Clinical Assessment and Diagnosis Validity is whether something measures what it

is designed to measure—in this case, whether a

Clinical assessment technique assesses what it is supposed to.
concurrent or descriptive validity
- is the systematic evaluation and measurement of - Comparison
psychological, biological, and social factors in an - Comparing the results of an assessment measure
individual presenting with a possible under consideration with the results of others that
psychological disorder are better known allows you to begin to
Diagnosis determine the validity of the first measure
- process of determining whether the particular Ex: results of a long IQ test were essentially the
problem afflicting the individual meets all criteria same as the results from a new, brief version
for a psychological disorder, as set forth in the Predictive validity
fifth edition of the Diagnostic and Statistical - how well your assessment tells you what will
Manual of Mental Disorders, or DSM-5 (American happen in the future. For example, does it predict
Psychiatric Association, 2013). who will succeed in school and who will not
(which is one of the goals of an IQ test)?
Key Concepts in Assessment
- The process of clinical assessment in Standardization
psychopathology has been likened to a funnel - process by which a certain set of standards or
- Clinician begins by collecting a lot of information norms is determined for a technique to make its
across a broad range of the individual’s use consistent across different measurements.
functioning to determine where the source of the - Applied to the procedures of testing, scoring, and
problem may lie. After getting a preliminary sense evaluating data.
of the overall functioning of the person, the - Ex: The assessment might be given to large
clinician narrows the focus by ruling out problems numbers of people who differ on important
in some areas and concentrating on areas that
factors such as age, race, gender, socioeconomic
seem most relevant.
status, and diagnosis; their scores would be
- To understand the different ways clinicians
assess psychological problems, we need to pooled with other individuals like them and then
understand three basic concepts that help be used as a standard, or norm, for comparison
determine the value of our assessments: purposes.
reliability, validity, and standardization - Reliability, validity, and standardization are
important to all forms of psychological
Reliability assessment.
is the degree to which a measurement is
consistent Clinical assessment: strategies and procedures
that help clinicians acquire the information they
inter- rater reliability need to understand their patients and assist them.
- raters ▪ clinical interview (a mental status exam
- One-way psychologists improve their reliability that can be administered either formally or
is by carefully designing their assessment devices informally
and then conducting research on them to ensure ▪ often a thorough physical examination
that two or more raters will get the same answers ▪ behavioral observation and assessment
▪ psychological tests
test–retest reliability
- They also determine whether these assessment The Clinical Interview
techniques are stable across time. In other words, - core of most clinical work
if you go to a clinician on Tuesday and are told you - used by psychologists, psychiatrists, and other
have an IQ of 110, you should expect a similar mental health professionals.
result if you take the same test again on Thursday.
- The interview gathers information on current 3. Mood and affect.
and past behavior, attitudes, and emotions, as well Mood - predominant feeling state of the individual
as a detailed history of the individual’s life in Affect- feeling state that accompanies what we say
general and of the presenting problem. at a given
- clinicians determine when the specific problem point. “Expressed mood”/ visible reaction (facial
started and identify other events (for example, life expression)
- Usually our affect is “appropriate”; that is, we
stress, trauma, or physical illness) that might have
laugh when we say something funny or look sad
occurred about the same time
when we talk about something sad. If a friend just
Some information needed to be collected: told you his mother died and is laughing about it
▪ current and past interpersonal and social - A mental health clinician would note that your
history, including family makeup (for friend’s affect is “inappropriate.” Then again, you
example, marital status, number of might observe your friend talking about a range of
children, or college student currently living happy and sad things with no affect whatsoever-
with parents) “blunted” or “flat”
▪ individual’s upbringing
▪ sexual development, religious attitudes 4. Intellectual functioning.
(current and past) and educational history - rough estimate of others’ intellectual functioning
just by talking to them.
mental status exam- clinicians use to organize - what words would you associate with
information obtained during an interview intellectual functioning
- vocabulary, memory, intelligence
Mental Status exam - Do they seem to have a reasonable vocabulary?
- involves systematic observation of an Can they talk in abstractions and metaphors (as
individual’s behavior. This type of observation most of us do much of the time)? How is the
occurs when any one person interacts with person’s memory? Clinicians usually make a
another rough estimate of intelligence that is noticeable
only if it deviates from normal, such as concluding
- structured and detailed, but mostly they are the person is above or below average intelligence.
performed relatively quickly by experienced
clinicians in the course of interviewing or 5. Sensorium.
observing a patient. The exam covers five - The term sensorium refers to our general
categories: awareness of our surroundings.
