chapter 13

Chapter 13: Psychological Disorders Abnormal Behavior: Myths and Realities The Medical Model Applied to Abnormal Behavior Medical model ? proposes that is ti is useful to think of abnormal behavior as a disease. Includes: mental illness, psychological disorders, psychopathology (manifestations of disease). Came from the 18th and 19th centuries, still strong today. before this model, conceptions were based on superstition- strange people were ?possessed by the devil, or demons? , these acts led to torture, etc. this model gave more sympathy and understanding to people who acted ?strangely? Thomas Szasz: critic that said the medical model may have outlived its usefulness, said disease or illness can affect only the body, there is no mental illness? minds can only be ?sick?. Also that abnormal behavior involves a deviation from social norms rather than an illness. ?problems in living? rather than medical problems. the model is just converting moral and social questions about what is acceptable behavior into medical questions. Medical Model still applicable. Diagnosis: involves distinguishing one illness from another. Etiology: refers to the apparent causation and developmental history of an illness. Prognosis: a forecast about the probable course of an illness. Criteria of Abnormal Behavior All people make judgments about others? ?normality?, but formal diagnoses are made by medical professionals, based on: Deviance: differing from social norms in where that person lives/ exists. Ie: transvestic fetishism: sexual disorder where a man achieves sexual arousal by dressing in women?s clothing. (deviating from our culture?s norms). Maladaptive behavior: interferes with the day to day, social or occupational functioning. (ie: substance abuse stems from this type of behavior/ quality). Personal Distress: troubled, depressed or anxiety disorders, not necessarily deviance or maladaptive behavior, but more problems with friends or relationships. -sometimes only one of these exists and that is enough to be considered ?disordered?. - ?value judgments?: more than just the physical disorders are enough; sometimes emotional judgments are valid: cultural values, social trends, political forces all in account. - difficult to draw a line between mentally healthy and mentally ill, etc. on occasion everyone acts in deviant ways; people are judged to have psychological stress when it becomes extremely deviant, maladaptive or distressing. A matter of degree, not either-or. Psychodiagnosis: The Classifications of Disorders In the book: ?Diagnosistic and Statistical Manual of Mental Disorders? ? a multiaxial system, judgments on 5 different dimensions. -axes 1 and 2 are used for diagnoses: 1 where most types of disorders are; 2 to list long-running personality disorders or mental retardation. -people may receive diagnoses on both axes 1 and 2; the remaining axes are for supplemental info. - axes 3: physical disorders. -axes 4: notations about types of stress in past year. -axes 5: current level of adaptive functioning and highest level of functioning in last year. *page 392: study table of the classifications* Anxiety Disorders Anxiety Disorders: class of disorders marked by feelings of excessive apprehension and anxiety. Quite common: 19% of population has them. Generalized Anxiety Disorder- chronic, high level of anxiety, not tied to any specific threat. Worry constantly, physical side effects: trembling, muscle tension, diarrhea, dizziness, faintness, sweating heart palpitations. Phobic Disorder- persistent and irrational fear of an object or situation that presents no realistic danger, constricts day to day behavior, sometimes caused by traumatic experiences as a child. Panic disorder and agoraphobia Panic disorder- characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly, always worrying if the next attack will happen. ->causes agoraphobia. Agoraphobia- fear of going out in public places., may go out with trusted companion. A phobic disorder, mainly a complication of panic disorder; 2/3 or people who suffer from panic disorder are female. Onset: late adolescence or early adulthood. Obsessive-Compulsive Disorder- obsessions- thoughts repeatedly intrude on one?s consciousness in a distressing way. Compulsions are actions that ones feels forced to carry out. Obsessive-compulsive disorder (ocd) is marked by persistent, uncontrollable intrusions of unwanted thoughts and urges to engage in senseless rituals. Onset: early adulthood, center on inflicting harm on others, personal failures, suicide, sexual acts. 2.5% of the population. Posttraumatic stress disorder- involves enduring psychological disturbance attributed to the experience of a major traumatic