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Psychological Disorders

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Title: Psychological Disorders


1
Psychological Disorders
2
Defining Psychological Disorders
  • What does it mean to be abnormal?

3
What is abnormal?
  • Psychological disorders are also often referred
    to as abnormal psychology
  • If we define normality as what most people do
  • Then abnormality becomes something unusual or
    rare that people do.
  • What are the potential problems with labeling
    people abnormal or psychologically disordered
    based upon this criteria?

4
What is abnormal? (cont.)
  • For instance, if you were walking down the street
    and someone hissed at you, what would you think?
  • What would come to mind if you saw two male
    friends holding hands?
  • What about if your friend got really upset with
    you for using a straw?
  • If someone suggested cutting a hole in your skull
    to cure your headache, would this seem like a
    normal solution to you?

5
What is abnormal? (cont.)
  • Some cultures have social practices that may be
    considered abnormal compared with most social
    practices in contemporary U.S. culture.
  • We have to be careful with who or what we label
    abnormal.
  • Hissing is a polite way to show respect for
    superiors in Japan.
  • Public displays of affection between men and
    women in Thailand are unacceptable.
    Interestingly, however, men holding hands is
    considered a sign of friendship. Additionally,
    the use of straws is considered vulgar.
  • Ancient cultures used trephining a practice of
    cutting a hole in the skull to release evil
    spirits that caused migraines or epilepsy (more
    on this in the Treatment Unit).

6
Criteria for diagnosing psychological disorders
  • So how do we determine if someone is acting
    abnormally?
  • Psychologists define a psychological disorder as
    a harmful dysfunction in which behaviors are
  • Maladaptive
  • Unjustifiable
  • Disturbing
  • Atypical

7
Consider the following scenario
  • Every morning, a woman who lives in a Boston
    suburb asks her husband to bring in the morning
    newspaper, which the carrier throws just inside
    their fence. She does this because she is
    terribly afraid of encountering a poisonous
    snake. Her husband, concerned about her
    behavior, repeatedly tells her that there are no
    poisonous snakes living in their town.
    Nevertheless, she is afraid to leave the house.
  • Is she suffering from a psychological disorder?
    Lets look at the four diagnostic criteria to
    find out.

8
Maladaptive
  • The first criteria for diagnosis is to determine
    if the behavior is maladaptive, or destructive to
    oneself or others.
  • Does her behavior seem maladaptive to you? Why
    or why not?

9
Maladaptive (cont.)
  • Answer
  • Yes, her behavior is maladaptive. It is
    destructive to her because it restricts her
    ability to lead a normal life, since she is
    unable to leave the house without feeling
    extreme fear.

10
Unjustifiable
  • Unjustifiable refers to a behavior that occurs
    without a rational basis.
  • Does her behavior seem unjustifiable to you? Why
    or why not?

11
Unjustifiable (cont.)
  • Answer
  • Yes, her behavior is unjustifiable. It is an
    exaggeration of normal, acceptable behavior. In
    some cases, fear of poisonous snakes is a wise
    and practical response (say, if youre in an
    Arizona desert).
  • However, this womans fear is unwarranted in a
    Boston suburb. It is not rational to refuse to
    leave your home to avoid a snakebite in an area
    that has no poisonous snakes.

12
Disturbing
  • Disturbing refers to a behavior that is
    troublesome to other people.
  • Does her behavior seem disturbing to you? Why or
    why not?

13
Disturbing (cont.)
  • Answer
  • Yes, her behavior is disturbing.
  • The womans fear of snakes disturbs at least her
    husband, who worries about her.

14
Atypical
  • Atypical refers to a behavior that is so
    different, it violates a norm.
  • This has two parts.
  • First, the behavior is not like other peoples
    behavior.
  • Second, it violates a rule for accepted and
    expected behavior in a particular culture.
  • Does her behavior seem atypical to you? Why or
    why not?

15
Atypical (cont.)
  • Answer
  • Yes, her behavior is atypical. She is
    definitely behaving differently from almost all
    people in her culture.

