Fluent Essays

Assignment 1 Q1: What is the difference between Normal and Abnormal Behavior? Q2: What are the different historical views regarding abnormality? Q3:Write a short note on 4 Ds (One paragraph). Abnormal Behavior, Historical Perspectives on Abnormal Behavior :Etiology and treatment Dr. Sumaira Khurshid Tahira (MSc, MPhil, Phd, Psychology) Associate Prof NNU,China Abnormal Psychology Abnormal and Normal Behavior  The scientific study of abnormal behavior undertaken to describe, predict, explain, and change abnormal patterns of functioning.  Abnormality (or dysfunctional behavior) is a behavioral characteristic assigned to those with conditions regarded to as rare or dysfunctional.  Behavior is considered abnormal when it is atypical or out of the ordinary, consists of undesirable behavior, and results in impairment in individuals functioning. Continue…  Abnormality is the significant deviation from commonly accepted patterns of behavior, emotion or thought, while normality is the absence of illness and the presence of state of well being What Is Psychological Abnormality? Many definitions of abnormality have been proposed, yet none has won total acceptance (Bergner & Bunford, 2014; Pierre, 2010). Most definitions share 4 features, often called “the four Ds”: Deviance  From what? From behaviors, thoughts, and emotions that differ markedly from a societys ideas about proper functioning From social norms ◼Stated and unstated rules for proper conduct  Judgments of abnormality vary from society to society as norms grow from a particular culture They also depend on specific circumstances Distress  Behavior, ideas, or emotions usually have to cause distress before they can be labeled abnormal .  Not always the case Examples of behavior that deviates from social norms but does not cause distress: Clothing styles, Skydiving, bungee jumping Culture plays a role in the definition of abnormality Dysfunction  Interferes with daily functioning  Dysfunction alone does not necessarily indicate psychological abnormality Danger  Behavior that is dangerous to oneself or others . May be careless, hostile, or confused.  Although cited as a feature of psychological abnormality, research suggests that being dangerous is the exception rather than the rule. Four Factors  These 4 factors – deviance, distress, dysfunction, and danger are all taken into account to determine whether behavior is abnormal. What Is Treatment?  Once clinicians decide that a person is suffering from abnormality, they seek to treat it.  Treatment, or therapy, is a procedure designed to change abnormal behavior into more normal behavior. What Is Treatment? According to Jerome Frank, all forms of therapy have three essential features How Was Abnormality Viewed and Treated in the Past?  In any given year as many as 30\% of adults and 19\% of children and adolescents in the U.S. display serious psychological disturbances and are in need of clinical treatment  In addition, most people have difficulty coping at various times  Is this the fault of modern society?  Although modern pressures may contribute, they are hardly the primary cause; every society, past and present, has witnessed psychological abnormality How Was Abnormality Viewed and Treated in the Past? Many present-day ideas and treatments have roots in the past. Expelling evil spirits The two holes in this skull recovered from ancient times indicate that the person underwent trephination, possibly for the purpose of releasing evil spirits and curing mental dysfunctioning. Ancient Views and Treatments  Ancient societies probably regarded abnormal behavior as the work of evil spirits.  This view may have begun as far back as the Stone Age.  The treatment for severe abnormality was to force the demons from the body through trephination and exorcism(Symbolic acts that are performed to drive out the devil from persons believed to be possessed. It was usually performed by the gentle laying of hands). Greek and Roman Views and Treatments 500 B.C. to 500 A.D. Philosophers and physicians offered different explanations and treatments for abnormal behaviors Hippocrates believed and taught that illnesses had natural causes • Looked to an unbalance of the four fluids, or humors • Suggested treatments attempted to “rebalance” Humors: Bodily chemicals that influence mental and physical functioning Europe in the Middle Ages: Demonology Returns 500 – 1350 A.D. The church rejected scientific forms of investigation, and it controlled all education • Religious beliefs dominant • Abnormality was seen as a conflict between good and evil • Some of the earlier demonological treatments reemerged At the close of the Middle Ages, demonology and its methods began to lose favor again Asylum A type of institution that first became popular in the sixteenth century to provide care for persons with mental disorders. The Renaissance and the Rise of Asylums 1400 – 1700 A.D. Demonological views of abnormality continued to decline German physician Johann Weyer believed that the mind was as susceptible to sickness as the body The care of people with mental disorders continued to improve in this atmosphere The Renaissance and the Rise of Asylums  Across