PSY 100Y5 PSYCHOLOGICAL DISORDERS LECTURE DR. KIRK R. BLANKSTEIN

1. PSY 100Y5PSYCHOLOGICAL DISORDERS LECTUREDR. KIRK R. BLANKSTEIN OUTLINE • Studying Psychological Problems • What’s Abnormal?: “And you thought you were crazy!” • Classification of Disorders: The Diagnostic and Statistical Manual • Prevalence of Disorders in Ontario • Causes of Disorders: The Biopsychosocial Model • Video: Review and Introduction to Specific Disorders • The DSM Definition of Mental Disorders • Specific Examples: Anxiety Disorders and Schizophrenia

2. Studying Psychological Disorders FOCUS TREATMENT/ OUTCOME CAUSATION DESCRIPTION

3. AND YOU THOUGHT YOU WERE CRAZY! • “WHEN I TAKE A SHOWER, I HAVE A FEAR THAT A SNAKE OR SOME KIND OF REPTILE WILL COME UP THROUGH THE PIPES, SO I CLOSE DOWN THE DRAIN. I USUALLY HAVE TO TAKE A MEDIUM TO SHORT SHOWER AS A RESULT AND END UP WITH WATER UP TO MY KNEES, BUT I DEFINITELY MANAGE TO DO AWAY WITH THE SNAKES.” UNIVERSITY STUDENT,MALE,AGE 22

4. Davison, Neale, Blankstein, & Flett (2002) • COMPONENTS OF ABNORMAL BEHAVIOR • STATISTICAL INFREQUENCY • VIOLATION OF NORMS • PERSONAL DISTRESS • DISABILITY OR DYSFUNCTION • UNEXPECTEDNESS • “BECAUSE THE FIELD IS CONTINUALLY EVOLVING, IT IS NOT POSSIBLE TO OFFER A SIMPLE DEFINITION OF ABNORMALITY THAT CAPTURES IT IN ITS ENTIRETY. THE CHARACTERISTICS PRESENTED CONSTITUTE A PARTIAL DEFINITION, BUT THEY ARE NOT EQUALLY APPLICABLE TO EVERY DIAGNOSIS” (p. 5).

5. SUMMARY OF THE DSM-IVDEFINITION OF MENTAL DISORDERS • DEFINING CHARACTERISTICS • A BEHAVIORAL OR PSYCHOLOGICAL SYNDROME (GROUPS OF ASSOCIATED FEATURES) THAT IS ASSOCIATED WITH • PRESENT DISTRESS (PAINFUL SYMPTOMS), OR • DISABILITY (IMPAIRMENT IN ONE OR MORE IMPORTANT AREAS OF FUNCTIONING), OR WITH • A SIGNIFICANTLY INCREASED RISK OF SUFFERING DEATH, PAIN, DISABILITY, OR AN IMPORTANT LOSS OF FREEDOM • CONDITIONS EXCLUDED FROM CONSIDERATION • THIS SYNDROME OR PATTERN MUST NOT BE MERELY: • AN EXPECTABLE AND CULTURALLY SANCTIONED RESPONSE TO A PARTICULAR EVENT (SUCH AS THE DEATH OF A LOVED ONE) • DEVIANT BEHAVIOR (SUCH AS THE ACTIONS OF POLITICAL, RELIGIOUS, OR SEXUAL MINORITIES) • CONFLICTS THAT ARE BETWEEN THE INDIVIDUAL AND SOCIETY (SUCH AS VOLUNTARY EFFORTS TO EXPRESS INDIVIDUALITY) PSY240L1

6. CRITICAL THINKING • DO YOU THINK IT IS POSSIBLE TO ELIMINATE SOCIAL VALUES FROM A DEFINITION OF ABNORMAL BEHAVIOR? HOW WOULD YOU ACCOMPLISH THIS GOAL? IS THERE ANY WAY OF DEFINING MENTAL DISORDERS THAT WOULD AVOID VALUE JUDGMENTS ABOUT WHICH BEHAVIORS ARE ADAPTIVE AND WHICH ARE NOT? PSY240L1

7. DEFINITIONS CLASSIFICATION (or TAXONOMY) SYSTEMATIC DESCRIPTION OF THE MAJOR CATEGORIES OR DIMENSIONS OF DISORDERS (for either scientific or clinical purposes) DIAGNOSIS PROCESS OF ASSIGNING AN INDIVIDUAL TO A CATEGORY OF THE CLASSIFICATION SYSTEM

8. DSM-IVCoverage of “Mental Disorders” • 49 main headings • 41 subcategories • 394 total listings within categories

9. NEWROSES FOR THE ‘80s (New Millennium?)by JOHN V. FLOWERS & BERNARD SCHWARTZexample postmature ejaculation  AFFLICTS THOSE PEOPLE WHO HAVE READ TOO MANY SEX MANUALS THAT STRESS PLEASING ONE’S PARTNER, WITH THE RESULT THAT THEY CANNOT HAVE AN ORGASM BEFORE THEIR MATE DOES.  THIS IS NOT A PROBLEM UNTIL THEY MEET ANOTHER PERSON SUFFERING FROM THE SAME DISORDER.

