Learn: Psychiatric Diagnosis: History, Approaches, and Validity Concepts

QuestionAnswerWhat is diagnosis?

The art and science of classifying disorders by symptoms and signs.

Why is diagnosis important?

It helps psychologists communicate, guides treatment planning, and supports clinical care and research.

What is the categorical approach to classification?

A qualitative approach in which a person either has a disorder or does not have it.

What is the dimensional approach to classification?

A quantitative approach that views symptoms as existing along a continuum of severity or degree.

What was the first edition of the DSM?

DSM-I, released in 1952 by the American Psychiatric Association.

How many disorders were listed in DSM-I

106

What happened with DSM-II in 1968?

It expanded the number of disorders to 182.

What were major problems with DSM-II?

It was culturally insensitive, had vague criteria, and made meaningful diagnoses difficult

What was an example of a problematic DSM-II diagnosis?

Homosexuality was classified as a mental illness until it was removed in 1973.

What were the Feighner Criteria?

Criteria developed in 1972 to bring more scientific rigor to diagnostic classification.

When was DSM-III released?

1980

When was DSM-IV released?

1994

When was DSM-5 released?

2013

What was a major goal of DSM-III and later editions?

To make diagnosis more scientific and more atheoretical.

How many diagnoses does the lecture list for DSM-5?

347

What happened to the five-axis system in DSM-5?

The axial system used in DSM-IV was retired.

What did DSM-5 add more of?

Dimensional elements and expanded cultural considerations.

What is the Cultural Formulation Interview?

A DSM-5 tool containing 16 questions designed to consider cultural factors in assessment.

Why is culture important in diagnosis?

Behaviors or experiences considered abnormal in one culture may be normal in another.

What is reliability?

The consistency of a diagnosis or test result across practitioners, testing occasions, or time.

What is validity?

The accuracy of a diagnosis or test; whether it measures what it is supposed to measure.

What is inter-rater reliability?

The degree to which different clinicians or raters agree on a diagnosis or rating.

What is test-retest reliability?

The similarity of scores when the same test is administered repeatedly.

What is alternate-forms reliability?

The similarity of scores on tests that are similar but not identical.

What is internal consistency?

The extent to which items on a test are related to one another.

What is kappa?

A statistic measuring agreement while taking chance agreement into account.

What does a kappa of 0 mean?

Chance agreement.

According to the lecture, what kappa range indicates good agreement?

.70-1.00.

What is content validity?

Whether a measure covers all relevant aspects of the concept being measured.

What is criterion validity?

Whether a diagnosis or test can predict relevant real-world outcomes.

What is construct validity?

Whether the measurement accurately represents the theoretical concept it is intended to measure.

Why does reliability put a cap on validity?

A measure cannot be consistently accurate if it is not consistently measuring something.

What is one criticism of psychiatric classification?

Diagnosis can contribute to stigma and cause people to be treated differently.

Why can diagnostic categories be problematic?

They may fail to capture the uniqueness of an individual or over-pathologize normal experiences.

What did the Rosenhan Experiment examine?

How psychiatric labels can influence the interpretation of behavior.

What happened in the Rosenhan Experiment?

Pseudo-patients reported auditory hallucinations, were admitted to psychiatric hospitals, then behaved normally but were still interpreted as mentally ill.

What is a diagnosis?

Classifying disorders based on symptoms and signs.

Why are diagnoses useful?

They improve communication, treatment planning, and clinical care.

Categorical vs. dimensional classification?

Categorical = present/absent; dimensional = degrees of symptoms.

What was DSM-I?

1952; 106 disorders; first DSM.

Why was DSM-II criticized?

It had vague criteria and was culturally insensitive.

What major change occurred in 1973?

Homosexuality was removed from the DSM as a mental illness.

What was DSM-III's major approach?

More objective, descriptive, and atheoretical diagnostic criteria.

When was DSM-5 published?

2013.

What happened to DSM-5's five-axis system?

The five-axis system was retired.

What is reliability?

Consistency of a measurement or diagnosis.

What is validity?

Accuracy: whether a measure assesses what it should.

Why is reliability important for validity?

Poor reliability limits validity.

What is inter-rater reliability?

Agreement between different observers or clinicians.

What does kappa measure?

Agreement between raters while accounting for chance.

What are three types of validity?

Content, criterion, and construct validity.

What was the Rosenhan study's main finding?

Labels could cause normal behavior to be interpreted as pathological.

What are the three broad assessment methods?

Subjective, observer-rated, and objective.

What is a structured clinical interview?

A standardized interview using predetermined questions.

What is the SCID used for?

Structured diagnostic assessment based on DSM criteria.

What is integrated assessment?

Using multiple assessment methods for a comprehensive picture.

What is a mood?

A sustained emotional state.

What is affect?

The observable display of emotion.

What is MDD?

Major depressive disorder involving significant depressive symptoms lasting at least 2 weeks.

What is required for an MDD episode?

Depressed mood or loss of interest/pleasure plus additional symptoms.

How is clinical depression different from normal sadness?

It is persistent, pervasive, and impairs functioning.

What is PDD?

A chronic depressive disorder lasting at least 2 years in adults.

What is PMDD?

Mood and physical symptoms occurring before menstruation.

What is DMDD?

Severe recurrent temper outbursts with persistent negative mood.

What is required for Bipolar I?

At least one lifetime manic episode.

What is required for Bipolar II?

At least one hypomanic episode and one major depressive episode.

Mania vs. hypomania?

Hypomania is less severe and does not cause the impairment associated with mania.

How long must mania last?

At least 1 week.

How long must hypomania last?

At least 4 days.

What is cyclothymia?

Chronic high-low mood changes without full manic or depressive episodes.

What percentage have MDD lifetime?

About 16.2%.

What is the estimated heritability of MDD?

About 52%.

What is the estimated heritability of bipolar disorder?

About 80%.

What is the cognitive triad in depression?

Negative views of the self, world, and future.

What does CBT target in depression?

Negative automatic thoughts and behavioral patterns.

What does IPT focus on?

Grief, role transitions, interpersonal disputes, and social support.

What does behavioral activation do?

Increases rewarding and meaningful activities.

What are common biological systems involved in depression?

Serotonin, norepinephrine, dopamine, and the HPA axis.

What treatments can be used for mood disorders?

Psychotherapy, medication, ECT, TMS, and light therapy.

What is suicidal ideation?

Thoughts about killing oneself.

What is NSSI?

Self-harm without intent to die.

What are major suicide risk factors?

Mood disorders, substance use, isolation, trauma, and previous attempts.

What are common suicide warning signs?

Hopelessness, withdrawal, major behavior changes, and talking about death.