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Psychology 1000
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The Scope and Nature of Psychological Disorders • Psychological disorders have a major impact on individual and societal well-being • Psychological disorders are the second leading cause of disability, exceeding physical illnesses and accidents • Medications used to treat anxiety and depression are among the most frequently prescribed drugs in North America • One adolescent commits suicide every 90 seconds What is “Abnormal”? • Defining what is normal and what is abnormal is no easy matter, as there are many measures we could apply • 1. The personal values of a given diagnostician • 2. The expectations of the culture in which a person currently 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 • Most people would not find criteria 1 and 5 satisfactory bases for judging a person to be disordered • Criteria 2 through 4 reflect cultural or even more widespread beliefs about what is appropriate, so that judgments about what is normal and what is abnormal can differ depending on the time and the culture • Despite the arbitrariness of time, place, and value judgments, three criteria inherent in criterion 6 -distress, dysfunction, and deviance- seem to govern decisions about abnormality, and one or more of them seem to apply to virtually any behavior regarded as abnormal • Abnormality as a social construct, whether a behavior is considered abnormal involves a social judgment made on the basis of the 3 Ds: distress, dysfunction and deviance • First, we are likely to label behaviors as abnormal if they are intensely distressing to the individual • Second, most behaviors judged abnormal are dysfunctional either for the individual or for society • The third criterion for abnormality is society's judgments concerning the deviance of a given behavior • Both personal and social judgments of behavior enter into considerations of what is abnormal • Therefore, we may define abnormal behavior as behavior that is personally distressing, personally dysfunctional, and/or so culturally deviant that other people judge it to be inappropriate or maladaptive • No less than 374 disorders are included in the current manual of the American Psychiatric Association—the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Textual Revision (DSM-IV-TR) • Some of the major categories include Anxiety disorders, Mood (affective) disorders, Somatoform disorders, Dissociative disorders, Schizophrenic and other psychotic disorders, Substance-abuse disorders, Sexual and gender identity disorders, Eating disorders, and Personality disorders Historical Perspectives On Deviant Behavior • Contemporary celebrities Howie Mandel and Cameron Diaz both have publicly discussed their obsession with germs, which causes Mandel to avoid pushing elevator buttons or shaking hands and compels Diaz to wash her hands many times a day and open doors with her elbows • The belief that abnormal behavior is caused by supernatural forces goes back to the ancient Chinese, Egyptians, and Hebrews, all of whom attributed deviance to the work of the devil • One ancient treatment was based on the notion that bizarre behavior reflected an evil spirit's attempt to escape from a person's body • To release the spirit, a procedure called trephination was carried out • A sharp tool was used to chisel a hole about 2 centimeters in diameter in the skull • The Greek physician Hippocrates suggested that mental illnesses were diseases just like physical disorders • By the 1800s, Western medicine had returned to viewing mental disorders as biologically based and was attempting to extend medical diagnoses to them • In the early 1900s, Sigmund Freud's theory of psychoanalysis ushered in psychological interpretations of disordered behavior • Today, according to the 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, 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 • It could also be due to a personality factor, such as low self-esteem or extreme pessimism, or to previous environmental factors, such as poverty or a severe trauma or loss earlier in life • A person who has a genetic pre- disposition to depression or who suffered a traumatic loss of a parent early in life may be primed to develop a depressive disorder if faced with the stress of a significant loss later in life Diagnosing Psychological Disorders • Reliability means that clinicians using the system should show high levels of agreement in their diagnostic decisions • Validity means that the diagnostic categories should accurately capture the essential features of the various disorders • The DSM-IV-TR, is the most widely used diagnostic classification system in North America • For each of its more than 350 diagnostic categories, DSM-IV-TR contains detailed lists of observable behaviors that must be present in order for a diagnosis to be made • The DSM-IV-TR allows diagnostic information to be represented along five dimensions, or axes, that take both the person and his or her life situation into account • Axis I, the 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 