Key things need to KNOW

• Kupfer and Kraemer (2012)

  Testing for DSM 3 was conducted under controlled settings (trained clinicians, screening clients).  However, DSM 5 was tested under normal conditions and therefore the level of agreement would be lower as it was in normal conditions.  As well the DSM5 task force suggested that values as high as 0.8 would be miraculous’ and note that values of 0.4-0.6 are ‘realistic’ but values of 0.2-0.4 are ‘acceptable’.
• Rachael Cooper (2014): Falling Standards

  DSM 5 is unreliable as the acceptable level of agreement is 0.2-0.4 which is low and suggests the DSM 5 may be less reliable than the DSM from previous years.  Levels of agreement after DSM III were meant to be 0.7, as proposed by Robert Spitzer using the statistical analysis of Cohen’s Cappa.
• Regier (2013) reported, using the DSM V  that three disorders including PTSD had levels of agreement values amongst clinicians ranging from 0.6-0.79.
• DSM 5 had a concordance rate of 0.46 for schizophrenia according to Reiger et al. (2013) so the inter rater reliability of diagnosis of mental health disorders such as schizophrenia may be questioned.
• Since structured interview are used in the diagnosis process using the DSM, such as the Beck Inventory Scale, according to Sheenan etl 1998, the use of structured interviews should increase the reliability of the of the diagnosis proces
• Diagnosis can be affected by what the patients tell the psychiatrist, so if a patient reports different symptoms to the psychiatrist on two  different occasions  this may affect the test/re test reliability of their diagnosis, as with the DSM the clinician uses interviews to help in the diagnosis process.  
• Stinchfield et al. (2015) found that DSM 5 led to fewer false negatives than DSM IV when diagnosing gambling disorder suggesting classification systems are valid.
• DSM still lacks validity because the classification tool can tell us nothing about the cause of a disorder and appropriate treatment.
• Longitudinal study, conducted by Cohen 2232 children involved in another longitudinal study  Children’s mothers, teachers were asked to complete a questionnaire asking about conduct disorder symptoms over the previous 6 months. A diagnosis was research using the DSM IV symptoms of conduct disorder

  Results: The disorder was able to predict educational difficulties and conduct disorder 2 years later.
• Clinician may be reluctant to provide correct diagnosis due to negative ramifications in society (Kim and Berrios 2001 – Japan. Found only 20% of patients were aware of the SZ diagnosis)
• Lee (2006) conducted a study using the DSM, an acknowledged Western classification system, to diagnose ADHD in 1663 Korean children. Results demonstrated consistency with Western cultures
• Luhrmann et al. (Ghana, India and USA – SZ) An anthropologist and several psychiatrists interviewed participants from the USA, India and Ghana, each sample comprising 20 persons who heard voices and met the inclusion criteria of schizophrenia, about their experience of voices.  Relationships with others are far more salient to the ways non-Westerners (certainly South Asians and Africans) interpret their experience than they are to Westerners. We believe that these social expectations about minds and persons may shape the voice-hearing experience of those with serious psychotic disorder.
• DSM Is published by the APA, a single nation professional body and is published only in English. This provides a stream of revenue for the organisation who publish it
• Finally DSM, it is specific to mental disorders and does not contain guidance on diagnosing physical health conditions and is only used by Psychiatrists. 
• Section One offers guidance on the new system. Section Two details the disorders and is categorised according to our current understanding of underlying causes and similarities between symptoms
• Section Three includes suggestions for new disorders (internet gaming), which are still under investigation.  It also includes information on the impact of culture on symptoms.
• Clinicians can gather information about individual groups thorough observation however, much I gathered through interviews, which can be either structured (Beck Depression Inventory) or unstructured.  The clinician than rules out disorders that do not  match the person’s symptoms, which offers a best fit for the individual.
• Inter- rater reliability is the extent to which two or more clinicians agree on a diagnosis.A correlation coefficient is calculated to determine the degree of consistency.
• Predictive Validity is the extent Predictive validity demonstrates the extent to which a diagnosis can accurately foresee and explain the development and experiences of a condition in the future.
• Cross cultural validity suggests that if two or more different cultures are unable to find similar conclusions when diagnosing and describing conditions it may suggest that a particular disorder is not universal or the classification tool is not universal
• Test re-test reliability in clinical psychology measures how consistently the same diagnosis tool measures the symptoms of the same individual.