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Assessment and Diagnosis in Abnormal Psychology

Chapter 3

Objectives

What are the purposes of assessment in abnormal psychology?

What are important characteristics of assessment approaches?

How would one use interviews and testing to assess psychological disorders?

How are diagnoses made for psychological disorders?

Assessing Psychological Disorders

Purposes of Clinical Assessment To understand the individual To predict behavior To plan treatment To evaluate treatment outcome

Analogous to a Funnel Starts broad Narrow to specific problem areas

Multidimensional in approach

Characteristics of Assessment

Reliability Consistency in measurement Examples include test-retest, inter-rater reliability

Validity What the test measures and how well it does so Examples include content, concurrent, discriminant,

construct, and face validity Sensitivity and specificity

Negative Positive

No 800 100

Yes 10 90

What does the test say?

Does

the p

ers

on

truly

have

the d

isord

er?

false positives

false negatives

true positives

true negatives

Sensitivity

90/(90+10) = .90

Specificity

800/(800+100) = 88.9%

Sensitivity and Specificity

Characteristics of Assessment

Standardization Standards and norms help ensure consistency in the

use of a technique Examples include administration procedures,

scoring, and evaluation of data

Domains of Assessment:The Clinical Interview

Clinical Interview Most common clinical assessment method Structured or semi-structured

Purposes of interview Explore presenting problem Associated problem(s), History Biopsychosocial context Diagnose

Domains of Assessment:Clinical Interview (cont.)

Mental Status Exam Appearance and behavior Thought processes Mood and affect Intellectual functioning Sensorium

Mini Mental State Examination (MMSE) Assesses for cognitive functioning Useful for screening for dementia or other

neuropsychological deficits

Domains of Assessment:Behavioral Assessment and Observation

Behavioral Assessment Focus on here and now Tends to be direct and minimally inferential Purpose is to identify problematic behaviors and

situations Identify 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

methods

Domains of Assessment:Psychological Testing and Projective Tests

Psychological Testing Must be reliable and valid

Projective Tests Project aspects of personality onto ambiguous test

stimuli Roots in psychoanalytic tradition Require high degree of clinical inference in scoring

and interpretation Examples include the Rorschach Inkblot Test,

Thematic Apperception Test Reliability and validity data tend to be mixed

Objective Tests Test stimuli are less ambiguous Roots in empirical or scientific tradition Require minimal clinical inference in scoring and

interpretation Objective Personality Tests

Minnesota Multiphasic Personality Inventory (MMPI, MMPI-2, MMPI-A)

Over 549 true or false items Extensive reliability, validity, and normative database

Objective Intelligence Tests Nature of intellectual functioning and IQ The deviation IQ Verbal and performance domains

Domains of Assessment: PsychologicalTesting and Objective Tests

Diagnosing Psychological Disorders:Foundations in Classification

Clinical Assessment vs. Psychiatric Diagnosis Assessment – Idiographic approach (individual) Diagnosis – Nomothetic approach (norms) Both are important in treatment planning and

intervention

The Nature and Forms of Classification Systems Classical (or pure) categorical approach – Strict

categories Dimensional approach – Classification along dimension Prototypical approach – Combines classical and

dimensional views

DSM-IV and ICD-10

Purposes and Evolution of the DSM

Purposes of the DSM System Aid communication, evaluate prognosis, need for

treatment, and treatment planning

Basic Characteristics Five axes describing full clinical presentation (person

and environment) Clear inclusion and exclusion criteria for disorders,

including duration Disorders are categorized under broad headings Prototypic approach to classification; one that is

empirically grounded

The DSM-IV

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 affecting functioning

or treatment Axis V – Global clinician rating of adaptive

functioning

Be sure to….

Read second half of Chapter 3, Research Methods