- Does an individual know what the date is, what
1. Appearance and behavior- overt physical time it is, where he or she is, who he or she is, and
behaviors, as well as the individual’s dress, who you are?
general appearance, posture, and facial - Sensorium is clear and is oriented times three
expression. (person, place, time)
- allow the clinician to make a preliminary
2. Thought processes- rate/flow/continuity o determination of which areas of the patient’s
speech, delusions, hallucinations behavior and condition should be assessed in
- Do you ever see things or maybe hear things more detail and perhaps more formally
when you know there is nothing there? - Psychologists and other mental health
They might look for several things here, ex: does professionals are trained extensively in methods
the patient make sense when talking, or are ideas that put patients at ease and facilitate
presented with no apparent connection? In some
communication, including nonthreatening ways of
patients with schizophrenia, a disorganized
seeking information and appropriate listening
speech pattern, referred to as loose association or
derailment- sequence of unrelated or only skills.
remotely related ideas
- Information provided by patients to interviews, fully structured interviews
psychologists and psychiatrists is protected by administered wholly by a computer have not
laws of “privileged communication” or caught on, although they are used in some
confidentiality in most states; that is, even if settings.
authorities want the information the therapist has
Anxiety Disorders Interview Schedule for DSM-5
received from the patient, they cannot have access
(ADIS-5)
to it without the expressed consent of the patient. - asks first about obsessions and compulsions
- Based on a 9-point rating scale that ranges from
- only exception to this rule occurs when the “never” to “constantly,”
clinician judges that, because of the patient’s - the clinician then asks the patient to rate each
condition, some harm or danger to either the obsession
patient or someone else is imminent. At the outset on two measures:
of the initial interview, the therapist should persistence–distress- how often it occurs and how
inform the patient of the confidential nature of much distress it causes
their conversation and the (quite rare) conditions Resistance- attempts to get rid of the obsession
under which that confidence would not hold. Compulsions- patient provides a rating of their
frequency
- Despite these assurances of confidentiality and
Physical Examination
the clinician’s interview skills, patients sometimes
find it difficult to volunteer sensitive information.- Many problems presenting as disorders of
behavior, cognition, or mood may, on careful
Semi-structured Clinical interviews physical examination, have a clear relationship to
Semistructured interviews a temporary toxic state
- made up of questions that have been carefully - This toxic state could be caused by bad food, the
phrased and tested to elicit useful information in a wrong amount or type of medicine, or onset of a
consistent manner so that clinicians can be sure medical condition
they have inquired about the most important - Hyperthyroidism- may produce symptoms that
aspects of particular disorders mimic anxiety disorders, like generalized anxiety
disorder
- Clinicians may also depart from set questions to - Hypothyroidism (underactive thyroid gland)
follow up on specific issues—thus the label might produce symptoms consistent with
“semistructured.” depression
- Certain psychotic symptoms, including delusions
- wording and sequencing of questions has been or hallucinations, might be associated with the
carefully worked out over a number of years, the development of a brain tumor
clinician can feel confident that a semistructured - Withdrawal from cocaine often produces panic
interview will accomplish its purpose. attacks
- If the depression developed simultaneously with
- disadvantage: it robs the interview of some of the initiation of sedative drugs and diminished
the spontaneous quality of two people talking considerably when the drugs were discontinued,
about a problem the clinician would be likely to conclude the
depression was part of a substance-induced mood
- if applied too rigidly, a semistructured interview disorder
may inhibit the patient from volunteering useful
information that is not directly relevant to the
questions being asked. Because of these few
drawbacks associated with semistructured
Behavioral assessment researchers are using hypnosis to produce
analogue assessments (conditions that mimic
- takes this process one step further by using
real-life clinical symptoms or situations) by
direct observation to assess formally
an individual’s thoughts, feelings, and behavior in inducing symptoms of psychopathology in healthy
specific situations or contexts individuals to study these characteristics in a
- may be more appropriate than an interview in more controlled way
terms of assessing individuals who are not old
enough or skilled enough to report their problems The ABCs of Observation
and experiences - Observational assessment is usually focused on
- Clinical interviews sometimes provide limited the here and now. Therefore, the clinician’s
assessment information. For instance, young attention is usually directed to the immediate
children or individuals who are not verbal behavior, its antecedents (what happened just
because of the nature of their disorder or because before the behavior), behavior, and its
of cognitive deficits or impairments are not good consequences (what happened afterward)
candidates for clinical interviews.
