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Chapter 14

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University of Toronto Mississauga
Dax Urbszat

Chapter 14: Psychological Disorders Abnormal Behaviours: Myths, Realities and Controversies Medical Models Applied to Normal Behaviour - Model proposed that it is useful to think of abnormal behaviour as a disease  Used to describe psychopathology, mental illness and psychological disorders - Thomas Szasz criticized medical model, that disease/ illness can only affect body and not mind therefore no such thing as mental illnesses  Abnormal behaviour involves deviation from social norms  Questions morally/socially about what is acceptable behaviour into medical questions - Diagnosis: distinguishing ones illness from another - Etiology: apparent causation and developmental history of an illness - Prognosis: forecast about probable course of the illness Criteria of Abnormal Behaviour - In making diagnoses, clinicians rely on a variety of criteria: 1) Deviance  Deviates from social norm and violate society’s standards and expectations is known as abnormal behaviour  All cultures have similar norms about mental illness  Transvestic fetish: disorder where man achieves sexual arousal by dressing as a woman ( considered disorder because it is deviating from social norms) 2) Maladaptive Behaviour  everyday adaptive behaviour is impaired, usually from drug consumption  Substance use disorder– substance interfere with social and occupational functioning 3) Personal distress  Troubled via depression or anxiety  These people labeled to have an disorder when they may/may not exhibit deviant/maladaptive disorder - Diagnosis on mental illness involves value judgement about what is normal/abnormal behaviour - Judgements about mental illness reflect cultural values, social trends, political forces & scientific knowledge - Normality and abnormality exist on a continuum Stereotypes of Psychological Behaviour - Largely inaccurate stereotypes include 1) Disorders are incurable  Some individuals do get better ( spontaneously or through treatment and lead normal lives) 2) People with disorders are often violent and dangerous  No consistent evidence 3) People with psychological disorders behave in bizarre ways and are very different from normal people  BUT it is difficult to distinguish norm and abnorm, Rosenhan’s pseudopatients with one false symptom were admitted into mental institution Psycho diagnosis: The Classification of Disorders - DSM (diagnostic and statistical manual of mental disorders)  Found by American psychiatric association  Currently on DSM-IV and again revised - Use a multiaxial 5 axes diagnosis system to classify disorders  Axis 1 : Clinical Syndromes • Different disorders ; mood, anxiety, eating  Axis 2: Personality Disorders or Mental Retardation • Personality disorders; long lasting patterns of extreme, inflexible personality traits that are deviant or maladaptive and lead to impaired functioning or subjective distress • Mental retardation; subnormal general mental ability accompanied by deficiencies in adaptive skill, appears before age 18  Axis 3: General Medical Conditions • Physical disorders or conditions ( diabetes, arthritis, hypertension)  Axis 4: Psychosocial and Environmental Problems • Negative life events, environmental difficulty, familial or interpersonal stress, lack of social support • Problems that affect diagnosis, prognosis and treatment of disorder  Axis 5: Global Assessment of functioning scale • Estimates individual’s current level of adaptive functioning • Scale of 1 -100 with 1 being severely psychologically impaired and 100 being close to normal (Refer to page 610 for details on this diagnostic system) Criticism: • Can people be reliably placed in discontinuous (non-overlapping) diagnostic categories • Comorbidity: coexistence of 2 or more disorder o Lots of overlapping • Diagnose may not reflect specific disorders SO categorical approach should become dimensional approach o Dimensional approach: describe pathology in terms of how the score on a limited number of continuous dimensions such as the degree to which they exhibit anxiety/depression/agitation/hypochondria etc The Prevalence of Psychological Disorders - Epidemiology: the study of the distribution of mental or physical disorders in a population  Prevalence: % of a population that exhibits a disorder during a specified time period • Life time prevalence: % of pop. that exhibit disorder any time in their life - Life time risk of a psychiatric disorder is found to be 51% - Most common disorder in America: substance use, anxiety, mood disorders - Etiology: apparent causation and developmental history of an illness Anxiety Disorders - Anxiety disorders are a class of disorders marked by feelings of excessive apprehension (fear) and anxiety - Such as: anxiety, phobic, panic, obsessive compulsive disorder, agoraphobia Generalized Anxiety Disorder - Marked by a chronic high level of anxiety that is not tied to any specific threat ( often called free floating anxiety as it is nonspecific) - Free floating and not specific - More common in females than males - People worry about almost everything in life ( their yesterday and their tomorrow)  Mostly about minor matters related to family, finances, work and personal illness - Cannot make decisions quickly and take a long time - Anxiety accompanied by physical symptoms including  Trembling, Muscle tension, Diarrhoea, Dizziness, Faintness, Sweating, & heart palpitations Phobic Disorder - An individual’s troublesome anxiety has a specific focus - Marked by a persistent and irrational fear of an object or situation that presents no realistic danger - Fear interferes with everyday behaviour - Physical symptoms = trembling and heart palpitations - Phobia can be developed towards anything ( e.g. driving even if the person is a good driver , or snakes , even if the snake is only seen on television) - Common phobias include:  Acrophobia ( fear of heights), Claustrophobia (fear of small enclosed spaces), Brontophobia (fear of storms), Hydrophobia (fear of water), & Animal and insect phobias - Irrationality of fear is understood by patients, but they can’t stay calm when confronted with focus of phobia Panic Disorder and Agoraphobia - Characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly - Victims become apprehensive, wondering when the next one will occur - Agoraphobia: a fear of going out in public places  Happens