Assessing Psychological Disorders

• In this chapter, you’ll learn about clinical assessment and diagnosis.

Chapter 3: • Clinical assessment* (words with an asterisk are key terms)

Clinical Assessment and • Systematic evaluation and measurement of psychological, biological, and
social factors
Diagnosis • Diagnosis*
• Degree of fit between symptoms and diagnostic criteria

Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.

Key Concepts in Assessment (1 of 2) Key Concepts in Assessment (2 of 2)

• Three concepts are key to the usefulness of an assessment: reliability; validity; • Validity*
and standardization
• Does the test measure what it’s supposed to?
• Reliability* • Concurrent (descriptive): Comparison of results of one assessment with
• Degree of consistency of a measurement another measure known to be valid
• Inter-rater reliability: Consistency between scores generated by different • Predictive: How well the assessment predicts outcomes
evaluators
• Standardization*
• Test-retest reliability: Consistency in scores when test is administered
• Process by which a certain set of standards or norms is determined for a
repeatedly
technique to make its use consistent across different measurements

The Clinical Interview The Mental Status Exam

• Clinical interviews are the core of clinical work • Mental status exam* involves systematic observation of an individual’s
behavior
• Addresses multiple domains
• Appearance and behavior
• Presenting problem
• Thought processes
• Current and past behavior
• Mood and affect
• Detailed history
• Intellectual functioning
• Attitudes and emotions
• Sensorium

©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 1
 Figure 03.02 Components of the mental Semistructured Clinical Interviews
status exam
Carefully phrased and tested questions that elicit useful information in a
consistent manner
• Advantages:
• Clinician can feel confident that a semistructured interview will accomplish its
purpose
• Disadvantages
• Loss of spontaneity
• May inhibit the patient from volunteering useful information that is not directly
relevant to the questions being asked

Physical Examination Behavioral Assessment (1 of 2)

• Physical examinations can be helpful in diagnosing mental health problems • Behavioral assessment* uses direct observation to assess formally an
individual’s thoughts, feelings, and behavior in specific situations or contexts
• Understand and rule out physical etiologies
• Lack of nutrients • Target behaviors are identified and observed with the goal of determining the
factors that seem to influence them (antecedents and consequences)
• Medication issues
• May use analogue settings that are similar to real-life settings
• Physical disorders

Behavioral Assessment (2 of 2) Psychological Testing: Projective Tests (1

of 2)
• Formal observation involves identifying specific behaviors that are observable • Projective tests
and measurable
• Rooted in psychoanalytic tradition
• May involve checklists or behavior rating scales
• Used to assess unconscious processes
• Self-monitoring* involves an individual monitoring their own behavior • Project aspects of personality onto ambiguous test stimuli
• Reactivity can distort any observational data • Require high degree of inference in scoring and interpretation
• Knowing you are being observed can change behavior • Examples:
• Rorschach
• Thematic Apperception Test

©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2
 Psychological Testing: Projective Tests (2 Personality Inventories
of 2)
• Strengths • Personality inventories*: self-report questionnaires that assess personal traits
• May be useful icebreakers • Minnesota Multiphasic Personality Inventory
• One way to gather qualitative data • Empirical approach
• Criticisms: • Easy to administer and score
• Hard to standardize • Includes validity scales to detect lies, defensiveness, and infrequent
responses
• Reliability and validity data tend to be mixed
• Excellent reliability

Intelligence Testing Neuropsychological Testing

• Originally developed to identify children who would benefit from additional help in • Neuropsychological tests measure abilities in areas such as receptive and
school expressive language, attention and concentration, memory, motor skills,
• Intelligence quotient*: mental age divided by chronological age and multiplied by 100 perceptual abilities, and learning and abstraction

• Deviation IQ: estimates how much a child’s performance in school will deviate from the • Allow the clinician to make inferences about brain functioning and organic
average performance of others of the same age damage
• IQ is not the same as intelligence • Examples:
• Intelligence involves more than is typically measured in an IQ test, including the • Bender Visual–Motor Gestalt Test
ability to adapt to the environment, the ability to generate new ideas, and the ability
to process information efficiently • Luria-Nebraska Neuropsychological Battery
• Halstead-Reitan Neuropsychological Battery

Neuroimaging: Pictures of the Brain Psychophysiological Assessment

• Neuroimaging*: pictures of the structure and function of the brain
• Structural imaging methods:
• Computerized axial tomography (CAT) scan or CT scan
• Nuclear magnetic resonance imaging (MRI)
• Functional imaging methods:
• Positron emission tomography (PET) scan
• Single photon emission computed tomography (SPECT)
• Functional MRI (fMRI) and blood-oxygen-level-dependent (BOLD) fMRI
• Psychophysiological assessment* measure changes in indicators of nervous
system functioning that reflect emotional or psychological events
• Electroencephalogram* (EEG) measures electrical activity in the brain
• Electrodermal responding measures sweat gland activity controlled by the
peripheral nervous system
• Used in assessment of PTSD and sexual dysfunctions and disorders
• Physiological measures form the basis of biofeedback
• Requires expertise to administer

