Download four characteristics of stigma

Week 1 Introduction to abnormal psychology
Introduction and historical overview (Ch. 1)
four characteristics of stigma:
1. a label is applied to a group of people that distinguishes them from others
2. label linked to deviant or undesirable attributes by society
3. people with label seen as essentially different from those without the label
4. people with label discriminated against unfairly
psychological disorders remain most stigmatised of conditions in the twenty-first century
fighting against stigma with strategies:
policy and legislative: policy in insurance coverage; discriminatory laws; employment;
decriminalisation—people with psychological disorders (e.g. substance abuse) often end
up in jail rather than hospitals
community: housing options; personal contact; education
mental health/profession: mental health evaluations; education and training
individual and family: education; support and advocacy groups
defining psychological disorder
disorder occurs within the individual
involves clinically significant difficulties in affect behaviour and cognition
involves personal distress of some sort
involves dysfunction in processes that support mental functioning
not a culturally specific reaction to an event
not primarily a result of social deviance or conflict with society
personal distress: person’s behaviour may be classified as disordered if it causes person
great distress
disability: impairment in some important area of life like work or personal relationships
violation of social norms: social norms are widely held standards—vary across cultures and
ethnic groups
dysfunction: harmful dysfunction; a subjective judgment ‘harmful’ objective component
‘dysfunction’
history of psychopathology
demonology: doctrine that an evil spirit can dwell within a person and control his or her mind
and body
exorcism
Hippocrates
psychological disorders as: mania, melancholia, phrenitis (brain fever)
four humours: blood, phlegm, black and yellow bile
he moved treatment of psychological disorders from priest to physician; identified that
human behaviour is affected by bodily structures or substances—led to contemporary
thought
Galen, last great physician of classical era
dark ages after he died, return to demonology, monks and monasteries nursed
psychologically disturbed, lunacy
persecution of witches
mid 14 century, people hospitalised not thought of as being possessed
13 century, lunacy trials
development of asylums
15 century, less hospitals for people with psychological disorders but many hospitals for
leprosy, these hospitals converted to mental asylums as leprosy was reduced
Bethlehem, bedlam
Pinel’s reforms, light and airy rooms replaced dungeons, reserved more humanitarian
treatment only for upper classes
Dorothea Dix Moral treatments: encouraged people to engage in purposeful activity, patients
led lives as close to normal people as possible, took responsibility for themselves, applied
to all classes, but abandoned in latter part of 19 century
evolution of contemporary thought
biological approaches
discovering biological origins in general paresis (psychopathology) and syphilis; germ
theory; for the first time a causal link was established between infection, damage to
certain areas of the brain and a form of psychopathology
genetics
Galton, nature and nurture, heritability of psychological disorders like schizophrenia, bipolar
disorder and depression, created the eugenics movement, 45000 people sterilised in US
biological treatments
use of ECT electroconvulsive therapy, Cerletti and Bini, to induce seizures to help
schizophrenia and depression, still used to deal with depression
use of prefrontal lobotomy, removal of tracts connecting frontal lobes to other areas of the
brain, Walter Freeman did 2500 lobotomies, too easily done/accessed
psychological approaches
-Mesmer and Charcot: treated hysteria, which referred to physical incapcities, such as
blindness or paralysis for which no physical cause could be found; mesmerised, similar to
hypnotism; believed to be altered magnetism, lots of mysterious rituals, talking
-Breuer and cathartic method, case of Anna O, reliving an earlier emotional trauma and
releasing emotional tension by expressing previously ‘forgotten’ thoughts about the
event—catharsis
-Freud and psychoanalysis: unconscious conflicts in individual causes psychopathology
-structure of the mind: or psyche: id, ego, and superego.; id—energy (libido) for psyche,
basic urges, works on pleasure principle, immediate gratification of urges; ego develops
from id during second 6 months of life, reality principle mediates between the demands of
reality and immediate gratification; superego, conscience, develops from childhood,
arises from ego like ego to id; defines mechanisms, how ego protects itself from anxiety
psychoanalytic therapy: free association, interpretation and analysis of transference
neo-Freudian Jung and analytical psychology, collective unconscious: part of unconscious
common to all human beings, archetypes, or basic categories that all human beings use
in thinking about the world; Jung’s extraversion v introversion
