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Chapter 1-6

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John Stephens

CHAPTER ONE Psychopathology  The field concerned with the nature and development of abnormal behaviour, thoughts and feelings  Abnormal behaviour- includes such characteristic as statistical infrequency, violation of norms, personal distress, disability or dysfunction and unexpectedness. These are components of abnormal behaviour which are inadequate on their own but each have merit and capture a piece of a full definition  Abnormal behavior criteria: o Statistical infrequency  Most abnormal behaviours are infrequent but so are lots of other things (ex. athletic success) o Violation of norms  Norms are culturally created- what is the norm in one culture is abnormal in another  Prostitutes violate norms and anxious people don’t so it doesn’t fit perfectly o Personal distress  Exceptions: psychopaths don’t feel distress and childbirth causes distress o Disability or dysfunction  Impairment in some important area of life due to an abnormality  Some things that cause disability (like shortness if you want to play basketball) don’t count as abnormal o Unexpectedness  When the reaction doesn’t fit or is disproportionate to the situation Mental Health Professionals  Clinical psychologists o Psychologists usually have a PhD or PsyD o The clinical part means that they have training in diagnostic techniques and that they learn to practice psychotherapy (verbal treatment)  Psychiatrist o Has an MD plus residency in which they learn diagnosis and psychotherapy o Can prescribe psychoanalytic drugs  Psychoanalyst o Has received specialized training at a psychoanalytic institute, usually after an MD and residency  There are also social workers, counseling psychologists and psychiatric nurses  Most mental health care in Canada is given by family doctors History of Psychopathology  Early demonology o The doctrine that an evil being dwells in a person and controls their mind or body o Treatment often involved exorcism- the casting out of evil spirits by chanting or torture o Trepanning (cutting a hole in) skulls was common because they thought the evil spirit would escape through the whole  Somatogenesis o The idea that a problem with the body causes disturbed thought and action o Hippocrates made the separation of medicine from religion, magic and superstition, he thought that deviant thinking and behaviour was caused by brain pathology o Abnormal behaviour became an issue for physicians o Hippocrates classified mental disorders into  Mania- he suggested treating with tranquility sobriety, care in choosing food and abstinence from sex  Melancholia  Phrenitis (brain fever) o He thought that abnormal brain functioning was due to an imbalance in bodily fluids: blood, black bile, yellow bile and phlegm  The dark ages o The church gained power and abnormal behaviour went back to being a religious issue o Monks cared for the sick th o During the 13 century and on, Europeans began to blame witches for their problems and persecuted them o “Witches” were tortured, burned, imprisoned and killed o Most mentally ill people, however, were kept in hospitals run by religious people o They had “lunacy” trials but most people were found sane and mental illness wasn’t as big a thing as people think it was  Development of asylums o Leprosariums were converted into asylums in the 15 and 16 centuries o The Priory of St. Mary of Bethlehem was an asylum that was named Bedlam- a word that now means a scene of uproar and confusion. It begin a tourist attraction to watch the crazy people o The treatment was horrible  Moral treatment o Philippe Pinel called for humanitarian treatment of the mentally ill in asylums o He was put in charge of an asylum in Paris in 1793 and started treatment them as patients o He thought the patients were basically normal people whose reason could be restored to them through counsel and purposeful activity o He still treated lower class patients worse o At this time, drugs began to be used as treatment, but they were very successful o Dorothea Dix crusaded for improved conditions and helped see that state hospitals were built to accommodate patients that couldn’t afford private ones. Unfortunately, these state hospitals were mostly run by doctors who were more into the science side of things than the humane treatment side. o Dorothea also complained about horrible treatment in Canada o Deinstitutionalization began in Canada in the 1970’s  The beginning of contemporary thought o Wilhelm Griesinger pushed back to Somatogenesis o Emil Kraepelin wrote a textbook of psychiatry starting a classification system. She discerned a tendency for a group of symptoms (a syndrome) to appear together regularly enough to deduce that they had a common physical cause o He proposed two groups of mental illness  Dementia praecox (now schizophrenia)- he thought caused by a chemical imbalance  Manic-depressive disorder (not bipolar disorder)- he thought caused by irregularity in metabolism o A biological cause was found for syphilis and general paresis (a deterioration in mental and physical health) in germs so somatogenesis gained credibility o Breuer worked with hysterical