Psychological Assessment?

[JackD]

I have been wondering something and i am sure i can relate it to the designed purpose of this forum in some convoluted way. When i am studying the various psychological disorders out there, it seems to me like it would be obvious what the diagnosis would be when a clinician is assessing someone. If someone is depressed for a two weeks, comes out of it, and then suddenly becomes wild and energetic, it seems like the person's problem is obvious. However, in real life, would it be obvious or would there be thirty different possible diagnoses? Perhaps it is easy if a person has one condition and comorbid conditions are where the difficulties lie?

I guess to relate it to what we are all doing here, do you spend a ton of time in grad school looking at the various possible nuances between conditions or are the diagnostic aspects fairly obvious and you spend all that time learning treatment?

What am i not seeing here?

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[RayneeDeigh]

do you spend a ton of time in grad school looking at the various possible nuances between conditions

Oh god yes.

Here's an example. Unfortunately I definitely can't provide details, but I'll try to make the point while being vague.

In my assessment course last semester four people in my cohort had to watch an assessment interview conducted by the 5th cohort member for our final assignment. After 3 hours of interview and four separate tests, all FIVE of us had different diagnoses.

I also gave a presentation last week about substance abuse. After handing out a vignette about a case I made up we split into four groups. We had two different diagnoses and strong cases were made for each diagnosis.

It's definitely not black and white at all. Factor in comorbidity and it's a veritable melting pot of diagnoses most of the time. But even with just one disorder, you can often argue a number of different things with the information you have.

 

[Therapist4Chnge]

What makes clinical psychologists the experts in Dx is the fact we spend a TON of time studying the nuances. Presentations are rarely cut and dry, and it takes being proficient in a number of areas to be strong at Dx.

-t

 

[Ollie123]

Yes, diagnosis gets hella-complicated.

Mood disorder with psychotic features vs. schizoaffective anyone?

Some cases are straightforward, but many are not. Its actually pretty rare to see a "pure" disorder. Schizophrenics are drinking, depressed folks are also anxious, drug addicts have ADHD, etc.

Even if the problems are pretty clear, its also often important to determine which is "primary" (e.g. is the person depressed because they are so nervous around people they can't live their life, or do they have poor self-esteem due to depression and therefore get nervous around people). Its subtle, but can be an important distinction to make.

So yes - it can be tricky. What you're learning about in the classroom is not really reflective of what you will actually see in the population - disorders are rarely completely independent of one another.

 

[JackD]

Certainly the various diagnostic tests out there help, no? I believe i read descriptions of about 500 million different tests out there. I would have to think those would make your lives easier. Then again, i am guessing that learning about them and how to administer them is an adventure in and of itself.

 

[RayneeDeigh]

Certainly the various diagnostic tests out there help, no?

Help, yes.

But just because an MCMI comes out with a high Histrionic scale doesn't mean that your client won't be Borderline or Dependent instead/also.

 

[JackD]

Help, yes.

But just because an MCMI comes out with a high Histrionic scale doesn't mean that your client won't be Borderline or Dependent instead/also.

So the problem is that you can narrow it down with the tests but you are only left with a general category? Would a test come out saying your client has an "Anxiety Disorder" but you just look at it and say "ok, now which one?"

 

[Ollie123]

Sometimes, yes.

Other times, for things like the MMPI-2 and the like, it will come up as anxiety, and there will be no discernable symptom of anything remotely close to an anxiety disorder.

Psychometrics is not an exact science, and even the "best" tests only help, they can't give a diagnosis for you. Really they are just various ways of gathering information, compiling that information is what gets you to a diagnosis. A psychologist who takes any test at face value without exploration is one who does not deserve to be in the profession.

 

[Therapist4Chnge]

Certainly the various diagnostic tests out there help, no? I believe i read descriptions of about 500 million different tests out there. I would have to think those would make your lives easier. Then again, i am guessing that learning about them and how to administer them is an adventure in and of itself.

They tend to offer support of a Dx, but they shouldn't solely be used for a Dx. In addition to traditional assessments, the clinical interview plays a vital role in the clinician's ability to properly Dx a person. There are many out there who aren't strong in this area......and it shows. I've seen a ton of shotty Dx'ing. Things like PTSD, borderline, and anxiety are things I see the most issues with. (over-dx of all of them).

