Transcript Psychological Disorders

Psychological
Disorders
Defining Psychological
Disorders
What does it mean to be
“abnormal”?
What is “abnormal”?
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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.
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What are the potential problems
with labeling people abnormal or
psychologically disordered based
upon this criteria?
What is “abnormal”? (cont.)
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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?
What is “abnormal”? (cont.)
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Some cultures have social practices that may be
considered abnormal compared with most social
practices in contemporary U.S. culture.
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We have to be careful with who or what we label “abnormal.”
 Hissing is a polite way to show respect for superiors in
Japan.
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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).
Criteria for diagnosing
psychological disorders
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So how do we determine if someone is acting
“abnormally”?
Psychologists define a psychological disorder
as a harmful dysfunction in which
behaviors are:
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Maladaptive
 Unjustifiable
 Disturbing
 Atypical
Consider the following
scenario:
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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.
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Is she suffering from a psychological disorder?
Let’s look at the four diagnostic criteria to find
out.
Maladaptive
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The first criteria for diagnosis is to
determine if the behavior is maladaptive, or
destructive to oneself or others.
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Does her behavior seem maladaptive to you?
Why or why not?
Maladaptive (cont.)
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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.
Unjustifiable
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Unjustifiable refers to a behavior that
occurs without a rational basis.
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Does her behavior seem unjustifiable to you?
Why or why not?
Unjustifiable (cont.)
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Answer:
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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
you’re in an Arizona desert).
However, this woman’s 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.
Disturbing
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Disturbing refers to a behavior that is
troublesome to other people.
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Does her behavior seem disturbing to you?
Why or why not?
Disturbing (cont.)
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Answer:
Yes, her behavior is disturbing.
The woman’s fear of snakes disturbs at
least her husband, who worries about her.
Atypical
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Atypical refers to a behavior that is so
different, it violates a norm.
This has two parts.
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First, the behavior is not like other people’s
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?
Atypical (cont.)
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Answer:
Yes, her behavior is atypical. She is
definitely behaving differently from almost
all people in her culture.
Criteria for diagnosing
psychological disorders (cont.)
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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:
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Culture
Time period
Environmental conditions
The individual person
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 one’s behavior is deviant,
personally distressing, or maladaptive.
Understanding
Psychological Disorders
The Medical Model vs. The
Biopsychosocial Model
The Medical Model
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When physicians discovered that syphilis led
to mental disorders, they started using
medical models to review the physical
causes of these disorders.
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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.
The Biopsychosocial Approach to
Disorders
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Thomas Szasz and others argue against this
medical model, contending that psychological
problems are “problems in living,” rather than
psychological problems.
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These critics argue that psychological disorders
may not reflect a deep internal problem but
instead a difficulty in the person’s environment
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In the person’s current interpretation of events, or in the
person’s bad habits and poor social skills.
The Biopsychosocial Approach to
Disorders
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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).
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The biopsychosocial approach assumes that
disorders are influenced by genetic
predispositions, physiological states, inner
psychological dynamics, and social and cultural
circumstances.
The Biopsychosocial
Approach to Disorders
Terms you need to be familiar
with…
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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.
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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.
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.
Classifying
Psychological Disorders
The DSM-IV & DSM 5
Classifying disorders
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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.
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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.
The DSM
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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:
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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
Axis I and II can be
seen online here:
The 5 Axes of the DSM-5
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http://www.behavenet.com
/apa-diagnosticclassification-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…
Axis I: Clinical Syndromes
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This is what we typically think of as the diagnosis
(e.g., depression, schizophrenia, social phobia).
Axis II: Developmental Disorders
and Personality Disorders
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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.
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The remaining axes you’ll see on the upcoming slides are
used to record supplemental information.
Axis III: General Medical
Conditions :Physical conditions which
play a role in the development,
continuance, or exacerbation of Axis I and
II Disorders
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Physical conditions such as brain injury,
diabetes, arthritis, or HIV/AIDS, etc. that can
result in symptoms of mental illness are
included here.
Axis IV: Psychosocial and
Environmental Problems: Severity of
Psychosocial Stressors
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The types of stress they have experienced
in the past year
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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.
Axis V: Global Assessment of
Functioning (GAF) Scale (Highest
Level of Functioning)
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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.
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
Figure 14.4: Example of a multiaxial evaluation.
A multiaxial evaluation for a depressed man with a cocaine
problem might look like this.
Labeling Psychological
Disorders
Pros and Cons
Labeling Psychological
Disorders – Pros and Cons
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Critics of the DSM-IV argue that labels may stigmatize
individuals
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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.
“Insanity”
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“Insanity” labels raise moral and ethical
questions about how society should treat
people who have disorders and have
committed crimes.
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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.
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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
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).
Theodore Kaczynski
(Unabomber)
Figure 14.22: The insanity defense: Public perceptions and actual realities.
Silver, Cirincione, and Steadman (1994) collected data on the general public’s
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.