Readings - 300

What is the definition of diagnosis in psychopathology?

The critical first step in the study and treatment of psychopathology; a formal label assigned based on a set of symptoms.

What are the four main functions of diagnosis?

1) Enables clinicians to communicate accurately with each other; 2) Informs patients about base rates, causes, and treatment options; 3) Fosters research; 4) Provides relief by reducing feelings of isolation.

How does assessment differ from diagnosis?

Assessment goes beyond diagnosis — it answers questions like: Why does the person behave this way? What obstacles might interfere with treatment?

What is reliability in psychological measurement?

The consistency of a measurement — like a rigid wooden ruler vs. a stretchy elastic one.

What is inter-rater reliability?

The degree of agreement between two or more raters scoring the same assessment independently.

What is test–retest reliability?

The consistency of scores when the same test is given to the same person on two separate occasions.

What is alternate-form reliability?

The consistency between two different forms of the same test; used when test-takers might remember their answers.

What is internal consistency reliability?

The extent to which all items within a test are interrelated — i.e., they all measure the same underlying construct.

On what scale is reliability measured?

0 to 1.0 — closer to 1.0 indicates higher reliability. A score of .91 is very reliable; .65 is moderate.

What is validity in psychological measurement?

Whether a measure actually measures what it is supposed to measure.

What is the key relationship between reliability and validity?

Reliability does not guarantee validity, but unreliable measures CANNOT be valid. (e.g., height is reliably measured but is not valid for measuring anxiety.)

What is criterion validity, when is it most used?

Whether a test predicts related real concrete outcomes; the most common form evaluated in test development.

What is content validity?

Whether a test adequately covers all relevant aspects of the construct and excludes irrelevant material. Assessed by consulting subject matter experts.

What is construct validity?

Whether a test accurately measures the theoretical concept it claims to measure — shown by strong correlations with related measures and weak correlations with unrelated ones.

How is construct validity evaluated?

Through a variety of data: comparing diagnosed vs. non-diagnosed groups, relating scores to physiological indicators, behavioral observations, and examining etiological, concurrent, and predictive relationships.

Why did DSM-5 switch from Roman numerals to Arabic numerals?

"To facilitate electronic updating and printing as a ""living document."""

What information does the DSM-5 provide for each disorder?

Diagnostic criteria (symptom list), diagnostic features, associated features, age of onset, course, prevalence, risk factors, prognosis, cultural factors, gender ratios, and differential diagnosis.

State the multiaxial system used in DSM-III to DSM-IV?

Axis I: Clinical Disorders; Axis II: Developmental & Personality Disorders; Axis III: General Medical Conditions; Axis IV: Psychosocial/Environmental Problems; Axis V: Global Assessment of Functioning (GAF).

Was the multiaxial system retained in DSM-5?

No — it was eliminated in DSM-5.

"What two DSM-IV diagnoses were combined into ""substance use disorder"" in DSM-5?"

Substance abuse and substance dependence.

"What two DSM-IV diagnoses were combined into ""autism spectrum disorder"" in DSM-5?"

Autistic disorder and Asperger's disorder.

What basis does DSM-5 use to organize diagnoses?

Symptoms (not etiology/causes). Chapters are organized to reflect patterns of comorbidity and shared causes.

What is comorbidity?

The presence of a second (or more) diagnosis alongside a primary diagnosis; about 45% of people with one diagnosis meet criteria for at least one more.

What are externalizing disorders?

A proposed grouping including conduct disorder, antisocial personality disorder, and alcohol/substance use disorders.

What are internalizing disorders?

A proposed grouping including anxiety disorders, PTSD, and depressive disorders.

"What is the ""p"" factor?"

A general psychopathology factor — some risk factors predict all types of psychopathology, suggesting a shared underlying dimension.

What are Research Domain Criteria (RDoC)?