- Ex; violent boy, an observer would note that the
- As we already mentioned, sometimes people sequence of events was
withhold information deliberately because it is (1) his mother asking him to put his glass in the
embarrassing or unintentionally because they sink (antecedent)
aren’t aware it is important (2) the boy throwing the glass (behavior)
(3) his mother’s lack of response (consequence)
- Others set up role-play simulations in a clinical
setting to see how people might behave in - This is an example of a relatively informal
similar situations in their daily lives/ going to observation- problem with this type of
the home/community to observe observation: relies on the observer’s recollection,
- Direct observation in naturalistic as well as interpretation, of the events
environment
Analogue, or similar settings/ simulated - Formal observation involves identifying specific
situations behaviors that are observable and measurable
- But going into a person’s home, workplace, or (called an operational definition)
school isn’t always possible or practical, so
clinicians sometimes arrange analogue, or similar, - For example, it would be difficult for two people
settings to agree on what “having an attitude” looks like.
- Analogue behavioral observation involves the An operational definition (“an attitude”), however,
measurement of a clients overt behavior in a clarifies this behavior by specifying that this is
contrived situation that is analogous to situations “any time the boy does not comply with his
that the client is likely to encounter in his or her mother’s reasonable requests.”
natural environment
- For example, one of us studies children with - Once the target behavior is selected and defined,
autism spectrum disorder. The reasons for self- an observer writes down each time it occurs,
hitting (called self-injurious) behavior are along with what happened just before
discovered by placing the children in simulated (antecedent) and just after (consequence)
situations, such as sitting alone at home, playing
with a sibling, or being asked to complete a - Goal of collecting this info: whether there are any
obvious patterns of behavior and then to design a
difficult task.
treatment based on these patterns.
- Observing how the children behave in these
different situations helps determine why they hit
themselves so that we can design a successful
treatment to eliminate the behavior. Other
 - Clinicians sometimes depend on the reactivity of
self-monitoring to increase the effectiveness of
their treatments.

Psychological Testing
- tests used to assess psychological disorders must
meet the strict standards we have noted
- must be reliable so that two or more people
administering the same test to the same person
will come to the same conclusion about the
problem
- must be valid so that they measure what they
say they are measuring
Self-Monitoring - Psychological tests include specific tools to
- technique known as self-monitoring or self- determine cognitive, emotional, or behavioral
observation - observe their own behavior to responses that might be associated with a specific
find patterns disorder and more general tools that assess long
Checklists and behavior rating scales standing personality features
- more formal and structured way to observe - Intelligence testing- determine the structure
behavior and patterns of cognition
- are used as assessment tools before treatment - Neuropsychological testing - determines the
and then periodically during treatment to assess possible contribution of brain damage or
changes in the person’s behavior dysfunction to the patient’s condition.
- Neuroimaging - uses sophisticated technology
Brief Psychiatric Rating Scale to assess brain structure and function
- assesses 18 general areas of concern
- Each symptom is rated on a 7-point scale from 0 Projective Testing
(not present) to 6 (extremely severe) - known as projective tests
- The rating scale screens for moderate to severe - They include a variety of methods in which
psychotic disorders and includes such items as ambiguous stimuli, such as pictures of people or
somatic concern (preoccupation with physical things, are presented to people who are asked to
health, fear of physical illness, hypochondriasis), describe what they see
guilt feelings (self-blame, - The theory here is that people project their own
shame, remorse for past behavior), and personality and unconscious fears onto other
grandiosity (exaggerated self-opinion, arrogance, people and things—in this case, the ambiguous
conviction of unusual power or abilities) stimuli—and, without realizing it, reveal their
unconscious thoughts to the therapist
Reactivity
- A phenomenon that can distort any Hermann Rorschach
observational data. Any time you observe how - Swiss physician
people behave, the mere - developed a series of inkblots, initially to study
fact of your presence may cause them to change perceptual processes and then to diagnose
their behavior psychological disorders.
