3.4 SUMMING UP

Diagnosing Psychological Disorders

• Among other purposes, classification systems for diagnosis allow (1) patients to be able to put a name to their experiences and to learn that they are not alone; (2) clinicians to distinguish “normal” from “abnormal” psychological functioning and to group together similar types of problems; and (3) researchers to discover the etiology, course, and effectiveness of treatments for abnormal psychological functioning.
• Classification systems have drawbacks: (1) They can be subject to diagnostic bias—perhaps on the basis of the patient’s sex, race, or ethnicity; and (2) for some people, being diagnosed with a psychological disorder is experienced as stigmatizing, which changes how the person feels about himself or herself or is seen by others.
• Classification systems should be both reliable and valid.
• The most commonly used classification system in the United States is the Diagnostic and Statistical Manual of Mental Disorders, presently in its fifth edition (DSM-5). The DSM-5 generally does not focus on etiology but instead focuses on what can be observed rather than inferred and lists explicit criteria for each disorder.
• DSM-5 has been criticized on numerous grounds, including:
  • What constitutes clinically significant distress or impaired functioning is subjective and can vary widely from one clinician to another.
  • Most disorders are classified as categorical rather than as on continua.
  • The way the criteria are structured leads heterogeneous groups to be diagnosed with the same disorder.
  • The duration criteria can be arbitrary and not necessarily supported by research.
  • Many diagnoses have been created in order to ensure payment from health insurance providers. Moreover, diagnoses have been added for disorders that clearly are medical problems.
  • Social factors that lead or contribute to psychological disorders are deemphasized.
  • There is a high comorbidity rate: Half the people diagnosed with one disorder have at least one other disorder.
• Psychological disorders are generally diagnosed by clinical and counseling psychologists, psychiatrists, psychiatric nurses, and social workers. Other clinicians in a position to diagnose psychological disorders include general practitioners, pastoral counselors, and marriage and family therapists.

Assessing Psychological Disorders

• Neurological and other biological factors may be assessed using various methods. Neuroimaging techniques can assess brain structure (X-rays, computerized axial tomography, and magnetic resonance imaging) and brain function (positron emission tomography and functional magnetic resonance imaging). Neuropsychological testing can assess brain functioning.
• Various methods are used to assess psychological factors. These include the clinical interview, observing the patient, patient self-report, and reports of others involved in the patient’s life. Specific aspects of psychological functioning can be assessed through tests of cognitive abilities, and personality functioning can be assessed with inventories, questionnaires, and projective tests.
• Some techniques used to assess psychological factors also can be used to assess social factors—such as family functioning—as well as to provide a more detailed portrait of the patient’s community and culture. These social factors affect and are affected by neurological and psychological factors.