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Chapter 14

PSY100 Chapter 14

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University of Toronto St. George
Dan Dolderman

Chapter 14 - Psychological Disorders Psychopathology: a sickness or disorder of the mind  Sigmund Freud was the first to develop a theory of psychopathology and to propose specific treatment techniques based on his theory How are Mental Disorders Conceptualized and Classified?  The diagnostic criteria for all of the major disorder categories include the stipulation that the symptoms of the disorder must interfere with at least one aspect of the person’s life, such as work, social relations, or self-care Psychological disorders are classified into categories • Etiology: study of factors that contribute to development of a disorder • Diagnostic and Statistical Manual of Mental Disorders • Disorders classified in terms of observable symptoms and patient must meet specific criteria to receive particular diagnosis • Multiaxial system: system used in DSM that provides assessment along 5 axes describing important mental health factors Axis I: clinical disorders (schizophrenia, mood disorders, eating and sleep disorders) Axis II: mental retardation or personality disorders (anti-social personality, borderline) Axis III: medical conditions (Alzheimer’s, Parkinson’s) Axis IV: psychosocial problems (unemployment, divorce, homeless, poverty) Axis V: global overall assessment of how person is functioning (social, psych, etc.) Mental Disorders Must be assessed before Diagnosis Assessment: the process of examining a person’s mental functions and psychological health  Goal: to make a diagnosis to that appropriate treatment can be provided for the specific disorder  The prognosis (course or probable outcome) of different mental disorders varies, and the correct diagnosis can help the patient and family understand what the future might bring  Mental Status Exam: provide a snapshot of their psychological functioning  Involves evaluation the person for things such as personal grooming, ability to make eye contact, tremors or twitches, mood, speech, thought content, and memory  Useful for determining if the mental impairments are due to a psychological condition or to some sort of physical condition  The first step in a psychological assessment is for the psychologist to ask the person about current symptoms and any recent experiences that might be causing distress  Clinical interview: most common method of psychological assessment Most interviews have been unstructured, with the topics of discussion varying as the interviewer probes different aspects of the person’s problems • Guided by the clinician’s past experiences • Although it is very flexible, no two unstructured interviews are likely to elicit identical information (too dependent on the quality of the interviewer) Structured interviews: standardized questions asked in same order, answers coded according to formula (ex: Structured Clinical Interview for DSM) Psychological testing • Beck Depression inventory • MMPI 10 clinical scales (paranoia, emotions, thoughts, behaviours) • Problem: ppl can lie on scales, but tests often include validity scales, also criticized for scores not being representative of poor, elderly ppl, etc. Neuropsychological tests can help determine mental function • Ex: tasks that require planning, coordinating, remembering • Actions that client performs poorly on highlight problems with specific brain regions Alzheimer’s Evidence based assessment- research guides the evaluation of mental disorders, selection of appropriate tests, and use of critical thinking to make a diagnosis • Research often indicates comorbidity: occurrence of many disorders together Ex: ppl who are depressed also have substance abuse problems evidence shows that ppl who are depressed should also be assessed for substance abuse Dissociative identity disorder (DID): formally called multiple personality disorder, the occurrence of two or more district identities in the same individual Psychological disorders have many causes • Diathesis-stress model: diagnostic model that proposes that a disorder may develop when an underlying vulnerability/predisposition (diathesis) is coupled with a precipitating event (additional stressful circumstances) Biological factors • Some mental disorders arise from prenatal problems such as malnutrition, exposure to toxins, maternal illness affect CNS • Brain imaging reveals differences in certain brain structures Psychological factors • Family systems model: proposes that individual’s behaviour must be considered within a social context, particularly within the family • Problems that arise within individual are manifestations of problems with the family Socio-cultural model: views disorders as result of interaction between individuals and their cultures ex: seeing skinny models anorexia • Differences in occurrence of disorders are due to differences in lifestyles, in expectations (dr. less likely to diagnose rich person with schizophrenia), and in opportunities among classes Cognitive behavioural approach: abnormal behaviour is learned • Thought processes are available to conscious mind; individuals are aware of thought processes that give rise to maladaptive emotions and behaviours Sex differences in mental disorders • Alcohol drugs, APD, ADHD 2x more likely in males • Anorexia, PTSD, panic disorders more common in females • Internalizing disorders - emotions such as distress or fear (more common in females) • Ex: depression, dysthymia, generalized anxiety disorder, phobias • Externalizing disorders ex: disinhibition, alcoholism (more common in males) Anxiety disorders • Excessive anxiety in the absence of true danger • Chronic anxiety chronic arousal of the autonomic NS may lead to damage the body and brain Phobic disorders: specific • Specific phobias: fear or particular objects and situations • Social phobia: social anxiety disorder, fear or being negatively socially evaluated by others • More social fear a person has (develops early on), more likely to develop other disorders, depression, substance abuse etc. (=comorbid with other disorders) Generalized anxiety disorder • Diffuse, always present • Constant anxiety and worry about anything and everything, always on alert for problems Panic disorder • Sudden and overwhelming attacks of terror that come out of nowhere • Last for several minutes, victim sweats, tremble, heart facing, shortness of breath, feel they are going crazy or that they’re dying Agoraphobia: fear or being in situations in which escape may be difficult or impossible (crowded shopping mall) to extent that such situations will cause panic attacks OCD • Frequent intrusive thoughts and compulsive actions • Obsessions: recurrent, intrusive, unwanted thoughts or mental images, often include fear of contamination, accidents, of one’s own aggression • Compulsion: acts person senses need to perform over and over again (cleaning, counting, checking) • People with OCD fear what they might do or might have done vs. other anxiety disorders what might happen to them Anxiety disorders have cognitive, situational, and biological components Cognitive factors • When presented with ambiguous or neutral situations, anxious individuals tend to perceive them as threatening vs. non-anxious viewed situations as non-threatening • Anxious individuals pay more attention to threatening events, more easily recall them Situational factors • Monkeys learned by observing other monkeys to fear snakes • Person fearing flying by seeing another person’s fearful expression Biological factors • Children who have an inhibited temperamental style (shy, avoid unfamiliar ppl or novel objects) as children more likely to have anxiety disorders later in life • Inhibited group showed greater activation of amygdala, brain region activated when ppl are threatened OCD • Anxiety paired to a specific event, through classical conditioning person engages in behaviour that reduces anxiety and therefore is reinforced through operant conditioning • Ex: anxiety (forced to shake hands with person who just picked nose) compulsion (run to bathroom) wash hands (reduce anxiety) obsession (fear of contamination) • Brain imaging evidence of certain brain systems involved in OCD • Caudate: brain structure involved in suppressing impulses, is smaller and has structural abnormalities • Results in leak of impulses into consciousnessprefrontal cortex then becomes overactive in an effort to compensate • May be triggered by enviro factors such as strep infection in youth • Autoimmune response damages caudate OCD Mood disorders 1. Depressive disorders: pervasive feelings of sadness • Major depression: disorder characterized by severe negative moods or lack of interest in normally pleasurable activities • Dysthymia: form of depressed mood that is mild to moderate, long lasting (2-20 years) • Thought that dysthymia precedes major depression • Twice as many women as men suffer from depression across all countries and contexts • May be caused by overwork and lack of support, low income, lack of education • Higher rate may also be explained by women’s tendency to respond to stressful events by internalizing feelings depression and anxiety vs. men that externalize feelings drink, drugs, violence, less likely to admit to depre
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