reflects the vulnerability- stress model, the clinician also rates the intensity of environmental stressors in the person's recent life • Axis V represents the person's coping resources as reflected in recent adaptive functioning DSM-V: Integrating Categorical and Dimensional Approaches • The categorical system does not provide a way of capturing the severity of the person's disorder • An alternative to the categorical system is a dimensional system, in which relevant behaviors are rated along a severity measure • In February 2010, the American Psychiatric Association released its DSM-V revision proposals for professional comment • The proposed system incorporates dimensional scales that are used to rate the presence and severity of specific symptoms and personality characteristics • A prime example is in the personality disorders, where six basic dimensions of disordered personality functioning—Negative Emotionality, Schizotypy (odd thinking and behavior), Disinhibition, Introversion, Antagonism, and Compulsivity—are rated by clinicians to define a set of six personality disorders • One beneficial consequence of the proposed DSM-V approach to the diagnosis of personality disorders is that it 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 then becomes difficult to look at the person's behavior objectively, without preconceptions about how he or she will act • It also is likely to affect how we will interact with that person Legal Consequences • The law tries to take into account the mental status of individuals accused of crimes • Two particularly important legal concepts are competency and insanity • Competency refers to a defendant's state of mind at the time of a judicial hearing (not at the time the crime was committed) • A defendant judged to be too disturbed to understand the nature of the legal proceedings may be labeled as “not competent to stand trial” and institutionalized until judged competent • Insanity, a far more controversial issue, relates to the presumed state of mind of the defendant at the time the crime was committed • Defendants may be declared “not guilty by reason of insanity” if they are judged to have been so severely impaired during the commission of a crime that they lacked the capacity either to appreciate the wrongfulness of their acts or to control their conduct • To balance punishment for crimes with concerns about a defendant's mental status and possible need for treatment, Canada and an increasing number of U.S. jurisdictions have adopted a verdict of “guilty but mentally ill” • This verdict imposes a normal sentence for a crime but sends the defendant to a mental hospital for treatment • Defendants who are considered to have recovered before serving all their time are then sent to prison for the remainder of the sentence Do I Have That Disorder? • When people read descriptions of disorders, whether physical or psychological, they often see some of those symptoms or characteristics in themselves • We all experience problems in living at various times, and we may react to them in ways that bear similarities to the behaviors you will be reading about • On the one hand, seeing such a similarity does not necessarily mean that you have the disorder, but if you find that maladaptive behaviors are interfering with your happiness then seek help Anxiety Disorders • In 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, 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 and blood pressure, muscle tension, rapid breathing, nausea, dry mouth, diarrhea, and frequent urination • 4) Behavioral responses, such as avoidance of certain situations and impaired task performance • Large-scale population studies indicate that anxiety disorders are the most prevalent of all psychological disorders in North America, affecting 18.6 percent of the population during their lifetimes Phobic Disorder • Phobias are strong and irrational fears of certain objects or situations • People with phobias realize that their fears are out of all proportion to the danger involved, but they feel helpless to deal with these fears • Among the most common phobias in Western society are agoraphobia, a fear of open and public places, social phobias (excessive fear of situations in which the person might be evaluated and possibly embarrassed), and specific phobias, such as fears of dogs, snakes, spiders, airplanes, elevators, enclosed spaces, water, injections, illness, or death • Animal fears are common among women, and fear of heights, among men • Phobias can develop at any point in life, but many of them develop during childhood, adolescence, and early adulthood 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 • In such cases, the anxiety may last for months on end, with the signs almost continuously present • The person will feel jittery, tense and constantly on edge • Cognitively, they expect something awful to happen but don’t know what • Physically, they experience a mild chronic emergency reaction • They sweat, their stomach is usually upset, they have diarrhea and so forth • The person may find it hard to concentrate, make decisions, and