Caraga State University

Butuan City
1st Sem., AY 2021-2022

Psych 110 - Abnormal Psychology

Facilitator: Ruth E. Sanchez

Assessing and Diagnosing Abnormality

A. Assessment and Diagnosis

B. Assessment Tools
C. Challenges in Assessment
D. Diagnosis

 Assessment is the process of gathering information about people's symptoms and the possible
causes of these symptoms.
o The information gathered in an assessment is used to determine the appropriate
diagnosis for a person's problems
 A diagnosis is a label for a set of symptoms that often occur together.

ASSESSMENT TOOLS

All assessment tools must be valid, reliable, and standardized.

VALIDITY is the accuracy of a test in assessing what it is supposed to measure.

 The validity of a test can be estimated in several other ways

o A test is said to have face validity when, on face value, the items seem to measure what
the test is intended to measure.e.g
o Content validity is the extent to which a test assesses all the important aspects of a
phenomenon that it purports to measure.
o Concurrent (or convergent) validity is the extent to which a test yields the same results
as other, established measures of the same behavior, thoughts, or feelings.
o A test has predictive validity if it is good at predicting how a person will think, act, or
feel in the future.
o Construct validity is the extent to which a test measures what it is supposed to measure
and not something else altogether, e.g level of emotions,stress

RELIABILITY

The reliability of a test indicates its consistency in measuring what it is supposed to measure.

 Types of reliability
o Test-retest reliability describes how consistent the results of a test are over time
o Researchers often will develop two or more forms of a test. When people's answers to
different forms of a test are similar, the tests are said to have alternate form reliability.
o Researchers often split a test into two or more parts to determine whether people's
answers to one part of a test are like their answers to another part
  When there is similarity in people's answers among different parts of the same
test, the test is said to have high internal reliability
o Different raters or judges who administer and score the interview or test should come
to similar conclusions when they are evaluating the same people, then it is said to have
a high interrater, or inter judge reliability e,g pageant

STANDARDIZATION

One important way to improve both validity and reliability is to standardize the administration and
interpretation of tests

 A standard method of administering a test prevents extraneous factors from affecting a person's
response
 Similarly, a standard way of interpreting results makes the interpretation of the test more valid
and reliable.

Assessment tools

CLINICAL INTERVIEW

 A mental status exam assesses the person's general functioning. Here the clinician probes for
five types of information.
o First, the clinician assesses the individual's appearance and behavior. Second, in a
mental status exam a clinician will take note of the individual's thought processes,
including how coherently and quickly he or she speaks.
o Third, the clinician will be concerned with the individual's mood and affect.
o Fourth, the clinician will observe the individual's intellectual functioning, that is, how
well the person speaks and any indications of memory or attention difficulties.
o Fifth, the clinician will note whether the individual seems appropriately oriented to
place, time, and person
o In a structured interview, the clinician asks the respondent a series of questions about
symptoms he or she is experiencing or has experienced in the past.
o The format of the questions and the entire interview is standardized
o At the end of the interview, the clinician should be able to determine whether the
respondent's symptoms qualify for a diagnosis of any major psychological problems.

SYMPTOM QUESTIONNAIRES

 These questionnaires can cover a wide variety of symptoms representing several different
disorders.

PERSONALITY INVENTORIES

Personality inventories usually are questionnaires meant to assess people's typical ways of thinking,
feeling, and behaving.

 The most widely used personality inventory in professional clinical assessments is the Minnesota
Multiphasic Personality Inventory (MMPI).
BEHAVIORAL OBSERVATION AND SELF-MONITORING

Clinicians often will use behavioral observation of individuals to assess deficits in their skills or their
ways of handling situations.

 The clinician looks for specific behaviors and what precedes and follows these behaviors
 One of its advantages is that the clinician sees firsthand how the individuals handle important
situations.
 One disadvantage is that individuals may alter their behavior when they are being watched.
 Another disadvantage is that different observers may draw different conclusions about
individuals' skills.
 In addition, any individual rater may miss the details of an interpersonal interaction
 Finally, direct observation may not be possible in some situations

If direct observation or role playing is not possible, clinicians may require self-monitoring by individuals-
that is, keeping track of the number of times per day they engage in a specific behavior and the
conditions under which this behavior occurs.

INTELLIGENCE TESTS

Intelligence tests are used to get a sense of an individual's intellectual strengths and weaknesses,
particularly when mental retardation or brain damage is suspected

 Some examples of intelligence tests include Wechsler Adult Intelligence Scale, the Stanford-
Binet Intelligence Test, and the Wechsler Intelligence Scale for Children
 These tests were designed to measure basic intellectual abilities, such as the ability for abstract
reasoning, verbal fluency, and spatial memory.


NEUROPSYCHOLOGICAL TESTS

If the clinician suspects neurological impairment in a person, paper-and-pencil neuropsychological tests

may be useful in detecting specific cognitive deficits such as a memory problem, e,g brain and behavior
relationship

 One frequently used neuropsychological test is the Bender-Gestalt Test: this test assesses
individuals' sensorimotor skills by having them reproduce a set of nine drawings
 Two of the most popular batteries are the Halstead-Reitan Test and the Luria-Nebraska Test
o These batteries contain several tests that provide specific information about an
individual's functioning in several skill areas, such as concentration, dexterity, and speed
of comprehension.

BRAIN-IMAGING TECHNIQUES

Brain imaging is used to determine if a patient has a brain injury or tumor.