patients and found that if he got them to talk freely about upsetting event, they did better, starting the cathartic method o Clarence Hincks started the Canadian National Committee for Mental Hygiene which became the Canadian Mental Health Association and did huge amounts advocating for mental health patients in asylums and he also admitted he had bipolar disorder to try and reduce stigma Canada’s Mental Health System  Medicare- mental health care is part of it  Current stress, social support and childhood trauma relate closely to mental health status  Traditional therapy o The waiting mode o Professionals make themselves available to clients o Includes inpatient and outpatient therapy  Community psychology o The seeking mode o Community psychologists seek out problems and potential problems o They focus on prevention  The Romanow report o Romanow recommended expanding medicare beyond physicians and hospitals o Specific propositions included increased access to drug treatments (especially helpful for those with chronic psychiatric disorders), inclusion of selective home care services, support to informal caregivers and improvement of services to rural areas CHAPTER TWO Paradigm  Set of assumptions that defines how to study and think about a subject and gather relevant info  A conceptual framework or approach in which a scientist works The Biological Paradigm  Aka the medical model, the disease model  A continuation of the somatogenic hypothesis  Mental disorders are caused by aberrant biological processes  Behaviour Genetics o The study of individual differences in behaviour that are attributed in part to differences in genetic make-up o Genotype- unobservable genetic constitution o Phenotype- observable characteristics, the product of an interaction between the genotype and environment o Many clinical syndromes are disorders of the phenotype; just because you have the genotype for the disorder, doesn’t mean you’ll get it (diathesis) (AKA, the predisposition may be inherited, but not the disorder itself) o Methods used to uncover whether a predisposition for psychopathology is inherited:  Family method  First-degree relatives: those who share 50% of their genes, siblings, parents and children  Second-degree relatives: those who share 25% of their genes, nephews and nieces  Index cases or probands are the people who bear the diagnosis in question, their relatives are studied to find out if a higher percentage of their relatives have the diagnoses than the general population  Ex. 10% of first-degree relatives of index cases with schizophrenia have schizophrenia but only 1% of the general population has it  Twin method  MZ and DZ twins are compared  If the twins are similar diagnostically, they are concordant  When the MZ concordance rate is higher than the DZ concordance rate, the characteristic under study is heritable  Adoptees method  Study of kids who were adopted and reared apart from their parents with abnormal disorders  If a high frequency of panic disorder were found in kids reared apart from parents with a panic disorder, genetic predisposition figures in the disorder would be supported  Linkage analysis  Molecular Genetics o Tries to specify the particular genes involved in the genetic component of a disorder and their functions o Genetic polymorphism- variability among members of the species, mutations in a chromosome that can be induced or naturally occurring o Linkage analysis  Researchers study families in which a particular disorder is heavily concentrated and collect diagnostic info and blood samples from family members to try and figure out which genes are related to what o Gene-environment interactions- disorders are the joint product of genetic vulnerability and environmental experiences  Neuroscience and biochemistry in the nervous system o Neurons have cell body, dendrites, axon(s) and terminal buttons o Changes in neurotransmitter levels in adolescence have been linked to increased risk for psychopathology during adolescence o There are theories that a given disorder is caused by too much or too little of a certain neurotransmitter or the receptors on the postsynaptic neuron being too numerous or too easily excited  Biological approaches to treatment o An implication of the biological paradigm is that treatment should be possible through altering bodily functioning o Drugs help interventions because they work fast o Scientists can believe in a biological basis and still suggest psychological interventions (exp. For OCD)  The biological paradigm has been criticized for reductionism- the view that whatever is under study should be reduced to its most basic elements Structure and function of the human brain  Meninges- membranes surrounding the brain, 3 layers  Frontal lobe- higher mental processes and fine voluntary movements  Occipital lobe- vision  Temporal lobe- discrimination of sounds  Parietal lobe- integrates sensory info  Left hemisphere- right side of the body, analytical thinking, speech  Right hemisphere- left side of body, spatial relations, emotion and intuition  Diencephalon o Thalamus- relays sensory info to cerebrum o Hypothalamus- regulates metabolism, temperature, appetite etc.  