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Chapter 14

[Textbook Note] Chapter 14 - Psychological Disorders.docx

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University of Toronto Scarborough
Steve Joordens

Chapter 14 – Reading Notes Psychological Disorders 14.0  Psychological or mental, disorders: Symptoms reflecting abnormalities of the mind. 14.1  Medical model: The conceptualization of psychological disorders as diseases that, like physical diseases, have biological causes, defined symptoms, and possible cures.  Diagnosis: Clinicians seek to determine the nature of the patient’s mental disease by assessing symptoms.  Symptoms: Behaviours, thoughts, and emotions suggestive of an underlying abnormal syndrome.  Syndrome: A coherent cluster of symptoms usually due to a single cause. 14.2  Diagnostic and Statistical Manual of Mental Disorders (DSM): A consensual diagnostic system for therapists and researchers which was published in 1952. o Early versions provided common language for talking about disorders, but diagnostic criteria were still often vague and based on tenuous theoretical assumptions. o The current fourth edition (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 and classified as though it were a distinct illness.  DSM-IV-TR takes into account 3 key elements that must be present for a cluster of symptoms to qualify as a potential mental disorder: o A disorder is manifested in symptoms that involve disturbances in behaviour, thoughts, or emotions. o The symptoms are associated with significant personal distress or impairment. o The symptoms stem from an internal dysfunction (biological, psychological, or both).  Comorbidity: The co-occurrence of two or more disorders in a single individual. 14.3  Specifiable pattern of causes (or etiology) may exist for different psychological disorders.  Each category of psychological disorder is likely to have a common prognosis. o Prognosis: A typical course over time and susceptibility to treatment and cure. o However, it is rarely useful to focus on a single cause that is internal to the person and that suggests a single cure.  Diathesis-stress model: A person may be predisposed for a psychological disorder that remains unexpressed until triggered by stress.  Intervention-causation fallacy: Search for biological causes of psychological disorders in the brain and body tends to invite particular error in explanation. o Involves assumption that if a treatment is effective, it must address the cause of the problem. 14.4  The negative stereotypes and stigma such as mental disorder is a sign of personal weakness or the idea that psychiatric patients are dangerous explains why nearly 70% of people with diagnosable psychological disorders do not seek treatment.  Labelling someone as having a psychological disorder makes it hard for the patient to return to life as a nonpatient. o People given such label may come to view themselves not just as mentally disordered, but as hopeless and worthless. o Causes these people to develop an attitude of defeat and as a result, fail to work toward their own recovery. 14.5  The study of psychological disorders follows a medical model in which symptoms are understood to indicate an underlying disorder.  Many psychological disorders arise from multiple causes or as a result of the interaction of diathesis (internal predisposition) and stress. It is a common error to assume that an intervention that cures a disorder reflects the cause of the disorder. 14.6  Anxiety disorder: The class of mental disorder in which anxiety is the predominant feature. o Generalized anxiety disorder o Phobic disorders o Panic disorder o Obsessive-compulsive disorder 14.7  Generalized anxiety disorder (GAD): Called generalized because the unrelenting worries are not focused on any particular threat. Chronic excessive worry is accompanied by three or more of the following symptoms – restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance. o Occurs more frequently in lower socioeconomic groups and is approximately twice as common in women as in men. 14.8  Phobic disorders: Marked, persistent, and excessive fear and avoidance of specific objects, activities, or situations.  Specific phobia: An irrational fear of a particular object or situation that markedly interferes with an individual’s ability to function. o Specific phobias fall into 5 categories:  Animals (dogs, cats, rates, snakes, spiders, etc.)  Natural environment (heights, darkness, water, storms, etc.)  Situations (bridges, elevators, tunnels, enclosed places, etc.)  Blood, injections, and injury  Other phobias, including illness and death o Specific phobias are more common among women than among men (ratio 4:1).  Social phobia: An irrational fear of being publicly humiliated or embarrassed. o Emerges between early adolescence and the age of 25. o About 11% of men and 15% of women. o Higher rates among people who are undereducated, have low incomes, or both.  Preparedness theory: People are instinctively predisposed toward certain fears.  