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Chapter 13

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Western University
Psychology 1000

CHAPTER 13: PSYCHOLOGICAL DISORDERS • 22% of ppl have a diagnosable mental disorder > HISTORICAL PERSPECTIVES The Demonological View: • The Chinese, Egyptian and Hebrews attributed deviance to the work of the devil • Ancient “treatment” based on notion that bizarre behaviour reflected an evil spirit’s attempt to escape the human body • Trephination: a sharp tool was used to chisel a hole in the skull in order to release spirits • Medieval Europe  Religious Dogma held that disturbed ppl were either possessed or had voluntarily made a pact with evil, such as “witches” Early Biological View: • 5 century BC: Hippocrates suggested mental illness is the same as physical disorders • People with disordered behaviour were sick not possessed by evil • Site of mental illness is the brain • general paresis: mental deterioration and bizarre behaviour caused by syphilis  first demonstration that a psychological disorder was linked to a physical sickness Psychological Perspectives: Psychodynamic • Freud: convinced that psychological disorders are caused by unresolved conflicts from childhood that make the person vulnerable • The inappropriate or extreme use of defense mechanisms such as repression result in maladaptive patterns of behaviour • Neuroses: (obsessions, phobias, depression )– no loss of contact with reality • Psychoses: when an unresolved conflict is so great that they withdraw from reality (schizophrenia) Behavioural • Disordered behaviours are learned responses that are learned through classical conditioning, operant conditioning, and modeling • Think about how environmental factors influence abnormal behaviour Cognitive • Emphasizes the important role of people’s thoughts and perceptions about themselves and the environment • Aaron Beck – identified maladaptive and self-defeating thought patterns are linked to a number of different disorders like depression and anxiety • Key to understanding may disorders is to isolate specific thought patterns and attitudes that underlie them Humanistic • Views abnormality as the result of environmental forces that frustrate or pervert people’s self-actualization tendencies and their search for meaning in life • If experience becomes incongruent with the self-concept that it arouses severe threat, a breakdown may occur Vulnerability-stress Model • Vulnerability-stress model: Everyone has some degree of vulnerability to developing a given psychological disorder • Vulnerability: predisposition  can be biologically based (brain/hormones), personality based (low self-esteem, pessimism, etc), or environmentally based (poverty, trauma) • Stressor: some recent or current event that requires a person to cope • both factors are combined to trigger the appearance of a disorder > DEFINING AND CLASSIFYING PSYCHOLOGICAL DISORDERS What is Abnormal? • Abnormality: a social construction affected by value judgments and political agenda • Drapetomania: an obsessive desire for freedom that drove slaves to try more than twice to escape • Self-defeating/ masochistic personality disorder: people who continually involve themselves in hurtful circumstances and relationships • Criteria that determine decisions about abnormality: “three Ds” o Distress to self or others o Dysfunctional for the individual or society o Deviance towards social norms • Abnormal behaviour: behaviour that is personally distressful, personally dysfunctional, and/or so culturally deviant that other ppl judge it to be inappropriate or maladaptive Diagnosing Psychological Disorders • classification systems have to meet standards of reliability and validity o reliability: clinicians using the system should show high levels of agreement in their diagnostic decisions o validity: diagnostic categories should accurately capture the essential features of the various disorders, and differentiate between them • Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) • most widely used diagnostic classification system in North America • has more than 350 diagnostic categories • diagnostic information represented on five dimensions or axes that take the person and his or her life situation into account o Axis I: primary clinical symptoms o Axis II: long-standing personality or developmental disorders o Axis III: any relevant physical conditions (high blood-pressure) o Axis IV: intensity of environmental stressors in the person’s recent life o Axis V: person’s coping resources reflected in recent adaptive functioning Critical Issues in Diagnostic Labeling Social and Personal Implications • once a diagnostic label is attached to a person it becomes very easy to accept the label as an accurate description of the individual rather than the behaviour  affects how we interact with a person • expectations that accompany a label may result in a self-fulfilling prophecy in which expectations of a disorder become a reality Legal Consequences • law tries to take into account the mental status of individuals accused of crimes, based on: • Competency: refers to a defendant’s state of mind at the time of a judicial hearing. If judged to be too disturbed to understand the nature of the legal proceeding then they cannot stand trial • Insanity: a far more controversial issue, relates to the presumed state of mind of the defendant at the time of the crime  may be declared “not guilty by reason of insanity” if they are judged t have been so severely impaired during the commission of a crime that they lacked the capacity to understand what they did > ANXIETY DISORDERS • Anxiety disorders: when the frequency and intensity of anxiety responses are out of proportion to the situations that trigger them and interferes with everyday life • four components of anxiety response: 1. subjective-emotional: including feeling of tension and apprehension 2. cognitive component: including subjective feelings of apprehension a sense of impending danger, and inability to cope 3. physiological responses: increased heart rate and blood pressure, muscle tension, rapid breathing, dry mouth, diarrhea, etc. 4. behavioural responses: avoidance of certain situation, impaired performance… • anxiety disorders are the most prevalent of all psych disorders in NA  17.6% of pop. Phobic Disorders • Phobia: strong and irrational fears of certain objects or situations • Agoraphobia: fear of public open spaces • Social phobia: fear of being judged by others • Specific phobia: dogs, snakes, spiders, etc. • Phobias