Midbrain- connects cerebral cortex with pons, medulla, cerebellum and spinal cord  Brain stem- neural relay station o Pons- connects cerebellum with spinal cord and motor areas of the cerebrum o Medulla oblongata- traffic area between spinal cord and higher brain centres o Reticular formation/reticular activating system- works on arousal and alertness  Cerebellum- receives sensory info and integrates it into coordination  Limbic system- primary drives (appetite, sweating, mating, defense etc.) The Psychoanalytic Paradigm  Originally developed by Freud  Psychopathology results from unconscious conflicts in an individual  Classical psychoanalytic theory/ Freud’s original views o Three parts of psyche:  Id  Present at birth  Accounts for basic urges  Seeks immediate gratification (pleasure principle)  Primary process thinking- generating fantasies of what is desired to obtain short-term satisfaction  Ego  Primarily conscious and begins to develop during second six months of life  Secondary process thinking- planning and decision-making  Works on reality principle, mediating between demands of reality and immediate gratification desired by Id  Superego  Develops throughout childhood  Like the conscience  As kids figure out that some of their impulses are unacceptable, they begin to take on some parental values as their own in order to enjoy approval and avoid disapproval  Behaviour is a complex interplay between these three parts which is referred to as the psychodynamics of the personality  Freud thought the most important determinants of behaviour were unconscious o Anxiety  Objective (realistic) anxiety- the ego’s reaction to danger in the external world  Neurotic anxiety- a feeling of fear that is not connected to reality or any real threat  Moral anxiety- when the impulses of the superego punish an individual for not meeting expectations o Defense mechanisms- strategies used unconsciously to protect the ego from anxiety (usually neurotic anxiety)  Repression- pushes unacceptable impulses and thoughts into the unconscious  Denial- pushing a traumatic experiences into the unconscious  Projection- attributing characteristics that an individual has but can’t deal with in their conscious awareness on to other people  Displacement- redirecting emotional responses from a perhaps dangerous object/person to a substitute  Reaction formation- converting a felling into its opposite  Regression- retreating to the behaviour patterns of an earlier age  Rationalization- inventing a reason for an unreasonable action or attitude  Sublimation- converting sexual or aggressive impulses into socially valued behaviours, often creative activity  These all allow the ego to discharge some id energy while avoiding the real problem  Defense mechanisms are mostly maladaptive, though once in a while they’re helpful in certain situations o Freud said that psychopathological problems were caused by things in the system he described (above) not going the right way  Lots of people worked with Freud but disagreed on some things: Jung, Adler  Psychoanalytic therapy o Based on neurotic anxiety- the reaction of the ego when a previously punished and repressed id impulse presses for expression o It attempts to remove the earlier repression and help the client face and resolve the childhood conflict o Techniques used to life repressions  Free association- the patient lies on a couch and is encouraged to give free rein to their thoughts without censoring  Resistances- when the client is suddenly silent or changes the topic, these are the things the therapist wants to dig into more  Dream analysis- the idea is that ego defenses are relaxed in sleep, allowing normally repressed material to enter consciousness  Latent content- this material is so threatening that it usually comes in disguise and is symbolic  Transference- the patients responses to the analyst seem to reflect relationships with important people in the patient’s past, therapists encourage this because it gives them insight into their clients childhood  Countertransference- the analyst’s feelings toward the patient  Interpretation- the analyst points out the meaning of certain behaviours to the patient o Modifications in psychoanalytic therapy  It has been applied to groups as well as individuals  Ego analysis  A greater emphasis is placed on a person’s ability to control the environment and select the time and means for satisfying instinctual drives, contending that the individual is as much ego as id  A greater emphasis on the person’s current living situation is also used  Ego analysts assume that an individuals’ social interactions (the area of the ego) can provide their own gratification  Brief psychodynamic therapy  It was developed for clients who wanted short-term, targeted therapy  Assessments are made rapidly and early, it is clear right away that therapy will be limited and quick improvement is expected, goals are concrete and focus on the worst symptoms, interpretations are more focused on the present than past, transferences isn’t encouraged (except positive to the therapist so client will follow their advice), there’s an understanding that it won’t cure, but rather helped people learn to cope better with stressors  Interpersonal psychodynamic therapy  Emphasizes the interactions between patient and social environment  The basis is that a patient’s problem arises from a misperception created by disorganization in interpersonal relationships in childhood  The therapist is a participant observer (not a blank slate)  Interpersonal therapy- focuses on patient’s current interpersonal difficulties and discusses better ways of relating to others  Freud has been the most honoured and criticized. His theory is based on anecdotal evidence from his patients (not representative) and his personal interest in topics affected his patients.  