G543 Applied Question (June 2010)
Diagnosing
dysfunctional behaviour
b)
Discuss limitations of diagnosing dysfunctional behaviour
(15 marks)
In order to treat dysfunctional behaviour and help
people through clinical psychology, it is necessary to diagnose dysfunctional
behaviour, which consists of both defining what dysfunctional behaviour is, and
then classifying it. However, with both of these steps, there are limitations.
Furthermore, actually implementing the diagnoses, even after classifying it
with the DSM or ICD, has limitations of subjectivity.
One of the main limitations of diagnosing
dysfunctional behaviour is actually trying to define what dysfunctional
behaviour is, because everybody varies, and what one person sees as
dysfunctional may actually be quite normal or adaptive for somebody else. This could be seen in Rosenhan’s study “On
being sane in insane places”, where behaviour such as waiting for food was
misinterpreted as the participant being “oral-acquisitive”. Rosenhan and
Seligman formulated criteria for defining behaviour as dysfunctional, but this
has limited validity for a number of reasons. For example, the inclusion of
Jahoda’s list of “ideal mental health” is actually very ethnocentric as it is
more of a part of Western culture to act independently, whereas many Eastern
cultures are more concerned with the group dynamic. This makes the list less
useful and nomothetic, as it cannot be reliably applied to all people.
Similarly, deviation from social norms is one of the four criteria, but this
would mean that behaviour exhibited that caused the feminist and civil rights
movements, as well as anybody who was homosexual, would be labelled as
dysfunctional. The list is too simplistic and reductionist, because it doesn’t
take into account that people vary so significantly that a few criteria on a
list, or how statistically rare a behaviour is does not make it any more or
less dysfunctional, as depression is more common than an IQ over 130, though
most would see the latter as more preferable. If we are unable to correctly
define dysfunctional behaviour, this means construct validity is weakened, and
we may be unable to tell what behaviours are actually maladaptive and negative
for the individual, and thus be unable to treat it properly.
A further issue with ethnocentrism, which is a
limitation of diagnosing dysfunctional behaviour, is that there tends to be
gender bias when diagnosing certain disorders. Ford and Widiger’s (1989) study
demonstrated how females are more likely to be correctly diagnosed with HPD and
males are more likely to be diagnosed with ASPD, which shows that even
experienced clinical psychologists have a tendency towards gender stereotyping.
Despite the ICD and DSM, it appears that diagnosing dysfunctional behaviour is
actually somewhat subjective and therefore diagnoses may lack face validity. As
diagnoses tend to be ethnocentric in terms of both gender and culture, it
appears that diagnoses of certain disorders made, particularly if they refer to
the DSM rather than the ICD, will favour and be more generalizable to one
gender and countries in Europe and North America rather than Asia, which
ultimately makes diagnoses less applicable and useful.
There are two main manuals used for categorizing
dysfunctional behaviour: the ICD and the DSM. However, there are
inconsistencies, which result in differences between the main manuals used, and
thus how you are diagnosed is affected by the manual that is used. For example,
the DSM is more holistic as its fourth and fifth axes take into account social
and external factors, whilst the ICD is more symptom-based and has more
specific categorization of mental disorders. This means that diagnosis of
disorders is likely to be somewhat unreliable, and this makes it more difficult
to treat patients efficiently as they may be misdiagnosed. This could also be
somewhat dangerous, as giving the wrong medication to a patient breaks ethical
guidelines of protection from harm, and may actually worsen their condition.
The poor reliability therefore implies that there is an issue with validity,
which reduces the usefulness of the manuals and diagnoses themselves.
Thus, the main limitations of diagnosing
dysfunctional behaviour include subjectivity, validity, reliability and
ethnocentrism. The proposed introduction of a DSM based on biological symptoms
instead of behavioural symptoms could potentially go some way to reducing these
limitations, but for now, it is better than there are classification systems
and definitions that are not perfect than having no way to diagnose and thus
treat dysfunctional behaviour at all.
