Professional Documents
Culture Documents
Personality Factors
Assessment should include a description of any relevant long-term personality characteristics.
Has the person typically responded in deviant ways to particular kinds of situations-for example,
those requiring submission to legitimate authority? Are there
personality traits or behavior patterns that predispose the individual to behave in maladaptive
ways? Does the person tend to become enmeshed with others to the point of losing
his or her identity, or is he or she so self-absorbed that intimate relationships are not possible? Is
the person able to accept help from others? Is the person capable of genuine affection and of
accepting appropriate responsibility for the welfare of others? Such questions are at the heart of
many assessment efforts.
PET Scans
Another scanning technique is positron emission tomography, the PET scan. Although a CAT
scan is limited to distinguishing anatomical features such as the shape of a particular internal
structure, a PET scan allows for an appraisal of how an organ is functioning (Mazziotta, 1996).
The PET scan provides metabolic portraits by tracking natural compounds, such as glucose, as
they are metabolized by the brain or other organs. By revealing areas of differential metabolic
activity, the PET scan enables a medical specialist to obtain more clear-cut diagnoses of brain
pathology by, for example, pinpointing sites responsible for epileptic seizures, trauma from head
injury or stroke, and brain tumors. Thus the PET scan may be able to reveal problems that are not
immediately apparent anatomically. Moreover, the use of PET scans in research on brain
pathology that occurs in abnormal conditions such as schizophrenia, depression, and alcoholism
may lead to important discoveries about the organic processes underlying these disorders, thus
providing clues to more effective treatment (Zametkin & Liotta, 1997). Unfortunately, PET scans
have been of limited value thus far because of the low-fidelity pictures obtained
Ratings like these may be made not only as part of an initial evaluation but also to check on the
course or outcome of treatment.
One of the rating scales most widely used for recording observations in clinical practice and in
psychiatric research is the Brief Psychiatric Rating Scale (BPRS).The BPRS provides a structured
and quantifiable format for rating clinical symptoms such as somatic concern, anxiety, emotional
withdrawal, guilt feelings, hostility, suspiciousness, and unusual thought patterns .. It contains 18
scales that are scored from ratings made by a clinician following an interview with a patient. The
distinct patterns of behavior reflected in the BPRS ratings enable clinicians to make a
standardized comparison of their patients' symptoms with the behavior of other psychiatric
patients. The BPRS has been found to be an extremely useful instrument in clinical research
especially for the purpose of assigning patients to treatment groups on the basis of similarity in
symptoms. However, it is not widely used for making treatment or diagnostic decisions in clinical
practice. The
Hamilton Rating Scale for Depression (HRSD) a similar but more specifically targeted
instrument, is one of the most widely used procedures for selecting clinically depressed research
subjects and also for assessing the response of such subjects to various treatments 2004)
Psychological Tests
Interviews and behavioral observation are relatively direct attempts to determine a person's
beliefs, attitudes, and problems. Psychological tests are a more indirect means of assessing
psychological characteristics. Scientifically developed psychological tests (as opposed to the
recreational ones sometimes appearing in magazines or on the
Internet) are standardized sets of procedures or tasks for obtaining samples of behavior. A
subject's responses to the standardized stimuli are compared with those of other people who have
comparable demographic characteristics, usually through established test norms or test score
distributions. From these comparisons, a clinician can then draw inferences about how much the
person's psychological qualities differ from those of a reference group, typically a
psychologically normal one. Among the characteristics that these tests can measure are coping
patterns, motive patterns, personality characteristics, role behaviors, values, levels of depression
or anxiety, and intellectual functioning. Impressive advances in the technology of test
development have made it possible to create instruments of acceptable reliability and validity to
measure almost any conceivable psychological characteristic on which people may vary.
Moreover, many procedures are available in a computer-administered and computer interpreted
Although psychological tests are more precise and often more reliable than interviews or some
observational techniques, they are far from perfect tools. Their value often depends on the
competence of the clinician who interprets them. In general, they are useful diagnostic tools for
psychologists in much the same way that blood tests, X-ray films, and MRI scans are useful to
physicians. In all these cases, pathology may be revealed in people who appear tobe normal, or a
general impression of "something wrong” can be checked against more precise information.
Two general categories of psychological tests for use in clinical practice are intelligence tests and
personality tests(projective and objective).
