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Psychology 1000 Study Guide - Generalized Anxiety Disorder, Anxiety Disorder, Aaron T. Beck


Course Code
PSYCH 1000

of 21
Chapter 13: Psychological Disorders
- Surgeon General of US (Dec 1999) mental health report summary:
o 22% pop suffers diagnosable mental health disorder
o 50% NA between 15-54 will experience psychological disorder at some time in lives
o Psychological disorders are the 2nd leading cause of disability, after heart disease
o Medications used to treat anxiety and depression = most commonly prescribed in NA
o One adolescent commits suicide every 90 seconds
o Millions students withdraw from univ because of emotional problems each year
o ¼ NA will have a substance abuse disorder during lifetime. Loss to NA businesses is over $120 billion annually, much
because alcoholic’s productivity at job decreases a lot
- Stats don’t communicate intense suffering (confusion/terror of schizo, misery of depressed person, suffering from family/friends)
- Prominent people in history suffered from psychological disorders
o Tamerland (14th century Mongol conquerer of central Asia / Europe) built pyramids of human skulls (one had 40,000)
o Jean-Jacques Rousseau (18th century French philosoph) = paranoid in later life and obsessed with fears of secret enemies
o Mozart convinced was being poisoned when writing Requium
o Winston Churchill = period severe depression (his “black dog”)
- People notice abnormal behaviour, responded diff at diff times based on values at time
The Demonological View
- Abnormal bhvr caused by supernatural back to ancient Chinese, Egyptians, Hebrews
o behaviour = evil spirit trying to escape from body, .: “treatment” = trephination to “release” (chisel 2 cm hole in skull)
- view prominent in Medieval Europe religious dogma so disturbed = possessed by devil or made pact with darkness
o justified killing of witches, “diagnostic” tests (e.g. float, sink = pure)
o 16th-17th century 100,000+ psychological disorder people identified as witches, hunted, executed
Early Biological Views
- 5th century, Greek physician Hippocrates believed psychological disorders = diseases like physical ones, based in brain (organ of mind)
o First to say caused by physical problems (we agree today) 1800s beginning of medical diagnosis of mental disorders,
o general paresis (advanced stages = mental deterioration and bizarre behaviour) resulted from massive brain deterioration
by syphilis showed psychological disorder linked to physical malady
Psychological Perspectives
- early 1900s, Freud’s psychoanalysis way of viewing behaviour
o psychological disorders caused by unresolved childhood conflicts making vulnerable to certain kinds of life events, arouse
anxiety, person tries to cope using defence mechanisms (repression, projection, reaction formation, displacement)
use inappropriately/extreme = maladaptive behaviour patterns some disorders (obsessions, phobias,
depression = loss contact with reality = neuroses)
some anxiety from unresolved conflicts so great can’t deal with reality, withdraw from it severe
disorders (e.g. schizophrenia) = psychoses
- behavioural perspective: abnormal behaviour = learned responses (through classical/operant conditioning, modelling); environment
can shape abnormal behaviour too
- cognitive: thoughts/perceptions about selves/environment
o maladaptive/self-defeating thought patterns linked to disorders (Aaron Beck) e.g. depression/anxiety
o .: to understand, isolate specific thought patterns, beliefs, attitudes
- Humanistic: abnormality = result of environmental forces frustrating/perverting inherent self-actualization tendencies / search for
o Conditions of worth can lead to negative self-concept, need to deny/distort experience if experience (including feelings)
way off from self-concept, “self” breaks down
- Socio-cultural: cultural factors, cultural context in which psychological disorders occur = important
Today’s Vulnerability-Stress Model
- Ways bio/psychological/environment interact in particular disorder in particular individual varies
- Vulnerability-stress model: each and every one of us has some degree of vulnerability (ranging from very low to very high) to develop
a given psychological disorder
o Vulnerability (predisposition) = bio basis (genes, brain malfunction), personality factor (low self-esteem, extreme
pessimism), previous environmental factors (poverty, severe trauma), or culture
Genetic factors, biological characteristics, psychological traits, previous maladaptive learning, low social support
o Stressor (recent event requiring person to cope) combines with vulnerability to trigger appearance of disorder
E.g. loss early in life primed to develop depression IF another loss, then depressed
Economic adversity, environmental trauma, interpersonal stresses or losses, occupational setbacks or demands
- Hard to define “normal” and “abnormal”
What is “Abnormal”?
