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Chapter 14

PSYA02 - Chapter 14.docx

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Steve Joordens

Chapter 14 – Psychological Disorders - to qualify as a mental disorder, thoughts, feelings, and emotions must be persistent, harmful to the person experiencing them and uncontrollable - the complicated human mind can produce behaviors, thoughts, and emotions that change radically from moment to moment Identifying Psychological Disorders: What is Abnormal? - in ancient times people who acted strangely or reported bizarre thoughts or emotions were often understood in the context of religions or the supernatural - in some cultures and religious traditions, madness is still interpreted as possession by animal spirits or demons or as God’s punishment - these ways of looking at psychological abnormalities have been replaced in industrialized areas of the world by a MEDICAL MODEL => the conceptualization of psychological disorders as diseases that, like physical diseases, have biological causes, defined symptoms, and possible cures - treating abnormal behavior in the way we treat illness suggests that the first step is to determine the nature of the problem through diagnosis - in diagnosis, clinicians seek to determine the nature of the patient’s mental disease by assessing symptoms -> behaviors, thoughts and emotions suggestive of an underlying abnormal syndrome, a coherent cluster of symptoms due to a single cause - every action or thought suggestive of abnormality cannot be traced to an underlying disease Classification of Disorders - psychologists have adopted an approach developed by psychiatrists who use a system for classifying mental disorders - that is why a consensual diagnostic system was published - the current version of this manual is the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) or DSM-IV-TR - DSM-IV-TR => a classification system that describes the features used to diagnose each recognized mental disorder and indicates how the disorder can be distinguished from other, similar problems - each disorder is named as classified as though it were a distinct illness - major misconception -> that a mental disorder can be defined entirely in terms of deviation from the average, the typical, or “healthy” - people who have mental disorders may behave, think, or experience emotions in unusual ways, but simple departure from the norm is not the whole picture - the DSM-IV-TR definition takes these concerns into account by focusing on 3 key elements that must be present for a cluster of symptoms to qualify as a mental disorder => a disorder is manifested in symptoms that involve disturbances in behavior, thoughts, or emotions => the symptoms are associated w/ significant personal distress or impairment => the symptoms stem from an internal dysfunction (biological, psychological, or both) - psychological disorder exists along a continuum from normal to abnormal w/o a bright line of separation - the DSM-IV-TR recognizes this explicitly by recommending that diagnoses include a global assessment of functioning, a 1 to 100 rating of the person, w/ more severe disorders indicated by lower numbers and more effective functioning by higher numbers - in general the DSM-IV-TR produces better diagnostic reliability than earlier DSM versions - many diagnostic categories continue to depend on interpretation – based criteria rather than on observable behavior and diagnosis continues to focus on patient self- reports - level of agreement among different diagnosticians can vary depending on the diagnostic category - diagnostic difficulty is further increased when a person suffers from more than one disorder - people w/ depression (a mood disorder) often have secondary diagnoses of anxiety disorders - the co-occurrence of two or more disorders in a single individuality is referred to as COMORBIDITY and is very common - Comorbidity raises a host of confusing possibilities Causation of Disorders - the medical model suggests that knowing a person’s diagnosis is useful because any given category of mental illness is likely to have a distinctive cause - a specifiable pattern of causes (or etiology) may exist for different psychological disorders - it also suggests that each category of psychological disorder is likely to have a common prognosis, a typical course over time and susceptibility to treatment and cure - but it is rarely useful to focus on a single cause that is internal to the person and suggests a single cure - an integrated perspective that incorporates biological, psychological, an environmental factors offers the most comprehensive and useful framework for understanding most psychological disorders - on the biological side => the focus is on genetic influences, biochemical imbalances, and structural abnormalities of the brain - psychological perspective focuses on => maladaptive learning and coping, cognitive biases, dysfunctional attitudes and interpersonal problems - environmental factors include => poor socialization, stressful life circumstances, and cultural and social inequities - the complexity of causation suggests that different individuals can experience a similar psychological disorder for different reasons - the observation that most disorders have both internal (biological and psychological) and external (environmental) causes has given rise to a theory known as the DIATHESIS-STRESS MODEL => which suggests that a person may be predisposed for a psychological disorder that remains unexpressed until triggered by stress - the diathesis is the internal predisposition, which would be genetic, and the stress is the external trigger - the tendency to oversimplify mental disorders by attributing them to single, internal causes is nowhere more evident than in the interpretation of the role of the brain in psychological disorders - for example: a person who inherits a diathesis may never encounter the precipitating stress, whereas someone w/ little genetic propensity to a disorder may come to suffer from it given the right pattern of stress - searching for the