-t

 

[JackD]

So would i be correct in assuming that diagnostics is more difficult in the clinical psychology field than in counseling psychology?

It just seems like people with less severe psychological disorders would have an easier time describing how they are feeling than someone who is delusional and brought into a clinic. Is someone someone who decides to see a counseling psychologist because they are depressed more easily diagnosed than someone who is hauled into a psychiatric facility by family members because he or she lock them self in their apartment, since the government's mind control beams can't get them there? It just seems like counseling psychologist is going to have clients with much more straight forward problems than the clinical psychologist working at the psychiatric facility.


I think i am really seeing why my research method's professor keeps saying that if you go on to grad school, even if you don't do research, you are really going to need this information.

 

[RayneeDeigh]

So would i be correct in assuming that diagnostics is more difficult in the clinical psychology field than in counseling psychology?

It just seems like people with less severe psychological disorders would have an easier time describing how they are feeling than someone who is delusional and brought into a clinic. Is someone someone who decides to see a counseling psychologist because they are depressed more easily diagnosed than someone who is hauled into a psychiatric facility by family members because he or she lock them self in their apartment, since the government's mind control beams can't get them there? It just seems like counseling psychologist is going to have clients with much more straight forward problems than the clinical psychologist working at the psychiatric facility.

I think that's an over-simplification of the professions. Diagnosing is difficult whether the disorder is severe or not. There are some cases of any diagnosis that are going to be blatant "wow how could anyone not see that" kinds of things and others that will require a lot of detective work in the form of interviewing and informed testing.

Whether it's schizophrenia or depression, it's rarely gonna be clear-cut what the diagnosis section of a report's gonna look like.

 

[psychanon]

Diagnosis is hard because clinical presentations often vastly differ from those in textbooks. The case studies in your textbooks seem easy to diagnose because they are designed with the intention of illustrating a prototypical case of the disorder. In real life settings...hospitals, outpatient settings, you name it-- people don't present with straightforward DSM symptoms. Furthermore, you shouldn't view the DSM as a wholly accurate document. It's basically the field's "best guess" at providing a taxonomy to the complexities of psychopathology, based on a mixture of empiricism and clinical lore, but it's by no means perfect. As a result, there are many patients who do not fit firmly into any diagnostic category, or for whom one problem may be masked by another, and so on. Even when assisted by tests and interviews, clinical judgment is critical. I think as soon as you work with a clinical population, you'll see what I'm saying.

PS- A little off topic, but in response to JackD's post above: a lot of people imply that the difference between clinical and counseling is that counselors see depressed and anxious clients and clinical psychologists see more severe psychopathology like schizophrenia and bipolar d/o. This is a mischaracterization: There are probably way more clinical psychologists who study or work with depression & anxiety than there are who work with/ study schizophrenia. I think that counseling psychologists are more in the realm of life stress, marital discord, vocation troubles, etc. But I am not a counseling psychology person, so I'm not necessarily qualified to say that. I think there is more overlap than not.

 

[JockNerd]

PS- A little off topic, but in response to JackD's post above: a lot of people imply that the difference between clinical and counseling is that counselors see depressed and anxious clients and clinical psychologists see more severe psychopathology like schizophrenia and bipolar d/o. This is a mischaracterization: There are probably way more clinical psychologists who study or work with depression & anxiety than there are who work with/ study schizophrenia. I think that counseling psychologists are more in the realm of life stress, marital discord, vocation troubles, etc. But I am not a counseling psychology person, so I'm not necessarily qualified to say that. I think there is more overlap than not.

Eeeeh it depends. Counseling Psych tends to stay away from things like schizophrenia, but depression and especially anxiety are well within the purview of our training. We definitely don't just focus on life stress or vocational counseling (although the latter is a mainstay of applied counseling psych). As an example, I'm in Counseling psych, but I'm making contacts now to spend my third year working with sex offenders.

 

[JackD]

I'm making contacts now to spend my third year working with sex offenders.

You're living the dream my friend.

 

[JockNerd]

You're living the dream my friend.

It's funny that I have absolutely no clue whether this is sarcasm or not. I get such mixed reactions to my educational passions.

 

[Therapist4Chnge]

It's funny that I have absolutely no clue whether this is sarcasm or not. I get such mixed reactions to my educational passions.