A framework focusing on psychological variables (responses to negative/positive stimuli, cognitive problems, social problems) with the goal of developing a classification system based on neuroscience and genetics rather than symptoms alone.

What is categorical classification?

A yes/no diagnostic approach — a person either has the diagnosis or does not. This is how DSM-5 primarily operates.

What is dimensional classification?

A system that describes the degree of symptoms on a continuum (e.g., a 1–10 scale), rather than a yes/no threshold.

What step did DSM-5 take toward dimensional classification?

It added severity ratings, but remains primarily categorical.

What are key validity concerns about DSM diagnoses?

Diagnoses are symptom-based (not lab-confirmed); a valid diagnosis should predict clinical characteristics, course of disorder, treatment response, and possible causes.

What is stigma in the context of diagnosis?

The widespread negative social view of psychological disorders. Research shows symptomatic behavior is often viewed more negatively than diagnostic labels themselves.

What is person-first language?

"Language that identifies the person before the diagnosis (e.g., ""a person with schizophrenia"" rather than ""a schizophrenic"")."

What are cultural concepts of distress?

Culture-specific syndromes described in the DSM-5 appendix that represent ways distress is expressed in particular cultures.

What is the Cultural Formulation Interview (CFI)?

A 16-question structured interview in DSM-5 designed to help clinicians assess cultural factors influencing a patient's presentation.

What is the purpose of a clinical interview?

To gather information about a patient's history, symptoms, functioning, and life context; used to make a diagnosis and plan treatment.

Why is rapport important in clinical interviews?

Trust does not come automatically; without rapport, patients may not disclose accurately, reducing validity of the assessment.

What is the difference between structured and unstructured interviews, which has a higher reliability?

Structured interviews have predetermined questions, yielding higher reliability. Unstructured interviews rely on clinician judgment, yielding lower reliability but potentially richer data.

What does research say about unstructured vs. structured interviews?

Using informal/unstructured interviews reduces diagnostic reliability; structured interviews (like SCID) improve inter-rater reliability with adequate training.

What is stress (psychological definition)?

The subjective experience of distress in response to perceived environmental problems.

What are life stressors?

Environmental problems that trigger the subjective sense of stress.

What is the Life Events and Difficulties Schedule (LEDS)?

A comprehensive semistructured interview that contextualizes stressors within the individual's life.

What are the three key features of the LEDS?

1) Evaluates each stressor in the context of the person's life; 2) Excludes events that may be consequences of symptoms; 3) Carefully dates when stressors occurred.

What disorders do life stressors robustly predict?

Anxiety, depression, schizophrenia, and even the common cold.

What are the three stages of Hans Selye's General Adaptation Syndrome (GAS)?

1) Alarm Reaction — ANS activated; 2) Resistance — organism tries to adapt; 3) Exhaustion — irreversible damage or death if stressor persists.

What are projective tests?

Personality tests that present ambiguous stimuli, with responses assumed to reveal unconscious psychological processes.

What is the MMPI-2?

The Minnesota Multiphasic Personality Inventory-2 — a standardized self-report personality test designed to detect several psychological problems simultaneously.

What are the three validity scales of the MMPI-2 and what do they detect?

L (Lie) Scale: endorsement of unrealistically virtuous items; F (Infrequency) Scale: distinguishes faking from true disorders; K (Correction) Scale: detects defensiveness.

What is the Big Five Inventory-2 (BFI-2)?

A personality questionnaire assessing the OCEAN model — Openness, Conscientiousness, Extraversion, Agreeableness, Neuroticism — with specific facets for each domain.

What does the acronym OCEAN stand for in personality psychology?

Openness to experience, Conscientiousness, Extraversion, Agreeableness, Neuroticism.

What are IQ tests primarily used for?

To assess current cognitive ability and predict school performance; also used to diagnose learning disorders, identify gifted children, and conduct neuropsychological evaluations.

What are the four major intelligence tests and their populations?

