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Psychology 1000

HISTORICAL PERSPECTIVES ON PSYCHOLOGICAL DISORDERS THE DEMONOLOGICAL VIEW -the belief that abnormal behaviour is caused by supernatural forces Ex. based on the notion that bad behaviour reflected an evil’s spirits attempt to escape; a procedure of trephination was used to release the spirit; chiseling a hole in the person’s skulls -Medieval Europe: disturbed people either were possessed involuntary by the devil or had voluntarily made a pact with the forces of evil -killing of witches were justified on these ground Ex. the notion that impurities float to the surface- throw a bound woman into water and see if they were pure EARLY BIOLOGICAL VIEWS Hippocrates: insisted that mental illnesses are diseases; people with the disordered behaviour were sick -believed that the root of the problem was in the brain; first to believe that a behavioural disorder could be caused by physical damage General paresis: a disorder which resulted in mental deterioration was caused by massive brain deterioration; first demonstration that a psychological disorder was linked to physical damage PSYCHOLOGICAL PERSPECTIVES Psychodynamic (Freud) -psychological disorders are caused by unresolved conflicts from childhood which make them vulnerable to a certain situation; situations arouse anxiety which the person copes with using defense mechanisms -inappropriate or extreme use of defense mechanisms leads to maladaptive patterns of behaviour Neuroses: disorders that don’t involve a loss of contact with reality (Ex. phobias) Psychoses: the anxiety is so strong that the person can no longer deal with reality and withdraws from it (Ex. schizophrenia) Behavioural perspective: -views disorders and learned responses learned through classical, operant, and modeling conditioning Cognitive perspective: -the role of people’s thoughts and perspectives; identified maladapted thought patterns that are linked to a number of different disorders Humanistic perspective: -views abnormality as the result of environmental forces that frustrate people’s inherent self-actualization tendencies -conditions of worth imposed by parents can cause the development of a negative self-concept; could get so incompatible with the self-concept that it arouses severe threat = mental breakdown Socio-cultural perspective: -must take into account the culture in which they occur and the cultural factors that influence the forms they take Today’s Vulnerability-stress model: -a useful way to understand the interactions and relations between vulnerabilities and stress Vulnerability-stress model: -each of us has some degree of vulnerability to developing a given psychological disorder -the vulnerability can have a biological basis (our genes, a brain malfunction, hormonal factor) -could also arise from a personality factor (severe trauma or loss) -could be influenced by cultural factors -the predisposition (vulnerability) arises only when a stressor (some recent event that requires the person to cope) combines with the vulnerability to trigger the appearance of the disorder DEFINING AND CLASSIFYING PSYCHOLOGICAL DISORDERS WHAT IS ABNORMAL? -drawing the line between normal and not normal differs depending on the time and culture Ex. in the 1940s; it was abnormal for a woman to not marry and have children -abnormality is a social construction (can be affected by value judgments and political agendas) The “three Ds” govern decisions about abnormality: 1) Distressing: -people may be viewed as having a psychological disorder if they are otherwise seriously upset with themselves and about their life experiences -all of us experience suffering; when the suffering is disproportionate to the situation or too long lasting it may be viewed as abnormal -personal distress is neither necessary nor sufficient to define abnormality Ex. some mental patients are so out of contact with reality that they display little distress 2) Dysfunctional: -behaviours that interfere with a person’s ability to work or form relationships are seen as being maladaptive (especially if they are unable to control these behaviours) -behaviours could interfere with the well-being of society; 3) Deviance: -based on society’s judgments; the deviation of a person’s behaviour from a society’s norms (whether codified as laws, or as behavioural rules) -thought to be abnormal when they deviate from these norms; especially when the behaviour can not be attributed to environmental causes and if they make others uncomfortable DIAGNOSING PSYCHOLOGICAL DISORDERS -classification must follow the rules of reliability and validity: Reliability: clinicians using the system show high levels of agreement in their diagnosis decisions; the system should involved observable behaviours that minimize subjective judgments Validity: diagnostic categories should capture the essential features of various disorders; if a disorder has four behavioural characteristics, then the test should have those four features -the DSM-IV; -the most largely accepted used for diagnostic classification -a few of the diagnostic categories are … PAGE 533, TABLE 13.1 -allows diagnostic information to be represented along a FIVE dimensional axis: 1) primary diagnosis: the person’s primary clinical symptoms 2) long-standing personality disorders that could influence the person’s behaviour and response to treatment 3) physical conditions that might be relevant (ex. high blood pressure) 4) reflects the vulnerability stress model: rates the intensity of environmental stressors 5) a person’s coping resources reflected in recent adaptive functions -criteria are sometimes so strict that people don’t fit into the categories -validity problem especially with Axis II as it overlaps with Axis I CRITICAL ISSUES IN DIAGNOSTIC LABELLING Social and Personal implications: -once a diagnostic label is attached to a person it becomes difficult to look at this person objectively without preconceptions about how they will act -once the labels are attached, they are not easy to remove; even if the person acts completely “normal” -labels may play a role in worsening the psychological disorders; people diagnosed may accept the new label and develop