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Chapter 8


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Ryerson University
PSY 105
Kristin Vickers

CHAPTER 8: PSYCHOLOGICAL DISORDERS Defining, Classifying & Diagnosing Psychological Abnormality -Abnormal psychology is the scientific study of psych disorders, aka as psych dysfunctioning, psychopathology or mental disorders. It has been estimated that ~22% of Cdns per year experience abnormal psych. In ancient times, madness was seen as sign of demonic possession or witch/warlock status & in most cases the cures weren’t helping b/c it involved drowning & burning to cast out evil spirits. It’s not that much better today b/c being mentally ill is seen as less human & inferior thus families who can afford it hide their mentally ill relatives from society & those who can’t left their mentally ill relatives in mental hospitals, eg. Bethlehem hosp in London, care was minimal & use of restraints typical. -Many argued for more humanitarian treatment for the mentally ill but reform gov’ts did really gain ground until there was a clear connection made b/w physical illness & madness. General paresis is usually afflicted in males 20&40 yrs; initial symptoms include memory loss, impairment of judgement & dec in motivation & language, later symptoms include hallucinations, delusions, inappropriate bouts of anger, dementia, seizures & death; symptoms can progress over a few months-2 yrs & death was inevitable. General paresis was a result of syphilis & when this was discovered 2 things resulted: 1) it was possible to treat syphilis & avoid general paresis & 2) clearly showed that the signs of madness could be symptoms of an underlying physical illness. This gave strong support to mental health reform movements, eg. moral treatment—more humnane. -The medical model to treat mental illness: 1) encourages a search for patterns in the symptoms ppl present w/ the goal of 1 identifying the syndrome/collection of symptoms, eg. general paresis; 2) search for possible causes of observed symptoms which may suggest viable treatments. Some limitations of the medical model include: by focusing on physical/biological causes, it can neglect psychological processes & socio-cultural circumstances. -Defining Psychological Abnormality: there is no universal defn for pysch abnormality but most have common key features often called the 4 D’s: deviance, distress, dysfunction & danger. The current defn of abnormality depends heavily on social norms & values & often times societies have trouble distinguishing b/w abnormality & eccentricity thus psychologists rely upon classification & diagnosis to determine which experiences constitute a psych disorder. -Deviance=behaviours, thoughts & emotions considered abnormal when they differ from society’s ideas about proper functioning; judgements on deviance varies from each society, societal values may change over time leading to new societal view of what is considered psychologically abnormal. -Distress=behaviours, ideas or emotions that cause distress/unhappiness/ -Dysfunction=abnormal behaviour tends to interfere w/ daily functioning vs. eccentric behaviour that’s a part of person’s life, ie. When behaviours upsets ppl so they can’t take care of themselves, interact well w/ others or work effectively, its abnormal. -Danger=some w/ psych dysfunctioning is a danger to themselves & others but it is important to note that research has indicated danger is an exception vs. a rule. -Classifying & Diagnosing Psychological disorders: A symptom is a physical, behavioural/mental feature that helps indicate a condition, illness or disorder. When certain symptoms regularly occur together & follow a course, clinicians agree they make up a clinical disorder. The classification system is a list of disorders w/ description of symptoms & guidelines for determining when individuals should be assigned to categories, eg. ICD (International Classification of Diseases) published by WHO is used by most countries & currently in its 10 ed; DSM-IV-TR (Diagnositc & Statistical Manual of Mental disorders, 4 th ed, text revision) is the leading classification system in NA & lists ~400 mental disorders. A diagnosis is a clinician’s determination that a person’s cluster of symptoms represent a particular disorder. Assigning a diagnosis suggests that the client’s symptoms is consistent w/ patterns displayed by others who show the same symptoms as indicated in many studies which usually suggest effective approaches to treatment & ensures clinicians are acting in a consistent manner & basing their decisions on a set of clearly articulated & shared criteria. Additionally, clinicians gather data from their clients on each of the 5 dimensions or axes to arrive at a diagnosis & begin w/ process of treatment planning: -Axis I=contains detailed criteria for most of principal disorders in DSM w/ exception of mental retardation & personality disorders; axis I disorders are usually why client seeks help (eg. panic disorder, depression, schizo) & these