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Chapter 15

PSY 202 Chapter 15: CH15Textbook Psychological Disorders

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PSY 202
Kathleen Fortune

Chapter 15: Psychological Disorders – When Adaptation Breaks Down Conceptions of Mental Illness: Yesterday and Today  Identify criteria for defining mental disorders  Describe conceptions of diagnoses across history and cultures  Identify common misconceptions about psychiatric diagnoses, and the strengths  many psychopathology researchers adopt a failure analysis approach to mental disorders What is Mental Illness? Deceptively Complex Question  Host of criteria Statistical Rarity  Can’t rely on statistical rarity to define mental disorder  Not all infrequent conditions are pathological  Many mental illnesses are common Subjective Distress  Mental disorders  emotional pain for individuals afflicted with them  Not all psychological disorders generate distress Impairment  Most mental disorders interfere with people’s ability to function in everyday life  The presence of impairment by itself can’t define mental illness Biological Dysfunction  Mental disorder may result from breakdown or failure of physiological systems  Unlikely that any one criterion distinguishes mental disorders from normality  Family resemblance view; they look like each other but don’t have any one feature in common. The broad category of “mental disorders” may be similar. Different mental disorders aren’t alike in the same exact way, but they share a number of features Historical Conceptions of Mental Illness: From Demons to Asylums The Demonic Model  Middle age viewed mental illnesses through the lens of a demonic model  Hearing voices, talking to oneself, and other add behaviours to the actions of evil spirits infesting the body  Malleus Malleficarum assists in identifying witches  Executions of thousands of innocent individuals  Treatment: exorcisms The Medical Model  Renaissance – medical model  View of mental illness as due to a physical disorder requiring medical treatment  European government established asylums  Institutions for those with mental illness created in the 15 century  “place of safety” but often overcrowded and understaffed  Treatment: bloodletting  Mistaken excessive blood causes mental illness  Treatment: snake pit  Frighten patients “out of their diseases” by tossing into snake pits  Improved in the short term – placebo effect  Phillippe Pinel and Dorthea Dix  Moral treatment: approach those with mental illness be treated with dignity, kindness, and respect The Modern Era of Psychiatric Treatment  Early 1950s, medical (chlorpromazine) is introduced  1960s and 1970s – deinstitutionalization  Governmental policy in the 1960s and 1970s that focused on releasing hospitalized psychiatric patients into the community and closing mental hospitals  Some returned to regular life, others spilled into cities without adequate follow-up care  Community mental health centres and halfway houses are free treatment care facilities Psychiatric Diagnoses Across Canada Cultural Universality  Most disorder exist in most cultures  E.g. Inuit use kunlangeta to describe a person who lies, cheats, steals, is unfaithful to women, and doesn’t obey elders Special Considerations in Psychiatric Classification and Diagnosis  Help us pinpoint the psychological problem a person is experiencing  Easier for mental health professionals to communicate  Simplifying complex descriptions  Psychiatric diagnosis misconceptions 1. Pigeonholing a. Within a diagnosis category, people differ dramatically in their other psychological difficulties, and social identities 2. Unreliable a. Interrater reliability: different raters agree on patients’ diagnoses b. “duelling expert witness” in criminal trials b.i. Psychologists can’t agree on the diagnoses of individual with suspected disorders c. Major mental disorders have high correlations of 0.8 d. Personality disorders have lower interrater reliability 3. Invalid a. Eli Robins and Samuel Guze outlined a valid criteria of valid diagnosis 4. Stigmatize people a. Labelling theories: scholars who argue that psychiatric diagnosis exert powerful negative effects on people’s perceptions and behaviours b. David Rosenhan b.i. Asked 8 individuals with no symptoms of mental illness pose fake patients in 12 hospitals  diagnosed with schizophrenia b.ii. Remained for 3 weeks even without displaying further symptoms  self-fulling prophecy b.iii. Interpreted one pseudopatient’s note taking as “abnormal