Chapter 4 Classification and Assessment of Abnormal Behaviour Copyright © 2006 Pearson Education Canada Inc

Chapter 4Classification and Assessment of

Abnormal Behaviour

Copyright © 2006 Pearson Education Canada Inc.

Copyright © 2006 Pearson Education Canada Inc. 2

Assessment

Assessment is the process of gathering information.

Diagnosis refers to the identification or recognition of a disorder based on the characteristics of symptoms.

Does not mean we know the etiology What information should we collect and how?


Why a Classification Scheme for Mental Disorders?

Three Cs:

– Communication: between mental health professionals

– Control: prevention and treatment of disorders

– Comprehension: studying underlying causes


Classification Systems

Is used to subdivide or organize a set of objects

There are many ways to subdivide information any class of objects (i.e., vehicle)

There are not right or wrong ways to classify objects, just ones that are useful and one that are not


Classification Systems

Categorical approach– distinctions among members of different

categories are qualitative (taxonomy)– “all or none”

Dimensional approach– focus on level of the characteristics– place a specific characteristic along an ordered

sequence


History of Classifying Abnormal Behaviour

Emil Kraepelin (1856-1926)– dementia praecox– manic-depressive psychosis

Diagnostic and Statistical Manual (DSM) International Classification of Diseases (ICD) 1960s classification criticized for self-fulfilling

prophesies


Diagnostic and Statistical Manual

Criteria– inclusion criterion– exclusion criterion

Multiaxial classification system– each concerned with a different domain of

information




Multiaxial Classification System


Culture & Classification

Manual encourages clinicians to consider:– cultural influences on behaviour– cultural context in which the problems appeared

glossary of culture-bound syndromes– i.e., amok found in people in Malaysia &

Philippines


Pibloktoq: Culture-Bound Syndrome

abrupt, dissociative, episodes accompanied by confusion & extreme excitement

(e.g., tearing off clothing, rolling in snow) 5-60 minutes dissociative disorder? etiology:

– culturally sanctioned way of showing distress and the desire to be cared for

– diet?


Evaluating Classification Systems

reliability– cross-diagnostic consistency

validity– concurrent– predictive


Limitations of DSM-IV-TR

comorbidity

failure to make better use of information regarding course of mental disorders


Basic Issues in Assessment:

purpose of clinical assessment– collect/interpret information on person

consistency of behaviour– corroboration

levels of analysis– micro- vs macro-analysis


Assessment Procedures

interviews– structured, semi-structured & unstructured

observation– mental status exam– rating scales (e.g., Personality Tests) – Behavioural coding systems


Mental Status Exam

Provides a simple way of organizing interview observations about a client’s mental functioning in 5 categories:

1) Appearance & Behaviour

2) Thought Processes

3) Mood & Affect

4) Intellectual Function

5) Sensation & Perception


The Clinical Interview

Unstructured Interview- open ended, places few constraints on what the client can

discuss

- guided by the clinician’s implicit theory of personality which provides some structure

- low inter-rater reliability

Structured Interview- clinician asks a series of prepared questions- higher inter-rater reliability


Structured Clinical Interview For DSM (SCID)

The interview takes 45 to 90 minutes to complete It is divided into six self-contained modules that

can be administered in sequence that include: mood episodes

psychotic symptoms

psychotic disorders

mood disorders

substance use disorders

anxiety disorders.


Pros & Cons of Clinical Interviews

advantages– interviewer control– non-verbal assessment– rich information in short time

disadvantages– lack of comprehensive reporting– selective reporting– distorted recall– suggestibility


Personality Inventories

Minnesota Multiphasic Personality Inventory

MMPI-II – most widely used psychological test

actuarial interpretation 567 True/False items large, culturally diverse standardized sample


MMPI-II

10 clinical scales and several Auxiliary scales

Mean score of 50, score > 70 = deviant look for elevations and profiles

MMPIMMPI


Table 4-6



MMPI-II

3 validity scales Lie Scale (L) - high score = faking good, a

blatant attempt to appear socially desirable Frequency Scale (F) - high score = faking

bad, cry for help

Defensiveness Scale (K) - may be a

reluctance to admit problems


Advantages of MMPI-II

test-taking attitude/honesty wide range of problems objective ratings excellent norms


Disadvantages of MMPI-II

lack of sensitivity to certain conditions literacy requirement actuarial interpretation not always

possible reliability of profiles?


Projective Personality Tests

psychoanalytic tradition show client ambiguous stimuli responses indicate unconscious conflicts popular projectives include the Rorschach,

T.A.T.

strength: allow person to communicate difficult themes

weakness: reliability problem, validity problem


The Rorschach Inkblot Test

The Rorschach Inkblot Test is the most commonly used projective test

– It is one of the most widely used tests that exists– It is widely cited in research


History

Herman Rorschach, a Swiss psychiatrist, was the first to suggest (1911) the use of inkblot responses as a diagnostic instrument– In 1921 he published his book on

the test, Psychodiagnostik (and soon thereafter died, age 38)


History

Rorschach's test was not well-received, attracting little notice

– David Levy brought it to the United States - thought it was scientifically unsound.

– His student, Samuel Beck, popularized its use here, writing several papers and books on it starting with Configurational Tendencies in Rorschach Responses (1933)

Several other early users also published work on he Rorschach

– Several offered their own system of administration, scoring, and interpretation, leading to later problems in standardization


What is the Rorschach?

