Basic Concepts of Psychological Disorders Module 40 Basic Concepts of Psychological Disorders Josef F. Steufer/Getty Images

Basic Concepts of Psychological Disorders 40-1: HOW SHOULD WE DRAW THE LINE BETWEEN NORMALITY AND DISORDER? According to psychologists and psychiatrists, psychological disorders are marked by a “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior” (American Psychiatric Association, 2013). Such thoughts, emotions, or behaviors are dysfunctional or maladaptive. They interfere with normal day-to-day life. The dysfunctional person is often distressed.

Basic Concepts of Psychological Disorders Understanding Psychological Disorders 40-2: HOW DO THE MEDICAL MODEL AND THE BIOPSYCHOSOCIAL APPROACH INFLUENCE OUR UNDERSTANDING OF PSYCHOLOGICAL DISORDERS? In earlier times, abnormal behavior attributed to strange forces (movement of the stars, godlike powers, evil spirits). During the Middle Ages, it was commonly believed that abnormal people were possessed by devils. “Therapy” often involved physical and mental torture. Philippe Pinel (1745–1826) recognized abnormal behavior as sickness of the mind. Opposed barbaric treatments of patients. Introduced and encouraged reforms and humane treatments.

YESTERDAY’S “THERAPY” Through the ages, psychologically disordered people have received brutal treatments, including the trephination evident in this Stone Age skull. Drilling skull holes like these may have been an attempt to release evil spirits and cure those with mental disorders. It looks doubtful that this patient would have survived the “cure.”

Basic Concepts of Psychological Disorders Understanding Psychological Disorders The Medical Model By the 1800s the search began for physical causes of mental disorders and for curative treatments. With the medical model of mental disorders, mental illness is to be diagnosed on the basis of symptoms and treated through therapy, often in a psychiatric hospital. Reinvigoration of the medical model has come from recent research in genetically influenced brain abnormalities in brain structure and biochemistry. Medical model: The concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and, in most cases, cured, often through treatment in a hospital.

Basic Concepts of Psychological Disorders Understanding Psychological Disorders The Biopsychosocial Approach General approach positing that biological, psychological, and social-cultural factors all play a significant role in human functioning in the context of disease or illness. Some symptoms of disorders are culture-related, which points to environmental influences. For example, the eating disorders anorexia nervosa and bulimia nervosa occur mostly in food-abundant cultures. Depression and schizophrenia occur worldwide.

Basic Concepts of Psychological Disorders Understanding Psychological Disorders The Biopsychosocial Approach Disorders reflect Genetic predispositions and physiological states Psychological dynamics Social and cultural circumstances The biopsychosocial approach emphasizes that mind and body are inseparable. Epigenetics: The study of environmental influences on gene expression that occur without a DNA change. Epigenetics shows that our environment can affect the expression (or not) of a gene, thus affecting the development of psychological disorders.

BIOPSYCHOSOCIAL APPROACH TO PSYCHOLOGICAL DISORDERS Today’s psychology studies how biological, psychological, and social-cultural factors interact to produce specific psychological disorders.

Basic Concepts of Psychological Disorders Classifying Disorders—and Labeling People 40-3: HOW AND WHY DO CLINICIANS CLASSIFY PSYCHOLOGICAL DISORDERS, AND WHY DO SOME PSYCHOLOGISTS CRITICIZE THE USE OF DIAGNOSTIC LABELS? Classification orders and describes symptoms Diagnostic classification in psychiatry and psychology attempts to: Predict the disorder’s future course Suggest appropriate treatment Prompt research into its causes

Basic Concepts of Psychological Disorders Classifying Disorders—and Labeling People The most common tool for system for classifying disorders is the Diagnostic and Statistical Manual of Mental Disorders now in its fifth edition (DSM-5), 2013 Published by the American Psychiatric Association Describes disorders and estimates their occurrence In the new DSM-5, some changes include: Some label changes (e.g., autism spectrum disorder; intellectual disability) New categories: Hoarding disorder, binge-eating disorder New or altered diagnoses—some controversial (e.g., concern that simple bereavement may be too quickly diagnosed as a depressive disorder)