I'm glad there are people out there who are passionate for this particular group, as they are often in need of help and many choose not to work in this area (myself included).

As for counseling vs. clinical...there is a thread on this at the top of the forum.

As for the assessment stuff....presentation is often tricky because many DON'T want to get labeled, so instead they mask their symptoms and/or lie. It often takes some prying and exploration to get the necessary information. I liken being able to Dx to figuring out someone's religion. You may be able to figure out that they are Christian....but are they Catholic, Protestant, Baptist....etc? It is all in the nuance.

-t

 

[73BARMYPgsp]

So the problem is that you can narrow it down with the tests but you are only left with a general category? Would a test come out saying your client has an "Anxiety Disorder" but you just look at it and say "ok, now which one?"

There is one that I can think of off hand that offers a confirmation--yes or no--of a specific diagnosis. The CAPS. (Clinician Administered PTSD Scale). It tells you whether or not the person meets "criterion A" (Necessay for the Dx) and then gives you a very good idea about the nature and severity of their symptoms or "the flavor" of how that particular person experiences it. It takes about an hour and a half to do, and you have to know what you are doing. I know there are others that are very Dx specific like that, I just happen to work with the CAPS alot. But in general, everyone has pretty much made it clear--they are not for diagnosis but rather for helping confirm your hypothesis.

 

[RileyG]

Maybe I should've posted this under the thread to distract yourself. Regardless, here's an "assessment" that shows what not to do.

NSFW and if you are easily offended, ignore this bc it's definitely not PC...

http://www.funnyordie.com/videos/f02d0b8cca

 

[JackD]

So let me shift us to mental health counseling for one second, as i am intrigued by this field as well. Would someone who is a mental health counselor have less to do with the assessment aspect and more to do with the therapy? Would someone else assess the client and they then hand that person off to you for dealing with the treatment. Like you be sitting there and someone would say "this guy has generalized anxiety disorder. Treat him".

I was talking to an admissions advisors at two of the schools i am looking at and they both asked "are you more interested in performing tests or therapy?" I don't quiet remember which degrees they said each was related to though.

 

[Therapist4Chnge]

So let me shift us to mental health counseling for one second, as i am intrigued by this field as well. Would someone who is a mental health counselor have less to do with the assessment aspect and more to do with the therapy? Would someone else assess the client and they then hand that person off to you for dealing with the treatment. Like you be sitting there and someone would say "this guy has generalized anxiety disorder. Treat him".

I was talking to an admissions advisors at two of the schools i am looking at and they both asked "are you more interested in performing tests or therapy?" I don't quiet remember which degrees they said each was related to though.

They would still do a clinical interview (it may vary....I don't know their training), do suicide assessments, and maybe some self-report measures (BDI, BAI, etc)....but not something like IQ testing, ADHD, personality testing, etc.

-t

 

[73BARMYPgsp]

They would still do a clinical interview (it may vary....I don't know their training), do suicide assessments, and maybe some self-report measures (BDI, BAI, etc)....but not something like IQ testing, ADHD, personality testing, etc.

-t

Agreed. As of right now, clinical psychologists get to claim the territory of assessment (well, testing). That is one of the things that seperates us from everyone else.

 

[RayneeDeigh]

Speaking of IQ testing (sorry to hijack the thread for a moment), when you guys were learning the WAIS did your program require you to reach a certain number of mastery criterion before you were able to move on? I'm learning it right now and we have to get 90% of the standardized procedures correct and it's killing me. I had my first administration today and it was such a hilarious event.

 

[Therapist4Chnge]

Speaking of IQ testing (sorry to hijack the thread for a moment), when you guys were learning the WAIS did your program require you to reach a certain number of mastery criterion before you were able to move on? I'm learning it right now and we have to get 90% of the standardized procedures correct and it's killing me. I had my first administration today and it was such a hilarious event.

I think 90% was what we needed. After learning each sub-test, research behind it, and etc in class, we had to 'test out' and get a 90% or above. Once we did that, then we had to give a certain number of assessments, and audio tape/video tape each. It was a PITA, but it was great for training.

 

[Ollie123]

Oh the things I have to look forward to.

