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Chapter 3

Assessment & Classification of Mental Disorders
Reliability (degree to which a test or procedure yields the same results repeatedly under the same
circumstances)
• Test-retest reliability: same results when given at two different points in time
• Internal consistency: various parts of measure yield similar or consistent results
• Interrater reliability: consistency of responses when scored by different test
administrators
Validity (extent to which a procedure actually performs its designed function)
• Predictive validity: how well a test predicts a person’s behavior or response
• Construct validity: how well a test or measure relates to the characteristics or disorder in
question
• Content validity: how well a test measures what it is intended to measure
o Assesses all areas known to be associated with a particular disorder
Standardization
• Standard administration
• Professionals administering a test much follow common rules of procedures
• Standardization sample: group of people who initially took the measure
o Performance is used as standard or norm
• Test-takers should be similar to the standardization sample for the test to be valid
Assessment and Classification of Mental Disorders
• Psychological assessment
o Gathering information and drawing conclusions
▪ Traits, abilities, emotional function, and more
• Four main assessment methods…
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Interviews
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Neurological tests
Observations
• Controlled (analogue) observations: made in laboratory, clinic, or other contrived setting
• Naturalistic observations: informal observations made in a natural setting (schoolroom,
office, hospital ward, home)
o Usually in conjunction with an interview
• Observe appearance and behavior

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Interviews
• Observe client and collect data about the person’s life history, current situation, and
personality
• Analyzes…
o Verbal behavior
o Nonverbal behavior
o Content
o Process of communication
• Types of interviews (interviews vary in degree of structure and formality)
o Structures interviews…
▪ Common rules and procedures
▪ Standard series of questions
▪ Disadvantage: limit conversation
▪ Advantage: collect consistent and comprehensive information
Mental Status Examination
• Objective: evaluate client’s cognitive, psychological, and behavioral functions
• Uses questions, observations, and tasks
• Clinician considers the appropriateness and quality of the client’s responses
o Forms tentative opinion of diagnosis and treatment needs
Psychological Tests and Inventories
• Standardized tools
• Measure characteristics such as personality, social skills, and more
• Projective personality tests (test taker presented with ambiguous stimuli and asked to
respond in some way)
o Rorschach Technique
o Thermatic Appereception Test (TAT)
o Sentence-completion test
o Draw-a-person test
• Problems with projective personality tests…
o Do not meet reliability and validity standards
o Analysis and interpretation of responses subject to wide variation
o May have limited cultural relevance
Self-Report Inventories
• Used to access depression, anxiety, or emotional reactivity
• May involve completion of open-ended sentences
• Minnesota Multiphasic Personality Inventory (MMPI and MMPI-2)
• Beck Depression Inventory (BDI)
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Intelligence Tests
• Primary functions
o Obtain intelligence quotient (IQ), or estimate of current level of cognitive
functioning
o Provide clinical data
• Wechsler scales (WAIS V)
o Used for ages 16 and older
• Stanford-Binet scales
o Used for ages 2 to 85
Criticisms of Intelligence Tests
• Fail to consider the effects of culture, poverty, discrimination, and oppression
• Do not consider multidimensional attributes of intelligence
• Have a poor level of predictive validity
o Do not accurately predict future behaviors or achievement
o Motivation and work ethic may matter more
Tests for Cognitive Impairment
• Bender-Gestalt Visual-Motor Test
o Involves copying geometric designs
• Halstead-Reitan Neuropsychology Test Battery
o Differentiates patients with brain damage
▪ Can provide valuable information about the type and location of the
damage
Neurological Tests
• Allows noninvasive visualizations of brain structures
• Electroencephalograph (EEG)
• Computerized axial tomography (CT)
• Magnetic resonance imaging (MRI)
o Functional MRI (fMRI)
o Diffusion tensor imaging (DTI)
• Magnetoencephalography (MEG)
• Positron emission tomography (PET)
Diagnosing Mental Disorders
• Psychiatric classification system
o Similar to a catalogue, with detailed descriptions of each disorder
▪ Patterns of behavior are distinctly different
o Each category accommodates symptom variations
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DSM 5 Criteria for Diagnosis of Bipolar I
• Manic episode
a) Persistent elevated, expansive, or irritable mood for at least one week
b) At least 3 of the following symptoms are present during mood disturbance
▪ inflated self-esteem or grandiosity
▪ decreased need for sleep
▪ increased talkativeness
▪ flight of ideas or racing thoughts
▪ distractibility
▪ increase in goal-directed activity or psychomotor agitation
▪ increase in risky behavior
• Major depressive episode
a) At least 5 of the following symptoms present during a two-week period nearly every
day; at least one symptom is either depressed mood or loss of interest/pleasure:
▪ depressed mood most of the day
▪ diminished interest in nearly all activities most of the day
▪ significant change in weight or appetite
▪ insomnia or hypersomnia
▪ psychomotor agitation or retardation
▪ fatigue or decreased energy
▪ inappropriate guilt or feelings of worthlessness
▪ difficulty concentrating or making decisions
▪ recurrent thoughts of death, suicidal thoughts, plans, or attempts
Diagnostic and Statistical Manual of Mental Disorders (DSM)
• Widely used classification system
o DSM-I (1952): identified 106 mental disorders
o DSM-II (1968): identified 182 disorders
o Revisions (DSM-II, DSM-III, DSM-III-R, DSM-IV, DSM-5) increase reliability
and validity
o DSM-5 (2013)