have a recognizable pt of onset (not always there) & realistic probability of recovery -Axis II=incl criteria relating to long term disorders, eg. personality & mental retardation disorders which may complicate/influence expression of any Axis I disorders that are present. -Axis III=lists any medical problems that may be important to consider in relation to current/past psychiatric problems, eg. if have asthma, consider if there was any indication of panic disorder in axis I. -Axis IV=records any psychosocial stressors the individual recently faced, eg. divorce, death of spouse, job loss, etc. -Axis V=uses a 100pt detailed general functioning scale that clinicians use to assess the client’s current level of functioning & their highest level of functioning in the past year; data can be useful for treatment decisions & options & provides info about how quick symptoms have been expressed & impacted the client’s life. *Comorbidity is the condition in which a person’s symptoms qualify him/her for 2/more diagnoses, eg. Diana Markos may have major depressive disorder & avoidant personality disorder. DSM-IV-TR is quite useful but doesn’t always lead to accurate diagnoses. Assessment & diagnosis can sometimes cause harm: misguided treatments, diagnostic labels can become self-fulfilling prophecies, society attaches a stigma/neg prejudice to abnormality which makes it less likely for ppl to seek treatment. Clinicians have argued that we mist simply work to inc our understanding of psych disorders & improve assessment & diagnostic techniques. Before You Go On 1. Define & explain the 4D’s of abnormal behaviour. 2. What is DSM-IV-TR Models of Abnormality -The Neuroscience model: neuroscientists view abnormal behaviour as structural/ biochemical malfunctions in the brain, eg. Huntington’s disease is a cognitive disorder linked to loss of cells in striatum. Mental disorders may be linked to deficient/excessive activity of neurotransmitters, eg. depression is linked to low levels of NE & serotonin. Mental disorders are sometimes related to abnormal hormonal activity, eg. depression has also been tied to abnormal levels of cortisol. Genetics & viral infections particularly may the cause of these problems w/ brain anatomy & chemical functioning. Studies suggest genetics play a role in mood disorders, eg. schizo, intellectual disability, Alzheimers, etc but it appears that multiple genes help produce our actions & rxns that are both functional & dysfunctional. Genetic predispositions often result in psych disorders only when individuals are exposed to adverse environments. Some research on viral infections suggest that schizo may be related to certain viruses before birth or during childhood & that the damaging virus may enter the brain of fetus/young child & stay into adulthood where in which it is activated by hormonal changes, another infection, stressful life events & thus setting in motion symptoms of schizo. Research has linked viruses to mood & anxiety disorders. This view expect that biological factors & brain interventions alone can explain & treat abnormal behaviours & neglect the complex interplay of biological factors & ppl’s environmental experiences. -The Cognitive-Behavioural model: theorists propose that psych disorders result largely from a combo of problematic learned behaviours & dysfunctional cognitive processes, ie. Unconscious conflicts rooted in childhood, & how these interact w/ & mutually influence one another. They view emotions & biological events as key variables of the model & seek to understand how they influence behaviour & cognition that lead to abnormal functioning. A number of theorists argued that humans engage in unseen cognitive behaviours, eg. private thoughts, beliefs, which had largely been ignored by behaviourists at the time & observed that ppl’s cognitions greatly influence & are influenced by their behaviours. -The behavioural perspective: behavioural theorists use learning principles to explain functioning which focuses on how the environment changes a person’s behaviours, eg. via conditioning & modelling. Abnormal behaviours are acquired by the same learning principles as adaptive behaviour, eg. classical conditioning to induce phobias & fear—Little albert; operant conditioning can also cause abnormal behaviours, eg. learning to abuse alcohol & drugs b/c of initial comport, calmness & pleasure; modelling in which we learn by observing others can lead to abnormality, eg. Bobo doll. Behavioural principles can be tested in the lab, behavioural interventions can help ppl w/ phobias, compulsive behaviours, social deficit, intellectual disabilities, etc. -The cognitive perspective: when ppl play abnormal patterns of functioning, cognitive problems are to blame which can result to maladaptive beliefs & illogical thinking processes. Albert Ellis & Aaron Beck proposed that each of us holds broad beliefs about ourselves & our world to help guide us through life & determine our rxns to situations we encounter but some beliefs are unjustified & unhelpful leading them to react in ways that are inappropriate, reduce chances of being happy & inc tension & disappointment, eg. Diana Markos story. Beck also found that some ppl continuously think in illogical ways & keep drawing self- defeating & pathological conclusions, identified several illogical-thinking processes which were very common in depression & anxiety disorders: selective perception (seeing only the neg), magnification (exaggerating importance of undesirable effects) & overgeneralization (drawing broad neg conclusions based on a single insig event). Embraces the viewpoint that thought is a key factor in normal & abnormal behaviour; modifying these beliefs via psychotherapy can improve psychological functioning. -The Psychodynamic model: roots in Sigmund Freud’s theories; theorists believe that a person’s behaviour is largely determined by underlying psychological forces in a person’s unconscious. Abnormal behaviour/symptoms are viewed as the consequences of conflicts of unconscious attempts to resolve conflict & lessen painful inner turmoil. Freud proposed that a child’s environment may prevent his id, ego & superego from maturing properly & thus the child becomes fixated which affects subsequent functioning & eventually lead to abnormal functioning. Many of Freud’s colleagues disagreed w/ his view thus giving rise to other possible explanations, eg. object relations theorists believe that ppl are motivated primarily by the need to establish relationships which others (objects) & that severe problems in early relationships may result in abnormal development & psych problems. Freud & his followers were the first to demonstrate the value of systematically applying theory & techniques to treatment but research hasn’t supported its effectiveness. -The Humanistic-Essential model: grouped together b/c of their common focus on broder dimensions of human existence. Humanists believe that all of us are born w/ the natural desire & motive to fulfill our potential for goodness & growth but it’s only possible if we honestly accept our strengths & weaknesses & find pos values to live by, those who don’t do this are more likely to suffer some degree of psych dysfunction. Carl Rogers proposed that from birth onward, we all have the basic need to receive unconditional positive regard from other esp our parents & he believed children who don’t receive this acquire conditions of worth—person’s perception that they must meet certain stds in order to gain the love of their parents/other important figures. Harsh & rigid conditions of worth can prevent a person from reaching his/her full potential, distort thoughts & actions that don’t line up to their conditions of worth creating a warped view of themselves & their experiences, eventually they won’t genuinely what they feel or want & then psych dysfunctioning is inevitable. Existentialists agree that humans are aware of themselves & live authentic lives in order to be well adjusted but disagree that ppl are inclined to live constructively. They believe that from birth, we are free to confront our existence & give meaning to our lives or run away from that; they say many become intimidated by societal pressures & look to others for guidance & authority thus they surrender their freedom of choice & hide from their responsibility to live & make decisions about their life. These ppl are left w/ empty, inauthentic lives & primarily feel anxiety, frustration & depression. Humanists & existentialists outline factors that are critical to pos functioning, eg. self-acceptance, personal values, meaning & personal choice which are lacking in those w/ psych disorders. -The Socio-cultural model: many theorists believe that abnormal behaviour is best understood in light of social, cultural & family forces brought to bear on an individual; the unique characteristics of a society may create special stresses that inc likelihood of abnormal functioning in its members. -Social change: when society undergoes major change, mental health of its members can be greatly affected, eg. society undergoing rapid urbanization=inc mental disorders vs. societies undergoing economic depression=inc clinical depression & suicide rates. -Socio-economic class: Sareen, Cox & Stein at Uni of Manitoba have found higher rates of severe psychological abnormality among members of lower SE class than higher ones; this may b/c of special pressures of lower class life, eg. poverty which is linked to many stressors like high crime rates, unemployment, homelessness, etc. Ppl who suffer from mental disorder may be less effective at work, earn less money & thus drift toward lower SES. -Cultural factors: many theorists believe human & abnormal behaviour is understood best by examining one’s unique cultural context incl the values & external pressures faced by cultural members. Ethnic, racial minority groups & economically disadv persons (women, homosexual ppl) have been studied the most. Women are 2x as likely than men to be diagnosed w/ depressive & anxiety disorders but