usually develop in childhood or adolescence Generalized Anxiety Disorder • Generalized anxiety disorder: a chronic state of “free-floating” anxiety that is not attached to specific situations or objects • May last for months on end with continuous symptoms of tension and apprehension, including mild emergency reactions such as sweating, and upset stomach • Must be present for 6 months for a formal diagnosis • Onset tends to occur in childhood and adolescence  5% of ppl between 15-45 Panic Disorder • Panic disorders: occur suddenly and unpredictably, usually without a specific stimulus, and are much more intense • Many ppl develop agoraphobia out of fear of having a panic attack in public • Usually occur in late adolescence or early adulthood  3.5% of pop. Obsessive Compulsive Disorder (OCD) • Obsessions: repetitive and unwelcome thoughts, images, or impulses that invade consciousness, uncontrollable by the person. • Compulsions: repetitive behavioural responses that can be resisted with much difficulty o are often responses to obsessive thoughts and work to reduce anxiety • Onset usually occurs in 20s  about 2.5% of pop Post-Traumatic Stress Disorder (PSTD) • Post-traumatic stress disorder: severe anxiety disorder that can occur in people who suffered a traumatic experience • Four common symptoms: 1. experience severe symptoms of anxiety, arousal, and distress that were not present prior to the trauma 2. the person relives the trauma recurrently in “flashbacks” in dreams and in fantasy 3. the person becomes numb to the world and avoids stimuli that serve as reminders 4. the individual experiences intense “survivor guilt” in instances where others were killed and the individual was spared Causal Factors in Anxiety Disorders Biological • autonomic nervous system overacts to perceived threat, creating high level of physiological arousal • heredity may cause overactivity of neurotransmitters involved in emotional responses o twin studies  heredity accounts for 50-60% of the variation in anxiety scores o identical twins have a 40% concordance rate (if one has it the other does too) • over-activity in the emotional systems in the right hemisphere (negative emotions) • GABA: inhibitory transmitter the reduces neural activity in the amygdale and other physically arousing areas o Low levels may cause ppl to have highly reactive nervous systems that quickly produce anxiety in response to stressors o Ppl who suffer from panic attacks had a 22% lower level of GABA • Biological preparedness: makes it easier for us to learn to fear certain stimuli of a “primal” nature such as snakes, spiders, storms, and heights Physiological Psychodynamic: • neurotic anxiety: Freud  occurs when unacceptable impulses threaten to overwhelm the ego’s defenses and explode into action • in phobic disorders, neurotic anxiety is displaced onto some external stimulus that has symbolic significance in relation to the underlying conflict • how the ego’s defense mechanisms deal with the anxiety determines the disorder • obsessions and compulsion are also a way of dealing with anxiety  a way of “taking back” or undoing one’s unacceptable urges (eg washing hands b/c of dirty sexual desire) Cognitive: • stress the role of maladaptive thought patterns and beliefs in anxiety disorders • anticipate the worst and feel powerless to cope • panic attacks are triggered by exaggerated misinterpretations of normal anxiety symptoms Learned Anxiety Response: • some fears come b/c of traumatic experiences that produce classically conditioned responses • can also be acquired through observational learning  some more predisposed to fear • if a behaviour such as a compulsion or phobia is successful in reducing anxiety, they are strengthened  does not allow for extinction to occur Sociocultural Factors • Culture-bound disorders: anxiety that only occurs in certain places o Koro  Southeast Asian anxiety  fear that the penis will retract back in to the abdomen and kill him o Taijin Kyofushu  Japanese  fear of offending someone by farting, blushing, or having an improper facial expression > MOOD (AFFECTIVE) DISORDERS Depression • Major depression: leaves them unable to function effectively in their lives • Dysthymia: less intense form of depression  less dramatic effects on personal and occupational functioning, but is a more chronic and long-lasting form of misery • Symptoms: o Emotional: report sadness, loneliness, lose capacity to experience pleasure o Cognitive: difficulty concentrating and making decisions, negative cognitions of self, world and future o Motivational: loss of interest, lack of drive, difficulty starting anything o Somatic: loss of appetite, lack of energy, sleep difficulty, weight loss/gain Bipolar Disorder • Depression (which is usually the dominant state) alternates with periods of mania • Mania: state of highly excited mood and behaviour that is quite the opposite of depression (mood is euphoric and cognitions grandiose) • no limits to what can be accomplished and ignore consequences of grandiose actions • behaviour is hyperactive  engages in frenzied activity • speech is often rapid or pressured • can go days without sleeping Prevalence and Course of Mood Disorders • 1 in 20 is depressed • 1 in 5 will be depressed at some point • on the rise in younger groups (15-19) • Similar among socio-economic groups, but there is a major sex difference in our culture (women are about twice as likely to suffer from depression) • Depression typically lasts 5-10 months when untreated • May never reoccur (half of all cases), may recover and then reoccur (40%), and some never recover (10%) Causal Factors in Mood Disorders Biological • Identical twins have a 67% concordance rate for clinical depression • Possibly linked to underactivity of neurotransmitters norepinephrine, dopamine, serotonin o Play important role in brain areas associated with rewards and pleasure  when activity decreases, we feel unhappy and lack motivation • bipolar disorder more genetically based  50% have a relative with it • manic disorders may stem from an overactivity, or increase of these neurotransmitters o lithium chloride used to calm manics down Monoamine Theory: - NE, Serotonin and Dopamine are monoamines - Use tricyclics and monoamine oxidase inhibitors (MAO) - MAOI inhibits the protein that neutralizes NE…leaving more in the synapse Psychological Personality based vulnerability: • Early traumatic loss triggers grieving and rage that becomes part of the individuals personality
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