Abnormal Psychology Feature — Part B: Clinical Assessment & Diagnosing

This piece is a part of a collection of blogs highlighting psychology. The compilation will feature six individual series about abnormal psychology, educational psychology, developmental psychology, cognitive psychology, health psychology, and experimental psychology. Our staff writers are working together with our Research + Development team to bring you accurate research that is digestible, entertaining and engaging to read. Thank you for reading and learning with us! 

Written by: Mikaela Brewer

Contributing author & researcher: Benetta Wang

Clinical Assessments & Key Concepts

A clinical assessment of a client is an ongoing process of compiling information and drawing conclusions, which can only be made after careful observation, various types of tests, and interviews. Here, a course of action is determined based on presented symptoms. For example, a few questions that might arise are: is treatment needed? Which treatment would work the best? After treatment is employed, is it effective?

Some key concepts include reliability, validity, and standardization. 

Reliability: The assessments made should be reliable and consistent. There are a few types of reliability — inter-rater reliability, which ensures that two different raters are consistent in their assessment of patients; and test-retest reliability, which is the expectation of consistent results if a patient were to take the same test on two different days. 

Validity: Assessments and tests should measure what they say they measure. There are a few types of validity — concurrent or descriptive validity is how well a new test measures up to a precedented and proven test. Predictive validity is when a tool accurately measures and predicts future events. 

Standardization: The experience of one patient during an assessment should be the same as another patient’s experience during the same assessment. Standardization requires clear rules, norms, and procedures. To ensure that any given score’s meaning is clear, mental health professionals should work to interpret all results congruently. 

Methods of Assessment

There are several ways to conduct assessments — observation, clinical interviews, psychological tests and inventories, neurological tests, physical examinations, behavioural assessments, and intelligence tests. Let’s dive into what each branch of assessment encompasses. 

Observation can be conducted in two different ways. The first is through naturalistic observation, which is simply observing someone in their environment. Laboratory observation occurs in a controlled, and often artificial setting, alongside the use of sophisticated equipment, recorded experiments, or one-way mirrors. Importantly, laboratory observation can be limiting, as it might disrupt the natural course of behaviour — a process called reactivity. 

Clinical interviews are face-to-face encounters between a patient and mental health professional. These interactions are designed to allow the mental health professional to gather data about the patient, such as their behaviour, attitudes, current situation, personality, and life history. To organize information collected during an interview, mental status examinations are used to evaluate the patient via a series of questions. Notably, clinical interviews lack reliability, especially if they are unstructured. 

Psychological tests and inventories fall into a few different camps. Psychological tests assess the personality, social skills, cognitive abilities, emotions, behavioural responses, and interests of the patient. Projective tests utilize simple, ambiguous stimuli and elicit an unlimited number of responses. For example, see the Rorschach (inkblot) test or the Thematic Apperception Test (TAT). Personality inventories ask clients to state whether each item in a long list of statements applies to them. These statements typically ask questions about feelings, behaviours, or beliefs. For example, see the Minnesota Multiphasic Personality Inventory-2 (MMPI-2).

Neurological tests are used to more precisely diagnose changes in brain activity or cognitive impairments caused by brain damage, tumours, infections, or head injuries. This information is typically gathered through Positron Emission Tomography (PET) scans, which are used to study brain chemistry; Magnetic Resonance Imaging (MRI), which provides 3D images of the brain and body structures through magnetic fields and computers; or Computed tomography (CT) scans, which take X-rays of the brain at a variety of angles. 

Physical examinations are similar to check-ups and are conducted to observe potential organic conditions, such as hormonal irregularities (hyperthyroidism), which may cause symptoms that mimic mental disorders. This is why many mental health professionals recommend that patients additionally see a physician.

Behavioural assessments measure a target behaviour that needs to be reduced or increased. Mental health professionals often refer to the ABC method here — antecedents, behaviours, and consequences — an environment or stimuli triggers a behaviour (antecedent), which is what one does, says, thinks, or feels (behaviour), and the outcome of this behaviour either encourages or discourages its use and occurrence in the future (consequence). 

Intelligence tests determine a patient’s cognitive level of functioning. They typically consist of a series of tasks, asking the patient to use both verbal and nonverbal skills. For example, see the Stanford-Binet Test. Importantly, these tests are often criticized for not predicting future behaviours. 

Diagnosing & classifying abnormal behaviour

Abnormal behaviour is diagnosed as either a clinical diagnosis or a syndrome, and is classified through a detailed diagnostic system — a list of disorders organized into distinct, clearly described categories and criteria. The most widely used systems are the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM -5) produced by the American Psychiatric Association (APA) or the International Statistical Classification of Diseases and Related Health Problems 11th edition (ICD-11) published by the World Health Organization (WHO). 

A clinical diagnosis is the process of compiling assessment data to determine if a pattern of symptoms maps to the diagnostic criteria for a specific mental disorder, embedded in an established classification system, such as the DSM-5 or ICD-11 mentioned above. However, receiving a diagnosis does not necessarily incite treatment requirements.

A syndrome is a regular clustering of symptoms. If these symptoms additionally follow a predictable course, they are considered characteristics of a specific disorder.

Thank you for reading! Key terms are underlined and/or italicized. Check back in for more about abnormal psychology coming soon! 

Sources

I’d love to hear from you: mbrewer@magnifywellness.org

Listen to the audio version of this blog: here!

Artwork designed by: Ella Kang 

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