event. Ie: rape or assault, severe accident, natural disaster, etc. much more common than widely assumed, doesn?t show up until many months or years after the fact. Nightmares or flashbacks, emotional numbing, social alienation, increased sense of vulnerability, elevated arousal, anxiety, anger, guilt. Etiology of Anxiety of Disorders Biological factors -concordance rate: indicates the percentage of twin pairs or other pairs of relatives that exhibit the same disorder. ? a higher concordance rate indicates heredity is more involved. *there is a moderate genetic predisposition to anxiety disorders. -anxiety sensitivity: may make people vulnerable to anxiety disorders. Some people are very sensitive to internal physiological symptoms of anxiety and tend to overreact with fear when experiencing these symptoms. - link between anxiety disorders, and neurochemical activity in the brain. - therapeutic drugs (valium) reduce excessive anxiety and alter neurotransmitter activity at synapses where GABA is released. Conditioning and Learning - many anxiety response acquired through classical conditioning and maintained through operant. Avoiding a certain stimulus is negatively reinforced because it is followed by a reduction in anxiety. - Martin Seligman: concept of preparedness. Believes that classical conditioning creates most phobic response. **suggests that people are biologically prepared by their evolutionary history to acquire some fears much more easily than others. * (ie: snakes, heights, spiders, etc.) Cognitive Factors Certain styles of thinking make some people vulnerable to anxiety disorders. They tend to A) misinterpret harmless situations as threatening. B) focus excessive attention on perceived threats. C)selectively recall information that seems threatening. Personality Neuroticism: high scores in this trait, tend to be self conscious, guilt prone and goomy. Correlated with high anxiety, and bad recovery. Stress Stressful accidents, etc. -Faravelli and Pallanti found that patients with panic disorder had experienced a dramatic increase in stress in the month prior to the onset of the disorder. -Brown and colleagues: association between stress and development of social phobia. *high stress helps precipitate onset of anxiety disorders. Somatoform Disorder Psychosomatic diseases: genuine physical ailments caused in part by psychological factors, esp. emotional distress. Ie: ulcers, asthma, high blood pressure. Somatoform disorders: physical ailments that cannot be fully explained by organic conditions and are largely due to psychological factors., more imaginary than real, but still real. Malingering: is faking all together. Somatization Disorder Somatization disorder: marked by a history of diverse physical complaints that appear to be psychological in origin. Mostly in women, coexists with depression and anxiety disorders diversity to victim?s complaints Conversion Disorder- characterized by a significant loss of physical function (no organic basis), single organ system, ie: partial or complete loss of vision, hearing, paralysis, laryngitis, limb feeling, etc. more severe ailments than somatization disorders. Hypochondriasis- (hypochondria), excessive preoccupation with one?s health and incessant worry about developing physical illnesses. Constantly monitor physical condition, on lookout for something to be wrong with them. Etiology of Somatoform Disorders Cognitive Factors: people with these disorders tend to make mountains out of molehills, and wrongly equate health with no aches, pains, etc. The sick role: people like the role of being sick; can avoid having to confront life?s challenges, convenient excuse when people fail, attention from others. Dissociative Disorders class of disorders where people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity. Dissociative Amnesia and Fugue- sudden loss of memory for important personal information that is too extensive to be due to normal forgetting; from single tragic event, or around that time. Dissociative fugue : people lose their memory for their entire lives along with the sense of personal identity. Dissociative Identity Disorder ? (DID) coexistence in one person of two or more largely complete, and usually different personalities. (multiple personality disorder). Sometimes wrongly called schizophrenia. -usually personalities are quite different from the original personality. -each personality only recalls/ knows that certain personality. - sudden transitions between personalities -bizarre differences between them, ie: race, gender, etc. -been thought to be overdiagnosed. Etiology of Dissociative Disorders -both of the above, attributed to excessive stress. Nicholas Spanos: believe people with