Psychology 1000 Chapter Notes - Chapter 16: Mania, Hypochondriasis, Disorganized Schizophrenia

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13 Apr 2012
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Chapter 16:
Psychological Disorders
The Scope and Nature of Psychological Disorders
What is “Abnormal”?
Defining what normal and abnormal is takes into account many measures such as:
- Personal values of a given diagnostician
- Expectations of the culture in which a person lives
- Expectations of the person’s culture of origin
- General assumptions about human nature
- Statistical deviation from the norm
- Harmfulness, suffering and impairment
Abnormal behaviour can be defined as behaviour that is personally dysfunctional, and/or so culturally deviant
that other people judge it to be inappropriate or maladaptive
Historical Perspectives on Deviant Behaviour
According to the vulnerability-stress model, each of us has some degree of vulnerability for developing a
psychological disorder, given sufficient stress
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 vulnerability to trigger the disorder
Diagnosing Psychological Disorders
Reliability in psychological testing, the consistency with which a measure assess a given characteristic, or
different observers agree on a given score; the degree to which clinicians show high levels of agreement in their
diagnostic decisions
Validity the extent to which a test measures what it is supposed to; the degree to which a diagnostic system’s
categories contain the core features of the behaviour disorders and permit differentiation among the disorders
DSM-IV-ITR most widely used diagnostic classification system in North America
- Contains detailed lists of observable behaviours that must be present in order for a diagnosis to be
made
- Allows diagnostic information to be represented along five dimensions, or axes, that take both the
person and his or her life situation into account
o Axis I the primary diagnosis/primary clinical symptoms
o Axis II reflects long-standing personality or developmental disorders
o Axis III notes relevant physical disorders
o Axis IV rates intensity of environmental stressors
o Avis V global assessment of level of functioning
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DSM-V: Integrating Categorical and Dimensional Approaches
Current classification system is a categorical system, in which people are placed within specific diagnostic
categories
- However, criteria is so detailed and specific that many people don’t fit neatly into the categories
- Also 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 to the categorical system is a dimensional system, in which relevant behaviours are rated along a
severity measure
Critical Issues in Diagnostic Labelling
Social and personal implication once a diagnostic label is attached to a person, it becomes easy to accept the
label as an accurate description of the individual rather than of the behaviour
Legal consequences psychiatric diagnoses also have important legal consequences
- Competency refers to a defendant’s state of mind at the time of a judicial hearing (not at the time the
crime was committed)
- Insanity relates to the presumed state of mind of the defendant at the time the crime was committed
Anxiety Disorders
Anxiety state of tension and apprehension that is a natural response to perceived threat
In anxiety disorders, the frequency and intensity of anxiety responses are out of proportion to the situations
that trigger them, and the anxiety differs with daily life
Anxiety responses have four components:
- a subjective-emotional component includes feelings of tension and apprehension
- a cognitive component includes subjective feelings of apprehension, a sense of impeding danger, and
a feeling of inability to cope
- physiological responses includes increased heart rate and blood pressure, muscle tension, rapid
breathing, nausea, dry mouth, diarrhea, and frequent urination
- behavioural responses includes avoidance of certain situations and impaired task performance
Anxiety disorders take a number of different forms, including phobic disorders, generalized anxiety disorders,
panic disorders, post-traumatic stress disorders, and obsessive-compulsive disorders
Two statistics are commonly used in epidemiological research:
- Incidence refers to the number of new cases that occur during a given period
- Prevalence refers to the number of people who have a disorder during a specified period of time
Phobic Disorder
Phobias are strong and irrational fears of certain objects or situations
Can develop at any point in life, but many of them develop during childhood, adolescence and early adulthood
Once developed, they rarely go away on their own, and may broaden or intensify over time
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Generalized Anxiety Disorder
Generalized anxiety disorder is a chronic state of diffuse or “free-floating” anxiety that is not attached to
specific situations or objects
Can interfere with daily functioning hard to concentrate, make decisions, and remember commitments
Panic Disorder
Panic disorders occur suddenly and unpredictably, and are much more intense
In most cases, they occur out of the blue and in the absence of any identifiable stimulus
Formal diagnosis requires recurrent attacks that do not seem tied to environmental stimuli, followed by
psychological or behavioural problems
Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorders usually consist of two components one cognitive and one behavioural
although either one can occur alone
Obsessions are repetitive and unwelcome thoughts, images, or impulses that invade consciousness, are often
abhorrent to the person, and are very difficult to dismiss or control
Compulsions are repetitive behavioural responses that can be resisted only with great difficulty often
responses to obsessive thoughts and function to reduce the anxiety associated with the thoughts
Causal Factors in Anxiety Disorders
Biological factors:
- Genetic factors may create a vulnerability to anxiety disorders
- Hereditary factors may cause overreactivity of neurotransmitter systems involved in emotional
responses
- Low levels of the inhibitory neurotransmitter, GABA, activity in arousal areas may cause some people to
have highly reactive nervous systems that quickly produce anxiety responses in response to stressors
- Sex differences women exhibit anxiety disorders more often than men do
Psychological factors:
- According to Freud, neurotic anxiety occurs when unacceptable impulses threaten to overwhelm the
ego’s defenses and explode into action
- Cognitive theorists stress the role of maladaptive thought patterns and beliefs in anxiety disorders
anxiety-disordered people “catastrophize” about demands and magnify them into threats
- From the behavioural perspective, anxiety disorders result from emotional conditioning once anxiety is
learned (through classical conditioning or observational learning), it may be triggered either by cues
from the environment or by internal cues, such as thoughts and images
o In the case of phobic reactions, the cues tend to be external ones, relating to the feared object
or situation
o In panic disorders, the anxiety-arousing cues tend to be internal ones, such as bodily sensations
or mental images
Sociocultural factors:
- Role of culture is most dramatically shown in culture-bound disorders that occur only in certain places
(e.g. anorexia nervosa is a culture-bound anxiety-based disorder that occurs in the United States)
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