Three commonly held assumptions that Freud helped make o Childhood experiences help shape adult personality o There are unconscious influences on behaviour o People use defense mechanisms to control anxiety or stress Humanistic and Existential Paradigms  They are based on the assumption that disordered behaviour results from a lack of insight and is best treated by increasing the individual’s awareness of motivations and needs  Places emphasis on the person’s freedom of choice- free will is their most important characteristic  The idea is that therapy is need for those who can’t deal with the suffering caused by free will  It doesn’t worry about the cause of psychological problems and focuses on therapy  Client-centered therapy (Rogers) o Based on these assumptions of human nature  People can only be understood by how they view events, not the actual events  Healthy people are aware of their behaviour- that’s the goal of counseling  Faulty learning causes ineffectiveness and disturbance  Healthy people are goal-oriented and don’t respond passively to their environment or inner drives  Therapists shouldn’t try to manipulate events for clients, but rather facilitate independent decision making and guide toward self-actualization (fulfilling one’s potential) o Interventions  The client should take the lead  Unconditional positive regard- accepting a person for who they are, thought to allow a person’s innate capacity for growth and self-direction to assert itself  It’s not technique oriented, but empathy is key  Primary empathy- therapists understanding, accepting and communicating to the client what they client is feeling  Advanced empathy- inferences by the therapist of the thoughts and feelings that are behind what the client is saying that the client may not really be aware of  The goal is to get a client to adapt a new framework (phenomenology) than what they had before therapy  Existential therapy o A bit gloomier than humanistic therapy. It still emphasizes free will, but also the anxiety that is inevitable from making life choices o Goals  Encourage clients to confront their anxiety concerning choices  Get the client to behave differently toward the therapist and outside world in order to change their existential condition  People need to be encouraged to accept responsibility for their existence and realize that they can redefine themselves at any moment and behaviour and feel differently in their social environment  Gestalt therapy o People have an innate goodness and this should be allowed to express itself o Psychological problems are caused by frustrations and denials of this goodness o The main goal is to help clients understand their needs, desires and fears and how they block themselves from reaching their goals and satisfying their needs o Gestalt therapy techniques  Mostly focuses on present  Noted for having technique (unlike humanistic and existential therapies)  I-language- encourages patients to take responsibility for their feelings and behaviour (“I am crying”)  The empty chair- a client projects and talks to the projection by visualizing a significant other  Projection of feelings- think about a person then look at partner, think about something neutral then look at partner- proves the impact of feelings on our interactions  Attending to nonverbal cues- therapists pay attention to nonverbal and paralinguistic cues  The use of metaphor- unusual scenarios are used to make a point Learning (Behavioural) Paradigms  Abnormal behaviour is viewed as responses learned in the same ways that other human behaviour is learned  Behaviourism- an approach that focuses on observable behaviour rather than consciousness  Three types of learning o Classical conditioning- Pavlov  Unconditioned stimulus- a stimulus that elicits a response without prior learning  Unconditioned response- a natural response  Conditioned stimulus- a thing that used to be neutral that, after conditioning, produces a response (sometimes the same as the UCS)  Conditioned response- the response that was attached to the CS  Extinction- when the CS is produced again and again without the reward, so the CR gradually disappears  Classical conditioning could be a cause of phobias because fear can be conditioned o Operant conditioning  Thorndike:  Law of effect- behaviour that is followed by satisfying consequences is repeated, behaviour that is followed by unsatisfying consequences is discouraged  Instrumental learning- learning that focuses on consequences  Skinner:  Operant conditioning- focuses on the relationships between stimuli and responses  Discriminative stimulus- external events that tell an organism that if it performs a certain behaviour, a certain