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Joe Kim

Psychopathology 11/5/2011 4:52:00 PM DEFINING ABNORMAILITY - The four D’s – Deviance, Distress, Dysfunction, and Danger. - Keep in mind, you do not need all four D’s to be considered as abnormal. Deviance  Having thoughts, emotions and behaviours that fall far outside of the standards of what other are doing – acceptable by society.  People with psychological disorders deviate in some way from the typical behaviours of others.  We define abnormality by whether or not the individual’s behaviour is accepted by the culture to which the individual belongs too.  This can be related to both those who fall below and above the norm are labeled deviant.  Example: Those with major depressive disorder experience an excessive decrease in normative mood regulation, whereas in bipolar disorder, individuals experience episodes of mania in which they have an excessive increase in normative mood regulation. Distress  When a person experiences intense negative feelings due to their behaviour, such as anxiety, sadness, or despair.  Keep in mind that not all psychological disorders have strong feelings of distress.  People with mental illnesses often report feelings of being deeply troubled by their illness.  However not all disorder are accompanied by feelings of distress (example: sociopaths). Dysfunction  Where behaviour interferes with the person’s ability to function properly.  They can no longer go to work and earn a living, or run a household.  Dysfunctional behaviour’s are described as being “maladaptive” – because they prevent an individual from adapting well to their environment.  Psychological disorders often cause dysfunction in completing everyday tasks, but this dysfunction may also be voluntary. Danger  Danger to either oneself, or others.  Examples: a person who engages in risky behaviour that led to drug addition, a person who engages in violence towards others, athletes who participate in extreme sports, or office workers who do not get weekly exercise and continue to eat shitty. STIGMA OF PSYCHOLOGICAL DISORDERS Labeling Theory Of Mental Illness - The application of a deviant label to an individual can result in changes of self-perception and perception by others, and a decrease in social opportunities. - Mental illness stereotypes are learned during socialization and are then reinforced as to create rigid stereotypes. “On Being Sane in Insane Places” - Showed that health professionals are subject to the effects of labeling and stereotyping. - Eight people were committed to different psychiatric hospitals around the USA. - All eight people were deemed as sane prior to the study. All eight faked symptoms of schizophrenia. All but one were admitted and diagnosed schizophrenia. - Once admitted they all reported being dehumanized and essentially ignored by hospital staff despite returning to their normal behaviour. - Psychiatric staff continued to interpret their behaviour as abnormal and as further evidence of mental illness. - Average of 19 days all of the patients were discharged and given the label as “schizophrenia-in remission”. DIAGONISTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS - Aka DSM - Symptom – Any characteristic of a person’s actions, thoughts or feeling that could be a potential indicator of mental illness. - Syndrome – A collection of interrelated symptoms manifested by any given individual. - The most current DSM 9s the fourth edition with a text revision. - It categorizes and describes mental disorders so that clinician will have a common set of criteria for applying a diagnostic label to the symptoms of their patients. - It allows researchers to talk to each other about mental disorders using a common language. - DSM attempts to group together disorders that have similar sets of symptoms, with the assumption that similarities suggest a common cause and that they can be similarly treated. Things can change as researchers discover new information about specific disorders. - Includes important information about cultural differences, as it acknowledges that we live in a culturally diverse world. Example: Individuals from other cultures (Japan, Korea) may develop excessive fear of offending others in social situations, instead of the classic fear of embarrassing oneself which is evident among North Americans with a social phobia. - DSM outlines two general criteria that must be met before a clinician can make any diagnosis regarding mental health.  1) Disordered behaviour must originate from within the person, not as a reaction to external factors.  