Psychopathology 751

1
Psychopathology 751
? diathesis stress models ? uses/problems with
diagnostic enterprise ? evolutionary thoughts
2
theory in psychopathology

• Diathesis Complexities
• Include perhaps include cognitive deficits/styles
  but harder to differentiate from symptoms of
  disorders.
• I favor focusing attention on those at a
  somewhat lower level of functioning (soft
  neurology and psychophysiology) rather than
  social behavior, or even psychometrics, on the
  ground that the former kinds of behavior are
  closer to the DNA and so have, by and large, been
  subject to less influence from complex social
  learnings contributing to individual differences
  variation and, hence, to increased statistical
  overlap. (Meehl, 1990, p. 3).

3
theory in psychopathology

• Stress
• an interference or change in conditions
  affecting the individual which has an adverse
  effect, such as worry or hostility, especially
  when prolonged also external conditions
  producing anxiety Walton, 1985, p.157.
• state like (versus trait of diathesis)
• desire to create objective, temporally proximal
  stress definition.

4
theory in psychopathology

• Difficulties defining Stress
• Difficult but worthy goal to reduce the reliance
  on individual differences in stress definitions
  (what makes me stressed out is because these
  differing stressor may reflect various diatheses.
  
• e.g., shy people stress in social situations
  whereas extroverts enjoy such contact.

5
theory in psychopathology

• DiathesisStress Model put forth by Paul Meehl
  (1962)
• Argued that vulnerability interacts with stress
  (i.e., schizogenic mother) to cause
  schizophrenia.
• Posited that without right kind/amount of stress,
  an individual will have a residual, genetically
  coded, condition he labeled schizotaxia which he
  saw as akin to a necessary but not sufficient
  condition for schizophrenia.

6
theory in psychopathology

• DiathesisStress Model
• elegant
• fits data that humans are genetically coded to be
  the least biologically determined animals. We are
  the animal most open to good and environmental
  influence (culture, language)
• limitations
• In the simplified model we are seduced into a
  limited view of both vulnerability and stress as
  unidimensional but they are not.
• e.g., time of stressor may be very important,
  most disorders are polygenic

7
theory in psychopathology

• DiathesisStress modified models
• additive model
• stress causes x disorder but those with a low
  level of diathesis require much more
  stressimplies that disorder x will occur with
  sufficient stress
• threshold model
• sufficient diathetic risk required to develop x
  disorder
• at some threshold of diatheses, the individual
  will develop disorder x (without stressors).

8
theory in psychopathology

• DiathesisStress complications
• diathesisstress interactions
• complicate the picture by questioning the
  independence of diatheses and stressors.
• diathesis may cause stressors (e.g., traits of
  anxiousness and introversion may lead to greater
  strain in social support
• timing of stressors may be critically linked
• x stressor my be crucial a y developmental window
  but not important before/after
• multiple genetic pathways may independently
  contribute to clinical condition (hard to
  measure)
• genetics probably code for both vulnerability and
  protection (stress may work similarly)

9
psychodiagnosis

• Why diagnose? Many clinical reasons
• treatment planning
• predict outcomes/responses
• protection of consumers (informs client what to
  expect)
• can be used to communicate empathy
• reduce risk of flight from treatment
• nomenclature for communication
• organize, retrieve info
• describe patterns
• facilitate theory/research
• socio-political functions (who are patients, who
  gets to treat whom?)

10
psychodiagnosis

• Whats wrong with the DSM-III (III-R, and IV)?
• Valliant
• it is parochial
• reductionistic
• muddles state and trait
• no theory (ignores conflict, adaptation,
  development, time course of symptoms)
• validity sacrificed for reliability

11
psychodiagnosis

• More problems with the DSM-IV
• Co-morbidity threatens specificity of treatment
  goal.
• not very good reliability under the best of
  circumstances
• those kappa estimates are under structured
  diagnostic interview conditions but you wont be
  applying the DSM under such circumstances
• there is no gold standard (its a
  consensus/compromise document).

12
(No Transcript)
13
psychodiagnosis

• ALTERNATIVE MODELS
• Use taxometrics to help identify discrete
  disorders
• schizophrenia, schizotypy, unipolar and bipolar
  disorders, anti-social PD
• from those probably not dysthymia, impulse
  regulation problems
• Dimensional models such as
• Watson and Clarks
• Eysencks Model
• Widiger et al.s (1987) model with superordinate
  traits of social involvement, assertiveness,
  anxious

14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17

• A few evolutionary thoughts (de Waal)
• a point or two to ponder
• the presence of observable behaviors/traits do
  not imply adaptive success/fitness.
• the position that aberrant behaviors are adaptive
  has to account for majority of folks w/out beh.
• rape, murder, etc.
• ideas more consistent with the data
• we have a wide range of possible behaviors that
  can be learned. we are coded to be possible
  murderers, rapists, etc.
• conservation of formnature can only use what is
  available
• if specific traits are not sufficiently
  maladaptive they will not be removed from our
  genotype.

18

• A few more evolutionary thoughts
• evolution requires
• small isolated gene pool of organisms mating so
  that a particular trait can become dominant
• think of the Galapagos islands of Darwins
  finches
• FINCHES!
• Check em out (with pictures!)
• http//www.rit.edu/rhrsbi/GalapagosPages/DarwinFi
  nch.html

19

• A few more evolutionary thoughts
• "Seeing this gradation and diversity of structure
  in one small, intimately related group of birds,
  one might really fancy that from an original
  paucity of birds in this archipelago, one species
  had been taken and modified for different ends.
• Darwin The Voyage of the Beagle, 1909
• evolution requires
• pressures towards fitness (organisms w/out x
  trait need to fail to reproduce or be outstripped
  in future procreation)
• we are not evolving.
• we do not effectively practice eugenics (Hitlers
  efforts notwithstanding)
• the handicapped/disabled folks procreate

20

• The Concept of a Mental Disorder (Wakefield)
• there are no mental illness
• labels are used for pathologizing the difficult,
  undesirable, etc. social control.
• refutation yes, there are no diseases only
  what we decide are natural circumstances that
  precipitate death, but there is harmful mental
  dysfunction.
• disorders as whatever professionals treat
• personal attributes that are of therapeutic
  concern
• refutation not specific enough. what about
  marital distress, occupational concerns, etc.
• disorder as statistical deviance
• objective/scientific, deviation from the mean.
• refutation/problems what about the other end of
  scale??extreme conscientiousness, intelligence,
  what qualifies as a dimension? clumsy, short,

21

• disorder as biological disadvantage
• 1. harmful dysfunction (science) values (real
  harm)
• dysfunction as unfulfilled function-emotions as
  information.
• (problem here with assumed functions that we
  dont really understand and mental functions may
  not be as functionally hardwired but flexible by
  design.
• harm requires values such as freedom, distress,
  symptoms.
• fits with Freud (repression) and Behaviorism
  (distressing maladaptive behaviors).