16
Criteria for diagnosing psychological disorders
(cont.)
  • Someone might exhibit a behavior that is
    maladaptive, unjustifiable, disturbing, OR
    atypical, but unless the behavior meets all four
    of the criteria, it is not considered a
    psychological disorder.
  • You can try to remember the four criteria by
    remembering the mnemonic device MUDA.
  • What is maladaptive, unjustifiable, disturbing,
    and atypical depends on
  • Culture
  • Time period
  • Environmental conditions
  • The individual person

17
Figure 14.2 Normality and abnormality as a
continuum. No sharp boundary exists between
normal and abnormal behavior. Behavior is normal
or abnormal in degree, depending on the extent to
which ones behavior is deviant, personally
distressing, or maladaptive.
18
Understanding Psychological Disorders
  • The Medical Model vs. The Biopsychosocial Model

19
The Medical Model
  • When physicians discovered that syphilis led to
    mental disorders, they started using medical
    models to review the physical causes of these
    disorders.
  • The medical model assumes that psychological
    disorders are mental illnesses that need to be
    diagnosed on the basis of their symptoms and
    cured through therapy.
  • Basically, the medical model proposes that it is
    useful to think of abnormal behavior as a disease.

20
The Biopsychosocial Approach to Disorders
  • Thomas Szasz and others argue against this
    medical model, contending that psychological
    problems are problems in living, rather than
    psychological problems.
  • These critics argue that psychological disorders
    may not reflect a deep internal problem but
    instead a difficulty in the persons environment
  • In the persons current interpretation of events,
    or in the persons bad habits and poor social
    skills.

21
The Biopsychosocial Approach to Disorders
  • Psychologists who reject the sickness idea
    typically contend that all behavior arises from
    the interaction of ________ (genetic and
    physiological factors) and __________ (past and
    present experiences).
  • The biopsychosocial approach assumes that
    disorders are influenced by genetic
    predispositions, physiological states, inner
    psychological dynamics, and social and cultural
    circumstances.

22
The Biopsychosocial Approach to Disorders
23
Terms you need to be familiar with
  • Epidemiology The study of the distribution of
    mental or physical disorders in the population.
  • Prevalence The percentage of a population that
    exhibits a disorder during a specified time
    period.
  • Lifetime prevalence The percentage of people
    who have been diagnosed with a specific disorder
    at any time in their lives.
  • Current research suggests that about 44 of the
    adult population will have some sort of
    psychological disorder at some point in their
    lives (see next slide).
  • Diagnosis A means of identifying (symptoms) and
    distinguishing one illness from another.
  • Etiology The apparent causation and
    developmental history of an illness.
  • Treatment - Treating a disorder in a psychiatric
    hospital.
  • Prognosis A forecast about the probable course
    of an illness.

24
Figure 14.5 Lifetime prevalence of
psychological disorders. The estimated percentage
of people who have, at any time in their life,
suffered from one of four types of psychological
disorders or from a disorder of any kind (top
bar) is shown here. Prevalence estimates vary
somewhat from one study to the next, depending on
the exact methods used in sampling and
assessment. The estimates shown here are based on
pooling data from Wave 1 and 2 of the
Epidemiological Catchment Area studies and the
National Comorbidity Study, as summarized by
Regier and Burke (2000) and Dew, Bromet, and
Switzer (2000). These studies, which collectively
evaluated over 28,000 subjects, provide the best
data to date on the prevalence of mental illness
in the United States.
25
Classifying Psychological Disorders
  • The DSM-IV DSM 5

26
Classifying disorders
  • Once someone is determined to have a disorder,
    the next step is identifying what the disorder
    might be.
  • For this, psychologists use what is called the
    Diagnostic and Statistical Manual of Mental
    Disorders (or DSM 5 for short).
  • This manual has currently been revised five times
    in order to keep up with the ever-changing field
    of psychology.
  • It was first developed in 1952 by the American
    Psychiatric Association.
  • The most recent edition describes roughly 400
    psychological disorders compared to 60 in the
    1950s.

27
The DSM
  • The DSM is divided into main categories of
    disorders, like anxiety disorders, somatoform
    disorders, dissociative disorders, mood
    disorders, schizophrenia, and personality
    disorders.
  • Within each category, the following descriptions
    are included
  • Essential features characteristics that define
    the disorder
  • Associated features additional features that
    are usually present
  • Information on differential diagnosis how to
    distinguish this disorder from other disorders
    with which it might be confused
  • Diagnostic criteria a list of symptoms that
    must be present for the patient to be diagnosed

