Chapter 3

Classification andAssessment
ofAbnormal Behavior
How are Abnormal Bx Patterns Classified?
• Diagnostic and Statistical Manual of Mental Disorders (DSM) first
introduced in 1952.
• DSM-5 published in 2013.
• International Statistical Classification of Diseases and Related Health
Problems (ICD), is a classification system published by the World
Health Organization
• Used mainly for compiling statistics on the worldwide occurrence of disorders
• DSM-5 compatible with the ICD.
DSM-5
• DSM system treats abnormal behaviors as signs or symptoms of
underlying disorders or pathologies.
• Is descriptive, not explanatory – DSM does not make assumptions about causes of
behavior.
• Uses term mental disorder to describe clinical syndromes involving a significant level of
disturbance in cognitive, emotional, or behavioral functioning.
• DSM is based on a categorical model of classification.
• Clinicians make a categorical yes–no type of judgment about whether disorder is present.
• DSM-5 expanded on the categorical component to include a dimensional
component for many disorders.
• Evaluator can determine whether disorder is present and also rate severity of symptoms
Culture-Bound Syndromes
• Culture-bound syndromes – Patterns of abnormal behavior that
occur in some cultures but are rare or unknown in others.
• May reflect exaggerated forms of common folk superstitions and belief
patterns within a particular culture.
• Culture-bound syndromes in the United States include anorexia nervosa
and dissociative identity disorder.
Evaluating the DSM System
• A useful diagnostic system must demonstrate reliability and
validity.
• The system is reliable if different evaluators using the same system are
likely to arrive at the same diagnosis.
• The system is valid if diagnostic judgments correspond with observed
behavior, or predict the course the disorder is likely to follow (predictive
validity).
• Evidence supports the reliability and validity of many DSM categories, yet
questions persist about the validity of some categories.
Changes in the DSM-5
• The DSM system is periodically revised.
• Despite many years of debate, editing, and review, the final version
of the DSM-5 remains steeped in controversy over:
• Expansion of diagnosable disorders.
• Changes in classification of mental disorders.
• Changes in diagnostic criteria for particular disorders.
• Process of development.
Reliability & Validity
• The reliability of a method of • Assessment techniques must also be
assessment refers to its valid; that is, measure what they
consistency. intend to measure.
• Internal consistency – Different parts • Content validity – The degree to which
of the assessment yield consistent the content of a test or measure
results. represents the traits it purports to
• Test–retest reliability – The test yields measure.
similar results on separate occasions. • Criterion validity – The degree to which
• Interrater reliability – An assessment a test correlates with an independent,
method that relies on judgments external criterion or standard.
from multiple observers; raters show • Construct validity – The degree to
a high level of agreement in their which a test measures the theoretical
ratings. construct or underlying construct that
it purports to measure.
The Clinical Interview & Formats
The Clinical Interview Interview Formats
• The most widely used means of • Unstructured interview – Interview in which
the clinician adopts his or her own style of
assessment. questioning rather than following any
• Most interviews cover these standard format.
topics: • Semistructured interview – Interview in
• Identifying data which the clinician follows a general outline
of questions designed to gather essential
• Description of the presenting information but is free to ask them in any
problem(s) order and to branch off in other directions.
• Psychosocial history • Structured interview – Interview that
• Medical/psychiatric history follows a preset series of questions in a
particular order.
• Medical problems/medication
Tests
Psychological Tests Intelligence Tests
• A psychological test is a structured • The assessment of abnormal behavior often
includes an evaluation of intelligence.
method of assessment used to
• The first formal intelligence test was
evaluate reasonably stable traits, developed by a Frenchman, Alfred Binet
such as intelligence and (1857–1911).
personality. • The definition of intelligence continues to
• Tests are standardized to provide stir debate.
norms that compare clients’ scores • Scores on intelligence tests are expressed as
with the average. an intelligence quotient, or IQ.
• Psychological tests predict criterion • Score of 100 is defined as average.
variables such as underlying • Wechsler (WAIS) scales most widely used
conditions or future outcomes. today.
Tests
Table 3.5 Examples of Items Similar to Those on the Wechsler Adult Intelligence Scale

Comprehension: Why do people need to obey Picture completion: Identify the missing part from a
traffic laws? What does the saying “the early bird picture, such as the picture of the watch in Figure
catches the worm” mean? 3.1.
Arithmetic: John wanted to buy a shirt that cost Block design: Using blocks such as those in Figure
$31.50, but only had $17. How much more money 3.1, match the design shown.
would he need to buy the shirt?
Similarities: How are a stapler and a paper clip Letter–number sequencing: Listen to this series of
alike? numbers and letters and repeat them back, first
saying the numbers from least to most, and then
saying the letters in alphabetical order: S-2-C-1.

Digit span: Forward order: Listen to this series of

numbers and repeat them back to me in the same
order: 6 4 5 2 7 3. Backward order: Listen to this
series of numbers and then repeat them in reverse
order: 9 4 2 5 8 7.

Vocabulary: What does capricious mean?

