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Chapter 16

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Psychology 1000

Psychological Disorders 1 Psychology Chapter 16: Psychological Disorders THE SCOPE AND NATURE OF PSYCHOLOGICAL DISORDERS The three D’s that typically underlie judgments that behaviour is abnormal: Distress—distressing to self or others Dysfunctional—for person or society, behaviour that interferes with ability to work or have relationships with people Deviance—violates social norms Abnormal behaviour—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 Trephination—treatment to release evil spirits from the body—a sharp tool was used to chisel a hole about 2cm in diameter in the skull  Ancient Chinese, Egyptians, and Hebrews attributed deviance to the work of the devil ^  Medieval Europe—disturbed people either were possessed involuntarily by the devil or had made a pact with the forces of darkness  Hippocrates suggested that mental illnesses were diseases just like physical disorders—said mental illness was in the brain  Biological emphasis came in 1800 western medicine by the discovery that general paresis—a disorder characterized in its advanced stages by mental deterioration and bizarre behaviour, resulted from massive brain deterioration caused by syphilis  In early 1900, Freud’s psychoanalytic theory brought about many other theories 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 or can be due to a personality factors, environmental factors, or cultural factors. Predisposition may only create a disorder when a stressor combines with the vulnerability to trigger the disorder DIAGNOSING PSYCHOLOGICAL DISORDERS  To be scientifically useful, there must be a classification system that meets standards of reliability and validity Psychological Disorders 2 Reliability—means that clinicians using the system should show high levels of agreement in their diagnostic decisions. The system should be couched in terms of observable behaviours that can be reliably detected and should minimize subjective judgments Validity—the diagnostic categories should accurately capture the essential features of the various disorders DSM-IV-TR  Is the most widely used diagnostic classification system in North America.  Contains detailed lists of observable behaviours that must be present in order for diagnosis to be made  Allows diagnostic info to be represented along 5 dimensions, or axes, that take both the person and their life situation into account o Axis I: the primary diagnosis (clinical symptoms) o Axis II: longstanding personality or developmental disorders o Axis III: relevant physical disorders o Axis IV: intensity of environmental stressors (severity of psychosocial stressors) o Axis V: global assessment of level of functioning DSM-V: integrating categorical and dimensional approaches  Revising the system, which will be called DSM-V to show up in 2013  Current classification system is a categorical system, people are placed within specific diagnostic categories  Current version, axis I is too specific and 50% don’t neatly fit into the categories—people diagnosed with the same thing may be very different from each other  Current categorical system does not provide a way of capturing the severity or the symptoms that are adaptively important but not severe enough to meet behavioural criteria for the disorder  An alternative to the categorical system is a dimensional system, relevant behaviours are rated along a severity measure—see it as a difference in degree rather than kind of disorder  Believe the new system will be better because it better represents peoples uniqueness and gets ride of the one size fits all mentality  New system incorporates both categorical and dimensional systems Psychological Disorders 3 Clinical issues in diagnostic labeling  Social and personal implications: giving a label causes us to make judgments and think of the behaviour rather than the individual?  Legal consequences: o Competency—a defendant’s state of mind at the time of a judicial hearing (not at the time the crime was committed). If person is too disturbed to understand the nature of legal proceedings, incompetent o Insanity—relates to the presumed state of mind of the defendant at the time the crime was committed. Person may be judged so severely impaired during crime they lacked the capacity to know it was wrong. “Not guilty by reason of insanity”  Do I have that disorder?: medical student’s disease—when people read descriptions of disorders they often see some of those symptoms in themselves ANXIETY DISORDERS Anxiety disorders—the frequency and intensity of anxiety responses are out of proportion to the situations that trigger them, and the anxiety interferes with daily life Anxiety responses have four components: 1. A subjective-emotional component (feelings of tension and apprehension) 2. A cognitive component (subjective feelings of apprehension, a sense of impending danger, and a feeling of inability to cope) 3. Physiological responses (increased heart rate and blood pressure, muscle tension, rapid breathing, nausea, dry mouth, diarrhea, and frequent urination) 4. Behavioural responses (avoidance of certain situations, impaired task performance) Incidence—number of new cases that occur during a given period Prevalence—number of people who have a disorder during a specified period of time Anxiety disorders are most prevalent of all psychological disorders in North America Phobic disorder  Phobias are strong and irrational fears of certain objects or situations  They know its irrational but feel helpless to stop it  Agoraphobia—fear of open and public places  Social phobias—fear of situations in which they can be embarrassed  Specific phobia—fear of dogs, spiders, heights, etc. Generalized anxiety disorder  Chronic state of diffuse, or “free floating”, anxiety that is not attached to specific situations or objects  Can last for months on end with the signs almost always present  Cognitively, expecting something awful to happen but don’t know what  Physically, experiencing a mild chronic emergency reaction Psychological Disorders 4 Panic disorder  Occur suddenly and unpredictably, and they are much more intense  Symptoms can be terrifying, can feel like dying  Occur out of the blue without any identifiable stimulus  Many develop agoraphobia Obsessive-compulsive disorder (OCD)  Usually consists of behavioural and cognitive components  Obsessions—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—repetitive behavioural responses that can be resisted only with great difficult; usually responses to obsessive thoughts  If they cant perform compulsive act, may result in anxiety or panic attack o Strengthened through negative reinforcement (getting to avoid anxiety) Causal factors in anxiety disorders Biological factors:  Genetic factors may create a vulnerability to anxiety disorders  Concordance between twins who have it  Vulnerability may take the form of an autonomic nervous system that overreacts to a perceived threat  Heredity may cause overreactivity of neurotransmitter systems  Trauma-produced overactivity in the emotional systems of the right hemisphere may produce vulnerability to PTSD  GABA—inhibitory transmitter that reduced neural activity in the amygdala and other brain structures that stimulate physiological arousal—low amounts may cause highly reactive nervous systems  Sex-linked biological predisposition for anxiety disorders—women more likely  Evolutionary factors may predispose people to fear certain types of stimuli Psychological factors  Psychodynamic theories: o According to Freud, neurotic anxiety occurs when unacceptable impulses threaten to overwhelm the ego’s defenses and explode into action. Believed that neurotic anxiety is displaced onto some external stimulus that has symbolic significance in relation to the underlying conflict o The obsession is symbolically related to, but less terrifying than, the underlying impulse  Cognitive factors o Stress the role of maladaptive thought patterns and beliefs in anxiety disorders o Anxiety disordered people “catastrophize” about demands and magnify them into threats—anticipate the worst and feel powerless to cope Psychological Disorders 5 o Attentional processes are especially sensitive to threatening stimuli— intrusive thoughts  Anxiety as a learned response o Anxiety disorders result from emotional conditioning o Some fears are acquired as a result of traumatic experiences that produce a classically conditioned fear response o Can be acquired through observational learning o Once its learned, it may be triggered by environmental cues o Behaviours successful in relieving anxiety are strengthened through negative reinforcement Sociocultural factors—culture bound disorders are ones developed and occur in certain places. Ex. Koro is a Southeast Asian anxiety disorder where a man is afraid his penis will retract into his body and kill him. Anorexia nervosa is also a culture bound disorder popular in developed countries Eating disorders Anorexia nervosa—intense fear of being fat and severely restrict their food intake to the point of self-starvation. Even when they’re freakishly skinny, they view themselves as fat. They often crave food but won’t eat because of their fear. Causes menstruation to stop, strains the heart, produces bone loss, and increases risk of death. Feel a need for control and are influenced by standards set by society; perfectionists. Leptin may make it more difficult for them to gain weight Bulimia nervosa—overly concerned with becoming fat, but instead of self-starvation they binge eat and then purge the food. Are of normal body weight but can have health problems because of damage done to GI and teeth. Tend to be depressed and exhibit low self-control and self-identity. Often triggered by stress and/or guilt. Stomach acid destroys taste buds and makes vomiting less unpleasant making it easier to keep purging MOOD (AFFECTIVE) DISORDERS Mood disorders—involve depression and mania (excessive excitement). Together