Psychopathology 751

1. Psychopathology 751 Ψ diathesis stress models Ψ uses/problems with diagnostic enterprise Ψ evolutionary thoughts

2. theory in psychopathology • Diathesis Complexities— • Include perhaps include cognitive deficits/styles but harder to differentiate from symptoms of disorders. • “I favor focusing attention on those at a somewhat lower level of functioning (soft neurology and psychophysiology) rather than social behavior, or even psychometrics, on the ground that the former kinds of behavior are closer to the DNA and so have, by and large, been subject to less influence from complex social learnings contributing to individual differences variation and, hence, to increased statistical overlap.” (Meehl, 1990, p. 3).

3. theory in psychopathology • Stress— • “an interference or change in conditions affecting the individual which has an adverse effect, such as worry or hostility, especially when prolonged; also external conditions producing anxiety” Walton, 1985, p.157. • state like (versus trait of diathesis) • desire to create objective, temporally proximal stress definition.

4. theory in psychopathology • Difficulties defining Stress— • Difficult but worthy goal to reduce the reliance on individual differences in stress definitions (“what makes me stressed out is…” because these differing stressor may reflect various diatheses. • e.g., shy people stress in social situations whereas extroverts enjoy such contact.

5. theory in psychopathology • Diathesis—Stress Model put forth by Paul Meehl (1962) • Argued that vulnerability interacts with stress (i.e., schizogenic mother) to cause schizophrenia. • Posited that without right kind/amount of stress, an individual will have a residual, genetically coded, condition he labeled schizotaxia which he saw as akin to a necessary but not sufficient condition for schizophrenia.

6. theory in psychopathology • Diathesis—Stress Model • elegant: • fits data that humans are genetically coded to be the least biologically determined animals. We are the animal most open to good and environmental influence (culture, language) • limitations: • In the simplified model we are seduced into a limited view of both vulnerability and stress as unidimensional but they are not. • e.g., time of stressor may be very important, most disorders are polygenic

7. theory in psychopathology • Diathesis—Stress modified models • additive model • stress causes x disorder but those with a low level of diathesis require much more stress…implies that disorder x will occur with sufficient stress • threshold model • sufficient diathetic risk required to develop x disorder • at some threshold of diatheses, the individual will develop disorder x (without stressors).

8. theory in psychopathology • Diathesis—Stress complications • diathesis—stress interactions: • complicate the picture by questioning the independence of diatheses and stressors. • diathesis may cause stressors (e.g., traits of anxiousness and introversion may lead to greater strain in social support • timing of stressors may be critically linked • x stressor my be crucial a y developmental window but not important before/after • multiple genetic pathways may independently contribute to clinical condition (hard to measure) • genetics probably code for both vulnerability and protection (stress may work similarly)

9. psychodiagnosis • Why diagnose? Many clinical reasons… • treatment planning • predict outcomes/responses • protection of consumers (informs client what to expect) • can be used to communicate empathy • reduce risk of flight from treatment • nomenclature for communication • organize, retrieve info • describe patterns • facilitate theory/research • socio-political functions (who are patients, who gets to treat whom?)

10. psychodiagnosis • What’s wrong with the DSM-III (III-R, and IV)? • Valliant: • it is parochial • reductionistic • muddles state and trait • no theory (ignores conflict, adaptation, development, time course of symptoms) • validity sacrificed for reliability

11. psychodiagnosis • More problems with the DSM-IV • Co-morbidity threatens specificity of treatment goal. • not very good reliability under the best of circumstances • those kappa estimates are under structured diagnostic interview conditions but you won’t be applying the DSM under such circumstances • there is no gold standard (it’s a consensus/compromise document).

13. psychodiagnosis • ALTERNATIVE MODELS— • Use taxometrics to help identify discrete disorders • schizophrenia, schizotypy, unipolar and bipolar disorders, anti-social PD • from those probably not; dysthymia, impulse regulation problems • Dimensional models such as • Watson and Clark’s • Eysenck’s Model • Widiger et al.’s (1987) model with superordinate traits of social involvement, assertiveness, anxious

17. A few evolutionary thoughts (de Waal) • a point or two to ponder • the presence of observable behaviors/traits do not imply adaptive success/fitness. • the position that aberrant behaviors are adaptive has to account for majority of folks w/out beh. • rape, murder, etc. • ideas more consistent with the data • we have a wide range of possible behaviors that can be learned. we are coded to be possible murderers, rapists, etc. • conservation of form—nature can only use what is available • if specific traits are not sufficiently maladaptive they will not be removed from our genotype.

18. A few more evolutionary thoughts • evolution requires • small isolated gene pool of organisms mating so that a particular trait can become dominant • think of the Galapagos islands of Darwin’s finches • FINCHES! • Check em out (with pictures!): • http://www.rit.edu/~rhrsbi/GalapagosPages/DarwinFinch.html

19. A few more evolutionary thoughts • "Seeing this gradation and diversity of structure in one small, intimately related group of birds, one might really fancy that from an original paucity of birds in this archipelago, one species had been taken and modified for different ends.” • Darwin The Voyage of the Beagle, 1909 • evolution requires • pressures towards fitness (organisms w/out x trait need to fail to reproduce or be outstripped in future procreation) • we are not evolving. • we do not effectively practice eugenics (Hitler’s efforts notwithstanding) • the handicapped/disabled folks procreate

20. The Concept of a Mental Disorder (Wakefield) • there are no mental illness • labels are used for pathologizing the difficult, undesirable, etc.: social control. • refutation: yes, there are no ‘diseases’ only what we decide are natural circumstances that precipitate death, but there is harmful mental dysfunction. • disorders as whatever professionals treat: • personal attributes that are of therapeutic concern • refutation: not specific enough. what about marital distress, occupational concerns, etc. • disorder as statistical deviance: • objective/scientific, deviation from the mean. • refutation/problems: what about the other end of scale?extreme conscientiousness, intelligence, what qualifies as a dimension? clumsy, short, …

21. disorder as biological disadvantage 1. harmful dysfunction (science) + values (real harm) • ‘dysfunction’ as unfulfilled function-emotions as information. • (problem here with assumed functions that we don’t really understand and mental functions may not be as functionally hardwired but flexible by design. • ‘harm’ requires values such as freedom, distress, symptoms. • fits with Freud (repression) and Behaviorism (distressing maladaptive behaviors).