LESSON 3: CLINICAL  Three (3) issues are

ASSESSMENT AND DIAGNOSIS important in evaluating the

usefulness of any diagnostic
Assessing Psychological system.
Disorders o Diagnostic
Reliability: Refers to
Clinical Assessment the extent with which
 The process clinicians use to clinicians agree on
gather the information they which signs and
need to diagnose, determine symptoms signal a
causes, plan treatment, and specific disorder.
predict future course of a o Diagnostic Validity:
disorder. The capacity of a
 The process of classification diagnostic system to
is based on an accurate identify and predict
assessment of past and behavioral and
present signs and symptoms. psychiatric disorders.
o Sign: characteristic  Concurrent
feature of a disorder Validity:
that may be Diagnostic
recognized by the system’s
clinician, but not the ability to
patient. categorize
o Symptoms: A current
disorders
characteristic that
accurately.
the patient
 Predictive
recognizes.
Validity:
Diagnosis Diagnostic
system’s
 Act of identifying and naming capacity to
a disorder or disease using a predict future
system of categorization. conditions.
 The process of determining
whether the particular
problem afflicting the
Key Concepts in Assessment
individual meets all criteria
for a psychological disorder,
as set forth in the fifth edition
of the Diagnostic and
Statistical Manual of Mental
Disorders, or DSM-5
(American Psychiatric
Association, 2013).
 In abnormal Psychology the
most common classification
system is the Diagnostic
Statistical Manual of Mental
Disorders (DSM).
Assessment Techniques Clinical Interview

 Are subject to a number of  Gathers information on

strict requirements, not the current and past.
least of which is some  Clinicians determine when
evidence (research) that they the specific problem started
actually do what they are and identify other events (for
designed to do. example, life stress, trauma,
or physical illness) that might
Reliability have occurred about the
 The degree to which a same time.
measurement is consistent.  In addition, most clinicians
 One way psychologists gather at least some
improve their reliability is by information on the patient’s
carefully designing their current and past
assessment devices and interpersonal and social
then conducting research on history, including family
them to ensure that two or makeup (for example, marital
more raters will get the same status, number of children, or
answers. college student currently
living with parents).
Validity  Information on sexual
development, religious
 Is whether something
attitudes (current and past),
measures what it is designed
relevant cultural concerns
to measure—in this case,
(such as stress induced by
whether a technique
discrimination), and
assesses what it is supposed
educational history are also
to.
routinely collected.
 Comparing the results of an
assessment measure under
consideration with the results
of others that are better Mental Status Examination
known allows you to begin to  In essence, the mental status
determine the validity of the exam involves the systematic
first measure. observation of an individual’s
Standardization behavior. This type of
observation occurs when any
 The process by which a one person interacts with
certain set of standards or another.
norms is determined for a  The exam covers five
technique to make its use categories:
consistent across different
measurements. 1. Appearance and Behavior
- The clinician notes any
overt physical behaviors
as well as the individual’s
dress, general
appearance, posture,
and facial expression.
 - For example, slow and - Delusions of
effortful motor behavior, Persecution: In which
sometimes referred to as someone thinks people
psychomotor retardation, are after him and out to
may indicate severe get him all the time.
depression. - Delusions of Grandeur:
In which an individual
Item Presentation thinks she is all-powerful
in
in some way.
Psychomotor
- Ideas of Reference: In
Retardation
Gross Decreased which everything
movement and/or slowed everyone else does
movement of somehow relates back to
hands, legs, the individual.
torso, head - Hallucinations: Are
Posture Slumped while things a person sees or
sitting or hears when those things
standing really aren’t there.
Self-touching Increased self- 3. Mood and Affect
touching, - Mood: Is the
especially face predominant feeling state
Facial Flat expression of the individual.
expression
- Does the person appear
to be down in the dumps
2. Thought Process or continually elated?
- Clinicians might look for - Does the individual talk
several things here. For in a depressed or
example, what is the rate hopeless fashion?
or flow of speech? Does - How pervasive is this
the person talk quickly or mood?
slowly? - Are there times when the
- What about continuity of depression seems to go
speech? In other words, away?
does the patient make - Affect: Refers to the
sense when talking, or feeling state that