- Different line between normal/abnormal depending on time/culture
o e.g. 1940s women forsaking kids for job; Ecuador women loss depression or susto (“soul loss”)
- abnormality = social construction .: affected by value judgements and politics
o e.g. slavery census they’re idiots so abolishing slavery = bad for them
then new medical mental disorder drapetomania = obsessive desire for freedom driving slaves to flee from
captivity; diagnosis applied if try to leave more than twice
- self-defeating/masochistic personality disorder including people repeatedly involving themselves in hurtful
o political debate to include in psychiatric diagnostic system (do encounter these people, abusers shift blame to abused
not included
- arbitrary judgements (time place and value) but usually at least one of the “three Ds”
o distressing to individual if anxious, depressed, dissatisfied, upset about selves/life esp if little control psychological
but distress not necessary nor sufficient some serious disturbed mental so out of reality, very little distress, but
bizarre .: seriously abnormal
conversely, we all suffer (distress), so it’s normal; but if disproportionate to situation or too long abnormal
o dysfunctional to individual/society behaviours interfering with ability to work/experience satisfying relationships = bad,
esp if unable to control
if to society, but no standards: e.g. bomber = criminal, disturbed, or patriot?
o Deviance of behaviour based on society’s judgements some norms legal (violation = criminal), others unspoken (violation
= weird esp if can’t attribute to environment or makes others uncomfortable)
- Abnormal behaviour: behaviour personally distressful, personally dysfunctional, and/or so culturally deviant that other people judge
to be inappropriate or maladaptive
Diagnosing Psychological Disorders
- To be scientifically and practically useful, classification system must been standards of
o Reliability: clinicians using system should show high levels of agreement in diagnostic decisions diff types with diff
training .: system based on observable behaviours that can be reliably detected, minimize subjective
o Validity: accurately capture essential features of various disorders (e.g. disorder has 4 behavioural characteristics, 4
features), allow to differentiate one disorder from another
- Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) = most used diagnostic classification system in NA
o 350 categories, each detailed list observable behaviours in order for diagnosis p. 533***
o Allows diagnostic info represented along 5 dimensions/axes to take into account both person and life situation
Axis I: primary diagnosis = primary clinical symptoms
Axis II: long-standing personality/developmental disorders e.g. ingrained, inflexible aspects of personality that
influence person’s behaviour / response to treatment
Axis III: relevant physical conditions e.g. blood pressure
Axis IV: rate intensity of environmental stressors in person’s recent life
Axis V: person’s coping resources as reflected in recent adaptive functioning
o Validity improved from earlier versions, but sometimes too strict so people can’t fit in category, Axis II disorders overlap
with each other and Axis I reducing validity and reliability; some say bun, but in next version less overlap needed
- Europe = International Statistical Classification of Diseases
Critical Issues in Diagnostic Labelling
- Diagnostic labels can have personal, social, legal consequences
Social and Personal Implications
- After diagnostic label accurate description of INDIVIDUAL vs BEHAVIOUR .: hard to look objectively (e.g. neighbour “sex fiend”)
o E.g. David Rosenhan (1973) = mental hospital with “schizo”, then normal, when out “schizo in remission”
- Labels can create/worsen disorders e.g labels = self-fulfilling prophecy, expectation becomes reality (devastating implications)
o Give up dealing with life circumstances causing problems
Legal Consequences
- Involuntarily committed to institutions if danger to self/others then lose some civil rights, detained indefinitely
- For crimes, mental status taken into account:
o Competency: defendant’s state of mind at time of judicial hearing (not @ crime) not competent to stand trial (too fucked
to understand legal proceedings) institution until judged competent
o Insanity: far more controversial, presumed state of mind @ crime not guilty by reason of insanity if so severely impaired
lacked capacity to appreciate wrongness or control self (1992: CDN renamed NCRMD “not criminally responsible on
account of mental disorder”)
Insanity = legal term, not psych term
Defence hotly debated John Hinckley (1981, Regan shot), Jeff Dahmer (murderer) 1st acquitted
because prosecution needed to prove SANE; then Jeff rejected because defence had to prove INSANE
If defence wins, institution, reintroduced when no longer risk to society
“Do I Have That Disorder”?
