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Exemplar 20 mark essays for clinical psychology
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These are exemplar 20 mark essays for Anorexia Nervosa and Diagnosis in clinical psychology with AO1, AO3 evaluations
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Clinical 20 mark essaysDiagnosis: 4Ds and ICD & DSM and Rosenhan’s study
4Ds: Deviance is when a person’s thinking or behaviour is classified as abnormal because it violates
the rules about what is expected or acceptable behaviour in society. In this scenario, X has started to
talk to herself in public therefore, her thinking would be classified as abnormal as she also thinks she
has superpowers to turn into a bat. Therefore, X’s behaviour would be seen as unusual and atypical
to people of society. Dysfunction relates to acting abnormally, it focuses on everyday behaviour of
the person such as whether they can have a job, manage their family and social life or even
something as simple as feeding themselves. X eats only white foods and she will not go out during
the day because she thinks she’ll catch on fire and has no social life such as going out with her
friends. These suggest that X is unable to cope with everyday activities and avoids embarrassing
herself in front of others. Distress is when someone suffers from a sense of psychological distress or
discomfort. The level of distress is personal to the individual and will vary depending on how the
person is experiencing their disorder and what they think of their situation. X cannot go out with her
friends as she fears being laughed at. This suggest that she may feel anxious going out and gets
upset. Danger is where the individual is either in danger of harming themselves or others. Examples
include suicidal thoughts or unintentionally running into the road to avoid something and causing a
crash. X shows no sign of danger to herself or others.
On the one hand, the 4Ds are useful as they might help clinical professionals avoid errors when
diagnosing individuals. For example deviance can show that those who are eccentric may not be
harmful to others and so cannot atomically be considered to have a mental illness. Although X only
etas white foods that doesn’t not harm her or others in a malicious way. This is important because a
valid system should neither over nor underestimate a persons abnormal behaviour as the clinician
would not want to miss any details of X’s symptoms and misdiagnose her. In addition, the 4Ds can be
used to apply to diagnosis from the classification systems DSM and ICD. For example, X’s
dysfunctional of being unable to go out in the day because of the fear of catching on fire could help
find a treatment that fits her symptoms and diagnosis through the DSM or ICD. This is a strength as it
supports the classification systems and the factors that lead to diagnose relates to the 4Ds. However
to an extent the 4Ds cannot explain her behaviour and whether it is a long-term behaviour that will
affect X for a long time.
On the other hand, the 4Ds are not useful due to the lack of objectivity. This is because there are
various methods used that aim to be objective as these affect reliability. Since the 4Ds involve
making comparisons between individuals and other sin society decisions would be better if made to
a reference group. X talking to herself in public may be seen as abnormal, however this does not
indicate what symptom of a mental disorder this links to. This shows that the 4Ds can only be
applicable for a diagnosis if there is further detail on how X’s community perceives her and more
information from her personal history. Furthermore, labelling Alice as ‘abnormal’ or ‘deviant’ could
upset her even more, especially if in fact she does not suffer from any mental disorders. She may
believe herself to be abnormal and affect her self-esteem and relationship management. This could
lead her to avoid public situations and everyday activities to the point she cannot leave her house.
However, the 4Ds used along the DSM and ICD could be far more objective when evaluated by
multiple psychologists in order to get a range of opinions on X’s diagnosis.
, ICD&DSM: Reliability is the extent to which psychiatrists can agree on the same diagnosis when
independently assessing patients. There are two types; Inter-rather reliability explains what this
would mean in relation to clinicians making a diagnosis of schizophrenia. Test retest reliability is
measured on a ‘kappa score’ scale 0-1, where a score of 0.7 is good. This provides a standardised
method of recognising mental disorders. Reliability of diagnosis has improved over time as newer
versions of DSM has been published.
Classification systems can be considered reliable because field trails demonstrate impressive levels
of agreement between clinicians for a variety of disorders. Reiger et al (2013) reported that three
disorders had kappa values ranging from 0.60 to 0.79 while seven more diagnoses including
schizophrenia had Kappa values of 0.40 to 0.59. This supports classification systems can be reliable
as the research evidence can be replicated and clinicians can make consistent diagnosis. However,
over time accepted levels of agreements has changed therefore there are a lot of varied opinions on
this matter.
Classification systems can be considered not reliable as there is evidence that diagnosis using the
DSM-V cannot be fully reliable for all disorders. This is because Cooper (2014) explains that the DSM
task force classified levels as low as 0.2-0.4 as ‘acceptable’ and Reiger (2013) found that a poor
reliability score of 0.28 for MDD. This may suggest that the DSM may be less reliable than previous
versions and that diagnoses may have been made in error while other missed altogether. However,
Kupfer and Kraemer (2012) argue that clinicians were asked to mirror normal practices in the DSM-5
field trials. In contrast DSM-3 used carefully screened ‘test’ clients and clinicians were given detailed
training. Therefore reliability varies as the way all these studies were carried out differs.
Validity is the extent to which the diagnosis can accurately predict the development and prognosis of
a disorder known as predictive validity. The degree to which a test corresponds to external criteria or
another method is known as concurrent validity. A valid diagnostic system will operationalise the
symptoms and behaviours that make up a mental health disorder. Comorbidity is the presence of
one or more additional disorders co-occurring with a primary disorder. This is common among
patients with schizophrenia, as anxiety and depressive symptoms are very common and an
estimated prevalence of 15% with panic disorder and 23% obsessive compulsive disorder.
Comorbidity and symptom overlap reduces the validity of diagnosis.
Classification systems can be considered valid because there is evidence that suggests if a disorder
has high predictive validity then this is desirable as it would be clear how the disorder would
develop. This was demonstrated in 5-year old children with conduct disorder who were significantly
more likely to display behavioural and educational difficulties aged 7. Kim-Cohen et al. (2005)
demonstrated the concurrent validity in the DSM-IV-TR of conduct disorder through interviewing
children and their mothers using questionnaires completed by children’s teachers. This is important
as accurate diagnosis could reduce adult mental a health problems which are frequently preceded
by the symptoms of conduct disorders. In addition, Mason (1997) has showed that the diagnosis of
schizophrenia using the ICD showed good predictive validity of future disabilities. This is useful as it
allow for long-term treatments to develop and support patients accordingly to manager their
disorder effectively. However, schizophrenia has low predictive validity as shown by Bleuer’s study
where 20% would have full recovery whereas 40% would continue to have psychotic episodes.
Therefore we cannot fully predict how and when schizophrenia develops and contradicts predictive
validity figures.
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