when people fear that their panic may be seen in public ; they become afraid of leaving their home  Some only go out if in the company of a trusted person Obsessive Compulsive Disorder - Marked by persistent, uncontrollable repetition of distressing thoughts(obsessions) and urges to engage in senseless activities ( compulsions) - Obsessions: repetitive thoughts that keep on occurring in a distressing way  May centre on inflicting harm on others, personal failures, suicide or sexual acts - Compulsions: actions ( stereotyped rituals) that one feels necessary to carry out  These actions help to relieve anxiety - e.g. OCD for contamination and germs ( consistently washing hands after shaking someone’s hand, and feeling like the germs are not coming off) - constant hand washing, rechecking of locks, repetitively cleaning are also other examples - Certain obsessions paired with certain compulsions  If the obsession was contamination, then the compulsion would be need to clean  If the obsession was symmetry, then the compulsion would be ordering and arranging things Post- Traumatic Stress Disorder - A disorder that surfaces due to a person’s exposure to severe stress  E.g. veterans of war, rape or assault, car accidents, witnessing death and natural deaths are all causes of PTSD - prevalence in women - Common symptoms :  Re-experiencing the traumatic event in form of nightmares and flashbacks  Emotional numbing  Alienation  Problems of social relationships  Increased sense of vulnerability  Elevated levels of arousal, anxiety, anger, & guilt - Key predictor of vulnerability is the intensity of one`s reaction at the time of the traumatic event  The more intense the reaction, the higher their vulnerability to PTSD Etiology of anxiety disorders Biological Factors - In studies assessing impact of heredity of psychological disorders, concordance rates are studied - Concordance rate: indicates the percentage of twin pairs or other pairs of relatives who exhibit the same disorder - If studies show that relatives that share more genetic info vs. those who share less ; there is a genetic predisposition to the disorder - Results of twin studies ( study of similarity is disorders between twins), and family studies ( disorder predisposition in families) say that there is a moderate genetic disposition to anxiety disorders - Anxiety sensitivity may result in vulnerability to anxiety disorders  May fuel anxiety to a point where it becomes anxiety disorder in those who over react with fear when experiencing anxiety - Recent research: link between anxiety disorders and neurochemical activity in brain  Neurotransmitters altered by anxiety relieving drugs ; valium, at GABA synapses  Abnormalities in neural circuits using serotonin found to be implicated in panic disorder and OCDs Conditioning and learning - Many anxiety responses can be acquired through classical conditioning and maintained through operant conditioning E.g. young child buried in snow by avalanche. – As an adult, she is scared of snow. This means that the neutral stimulus (the snow) was paired with the frightening event, the avalanche, therefore becoming a conditioned stimulus causing anxiety - Once the fear is acquired through classical conditioning, it is usually avoided by the person conditioned to it  This avoidance response is negatively reinforced as there is a reduction in anxiety - Martin Seligman’s concept of preparedness:  Suggested that people are biologically prepared by their evolutionary history to acquire some fears much more easily than others  Explains ancient sources of threat such as fear of snakes and spiders - Criticism for conditioning models of phobia:  Many people cannot recall traumatic incidences causing phobia, whereas various individuals have had traumatic incidences, but don’t have a phobia – this does not fit with the model developed which states that phobias are caused because of previous traumatic incidences. - Phobias can also be learned through observational learning; most of which are passed on from parent to child  A dad, who is afraid of thunderstorms and hides in the closet every time they occur, aids in his children acquiring the same phobia when they see him hide over and over again. Cognitive Factors - Certain styles of thinking make some people more vulnerable to anxiety disorders  Tendency to misinterpret harmless situations  Focus excessive attention on perceived threats  Recall information that seemed threatening Stress - Study supports that stress is related to the development of anxiety disorders Somatoform Disorders (SD) - Psychosomatic disease involves genuine physical ailment caused partially by psychological factors - Somatoform disorders: physical ailments that cannot fully be explained by organic conditions and are largely due to psychological factors - Malingering: faking illness for personal gain Somatization Disorder - Marked by a history of diverse physical complaints that appear to be psychological in origin - Occur mostly in women and often coexist with depression + anxiety disorders - Pain increases and decreases according to stress level in their lives - Patients very resistant to the idea that their disease resulted from psychological distress Conversion Disorder - Characterized by significant loss of physical function (no organic basis) in a single organ system - Triggered by stress - Common symptoms such as partial/complete loss of vision, hearing, partial paralysis etc - E.g. a girl losing use of her legs due to traumatising event where someone attempted to sexually assault her. Her legs buckled during the incident and afterwards, when she tried to walk, she couldn’t. Hypochondriasis - Characterized by excessive preoccupation with health concerns and incessant worry about developing physical illnesses. - Skeptical and disbelieving of doctors Etiology of Somatoform disorders Personality Factors - Certain personality characteristics make people more susceptible in developing somatoform disorders  Histrionic personality ; self centered, suggestible, excitable, highly emotional, & overly dramatic  Neuroticism also susceptible Cognitive Factors - People with SD, draw catastrophic conclusions about minor bodily complaints - Faulty standard of health ; health equated with absence of symptoms+ discomfort  unrealistic The Sick Role Benefits of the sick role:  Illness is great way to avoid facing life problems; high demands aren’t usually placed on
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