Chapter 4 - Classification, Assessment, and Treatment

Question 1

Advantages of classification

Answer 1

1) Predictions - can predict future behavior, know what to expect
2) Communication - means to communicate among clinicians
3) Research - provides research categories
4) Stats - provide basis for epidemiological records -> increase understanding

Question 2

Disadvantages of classification

Answer 2

1) Puts label on people, produces social stigma, can be self-fulfilling prophecy
2) Categories not perfect - much overlap across categories
3) Diagnoses may not be reliable/consistent - diff clinicians -> diff conclusions, variations in client behavs over time
4) Subjectivity of diagnostic categories

Question 3

Examples of subjectivity of diagnostic categories

Answer 3

• Drapetomania
• Homosexuality
• Passive Aggressive Personality Disorder
• Road Rage disorder

Question 4

Changes in DSM-5

Answer 4

• Categorical -> Dimensional
• Move away from distinct categories
• Scales: none, slight, mild, moderate, severe
• Purpose: increase reliability and validity
• Criticisms: may decrease reliability/validity, pathologizing behavior that would not be previously diagnosed, more patients treatable -> can be medicated -> $$$$
• Collapsed across 3 axes: diagnoses, severity, additional info
• Added causal specifiers - biological, genetic, environmental, developmental, social, cultural, behavioral
• Cultural section - symptoms vary across cultures

Question 5

Evolution of DSM

Answer 5

Early editions: psychodynamically oriented
Version III: more medical approach -> multiaxial, 5 axes (primary diagnosis, personality disorders, relevant physical disorders, psychosocial/environmental stressors, global assessment of functioning)

Question 6

Reliability of classification

Answer 6

Diagnosis on same client consistent over different clinicians, consistent over time

Question 7

Validity of classification

Answer 7

Does it group people together with the same cause of symptoms and same effective treatments

Question 8

Types of interview assessments

Answer 8

• Therapeutic: include both assessment and therapy
• Assessment: get overall picture of person, assess both verbal and nonverbal
• Structured: preestablished questions/format, standardized, closed-ended answers

Question 9

“Intelligence” tests

Answer 9

Measure intellectual functioning and speed of cog functioning

• Highly standardized, admin and scoring
• Verbal and spatial reasoning/functioning

Question 10

Personality Assessments

Answer 10

• Objective test: MMPI
• Projective test: psychodynamic orientation - assumes that given an ambiguous stimulus, individual will project unconscious elements of personality onto stimulus (Rorschach, TAT, CAT)

Question 11

Behavioral Assessment

Answer 11

Observe/record frequency/duration of target behavior

Question 12

Cognitive assessment

Answer 12

Measure thoughts/beliefs, attitudes, etc. Questionnaires, self-measuring, interviews

Question 13

Relational assessment

Answer 13

Context of behavior

Question 14

Bodily assessment

Answer 14

Measure physiological functioning - skin conductance, BP, arousal, brain imaging

Question 15

Reliability of assessment instruments

Answer 15

Consistency of measure

• Test/Retest: scores at t1 consistent with t2
• Internal consistency: consistency within measure - confident that all items in measure yield similar results. Rules out “rogue” items

Question 16

Validity of assessment instruments

Answer 16

Is the test measuring what I want it to?

• Predictive: predict behavior measured?
• Construct: depict complex phenomenon set out to measure
• Content: cover all important facets/aspects of what you are measuring
• Face: does it look like it will measure what it measures

Question 17

Cultural issues in assessment

Answer 17

Constructs not equivalent cross-culturally (like intelligence) - scores on some measures may not be equivalent/comparable to same scores on different cultural samples

Question 18

Cultural issues in diagnosis

Answer 18

Behavior associated with disorder in 1 culture may not be abnormal in another culture