biological causes of psychological disorders in the brain and body tends to invite a particular error in explanation – the intervention-causation fallacy - this fallacy involves the assumption that if a treatment is effective, it must address the cause of the problem - this is only sometimes true - we should be cautious about drawing inferences about causality based on responsiveness to treatment; the cure does not necessarily point to the cause Dangers of Labeling - psychiatric labels can have negative consequences, since many of these labels carry the baggage of negative stereotypes and stigma, such as the idea that mental disorder is a sign of personal weakness or the idea that psychiatric patients are dangerous - expectations created by psychiatric labels can sometimes even compromise the judgment of mental health professionals - once a person has been labeled as having a psychological disorder, the label becomes a kind of prison that makes it difficult to return to life as a nonpatient - labeling may even affect how the labeled person views him/herself - persons given such a label may come to view themselves not just as mentally disorders, but as hopeless or worthless - such a view may cause these persons to develop an attitude of defeat and as a result, to fail to work toward their own recovery Anxiety Disorders: When Fears Take Over - when anxiety arises that is out of proportion to real threats and challenges, it is maladaptive: it can take hold of people’s lives, stealing their peace of mind and undermining their ability to function normally - pathological anxiety is expressed as ANXIETY DISORDER => the class of mental disorder in which anxiety is the predominant feature - people commonly experience more than one type of anxiety disorder at a given time an there is significant comorbidity b/w anxiety and depression Generalized Anxiety Disorder - GENERALIZED ANXIETY DISORDER (GAD) => called generalized because the unrelenting worries are not focused on any particular threat; they are in fact often exaggerated and irrational - people suffering from GAD=> chronic excessive worry is accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension and sleep disturbance - the uncontrollable worrying produces a sense of loss of control that can so erode – self-confidence that simple decisions seem fraught w/ dire consequences - for example: while buying a new suit, a person will begin shaking and sweating as he/she approaches the store because the person was afraid of choosing the “wrong” suit. That person would become so anxious that he wouldn’t even enter the store - GAD occurs more frequently in lower socioeconomic groups than in middle- and upper-income groups - it is approximately twice as common in women than men - research suggests that both biological and psychological factors contribute to the risk of GAD - some evidence suggests that compared w/ fraternal twins, identical twins have modestly higher concordance rates (the percentage of pairs that share the characteristic) - some patients w/ GAD respond to certain prescription drugs, which suggests that neurotransmitter imbalances may a play a role in this disorder - precise nature of imbalance is clear, but benzodiazepines -> a class of sedative drugs (eg: Valium, Librium) that appear to stimulate the neurotransmitter gamma- aminobutyric acid (GABA) can sometimes reduce the symptoms of GAD - other drugs that do not directly affect GABA levels (eg: buspirone and antidepressants such as Prozac) can also be helpful in the treatment - these drugs can sometimes produce side effects and dependency - psychological explanations focus on anxiety – provoking situations in explaining high levels of GAD - the relatively high rates of GAD among women may also be related to stress because women are more likely than men to live in poverty, experience discrimination or be subjected to sexual or physical abuse - unpredictable traumatic experiences in childhood increase the risk of developing GAD Phobic Disorders - the DSM describes PHOBIC DISORDERS => as characterized by marked, persistent, and excessive fear and avoidance of specific objects, activities, or situations - an individual w/ this disorder recognizes that the fear is irrational but cannot prevent it from interfering w/ everyday functioning - SPECIFIC PHOBIA => is an irrational fear of a particular object or situation that markedly interferes w/ an individual’s ability to function - specific phobias fall into 5 categories: 1. animals (eg: dogs, cats, rats, snakes) 2. natural environments (eg: heights, darkness, water) 3. situations (eg: bridges, elevators, tunnels) 4. blood, injections and injury 5. other phobias including illness and death - SOCIAL PHOBIA => involves an irrational fear of being publicly humiliated or embarrassed - social phobia can be restricted to situations such as public speaking, eating in public or generalized to a variety of social situations that involve being observed or interacting w/ unfamiliar people - individuals w/ social phobia try to avoid situations where unfamiliar people might evaluate them, they experience intense anxiety and distress when public exposure is unavoidable - the high rates of both specific and social phobias suggest a predisposition to be fearful of certain objects and situations - PREPAREDNESS THEORY of phobias => maintains that people are instinctively predisposed toward certain fears - this theory proposed by Martin E. P. Seligman is supported by research showing that both humans and monkeys can quickly be conditioned to have a fear response for stimuli such as snakes and spiders but not for neutral stimuli such as flowers - phobias are particularly likely to form for objects that evolution has predisposed us to avoid - family studies of specific phobias indicate greater concordance rates for identical than fraternal - temperament may also play a role in vulnerability to phobias - researchers have found that infants who display excessive shyness and inhibition are at an increased risk for developing a phobic behavior later in life - abnormalities in the neurotransmitters