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Chapter 47-56

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University of Waterloo
Richard Ennis

Psychology - Disorders And Therapy Chapters 47-51 Chapter 47- Introduction to Psychological Disorders - at various moments, all of us think, act and feel the way disturbed people do much of the time. We to get anxious, depressed. - “To study the abnormal is the best way of understand the normal” - WHO reports that, worldwide, 450 million people suffer from mental or behavioral disorders, and accounts for 15.4% of the YLL due to disability or disorder, scoring below CVD and above cancer. - Mental health workers view psychological disorders as patterns of thoughts, feelings or actions that are deviant, distressful and dysfunctional - being different (deviant) from most people in ones culture is a part if what it takes to define a psych disorder, standards for deviant behavior vary by context and by culture - ie, war time mass killing, hearing voices in their head - standards also very with time, homosexuality was once view as a pscyh disorder, how ever now theAmerican PsychiatricAssociation has dropped homosexuality as a disorder - there is more to a disorder than being deviant, this behavior also causes them to be distressed. - dysfunction is key to defining a disorder - an intense fear of spiders may be deviant, but if it dosent impair your life its not a disorder Definition: Psychological Disorder: deviant, distressful and dysfunctional patters of thoughts, feelings or behaviors Medical Model: the concept that diseases in this case psychological disorders, have physical causes that can be diagnosed, treated and in most cases, cured. often in a hospital. - in earlier times people believed that puzzling behavior was the work of evil spirits or god-like powers - rid the evil by exorcising the demon - in other times “mad” people were cages like zoo animals, castration, burnings and beatings, pulling teeth, giving transfusions with animal blood - in opposition to brutal treatment Philippe Pinel insisted that madness is not a demon possession but a sickness of the mind caused by severe stresses and inhumane conditions - Pinel’s moral treatment included unchaining them and talking with them, replacing brutality with gentleness, often did not cure patients - 1800’s the discovery of syphilis infects the brain and drove further gradual reform. from here hospitals replaced asylums and began to search for physical causes and treatments for disorders. Today the medical model “mental health movement”: a mental illness needs to be diagnosed on the basis of its symptoms and treated through therapy, may include time in psychiatric hospital - recent discoveries that genetically influenced abnormalities in brian structure and biochemistry contribute to many disorders - all behavior whether normal or disordered, arise from the interactions of nature ( genetic and psychological factors) and nurture (past and present experiences) - evidence of such effects comes from links btwn specific disorders and cultures - cultures differ in their sources of stress and they produce different ways of coping - anorexia nervosa and bulimia nervosa occur mostly in Western cultures - disorders may share an underlying dynamic (anxiety) while differing in the symptoms (an eating problem) manifested in a particular culture. - not all disorders are culture bound. ex, depression and schizophrenia occur world wide - influences: genetic predisposition, physiological states, inner psychological dynamics , social and cultural circumstances- the biopsycho-social model helps, it recognizes that mind and body are inseparable - (-) emotions contribute to physical illness and physical abnormalities contribute to (-) emotions The biopsychosocial approach to psychological disorders Biological influences: - evolution, individual genes, brain structure and chemistry Psychological influences: - stress, trauma, learned helplessness, mood related perception and memories Social cultural influences: - roles, expectations, definitions of normal and disorder - all of these influences can lead to psychological disorders or at least contribute to them Classifying Psychological Disorders - in biology, classification creates order - in psychiatry and psychology, classification orders and describes symptoms, for ex. to classify a person’s disorder as schizophrenia, suggests that the person talks incoherently ; hallucinates, and shows little or no emotion - in psychology, classification not only aims to describe a disorder but also predict future outcomes, treatment - current scheme for classifying disorders is the DSM-IV-TR (American psychiatric association’s diagnostic and statistical manual of mental disorders) - some changes have been made since the original such as “mental retardation” to “intellectual developmental disorder” - most MD’s use this as a practical tool, and insurance companies require a diagnosis from the DSM before they pay for therapy - aim is to support integration of psychiatric diagnosis into main stream medical practices - the DSM defines a diagnostic process and clinical syndromes, these diagnostic guidelines must be reliable, to prevent different diagnosis from 2 different practitioners. - there are some discrepancies, increased number of disorder categories - 26% of adults meet the criteria for at least 1 disorder, and 46% at some point in there life - others worry the DSM will extend the pathologizing into everyday life, turning bereavement into depression Labeling Psychological disorders - labels create preconceptions that guide our perceptions and our interpretations - many psychological disorders are diseases of the brian, not failures of character, the stigma seems to be lifting - people express greatest sympathy for people whose disorders are gender atypical- men suffering from depression - women with alcohol abuse - stereotypes bombard media an portray as objects of humor and ridicule - in real life, people with disorders tend to be the victims of violence, not only can labels bias perception, they can also change reality. - ex. when teachers are told certain students are gifted or hostile, they may act in ways that elicit the behaviors expected - in contrast the benefit of diagnostic labels, in the mental health profession can use labels to help communicate about there cases, to comprehend underlying cause and to pick effective treatment programs - diagnostic definitions also inform patients, self understanding. Useful in research that explores that causes and treatments of disorder Rated of Psychological Disorders - WHO study of prior year mental disorders, lowest rate was in Shanghai and highest rate in U.S, and immigrants to the U.S from mexico, africa and asia on average have better mental health than native U.S residences As for who is most vulnerable to mental disorders, this answer varies from each disorder - one predictor of mental disorders, poverty, crosses