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Chapter 15

Psych 101 Detailed Textbook Notes: Chapter 15

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Wilfrid Laurier University
Kathy Foxall

Psych Chapter 15 DEFINING AND DIAGNOSING DISORDER Dilemmas of Definition  The definition of a disorder depends on which perspective you look at it from: 1. Mental disorder as a violation of cultural standards  Emphasizes rules and roles of the culture  Every society sets up standards, when they are not met it’s considered deviant  Our culture vs. others on things such as hearing the voice of a dead loved one, might think it’s normal or might think they’re crazy 2. Mental disorder as emotional distress  Identified in terms of a person’s suffering  A behaviour that is upsetting for one person may be normal for another  Does not cover people who are disturbed but feel no regret 3. Mental disorder as behaviour that is self-destructive or harmful to others  Emphasizes negative consequences of a person’s behaviour  Some behaviour is harmful to the sufferer, ex. alcoholic can’t hold a job  Other might report feeling fine, yet behaviour is disruptive or out of touch with reality, ex. when a child sets fires  Mental Disorder – 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  7% of US population suffer from mental illnesses that are seriously debilitating  Nearly half fall victim to other things such as drug abuse, depression, anxiety  Mental disorders are the leading cause of disability Dilemmas of Diagnosis  Classifying disorders: the DSM o Standard reference manual used to diagnose mental disorders is the Diagnostic and Statistical Manual of Mental Disorders o Primary aim is descriptive: to provide clear categories to agree upon & then treat o Clinicians are encouraged to evaluate each client according to five axe: 1. The primary clinical problem (ex. depression) 2. Ingrained aspects of the client’s personality that are likely to affect the person’s ability to be treated, such as negative emotionality (neuroticism) 3. Medical conditions or medications that might contribute to symptoms 4. Social and environmental stressors that can make the disorder worse 5. A global assessment of the client’s overall level of functioning in work, relationships, and leisure time. Also whether the problem is recent, how intense, and how long of a duration o Might not be relevant to legal judgements o Economic reason for the explosion of mental disorders  Problems with the DSM: 1. The danger of over diagnosis  “if you give a small boy a hammer, it will turn out that everything he runs into needs pounding”  New diagnostic label, all of a sudden everyone they meet has symptoms  Example would be ADHD in boys  Normal rowdy boy behaviour is turned into a psychological problem  Only about 20% of children diagnosed with bipolar disorder meet the strict criteria 2. The power of diagnostic labels  Everyone wants an explanation for their emotional problems/symptoms  Once labelled with a diagnosis, it sticks to their personality  Like diagnostic stereotyping, people will ignore any changes in behaviour or when they are not being defiant 3. The confusion of serious mental disorders with normal problems  Each edition of the DSM adds more everyday problems  Implies that everyday problems are comparable to disorders and equally likely to require treatment  Ex. shopping addiction, mathematics disorder, binge eating 4. The illusion of objectivity and universality  Attempts to impose an appearance of science on a subjective process  Decisions about what to include as a disorder are based on group consensus and not empirical evidence  Reflects prevailing attitudes and prejudices o Prejudices are easily identified in the past – drapetomania, the urge to escape from slavery o Doctors could assure slave owners it was the mental illness, not the intolerable condition of slavery that made them seek freedom o Current prejudices are also present, ex. wanting sex too much, or not enough  Advantages of the DSM o Many psychological symptoms fall along a continuum ranging from mild to severe o When used correctly and diagnoses are made with valid tests, it improves the reliability of diagnosis o Helps clinicians distinguish among disorders that share symptoms to select the best treatment Culture and Mental Illness  Some disorders occur in all parts of the world  Culture influences and shapes the particular symptoms,  Which symptoms people will and will not reveal varies in ethnic groups, ex. crying  Difficulty in diagnosing mental disorders is raised by culture-bound syndromes o Defn: disorders that are specific to particular cultural contexts  These syndromes rarely overlap with DSM diagnostic categories, yet cause great suffering and qualify as mental disorders in themselves Dilemmas of Measurement  Projective Tests o Defn: psychological tests used to infer a person’s motives, conflicts, and unconscious dynamics on the basis of the person’s interpretations of ambiguous stimuli o Consists of pictures, sentences, or stories the test taker is asked to interpret or complete o Hopes that the unconscious thoughts and feelings will be revealed in their answers o Helps clinicians establish rapport o Lack reliability and validity, making them inappropriate for most uses o The clinician interprets same scores differently, perhaps projecting their own beliefs and assumptions o Many factors such as sleepiness, hunger, worry, the clinician’s instructions, can all affect the response o Rorschach Inkblot Test  Consists of 10 symmetrical abstract patterns, originally formed by spilling ink and folding the paper in half  Failed to confirm validity o Used to help young children express themselves non-verbally o Some therapists began using dolls as a way to tell whether or not a child had been sexually abused  How they play with dolls that have realistic genitals  They never compared results to a control group – non-abused children were just as fascinated with the dolls’ anatomy  Inconclusive o Also used in child-custody assessments  Objective Tests o Defn: standardized objective questionnaires requiring written responses; they typically include scales on which people are asked to rate themselves o Used for assessing behaviour and feelings o The Minnesota Multiphasic Personality Inventory (MMPI)  Organized into 10 categories or scales  Four additional validity scales show whether a test taker is likely to be lying, defensive, or evasive while answering  Generally more reliable than projective and subjective methods  Although fails to take