are ideas presented with accompanies what we
no apparent connection? say at a given point.
- In some patients with - Usually our affect is
schizophrenia, a “appropriate”; that is, we
disorganized speech laugh when we say
pattern, referred to as something funny or look
loose association or sad when we talk about
derailment, is quite something sad. If a friend
noticeable. just told you his mother
- What about the content died and is laughing
of the speech? Is there about it, or if your friend
any evidence of has just won the lottery
delusions? and she is crying, you
would think it strange, to
 say the least. A mental Physical Examination
health clinician would
note that your friend’s  Many patients with problems
affect is “inappropriate.” first go to a family physician.
Then again, you might  For example, thyroid
observe your friend difficulties, particularly
talking about a range of hyperthyroidism (overactive
happy and sad things thyroid gland), may produce
with no affect symptoms that mimic certain
whatsoever. In this case, anxiety disorders, such as
a mental health clinician generalized anxiety disorder.
would say the affect is  Hypothyroidism (underactive
“blunted” or “flat.” thyroid gland) might produce
4. Intellectual Functioning symptoms consistent with
- Clinicians make a rough depression.
estimate of others’
intellectual functioning
just by talking to them. Personality Assessment
- Can they talk in
 Personality Assessment
abstractions and
attempts to measure
metaphors (as most of
enduring traits of character,
us do much of the time)?
skills, ability, and
- How is the person’s
competence that makes on
memory?
person different from
- Clinicians usually make a
another.
rough estimate of
 Divided into Projective
intelligence that is
noticeable only if it methods and Personality
deviates from normal, inventories.
such as concluding the Projective Tests
person is above or below
average intelligence  Ask respondents to impose
5. Sensorium their own structure and
- The term sensorium meaning on unstructured,
refers to our general ambiguous test stimuli.
awareness of our  Rorschach Inkblot Test:
surroundings. Consist of 10 inkblots, some
- If the patient knows who black and white, some color,
he is and who the but all sufficiently ambiguous.
clinician is and has a Developed by Hermann
good idea of the time Rorschach who called it a
and place, the clinician “form interpretation test”
would say that the because it uses inkblots as
patient’s sensorium is forms to be interpreted. •
“clear” and is “oriented Consists of 10 bilaterally
times three” (to person, symmetrical inkblots printed
place, and time). on separate cards. No
manuals though many
researchers have put forward
 manuals for interpretation,  The theory here is that
the most comprehensive of people project their own
which was Exner’s. personality and unconscious
Procedure: fears onto other people and
o Presenting the things—in this case, the
inkblots “What might ambiguous stimuli—and,
this be?” without realizing it, reveal
o Inquiry: second their unconscious thoughts to
administration where the therapist
examiner attempts to
Personality Inventories
determine what
features of the  Are self-report
inkblots played a role questionnaires that assess
in the testtaker’s personal traits (Meehl, 1945).
percept. “What made  Minnesota Multiphasic
it look like…?” Personality Inventory
o Testing the limits: (MMPI): The most widely
asking specific used and researched clinical
questions that assessment tool used by
provide additional mental health professionals
information about the to help diagnose mental
personality. health disorders. The MMPI
 Thematic Apperception was developed in 1937 by
Test: It assumes that clinical psychologist Starke
behaviors and feelings R. Hathaway and
respondents attribute to the neuropsychiatrist J. Charnley
main character in a story McKinley at the University of
represent their own Minnesota. The MMPI-2
tendencies. Developed by consists of 567 true-false
Christina Morgan and Henry questions and takes
Murray. Originally designed approximately 60 to 90
to elicit material as an aid to minutes to complete.
eliciting fantasy material from
patients in psychoanalysis. 10 Clinical Scales of MMPI
Consists of 31 pictures one
of which is blank. Goal is to Scale 1—Hypochondriasis
measure apperception, from - This scale was designed
the root word apperceive to assess a neurotic
(perceive in terms of past concern over bodily
perceptions). functioning.
 Sentence-completion Test: - The items on this scale
Ask respondents to complete concern physical
sentences beginning with symptoms and wellbeing.
such open-ended phrases - It was originally
Ex. My mother was…, The developed to identify
happiest time was… people displaying the
 Projective Drawings: Ask symptoms of
people to draw familiar hypochondria, or a
objects or people. tendency to believe that
 one has an undiagnosed Scale 5—Masculinity-
medical condition. Femininity

