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For one thing, they are not always reliable. It is possible for various clinicians who observe the same person to focus on different aspects of behavior, assess the person differently, and arrive at different conclusions. Careful training of observers and the use of observer checklists can help reduce this problem

Similarly, observers may make errors that affect the validity, or accuracy, of their observations ). The observer may suffer from overload= and be unable to see or record all of the important behaviors and events. Or the observer may experience observer drif+t, a steady decline in accuracy as a result of fatigue or of a gradual unintentional change in the standards used when an observation continues for a long period of time. Another possible problem is observer bias—the observer's judgments may be influenced by information and expectations he or she already has about the person

An ideal observation Using a one-way mirror, a clinical observer is able to view a mother interacting with her child without distracting the duo or influencing their behaviors.


A client's reactivity may also limit the validity of clinical observations; that is, his or her behavior may be affected by the very presence of the observer ). If schoolchildren are aware that someone special is watching them, for example, they may change their usual classroom behavior, perhaps in the hope of creating a good impression.

Finally, clinical observations may lack cross-situational validity. A child who behaves aggressively in school is not necessarily aggressive at home or with friends after school. Because behavior is often specific to particular situations, observations in one setting cannot always be applied to other settings
The validity of a classification system is the accuracy of the information that its diagnostic categories provide.

Categories are of most use to clinicians when they demonstrate predictive validity—that is, when they help predict future symptoms or events.
A common symptom of major depressive disorder is either insomnia or excessive sleep. When clinicians give Franco a diagnosis of major depressive disorder, they expect that he may eventually develop sleep problems even if none are present now. In addition, they expect him to respond to treatments that are effective for other depressed persons. The more often such predictions are accurate, the greater a category's predictive validity.


DSM-5's framers tried to also ensure the validity of this new edition by conducting extensive reviews of research and consulting with numerous clinical advisors. As a result, its criteria and categories may have stronger validity than those of the earlier versions of the DSM. But, again, many clinical theorists worry that at least some of the criteria and categories in DSM-5 are based on weak research and that others may reflect gender or racial bias. In fact, one important organization, the National Institute of Mental Health (NIMH), has already concluded that the validity of DSM-5 is sorely lacking and is acting accordingly). The world's largest funding agency for mental health research, NIMH has announced that it will no longer give financial support to clinical studies that rely exclusively on DSM-5 criteria.
1.Adding a new category, "autism spectrum disorder," that combines certain past categories such as "autistic disorder" and "Asperger's syndrome" .



2.Viewing "obsessive-compulsive disorder" as a problem that is different from the anxiety disorders and grouping it instead along with other obsessive-compulsive-like disorders such as "hoarding disorder," "body dysmorphic disorder," "trichotillomania" (hair-pulling disorder), and "excoriation (skin-picking) disorder" (see Chapter 4).



3.Viewing "posttraumatic stress disorder" as a problem that is distinct from the anxiety disorders (see Chapter 5).


4.Adding new categories, "disruptive mood dysregulation disorder," "persistent depressive disorder," and "premenstrual dysphoric disorder," and grouping them with other kinds of depressive disorders (see Chapter 6).



5.Adding a new category, "somatic symptom disorder" (see Chapter 8).



6.Replacing the term "hypochondriasis" with the new term "illness anxiety disorder" (see Chapter 8).



7.Adding a new category, "binge eating disorder" (see Chapter 9).



8.Adding a new category, "substance use disorder," that combines past categories "substance abuse" and "substance dependence" (see Chapter 10).



9.Viewing "gambling disorder" as a problem that should be grouped as an addictive disorder alongside the substance use disorders (see Chapter 10).



10.Replacing the term "gender identity disorder" with the new term "gender dysphoria" (see Chapter 11).



11.Replacing the term "mental retardation" with the new term "intellectual disability" (see Chapter 14).



12.Adding a new category, "specific learning disorder," that combines past categories "reading disorder," "mathematics disorder," and "disorder of written expression" (see Chapter 14).



13.Replacing the term "dementia" with the new term "neurocognitive disorder" (see Chapter 15).



14.Adding a new category, "mild neurocognitive disorder" (see Chapter 15).
Even with trustworthy assessment data and reliable and valid classification cate.gories, clinicians will sometimes arrive at a wrong conclusion

Like all human beings, they are flawed information processors. Studies show that they may be overly influenced by information gathered early in the assessment process. In addition, they may pay too much attention to certain sources of information, such as a parent's report about a child, and too little to others, such as the child's point of view. Finally, their judgments can be distorted by any number of personal biases—gender, age, race, and socioeconomic status, to name just a few. Given the limitations of assessment tools, assessors, and classification systems, it is small wonder that studies sometimes uncover shocking errors in diagnosis, especially in hospitals

classifying-
the very act of classifying people can lead to unintended results., for example, many family-social theorists believe that diagnostic labels can become self-fulfilling prophecies. When people are diagnosed as mentally disturbed, they may be perceived and reacted to correspondingly. If others expect them to take on a sick role, they may begin to consider themselves sick as well and act that way. Furthermore, our society attaches a stigma to abnormality. People labeled mentally ill may find it difficult to get a job, especially a position of responsibility, or to be welcomed into social relationships. Once a label has been applied, it may stick for a long time.


Because of these problems, some clinicians would like to do away with diagnoses. Others disagree. They believe we must simply work to increase what is known about psychological disorders and improve diagnostic techniques. They hold that classification and diagnosis are critical to understanding and treating people in distress.