consequence will follow  Positive reinforcement- the strengthening of a tendency to respond through a positive reinforcer  Negative reinforcement- strengthens a response through the removal of an aversive event (negative reinforcer)  Skinner argues that free-will doesn’t exist and all behaviour is determined by reinforcers in our environment  Shaping- rewarding a series of responses that are successive approximations of the desired response  Abnormal behaviour can be produced by operant conditioning (aggressiveness being rewarded) o Modelling  Watching and imitating others  Bandura’s four parts to observational learning  Attention- noticing behaviour  Retention- remembering behaviour  Reproduction- doing  Motivation- repeating behaviour if they received positive consequences  Mediational theory of learning o An environmental stimulus doesn’t initiate an overt response directly, but through a mediator, such as fear or thinking  Behaviour therapy/ behaviour modification o Applies procedures based on classical and operant conditioning to alter clinical problems o Counterconditioning and exposure  Counterconditioning- relearning achieved by eliciting a new response in the presence of a particular stimulus  Systematic desensitization- the client makes a list of things that create anxiety and they work through the list, relaxing while thinking about those things and then working on gradually harder situations  Aversive conditioning- a stimulus that is attractive to the patient is paired with an unpleasant event, in the hope of endowing it with negative properties, pretty tricky with ethics and is now rare in NA o Operant conditioning  Problem behaviour is analyzed to try and figure out what’s reinforcing it. It’s usually attention seeking, escape from tasks, the generation of sensory reinforcement or accessing tangible items or other reinforcers  The idea is that the same learning conditions and processes that created maladaptive behaviour can be used to change it (unlearn it)  Token economy- tokens are given for desired behaviour and can later be exchanged for desirable items and activities o Modelling  Usually involves seeing someone else calmly deal with something (dentist, snakes etc.)  Assertion training- encouraging socially inhibited people to express their feelings openly and spontaneously  Learning theories are great for some things but don’t work for everything (depression)  Just because treatment based on learning principles works, doesn’t mean that’s how the behaviour was forming originally The Cognitive Paradigm  Focuses on how people structure their experiences and relate to past ones stored in memory  Schema- organized network of already accumulated knowledge  New info may fit the schema, and if not, the learner adjusts the schema or the info so it does fit  Cognitive behaviour therapy o A blend of the cognitive and learning paradigms o Cognitive restructuring- changing a pattern of thought that is presumed to be causing a disturbed emotion or behaviour o Beck’s cognitive therapy  Developed a cognitive therapy for depressed based on the idea that a depressed mood is caused by distortions in people’s perception of experiences  The therapist often provides examples of the client overlooking favourable things o Elli’s rational-emotive behavioural therapy  His idea was that emotional reactions are caused by internal sentences that people repeat to themselves that sometimes reflect irrational beliefs about what is necessary for a meaningful life  The goal is to eliminate self-defeating beliefs through rationally examining them  Therapists get the client to see that looking at their emotions rationally will help them and that changing their self-talk is important (how they go about this varies) o Meichenbaum’s cognitive-behaviour modification  Emphasizes the narrative organization of experience o Behavioural therapy and CBT in groups  Criticisms o There’s no real explanation for the history of disorders Consequences of adopting a paradigm  If you choose a specific paradigm, you’ll probably ignore other possibilities and info  Eclecticism- employing ideas and therapeutic techniques from a variety of schools  Prescriptive eclectic therapy- the main approach employed by most clinicians  Even clinicians who use a certain paradigm often incorporate aspects of other ones that they know from experience work Diathesis-stress paradigm  An integrated paradigm linking biological, psychological and environmental factors  Focuses on the interaction between a predisposition toward disease (diathesis) and life disturbances (stress)  Both diathesis and stress are necessary for the development of disorders  We don’t really understand the nature of the diathesis but we know it exists Biopsychosocial paradigm  Another, similar integrated paradigm  Explanations for the causes of disorders usually involve complex interactions among many biological, psychological and socio-environmental and socio-cultural factors  It accepts the interplay of many factors and draws on diverse sources of info about the causes of psychological disorders  Both these paradigms focus on factors that put people at greater risk for disorders and also resilience (factors that create protection from risk factors)  