Issues In Forensic Psychology - Diagnostic Classification

ISSUES IN FORENSIC PSYCHOLOGY
Diagnostic Classification (DSM-IV)

Classification is a fundamental characteristic of all scientific endeavor, and diagnostic classification is fundamental to psychology and psychiatry. Psychologists and psychiatrists typically rely on the Diagnostic and Statisical Manual of Mental Disorders-4th Edition (DSM-IV) for their diagnostic work.
The merits of all classification procedures ultimately rest upon their reliability. If many experts disagree on how something should be classified, their classification procedure is seriously flawed because of its unreliability.
Unfortunately, the history of diagnostic classification in psychology and psychiatry is a legacy of unreliability born out of chronic uncertainities and insidious biases.
Psychologists and psychiatrists regularly assign different diagnoses to the same patients; and as a result, diagnostic decisions are characterized by their gross inconsistency.
There is no available evidence indicating that the criteria of DSM-IV have reduced the subjective biases associated with the diagnostic work of psychologists and psychiatrists.
Diagnoses too often reflect the ethnic and social-class prejudices of diagnosticians and the social stereotypes they associate with a particular disorder.
The unavailability of inter-rater reliability data for the many diagnostic classifications of DSM-IV profoundly undermines its evidentiary value.
The critically important question of inter-rater reliability asks: If two or more mental health professionals evaluate the same client, to what extent will they agree in their diagnostic conclusions? Low levels of inter-rater consistency related to any classification procedure indicates that the procedure frequently leads to mistaken findings.
Surprising as it may seem, there are no inter-rater reliability data to be found in DSM-IV. DSM-III contained inter-rater reliability data for its various diagnostic categories, but the supposedly improved DSM-IV neglected to report this information.
If you are interested in issues related to diagnostic classification, you may want to order any, or all, of the following publications authored by Dr. Campbell.

Challenging the evidentiary reliability of DSM-IV. American Journal of Forensic Psychology, 1999, 17 (1), 47-68. (Order article #14, Cost $10.00).

"Cross-Examining Psychologists and Psychiatrists as Expert Witnesses." This is a 79-page, single-spaced outline, containing 214 footnoted references. This outline is bound. (Order article #15, cost $59.00).

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