Private Practitioner, USA
Title: Formulating diagnostic impressions and pitfalls of self-report
Biography: Catherine A. Carlson
Critical analysis is the sine qua non of assessment. The role of a psychiatric diagnostician is akin to a sleuth because similar skills are required. Both must gather, recognize, identify, and determine the reliability of available data to arrive at a hypothesis. Reliability, in this case, refers to whether data can be believed, trusted, and relied upon in forming valid diagnostic conclusions. The self-report of people with mental illness, who may be guarded, misguided or have poor insight, is often unreliable and accepting self-report and/or self-diagnosis at face value can lead to erroneous diagnoses and thus, inappropriate treatment.
Available data can be broken down into two types, objective and subjective. Objective and behavioral data is inherently more reliable than subjective data which can be colored by conscious or unconscious distortions or erroneous conclusions. Subjective data is contained in personal and professional accounts, endorsements, and opinions. Self-report regarding symptoms, or Symptom Expression (SE), and the diagnosis of another clinician are examples of subjective data. Observable behavior recognized manifestations of genuine mental illness, and voluntary versus involuntary presentations are examples of objective data. An examinee who endorses (SE) debilitating symptoms of depression, should show overt signs of debilitating depression because people who are severely depressed show overt signs of depression. Important, and often unrecognized data, is embedded in behavioral functioning and can expose unreliable SE. The SE of an examinee who endorses debilitating symptoms of depression and presents with bubby effect, perfectly coiffed hair, and bright red lipstick is probably unreliable. Learning what major mental illness looks like outside the diagnostic manual, and how to categorize, recognize, and look at data, will assist in the formulation of valid diagnostic impressions.
Several clinical vignettes will illustrate the analytic and didactic material. The user-friendly content is captivating, supported by research citations, and geared toward mental health professionals who conduct psychiatric evaluations.