Abnormal Psychology

88 CHAPTER 3

Assessing Psychological Disorders

People came to know about Rose Mary and Rex Walls through the eyes of their

daughter, Jeannette. In her memoir, Jeannette reports incidents that seem to be

clear cases of neglect and irresponsible behavior. How might a mental health clini-

cian or researcher have gone about assessing Rose Mary’s or Rex’s mental health?

Although mental health clinicians might read Jeannette Walls’s memoir, hear her

speak about her parents, or even see brief video clips of Rose Mary Walls, the

information conveyed by those accounts isn’t adequate to make a clinical assessment:

Jeannette’s memoir—and Rose Mary’s brief statements on videotape— portray

what Jeannette and the video directors chose to include; we don’t know about

events that were not discussed or portrayed, and we don’t know how accurate

Jeannette’s childhood memories are. Other people’s accounts of an individual’s

mental health generally provide only narrow slices of information—brief glimpses

as seen from their own points of view, none of which is that of a mental health

clinician. Without use of the formal tools and techniques of clinical assessment,

any conclusions are likely to be speculative.

Key Concepts and Facts About Diagnosing Psychological Disorders

• Among other purposes, classifi cation systems for diagnosis al-
  low: (1) patients to be able to put a name to their experiences
  and to learn that they are not alone; (2) clinicians to distinguish
  “normal” from “abnormal” psychological functioning and to
  group together similar types of problems; and (3) researchers
  to discover the etiology, course, and effectiveness of treat-
  ments for abnormal psychological functioning.


• Classifi cation systems also have drawbacks. They can be subject
  to diagnostic bias—perhaps on the basis of the patient’s sex, race,
  or ethnicity. For some people, being diagnosed with a psychologi-
  cal disorder is experienced as stigmatizing, which changes how
  the person feels about himself or herself or is seen by others.


• Classifi cation systems should be both reliable and valid. Reliability
  is less likely when the criteria for disorders are not clear and when
  the criteria for different disorders signifi cantly overlap.


• The most commonly used classification system in the United
  States is the Diagnostic and Statistical Manual of Mental
  Disorders, presently in its fourth edition, text revision (DSM-IV-
  TR). The DSM-IV-TR:
  
  
  • generally does not focus on etiology (the causes of disor-
    ders), but instead focuses on what can be observed rather
    than inferred;
  
  
  • lists explicit criteria for each disorder and includes a multiaxial
    system for clinicians and researchers to record diagnoses as
    well as additional information (medical status, comorbid psy-
    chological disorders, psychosocial and environmental prob-
    lems, assessments of current and past functioning) that may
    affect diagnosis, prognosis, and treatment.
  
  
  
  


• DSM-IV-TR has been criticized on numerous grounds:
  
  
  • What constitutes clinically significant distress or impaired
    functioning is subjective and can vary widely from one clinician
    to another.
    
    
    • Disorders are classified as categorical rather than as on
      continua.
    
    
    
    
  
  
  
  


• The way the criteria are structured leads to heterogeneous
  groups being diagnosed with the same disorder.
  
  
  • Every criterion for a given disorder is generally weighted
    equally to the others.
  
  
  • The duration criteria can be arbitrary and not necessarily sup-
    ported by research.
  
  
  • Some sets of criteria are too restrictive.
  
  
  • With each edition of the DSM, the number of psychological
    disorders grows (DSM-IV-TR identifi es almost 300 disorders).
    Many diagnoses have been created in order to ensure pay-
    ment from health insurance providers.
  
  
  • Diagnoses have been added for disorders that clearly are med-
    ical problems.
  
  
  • Social factors that lead or contribute to psychological disor-
    ders are deemphasized.
  
  
  • There is a high comorbidity rate: Half the people diagnosed
    with one disorder have at least one other disorder.
  
  
  • Commonalities that underlie disorders across the categories
    are diffi cult to identify.
  
  
  
  


• Psychological disorders are generally diagnosed by clinical and
  counseling psychologists, psychiatrists, psychiatric nurses,
  and social workers. Other clinicians in a position to diagnose
  psychological disorders include general practitioners, pastoral
  counselors, and marriage and family therapists. Each type of cli-
  nician has received somewhat different training and therefore
  may gather different types of information and use that informa-
  tion in different ways.