Abnormal Psychology

Clinical Diagnosis and Assessment 103

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Note that the presence of certain distinctive characteristics in families with N

a member who has a psychological disorder does not necessarily indicate that

these characteristics caused the disorder; it is possible that something about

the affected family member (such as particularly intense symptoms of his or

her disorder or some other characteristic) elicits certain types of behavior from

other members of the family. So, for instance, families with a member who

has schizophrenia may be less cohesive because the ill family member’s symp-

toms and ensuing family stress lead other members to seek support from friend-

ships. That is, the ill member’s symptoms may decrease family cohesion, not

the other way around. Thus, the assessed family environment may contribute

toward, or be a product of, the family member’s illness—or the family environ-

ment and the member’s illness may both reflect other factors, such as living in

extreme poverty.

Community

When making a clinical assessment, the clinician should try to learn about the

patient’s community in order to understand what normal functioning is in that

environment. As we saw in Chapter 2, people who have low socioeconomic sta-

tus (SES) are more likely to have psychological disorders. Those people live in

poorer communities, which tend to have relatively high crime rates—and so they

are more likely to witness a crime, be a victim of crime, or to live in fear. What,

then, is “normal” functioning in this context?

In an effort to understand a patient within his or her social environment, “com-

munity” may be defi ned loosely—it can refer not only to where the patient lives, but

also to where he or she spends a lot of time, such as school or the workplace. Some

jobs and work settings can be particularly stressful or challenging, and a compre-

hensive assessment should take such information about a patient into account. Con-

sider that some work settings place very high demands on employees—high enough

that some may become “burned out” (Aziz, 2004; Lindblom et al., 2006). Symp-

toms of burnout (a psychological condition, though not a psychological disorder in

DSM-IV-TR) include feeling chronically mentally and physically tired, dissatisfi ed,

and performing ineffi ciently—which resemble symptoms of depression (Maslach,

2003; Mausner-Dorsch & Eaton, 2000).

In some cases, such as when determining whether an elderly patient whose

memory is deteriorating is able to continue living at home alone, a thorough

assessment may require the participation of a wide range of people in the pa-

tient’s community (Gilmour, Gibson, & Campbell, 2003). The patient’s medical

doctor, neighbors, relatives, and community-based elder services coordinator

may each contribute vital information to the assessment.

The clinician should also assess the patient’s capacity to manage daily life in his

or her community, considering factors such as whether the patient’s psychological

problems interfere with the sources for social support and ability to communicate

his or her needs and interact with others in a relatively normal way. Similarly, the

clinician may be asked to determine whether the patient would benefi t from train-

ing to enhance his or her social skills (Combs et al., 2008).

Culture

To assess someone’s reports of distress or impairment, a clinician must

understand the person’s culture. Different cultures have different views about

complaining or describing symptoms, which infl uence the amount and type of

symptoms people will report to a mental health clinician—which, in turn, can

affect the diagnosis a clinician makes. For instance, compared to white Brit-

ish teenagers with anorexia nervosa, who say they are afraid of becoming fat

and report being preoccupied with their weight (both symptoms are part of the

criteria set for anorexia), British teenagers of South Asian background do not

report these symptoms, but are more likely to report a loss of appetite (Tareen,

Clinicians should inquire about the problems and

strengths of a patient’s community, such as the

presence of violence and the sources for support.

Such information helps us understand the wider

context of the patient’s symptoms, as well as

interventions that might be helpful.

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