- The same phenomenon occurs if you observe - Rorschach inkblot test is one of the early
your own behavior, or selfmonitor projective tests. In its current form, the test
- Behaviors people want to increase, such as includes 10 inkblot pictures that serve as the
talking more in class, tend to increase, and ambiguous stimuli. The examiner presents the
behaviors people want to decrease, such as inkblots one by one to the person being assessed,
smoking, tend to decrease when they are self- who responds by telling what he sees
monitored
- extremely controversial because of the lack of Personality inventories
data on reliability or validity, among other things
Face validity
John Exner’s - The questions in psychological tests published in
- developed a standardized version of the mainstream magazines typically make sense when
Rorschach inkblot test, called the Comprehensive you read them
System - The wording of the questions seems to fit the
- Exner’s system of administering and scoring the type of information desired
Rorschach specifies how the cards should be
presented, what the examiner should say, and Paul Meehl
how the responses should be recorded - pointed out that what is necessary from these
- critics of the Rorschach question whether types of tests is not whether the questions
research on the Comprehensive System supports necessarily make sense on the surface but, rather,
its use as a valid assessment technique for people what the answers to these questions predict
with psychological disorders - If we find that people who have schizophrenia
tend to respond “true” to “I have never been in
Thematic Apperception Test (TAT) love with anyone,” then it doesn’t matter whether
- best known projective test after the Rorschach we have a theory of love and schizophrenia
- developed in 1935 by Christiana Morgan and - What matters is if people with certain disorders
Henry Murray at the Harvard Psychological Clinic tend, as a group, to answer a variety of questions
- consists of a series of 31 cards: 30 with pictures in a certain way, this pattern may predict who else
on them and 1 blank card, although only 20 cards has this disorder
are typically used during each administration - The content of the questions becomes irrelevant.
- Unlike the Rorschach, which involves asking for The importance lies in what the answers predict
a fairly straightforward description of what the Minnesota Multiphasic Personality Inventory
test taker sees, TAT ask the person to tell a (MMPI)
dramatic story about the picture. The tester - most widely used personality inventory in the
presents the pictures and tells the patient, “This is United States
a test of imagination, one form of intelligence.” - developed in the late 1930s and early 1940s
- TAT is based on the notion that people will - first published in 1943
reveal their unconscious mental processes in their - based on an empirical approach, that is, the
stories about the pictures collection and evaluation of data
Variations of the TAT - individual being assessed reads statements and
• Children’s Apperception Test (CAT) answers either “true” or “false.”
• Senior Apperception Technique (SAT) - Following are some statements from the MMPI:
• formal scoring systems for TAT stories,
including the Social Cognition and Object ● Cry readily
Relations Scale ● Often happy for no reason
● Am being followed
- Despite the popularity and increasing ● Fearful of things or people that can’t hurt me
standardization of these tests, most clinicians who
use projective tests have their own methods of - little room for interpretation of MMPI responses,
administration and interpretation unlike responses to projective tests such as the
- When used as icebreakers, for getting people to Rorschach and the TAT
open up and talk about how they feel about things - problem with administering the MMPI, however,
going on in their lives, the ambiguous stimuli in is the time and tedium of responding to the 550
these tests can be valuable tools items on the original version and now the 567
- Their relative lack of reliability and validity, items on the MMPI-2
however, makes them less useful as diagnostic - A version of the MMPI that is appropriate for
tests adolescents is also available— MMPI-A (published
in 1992)
- Individual responses on the MMPI are not - child’s mental age /divided by the child’s
examined; instead, the pattern of responses is chronological age x 100 to get the = IQ score
reviewed to see whether it resembles patterns - current test use a Deviation IQ- A person’s score
from groups of people who have specific disorders is compared only with scores of others of the
- clinicians can have these responses scored by same age. The IQ score, then, is an estimate of how
computer; the program also includes an much a child’s performance in school will deviate
interpretation of the results from the average performance of others of the
same age
Scales that determine the validity of each
administration: David Wechsler
Lie scale- a statement such as “Have hurt - tests include: versions for adults (Wechsler Adult
someone when angry,” when answered “false” Intelligence Scale, third edition, or WAIS-III),
might be an indication that the person may be children (Wechsler
falsifying answers to look good Intelligence Scale for Children, fourth edition, or
Infrequency scale- measures false claims about WISC-IV)
psychological problems or determines whether young children
the person is answering randomly (Wechsler Preschool and Primary Scale of
Subtle Defensiveness scale- assesses whether the Intelligence, third edition, or WPPSI-III)
person sees herself in unrealistically positive - these tests contain:
ways verbal scales- measure vocabulary, knowledge of
- Reliability and Validity of MMPI is high facts, short-term memory, and verbal reasoning
skills
performance scales- assess psychomotor abilities,
Intelligence Testing nonverbal reasoning, and ability to learn new
relationships
- intelligence tests were developed for one specific
purpose: to predict who would do well in school - biggest mistakes non-psychologists (and a
- In 1904, a French psychologist, Alfred Binet, distressing number of psychologists) make is to
and his colleague, Théodore Simon, were confuse IQ with intelligence
commissioned by IQ tests - measure abilities such as attention,
the French government to develop a test that perception, memory, reasoning, and verbal
would identify “slow learners” who would benefit comprehension
from remedial help - tend to be reliable, and to the extent that
- two psychologists identified a series of tasks that
they predict academic success, they are valid
presumably measured the skills children need to
assessment tools.
