Clinical Psychology
Prehistoric cultures often held a supernatural view of abnormal behaviour and saw it as the
work of evil spirits, demons, gods, or witches who took control of the person. After regression
during the Middle Ages, the field progressed in the 19th and 20th centuries, with the help of
individuals like Sigmund Freud who helped develop therapies and treatment. The 20th century
also saw the creation of the Diagnostic and Statistical Manual of Mental Disorders (DSM)
Definitions of Abnormality
How the term ‘abnormality’ has changed over the years. How is abnormality viewed differently
now?
● statistical infrequency
● deviation from social norms
● failure to function adequately
● deviation from ideal mental health
2 definitions of abnormality; (Rosenhan and Seligman, 1989).
Statistical Infrequency:
- It is a mathematical method for defining abnormality. This definition works on the
idea that abnormality should be based on infrequency; if it occurs rarely then it is
abnormal.
- those behaviours that are extremely rare or statistically unusual i.e any behaviour that
is found in very few people is regarded as abnormal
- For example, lower than average IQ, <70 therefore may be diagnosed with intellectual
disability disorder
Evaluation
- This does not consider the desirability of behaviours or traits. For example, very high
intelligence or extremely altruistic behaviour are both statistically rare, but would not
generally be classed as ‘abnormal’. Additionally, many rare behaviours or characteristics
(e.g. left handedness) have no bearing on normality or abnormality.
- Statistical infrequency does not accurately reflect an individual's situation or daily
experiences during the course of a disorder because it only takes into account whether
the behaviours are unusual across a population on a quantifiable, numerical level, not
how they are experienced. Therefore, there is limited application for describing the
course of a disorder and the impact it may have on an individual’s life experiences
- The mathematical nature of this definition means that it is clear what is defined as
abnormal and what is not. There is no opinion involved which means there is no bias.
Failure to Function adequately:
Occurs when someone is unable to cope with ordinary demands of day-to-day living.
- unable to just go about day to day life such as eating regularly, washing clothes,, getting
up to go out to a job or activity, being able to communicate with others.
, - It causes distress and suffering for the individual but also distress to others: in some
mental disorders the individual may not be distressed at all, people with schizophrenia
generally lack awareness that anything is wrong but their behaviour (hallucinations,
believing that they are being persecuted) may be distressing to others.
Rosenhan & Seligman (1989) suggested the following characteristics would not enable
someone to function adequately:
● Suffering
● Maladaptiveness (being a danger to self)
● Vividness and unconventionality (standing out)
● Unpredictability & loss of control
● Irrationality/incomprehensibility
● Causes the observer discomfort
● Violates moral/social standards
Evaluation
- A strength is that this definition acknowledges the patient’s own feelings, for example if
they are suffering, whereas the other definitions do not.
- Behaviours that are maladaptive or irrational that do not fit with socially expected
norms of behaviour could be easily observable by others so the definitions of
abnormality can be empirically measured as they are not reliant on introspective
methods or personal reflective accounts.
- A weakness is that ‘failing to function’ could just be going against a social norm (e.g.
living an alternative lifestyle which involves not going to work, not living in a fixed
home). Therefore, a person could be judged as not functioning when they actually are.
- Most people fail to function adequately at some time, but are not considered
‘abnormal’. For example, after a bereavement most people find it difficult to cope
normally. Indeed, they might actually be considered more abnormal if they functioned
as usual. Therefore, this definition cannot be applied in all circumstances.
Classification systems
Reliable diagnoses are essential for guiding treatment recommendations, to ensure that the
patient receives the correct treatment for their conditions and an accurate prognosis can be
given.
As mental disorders don't have measurable physiological symptoms, and they are instead
measured through behavioural symptoms, there may be issues of reliability and validity
surrounding diagnosis. Therefore, ICD and DSM describe a cluster of symptoms that define
disorders that have been derived from clinical practice, that if applied properly lead to more
accurate diagnosis. However, this does not mean that they are universally accepted and there
are many influential critics of these systems.
, International classification of diseases (ICD)
- Not only concerned with mental disorders, but with all diseases
- Contains a section ‘F’ which is for mental health disorders
- Clinicians can use the system to guide their diagnosis through a clinical interview,
however this requires expertise on the clinician's part as mental disorders are not clear
in their presentation.
- In some cases diagnosis is provisional unless the patient clearly shows symptoms that
match with the description in the ICD manual.
DSM V
- Disorders are grouped into ‘families’ where linked disorders are grouped together, to
allow the clinician to go from a very general diagnosis to a specific one with guidance on
the symptoms and severity.
- Manual used alongside information from clinical interview and medical records
- Divided into three sections
a) Introduction to manual
b) Classification of main mental health disorders (schizophrenia, bipolar disorders,
depressive disorders, anxiety disorders, etc)
c) Assessment measures to aid diagnosis
DSM IV-TR
- DSM IV was updated to DSM IV-TR in 2000
- Contains 5 axis/chapters
- Includes a scale to assess how well an individual is able to go about normal day to day
activities such as washing, dressing and socialising (axis 5)
- Functioning score also helps to assess the need/type of treatment
Evaluation of DSM
One strength is the DSM is considered a reliable classification system as the diagnostic criteria
has been shown to have strong inter-rater reliability with patients receiving the same diagnosis
by different clinicians. Brown et al. (2001) found two independent interviews using the DSM
IV criteria resulted in the same diagnosis of anxiety and mood disorders in 362 outpatients.
Goldstein (1998) found that depending on the version of the DSM used there could be
differences in diagnosis. This could potentially mean that people could receive different
diagnoses based on which version of the DSM is used, reducing reliability of using DSM.
Andrews et al. (1999) found agreement in diagnosis for depression, substance dependence and
anxiety, highlighting good criterion validity when assessing 1500 people with the DSM-IV and
ICD-10. Therefore high validity is present in the diagnosis.
Cultural issues in diagnosis
Sample answer