writing behaviour” Psychiatric Diagnosis Today: DSM-5  Diagnostic and Statistical Manual of Mental Disorders (DSM): diagnostic system containing the American Psychiatric Association (APA) criteria for mental disorders  18 different classes of disorders Diagnostic Criteria and Decision Rules  Provides a list of diagnostic criteria for each condition  Set of decision rules for deciding how many of these criteria need to be met “Thinking Organic”  Medically induced – conditions that can simulate certain psychological disorders  Rule out medical causes of disorder when diagnosing psychological conditions The DSM-5: Other Features  Prevalence: percentage of people in the population with a disorder  E.g. Major depression  10% among women and 5% among men  Adopts a biopsychosocial approach – acknowledges the interplay of biological, psychological, and social influences  Provide information about how differing cultural backgrounds can affect the content and expression of symptoms The DSM – 5: Criticism  Diagnostic criteria are not based completely on scientific evidence (driven more by drug companies)  High level of comorbidity among many of its diagnoses  Individuals with one diagnosis frequently have one or more additional diagnoses  Whether DSM-5 is diagnosing genuinely independent conditions as opposed to slightly different variations of one underlying condition  Reliance on categorical model  A mental disorder differs from normal functioning in kind rather than degree  Either present or absent, no in-between  E.g. Pregnancy  Dimensional model: a mental disorder differs from normal functioning in degree rather than kind  E.g. Height: differences aren’t all or none  Tendency to “medicalize normality” – classify relatively mild psychological disturbances as pathological  Open floodgates to diagnosing many people with relatively normal grief reactions as disordered Mental Illness and the Law: A Controversial Interface Mental Illness and Violence  Only a few percent of people with mental illness commit aggressive acts  Insanity defense: shouldn’t hold people legally responsible for their crimes if they weren’t of “sound mind” when they committed them Involuntary Commitment  Involuntary commitment: procedure of placing some people with mental illnesses in a psychiatric hospital or other facility based on their potential danger to themselves or others, or their inability to care for themselves  Raised ethical questions  depriving them of their civil liberties Anxiety-Related Disorders: The Many Faces of Worry and Fear  Describe the many ways people experience anxiety  Somatic symptom disorder: condition marked by physical symptoms that suggest an underlying medical illness, but that are actually psychological in origin  Illness anxiety disorder: an individual’s continual preoccupation with the notion that he or she has a serious physical disease Generalized Anxiety Disorder: Perpetual Worry  Generalized anxiety disorder (GAD): continual feelings of worry, anxiety, physical tension, and irritability across many areas of life functioning  People with GAD spend an average of 60% of each day worrying  Feel irritable and on edge, have trouble sleeping, and experience considerably bodily tension and fatigue  More likely to be female than male  Core anxiety disorder Panic Disorder: Terror That Comes Out Of The Blue  Panic attacks: free, intense episodes of just extreme fear characterized by sweating, dizziness, light-headedness, racing heartbeat, and feelings of impending death or going crazy  Peak in less than 10 minutes  Mistaken as heart attacks  Some are associated with specific situations  E.g. riding an elevator  Others come without warning  Can occur in every anxiety, mood, and eating disorders  Panic disorder: repeated and unexpected panic attacks, along with other persistent concerned about future attacks or a paint and personal behavior in an attempt to avoid them  Develops in early adulthood  Associated with the history of fears a separation from parent during childhood Phobia: Irrational Fears  Phobia: intense fear of an object or situation that greatly out of proportion to its actual threat  Create distress  Most common of all anxiety disorders Agoraphobia  Agoraphobia: fear of being in a place or situation in which escape is difficult or embarrassing, or in which help is unavailable in the event of a panic attack  Originated in Greece  Emerge in the mid-teens  Most people with panic disorder develop agoraphobia Specific Phobia and Social Anxiety Disorder  Specific phobia: phobia