Validity and Reliability
Validity and Reliability of DSM IV TR Diagnostic System
The Diagnostic and Statistical Manual of Mental Disorders IV-Text Revision (DSM IV TR) has a multiaxial system whereby people are diagnosed with mental illness. Last year, a complete revision of the system was published in the DSM 5. As discussed, there are significant questions and concerns in our current diagnostic system -- Is it valid? (once a person is diagnosed, is it a valid, or "true" diagnosis)? Is it reliable? Here are some simple explanations of validity and reliability for purposes of this class. Please note that there are many types of validity and reliability, and both are important considerations in the development and implementation of research in our field.
VALIDITY:
Validity is the concept of how "true" a result is from any instrument or test. For example, there are a number of personality tests now on facebook that claim to be able to discern, from a few random questions (e.g., what picture looks best to you), what your personality might be like. I would argue that the validity of such measures is questionable. In another example, is the SAT a valid measure of academic ability? A test is valid when it measures what it claims to measure.
RELIABILITY:
Reliability is the concept of consistency. Does the test, when given over and over, produce the same result? A regular bathroom scale should be consistent, for example, and each time you get on the scale, within say an hour or 2, should give you the same result. SATs are very reliable, as are the Praxis tests, and the Myers-Briggs personality indicator.
Given the readings, do you think the current diagnostic system (DSM IV-TR) is Valid? Reliable? Why are validity and reliability important? Is this the best nosology for mental illness? why is it important to have a diagnostic system and labels? Please note that we do not have enough data on the DSM 5 system to make any kind of determination if the revisions have made the system more valid and/or reliable. Many people in the system have medical records reflecting the DSM IV system of diagnosis, despite the DSM 5 being published in 2013.
Reply to these questions, and to at least 2 of your classmates' replies.
VALIDITY:
Validity is the concept of how "true" a result is from any instrument or test. For example, there are a number of personality tests now on facebook that claim to be able to discern, from a few random questions (e.g., what picture looks best to you), what your personality might be like. I would argue that the validity of such measures is questionable. In another example, is the SAT a valid measure of academic ability? A test is valid when it measures what it claims to measure.RELIABILITY:
Reliability is the concept of consistency. Does the test, when given over and over, produce the same result? A regular bathroom scale should be consistent, for example, and each time you get on the scale, within say an hour or 2, should give you the same result. SATs are very reliable, as are the Praxis tests, and the Myers-Briggs personality indicator.
Given the readings, do you think the current diagnostic system (DSM IV-TR) is Valid? Reliable? Why are validity and reliability important? Is this the best nosology for mental illness? why is it important to have a diagnostic system and labels? Please note that we do not have enough data on the DSM 5 system to make any kind of determination if the revisions have made the system more valid and/or reliable. Many people in the system have medical records reflecting the DSM IV system of diagnosis, despite the DSM 5 being published in 2013.
Reply to these questions, and to at least 2 of your classmates' replies.
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ReplyDeleteI do not believe the current system is accurate with regards that two different professionals can diagnose someone with two different systems, the new DSM and old DSM. When both of the DSM's are actively being used it creates a larger gap for misdiagnoses and inconsistency. Not only the inconsistency within our own society, but inconsistencies between societies. What we understand in our society on mental health is different than what other societies understand with mental health. Society has a way of accepting anything we are told, which creates misconceptions and social constructs in the mental health field. A clinician can create someone's mental status and be the force that pushes it versus the person's true mental status. Labels are needed in today's society to qualify individuals for services. Unfortunately, those labels are most often taken negatively. There is better treatments that come with labels (rightly diagnosed or wrongly diagnosed). Having a diagnoses gives caseworkers, clinicians, and other professionals a place to start and to build off of. Having a diagnoses also gets the individual's services faster than waiting or having to keep revisiting a professional to get diagnosed and then receive services. I believe there are parts to the DSM that are valid and reliable, not not enough of it to make it valid or reliable. Unfortunately, in this time, the DSM is the best reliable and valid way to diagnose individuals.
