DSM Classification and Clinical Interview Quiz

Classification of Psychological Disorders

• The categorical approach assumes that psychological disorders are real, discrete entities that differ from normality in kind.
• The dimensional approach assumes that psychological disorders differ from normality in degree.
• The DSM traditionally adopts a categorical approach to classification.

Problems with Categorical Approach

• Two problems with the categorical approach are:
  • It assumes that disorders are discrete entities, which may not be the case.
  • It does not account for comorbidity (the presence of multiple disorders).

Comorbidity

• Comorbidity refers to the presence of multiple disorders in an individual.
• Boundary disputes in the context of comorbidity refer to the difficulty of distinguishing between disorders.

DSM-V Approach

• The DSM-V maintains a categorical approach to classification, but with a dimensional assessment component.

Aetiology and Pathophysiology

• Aetiology refers to the causes of a disorder.
• Pathophysiology refers to the underlying biological processes that contribute to a disorder.

Gold Standard for Classification

• Clinical interviews are considered the gold-standard for classification of disorders.

DSM-V Classification

• The DSM-V classification of psychological disorders relies on a combination of clinical interviews, behavioral observations, and self-report measures.

Benefits and Drawbacks of Diagnosis

• A potential benefit of diagnosing a psychological disorder is that it can guide treatment and improve outcomes.
• A potential drawback of diagnosing a psychological disorder is that it can lead to stigmatization and labeling.
• A potential benefit of diagnosing a psychological disorder is NOT that it can provide a clear understanding of the causes of the disorder.

Rosenhahn Study

• The driving factor in determining the diagnoses of the participants in the Rosenhahn Study was the clinically significant distress or impairment they experienced.

Diagnostic Reliability

• Diagnostic reliability is important in a classification system because it ensures that different clinicians arrive at the same diagnosis for a given individual.
• The diagnostic criteria approach adopted in the DSM-III and all subsequent DSMs is the polythetic approach.

Polythetic Approach

• The polythetic approach to diagnosis involves meeting a certain number of criteria from a larger list of potential symptoms.
• The main reason for using polythetic diagnostic criteria in the DSM is to increase sensitivity and flexibility in diagnosis.
• A potential problem with the polythetic approach to diagnosis is that it can lead to heterogeneity within a diagnostic category.
• A result of using the polythetic approach to diagnosis can be that individuals with different symptom profiles are given the same diagnosis.

Diagnostic Reliability Assessment

• The method used to assess diagnostic reliability in the development of the DSM-5 was the kappa statistic.
• Diagnostic reliability is operationalized in the DSM-5 as the extent to which different clinicians arrive at the same diagnosis for a given individual.
• Kappa reflects the degree of agreement between clinicians above and beyond chance.

Evaluating Diagnostic Reliability

• According to the 'rules of thumb' for evaluating diagnostic reliability, a level of agreement < 0.40 is considered poor, and a level of agreement > 0.80 is considered excellent.

Sources of Disagreement

• A common source of disagreement among interviewers when diagnosing a disorder is the interpretation of symptoms and criteria.

Purpose of Assessment

• The purpose of assessment in clinical psychology is NOT to determine the causes of a disorder.

Diagnostic Criteria

• The DSM recommends using a combination of clinical interviews, behavioral observations, and self-report measures to inform the diagnosis of a psychological disorder.

Clinician's Approach

• One approach that clinicians rely upon to inform the diagnosis of a psychological disorder is the use of clinical interviews.
• The approach that clinicians do NOT rely upon to inform the diagnosis of a psychological disorder is the use of a single laboratory test.

Semi-Structured Interviews

• The semi-structured interview combines the strengths of both unstructured and structured interviews.
• The key characteristic of semi-structured interviews is that they use a predetermined set of questions and topics, but allow for flexibility and exploration.

Clinical Interview

• The main focus of the body of a clinical interview is on the symptoms and experiences of the individual.
• The purpose of the opening of a clinical interview is NOT to establish a diagnosis.
• At the close of a clinical interview, the clinician should summarize the main points and provide feedback to the individual.
• Clinical interviewers should balance open-ended and closed-ended questions during an interview.
• One thinking error that clinical interviewers must be aware of is the confirmation bias.
• Clinical interviewers should avoid using too many 'why' questions because they can lead to defensiveness and decreased rapport.