with anxiety disorders, are most frequent psychological disorders. Anxiety and mood disorders have a high comorbidity (co-occurrence). About half of all depressed people also experience an anxiety disorder Depression  Clinical depression—the frequency, intensity, and duration of depressive symptoms are out of proportion to the person’s life situation  Major depression—leaves person unable to function effectively in their life  Dysthymia—less intense form of depression, has less dramatic effects on personal and occupational functioning. It is a more chronic and long-lasting form of misery, Psychological Disorders 6 occurring for years on end with intervals of normal mood that never last more than a few weeks or months  There are 4 types of symptoms: 1. Emotional symptoms: sadness, hopelessness, anxiety, misery, inability to enjoy 2. Cognitive symptoms: negative cognitions about self, world and future 3. Motivational symptoms: loss of interest, lack of drive, difficulty starting anything 4. Somatic symptoms: loss of appetite, lack of energy, sleep difficulties, weight loss/gain  Negative mood state is the core feature of depression Bipolar disorder  Depression (which is usually the dominant state) alternates with periods of mania, a state of highly excited mood and behaviours that is quite the opposite of depression  During mania, person is euphoric and has feelings of grandeur; person believes there are no limits. Manic behaviour is hyperactive Prevalence and course of mood disorders  No age group is exempt from depression  Men and women are equal in bipolar disorder but women are 2x more likely to get unipolar disorder  Once a depressive episode has occurred, one of 3 patterns may follow: 1. Depression will never recur 2. Recovery with recurrence (will be symptom free for sometime before it returns) 3. Will never recover and will remain chronically depressed  Mania is far more likely to recur. Only 1% have it, but 90% of those will have recurrence Causal factors in mood disorders Biological factors:  Both genetic and neurochemical have been linked  Genetically based temperament systems, the behavioural inhibition system(BIS) (neuroticism) and the behavioural activation system(BAS) (extraversion) are heavily involved in development of mood disorders  BAS is reward oriented and activated by cues that predict future pleasure  BIS is pain-avoidant and generates fear and anxiety  Depression is predicted by high BIS sensitivity and low BAS activity  Mania is linked to high reward-oriented BAS functioning. Extraversion tied to BAS predicted the future development of bipolar mania o BAS deactivation caused the depression Psychological Disorders 7  Depression is a disorder of motivation caused by under activity in a family of neurotransmitters that include norepinephrine, dopamine, and serotonin— involved in BAS, produce reward and pleasure  Bipolar disorder is genetic  Mania is from an overproduction of the neurotransmitters Psychological factor  Personality-based vulnerability—Freud and Abrahambelieved thatearlytraumatic lossesor rejectionscreate vulnerabilityfor laterdepression bytriggeringagrievingand rage processthat becomes part oftheindividualspersonality—when ithappensagain, they freak out x2.Humanisticssayitsbecauseweneedtomuchcontroltohaveself- worth which isn’t always easy(Seligman)  Cognitive process—Beck saysdepressed peoplevictimizethemselvesthroughown beliefs that they are defective o Depressive cognitive triad—negativethoughtsconcerningthe(1)world,(2) oneself,and (3) the futureseemstopopintoconsciousnessautomatically, and many depressed peoplereport thattheycannotcontrolor suppressthe negative thoughts o Tendto focuson failures,notsuccesses o Depressive attributional pattern—takingnocreditfor successesbut blaming themselvesfor failuresmaintainsdepressed peopleslow self-esteem and their belief that they are worthlessfailures o Learned helplessness theory—depression occurswhen peopleexpect thatbad eventswilloccur and that thereisnothingtheycan doto prevent or copewith them  Failures are personal,stable,and global  Learning and environmental factors:Lewinsohn believe that depression isusually triggered by a loss,some other punishingevent,orbyadrastic decreasein theamount of positive reinforcement that thepersonreceivesfromher orhisenvironment  Inadequate positive reinforcement or manypunishers depression decreased reward-seeking behaviour,avoidance ofothers increasedepression noxious behaviours that alienate others and reduce social support deeper depression inadequate positive reinforcement or manypunishers Sociocultural factors  Lessin Hong Kong where connectionstofamilyand other groupshelptoreduce negative impacts  Waysof feeling depression isdifferent indifferent cultures SOMATOFORMDISORDERS Somatoform disorders—involve physicalcomplaintsordisabilitiesthatsuggestamedical problem, but which have no known biologicalcauseand arenotproducedvoluntarilybythe person Psychological Disorders 8
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