The stimuli were generated by dropping ink onto a card and folding it– They are not, however, random: the ten cards in the current test were

hand-selected out of thousands that Rorschach generated

Ten blots – 5 black/white, 2 red/gray (II & III) and 3 color (VIII – X)

Thought to tap into the deep layers of personality and bring out what is not conscious to the test taker

The following are the inkblots






Administering the Rorschach

The test is usually administered with as little instruction and information as possible

– The tester asks 'What might this be? and gives no clues or restrictions on what is expected as a response

– Anxious subjects often do ask questions, and vague answers are offered

– Some advocate sitting beside the subject to avoid giving clues by facial expression

– If only one response is given, some hint to find more may be offered: "Some people see more than one thing.“


Administering the Rorschach

The cards are shown twice:

– The first time responses are obtained - free association phase

– The second time they are elaborated – inquiry phase


Rorschach (cont.)

Exner’s Comprehensive Scoring System

1. Location

- W = whole (intellectual potential)

- D = subdivisions (common sense)

- Dd = details (compulsive tendencies)

- DW (confabulated detail)

2. Content (i.e., general class to where response belongs)

- people, part of a person, clothing, animal, part of an

animal, nature, anatomical


Rorschach (cont.)

3. Determinants (i.e., specific property of the blot)

- F = shape/outline (rational approach)

- M = movement (imagination)

- C = color (emotional reactions)

- Y = shades of grey (depression)

4. Form Quality

5. typical vs. unusual response

6. time


Rorschach (cont.)

norms = unrepresentative inter-rater reliability test-retest reliability construct validity criterion validity


Psychometric Properties of the Rorschach

The Rorschach is a popular test, however, it has been plagued by low reliability and validity.

Obviously, it is difficult to measure any of the usual psychometric properties in the usual way

– Validity and reliability are usually low because of the open-ended multiplicity of possibility that is allowed and by the lack of universally-accepted standardized instructions, administration protocol, and scoring procedure


Interpreting the Rorschach

Uses norms for five groups: nonpatient, outpatient nonpsychotic, inpatient character problem, inpatient depressive, inpatient schizophrenics one

Deviation from norms can mean an invalid protocol, or brain damage, or emotional problems, or a low mental age (or just an original person)


Thematic Apperception Test (TAT)

Construct a story about what you see on the following picture

Describe: - what led up to the scene - what is happening - what the characters in the story might think or feel - how the story will end




Thematic Apperception Test

The Thematic Apperception Test (TAT): 30 grayscale pictures + one blank for elicitation of stories – each contain a dramatic event or critical situation

Most subjects see 10-12 cards, over two sessions Based on Murray's (1938) theory of 28 social needs (sex,

affiliation, dominance, achievement, attitudes etc.) People would project into their story their needs Attention is paid to the protagonist in each story and

his/her environmental stressors Many variations on this 'story-telling' test exist


TAT (cont.)

Administration: not standardized- Not the same 20 cards- Not the same order- Seldom 2 sessions- Instructions differ

• Scoring is Minimal• Low Reliability & Validity


TAT – scoring/interpretation

Scoring Congruence with picture stimuli Conformity with directions Conflict

Psychometric properties: internal consistency is low; high reliability but diminishes with time, 2 months, r

= .80; 10 months r = .50; Inter-rater reliability vary with studies: range .3 to .9


Draw-a-Person Test

- Originally to assess children’s intelligence- Now: a screening procedure for emotional disturbance- Cannot constitute a diagnosis

- The administration:• Draw a person• Draw a person of the opposite sex• Draw yourself


Draw-a-Person Test

Administrator Asks:

- Can you please draw a person?- Draw whatever you like in any way you like?

Administrator Then Asks:

- Draw a person of the opposite sex?


Draw-a-Person Test (cont.)

Subjective vs. quantitative scoring system Clinician looks for:

– Sequence of body parts– Verbalizations during the drawing process– Size & placement of figures on the page– Number of erasures– Shading– Gender of picture– Over attention to certain body parts


Draw-a-Person Test (cont..)

Among the plausible but empirically untrue relations that have been claimed:

- Large size = Emotional expansiveness or acting out

- Small size = emotional constriction; withdrawal, or timidity

- Overworked lines = tension, aggression

- Distorted or omitted features = Conflicts related to that feature

- Large or elaborate eyes = Paranoia


Sources of Inaccuracy in Personality Self-Report Testing

Personality assessment largely depends on self-report

Response sets may affect personality results


Social Desirability

Some test takers choose socially acceptable answers or present themselves in a favourable light

People often do not attend as much to the trait being measured as to the social acceptability of the statement

This represents unwanted variance


Social Desirability (cont.)

Example items:

– People I know can count on me to finish what I start.

– I would rather work in a group than by myself.

– I often get stressed-out in many situations.


Faking

Faking -- some test takers may respond in a particular way to cause a desired outcome

– may “fake good” (e.g., in employment settings) to create a favourable impression

– may “fake bad” (e.g., in clinical or forensic settings) as a cry for help or to appear mentally disturbed

– may use some subtle questions that are difficult to fake because they aren’t clearly face valid


Assessing for Depression

Beck Depression Inventory – 21 item self report rating inventory

measuring supposed manifestations of depression

– Take approximately 10 minutes to complete


Assessing for Depression

Beck Depression Inventory Scoring

5 - 9 considered normal

10 -18mild to moderate depression

19 -29moderate to severe depression

30 - 63 severe depression


Assessing Social Systems

Family Environment Scale – relationships– personal growth


Assessing Biological Systems

Psychophysiological assessment Brain imaging techniques

– CT scan– PET scan– MRI– fMRI

Documents

Chapter 4 Classification and Assessment of Abnormal Behaviour Copyright © 2006 Pearson Education Canada Inc