Psychological Disorders and Diagnosis An Introduction

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

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 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 anotherThe same behavior may be considered normal in one culture but abnormal in another Examples of Cultural Bound Disorders: Examples of Cultural Bound Disorders: Susto – Latin America – anxiety and fear of black magic Susto – Latin America – anxiety and fear of black magic Koro – Southeast Asian Men Koro – Southeast Asian Men Time Period and Social Conditions ADHD ADHD Is it a real problem or just kids being active kids??Is it a real problem or just kids being active kids?? Energetic child + boring school = ADHD overdiagnosis?Energetic child + boring school = ADHD overdiagnosis? Homosexuality Homosexuality

How do we classify and learn about Psychological Disorders??? We use the DSM DSM-IV-TR: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??

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

So How does the DSM work?? Axes or Dimensions (5 in total)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 IIAxis I and Axis II –Contains lists of disorders Axis IIIAxis III –Contains general medial conditions and diseases Axis IVAxis IV –Any psychosocial and environmental problems that may impair function Axis VAxis V (GAF) –Global assessment of functioning (GAF) –A numerical value that indicates overall level of mental health

A Sample DSM Evaluation 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. The Clinical Picture of Angela Savanti

The Diagnosis Axis IAxis I –Major Depressive Disorder Axis IIAxis II –Dependent personality Disorder Axis IIIAxis III –Diabetes Axis IVAxis IV –Problems related to social environment (termination of relationship – Jerry and Father) Axis VAxis V –GAF = 55 The Clinical Picture of Angela Savanti

A Cautionary Note… The DSM-IV provides an invaluable tool to psychologists, but it doesn’t come without its criticismsThe 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 PMSSome 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 subjectiveAlso, some believe the DSM-IV makes diagnosis of disorders scientific when they are actually highly subjective The problem of Labeling…The problem of Labeling…

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 Can lead to stigmatization –The Rosenhan Study –rooms for rent story Can change reality Can change reality –a student is “gifted” or “hostile”

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

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

Are you Insane?? Mental Illness vs. Insanity Mental Illness Mental Illness –A medical decision Insanity 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

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??

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

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

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.

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

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

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

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

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

Anxiety Disorders A group of disorders in which either fear or anxiety is a major symptom 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 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

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

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

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

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

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