Tests
Minnesota Multiphasic Personality
Objective Tests Inventory (MMPI-2)
• Objective tests – Self-report personality • MMPI-2 is widely used as a test of
tests that can be scored objectively and personality and to assist clinicians in
that are based on a empirical evidence. diagnosing abnormal behavior patterns.
• Subjects are asked to respond to specific
questions or statements about items that
• Contains more than 500 true–false
reflect personality such as interests, statements that assess interests, habits,
feelings, thoughts, concerns, attitudes, family relationships, physical (somatic)
interests, and beliefs. complaints, attitudes, beliefs, and
• Two of the most widely used objective behaviors characteristic of
tests: psychological disorders.
• Minnesota Multiphasic Personality • Consists of a number of individual
Inventory (MMPI)
scales.
• Million Clinical Multiaxial Inventory (MCMI)
Tests
Table 3.6 Clinical Scales of the MMPI-2 (Part 1 of 2)
Scale Scale Label Items Similar to Those Found on Sample Traits of High Scorers
Number MMPI Scale
1 Hypochondriasis My stomach frequently bothers me. At Many physical complaints, cynical defeatist
times, my body seems to ache all over. attitudes, often perceived as whiny, demanding

2 Depression Nothing seems to interest me anymore. Depressed mood, pessimistic, worrisome,

My sleep is often disturbed by despondent, lethargic
worrisome thoughts.

3 Hysteria I sometimes become flushed for no Naïve, egocentric, little insight into problems,
apparent reason. immature, develops physical complaints in
I tend to take people at their word when response to stress
they’re trying to be nice to me.

4 Psychopathic My parents often disliked my friends. Difficulties incorporating values of society,

deviate My behavior sometimes got me into rebellious, impulsive, antisocial tendencies,
trouble at school. strained family relationships, poor work and
school history

5 Masculinity– I like reading about electronics. (M) Males endorsing feminine attributes: have
femininity I would like to work in the theater. (F) cultural and artistic interests, effeminate,
sensitive, passive; females endorsing male
attributes: aggressive, masculine, self-confident,
active, assertive, vigorous
Tests
Table 3.6 Clinical Scales of the MMPI-2 (Part 2 of 2)
Scale Scale Label Items Similar to Those Found on Sample Traits of High Scorers
Number MMPI Scale

6 Paranoia I would have been more successful in life but Suspicious, guarded, blames others, resentful,
people didn’t give me a fair break. aloof, may have paranoid delusions
It’s not safe to trust anyone these days.

7 Psychasthenia I’m one of those people who have to have Anxious, fearful, tense, worried, insecure,
something to worry about. difficulties concentrating, obsessional, self-
I seem to have more fears than most people doubting
I know.

8 Schizophrenia Things seem unreal to me at times. Confused and illogical thinking; feels alienated
I sometimes hear things that other people and misunderstood; socially isolated or
can’t hear. withdrawn; may have blatant psychotic
symptoms such as hallucinations or delusional
beliefs; may lead detached, schizoid lifestyle

9 Hypomania I sometimes take on more tasks than I can Energetic, possibly manic, impulsive, optimistic,
possibly do. sociable, active, flighty, irritable, may have overly
People have noticed that my speech is inflated or grandiose self-image or unrealistic
sometimes pressured or rushed. plans

