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SOCI 2030 Lecture Notes - Anxiety Disorder, Specific Phobia, Thought Disorder

Course Code
SOCI 2030
Eytan Lasry

of 3
Lecture #28
Mental Disorder (Part II)
ŸMany ways in defining abnormal, but none of the definitions are complete, many ways of constituting
it, but it is hard to cover all that we mean by this term
ŸPatterns of behaviour from what is normative or expected, typically but not always involves personal
distress at a developmental stage, particular way in who other people think feel or act is distressing to
you, and it worries other people, and at some level this set of symptoms, impairs your ability to
function and thrive in an important domain, you want to succeed but as a result of your situation you
are unable to
ŸTheories and origins of abnormal behaviour=etiology is the study of the origins of behaviour
ŸNot trying to say by resisting medical model, resist medicine, and use symptom and disease theology,
clinical psychology is different, where a disease that is postulated has the same symptoms as the
disease (sadness and depression)
ŸIf symptoms cluster, anxiety, depression, the cluster of symptoms does not mean there is a biological
cause, there is something going on in the brain, but whether or not those things in the brain is the cause
of the symptoms is another matter
ŸWe should not assume then that a biological basis for disorder means that culture has no role, many
disorders have biological predisposition, but culture is also relevant, for e.g. schizophrenia (delusions,
thought disorder, hallucinations), but cultural meanings vary, different cultural meanings, a young adult
in our culture will be stigmatized, resources withdrawn, occupation limited, but in other cultures, when
you demonstrate the same symptoms, you can be made a venerated member of society, everything will
be brought to you, hallucination in that society it’s a sign of a vision
ŸDifficulties with classifying of behavioural disorders, if a person talks about all their symptoms, you
must categorize them to inform how you treat them
ŸThere are many issues with classifying, how do clinicians go about making decisions
ŸIn the role of a clinician, someone is in your office and presenting series of symptoms, how can you
figure out what disorder best suits this person, most often clinicians use their head, use their expertise
of the knowledge they have, administer some tests, interview of some kind, all of this data which you
must make sense of=use your head to arrive to a decision
ŸThe problem is, if there is any formula being used, its not explicit, when researchers make decisions
they want to be more explicit it so they developed a general formula instead of using their best
judgement (formula is NOT always right, and clinicians aren’t always wrong, if you study these two
entities over time, on average the formula will outperform the clinician)
ŸThe clinician is more often right than wrong too, but computer will outperform
ŸIf someone comes in with a set of symptoms, if you bring different doctors, they should arrive at the
same decision and conclusion, and when deciding what disorder they have, your eliminating the ones
that they don’t have as you collect more and more information about the patient
ŸOnce you know what diagnosis to give patient, you know how to treat them, this derails over and over
again (this example for medical community)
ŸFirst is problem of reliability, level of agreement for clinicians are not idea, factors that increase
reliability, if we use standardized tests and structured interviews rather than un-systemized processes
ŸAs our field evolves, clinical psychologists are becoming better and more reliable
ŸThe concept of comobidity, refers to the co occurrence of diagnosis (dual or multiple)
ŸIn clinical psychology, as your probability of one diagnosis goes up, you are more likely to get another
diagnosis, which completely defeats the purpose of figuring out the main diagnosis (like in medical
decision making)
ŸDisgnosis should be the process fo figuring out what you have by eliminating other possibilities
Ÿa lot of the time the whole process of differential diagnosing makes no difference when it comes to
treatment, for e.g. if you have major depresive disorder, you will receive anti-depressents and therapy,
if you have an anxiety disorder, you receive anti-depressants and therapy, doesn’t matter what you get,
you get the same treatment
ŸThe treatment will change depending on the diagnosis, (point overstated), small differences, but
virtually everyone is recommended to egt psychotherapy, and if you talked ot practising
psychotherapists, their diagnosis is not important, what is going to inform what you do in the session is
your theory of how they became sick and what caused it (your theory of how person is the way they
are=case formulation theory)
