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Chapter 16

Chapter 16 Psychological Disorders Reading.docx

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Psychology 1000
Terry Biggs

Ch. 16 Psychological Disorders Reading Michael Hua What is Abnormal?  Some criterion on what is abnormal and what isn’t: 1. The person values of a given diagnostician 2. The expectations of the culture in which a person lives 3. The expectations of the person’s culture of origin 4. General assumptions about human nature 5. Statistical deviation from the norm 6. Harmfulness, suffering, and impairment – distress, dysfunction and deviance  We are likely to label behaviors as abnormal if they are intensely distressing to the individual  Most behaviors judged abnormal are dysfunctional either for the individual or for society (e.g., interferes with a person’s ability to work or to experience satisfying relationships)  Abnormality is society’s judgments concerning the deviance of a given behavior  Conduct within every society is regulate by norms, rules that specify how people are expected to think, feel, and behave  Abnormal Behavior – behavior 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 Behavior  One ancient treatment was based on the notion that bizarre behavior reflected an evil spirit’s attempt to escape from a person’s body – trephination was used to release it  General Paresis – a disorder characterized in its advanced stages by mental deterioration and bizarre behavior, resulting from massive brain deterioration caused by syphilis  Vulnerability-Stress Model – each of us has some degree of vulnerability (ranging from low to 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, or a hormonal factor Diagnosing Psychological Disorders  Reliability – clinicians using the system should show high levels of agreement in their diagnostic decisions  Validity – the diagnostic categories should accurately capture the essential features of the various disorders  DSM-IV-TR – the most widely used diagnostic classification system in North America  Contains detailed lists of observable behaviors that must be present in order for a diagnosis to be made  Five dimensions, or axes, that take the person and his/her life situation into account:  Axis I – primary diagnosis; represents the person’s primary clinical symptoms  Axis II – reflects long-standing personality or developmental disorders, such as ingrained, inflexible aspects of personality, that could influence the person’s behavior and response to treatment  Axis III – notes any physical conditions that might be relevant, such as high blood pressure)  Axis IV – intensity of environmental stressors in the person’s recent life  Axis V – person’s coping resources DSM-V: Integrating Categorical and Dimensional Approaches  The current classification system is a categorical system, in which people are placed within specific diagnostic categories  An alternative to the categorical system is the dimensional system – relevant behaviors are rated along a severity measure  Based on the assumption that psychological disorders are extensions different in degree, rather than kind, from normal personality functioning  E.g., the maladaptive exaggeration of what is a normally adaptive personality style, or inability to engage in the adaptive behaviors, can be applied to virtually all disorders  People believe that this 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  The new system is rated by clinicians to define a set of six personality disorders – Negative Emotionality, Schizotypy (odd thinking and behavior), Disinhibition, Introversion, Antagonism, and Compulsivity  This system helps to link normal and abnormal personality functioning Critical Issues in Diagnostic Labeling Social and Personal Implications  Once a diagnostic label is attached to a person, it becomes all too easy to accept the label as an accurate description of the individual rather than of the behavior  It becomes difficult to look at the person’s behavior objectively, without preconceptions about how he/she will act  It is also likely to affect how we will interact with the person Legal Consequences  Two important legal concepts are competency and insanity  Competency – refers to a defendant’s state of mind at the time of a 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 as committed “Do I Have That Disorder?” Anxiety Disorders  Anxiety Disorders – the frequency and intensity of anxiety responses that are out of proportion to the situations that trigger them  Four components: 1. A subjective-emotional component, including feelings of tension and apprehension 2. A cognitive component, including subjective feelings of apprehension, a sense of impending danger, and a feeling of inability to cope 3. Physiological responses, including increased heart rate, rapid breathing, nausea, dry mouth, diarrhea, and frequent urination 4. Behavioral responses, such as avoidance of certain situations and impaired task performance  Incidence – refers to the number of new cases that occur within a given period  Prevalence – refers to the number of people who have a disorder during a specified period of time (i.e., both new and previously existing cases) Phobic Disorder  Phobias – strong and irrational fears of certain objects or situations  Agoraphobia – fear of open and public places  Social Phobias – excessive fear of situations in which the person might be evaluated and possibly embarrassed  Specific Phobias – such as fears of dogs, snakes, spiders, airplanes, elevators, enclosed spaces, water, injections, illness, or death  Many social phobias evolve out of extreme shyness during childhood Generalized Anxiety Disorder  A chronic state of diffusion, or “free-floating” anxiety that is not attached to specific situations or objects Panic Disorder  In contrast to generalized anxiety disorder, which involves chronic tension and anxiety, panic disorders occur suddenly and unpredictably, and are much more intense  They occur out of the blue and in the absence of any