A2 Ocd diagnosis issues
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The document discusses several issues surrounding the classification and diagnosis of OCD. It addresses the reliability and validity of diagnoses using tools like the DSM-IV and ICD-10. While studies have found good inter-rater reliability for diagnoses of OCD, there is less consistency between the DSM-IV and ICD-10. The validity of OCD diagnoses can be challenging due to overlap with other disorders and difficulty distinguishing obsessions from normal worries. Culture can also influence the presentation and diagnosis of OCD symptoms.
A2 Ocd diagnosis issues
- 1. OCD: issues surrounding classification and diagnosis • There are several issues surrounding the classification and diagnosis of OCD that need to be assessed. • These include addressing issues surrounding the reliability and validity of diagnosis.
- 2. DSM- IV • The Diagnostic and • • Statistical Manual of Mental Disorder (Edition 4), was last published in 1994. The DSM is produced by the American Psychiatric Association. It is the most widely used diagnostic tool in psychiatric institutions around the world.
- 3. ICD - 10 • There is also the • International Statistical Classification of Diseases (known as ICD). It is produced by the World Health Organisation (WHO) and is currently in it’s 10th edition.
- 4. Labelling • Someone who has suffered • a mental disorder has to disclose that information in situations such as job interviews, or they could face formal action. Unlike influenza, the label of ‘mental illness’ stays with a person.
- 5. Measuring obsessions and compulsions • There are scales for the measurement of general anxiety and specific scales for the assessment of obsessions and compulsions. • According to RUSH (2007) the best is the Y-BOCS devised by Goodman et al. • This is a semi structured interview asking about obsessions and compulsions and the extent to which they affect everyday life. • More recently Goodman has developed a new scale – the Florida Obsessive-Compulsive Inventory.
- 6. Reliability and validity of DSMIV and ICD-10 • Diagnosing a mental disorder is almost always • • done using the DSM-IV and the ICD-10. However, there is a risk of using this professional jargon. (Wording in the manuals is written for specialists to understand, not laymen). The main issues surrounding the diagnosis of mental disorders centre on the reliability and validity of the diagnoses.
- 7. Reliability of Diagnosis • This refers to the consistency of a measuring instrument such as a scale to assess fear. • It can be measured in terms of whether two independent assessors give similar scores: known as INTER-RATER RELIABILITY • Patients are generally diagnosed on the basis of one or more interviews with a therapist.
- 8. Inter-rater reliability and test-retest reliability -do bloke thinks? psychiatrists agree? I wonder • Woody et al (1995) assessed 54 patients with OCD using the Y-BOCS and found good internal consistency. Interrater reliability was was reported as excellent. • However, test-retest results after an average of 48 days was lower than desirable. Other studies have however, found good test-retest reliability. what the other psychiatris t thinks?
- 9. Findings on reliability • Brown et al carried out two interviews on 1400 patients WITH A GAP OF TWO WEEKS BETWEEN INTERVIEWS. The inter-rater reliability was excellent. The most likely explanation is that compulsions provide a clear behavioural indication of the presence of OCD. There were some sources of unreliabilityThe main one was • Differences in the symptoms were reported by patients in the two interviews.
- 10. More findings • Steinberger et al compared DSM-IV and • ICD-10 in their diagnoses of OCD. Found large differences between the two systems suggesting problems with consistency of diagnosis. Using DSM-IV 95% of patients were diagnosed with OCD compared to only 46% using ICD-10 criteria. The criteria for ICD-10 are less detailed and clear so the DSM system is preferable.
- 11. Reliability of self report and computerised versions of Y-BOCS. • These appear to yield reliability scores similar to interviewer-administered versions. • The children’s version has also been shown to have good inter-rater reliability.
- 12. Validity of diagnosis This considers whether the system of classification and diagnosis reflect the true nature of the condition as something that is real and distinct from other conditions. Discriminant validity: refers to the ability of a diagnosis to distinguish between OCD and other conditions. • OCD can resemble the delusional beliefs of schizophrenia when the nature of the thoughts is bizarre. • Obsessions and compulsions occur in a number of other disorders- e.g. eating disorders/ body dysmorphic disorder/social phobias. DSM-1v specifically warns clinicians not to diagnose OCD when the obsessions and compulsions are restricted to another disorder. • There can be some overlap between OCD and obsessive personality disorder – this people who are inflexible, obstinate, rigid and apt to focus on unimportant detail. They are frequently humourless and judgemental, with a need for perfectionism and rigidity.
- 13. Validity - Distinguishing between ‘worries’ and obsessions • It is difficult to distinguish between obsessions and simple ‘worries’ which are not pathological (related to a mental disorder.) • Worries include things such as family, finances and work. • According to Brown (1993) most clinicians can reliably distinguish between worries and obsessions.
- 14. Validity of diagnosis • It is possible that people may not produce honest answers to questionnaires about their OCD symptoms and this reduces the validity of any such questionnaire(may fear interviewer will think they have a deeper mental illness or be embarrassed). It has been estimated that only about 40% of people with OCD symptoms come forward for treatment. • Patients may also be fearful of handling questionnaires because they fear they are dirty. • A further problem is that some patients may lack awareness of the severity and frequency of their symptoms. Validity is likely to be improved by interviewing close friends and partners.
- 15. Findings on Validity • Rosenfield et al found that patients diagnosed • with OCD had higher Y-BOCS scores than patients with other anxiety disorders and normal controls – therefore it does distinguish OCD patients from others. However, Woody et al found poor discrimination with depression – patients diagnosed with OCD were often also diagnosed with depression and it can be difficult to disentangle the two disorders. (67% of people with OCD also have depression – Gibbs)
- 16. Cultural Relativism • The incidence of OCD tends to be the same in most countries/cultures (about 2-3%. • However the symptoms are often shaped by a patient’s culture of origin. • For example a patient from India may fear contamination by touching a person from a lower social caste. • This may lead to problems with diagnostic scales because symptoms checklists may be culturally based.
- 17. Cultural problems • Williams et al 2005 demonstrated that there were significant differences between normal populations of black and white Americans in the scores for contamination obsessions. Black Americans have less interaction with animals and have a greater fear of contamination from them – increasing the diagnosis of OCD. • However – Matsunaga studied Japanese OCD patients and found symptoms remarkably similar to those in the West – concluding that OCD transcends cultures.
- 18. Conclusions about diagnosis: Meehl (1977) Suggests that mental health professionals should be able to count on the diagnostic tools if they: – – – Paid close attention to medical records Were serious about the process of diagnosis Took account of the very thorough descriptions presented by the major classificatory systems – Considered all the evidence presented to them.