Adler and individual psychology: people as inextricably tied to their society, fulfilment was
found in altruism
influences on current field of psychopathology:
1. childhood experiences help shape adult personality
2. unconscious influences behaviour
3. causes/purposes of human behaviour not always obvious
rise of behaviourism
beaviourism: focuses on observable behaviour rather than on consciousness or mental
functioning
classical, operant conditioning and modelling
Thorndike’s law of effect: behaviour that is followed by consequences satisfying organism
will be repeated, behaviour followed by noxious/unpleasant consequences will be
discouraged
behaviour therapy, systematic desensitisation: 1. deep muscle relaxation; 2. gradual
exposure to list of feared situations, starting with those that arouse minimal anxiety to
those that are most frightening
modeling sed as well for behaviour therapy
importance of cognition and emotion: cognitive therapy: emphasise how people construe
themselves and world is major determinant of psychological disorders
by changing cognition, therapists think they can change people’s feelings, behaviours and
symptoms
Beck’s REBT (rational emotive behaviour therapy) that sustained emotional reactions are
caused by internal sentences that people repeat to themselves
Diagnosis and assessment (Ch. 3)
reliability and validity
reliability: consistency of measurement
interrater reliability: degree to which two independent observers agree on what they have
observed
test-retest reliability: extent to which people taking same test twice receive similar scores
alternate form reliability: extent to which scores on two forms of test are consistent
internal consistency reliability: whether items on a test are related to one another
validity: whether a measure does what it is supposed to do
content validity: whether a test adequately samples domain of interest—social anxiety test
should include items that cover feelings of anxiety in different social situations
criterion validity: whether a measure is associated in an expected way with some other
measure (criterion)
concurrent validity: if both variables measured at the same point in time, resulting validity
predictive validity: can measure predict some other variable measured at point in future
construct validity: does it measure characteristic or construct not observed simply or overtly
DSM-5 diagnostic and statistical manual of mental disorders
1. specific diagnostic criteria—symptoms for a given diagnosis—are spelled out precisely
2. characteristics of each diagnosis described much more extensively: age of onset,
course, prevalence, risk…….
changes in DSM-5
removal of multiaxial system, in place of three axes, clinicians simply note psychiatric and
medical diagnosis
changing organisation of disorders by causes to symptoms because knowledge base is not
yet strong enough to organise diagnoses around aetiology
DSM-4-TR diagnoses clustered into chapters based on similarity of symptoms, but in DSM-5
chapters were reorganised to reflect patterns of comorbidity and shared etiology
enhanced sensitivity to developmental nature of psychopathology: childhood diagnoses
were considered in separate chapter, but have now been moved into other relevant
chapters of DSM-5 to highlight continuity between childhood and adulthood forms of
disorder
new diagnoses, e.g. disruptive mood dysregulation, to reduce overdiagnosis of bipolar
disorder in children; other new: hoarding disorder, binge eating disorder, premenstrual
dysphoric disorder, gambling disorder
combining diagnoses: some diagnoses from DSM-4-TR combined because not enough
evidence for differential etiology, course or treatment response to justify separate
diagnostic categories
ethnic and cultural considerations in diagnosis: DSM-5 includes a list that cross-references
the DSM diagnoses with the International Statistical Classification of Disease and Related
Health Problems (ICD) codes
appendix devoted developing a cultural informed case formulation; clinicians ar cautioned
not to diagnose symptoms unless they are atypical and problematic within a person’s
culture; cultures may shape the language used to describe distress
DSM-5 includes nine cultural concepts of distress; following are examples of syndromes
listed in DSM-5 glossary: Dhat syndrome, Indian, fear of discharging semen; 神經衰弱
neurasthenia, fatigue, dizziness, headaches…; 対人恐怖症 fear that one could offend
others through eye contact, blushing… body odour…; ataque de nervios, fear of
screaming and shouting uncontrollably (Latino/Latina)
not listed in DSM-5: amok, period of brooding and then violent outburst; ghost sickness,
preoccupation with death and those who have died (Native American); ひきこもり 自閉症
specific criticisms of the DSM
too many diagnoses: now 347 from 297 in DSM-4-TR
too many minute distinctions based on small differences in symptoms; side effect of huge
number of diagnostic categories is comorbidity, presence of a second diagnosis, people
who meet one psychiatric diagnosis, 45% meet criteria for one more psychiatric diagnosis
risk factors seem to trigger more than one disorder
should we keep finer distinctions or lump?
