Abnormal Psychology

Bolton Aim (DSM)

Bolton believed there was a need for an emic approach for diagnosis. Hence, he wanted to

investigate the validity of Western Criteria in a local setting

Bolton Procedure

• study took place to study the psychological aftermath of the Rwandan genocide

  • ≥800,000 people killed

• 40 participants, all local people in Rwandan village

• 3 interview styles

1. Free Listing

• Asked people to list all the problems they had and briefly describe each

• With the responses, they did a conductive content analysis

• highlighted the symptoms of mental health

2. Key informant

• gave information about key disorders

• asked each participant if they knew who would be knowledgeable about these problems

• 7 people were identified as knowledgable

  • all 7 were local leaders/traditional healers

3. Pile sorts

• Had cards with symptoms: some of the DSM MDD and some from the interviews

• 7 knowledgeable people asked to sort the cards out by similarity

•  Used the local symptoms in questionnaire to determine the prevalence of depression

Bolton Findings + Conclusion

• 3 symptoms that were consistent between the local disorder & DSM MDD

  • lack of trust

  • loss of intelligence

  • mental instability

Hafstead aim (DSM vs ICD)

Investigate the concordance rate of 2 classification systems (ICD and DSM)

Hafstead Procedure

• 776 participants (325 kids—survivors of shooting—, 451 parents—bystanders of kids shooting.

• Interviews in 2 waves

  • 4-6 months after

  • 15-18 months after

• PTSD assessed with DSM scale & ICD scale

Hafstead findings & conc

• Concordance rates of kids diagnoses quite high - no major differences in PTSD diagnoses

• for parents, the DSM had higehr prevalance rates of PTSD than the ICD

  • either underdiagnosis or over

• Therefore, both systems performed well for people in immediate, direct distress (kids), but not otherwise

Lobbastael Aim (DSM)

Investigate the reliabilty of DSM-IV criteria

Lobbastael procedure

• 151 participants: both patients & non-patients

• 2 interviews with clinicians using the same classifcation system (DSM-IV)

  • first interviews were audio taped

  • second clinician blind to first diagnosis

Lobbastael findings & conc

• Higher rate of reliabilty for personality disorders than other disorders

  • 82% rate of reliability for personality disorders versus 71% for MDD

• however, relatively high rate of reliabilty

• BUT reliability ≠ validity !

Rosenhan Aim

Demonstrate the unreliable nature of psychiatric diagnoses and the poor treatment of patients

Rosenhan procedure

• 12 pseudopatients including him

  • all mentally healthy, faking being mentally ill

• naturalistic covert observation

• All 12 went to 12 diff hospitals across the US

  • they all mentioned the same symptom

    • they had been hearing voices: they couldn’t make out any words except “hollow” “thud” “empty”

  • everything else was true

• Throughout the experience, they were taking notes

  • secretly at first, and then when realising that the doctors didn’t care, openly

Rosenhan findings + conclusion

• 11 patients diagnosed with schizophrenia, 1 with manic depressive psychosis

• eventually other patients at the hospitals started expressing concern that these pseudopatients weren’t actually ill

  • dismissed by doctors

• all participants noted dehumanisation by the doctors

  • likely as a result of the “abnormal”/”mentally ill” label

  • NOT RELEVANT FOR VALIDITY

• they cobncluded that there was clear confirmation bias in the diagnoses

  • after hearing one symptom, they were looking for other symptoms to confirm their suspicion of the disorder

• Diagnoses are often not valid, as they rely on self-reported data + subjective interpretations of symptoms

Andrews Aim (DSM vs ICD)

Investigate the concordance rate between PTSD diagnoses between ICD and DSM

Andrews Procedure

• 2 waves of participants

  • 10,000 randomly selected, all questioned for mental health symptoms

  • of this, a smaller second wave was created

    • a third was people who had lots of PTSD symptoms, while the rest was people who didn’t

• The second group completed structured interviews

  • interviewer random person, not clinically trained

  • used a computer program CIDI

  • interviewer followed CIDI instructions on questions → standardised procedure

  • Questions made to understand symptoms

• after interviews, CIDI generated whether the participant met the criteria for PTSD in DSM, ICD, or neither

• researchers compared prevalence rates

Andrews Findings + Conclusion

• 95% of the sample was agreed by both systems

  • however, a majority of this was the systems agreeing on NO diagnosis

• ICD actually diagnosed almost double the amount of people with PTSD as the DSM

  • 65 mismatched cases: 59 was ICD not DSM, 6 was DSM not ICD

• shows that the systems usually agree on whether the person has a disorder or not, but disagree on what the disorder is

• likely because the DSM has stricter criteria for PTSD

  • i.e. emotional numbing and clinically significant impairment/distress

Swami Aim

To investigate the gender differences in diagnosis

Swami Procedure

• 1218 British adults

• randomly allocated into 1 of 2 conditions

• all participants got a sheet of paper with a vignette (a short description) of either a man or a woman, and their mental state

  • the description listed symptoms of depression according to the DSM and ICD

  • both the man and woman conditions had the same description, the only difference was the gender of the character

• all participants were asked

  • should the character get a clinical diagnosis

  • what are your personal beliefs on seeking treatment for mental health

  • explain your psychiatric skepticism (general mindset about metnal health, treatment, etc) .

Swami findings + conc

• Significantly more women were diagnosed with depression than men

• Women participants tended to diagnose the men with depression more than the men did

• the more negative a persons beliefs were towards seeking help, the less likely they were to trust/believe in disorders

• this shows the gender bias in diagnoses, as people were more willing to diagnose a woman than a man with depression

Parker Aim

To investigate the cultural biases in the reporting of symptoms

Parker procedure

• 50 Chinese people living in Malaysia, 50 caucasian/white Australians

  • all had diagnoses of MDD

  • no other diagnoses

• questionnaire based on 2 symptom types

  • cognitive and emotional: common in Western classification systems

  • somatic: commonly observed by Singaporean psychiatrists

• participants had to

  • rate each symptom for how frequently they face it

  • rank symtpoms in order of how distressing they are

  • identify 1 symptom as their primary symptom for why they sought treatment

Parker findings + conc

• 60% of Chinese identified somatic symptoms as primary, only 13% of Australians

• no significant difference in the number of somatic symptoms they faced

• Chinese participants are significantly less likely to identify cognitive or emotional symptoms

• showcases the cultural differences in symptom facing + reporting

Li-repac Aim

Investigate the cultural biases in diagnosis

Li-repac Procedure

• 10 participants - 5 chinese, 5 white

  • all had been diagnosed with mental illnesses

  • controlled for age, socioeconomic status, and level of pathology

• 5 Chinese clinicians, 5 white clinicians

  • No clinicians knew the participants

• Semi-structured interviews between clinicans and participants

  • all video-taped

  • asked general questions about mental state, etc

• Clinician tasks

  • create a 121-point list about characteristics of normality (used to ensure standardised definitions of normality)

  • randomly given 4 video taped interviews (each clinician got 2 white patients, 2 chinese)

    • had to fill an inventory of personal details and signs of pathology

Li-repac findings + conc

• no significant difference in the 112 item list → shows standard definitions of normality

• personality traits

  • chinese people viewed white people as more aggressive

  • white people saw chinese people with lower self esteem

• signs of pathology

  • in comparison to how the chinese people saw the chinese people, white people saw chinese patients as:

    • less socially competent

    • less able to maintain interpersonal relationships

    • more depressed

• Clinicians interpret symptoms in certain ways, and this doesn’t always match the behaviour of other cultures