Discuss the validity and reliability of the diagnosis.
For a classification system to be reliable, it should be possible for different clinicians to use the
same system, to arrive at the same diagnosis for the same individual. So the reliability of a
diagnosis is whether two or more psychiatrists using the same classification system make
the same diagnosis. Although diagnostic systems now use more standardized assessment
techniques and specific diagnostic criteria, the classification systems could be better.
One study discussing the reliability of diagnosis is Regier’s study. The aim of the study was to
assess the reliability of selected disorders in the DSM-5. The method used was that field
trials were conducted at 11 different academic centers in the USA and Canada. The
procedure began with the screening of participants visiting a psychological treatment site.
These participants then underwent diagnostic interviews with two clinicians. The clinicians
then made their diagnoses. The results were that the reliability of diagnoses was 'very good'
for five of the diagnoses, 'good' for nine diagnoses, 'questionable' for six diagnoses, and
'unacceptable' for three. The conclusion of the study was that reliability was good or very
good for most of the disorders, and the rates of inter-rater reliability were as good or better
than the rates achieved by doctors in medical diagnoses. The strengths of the study were
that this study has wide applications. It emphasizes that the diagnosis of psychological
disorders is far from an exact science, and in some ways, the low reliability indicated by the
field trials only emphasizes that diagnosis should not be a one-time thing. Instead, it should
be part of the ongoing conversation between patient and clinician. Additionally, the use of a
single-blind technique ensured a high level of control in this study. The limitations were
that another study argued that the diagnosis of depression has always been problematic,
simply because it includes such a wide range of symptoms presenting at varying levels of
severity, and because it occurs in conjunction with many other disorders. Continuing work
must be done to improve the reliability of diagnostic criteria for depression, among other
disorders.
For a classification system to be valid, it should be able to classify a pattern of symptoms
that can lead to an effective treatment. The question of the validity of a diagnosis is complex.
The psychiatrist is often highly dependent on the self-reported data from the patient. In
addition, judging the validity of a diagnosis, by the effectiveness of a treatment, is
problematic. Treatments make assumptions about the origins of a disorder, the diagnosis
could be correct, but the treatment could be ineffective. On the other hand, an individual may
show significant improvement over time, but it may not be due to the treatment. This would
mean that although the individual improved, this was not due to a valid diagnosis.
, One study discussing the validity of diagnosis is Bolton’s study. The aim was to investigate
the local validity of Western mental illness concepts. The procedure was that first he
investigated the validity of diagnosis by outlining 6 steps that were needed for an emic
approach to diagnosis:
1) Collect data on the way mental health is viewed in the community.
2) Analyze the data for similarities to the Western culture.
3) Using the data, questionnaires were adapted and translated to meet the indicator of
mental health.
4) Tested the credibility of the questionnaires.
5) Use a validated instrument in a community-based survey.
6) Analyze the data to assess the local prevalence and characteristics of mental health
indicators.
Next, three methods were used to interview the people of Rwanda. Free listing, key
informant interviews, and a task asking to sort cards. These were then used as a part of the
questionnaire to determine how prevalent depression was in the society. The results were
that interviewees described symptoms of depression and PTSD. After the first questionnaire,
93 people were diagnosed with having a mental health issue. After the new questionnaire
was conducted, 30 of those showed signs of depression. While 368 adults were interviewed,
17.9% met the DSM for depression and 41.8% described themselves as having another
named disorder in the society. The conclusion was that the relationship between the rural
area and depression was the same as grief and depression in the Western World. The
strengths of the study were that the focus was placed on individual experiences through
semi-structured interviews. There’s an in-depth understanding of the participant’s
situation which increased reliability. The limitations were that it could not be generalized
because only women were interviewed. Additionally, it was based on self-reporting therefore
it is difficult to accurately determine the extent of depression in each woman.
The studies are mostly correlational meaning that no cause-and-effect relationship can be
established. There are some obstacles to effective diagnosis, such as self-reported data by
patients that lead to participants' bias. Additionally, many symptoms are difficult to
measure, which creates problems related to construct validity. Lastly, there is also the
problem of comorbidity since the patient might have more than one disorder. However,
most studies have a high ecological validity since they are conducted in a less artificial
environment.
Discuss the use of one or more classification systems
The controversies associated with definitions of abnormality and psychological disorders
only get more controversial in the various diagnostic manuals and classification systems
used to diagnose abnormal behavior. However, diagnostic manuals and classification systems
provide a common language for discussing psychological disorders, and in theory, they
facilitate research on psychological disorders with similar sets of symptoms and possible
causes.
