Objectives

 Develop skills and techniques in

assessing and diagnosing psychological
Chapter 3 disorders.
 Master various symptomatology terms
Clinical Assessment and Diagnosis used in assessment and diagnosis of
psychological disorders.

Assessing Psychological Disorders Three Concepts Determine the Value of Assessment

 Purposes of Clinical Assessment

 To understand the individual
 To predict behavior
 To plan treatment
 To evaluate treatment outcome
 Analogous to a Funnel
 Starts broad
 Multidimensional in approach
 Narrow to specific problem areas

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Three Concepts Determine the Value of Assessment Domains of Assessment:
The Clinical Interview and Physical Exam
 Reliability
 Physical Exam – Referral to physician
 Examples include test-retest, inter-rater reliability
 Rule out medical conditions
 Validity  Clinical Interview
 Examples include content, concurrent,  Most common clinical assessment method
discriminant, construct, and face validity  Structured or semi-structured
 Standardization and Norms  Mental Status Exam
 Examples include administration procedures,  Appearance and behavior
scoring, and evaluation of data  Thought processes
 Mood and affect
 Intellectual functioning
 Sensorium

Clinical Assessment Mental Status Exam

Collect
Data

 “The process of clinical assessment in

psychopathology has been likened to a
funnel” p.70 The Clinical Interview
 The clinical interview- the interview
gathers information on current and The Mental Status exam
past behavior, attitudes, and emotions, Behavioral Assessment
as well as a detailed history of the Psychological Testing
individual’s life in general and of the
presenting problem Physical Examination
 Mental Status Exam- involves the Neuropsychological
systematic observation of an Testing
individual’s behavior ( appearance, Psychophysiological
behavior, thoughts process, mood, EKG/EEG
affect, intellectual functioning and Neuroimaging
sensorium).
Diagnosis

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 Domains of Assessment: Domains of Assessment:
Behavioral Assessment and Observation Behavioral Assessment and Observation
 Behavioral Assessment
 Focus on here and now
 Tends to be direct and minimally inferential
 Target behaviors are identified and observed
 Focus on antecedents, behaviors, and
consequences
 Behavioral Observation and Behavioral Assessment
 Can be either formal or informal
 Self-monitoring vs. others observing
 Problem of reactivity using direct observation

Domains of Assessment: Rorschach Test

Psychological Testing and Projective Tests

 Psychological Testing
 Must be reliable and valid
 Projective Tests
 Project aspects of personality onto ambiguous
stimuli
 Roots in psychoanalytic tradition
 High degree of inference in scoring and
interpretation
 Examples include the Rorschach Inkblot Test,
Thematic Apperception Test
 Reliability and validity data tend to be mixed

