Intro to Clinical Psych Exam 2

psychopathology

a significant disturbance in cognition, emotion regulation, or behavior that indicates a dysfunction in mental functioning

-usually associated with a significant distress or disability in work, relationships, or other areas of functioning

Jerome Wakefield’s view of psychopathology

harmful dysfunction theory: a theory of psychopathology stating that the definition of disorder should include aspects of harmfulness (which is more socially determined) and dysfunction (which is more scientifically determined).

Who is involved in the creation of the diagnostic categories in the DSM?

-task force

-published by American Psychiatric Association

-follows a medical model of psychopathology

-each disorder defined categorically and features list of specific symptoms

DSM I (1952) and II (1968)

-very similar in content

-only 3 broad categories of disorders:

psychoses (schizophrenia)

neuroses (depression, bipolar, anxiety disorders)

character disorders (personality disorders)

-psychoanalytic

-did not provide diagnostic criteria

-not empirically based

DSM-III (1980)

-relied on empirical data to determine which disorders to include and how to define them

-specific diagnostic criteria to define disorders

-atheoretical

-much longer/more extensive: 265 new disorders added

-introduced multiaxial system (dropped in DSM-5)

DSM IV (2000) retained most of these major changes

DSM-5 (2013) and DSM-5-TR (2022)

-first substantial revision in 20 years

-Task Force: hundreds of experts from over 12 countries

-Work Groups: composed of experts, each focused on particular area of mental disorders (eg eating disorders)

-scientific review committee separate from work group

-Field trials

-communication with WHO, who publishes International Classification of Diseases (ICD)

Changes DSM-5 didn’t make

-initially considered emphasizing biological roots of mental disorders (gene analysis, blood tests)

-dimensional approach considered but ultimately rejected

-proposed disorders that didn’t make it: internet gaming disorder, nonsuicidal self injury disorder

new features in DSM-5

-DSM5 not DSM V (enables updates like 5.1, 5.2)

-eliminated multiaxial system

-disorders thought to be short term no longer listed on separate axis than those thought to persist long term

-elimination of Axis V (global assessment of functioning)

New disorders in DSM-5

-Premenstrual Dysphoric Disorder (PMDD)

-Disruptive Mood Dysregulation Disorder (DMDD)

 Essentially frequent temper tantrums in children 6-18 years old
 At least 3 tantrums per week over a year-long period
 Tantrums are clearly below expected level of maturity
 Occur in at least two settings (e.g., school, home)
 Irritable or angry mood between tantrums
-Binge Eating Disorder (BED)

-Hoarding Disorder

Major Revisions in DSM-5

bereavement exclusion was dropped for major depressive

episode

 Ensures that people in mourning who are suffering from

depression will be recognized, diagnosed, and receive prompt

treatment

Diagnoses of autistic disorder and Asperger’s disorder were

combined into a single diagnosis: autism spectrum disorder

 Represent various points on the same spectrum of

impairment—mild, moderate, or severe versions of the same

problem

The two separate DSM-IV diagnoses of substance abuse
and substance dependence were combined into
substance use disorder
 Previously, tolerance and withdrawal linked solely with
dependence—research has demonstrated this is not true
Mental retardation was renamed intellectual disability
 In DSM-5-TR, it was again re-named to Intellectual
Developmental Disorder

Obsessive-Compulsive Disorder was removed from the
Anxiety Disorders category and placed in its own new
category (along with related diagnoses)
Mood Disorders were split into two separate categories:
Depressive Disorders and Bipolar and Related Disorders

DSM-5-TR changes

 Prolonged Grief Disorder was added as a diagnosis
 Suicidal Behavior and Nonsuicidal Self-Injury were
added to the proposed criteria sets/conditions for further
study section

Criticisms of DSM-5 an d DSM-5 TR

-diagnostic overexpansion: concern that diagnoses take difficult or inopportune life experiences and label them as mental illnesses

-transparency of the revision process: critics argue that DSM5 authors too vague and selective about what they shared and too many decisions made behind closed doors

-memberships of the work groups: those invited were predominantly researchers, concerns about clinical utility

-price:  DSM-IV sold for $65 in 1994
 DSM-5 had a list price of $199 (hardback) when it was first
released
 DSM-5-TR is listed at $220 (hardback)

general DSM criticisms

Controversial Cutoffs

 Seemingly arbitrary requirement of a certain number of

symptoms/certain time period

 E.g., why a minimum of 5 symptoms for MDD? Why for two

weeks?

