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The Uncertainty of Psychological and Psychiatric Diagnoses

The Uncertainty of Psychological and Psychiatric Diagnoses Psychiatric and psychological diagnoses are imperfect. Unlike somatic medicine, most psychological and psychiatric phenomena have no gold standard to establish their presence beyond reasonable doubt. Consequently, prevalence estimates are based on the average agreement of imperfect evaluators. Küchenhoff, Augustin, and Kunz (2012) provided a statistical method for estimating confidence intervals of the prevalence based on the well-known kappa coefficient of interrater agreement. We expand this method and derive confidence intervals for the probability of a diagnosis being true (i.e., the positive predictive value). We illustrate the method and its results with empirical data for a particular type of paraphilia (pedophilia) in sexual offenders. The findings indicate that up to 1 in 3 diagnoses of pedophilia may be wrong. Given the similar rates of prevalence and interrater agreement reported for diagnoses in general psychiatry (such as schizophrenia or affective disorders), the results likely apply to other diagnostic domains as well. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Psychological Assessment American Psychological Association

The Uncertainty of Psychological and Psychiatric Diagnoses

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References (28)

Publisher
American Psychological Association
Copyright
© 2017 American Psychological Association
ISSN
1040-3590
eISSN
1939-134X
DOI
10.1037/pas0000524
Publisher site
See Article on Publisher Site

Abstract

Psychiatric and psychological diagnoses are imperfect. Unlike somatic medicine, most psychological and psychiatric phenomena have no gold standard to establish their presence beyond reasonable doubt. Consequently, prevalence estimates are based on the average agreement of imperfect evaluators. Küchenhoff, Augustin, and Kunz (2012) provided a statistical method for estimating confidence intervals of the prevalence based on the well-known kappa coefficient of interrater agreement. We expand this method and derive confidence intervals for the probability of a diagnosis being true (i.e., the positive predictive value). We illustrate the method and its results with empirical data for a particular type of paraphilia (pedophilia) in sexual offenders. The findings indicate that up to 1 in 3 diagnoses of pedophilia may be wrong. Given the similar rates of prevalence and interrater agreement reported for diagnoses in general psychiatry (such as schizophrenia or affective disorders), the results likely apply to other diagnostic domains as well.

Journal

Psychological AssessmentAmerican Psychological Association

Published: Apr 19, 2018

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