this may due to women being more likely than men to seek treatment. In Canada, cultural origins, immigrant status & Aboriginal status have been linked to varying rates of mental illness & adjustment issues. Chandler & Lalonde examined youth suicide rates among a large # of First Nations Band communities in BC & gathered data about whether each bad was or had been engaged in land claim negotiations w/ prov gov’t, whether the band had taken control of edu, fire, police & child welfare services & whether there was a physical structure in the community dedicated to cultural heritage. If all these things were in place, suicide rates in Canada were the lowest but if none, rates in Canada were among the highest thus having a culturally rich context for development clearly benefits individual mental health & identity development. Researchers have also studied links b/w religion & mental health & found the 2 are often correlated; genuinely spiritual ppl, on ave, tend to be less lonely, pessimistic, depressed or anxious vs. others & they often seem to cope w/ major life stressors better & appear less likely to abuse drugs or attempt suicide, ie. Spirituality can be a source of comfort, hope & meaning. -Social networks & support: researchers have often linked deficiencies in a person’s social networks to that person’s functioning, eg. ppl who are isolated, lack social support or intimacy in their lives are more likely to become depressed when under stress or remain depress vs. ppl w/ supportive spouses or warm friendships. -Family systems: the family systems theory holds that each family has its own implicit rules, relationship structure & communication patterns that shape the behaviour of the individual members. Members usually act in ways that otherwise seem abnormal & if they try to behave normally, they would severely strain the family’s usual manner of operation & would inc their own & their family’s turmoil. -The Developmental Psychopathology model: developmental psych is the study of how problem behaviours emerge as a function of a person’s genes & early experiences & how these early issues affect the person at later life stages. They attempt to identify risk factors which are biological & environmental factors that contribute to problem outcomes & also seek to identify factors that can help children avoid/recover from such outcomes. A full accounting of how individuals get off/on track requires looking at how genetics, early environmental influences & psych processes interact to form their current pattern & functioning. Developmental psychologists present 2 concepts: equifinality (idea that diff children can start from diff pots & wind up at the same outcome) & multifinality (idea that children can start from the same pt & wind up at any # of diff outcomes). In conduct disorder which is when childhood/adolescence is characterized by repeated violations of others’ rights, aggression & destructive behaviour, equifinality would say that various roads can lead to the disorder, eg. children may have been born w/ difficult temperament, experienced poor parenting, developed poor social skills, etc but outcome is similar. Multifinality assures at that not every difficult abbay & not every baby w/ ineffective parents will get conductive disorder. This view is particularly interested in biological, psychological or environmental events that help buffer/negate impact of risk factors producing resilience which is the ability to recover from/avoid the serious effects of neg circumstances. Ie. It’s just as critical to know what’s right & to understand what’s wrong. Before You Go On 3. What are the major models used by psychologists to explain ab functioning? 4. What major types of brain problems are linked to ab functioning? 5. In the view of cognitive-behaviour theorists, what problems can lead to ab functioning? 6. How are the humanistic & existential models similar & how are they diff? 7. What social & cultural factors have been found to be related to ab functioning? Mood Disorders -Depression & mania are the key features in mood disorders. Depression is a persistent sad state in which life seems dark & its challenges overwhelming. Mania is a persistent state of euphoria or frenzied energy, ie. Exaggerated belief that the world is theirs for the taking. Most people w/ mood disorders suffer from depression, a common pattern in major depressive disorder or dysthymic disorder (less disabling but chronic, a diagnoses of this in adults req symptoms that persist at least 2 yrs); in bipolar disorder, people experience mania in mix w/ depression or cyclothymic disorder (less severe but chronic). -Major depressive disorder: this disorder bring severe & long-term psychological pain that may intensify over time & those who suffer from it may become unable to carry out simple life activities & some even attempt suicide. Nearly 5% of Cdns are diagnosed w/ major depressive disorder & ~3% diagnosed w/ less severe forms; women are 2x likely to be diagnosed than men but this diff reflects # of