10. Two important changes inDSM-III, III-R, & IV • INCREASE IN THE SPECIFICITY OF CRITERIA FOR EACH CLASS OF DISORDERS • USE OF A MULTIAXIAL DIAGNOSTIC SYSTEM

11. DSM-IV:MULTIAXIAL CLASSIFICATION AXIS I: CLINICAL DISORDERS OTHER CONDITIONS THAT MAY BE A FOCUS OF CLINICAL ATTENTION AXIS II PERSONALITY DISORDERS MENTAL RETARDATION AXIS III GENERAL MEDICAL CONDITIONS (WITH ICD9CM CODES) AXIS IV PSYCHOSOCIAL & ENVIRONMENTAL PROBLEMS AXIS V GLOBAL ASSESSMENT OF FUNCTIONING (GAF)

12. Different Cultures and theDSM-IV • Brain Fag: A term initially used in West Africa to refer to a condition experienced by high school or university students in response to the challenges of schooling. Symptoms include difficulties in concentrating, remembering, and thinking. Students often state that their brains are “fatigued.” Additional somatic symptoms are usually centered around the head and neck and include pain, pressure or tightness, blurring of vision, heat, or burning. “Brain tiredness” or fatigue from “too much thinking” is an idiom of distress in many cultures, and resulting syndromes can resemble certain Anxiety, Depressive, and Somatoform Disorders. Have you ever experienced “brain fag”? Would your family/significant others accept your attribution to brain fag as a credible explanation for your own responses to the challenges of university?

13. CRITICAL THINKING Hooked on the Net “Is ‘Internet Addiction Disorder’ truly the scourge of the info age, or merely the fanciful notion of yet another late 20th century would-be pop psychology guru?” EXPLAIN YOUR ANSWER. (By S. J. Ross, Special to the Star: The Toronto Star, May 21, 1998, Section J.)

14. UNTREATED MENTAL DISORDER? • IN 1990, ALMOST 19% (1,218,000) OF ONTARIONS AGED 15 TO 64 YEARS MET THE CRITERIA FOR A MENTAL DISORDER • 75% (920,000) DID NOT SEEK HELP OF ANY KIND FOR THEIR EMOTIONS, NERVES, MENTAL HEALTH OR USE OF ALCOHOL OR DRUGS • PROPORTION OF PEOPLE NOT SEEKING HELP HIGHEST FOR 15 TO 24 YEAR OLDS (86%), MALES (81%) & THOSE LIVING IN RURAL AREAS (81%)

15. DISABILITY COSTSTO SOCIETY(OFTEN UNRECOGNIZED BECAUSE OF STIGMA ATTACHED TO SYMPTOMS OF MENTAL DISORDERS & TREATMENT) • LOSS OF PRODUCTIVITY • IN ONTARIO, THE MONTHLY TOTAL NUMBER OF DAYS LOST BY THOSE WITH MENTAL DISORDERS CAN BE ESTIMATED AT 1,828,200 • DISRUPTION OF FAMILY LIFE • DYSFUNCTIONAL INTERPERSONAL RELATIONSHIPS CREATE GREATER HEALTH RISKS FOR ALL WHO ARE INVOLVED • LOWER QUALITY OF LIFE • TRULY ECONOMICALLY DISADVANTAGED • PERSONAL MISERY

16. Levels of Analysis in ASSESSMENT Psychological factors personality cognitive style social skills symptoms of psychopathology (diagnosis) Biological factors brain structure neurochemistry hormones autonomic nervous system functions Social factors marital adjustment family functioning peer relationships work & school satisfaction The clinician’s conceptual approach to a person’s problem will determine the selection of assessment instruments. This figure lists examples of variables that might be considered within each broad conceptual level.

17. VIDEO WHAT IS NORMAL? WHAT TO LOOK FOR: DEFINITIONS OF ABNORMAL EXAMPLES DIAGNOSIS: THE DSM PROS & CONS? EXAMPLES OF DISORDERS: DEPRESSION & ANXIETY CAUSES TREATMENT

18. CRITICAL THINKING THINK OF 2 OR 3 BEHAVIORAL PATTERNS THAT OTHERS WOULD SAY ARE MOST CHARACTERISTIC OF YOU. WHAT BIOLOGICAL, SOCIAL, AND PSYCHOLOGICAL FACTORS INFLUENCED THE DEVELOPMENT OF THESE BEHAVIORS? EXPLAIN YOUR ANSWER.

19. CRITICAL THINKING • WHAT IS THE APPROPRIATE LEVEL FOR INTERVENTION WITH PSYCHOLOGICAL DISORDERS? • DO YOU FAVOR MEDICATION, PSYCHOTHERAPY, FAMILY TREATMENT, OR SOCIAL CHANGE? • IN WHAT WAYS DO YOUR VIEWS ABOUT THE NATURE AND CAUSES OF ABNORMAL BEHAVIOR INFLUENCE YOUR THOUGHTS ABOUTTREATMENT?