ŸVarieties of anxious experience, with respect to four disorders
ŸGood reason why we have capacity of become anxious, all of us experience some level of this, for
good reason, panic, fear, apprehensiveness, over the course of evolutionary history, organisms that
have this capacity survive better, anxiety is a threat-detective system, it is your body’s way of telling
you something bad is happening, or will happen in the future
ŸThe problem is to what extent and when you become anxious, disproportionate levels, warning system
goes off with many false alarms, then there is a problem (psychotherapy realigns the warning system)
ŸPanic disorders involve experience of panic attacks, tend to show up in the late teens and early 20s,
more frequently in women than men (2:1)àdoes not mean women are more anxious than men, but
they have different coping strategies
ŸPanic involves a very brief and intense shot of anxiety, comes with a host but not limited to some
features, heart palpitation, sweating, trembling, shaking, etc. happen spontaneously and unpredictably
ŸYou see panic attacks usually in the medical room because you are convinced something is medically
wrong with you, but after tests you will be handed over to psychotherapy
ŸThis raises another issue that individuals with anxiety disorders have two feature, allergic to
uncertainty harder time to deal with uncertainty, part of that allergy is expressed because they
catastrophize along the signs of catastrophe, they think of the worst possibility, and that they wont be
able to handle it
ŸPeople who have this on a regularity become apprehensive of when and where they will experience
panic attacks, they may think they may be in situation where no one helps them, this presents
agoraphobia (Greek, fear of market place, public spaces) fear and avoidance of where you may not be
able to escape or get help in the event of a panic attack
ŸIndividuals with this will enclose themselves in their houses, they don’t come to clinics, obstacle to
treat them (natural defence from a panic attack by not exposing themselves from risky environment)
ŸPhobias means fears, and they are different from everyday fears, they represent extreme and irrational
fears, phobic individuals can usually see there is no reason to be afraid of their phobia, but they cant
help but be fearful
ŸThree big classifications of phobic experience, agoraphobia, social phobia (fear of negative evaluation
from others, in two varieties, generalized variety in which social phobic is anxious about any type of
social interaction, and also in specific areas, performance related social phobia, public speaking
phobia, etc.) and specific phobias, fear of heights, close spaces, spiders, strangers, etc., sometimes
called simple phobia, but to patient it is not simple
ŸThe things we become afraid of are not arbitrary, its easier to develop a phobia for snakes or heights
than pigeons, snakes and heights are more likely to kill you than pigeons, biological disposition to
learn some fears than others
ŸPhobias are often learned through classical conditioning, the association between something were not
afraid of before with something that produces a fear response (learn to be afraid) what maintains our
phobia is operan conditioning
ŸWhen we become afraid of something, we usually avoid it, and avoidance gives us a sense of relief,
and relief is negatively reinforcing, the next time your exposed to the thing your afraid of, it is more
likely you will avoid the feared object because it will relieve you, and avoiding it will prevent you
from habituating it
ŸProf had phobia, dog cahsed him when he was 2, and he got enormous states of panic when he saw
dogs, he would be very apprehensive, different routes home if he knew there were dogs, he treated
himself by walking passed a house with a dog, but he forced himself to walk passed the dog, even
though he had a great deal of anxiety, he became better (progressive regular exposure)
ŸTreatment is controlled and moderated exposure, preventing you to escape and run away
ŸOCD, obsessive compulsion disorder consists of a combination of obsession and compulsion
ŸObsessions are reparably intrusive thoughts which are anxiety provoking, usually things that are
uncertain (did I leave the stove on, did I lock the front door, remember yesterday, etc.) revisit this kind
of uncertainty, with symmetry, contamination
ŸThe way obsessive’s cope is by developing little ritualistic behaviours=compulsion, external or mental
acts which serve to reduce obsession
Ÿe.g. people will order things, count things, hoard things, etc.
ŸRelative to their anxiety disorder patients, OCDs are not as observable anxious, because of their coping
mechanisms, but once you tell someone to for example get rid of all the junk in ones home (hoarders)
then it develops in abnormal anxiety
ŸPTSD slide skipped, read