For a classification system to be reliable, it should be possible for different clinicians to use the
same system, to arrive at the same diagnosis for the same individual. So the reliability of a
diagnosis is whether two or more psychiatrists using the same classification system make
the same diagnosis. Although diagnostic systems now use more standardized assessment
techniques and specific diagnostic criteria, the classification systems could be better.
One study discussing the reliability of diagnosis is Regier’s study. The aim of the study was to
assess the reliability of selected disorders in the DSM-5. The method used was that field
trials were conducted at 11 different academic centers in the USA and Canada. The
procedure began with the screening of participants visiting a psychological treatment site.
These participants then underwent diagnostic interviews with two clinicians. The clinicians
then made their diagnoses. The results were that the reliability of diagnoses was 'very good'
for five of the diagnoses, 'good' for nine diagnoses, 'questionable' for six diagnoses, and
'unacceptable' for three. The conclusion of the study was that reliability was good or very
good for most of the disorders, and the rates of inter-rater reliability were as good or better
than the rates achieved by doctors in medical diagnoses. The strengths of the study were
that this study has wide applications. It emphasizes that the diagnosis of psychological
disorders is far from an exact science, and in some ways, the low reliability indicated by the
field trials only emphasizes that diagnosis should not be a one-time thing. Instead, it should
be part of the ongoing conversation between patient and clinician. Additionally, the use of a
single-blind technique ensured a high level of control in this study. The limitations were
that another study argued that the diagnosis of depression has always been problematic,
simply because it includes such a wide range of symptoms presenting at varying levels of
severity, and because it occurs in conjunction with many other disorders. Continuing work
must be done to improve the reliability of diagnostic criteria for depression, among other
disorders.
For a classification system to be valid, it should be able to classify a pattern of symptoms
that can lead to an effective treatment. The question of the validity of a diagnosis is complex.
The psychiatrist is often highly dependent on the self-reported data from the patient. In
addition, judging the validity of a diagnosis, by the effectiveness of a treatment, is
problematic. Treatments make assumptions about the origins of a disorder, the diagnosis
could be correct, but the treatment could be ineffective. On the other hand, an individual may
show significant improvement over time, but it may not be due to the treatment. This would
mean that although the individual improved, this was not due to a valid diagnosis.
, One study discussing the validity of diagnosis is Bolton’s study. The aim was to investigate
the local validity of Western mental illness concepts. The procedure was that first he
investigated the validity of diagnosis by outlining 6 steps that were needed for an emic
approach to diagnosis:
1) Collect data on the way mental health is viewed in the community.
2) Analyze the data for similarities to the Western culture.
3) Using the data, questionnaires were adapted and translated to meet the indicator of
mental health.
4) Tested the credibility of the questionnaires.
5) Use a validated instrument in a community-based survey.
6) Analyze the data to assess the local prevalence and characteristics of mental health
indicators.
Next, three methods were used to interview the people of Rwanda. Free listing, key
informant interviews, and a task asking to sort cards. These were then used as a part of the
questionnaire to determine how prevalent depression was in the society. The results were
that interviewees described symptoms of depression and PTSD. After the first questionnaire,
93 people were diagnosed with having a mental health issue. After the new questionnaire
was conducted, 30 of those showed signs of depression. While 368 adults were interviewed,
17.9% met the DSM for depression and 41.8% described themselves as having another
named disorder in the society. The conclusion was that the relationship between the rural
area and depression was the same as grief and depression in the Western World. The
strengths of the study were that the focus was placed on individual experiences through
semi-structured interviews. There’s an in-depth understanding of the participant’s
situation which increased reliability. The limitations were that it could not be generalized
because only women were interviewed. Additionally, it was based on self-reporting therefore
it is difficult to accurately determine the extent of depression in each woman.
The studies are mostly correlational meaning that no cause-and-effect relationship can be
established. There are some obstacles to effective diagnosis, such as self-reported data by
patients that lead to participants' bias. Additionally, many symptoms are difficult to
measure, which creates problems related to construct validity. Lastly, there is also the
problem of comorbidity since the patient might have more than one disorder. However,
most studies have a high ecological validity since they are conducted in a less artificial
environment.
Discuss the use of one or more classification systems
The controversies associated with definitions of abnormality and psychological disorders
only get more controversial in the various diagnostic manuals and classification systems
used to diagnose abnormal behavior. However, diagnostic manuals and classification systems
provide a common language for discussing psychological disorders, and in theory, they
facilitate research on psychological disorders with similar sets of symptoms and possible
causes.
