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Chapter 14

Textbook Chapter 14

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Ayesha Khan

C HAPTER 14: P SYCHOLOGICAL D ISORDERS Abnormal Behaviour: Myths, Realities and Controversies The Medical Model Applies to Abnormal Behaviour • Medical Model: proposes that it is useful to think of abnormal behaviour as a disease • Medical model can lead to social stigma that is hard to get rid of • Medical model continues to dominate thinking about psychological disorders • Diagnosis: distinguishing one illness from another • Etiology: the apparent causation and development history of an illness • Prognosis: forecast about the probably course of an illness Criteria of Abnormal Behaviour • Deviance: people are often said to have a disorder if their behaviour deviates from what their society considers acceptable (ex. Transvestic fetishism: sexual disorder when man achieves sexual arousal by dressing in female clothes --> disorder because this deviates `from norm) • Maladaptive Behaviour: labeled as having psychological disorder because everyday adaptive behaviour is impaired - key criterion in diagnosis of substance-use disorders • Personal distress: individual’s report of great personal distress (criterion for people with depression and anxiety disorders) • People usually viewed as disordered when only one criterion above is met • Difficult to draw a clear cline between normality and abnormality (it’s a continuum) Stereotypes of Psychological Disorders • Three stereotypes about psychological disorders that are largely inaccurate: • Psychological disorders are incurable: large majority of mentally ill people eventually improve and lead normal, productive lives • People with psychological disorders are often violent and dangerous: No large correlation between mental illness and violent behaviour but it is largely publicized if it does occur therefore creating the stereotype • People with psychological disorders behave in bizarre ways and are very different from normal people: only true for small majority of cases Psychodiagnosis: The Classification of Disorders • Diagnostic and Statistical Manual of Mental Disorders: employs a multi-axial system of classification which asks for judgements about individuals on 5 separate axes • Diagnoses of disorders are made on Axes I and II • Axis I: where physicians record most disorders • Axis II: used to list long-running personality disorders or intellectual disability • Remaining axes used to record supplemental information • Axis III: patient’s physical disorders • Axis IV: notations regarding types of stress experienced by individual in previous year Axis V: estimates of individual’s current level of adaptive functioning • • Biggest issue with DSM is whether to reduce the system’s commitment to a categorical approach • Critics not that there is overlap among disorders in symptoms making for fuzzier boundaries between diagnoses • Theorists want to replace current categorical approach with dimensional approach, which would describe pathology in terms of how they score on a limited number of continuous dimensions The Prevalence of Psychological Disorders • Epidemiology: the study of the distribution of mental or physical disorders in a population • Prevalence: the percentage of a population that exhibits a disorder during a specific time period • Lifetime prevalence: percentage of people who endure a specific disorder at any time in their lives Chapter 14: Psychological Disorders Most common psychological disorders are: substance-use, anxiety and mood disorders • Anxiety Disorders • Class of disorders marked by feelings of excessive apprehension and anxiety • Five principal types: generalized anxiety disorder, phobic disorder, panic disorder and agoraphobia, obsessive-compulsive disorder, and post-traumatic disorder (these are not mutually-exclusive) Generalized Anxiety Disorder • Marked by a chronic, high level of anxiety that is not tied to any specific threat • People with this disorder worry constantly about yesterday’s mistakes and tomorrow’s problems and hope their worrying will help ward off negative events • Often dread decisions and brood over them endlessly • Anxiety often accompanied by physical symptoms (i.e. Trembling, dizziness, sweating, heart palpitations) • Tends to have gradual onset and more frequent in females Phobic Disorder • Marked by a persistent and irrational fear of an object or situation that presents no realistic danger • People are said to have phobic disorder only when it seriously interferes with everyday behaviour • Accompanied by physical symptoms of anxiety (i.e. Trembling and palpitations) Common phobias are acrophobia (fear of heights), claustrophobia (fear of small, enclosed spaces), • brontophobia (fear of storms), hydrophobia (fear of water) and others associated with animals and insects • People with phobias often realize their fear is irrational but still unable to cope Panic Disorder and Agoraphobia • Panic disorder: characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly • Accompanied by physical symptoms of anxiety • After having a few attacks, people become apprehensive, wondering when it’ll happen again • Concern with panic in public may make them scared to leave home • Agoraphobia: fear of going out to public places • Agoraphobia mainly a complication of panic disorder • Onset of panic disorder typically occur during late adolescence or early adulthood Obsessive-Compulsive Disorder • Marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsion) • Obsessions sometimes centre on inflicting harm on others, personal failures, suicide, or sexual acts • People with obsessions may feel they have lost control of their mind Prevalence of OCD seems to be increasing • Post-Traumatic Stress Disorder (PTSD) • Often elicited by any of a variety of traumatic events, including a rape or assault, a severe automobile accident, a natural disaster, or the witnessing of someone’s death • In some cases PTSD doesn’t surface until many months or years after a person’s exposure to severe stress and is tied to memory