remember commitments Panic Disorder • Panic Disorder: a somatoform disorder in which the person’s complaints of pain cannot be accounted for in terms of physical damage • Involves tension and anxiety, occurs suddenly and unpredictably • Out of the blue, in the absence of any identifiable stimulus • Many people with panic attacks develop agrophobia, a fear of public places and are known to be housebound • Fear they will have an attack and be stranded and helpless Obsessive-Compulsive Disorder (OCD) • Obsessive-Compulsive Disorder: an anxiety disorder characterized by persistent unwanted thoughts and compulsive behaviours • Usually consists of two components, cognitive and behavioral • 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 – such as the cleaning rituals – that can be resisted only with great difficulty • Responses to obsessive thoughts and function to reduce the anxiety associated with the thoughts • If the person does not perform the compulsive act, he or she may experience tremendous anxiety, perhaps even a panic attack • Compulsions appear to reduce anxiety and are strengthened through a process of negative reinforcement because they allow a person to avoid anxiety Causal Factors inAnxiety Disorders • Anxiety has biological, psychological and environmental causes • Biological Factors: • Genetic factors may create a vulnerability to anxiety disorders • Identical twins have a concordance rate of about 40% for anxiety disorders, compared with a 4% concordance rate in fraternal twins • Such vulnerability may overreacts to perceived threat, creating high levels of physiological arousal • Hereditary factors may cause over- reactivity of neurotransmitter systems involved in emotional responses • Other evidence suggests that trauma- produced over-activity in the emotional systems of the right hemisphere may produce vulnerability to PTSD • Abnormally low levels of inhibitory GABA activity in these arousal areas may cause some 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 • Psychological Factors • NeuroticAnxiety: in psychoanalytic theory, a state of anxiety that arises when impulses from the ID threaten to break through into behaviour • Freud 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 • Intrusive thoughts about the previous traumatic event are a central feature of PTSD, and the presence of such thoughts after the trauma predicts the later development of PTSD • Panic attacks are triggered by exaggerated misinterpretations of normal anxiety symptoms, such as heart palpitations, dizziness, and breathlessness • Some fears are acquired as a result of traumatic experiences that produce a classically conditioned fear response • Ex: a person who has a traumatic fall from a high place may develop a fear of heights • However, phobias also can be acquired through observational learning • Televised images of air crashes can evoke high levels of fear in some people • In panic disorders, the anxiety-arousing cues tend to be internal ones, such as bodily sensations (one’s heart rate) or mental images (image of collapsing and having a seizure) • Sociocultural Factors • Culture-bound Disorders: behaviour disorders whose specific forms are restricted to one particular cultural context • Koro is a SoutheastAsian anxiety disorder in which a man fears that his penis is going to retract into his abdomen and kill him • Windigo is an anxiety disorder found among certain NorthAmerican Indians who are fearful of being possessed by monsters who will turn them into homicidal cannibals Eating Disorders • Anorexia Nervosa: an eating disorder involving a severe and sometimes fatal restriction of food intake • Fear of being fat and view themselves as fat • Can be life-threatening • Causes menstruation to stop, strains the heart, produces bone loss, and increases the risk of death • Bulimia Nervosa: a disorder involving the binging and purging of food, usually by vomiting or laxative use, because of a concern with becoming fat • Can cause gastric problems badly eroded teeth • Anorexia and bulimia are more common in industrialized cultures in which beauty is equated with “thinness” • Variations in beauty norms among different ethnic groups also may help to explain why, in North America, eating disorders are more common among Whites than Blacks • Some researchers believe that personality factors are another piece to the puzzle – anorexics are often perfectionists • For anorexics, losing weight becomes a battle for success and control: “Me vs. food, and I’m going to win” • Bulimics, often are depressed and anxious, exhibit low impulse control, and seem to lack a stable sense of personal identity and self-sufficiency • Concordance rates for eating disorders are higher among identical twins than fraternal twins, and higher among first-degree relatives than second or third degree relatives • Anorexics and bulimics exhibit abnormal activity of serotonin and other body chemicals that help to regulate eating • Leptin circulating in their bloodstream is abnormally low because leptin is secreted by fat cells and anorexics have low fat mass • But when anorexics begin to eat more, their