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 Thematic Apperception Test
Domains of Assessment: Psychological
Testing and Neuropsychology
 Neuropsychological Tests
 Assess broad range of skills and abilities
 Goal is to understand brain-behavior relations
 Used to evaluate a person’s assets and deficits
 Examples include the Luria-Nebraska and
Halstead-Reitan Batteries
 Overlap with intelligence tests
Domains of Assessment: Psychological
Testing and Objective Tests
 Objective Tests
 Test stimuli are minimally ambiguous
 Roots in empirical tradition
 Require minimal inference in scoring and interpretation
 Objective Personality Tests
 Minnesota Multiphasic Personality Inventory (MMPI, MMPI-
2, MMPI-A)
 Millon Clinical Multiaxial Inventory
 Objective Intelligence Tests
 WAIS/WISC – Performance and Verbal Scales
 Stanford-Binet – Mental Age/Age = IQ
 Raven Progressive Matrices Test – Non-verbal
Domains of Assessment:
Neuroimaging and Brain Structure
 Neuroimaging: Pictures of the Brain
 Allows examination of brain structure and function
 Imaging Brain Structure
 Computerized axial tomography (CAT or CT scan)
 CAT utilizes X-rays of brain; pictures in slices
 Magnetic resonance imaging (MRI)
 MRI has better resolution than CAT scan
 MRI operates via strong magnetic field around
head
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 Domains of Assessment:
Neuroimaging and Brain Function (cont.)
 Imaging Brain Function
 Positron emission tomography (PET)
 Single photon emission computed tomography (SPECT)
 Both involve injection of radioactive isotopes
 React with oxygen, blood, and glucose in the brain
 Functional MRI (fMRI) – Brief changes in brain activity
 Used mainly in research
Diagnosing and Classifying Psychological
Disorders
 The Nature and Forms of Classification Systems
 Classical (or pure) categorical approach – Categories
 Dimensional approach – Classification along dimensions
 Prototypical approach – Both classical and dimensional
 Two Widely Used Classification Systems
 International Classification of Diseases and Health
Related Problems (ICD-10); published by the World
Health Organization
 Diagnostic and Statistical Manual of Mental Disorders
(DSM); published by the American Psychiatric
Association; currently the DSM-V
Diagnosing Psychological Disorders:
Foundations in Classification
 Clinical Assessment vs. Psychiatric Diagnosis
 Assessment – Idiographic approach
 Diagnosis – Nomothetic approach
 Both are important in treatment planning and
intervention
 Diagnostic Classification
 Classification is central to all sciences
 Develop categories based on shared attributes
 Terminology of Classification Systems
 Taxonomy – Classification in a scientific context
 Nosology – Taxonomy in psychological / medical
contexts
 Nomenclature – Nosological labels (e.g., panic
disorder)
Purposes and Evolution of the DSM
 Purposes of the DSM System
 Aid communication
 Evaluate prognosis and need for treatment
 Treatment planning
 DSM-I (1952) and DSM-II (1968)
 Both relied on unproven theories and were unreliable
 DSM-III (1980) and DSM-III-R
 Were atheoretical, emphasizing clinical description
 Multiaxial system with detailed criterion sets for
disorders
 Problems included low reliability, and reliance on
committee consensus
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 History of the DSM
DSM-5 Diagnostic Categories
 DSM-I: 1952
 Neurodevelopmental
 DSM-II: 1968 disorders
 DSM-III: 1980; DSM-III-R: 1987  Elimination disorders
 Disruptive, impulse-control,
 DSM-IV: 1994; DSM-IV-TR: 2000 and conduct disorders
 DSM-5: 2013  Schizophrenia spectrum
and other psychotic
 The general consensus is that DSM-5 is largely disorders
unchanged from DSM-IV although some new disorders  Bipolar and related
disorders
are introduced and other disorders have been
 Depressive disorders
reclassified
 Anxiety disorders
 Obsessive-compulsive and
related disorders
 Trauma- and stressor-
related disorders
 Dissociative disorders
 Somatic symptom and
related disorders
 Feeding and eating
disorders
 Sleep-wake disorders
 Sexual dysfunctions
 Gender dysphoria
 Substance-related and
addictive disorders
 Neurocognitive disorders
 Personality disorders
 Paraphilic disorders
 Other mental disorders

The DSM-IV Unresolved Issues in the DSM-IV

 Basic Characteristics
 Five axes describing full clinical presentation
 Clear inclusion and exclusion criteria for disorders
 Disorders are categorized under broad headings
 Empircally grounded prototypic approach to
classification
 The Five DSM-IV Axes
 Axis I – Most major disorders
 Axis II – Stable, enduring problems (e.g., personality
disorders, mental retardation)
 Axis III – Medical conditions related to abnormal
behavior
 Axis IV – Psychosocial problems
 Axis V – Global clinician rating of adaptive functioning
 Other Unique Features of the DSM-IV
 What Are the Optimal Thresholds for Diagnosis?
 Examples include level or distress, impairment, number
of required symptoms
 Arbitrary Time Periods in the Definitions of Diagnoses
 Should Other Axes Be Included?
 Examples include premorbid history, treatment response,
family functioning
 Is the DSM-IV System Optimal for Treatment or Research?
 The Problem of Comorbidity
 Defined as two or more disorders for the same person
 High comorbidity is the rule clinically
 Comorbidity threatens the validity of separate diagnoses

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Summary of Clinical Assessment and Diagnosis

 Clinical Assessment and Diagnosis

 To provide a complete picture of the client
 To aid understanding and ameliorating human
suffering
 Require reliable, valid, and standardized
information
 Dangers of Diagnosis
 Problem of reification
 Problem of stigmatization
 Assessment and Diagnosis
 The core of abnormal psychology
 Requires a multidimensional perspective