Dysfunctional Behaviour
G543
– Categories: DSM and ICD
– Definitions by Rosenhan & Seligman
– Diagnostic bias (gender) Ford & Widiger
• How did we used to define mental health?
– Phrenology (bumps on the head)
– Body size and shape (small head)
• Categories used for mental health by health care
professionals:
– ICD and DSM
– International Classification of Diseases
– Diagnostic Statistical Manual of Mental Disorders
Task
• Students discuss both diagnostic tools
ICD
• The ICD (mental and physical health)
– Set up to help track and diagnose diseases and
mental health issues world wide and is now published
by WHO (the World Health Organisation).
– The ICD has descriptions of the main features of
mental health disorders and each section indicates to
the health professional how many features of a
disease might be required in order to diagnose the
problem.
– The ICD has over 100 different categories for mental
health disorders ranging from dementia to
schizophrenia.
DSM
• The DSM (mental health only)
– Set up in the USA by a team of mental health
professionals specifically to help improve the
reliability of mental health diagnosis, not just in the
USA but across the world.
– The DSM is more complex than the ICD including a
range of ‘Axis’ (variables) to be considered alongside
the features of the mental health condition such as
physical illnesses, social conditions and
environmental problems.
Task
• Explain the advantages of categorising
• Advantages of categories for mental health
– Improves reliability of diagnosis between physicians
– Enables people to obtain a diagnosis so that help and
support can be obtained (disablement benefit etc)
– Is regularly monitored and reviewed and updated
giving a forum for psychiatrists to come together to
discuss and share new issues or problems as they
arise.
• Explain the disadvantages of categorising
• Disadvantages of categorisation
– May contain ethnocentric bias (is based on the
American model of abnormality). The categories
reflect cultural bias for example homosexuality used
to be considered an abnormality when the categories
were first discussed.
– Are based on the medical model of health which
assumes there is a method of reliably and
consistently measuring mental health – some people
dispute this is possible
Disadvantages of categorisation
– There is a wide range of individual differences
in mental health and as a disease cannot be
reliably scientifically tested this has led to
more and more categories making the system
more and more complex to use.
– An example of this is that the category
‘personality disorder unknown’ is one of the
most commonly used.
Disadvantages of categorisation
– Does still not avoid doctor bias in the
interpretation of the symptoms presented
(Rosenhan) because of the environmental
conditions in which the diagnosis takes place.
– Has not led to reliable diagnosis and research
shows that still different doctors will use
different categories and different drugs to treat
the same patients.
Rosenhan and Seligman
• Where do you see signs of failure to
function normally but without indicating
mental health problems?
Rosenhan and Seligman
• Criteria for diagnosis
• Students outline on A3 paper and evaluate
Biases
• Kaplan (1983),argued that:
• Diagnostic systems, are male centered
• The authors of every edition of the DSM have been
predominately male, including the membership on the
more recent personality disorder work groups:
• 89% for DSM-III, with only one of the 9 members female
• It might not be surprising to find that male members of
these DSM committees have pathologised stereotypic
feminine traits rather than, or more so than, stereotypic
masculine traits, reflecting & masculine-biased
assumptions about what behaviours are healthy and
what behaviours are crazy; (Kaplan, 1983,). (Discuss)
Sex Biases
• When provided with the same symptoms
via case histories, clinicians are more
likely to provide a diagnosis of histrionic
personality disorder if the patient is female
than if the patient is male.
• In a complementary fashion, clinicians are
somewhat more likely to diagnose a male
patient with antisocial personality disorder
than a female patient
• If clinicians apply the criteria differentially
to men and women, then whatever biases
occur must be within the clinicians rather
than the criteria sets.
•
Ford and Widiger 1989 Sex Bias in the
diagnosis of disorders
–
–
–
•
Method self report
health practitioners given scenarios and asked to
make a diagnosis.
The IV was gender and the DV was the type of
diagnosis
Sample of 354 clinical psychologists with a
mean of 15.6 years clinical experience
selected randomly from the national register
•
Procedure
–
–
–
Participants were randomly provided with one of
nine case histories.
Case studies of patients with antisocial
personality disorder or histrionic personality
disorder or an equal balance of both were given
to the clinicians.
They had to make a diagnosis and rate it on a 7
point scale the extent to which the patient displayed
the symptoms of the disorders.
Task
• Students to research both disorders and
develop a mind map for group discussion
•
Findings
– Sex unspecified case histories were most
often diagnosed with borderline personality
disorder.
– Antisocial personality disorder was
diagnosed correctly 52% of the time in
males but only 15% of time in females.
– Females were misdiagnosed with histionic
personality disorder 46% of the time but
males on 15% of the time.
Conclusions
• Can you write out the conclusions and
evaluation points of the study
– Examination Question:
– Outline one way of diagnosing mental health
problems(10)
– Evaluate biases that may be present in the
diagnosis of mental health (15)