2) The disorder is involuntary and the person suffering from the disorder is unable to control the symptoms that they experience. DSM Categorization - Multiaxial System which requires assessment of individuals to be placed on five separate axes, describing important mental health factors. - Diagnoses of psychological disorders are made on Axes I and II, wherein most disorders are recorded on Axis I, with the exception of personality disorders and mental retardation, which are recorded on Axis II. - Axis I is state dependant – the current condition or state of functioning for a certain individual. - Axis II is trait dependent – enduring maladaptive problems with the person’s functioning. - Axes III-V are used to provide additional information on the individual’s overall functioning. - Axis III describes current physical conditions, such as diabetes or heart disease. This axis is important because medical conditions may cause/contribute to a mental illness. - Axis IV is used to report psychosocial or environment stressors that may affect the diagnosis, treatment, or prognosis of disorders. Examples would be a recent death in the family, divorce or natural disaster. - Axis V provides a global assessment of functioning – made on the individual’s current level of adaptive functioning. The Axes of the DSM  Axis I: Clinical Syndromes  Axis II: Developmental Disorders & Personality Disorders  Axis III: Physical Conditions  Axis IV: Severity of Psychosocial Stressors  Axis V: Highest Level of Functioning - DSM does not provide treatment plans for disorders or an explanation; it only provides a pattern of symptoms. - Epidemiology is the study of the distribution of mental or physical disorders in a population. - Prevalence is the percentage of a population that exhibits a disorder during a specific time period. Lifetime Prevalence is an estimate of the percentage of people afflicted by a specific disorder at any given point in time. - Comorbidity is the coexistence of two or more disorders at the same time. - Prognosis is the probable course of an illness. Criticisms Of The DSM - Categorical classification model where psychological disorder differs from normal functioning in kind rather than degree (no middle ground, either you are, or aren’t). - Dimensional classification model in which psychological disorders differ from normal functioning in degree rather than kind. - This is problematic because discrete categories insinuate that there is a clear boundary between normal and abnormal, and this is not true. - DSM has a high degree of comorbidity among many of its diagnoses. There is too much overlap between psychological disorders. MODELS Biological Model  Known as the medical or disease model.  Assumes that a psychological disorder results from malfunction in the brain.  The brain may malfunction because it is physically damages, or because there is abnormal activity of chemicals in the brain known as neurotransmitters.  Usually points to genetics, nutrition, disease and stress.  Treatment often relies on drug therapy, however in extreme cases, treatment may also include electroconvulsive shock or brain surgery. Psychodynamic Model  Pioneered by Freud.  Believes that mental disorders are rooted in an internal malfunction; it is thought to be a psychological malfunction, the mind and processes.  A mental disorder is usually attributed to maladaptive attempts to deal with strong, unconscious conflicts.  Freud believed that these conflicts stemmed from unresolved childhood issues.  No physical therapy (drug therapy) can cure a mental disorder – it will just temporarily alleviate the symptoms.  Only psychoanalysis can get to the root of the problem.  Current therapies include a focus on personal insight in which therapists try to help patients understand themselves better so they can cope with life stressors. Behaviourist Model  Views psychological disorders as external, overt behaviour rather than an internal malfunction.  These behaviours and emotions are the problem.  Disordered behaviours are established through classical and instrumental conditioning.  Attempt to treat maladaptive behaviours using principles from conditioning.  Example: Classical conditioning is often used to treat phobias.  Behaviour therapy focuses on seeking out positive situations and actions.  People may find that disordered behaviour provides “rewarding” attention from others.  Cannot compensate for disorders like people hearing voices in their head.  Although behavioural treatment is often effective while inside the comfort of the therapists’ office, it does not always transfer well to other environments.  Fails to see the complexity of human beings. Cognitive Model  Mental disorders result from maladaptive or inappropriate ways of selecting and interpreting information from the environment.  How you interpret situations (like public speaking) is going to lead to different behaviours, some of which may be considered “abnormal”.  Experience and learning play an important role in shaping maladaptive thinking.  Therapies are designed to identify maladaptive thinking, and to change it through more positive experiences.  Since cognitive and behavioural approaches complement each other, and many of therapies combine these procedures designed to change both thinking and behaviour. These therapies are known as cognitive-behavioural therapies, aka CBT. MOOD DISORDERS - Characterized by disturbances in emotion (includes depression and mania). - Mood disorders tend to be episodic in nature. Episodes of mood disturbance typically last between 3 and 12 months. - Two types of mood disorders: depressive and bipolar disorders. - 60% of all completed suicides occur in individuals suffering from a mood disorder. - Frequently comorbid with anxiety disorders, personality disorders, and substance abuse. - Main types of depressed mood disorders.  