Abnormal Psychology

Clinical Diagnosis and Assessment 89

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Were it possible to obtain information about Rose Mary and Rex Walls directly,

what specific information would a clinician want to know in order to make a

diagnosis and recommendations for treatment? More generally, what types of

information are included in a clinical assessment? The answer depends, in part, on

several factors related to the assessment:

• The reason for the assessment determines the questions that are to be asked and

answered by the assessment; possible reasons for making an assessment include:

° To obtain additional information in order to make a diagnosis;

° To monitor the course of the symptoms;

° To determine what type of treatment might be most benefi cial; or

° To monitor the progress of treatment.

• The type of clinician making the assessment determines, by virtue of his or her

training, the types of information to be obtained.

• The setting in which the clinician works determines how much information is

gathered; if the assessment is part of a research project, it may be more compre-

hensive than an assessment that is not part of a research project.

• Financial issues related to the assessment determine what specifi c methods of ob-

taining information will—and will not—be paid for. Health insurance companies,

for instance, may be reluctant to pay for assessment methods that are not crucial

in determining diagnosis or appropriate treatment.

Just like classifi cation systems, assessment tools and techniques must be reliable.

Other clinicians or researchers who make a clinical assessment of the same patient

using the same method should obtain the same information. Similarly, assessment

tools and techniques should be valid—they should assess the problem or aspect of

functioning that they are intended to assess. And just because an assessment tool

or technique is reliable, that doesn’t necessarily mean it is valid. For instance, a

questionnaire designed to assess the extent of an individual’s preoccupying worries

might be very reliable, but the questions might ask about preoccupying thoughts

generally. If so, then people newly in love (and preoccupied with thoughts of their

new partner) would achieve high scores; in that case, the test might measure preoc-

cupation reliably, but not be a valid measure of preoccupation with worries per se.

In addition, clinicians should take into account an individual’s cultural back-

ground when determining which assessment tools to use and how to interpret the

resulting information. Not all assessment tools have comparison data for people

from various ethnic backgrounds; comparing an individual’s data or scores against

those of a culturally dissimilar group will provide information that is not necessar-

ily valid (Poortinga, 1995).

A complete clinical assessment can include various types of information about

three main categories of factors: neurological and other biological factors (the struc-

ture and functioning of brain and body), psychological factors (behavior, emotion

and mood, mental processes and contents, past and current ability to function), and

social factors (the social context of the patient’s problems, the living environment

and community, family history and family functioning, history of the person’s rela-

tionships, and level of fi nancial resources and social support available). Most types

of assessment focus primarily on one type of factor. We’ll consider assessments of

each of these main types of factors in the following sections.

Assessing Neurological and Other Biological Factors

In some cases, clinicians assess neurological (and other biological) functioning in

order to determine whether abnormal mental processes and mental contents, affect,

or behaviors arise from a medical problem, such as a brain tumor or abnormal

hormone levels. In other cases, researchers seek to understand neurological and

other biological factors that may be related to a particular disorder, because this