some disorders co-occur more frequently than do others,some disorders co-occur so often
that they should be considered different manifestations of one underlying disease process
or vulnerability
categorical classification versus dimensional classification
discrete v continuous
categorical system forces clinicians to define one threshold as diagnosable, but many
people with sub threshold symptoms of a diagnosis will still receive treatment
NOS—not otherwise specified—when person meets many but not all criteria for diagnosis
reliability of the DSM in everyday practice—expecting high reliability may be unrealistic as
many medical diagnoses do not have great reliability at all
how valid are diagnostic categories
general criticisms of diagnosing psychological disorders
could have a stigmatising effect, though research suggests that people tend to view the
behaviours negatively more than the category labels, labels may actually relieve stigma
by providing an explanation for the symptomatic behaviour
when a diagnostic category is applied we may lose sight fo the uniqueness of that person
psychological assessment
clinical interviews
characteristics: one way a clinical interview is different is the attention the interviewer pays to
how the respondent answers or does not answer questions, recognise the importance of
establishing rapport, empathise, encourage to elaborate
operate on vaguest outlines
unstructured interviews are less reliable than structured interviews
structured interview: questions are set out in a prescribed fashion for the interviewer
eg SCID—structured clinical interview— branching interview, that is, a person’s response to
one question determines the next question that is asked
clinicians using unstructured diagnostic interviews tend to miss comorbid diagnoses that
accompany a primary diagnosis, interrater reliability for structured interviews are quite
good
assessment of stress
stress: subjective experience of distress in response to perceived environmental problems
Bedford college life events and difficulties schedule (LEDS), semistructured, interviewer and
interviewee work collaboratively to produce a calendar of each of the major events within
a given time period; designed to address problems in life stress assessment like need to
evaluate importance of any given life event in the context of a person’s life circumstances;
excluded life events that might be consequences of symptoms; includes a set of
strategies to carefully date when a life stressor occurred
self-report stress checklist, not collaborative, quicker way to assess stress
typically list different life events and participants are asked to indicate whether or not thees
events happened to them in a specified period of time; there is a great variability in how
people view these events—one difficulty
other problems include difficulties with recall and low test-retest reliability because of bias
during responses
personality tests
psychological tests include personality and intelligence tests
self-report personality inventories
in a personality inventory, person is asked to complete a self-report questionnaire indicating
whether statements assessing habitual tendencies apply to him or her
statistical norms for test can then be established—which is called standardisation
Minnesota multiphasic personality inventory (MMPI), multiphasic because designed to detect
a number of psychological problems
MMPI-2 addresses lack of ethnic minorities, sexist wording was eliminated along with
outmoded idioms
people who endorse a large number of statements in the lie scale might be attempting to
present themselves in a good light, high scores on the infrequency scale also discriminate
between people trying to fake psychopathology and people who actually have a
psychological disorder
a person who obtains high scores on the lie or infrequency scale may be viewed with
skepticism
projective personality tet
projective test: psychological assessment tool in which a set of standard stimuli—inkblots or
drawings—ambiguous enough to allow variation in responses is presented to the person
assumption is that because the stimulus materials are unstructured and ambiguous, the
person’s responses will be determined primarily by unconscious processes and will reveal
his or her true attitudes, motivations and modes of behaviour—projective hypothesis
thematic apperception test: person is shown a series of black-and-white pictures one by one
and asked to tell a story related to each; low construct validity, norms based on small and
limited sample
Rorschach inkblot test: a person is shown 10 inkblots one at a time and asked to tell what
the blots look like; Exner’s scoring system, concentrates on perceptual and cognitive
patterns in a person’s responses; unclear whether Rorschach provides information that
could not be obtained more simply through an interview; appears to have better validity in
assessing some issues more than others like schizophrenia, bpd, and dependent
personality traits
intelligence test
IQ test: way of assessing a person’s current mental ability
based on assumption that a detailed sample of a person’s current intellectual functioning can
predict how well s/he will perform in school, individually administered
purposes include: to diagnose learning disorders, identify strengths and weaknesses for
academic planning; to assess whether a person has intellectual disability; to identify
intellectually gifted children; as part of neuropsychological evaluations to show eg
deterioration of mental ability over time
100 is the mean, 15/16 is standard deviation, 65% receive 85-115