Europe, religious shrines were devoted to the humane and loving treatment of people with mental disorders  This time also saw a rise of asylums – institutions whose primary purpose was care of the mentally ill  Good care was the intention, but became virtual prisons due to overcrowding The Nineteenth Century: Reform and Moral Treatment  As 1800 approached, the treatment of people with mental disorders began to improve once again  Pinel (France) and Tuke (England) advocated moral treatment – care that emphasized moral guidance and humane and respectful techniques The Nineteenth Century: Reform and Moral Treatment  By the end of the nineteenth century, several factors led to a reversal of the moral treatment movement: Money and staff shortages Declining recovery rates Overcrowding Emergence of prejudice  By the early years of the twentieth century, the moral treatment movement had ground to a halt; long-term hospitalization became the rule once again. The Early Twentieth Century: Dual Perspectives  As the moral movement was declining in the late 1800s, two opposing perspectives emerged: The Early Twentieth Century: The Somatogenic Perspective  Two factors were responsible for the rebirth of this perspective: Emil Kraepelin argued that physical factors (such as fatigue) are responsible for mental dysfunction. New biological discoveries were made, such as the link between untreated syphilis and general paresis.  Despite the general optimism, biological approaches yielded mostly disappointing results throughout the first half of the twentieth century, until a number of effective medications were finally discovered. The Early Twentieth Century: The Psychogenic Perspective  The rise in popularity of this perspective was based on work with hypnotism: Friedrich Mesmer and hysterical disorders Sigmund Freud’s theory of psychoanalysis  Freud and his followers offered treatment primarily to patients who did not require hospitalization – now known as outpatient therapy By the early 20th century, psychoanalytic theory and treatment were widely accepted Current Trends  It would hardly be accurate to say that we now live in an period of great enlightenment about or dependable treatment of mental disorders 43\% of people surveyed believe that people bring mental health disorders upon themselves and 35\% consider mental health disorders to be caused by sinful behavior STILL… The past 50 years have brought major changes in the ways clinicians understand and treat abnormal functioning How Are People with Severe Disturbances Cared For?  In the 1950s, researchers discovered a number of new psychotropic medications: Antipsychotic drugs Antidepressant drugs Antianxiety drugs  These discoveries led to deinstitutionalization and a rise in outpatient care The Impact of Deinstitutionalization How Are People with Severe Disturbances Cared For?  Outpatient care has now become the primary mode of treatment  When patients do need institutionalization, it is usually short-term hospitalization, and then, ideally, outpatient psychotherapy and medication in community settings  The approach has been helpful for many patients, but too few community programs are available in the U.S.; only 40 to 60\% of those with severe disturbances receive treatment of any kind How Are People with Less Severe Disturbances Treated?  Since the 1950s, outpatient care has continued to be the preferred mode of treatment for those with moderate disturbances Although this type of care was once exclusively private psychotherapy, most health insurance plans now cover various settings, as well as specialty care How Are People with Less Severe Disturbances Treated? A Growing Emphasis on Preventing Disorders and Promoting Mental Health  The community mental health approach has given rise to the prevention movement Many of todays programs aim to: Correct the social conditions that underlie psychological problems Help individuals at risk for developing disorders Prevention programs have been further energized by the growing interest in positive psychology – the study and enhancement of positive feelings, traits, and abilities Multicultural Psychology  In response to growing diversity in the U.S., this new area of study has emerged Multicultural psychologists seek to understand how culture, race, ethnicity, gender, and similar factors affect behavior and thought and how people of different cultures, races, and genders may differ psychologically The Growing Influence of Insurance Coverage Today the dominant form of insurance coverage is the managed care program – in which the insurance company determines key care issues At least 75\% of all privately insured persons in the U.S. are enrolled in managed care programs A key problem is that reimbursements for mental disorders tend to be lower than those for medical disorders What Are Todays Leading Theories and Professions?  