Intelligence Tests
A clinician can choose from wide range of intelligence tests. The Wechsler Intelligence Scale for
Children-Revised (WISC-III) and the current edition of the Stanford-Binet Intelligence Scale
(Kamphaus& Kroncke, 2004) are widely used in clinical settings for measuring the intellectual
abilities of children. Probably the most commonly used test for measuring adult intelligence is the
Wechsler Adult Intelligence Scale-Revised (WAIS-III) (Zhu, Weiss, Prifitera, &Coalson. 2004). It
includes both verbal and performance material and consists of 11 subtests.
The Rorschach test is a psychological test in which subjects' perceptions of inkblots are recorded
and then analyzed using psychological interpretation, complex scientifically derived algorithms,
or both. Some psychologists use this test to examine a person's personality characteristics and
emotional functioning. It has been employed to detect an underlying thought disorder, especially
in cases where patients are reluctant to describe their thinking processes openly. The test takes its
name from that of its creator, Swiss psychologist Hermann Rorschach
The tester and subject typically sit next to each other at a table, with the tester slightly behind the
subject.[22] This is to facilitate a "relaxed but controlled atmosphere". There are ten official
inkblots, each printed on a separate white card, approximately 18x24 cm in size.[23] Each of the
blots has near perfect bilateral symmetry. Five inkblots are of black ink, two are of black and red
ink and three are multicolored, on a white background.[24][25][26] After the test subject has seen and
responded to all of the inkblots (free association phase), the tester then presents them again one at
a time in a set sequence for the subject to study: the subject is asked to note where he sees what
he originally saw and what makes it look like that (inquiry phase). The subject is usually asked to
hold the cards and may rotate them. Whether the cards are rotated, and other related factors such
as whether permission to rotate them is asked, may expose personality traits and normally
contributes to the assessment. As the subject is examining the inkblots, the psychologist writes
down everything the subject says or does, no matter how trivial. Analysis of responses is recorded
by the test administrator using a tabulation and scoring sheet and, if required, a separate location
chart.[22]
The general goal of the test is to provide data about cognition and personality variables such as
motivations, response tendencies, cognitive operations, affectivity, and personal/interpersonal
perceptions. The underlying assumption is that an individual will class external stimuli based on
person-specific perceptual sets, and including needs, base motives, conflicts, and that this
clustering process is representative of the process used in real-life situations.[28] Methods of
interpretation differ. Rorschach scoring systems have been described as a system of pegs on
which to hang one's knowledge of personality.
The TAT is popularly known as the picture interpretation technique because it uses a standard
series of provocative yet ambiguous pictures about which the subject must tell a story. The
subject is asked to tell as dramatic a story as they can for each picture presented, including:
There are 31 cards in the standard form of the TAT. Some of the cards show male figures, some
female, some both male and female figures, some of ambiguous gender, some adults, some
children, and some show no human figures at all. One is completely blank. Although the cards
were originally designed to be matched to the subject in terms of age and gender, any card may be
used with any subject. Most practitioners choose a set of approximately ten cards, either using
cards that they feel are generally useful, or that they believe will encourage the subject's
expression of emotional conflicts relevant to their specific history and situation. ]. Declining
adherence to the Freudian principle of repression on which the test is based has caused the TAT to
be criticised as false or outdated by many professional psychologists. Their criticisms are that the
TAT is unscientific because it cannot be proved to be valid (that it actually measures what it
claims to measure), or reliable (that it gives consistent results over time, due to the challenge of
standardising interpretations of the stories produced by subjects). Some critics of the TAT cards
have observed that the characters and environments are dated, even ‘old-fashioned,’ creating a
‘cultural or psychosocial distance’ between the patients and these stimuli that makes identifying
with them less likely Also, in researching the responses of subjects given photographs versus the
TAT, researchers found that the TAT cards evoked more ‘deviant’ stories (i.e., more negative) than
photographs, leading them to conclude that the difference was due to the differences in the
characteristics of the images used as stimuli.
Sentence Completion
A sentence completion test form may be relatively short, such as those used to assess responses to
advertisements, or much longer, such as those used to assess personality. A long sentence
completion test is the Forer Sentence Completion Test, which has 100 stems. The tests are usually
administered in booklet form where respondents complete the stems by writing words on paper.
The structures of sentence completion tests vary according to the length and relative generality
and wording of the sentence stems. Structured tests have longer stems that lead respondents to
more specific types of responses; less structured tests provide shorter stems, which produce a
wider variety of responses. test was used as part of an intelligence test
Carl Jung’s word association test may also have been a precursor to modern sentence completion
tests.