10 Social I don’t like loud parties. Shy, inhibited, withdrawn, introverted, lack self-
introversion I was not very active in school activities. confidence, reserved, anxious in social situations
Tests
• MCMI developed to help clinicians form diagnoses for personality
disorders.
• Now in 3rd edition (MCMI-III)
• Only objective test that focuses specifically on personality disorders.
• Evidence that the MCMI is useful in helping clinicians discriminate among
various personality disorders and non-personality disorders.
Tests
• Evaluations of Objective Tests
• Objective or self-report tests are relatively easy to administer.
• Objective tests often reveal information that might not be revealed during
a clinical interview or by observing the person’s behavior.
• Tests are also only as valid as the criteria that were used to validate them.
Tests
• Projective tests – Psychological tests that present ambiguous
stimuli onto which the examinee is thought to project his or her
personality and unconscious motives.
• Projective tests may offer clues to unconscious processes
• Critics suggest that results of projective tests are based on clinicians’
subjective interpretation.
Tests
The Rorschach Test Thematic Apperception Test (TAT)
• The Rorschach test was • The Thematic Apperception Test
developed by a Swiss psychiatrist, (TAT) was developed by Harvard
Hermann Rorschach (1884–1922). University psychologist Henry
• Clinicians interpret based on the Murray in the 1930s.
content and the form of the • Respondents are asked to describe
responses. what is happening in each scene.
• A response consistent with the • Psychodynamic theorists believe
form of the blot suggests adequate that people project underlying
reality testing – The ability to
psychological needs and conflicts
perceive the world accurately and
into their responses.
to distinguish reality from fantasy.
Tests
• Evaluation of Projective Techniques
• The reliability and validity of projective techniques continues to be a
subject of extensive research and ongoing debate.
• Proponents argue that more comprehensive scoring systems have
improved scoring standardization and that there is evidence to support the
use of the Rorschach for measuring some aspects of psychological
functioning.
• Critics argue that interpretation of response is subjective and can vary
among examiners and that evidence of the validity of the Rorschach is
lacking.
Tests
• Neuropsychological assessment – Measurement of behavior or
performance that may be indicative of underlying brain damage or
defects.
• When neurological impairment is suspected, a neurological
evaluation may be requested from a neurologist—a medical doctor
who specializes in disorders of the nervous system.
• A clinical neuropsychologist may also be consulted to administer
neuropsychological assessment techniques, such as behavioral
observation and psychological testing, to reveal signs of possible
brain damage.
Tests
• The Bender Visual Motor Gestalt Test was one of the first
neuropsychological tests to be developed to test for underlying
brain damage.
• One of the most widely used neuropsychological tests.
• Consists of geometric figures that illustrate various Gestalt principles of
perception.
• Client is asked to copy geometric designs.
• Signs of possible brain damage include rotation of the figures, distortions
in shape, and incorrect sizing of the figures in relation to one another.
Tests
• The Halstead-Reitan Neuropsychological Battery was developed to study
brain-behavior relationships among organically impaired individuals.
• Includes the following subtests:
• The Category Test – abstract thinking
• The Rhythm Test – concentration and attention
• The Tactual Performance Test – visual memory
• Behavioral assessment – The approach to clinical assessment that focuses
on the objective recording and description of problem behavior.
• Samples behavior in real-life situations to maximize the relationship between the
testing situation and the criterion.
• May include a functional analysis — an analysis of the problem behavior in relation to
antecedents, or stimulus cues that trigger it, and consequences, or reinforcements
that maintain it.
Self-Monitoring & Analogue Measures
• Self-monitoring – The process of observing or recording one’s own
behaviors, thoughts, or emotions.
• Behaviors that can be easily counted, such as food intake or cigarette smoking, are
well suited for self-monitoring.
• Can produce highly accurate measurement because the behavior is recorded as it
occurs, not reconstructed from memory.
• Disadvantage is that some clients are unreliable and do not keep accurate records.
• Analogue measures are intended to simulate the setting in which the
behavior naturally takes place but are carried out in laboratory or controlled
settings.
• Role-playing exercises are common.
• The Behavioral Approach Task, or BAT, is a widely used analogue measure of a phobic
person’s approach to a feared object, such as a snake.
Behavioral Rating Scales
• A behavioral rating scale is a checklist that provides information
about the frequency, intensity, and range of problem behaviors.
• Often used by parent to assess children’s problem behaviors.
• For example, the Child Behavior Checklist (CBCL; Achenbach & Dumenci,
2001) asks parents to rate their children on more than 100 specific problem
behaviors, including the following:
• Refuses to eat
• Is disobedient
• Hits
• Is uncooperative
• Destroys own things
Cognitive Assessment
• Cognitive assessment – Measurement of thoughts, beliefs, and
attitudes that may be associated with emotional problems.
• Clients may keep a thought diary to keep a daily record of dysfunctional
thoughts.
• The Automatic Thoughts Questionnaire (ATQ-30-Revised) asks clients to
rate both frequency and strength of belief of 30 automatic negative
thoughts.
• The Dysfunctional Attitudes Scale (DAS) is an inventory of underlying
attitudes associated with depression.
Automatic Thought Questionnaire
Table 3.7 Items Similar to Those on the Automatic Thoughts Questionnaire

Negative automatic thoughts such as those shown ahead may pop into a person’s head and
have a depressing effect on the person’s mood and level of motivation. Therapists use
questionnaires such as the ATQ to help clients identify their automatic thoughts and replace
them with rational alternative thoughts.

• I’m a loser. • I’m incompetent.

• I wonder what’s the matter with me. • I wish I were someone else.

• I think the worst is about to happen. • I think I’m going to fail.

• What’s wrong with me? • I’m just not as good as other people.

• Things always go wrong. • I’m never going to succeed.

• I’m just worthless. • I’m really disappointed in myself.

Physiological Measurement
• Physiological assessment – Measurement of physiological
responses that may be associated with abnormal behavior.
• Examples include:
• Galvanic skin response (GSR)
• Electromyograph (EMG)
• Electroencephalograph (EEG)
• Computed tomography (CT)
• Positron emission tomography (PET)
• Functional magnetic resonance imaging (fMRI)
Brain-Imaging and Recording Techniques
• The electroencephalograph (EEG) – A record of electrical activity of
the brain. Brain wave patterns are associated with mental states such
as relaxation and sleep, and also with psychological disorders and
brain damage.
• The computed tomography (CT) scan – radiation is measured from
multiple angles.
• Positron emission tomography (PET) is used to study functioning of
parts of brain.
• Functional magnetic resonance imaging (fMRI) is a specialized type of
MRI that allows investigators to determine the parts of the brain that
are activated during particular tasks.
Sociocultural & Ethnic Factors in
Assessment
• Researchers and clinicians must keep sociocultural and ethnic
factors in mind when assessing personality traits and psychological
disorders.
• Tests that are valid and reliable in one culture may not be so when
used in another culture.
• Careful translations are essential to capture the meanings of the
original items when testing different cultures.
• Important to recognize importance of language preferences with
multicultural assessments.