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Psychology 1000

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 experndnce psychological disorder at some time in lives o Psychological disorders are the 2 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 NA will have a substance abuse disorder during lifetime. Loss to NA businesses is over $120 billion annually, much because alcoholics productivity at job decreases a lot - Stats dont communicate intense suffering (confusion/terror of schizo, misery of depressed person, suffering from family/friends) HISTORICAL PERSPECTIVES ON PSYCHOLOGICAL DISORDERS - 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) th o Jean-Jacques Rousseau (18 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 justhfith killing of witches, diagnostic tests (e.g. float, sink = pure) o 16 -17 century 100,000+ psychological disorder people identified as witches, hunted, executed Early Biological Views th - 5 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, Freuds 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 cant 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 meaning 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 Todays 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 DEFINING AND CLASSIFYING PSYCHOLOGICAL DISORDERS - 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 theyre 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 circumstances/relationships o political debate to include in psychiatric diagnostic system (do encounter these people, abusers shift blame to abused disorder 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 disorder 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 its 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 societys judgements some norms legal (violation = criminal), others unspoken (violation = weird esp if cant 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 persons behaviour / response to treatment Axis III: relevant physical conditions e.g. blood pressure Axis IV: rate intensity of environmental stressors in persons recent life Axis V: persons coping resources as reflected in recent adaptive functioning o Validity improved from earlier versions, but sometimes too strict so people cant 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 D
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