Goals of Clinical

Assessment

Diagnostic ClassificationDescription

Treatment Planning

Prediction

Diagnostic Classification

What is Abnormal Behavior?

Abnormal Behavior can be difficult to define because of the following:

a) No single descriptive feature is shared by all forms of abnormal behavior, and no one criterion for “abnormality” is sufficient.

b) No discrete boundary exists between normal and abnormal behavior.

When do we consider a person normal or abnormal?

When a person’s behavior tends to conform to prevailing social norms or when this particular behavior is frequently observed in other people, the individual is not likely to come to the attention of mental health professionals.

When a person’s behavior becomes patently deviant, outrageous, or otherwise nonconforming, then he or she is more likely to be categorized as “abnormal”.

Jerome Wakefield (1990s)- a renowed scholar in the field of abnormal psychology

• Wakefield (1992) explains his harmful dysfunctional theory

I argue that a disorder is a harmful dysfunction, wherein harmful is a value

term based on social norms, and dysfunction is a scientific term referring to

the failure of mental mechanism to perform a natural function for which it was

designed by evolution.

Diagnostic and Statistical Manual for Mental Disorders (DSM)

• A prevailing diagnostic guide for mental health professionals- used in their everyday activities (assessment, conduct of therapy, and design and execution of research studies)

Diagnostic and Statistical Manual for Mental Disorders (DSM)

• DSM 5, mental disorder is defined as a “clinically significant disturbance” in “cognition, emotion regulation, or behavior” that indicates a “dysfunction” in “mental functioning” that is “usually associated with significant distress of functioning (APA, 2013, p.20)

Why is it important to distinguish

abnormality from normality?

DSM IV-TR VS DSM 5 Diagnostic Classification

• DSM IV-TR retains the multiaxial system of classification and diagnosis first introduced in DSM –III, with some modification in the earlier terminology and rating schemes used on the various axes.

DSM IV-TR Diagnostic ReportAxis I: Clinical Disorder 296.22 Major Depressive Disorder, single

episode, moderate, V61.20 Parent-Child Relation Problem

Axis II: Personality Disorder/ Mental Retardation

V71.09 No diagnosis on Axis II

Axis III: General Medical Condition

345.40 Epilepsy, partial with impairment of consciousness

Axis IV: Psychosocial and Environmental Factors

Problems with Primary Support Group: Family Conflict, Parental Divorce, Educational Problems: Discord with teachers and classmates

Axis V: Global Assessment of Functioning

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DSM 5 Introduction• Elements of a Diagnosis:1. Diagnostic Criteria and DescriptorsDiagnostic Criteria serves as guidelines for

making diagnoses.Following assessment of diagnostic criteria,

clinicians should consider the application of disorder subtypes/ or specifiers as appropriate. Severity and course specifiers should be applied to denote the individual’s current presentation, but only when the full criteria are met. When full criteria are not met, clinicans should consider whether the symptom presentation meets criteria for an “other specified” or unspecified” designation.

DSM 5 Introduction• Elements of a Diagnosis1. Diagnostic Criteria and DescriptorsSeverity (mild, moderate, severe, extreme)Descriptive features (with good to fair insight; in

a controlled environment)Course (in partial remission, in full remission,

recurrent)

DSM 5 Introduction• Elements of a Diagnosis2. Subtypes and SpecifiersSubtypes define mutually exclusive and jointly

exhaustive phenomenological subgroupings within a diagnosis and are indicated by the instructions “specify whether”

Example: Delusional DisorderSubtype: Erotomanic Type, Grandiose Type, Jealous Type etc.

Specifiers are not intended to be mutually exclusive or jointly exhaustive, and as a consequence, more than one specifier may be given. Specifiers are indicated by the instruction “Specify” or “Specify if”

DSM 5 Introduction• Elements of a Diagnosis2. Subtypes and SpecifiersSpecifiers are not intended to be mutually

exclusive or jointly exhaustive, and as a consequence, more than one specifier may be given. Specifiers are indicated by the instruction “Specify” or “Specify if”

Example: Major Depressive DisorderSpecifier: Generalized

DSM 5 Introduction• Elements of a Diagnosis3. Medication-Induced Movement Disorders

and Other Conditions That May be a Focus of Clinical Attention

Section II also contains other conditions that are not mental disorders but may be encountered by mental health conditions.

Example: Akathisia, Tardive dyskinesia, and dystonia, neuroleptic malignant syndrome

DSM 5 Introduction• Elements of a Diagnosis4. Principal DiagnosisWhen more than one diagnosis for an individual

is given in an inpatient setting, the principal diagnosis is the condition established after study to be chiefly responsible for occasioning the admission of the individual.

When more than one diagnosis is given for an individual in an outpatient setting, the reason for visit is the condition that is chiefly responsible for the ambulatory care medical services received during the visit.

DSM 5 Introduction• Elements of a Diagnosis4. Principal DiagnosisIn most cases, the principal diagnosis or the

reason for visit is also the main focus of attention or treatment.

DSM 5 Introduction• Elements of a Diagnosis5. Provisional DiagnosisThe specifier “provisional” can be used when

there is a strong presumption that the full criteria will be met for a disorder but not enough information is available to make a firm diagnosis.

Steps in Writing a Diagnosis1. Locate the disorder that meets criteria2. Write out the name of the disorder:Ex: Posttraumatic Stress Disorder3. Add any subtype or specifiers that fit the presentation:Ex: Posttraumatic Stress Disorder, with dissociative symptoms,

delayed expression4. Add the code (locate either at the top of the criteria or within

the subtypes or specifiers-Two code numbers are listed, one in bold (ICD-9) and one in

parentheses (ICD 10)5. Order of multiple diagnoses: The focus of treatment or

reason for visit is listed first (principal diagnosis), followed by the other diagnoses in descending order of clinical importance.

Diagnostic Report

____ (_____) Specific Phobia, Situational____ (_____) Dependent Personality

Disorder ____ (____) Mitral Valve Prolapse (patient

report)Axis IV: work difficulties

Assignment:

• What is Descriptive Assessment?• How does a clinician describe a specific

client?• What is prognosis?• How does a clinician make a prediction

about a client?

Descriptive Assessment

• Diagnostic classification is not the only goal of assessment, nor should we expect any classification system to convey all that is meaningful or useful about a person suffering from a psychological disorder.

• Descriptive assessment seen too as more important than diagnostic classification.

Descriptive Assessment

• Descriptive-oriented assessment makes it easier for clinicians to pay attention to client’s assets and adaptive functions, not just to their weaknesses and problems. Accordingly, descriptive assessment data are used to provide pretreatment measures for clients’ behavior, to guide treatment planning, and to evaluate changes in behavior after treatment.

Treatment Planning

• Treatment Planning goes beyond the basic medical-model question: Which treatment work best for which disorders?

• It addresses the more detailed question, famously stated by Gordon Paul (1967): “What treatment, by whom, is most effective for this individual with that specific problem, and under which circumstances?”

Treatment Planning

• Treatment-related assessment can include assessing how well treatment has worked.

Prediction

• The final goal of clinical assessment. • Prediction might include prognosis

(descriptions of how the symptoms of disorder might change with or without treatment, future performance (descriptions of how someone will perform in a given job or situation, or dangerousness (descriptions of the likelihood of someone behaving violently toward the self or others).