Scale 2—Depression - This scale was designed

by the original authors to
- This scale was originally identify what they
designed to identify referred to as
depression, "homosexual
characterized by poor tendencies," for which it
morale, lack of hope in was largely ineffective.
the future, and general - Today, it is used to
dissatisfaction with one's assess how much or how
own life situation. little a person identifies
- Very high scores may how rigidly an individual
indicate depression, identifies with
while moderate scores stereotypical male and
tend to reveal a general female gender roles.
dissatisfaction with one’s
life. Scale 6—Paranoia

Scale 3—Hysteria - This scale was originally

developed to identify
- The third scale was individuals with paranoid
originally designed to symptoms such as
identify those who suspiciousness, feelings
display hysteria or of persecution, grandiose
physical complaints in self-concepts, excessive
stressful situations. sensitivity, and rigid
- Those who are well- attitudes.
educated and of a high - Those who score high on
social class tend to score this scale tend to have
higher on this scale. paranoid or psychotic
Women also tend to symptoms.
score higher than men
on this scale. Scale 7—Psychasthenia

Scale 4—Psychopathic - This diagnostic label is

Deviate no longer used today,
and the symptoms
- Originally developed to described on this scale
identify psychopathic are more reflective of
individuals, this scale anxiety, depression, and
measures social obsessive-compulsive
deviation, lack of disorder.
acceptance of authority, - This scale was originally
and amorality (a used to measure
disregard for morality). excessive doubts,
- This scale can be compulsions,
thought of as a measure obsessions, and
of disobedience and unreasonable fears.
antisocial behavior.
 Scale 8—Schizophrenia intelligence developed by
Alfred Binet by calculating a
- This scale was originally mental age and dividing this
developed to identify by the child’s chronological
individuals with age.
schizophrenia.  The scale originally
- It reflects a wide variety developed by Binet is known
of areas including bizarre today as Stanford-Binet Test.
thought processes and  Stanford-Binet Intelligence
peculiar perceptions, Scale: The first published
social alienation, poor intelligence test to provide
familial relationships, detailed administration and
difficulties in scoring instructions. It
concentration and creates a test composite
impulse control, lack of (test score or index derived
deep interests, disturbing from the combination of
questions of self-worth and/or a mathematical
and self-identity, and transformation of one or
sexual difficulties. more subtest scores). 5th
Scale 9—Hypomania edition can be administered
to examinees as young as 2
- This scale was and as old as 85.
developed to identify
characteristics of Measured IQ Category
hypomania such as Range
elevated mood, 145 - 160 Very Gifted or
Highly
hallucinations, delusions
Advanced
of grandeur, accelerated 130 - 144 Gifted or Very
speech and motor Advanced
activity, irritability, flight of 120 - 129 Superior
ideas, and brief periods 110 - 119 High Average
of depression. 90 - 109 Average
80 - 89 Low Average
Scale 0—Social 70 - 79 Borderline
Introversion Impaired or
Delayed
- This scale was
55 - 69 Mildly Impaired
developed later than the or Delayed
other nine scales. 40 - 54 Moderately
- It's designed to assess a Impaired or
person’s shyness and Delayed
tendency to withdraw  Wechsler Tests: Individually
from social contacts and administered intelligence
responsibilities. tests to assess the
intellectual abilities of people
from preschool to adulthood.
Intelligence Measures Items may be presented
orally. The Wechsler Tests
 Intelligence Quotient (IQ): are all point scales that yield
Was an estimate of deviation IQs with a mean of
 100 (interpreted as average) diagnosed as having organic
and a standard deviation of brain syndrome or organicity
15. for short.
 Subtests are designated as  Signs signaling the need for
either core or supplemental. a more thorough
 Core Subtest: Administered neuropsychological work-up
to obtain a composite score. can be classified as being
 Supplemental Subtest: hard or soft.
(also called optional subtest) o Hard Sign: May be
is used to provide additional defined as a definite
clinical information or indicator of
extending the number of neurological deficit.
abilities or processes Ex. abnormal reflex
sampled. performance.
 3 Wechsler Intelligence o Soft Sign: An
Tests: indicator merely
o Wechsler Adult suggestive of
Intelligence Scale – neurological deficit.
Fourth Edition An example is the
(WAIS-IV): For ages apparent inability to
16 to 90 years 11 copy a stimulus
months. figure while
o Wechsler attempting to draw it.
Intelligence Scale
for Children – Fifth Neuropsychological Tests
Edition (WISC-V):  Clock Drawing Test (CDT):
For ages 6 through The task in this test is to
16 years 11 months. draw the face of the clock
o Wechsler usually with the hands of the
Preschool and clock indicating a particular
Primary Scale of time. Observed abnormalities
Intelligence – Third in the patient’s drawing may
Edition (WPPSI-III): be reflective of cognitive
For ages 3 years to 7 dysfunction resulting from
years 3 months. dementia or other
neurological or psychiatric
procedures.
Assessment of Brain Disorders  Confrontation Naming:
Naming each stimulus
 Brain Damage: A general presented. This seemingly
reference to any physical or simple task entails 3
functional impairment that component operations: a
results in sensory, motor, and perceptual component
cognitive, emotional, and/or (perceiving the visual
related deficit. features of the stimulus), a
 Organicity: Came from the semantic component
research of German (accessing the underlying
neurologist Kurt Goldstein of conceptual representation or
brain-injured soldiers he core meaning of whatever is
 pictured), and a lexical  People can also observe
component (accessing and their own behavior to find
expressing the appropriate patterns, a technique known
name). as self-monitoring or self-
 Picture Absurdity Item: observation (Haynes,
Task is to identify what is O’Brien, & Kaholokula,
wrong or silly about the 2011).
picture. It can provide insight  When behaviors occur only
into the test taker’s social in private (such as purging
comprehension and by people with bulimia), self-
reasoning abilities. (Similar monitoring is essential.
to Picture Absurdity items on  A more formal and structured
the Stanford-Binet way to observe behavior is
Intelligence Test). through checklists and
behavior rating scales.

Behavioral Assessment

 Direct observation to assess

formally an individual’s
thoughts, feelings, and
behavior in specific situations
or contexts.
 Behavioral assessment may
be more appropriate than an
interview in terms of
assessing individuals.
 Focuses on those specific
aspects of a person’s
behavior that led to the
person to seek treatment.
 Detailed information is
sought for: (ABC Model)
 Antecedents: Events, and
circumstances that typically
precede the target behavior.
 Behavior (Target Behavior):
Are the disturbed and
disturbing behaviors as well
as the thoughts and feelings
that accompany them.
 Consequences: Events, and
circumstances that typically
follow the target behaviors.

Self-Monitoring