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Chapter 17

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Eileen Wood

o Clinicians evaluate each client according to the five axes, or dimensions (primary clinical problem, ingrained aspects that affect the person’s ability to be treated, medical conditions or medication that could contribute, social and environmental stressors that make it worse, and a global assessment of the client’s overall functioning in work, etc…) o Number of disorders is increasing o Problems with the DSM  Danger of over diagnosis – could think that many people have a disorder (e.g ADHD)  Power of diagnostic labels – reassures people who are seeking an explanation for their symptoms but it may not actually be the case…label sticks on them.  Confusion of serious mental disorders with normal problems – implies that everyday problems are comparable to disorders and are equally likely to require treatment  Illusion of objectivity and universality – vain attempt to impose a veneer of science on an inherently subjective process  Sam Cartwright argued that slaves were suffering from drapetomania – urge to escape slavery –so doctors could assure slave owners that they had a mental illness that wanted them to escape  Critics feel that diagnoses depend on a cultural consensus, not on empirical evidence about what constitutes normal behaviour and a mental disorder o Advantages of the DSM  When the manual is used correctly and diagnoses are made with valid objective tests, DSM improves reliability of diagnosis o Culture bound syndromes: disorders that are specific to particular cultural contexts - Dilemmas of measurement o Projective tests: psychological tests used to infer a person’s motives, conflicts, and unconscious dynamics on the basis of the person’s interpretations of ambiguous stimuli – ambiguous pictures, sentences, or stories  Disorder revealed in person’s responses  Rorschach Inkblot Test: one of the most popular projective tests consisting of 10 cards with symmetrical and abstract patterns – taker reports what they see and it is interpreted by symbols emphasized by psychodynamic theories  Used with young children to reveal feelings that they can’t verbally o Objective tests (inventories): standardized objective questionnaires requiring written responses; typically include scales on which people are asked to rate themselves  Minnesota Multiphasic Personality Inventory (MMPI) – most widely used test for assessing personality and emotional disorders; organized into 10 categories or scales covering many problems and four additional validity scales indicate if the test taker is lying, defensive, or evasive while answering  More reliable and more valid than projective and subjective methods – fail to take into account different cultural groups Anxiety Disorders - Chronic anxiety (long-lasting feelings of apprehension and doom), panic attacks (short- lived but intense feelings of anxiety), phobias (excessive fears of specific things or situations), obsessive-compulsive disorder (OCD – repeated thoughts and rituals are used to ward off anxiety) - Anxiety and panic o Generalized anxiety disorder: continuous state of anxiety marked by feelings of worry and dread, apprehension, difficulties in concentration, and signs of motor tension – majority of days on a six month period o Posttraumatic stress disorder (PTSD): anxiety disorder in which a person who has experience a traumatic or life-threatening event has symptoms such as psychic numbing, reliving of the trauma, and increased psychological arousal  Symptoms include insomnia, agitation, jumpiness persisting for more than a month and impair a person from functioning  Difficult to study because symptoms can be intermittent rather than continuous  Hippocampus is apt to be smaller than average – autobiographical memory  Most people recover without developing PSTD from a traumatic experience  Can be heritable and people that develop long-lasting PSTD have a prior history of psychological problems o 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 rapid heart rate and dizziness  Can last a few minutes to several hours  Symptoms include trembling and shaking, dizziness, chest pain or discomfort, rapid heart rate, feelings of unreality, hot and cold flashes, sweating, and as a result fear of dying, going crazy, or losing control – heart attack feelings  Occur in aftermath of stress, prolonged emotion, specific worries, or frightening experiences  Difference between people who develop panic disorder and don’t lies in how they interpret their bodily reactions - Fear and Phobias o Phobia: exaggerated, unrealistic fear of a specific situation, activity, or object o People with a social phobia become anxious in situations in which they will be observed by others…worry that they will do or say something that will embarrass them. They can be o Feel like they have no control over the compulsions o Prefrontal cortex is depleted of serotonin, which creates a kind of cognitive rigidity o Several parts of the brain are hyperactive – one area of the frontal lobes sends messages of danger to other areas to prep the body to feel fear and danger o Hoarders have less activity in parts of the brain involved in decision making, problem solving, and memory - Depression o Major depression: mood disorder involving disturbances in em
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