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CHAPTER 17 The Nature and Causes of Mental Disorders CLASSIFICATION AND DIAGNOSIS OF MENTAL DISORDERS To understand, diagnose, and treat psychological disorders, some sort of classification system is needed. The need for a comprehensive classification system of psychological disorders was first recognized by Emil Kraepelin.  What is “Abnormal”? The term “abnormal” literally refers to any departure from the norm (e.g. a really tall or really short people, or really smart people like me are considered abnormal). However, the distinction between normal and abnormal behaviour can be very subjective. Psychologists stress that the most important feature of mental disorder is not whether behaviour is abnormal but rather if it’s maladaptive. Mental disorders cause distress or discomfort and interfere with people’s ability to lead satisfying, productive lives. Although the diagnosis of mental disorders should be as objective as possible, it may never be completely free from social and political judgments (i.e. what is thought of as retarded in one culture may be sacred in another). It is important to note that mental disorders bring pain and discomfort to these people and to their friends and families.  Perspectives on the Causes of Mental Disorders There isn’t a single cause of mental disorders but in general, they are cause by the interaction of hereditary, cognitive and environmental factors. Sometimes, genetics can play a strong role and the person carrying those genes is likely to develop a mental disorder. To understand mental disorders, a complete study must be taken deriving all possible factors. There are many psychology related profession who try to understand mental disorders and each vary their emphasis on the three given factors. The perspectives differ primarily in their explanation of the etiology (origin) of mental disorders. o The Psychodynamic Perspective This is based on Freud’s early work: mental disorders originate in the intrapsychic conflict produced by the three components of the mind—id, ego and superego. For some people the conflicts become so sever the mind’s defence mechanisms fail and begin to distort reality or the individual may revert to an earlier stage of life (e.g. begin acting like a kid). Mental disorders may involve extreme anxiety, obsessive thoughts and compulsive behaviour, depression, and etc. o The Medical Perspective The origins of the medical perspective like in the work of the ancient Greek physician Hippocrates. The medical model is based on the ideas that mental disorders are caused by specific abnormalities of the brain and nervous system and that they should be approached for treatment in the same way as physical illnesses. However, not all mental disorders can be traced so directly. o The Cognitive-Behavioural Perspective The cognitive-behavioural perspective holds that mental disorders are learned maladaptive behaviour patterns that can be best understood by focusing on environmental factors and a person’s perception of those factors. A mental disorder is not something that arises spontaneously within a person but caused by the person’s interaction with his or her environment. o The Humanistic Perspective Mental disorders arise when people perceive that they must earn the positive regard of others. They become overly sensitive to the demands and criticisms of others and come to define their personal value primarily in terms of others’ reaction to them. They lack confidence in their abilities and fell as though they have no stable, internal value as persons. They may come to feel that they have no control over the control over the outcomes of the important events in their lives. The goal of humanistic therapy is to persuade people that they do have intrinsic value to help them achieve their own unique, positive potential as human beings. o The Sociocultural Perspective Psychologists are paying more attention to the role of sociocultural factors in their attempts to understand how people thinking and behave and the development of disorders is the same. Proper treatment requires an understanding of cultural issues which influence the nature and extent to which people interpret their own behaviours as normal or abnormal. o The Diathesis-Stress Model of Mental Disorders Elements of the previous perspective are often combined to form a different, more comprehensive, perspective on mental disorders. The diathesis-stress model says a casual account of mental disorders based on the idea that mental disorders develop when a person possesses a predisposition for a disorder and faces stressors that exceed his or her abilities to cope with them.  The DSM-IV Classification Scheme A system most commonly used in N. America for classifying mental disorders today is the Diagnostic and Statistical Manual IV (DSM-IV). Axis I contains information on major psychological conditions. Axis II is where personality disorders are found. Axis III is used to describe any physical disorders. Axis IV specifies the severity of stress that a person has experienced and Axis V is to estimate the extent to which a person’s quality of life has been diminished by the disorder.  Some Problems with DSM-IV Classification This system is more consistent with the medical perspective on mental disorders than with other perspectives. It is not very reliable since mental disorders do not have distinct borders and can one disorder can be a combination of two other disorders.  