Psychological Disorders and Diagnosis

1. Psychological Disorders and Diagnosis An Introduction

2. What are the Boundaries between Normal and Abnormal Behavior?? • Unconventional and Unusual • behavior that is so different that it violates a norm or cultural standard AND experienced by only a few • Disturbing • behavior that is troublesome to other people • Maladaptive • behavior that is destructive or harmful to oneself or others • Unpredictable and Irrational • Does not make sense to the average person May only need to meet one to be diagnosed with a disorder

3. What fits the description for abnormal behavior depends on a few things… • Culture Bases of Abnormal Behavior • Psychologists take into account the cultural context when making judgments about abnormal behavior • The same behavior may be considered normal in one culture but abnormal in another • Examples of Cultural Bound Disorders: • Susto – Latin America – anxiety and fear of black magic • Koro – Southeast Asian Men Time Period and Social Conditions • ADHD • Is it a real problem or just kids being active kids?? • Energetic child + boring school = ADHD overdiagnosis? • Homosexuality

4. How do we classify and learn about Psychological Disorders??? We use the DSM • DSM-IV-TR: • the big book of disorders • Classifies disorders on the basis of their distinctive features or symptoms Classifies and describes the disorders but does NOT NOT NOT discus their causes or treatments…WHY??

5. Two Major Classifications in the DSM Neurotic Disorders Psychotic Disorders Distressing but one can still function in society and act rationally. Person loses contact with reality, experiences distorted perceptions. John Wayne Gacy

6. So How does the DSM work?? • Uses a system of Axes or Dimensions (5 in total) that help the examiner conduct a comprehensive evaluation of a person’s mental health • Axis I and Axis II • Contains lists of disorders • Axis III • Contains general medial conditions and diseases • Axis IV • Any psychosocial and environmental problems that may impair function • Axis V • Global assessment of functioning (GAF) • A numerical value that indicates overall level of mental health

7. A Sample DSM Evaluation The Clinical Picture of Angela Savanti • Angela was rarely reinforced for any of her accomplishments at school, but she gained her mother’s negative attention for what Mrs. Savanti judged to be poor performance at school or at home. Mrs. Savanti repeatedly told her daughter that she was incompetent, and any mishaps that happened to her were her own fault.......When Mr. Savanti deserted the family, Angela’s first response was that somehow she was responsible. From her mother’s past behavior, Angela had learned to expect that in some way she would be blamed. At the time that Angela broke up with her boyfriend, she did not blame Jerry for his behavior, but interpreted this event as a failing solely on her part. As a result, her level of self-esteem was lowered still more. • Angela’s uncertainties intensified when she was deprived of the major source of gratification she had, her relationship with Jerry. Despite the fact that she was overwhelmed with doubts about whether to marry him or not, she had gained a great deal of pleasure through being with Jerry. Whatever feelings she had been able to express, she had shared with him and no one else. Angela labeled Jerry’s termination of their relationship as proof that she was not worthy of another person’s interest. She viewed her present unhappiness as likely to continue, and she attributed it to some failing on her part. As a result, she became quite depressed.

8. The Clinical Picture ofAngela Savanti The Diagnosis • Axis I • Major Depressive Disorder • Axis II • Dependent personality Disorder • Axis III • Diabetes • Axis IV • Problems related to social environment (termination of relationship – Jerry and Father) • Axis V • GAF = 55

9. A Cautionary Note… • The DSM-IV provides an invaluable tool to psychologists, but it doesn’t come without its criticisms • Some believe it can turn normal problems of living into “diseases” – i.e. ADHD or the argument over PMS • Also, some believe the DSM-IV makes diagnosis of disorders scientific when they are actually highly subjective • The problem of Labeling…

10. The Influence of Labels Should people who were once diagnosed with a psychological problem carry that diagnosis for the rest of their lives? • Can lead to stigmatization • The Rosenhan Study • rooms for rent story • Can change reality • a student is “gifted” or “hostile”

11. What are the Causes of Psychological Disorders?? It depends on your views of psychology • Medical Perspective • disorders are sicknesses and can be diagnosed, treated and often cured. • Learning or Behavioral Perspective • disorders result from the reinforcement of abnormal behavior • Psychodynamic Perspective • disorders result from defenses against internal, unconscious conflicts • Humanistic Perspective • disorders result from a failure to strive towards one’s potential or being out of touch with one’s feelings • Sociocultural Perspective • disorders result from a dysfunctional environment

12. Current Perspectives…cont. Bio-Psycho-Social Perspective: • assumes biological, psychological and sociocultural factors combine to interact causing disorders. One Example The Diathesis-Stress Model Diathesis = predisposition or vulnerability Inherited predisposition To develop the disorder Environmental Stressors Disorder

13. Are you Insane?? Mental Illness vs. Insanity • Mental Illness • A medical decision • Insanity • A legal decision • To be insane a person must be unable to control behavior and be unaware that behavior is wrong • Insanity defense is based on the principle that punishment is justified only if the person is capable of understanding and controlling his or her behavior

14. Sex and Mental Disorders Does the gender of a person influence (1) the type of disorder or (2) the frequency of various disorders?? Of Course it Does …but Why??

15. Differences in reporting or suppressing psychological distress • Clinicians expectations • Differences in social roles and experiences • Differences in ways of responding to stressful situations

16. Early Theories on Mental Illness and Disorders • Afflicted people were possessed by evil spirits.

17. Early Theories on Treatment • Music or singing was often used to chase away spirits. • In some cases trephining was used: Cutting a hole in the head of the afflicted to let out the evil spirit.

19. Early Theories on Treatment Another theory on treatment was to make the body extremely uncomfortable. Hopefully, this would drive out the evil spirits

20. History of Mental Disorders In the 1800’s, disturbed people were no longer thought of as madmen, but as mentally ill. They were first put in hospitals. Did this mean better treatment?

21. Early Mental Hospitals • The patients were chained and locked away. • They were nothing more than barbaric prisons. • Some hospitals even charged admission for the public to see the “crazies”, just like a zoo.

22. Philippe Pinel and Dorethea Dix Moral-treatment Movement • Doctors who were the first to take the chains off and declare that people are sick and “a cure must be found!!!” Out of this movement, large state-supported asylums were built Good intentions, but poor concept….why??

23. Deinstitutionalization New Drugs and a feeling of optimism – “all could make it if given a chance” – lead to an emptying of mental hospitals Most ended up either homeless or in prisons

24. Types of Disorders

25. Anxiety Disorders • A group of disorders in which either fear or anxiety is a major symptom • fear, phobia and nervous condition, that come on suddenly and prevent pursuing normal daily routines »Includes panic disorder, obsessive-compulsive disorder (ocd), post-traumatic stress disorder, general anxiety disorder, and phobias

26. Mood Disorders • A condition where the emotional mood is distorted or inappropriate to the circumstances »Includes major depression, dysthymic disorder (mild depression) and bipolar disorders

27. Dissociative Disorders • A psychological state or condition in which certain thoughts, emotions, sensations, or memories are separated from the rest of the conscious identity »Includes Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder (MPD), and different types of amnesia

28. Schizophrenia • Mental disorder characterized by impairments in the perception or expression of reality and by significant social or occupational dysfunction

29. Personality Disorders • A class of mental disorders that are characterized by long-lasting rigid patterns of thought and behavior that disrupt social functioning »Includes paranoid personality disorder, avoidant personality disorder, narcissistic personality disorder and borderline personality disorder

30. Eating Disorders • A person eats in a way which disturbs their physical health »Includes anorexia, bulimia, and binge-eating