Diagnostic Consistency in Assessing Conduct Disorder: An Experiment on the Effect of Social Context.

Abstract

The major objective of the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (see, e.g., the 4th ed., American Psychiatric Association, 1994) has been to achieve better diagnostic consistency. This has proved to be an elusive goal, because the diagnostic criteria and their rules for application can be ambiguous. This study mailed systematically varied case vignettes of conduct disorder to a nationally representative sample of 1,500 mental health clinicians in order to examine the effect of social context on diagnostic consistency. It found that consistency of diagnosis was modest and that it was affected by context and varied by profession.

Diagnosing Conduct Problems of Children and Adolescents in Residential Treatment

“…The findings are consistent with recent studies that indicate that diagnoses made without information regarding youths' social contexts have limited reliability and validity (Hsieh & Kirk, 2003;Kirk & Hsieh, 2004; also see Wakefield, Pottick, & Kirk, 2002). Diagnoses may be more valid if they include information such as that provided by dimensional behavioral instruments such as the CBCL and other dimensional behavior measures (RubioStipec, Walker, Murphy, & Fitzmaurice, 2002).…”

Do Clinical Psychologists Extend the Bereavement Exclusion for Major Depression to Other Stressful Life Events?

“…In conjunction with previous work examining the influence of explanatory life event context on assessments of conduct disorder and artificial disorders, [35][36][37][38]40,41 clinical psychologists are consistently influenced by explanatory context across disorders in assessment, even when the DSM is inconsistent in its treatment of explanatory context between disorders (e.g., between MDD and PTSD, in which a traumatic life event is one of the formal criteria for diagnosis 43 ). As argued in previous work, 57 although the DSM is often predominantly descriptive, clinical psychologists seem to push beyond the surface and incorporate causal factors into their assessments.…”

How Clinical Social Workers Are Using theDSM-IV: A National Study

“…A classic textbook, The Selling of DSM (Kirk & Kutchins, 1992) directly challenged the DSM system as being more about social control than reliable or socially sensitive diagnoses. Kirk and Hsieh (2004) conducted a fascinating study that showed that case vignettes that met the conduct disorder criteria but added social context resulted in greater variability in diagnostic decisions by mental health clinicians. Kirk (2005) recently edited a thought-provoking textbook with various authors that confront the growing dependence on psychiatric medication to sedate rather than solve social issues, the flawed DSM system, and the covert subservient relationship that social work has to biological psychiatry.…”