One of the most important developments in the field of abnormal psychology has been the growth of theoretical perspectives, including: Models of Abnormality/Psychopathology Dr. Sumaira Khurshid Tahira Associate Prof NNU,China Models of Abnormality • Model: A set of assumptions and concepts that help scientists explain and interpret observations. Also called a paradigm. Models of Abnormality • Paradigms the perspectives used to explain phenomena (abnormal behavior for this class) • Biological model • Psychodynamic model • Behavioral model • Cognitive model • Humanistic-Existential model • Sociocultural model The Biological Model Takes a medical perspective Main focus is that psychological abnormality is an illness brought about by malfunctioning parts of the organism Typically focused on the brain anatomy or brain chemistry How Do Biological Theorists Explain Abnormal Behavior? Brain anatomy  The brain is composed of ~100 billion nerve cells (called neurons) and thousands of billions of support cells (called glia).  Within the brain, large groups of neurons form distinct areas called brain regions Brain anatomy and abnormal behavior  Clinical researchers have discovered connections between certain psychological disorders and problems in specific brain areas Example: Huntingtons disease and basal ganglia (forebrain) (is a progressive brain disorder that causes uncontrolled movements, emotional problems, and loss of thinking ability). How Do Biological Theorists Explain Abnormal Behavior? Brain chemistry Neurons do not actually touch each other; they are separated by a space (the synapse), across which a message moves When an electrical impulse reaches a nerve ending, the ending is stimulated to release a chemical, called a neurotransmitter (NT), that travels across the synaptic space to receptors on the dendrites of neighboring neurons How Do Biological Theorists Explain Abnormal Behavior? Brain chemistry and abnormal behavior  Researchers have identified dozens of (Neuro transmitters) Examples  serotonin, dopamine, and GABA  Studies indicate that abnormal activity in certain NTs can lead to specific mental disorders Examples  depression (low activity of serotonin and norepinephrine) and anxiety (GABA) How Do Biological Theorists Explain Abnormal Behavior? Brain chemistry and abnormal behavior Additionally, researchers have learned that mental disorders are sometimes related to abnormal chemical activity in the endocrine system Hormone release, triggered by a variety of factors, propels body organs into action. Abnormal secretions have been linked to psychological disorders Example Cortisol release is related to anxiety and mood disorders How Do Biological Theorists Explain Abnormal Behavior? Sources of biological abnormalities Genetics Humans have 23 pairs of chromosomes, each with numerous genes that control the characteristics and traits a person inherits Studies suggest that inheritance plays a part in mood disorders, schizophrenia, mental retardation, Alzheimers disease, and other mental disorders How Do Biological Theorists Explain Abnormal Behavior? Another possible source of abnormal brain structure or biochemical dysfunction is viral infections Example: Schizophrenia and prenatal viral exposure Interest in viral explanations of psychological disorders has been growing in the past decade Example: Anxiety and mood disorders Biological Treatments Biological practitioners attempt to pinpoint the physical source of dysfunction to determine the course of treatment Three types of biological treatment Drug therapy Electroconvulsive therapy (ECT) Psychosurgery Biological Treatments Drug therapy:  1950s = advent of psychotropic medications  Greatly changed the outlook for a number of mental disorders  Four major drug groups:  Antianxiety drugs (anxiolytics; minor tranquilizers)  Antidepressant drugs  Antibipolar drugs (mood stabilizers)  Antipsychotic drugs Biological Treatments Electroconvulsive therapy (ECT) Used primarily for depression, particularly when drugs and other therapies have failed This treatment is used on tens of thousands of depressed persons annually Biological Treatments Psychosurgery (or neurosurgery): Historical roots in trephination 1930s = first lobotomy Much more precise today than in the past Considered experimental and used only in extreme cases Assessing the Biological Model Weaknesses • Can limit rather than enhance our understanding • Too simplistic • Evidence is incomplete or inconclusive • Treatments produce significant undesirable (negative) effects Strengths • Enjoys considerable respect in the field • Fruitful • Creates new therapies • Suggests new avenues of research The Psychodynamic Model • Oldest and most famous psychological model • Based on belief that a persons behavior (whether normal or abnormal) is determined largely by underlying dynamic psychological forces of which she or he is not aware • Abnormal symptoms are the result of conflict among these forces • Sigmund Freud (1856 1939) Father of psychodynamic theory and psychoanalytic therapy How Did Freud Explain Normal and Abnormal Functioning? • Freud says abnormal behavior is caused by three Unconscious forces • Id guided by the Pleasure Principle • Instinctual needs, drives, impulses • Sexual; fueled by libido (sexual energy) • Ego guided by the Reality Principle • Seeks gratification but guides us to know when we can cant express our wishes • Superego – guided by the Morality Principle • Ego defense mechanisms protect us from anxiety How Did Freud Explain Normal