 Researchers use brain imaging to search for differences in brain activity or structure between
people with a psychological disorder and people with no disorder. Eg brain structures
Examples:

 Computerized tomography (CT)

o A CT scan can reveal brain injury, tumors, and structural abnormalities.
o The two major limitations of CT technology are that it exposes patients to X-rays, which
can be harmful, and that it provides an image of brain structure rather than brain
activity.
 Positron-emission tomography (PET) can provide a picture of activity in the brain.
o PET scans can be used to show differences in the activity level of specific areas of the
brain between people with a psychological disorder and people without a disorder.
 Another procedure to assess brain activity is single photon emission computed tomography, or
SPECT
o The procedure is similar to PET except there is a different tracer substance injected.
o It is less accurate than PET but also less expensive
 Magnetic resonance imaging (MRI) provides much more finely detailed pictures of the anatomy
of the brain than do other technologies and it can image the brain at any angle.
o Structural MRI provides static images of brain structure.
o Functional MRI (fMRI) provides images of brain activity
o Researchers are using MRI to study structural and functional brain abnormalities in
almost every psychological disorder.

PSYCHOPHYSIOLOGICAL TESTS

Psychophysiological tests are alternative methods to CT, PET, SPECT, and MRI used to detect changes in
the brain and nervous system that reflect emotional and psychological changes.

 An electroencephalogram (EEG) measures electrical activity along the scalp produced by the
firing of specific neurons in the brain.
o EEG patterns recorded over brief periods are referred to as evoked potentials or event-
related potentials.
o Clinicians can compare an individual's response to the standard response of healthy
individuals
 Heart rate and respiration are highly responsive to stress and can be easily monitored.
o Sweat gland activity, known as electrodermal response can be assessed with a device
that detects electrical conductivity between two points on the skin.

PROJECTIVE TESTS

A projective test is based on the assumption that when people are presented with an ambiguous
stimulus, such as an oddly shaped inkblot or a caption less picture, they will interpret the stimulus in line
with their current concerns and feelings, relationships with others, and conflicts or desires.

 Rorschach Inkblot Test

o The test consists of 10 cards, each containing a symmetrical inkblot in black, gray, and
white or in color. The examiner tells the respondent something like "People may see
many different things in these inkblot pictures; now tell me what you see, what it makes
you think of what it means to you"
  The Thematic Apperception Test (TAT) consists of a series of pictures
o The individual is asked to make up a story about what is happening in the pictures

CHALLENGES IN ASSESSMENT

 One of the greatest challenges to obtaining valid information from an individual can be his or
her resistance to providing information
 Evaluating children is also a challenge in assessment.
o Children, particularly preschool-age children, cannot describe their feelings or
associated events as easily as adults can
 Parents are often the first source of information about a child's functioning
 Teachers also provide information about children's functioning
 A number of challenges to assessment arise when there are significant cultural differences
between the assessor and the person being assessed
o The first problem you may run into is that the person may not speak your language or
may speak it only partially
o Symptoms can be both underdiagnosed and over diagnosed when the individual and the
assessor do not share a language
o One solution is to find an interpreter to translate between the clinician and the person.

DIAGNOSIS

Recall that a diagnosis is a label we attach to a set of symptoms that tend to occur together. This set of
symptoms is called a syndrome.

 Syndromes are not lists of symptoms that all people have all the time if they have any of the
symptoms at all. Rather, they are lists of symptoms that tend to co-occur within individuals
 A set of syndromes and the rules for determining whether an individual's symptoms are part of
one of these syndromes constitute a classification system.
 One of the first classification systems for psychological symptoms was proposed by Hippocrates
o Hippocrates divided all mental disorders into mania (states of abnormal excitement),
melancholia (states of abnormal depression), paranoia, and epilepsy.
 Emil Kraepelin published the first modern classification system, which is the basis of our current
systems.
 The classification system most widely used in the United States is the Diagnostic and Statistical
Manual of Mental Disorders, or DSM. The classification system used in Europe and much of the
rest of the world, the International Classification of Disease (ICD), has many similarities to the
most recent editions of the DSM.

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM)

The first edition of the DSM, published in 1952, outlined the diagnostic criteria for all the mental
disorders recognized by the psychiatric community at the time.

 These criteria were somewhat vague descriptions heavily influenced by psychoanalytic theory.

The second edition of the DSM (DSM-II), published in 1968, included some disorders that had been
newly recognized since the publication of the first edition but otherwise was not much different.
  Because the descriptions of disorders in the first and second editions of the DSM were so
abstract and theoretically based, the reliability of the diagnoses was low
 In response to the reliability problems of the first and second editions of the DSM, in 1980 the
American Psychiatric Association published the third edition of the DSM, known as DSM-III
 This third edition was followed in 1987 by a revised third edition, known as DSM-IIIR, and in
1994 by a fourth edition, known as DSM-IV, revised as DSM-IV-TR in 2000
 In 2013, the newest edition of the DSM, DSM-5 was released
o This new edition removed some diagnoses that were in the DSM-IV-TR, added some
new diagnoses, and modified the criteria for others

THE SOCIAL-PSYCHOLOGICAL DANGERS OF DIAGNOSIS

We noted earlier that once a diagnosis is given, people tend to see it as real rather than as a judgment.
This can make people oblivious to the biases that may influence diagnose

 One influential critic of psychiatry, Thomas Szasz (1920-2012), argued that so many biases are
inherent in determining who is labeled as having a mental disorder that the entire system of
diagnosis is corrupt and should be abandoned
o He suggested that mental disorders do not really exist and that people who seem to be
suffering from mental disorders are oppressed by a society that does not accept their
alternative ways of behaving and looking at the world.
 The primary role of diagnostic systems is to organize the confusing array of psychological
symptoms in an agreed-on manner.
 Standardization can lead to faster advances in our understanding of the causes of and effective
treatments for disorders.

Reference: Abnormal Psychology by Nolen-Hoeksema

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