28
The 5 Axes of the DSM-5
Axis I and II can be seen online
here http//www.behavenet.com/apa-diagnostic-clas
sification-dsm-iv
  • The DSM-5 lists known causes of these disorders,
    statistics in terms of gender, age at onset, and
    prognosis as well as some research concerning the
    optimal treatment approaches.
  • Mental Health Professionals use this manual when
    working with patients in order to better
    understand their illness and potential treatment
    and to help 3rd party payers (e.g., insurance)
    understand the needs of the patient.
  • The book is typically considered the bible for
    any professional who makes psychiatric diagnoses
    in the United States and many other countries.
  • The DSM uses a multi-axial or multidimensional
    approach to diagnosing because rarely do other
    factors in a person's life not impact their
    mental health.
  • It assesses five dimensions as described on the
    following slides

29
Axis I Clinical Syndromes
  • This is what we typically think of as the
    diagnosis (e.g., depression, schizophrenia,
    social phobia).

30
Axis II Developmental Disorders and Personality
Disorders
  • Developmental disorders include autism, and
    disorders which are typically first evident in
    childhood
  • Personality disorders are clinical syndromes
    which have a more long lasting symptoms and
    encompass the individual's way of interacting
    with the world. They include Paranoid,
    Antisocial, and Borderline Personality Disorders.
  • The diagnoses of disorders are made on Axes I and
    II, with most falling on Axis I.
  • The remaining axes youll see on the upcoming
    slides are used to record supplemental
    information.

31
Axis III General Medical Conditions Physical
conditions which play a role in the development,
continuance, or exacerbation of Axis I and II
Disorders
  • Physical conditions such as brain injury,
    diabetes, arthritis, or HIV/AIDS, etc. that can
    result in symptoms of mental illness are included
    here.

32
Axis IV Psychosocial and Environmental Problems
Severity of Psychosocial Stressors
  • The types of stress they have experienced in the
    past year
  • Events in a person's life, such as death of a
    loved one, starting a new job, college,
    unemployment, and even marriage can impact the
    disorders listed in Axis I and II.
  • These events are both listed and rated for this
    axis.

33
Axis V Global Assessment of Functioning (GAF)
Scale (Highest Level of Functioning)
  • On the final axis, the clinician rates the
    person's level of functioning both at the present
    time and the highest level within the previous
    year.
  • This helps the clinician understand how the above
    four axes are affecting the person and what type
    of changes could be expected.

34
Axis I Clinical Syndromes (On the AP Exam) Axis
II Personality Disorders  (On the AP Exam) Axis
III Medical Conditions Axis IV Environmental
Stressors Axis V Current Level of Functioning
35
Figure 14.4 Example of a multiaxial evaluation.
A multiaxial evaluation for a depressed man
with a cocaine problem might look like this.
36
Labeling Psychological Disorders
  • Pros and Cons

37
Labeling Psychological Disorders Pros and Cons
  • Critics of the DSM-IV argue that labels may
    stigmatize individuals

Elizabeth Eckert, Middletown, NY. From L. Gamwell
and N. Tomes, Madness in America, 1995. Cornell
University Press.
Asylum baseball team (labeling)
  • However, labels may be helpful for healthcare
    professionals when communicating with one another
    and establishing therapy.

38
Insanity
  • Insanity labels raise moral and ethical
    questions about how society should treat people
    who have disorders and have committed crimes.
  • First, insanity is not a diagnosis, it is a legal
    concept. Insanity is a legal status indicating
    that a person cannot be held responsible for his
    or her actions because of mental illness.
  • Insanity exists when a mental disorder makes a
    person unable to distinguish right from wrong.
  • Involuntary commitment occurs when people are
    hospitalized in psychiatric facilities against
    their will. Rules vary from state to state, but
    generally, people are subject to involuntary
    commitment when they are a danger to themselves
    or others or when they are in need of treatment
    (as in cases of severe disorientation).
  • In emergency situations, psychiatrists and
    psychologists can authorize temporary commitment
    only for a period of 24-72 hours.Long-term
    commitments must go through the courts and are
    usually set up for renewable six-month periods.

Elaine Thompson/ AP Photo
Theodore Kaczynski (Unabomber)
39
Figure 14.22 The insanity defense Public
perceptions and actual realities. Silver,
Cirincione, and Steadman (1994) collected data on
the general publics beliefs about the insanity
defense and the realities of how often it is used
and how often it is successful (based on a
large-scale survey of insanity pleas in eight
states). Because of highly selective media
coverage, dramatic disparities are seen between
public perceptions and actual realities, as the
insanity defense is used less frequently and less
successfully than widely assumed.
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