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Psychology - Psychological Disorders.docx

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York University
PSYC 2510
Richard N Lalonde

Psychology – Lecture 21 March 20, 2013 Psychological Disorders Psychological Disorders – Dilemmas of Definition  Ways of defining disorders o Deviant – violates cultural standards (hallucinations); have to look at the time period o Maladaptive or harmful (agoraphobia – going out on your own in public places) o Causing emotional distress (unreasonable anxiety)  Mental Disorder o Normal-abnormal continuum o We all have our own peculiar ways of doing things, but when do they slip into the abnormal range?  Causing person great suffering  Self-destructive or maladaptive  Disrupts person’s relationship with community (family & friends) Legal definition – Insanity  In Canada, Not Criminally Responsible on Account of Mental Disorder (NCRMD) o If person is mentally ill at time of committing offense and unable to know what he/she was doing, that it was wrong, or to be able to control his/her behaviour  Unfit to stand trial o So ill that he/she is unable to participate in the defense or of communicating with lawyer Diagnostic and Statistical Manual – DSM  Bible/Koran/Torah of psychiatric diagnosis  5 editions since 1952 (DSM-IV-TR is latest)  Very descriptive; little about causes  Encourages diagnosis on 5 axes  DSM 5 – Something Wicked this Way Comes (Disagreement) DSM: 5 axes (removed with DSM 5?)  I: Primary clinical problem o Eg. anxiety disorder  II: Personality (Minnesota Multiphasic Personality Inventory) o Eg. dependency  III: General medical conditions (physical factors) o Eg. Insomnia  IV: Social & Environmental stressors (Social Readjustment Rating Scale) o Eg. move to a new country to study, lost job  V: Overall functioning o Eg. inability to work Explosion of Mental Disorders in DSM  Supporters o Need to distinguish disorders precisely o DSM improves reliability & agreement among clinicians  Critics o Driven by insurance industry o Healthy people may be over-treated & remove services from those who truly need them Concerns about diagnostic system  Danger of over-diagnosis  Power of diagnostic labels o Bad – self-fulfilling prophecy (Using disorder as an excuse to explain behaviour) o Good – helps problem-focused coping  Confusion of serious mental disorder with normal problems (eg. depression after spouse dies)  Illusion of objectivity & universality Rosenham (1973) On Being Sane in Insane Places  Procedure: 8 normals gain admission to psychiatric hospitals after report of hearing voices (hollow, empty, thud); told the truth about everything else  Results o 7 diagnosed as schizophrenic o Released after average of 19 days (in remission) o Real patients better at spotting pseudo-patients (30% other patients voiced suspicions)  They have luxury of time  They have the actual experience  There are no expectations – don’t have to diagnosis Other classification systems  International Statistical Classification of Diseases and Related Health Problems (IDC-10), produced by the World Health Organization (WHO) – used in Europe and other parts of the worl  Chinese Classification of Mental Disorders (CCMD-3) Psychological Disorders Within these disorders, there are other disorders; Over 300 disorders  Adjustment Disorders  Anxiety Disorders *  Delirium, Dementia and Amnestic and Other Cognitive Disorders  Dissociative Disorders  Eating Disorders  Factitious Disorders  Impulse-control Disorders  Mental Disorders Due to a General Medical Condition  Mood Disorders *  Other Conditions That May Be a Focus of Clinical Attention  Personality Disorders  Schizophrenia and Other Psychotic Disorders  Sexual and Gender Identity Disorders  Sleep Disorders  Somatoform Disorders  Substance-Related Disorders* Survey – Canadians > 15 year Statistics Canada (2003) Anxiety Disorders  Anxiety and panic  Fears and phobias  Obsessions & compulsions Anxiety and Panic  Generalized Anxiety Disorder o Continuous & uncontrollable state of anxiety  Marked by worry, difficulties in concentration & signs of motor tension o Can be felt without a specific anxiety-producing event o Some have a history of disorder starting in childhood Posttraumatic Stress Disorder (PTSD)  Associated with traumatic events  May immediately follow event or occur later The Aldermans Video  Their youngest son, Peter, was killed  It changed the trajectory of their lives  They opened a health clinic; now operate 9 health care clinics around the world  “We are creating a profound and memorable mark that Peter lived on this world” Panic Disorder  Recurring panic attacks  Periods of intense fear  Feelings of impending doom  Rapid heart rate & dizziness Phobias  Unrealistic fear of a specific situation, activity or object  Agoraphobia – basic fear of being away from a safe place or person (can’t leave home) Giving something a name does not make it a real problem  Be a critical thinker – is the anxiety disabling? o If not, they don’t really need treatment; just avoid the situation o Luposlipophobia: the fear of being chased by timber wolves around a table while wearing socks on a floor that has been recently waxed Obsessive-Compulsive Disorder (OCD) Case Study Video  Elizabeth obsessed with germs: washes her hands over 100 times a day, opens the door/switches on the light with her foot, doesn’t wear certain clothes because she perceives them as threatening (contaminated)  Between 4-8 million people in the US  No treatment; Behaviour modification treatment is a step in the right direction  Anxiety of being trapped in repetitive, persistent thoughts (obsessions) and repetitive, ritualized behaviours (compulsions) designed to reduce anxiety o Most common Obsessions – fear of contamination (germs) o Person understands that ritual behaviour is senseless but guilt mounts if not performed (& anxiety occurs) OCD in the movies  AS Good as it Gets – Jack Nickolson  Leonardo Dicaprio as Howard Hughes Etiology of Anxiety Disorders  Biological factors o Genetic predisposition, anxiety sensitivity o GABA circuits in the brain (type of neurotransmitter)  Conditioning and learning o Learned through classical conditioning & observational learning o Maintained through operant conditioning  Cognitive factors o Judgements of perceived threat (people with anxiety disorders may interpret things as more threatening)  Personality – Neuroticism  Stress – A precipitator Mood Disorders  Depression and Bipolar Disorder  Etiology of Depression Clara Hughes  Won 6 Olympic medals for speed skating/cycling in Canada  Suffered from depression for 2 years: felt afraid and alone but got help & got through it  Let’s Talk Campaign – to help people suffering from depression  Big step: something is wrong Major Depression  Mood disorder o Emotion (excessive sadness) o Behaviour (loss of interest in usual activities, changes in sleep) o Cognition (thoughts of hopelessness, lost concentration) o Body function (fatigue, appetite loss, weight loss/gain) Gender, Age & Depression  Women about 2X likely to be diagnosed o Stable around the world  After age 65, rates of depression drop sharply in both sexes Research Example – The Cultural shaping of depression  Common among cultures but not manifested the same way  Ryder et al. (2008) o
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