Basic Concepts of Psychological Disorders Classifying Disorders—and Labeling People DSM criticisms include: Critics have long faulted the DSM for casting too wide a net Antisocial personality disorder and generalized anxiety disorder did poorly on field trials for the new DSM-5 . DSM-5 continues the path of potentially pathologizing everyday life Labels are or may act as society’s subjective value judgments DSM benefits include: Helping mental health professionals communicate It is useful in research Clients often relieved to identify suffering

ADHD—Normal High Energy or Disordered Behavior? 40-4: WHY IS THERE CONTROVERSY OVER ATTENTION- DEFICIT HYPERACTIVITY DISORDER? Attention-deficit/hyperactivity disorder (ADHD): Marked by extreme inattention and/or hyperactivity and impulsivity 11 percent American 4- to 17-year-olds receive this diagnosis after displaying its key symptoms; 2.5 percent adults have ADHD symptoms. Critics fear this disorder is overdiagnosed, leading to overuse of prescription drugs. Those who say ADHD is overdiagnosed argue: Symptoms displayed sound like the “ disorder” of having a Y chromosome; ADHD is three times more prevalent in boys than girls. ADHD may in effect be marketed by companies that offer drugs for its treatment (Thomas, 2015). Energetic child + boring school = ADHD diagnoses?

ADHD—Normal High Energy or Disordered Behavior? Alternate view of those arguing that ADHD is not overdiagnosed: More frequent diagnoses due to increased awareness of disorder Scientific community agrees ADHD is a real neurobiological disorder Coexists with learning disorders Is heritable It is treatable with medications There is debate over the safety of long-term use of these stimulant medications in treating ADHD.

Basic Concepts of Psychological Disorders Are People With Psychological Disorders Dangerous? 40-5: DO PSYCHOLOGICAL DISORDERS PREDICT VIOLENT BEHAVIOR? Mental disorders seldom lead to violence and clinical prediction of violence is unreliable. Most people with disorders are nonviolent and are more likely to be victims than perpetrators of violence. When they are violent, moral and ethical questions about whether society should hold people with disorders responsible for their violent actions are raised. Triggers for violence acts by people with mental disorders, in addition to disordered thinking, include substance abuse.

Basic Concepts of Psychological Disorders Rates of Psychological Disorders 40-6: HOW MANY PEOPLE HAVE, OR HAVE HAD, A PSYCHOLOGICAL DISORDER? IS POVERTY A RISK FACTOR? The U.S. National institute of Mental Health estimates just over 1 in 4 adult Americans “suffer from a diagnosable mental disorder in a given year” (Kessler et al., 2008). Psychological disorder rates vary by time and place. Immigrant paradox: Those born to immigrants to the United States at greater risk of mental disorder than the immigrants (for example, Mexican-Americans born in the U.S.). Poverty is a risk factor: Incidence of serious psychological disorders is doubled . Conditions and experiences associated with poverty contribute to the development of psychological disorders. But some disorders, such as schizophrenia, can drive people into poverty; correlation goes both ways.

Basic Concepts of Psychological Disorders Rates of Psychological Disorders Psychological disorders usually strike by early adulthood (first symptoms by age 24 in most cases) Symptoms arrive at the following median ages: Antisocial personality disorder (age 8) Phobias (age 10) Alcohol use disorder (near age 20) Obsessive-compulsive disorder (near age 20) Schizophrenia (near age 20) Major depressive disorder (age 25)

PERCENTAGE OF AMERICANS REPORTING SELECTED PSYCHOLOGICAL DISORDERS IN THE PAST YEAR

What Increases Vulnerability to Mental Disorders? Risk and Protective Factors for Mental Disorders