leptin levels rebound more quickly than their weight gain Mood (Affective) Disorders • Mood Disorders: psychological disorders whose core conditions involve maladaptive mood states, such as depression or mania Depression • Occur when we feel blue, sad, discouraged, apathetic, and passive • Feelings usually fade away after the event has passed or as the person becomes accustomed to the new situation • Major Depression: a mood disorder characterized by intense depression that interferes markedly with functioning • Dystheymia: a depressive mood disorder of moderate intensity that occur over a long period of time but does not disrupt functioning as a major depression does • When depressed people are asked how they feel, they most commonly report sadness, misery, and loneliness • Although depression is primarily a disorder of mood, there are three other types of symptoms: cognitive symptoms, motivational symptoms, and somatic (physical) symptoms • Cognitive Symptoms • Depressed people have difficulty concentrating and making decisions • Low self-esteem, believing they are inadequate and incompetent • View the future with great pessimism and hopelessness • Motivational Symptoms • Inability to get started and perform behaviors that might produce pleasure or accomplishment • Everything seems too much effort (e.g. a depressed student may be unable to get out of bed in the morning, let alone go to class or study) • Slow movements, person walks or talks slowly • Somatic Symptoms • Loss of appetite and weight loss in moderate and severe depression, • Sleep disturbances, particularly insomnia • These lead to fatigue and weakness • Lose sexual desire and responsiveness Bipolar Disorder • Bipolar Disorder: mood disorder in which intermittent mania appears against a background of depression • Mania: a state of intense emotional and behavioral excitement in which a person feels very optimistic and energized • Mood is euphoric and cognitions are grandiose • Person believes there are no limits to what can be accomplished and does not recognize the negative consequences that may ensue if grandiose plans are acted on • Engages in frenetic activity • Manic people may go for several days without sleeping, until exhaustion inevitably sets in and the mania slows down Prevalence and Course of Mood Disorders • The rate of depressive symptoms in children and adolescents is as high as the adult rate • Studies indicate that depression is on the rise in young groups, with the onset of depression increasing dramatically in 15-19 year olds • Women are about twice as likely as men to suffer unipolar depression • Women are most likely to suffer their first episode of depression in their 20s, men in their 40s Causal Factors in Mood Disorders • Biological Factors • Both genetic and neurochemical factors have been linked to depression • Among adopted people who developed depression, biological relatives were found to be eight times more likely than adoptive relatives to also suffer from depression • The behavioural inhibition system (neuroticism) and the behavioural activation system (extraversion) are heavily involved in the development of mood disorders • Behavioural activation system (BAS) is reward-oriented and activated by cues that predict future pleasure, whereas the behavioural inhibition system (BIS) is pain-avoidant and generates fear and anxiety • Depression is predicted by high BIS sensitivity and low BAS activity • Mania, on the other hand, is linked to high reward-oriented BAS functioning, and score on the personality variable of extraversion predicts by high BIS sensitivity and low BAS activity • One influential theory holds that depression is a disorder of motivation caused by under-activity in a family of neurotransmitters that include norepinephrine, dopamine and serotonin • When neural transmission decreases in these brain regions, the result is the lack of pleasure and loss of motivation that characterize depression • Manic disorders may stem from an overproduction of the same neurotransmitters that are underactive in depression Psychological Factors • Biological factors seem to increase vulnerability to certain types of psychological and environmental events that then can trigger the disorders Personality-Based Vulnerability • Psychoanalysts KarlAbraham 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 • Subsequent losses and rejection reactivate the original loss and cause a reaction not only to the current event, but also to the unresolved loss from the past • The humanistic perspective also addresses causes of depression • Martin Seligman has suggested that the “me” generation, with its overemphasis on individuality and personal control, has sown the seeds for its own depression • Because 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 Processes • According toAaron Beck, depressed people victimize themselves through their own beliefs that they are defective, worthless, and inadequate • They also believe that whatever happens to them is bad, and that negative things will continue happening because of their personal defects • This depressive cognitive triad of negative