DSM classification system

Who is the DSM published by

APA

DSM language(s)

English

What and who is the DSM specific for?

• psychiatrists’ use only

• mental health disorders

Section 1 DSM

Offers guidance on the new system

Section 2 DSM

• Details disorders

• categorised on understanding of causes and similarities between symptoms

Section 3 DSM

• Suggestions for new disorders, ongoing

• impact of culture on symptoms

How does a clinician use the DSM for diagnosing

• Gather info about person

• Most is gathered through interviews - structured or unstructured

• Clinician then rules out disorders that don’t match symptoms to offer best fit diagnosis

Inter-rater reliability

Extent to which 2+ clinicians agree on diagnosis

Test re-test reliability

How consistently same diagnosis tool measures the symptoms of the same individual

What the DSM is: weakness reliability

Rachael Cooper 2014

• DSM 5 unreliable

• Low acceptable levels of agreement

• Less reliable than DSM of prior years, so newer DSM versions may have lower reliability than older versions, like DSM 2 (high)

What the DSM is: strength reliability

Kupfer and Kraemer 2012

Testing for DSM 3 was under controlled conditions however under normal conditions for DSM 5, so DSM 5 was expected to have lowers levels of agreement

• less artificial more realistic

• highly reliable

Inter-rater reliability strength

Regier

• DSM 5 3 disorders including PTSD had high levels of agreement

• High inter rater reliability

Inter rater reliability weakness

Regier

• For SZ, concordance rate low

• inter rater for specific disorders may be low

Test re-test reliability strength

Structured interviews used like Beck

• increase reliability as same structured qs will be used to re-test the diagnosis

Test re-test reliability weakness

Diagnosis can be affected by what patient tells psychiatrist

• If patient reports different symptoms this may affect the test re-rest reliability

What the DSM is: strength validity

Stinchfield

• Found that DSM 5 led to fewer false negatives than DSM IV when diagnosing gambling disorder

• suggests DSM is accurate + valid as less patients being incorrectly diagnosed

What the DSM is: Weakness validity

Lacks Cause information on disorder and appropriate treatment

• incomplete

• Lacks accuracy + validity

• Patients may not get right/any treatment

predictive validity

Extent to which a diagnosis can accurately foresee and explain the development and experiences of a condition in the future

Predictive validity strength

Cohen

• Longitudinal study on 2232 children

• mothers + teachers asked to complete questionnaire on conduct disorder symptoms in last 6 months

• Diagnosis researched using DSM 4

• Found able to predict educational struggles and conduct disorder 2 years later

• Supports predictive validity as disorder correct in ability to predict

Predictive validity weakness

Clinician may be reluctant to provide correct diagnosis due to negative ramifications in society

• DSM may not be being used correctly as a resource

• More likely inaccurate prediction will form

• lowers predictive validity

Cross cultural validity

If 2+ cultures unable to find similar conclusions when diagnosing conditions, the disorder may not be universal or the classification tool may not be universal

• (DSM 5 includes section 3 which advises on cultural differences to be considered)

Cross cultural validity strength

Lee

• used DSM to diagnose 1663 ADHD Korean children

• Results showed consistency with western cultures

• High cross cultural validity

Cross cultural validity weakness

Luhrmann et al

• Interviewed ppts from Ghana, USA and India

• 20 ppts from each sample

• They heard voices + met criteria for SZ

• Did not take into account cultural differences as experiences interpreted very differently

• Low cross cultural validity