Resilience can occur in the individual or environment  SES and mental illness are correlated, but it is unknown which causes which or if a third variable causes both Cultural considerations  Generally, mental health problems are similar between Canadians of different ethnicities, except for Aboriginals  Healthy immigrant effect- recent immigrants to Canada are generally in better mental health than average Canadians, probably due to pre-screening of immigrants  Minority groups tend to underuse mental health services, especially Asians (they tend to use informal supports like family) o Two reasons: poor English language ability and a culturally determined interpretation of psychological disorders that decrease the likelihood of them getting help CHAPTER THREE Diagnostic and statistical manual of mental disorders (DSM)- the official diagnostic system employed by mental health professionals History of Classification  During the 19 and early 20 centuries, there was lots of inconsistency in classifying abnormal behaviour and there were several attempts to create classification systems, but none of them were widely adopted  In 1948, the World Health Organization (WHO) incorporated a classification of abnormal behaviour into their International statistical classification of disease, injuries and causes of death but the abnormal behaviour part was really controversial and not widely adapted.  Despite their work with the WHO, the APA published the first DSM in 1952  Both the WHO and DSM were updated and more widely accepted 20 years later, but didn’t actually specify the symptoms that went with specific disorders  The DSM-III (1980) was extensively revised and pretty good, and the DSM-IV is even better, thought there still is controversy Diagnostic system of the DSM-IV  Definition of Mental disorder- a clinically significant behavioural or psychological syndrome or patter that occurs within an individual and is associated with present distress or disability or a significantly increased risk of suffering death, pain disability or loss of freedom  Five dimensions of classification- multiaxial classification- each individual is rated on five separate dimensions 1. All diagnostic categories except personality disorders and mental retardation 2. Personality disorders and mental retardation 3. General medical conditions 4. Psychosocial and environmental problems 5. Current level of functioning (global assessment of functioning)  Axis 1 and II compose the classification of abnormal behaviour  They are separate to encourage the consideration that a client had an axis II disorder prior to them seeking help for their axis I disorder  Diagnostic categories o Disorders usually diagnosed in infancy, childhood or adolescence  Separation anxiety disorder  Conduct disorder  Attention-deficit/hyperactivity disorder  Mental retardation  Pervasive developmental disorders (includes autistic disorder)  Learning disorders o Substance-related disorders- diagnosed when the ingestion of some substance has changed behaviour enough to impair social or occupational functioning o Schizophrenia- contact with reality is faulty; language, communication and emotions are disordered o Mood disorders  Major depressive disorder  Mania- overly euphoric, irritable and distractible  Bipolar disorder- if a person experiences episodes of mania and depression o Anxiety disorders  Phobia  Panic disorder  Generalized anxiety disorder  OCD  PTSD  Acute stress disorder (like PTSD but symptoms don’t last as long) o Somatoform disorders  Somatization disorder- long history of physical complaints for which one has taken medicine or seen doctors  Conversion disorder- loss of motor or sensory function  Pain disorder- severe and prolonged pain  Hypochondriasis- misinterpretation of minor physical sensations as serious illness  Body dysmorphic disorder- preoccupation with an imaginary defect in appearance o Dissociative disorders  Dissociative amnesia- may forget entire past or particular time period  Dissociative fugue- individual suddenly travels to a new place and starts a new life and can’t remember past identity  Dissociative identity disorder- possessing two or more distinct personalities  Depersonalization disorder- severe feeling of self-estrangement or unreality o Sexual and gender identity disorders  Paraphilias- unconventional sources of sexual gratification  Sexual dysfunctions- inability to complete usual sexual response cycle  Gender identity disorder- feeling extreme discomfort with anatomical sex and identify themselves as the opposite sex o Sleep disorders  Dyssomnias- sleep disturbed in amount, quality or timing  Parasomnias- unusual event occurs during sleep o Eating disorders  Anorexia nervosa  Bulimia nervosa o Factitious disorder- intentional production or complaint of symptoms due to the need to assume the role of a sick person o Adjustment disorders- involves development of emotional or behavioural symptoms following the occurrence of a major life stressor o Impulse-control disorder  Intermittent explosive disorder- person has episodes of violent behaviour that result in destruction of property or injury to others  Kleptomania- repeated stealing, not for the value or use of object  Pyromania  Pathological