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Chapter 15.docx

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Todd Ferretti

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Chapter 15: Psychological Disorders Defining Mental Disorder  Mental Disorder o Any behaviour or emotional state that:  Causes an individual great suffering  Is self-destructive  Seriously impairs the person's ability to work or get along with others, or endangers others or the community  See Table 15.1 for table of various disorders  Mental health is conceived in context of society (i.e. if society is homophobic, then homosexuality can be considered a mental health disorder)  Not the same as insanity o Legal term only involving mental illness and whether a person is aware of consequences and can control their behaviour Dilemmas of Definition  Varying definitions of mental disorders: o Mental disorder as a violation of cultural standards o Mental disorder as emotional distress o Mental disorder as behaviour that is self-destructive or harmful to others  In Canada, mental disorders are the leading cause of disability in those aged 15-24  Have to be careful in whether we are simply applying a bias or cultural norm against someone, or whether there is a legitimate mental health concern Dilemmas of Diagnosis  Disorders typically classified using the Diagnostic and Statistical Manual of Mental Disorders (DSM)  Primary goal of DSM is to be descriptive and to provide clear diagnostic categories (see table 15.1)  Lists symptoms, onset, predisposing factors, course of disorder, prevalence, sex ratio, and cultural issues in diagnosis DSM Categories  Five dimensions (axes) clients are evaluated on: o Axis I: Primary clinical problem (Actual Diagnosis of Disorder) o Axis II: Personality factors/disorders (Influence of Personality on Disorder) o Axis III: General medical conditions o Axis IV: Social and environmental stressors o Axis V: Global Assessment of Functioning (Scale of Disorder)  Assess client on scale out of 100, do it before and after treatment to determine changes etc Increasing DSM Disorders  As time has passed, there are more and more people being diagnosed with mental disorders  Supporters of new categories answer that it is important to distinguish disorders precisely  Critics point to economic reasons; diagnoses are needed for insurance reasons so therapists will be compensated Problems with the DSM  It is important to be aware of limitations and problems present in attempts to classify mental disorders: 1. The danger of over-diagnosis (e.g. ADHD) 2. The power of diagnostic labels (once diagnosed, will always be stuck with it) 3. The confusion of serious mental disorders with normal problems (i.e. shyness) 4. The illusion of objectivity and universitality (e.g., drapetomania, reflect cultural and social prejudices) -Changes in time, thought that prior ways were always wrong  Very Western-influenced device, does not take into high account community or spirituality Advantages of the DSM  Defenders agree that boundaries between "normal problems" and "mental disorders" are fuzzy and difficult to determine o Many psychological symptoms fall along a continuum ranging from mild to severe  When DSM used correctly, in conjunction with valid objective tests, improve reliability of diagnosis Culture Bound Symptoms  Recent inclusion of culture-bound syndromes: disorders that are specific to a particular culture context (see Table 15.2) o E.g. ghost sickness, bad dreams, fainting, preoccupation with death and the dead  Comparing mental and emotional symptoms allows researchers to distinguish between universal disorders and culture-bound syndromes Dilemmas of Measurement  Diagnosis usually made by combination of clinical interview and psychological tests o Projective Tests: Tests used to infer a person's motives, conflicts, and unconscious dynamics on the basis of the persons interpretations of ambiguous stimuli o Objective Tests: standardized objective questionnaires requiring written responses, typically include scale that people rate themselves on Projective Tests  Can help establish rapport with client  Tests lack reliability and validity (although some have tried to develop comprehensive scoring systems for responses)  Sometimes used inappropriately Objective Tests  Popular personality assessment is the Minnesota Multiphasic Personality Inventory (MMPI) o Contains 10 clinical scales for problems such as depression, paranoia, schizophrenia, introversion o Contains 4 validity scales to indicate whether responder is lying, defensive, or evasive o Has been revised but still some cultural differences in scores on certain subscales Anxiety Disorders  Anxiety: o A general state of apprehension or psychological tension o Can be adaptive as they energize us to cope with danger  Anxiety Disorders: o When fear and anxiety become detached from actual danger  E.g. Chronic anxiety, panic attacks, obsessive-compulsive disorder  Generalized Anxiety Disorder o A continuous state of anxiety, marked by feelings of worry and dread, apprehension, difficulties in concentration, and signs of motor tension o Symptoms experienced in challenging or uncontrollable situations o No specific anxiety-producing event o Develop habits that foster their worry o No delusional symptoms  Posttraumatic Stress Disorder (PTSD) o Person who has experienced a traumatic or life-threatening even has symptoms such as psychic numbing, reliving of the trauma, and increased physiological arousal o Not all who experience trauma develop PTSD  May involved a genetic pre-disposition, history of prior psychological problems, poor emotional adjustment and catastrophizing, smaller hippocampus than average Panic Disorders  An anxiety disorder in which a person experiences recurring panic attacks, feelings of impending doom or death, accompanied by physiological symptoms such as rapid breathing and dizziness o Interpretation of bodily reactions key in development of disorder Fears and Phobias  Phobia: o An exaggerated, unrealistic, fear of a specific situation, activity, or object  Social Phobia: o Irrational fear where sufferers become extremely anxious in which they will be observed by others, worrying they will do or say something that will be excruciatingly humiliating or embarrassing  Agoraphobia: o Set of phobias, often set off by a panic attack, involving the basic fear of being away from a safe place or person Anxiety Disorders  OCD o An anxiety disorder in which a person feels trapped in repetitive, pertinent thoughts (obsessions) and repetitive, ritualized behaviours (compulsions) designed to reduce anxiety o May involve depletion of serotonin from prefrontal cortex (may create cognitive rigidity) R.D. Laing  Born 1927  Asserted that there are no legitimate mental illnesses  Perfectly normal reactions by perfectly normal people to actions by an insane society  Worked as a psychiatrist when lobotomies, ECT and insulin coma therapy were common  In modern medicine, we are classifying everything on the outskirts and strange, and making the box of normal much smaller  In the process of trying to make things normal and make the wor
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