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PSYC 102
Russell Day

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Chapter 15 Defining and Classifying Psychological Disorders  Vulnerability-stress model, each of us has some degree of vulnerability (ranging from very low to very high) for developing a psychological disorder, given sufficient stress. - Vulnerability (predisposition) can have a biological basis, such as genotype, over/under activity of neurotransmitter, hormone. Or due to personality factor, such as low self-esteem, extreme pessimism. Or due to previous environmental factors, such as poverty or extreme trauma. Cultural factors can also create vulnerability to certain kinds of disorders. - A predisposition creates a disorder only when stressor (some event that requires person to cope) combines with a vulnerability to trigger the disorder.  First, we’re likely to label behaviors as abnormal if they intensely distressing to the individual.  Second, most behaviors judged abnormal are dysfunctional either for the individual or for society.  Third criterion for abnormality is society’s judgements concerning the deviance of a given behavior.  We may define abnormal behavior as behavior that is personally distressing, personally dysfunctional, and/or so culturally deviant (violation of norms) that other people judge it to be inappropriate or maladaptive.  Reliability means that clinicians using the system should show high levels of agreement in their diagnostic decisions.  Validity means that the diagnostic categories should accurately capture the essential features of the various disorders.  DSM allows diagnostic information to be represented along 5 dimensions/axes, that take both the person and his life situation into account. 1. Axis I, primary diagnosis, represents the person’s primary clinical symptoms, that is, the deviant behaviors or thought processes that are occurring at present time. 2. Axis II reflects longstanding personality disorders/mental retardation, both of which can influence person’s behavior/response to treatment. 3. Axis III notes any medical conditions that might be relevant, such as high blood pressure or a recent concussion. 4. Axis IV, reflecting the vulnerability-stress model, the clinician also rates intensity of psychosocial/environmental problems in person’s recent life. 5. Axis V, global assessment of level of functioning.  One trade-off, is that the criteria are so detailed/specific that many people don't fit neatly into the categories.  Once a diagnostic label is attached to a person, it becomes all too easy to accept the label as an accurate description of the individual rather than of the behavior.  Diagnostic labels may also play a role in creating or worsening psychological disorders, self-fulfilling prophecy, in which expectation becomes reality.  Two particularly important legal concepts are competency and insanity. - Competency refers to defendant’s state of mind at the time of a judicial hearing - Insanity relates to the presumed state of mind of the defendant at the time when crime was committed. Anxiety Disorders  Anxiety, the state of tension and apprehension that is a natural response to perceived threat.  In anxiety disorders, the frequency and intensity of anxiety responses are out of proportion to the situations that trigger them, and the anxiety interferes with daily life.  Anxiety responses have 4 components: 1. Subjective-emotional component, including feelings of tension and apprehension 2. Cognitive component, including worrisome thoughts and a sense of inability to cope 3. Physiological responses, including increased heart rate/blood pressure. Muscle tension, etc. 4. Behavioral responses, such as avoidance or certain situations and impaired task performance. Phobic Disorder  Phobias are strong and irrational fears of certain objects or situations.  People with phobias realize their fears are out of proportion to the danger involved, but they feel helpless to deal with these fears.  Agoraphobia, excessive fear of situations in which the person might be evaluated and possibly embarrassed.  Specific phobias, such as a fear of dogs, snakes, spiders, elevators. etc.  Once phobias develop, they seldom go away on their own, and they may broaden/intensify over time.  The degree of impairment produced by a phobia depends in part on how often the phobic stimulus is encountered in the individual’s normal activities. Generalized Anxiety Disorder  Generalized anxiety disorder is a chronic (ongoing) state of diffuse, or free- floating, anxiety that is not attached to specific situations or objects.  May last for months, with signs almost continually present. Panic Disorder  In contrast to generalized anxiety disorder, which involved chronic (ongoing) tension and anxiety.  Panic disorders occur suddenly and unpredictably, and they are much more intense.  Many people who suffer recurrent panic attacks develop agoraphobia.  Formal diagnosis of a panic disorder requires recurrent attacks that do not seem tied to environmental stimuli, followed by psychological or behavioral problems. Obsessive-Compulsive Disorder  Such disorders usually consist of two components, one cognitive, the other behavioral, although either can occur alone.  Obsessions are repetitive and unwelcome thoughts, images, or impulses that invade consciousness, are often abhorrent to the person, and are very difficult to dismiss or control.  Compulsions are repetitive behavioral responses that can be resisted only with great difficulty.  Compulsions are often responses that function to reduce the anxiety associated with the intrusive thoughts  Like phobic avoidance responses, compulsions are strengthened through negative reinforcement because they allow the person to avoid anxiety. Posttraumatic Stress Disorder  PTSD is a severe anxiety disorder that can occur in people who have been exposed to traumatic life events.  4 major symptoms commonly occur in this anxiety disorder 1. The person experiences severe symptoms of anxiety, arousal, and distress that were not present before the trauma. 2. The victim relives the trauma recurrently in flashbacks, dreams, fantasy. 3. The person becomes numb to the word and avoids stimuli that serve as reminders of the trauma 4. The individual experiences intense survivor guilt in instances where others were killed and individual was somehow spared.  Traumas caused by human actions, such as war, rape, torture, are 5-10 times more likely to precipitate PTSD than are natural disasters. Women exhibit twice the rate of PTSD. Causal Factors in Anxiety Disorders  Genetic factors may create a vulnerability to anxiety disorders.  David Barlow, suggests that genetically caused vulnerability may take the form of an autonomic nervous system that overreacts to perceived threat, creating high levels of physiological arousal.  GABA, inhibitory transmitter that reduces neural activity in amygdala, and other brain structures that trigger emotional arousal. Individual with low concentration of GABA in these areas may be more susceptible to anxiety disorder.  According to Freud, neurotic anxiety occurs when unacceptable impulses threaten to overwhelm the ego’s defenses and explode into consciousness or action.  How the ego’s defense mechanisms deal with neurotic anxiety determines the form of anxiety disorder. - Freud believed that in phobic disorders, neurotic anxiety is displaced onto some external stimulus that has symbolic significance in relation to the underlying conflict. - Generalized anxiety and panic attacks are thought to occur when one’s defenses are not strong enough to control or contain neurotic anxiety but are strong enough to hide the underlying conflict.  Cognitive theorists stress the role of maladaptive though patterns and beliefs in anxiety disorders. People with anxiety disorders catastrophize about demands and magnify them into threats.  Panic attacks can be triggered by exaggerated misinterpretations of normal anxiety symptoms such as heart palpitations, dizzinesss, and breathlessness.  Culture-bound disorders that occur only in certain locales Mood Disorder Somatoform Disorders  Somatoform disorders involve physical complaints or disabilities that suggest a medical problem but that have no known biological causes and are not produced voluntarily by the person  In hypochondriasis, people become unduly alarmed about any physical symptom they detect and are convinced that they have or are about to have a serious illness.  People with pain disorder experience intense pain that either is out of proportion to whatever medical condition they might have or for which no physical basis can be found.  Somatoform disorders differ from psychophysiological disorders, in which psychological factors cause or contribute to a r
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