the expected role and outlook -can affect the person’s self esteem; the person may give up attempts to deal with life circumstances that may be responsible for the problem -result in a self-fulfilling prophecy: expectations become reality Legal consequences: -once labeled, people may be involuntarily admitted to mental institutions and lose some of their civil rights Competency: a defendant’s state of mind at a judicial hearing (not at the time the crime was committed) -someone judged to be too disturbed to understand the legal proceedings may be labeled as not competent as assigned to a mental institution until judged competent Insanity: the presumed state of mind at the time the crime was committed -can be judged as not guilty by reason of insanity; now in Canada changed to not criminally responsible on account of mental disorder (NCRMD) -to balance the punishment for crime (if they are or aren’t sane), the NCRMD requires the defendant to be institutionalized for treatment and then slowly reintroduced into society Do I have that disorder? “mental student’s disease” – when people read descriptions of disorders they often see some of the symptoms or characteristics within themselves ANXIETY DISORDERS Anxiety disorders: the frequency and intensity of anxiety (a state of tension) are out of proportion to the situation that triggers them and the anxiety interferes with daily life 4 components: 1) subjective-emotional component: feelings of tension and apprehension 2) Cognitive component: subjective feelings of apprehension, a sense of impending danger, a feeling of inability to cope 3) Physiological responses: increased heart rate, blood pressure, muscle tension etc… 4) Behavioural responses: avoidance of certain situations and impaired task performance -All disorders tend to occur more frequently in females than males PHOBIC DISORDER Phobias: strong and irrational fears of certain objects or situations -people with phobias realize that their fears are out of proportion but they feel helpless to deal with the fears Agoraphobia: a fear of open or public places; common in Westernized cultures Social phobias: excessive fear of situations where the person may be judge or embarrassed Specific phobias: of certain things (ex. water, dogs) -once a phobia is developed they rarely go away on their own and may broaden and intensify over time -the degree of impairment depends on how often the person encounters the phobia stimulus GENERALIZED ANXIETY DISORDER -a chronic state of diffuse or “free floating” anxiety that is not attached to specific situations or objects -may last for months with the signs continuously present; may interfere with daily functions Cognitively: expects something awful to happen Physically: a mild chronic emergency reaction -onset tends to occur in childhood and adolescence PANIC DISORDER -occurs suddenly and unpredictably and are much more intense than generalized anxiety disorder; the symptoms can be terrifying -tend to appear in late adolescence or early adulthood OBSESSIVE COMPULSIVE DISORDER -Two components; one cognitive and one behavioural (either can occur alone) Obsessions: repetitive and unwelcome thoughts, impulses, images that invade consciousness and are often vary hard to dismiss or control (cognitive) Compulsions: repetitive behavioural responses that can be resisted only with great difficulty; often responses to obsessive thoughts and function to reduce the anxiety associated with these thoughts (behavioural) -compulsions are very difficult to control; if the person does not perform the compulsive act they may experience tremendous anxiety (even a panic attack) -compulsions = process of negative reinforcement because the person is avoiding anxiety POST-TRAUMATIC STRESS DISORDER (PTSD) -a severe anxiety disorder that can occur in people who have been exposed to traumatic life events; 4 major symptoms: 1) Symptoms of anxiety and distress that weren’t present before the trauma 2) Relives the trauma through “flashbacks” 3) Becomes numb to the world and avoid stimuli that remind them of the trauma 4) “Survival guilt” in instances where others were killed but they were spared -women exhibit twice the rate of PTSD after the trauma than men do CAUSAL FACTORS OF ANXIETY DISORDERS Biological Factors: -genetic factors may create a vulnerability to anxiety disorders; an autonomic nervous system that overreacts to perceived threat creating high levels of arousal -vulnerability to PTSD may be produced by over-activity in the emotional systems of the right hemisphere  PTSD is primarily the right hemisphere activated Evidence: -identical twins are much more correlated on tests that measure anxiety than fraternal twins are regardless of whether they were reared together or apart -identical twins have a high concordance rate for psychological disorders (if one has it, so does the other one); concordance is only 40% therefore a lot have to do with psychological and environmental factors GABA: -an inhibitory neurotransmitter that reduces neural activity in the Amygdala and other brain structures that stimulate arousal -some believe that low levels of GABA in arousal areas may cause people to have a highly reactive nervous system and quickly produce anxiety in response to stressors -people with low levels of GABA may be susceptible to classical conditioned phobias since they already have a strong UCS in place Evidence: brain scans show that patients with a history of panic attacks have lower levels of GABA Sex-linked: -females are more likely to have an anxiety related disorder; even when the 11 psychosocial factors that differ between men and women, the outcome were still the same -support a sex-linked biological predisposition to anxiety disorders -could also be environmental; social conditions give women less power and control Evolutionary factors: Biological preparedness: makes it easier for us to learn to fear certain stimuli Psychological Factors: Psychodynamic theories: -neurotic anxiety occurs when unacceptable impulses threaten to overwhelm the ego’s defenses and explode into action; how the defense mechanisms deal with neurotic anxiety determines the type of disorder Phobias: neurotic anxiety is displaced onto some