The Pursuit of a Perfect Test
Updating the Diagnostic Statistical Manual of Mental Disorders and it’s practical implications
Abnormal psychology has always been an interesting topic to me, as was research on treatment development, as it aims to provide good, scientifically proven techniques to aid those suffering from mental disorders. This is why my third year self couldn't wait to sink my teeth into a class that centered on psychopathology, how it develops in infancy, and how it changes over the course of one’s life. It was like every single first year psychology class I begrudgingly dragged myself to and the countless hours of memorizing trivial facts were finally going to pay off! My love for this course grew, despite the fact that it required me to get up close and personal to the Diagnostic Statistical Manual of Mental Disorders (DSM) and ultimately it is one of the main reasons I've set my sights on psychology as a career.
While becoming best friends with the DSM, I noticed that many researchers focus their careers on updating it in a timely fashion, and making its diagnoses as specific, reliable and valid as possible. The same could be said for many psychological tests, and the numerous updates that are subsequently published. There is constantly something to improve that makes a tests more accurate and I believe striving for the perfect test is a great pursuit in theory. However, do the benefits hold in a practical sense?
Take Autism for example, a group of diagnoses that have been overhauled between the DSM- IV and the DSM V. Most noticeably, the diagnoses of Asperger’s disorder, and Pervasive developmental disorder not otherwise specified (PDD-NOS) have been completely removed as diagnostic categories. Instead, there is now one broad category called Autism spectrum Disorder (ASD), which is further divided based on how severe your symptoms are, and how much support you need. Furthermore, criteria or symptoms that one needs to show to be diagnosed have been made stricter. This is reflected in the fact that one needs to show more symptoms in the DSM-V that indicate fixated interests and engagement in repetitive behavior. Generally, any changes made were done so on the basis of research, expert opinion and careful analysis in hopes of making an autism diagnosis more reliable and valid. In the DSM-IV, the inter-rater agreement on diagnosis was low, as was test-retest reliability.
Now, a precise test is imperative due to the serious nature of an Autism diagnosis, but does a reliable and valid test translate to better outcomes in everyday life? It will certainly have an impact including changing the diagnosis of those who fell under Asperger’s disorder, and PDD-NOS. This may be confusing for patients and their parents, particularly in adult populations, where their diagnosis may integrated into their identity. Furthermore, having stricter criteria may mean those who are relatively more functional no longer meet the diagnostic cut off. This may mean losing vital resources and services that they have become accustom to, yet still dealing with the same difficulties they had before the DSM change. I believe it’s safe to say, that this change needs to be made clear to patients, their families as well as those who supply services to this population, such as educational services and insurance providers.
While striving for an optimal test that diagnoses patients in a reliable and valid way is a great ideal, I believe we should be putting equal effort into examining how this change plays out practically, and identifying the best method to insure these changes go smoothly, disrupting the lives of the patients as little as possible.
Autism Research Institute. (n.d.). Updates to the APA in DSM-V : What do the changes mean to families living with autism? Retrived from: http://www.autism.com/news_dsmV