and Abnormal Functioning? Developmental stages • Freud proposed that at each stage of development, new events and pressures require adjustment in the id, ego, and superego • If successful ? personal growth • If unsuccessful ? fixation at an early developmental stage, leading to psychological abnormality • Because parents are the key figures in early life, they are often seen as the cause of improper development How Did Freud Explain Normal and Abnormal Functioning? Developmental stages Oral (0 to 18 months of age) Anal (18 months to 3 years of age) Phallic (3 to 5 years of age) Latency (5 to 12 years of age) Genital (12 years of age to adulthood) How Do Other Psychodynamic Explanations Differ from Freuds? Although current models deviate from Freuds in important ways, each retains the belief that human functioning is shaped by dynamic (interacting) forces Ego theorists Emphasize the role of the ego consider it independent Self theorists Emphasize the unified personality over any one component Object-relations theorists Emphasize the human need for interpersonal relationships Psychodynamic Therapies Range from Freudian psychoanalysis to more modern therapies All seek to uncover past trauma and inner conflicts Understanding early life experience critically important Therapist acts as subtle guide Psychodynamic Therapies Utilize various techniques Free association Therapist interpretation Resistance Transference Dream interpretation Catharsis Working through Assessing the Psychodynamic Model Strengths First to recognize importance of psychological theories treatment Saw internal conflict as important source of psychological health and abnormality First to apply theory and techniques systematically to treatment monumental impact on the field Weaknesses Unsupported ideas difficult to research Non-observable Inaccessible to human subject (unconscious) The Behavioral Model Like the psychodynamic perspective, behaviorism is deterministic, and is based on the idea that our actions are determined largely by our life experiences Emphasizes observable behavior and environmental factors Focuses on how behavior is acquired (learned) and maintained over time The Behavioral Model Historical beginnings in laboratories where conditioning studies were conducted Three forms of conditioning (learning) Operant conditioning Modeling Classical conditioning May produce normal or abnormal behavior How Do Behaviorists Explain Abnormal Functioning? Operant conditioning Organism operates on environment and produces an effect Humans and animals learn to behave in certain ways as a result of receiving rewards whenever they do so How Do Behaviorists Explain Abnormal Functioning? Modeling Individuals learn behavioral responses by observing and repeating behavior No direct reinforcement How Do Behaviorists Explain Abnormal Functioning? Classical conditioning Learning by temporal association When two events repeatedly occur close together in time, they become fused in a persons mind before long, the person responds in the same way to both events Father of classical conditioning Ivan Pavlov (1849 1936) Classic study using dogs meat powder Classical Conditioning UR Salivate US Meat UR Salivate Tone US Meat CS Tone CR Salivate How Do Behaviorists Explain Abnormal Functioning? • Classical conditioning • If, after conditioning, the CS is repeatedly presented alone, it will eventually stop eliciting the CR • This process is called extinction • Explains many familiar behaviors (both normal and abnormal) Behavioral Therapies Aim is to identify the behaviors that are causing problems and replace them with more appropriate ones May use classical conditioning, operant conditioning, or modeling Therapist is teacher rather than healer Behavioral Therapies Classical conditioning treatments may be used to change abnormal reactions to particular stimuli Example: systematic desensitization for phobia Step-by-step procedure Learn relaxation skills Develop a fear hierarchy Confront feared situations ( in vivo) Assessing the Behavioral Model Strengths • Powerful force in the field • Rooted in empiricism • Phenomena can be observed and measured • Significant research support for behavioral therapies Weaknesses • Too simplistic • Unrealistic • Downplays role of cognition • New focus on self-efficacy, social cognition, and cognitive-behavioral theories The Cognitive Model Seeks to account for behavior by studying the ways in which the person attends to, interprets, and uses available information Argues that clinicians must ask questions about assumptions, attitudes, and thoughts of a client Concerned with internal processes Present-focused How Do Cognitive Theorists Explain Abnormal Functioning? Maladaptive thinking is the cause of maladaptive behavior Several kinds of faulty thinking Faulty assumptions and attitudes Illogical thinking processes Example overgeneralization Cognitive Therapies People must be taught a new way of thinking to prevent maladaptive behavior Main model Becks Cognitive Therapy The goal of therapy is to help clients recognize and restructure their thinking Therapists guide clients to challenge dysfunctional thoughts, try out new interpretations, and apply new ways