Abnormal Psychology,
Thirteenth Edition
by
Ann M. Kring,
Sheri L. Johnson,
Gerald C. Davison,
& John M. Neale
© 2015 John Wiley & Sons, Inc. All rights reserved.
 Chapter
3: Diagnosis and Assessment
I. Cornerstones of Diagnosis and Assessment
II. Classification and Diagnosis
III. Psychological Assessment
IV. Neurobiological Assessment
V. Cultural and Ethnic Diversity and Assessment
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 Diagnosis
• The classification of disorders by symptoms and
signs.
 Advantages
of diagnosis:
• Facilitates communication among professionals
• Advances the search for causes and treatments
• Cornerstone of clinical care
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 Consistency
of measurement
• Interrater
 Observer agreement
• Test-retest
 Similarity of scores across repeated test administrations or
observations
• Alternate Forms
 Similarity of scores on tests that are similar but not identical
• Internal Consistency
 Extent to which test items are related to one another
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

How well does a test measure what it is supposed to
measure?
Content validity
• Extent to which a measure adequately samples the domain of
interest, e.g., all of the symptoms of a disorder

Criterion validity
• Extent to which a measure is associated with another measure (the
criterion)
 Concurrent
 Two measures administered at the same point in time
 Predictive
 Ability of the measure to predict another variable measured at some future point
in time
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 Construct
validity (Cronbach & Meehl, 1955)
• A construct is an abstract concept or inferred
attribute
• Involves correlating multiple indirect measures of
the attribute
 e.g., self-report of anxiety correlated with increased HR,
shallow breathing, racing thoughts
• Important for validating our theoretical
understanding of psychopathology
• Method for evaluating diagnostic categories
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 Diagnostic
and Statistical Manual
of Mental Disorders (DSM) published by
American Psychiatric Association
• First edition published in 1952
 Previous
revised)
edition: DSM-IV-TR (fourth edition,
• Published in 1994, text revised in 2000
• Many texts and research articles will continue to use
DSM-IV terminology for a period of time
 Current edition: DSM-5
• Published summer of 2013
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© 2015 John Wiley & Sons, Inc. All rights reserved.
© 2015 John Wiley & Sons, Inc. All rights reserved.

Categorical
• Presence/absence of a
disorder
 Either you are anxious or you
are not anxious

Dimensional
• Rank on a continuous
quantitative dimension
 Degree to which a symptom is
present
 How anxious are you on a
scale of 1 to 10?
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 Changes in multiaxial system
• Five axes in DSM-IV-TR changed to two axes in DSM-5
 Clinical Syndromes
 Psychosocial and Environmental Problems
 Changes in organization of diagnoses
• DSM-IV-TR clusters diagnoses on similarity of
symptoms
• DSM-5 diagnoses are reorganized to reflect new
knowledge of comorbidity and shared etiology
 OCD moved from anxiety cluster to new cluster that also
includes hoarding and body dysmorphic disorder
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© 2015 John Wiley & Sons, Inc. All rights reserved.
 Personality Disorder Diagnoses
• Remain unchanged from DSM-IV
• Proposed revisions included in Section III
 For further study
 New Diagnoses
• Disruptive mood dysregulation, premenstrual dysphoric
disorder, etc.
 Renaming of Diagnoses
• Mental retardation to intellectual disability
• Dysthymia to persistent depressive disorder
 Combining Diagnoses
• Substance use disorder replaces substance abuse and
substance dependence, etc.
 Clearer
Criteria
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 Mental
illness universal
 Culture can influence:
•
•
•
•
Risk factors
Types of symptoms experienced
Willingness to seek help
Availability of treatments
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 Cultural
Formulation
 9 Concepts of Distress
• Replaces 25 separate diagnoses
• E.g., Amok, Drat, Koru, Taijin kyofusho,
Hikikomori, etc.
 Focus
on influence of culture on disorder
presentation
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 Too
many diagnoses?
• Should relatively common reactions be
pathologized?
• Comorbidity
 Presence of a second diagnosis
 45% of people diagnosed with one disorder will meet
criteria for a second disorder
 Reliability
in everyday practice
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© 2015 John Wiley & Sons, Inc. All rights reserved.
 Extent
to which
clinicians agree on
the diagnosis
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

Construct validity of highest concern
Diagnoses are constructs
• For most disorders, no lab test available to diagnose with certainty