WAIS-IV (adults, 2008); WISC-V (children, 2014); WPPSI-IV (preschool, 2012); Stanford–Binet 5th edition (SB5, 2003).

What are the limitations of IQ tests?

Explain only a small part of school performance; don't capture family circumstances, motivation, anxiety, or curriculum difficulty; subject to stereotype threat.

What is stereotype threat?

A phenomenon where awareness of a negative stereotype about one's group interferes with test performance (e.g., women told men score higher on math subsequently score lower).

At what age are children aware of ethnic/ability stereotypes, and what percentage are aware by age 10?

Stereotype awareness develops between ages 6–10; 93% are aware by age 10.

What is self-monitoring in behavioral assessment?

People recording their own behavior, moods, stressors, and thoughts over time; used to identify patterns linked to symptoms.

What is direct observation of behavior?

An observer divides behavior into antecedents and consequences (learning framework); often done in laboratory or contrived settings; linked directly to intervention design.

What is the Dysfunctional Attitude Scale (DAS)?

"A cognitive-style questionnaire based on Beck's theory assessing maladaptive beliefs (e.g., ""People will probably think less of me if I make a mistake""); distinguishes people with/without depression and improves after treatment."

What does CT/CAT scan measure, what does it detect?

Brain structure — uses X-rays through brain cross-sections; detects enlarged ventricles, tumors, and blood clots.

What does MRI measure?

Brain structure — superior image quality compared to CT; uses hydrogen atoms in a magnetic field; no radiation.

What does fMRI measure, how does it work?

Both brain structure AND function — measures blood flow via the BOLD (blood oxygenation level dependent) signal; most widely used neuroimaging method.

What is the BOLD signal?

Blood Oxygenation Level Dependent signal — a proxy for neural activity used in fMRI.

What does a PET scan measure, why is useful, and why is it not readily used?

Brain function and metabolic activity — a radioactive isotope is injected; also useful for studying neurotransmitter functioning; invasive and expensive.

What does SPECT measure, why is it better than PET and what does it measure?

Neurotransmitter activity — less expensive than PET but still invasive; directly measures gamma rays.

What is structural connectivity?

How brain structures connect via white matter tracts.

What is functional connectivity?

Correlations between BOLD signals in different brain regions measured by fMRI; reduced in the frontal cortex of people with schizophrenia.

What is effective connectivity?

A measure combining structural and functional connectivity that reveals the direction and timing of brain region activations.

What is a key limitation of neuroimaging for diagnosis?

Brain-imaging techniques are not yet strong enough to diagnose psychopathology; results are correlational, not causal; being in a scanner is itself stressful.

What is neuropsychological assessment, what are they used for?

Behavioral tests that assess psychological functions linked to specific brain areas; used to detect brain dysfunction and identify affected regions.

What is the Halstead–Reitan Battery?

A neuropsychological battery`; valid for detecting changes from tumors, stroke, and head injury.

What does the Tactile Performance Test – Memory assess?

After completing a timed block-fitting task while blindfolded, the person draws the form board from memory; sensitive to right parietal lobe damage.

What does the Speech Sounds Perception Test assess?

Matching heard nonsense words to written alternatives; measures left-hemisphere function (temporal and parietal areas).

What is the Luria–Nebraska Battery?

A neuropsychological battery in 11 sections; correctly distinguishes 86% of people with/without neurological disease.

What is a key advantage of the Luria–Nebraska Battery over other neuropsychological tests?

It controls for educational level — a less educated person won't receive a lower score solely due to limited education.

What is psychophysiology?

The study of bodily changes (physiological responses) associated with psychological events.

What does electrodermal responding (skin conductance) measure?

Sweat-gland activity via electrical current between hand electrodes; reflects sympathetic nervous system activity; increases with anxiety, fear, anger, and happiness.

What does an EKG (electrocardiogram) measure in psychophysiological assessment, what does it detect?