of thinking in their daily lives Widely used in treating depression Assessing the Cognitive Model Strengths Very broad appeal Clinically useful ,effective Focuses on a uniquely human process Correlation between symptoms and maladaptive cognition Therapies effective in treating several disorders Adapt well to technology Research-based Assessing the Cognitive Model Weaknesses Singular, narrow focus Overemphasis on the present Limited effectiveness Verification of cognition is difficult Precise role is hard to determine The Humanistic-Existential Model Combination model The humanist view Emphasis on people as friendly, cooperative, and constructive focus on drive to self-actualization The existentialist view Emphasis on self-determination, choice, and individual responsibility focus on authenticity Rogers Humanistic Theory and Therapy  Basic human need for unconditional positive regard  If received, leads to unconditional self-regard  If not, leads to “conditions of worth”  Incapable of self-actualization because of distortion dont know what they really need, etc.  Rogers client-centered therapy  Therapist provides unconditional positive regard  Both accurate genuine in reflection (reflective listening)  Focus on the experiencing person  Little research support Gestalt Theory and Therapy Humanistic approach Developed by Fritz Perls Goal is to guide clients toward self-recognition through challenge and frustration Techniques: Skillful frustration Role playing Rules, including “Here and Now” and “I” language Little research support Existential Theories and Therapy Psychological dysfunction is caused by self-deception people hide from lifes responsibilities and fail to recognize that it is up to them to give meaning to their lives Therapy is focused on patient acceptance of personal responsibility and recognition of freedom of action Goals more important than technique Great emphasis placed on client-therapist relationship Assessing the Humanistic-Existential Model Strengths Emphasizes the individual Taps into domains missing from other theories Non-deterministic Optimistic Emphasizes health Weaknesses Focuses on abstract issues Difficult to research Not much influence Weakened by disapproval of scientific approach Changing somewhat The Sociocultural Model Argues that abnormal behavior is best understood in light of the social and cultural forces that influence an individual Addresses norms and roles in society Argues that we must examine a persons social surroundings to understand their (abnormal) behavior Influenced by sociology and anthropology How Do Sociocultural Theorists Explain Abnormal Functioning? Focus on Societal labels roles Diagnostic labels (example Rosenhan study) Sick role Social networks and support How Do Sociocultural Theorists Explain Abnormal Functioning? Focus on Family structure and communication Family systems theory abnormal functioning within family leads to abnormal behavior Examples enmeshed, disengaged structures How Do Sociocultural Theorists Explain Abnormal Functioning? Focus on Culture Set of values, attitudes, beliefs, history, and behaviors shared by a group of people and communicated from one generation to the next Multicultural psychology is a growing field of study How Do Sociocultural Theorists Explain Abnormal Functioning? Focus on Religion and spirituality For most of the twentieth century, clinical scientists viewed religion as a negative factor in mental health but this alienation now seems to be ending Researchers have begun to systematically study the influence of religion and spirituality on mental health Many therapists now address spiritual issues when treating religious clients Sociocultural Treatments May include traditional individual therapy Broadened therapy to include Culturally sensitive therapy Group therapy Family therapy Couple therapy Community treatment Assessing the Sociocultural Model Strengths Added greatly to the clinical understanding of abnormality Increased awareness of labeling Clinically successful when other treatments have failed Weaknesses Research is difficult to interpret Correlation ? Causation Model unable to predict abnormality in specific individuals Integration of the Models Each perspective is valuable to understanding abnormal behavior Different perspectives are more appropriate under differing conditions An integrative approach provides a general framework for thinking about abnormal behavior, and also allows for specification of the factors that are especially pertinent to particular disorders Integration of the Models Many theorists, clinicians, and practitioners adhere to a biopsychosocial model Abnormality results from the interaction of genetic, biological, developmental, emotional, behavioral, cognitive, social, and societal influences Diathesis-stress approach  explanation of how the various factors together cause abnormality (“diathesis” means a predisposed tendency). According to this theory, people must first have a biological, psychological, or sociocultural predisposition to develop a disorder and must then be subjected to episodes of severe stress. Integration of the Models Integrative therapists are often called eclectic taking the strengths