Posted by Larry Hoover on May 31, 2003, at 18:31:30
In reply to Why am I so obsessed with a label?, posted by Dinah on May 30, 2003, at 8:51:34
> A year or two ago, I went through psychological testing to see why on earth I do the things I do. (That was my official reason for being there, when the psychologist asked.) And I found the results less than eye opening or even useful. The MMPI was interesting, and the results pretty accurate, but it didn't tell me much I didn't know.
>
> Moreover, I know that the DSM-IV is sadly lacking. There is so much overlap between diagnostic categories. And some are overly limited, while others are overly inclusive. It's a noble effort but falls far short of the goal. I'll bet it's more than possible to go to several practitioners and get completely different diagnoses.It's probably worse than you even imagined. (I know the first abstract mentions DSM III-R, but diagnostic concordance, in a study using written descriptions submitted to the *authors* of DSM-IV, failed to find inter-rater agreement above 70% on any diagnosis, including Axis 1. In other words, I don't think things have got that much better.)
Psychopathology 1994;27(6):312-20
Comparison of a diagnostic checklist with a structured interview for the assessment of DSM-III-R and ICD-10 personality disorders.
Bronisch T, Mombour W.
Department of Psychiatry, Clinical Institute, Max Planck Institute, Munich, FRG.
The International Diagnostic Checklists for the assessment of the DSM-III-R and ICD-10 personality disorders (IDCL-P) were compared with a structured interview, the International Personality Disorder Examination (IPDE), using a balanced test-retest design with forty psychiatric inpatients. The results, using pairwise kappa for the calculation of agreement, were as follows: any personality disorder versus no personality disorder 0.52 for DSM-III-R diagnoses and 0.75 for ICD-10 diagnoses. The range for the single personality disorders diagnosed at least five times was from -0.07 to 0.71 for DSM-III-R diagnoses and from 0.38 to 0.68 for ICD-10 diagnoses. Only for DSM-III-R diagnoses do figures exist from three other studies comparing two structured interviews with each other. The results of all four studies suggest that 60% of the variance in personality disorder diagnoses represents variance not attributable to the patients, which is scientifically unacceptable.
Compr Psychiatry 2002 Jul-Aug;43(4):285-300
Evaluation of DSM-IV personality disorder criteria as assessed by the structured clinical interview for DSM-IV personality disorders.Farmer RF, Chapman AL.
Department of Psychology, Idaho State University, Pocatello, ID, USA.
The primary objective of this research was to investigate the psychometric and diagnostic efficiency properties of DSM-IV personality disorder (PD) criteria as assessed by the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Logistic regression analyses were also employed to identify discriminating and nondiscriminating diagnostic criteria within specific PD categories. Results based on a community sample of 149 psychotropic medication-free persons, 58% of whom had at least one PD as determined from the SCID-II, suggest problems with the assessment and/or conceptualization of some PD categories, most notably obsessive-compulsive PD. For many PD concepts, diagnostic criteria were identified that either detracted from the overall internal consistency and diagnostic efficiency of their associated PD criteria set or failed to uniquely discriminate individuals with specific PDs from those without. Most of these findings cannot be clearly attributed to limitations associated with the method used to assess PD criteria.
J Pers Assess 1996 Jun;66(3):569-82
Comparative validity of MMPI-2 and MCMI-II personality disorder classifications.
Wise EA.
Mental Health Resources, Memphis, Tennessee, USA.
Minnesota Multiphasic Personality Inventory-2 (MMPI-2) overlapping and nonoverlapping scales were demonstrated to perform comparably to their original MMPI forms. They were then evaluated for convergent and discriminant validity with the Million Clinical Multiaxial Inventory-II (MCMI-II) personality disorder scales. The MMPI-2 and MCMI-II personality disorder scales demonstrated convergent and discriminant coefficients similar to their original forms. However, the MMPI-2 personality scales classified significantly more of the sample as Dramatic, whereas the MCMI-II diagnosed more of the sample as Anxious. Furthermore, single-scale and 2-point code type classification rates were quite low, indicating that at the level of the individual, the personality disorder scales are not measuring comparable constructs. Hence, each instrument is providing similar and unique information, justifying their continued use together for the purpose of diagnosing personality disorders.
> If I had a label that I could agree with, would it help me understand myself? Would it help me find a solution for living a steadier life? Or is it just the quest for the mythical answer to life...I think the key component of your statement, above, is the question of your agreeing with the label, whatever it might be.
Given the standard medical diagnostic/treatment model, that flows: sx --> dx --> tx --> px
(symptoms to diagnosis to treatment to prognosis), there is a disconnect between symptom and treatment. In other words, the doctor treats the diagnosis more than he does the symptoms presented to him. With that sort of bias, I guess it makes sense that you might do the same sort of thinking.Lar
poster:Larry Hoover
thread:230170
URL: http://www.dr-bob.org/babble/psycho/20030529/msgs/230466.html