PSYA02H3 Study Guide - Final Guide: Dorothea Dix, Philippe Pinel, Biopsychosocial Model
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PSYA02 Final Exam - Chapter 15
Monday, April 6, 2020 4:23 PM
Defining Abnormal Behaviour
Asylums
•Asylums: residential facilities for the mentally ill
•Their treatments would certainly not meet modern standards of medical care and were generally ineffective, such as
draining up to 40% of a person’s total blood volume!
•The hope was to shock the person out of their diseased state
Moral Treatment
•Philippe Pinel and Dorothea Dix led to reform which ushered new approach to mental health, moral treatment which led
patients to be treated with kindness and decency.
•However, there were still virtually no effective treatments, and many people afflicted with mental illness were
permanently incarcerated.
Chlorpromazine Drug
•Chlorpromazine drug which enables person with schizophrenia and other disorders to function independently.
•The success of chlorpromazine and other medications led to widespread deinstitutionalization, the movement of
large numbers of psychiatric in-patients from their care facilities back into regular society
Medical Model
•Medical Model developed in middle ages, sees psychological conditions through the same lens as Western medicine tends
to see physical conditions – as a set of symptoms, causes and outcomes, with treatments aimed at changing physiological
processes in order to alleviate symptoms.
•Psychological disorders such as depression, anxiety disorders, or autism can be approached in the same manner as
conventional medicine would approach diabetes or cancer.
•What the medical model is generally missing is an appreciation for the whole system of factors that affects the
person’s overall functioning.
•Too narrow. Is not very good
Biopsychosocial Model
•Biopsychosocial model includes physiological processes within a more holistic view of the person as a set of multiple
interacting systems.
•Eg. depression involves biological factors (e.g., serotonin transmission in the brain), psychological factors (e.g., negative
beliefs about the self), and social factors (e.g., relationship rejection and social isolation)
•Understanding the multiple systems that underlie disorders such as depression gives us greater insight into how to
develop more effective treatments
What is “Normal” Behaviour?
Maladaptive
•However, one of the main insights we have gained as a global society is just how different “normal” can be from different
perspectives.
•Key criterion used to decide whether a person has a disorder is whether the person’s thoughts, feeling or behaviours are
maladaptive, is determined by three key criteria whether it causes distress to oneself or others, impairs day-to-day
functioning, or increases the risk of injury or harm to oneself or others.
•There are many exceptions to this guideline. Some behaviours fulfill these criteria but do not necessarily indicate
mental illness
•Eg. Mourning the loss of a loved one or having a religious conversion may interfere with one’s day-to-day
activities.
•Generally speaking, when a person’s behaviour and experience start to become significantly dysfunctional, there may
be cause for concern
Psychology’s Puzzle: How to Diagnose Psychological Disorders
Diagnostic and Statistical Manual of Mental Disorders (DSM)
•Diagnostic and Statistical Manual of Mental Disorders (DSM) a standardized manual to aid in the diagnosis of disorders.
Purpose of DSM
•The purpose for developing the DSM was to provide mental health workers with a reliable method for diagnosing mental
illness and to ensure consistency across different institutions and hospitals.
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•DSM-5 describes three important pieces if information for each disorder:
1. Set of symptoms and the number of symptoms that must be met in order to have the disorder
2. The etiology (origin of causes) of symptoms
3. Prognosis or prediction of how these symptoms will persist or change over time
Critiquing the DSM
1. Diagnosis of specific disorders is often not highly reliable, definitions not based on empirical
evidence, and different disorders often share many symptoms.
a. The DSM was created, in large part, to help making the process of diagnosing a disorder more objective and reliable,
but the very nature of human experience is often subjective, vague, and unreliable
2. Also so many labels can lead to over diagnosis.
a. 3% to 20% of the population has ADHD. 20% to 70% of children diagnosed with ADHD do not meet the criteria when
they become an adult.
b. Critics charge that the handy availability of the ADHD diagnosis makes it too easy to label children as having
a “condition” and then medicate them.
3. There is a fine line between whether a person is considered to have a disorder or not.
a. For each disorder, the DSM provides a list of possible symptoms and guidelines as to how many of the symptoms the
person must have before being given the diagnosis
b. In practice, what this means is that the diagnosis a person receives, and even whether a person receives any
diagnosis at all, can depend on a single symptom. This obviously creates a major accuracy problem.
4. Judgements can be very subjective.
5. The DSM, by its very existence, also implies that disorders can be objectively defined
a. The DSM has a lot of authority, and if a set of symptoms is given a diagnostic label, people conclude that there is a
real disorder, like a sickness or a disease, that people can “get.”
b. This way of thinking has contributed to the stigmatization of mental illness, and has added to the discomfort and
resistance people feel towards the mental health field
The Power of a Diagnosis
•The long-term effects of receiving a specific diagnosis can be substantial.
○To continue the example of ADHD, for most children, by the time they get assessed for this condition, they will have
experienced an accumulation of problematic behaviours
•Sub-clinical means that symptoms do not quite meet the criteria of the diagnosis.
