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validity + reliability of diagnosis (22) (validity (psychologists diagnose…
validity + reliability of diagnosis (22)
introduction
important to consider validity + reliability of these systems
ethical implications of misdiagnosis
DSM, ICD + CCMD
various diagnostic systems
diagnostic systems
analyses origin of person's problem according to bio-psycho-social framework
ICD
- standardises recording of cause of death
encourages holistic approach
covers wide range of diseases + mental disorders for sake of classification (rather than diagnosis)
multi axial approach - considers medical conditions psychosocial + environmental problems, general function
few differences between DSM + ICD for mental disorders
lists symptoms required for diagnosis
CCMD
- maintains focus on issues in interest of Chinese culture
DSM
- groups disorders into categories
some disorders in DSM /ICD don't appear on CCMD as they're uncommon / don't exist in China
others included that are only found in China
eg. koro = anxiety / depression due to a form of meditative exercise (qigang)
ethical considerations
fundamental ethical objections regarding way in which systems are used
eg. where ego-dystonic homosexuality is considered a disorder - treatments are available to remove problem
also not valid to take such a medical approach to treatment of psychological disorders
in soviet union, diagnosis of schizophrenia was applied much more liberally than in USA at the time
strong arguments that these systems aren't reliable
lead to unnecessary compulsory treatment for many
also lack of certainty that ethnic minorities / women are treated equally in terms of: receiving diagnosis, offered level of understanding, type of treatment
reliability
2 practitioners diagnosed 81 kids with eating problems
reliability was measured based on rates of agreement
*Nicholls et al. (2000)
ICD = 0.357 + DSM = 0.636
more than 1 practitioner observes same person with same diagnostic system
GOS system = 0.879 (most reliable)
inter-rater reliability
test-retest reliability
assessed more than once
*Seeman (2007)
initial diagnosis of schizophrenia was susceptible to change as more info was uncovered about the patient
a number of other conditions can cause symptoms mistakably diagnosed as schizophrenia
important to ask whether systems are reliable
validity
psychologists diagnose by categorising behaviour, thoughts + emotions
Thomas Szasz
his work suggests diagnosis = more of a social fact than a medical one (although made within a medical model)
wrong to use mental illness metaphor to describe behaviour that doesn't conform to our expectations
R.D Laing
= critic of biomedical diagnostic approach
attractive for us to imagine that condition of depression = cause of person's severe unhappiness
key concern = do diagnostic systems correctly diagnose?
depression IS the unhappiness (symptom) rather than cause
anorexia doesn't cause the eating problem - it IS the eating problem
Caetano (1973)
pp's asked to diagnose individuals in video interviews as mentally / not mentally ill
2 conditions:
pps told interviewees were volunteers
pps told interviewees were patients in mental hospital
results demonstrated labelling theory
- behaviour wasn't the most important component of diagnosis
any suggestion that individual has been / is mentally ill significantly influenced diagnosis decision