thoughts concerning (1) the world, (2) oneself, and (3) the future, seems to pop into consciousness automatically, and many depressed people report that they cannot control or suppress the negative thoughts • Depressed people also tend to recall most of their failures and few of their successes, and they tend to focus much of their attention on their perceived inadequacies • Depressed people interpret successes as being due to factors outside the self, while attributing negative outcomes to personal factors • Beck believes that this depressive attributional pattern of taking no credit for successes but blaming themselves for failures maintains depressed peoples low self-esteem and their belief that they are worthless • Learned helplessness theory holds that depression occurs when people expect that bad events will occur and that there is nothing they can do to prevent or cope with them Learning and Environmental Factors • Depressed people tend to generate additional negative life events through their negative moods, pessimism, and reduced functioning • Moreover, depressed people tend to make those who come in contact with them feel anxious, depressed, and hostile • Eventually, these other people begin to lose patience, failing to understand why the person doesn’t snap out of it • Behavioural theorists believe that to begin feeling better, depressed people must break this vicious cycle by initially forcing themselves to engage in behaviours that are likely to produce some degree of pleasure • Environmental factors may also help to explain why depression tends to run in families Sociocultural Factors • Although depression is found in virtually all cultures, its prevalence, symptom pattern, and causes, reflect cultural variation • For example, compared with Western nations, the prevalence of depressive disorders is far lower in Hong Kong and Taiwan, where strong connections to family and other groups help to reduce the negative impact of loss and disappointments and provide strong social support when they occur • Cultural factors also can affect the ways in which depression is manifested • Feelings of guilt and personal inadequacy seem to predominate in NorthAmerican and western European countries, whereas somatic symptoms of fatigue, loss of appetite, and sleep difficulties are more often reported in Latin, Chinese, andAfrican cultures Somatoform Disorders • Somatoform disorders involve physical complaints or disabilities that suggest a medical problem, but which have no known biological cause and are not reduced voluntarily by the person • In hypochondriasis, people become alarmed about any physical symptom they detect and are convinced that they have or are about to have a serious illness • People with pain disorder experience intense pain that either is out of proportion to whatever medical condition they have or for which no physical basis can be found • Somatoform disorders differ from psychophysiological disorders, in which psychological factors cause or contribute to a real medical condition, such as an ulcer, asthma, hypertension, or a cardiac problem • In ulcers a stress-produced outpouring of peptic acid into the stomach produces an actual lesion in the stomach wall • The resulting pain is therefore caused by the actual physical damage • In a somatoform disorder, no physical basis for the pain would be found • Conversion disorder, serious neurological symptoms, such as paralysis, loss of sensation, or blindness suddenly occur • In such cases, electrophysiological recordings and brain imaging indicate that sensory and motor pathways in the brain are intact • People with conversion disorders often exhibit la belle indifference, a strange lack of concern about their symptom and its implications • In some cases, the complaint itself is physiologically impossible • An example is the so-called “glove anesthesia” in which a person loses all sensation below the wrist • The hand though is served by nerves that also provide sensory input above the hand, making glove anesthesia automatically impossible • Conversion disorders are relatively rare, but occur more frequently under wartime conditions • Thus, a soldier about to return to the trauma of combat may suddenly develop blindness or paralysis for which no physical cause can be found • Psychogenic blindness is rare • Reports of victims state that their blindness occurred suddenly after witnessing traumatic scenes of murder • To Freud, such symptoms were a symbolic expression of an underlying conflict that aroused so much anxiety that the ego kept the conflict in the unconscious by converting the anxiety into a physical symptom that in some way symbolized the conflict Dissociative Disorders • Dissociative disorders involve a breakdown of this normal integration, resulting in significant alternations in memory or identity • Three forms that such disorders can take are: • Psychogenic amnesia • Psychogenic fugue • Dissociative personality disorder • (1) PsychogenicAmnesia: • Aperson responds to a stressful event with extensive but selective memory loss • Some peop
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