Heart rate, detect emotional arousal via cardiac activity.

What is a cautionary note about skin conductance?

It increases with multiple emotions (anxiety, fear, anger, happiness) — it is NOT specific to anxiety alone.

What is cultural bias in psychological assessment?

When a measure developed for one culture/ethnic group is not equally reliable and valid for a different group.

What is an example of cultural bias in diagnosis of African Americans?

African Americans are more likely to receive a schizophrenia diagnosis than Caucasians — likely reflecting ethnic bias, not actual differences in prevalence.

How might clinicians misinterpret Asian American patients' behavior?

Clinicians may mistake reduced emotional expressiveness (a cultural norm) for depression.

What is a risk of overdiagnosing schizophrenia in African Americans?

It leads to unnecessarily high antipsychotic dosages and inappropriate treatment.

What challenge arises when translating assessment tools across cultures?

Simply translating words is insufficient — meaning may not transfer across cultures; cultural norms affect how items are interpreted and endorsed.

What did Lopez (2002) identify as three issues for graduate training in culturally fair assessment?

1) Learn basic assessment concepts (reliability and validity); 2) Become informed about specific ways culture/ethnicity impacts assessment; 3) Recognize culture may not impact assessment in every individual case.

What is one practical strategy for reducing cultural bias in assessment?

Use structured interviews like the SCID — research shows they reduce overdiagnosis across ethnic groups (Garb, 2005).

Why did the DSM-5 enhance cultural content?

Because culture influences risk factors, symptom expression, stigma, help-seeking behavior, and available treatments; disorders are universal but culturally shaped.

What mental health finding was observed with Mexican immigrants?

Mexican immigrants initially show lower rates of psychological disorders; over time, their rates approach those of U.S.-born individuals.

What were findings on schizophrenia outcomes across countries, what does this suggest`?

Outcomes were more favorable in Nigeria, India, and Colombia than in industrialized countries — suggesting social/cultural factors influence course of illness.

How does the MMPI-2 perform across cultures?

Even in translated versions, cultural differences persist — Asian Americans score higher on most scales regardless of actual psychopathology.

What is standardization of a test?

Establishing a statistical norms against which individual scores are compared.

"What is the ""unspecified"" category in DSM-5?"

A catch-all category applied when a person's symptoms don't fully meet criteria for a named disorder but still cause significant distress or impairment.

Why is the categorical approach to diagnosis considered problematic?

Cutoffs are often arbitrary; many people with subthreshold symptoms still experience significant distress but don't qualify for a diagnosis.

What analogy illustrates the tension between categorical and dimensional diagnosis?

Blood pressure — it exists on a dimensional continuum, but a categorical threshold (e.g., 140/90) helps guide treatment decisions.

What does it mean for a diagnosis to have predictive validity?

The diagnosis should predict the course of the disorder, treatment response, and possible causes (genetic predisposition, biochemical imbalance, etc.).

Why might diagnosis provide relief to patients?

Knowing a diagnosis is common can reduce feelings of isolation and provide an explanation for distressing experiences.

What role did DSM inclusion play in autism research?

Research on autism spectrum disorder exploded after its inclusion in DSM-III in 1980, illustrating how diagnosis fosters scientific investigation.

What is stigma (in the context of psychological disorders)?

The destructive beliefs and attitudes held by society, ascribed to groups seen as different — including people with psychological disorders.

What are the four characteristics of stigma?

"1. A distinguishing label is applied (e.g., ""crazy"") 2. The label links to undesirable attributes 3. People with the label are seen as fundamentally different (""us vs. them"") 4. People with the label are discriminated against unfairly"

How many people in the U.S. are estimated to have a psychological disorder?

~44 million (about 1 in 5), according to the Center for Behavioral Health Statistics and Quality (2015)

What did the U.S. Surgeon General say about stigma in 1999?

"Called it ""the most formidable obstacle to future progress in the arena of mental illness."""