Psychology 1000 Chapter Notes - Chapter 16: Borderline Personality Disorder, Antisocial Personality Disorder, American Psychiatric Association
13 May 2018
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THE SCOPE AND NATURE OF PSYCHOLOGICAL DISORDERS!
•At any given point in time, one in five Canadians suffers from a diagnosable mental
disorder.!
•Nearly half of all North Americans between the ages of 15 and 54 will experience a
psychological disorder.!
•Psychological disorders are the second leading cause of disability,!
•Medications used to treat anxiety and depression are among the most frequently
prescribed drugs in North America.!
•One adolescent commits suicide every 90 seconds in North America.!
•Four thousand Canadians commit suicide every year; 90 percent of these were diagnosed
with a mental disorder.!
•Each year, more than a million students withdraw from universities in North America
because of emotional problems.!
•One in four North Americans will have a substance abuse disorder during his or her lifetime.!
What Is “Abnormal”?
•Here are several possibilities!
1. The expectations of the culture in which a person currently lives!
2. The expectations of the person's culture of origin!
3. General assumptions about human nature!
4. Statistical deviation from the norm!
5. Harmfulness, suffering, and impairment!
•Until December 15, 1973, homosexuality was officially considered a form of mental illness. !
•On that day, however, the trustees of the American Psychiatric Association voted to
remove homosexuality from the psychiatric classification system—surely, the
quickest and most widespread cure in the history of psychiatry.!
•Despite this formal change in the psychiatric status of this sexual orientation, some people
in our society continue to view homosexuality as an indicator of psychological disturbance,
illustrating to some the arbitrary nature of abnormality judgments !
1. First we are likely to label behaviours as abnormal if they are intensely distressing to
the individual. !
•On the one hand, people who are excessively anxious, depressed,
dissatisfied, or otherwise seriously upset about themselves or about life
circumstances may be viewed as disturbed, particularly if they seem to have
little control over these reactions. !
•On the other hand, personal distress is neither necessary nor sufficient to
define abnormality. !
•Some seriously disturbed mental patients are so out of touch with reality that
they seem to experience little distress, and yet their bizarre thought
processes and behaviours are considered very abnormal!
2. Second, most behaviours judged abnormal are dysfunctional either for the individual
or for society. !
•Behaviours that interfere with a person's ability to work or to experience
satisfying relationships with other people are likely to be seen as
maladaptive and self-defeating!
• Some behaviours are labelled as abnormal because they interfere with the
well-being of society.!
3. The third criterion for abnormality is society's judgments concerning the deviance of
a given behaviour. !
•Conduct within every society is regulated by norms—behavioural rules that
specify how people are expected to think, feel, and behave. Some norms are
explicitly codified as laws, and violation of these norms defines criminal
behaviour!
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•Both personal and social judgments of behaviour enter into considerations of what is
abnormal. !
•Thus, we may define abnormal behaviour as behaviour that is personally
distressing, personally dysfunctional, and/or so culturally deviant that other people
judge it to be inappropriate or maladaptive.!
HISTORICAL PERSPECTIVES ON DEVIANT BEHAVIOUR!
•The belief that abnormal behaviour is caused by supernatural forces goes back to the
ancient Chinese, Egyptians, and Hebrews, all of whom attributed deviance to the work of
the devil. !
•One ancient treatment was based on the notion that bizarre behaviour reflected an
evil spirit's attempt to escape from a person's body. !
•To release the spirit, a procedure called trephination was carried out. !
•A sharp tool was used to chisel a hole about 2 centimetres in diameter in the
skull!
•In medieval Europe, the demonological model of abnormality held that disturbed people
either were possessed involuntarily by the devil or had voluntarily made a pact with the
forces of darkness !
•The killing of witches was justified on theological grounds, and various “diagnostic”
tests were devised. One was to bind a woman's hands and feet and throw her into a
lake or a pond.!
•Hippocrates suggested that mental illnesses were diseases just like physical disorders. !
•Anticipating the modern viewpoint, Hippocrates believed that the site of mental
illness was the brain. !
•General paresis, a disorder characterized in its advanced stages by mental deterioration
and bizarre behaviour, resulted from massive brain deterioration caused by the sexually
transmitted disease syphilis. !
•According to the vulnerability-stress model (sometimes called the diathesis-stress model),
each of us has some degree of vulnerability (ranging from very low to very high) for
developing a psychological disorder, given sufficient stress. !
•The vulnerability, or predisposition, can have a biological basis, such as our
genotype, over- or under-activity of a neurotransmitter system in the brain, a hair-
trigger autonomic nervous system!
• It could also be due to a personality factor, such as low self-esteem !
• cultural factors can create vulnerability to certain kinds of disorders!
•But vulnerability is only part of the equation. In most instances, a predisposition
creates a disorder only when a stressor—some recent or current event that requires
a person to cope—combines with the vulnerability to trigger the disorder !
•Thus, a person who has a genetic predisposition to depression or who
suffered a traumatic loss of a parent early in life may be primed to develop a
depressive disorder if faced with the stress of a significant loss later in life. !
DIAGNOSING PSYCHOLOGICAL DISORDERS!
•Reliability means that clinicians using the system should show high levels of agreement in
their diagnostic decisions. !
•Because professionals with different types and amounts of training make diagnostic
decisions, the system should be couched in terms of observable behaviours that
can be reliably detected and should minimize subjective judgments. !
•Validity means that the diagnostic categories should accurately capture the essential
features of the various disorders. !
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•Thus, if research and clinical observations show that a given disorder has four
behavioural characteristics, the diagnostic category for that disorder should also
have those four features..!
•The DSM-5 is the most widely used diagnostic classification system in North America !
DSM-5: Integrating Categorical and Dimensional Approaches
•The DSM-IV-TR was a categorical system, in which people were placed within specific
diagnostic categories. !
•The highly specific behavioural criteria in the DSM-IV-TR diagnostic categories
clearly have improved reliability over earlier versions !
•many people don't fit neatly into the categories !
• Finally, the categorical system does not provide a way of capturing the severity of
the person's disorder, nor can it capture symptoms that are adaptively important but
not severe enough to meet the behavioural criteria for the disorder.!
•An alternative (or supplement) to the categorical system is a dimensional system, in which
relevant behaviours are rated along a severity measure. !
•Such a system is based on the assumption that psychological disorders are
extensions different in degree, rather than kind, from normal personality functioning. !
•As an example, consider the dimension of behaviour that extends from normal,
adaptive conscientiousness to the maladaptive extremes seen in a person with a
compulsive disorder !
•Representing individuals along basic personality or symptom dimensions was attractive to
the experts on the DSM-5 revision panels because they believed that such a system may
better represent the uniqueness of each individual and avoid the one-size-fits-all
disadvantages of being assigned to a particular diagnostic category!
•DSM-5 incorporates dimensional scales that are used to rate the presence and severity of
specific symptoms and personality !
• A prime example is in the personality disorders, where six basic dimensions of
disordered personality functioning—Negative Emotionality, Schizotypy (odd thinking
and behaviour), Disinhibition, Introversion, Antagonism, and Compulsivity different
combinations of the personality dimensions (and their more specific behavioural
facets) give rise to antisocial and borderline personality disorders (described later in
this chapter).!
•The dimensional severity ratings that clinicians will give to the behaviours involved in each
diagnostic category in the DSM-5 will result in a fine-grained description that better reflects
each person's individuality while also helping clinicians develop an effective treatment
strategy!
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