multiple personalities are engaging in intentional role playing, and using it as excuses for failures. small number of therapists create DID by subtly encouraging the emergence of other personalities DID is a creation of modern North American culture, and influenced by media. -still considered an authentic disorder. No incentive for people to create it on their own, (skepticism) Mood Disorders ? class of disorders marked by emotional disturbances of varied kinds that may spill over to disrupt physical, perceptual, social, and thought processes. Bipolar disorder: emotional extremes at both ends of the mood continuum, with both depression and mania (excitement and elation) Unipolar disorder: emotional extremes at just one end of the spectrum. With depression . Major Depression Disorder ?people show persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure. -give up activities they used to enjoy, lack energy, reduced appetite, insomnia, talk slowly, move sluggishly, anxiety, irritability, brooding are common. Hopelessness, dejection, boundless guilt. -severity differs, onset can start anytime in a lifetime. -majority of people with it have more than one episode. -7-18 % experience it sometime in their life. -higher in age groups born in more recent decades -twice as high in women as men, opening up in mid to late adolescence. Susan Nolen- Hoeksema: argues that women experience more depression than men, b/c more likely to have sexual abuse, poverty, role constraints, and also dwell more than men. Bipolar Disorder ?(formerly manic depressive disorder) experience both depressed and manic periods, opposite of depression, becomes overly happy, high self esteem, bubbly, and excited. Very temporary success and happiness. Unipolar disorder: more common than bipolar disorder, equally often in females as males. Peak of times is in ages 20 -29. Etiology of Mood Disorders Genetic vulnerability: with predispositions to mood disorders in heredity, more effect on bipolar disorder. Neurochemical Factors: with norepinephrine and serotonin ->relation between these levels and mood. Cognitive Factors: Martin Seligman : learned helplessness model of depression, and hopelessness theory. Based on animal research, depression is caused by learned helplessness, ?passive giving up?, roots come from how people explain the setbacks and other neg events. -people who exhibit a pessimistic explanatory style are especially vulnerable to depression. Drawing big conclusions about themselves about small inadequacies . Hopelessness theory: hopelessness is the ?final pathway? leading to depression. A pessimistic outlook/ answer, also high stress, low self esteem, etc. Susan Nolen-Hoeksema, found depressed people who ruminate (worry) about depression, worry longer. Women ruminate more than men. -negative thinking.. caused by depression? Or vice versa. ? Lauren Alloy: studied depression on college kids, high risk and low risk. Findings show that negative thinking makes a causal contribution to development of depressive disorders. Interpersonal Roots -Depression-prone people lack the social finesse needed to acquire many important kinds of reinforcers, friends, jobs and spouses, etc. ( leads to negative emotions and depression. -depressed people are depressing and irritable, therefore have less supportive people in their lives. Precipitating Stress stress affects how people with mood disorders respond to treatment and whether they experience a relapse of disorder. Schizophrenic Disorders ?split mind? - Eugen Bleuler coined the name, meant fragmentation of thought processes seen in the disorder, not to a ?split personality?. Much more common that MPD. Schizophrenic disorders encompass a class of disorders marked by delusions, hallucinations, disorganized speech, and deterioration of adaptive behavior. 1% of pop. Very expensive to treat. General Symptoms -irrational thought: delusions : are false beliefs that are maintained even though they clearly are out of touch with reality. Delusions of grandeur: believe they are famous or important. -deterioration of adaptive behavior: ?she just isn?t herself anymore? -distorted perception: hallucinations. , hearing voices -disturbed emotion: little emotional responsiveness. Subtypes and Course paranoid type: dominated by delusions of persecution, along with delusions of grandeur (thinking you are famous or special to cover up for thoughts of people hating you). catatonic type: striking motor disturbances, ranging from muscular rigidity to random motor activity. , sometimes withdrawal, or excitement. Not very common. disorganized type: severe deterioration of adaptive behavior is seen. , emotional indifference, frequent incoherence, virtually complete