for the events More common than widely assumed (more common in women) • • Common symptoms: re-experiencing the traumatic event in nightmares and flashbacks, emotional numbing, alienation, problems in social relationships, an increased sense of vulnerability, and elevated levels of arousal, anxiety, anger and guilt C HAPTER 14: PSYCHOLOGICAL D ISORDERS Predictors of increased vulnerability: greater personal injuries and losses, greater intensity of exposure • to the traumatic event, and more exposure to the grotesque aftermath • Frequency and severity of post-traumatic symptoms usually decline gradually over time, but recovery tends to be gradual in many cases, the symptoms never completely disappear Etiology of Anxiety Disorders Biological factors: • To assess the impact of heredity on psychological disorders, investigators look at concordance rate • Concordance rate: indicated the percentage of twin pairs or other pairs of relatives who exhibit the same disorder • Both twin and family studies suggest there is moderate genetic predisposition to anxiety disorders • Some research suggests that anxiety sensitivity (may fuel inflationary spiral where anxiety breeds more anxiety) may make people vulnerable to anxiety disorders • Recent research shows link may exist between anxiety disorders and neurochemical activity in the brain Conditioning and Learning: • Many anxiety responses may be acquired through classical conditioning and maintained through operant conditioning • Once fear acquired through classical conditioning, person may start avoiding anxiety-producing stimulus • Avoidance response negatively reinforced because it is followed by a reduction in anxiety Martin Seligman’s concept of preparedness: suggests people biologically prepared by their evolutionary • history to acquire some fears much more easily than others Cognitive factors: • Theorists maintain that certain styles of thinking make people more vulnerable to anxiety disorders • Vulnerability because they tend to: • Misinterpret harmless situations as threatening • Focus excessive attention on perceived threats • Selectively recall information that seems threatening Stress: • There is reason to believe that high stress often help to precipitate the onset of anxiety disorders Dissociative Disorders • A class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity Dissociative Amnesia and Fugue • They are overlapping disorders characterized by serious memory deficits • Dissociative amnesia: sudden loss of memory for important personal information that is too extensive to be due to normal forgetting • Memory losses occur for single traumatic event or for an extended period of time surrounding the event Dissociative fugue: people lose their memory for their entire lives along with their sense of personal • identity • They forget their names, families, home, workplace but can remember things unrelated to their identity Dissociative Identity Disorder • Involves the coexistence in one person of two or more largely complete, and usually very different, personalities (formerly know as multiple personality disorder) • People with DID feel they have more than one identity, each with their own name, memories, traits and physical mannerisms and are often unaware of each other • DID rarely occurs in isolation (i.e. Patients have previous history of anxiety or mood or personality disorders) and is more often occurs in women than men Chapter 14: Psychological Disorders Etiology of Dissociative Disorders • Psychogenic amnesia and fugue usually attributed to excessive stress • Some theorists believe that people with multiple personalities are engaging in intentional role-playing to use mental illness as a face-saving excuse for their personal failings • Another theory is that these disorders may be rooted in emotional trauma that happened during childhood Mood Disorders • A class of disorders marked by emotional disturbances of varied kinds that may spill over to disrupt physical, perceptual, social and thought processes • Two basic types of mood disorders: unipolar and bipolar • Unipolar disorder: people experience emotional extremes at just one end of the mood continuum, as they are troubled only by depression • Bipolar disorder: vulnerable to emotional extremes at both ends of the mood continuum, going through periods of both depression and mania (excitement and elation) Major Depressive Disorder • People show persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure Common symptoms: gloomy, irritable, inability to make decisions, negative self-image, less active, • difficulty sleeping • Central feature of depression is anhedonia: a diminished ability to experience pleasure • Depressed people have lack of motivation to tackle everyday tasks hence, they often give up activities they used to like • Self-esteem seems to sink and they plunge unto feelings of hopelessness and boundless guilt • Onset of depression can happen at any point of life but majority emerge before age 40 • Average # of depressive episodes is 5-6 • Mild symptoms of depression usually diagnosed as dysthymic disorder: consists of chronic depression that is insufficient in severity to justify diagnosis of a major depressive episode • Depressive disorder is very common in Canada and twice as high in women Bipolar Disorder (formerly manic-depressive disorder) • Characterized by the experience of one or more manic episodes as well as periods of depression • Symptoms: elated, racing thoughts, talkativeness, hyperactive, tireless, requiring less sleep than usual • In a manic episode, person’s mood becomes elevated to a point of euphoria and judgement is often impaired • Cyclothymic disorder: diagnosis when people exhibit chronic but relatively mile symptoms of bipolar disturbance • Much less common than unipolar disorders and is seen equally as often in men and women Onset is age-related and typical age is in the late teens • • Episodes typically last for about 4 months Diversity in Mood Disorders • Seasonal affective disorder: a type of depression that follows a seasonal
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