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Chapter 15

Chapter 15.docx

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Kathy Foxall

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Psychological Disorders Defining and Diagnosing Disorder Dilemmas of Definition  Mental disorder as a violation of cultural standards o Many specific to certain time or group  Mental disorder as emotional stress o Based on person’s suffering, depression, anxiety, incapacitating fears  Mental disorder as behaviour that is self-destructive or harmful to others  Mental disorder o Any behaviour or emotional state that causes an individual great suffering, is self destructive, seriously impairs the person’s ability to work or get along with others, or endangers others or the community Dilemmas of Diagnosis Classifying Disorders: the DSM (Diagnostic and Statistical Manual of Mental Disorders)  Evaluate according to five axes o Primary problem, such as depression o Ingrained aspects of client personality likely to affect person ability to be treated o Medical conditions or medications that might contribute to symptoms o Social and environmental stressors that make the disorder worse o Global assessment of clients overall level of functioning  DSM continually updated, important to distinguish disorders precisely to treat them properly Problems with DSM  The Danger of Overdiagnosis o Everyone has symptoms of the disorder o ADHD, fastest growing disorder  Overused, most people with ADHD symptoms declined over time  The power of diagnostic labels o Reassures people seeking an explanation o Once person diagnosed, people see disorder as permanent, official condition, overlook other explanations  Confusion of serious mental disorders with normal problems o Implies everyday problems comparable to disorders? Likely to require treatment?  Illusion of objectivity and universality o Many decisions based not on empirical evidence but group consensus  Prejudice in past notion of mental problems  Samuel Cartwright o Drapetomania o Crazy runaway slave  Reflect cultural prejudices and lack empirical validation Advantages  Help clinicians distinguish among disorders that share certain symptoms  Highest risk of suicide Native American men, group at lowest risk African American women Culture bound syndromes  Disorders specific to particular cultural contexts  Sometimes overlap with DSM categories  Japan taijin kyofusho o Disorder in which person feels intensely frightened and irrationally embarrassed that his or her body parts  Brain fag o Mental exhaustion of west Africans brains  Amok o Violent murderous outburst in Malaysian men  Ataque de nervous o Uncontrollable screaming, crying, and agitation  Ghost sickness o Preoccupation with death among natives  Piblokotoq o Episodes of extreme excitement amongst Inuit’s  Qi gong psychotic reaction o Chinese have mental symptoms  Zar o North Africa belief in possession of spirit causing shouting, laughing Dilemmas of Measurement Projective tests  Psychological tests used to infer a persons motives, conflicts, and unconscious dynamics on the basis of the person’s interpretations of ambiguous stimuli (pictures, sentences, or stories)  Help clinicians establish rapport with clients  Tests lack reliability and validity when assessing traits and disorders o Clinicians interpret persons scores differently, projecting own beliefs and assumptions when they decide o Test score affected by sleepiness, hunger, medication, worry, verbal ability, and own personality  Rorshach Inkblot Test o Consists of 10 cards of patterns o Test takers interpret what they see on these inkblots, clinicians interpret answers according to symbolic meaning o Does not properly diagnose depression, posttraumatic stress  Comprehensive System o Significant reliability and validity problems  Use tests for children unable to express feelings verbally  Some therapists used it to determine whether a child has been abused o Use a doll to determine if sexual abuse o Did not test belief with non-abused children, both abused and non-abused groups fascinated with doll’s genitals  Often used inappropriately in child custody assessments,  No scientific justification Objective Tests  Standardized objective questionnaires requiring written responses; they typically include scales on which people are asked to rate themselves  Minnesota Multiphasic Personality Inventory o Organized into validity scales and scales  Generally more reliable and valid  Limitations o Don’t take into account difference in cultural groups o Significant rate of false positives, label a person’s responses as evidence of mental disorder when no problem exists Anxiety Disorders  Anxiety, general state of apprehension or psychological tensions  Chronic anxiety, long lasting feelings of apprehensions  Panic attacks, short lived but intense anxiety  Phobias, excessive fear of specific things or situations  OCD repeated thoughts and rituals to reduce anxiety Anxiety and