identifiable stimulus  Many people with panic attacks develop agoraphobia because of their fear that they will have an attack in public  Formal diagnosis of a panic disorder requires recurrent attacks that do not seem tied to environmental stimuli, followed by psychological or behavioral problems Obsessive-Compulsive Disorder (OCD)  Consist of two components: one cognitive and the other behavioral  Obsessions – repetitive and unwelcome thoughts, images, or impulses that invade consciousness, are often repulsive to the person, and are very difficult to dismiss or control  Compulsions – repetitive behavioral responses (i.e., cleaning rituals) that can be resisted only with great difficulty – are 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  Vulnerability may take the form of an autonomic nervous system that overreacts to perceived threat, creating high levels of physiological arousal  Hereditary factors may cause over reactivity of neurotransmitter systems involved in emotional responses  When experiencing PTSD, it is primarily the right hemisphere that is activated  The neurotransmitter, GABA, is associated with anxiety  It is an inhibitory transmitter that reduces neural activity in the amygdala and other brain structures that stimulate physiological arousal  Abnormally low levels of inhibitory GABA activity in these arousal areas may cause people to have highly reactive nervous systems that quickly produce anxiety responses in response to stressors  Women exhibit anxiety disorders more often than men do  Social conditions that give women less power and personal control may contribute  There is the possibility of an evolutionary role in predisposing people to fear certain types of stimuli that might have has survival significance in the past, such as snakes, spiders, storms, and heights  Biological preparedness makes it easier for us to lean to fear certain stimuli, and may explain why phobias seem to centre on certain classes of “primal” stimuli and not on more dangerous modern ones, such as guns and electrical power stations Psychosocial Factors  Neurotic Anxiety – occurs when unacceptable impulses threaten to overwhelm the ego’s defenses and explode into action  Freud believed that in phobic disorders, neurotic anxiety is displaced onto some external stimulus that has symbolic significance in relation to the underlying conflict  Ex. A little boy named Hans developed a fear of horses and the possibility of being bitten. To Freud, the phobia resulted from the boy’s unresolved Oedipus complex. The powerful horse represented Hans’ father, and the fear of being bitten symbolized Hans’ unconscious fear of being castrated by his father if he acted on his sexual desire for his mother  Obsession is symbolically related to, but less terrifying than, the underlying impulse  A compulsion is a way of “taking back,” or undoing, one’s unacceptable urges, as when obsessive thoughts about dirt and compulsive hand washing are used to deal with one’s “dirty” sexual impulses  Generalized anxiety and panic attacks are thought to occur when one’s defenses are not strong enough to control or contain anxiety, but are strong enough to hide the underlying conflict  Anxiety-disordered people anticipate that the worst will happen and feel powerless to cope effectively  Panic attacks are triggered by exaggerated misinterpretations of normal anxiety symptoms, such as heart palpitations, dizziness, and breathlessness  The panic-disordered person appraises these as signs that a heart attack of a psychological loss of control is about to occur, and these catastrophic appraisals create even more anxiety  Some fears are acquired as a result of traumatic events that produce a classically conditioned fear response  Phobias can be acquired through observational learning (e.g., television)  Once anxiety is learned, it may be triggered either by cues from the environment or by internal cues, such as thoughts and images  In panic disorder, the anxiety-arousing cues tend to be internal ones, such as bodily sensations (e.g., heart rate) or mental images (such as the image of collapsing and having a seizure in a public place)  Behaviors that are successful in reducing anxiety, such as compulsions or phobic avoidance responses, are strengthened through a process of negative reinforcement  E.g., The OCD mother’s scrubbing ritual reduces anxiety about contamination, and the water phobic’s avoidance of swimming prevents her from experiencing anxiety  In the case of agoraphobia, remaining at home serves as a safety signal, a place where the person is unlikely to experience a panic attack Sociocultural Factors  Culture-Bound Disorders – occurring only in certain places  E.g., Koro, Taijin Kyfushu, Windingo, Anorexia Nervosa Eating Disorders  Anorexia Nervosa – an intense fear of being fat and restricting food intake to the point of self-starvation  Most anorexics are female (90%)  Causes menstruation to stop, strains the heart, produces bone loss, and increases the risk of death  Bulimia Nervosa – concerned with becoming fat, but instead of self-starvation, they binge eat and then purge the food, usually by inducing vomiting or using laxatives  Most bulimics are female (90%) Causes of Anorexia and Bulimia  Most common in industrialized cultures in which beauty is equated with “thinness”  Views on one’s body as an object contributes to eating disorders  Personality factors – anorexics are often perfectionists; high achievers who often strive to live up to lofty self-standards, including distorted standards concerning an acceptably thin body  Anorexics describe their parents as disapproving and as setting abnormally high achievement standards, and they report more stressful events related to their parents than do non-anorexics  Bulimics, who tend to be depressed and anxious, exhibit low impulse control, and seem to lack a stable sense of personal identity and self-sufficiency  Genetic factors may create a predisposition toward eating disorders  Anorexics and bulimics exhibit abnormal activity