Construct validity and psychological diagnosis

Is construct validity a helpful term when it comes to psychological experience?

Construct validity is a term that is used when attempting to test the validity of a psychological diagnosis, but how useful and accurate is it to think in these terms?

How do you verify the sense of internal experience?

Is it a case that certain constructs and diagnoses are developed which then become more widely reported?

When a condition such as ADHD (Attention deficit hyperactivity disorder) becomes identified there tends to be a rise in the number of cases reported.

Construct validity – How helpful is a diagnosis?

Frequently in my practice a client will be referred who has been told they are depressed, or suffering from a particular type of depression or anxiety. They explain that they are not sure if the diagnosis is correct.

In my experience of working with people, of understanding more about the symptoms and experience they are describing it often seems that the diagnosis they are speaking of may:

a. not be very helpful in terms of helping them to think about their experience

b. stop them seeing the links between their current emotional experience and their personal histories

c. not help them to find a way of engaging in a more satisfying way with their emotions and states of mind

Testing the construct validity – a case example

A 40 year old man was referred to me who explained that he had been told he was suffering from a type of depression. His depression he explained was difficult to treat and had been referred to as resistant depression. This had been confirmed to him by his psychiatrist. It was not obvious that the diagnosis was helping him.

In psychotherapy one of the particular features of the man’s life that stood out concerned his exposure to early trauma and traumatic experience. It was not clear that enough attention had been paid to this early experience, the diagnosis of resistant depression was taking all of the attention.

He remained under the care of his GP and consultant at hospital but in his sessions with me the more we considered the impact of the early traumas the more he seemed to come alive.

It is often my experience that psychotherapy coincides with all kinds of improvements when compared to the original presenting situation.

In this case, the man was going through a difficult separation from his wife and there were all manner of custody implications for their small children. But, as he worked with me and talked through his early experiences, he reported that there were less problems in the day-to-day relationship with his wife. It was evident that a considerable amount of the anxiety symptoms that he reported and lived with were lessening and life was becoming more manageable.

It is often the case that PTSD and CPTSD underlie diagnoses of depression

If someone has gone through early and ignored trauma there are often profound consequences. It is likely that their engagement in school will have been significantly disrupted. PTSD creates problems with things like concentrating and concentration. It makes school and education difficult and has implications for learning, exams and achievements as well disrupting social life.

It is not uncommon for people who have gone through trauma to have become disorganised and disconnected from ordinary social interactions.

If these things are left unacknowledged then in time it is common that the symptoms that develop out of the experience become the things that end up being diagnosed and treated. In this way the underlying issues become obscured. But it is often the case that it is the underlying condition that needs the attention if the problem is going to be properly addressed.

Particular constructs of illness, particular diagnoses and treatment models tend to go through cycles of popularity.

We see this with the interest in CBT, or when Mindfulness is treated as the answer to all problems. Similarly with prescription medicines, selective serotonin reuptake inhibitors (SSRIs) have become the appropriate medication for anyone speaking of anxiety or depression. It may be that these medicines or treatments are helpful, but in the longer term being more able to consider the whole life of the person, not just their presenting symptom is more useful.

Being prepared to think outside the construct validity is necessary when trying to help someone find a way of transforming their experience.