Strong construct validity predicts wide range of
characteristics
• Possible etiological causes (past)
• Clinical characteristics (current)
• Predict treatment response (future)
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© 2015 John Wiley & Sons, Inc. All rights reserved.
 Stigma
against mental illness.
• Treated differently by others
• Difficulty finding a job
 Categories
person.
do not capture the uniqueness of a
• The disorder does not define the person.
 She is an individual with schizophrenia, not a “schizophrenic”
 Classification
may emphasize trivial similarities
• Relevant information may be overlooked.
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© 2015 John Wiley & Sons, Inc. All rights reserved.
 Techniques
employed to:
• Describe client’s problem
• Determine causes of problem
• Arrive at a diagnosis
• Develop a treatment strategy
• Monitor treatment progress
• Conducting valid research
 Ideal
assessment involves multiple measures and
methods
• Interviews, personality inventories, intelligence tests, etc.
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 Informal/less
structured interviews
• Interviewer attends to how questions are answered
• Is response accompanied by appropriate emotion?
• Does client fail to answer question?
• Good rapport essential to earn trust
• Empathy and accepting attitude necessary
• Reliability lower than for structured interviews
 Structured interviews
• All interviewers ask the same questions in a predetermined
order
• Structured Clinical Interview for Axis I of DSM (SCID)
 Good interrater reliability for most diagnostic categories
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© 2015 John Wiley & Sons, Inc. All rights reserved.
 Stress
• Subjective experience of distress in response to
perceived environmental problems
 Bedford
College Life Events and Difficulties
Schedule (LEDS)
• Semi-structured interview
• Evaluates stressors within the context of each
individual’s circumstances
 Self-Report Stress Checklists
• Faster way to assess stress
• Test-retest reliability low
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
Personality Tests
• Self-reported Personality Inventories
 Minnesota Multiphasic Personality Inventory (MMPI)
 Yields profile of psychological functioning
 Specific subscales to detect lying and faking “good” or “bad”
• Projective Tests
 Rorshach Inkblot Test and Thematic Apperception Test (TAT)
 Projective hypothesis
 Responses to ambiguous stimuli reflect unconscious processes
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© 2015 John Wiley & Sons, Inc. All rights reserved.
 Face-to-face
interviews can have low
validity for stigmatized and illegal
behaviors
• E.g., drug use, sexual behavior, violence
• Respondents are more likely to endorse behavior on
a computer questionnaire
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
Intelligence tests (IQ tests)
• Assess current mental ability
• Wechsler Scales
 Wechsler Adult Intelligence Scale, 4th ed. (WAIS-IV)
 Wechsler Intelligence Scale for Children, 4th ed. (WISC-IV)
 Wechsler Preschool and Primary Scale for Children, 3rd ed. (WPPSI-III)
• Stanford-Binet, 5th ed. (SB5)
• Used to predict school performance, diagnose learning
disabilities or intellectual developmental disorder (mental
retardation), identify gifted children, as part of a
neuropsychological examination
• Mean IQ = 100, SD = 15 (Wechsler) or SD = 16 (SB)
• Lower IQs associated with higher psychopathology and mortality
• Performance on IQ tests impacted by Stereotype Threat
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 Focus
on aspects of environment
 Characteristics of the person
 Frequency and form of problematic behaviors
 Consequences of problem behaviors
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 Observe
behavior as it occurs
 Sequence of behavior divided into segments
• Antecedents and consequences
 Behavioral
assessments often conducted in lab
setting
• e.g., mother and child interact in a lab living room
 Interaction observed through one-way mirror or videotaped for
later coding
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 Self-monitoring
• Individuals observe and record their own behavior
 e.g., moods, stressful events, thoughts, etc.
 Ecological
Momentary Assessment (EMA)
• Collection of data in real time using diaries or smart
phones
 Reactivity
• The act of observing one’s behavior may alter it
 Desirable behaviors tend to increase whereas undesirable
behaviors decrease
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 Use
to help plan treatment targets
 Format often similar to personality tests
 Dysfunctional Attitude Scale (DAS)
• Identifies maladaptive thought patterns
 “People will think less of me if I make mistakes”
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© 2015 John Wiley & Sons, Inc. All rights reserved.
© 2015 John Wiley & Sons, Inc. All rights reserved.
 Computerized
Axial Tomography (CT or CAT scan)
• Reveals structural abnormalities by detecting
differences in tissue density
 e.g., enlarged ventricles
 Magnetic
Resonance Imaging (MRI)
• Similar to CT but higher quality
• fMRI (functional MRI)
 Images reveal function as well as structure
 Measures blood flow in the brain
 (BOLD=blood oxygenation level dependent)
 Positron
Emission Tomography (PET scan)
• Brain function
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 Postmortem
studies
 Metabolite assays
• Metabolite levels
 Byproducts of neurotransmitter breakdown found in
urine, blood serum or cerebral spinal fluid
• May not reflect actual level of neurotransmitter
• Correlational studies
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 Neuropsychologist
• Studies how brain abnormalities affect thinking,
feeling, and behavior
 Neuropsychological Tests
• Reveal performance deficits that can indicate areas of
brain malfunction
• Halstead-Reitan battery
 Tactile Performance Test-Time
 Tactile Performance Test-Memory
 Speech Sounds Perception Test
• Luria-Nebraska battery
 Assesses motor skills, tactile and kinesthetic skills, verbal and
spatial skills, expressive and receptive speech, etc.
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 Psychophysiology
• Study of bodily changes that accompany psychological
characteristics or events
 Electrocardiogram
(EKG)
• Heart rate measured by electrodes placed on chest
 Electrodermal
responding (skin conductance)
• Sweat-gland activity measured by electrodes placed on
hand
 Electroencephalogram
(EEG)
• Brain’s electrical activity measured by electrodes
placed on scalp
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© 2015 John Wiley & Sons, Inc. All rights reserved.
 Cultural
bias in asessment
• Measures developed for one culture or ethnic group
may not be valid or reliable for another.
• Not simply a matter of language translation
 Meaning may be lost
 Cultural
bias can lead to minimizing or
exaggerating psychological problems
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 Increase
graduate students’ sensitivity to
cultural issues
 Insure participants’ understanding of task
 Establish rapport
 Distinguish “cultural responsiveness” from
“cultural stereotyping” (Lopez, 1994)
• Conclusions should be tentative and alternative
hypotheses should be entertained
© 2015 John Wiley & Sons, Inc. All rights reserved.
Copyright 2015 by John Wiley & Sons, Inc. All
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by this copyright may be reproduced or utilized in
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