Cultural Issues

 Many steps have been taken to consider culture in the DSM, but

criticisms remain

 Original creators of DSM were not diverse (primarily White and

male)

 Much of the research it is based on comes from homogeneous

samples

Potential gender bias
 Some disorders are diagnosed far more frequently in men, some are diagnosed more frequently in women
 Are some disorders biased toward pathologizing one gender more than the other?
Nonempirical influences
 At times politics and public opinion may have influenced DSM
 E.g., the changing status of homosexuality—an official disorder
in DSM-I and DSM-II, but absent from the manual since a
revision of the DSM-III

assessment techniques should posses

reliability, validity, utility

Case History

• Detailed description of a client’s background
• Often provides information necessary to make a diagnosis or determine
necessity of treatment
•What information is typically gathered?
• Birth and Development
• Complications during pregnancy, normative developmental milestones
• Family of Origin
• Who was the client raised by? Is the family still intact?
• Relationships with parents, siblings, etc.
• Family history of mental health problems (e.g., drug and alcohol abuse), etc.
• Education History
• Highest level of education obtained
• Learning disorders, special education services
• Significant behavioral problems (e.g., suspensions, expulsions)
• Employment History

• What types of jobs has client held

• History of being fired, changing jobs frequently

• Recreation/Leisure

• How client spends free time; hobbies and interests

• Sexual History

• Sexual functioning

• Relationship History

• When client began dating

• Significant romantic relationships

• Alcohol and Drugs

• Pattern of use of alcohol and drugs

• Any legal, employment, or social problems due to use?

• Physical Health

• Significant medical problems (e.g., head injuries, chronic illnesses)

• Allergies

• Other considerations

• Also gives the clinician the opportunity to make observations about

the client’s speech pattern, thought processes, ability to regulate

their emotions, etc.

• Gathering collateral information can be important

• E.g., when working with a child, asking parents, teachers, etc. for

information

General skills and interviewer should have

-quieting yourself

-being self-aware

-ability to develop positive working relationship

specific interviewing behaviors

• Eye contact—both facilitates and communicates listening
• Keep in mind this can be dependent on culture (i.e., some cultures may view it as rude to make prolonged eye contact)
• Body language
• Vocal qualities
• Verbal tracking I.e., repeating key words and phrases that clients use and weaving them into your own speech and questions
• Referring to the client by the proper name

rapport

• A positive, comfortable relationship between interviewer and client

• Typically leads to client disclosing more information

• How can this be accomplished?

• Remember that the first visit to a clinical psychologist is often

intimidating

• Follow the client’s lead

directive technique

questions targeted towards gathering specific information

nondirective technique

allows the client to guide the course of the interview

open-ended questions

Open-ended questions allow for individualized and spontaneous

responses from clients

• E.g., “What has your experience of depression been like?”

• Consistent with nondirective interview style

closed-ended questions

• Closed-ended questions allow for less elaboration and self-
expression by the client, but yield precise answers
• E.g., “Have you been hospitalized for depression in the past?”
• Consistent with directive interview style

active listening techniques

Clarification

• The purpose of a clarification question is to make sure the

interviewer has an accurate understanding of the client’s

comments

• Also communicates that the interviewer is actively listening

Confrontation

• Used when an interviewer notices discrepancies or

inconsistencies in a client’s comments

Paraphrasing

• Used to assure clients that they are being heard—not to clarify or

resolve contradictions

• A rephrasing of the content of the client’s message

Reflection of feeling

• Echoes the client’s emotions—intended to make the client feel that their emotions are being recognized

• Often involves the interviewer making an inference

Summarizing

• Typically involves tying together various topics that may have been discussed and identifying themes that have recurred

pragmatics of the interview

Note taking:

• Should an interviewer take notes during an interview?