IQ tests are highly reliable, good criterion validity, good predictors of educational attainment
and occupational success, though lack of causality between education and IQ
IQ tests explain only a small part of school performance
IQ tests measure only what psychologists consider intelligence
stereotype threat, social stigma of poor intellectual performance by some groups actually
interferes with performance on these tests
awareness of stereotypes develop early (gender race and intellect)
behavioural and cognitive assessment
identify: aspects of environment that might contribute to symptoms; characteristics of
person; frequency and form of problematic behaviours; consequences of problem
behaviours
direct observation of behaviour: formal behavioural observation, observer divides sequence
of behaviour into various parts that make sense within a learning framework; behavioural
assessment procedures yield data that could be used to measure effects of treatment
self-observation, self-monitoring: observe and track own behaviour and responses
ecological momentary assessment (EMA), collection of data in real time as opposed to the
more usual methods of having people reflect back over some time period and report on
recently experienced thoughts, moods, or stressors; with EMA, a person is signalled (via
smartphone) several times a day and asked to enter responses directly into the device
reactivity: phenomenon wherein behaviour changes because it is being observed; desirable
behaviour such as engaging in social conversation increases in frequency when it is selfmonitored
cognitive-style questionnaires
Neurobiological assessment
brain imaging
CT/CAT scan computerised axial tomography assesses structural brain abnormalities, uses
radioactivity,
magnetic resonance imaging superior to CT scan because it produces pictures of higher
quality and does not rely on even the small amount of radiation required by a CT scan
functional MRI allows researchers to measure both brain structure and brain function,
measures blood flow in the brain, called BOLD signal, blood flow in particular region of
brain is proxy for neural activity in that region
positron emission tomography, PET scan, allows measurement of both brain structure an
brain function although the measurement of brain structure not as precise as with MRI or
fMRI, less used because of how invasive it is
functional connectivity analysis: aims to identify how different areas of the brain are
connected with one another
neurotransmitter assessment
metabolite, an acid, is produced when a neurotransmitter is deactivated, these by-products
of neurotransmitters found in urine blood serum and cerebrospinal fluid, high level of
metabolite indicates high level of neurotransmitter and vice versa
the problem is that such measures are not direct reflections of levels of neurotransmitters in
the brain as metaolites measured could reflect neurotransmitters anywhere in the body,
even with CSF fluid however metabolites reflect activity throughout brain and spinal cord,
rather than regions directly involved in psychopathology
another problem is that they are correlational
more experimental data can be obtained from administering drugs that increase or decrease
levels of neurotransmitters, consider ethics, also levels of one neurotransmitter influences
other neurotransmitter systems
many brain abnormalities involve alterations in structure so subtle that they have thus far
eluded direct examination, cannot use brain scans to diagnose psychopathology
psychopathology so widespread that attributing it to one brain dysfunction is difficult
neuropsychological assessment
neurologist: specialist in things affecting nervous system
neuropsychologist: psychologist who studies how dysfunction of brain affects way we
think …
neuropsychological tests: used in in conjunction with brain-imaging techniques, to detect
brain dysfunction and pinpoint specific areas of behaviour impacted by problems in brain;
based on idea that psychological functions rely on different areas of brain
Reitan’s modification of a battery of test developed by Halstead
tactile performance test—time (timed)
tactile performance test—memory
speech sounds perception test, measures left-hemisphere function
valid for detecting behaviour changes linked to brain dysfunction resulting from a variety of
conditions
psychophysiological assessment
psychophysiology: bodily changes that are associated with psychological events
activities of autonomic nervous system used to understand emotion, heart rate, depicted by
electrocardiogram EKG
skin conductance, for ANS, detected by electrodermal responding—increased sweat-gland
activity indicates sympathetic autonomic excitation and taken as measure of emotional
arousal
electroencephalogram EEG, scalp, record electrical activity in underlying brain area
limitations: skin conductance detects more than anxiety; being in a scanner is scary
Cultural and ethnic diversity and assessment
cultural bias in assessment
simply translating words into a different language does not ensure that meaning of those
words will be the same across different cultures
cultural assumptions may cause clinicians to over- or underestimate psychological problems
in other cultures
strategies to overcome bias
use graduate training programs, education, become informed about culture and its effects on
assessment, do not rely on global stereotypes
examiner may need to make an extra effort to establish rapport that will result in person’s
best performance
be tentative
structured interviews less likely to overdiagnose people from different cultures