gambling- preoccupation with gambling as an escape from problems  Trichotillomania- irresistible urge to pull out hairs o Personality disorders  Schizoid personality disorder- person is aloof, has few friends and indifferent to praise and critiques  Narcissistic personality disorder- overblown sense of self-importance, likely to exploit others  Anti-social personality disorder (aka psychopathy)- looks like a conduct disorder before 15, indifference toward the law, future and responsibility. No guilt or shame o Other conditions that may be a focus of clinical attention  Anything else that may be a focus of attention or treatment o Delirium, dementia, amnestic and other cognitive disorders  Delirium- clouding of consciousness, wandering attention, incoherent stream of thought  Dementia- deterioration of mental capacities, especially memory  Amnestic syndrome- impairment in memory when there’s no delirium or dementia Issues in the classification of abnormal behaviour  Criticisms: o Some say classification results in a loss of info about that person and their uniqueness o In classifying people into the same group, we may be ignoring important differences between them o Being classified could have a negative effect on the client and their interactions o Discrete entity verses continuum  The DSM uses a categorical classification (yes or no approach) which critics say doesn’t allow for a continuum between normal and abnormal  Dimensional classification has things ranked on a quantitative dimension which can have a cut-off point which shows there’s a disorder and can help people with some symptoms that don’t “qualify” for a diagnosis  Value: o Noticing differences in groups of people with abnormal behaviour can contribute to the causes and treatments of the behaviours (treatments that are helpful for one subset of a disorder aren’t for others)  Reliability- does it get the same result each time? o Inter-observer reliability- do two judges agree on an event? o Sensitivity- agreement regarding presence of a diagnosis o Specificity- agreement concerning the absence of a diagnosis  Validity o Construct validity- to what extent does the construct enter into a network of lawful relationships? How do findings relate to other pieces of the theory or hypothesis? CHAPTER FOUR Reliability  Refers to consistency of measurement  Inter-rater reliability o The degree to which two independent observers agree  Test-retest reliability o The extent to which people being observed twice or taking the same test twice score generally the same way o It only makes sense when the theory assumes that people won’t change between testings on the variable being measured  Alternate-form reliability o The extent to which scores on different forms of a test are consistent  Internal consistency reliability o Assess whether the items on a test are related to one another  The higher the correlation, the better the reliability Validity  Whether a measure fulfills its intended purpose  Note that if reliability is now then validity will be low  Content validity o Whether a measure adequately samples the domain of interest (does it measure the right thing)  Criterion validity (aka predictive validity) o Evaluated by determining whether a measure is associated in an expected way with another measure o Concurrent validity- when both variables are measured at the same point in time  Construct validity o Relevant when we want to interpret a test as a measure of something that is not simply defined o Test validity measures the certain construct Psychological assessment  Clinical interviews o Differs from other interviews because  The interviewer pays more attention to how the respondent answers or doesn’t answer questions  The paradigm the interviewer uses likely influences the info sought and how it is obtained and interpreted o The information is not always dependable because of the situation o Structured interviews  An interview in which questions are set out in a prescribed fashion for the interviewer in order to assist researchers and clinicians in making diagnostic decisions  Ex. Structured Clinical Interview Diagnosis (SCID)  Symptoms are rated on a 1-3 severity scale. If it’s a 1 for a couple question about one diagnoses then the interviewer moves on, but if it’s a 2 or 3 then more questions about that problem are asked  Psychological tests o Standardized procedures designed to measure a person’s performance on a particular task or to assess their personality, thoughts, feelings or behaviour o Often reveal things that the client left out in the interview o Statistical norms have been established for these tests (standardization) and clients are compared to these norms o Personality inventories  The person completes a self-report questionnaire indicating whether statements assessing habitual tendencies apply to him or her  Most used is the Minnesota Multiphasic Personality Inventory (MMPI)  Designed to detect a number of psychological problems  Can be “psyched out” but usually aren’t because people want help o In order to help, validity scales are added through adding questions that set a trap for a person who is trying to look too good o Projective personalit
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