external stimulus that has symbolic significance in relation to the underlying conflict Ex. a little boy’s fear of horses and being bitten was from the unresolved Oedipus complex; the horse = the boys powerful father, being bitten = unconscious fear of being castrated Obsessions and compulsions: obsession = the underlying impulse (less terrifying); compulsion = undoing one’s unacceptable urges Ex. obsession of dirt, and compulsion and washing hands are used to deal with “dirty” sexual impulses Generalized Anxiety and Panic Attacks: when one’s defenses are not strong enough to control or contain anxiety; strong enough to hide the underlying conflict Cognitive Factors: -anxiety disordered people “catastrophize” about demands and magnify them into threats -anticipate that the worst will happen and feel powerless to cope effectively -panic attacks are triggered by exaggerated misinterpretations of normal anxiety symptoms (ex. breathlessness); appraises these signs as a heart attack and these appraisals create more anxiety -help these people by replacing danger appraisals with other interpretations of symptoms Anxiety as a learned response: -behavioural perspective; disorders result from emotional conditioning Ex. some fears are a result of a traumatic experience producing a classically conditioned fear response -phobias can also be acquired from observational learning (since many people with phobias have not experienced a traumatic event) Since most people don’t acquire a phobia from observational learning, it could be cognitions or biology that helps determine whether a person will develop a phobia by observing a traumatic event Ex. someone is predisposed to be easily fearful, therefore they think that “sooner or later it will happen” and the likelihood of developing a phobia by observing increases -once anxiety is learned, it can be triggered by internal cues (thoughts) or external cues (environment); Phobias = external cues related to feared object; panic disorders = internal cues (mental thoughts) Operant conditioning: -behaviours that reduce (avoid) anxiety is through process of negative reinforcement -avoidance prolongs the problem because it prevents extinction of the learned anxiety response Socio-cultural Factors: Culture bound disorders: occur only in certain places (show the influence of culture) Ex. anorexia nervosa: strong phobic component; fear of getting fat; found almost exclusively in developed countries MOOD (AFFECTIVE) DISORDERS Mood disorders: involve depression and mania (excessive excitement); with anxiety disorders, mood disorders are the most frequent psychological disorder DEPRESSION -in clinical depression, the frequency, intensity, and duration of depressive symptoms are out of proportion with the situation Major depression: responding to a minor setback or loss in a way that leaves them unable to function effectively in their lives Dysthymia: a less intense form of depression that has less dramatic effects on personal and occupational functioning; a more chronic and long lasting form of misery 3 types of symptoms: 1) Cognitive: difficulty concentrating and make decisions; believe they are inferior (low self esteem); negative cognitions about them self and the world (believe someone bad will happen) 2) Motivational: lack of interest; lack of drive; difficulty starting anything; everything seems like too much of an effort 3) Somatic (physical): loss of appetite, loss of energy, sleep difficulties, weight gain/ loss, may lose sexual desire and responsiveness Negative mood state: the core feature of depression; people lose their capacity to experience pleasure (people with anxiety disorders retain the capacity) BIPOLAR DISORDER Unipolar: person experiences only depression Bipolar: depression (the dominant state) alters with periods of mania (a state of highly excited mood and behaviour) Mania state: -believes that there are no limits to what can be accomplished; does not recognize the negative consequences -hyperactive at a motivational level -speech is rapid or pressured -loss of sleep; may go for days until exhaustion sets in and mania slows down PREVELANCE AND COURSE OF MOOD DISORDERS -no age group is exempt from depression (chances are 1/5 that you will be clinically depressed once in your life) -Onset of depression increases dramatically 15-19 years old -if you are born after 1960 you are more likely to be depressed -women are twice as likely as men to suffer Unipolar depression Biology: suggested that differences in the nervous systems or depression that occurs from menstrual cycle may be a reason for this difference Environment: society expects women to be more in touch with their feelings and emotions -men and women do not differ in prevalence for bipolar depression -once a depressive episode occurs, three patterns could happen 1) Depression can never happen again (1/2 or cases) 2) Recovery with recurrence (will be symptom free for around 3 years until another episode of similar duration and severity) 3) Will not recover and remain chronically depressed CAUSAL FACTORS IN MOOD DISORDERS Biological Factors: Genetic Factors: -identical twins had a higher concordance for depression than fraternal twins -in adoption studies, relatives were 8 times more likely than adoptive relatives to also suffer depression -believed to be a genetic predisposition to have a depressive disorder which is influenced by the environment (significant loses and low social support) Neurochemical factors: -a disorder of motivation caused by the under activity of a family of neurotransmitters that play an important role in brain areas that are associated with rewards and pleasure (ex. dopamine, serotonin) -lack of these neurotransmitters – a lack of motivation and a loss of pleasure Evidence: antidepressant drugs work by increasing the activity of these neurotransmitters Ex. Bipolar disorder: -has a stronger genetic basis than Unipolar depression; 50% of patients with bipolar disorder have a relative with the disorder -concordance rates for bipolar disorder are 5 times higher in identical twins than fraternal twins Manic disorders – caused by the same neurotransmitters that are under
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