from each model and using them in combination Thanks Clinical Assessment and Diagnosis Dr. Sumaira Khurshid Tahira Associate Prof NNU, China Clinical Assessment: How and Why Does the Client Behave Abnormally? • Assessment is collecting relevant information in an effort to reach a conclusion • Clinical assessment is used to determine how and why a person is behaving abnormally and how that person may be helped • Focus is idiographic (i.e., on an individual person) • Also may be used to evaluate treatment progress Characteristics of Assessment Tools • To be useful, assessment tools must be standardized and have clear reliability and validity • To standardize a technique is to set up common steps to be followed whenever it is administered • One must standardize administration, scoring, and interpretation Characteristics of Assessment Tools • Reliability refers to the consistency of an assessment measure • A good tool will always yield the same results in the same situation • Two main types: • Test–retest reliability – yields the same results every time it is given to the same people • Interrater reliability – different judges independently agree on how to score and interpret a particular tool Characteristics of Assessment Tools • Validity refers to the accuracy of a tools results • A good assessment tool must accurately measure what it is supposed to measure • Three specific types: • Face validity – a tool appears to measure what it is supposed to measure; does not necessarily indicate true validity Characteristics of Assessment Tools • Predictive validity – a tool accurately predicts future characteristics or behavior • Concurrent validity – a tools results agree with independent measures assessing similar characteristics or behavior Clinical Interviews • These face-to-face encounters often are the first contact between a client and a clinician/assessor • Used to collect detailed information, especially personal history, about a client • Allow the interviewer to focus on whatever topics they consider most important • Focus depends on theoretical orientation Clinical Interviews • Conducting the interview • Can be either unstructured or structured • In an unstructured interview, clinicians ask open-ended questions • In a structured interview, clinicians ask prepared questions, often from a published interview schedule • May include a mental status exam The mental status examination is an assessment of current mental capacity through evaluation of general appearance, behavior, any unusual or bizarre beliefs and perceptions (eg, delusions, hallucinations), mood, and all aspects of cognition (eg, attention, orientation, memory). Clinical Interviews • Limitations: • May lack validity or accuracy • Individuals may be intentionally misleading • Interviewers may be biased or may make mistakes in judgment • Interviews, particularly unstructured ones, may lack reliability Clinical Tests • Tests are devices for gathering information about a few aspects of a persons psychological functioning, from which broader information can be inferred • More than 500 clinical tests are currently in use Clinical Tests • Projective tests • Require that clients interpret vague and ambiguous stimuli or follow open-ended instruction. Mainly used by psychodynamic practitioners • Rorschach Test • Thematic Apperception Test • Sentence completion tests • Drawings Psychology’s Wiki Leaks? • In 2009 an emergency room physician posted all 10 Rorschach cards on the online encyclopedia, Wikipedia • Many psychologists argue that test responses of patients who have previously seen the cards on Wikipedia cannot be trusted. Clinical Test: Rorschach Inkblot Clinical Test: Sentence-Completion Test • “I wish ___________________________” • “My father ________________________” • For example Rotter Incomplete Sentences Blank Clinical Test: Drawings • Draw-a-Person (DAP) test: • “Draw a person” • “Draw another person of the opposite sex” Clinical Tests • Projective tests • Strengths and weaknesses: • Helpful for providing “supplementary” information • Have rarely demonstrated much reliability or validity • May be biased against minority ethnic groups Clinical Tests • Personality inventories • Designed to measure broad personality characteristics • Focus on behaviors, beliefs, and feelings • Usually based on self-reported responses • Most widely used: Minnesota Multiphasic Personality Inventory • For adults: MMPI (original) or MMPI-2 (1989 revision) • For adolescents: MMPI-A Clinical Test: Minnesota Multiphasic Personality Inventory (MMPI) • Consists of more than 500 self-statements that can be answered “true,” “false,” or “cannot say” • Statements describe physical concerns, mood, morale, attitudes toward religion, sex, and social activities, and psychological symptoms • Assesses careless responding and lying Clinical Test: Minnesota Multiphasic Personality Inventory (MMPI) • Comprised of ten clinical scales: • Hypochondriasis (HS) • Depression (D) • Conversion hysteria (Hy) • Psychopathic deviate (PD) • Masculinity-femininity (Mf) • Scores range from 0 to 120 • Above 70 = deviant • Graphed to create a “profile” • Paranoia (P) • Psychasthenia (Pt) • Schizophrenia (Sc) • Hypomania (Ma) • Social introversion (Si) Clinical Tests • Personality inventories(Strengths and weaknesses) • Easier, cheaper, and faster to administer than projective tests • Objectively scored and standardized • Appear to have greater validity than projective tests • Tests fail to allow for cultural differences in responses Standardized tests are designed by experts and come with explicit instructions for administering them. They are taken by a large quantity of learners under the same conditions. Questions, administration, and scoring are consistent for every evaluated group. Clinical Tests • Response inventories • Usually based on self-reported responses • Focus on one specific area of functioning • Affective inventories (example: Beck Depression Inventory) • Social skills inventories • Cognitive inventories Clinical Tests • Response inventories • Strengths and weaknesses: • Have strong face validity • Not all have been subjected to careful standardization, reliability, and/or validity procedures (Beck Depression Inventory and a few others are exceptions) Clinical Tests • Psychophysiological tests • Measure physiological response as an indication of psychological problems • Includes heart rate, blood pressure, body temperature, galvanic skin response, and muscle contraction • Most popular is the polygraph (lie detector) Clinical Tests • Psychophysiological tests • Strengths and weaknesses: • Require expensive equipment that must be tuned and maintained • Can be inaccurate and unreliable Clinical Tests • Neurological and neuropsychological tests • Neurological tests directly assess brain function by assessing brain structure and activity • Examples: EEG, PET scans, CAT scans, MRI, fMRI • Neuropsychological tests indirectly assess brain function by assessing cognitive, perceptual, and motor functioning • Most widely used is the Bender Visual-Motor Gestalt Test • Clinicians often use a battery of tests Clinical Tests • Neurological and neuropsychological tests • Strengths and weaknesses: • Can be very accurate • At best, though, these tests are general screening devices • Best when used in a battery of tests, each targeting a specific skill area Clinical Tests • Intelligence tests • Designed to indirectly measure intellectual ability • Typically comprised of a series of tests assessing both verbal and nonverbal skills • General score is an intelligence quotient (IQ) • Represents the ratio of a persons “mental” age to his or her “chronological” age Clinical Tests • Intelligence tests • Strengths: • Are among the most carefully produced of all clinical tests • Highly standardized on large groups of subjects • Have very high reliability and validity Clinical Tests • Intelligence tests • Weaknesses: • Performance can be influenced by nonintelligence factors (e.g., motivation, anxiety, test-taking experience) • Tests may contain cultural biases in language or tasks • Members of minority groups may have less experience and be less comfortable with these types of tests, influencing their results Intelligence Tests, Too? eBay and the Public Good • Intelligence tests can be found for sale on eBay’s online auction site • Test producer is concerned that they will be misused Clinical Observations • Systematic observations of behavior • Several kinds: • Naturalistic • Analog • Self-monitoring Clinical Observations • Naturalistic and analog observations • Naturalistic observations occur in everyday environments • Can occur in homes, schools, institutions (hospitals and prisons), and community settings • Most focus on parent–child, sibling–child, or teacher–child interactions Clinical Observations • Observations are generally made by “participant observers” and reported to a clinician • If naturalistic observation is impractical, analog observations are used and conducted in artificial settings Clinical Observations • Naturalistic and analog observations • Strengths and weaknesses: • Reliability is a concern • Different observers may focus on different aspects of behavior Clinical Observations • Validity is a concern • Risk of “overload,” “observer drift,” and observer bias • Client reactivity may also limit validity • Observations may lack cross-situational validity Reactivity is a phenomenon that occurs when individuals alter their performance or behavior due to the awareness that they are being observed. The change may be positive or negative, and depends on the situation. Observer drift Gradual, systematic changes over a period of time by a particular observer in his or her application of criteria for recording or scoring observations. Overload is a psychological condition in which situations and experiences are so cognitively, perceptually, and emotionally stimulating that they tax or even exceed the individuals capacity to process incoming information Clinical Observations • Self-monitoring • People observe themselves and carefully record the frequency of certain behaviors, feelings, or cognitions as they occur over time Clinical Observations • Self-monitoring • Strengths and weaknesses: • Useful in assessing infrequent behaviors • Useful for observing overly frequent behaviors • Provides a means of measuring private thoughts or perceptions