serotonin and dopamine are more common in individuals who report phobias than other people who don’t - individuals w/ phobias sometimes show abnormally high levels of activity in the amygdala, an area of the brain linked w/ development of emotional associations - this evidence does not rule out the influence of environments and upbringing on the development of phobic overreactions - phobias can be classically conditioned (little Albert and white rat experiment) - the idea that phobias are learned from emotional experiences w/ feared objects is not a complete explanation for the occurrence of phobias - most studies find that people w/ phobias are no more likely than people w/o phobias to recall personal experiences w/ the feared object that could have provided the basis for classical conditioning Panic Disorder - people who suffer panic attacks are frequently overwhelmed by intense fears and by powerful physical symptoms of anxiety – in the absence of actual danger - PANIC DISORDER => characterized by the sudden occurrence of multiple psychological and physiological symptoms that contribute to a feeling of stark terror - acute symptoms of a panic attack typically last only a few minutes and include: -> shortness of breath -> heart palpitations -> sweating -> dizziness -> depersonalization (a feeling of being detached from one’s body) -> derealization (a feeling that the external world is strange or unreal) -> fear that one is going crazy or about to die - according to the DSM-IV-TR diagnostic criteria, a person has panic disorder only on experiencing recurrent unexpected attacks and reporting significant anxiety about having another attack - common complication of panic disorder is AGORAPHOBIA => a specific phobia involving fear of venturing into public places - may individuals w/ agoraphobia are not frightened of public places in themselves, instead they are afraid of having a panic attack in a public place or around strangers - an occasional episode is not sufficient for a diagnosis of panic disorder – the individual also has to experience significant dread and anxiety about having another attack - panic disorder is prevalent among women who are twice as likely to be diagnosed with it as are men - if 1 identical twin has the disorder, the likelihood of the other twin having it is 30% - in an effort to understand the role that physiological arousal plays in panic attacks, researchers have compared the responses of experimental participants w/ and w/o panic disorder to sodium lactate -> a chemical that produces rapid, shallow breathing and heart palpitations - those w/ panic disorder were found to be acutely sensitive to the drug; within a few minutes after administration, 60% to 90% experienced a panic attack - those w/o the disorder rarely responded to the drug w/ a panic attack - the difference in responses to the chemical may be due to differing interpretations of physiological signs of anxiety => meaning, people who experience panic attacks may be hypersensitive to physiological signs of anxiety , which they interpret as having disastrous consequences for their well-being -there is research showing that people who are high in anxiety sensitivity (they believe that bodily arousal and other symptoms of anxiety can have dire consequences) have an elevated risk for experiencing panic attacks Obsessive – Compulsive Disorder - although anxiety play a role in obsessive-compulsive disorder, the primary symptoms are unwanted, recurrent thoughts and actions - OBSESSIVE – COMPULSIVE DISORDER => in which repetitive, intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) designed to fend off those thoughts interfere significantly w/ an individuals functioning - anxiety plays a role in here because the obsessive thoughts typically produce anxiety, and the compulsive behaviors are performed to reduce it - the obsessions and compulsions of OCD are intense, frequent, and experienced as irrational and excessive - attempts to cope w/ the obsessive thoughts by trying to suppress or ignore them are of little or not benefit - thought suppression can backfire, increasing the frequency and intensity of the obsessive thoughts - most common obsessions involve: -> contamination -> aggression -> death -> sex -> disease -> orderliness -> disfigurement - compulsions take form of: -> cleaning -> checking -> repeating -> ordering/arranging -> counting - obsessions that plague individuals w/ OCD typically derive from concerns that could pose a real threat (such as contamination, aggression, disease), which supports preparedness theory - identical twins show a higher concordance than fraternal twins - one hypothesis implicates heightened neural activity in the caudate nucleus of the brain – a portion of basal ganglia known to be involved in the initiation of intentional actions - drugs that increase the activity of neurotransmitter serotonin in the brain can inhibit the activity of the caudate nucleus and relieve some of the symptoms of OCD - this finding does not indicate that overactivity of the caudate nucleus is the cause of OCD Mood Disorders: At the Mercy of Emotions - moods are relatively long-lasting, nonspecific emotional states – and nonspecific means we often may have no idea what has caused a mood - MOOD DISORDERS => mental disorders that have mood disturbance as their predominant feature – take 2 forms: depression and bipolar disorder Depressive Disorders - depressive mood disorders are dysfunctional, chronic, and fall outside the range of socially or culturally expected responses - MAJOR DEPRESSIVE DISORDER => also known as unipolar depression is characterized by a severely depressed mood that lasts 2 or more weeks and is accompanied by feelings of worthlessness and lack of pleasure, lethargy, sleep and appetite disturbances - bodily symptoms in major depression may seem contrary – sleeping too much or sleeping very little - great sadness or despair is not always present, although intrusive thoughts of failure or ending one’s life are not uncommon - related condition called DYSTHYMIA
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