Author ORCID Identifier
https://orcid.org/0000-0001-8695-3379
Defense Date
2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Clinical Psychology
First Advisor
Jared Keeley
Abstract
The present study examined whether dimensional symptom rating scales systematically influence clinicians’ severity judgments and whether such effects vary as a function of symptom domain salience. Using secondary data from an ICD-11 vignette-based study, clinicians rated expert-designed vignettes across six psychotic symptom domains using multi-point severity scales. A Severity Deviation Index (SDI) was calculated to compare clinician ratings to expert-defined benchmarks. Results from one-sample t-tests indicated consistent, domain-specific deviations in severity ratings, with both higher and lower ratings observed relative to expert benchmarks across vignettes. Multivariate analyses further demonstrated that these differences varied as a function of symptom domain salience, with significant effects observed in the majority of cases. Mixed-effects models and Pearson correlation analyses examining clinician characteristics revealed minimal and non-systematic associations with severity deviation, indicating that factors such as profession, age, years of experience, and familiarity with psychotic disorders were not robust predictors of rating differences. Collectively, findings suggest that dimensional rating scales do not function as cognitively neutral tools, but instead shape how clinicians interpret and quantify symptom severity. These results highlight the importance of considering cognitive processes in the design and implementation of diagnostic systems.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
8-2-2026