Panic  Generalized anxiety disorder o Continuous state of anxiety marked by feelings of worry and dread, apprehensions, difficulties in concentration, and signs of motor tensions o Some live through anxiety without a specific producing event (sweaty palms, racing heart, shortness of breath) o Everything perceived as opportunity for disaster  Posttraumatic stress disorder o Anxiety disorder in which a person who has experienced a traumatic or life threatening event has symptoms such as psychic numbing, reliving of the trauma, and increased physiological arousal o Brain scans show detachment of PSTD patients was accompanied by increased activity across the lobes of the brain o Most activity in prefrontal cortex around brain o Originally thought trauma shrunk hippocampus  Turns out PTSD RESULT of small hippocampus o PTSD may be result of genetic predisposition, or prior history of psychological problems and other traumatic experiences o Also more self-defeating , lack social and psychological resources EXISTS BEFORE TRAUMA TAKES PLACES Panic Disorder  Anxiety disorder in which a person experiences recurring panic attacks, periods of intense fear, and feelings of impending doom or death, accompanied by physiological symptoms such as heart rate and dizziness  Result of aftermath of stress  ESSENTIAL DIFFERENCE  Lies in how they interpret bodily reaction o People who panic attack happens think they are dying o People with no disorder will shrug it off Fears and Phobias  Phobia o Exaggerated unrealistic fear of a specific situation, activity, or object o Acquired through reflected real dangers, personality differences, or observation of frightening events o Social phobia  Anxious in situations where observed by others, eating in a restaurant, speaking in front of a group of people, or performing to others  Agrophobia o A set of phobia, often set off by a panic attack, involving the basic fear of being away from a safe place or person o Fear of being trapped in a public place “fear of fears” Obsessions and Compulsions  OCD o Anxiety disorder in which a person feels trapped in repetitive, persistent thoughts (obsessions) and repetitive, ritualized behaviours (compulsions) designed to reduce anxiety o Obsessive thoughts reflect impaired ways of reasoning and processing info o People have no control over compulsions  Realize behaviour is senseless, tormented by their rituals  If they forgo it, tormented by anxiety, must give in o Prefrontal depleted of serotonin, several brain parts hyperactive in people o Feel in constant danger to due to constant firing of signals o Example is hoarder, less activity in brain parts involved in decision making Mood Disorders Depression  Major depression o Mood disorder involving disturbances in emotion (excessive sadness), behaviour (loss of interest in one’s activities), cognition (thoughts of hopelessness), and body function o Feel hopeless, think of death and suicide often, exaggerate minor failing, ignore or discount positive events o May overeat, difficulty falling asleep, headaches or inexplicable pain Bipolar Disorder  Bipolar disorder o Episode of depression and mania occur  Wired, irritable when thwarted  Feeling of power, plans based on delusional ideas, thinking they have solved the world’s problems  Rarer, distinctly different, occurs equally  Many people produce best work, but at high cost  Diagnosed amongst many children Origins of Depression  Vulnerability stress model o Approaches that emphasize how individual vulnerabilities interact with external stresses or circumstances to produce mental disorders  Genetic factors o Moderately heritable disorder o Unlikely a single gene directly or inevitably causes severe depression o Long form of one gene apparently helps protect people, short form makes them vulnerable  May affect levels of serotonin and other neurotransmitters  Affect production of stress hormone cortisol o Depressed patients, the system that regulates reactions to stress in overdrive, overproduces cortisol  Life experiences and circumstances o Violence a powerful experience that generates depression o Violent relationship increased rates of depression and anxiety o Higher depression rates among women not due to sexual abuse, more the result of depression o Also condition of people’s lives, satisfaction with work and family o Men more likely to have jobs and marriage, become less depressed o Women more likely than men to live in poverty and suffer from discrimination o Childhood maltreatment associated with high risk of adult depressive episodes  Prolonged stress puts body’s responses to stress in overdrive, overproduces stress hormone cortisol  Cognitive Habits  Involves specific, negative ways of thinking about one’s situation  Depressed people believe their situation is permanent and uncontrollable o Do nothing to improve their lives and remain unhappy o Nothing good will ever happen, powerless to change the
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