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? Let’s 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 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.

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 woman’s 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 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?

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 one’s 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 modelsto 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 adifficulty in the person’s environment • In the person’s current interpretation of events, or in the person’s 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 estimatedpercentage 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 ondifferential 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-classification-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 you’ll 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 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.