The Need for Classification Since labelling can have negative effects, some people, such as Thomas Szasz, suggested that we should abandon all attempts to classify and diagnose mental disorders. However, proper classification has advantages for a patient. One is that the recognition of a specific diagnostic category precedes the development of successful treatment for the disordered (e.g. diabetes, syphilis). To accurately treat a patient, we must accurately identify and diagnose the problem.  Prevalence of Mental Disorders In Canada, substance use disorders, mood disorders and anxiety disorders have found to be the most common types of mental disorders. ANXIETY, SOMATOFORM, AND DISSOCIATIVE MENTAL DISORDERS Often referred to as neuroses, anxiety, somatoform, and dissociative mental disorders are strategies of perception and behaviour that have gotten out of hand. People who have neuroses experience anxiety, fear, and depression, and generally are unhappy. However, unlike people who have psychoses, they do not suffer from delusions or severely disordered thought processes and hey almost universally realize that they have a problem.  Anxiety Disorders Fear and anxiety are the most prominent symptoms. Anxiety is a sense of apprehension or doom that is accompanied by certain physiological reactions (e.g. accelerated heart rate, sweaty palms, and tightness in the stomach. o Panic Disorder: Description Panic is a feeling of extreme fear mixed with hopelessness or helplessness. People with panic disorder suffer from episodic attacks of acute anxiety—periods of acute and unremitting terror that grip them for lengths of time lasting from a few seconds to a few hours. Shortness of breath, clammy sweat, and irregularities in heartbeat, dizziness, faintness, and feelings of unreality are often symptoms of panic attacks. Between panic attacks, people with panic disorder tend to suffer from anticipatory anxiety—a fear of having a panic attack. Anxiety is a normal reaction to many stresses of life and none of us is completely free from it. o Panic Disorder: Possible Causes  Genetic and Physiological Causes. A considerable amount of evidence implicates biological influences in the development of panic disorder. It appears to have a substantial hereditary component. People with panic disorder show physiological response patterns that seem to be biological controlled (e.g. breathing irregularly).  Cognitive Causes. The cognitive approach focuses on expectancies. People who suffer from panic attacks appear to be extremely sensitive to any element of risk or danger in their environment: these people expect to be threatened by environmental stressors and downplay or underestimate their abilities to cope with them. o Phobic Disorders: Description  Phobias are persistent, irrational fears of specific objects or situations. The term phobic disorder should be reserved for people whose fear makes their lives difficult. There are three types of phobia: agoraphobia, social phobia, and specific phobia. Agoraphobia is a mental disorder characterized by fear of and avoidance of being alone in public places; this disorder is often accompanied by panic attacks. Social phobia is a mental disorder characterized by an excessive and irrational fear of situations in which the person is observed by others. Specific phobia is an excessive and irrational fear of specific things, such as snake, darkness, or heights. o Phobic Disorders: Possible Causes  Environmental Causes—Learning. Not all phobias are learned through classical conditioning. Most do not remember a specific cause for their phobia.  Genetic Causes. Some suggest that a tendency to develop a fear of certain kinds of stimuli may have a biological basis that reflects the evolution of our species. The idea is that because of our ancestors’ history in relatively hostile natural environments, a capacity evolved for especially efficient fear conditioning to certain classes of dangerous stimuli. o Obsessive-Compulsive Disorder: Description People with an obsessive-compulsive disorder—recurrent, unwanted thoughts or ideas and compelling urges to engage in repetitive ritual-like behaviour—suffer from obsessions—thoughts will not leave them—and compulsions—behaviours that repeat some action over and over even though it serves no useful purpose. Unlike people with panic disorder, people with obsessive-compulsive disorder have a defence against anxiety—their compulsive behaviour. Obsessions are seen in many mental disorders, including schizophrenia. However, unlike those with schizophrenia, people with OCD generally recognize that their thoughts and behaviours are senseless and wish that they would go away. Most compulsions fall into four categories: counting, checking, cleaning and avoidance. o Obsessive-Compulsive Disorder: Possible Causes  Cognitive Causes. These people believe they should be competent at all times, avoid any kinds of criticism at all costs, and worry about being punished by others for behaviour that is less than perfect.  Genetic Causes. Evidence is beginning to accumulate suggesting that obsessive- compulsive disorder may have a genetic origin. One example is Tourette’s syndrome which entails muscular and vocal tics, including mak
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