○What happens after this point may differ dramatically, depending on the diagnosis.
○The person may enter treatment programs or take medications for quite different disorders, or the person may not
have sufficiently met the criteria for a disorder and may not get the help she needs
○Small differences in initial diagnosis can lead to big differences in long-term treatment and outcomes.
Applications of Psychological Diagnoses
The Mental Disorder Defence (AKA the Insanity Defence)
•This lack of diagnostic accuracy plays a big role in the criminal justice system.
○The legal reasoning behind a person being defined as legally sane (i.e., criminally responsible) or not, is based on the
M’Naghten rule, which goes all the way back to 1843 in Great Britain
•Mental disorder defence does not deny that the person committed the offence, but claims that the defendant was in such
an extreme, abnormal state of mind when committing the crime that he or she could not discern that the actions were
legally or morally wrong.
Defining and Classifying Personality Disorders
Personality Disorders
•Distinct features of personality disorders are their stability.
•Personality disorders: particularly unusual patterns of behaviour (relative to one’s cultural context) that are maladaptive,
distressing to oneself or others, and resistant to change. Personality disorders represent extreme and persistent cases.
Clusters in the DSM-5
•DSM-5 identifies 10 distinct personality disorders, categorized into three different clusters based on shared features
1. Cluster A - odd or eccentric behaviour and include Paranoid Personality Disorder, Schizoid Personality
Disorder and Schizotypal Personality Disorder.
2. Cluster B – indicated by dramatic, emotional and erratic behaviour and include Antisocial Personality
Disorder, Borderline Personality Disorder, Histrionic Personality Disorder and Narcissistic Personality
Disorder.
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3. Cluster C – characterized by anxious, fearful and inhibited behaviour, include Avoidant Personality Disorder,
Dependent Personality Disorder, and Obsessive-Personality Disorder.
4. DSM-5 also identifies Personality Disorder Not Otherwise Specified, which is diagnosis given to individuals
who exhibit patterns of behaviour consistent with that of a personality disorder, but does not fit into the
categories.
Borderline Personality
•Borderline personality disorder (BPD): characterized by intense extremes between positive and negative emotions, an
unstable sense of self, impulsivity and difficult social relationships.
•Wide range of emotions, fall in love quickly but fearful of abandonment, manipulative in relationships
•Impulsive, risky, substance abuse, indiscriminate sex, self-injury
•Arises from people with deeply rooted insecurity and severe emotional disturbances
•They are often highly manipulative in relationships, attempting to keep the person under their control.
•It is believed that borderline personality disorder arises out of the person’s attempts to deal with deeply rooted insecurity
and severe emotional disturbances that are ultimately rooted in emotionally difficult experiences, such as inconsistent,
abusive, or neglectful parenting.
Narcissistic Personality Disorder (NPD)
•Narcissistic personality disorder (NPD): characterized by an inflated sense of self-importance and an excessive need for
attention and admiration, as well as intense self-doubt and fear of abandonment.
•Little empathy for others, manipulative, putting themselves first. Strong sense of entitlement
•Believing that people should satisfy their demands, and being likely to do whatever it takes, including cheating, in
order to ensure their own success
Histrionic Personality Disorder (HPD)
•Histrionic personality disorder (HPD) characterized by excessive attention seeking and dramatic behaviour.
•Vibrant and attractive in social situations, use sexuality to gain attention
•Often engage in risky behaviour, highly sensitive to criticism and manipulative.
•Difference between histrionic and other disorders is the flamboyance and exhibitionistic tendencies in
histrionic behaviour.
Antisocial Personality Disorder (APD)
•Antisocial personality disorder (APD) have profound lack of empathy or emotional connection with others, a disregard for
others’ rights or preferences, and a tendency toward inserting their own desires, often violently, onto others regardless of
the consequences for other people.
•APD (often referred to as psychopathy) tends to be highly resistant to treatment, in part because individuals with APD are
not alarmed or distressed by their actions (although others frequently are), and they are thus rarely, if ever, motivated to
change.
•Physically and verbally abusive, destructive.
•Symptoms typically appear during childhood
•People with APD are often very successful, particularly in business.
The Biopsychosocial Approach to Personality Disorders
•Difficult to identify causes of personality disorders because they seem to arise from multiple causes over a long period of
time.
•Multiple causes are likely at play, and it may be possible for two people to develop the same symptomatic thoughts
and behaviours through entirely different routes
•Biopsychosocial model provides a comprehensive view, examining personality disorders from three different perspectives.
1. Psychological Factors
a. Attempt to cope with negative beliefs about oneself is a key part of APD.
b. NPD and HPD tend to have deeply rooted negative beliefs bout oneself.
i. Much of their dysfunctional behaviour patterns stem from attempts to compensate for these negative
self-beliefs
c. Adults with APD and children with conduct disorders (often a precursor to APD) have difficulty learning tasks
that require decision making and following complex rules.
i. Cognitive factors and their underlying brain systems are involved in personality disorders.
2. Sociocultural Factors
a. People with APD have often themselves experienced trauma or abuse.
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