• There are many different approaches—no consensus on what’s best

• Different job settings may have different expectations

• E.g., some require concurrent documentation

• It’s always a good idea to explain to clients why you are taking notes

Audio and video recording

• Requires written permission from client

• Can potentially hinder rapport/openness

The interview room

• Clients tend to prefer comfortable, neat rooms

• E.g., with soft lighting, comfortable furniture, art on the wall

• Clinical psychologists typically steer clear of overtly personal items (e.g., family photos)

intake interviews

Essentially to determine whether to “intake” the client—whether
the client needs treatment and what type of treatment

Diagnostic Interviews

• The purpose is to diagnose the client

• At the end, the interviewer should be able to assign DSM

diagnosis/diagnoses

structured diagnostic interview

a predetermined, planned sequence of questions that an interviewer asks a client

• Provide a diagnosis based explicitly on DSM criteria

• Tend to be more highly reliable

• Format is typically rigid—can inhibit rapport

• Don’t typically allow for inquiries such as relationship issues,

personal history, etc.

• Tend to be fairly lengthy

unstructured diagnostic interview

no predetermined or planned questions—
interviewers instead improvise based on what they believe is relevant during the interview

most prominent structured interview

Structured Clinical Interview for DSM Disorders SCID

Mental Status Exam

• Most often used in medical settings—assesses how the client is functioning at the time of the evaluation

• Areas typically assessed in a Mental Status Exam (MSE)

General Appearance and Behavior

• Gait, posture, dress, personal hygiene, level of activity

Speech and Thought

• Is client’s speech coherent? Is the client’s speech pressured (i.e., does it seem that the client is having a difficult time speaking fast enough to express his/her thoughts?)

• Evidence of delusional thinking?

Consciousness

• Is client alert, attentive?

Perception

• Evidence of hallucinations?

Memory

• Ability to accurately recall events from past (e.g., names of parents, place of birth)

• Recent memory—assessed by asking about knowledge of current events

• Short-term memory—often assessed by asking the client to remember the names of three items

and checking his/her recall later in the assessment

Affect and Mood

Orientation to person, place, and time

crisis interview

• Special type of clinical interview that is designed to assess a

problem demanding urgent attention (most often clients

considering suicide or harming others) and provide immediate

intervention

• Must quickly establish rapport, express empathy for crisis

• When assessing suicidality, must take into account five

specific issues:

• How depressed is the client?

• Does the client have suicidal thoughts?

• Does the client have a suicide plan?

• How much self-control does the client currently appear to have?

• Does the client have definite suicidal intentions?

intelligence tests

measure a client’s intellectual abilities

achievement tests

measure what a client has accomplished with those intellectual abilities

hierarchal model of intelligence

specific abilities (s) exist and are important, but they are all at least somewhat related to one another and to a global, overall intelligence (g)

-Spearman and Thurstone

common Wechsler subtests

Vocabulary: orally explain the meaning of a word

Similarities: orally explain how two things or concepts are alike

Information: orally answer questions focusing on specific items of general knowledge

Comprehension: orally answer questions about general social principles and social situations

Block Design: re-create a specific patter or design of colored blocks

Picture Completion: View picture of a simple object or scene and identify the important part that is missing

Matrix Reasoning: View an incomplete matrix and select the missing portion from multiple choices provided

Coding: using a pencil and paper, repeatedly copy simple shapes/symbols in appropriate spaces according to key provided

Digit Span: individual is given a string of numbers (7-8-3) and must repeat them back

Letter-Number Sequencing: the examiner presents a combination of letters and numbers, the individual must repeat first the numbers in order from smallest to largest, followed by letters in alphabetical order

Wechsler vs Stanford Binet

Similarities

-both are administered one on one and face to face

-both employ hierarchical model of intelligence

-same mean (100) and standard deviation (15)

-great psychometric properties (i.e. strong validity and reliability)

Differences

-Stanford-Binet covers the entire lifespan (2-85)

-Stanford-Binet includes normative data from individuals with specific disorders

-Stanford-Binet subtests each have greater number of very easy and very difficult items (better at assessing the extremes)

