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1. The DSM – how valid and reliable is it as a tool for diagnosis? 2. <ul><li>D ad </li></ul><ul><li>P urchased…
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  • 1. The DSM – how valid and reliable is it as a tool for diagnosis?
  • 2. <ul><li>D ad </li></ul><ul><li>P urchased </li></ul><ul><li>M ost </li></ul><ul><li>E xtraordinary </li></ul><ul><li>G lasses </li></ul>
  • 3. DSM – a multi-axial system <ul><li>Axis I D isorders, clinical and mental eg schizophrenia </li></ul><ul><li>Axis II P ersonality (underlying) including mental retardation </li></ul><ul><li>Axis III M edical and Physical conditions </li></ul><ul><li>Axis IV E nvironmental factors </li></ul><ul><li>Axis V G lobal functioning </li></ul>
  • 4. Evaluation of the DSM <ul><li>Strengths: </li></ul><ul><li>It’s the best attempt at diagnosis that there is and it allows a common diagnosis </li></ul><ul><li>There are studies which support its reliability and validity </li></ul><ul><li>Weaknesses </li></ul><ul><li>It can be considered a way of labelling people whose behaviour we see as “different” </li></ul><ul><li>In the US some people argue by inventing mental illnesses psychiatrists can make more money </li></ul>
  • 5. Goldstein (1988) use for RELIABILITY <ul><li>she re-diagnosed 199 patients using DSMIII, originally diagnosed using DSM–II; some differences....... But 85% consistent = Test-retest reliability </li></ul><ul><li>she asked two other experts to re-diagnose a random sample of 8 of the patients using the case histories with all indication of previous diagnoses removed – she found a high level of agreement/consistency of diagnosis = Inter rater reliability </li></ul>
  • 6. Stinchfield (2003) recent!! use for validity <ul><li>Diagnosis of pathological gambling (severe enough habit to inhibit and interfere with daily functioning) </li></ul><ul><li>803 men and women from general population of Minnesota and 259 men and women on gambling treatment programme </li></ul><ul><li>Questionnaire using 19 items from DSM IV criteria for pathological gambling </li></ul><ul><li>Questionnaire results were able to help researches to correctly sort the gamblers from the non-gamblers.- so the DSM is doing what it should .... It’s VALID! </li></ul>
  • 7. Lee (2006) recent! Use for VALIDITY and CROSS-CULTURAL <ul><li>  </li></ul><ul><li>Aimed to reveal whether the DSM criteria for diagnosing ADHD would be useful for Korean children </li></ul><ul><li>Assessed 18 ADHD criteria in DSM IV </li></ul><ul><li>Questionnaire given to 48 primary school teachers. </li></ul><ul><li>1663 children were rated – large sample </li></ul><ul><li>There was a match between the features of ADHD outlined in the DSM and the responses to the questionnaires, an ADHD test and teacher assessments </li></ul><ul><li>but the match was not as good for girls as it was for boys .... Maybe a validity problem </li></ul>
  • 8. Kim-Cohen et al (2005) use for validity <ul><li>Longitudinal study looking at conduct disorder in over two thousand 5 year olds </li></ul><ul><li>Children’s mothers were interviewed and the teachers were asked to complete postal questionnaires about conduct disorder symptoms (from DSM IV) observed in last 6 months </li></ul><ul><li>The children who received the diagnosis were also more likely to display behavioural and educational difficulties at age 7 = Predictive validity </li></ul>
  • 9. Rosenhan (1973) use for reliability and validity <ul><li>Because the diagnosis was the same across all 12 of the hospitals presumably using the current DSM at the time, we could say this shows the DSM to be reliable </li></ul><ul><li>Because the diagnosis of healthy people was schizophrenia, if they were using the DSM this means it lacks any validity </li></ul>
  • 10. Evaluation of validity issues <ul><li>STRENGTHS </li></ul><ul><li>The DSM has been shown to be valid across a variety of studies covering a range of different conditions </li></ul><ul><li>Because it is reliable it is likely to be valid too </li></ul><ul><li>Much work has been done to increase its validity as it has been rewritten </li></ul>
  • 11. WEAKNESSES <ul><li>It is hard to diagnose people who are suffering from more than one condition (co-morbidity) when using the DSM </li></ul><ul><li>It can be considered to be reductionist to break down a condition into a series of symptoms, so we shouldn’t over concentrate on Axis 1 </li></ul><ul><li>Questionnaires and interviews such as in the Kim-Cohen study may find what they are looking for </li></ul>
  • 12. CULTURAL ISSUES and the DSM <ul><li>Culture does not affect diagnosis </li></ul><ul><li>It’s scientific, and if we clearly define our symptoms then it can work all over the world eg Lee(2006) in Korea </li></ul><ul><li>Schizophrenia is more similar across cultures than different </li></ul><ul><li>Culture does affect diagnosis </li></ul><ul><li>Some times symptoms mean different things in different cultures eg hearing voices can make you “special” in a positive way (spiritual) </li></ul><ul><li>There are cultural differences in symptoms </li></ul><ul><li>Eg more auditory hallucinations in Mexico, more grandiosity in white Americans, </li></ul>
  • 13. Culture Bound Syndromes <ul><li>Genital retraction syndrome (Africa and Asia) </li></ul><ul><li>Kuru (Papua New Guinea) brain disease similar to mental illness here </li></ul>
  • 14. <ul><li> </li></ul>What should we do about the cultural problems in using the DSM? <ul><li>We should be aware of the cultural </li></ul><ul><li>problems in diagnosis </li></ul><ul><li>Concentrate less on first rank (positive) symptoms which tend to be more cultural </li></ul><ul><li>Concentrate more on negative symptoms which are less culture-bound and easier to measure objectively </li></ul>
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