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. 

Gender biases in DIAGNOSING DYSFUNCTIONAL BEHAVIOUR

The DSM-IV (soon to be DSM-V) and ICD-10 are intended to make diagnoses as valid and reliable as possible. But there's still only 50% agreement between clinicians in diagnoses, which suggests that subjectivity plays a significant part in diagnoses.

Thus far, we've seen from Rosenhan and Seligman that diagnosing dysfunctional behaviour is fairly subjective and ethnocentric. 

But diagnoses of disorders can also be affected by gender. Gender biases in diagnoses leads to poor reliability and validity, and could actually be life-threatening if someone is treated for the wrong disorder; and even if it wasn't, prescribing medication or therapy for a misdiagnosis is not desirable. 

One piece of research into gender bias is Ford and Widiger (1989). They aimed to find out if clinical psychologists were gender stereotyping when it came to diagnosing certain disorders, namely histrionic personality disorder and anti-social personality disorder.

Histrionic personality disorder (HPD) is a personality disorder which is characterised by seductive, manipulative behaviour, shallow expression of emotions and attention-seeking. For this reason, it's often stereotyped as a "female" disorder as it fits in with common stereotypes of women. Anti-social personality disorder (ASPD) is characterised by aggressive behaviour and impulsivity, and thus is often stereotyped as a "male" disorder. N.B both genders can have either personality disorder.

A sample of 266 clinical psychologists made diagnoses based on the information given to them, thus it was an experiment using self-report measures. The IV was the gender of the patient, and the DV was the diagnosis given. 

Participants were given anonymous case studies with the only detail being gender and were asked to identify the disorder. The case studies documented cases of HPD, ASPD, and patients with symptoms from the two disorders in an equal mix. 

ASPD was correctly documented in males considerably more than with females (42% to 15%), and the reverse was found in HPD as females were correctly diagnosed with HPD considerably more often than males (76% to 44%). This suggested that clinical psychologists, even with considerable clinical experience, gender stereotype certain disorders, and also that males were perhaps taken more seriously rather than being judged negatively for their gender, as they were misdiagnosed less often.