ReplyDeleteHey Ashley,
DeleteYou make a really good point about society just accepting anything we are told. I find that this comes a lot from social media and television. It's like all of the crime shows that portray individuals with schizophrenia and multiple personality disorder and other mental illnesses. It encourages individuals to be afraid of them which creates more stigma around the field. Like you said though, these label are needed to get services and while they might not be 100% valid or reliable they can be helpful and society needs to see that.
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DeleteHey Kylie, I agree with you in saying that we believe whatever we see on social media. Not only on the crime shows, but any kind of reality tv or movie, characters are made out to play their role of someone with a disability and its to the extreme. There has been on show I have watched, and so far this is show, "Parenthood", has been the only television series that correctly portrays what it's like for a kid to live with Asperger's. I think a lot of the time people who are given a diagnosis are only given the label of whoever is giving it, to what they think the most important "title" is. But I do agree with you Ashley in that by having a diagnoses given, it gives for case workers, clinicians and other professionals in the field to start at some kind of level with the person.
DeleteI believe that the current diagnostic system is a valid system but is not valid enough to allow for multiple doctors to use it on patients and correctly diagnose them 100% of the time. With the current diagnostic system not being completely valid it cannot be very reliable. With there being two forms of the DSM being used, the validity and reliability of them decrease. The DSM IV and the DSM V are slightly different from each other which causes doctors using one form of the DSM to be diagnose patients differently than doctors using the other form. At this point in time the DSM is the most valid and reliable way to diagnose individuals with a mental illness. It is important to have a diagnostic system because without it individuals who need medical help wouldn’t be able to receive the help they need. Also, if there wasn't a diagnostic system for mental illness then the individuals that need medical help may not be able to pay the expenses for it because without a diagnosis their insurance may not be willing to offset the medical bills. Labels would just be another word for a diagnosis, which can be taken both positively and negatively. Society tends to look at someones diagnosis as a negative thing, and stigmas have been put out there about them, but labels are necessary for a patient to get the correct help that they need, and for their insurance to help cover the expenses.
ReplyDeleteIt is always nice to hear other people's thoughts who are in the same area of study! I agree on the DSM is not a valid way of correctly diagnosing individuals 100% of the time. I do believe the DSM has an important impact when diagnosing an individual, but I feel even if the doctors were using all the same DSM, it will never be 100% valid. I find it hard to "diagnose" an individual based solely on text written that is written for a general disease or disorder versus the individualized person and their story/symptoms. I find it upsetting that the only way for an individual to receive benefits is to be diagnosed. It is unfortunate that an individual has to be determined "not normal" on paper to receive the right to affordable treatment.
DeleteHey Megan, I agree with what you said about society's view on diagnoses and labels. They are often seen as a negative thing, surrounded by a lot of stigma. Also, I believe diagnoses or labels are often viewed as shameful in our society. This causes some people to not seek treatment and services for fear of receiving a label and receiving harsh backlash from society. I also like what you said, Ashley, and agree with your statement: "It is unfortunate that an individual has to be determined "not normal" on paper to receive the right to affordable treatment."
DeleteDepending on the severity and the symptoms of whatever mental illness will help two professionals come to the same conclusion when diagnosing or come to two separate conclusions. The more specific the criteria the easier it is to come to the same conclusion but also harder to include those who have different symptoms yet need help. The DSM is valid and reliable to an extent. It is not however valid for everyone and every mental illness considering the social construction around mental illness. The DSM is however helpful. Many individuals rely on a diagnosis to get the help they need whether it be counseling, medication, etc. It is important to make sure the diagnosis is valid and reliable so we are not medicating individuals who don't need it or medicating those who really do. The system we have helps students in school and adults who are living on their own with mental illness as well as elderly individuals. It can be very important for independence. As sad as it is, labels help get better services...
