Chapter 4. Classification and Assessment
Classification
-We often categorize or classify people into a group based on their gender, race, SES, and age.
-In the area of abnormal behavior and personality, we group together different types of abnormal behavior or personality with similar characteristics (i.e., introverted vs. extroverted) or abnormal behavior (i.e., normal vs. abnormal).
Categorical Classification
Definition: Classifying individuals into discrete classes that are internally coherent but qualitatively different (i.e., absence or presence of certain symptoms).
-Advantages
(1)The descriptive nature of classification allows professionals to summarize various characteristics of an individual with a disorder in a single term, class, or diagnosis, facilitating communication among professionals.
(2)Good for detecting a rare disorder (i.e., autism)
-Disadvantages
(1)Heterogeneity of members of a class
(2)Loss of information (loss of information specific to an individual)
(3)Arbitrary cut-off points
(4)Procrustean (forcing individuals into a class)
(5)Classificatory dilemma for borderline cases
Dimensional Classification
Definition: Classifying individuals in terms of where they stand on continuous and quantitative multi-axes (i.e., not all or none, but point systems on each dimension). It is based on the actual scores of standardized tests.
-Advantages
(1)Comprehensive information on multivariate dimensions.
(2)Not all or none system (i.e., useful for borderline cases)
-Disadvantages
(1)Hard to integrate all information from all dimensions.
(2)May miss a rare disorder
A combination of both Categorical and Dimensional classification is the best.
Classification in general
-Advantages
(1)Facilitate communication
(2)Reflect current knowledge of etiology and pathology
(3)Provide information regarding etiology, treatment, and outcome
(4)Reassure that treatment is available
-Disadvantage
(1)Dehumanizing (i.e., schizophrenic rather than a person with schizophrenia)
(2)Labeling may crate stigmatization
(3)Self-fulfilling prophecy (i.e., Be as what he or she was labeled).
(4)May mislead that a disorder is fully understood or can fully be treated.
(5)May obscure cultural issues
(6)Diagnosis is not based on unifying theory
(7)May have a low reliability depending on clinician’s different theoretical orientations
(8)Two persons with the same diagnosis are not alike, and a person is different across settings and time.
DSM-IV (Diagnostic Statistical Manual of Mental Disorders: 1994)
A multi-axial diagnostic system that summarizes information about several aspects of the person’s history and behavior on various axes (more than a simple label).
Axis IClinical disorders (i.e., Mood, anxiety, psychotic disorders)
V71.09 (no DX)
799.9 Deferred
Other conditions that may be a focus of clinical attention (i.e., partner relational problems)
Axis IIPersonality disorders (i.e., antisocial, borderline, histrionic)
Mental retardation
Defense Mechanisms (i.e., frequent use of denial)
Axis IIIGeneral medical condition (i.e., cancer, migraine, ulcer)
Axis IVPsychosocial and environmental problems
Problems with primary support group (i.e., death of a family member)
Problems related to the social environment (i.e., loss of friend, discrimination)
Educational problems (i.e., illiteracy, discord with teachers)
Occupational problems (i.e., unemployment)
Housing problems (i.e., homelessness)
Economic problems (i.e., poverty)
Problems related to interaction with the legal system (i.e., arrest)
Axis VA Global Assessment of Psychosocial Functioning (GAF) (current and in the past) on a scale ranging 100 (superior functioning in a wide range of activities) to 0 (inadequate information).
(i.e., Persistent danger of hurting self or others may get 5 GAF).
This is the clinician’s judgment of the individuals’ overall level of functioning (psychological, social, and occupational functioning. Not physical functioning or environmental limitations)
DSM-V (Diagnostic Statistical Manual of Mental Disorders: 2013) (ICD-11)
- No more axial classification.
- No more MR but ID
- Autistic Spectrum disorder
Diagnosis must be done based on comprehensive data (i.e., psychiatric and physical history, personal history, family background, multiple settings, multiple informants, cultural factors, and etc).
Reliability and validity
*Reliability (kappa): The extent to which a measure is consistently measuring whatever it is measuring across times, situations, or raters (i.e., reliability of the DSM-IV between two clinicians).
*Validity: The extent to which a measure is measuring what it was intended/supposed to measure. The appropriateness of a measure.
Assessment: There many ways of gathering information and assess behavior.
1. Interview
-Ask questions such as age, gender, feelings, thoughts, problematic behaviors, onset of the problems, frequency/intensity/duration of problems, how vulnerable or resilient the client is, attitudes, values, expectations, etc.
-Structured Clinical interview for DSM (SCID)
-Diagnostic Interview Schedule (DIS)
-Mental Status Examination: Ask questions, observe the patient’s thoughts, mood, and behaviors, or ask the patient to perform some tasks (obtain information on orientation, appearance, alertness, speech, thought contents and patterns, memory, attention, concentration, affect/mood, energy, perception, judgment/insight, psychomotor behavior).
2. Personality assessment
(1)Objective tests:
(a)Minnesota Multiphasic Personality inventory-2 (567 items)
-Validity scales (L, F, K scales)
-10 clinical scales (Hypochondrias, Depression, Hysteria, Psychopathic Deviate, Masculinity-Femininity, Paranoia, Schizophrenia, Hypomania, Social Introversion).
(b) Millon Clinical Multiaxial Inventory (MCMI-II): Specifically designed to correspond to DSM-IV classification.
(2) Projective tests: Present ambiguous stimuli and ask to respond to the stimuli in a free manner.
(a) Rorschach inkblot tests (10 cards, what does it look like?)
(b) Thematic Apperception test (31 pictures, ask to make up a story, what led up to the event, what would happen, what they might be thinking and feeling?)
(c) Draw a person
3. Behavioral Assessment
-Observe the frequency of a particular type of response (i.e., personal attacks) in a specific situation (i.e., on the school playground) in a specific time.
-Only focus on the external behavior, situations leading to the behavior, reinforcers contributing to the maintenance of the behavior, etc.
-It can be done by rating (self or other), self-report, and observation.
4. Cognitive assessment
-Assess thoughts preceding, accompanying, and following maladaptive behavior.
-It can be done by the clinical interview (i.e., clinical judgment) or self-report measures (i.e., How I Think Questionnaire, Cognitive Interference Questionnaire).
5. Relational assessment
-Maladaptive behavior always occurs in some social/environmental context.
-Assess a person’s familial and social relationship.
6. Bodily Assessment
-Clients’ feelings, thoughts, and motivations can be understood by information about how their bodies function.
-Brain image techniques (i.e., observe shifts in metabolic activity of the brain while a person is responding to some perceptual and cognitive tasks).
-Biofeedback (i.e., monitor owns’ blood pressure)
-Polygraph (i.e., lie detector)
-Galvanic skin Response (i.e., measure an increase in r=the electrical conductivity of the skin that occurs when sweat glands increase their activity).
7. Neurological tests
-Measure the cognitive, sensoritmotor, and perceptual consequences of brain abnormality.
-Bender-Gestalt Visual-Motor Gestalt Test (ask to copy 9 figures).
8. Intelligence Tests
-Wechsler Adult Intelligence Tests-IV (11 subtests, VIQ-PIQ)