OF mental health care and mentally ill
types of abnormal behavior psychology and measurement
In the initial stages of developing a classification system, observations comprise a classification scheme. If the categories or subcategories are adequately defined, then the next step in the process is measuring the attributes. Measurement is the technological implementation of a classification scheme; in, it involves assessing or response patterns. Which response should be measured is determined by the definition of the particular category or subcategory, and involves operationally defining the category so that the presence or absence of the attribute or its magnitude and duration can be determined.
Several points are relevant to measuring both normal andfor diagnostic purposes. On a practical level, clinicians should devise a standardized psychological examination similar to the physical examination administered by physicians. This examination should inspect an individual’s response systems and include a specific examination of the person’s emotions, sensoryperceptual processes, cognitive processes, motor behavior, biological needs, acquired biological needs (addictions), and social behavior. This exam could be conducted by a standardized interview or, in some cases, by rapid screening tests to determine if a more thorough examination of a particular aspect of the individual’s behavior is indicated. Omnibus personality inventories, such as the Minnesota Multiphasic Personality InventoryII (MMPI-2) and problem checklists have been used for similar purposes or as screening devices. Unfortunately, these are not satisfactory because they fail to detect problems that are obvious by simple observation (e.g., obesity, tics, or substance abuse), give few clues to more precise assessment, are often cumbersome methods of determining the obvious (e.g., whether someone is hallucinating), and are based on theoretical propositions (e.g., trait theories) that can impede an objective evaluation of the problem. Furthermore, the psychological exam should indicate what particular aspect of the individual’s behavior is aberrant, not whether the individual is aberrant. Such a screening procedure should lead to specific tests or examinations for specific problem behaviors. Thus, if it were suspected that an individual was demonstrating a thought disorder, a more thorough examination of information processing could be conducted, perhaps by means of the situations or tests used in research programs such as that by Shakow. On the other hand, if there were no indication that the individual was experiencing sexual problems, then it would be foolish and an invasion of privacy to conduct an extensive examination of the individual’s sexual orientation and behavior. For the practicing clinician concerned with a variety of diagnostic problems, there is a serious need to organize and develop a series of different tests to evaluate different disorders and a need for some type of standardized psychological examination. The procedure for diagnosing specific problems should attempt to assess all three channels of behavior: cognitive, behavioral, and physiological. Adequate assessment should include the individual’s subjective report (both self-monitoring and self-reporting), behavioral observation or behavioral analogue tests, and when possible, physiological indexes, such as those used in assessing aberrant sexual behavior. Even though they are crude and imperfect, behavioral avoidance tests that are used to detect phobic behavior are an example of the way specific disorders should be evaluated. In this procedure, an individual is placed in an appropriate situation where a subjective report, observation of approach or avoidance behavior, and psychophysiological indexes of autonomic arousal can all be obtained. Similar experimental procedures already present in the literature could be modified and adapted to detect and evaluate other specific disorders. Because of the appeal of rapid screening devices and the influence of personality and trait theory, the role of stimulus variables and the environmental context of behavior has traditionally been ignored. Typically, every individual in an assessment situation is exposed to a standard set of stimuli (e.g., test items or ink blots), and it has been assumed that behavior exhibited in this situation allows predicting behavior in other situations. Unfortunately, this assumption has proven questionable. The constructive controversy, elicited by the work of Mischel on situationalism versus trait approaches to behavior, has indicated the naivete of that assumption and clearly has shown that situational or stimulus factors must be considered in assessing behavior. That situations often determine behavior is obvious to even the casual observer; it is not difficult to imagine oneself as aggressive with Pee-Wee Herman and being extremely considerate of Clint Eastwood’s ‘‘Dirty Harry.’’ Therefore, to make meaningful observations and inferences, one must consider two aspects of stimulus variables. First, the intensity of the stimulus must be varied, and then the change in response must be observed. For example, a phobic individual may exhibit fear upon entering a room containing a caged snake. Even a normal individual may exhibit the same response if the intensity is increased by requiring the person to handle the snake. Second, the variation in stimulus situations is also crucial. A person with a snake phobia may show little anxiety in New York City but may be greatly handicapped on an overgrown, rocky hillside. An interesting implication of the situationalversus-trait argument has been suggested by Adams (1981) and Marrioto and Paul (1975): Individuals who do not vary their behavior as situations change, and thus appear to be more ‘‘trait like,’’ may be more psychologically disturbed than people who have the more common pattern of varying their behavior as a function of stimulus situations. In any case, a basic factor in adequate assessment is that stimulus factors (the independent variables) must be manipulated if one is to observe changes in responses (the dependent variables).
Thus, adequatefor assessment involves a stimulus-organism-response-consequences (S-O-R-C) approach. The stimulus content and intensity can be varied as independent variables, whereas responses can be viewed as dependent variables. The organismic variable, which includes age, sex, activity levels, and so forth, can be viewed as modulating variables, which may directly influence the S–R relationship. The consequences of behavior are, strictly speaking, more relevant to etiological classification because consequences give a clue to the development and maintenance of a behavior pattern. Perhaps, at this stage of the game, consequences should not be considered in assigning behavior patterns to classification categories because confusion of the occurrence of a disorder with its cause results in a self-fulfilling prophecy. Currently, it seems that the more we know, the more we learn how rare are complete and specific associations between a disorder’s etiology, symptomatology, and consequences (Cawley, 1983). On the other hand, if it has been empirically demonstrated that a particular behavior is a direct function of a certain consequence of the behavior, then it is legitimate to use it as a classification attribute. A similar argument can be made with respect to personality traits, often used to classify types of behavior disorders. This is not usually advisable except in classifying dysfunctions of social behavior or personality disorders. For example, people with obsessive-compulsive personality traits may or may not demonstrate compulsive rituals, such as hand washing. Therefore, this personality type should not be used as an attribute for classifying behavior in a category of obsessive-compulsive disorders. This type of trait is an extraclassificatory correlate of behavior and is not an intrinsic attribute of the behavior disorder. Consequently, it should not be used to classify a behavior pattern. If it is used in this way, it often leads to a great deal of confusion. There are a number of parametric issues that must be addressed when devising suitable measuring instruments for classification purposes, including reliability, validity, demand characteristics, and similar issues. These are important and complex issues that cannot be adequately addressed in the limited space of this chapter. For further information in these areas, the reader is referred to more relevant references and textbooks .
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