MMPI
The original MMPI was developed in the late 1930s using an empirical keying approach, which
means that the clinical scales were derived by selecting items that were endorsed by patients
known to have been diagnosed with certain pathologie.The difference between this approach and
other test development strategies used around that time was that it was atheoretical (not based on
any particular theory) and thus the initial test was not aligned with the prevailing psychodynamic
theories of that time. The atheoretical approach to MMPI development ostensibly enabled the test
to capture aspects of human psychopathology that were recognizable and meaningful despite
changes in clinical theories. However, because the MMPI scales were created based on a group
with known psychopathologies, the scales themselves are not atheoretical by way of using the
participants' clinical diagnoses to determine the scales' contents.
MMPI-2
The first major revision of the MMPI was the MMPI-2, which was standardized on a new
national sample of adults in the United States and released in 1989. It is appropriate for use with
adults 18 and over. Subsequent revisions of certain test elements have been published, and a wide
variety of subscales was also introduced over many years to help clinicians interpret the results of
the original clinical scales, which had been found to contain a general factor that made
interpretation of scores on the clinical scales difficult. The current MMPI-2 has 567 items, all
true-or-false format, and usually takes between 1 and 2 hours to complete depending on reading
level. There is an infrequently used abbreviated form of the test that consists of the MMPI-2's
first 370 items. The shorter version has been mainly used in circumstances that have not allowed
the full version to be completed (e.g., illness or time pressure), but the scores available on the
shorter version are not as extensive as those available in the 567-item version.
Clinical Scales
Scale 1: Hypochondriasis (Hs) - This scale was originally developed to identify patients who
manifested a pattern of symptoms associated with the label of hypochondriasis.
Scale 2: Depression (D) - This scale was originally developed to assess symptomatic
depression. The primary characteristics of symptomatic depression are poor morale, lack of hope
in the future, and a general dissatisfaction with one's own life situation.
Scale 3: Hysteria (Hy) - This scale was developed to identify patients who demonstrated
hysterical reactions to stress situations. . Such people generally maintain a facade of superior
adjustment and only when they are under stress does their proneness to develop conversion-type
symptoms as a means of resolving conflict and avoiding responsibility appear. .
Scale 4: Psychopathic Deviate (Pd) - This scale was originally developed to identify patients
diagnosed as psychopathic personality, asocial or amoral type.
Scale 6: Paranoia (Pa) - This scale was originally developed to identify patients who were
judged to have paranoid symptoms such as ideas of reference, feelings of persecution, grandiose
self-concepts, suspiciousness, excessive sensitivity, and rigid opinions and attitudes
Scale 7: Psychasthenia (Pt) - This scale was originally developed to measure the general
symptomatic pattern labeled psychasthenia. . Psychasthenia was originally characterized by
excessive doubts, compulsions, obsessions, and unreasonable fears. The person suffering from
psychasthenia had an inability to resist specific actions or thoughts regardless of their
maladaptive nature.
\Scale 8: Schizophrenia (Sc) - This scale was originally developed to identify patients diagnosed
as schizophrenic. The items in this scale assess a wide variety of content areas, including bizarre
thought processes and peculiar perceptions, social alienation, poor familial relationships,
difficulties in concentration and impulse control, lack of deep interests, disturbing questions of
self-worth and self-identity, and sexual difficulties.
Scale 9: Hypomania (Ma) - This scale was originally developed to identify psychiatric
patients manifesting hypo manic symptoms. Hypomania is characterized by elevated mood,
accelerated speech and motor activity, irritability, flight of ideas, and brief periods of depression.
Scale 0: Social Introversion (Si) - This scale was originally designed to assess a person's
tendency to withdraw from social contacts and responsibilities.
1) Unlike projective tests, objective test's counter, objective tests are quite economical. This
is a certain upside since the cost of health care is rising and mental health facilities are
looking for new methods of cutting costs while still providing the services the community
needs. Since objective tests present a fixed set of questions and answer choices, they
make available the option of group testing. A therapist can even allow a patient to
complete such personality tests as the MMPI-2 alone and bring it back to them.
Additionally, in today's day and age it is possible to have a computer score the test as
opposed to having the therapist go over it, which can be an extremely time-consuming
process.
2) the scoring is objective, allowing for easier interpretation of data. Whereas projective
tests require a great deal of interpretation skill on the part of the clinician,objective
assessments make it easier on the clinician to interpret the score into something
meaningful for diagnosis and treatment. However, this is not to say that testers need not
be well trained and skilled. The simplicity of scoring and administration can often lead to
errors and misuse, one major flaw of objective exams. These flaws and misuse can
greatly affect the validity and reliability of the assessment, so it is important to take into
consideration the experience and skill of the test giver in any psychological testing
situation.