We've just done psychopathology assessment so far. We get a 1 or 2 week "neuropsych bootcamp" this summer to get trained on WAIS/WISC/etc. Now you have me nervous RD😉

 

[RayneeDeigh]

I think 90% was what we needed. After learning each sub-test, research behind it, and etc in class, we had to 'test out' and get a 90% or above. Once we did that, then we had to give a certain number of assessments, and audio tape/video tape each. It was a PITA, but it was great for training.

ugh the taping is the worst. Just TRY to act natural when you've got a camera above your head looking down on the table and another one across the room recording your every move.

Oh the things I have to look forward to.

We've just done psychopathology assessment so far. We get a 1 or 2 week "neuropsych bootcamp" this summer to get trained on WAIS/WISC/etc. Now you have me nervous RD😉

It's not as scary as the first half of my assessment class was (personality assessment) because there are set rules that you need to follow. That probably says something about me, haha. My advice is to put post-it note messages to yourself all over your WAIS book so while you flip through it when you're with a client you know what the heck you're doing. And practice, tons. Tell your friends to pretend that they have a learning disability so you'll need to practice reversal rules and stuff (that'll make sense later, haha)

 

[Therapist4Chnge]

ugh the taping is the worst. Just TRY to act natural when you've got a camera above your head looking down on the table and another one across the room recording your every move.

Get use to it....as you'll most likely have to do this throughout your training. I eased into it because we audio-taped first, and then video taped our last (practice) ones. I got over it quick because we use to video tape mock presentations at my own firm, and we'd pick it apart while playing it on a projector....which really stunk the first few times.

It's not as scary as the first half of my assessment class was (personality assessment) because there are set rules that you need to follow. That probably says something about me, haha. My advice is to put post-it note messages to yourself all over your WAIS book so while you flip through it when you're with a client you know what the heck you're doing. And practice, tons. Tell your friends to pretend that they have a learning disability so you'll need to practice reversal rules and stuff (that'll make sense later, haha)

Interesting that you start with personality. A lot of places start with IQ, which I think is a nice foray into the area. Most of the manuals in our testing library are tabbed, with the WISC/WAIS ones being the most popular. It is funny.....I don't think I've given either one in at least a year, and I think I can still give it in my sleep. It's like riding a bike........with a pencil, stop watch, set of blocks, manual, picture cars, etc.....and no bike.

 

[RayneeDeigh]

Interesting that you start with personality. A lot of places start with IQ, which I think is a nice foray into the area.

Yeah it's quite bizarre, I think it's because we need to do an integrated assessment at the end of February so they want us to have the personality background too. But my god it scared me when my first day of school in September started with "okay so you'll be booking your first interview client in the next 3 days."

 

[deleted106747]

Agreed. As of right now, clinical psychologists get to claim the territory of assessment (well, testing). That is one of the things that seperates us from everyone else.

PhD level counseling psych does a lot of assessment & testing - it is the realm of both clinical and counseling doctoral level training.

 

[biogirl215]

Coming a little late to this thread with an ancedote:
In my abnormal psych. class, our final project was to watch an assigned movie clip and fill out an intake form as though the main character was the client. The very first thing the professor told us was, "This isn't about getting the right diagnosis; it's about coming up with and justifying a possible diagnosis based on the information given. I don't expect you guys to be able to easily diagnose someone--heck, diagnosis is my job, and I still find it hard. Many, many times clinicians come us with different diagnoses. This is an art, not a science." And boy, was she right! The subject was pretty clearly psychotic, but I could have easily justified schizopherniform, schizoaffective d/o, or mania, depending on how I looked at the facts. Not to mention ruleouts for possible medical conditions. What did I learn from that assignment? Diagnosis is hard. Diagnosis is often subjective. In abnormal psych, it was easy to look at diagnosises as a yes/no clinical checklist, but even in our fake, "mickey mouse" assignment, it wasn;t about checking off little boxes based on answers; it was about collecting the data and then trying to see if the responses could maybe, possibly best fit one list of boxes a little bit more easily than others.

Just my naive, untrained, and probably incorrect $.02

 

[deleted176373]

Coming a little late to this thread with an ancedote:

"This is an art, not a science."


Just my naive, untrained, and probably incorrect $.02

Not to start a big discussion wrapped around the DSM, but really it's suppose to be a science and not an art!

I agree though, one thing that was hammered home was that regardless of your diagnosis, you have to justify your diagnosis and show the critical thinking skills that you used to arrive at it.

