Summary
Summary Clinical psychology
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All studies and theories with evaluations and conclusions for schizophrenia and anorexia nervosa.
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Clinical Psychology4D’s/ABNORMALITY
AO1
- Abnormality, A deviation from social norms, any behaviour that is different from what we
accept as the average for society. Failing to function adequately in their everyday life
- Deviance, Individuals behaviour, thoughts and emotions that significantly differ from societal
norms also outside the statistical norm (person believes they can talk to God)
- Distress, Any behaviour that is unpleasant and upsetting to a person causing emotional pain
or anxiety (endless crying, difficulty in sleeping)
- Dysfunction, Persons inability to carry out daily activities and failures to complete tasks,
getting up or not socialising (not leaving the house)
- Danger, Careless, hostile or hazardous behaviour that poses a threat to an individual and/or
those around them (eating inedible food)
AO3
- Davis shows that people with mental illness have a 25% higher chance of dying from
unnatural causes supporting the danger associated with mental health disorders which
shows that D’s diagnostic system is high in validity when diagnosing patients.
- Wittchen et al found that on average 165 million Europeans suffer some form of mental
illness such as anxiety or depression, suggesting that measuring abnormality via statistical
deviance is no longer valid as many would be inaccurately diagnosed as normal due to the
frequency of occurrence when using the D’s diagnostic system
- Remick found a threefold increase in the number of sick days in the month preceding the
illness for workers with depression compared with coworkers without depression, showing
that mental health disorders cause disruption to every day life. This shows that D’s
diagnostic system is high in validity when diagnosing patients.
- Distress is a subjective judgement as what is seen as distressing for one person may not be
for others so limits how distress can be used to define what a mental health issue is. This is a
weakness as it means that mental health won’t be consistently diagnosed in the same way
which decreases the reliability of the D’s diagnostic system.
- D’s diagnostic system is standardised as psychologists use the same set of reoccurring
themes of danger, distress, dysfunction and deviance in the same way to define mental
health. This increases the reliability of the D’s diagnostic system because it will increase the
consistency of the diagnosis from patient to patient as they are all assessed by the same
standard of abnormality
- D’s diagnostic system can cause patients to show social desirability as they can downplay
certain symptoms to the clinician such as their thoughts being dangerous and harmful due to
social stigma as they do not want to be perceived in a negative light. This lowers the validity
of diagnosis of the D’s diagnostic system as it won’t be a true reflection of the patients
condition so the diagnosis won’t be an accurate portrayal
Conclusion
- Useful as it allows tailored treatments to the specific D that helped diagnose the abnormality
so really focuses on helping individuals.
- Less Useful as it perpetuates negative stereotypes by labelling a person as abnormal which
can lead to discrimination
ICD-10
AO1
- A classification system for mental health, use by the world health organisation (WHO)
- Section F represents mental disorders that are followed by a digit to specify the category of
11 it belongs to: F20-29 is for schizophrenic, schizotypal and delusion disorders and F50-59 is
for behavioural syndromes associated with physiological disturbances and physical factors
, - A second digit comes after the first to represent a specific disorder: F20 is schizophrenia and
F50 is anorexia nervosa
- A further digit can come after the decimal point to signify a specific type of disorder: F20.2 is
catatonic schizophrenia and F50.3 is atypical bulimia nervosa. More digits are added to make
it more specific: F40.218 is the fear of the Easter bunny
- Annex 1 is disorders that are being researched but not yet classified: seasonal affective
disorder or narcissistic personality disorder. They are added when it is next revised and
there is enough evidence that they are real disorders.
- Annex 2 looks at culture specific disorders, which don’t easily fit into any of the established
categories but are often described as a local variation. Pa-Leng (China, South East Asia) is the
obsessive fear of cold and winds which are believed to produce fatigue, impotence or death
AO3
- Tarriha- found that inter-rated reliability for ICD 10 was 0.95 when assessing a clinical
sample of opioid uses in Iran showing that the system will give a consistent outcome when
diagnosing drug dependency.
- Cheniaux- 2 psychiatrists assessed 100 impatience and found that using ICD 10 schizophrenia
was more likely to be diagnosed when compared with the diagnosis given when DSM4 was
used suggesting it is not consistent with other classification systems
- Andrews et al assessed 1500 people using DSM and ICD and found an overall agreement of
68% therefore can be said that both systems have concurrent validity
- Jansson- found issues with the validity of ICD 10 due to it having a different focus in terms of
features/symptoms compared to other diagnosis systems so it cannot be made sure that
schizophrenia is being measured
- Powers et al- found that women who had suffered complex post-traumatic disorder also had
higher levels of alcohol and substance misuse as predicted by ICD 10, showing that ICD 10
does have good predictive validity.