Unipolar Depression (Major Depression): - Mood disorder defined by symptoms such as decreased mood, loss of motivation, significant fluctuation in weight, lack of energy, and thoughts of suicide. - May experience difficulties with memory, attention, decision-making, and cognitive speed (neurocognitive deficits). - Episodes are recurrent, but left untreated, can last for several months. Since this depression has such extreme risks, it is not a good idea to leave it untreated. - In between episodes a person usually returns to normal functioning. - Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least (1) depressed mood or (2) loss of interest or pleasure. - Across North America, the lifetime prevalence rate for major depressive disorder is over 16%. In Canada, 10% will experience a major depressive episode at some point in their lifetime. - Occurs twice as much in females than in males. The age of onset in females was 17.86 yrs, and in males it was 18.37 yrs. This is because females are more likely to be affected by victimization.  Bipolar Depression: - Experiences episodes of depression such as unipolar, however they also experience periods of elevated mood called mania. - During mania, a person experiences heightened self-esteem, activity, and energy and sleep very little. They feel as though their thoughts are racing ahead of their ability to deal with them. - The person may also do things that are potentially risky: sexual promiscuity, high-risk business investments, and unrestrained buying sprees. They may also become very angry when a person is an obstacle to their goals. - Usually talk rapidly, and can be in irritable moods often. - Average age of onset is 20 yrs of age, and there is no gender difference in frequency of diagnosis in males and females. - There are two different types of bipolar disorder: Bipolar I and II. - Bipolar I is characterized by at least one manic and one depressive episode. - Bipolar II is similar to BD I, except that it requires one hypomanic episode and one depressive episode. Hypomanic episodes are differentiated from full-blown manic episodes in that within hypomania the mood disturbance is not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization and there are no psychotic features. - Rapid cycling may be applied to BD I or BD II, it is the occurrence of four or more mood episodes during the span of 12 months.  Dysthymia: - Has symptoms of depression that are less severe, but they rarely return to normal levels of functioning in between episodes of depression. - Can be described as someone being mildly depressed all the time.  Cyclothymic Disorder (Cyclothymia): - Chronic but relatively mild symptoms of bipolar disturbance. - Experience numerous periods of hypomanic and depressive symptoms for at least 2 years, with periods of normalcy lasting no longer than 2 months.  Postpartum Depression: - Type of depression that occurs within four weeks of childbirth.  Seasonal Affective Disorder (SAD): - A type of depression that follows a specific season, such as winter or summer. - Most common season associated with SAD is winter. - One form of treatment is phototherapy. - Causes of Depression (Etiology):  Biological Model points to abnormal levels of chemical activity of neurotransmitters in the brain. Treatment: drug therapy – antidepressants change the balance of neurotransmitters. Irregularities in the amygdala, prefrontal cortex, anterior cingulated, and the hippocampus. Serotonin, norepinephrine, and dopamine are related to mood disorders. Low levels of dopamine and norepinephrine (regulated by serotonin) in mood disorders lead to depression and mania.  Behavioural Model suggests that depression arises in individuals who lack social skills, making it difficult for them to elicit normal positive social reinforcement from others. This may lead to lowered mood and self blame of depression. The depressive symptoms may elicit sympathy, attention and concern from other and this may lead to further reinforcement of the symptoms. Depression can also be learned through helplessness (shown in a dog experiment).  Cognitive Model says that depression arises in individuals who have a particular (and maladaptive) way of evaluating themselves and their experiences. Aaron Beck calls them depressogenic schemata. Under stress people with these tendencies develop unrealistically negative and demeaning interpretations. Negative cognitive triad is negative interpretations of themselves, the world and their futures. Selective Abstraction individuals draw a conclusion from a situation on the basis of many elements (example: a student feels worthless because himself and his group failed an assignment). Overgeneralization occurs when someone makes a broad conclusion drawn on the basis of a single, trivial event (example: a waitress working on a busy night forgets one drink order all night and fells stupid). Learned helplessness model was formulated on dogs; animals were exposed to unavoidable negative situations, then when the dogs could avoid the negative situations they didn’t even try to get away from it, they just whined. Pessimistic explanatory style means that depressed individuals attribute any setbacks they encounter to be personal, global and stable causes. The hoplessness theory says that depressed individuals expect that desirable outcomes will not happen, and that undesirable outcomes will occur, and that they cannot change it.  Psychological treatments include psychoanalysis therapy and cognitive behavioural therapy. Psychoanalysis tries to promote insight and awareness.  