Individuals with phobias sometimes show abnormally high levels of activity in the amygdala (linked to development of emotional associations). 14.9  Panic disorder: The sudden occurrence of multiple psychological and physiological symptoms that contribute to a feeling of stark terror.  Symptoms typically last only a few minutes and include shortness of breath, heart palpitations, sweating, dizziness, depersonalization or derealisation, and a fear that one is going crazy or about to die. o Depersonalization: A feeling of being detached from one’s body. o Derealisation: A feeling that the external world is strange or unreal.  Agoraphobia: A specific phobia involving a fear of venturing into public places.  Especially prevalent among women and are twice as likely to be diagnosed with it as are men. 14.10  Obsessive-compulsive disorder (OCD): Repetitive, intrusive thoughts (obsessions) and ritualistic behaviours (compulsions) designed to fend off those thoughts interfere significantly with an individual’s functioning.  Approximately 1.3% of people will develop OCD sometimes in their lives with lower rates in Asian cultures.  Women are more susceptible than men, but the difference is not large.  Most common obsessions involve contamination, aggression, death, sex, disease, orderliness, and disfigurement.  Compulsion typically that the form of cleaning, checking, repeating, ordering/arranging, and counting.  OCD typically derive from concerns that could pose a real threat. 14.11  People with anxiety disorders have irrational worries and fears that undermine their ability to function normally.  GAD involves a chronic state of anxiety, whereas phobic disorders involve anxiety tied to a specific object or situation.  People who suffer from panic disorder experience a sudden and intense attack of anxiety that is terrifying and can lead them to become agoraphobic and housebound for fear of public humiliation.  People with obsessive-compulsive disorder experience recurring, anxiety-provoking thoughts that compel them to engage in ritualistic, irrational behaviour. 14.12  Moods are relatively long-lasting, nonspecific emotional states. o Nonspecific means that we often have no idea what has caused a mood.  Mood disorders: Mental disorders that have mood disturbance as their predominant feature. o Take two main forms: Depression and bipolar disorder. 14.13  Major depressive disorder: A several depressed mood that lasts 2 or more weeks and is accompanied by feelings of worthlessness and lack of pleasure, lethargy, and sleep and appetite disturbances.  Dysthymia: The same cognitive and bodily problems as in depression are present, but they are less severe and last longer, persisting for at least 2 years.  Double depression: A moderately depressed mood that persists for at least 2 years and is punctuated by periods of major depression.  Seasonal affective disorder (SAD): Recurrent depressive episodes in a seasonal pattern.  Women are diagnosed with depression at a rate twice that of men.  Socioeconomic standing has invoked explanation for women’s heightened risk.  Sex differences in hormones are another possibility  Estrogen, androgen, and progesterone influence depression. o Some women experience postpartum depression (depression following childbirth) due to changing hormone balances.  It is also possible that higher rate of depression reflects greater willingness by women to seek out for help which leads to higher rates of diagnosis among women.  Women’s tendency to accept, disclose, and ruminate on their negative emotions in contrast with men’s tendency to deny negative emotions and engage in self-distraction such as work and drinking.  Depression may involve diminished activity in the left prefrontal cortex and increased activity in the right prefrontal cortex (areas of the rain involved in the processing of emotions). o Severely depressed individuals who do not have brain damage often show diminished activity in the anterior (prefrontal) regions of the cerebral hemispheres (especially on the left side).  These abnormal patterns may be effects of the mood disturbance, or may cause people to be more susceptible to depression.  Helplessness theory: Individuals who are prone to depression automatically attribute negative experiences to causes that are internal, stable, and global. 14.4  Bipolar disorder: An unstable emotional condition characterized by cycles of abnormal, persistent high mood (mania) and low mood (depression). o In about 2/3 of patient, manic episodes immediately precede or immediately follow depressive episodes. o The manic phase last at least a week to meet DSM requirements.  Mood can be elevated, expansive, or irritable.  Other prominent symptoms include grandiosity, decreased need for sleep, talkativeness, racing thoughts, distractibility, and reckless behaviour.  Psychotic features such as hallucinations and delusions may be present (causing the disorder to be misdiagnosed as schizophrenia).  The risk for bipolar disorder is abou
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