Mark

 

[biogirl215]

True; I should have said it's not a formulaic science. My bad!

 

[Lunabin]

... really it's suppose to be a science and not an art!

I agree though, one thing that was hammered home was that regardless of your diagnosis, you have to justify your diagnosis and show the critical thinking skills that you used to arrive at it.

And yet it is a bit of both - we spend enormous effort and skill focusing on the nuances that the DSM only 'globally' labels. For instance, seeing the actual disorder that may be masked under heavy substance abuse (because we know psych patients can self medicate)... it's an "art" in that it takes a lot of skill and not every psychologist, psychiatrist, etc. is always very good at it (rarely is anyone perfect at ALL areas of diagnostics, treatment, etc.)

Again, for the purposes of the original question, however, diagnosis is just one piece of the Psychology puzzle - it's just part of the foundation for what we do (ie-interviewing, diagnosis, assessment, intervention techniques and theory, etc.). It's all just a part of a greater whole... and grad school is a busy time. We do it all!

 

[73BARMYPgsp]

PhD level counseling psych does a lot of assessment & testing - it is the realm of both clinical and counseling doctoral level training.

Yes, but the point I was making is that assessment is "supposed" to be the thing that sets PhD's apart from MFT, LCSW, PsyD, etc. My Rorschach professor once told me that if you are not doing well in these classes, (the assessment block) you should think about transferring to a PsyD program.

 

[erg923]

How exactly does clinical assessment separate Ph.Ds and Psy.Ds? Psy.Ds are trained to the same extent in psychological assessment and report writing as Ph.D's to my knowledge. No? If not, how do they do diagnostic and assessment practicums? How do they do APA internships with no assessment experience? How do they become neuropsychologists for example? I know many Psy.D neuropsychologists who obviously are well versed in assessment/testing.

 

[Therapist4Chnge]

Yes, but the point I was making is that assessment is "supposed" to be the thing that sets PhD's apart from MFT, LCSW, PsyD, etc.

That's completely wrong. Ph.D's and Psy.D's vary in their level of focus on research, though all of the clinical skills will be the same, as that is required for licensure.

My Rorschach professor once told me that if you are not doing well in these classes, (the assessment block) you should think about transferring to a PsyD program.

If you do not do well in assessment you should think of a different career, as assessment is an important part of training, internship, possibly post-doc, and most people do at least some assessment. A BIG difference between a doctorally trained clinician and everyone else is our assessment expertise. I think I've taken at least half a dozen assessment coureses during my training (objective, projective, interviewing, intelligence/IQ, behavioral, etc), and that doesn't even include any neuropsych or subject specific assessment that is often used in practice.

 

[73BARMYPgsp]

Gosh, I really I had no idea this would be such a big deal. I got a PM telling me how wrong I was too. Let me try to clarify one more time.

PhD programs try to "sell" their product to prospective students by identifying 2 things that make them different from everything else-

1. Research
2. Assessment/psychometrics

This is what I remember from every discussion or interview I had when I was an applicant. If it is not true, may God stirke me dead.

Whether or not it is a realistic distinction is a perfectly legitimate debate to have, and NO PsyD's have to take it personally.

 

[erg923]

We didn't mean to gang up on you and I am actually in a Ph.D. program, not a Psy.D., so I wasn't taking it personally. I just had NEVER heard that distinction from ph.d to psy.d, even among the most steadfast boulder-model advocates. Again, I really think the difference lies in research training. All my Psy.D buddies at other programs are trained exactly the same as me on WAIS/WISC, MMPI-2, Rorshach, etc....😀.

 

[Therapist4Chnge]

PhD programs try to "sell" their product to prospective students by identifying 2 things that make them different from everything else-

1. Research
2. Assessment/psychometrics

This is what I remember from every discussion or interview I had when I was an applicant. If it is not true, may God stirke me dead.

Whether or not it is a realistic distinction is a perfectly legitimate debate to have, and NO PsyD's have to take it personally.

The reason why you got such a response is you posited it as fact, and not as something up for a legitimate debate. There is a great deal of misinformation floating around about clinical degrees, training, etc. I welcome any and all discussion, though it is important to differentiate what is factual and what is not.