or serotonin and other chemicals that help to regulate eating Mood (Affective) Disorders  Mood Disorders – involves depression and mania (excessive excitement)  Most frequently experienced psychological disorders, together with anxiety disorders Depression  These feelings usually fade away after the event has passed or as the person becomes accustomed to the new situation  In clinical depression, the frequency, intensity, and duration of depressive symptoms are out of proportion to the person’s life situation  Some people may respond to a minor setback or loss with an intense major depression that leaves them unable to function effectively in their lives  Dysthymia – a less intense form of depression that has less dramatic effects on personal and occupational functioning  It is a more chronic and long-lasting form of misery, occurring for years on end with intervals of normal mood that never last more than a few weeks or months  There are three other types of symptoms: cognitive, motivational, and somatic (physical) symptoms  The negative mood state is the core feature of depression (i.e., sadness, misery, loneliness)  People with anxiety disorders retain their capacity to experience pleasure, depressed people lose it  Cognitive Symptoms – depressed people have difficulty concentrating and making decisions – low self-esteem, inferior, inadequate, and incompetent – they tend to blame themselves for setbacks and expect that failures will happen  Motivational Symptoms – inability to get started and perform behaviors that might produce pleasure or accomplishment  Somatic (Bodily) Symptoms – loss of appetite and weight loss in moderate and severe depression – sleep disturbances and weight loss lead to fatigue and weakness – lose sexual desire and responsiveness Bipolar Disorder  When a person experiences only depression, the disorder is called unipolar depression  Bipolar Depression – depression alternates with periods of mania, a state of highly excited mood and behavior that is quite the opposite of depression Prevalence and Course of Mood Disorders  The rate of depressive symptoms in children and adolescents is as high as the adult rate  People born after 1960 are 10X more likely to experience depression than are their grandparents  Women appear to be 2X as likely to suffer unipolar depression than men  Women are likely to suffer their first episode of depression in their 20s, men in their 40s  Biological theories suggest that genetic factors, biochemical differences in the nervous system, or the monthly premenstrual depression that many women experience could increase vulnerability to depressive disorders  Traditional sex role expectation for females in Western cultures is to be passive and dependent in the face of stress or loss and to focus on their feelings, whereas men are more likely to distract themselves through activities such as physical activity and drinking  Depression lasts an average of 5-10 months when untreated Causal Factors in Mood Disorders  Genetic and neurochemical factors have been linked to depression  What is likely inherited is a predisposition to develop a depressive disorder, given certain kinds of environmental factors such as significant losses and low social support  The behavioral inhibition system (neuroticism) and the behavioral activation system (extraversion) are heavily involved in the development of mood disorders  Behavioral Activation System (BAS) – reward oriented and activated by cues that predict future pleasure  Behavioral Inhibition System (BIS) – pain avoidant and generates fear and anxiety  Depression is predicted by high BIS sensitivity and low BAS activity  Depression is a disorder of motivation caused by under activity in a family of neurotransmitters that include norepinephrine, dopamine, and serotonin  These transmitters are involved in the BAS and play important roles in brain circuitry that produce reward and pleasure  Antidepressant drugs increase the activity of neurotransmitters, thereby stimulating the neural systems that underlie positive mood and goal-directed behavior  Bipolar disorder may have a stronger genetic basis than does unipolar depression  Manic disorders may stem from an overproduction of the same neurotransmitters that are underactive in depression Psychological Factors  Karl Abraham and Sigmund Freud believed that early traumatic losses or rejections create vulnerability for later depression by triggering a grieving and rage process that becomes part of the individual’s personality  Humanistic perspective  the “me” generation with its overemphasis on individuality and personal control  people define their self-worth in terms of individual attainment and have lesser commitment to traditional values of family, religion, and the common good, they are likely to react much more strongly to failure, to view negative events as reflecting their own inadequacies, and to experience a sense of meaninglessness in their lives  Cognitive – people believe that what happens to them is bad, and that negative tings will continue happening because of their personal defects  Depressive Cognitive Triad – negative thoughts concerning: the world, oneself, and the future seem to pop into unconsciousness automatically, and many depressed people report they cannot control or suppress the negative thoughts  Depressed people have a perceptual and memory sensitivity to the negative, and are more likely to distort their memories of negative events (e.g., remember sad faces at lower exposure times)  Depressed people interpret successes or other positive events as being due to factors outside the self, while attributing negative outcomes to personal factors  Depressive Attributional Pattern – taking no credit for successes but blaming themselves for failures maintains depressed people’s low self-esteem  Learned Helplessness Theory – depression occurs when people expect that bad events will occur and there is nothing they can do to prevent or cope with them
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