©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 3
 Survey Activity: Neuroimaging Diagnosing Psychological Disorders

According to the National Institute of Mental Health, “No scientific studies to date
have shown that a brain scan by itself can be used for diagnosing a mental illness
or to learn about a person’s risk for disease.” Given this observation:
• Why might a psychologist involved in the care of a client want to know the
results of brain imaging studies?
• How might brain imaging be useful in research?
• Do you think it will ever be possible to use brain imaging to diagnose mental
disorders? Why or why not?
• Classification*: any effort to construct groups or categories and to assign
objects or people to these categories on the basis of their shared attributes or
relations
• Taxonomy*: classification of entities for scientific purposes
• Nosology*: application of a taxonomic system to psychological or medical
phenomena or other clinical areas
• Nomenclature*: the names or labels of the disorders that make up the nosology
• Most mental health professionals in North America use the DSM

Classification Issues (1 of 3) Classification Issues (2 of 3)

• Classification is at the heart of any science but can be particularly controversial • Dimensional approach*:
when dealing with people
• Notes the variety of cognitions, moods, and behaviors with which the patient
• Classical (or pure) categorical approach*: presents and quantifies them on a scale
• Assumes that every diagnosis has a clear underlying pathophysiological • Prototypical approach*:
cause and that each disorder is unique
• Identifies certain essential characteristics of an entity so it can be classified,
• Because each disorder is fundamentally different from every other, we need but also allows certain nonessential variations that do not necessarily
only one set of defining criteria change the classification
• Quite useful in medicine but inappropriate for psychological disorders, which
have multiple interacting causes

Classification Issues (3 of 3) Knowledge Check Activity

• Classification systems must be reliable Match each approach to classification with how diagnoses are made under that
• Unreliable classification systems are subject to clinician bias approach:
DESIGN EXAMPLE
• Must also be valid
Classical categorical approach Uses scales to quantify the cognitions, moods, and behaviors
• Construct validity: criteria are consistently associated and distinct from those associated with mental disorders and makes diagnoses
for other diagnostic categories based on those results
Dimensional approach Identifies the essential characteristics of each disorder and
• Predictive validity: tells the clinician what is likely to happen with the makes diagnoses based on those characteristics, while
prototypical patient allowing other characteristics to vary
• Content validity: criteria reflect the way most experts in the field think about Prototypical approach Makes diagnoses based on the unique pathophysiological
the disorder causes of each disorder

©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 4
 Knowledge Check Activity: Answers Evaluation of DSM-5

The correct answers are as follows:
DESIGN
Classical categorical approach
Dimensional approach
Prototypical approach
• “Fuzzy” categories associated with comorbidity* (more than one diagnosis at a
time)
EXAMPLE
Makes diagnoses based on the unique pathophysiological • Emphasis on reliability can undercut validity
causes of each disorder
• Methods of constructing a nosology of mental disorders have a way of
Uses scales to quantify the cognitions, moods, and
behaviors associated with mental disorders and makes
perpetuating definitions that may be fundamentally flawed
diagnoses based on those results
• Subject to misuse
Identifies the essential characteristics of each disorder
and makes diagnoses based on those characteristics, • Diagnostic labels may have negative connotations that contribute to stigma
while allowing other characteristics to vary

Creating and Abandoning Diagnoses Beyond DSM-5: Dimensions and Spectra

• DSM is the product of data-informed consensus meetings
• As society changes, diagnoses may be eliminated (e.g., homosexuality) or
added (e.g., premenstrual dysphoric disorder and complicated or prolonged
grief disorder)
• Existing diagnostic categories have significant issues with validity, lack of
information about causes, and lack of treatment specificity
• Conceptually substantial and consistent dimensional approaches are in
development
• Developments from neuroscience relating to brain structure and function may
be integrated with more psychological, social, and cultural information into a
diagnostic system

Summary

Now that the lesson has ended, you should have learned how to:
• 03.01 Define clinical assessment in terms of the goals of assessment and key
components of high-quality assessments.
• 03.02 Discuss how projective tests, personality inventories, and intelligence testing are
used to determine a person’s mental functioning.
• 03.03 Explain the benefits of administering neuropsychological testing, neuroimaging,
and psychophysiological assessment to individuals with psychological disorders.
• 03.04 Describe the strengths and weaknesses of categorical, dimensional, and
prototypical approaches to classifying mental disorders.

©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 5