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Chapter 16

Chapter 16 Psychological Disorders.docx

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Psychology 1000
Terry Biggs

Chapter 16 Psychological Disorders WHAT IS ABNORMAL - Several possibilities to measure what is abnormal o Personal values of diagnostician o Expectations of culture in person lives in o Expectations of person’s culture or origin o General assumptions on human nature o Statistical deviation from norm o Harmfulness, suffering and impairment - 1,5 not satisfactory - 2-4 focus on cultural beliefs on what is appropriate - Criterion 6 is what is used the most o 3 criteria in this  Distressing to self or others  Disproportionately intense or long  Dysfunctional for individual or for society  Deviance from the norms o Governs decisions about abnormality - Abnormal behavior: behavior that is personally distressing, personally dysfunctional, and/or culturally deviant so that other people see it as inappropriate HISTORICAL PERSPECTIVE ON DEVIANT BEHAVIOUR - Belief that abnormal behavior is caused by supernatural forces goes back to ancient Chinese, Egyptians, and Hebrews o To release spirit did trephination  Sharp tool used to chisel hole about 2cm in diameter in skull - Medieval Europe- abnormal people possessed by evil or made pact with evil - 16 and 17 centuries – abnormal people = witches and hunted down and killed - Hippocrates – mental illnesses were diseases o Site of mental illness = brain - 1800s – back to mental disorder is biologically based o Discovered general paresis: disorder characterized in advanced stages by mental deterioration and bizarre behavior - 1900s- Freud o Gave psychological interpretation of disordered behavior - Vulnerability-stress model: each of us have some degree of vulnerability for developing psychological disorder given enough stress o Vulnerability can have biological basis, personality factor, environmental factor, or cultural factor DIAGNOSING PSYCHOLOGICAL DISORDERS - Classification systems need reliability and validity o Reliability: clinicians that use the system should have high levels of agreement o Validity: diagnostic categories should accurately capture essential features of various disorders - DSM-IV-TR o Most widely used diagnostic classification system in North America o More than 350 categories  Each have behaviors that must be present o 5 axes  1. Primary diagnosis  Primary clinical symptoms  2. Long-standing personality or developmental disorders  3. Physical conditions  4. Environmental stressors  5. Person’s coping resources DSM-V: INTEGRATING CATEGORICAL AND DIMENSIONAL APPROACHES - DSM-IV-TR = categorical o Specific behavioral categories improved the reliability o BUT so detailed that 50% don’t fit into any categories o Some who get same diagnosis may only share some symptoms and look very different from each other o Categorical system doesn’t provide a way of capturing severity of disorder  Also cant capture symptoms that are important but not severe enough to meet the criteria for disorder - So got dimensional system o Relevant behavior rated along severity measure o Goes with the idea that psychological disorders are just different in severity from normal personalities o Better represent the uniqueness of individual o Avoid the strict boxed categories o Helps link normal and abnormal personality functioning o Severity ratings allow better descriptions that reflect the individual  Helps with making the treatment plan CRITICAL ISSUES IN DIAGNOSTIC LABELLING - Social and Personal implications o Once diagnosed, hard to look at the person’s behavior objectively  Masked by the preconceptions of how they will act - Legal consequences o If individuals judged as dangerous, can be involuntarily committed to mental institutions  Lose some civil rights and can be detained until improve o 2 important legal concepts  Competency: defendant’s state of mind during the hearing  If too disturbed then labeled not competent to stand trial and institutionalized until competent  Insanity: state of mind when crime was committed  Because of controversies, now made the verdict of “guilty but mentally ill” o Normal sentence for crime but sent to a institute o Then if recovered, serve the remaining time in prison - Medical students’ disease o People read descriptions of disorder, often see some symptoms in themselves ANXIETY DISORDER - Anxiety disorder: frequency and intensity of anxiety response out of proportion to situations that trigger them o Interferes with daily lives - Anxiety response have 4 components o Subjective-emotional  Feelings of tension  Apprehension o Cognitive  Worry  Thoughts about inability to cope o Physiological response  Increased heart rate  Muscle tension o Behavioral response  Avoidance  Decrease task performance - 2 statistics commonly used o Incidence: number of new cases o Prevalence: number of people who have disorder during a specified time PHOBIC DISORDER - Phobias: strong, irrational fears of certain objects or situations o Know that their fears are out of proportion of the danger o Make a lot of effort to avoid the fear o Most common in Western societies is agoraphobia: fear of open/public places and specific phobias  Animal fear common in women  Fear of heights common in men o Once developed, seldom go away but may broaden and intensify - Generalized anxiety disorder: chronic state of diffuse anxiety that is not attached to specific situations or objects o Interfere with daily functioning - Panic disorder: anxiety disorder that is more intense and appear suddenly and unpredictable o Occur in absence of any identifiable stimulus o Many people develop agoraphobia as well because fear of having an attack in public - OCD: anxiety disorder that has persistent and unwanted thoughts and compulsive behaviors o 2 components: cognitive and behavioral  Either one can occur alone o Obsessions: repetitive and unwelcomed thoughts that are very difficult to control and get rid of o Compulsions: repetitive behavioral responses  Responses to obsessive thoughts and function to reduce the anxiety the thoughts cause CAUSAL FACTORS IN ANXIETY DISORDERS - Biological factors o Genetic factors can create vulnerability to anxiety disorders o