Cognitive Behavioural Therapy aims to make people more aware of how they think and understand emotions. Treatment often includes setting up goals and doing tasks so they can practice their behavioural skills. CBT is good for decreasing the chance of depression relapsing but sometimes CBT is not enough and may have to be combined with psychological and biological treatments.  Negative life events can trigger depression.  Genetic heritability estimates are approximately 35% for MDD and 85% for BD.  Personality traits contribute to the emergence of depression. Perfectionism is a trait that is associated with depression. There are three types of perfectionism. Self-Oriented Perfectionism is where you set extremely high expectations for oneself. Other-Oriented Perfectionism is where you demand perfection from others. Socially Prescribed Perfectionism perceiving that other have expectations of one’s self; most frequently associated with depression.  Personality orientations are also related to depression: Introjective Personality Orientation it is characterized by feelings of guilt and worthlessness, and a sense that one has failed to live up to the expectations and standards imposed on them; Anaclitic Orientation is characterized by feelings of helplessness and weakness; individuals often experience intense feelings of abandonment and are desperately dependent on others.  Personality types that are also related to depression include: Sociotrophy which is associated with being inordinately invested in interpersonal relationships (overly concerned with pleasing others and actively avoid conflict in their relationships); Autonomy are people that prefer to preserve independence and freedom of choice, they engage in solitary activities, place high value on hard work and accomplishments, and are often insensitive to the needs of others. ANXIETY DISORDERS - Most common form of mental health problems, affecting approximately 1 in 10 people. - People suffering from an anxiety disorder suffer from intense, prolonged feelings of fright and distress that often interferes with their relationships and may sometimes even interfere with their ability to work and perform daily tasks. - There are six anxiety disorders, but only five will be covered.  General Anxiety - Feels repeatedly worried about minor things like normal life events and routine activities. - Constant, severe, and inescapable anxiety and worry. - A person diagnosed with generalized anxiety disorder experiences these feelings for at least six months. - People always feel tense, and this can lead to dizziness, sleep problems, muscle tension, headaches, fatigue, restlessness, irritability, and sometimes nausea. These people often have difficulty concentrating and feel irritable. - Occurs more frequently in females than males and has a lifetime prevalence of 5%.  Obsessive-Compulsive disorder - Symptoms are recurring obsessions or compulsions that disturb the person or interfere with day-to-day living. - Obsession is an idea, impulse or image that we can’t get out of our head. It might involve the recurring idea that we have done something wrong or the persistent fear that a loved one has been injured. - Compulsion is a behaviour ritual that a person feels compelled to perform over and over again. This person knows that the ritual is unreasonable, but feel anxious if the ritual is not completed. - Occurs in late adolescence or young adulthood, where it occurs earlier in men but its equally as common in males and females. The lifetime prevalence is about 1.6%. - Common obsessions are contamination, pathological doubt, symmetry, exactness, or perfectionism, religious. - Common compulsions are washing and cleaning, checking, arranging, hoarding, counting, and repeating. - Mysophobia is that obsession with contamination and germs.  Post-Traumatic Stress Disorder - Triggered by an extremely stressful event. - Does not necessarily have to surface until months after the event. - Feelings of persistent anxiety and intrusive thoughts about the even occur. - May have flashbacks of the traumatic event. - People with PTSD feel the need to avoid certain situations, objects or people that remind them of the traumatic event. - May suffer from intrusive thoughts, and nightmares, feel depressed, irritable, easily startled, hypervigilant and have trouble concentrating. - People have these symptoms for many years. It is helpful to discuss the event with one another as often as possible, and in as much detail as they can remember. - Lifetime prevalence rate is about 6.8%. There’s a higher frequency and intensity in women than men.  Phobic Disorders - Type of anxiety disorder marked by a persistent and irrational fear of an object or situation that presents no realistic danger. - Realize that their fear is irrational, but cannot help themselves. - Even imagining the phobic object, or situation can trigger feelings of anxiety. These can be accompanied by physical reactions. - Phobias are grouped into two categories: social phobia and specific phobias. - Social phobias demonstrate a marked fear of public appearances during which humiliation or embarrassment is possible. People actively avoid situations where they may have to interact with others, and are fearful of being scrutinized or evaluated by others. Common
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