Throughout my clinical psychology education, there have been multiple times when a lecturer, an academic resource or a paper has mentioned that clinical cutoffs aren’t the best and they are problematic. Yet they have never gone into any great detail about the advantages and disadvantages of clinical cutoffs and why they are not good for our clients. I wanted to change this, not only for my own education but so I can educate others have the pros and cons of the cutoffs. Therefore, in this clinical psychology podcast episode, you’ll learn about the advantages and disadvantages of clinical cutoffs and why they might disservice our clients instead of helping them. If you enjoy learning about mental health, psychotherapy and diagnosis then this will be a great episode for you.
Today’s psychology podcast episode has been sponsored by Clinical Psychology Reflections Volume 5: Thoughts On Clinical Psychology, Mental Health and Psychotherapy. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
As always the references for today’s podcast episode are at the bottom of the page.
What Are Clinical Cutoffs?
Within clinical psychology, we use clinical cutoffs as thresholds for mental health conditions so we can see if someone’s symptoms and mental health difficulties meet the criteria for a specific diagnosis. There are some pros and cons of clinical cutoffs and that’s what we’re going to be focusing on in today’s episode.
In addition, as a small example that is related to clinical cutoffs, a lot of psychometric tests use clinical cutoffs to measure if someone has a mental health condition and what the severity is. For instance, in my research, I like using the Mental Health Inventory-5 because it’s easy and validated and it uses the following clinical cutoffs. This study used the Youden Index to determine the MHI-5 cutoff point because it is the least dependent on population prevalence, giving a cutoff point of 76 (Kelly et al., 2008). Whereas the Depression, Anxiety and Stress Scale-21 uses the following: Depression, Anxiety and Stress scores from each subscale were calculated by adding up the item scores with the severity of depression reflecting 0-9=Normal depressive symptoms, 10-13= mild depressive symptoms, 14-20= moderate depressive symptoms, 21-27= severe depressive symptoms and 28+= extremely severe depressive symptoms. Anxiety severity was reflected in scores of 0-7= normal anxiety symptoms, 8-9= mild anxiety symptoms, 10-14= moderate anxiety symptoms, 15-19 severe anxiety symptoms and 20+ extremely severe anxiety symptoms. Stress severity was reflected in scores of 0-14= normal stress symptoms, 15-18= mild stress symptoms, 19-25= moderate stress symptoms, 26-33= severe stress symptoms and 34+= extreme severe stress symptoms (Lovibond & Lovibond, 1995).
As a result, you can see how different psychometric scales have different clinical cutoffs to help them determine if a mental health condition is present and the severity of the condition.
What Are The Advantages Of Clinical Cutoffs?
Let’s start off by focusing on the positive aspects of clinical cutoffs, because they can be very useful at times. Firstly, clinical cutoffs allow us to diagnose mental health conditions in a standardised way so we can ensure consistency across different mental health settings as well as professionals. For instance, if you’re using the Mental Health Inventory-5 in your diagnosis, it doesn’t matter if you’re assessing people in Manchester and they get a score of 80 or people down in Dover and they get a score of 80. Both of those numbers should mean the exact same thing in terms of the severity and presence of a mental health condition so that allows country-wide standardisation of diagnosis.
Even though, I will add I’ve spoken a lot on the podcast before about the inconsistency of diagnosis amongst mental health professionals and there is a lot of literature on the topic. Hence, you could argue clinical cutoffs help to get rid of some inconsistency but it certainly doesn’t solve the problem of inconsistency like it claims to. This is why the DSM-5 isn’t that great.
Secondly, one of the aspects that I like about clinical cutoffs is that it provides clients with a way to access treatment. Personally, in an ideal world, I am a firm believer that everyone should get access to mental health support when they need it most before they get so severe that their life is in danger. For example, I cannot get mental health support for my eating disorder until I am dangerously underweight so I’m going to keep getting more severe without any support.
Anyway, the reason why clinical cutoffs allow people to access treatment is because they can make individuals eligible for specific treatments, insurance coverage and support services. This is why in the UK, you cannot get access to eating disorder support until you meet the clinical cutoffs for your Body Mass Index and you have to be dangerously below your normal weight. Which is silly because the BMI is a useless and outdated concept which I covered on a past episode.
Although, to put a positive spin on this advantage, I want to mention that from a public services perspective, I understand why clinical cutoffs are needed. Since there will never be enough staff, money or support available for every single person who needs it and there definitely isn’t enough staff or money for preventive mental health support. Therefore, clinical cutoffs help public services to target their support to the people who need it most so they can focus on these individuals.
Finally, from a clinical research perspective, clinical cutoffs are very useful because standardised cutoffs give researchers a clear criteria for inclusion in their study. This can help them create more valid and credible studies that can improve our understanding as well as treatment of mental health conditions. In my opinion, this is a big advantage of clinical cutoffs because it is a way of knowing that your research participants do have the mental health condition to clinically significant levels, so this allows you to design and set up more valid experimental and control groups. This is an issue I have with mental health research done at university by Masters, undergraduates and even some PhD students, because university students are easier to get to. They make up the majority of the research samples even when they’re studying depression, and believe me, I know and I understand that depression, anxiety and other conditions are prevalent amongst university students. Yet from an empirical standpoint for better or for worse, part of me would like researchers to engage with clinical populations that have reached the clinical cutoff of the mental health condition that they’re investigating.