2) Next, some tests offer only one score for a range of different questions. Questions based on
behavior, cognitions, and needs all receive only a single score. This scoring system leaves
much to be desired as it eliminates the option for alternate interpretations to the answers
given. Grouping them all together can reflect different combinations of behaviors, cognitions,
and needs and thus a client may be misinterpreted by the overall score.
3) Client faking is also easy on an objective exam, however, newer versions of such tests as
the MMPI have put in place validity scales to check for faking and malingering. Still, test-
taker faking still has to be kept in mind, and taken very seriously. Another serious problem is
the self-knowledge aspect of objective exams. For some, knowing themselves is extremely
easy, for others, answering the types of questions found on objective exams can be extremely
hard. Since not all questions or answers given may match the test-taker exactly, and they
aren't allowed to elaborate on their answer, the tests can be frustrating and inaccurate.
4. INSUFFICIENT VALIDATION:
Some psychological assessment procedures in use today have not been sufficiently validated. For
example, unlike many of the personality scales, widely used procedures for behavioral
observation and behavioral self-report and the projective techniques have not been subjected to
strict psychometric validation.
THE EVOLUTION OF THE DSM The DSM is currently in its fourth edition (DSM-IV), with
some recent modifications, referred to as "DSM-IV-TR;' having been made in
2000.
This system is the product of a five-decade evolution involving increasing refinement and
precision in the identification and description of mental disorders. The first edition of the manual
(DSM -I) appeared in 1952 and was largely an outgrowth of attempts to standardize diagnostic
practices in use among military personnel in World War II. The 1968 DSM-II reflected the
additional insights gleaned from a markedly expanded postwar research effort in mental health
sponsored by the federal government.
Over time, practitioners recognized a defect in both these early efforts: The various types of
disorders identified were described in narrative and jargon-laden terms that proved too vague for
mental health professionals to agree on their meaning. The result was a serious limitation of
diagnostic reliability; that is, two professionals examining the same patient might very well come
up with completely different impressions of what disorder(s) the patient had.
To address this clinical and scientific impasse, the DSM-III of 1980 introduced a radically
different approach, one intended to remove, as far as possible, the element of subjective judgment
from the diagnostic process. It did so by adopting an "operational" method of defining the various
disorders that would officially be recognized. This innovation meant that the DSM system would
now specify the exact observations that must be made for a given diagnostic label to be applied.
In a typical case, a specific number of signs or symptoms from a designated list must be present
before a diagnosis can properly be assigned. The new approach, continued in the DSM-III's
revised version of 1987 (DSM-III-R) and in the 1994 DSM-IV, clearly enhanced diagnostic
reliability. As an example of the operational approach to diagnosis,
The number of recognized mental disorders has increased enormously from DSM -I to DSM-IV,
due both to the addition of new diagnoses and to the elaborate subdivision of older ones. Because
it is unlikely that the nature of the American psyche has changed much in the interim period, it
seems more reasonable to assume that mental health professionals view their field in a different
light than they did 50 years ago. The DSM system is now both more comprehensive and more
finely differentiated into subsets of disorders.
Axis I. The particular clinical syndromes or other conditions that may be a focus of clinical
attention. This would include schizophrenia, generalized anxiety disorder, major depression, and
substance dependence. Axis I conditions are roughly analogous to the various illnesses and
diseases recognized in general medicine.
Axis III. General medical conditions. Listed here are any general medical conditions potentially
relevant to understanding or management of the case. Axis III of
DSM -IV-TR may be used in conjunction with an Axis I diagnosis qualified by the phrase "Due to
[a specifically designated general medical condition]"
On any of these first three axes, where the pertinent criteria are met, more than one diagnosis is
permissible and in fact encouraged. The last two DSM-IV-TR axes are used to assess broader
aspects of an individual's situation.
Axis IV. Psychosocial and environmental problems. This group deals with the stressors that
may have contributed to the current disorder, particularly those that have been present during the
prior year. The diagnostician is invited to use a checklist approach for various categories of
problems-family, economic, occupational. legal, etc. For example, the phrase "Problems with
Primary Support Group" may be included where a family disruption is judged to have contributed
to the disorder.
Axis V. Global assessment of functioning. This is where clinicians indicate how well the
individual is coping at the present time. A 100-point Global Assessment of Functioning
(GAF) Scale is provided for the examiner to assign a number summarizing a patient's overall
ability to function
REFERENCES
3. http://en.wikipedia.org/wiki/Minnesota_Multiphasic_Personality_Inventory
4. http://en.wikipedia.org/wiki/Rorschach_test
5. http://en.wikipedia.org/wiki/Thematic_Apperception_Test
6. http://www.psychologicaltesting.com/objectiv.htm