Chapter 3 – Clinical Assessment and Diagnosis

I. Diagnosis vs Assessment

A. Assessment: uses a variety of measures and methods

B. Diagnosis: meets criteria for a specific problem?

II. Measurement Issues

A. Reliability – consistency of measurement

1. inter-rater

2. test-retest

3. alternate forms

4. internal consistency

B. Validity – does it measure what it’s supposed to measure

1. content

2. criterion (concurrent and predictive)

3. construct

C. Standardization

1. How measure is administered

2. Against whom one is compared

III. The DSM System

A. DSM = Diagnostic and Statistical Manual of Mental Disorders

B. Currently using DSM-IV-TR, DSM-V is in the works (amidst much drama)

C. Uses a multiaxial system

1. Axis I: Most psych disorders

2. Axis II: Pervasive chronic disorders

3. Axis III: Medical conditions

4. Axis IV: Psychosocial stressors

5. Axis V: GAF – Global Assessment of Functioning

D. Has appendices for:

1. Potential disorders and axes, in need of further study

2. Culture-bound syndromes

IV. Issues in Classification and Diagnosis

A. Political aspects behind inclusion/exclusion of diagnoses

B. Too many diagnoses? “Frivolous” diagnoses? Too much comorbidity?

C. Are diagnoses really reliable and valid?

D. Consequences of labeling

1. Both negative and positive

E. Potential Conclusions?

1. categorical vs. dimensional approach

2. increased recognition of potentially harmful consequences

3. increased attention to external pressures

4. increased attention to cultural issues

V. Assessment Instruments

A. Types of assessment instruments

1. Clinical Interviews

a. Structured

b. Unstructured

c. Mental Status Exam

i. can be structured or unstructured; usually quite brief and informal

2. Testing

a. Projective personality (e.g., Rorschach)

b. Objective personality (e.g., MMPI)

c. Cognitive/Intelligence (e.g., WAIS)

d. Biological (e.g., brain scans), psychophysiological (e.g., skin conductance)

e. Neuropsychological (e.g., Bender-Gestalt)

f. Others for specific reasons (e.g., Beck Depression Inventory)

3. Behavioral Assessment/Observation

4. Collateral Information (e.g., teacher reports, other reports)

B. Importance of reliability and validity

C. Importance of choosing appropriate measure for situation

D. Cultural bias and other related factors