But concordance rate in identical twins is far from 100%  So environmental and psychological factors also come into play o Genetic factors can cause over reactivity of neurotransmitter system in emotional responses o PTSD – usually right hemisphere is activated o GABA: inhibitory transmitter that reduce neural activity in amygdala and other places that stimulate physiological arousal  Low GABA = anxiety responses? o Some findings suggest sex-linked predisposition but social conditions can be a big factor in this o Possible role in evolutionary factors  Biological preparedness makes it easier for some of us to learn to fear certain stimuli - Psychological factors o Psychodynamic theories: Freud  Neurotic anxiety: occurs when unacceptable impulses threaten to overwhelm ego’s defenses  Believed disorders displaced onto some external stimuli that has symbolic significance relating to the unconscious conflict  Obsession is symbolically related to underlying impulse  Generalized anxiety and panic attacks caused when defenses are not strong enough to control it but are strong enough to hid the underlying conflict  Does not have much research support o Cognitive factors  Anxiety caused by anticipating the worst will happen and feeling powerless to cope effectively  Panic caused by exaggerated misinterpretations of normal anxiety symptoms o Anxiety as learned response  Some fears because of traumatic experience that produce a classically conditioned fear response  For those who haven’t experienced the fear, have the fear because of observational learning  Once learned, can be triggered by environment or internal cues  Phobic reactions = environment  Panic = internal  Negative reinforcement fosters avoidance of feared situations - Sociocultural factors o Role of culture most shown in culture-bound disorders o Koro  Southeast Asian anxiety disorder  Man fears penis is going to retract and kill him o Taijin Kyofushu  Japan  Afraid of offending others by offensive odors, blushing, staring, having a blemish, improper facial expression o Windigo  North American Indians  Afraid to be possessed by monsters that will turn them into homicidal cannibals o Anorexia nervosa  Developed countries  Fear of getting fat EATING DISORDERS - Anorexia nervosa o Weight less than 85% of what would be expected o 90% are female  Mostly adolescent and young adults o Cause menstruation to stop,, strain heart, bone loss, increase risk of death - Bulimia Nervosa o Instead of starving, binge eat then purge food by vomiting or laxatives o 90% are female o Most are normal body weight  But can cause gastric problems, badly eroded teeth - Causes o Combination of environmental, psychological, biological factor o More common in industrialized cultures  Cultural emphasis on viewing one’s body as objects leads to them o Personality  Anorexics = usually perfectionists  Bulimic = depressed, anxious, low impulse control  Lack stable sense of personal identity  Purging can be means of reducing depression and anxiety triggered by bingeing o Upbringing  Anorexics’ parents are usually disapproving, and high achievement standards o Genetic factors can create predisposition for eating disorders o Abnormal activity of serotonin and other body chemicals  But most believe that the physiological changes are response to the abnormal eating patterns  But once start continue the eating and digestive irregularities MOOD DISORDERS - With anxiety disorders, mood disorders most frequently experienced psychological disorder - Anxiety and mood disorder have high co=occurrence DEPRESSION - 20-30% of undergraduates are currently experiencing mild depression - Feelings usually fade away after event or when person becomes accustomed to new situation - Clinical depression – frequency, intensity and duration proportion to person’s life situation - Major depression: unable to function effectively in lives o 16.6% of Americans - Dysthymia: less intense form o More chronic and long-lasting form - 3 other symptoms than mood o Cognitive symptoms  Central part of depression  View future with pessimism and hopelessness  Negative thoughts of self, world, future o Somatic symptom  Loss of appetite  Lack of energy  Sleep difficulties  Weight gain/loss o Motivational symptom  Loss of interest  Lack of drive  Difficulty starting anything - Negative mod state = core feature of depression BIPOLAR DISORDER - Depression alternates with mania o Mania: state of highly excited mood and behavior  Very hyperactive motivation PREVALENCE AND COURSE OF MOOD DISORDERS - Depression on rise in young groups - No age group exempt from depression - Prevalence similar across socioeconomic and ethnic groups - Women twice as more likely to suffer from unipolar depression o Suffer first episode in 20s  Men in 40s - Once have depressive episode, 3 patterns occur o 1. Never recur  Half the cases o 2. Recovery with recurrence o 3. Not recover and remain chronically depressed  10% of major depressive episodes - Manic episodes less common than depressive reactions o Far more likely to recur CAUSAL FACTORS IN MOOD DISORDERS - Biological factors o Genetic  Identical twins have concordance of about 67%  Inherit predisposition to develop depressive disorder and stressors trigger o Neurochemical o Neuroticism and extraversion involved in development of mood disorder - Depression predicted by high BIS sensitivity and low BAS activity o BIS: Behavioural inhibition system  Pain-avoidant and high fear and anxiety o BAS: Behaviorual activation system  Reward-oriented  Activated by future pleasure - Mania predicted by high BAS o With clear failure and deactivation of BAS, can lead to feelings of depression - Influential theory = depression is disorder of motivation caused by under activation of neurotransmitters that involved in reward and pleasure o Cause lack of pleasure and lack of motivation o To support, effective antidepressant drugs operate by increasing the activity of these neurotransmitters - Bipolar has a greater link with genetics - Mania may stem from overproduction of the same neurotransmitters underactive in depression - Psychological factors o Personality  Vulnerability for depression can be with grieving and rage
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