social withdrawal. Giggling, etc. also body delusions ?my brain is melting out of my ears?. undifferentiated type: clearly schizophrenic but not one of the above 3. positive versus negative symptoms: negative symptoms: involve behavioral deficits, flattened emotions, social withdrawal, apathy, impaired attention, poverty of speech. Positive symptoms: behavioral excesses or peculiarities, hallucinations, delusions, bizarre behavior and wild flights of ideas. predictors of the course of schizophrenic illness: ½ of schizophrenic patients experience at least partial recovery. *Favorable prognosis: when 1) the onset of the disorder has been sudden rather than gradual 2) the onset has occurred at a later age 3) the patients social and work adjustment were relatively good prior to the onset of the disorder. 4) proportion of negative symptoms is relatively low. 5) the patient has healthy and supportive family. Etiology of Schizophrenia Genetic Vulnerability hereditary factors, concordance rates: 48% for identical twins, 17% fraternal, etc. Neurochemical Factors excess dopamine activity is a cause, also glutamate. Structural Abnormalities in the brain structural deterioration of enlarged ventricles, tissue, a consequence of schizophrenia or a contributing cause of the illness. The Neurodevelopmental Hypothesis schizophrenia is caused by many disruptions in the normal maturing process of the brain before or during birth. Expressed Emotion ?degree to which a relative of a schizophrenic patient is overly involved in that person?s life, involvement in general. Precipitating Stress with vulnerability. Culture and Pathology Relativistic views of disorders: criteria of mental illness vary greatly across cultures, no universal standards of normality and abnormality. , universalistic or pancultural view: criteria of mental illness is same around the world. ?are the psychological disorders seen in western societies found throughout the world?? -culture-bound disorders are abnormal syndromes found only in a few cultural groups. Understanding Eating Disorders Eating disorders: are severe disturbances in eating behavior characterized by preoccupation with weight concerns and unhealthy efforts to control weight. Anorexia nervosa: intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, dangerous measures to lose it. -starving themselves. * in binge-eating/ purging: forced vomit after meals. -both suffer from disturbed body image. -typically 25-30% below normal weight. -rarely seek treatment on own, because they don?t notice the maladaptive quality of their behavior. -anorexia can lead to medical problems, such as amenorrhea (loss of menstrual cycles in women), GI problems, low blood pressure, osteoporosis, 5% death. Busimia vervosa: habitually engaging in out of control overeating followed by unhealthyy compensatory efforts, such as self induced vomiting, fasting, abuse of laxatives and diuretics, and excessive exercise. -vomiting only preserves about ½ of food intake/ absorption. -maintain a normal weight -dental problems, cardiac arrythmias, metabolic deficiencies and GI problems. -much less life-threatening than anorexia, and more likely to cooperate with treatments. History and Prevalence Middle of the 20th century, prevalent in the western cultures, moving to other parts of the globe. -90-95% are female because of cultural pressures rather than biological factors. -1-1.5% develop anorexia and 2-3 % bulimia. Etiology of Eating Disorders Genetic Vulnerability some people inherit predispositions. Personality Factors certain traits may increase vulnerability: anorexia: obsessive, rigid, emotionally restrained. Bulimia: impulsive, sensitive, low self esteem Cultural Values women: to be attractive, and thin. Role of the Family parents push independence into an unhealthy struggle. ?you can never be too thin? Cognitive Factors thinking wrongly, false assumptions, all or nothing, slippery slope, etc. Working with probabilities in thinking about mental illness *Representativeness heuristic: basing the estimated probability of an event on how similar it is to the typical prototype of that event. *Cumulative probabilities: using the ?or? , ( makes percentages higher of having a disease. *conjunctive probabilities: using ?and? will limit the percentages. Comorbidity: coexistence of 2 or more disorders. Conjunction fallacy: when people estimate that the odds of 2 uncertain events happening together are greater than the odds of either happening alone. -physicians do this because they are influenced by the representativeness heuristic, widely overestimate. Availability heuristic: basing the estimated probability of an event on the ease with which relevant instances come to mind.