- “medical students’ disease” people read descriptions, see some symptoms/characteristics of disorders in selves
o We all have shit to deal with, some similarities DWAI, but if maladaptive behaviour interfering with happiness/effectiveness,
seek help
***p. 536 In Review
- Anxiety: tension/apprehension that’s natural response to perceive threat
- Anxiety disorders : frequency and intensity are out of proportion to triggering situations, interfere with daily life, 4 components:
o Subjective-emotional: feelings of tension/apprehension
o Cognitive: subjective feelings of apprehension, sense of impending danger, feeling of inability to cope
o Physiological responses: increased heart rate/blood pressure, muscle tension, rapid breathing, nausea, dry mouth, diarrhea,
frequent urination
o Behavioural responses: avoidance of certain situations / impaired task performance
- Diff forms: phobic disorders, generalized anxiety disorders, panic disorders, OCD
- Are the most prevalent of all psychological disorders in NA, 17.6% population during lifetime
Phobic Disorder
- Phobias: strong / irrational fears of certain objects/situations (Phobos, Greek god of fear)
o Know fears whack, but feel helpless to deal .: just make HUGE effort to avoid
o Most common:
Agoraphobia fear of open / public places
Social phobias excessive fear of situations in which person may be evaluated / possibly embarrassed
Specific phobias dogs, snakes, spiders, planes, elevators, enclosed spaces, water, injections, illness, death
o Develop anytime, esp child/youth/early adult, rarely go away on own but may broaden/intensity over time
- Degree of impairment ~ how often phobic stimulus encountered in normal activities (e.g. flying fear may not be bad or terrible)
Generalized Anxiety Disorder
- Generalized anxiety disorder: chronic state of diffuse (“free-floating”) anxiety not attached to specific situations /objects
o Emotion: jittery, tense, constantly on edge; cognitively: something awful soon but dno what; physically: mild chronic
emergency reaction sweats, upset stomach, diarrhea, etc
o Can interfere a lot with daily life; concentration, decision making, commitment remembering
o need 6 months of symptoms to be diagnosed formally, 5% 15-45 yrs symptoms, onset = childhood/adolescence
Panic Disorder
- panic disorders: suddenly, unpredictably, much more intense (not chronic); severe symptoms, e.g. feel like dying
o absence of identifiable stimulus (random) .: terrifying agoraphobia, because attack might hit in public
“fear of fear” can house-bound people
- Appear late adolescence/early adult, 3.5% pop; occasional panic attacks (but not disordererd unless inordinate fear of future attacks)
Obsessive-Compulsive Disorder
- Obsessive-compulsive disorder: 2 components, cognitive and behavioural, though happen just one
o Obsessions: repetitive unwelcome thoughts, images, impulses, invading consciousness, abhorrent to person often, very
hard to dismiss/control
o Compulsions: repetitive behavioural responses resisted only with great difficulty
Response to thoughts, .: reduce anxiety of thoughts, strengthened by negative reinforcement as allow avoidance
- 2.5%, usually in 20s
Post-traumatic Stress Disorder (PTSD)
- Post-traumatic stress disorder (PTSD): severe anxiety disorder that can occur in people who’ve been exposed to traumatic life events
o Severe symptoms anxiety, arousal, distress not present before trauma
o Relives trauma recurrently in “flashbacks”, dreams, fantasy
o Numb to world / avoids stimuli reminding of trauma
o Intense “survivor guilt” where others killed but individual spared
- E.g. war veterans, war victims even more vulnerable than soldiers (e.g. Kosovo refs)
- Human action traumas (rape, war, torture) more severe PTSD reactions than natural disasters; women 2x more rate PTSD
- PTSD may increase vulnerability to other disorders developing later (e.g. women 2x depression, 3x alcohol)
Research Foundations Rape, Trauma, PTSD
- Fear of another rape nearly as bad as rape itself (nervous, change address, nightmares, flashbacks, decrease sex enjoyment) 25% not
recovered after 6 years
- PTSD symptoms occur diff times, but important to deal emotionally with trauma early because recover much easier
- Sexual assault more PSD than regular, recover less quickly
- Lack of emotional engagement traumatic event bottling up feelings impeding recovery .: deal immediately
- Study shows value of repeated assessment over time longitudinal takes longer/more energy/money but worth it