succeed in school, including tasks of attention,
perception, memory, reasoning, and verbal Intelligence - ability to adapt to the environment,
comprehension the ability to generate new ideas, and the ability to
Lewis Terman process information efficiently
- In 1916, from Stanford University
- translated a revised version of this test for use in - delirium and intellectual disability - disorders
the United States that involve cognitive impairment. And IQ tests
- became known as the Stanford-Binet test are typically used in assessing these disorders
- test provided a score known as an intelligence
quotient, or IQ
Neuropsychological tests
- Initially, IQ scores were calculated by using the
- measure abilities in areas such as receptive and
child’s mental age. For example, a child who
expressive language, attention and concentration,
passed all questions on the 7-year-old level and
none of the questions on the 8-year-old level memory, motor skills, perceptual abilities, and
received a mental age of 7. learning and abstraction in such a way that the
Neuropsychological Testing
clinician can make educated guesses about the - possibility of false results is particularly
person’s performance and the possible existence troublesome for tests of brain dysfunction
of brain impairment - neuropsychological tests- used primarily as
- this method of testing assesses brain dysfunction screening devices and are routinely paired with
by observing the effects of the dysfunction on the other assessments to improve the likelihood that
person’s ability to perform certain tasks real problems will be found
Bender Visual–Motor Gestalt Test - do well with regard to measures of reliability
- simple neuropsychological test often used with and validity
children - downside: can require hours to administer and
- child is given a series of cards on which are are therefore not used unless brain damage is
drawn various lines and shapes suspected.
- The task is for the child to copy what is drawn
on the card Neuroimaging: Pictures of the Brain
- This test is less sophisticated than other Neuroimaging
neuropsychological tests because the nature or - take increasingly accurate pictures of the
location of the problem cannot be determined structure and function of the brain
with this test - can be divided into 2 categories
- useful for psychologists, however, because it 1. One category includes procedures that examine
provides a simple screening instrument that is the structure of the brain, such as the size of
easy to administer and can detect possible various parts and whether there is any damage.
problems 2. second category are procedures that examine
the actual functioning of the brain by mapping
2 of the most popular advanced tests of organic blood flow and other metabolic activity
(brain) damage that allow more precise
determinations of the location of the problem are; Images of Brain Structure (2)
- developed in the early 1970s
1. Luria-Nebraska Neuropsychological Battery - X-rays are passed directly through the head
- degree of blockage is picked up by detectors in
2. Halstead-Reitan Neuropsychological Battery the opposite side of the head
- includes the Rhythm Test - asks the person to 1. Computerized axial tomography (CAT) scan
compare rhythmic beats, thus testing sound or CT scan
recognition, attention, and concentration - X-ray exposures of the brain from different
- the Strength of Grip Test - compares the grips of angles
the right and left hands - computer then reconstructs pictures of various
- and the Tactile Performance Test - requires the slices of the brain
test taker to place wooden blocks in a form board - takes about 15 minutes, noninvasive, useful in
while blindfolded, thus testing learning and identifying and locating abnormalities in the
memory skills structure or shape of the brain.