Tests of Achievement

Wechsler Individual Achievement Test

-comprehensive achievement test for 4 to 50 years

-administered face-to-face, one-on-one

-measures achievement in reading, math, written language, and oral language

-mean of 100, SD 15

Halstead-Reitan Neuropsychological Battery HRB

-Full battery of eight standardized tests

-Trail-making tests, finger oscillation test

Bender Gestalt test

-most commonly used neuropsychological screen

-straightforward copying task: client is given pencil, paper, nine simple geometric designs and asked to copy each design as accurately as possible

objective personality tests

-unambiguous tests items

-offers clients a limited range of responses

-objectively scored

projective personality tests

-less structured (items ambiguous)

-responses are open ended and involve a greater degree of judgement in scoring and interpretation

MMPI

-most popular and psychometrically sound personality assessment

-initially consisted of 550 self-descriptive sentences

-mark true/false

development of the MMPI (1943)

-Starke Hathaway and J.C. McKinley

-emphasis on constructing an empirical measure

-empirical criterion keying: identifying distinct groups of people, asking them all to respond to the same tests items, and comparing responses between groups to select items that yield different patterns of responses between groups

-not theoretical

MMPI Validity Scales

provide information about how the client approached the test and allows psychologists to determine if the test is valid (if participants are “faking good” or “faking bad”

MMPI-2

-normative data obtained from much larger, more diverse group

-some items removed/revised that had outdated or awkward wording

MMPI-A

 Ages 14 to 18 years

 Published in 1992

 Similar in administration, scoring, and interpretation to

MMPI-2

MMPI-2-RF and MMPI-3

MMPI-2 Restructured Form (MMPI-2-RF)

 Released in 2008, shorter version of MMPI-2

 Contains only 338 of the (over 550) MMPI-2 items

 Restructured Clinical Scales

 Close to the 10 Clinical Scales of earlier versions

 Removal of items that overlapped between scales

 Separate scale created for demoralization

 Omission of Masculinity-Femininity Scale and Social

Introversion Scale

 Addition of PSY-5 Scales—correspond to personality

disorders

 MMPI-3 was also recently released (2020)

 335-item self-report measure

criticisms of the MMPI

-too lengthy and time consuming

-requires reading ability and prolonged attention

-focuses on forms of psychopathology as the factors that make up personality

Millon Clinical Multiaxial Inventory IV

-similar to MMPI, stronger emphasis on personality disorders

-separate clinical scales for each disorder

-1977 Theodore Millon

-195 tr/false items

-identify personality disorders

Rorschach Inkblot

Hermann Rorschach—created the Inkblot Method in

1921

 10 inkblots

 Administration occurs in 2 phases

 Response or Free Association Phase

 Inquiry Phase

 Not published with a scoring method

 Rorschach died about a year after publishing the

measure

Comprehensive System for Inkblots

John Exner combined aspects of scoring systems to create the

Comprehensive System

 Includes normative data collected from thousands of children and adults

 A small sample of variables considered in scoring:

 Location—does the response involve the whole inkblot, a large portion of it, or just a small detail?

 Determinants

 Form Quality

 Popular

 Content

 The way a client makes sense of the inkblot parallels the way they make sense of the world

 Psychometric issues

Thematic Apperception Test

 Involves presenting the client with a series of cards,

each with an ambiguous picture

 TAT cards feature interpersonal scenes

 Client must create a story to go along with the scene

 Includes 31 cards, but typically not all are used

 Often analyzed without formal scoring

 TAT interpretation is often more of an art than a science

Sentence Completion Tests

 Ambiguous stimuli are the beginnings of sentences

 Assumption that the client’s personality is revealed by the

endings they add

 Rotter Incomplete Sentences Blank (RISB) tests are most

widely known and commonly used

NEO Personality Inventory

a personality measure that assesses common, non-disordered personality characteristics

-OCEAN big 5 factors are primary scales

Universal Nonverbal Intelligence Test

language free test that requires no speaking or shared understanding of language

-intelligence measured through hand gestures, pointing, object manipulation