It isn’t a perfect idea but it is the world we live in.
What Are The Disadvantages of Clinical Cutoffs?
As you can tell already, I am a little critical of clinical cutoffs because I’ve already mentioned some extra disadvantages in the previous section. Yet we still need to investigate some more disadvantages.
Firstly, a disadvantage of clinical cutoffs is that they oversimplify mental health conditions by boiling them down into a set of numbers. They completely dismiss the complexity of mental health and they overlook the nuances of someone’s experience. The issue with oversimplifying mental health is that it can lead to misdiagnosis and it does lead to overlooking the people that need mental health support. For example, if we look at my eating disorder, I told the medical doctor (yes I have massive issues I was seen by a medical doctor for a psychological condition) that I’ve been losing a kilogram a week for about 2 months, I’ve made myself physically sick twice in the past few months through malnutrition, this is linked to my rape and I am barely eating a thousand calories most days because I am terrified to eat. Still because my Body Mass Index was okay, he said I was fine and let me go.
It is ridiculous.
I need the support and I was courageous enough to ask for the support as much as I didn’t want to, and then the medical doctors just turned me away.
Secondly, our next disadvantage builds off the last one because clinical cutoffs are very inflexible. Clinical cutoffs are very rigid so these fail to account for social, individual and cultural differences in how someone’s symptoms and difficulties manifest. Again, this means that people might not receive a diagnosis or the mental health support they really need. One example that shows the individual differences is when someone has anorexia nervosa and Atypical Anorexia. Both of these people have anorexia but one person has the extreme weight loss amongst all the other diagnostic criteria, but the person with Atypical Anorexia doesn’t have the extreme weight loss and still has all the other diagnostic criteria. Therefore, these are essentially the exact same condition, both are very deadly, but Atypical Anorexia doesn’t meet the clinical cutoff for mental health support at times.
It makes no sense when two people have the same deadly condition, but only one type of person gets mental health support from what I’ve seen.
Finally, the last major disadvantage of clinical cutoffs is that they tend to focus on deficits as well as pathology (what is wrong with someone) instead of their resilience and their strengths. You can tell that clinical cutoffs arose from the biomedical model that sees mental health conditions as evil disorders that needs to be cured at all costs instead of seeing them as conditions that a person lives with and needs to develop adaptive coping mechanisms to help them thrive in their everyday life. Just because a person has a mental health condition doesn’t make them flawed, evil or messed up. It just means they need a little more support to decrease their psychological distress, improve their lives and take back control of their lives so they can live their ideal life.
Clinical cutoffs dismiss that approach to mental health care completely. They imply that someone has a mental disorder that needs to be cured and fixed because there is something wrong with a person. I completely reject that notion like the majority of modern clinical psychology.
Clinical Psychology Conclusion
At the end of this mental health podcast episode, I want to say that I was rather surprised at how I was a little more critical of clinical cutoffs than I thought I was going to be. I won’t deny there are advantages, like clinical cutoffs mean we can diagnose mental health conditions in a standardised way, they allow clients to access treatment and they’re useful for designing standardised research samples in clinical research. Even though there are disadvantages within each of those advantages. Additionally, the disadvantages of clinical cutoffs include oversimplifying mental health, they’re inflexible and they pathologise a person’s mental health difficulties.
Ultimately, whilst there will not be an end to clinical cutoffs for a good long while because we don’t have anything to replace them with, probably until we come up with a valid and widely accepted alternative for the DSM, we need to be weary about them and not accept clinical cutoffs are perfect. As aspiring or qualified psychologists, it is our job to balance the use of clinical cutoffs with a holistic approach to mental health care so we can understand, appreciate and value the unique context and experience of every single client that we see.
Never ever reduce your client to a mere set of numbers as impossible as that might seem at times when we have the pressure of waiting lists, bosses and policy breathing down our necks. And that’s before we think of our ever-increasing caseload.
Clinical cutoffs are a tool for our jobs, and not a perfect tool at that.
I really hope you enjoyed today’s forensic psychology podcast episode.
If you want to learn more, please check out:
Clinical Psychology Reflections Volume 5: Thoughts On Clinical Psychology, Mental Health and Psychotherapy. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
Have a great day.
Clinical Psychology References
Pros and Cons of the DSM in Mental Health Diagnosis - Verywell Mind.
https://www.verywellmind.com/dsm-friend-or-foe-2671930.
Summary of Representative Clinical Depression Screening Tools.
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/Downloads/Summary-of-Representative-Clinical-Depression-Screening-Tools.pdf.
The Pros and Cons of Mental Health Diagnosis - MHM Group. https://mhmgroup.com/the-pros-and-cons-of-mental-health-diagnosis/.
What if Some Mental Disorders Weren't Disorders at All?. https://www.psychologytoday.com/us/blog/shouldstorm/202008/what-if-some-mental-disorders-werent-disorders-at-all.
Whiteley, C. (2024) Clinical Psychology Reflections Volume 5: Thoughts On Clinical Psychology, Mental Health and Psychotherapy. CGD Publishing. England.
Will a Diagnosis Do More Harm Than Good? The Pros and Cons of .... https://www.millennialtherapy.com/anxiety-therapy-blog/pros-and-cons-of-diagnostic-labeling.
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