ethnic and gender lines. The incidence of serious psychological disorders have been doubly high among those below the poverty line - the correlation btwn poverty-disorder association raises a chicken and the egg question. Dose poverty cause disorders? Or do disorders cause poverty ? - it is both, schizophrenia defiantly leads to poverty - Experiment on the poverty-pathology link, researchers tracked rates of behavioral problems in native american children, as the study began, kids of poverty exhibited more deviant and aggressive behavior. After 4 yrs, kids who's families had moves above the poverty line showed 40% decrease in the behavioral problems, while those who continued below the poverty line exhibited no change. At what times of life do disorders strike? - usually around early adult hood - the symptoms of antisocial personality disorders and phobias are the earliest to appear at a median of age 8 and 10 respectively. - symptoms of alcohol dependance, OCD, bipolar and schizophrenia appear at a median age near 20 - Major depression often hits later-on, around age 25 Chapter 48 - Anxiety Disorders - some of us call it shyness however some are more prone to notice and remember threats. This tendency may place us at risk for one of the anxiety disorders, marked by distressing, persistent anxiety or dysfunctional anxiety-inducing behaviors: • Generalized anxiety disorder, in which a person is unexplainably and continually tense and uneasy •Panic disorder, in which a person experiences sudden episodes of intense dread • Phobias, in which a person is intensely and irrationally afraid of a specific object, activity or situation • OCD, in which a person is troubled by repetitive thoughts, and/or actions • Post traumatic stress disorder, in which a person has lingering memories, nightmares, and other symptoms for weeks after a severely threatening, uncontrollable event Definitions Anxiety disorder: psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety Generalized anxiety disorder: an anxiety disorder in which a person continually tense, apprehensive and in a state of autonomic NS arousal Panic disorder: AD marked by unpredictable, minutes - long episodes of intense dread in which a person experiences terror and accompanying chest pain, chocking or other frightening sensations Post traumatic growth: positive psychological changes as a result of struggling with extremely challenging circumstances and life crises Generalized anxiety disorder: Sigmund Freud’s term the anxiety is “free floating” - this can also lead to health problems such as high bp - many ppl with this disorder were maltreated at a young age, as time passes emotions tend to mellow and by age 50 these disorders are fairly rare Panic disorders - they suddenly strike, heart palpitations, sob, chocking ect. - smokers have at least double the risk of panic disorders, b/c nicotine is a stimulant Phobias - many ppl accept and live with phobias - people with phobias tend to avoid stimulus that arouse the fear - not all phobias have specific triggers for ex. social phobia is shyness taken to an extreme - Charles Darwin suffered panic attacks Obsessive Compulsive Disorder - as with generalized anxiety and phobias we can see aspects of OCD in our everyday lives - obsessive thoughts and compulsive behaviors cross the fine line btwn normality and disorder when they constantly interfere with everyday living and cause distress - example : checking to see if the door is locked... 10 times , washing your hands until your skin is raw (not normal) - at some point, like late 20’s, 2-3 % cross the fine line and develop this disorder - the person knows them to be irrational and obsessive thoughts become so overwhelming that effective functioning becomes impossible - odc is more common in teens and young adults than among older people Post-Traumatic Stress Disorder - there is a biological wisdom in not being able to forget our most emotional and traumatic experiences - greatest embarrassments, our worst accidents - for some the unforgettable takes over our lives. War veterans have haunting memories - typical of what was once called shell shock - PTSD symptoms have also been reported in survivors of accidents, sexual assault and violent crimes - research indicates that the greater ones emotional distress during a trauma, the higher the risk for PTSD - sensitive limbic system tends to increase vulnerability, by flooding the body with stress hormones over and over as images of the traumatic experience come up into consciousness - genes may also play a role, such findings suggest that some PTSD may be genetically predisposed - what dosent kill you makes you stronger (post traumatic growth) the struggle with a challenging crisis, often leads people to report an increased appreciation for life, more meaningful relationships and a richer spiritual life UnderstandingAnxiety Disorders : how do the learning and biological perspectives explain anxiety disorders? The Learning Perspective Fear Conditioning - when bad events happen uncontrollably, anxiety often occurs - research on conditioning shows that dogs learn to fear neutral stimuli associated with shock and that infants fear furry objects associated with loud noises (little albert and the rat). Using classical conditioning, bringing assault victims back to the scene of the crime . This link btwn conditioned fear and general anxiety helps explain why anxious ppl are hyper attentive to possible threats and how panic-prone ppl associate anxiety with certain cues - 2 specific learning processes can contribute to such anxiety - 1st: a stimulus generalization occurs, ex. a person is attacked by a fierce dog later develops a fear of all dogs - 2nd: reinforcement, helps maintain our phobias and compulsions after they arise. Avoiding or escaping the feared situation reduces anxiety, thus reinforcing the phobic behavior - compulsive behaviors operate similarly, if washing yours hands relieves your feelings of anxiety, you may wash your hands again and again when those feelings return Observable learning - is not the only cognitive influence on anxiety, interpretations and irrational beliefs also make for anxiety - people with anxiety disorder tend to be hyper vigilant: a pounding heart is a sign of a heart attack, a lone spider becomes an infestation.Anxiety is common when ppl cannot switch off such intrusive thoughts and perceive a loss of control and sense of helplessness The Biological Perspective - this perspective can help us understand why few people develop long lasting phobias after suffering traumas, why we learn some fears more readily and why some are more vulnerable Natural Selection - humans seem biologically prepared to fear threats (those that fearless about occasional threats were less likely to survive and leave offspring) - its is easy to condition and hard to extinguish fears of such “evolutionary relevant” stimuli - m
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