 

[73BARMYPgsp]

The reason why you got such a response is you posited it as fact, and not as something up for a legitimate debate. There is a great deal of misinformation floating around about clinical degrees, training, etc. I welcome any and all discussion, though it is important to differentiate what is factual and what is not.

Well, that makes sense.

However, the other "evidence" I have (has an N=1) is my own school's differentiation. (We have both programs here). The PsyD's do not take as many assessment classes as we do and they do not have an assessment competency exam like we do. They have a clinical comp and they do something else to test their skills in research and assessment. (I think they do vignettes and case formulations or something) So at least at this school, it is a lesser focus for them. But--my present practicum is a research/assessment practicum and the other 2 students are PsyD's. Guess what? I can't tell the difference, so it really makes no difference to me.

 

[Therapist4Chnge]

Well, that makes sense.

However, the other "evidence" I have (has an N=1) is my own school's differentiation. (We have both programs here). The PsyD's do not take as many assessment classes as we do and they do not have an assessment competency exam like we do.

That is odd, as the APA requires certain classes from every accredited program, though most programs have additional assessment classes available for those who want them (neuro, advanced projectives, etc). My program also has a Ph.D and Psy.D. program and the only difference in classes are in regard to a couple more statistics classes and additional research credits vs. additional intervention classes and electives.

 

[Ollie123]

I think there are probably SOME differences in terms of assessment training between PhD and PsyD, but it has little to do with the actual assessment class.

PsyDs focus more in administering the test, PhDs focus more on how to develop the tests. A PsyD is probably going to spend more time learning IS the test valid and reliable for group x and y, whereas the PhD is going to learn the methods for setting up a study to prove whether or not it is valid and reliable.

If that's what the professor meant, than I'm inclined to agree. If they meant that PsyDs don't learn assessment, I think THEY ought to rethink being in the field when they don't even know what the various degrees qualify people to do😉

I agree about the importance of assessment for those doing clinical work, but I don't think its the end of the world if its not an academics strong point. Obviously there's a big difference between not being great at it and being completely incompetent - there's still a baseline level you have to meet. I've had limited experiences thus far but I seem to do fairly well with it. However I don't expect it to be an overly vital area for my career since chances are my only use of it will be in screening out participants with severe psychopathology, so even if I did find it a struggle as long as I was able to manage I don't think it would warrant changing careers.

 

[73BARMYPgsp]

I think there are probably SOME differences in terms of assessment training between PhD and PsyD, but it has little to do with the actual assessment class.

PsyDs focus more in administering the test, PhDs focus more on how to develop the tests. A PsyD is probably going to spend more time learning IS the test valid and reliable for group x and y, whereas the PhD is going to learn the methods for setting up a study to prove whether or not it is valid and reliable.

If that's what the professor meant, than I'm inclined to agree. If they meant that PsyDs don't learn assessment, I think THEY ought to rethink being in the field when they don't even know what the various degrees qualify people to do😉

I agree about the importance of assessment for those doing clinical work, but I don't think its the end of the world if its not an academics strong point. Obviously there's a big difference between not being great at it and being completely incompetent - there's still a baseline level you have to meet. I've had limited experiences thus far but I seem to do fairly well with it. However I don't expect it to be an overly vital area for my career since chances are my only use of it will be in screening out participants with severe psychopathology, so even if I did find it a struggle as long as I was able to manage I don't think it would warrant changing careers.

I think, if anything, this is difference observed for me. Development is something me and my Army colleagues are doing quite a bit of, and none of them are PysD's. When I think about all the readings and research I am doing on development of instruments, including theories about how people respond and behave when taking tests, as well as rationale for inclusion/exclusion of items, it's all written by PhD's. That is probably more a function of the research side of PhD than anything else though.

It certainly makes sense, however, that if I want to administer and score tests, PhD/Psyd should not make a lick of difference. Those are clinical skills.

 

[JackD]

There is something else i am wondering about that sort of goes along with this. Could any of you doctors or grad students start flipping through the DSM and find a ton of disorders that you had never heard of? I found out about three new disorders today, while reading about a movie on wikipedia. Is there ever going to be a point where you have heard of all of the disorders or are there just way too many?