into account cultural, regional, and sociocultural groups  Released the revised MMPI-2  Presents false positives  Labelling a person’s response as a mental disorder when it’s not  Inappropriately used in settings not trained in testing  Ex. business, legal settings, schools ANXIETY DISORDERS  Anxiety and fear are both adaptive emotions because they energize us to cope with danger, ex. first parachute jump – do you know how to operate the parachute first? Anxiety and Panic  Generalized Anxiety Disorder o Defn: a continuous state of anxiety marked by feelings of worry and dread, apprehension, difficulties in concentration, and signs of motor tension o Occurs on a majority of days during a 6 month period o Not brought on by physical causes o Do not have to go through an anxiety-producing event  May have physiological tendency to experience anxiety symptoms  Genes also play a role – can cause abnormalities in the amygdala (fear) and the prefrontal cortex (ability to realize when danger has passed)  Posttraumatic Stress Disorder o Defn: an 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 If symptoms of stress from a traumatic event such as war, rape, torture, sudden bereavement, etc. persist for a month of longer, the sufferer may have PTSD o Used fMRI technology to study neural circuitry - UWO  PTSD symptoms can be intermittent  Read participants stories on certain subjects  Those who reported a sense of detachment showed symptoms of PTSD  Most activity found in the prefrontal cortex and cortex o Hippocampus is apt to be smaller  Crucially involved in autobiographical memory o Study with twins – only one served in Vietnam  If trauma shrinks the hippocampus, one twin’s should be smaller  Not true, 2 things were necessary for a vet to develop PTSD: 1. Serving in combat 2. Having a smaller hippocampus than normal o Most people recover, other do not because:  Genetic predisposition – there is a heritable component  Prior history of psychological problems with poor emotional adjustment o More likely than resilient people to have neuroticism and sub-par intelligence o Many cases are a result of trauma that took place before  Panic Disorder o Defn: an 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 rapid heart rate and dizziness o Panic attacks may last from a few minutes to several hours o As a result of physical reactions, sufferers fear they are having a heart attack o Delayed attacks are common o The difference of who develops it lies in how they interpret their bodily reactions Fears and Phobias  Defn: an exaggerated, unrealistic fear of a specific situation, activity, or object  Fears such as snakes, heights, etc. may have evolved to be easily acquired in humans because these fears reflected real dangers to the species  Fears such as cats, or the colour purple may be acquired through classical conditioning or seeing a frightening event happen to someone else  Fears such as dirt and germs, or the number 13 may reflect personality differences or cultural traditions  Social phobias o Ex. eating at a restaurant, public speaking, performing for others o The thought of it is enough to cause sweating, trembling, nausea, etc. o Therefore do not follow through, increasing isolation and imagined fears  Most disabling fear disorder is agoraphobia o Defn: a set of phobias, often set off by a panic attack, involving the basic fear of being away from a safe place or person o Agora – public meeting place away from home o Being trapped in a public place where escape might be difficult or where help might be unavailable if the person has a panic attack o Ex. movie theatres, stuck in traffic, parties o After randomly onset panic attack, person will begin to avoid situations that they think will provoke another one o Regarded as a “fear of fear” Obsessions and Compulsions  Obsessive-compulsive disorder o Defn: an anxiety disorder in which a person feels trapped in repetitive persistent thoughts (obsessions) and repetitive, ritualized behaviours (compulsions) designed to reduce anxiety o Reflect impaired ways of reasoning and information processing o People feel they have no control over their compulsions o The prefrontal cortex is depleted of serotonin – creates an inability to let go of certain thoughts o Frontal lobes send out messages warning danger, with OCD false alarms go off  Constant state of danger  Tries to reduce the resulting anxiety o Hoarders PET scan  Less activity in parts of the brain involved in decision making, problem solving, spatial orientation, and memory  Keep things because they can’t decide what to throw away  Leave them in sight because they can’t remember where they put them MOOD DISORDERS Depression  Major Depression o Defn: a mood disorder involving disturbances in emotion (excessive sadness), behaviour (loss of interest in one’s usual activities), cognition (thoughts of hopelessness), and body function (fatigue and loss of appetite) o Feel unable to get up and do things o Thoughts of death and/or suicide o Exaggerate minor failings and ignore positive events o Interpret everything that goes wrong as evidence that nothing will ever go right o Conclude that they will never be happy ever again o Occurs twice as often among women as among men o “women think and men drink”  Bipolar Disorder o On the opposite side of depression is mania  High state of exhilaration  Person feels powerful and full of plans based on delusional ideas  People in a state of mania often get into trouble, go on spending sprees, make impulsive or bad decisions, have risky sexual adventures o When people experience at least one episode of mania altering with episodes of depression, they are said to have bipolar disorder  Defn: a mood disorder in which episodes of both depression and mania occur  Formerly called manic depressive disorder o Occurs equally in both sexes Origins of Depression  Researchers emphasize vulnerability-stress models of mental disorders o Defn: approaches that emphasize how individual vulnerabilities interact with external stresses or circumstances to produce mental disorders  Contributing factors in depression: 1. Genetic factors  Moderately heritable disorder  Identified a gene called 5-HTT that comes in two forms  Long form – helps protect people from depression  Short form – makes them more vulnerable to it  In depressed people, the system that regulates reactions to stress is in overdrive, and keep producing cortisol  New Zealand study  Anti-depressants raise serotonin, low serotonin did not cause depression
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