- Deciding which symptoms are being displayed by the patient is open to interpretation bias
by the psychiatrist so suggesting that it is possible that the list of symptoms under each code
may be limited as they can be misinterpreted
Conclusion
- Useful as it provides a comprehensive list of disorders which cover numerous symptoms for
each disorder
- Less useful as there is a lack of flexibility due to the rigid diagnostic categories which means
disorders can be missed
DSM5
AO1
- DSM was created in America and commonly used in the UK and USA. Based on cluster
analysis where groups of symptoms are identified and labelled
- Section 1 is an introduction to DSM5 and an explanation of how to use
- Section 2 lists diagnostic criteria for each disorder that is in a category of 20. The criteria
explains what symptoms must be present and for how long
- Example: for schizophrenia the patients must have at least two of the following symptoms
delusions, hallucinations, disorganised speech, disorganised or catatonic behaviour or
negative symptoms
- Example: feeding and eating disorders list criteria weighing less than 85% of normal weight,
avoiding food or drink, tendency to lie about how much they eat, cannot accept the severity
of the low body weight or excessive exercise to not gain weight
- Section 3 is the evaluation process for patient including cultural formulation to understand
cultural backgrounds and symptom descriptions, as well as assessment measures for
evaluating mental functioning, severity and disability
, - Additionally emerging disorders like Internet gaming disorder may be considered when
existing diagnostic categories are insufficient to capture a patient’s symptoms, allowing for
more comprehensive evaluation and treatment
A03
- Rosenhan- found that seven of the eight pseudo patient were diagnosed with schizophrenia
using DSM showing that it can be applied reliably to different patients getting the same
diagnosis
- Cheniaux- 2 psychiatrists assessed 100 impatience and found that using ICD 10 schizophrenia
was more likely to be diagnosed when compared with the diagnosis given when DSM4 was
used suggesting it is not consistent with other classification systems
- Andrews et al assessed 1500 people using DSM and ICD and found an overall agreement of
68% therefore can be said that both systems have concurrent validity
- Schwartz- found that Afro Americans are 3 to 4 times more likely to be diagnosed as
psychotic compared to Euro Americans showing that DSM5 is less accurate in diagnosis as it
is still affected by ethnicity
- Brown- found that using the proposed DSM-V criteria more patients are diagnosed with an
AN rather than EDNOS when compared to DSM-IV for suggesting DSM5 is better able to
recognise the disorder this means it is measuring AN symptoms more accurately than DSM-
IV
- Deciding which symptoms from the cluster are being displayed by the patient is open to
interpretation bias by the psychiatrist so suggesting that it is possible that the cluster of
symptoms under each category may be limited as they can be misinterpreted
Conclusion
- Useful as it helps match individuals with appropriate treatment approach is based on the
diagnostic criteria, facilitating more targeted and effective interventions
- Less useful as the categorical approach may not accurately capture the complexity of the
disorder by overlooking that disorders can coexist
Assess the validity of the classification systems used to diagnose disorders (20)
- In order to be a valid classification system it must accurately diagnose a mental health
disorder, and lead to the right treatment for the diagnosed mental health disorder.
Pihlajamaa found that ICD 10 was valid as it produced the diagnosis of schizophrenia that
matched the diagnosis of other classification systems.
- For a classification system to be valid then symptoms of a disorder must be operationalised
and measurable e.g. social withdrawal for schizophrenia. Many mental health disorders have
overlapping symptoms such as schizophrenia and depression both list social withdrawal as a
symptom, therefore making the use of classification system is less valid as it is hard to
operationalise the symptoms of one disorder.
- Predictive validity is when upon diagnosing a mental health disorder accurate prediction can
be made about how the disorder will progress, and how it will respond to treatment. Mason
found that diagnosis when assessing ICD 10 for 99 schizophrenia patient was a good
predictor of the future behaviour 13 years later showing that ICD 10 can be used as an
accurate measure of predicting the causes schizophrenia over time.
- Diagnosis of a disorder is open to bias due to different values of the psychiatrist leading to
the use of a classification system being low in validity as the symptoms may not be
accurately interpreted leading to wrong diagnosis. Classification systems allow for cognitive
bias of the psychiatrist to affect the final diagnosis given due to them applying a western
interpretation of the symptoms being presented such as interpreting hearing voices as
abnormal rather than a spiritual factor as seen in other cultures.
- If a classification system has concurrent validity, then it should come up with the same
diagnosis for the same symptoms at the same time as another classification system.
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