factors: women tend to seek more assistance, men tend to deny/ignore their feelings & women experiencing more stress due to their multiple roles. ~50% of ppl w/ the disorder recover w/in 6 wks & 90% recover w/in a year, some w/o treatment but most of them still experience at least one other episode of depression later in life. Symptoms of this disorder spans emotional, motivational, behavioural, cognitive & physical functioning. To be diagnosed as having a major depressive disorder, patient has to have 5 of the symptoms present in the same 2 wk period & represent a change from prev functioning & at least 1 of them is depressed mood or loss of interest/pleasure. -Characteristics of depression: many depressed ppl become uninterested in life/ wish t die, others wish to kill themselves & some actually try; they report feeling miserable, sad, not in the mood to participate in usual activities, lack drive, initiative & spontaneity. A cognitive symptom of depression is pessimism, sufferers belive nothing will improve & feel helpless to change their lives. Have physical ailments, eg. headaches, indigestion, constipation, dizzy spells & general pain, sleep disturbances & appetite. Often triggered by stressful events. -How do neuroscience explain depression? If there is a genetic predisposition to the disorder, many biologically related ppl to the depressed person will have it. When monozygotic twins had depression, 46% chance the other will have it vs. if dizygotic twins had depression, 20% chance the other will have it. Researchers found depression is linked to low activity of NE & serotonin. Roland Kuhn discovered antidepressant drugs by accident when he was administering them to schizo patients & found it improved depressive symptoms. Body’s endocrine system may influence depression, ie. Ppl w. depression have been found to have high levels of cortisol (released by the adrenal gland during stress) which is not surprising given that stressful events trigger depression. -How do cognitive-behavioral theorists explain depression? Believe that ppl w/ depression acquire distinctively neg behaviours & think in dysfunctional ways: 1) Learned helplessness—developed by Martin Seligman, holds that ppl become depressed when they think that they no longer have control over the rewards & punishments in their lives and that they themselves are responsible for their helpless state. Began when Seligman administered inescapable shocks to dogs, the dogs learn they have no control over the situation & thus were helpless so they just staid in their boxes & accepted the shocks. The newer version of the theory, the attribution-helplessness theory holds that when ppl view events beyond their control, they ask why & if they attribute the lack of control to an internal cause that is global & stable (a deficiency in themselves that’s wide ranging & will continue for a long time), they will feel helpless to prevent future neg outcomes & may experience depression. If ppl attribute the lack of control to an external cause that is unstable & specific, it is more likely he/she wouldn’t lose control & would not experience helplessness & depression. 2) Negative thinking—Beck believes neg thinking plays a key role in depression particularly involving dysfunctional attitudes, errors in thinking, the cognitive triad & automatic thoughts, the keys to clinical syndrome. The cognitive triad is a pattern of thinking in which individuals repeatedly interpret their experiences, themselves & their futures in negative ways that lead them to feel depressed, eg. “every encounter I have w/ ppl is a total disaster”, “I’m a social failure”, “Things will never improve, I’ll never get along w/ ppl”. Depressed ppl experience automatic thoughts which is a steady strain of specific upsetting thoughts that keep suggesting they are inadequate & their situation is hopeless. Research has shown that the more dysfunctional attitudes that depressed ppl hold, the more depressed they tend to be; cognitive triad is at work in depressed ppl. -How do socio-cultural theorists explain depression? Proposes that depression is often triggered by outside stressors & lack of social support. Some studies in England decades ago showed that women who had 3/more children, lack a close confidante & had no outside employment were more likely than other women to become depressed after experiencing stressful life events. -Bipolar Disorders: ppl w/ bipolar disorders experience extreme shifts in moods both the lows of depression & highs of mania (dramatic & inappropriate rises in mood). Symptoms of mania span the same 5 areas of functioning as in major depressive disorder. In mania, their mood of euphoric joy or extreme agitation is out of all proportion to the actual events happening in the person’s life. In the motivational realm, ppl w/ mania want constant excitement, involvement & companionship, they talk rapidly & loudly. In the cognitive realm, they show poor judgement & planning, they rarely liste
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