of objects places or situations  Wild spread in childhood but disappear with age  Social anxiety disorder: fear of public appearances Post-Traumatic Stress Disorder: The Enduring Effects of Experiencing Horror  Formally included in the category of anxiety disorders, but now are positioned in own separate diagnostic categories  Post-traumatic stress disorder: marked emotional disturbance After experiencing or witnessing a severely stressful event  Rape, wartime combat, or a natural disaster  high risk  Symptoms include:  Avoid thoughts, feelings, places, and conversations associated with the trauma semicolon reoccurring dreams of the trauma semicolon and increased arousal, such as sleep difficulties and startling easily  PTSD isn’t easy to diagnose Obsessive-Compulsive and Related Disorders: Trapped and One’s Thoughts and Behaviors  Obsessive compulsive disorder: condition marked by repeated and lengthy (at least one hour per day) immersion and obsessions, compulsions, or both  Obsessions: persistent ideas, thoughts, or impulses that are on wanted and inappropriate and cause marked distress  E.g. Consumed with fears of being dirty or thoughts of killing others  Disturbed by their thoughts and usually see that as irrational or nonsensical  Compulsions: repetitive behaviors or mental acts that they undertake to reduce or prevent the stress  Repeatedly check door locks Windows electronic controls and ovens  Performing tasks in set ways, like putting on one shoes in a fixed pattern  Repeatedly arranging and rearranging objects  Washing and cleaning repeatedly and unnecessarily  Counting the numbers of dots on a wall or touching or tapping objects  Howard Hughes, Cameron Diaz, Billy Bob Thornton, and David Beckham Explanations for Anxiety-Related Disorders the Roots of Pathological Anxiety Fear and Repetitive Thoughts and Behaviors Learning Models of Anxiety: Anxious Responses as Acquired Habits  Fears are learned  Rely on reinforcement and Punishment  Acquire fears by observing others engage in fearful behaviors  Stem from information or misinformation about others Catastrophizing and Anxiety Sensitivity  Catastrophizing is a core feature of anxious thinking  People catastrophize when they predicted terrible events despite their low probability  People with anxiety disorders tend to interpret ambiguous situations in a negative light  People with anxiety disorders Harbors high levels of anxiety sensitivity  Fear of anxiety-related Sensations Anxiety: Biological Influences  Twin studies show that many anxiety disorders, are genetically influenced  Tourette’s disorder – a condition marked by motor tics  OCD and Tourette’s disorder share biological roots Mood Disorders and Suicide  Identify the characteristics of different mood disorders  Describe how life evens interacts with characteristics of the individual to produce depression symptoms  Identify common myths and misconceptions about suicide  Major depressive episodes: state in which a person experiences a lingering depressed mood or diminished interest in pleasurable activities, along with symptoms that include weight loss and sleep difficulties Table 15.6 Mood Disorders and Conditions Disorder/Condition Symptoms Major depressive disorder Chronic or recurrent state in which a person experiences a lingering depressed mood or diminished interest in pleasurable activities, along with symptoms that include weight loss, sleep difficulties Manic episode  Markedly inflated self-esteem or grandiosity  Greatly decreased need for sleep  Much more talkative than usual  Racing thoughts  Distractibility  Increased activity level or agitation  Excessive involvement in pleasurable activities that can cause problems  E.g. Unprotected sex, excessive spending, reckless driving Bipolar disorder I Presence of one or more manic episodes Dysthymic (persistent depressive) disorder  Low level depression of at least two years’ duration  Feelings of inadequacy  Sadness  Low energy  Poor appetite  Decrease pleasure and productivity  Hopelessness Hypomanic episode A less intense and disruptive version of manic episode  Feelings of elation  Grouchiness or irritability  Distractibility  Talkativeness Bipolar disorder II Patients must experience at least one episode of major depression and one hypomanic episode Cyclothymic disorder Moods alternate between numerous periods of hypomanic symptoms and numerous periods of depressive symptoms  Think of “cycles” of up and down moods  Increases the risk of developing
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