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DSM-5 Disorders
Neurodevelopmental disorders
Neurocognitive disorders
Substance-related and addictive
disorders
Schizophrenia spectrum and other
psychotic disorders
Bipolar and related disorders
Depressive disorders
Anxiety disorders

Obsessive-compulsive and related
disorders
Trauma and stress-related
disorders
Somatic symptom and related
disorders
Dissociative disorders

Sexual dysfunctions
Gender dysphoria
Paraphilias
Eating disorders
Sleep-wake disorders

Personality disorders

Cognitive, learning, and language disabilities evident early in life
Psychological or behavioral abnormalities associated with
dysfunction of the brain
Excessive use of alcohol, illicit drugs, or prescription medications
that results in impaired functioning; behavioral additions such as
gambling
Disorders marked by severe impairment in thinking and
perception; often involving delusions, hallucinations, and
inappropriate affect
Disorders characterized by episodes of mania of hypomania,
alternating with periods of normal and/or depressed mood
Disorders involve feelings of sadness, emptiness, and social
withdrawal
Disorders characterized by excessive or irrational anxiety or fear
situations, often accompanied by avoidance behaviors and fearful
cognitions or worry
Disorders characterized by obsessions (recurrent thoughts) and/or
compulsions (repetitive behaviors) and other compulsive behavior
such as hoarding
Disorders associated with chronic or acute reactions to trauma and
stress
Disorders involving physical symptoms that cause distress and
disability, including high levels of health anxiety and
disproportionate concern over bodily dysfunctions
Disturbance or alteration in memory, identity, or consciousness,
including amnesia, having two or more distinct personalities, or
experiencing feelings of depersonalization
Disorders involving the disruption of any stage of a normal sexual
response cycle, including desire, arousal, or orgasm
Significant distress associated with conflict between biological sex
and gender assigned at birth
Recurrent, intense sexual fantasies or urges involving nonhuman
objects, pain, humiliation, or children
Disturbed eating patterns and body dissatisfaction, involving
bingeing, purging, and excessive dieting
Problems in initiating/maintaining sleep, excessive sleepiness,
sleep disruptions, sleepwalking, or repeated awakening associated
with nightmares
Disorders involving stable personality traits that are inflexible and
maladaptive and notable impair functioning or cause subjective
distress

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Dimensional Perspective
• DSM-5 is a categorical model
o Some professionals believe it’s ineffective for diagnosis
• Dimensional classification system
o Disorders reside on a continuum for normal to severe forms of a disorder
Final Version of the DSM-5
• Remains a categorical system with expectations
• Exceptions to DSM-5 categorical system
o Autism spectrum disorder
o Risk syndromes
▪ Indicate milder forms of well-established disorders
o Enhanced assessment procedures
▪ Allowing more than a “yes” or “no” answer
Other Attributes of the DSM-5
• Subtypes
• Specifiers
• Remission
• Cost-cutting measures
• Comorbidity (presence of 2 or more disorders in the same person)
Cultural Factors in Assessment
• Determining whether a behavior is consistent with cultural norms
o Responsibility of the clinician
• Bias
• DSM-5 includes guidelines for conducting a cultural assessment (16 questions)
Changes in the DSM-5 Classification System
• Changes in the criteria for some disorders
o May increase the number of individuals receiving a diagnosis
• Addition of some disorders
o i
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gambling disorder
• Bereavement removed as an exclusionary criteria when diagnosing depression
Objections to Classification and Labeling
• Labeling a person can lead to overgeneralization, stigma, and stereotypes
• Labeling may lead a person to believe they possess characteristics associated with the
label

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Chapter 3
•

Labels are required by social systems
o Do not provide precise information required by heath care organizations

Contemporary Trends and Future Directions
• Current trends
o Increased reliance on the biological model
▪ Advances based on biological and neurological research
o Effort to discover specific biomarkers associated with different conditions
o Increased consideration of psychological, social, and sociocultural factors
o Growing consensus that mental health professionals not merely objective
observers
Review
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How do mental health professionals evaluate a client’s mental health?

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What changes are occurring that will affect assessment?

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