Clinical Observations • Validity is often a problem • Clients may not record information accurately • When people monitor themselves, they often change their behavior Diagnosis: Does the Clients Syndrome Match a Known Disorder? • Using all available information, clinicians attempt to paint a “clinical picture” • Influenced by their theoretical orientation • Using assessment data and the clinical picture, clinicians attempt to make a diagnosis • A determination that a persons psychological problems constitute a particular disorder. Based on an existing classification system Classification Systems • Lists of categories, disorders, and symptom descriptions, with guidelines for assignment • Focus on clusters of symptoms (syndromes) • In current use in the U.S.: DSM-5 DSM-5 • Lists approximately 500 disorders • Describes criteria for diagnoses, key clinical features, and related features that are often, but not always, present Lifetime Prevalence of DSM-5 Diagnoses How many people in the United States qualify for a DSM diagnosis during their lives? Almost half, according to some surveys. Some people even experience two or more different disorders, which is known as comorbidity. (Information from: Greenberg, 2011; Kessler et al., 2005.) Categorical Information • DSM-5 requires clinicians to provide both categorical and dimensional information as part of a proper diagnosis. • Categorical information refers to the name of the category (disorder) indicated by the client’s symptoms. • Dimensional information is a rating of how severe a client’s symptoms are and how dysfunctional the client is across various dimensions of personality. • Is DSM-5 an Effective Classification System? • A classification system, like an assessment method, is judged by its reliability and validity • Here, reliability means that different clinicians are likely to agree on a diagnosis using the system to diagnose the same client • DSM-5 appears to have greater reliability than any previous edition • Used field trials to increase reliability • Reliability is still a concern Is DSM-5 an Effective Classification System? • The validity of a classification system is the accuracy of the information that its diagnostic categories provide • Predictive validity is of the most use clinically • DSM-5 has greater validity than any previous edition • Conducted extensive literature reviews and ran field studies • Validity is still a concern Is DSM-5 an Effective Classification System? • The framers of DSM-5 followed certain procedures in their development of the new manual to help ensure that DSM-5 would have greater reliability than the previous DSMs • A number of new diagnostic criteria were developed and categories, expecting that the new criteria and categories were in fact reliable. • Some critics continue to have concerns about the procedures used in the development of DSM-5 DSM-5 Changes • Adding a new category, “autism spectrum disorder,” that combines certain past categories such as “autistic disorder” and “Asperger’s syndrome” (see Chapter 17) • Viewing “obsessive-compulsive disorder” as a problem that is different from the anxiety disorders and grouping it instead along with other compulsive-like disorders such as “hoarding disorder,” “body dysmorphic disorder,” “hair- pulling disorder,” and “excoriation (skin-picking) disorder” (see Chapter 5) • Viewing “posttraumatic stress disorder” as a problem that is distinct from the anxiety disorders (see Chapter 6) DSM-5 Changes • Adding a new category, “somatic symptom disorder” (see Chapter 7) • Replacing the term “hypochondriasis” with the new term “illness anxiety disorder” (see Chapter 7) • Adding a new category, “premenstrual dysphoric disorder” (see Chapter 8) • Adding a new category, “disruptive mood dysregulation disorder” (see Chapters 8 and 17) DSM-5 Changes • Adding a new category, “binge eating disorder” (see Chapter 11) • Adding a new category, “substance use disorder,” that combines past categories “substance abuse” and “substance dependence” (see Chapter 12) • Viewing “gambling disorder” as a problem that should be grouped as an addictive disorder alongside the “substance use disorders” (Chapters 12) • Replacing the term “gender identity disorder” with the new term “gender dysphoria” (see Chapter 13) DSM-5 Changes • Replacing the term “mental retardation” with the new term “intellectual developmental disorder” (Chapter 17) • Adding a new category, “specific learning disorder,” that combines past categories “reading disorder,” “mathematics disorder,” and “disorder of written expression” (see Chapter 17) • Replacing the term “dementia” with the new term “neurocognitive disorder” (Chapter 18) • Adding a new category, “mild neurocognitive disorder” (see Chapter 18) Can Diagnosis and Labeling Cause Harm? • Misdiagnosis is always a concern • Major issue is the reliance on clinical judgment • Also present is the issue of labeling and stigma • Diagnosis may be a self-fulfilling prophecy (In a self-fulfilling prophecy an individuals expectations about another person or entity eventually result in the other person or entity acting in ways that confirm the expectations.) 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