Chapter 3: Diagnosis, Formulation, and Assessment

Raskin examines the essential processes of diagnosis, formulation, and assessment in psychology, psychiatry, and related fields. The chapter begins by defining diagnosis as both a medical and non-medical practice, showing how perspectives shape whether symptoms are labeled as mental disorders, cognitive distortions, or sociocultural stressors. It provides a historical and contemporary overview of the two most influential diagnostic systems: the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization’s International Classification of Diseases (ICD). Students learn the origins, current editions (DSM-5-TR and ICD-11), definitions of mental disorder, and how diagnostic guidelines (ICD) and diagnostic criteria (DSM) are applied, including their use of diagnostic codes for research, treatment planning, and insurance reimbursement. Issues of diagnostic reliability and validity are explored through examples such as generalized anxiety disorder, comorbidity, and the controversial pseudopatient study by David Rosenhan, later revealed to have been falsified. The chapter also outlines the strengths and limitations of DSM and ICD—providing a common language, advancing treatment, and reducing stigma, while also being critiqued for medicalization, cultural bias, overreliance on pharmaceuticals, and political influence. Alternatives to DSM and ICD are presented in detail: the Psychodynamic Diagnostic Manual (PDM) with its P-, M-, and S-axes; the Research Domain Criteria (RDoC) project’s biomarker-based research framework; the Hierarchical Taxonomy of Psychopathology (HiTOP), which organizes symptoms dimensionally and hierarchically; and the Power Threat Meaning Framework (PTMF), which reframes mental distress as a product of power, threat, and meaning in sociocultural contexts. The chapter then shifts to formulation, contrasting psychiatric diagnosis with case formulations that use psychological theory to explain presenting problems. Examples include integrative evidence-based case formulation and the 4P model (preconditions, precipitating, perpetuating, and protective factors). Assessment methods are surveyed comprehensively: clinical interviews (unstructured, structured, SCID, and mental status exams); personality tests such as the MMPI, 16PF, projective tests like the Rorschach and TAT; cognitive-behavioral assessments like the Daily Record of Dysfunctional Thoughts; humanistic assessments including the Q-sort and role construct repertory test; intelligence measures such as the WAIS, WISC, and IQ scoring; and neuropsychological and neurological tests including the Bender Gestalt, Halstead-Reitan, Luria-Nebraska, EEG, PET, and fMRI. Throughout, the importance of culture bias is emphasized, noting how diagnostic and assessment tools reflect their cultural contexts and may disadvantage marginalized groups. By the end, students understand how diagnosis, formulation, and assessment work together, while recognizing the controversies, cultural considerations, and alternative frameworks that shape mental health practice today.