How Robust is the Influence of Causal Explanation on Clinical Judgments? Assessments in Structured Clinical Interviews

Abstract

When causal life-event explanations for disorder symptoms are available, clinicians tend to explain away those symptoms (Ahn, Novick, & Kim, 2003 ; Meehl, 1973 ), eschewing formal diagnostic guidelines such as the DSM-5 (American Psychiatric Association, 2013 ). We asked whether this effect is attenuated in the context of a structured diagnostic clinical interview procedure, which deliberately directs evaluators' attention to symptoms alone, or whether it is robust enough to continue to emerge. Across two experiments, lay evaluators given causal life-event explanations for disordered behaviors gave them lower judgments of abnormality and need for treatment compared to evaluators not given such explanations, regardless of whether they used a structured clinical interview. Thus, causal life-event explanations may have significant impact on clinical evaluations regardless of the mode of assessment. Implications for the clinical utility of structured interviews and the role of life-event context in diagnosis and classification are discussed.