 

[erg923]

You become pretty familiar with psychopathology, psychodiagnostics, and the DSM in grad school. I have certainly "heard" of everything in there, in the since that i know what it is and what it means. But since the DSM is a polythetic diagnostic system, I certainly cant say I've memorized the criteria for every disorder....🙂 Depending on the populations you work with though, its likely there are more than a handful that you will never diagnose in your career. I have heard DSM-V will be shaking things up a bit as well in 2012. I just read through the some of the research committee meeting on the dsm-5 website. Looks like the schizophrenia construct as we know it may change significantly. http://dsm5.org/conference5.cfm Interesting stuff!

 

[JackD]

From what i have been told, the DSM IV is pretty good but not great. At minimum it has some criticism to it. I've had very little contact with a DSM other than a quick glance through it while we were passing it around in my adjustment psychology class.

Do you ever have moments where you are using it and think "this thing is crap" or is it very, very useful nearly all the time?

 

[erg923]

Well "pretty good" can mean alot of different things JackD. Pretty good for what purpose....research protocols, inter-rater reliability, communicating symptom presentations, or actual validity of the disorders (and the criteria for the disorders) within it? Toxometrics and the nosology of psychiatric disorders is notoriously difficult, and psychiatry has struggled with it since the time of Krapelin. Obviously, DSM-IV its the best we have done so far, but it has alot of critics. Pushing toward a more dimensional model of classifications (especially for the personality disorders) is a popular position these days.

I am certainly not an expert at his point in my training on psychopathology or nosology, but my personal opinion (and the opinion of many in practice) is that few if any clients' symptom presentations fit neatly into DSM categories/diagnoses. It's rarely a "clean fit" so to speak. There is always a piece of that disorder and pieced of this disorder intermixed in the clinical presentation, but they don't necessarily fulfill the requirements to meet the threshold for the full diagnosis. You just have to realize its an artificial system, setting boxes and borders on phenomenology that are in reality, continuous variables, not discrete ones, like most medical diseases.

 

[Ollie123]

I think its crap, but I think its also kind of necessary given the current state of research. We just aren't advanced enough yet for what it should be. Part of the problem is that its heavily based off the medical model of (disease vs. no disease) which is basically only useful for insurance companies since I think at this point, its pretty well established that's not how the world of psychopathology works.

Supposedly DSM-V is moving to a partially dimensional model, which is a step in the right direction. My research interests (cross-disorder latent variables) will hopefully help me contribute to that mission later in my career🙂

 

[JackD]

Supposedly DSM-V is moving to a partially dimensional model

I think that is what my psychopathology teacher used to criticize about the DSM IV. He would say for some condition, there would be ten symptoms listed. If you had five, you had the disorder but if you had four, you are considered fine. He also talked about the beck depression inventory having that problem. If you had a 16 or something like that, you are depressed but if you have a 15, you are not depressed.

Is that the kind of problem you are talking about? Kind of the all or nothing diagnosis with no gray area?

And erg923, i don't think i have ever seen so much psychology and research jargon in one paragraph. I think i understood what you said but i do have some doubts.

 

[erg923]

Sorry JackD. You will talk like that too someday...lol. Yes, I think you are on target, what I was getting at is that it's an artificial system, that makes it all or nothing, just like medical disease. As Ollie and I pointed out, psychopathology doesn't work like that....its on a continuum. It not like diabetes or a cancerous tumor where you either have it or don't.

Thats not really correct with the Beck Depression Inventory though. It goes from none (meaning not clinically significant), to mild, to moderate, to severe. The difference between a 16 and 15 isn't depression vs: no depression. It's a very useful brief screener actually.

 

[RayneeDeigh]

I was talking to someone the other day who sat in on a talk about the new DSM. Apparently they're toying with the idea of collapsing Axis I and Axis II because personality disorders have such high comorbidity. I'm so used to thinking about them as separate from Axis I, it'll be a HUGE change if that actually happens (but an interesting one, definitely).

The dimensional thing is huge and I predict that by the time the next DSM is out everyone will be thinking in a dimensional framework anyway. Although I'm definitely interested to find out what sorts of new problems this will lead to in terms of value judgments. For instance, how does one treat someone with "more" depression as compared to someone with "less" depression.

As for the BDI, I think it's quite useful. Any sort of diagnostic test is going to have to have a cutoff for something somewhere and most people use clinical judgment and infer a sort of dimensional quality when reading test results anyway.