- useful in locating brain tumors, injuries, and
- Battery of tests to assess a variety of skills in other structural and anatomical abnormalities.
adolescents and adults One difficulty, however, is that these scans, like all
- useful for detecting organic damage- about 80% X-rays, involve repeated x-radiation, which poses
correct some risk of cell damage

- These types of studies, however, raise the issue 2. Magnetic resonance imaging (MRI)
of false positives and false negatives - patient’s head is placed in a high-strength
false positive - shows a problem when none magnetic field through which radio frequency
exists signals are transmitted
false negative - no problem is found even though - These signals “excite” the brain tissue, altering
some difficulty is present the protons in the hydrogen atoms
- The alteration is measured, along with the time it 2. Single photon emission computed
takes the protons to “relax” or return to normal tomography (SPECT)
- Where there are lesions or damage, the signal is - different tracer substance is used and this
lighter or darker procedure is somewhat less accurate
- originally took as long as 45 minutes - newer - It is also less expensive, however, and requires
versions of MRI procedures take as little as 10 far less sophisticated equipment to pick up the
minutes signals. Therefore, SPECT is used more often than
- MRI is more expensive than a CT PET scans
- disadvantage: someone undergoing the
procedure is totally enclosed inside a narrow tube 3. Functional MRI, or fMRI
with a magnetic coil surrounding the head. People - Using sophisticated computer technology, these
who are somewhat claustrophobic often cannot procedures take only milliseconds and, therefore,
tolerate an MRI can actually take pictures of the brain at work,
recording its changes from one second to the next
Images of Brain Functioning (5) - largely replaced PET scans
1. Positron emission tomography (PET) scan - allow researchers to see the immediate response
of the brain to a brief event, such as seeing a new
- injected with a tracer substance attached to face
radioactive isotopes, or groups of atoms; this
substance interacts with blood, oxygen, or glucose 4. BOLD-fMRI (Blood-Oxygen Level-Dependent
- When parts of the brain become active, blood, fMRI)
oxygen, or glucose rushes to these areas of the - currently the most common fMRI technique used
brain, creating “hot spots” picked up by detectors to study psychological disorders
that identify the location of the isotopes 5. Radiolabeled neuroreceptor ligands
- we can learn what parts of the brain are working - view the brain all the way down to the level of
and what parts are not the synapse
- To obtain clear images, the individual - detect activity at the receptors for
undergoing the procedure must remain neurochemicals such as dopamine and serotonin
motionless for 40 seconds or more - radioactive chemicals designed to congregate at
- show the precise location of the active areas. Are specific receptor sites in SPECT and PET imaging
also useful in supplementing MRI and CT scans to study the distribution and density of
when localizing the sites of trauma resulting from neuroreceptors
head injury or stroke, as well as when localizing
brain tumors Psychophysiological Assessment
- used increasingly to look at varying patterns of ▪ Psychophysiological assessment-
metabolism that might be associated with another method for assessing brain
different disorders structure and function specifically and
- Recent PET scans have demonstrated that many nervous system activity
patients with early Alzheimer’s-type dementia ▪ Psychophysiology
show reduced glucose metabolism in the parietal - refers to measurable changes in the
lobes nervous system that reflect emotional or
- intriguing findings have been reported for psychological events
obsessive-compulsive disorder and bipolar - The measurements may be taken either
disorder directly from the brain or peripherally
- PET scanning is expensive: the cost is about $6 from other parts of the body
million to set up a PET facility and $500,000 a ▪ Electroencephalogram (EEG)
year to run it. Therefore, these facilities are - Measuring electrical activity in the head
available only in large medical centers related to the firing of a specific group of
neurons reveals brain wave activity;
 - brain waves come from the low-voltage Diagnosing Psychological Disorders
electrical current that runs through the - MSE are some other tools
neurons - form general conclusions- how did it last,
treatment
▪ Event-related potential (ERP) or evoked - Establish a prognosis- likely future course of a
potential disorder
- EEG patterns are recorded in response to
specific events such as hearing a Idiographic strategy
psychologically meaningful stimulus- In a - unique about an individual’s personality, cultural
normal, healthy, relaxed adult, waking background, or circumstances
activities are characterized by a regular
pattern of changes in voltage called alpha Nomothetic strategy.