ReplyDeleteHi Kylie! Your first sentence caught my attention right away. You say, "depending on the severity and the symptoms of whatever mental illness will help two professionals come to the same conclusion when diagnosing or come to two separate conclusions." Are you talking about two professionals diagnosing one person? Usually, from my understanding, only one professional makes a diagnoses instead of working together on a team to diagnose the individual. Even if two professional come to the same conclusion, I think they will never have the same conclusion. I think treatment comes a lot of time by perception. Even the diagnoses might be the same, the frequency, duration, or severity will not be the same. What one professional views are important or worth documenting another professional might have different feelings regarding if that is important or not when diagnosing the individual.
DeleteI was referring back to the video we watched and how many different professionals can look at the same person and give them a different diagnosis. I completely agree with what your saying though, I don't think two professionals will every truly come to the same conclusions. That's what makes the field so hard.
DeleteI believe that the current diagnostic system is valid to an extent, but not 100%. There are currently two different diagnostic systems (the DSM-IV TR and the DSM 5) being used by professionals to diagnose patients. This causes inconsistency among diagnoses by professionals, in turn causing the system to not be reliable either. Also, sometimes untrained professionals such as primary care physicians are the ones making the diagnoses instead of a trained psychiatrist. This is another reason why the system is not completely valid and reliable. However, it is important to have a diagnostic system and labels because it allows a person to receive treatment or services. This is unfortunate because there is a negative stigma that is often associated with diagnostic labels. While improvements need to be made for the future, the current system is the most reliable and valid way for a person to be diagnosed and receive treatment/services.
ReplyDeleteFor some reason it wouldn't let me post under my name, but the above "Unknown" post is mine!
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DeleteHey Alexis, I had the same problem at first. You need to go change your privacy settings!
DeleteI agree Alexis! You made a good point that sometimes diagnoses can come from primary care physicians and not psychiatrists, which could make for problems to arise and for the system to not be completely valid and reliable!
DeleteI think that by having both an old and a new DSM is tricky and makes it a little difficult to diagnose someone but I do agree that the current diagnostic system is valid to a certain point. Because we have two different systems, this makes it difficult for professionals to accurately diagnose a patients. This causes for the system to unreliable and inconsistent. I too believe that having labels is important but to in extent and sometimes these "labels" become too far. A lot of the time patients are given the wrong diagnoses because they exhibit a certain behavior but really that behavior is caused by their main diagnosis. I think by giving a patient a label, this should call for their case worker or clinician to look further into the diagnoses and validate that this is what is best for the client.
ReplyDeleteI agree with you that by using both the old version and the new version of the DSM to diagnose people currently, leads to inconsistent and unreliable diagnoses. Two different professionals could see the same person but each one could come to a different conclusion about the diagnosis of the client. This inconsistency could be attributed to the fact that one professional was using the DSM IV-TR and the other was using the DSM 5 to diagnose the client.
DeleteThis is true and I agree with you both. It is difficult getting two different diagnosis from two different professionals, but I believe we are now leaning more to the DSM V and I think this would be good because then we wouldn't have this big of a mishap.
DeleteRebekah, I agree with you that having labels are important but that they can also become very negative for the person living with that label. I also agree that the patients case worker or clinician should look further into the diagnoses, but I think that they should do that before they officially give the patient the label, this would save the patient and their family confusion incase it turns out they were given the wrong label.
DeleteI believe the DSM is not a valid way of correctly diagnosing individuals 100% of the time. I do believe it does help when diagnosing an individual and obviously, it has been changing through the years, but it doesn’t make them at all a 100%. Validity is important because if it’s not true or accepted, then it’s not going to be recognized. Reliability is also important because if clients are taking something that is not showing a similar result than it is not at all reliable. Now, I think that the DSM has been set as the best, but I’m not sure if I believe it is the best. I will agree that the DSM is helpful and it is important to have a diagnostic system and labels because it gives people treatment and services. This current system works, but hopefully we can make it more valid and reliable.
ReplyDelete