identify differs from
other categories.
Classification Issues ● Predictive validity- it may predict the course
● If we could not order and label objects or of the disorder and the likely effect of one
experiences, scientists could not communicate treatment or another.
with one another and our knowledge would ● Criterion validity- when the outcome is the
not advance criterion by which we judge the usefulness of
● When we are dealing with human behavior or the diagnostic category
human behavioral disorders, however, the ● Content validity- if you create criteria it
subject of classification becomes should reflect the way most experts in the
controversial. field think
Classical (pure) categorical approach- assume that
every diagnosis has a clear underlying Diagnosis before 1980
pathophysiological cause, and that each disorder is ● 1919, Kraepelin first identified what we now
unique know as the disorder of schizophrenia as
Dimensional approach- note the variety of dementia praecox, described bipolar disorder
cognitions, moods, and behaviors with which the as manic depressive psychosis
patient presents and quantify them on a scale ● 1948, WHO added mental disorder
Prototypical approach- identifies certain essential classification to the 6th edition of
characteristics of an entity
 Chapter 3: Clinical Assessment and Diagnosis

International Classification of Diseases and reclassified and some organizational and

Related Health Problems (ICD). structural changes manual itself.
● 1952, the first Diagnostic and Statistical
Manual (DSM-I) by American Psychiatric Social and Cultural Considerations in DSM-5
Association Cultural formulation allows the disorder to be
● 1968, published second edition of Diagnostic described from the perspective of the patient’s
and Statistical Manual (DSM-II) personal experience and in terms of his or her primary
social and cultural group.
DSM-III and DSM-III-R Suggested culture-related questions:
● 1980 Under leadership of Robert Spitzer, 1. What is the primary cultural reference group
DSM-III took an atheoretical approach to of the patient?
diagnosis, relying on descriptions rather than 2. Does the patient use terms and descriptions
psychoanalytic or biological theories of from his or her “old” country to describe the
etiology. The specificity and detail with which disorder?
the criteria for identifying a disorder were 3. What does it mean to be “disabled?”
listed made it possible to study their reliability Criticisms of DSM-5 is that it has “fuzzy” categories
and validity. that blur at the edges, making diagnostic decisions
difficult at times. Comorbidity is when individuals are
DSM-IV and DSM-IV-TR diagnosed with more than one psychological disorder
● 1994 The DSM-IV changes were to be based at the same time.
on sound scientific data. Distinction between ● First, the systems strongly emphasize
organically based disorders and reliability, sometimes at the expense of
psychologically based disorders that was validity.
present in previous editions were eliminated. ● Second, methods of constructing a nosology
of mental disorders have a way of
DSM-5 perpetuating definitions handed down to us
● 2013 DSM-5 is largely unchanged from from past decades, even if they might be
DSM-IV although some new disorders are fundamentally flawed.
introduced and other disorders have been Labeling a disorder associated with an impairment in
cognitive or behavioral functioning label itself has
negative connotations and contributes to stigma. A
 Chapter 3: Clinical Assessment and Diagnosis

combination of stereotypic negative beliefs,

prejudices, and attitudes resulting in reduced life
opportunities for the devalued group in question.

Creating a Diagnosis
Mixed anxiety-depression individuals report that
their symptoms of both anxiety and depression are
classic but not frequent or severe enough to meet
criteria for an existing anxiety or mood disorder.
Premenstrual dysphoric disorder evokes a different
issue that must be considered in the creation of any
diagnostic category: bias and stigmatization.