wave - determine a general class of problems to which
the presenting problem belongs
▪ Electrodermal responding - attempting to name or classify the problem
- formerly referred to as galvanic skin - When we identify a specific psychological
response (GSR) disorder, such as a mood disorder, in the clinical
- a measure of sweat gland activity setting, we are making a diagnosis. We can also
controlled by the peripheral nervous identify a general class or grouping of problems
system (PNS). by determining a particular personality profile on
a psychological test such as the MMPI
▪ Post-traumatic stress disorder additional terms:
▪ - Stimuli such as sights and sounds 1. classification - simply to any effort to construct
associated with the trauma evoke strong groups or categories and to assign objects or
psychophysiological responses, even if the people to these categories on the basis of their
patient is not fully aware that this is shared attributes or relations
happening 2. taxonomy- which is the classification of entities
for scientific purposes, such as insects, rocks, or—
Psychophysiological assessment is also used with if the subject is psychology — behaviors
many sexual dysfunctions and disorders. 3. nosology- study of diseases, classifications and
- For example, sexual arousal can be assessed nomenculture;
through direct measurement of penile - apply a taxonomic system to psychological or
circumference in males or vaginal blood flow in medical phenomena; infectious diseases
females in response to erotic stimuli, usually 4. nomenclature- describes the names or labels
movies or slides of the disorders that make up the nosology: e.g
anxiety/ mood disorders
▪ Biofeedback- levels of physiological
responding, such as blood pressure Classification Issues
readings, are fed back to the patient Classification
(provided on a continuous basis) by meters - is at the heart of any science,
or gauges so that the patient can try to - and much of what we have said about it is
regulate these responses common sense
- In your biology or geology courses, when you
- monitoring heart rate during relaxation study insects or rocks, classification is
exercises, are more common fundamental. Knowing how one species of insects
differs from another allows us to study its
functioning and origins.
- When we are dealing with human behavior or
human behavioral disorders, however, the subject
of classification becomes controversial
- Even among those who recognize the necessity moderately depressed (5), and mildly manic (2) to
of classification, major controversies have arisen create a profile of emotional functioning (10, 5, 2).
in several areas. Within psychopathology, for
example, definitions of “normal” and “abnormal” 3. Prototypical approach
are questioned, as is the assumption that a - certain essential characteristics of an entity so
behavior or cognition is part of one disorder and that you (and others) can classify it, but it also
not another allows certain nonessential variations that do not
- For better or worse, classifying behavior and necessarily change the classification
people is something we all do. Few of us talk - For example, if someone were to ask you to
about our own emotions or those of our friends by describe a dog, you could easily give a general
using a number on a scale (where 0 is totally description (the essential, categorical
unhappy and 100 is totally happy) characteristics), but you might not exactly
describe a specific dog
Categorical and Dimensional Approaches - Dogs come in different colors, sizes, and even
species (the nonessential, dimensional variations),
1. Classical (or pure) categorical approach but they all share certain doggish characteristics
- originates in the work of Emil Kraepelin (1856– that allow you to classify them separately from
1926) and the biological tradition in the study of cats.
psychopathology - Thus, requiring a certain number of prototypical
criteria and only some of an additional number of
criteria is adequate.

- When a prototypical approach is used in

classifying a psychological disorder, many
Categorical Model possible features or properties of the disorder are
- assumes each personality disorder is a separate listed, and any candidate must meet enough of
and distinct category, i.e. separate from other them to fall into that category
personality disorders and distinct from “normal” - As you can see, the criteria include many
personalities nonessential symptoms, but if you have either
- book: assume that every diagnosis has a clear depressed mood or marked loss of interest or
underlying pathophysiological cause, such as a pleasure in most activities and at least four of the
bacterial infection or a malfunctioning endocrine remaining eight symptoms, you come close
system, and that each disorder is unique enough to the prototype to meet the criteria for a
- abnormal or normal major depressive episode
- pregnant or not pregnant- little bit pregnant - One person might have depressed mood,
significant weight loss, insomnia, psychomotor
2. Dimensional approach agitation, and loss of energy, whereas another
- in which we note the variety of cognitions, person who also meets the criteria for major
moods, and behaviors with which the patient
depressive episode might have markedly
presents and quantify them on a scale
diminished interest or pleasure in activities,
Dimensional Model
fatigue, feelings of worthlessness, difficulty
- views various personality features along several
thinking or concentrating, and ideas of
continuous dimensions (or continuums). In this
committing suicide
dimensional approach, personality disorders
would represent the extremes along a continuum
of otherwise normal, healthy personality
dimensions.
- For example, on a scale of 1 to 10, a patient
might be rated as severely anxious (10),