Full mark part b) question

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. 

Tackling part b) questions

Part b) generally consists of an evaluation on the section of the syllabus relating to part a). So, if you had a part a) question on brain dysfunction, you'd get a part b) on biological explanations of crime. 

There is no set structure for how to answer these questions. I can give you some pointers, but essentially you're going to have to find a way that works for you. That being said, some starting points and structures can help. 

The most important thing
The most important piece of advice I can give you is answer the question you're being set. Not the one you can best answer, not one you'd like to have come up. Everything you write must be related to the question. I'd suggest highlighting key words in the question including the key verb (e.g. assess, compare, evaluate). This'll get you in the right frame of mind.


Questions; what they're asking for
"Assess," "evaluate" and "to what extent" questions are essentially asking you to look at both strengths and weaknesses of a section, and then to come to a judgement in your conclusion. "Compare" questions obviously require key words such as "both","on the other hand", "in contrast" and "similarly" to really emphasise that you're answering the question. 

The way that questions in this section are worded are sometimes a little tricky to get your head around. Words such as "appropriateness" and "effectiveness" are seemingly easy to understand until you start to write it down. So, learn some simple definitions. By defining a key term in the intro, you will start to think of evaluation issues to relate to it and give your mini-essay some structure. "Appropriateness" refers to suitability, and encompasses  suitability to a person or group, situation, or occasion. So you could evaluate temporal validity, generalizability, ethnocentrism, etc. "Effectiveness" refers to the extent to which it brings about an effect, or achieves the desired results. So, you could talk about if it has negative or positive implications, the strength of these applications, and more specific factors such as recidivism rates or benefits to society.


Remember that this is an evaluation section; they want you to make judgements and insights, and then to illustrate these with examples from studies/theories/techniques, but you won't get marks for just outlining or describing the studies. Using key terms such as "reliability", "validity", "usefulness" and "applications"

Structure
You need a brief intro, a main body consisting of two or three paragraphs (and about five to seven evaluative points), and a brief conclusion linking explicitly back to the question.

One way some people like to structure their paragraphs is PEcEC:

Point, Example, compare, Example, Conclude
Note that the conclude section will include at least two or three evaluation points. 

Final thoughts
But this isn't necessary and it doesn't work for some people. As long as you give a range of evaluation points related to the question, that you're concise, use relevant detail, illustrate with examples and conclude with explicit link back to the question, then that's all you need. Keep practising your timing too; you only have 15-20 mins for this section and if you run over, you run the risk of not having time to answer the other questions. 

If you'd like to see an example of a 15 mark question (full marks), click here.

Why the DSM-V is dividing psychiatry (and why you need to know this)

It's not strictly in the syllabus, but if you can fit this seamlessly into an exam question on diagnosing dysfunctional behaviour or disorders, then no doubt the examiner will be impressed.

If you've got a spare ten minutes, check out this article from the New Scientist on opposition to the DSM-V, and why the National Institute of Mental Health has withdrawn its support to the publication of the DSM-V. If not, read my very much condensed summary below.

The DSM-V is due out later this month (May 2013), replacing the current DSM-IV that's been around since the mid-1990s. Essentially, there's been a lot of complaints about the amount of reliance, by both the medical profession and researchers alike, on a psychiatry "bible". 

The main issue is that it's purely symptomatic - it ignores the biological nature of disorders.

Those who advocate psychology as a science want the biological and physical aspects of psychological disorders to be taken into account so that subjectivity isn't such an issue. They use the comparison of being diagnosed with physical illnesses such as cancer on the basis of self-report alone, rather than being screened and tested. (Though, note that not all "physical" illnesses can be tested for, such as IBS). 

Some of the more radical people want the DSM completely scrapped in favour of a biological approach to diagnosis, such as depression being diagnosed on the basis of serotonin, or schizophrenia after dopamine levels have been analysed. Others merely want both symptoms and biology to play a part in diagnosis.

Whatever you think is the right decision, including this in your G543 paper would show your interest in the subject, and could be a valuable evaluation point which makes the examiners stand up and take note. 

Tackling part a) questions

You've got to answer 4 part a) questions for the G543 paper, and it's important to get them right because it's a lot easier to get top marks in this part than part b). 

If you're struggling on how to go about it, here's how I answer part a):

• Is it asking about a theory or research? Some sections don't really have "theories" as such, like the stress subsection, but you'll need a bit of an intro. If they're asking about a theory, it won't hurt to make the last paragraph a bit of a study to help illustrate your point. It's generally what they're looking for.
• Identify what the question is asking you, and actually answer it. Pre-learned part a)s won't be the most effective way of gaining marks; you need to apply your knowledge of studies and theories to the actual question.  
• Keep referring back to the question.

Generally, this is my structure:

1. Set the scene. If it's a question on the behavioural approach to managing stress, briefly define stress and outline the assumption of the behaviourist approach. You might also want to list that there are many approaches to managing stress, but it's not necessary. 

e.g. Stress is the body's response to either physical, emotional or mental demands that are perceived to stretch an individual in some way (often because they may feel they are unable to deal with it). Some stress is good, like stress that makes you want to revise, but some stress is unnecessary and has a strong aversive effect on overall health. There are many proposed ways to manage stress. The behavioural approach to psychology believes that all behaviour, including stress is learned, and thus assumes that you can learn to manage stress.

2. The theory. Start with the basic explanation, as simple as you can. Then you can expand on it and show what you know, giving the example of a specific or main theory. 

e.g. The behavioural approach to managing stress often includes teaching stressed clients to be aware of their central nervous system and their stress, and then learning how to reduce the stress. This is often also combined with positive reinforcements. One key behavioural technique of managing stress emphasises the role of biofeedback. It involves being taught relaxation techniques, whilst being made aware of the effect on the body that they have, and then receiving feedback on their progress, through the use of biodots, or heart rate monitors which show the physical reduction of stress. This use of double positive reinforcement in the form of relaxation and biofeedback is supposed to help the client feel in control of their stress.

3. The study. Even if the question doesn't ask for it, I would rarely recommend skipping this step. It helps to illustrate your understanding and get you those full marks.

e.g. One study which illustrates how the behaviourist approach uses biofeedback to manage stress was conducted by Budzynski et al. It was a field experiment involving 18 volunteers with tension headaches who were split into three conditions. Group 1 received relaxation training for 2 weekly sessions for 8 weeks, during which they had their muscle tension measured by an EMG. They were informed of the biofeedback in the form of clicks as their positive reinforcement; more clicks meant higher tension, and thus they were encouraged to relax. Group 2 had the same relaxation training but didn't have accurate biofeedback, and Group 3 was a control group with neither. Both experimental groups showed improvement in tension headaches and other stress-related illnesses such as hysteria and depression, but Group 1 showed the most improvement. This suggests that biofeedback is one technique in which stress can be managed. 

If there's a question you'd like me to go over, leave a comment and I'll take a look.