Chapter 4
Assessment of Abnormal Behaviour
LINDSAY AYEARST, PH.D.
Diagnosis & Classification
Diagnosis – identification and recognition of a
disorder based on the characteristics of symptoms
Classification system = ease of communication
DSM – Diagnostic and Statistical Manual of Mental
Disorders
ICD – International Classification of Diseases
DSM-IV (1994), DSM-IV-TR (2000), DSM-5 (2013)
ICD & DSM
1939 World Health Organization (WHO) added
mental disorders to the International List of Causes
of Death
1948 – list expanded to become International
Statistical Classification of Diseases, Injuries, and
Causes of Death (ICD)
1952 – American Psychiatric Association (APA)
published DSM
ICD & DSM
1968 – DSM-II
1969 – ICD published along with glossary
Different symptoms listed across ICD & DSM for a
given disorder
1980 – DSM-III – extensive revision
1987 – DSM-III-R
1994 – DSM-IV
2000 – DSM-IV-TR
2013 – DSM-5
Goals of DSM-5
Decrease usage of “not otherwise specified”
diagnosis
Add dimensional assessments – not just presence of
symptom, but also severity rating
Align with ICD
All disorders & definitions based on strong empirical
evidence
DSM-5
Over 500 mental disorders described
Includes key clinical features of each
Prevalence, risk, course, age, culture, gender
Categorical information: name of distinct category of
disorder
Dimensional information: how severe the symptoms
are and how impaired the client is across various
domains of functioning
Changes to Specific Disorders
Autistic Disorders replaced with Autism Spectrum
Disorders
Schizophrenia replaced with Schizophrenia
Spectrum Disorders
Binge-eating moved from Appendix
New disorders: skin-picking, hoarding
Significant controversy and upset with DSM-5 –
Allen Frances (chair of DSM-IV task force) has been
very vocal (among others)
Wave of Criticism
Dec 2012 – “One last
chance for APA to make
DSM-5 safer”
Dec 2012 – “DSM-5 is a
guide, not a bible: Simply
ignore its 10 worst
changes”
Allen Frances, M.D. Jan 2013 – “Terrible news:
Chair of DSM-IV Task DSM-5 refuses to reduce
Force overdiagnosis of somatic
Saving Normal symptom disorder”
Categorical Vs. Dimensional Classification
DSM – categorical – present vs. absent
Categorical system – disorders are discrete
diagnostic entities – qualitatively different
Dimensional = abnormal behaviour exists on a
continuum – difference in quantity, not kind
DSM-5 = categorical system with dimensional
ratings
Most disorders are dimensional – not categorical!
Reliability & Validity
Reliability = consistent measurement across time (test-
retest) and observers (inter-rater)
Validity = appropriateness, meaningfulness, and usefulness
of inferences made from test scores
If test scores are consistent (across time or raters) then
reliability is assessed as “good” regardless of whether
validity has been demonstrated (e.g., that two raters agree
about a diagnosis says nothing about whether the diagnosis
is accurate)
Judgments can be consistent (reliable), but not valid (both
raters may agree, and both may be wrong!)
Reliability in Assessment
Inter-rater reliability – two raters agree
Test-retest reliability – test scores are similar across
time
Internal consistency reliability – test items are
correlated
Validity in Assessment
Does the test measure what it is intended to
measure?
Types of validity:
Concurrent
Predictive
Content
Construct
Psychological Assessment
Clinical Interview
Personality Tests – self-report tests & projective
tests
Behaviour Observation
Biological Assessment – Brain Imaging
Neuropsychological Assessment
Clinical Interview
Paradigm clinician operates from influences
information gathered during the interview
Rapport is a necessary component of the interview
process
Structured vs. unstructured reliable vs. unreliable
SCID-5
Structured Clinical Interview for DSM-5
(SCID-5, 2015)
Psychological Tests
Standardized
Strong psychometric properties (demonstrated
reliability & validity)
MMPI
Minnesota Multiphasic Personality Inventory
(MMPI, MMPI-2, MMPI-2-RF)
Most widely used test
Includes validity scales and clinical scales
Projective Tests
Standard set of stimuli presented to client (i.e.,
inkblots or drawings)
Stimuli are ambiguous
No right answer
Client’s responses determined by unconscious
processes and will reveal their true attitudes,
motivations, and behaviour
Rorschach Inkblot Test
Herman Rorschach, a Swiss
psychiatrist, was the first to
suggest (1911) the use of
inkblot responses as a
diagnostic instrument
In 1921 he published his book
on the test, Psychodiagnostik
(and soon thereafter died, age
38)
Thematic Apperception Test (TAT)
Black and white pictures – asked to tell a story
Describe:
- what led up to the scene
- what is happening
- what the characters in the story might think or
feel
- how the story will end
People will project their needs into the story
Attention given to protagonist in story and his/her
environmental stressors
Projective Tests
Derived from psychoanalytic paradigm
Used to reach unconscious feelings/beliefs of the
client
Lack reliability and validity
Popular and widely used measures
Behaviour Observation
Formally assesses an individual’s thought, feelings,
and behaviors in specific situations or contexts
Direct observation – “ABCs”
Antecedent
Behaviour
Consequence
• Self – monitoring
• Reactivity – act of observation causes behaviour change
Biological Assessment
Computerized Axial Tomography (CT Scan) –
assess structural brain abnormalities
Magnetic Resonance Imaging (MRI) – assess
structural brain abnormalities – superior to CT
scan
Functional MRI (fMRI) – assess abnormalities in
brain functioning
Positron Emission Tomography (PET Scan) –
assess abnormalities in brain function
McIntosh et al (2008)
Examined brain activation in people with
Schizophrenia or psychotic bipolar disorder vs.
normal controls
Sentence Completion task = experimental probe
(e.g., I feel upset when……)
Schizophrenia = decreased activation in dorsal
prefrontal cortex
Bipolar = decreased anterior insula activation
possibility of brain abnormalities that are
diagnosis specific!
Neuropsychological Assessment
Neuropsychologist – studies how dysfunction in the
brain affects the way we think, feel, and behave
Goals of Neuropsych Assessment
Seidman & Bruder (2003)
1. To measure as reliably, validly, and completely as possible
the behavioural correlates of brain functions
2. To identify the characteristic profiles associated with a
neurobehavioural syndrome (differential diagnosis)
3. To establish possible localization, lateralization, and etiology
of brain lesions
4. To determine whether neuropsychological deficits are
present (i.e., cognitive, perceptual, or motor) regardless of
diagnosis
5. To describe neuropsychological strengths, weaknesses, and
strategy of problem solving
6. To assess the patient’s feelings about his or her syndrome
7. To provide treatment recommendations (i.e., to client,
school, family)
Halstead-Reitan Battery
is the most commonly used neuropsych battery =
comprehensive assessment of cognitive functioning
Includes 10 subtests - measures of verbal and
nonverbal intelligence, language, tactile and
manipulative skills, auditory sensitivity, etc.
Cognitively intact individuals can perform tasks
well; persons with neurological damage have
difficulty with certain tasks depending on where
the damage is located
