Download SOSC 103 FALL 2012 BERNSTEIN ET AL. PSYCHOLOGICAL

SOSC 103
FALL 2012
BERNSTEIN ET AL. PSYCHOLOGICAL DISORDERS
Psychopathology
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Maladaptive, disruptive, or uncomfortable patterns of thinking, feeling, and behaving
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Affect individuals
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Affect the people with whom they interact
Incidence of Specific Psychological Disorders
Rates of Psychological Disorders
Defining Psychological Disorders
Definition used in Diagnostic and Statistical Manual of Mental Disorders (DSM) DSM-IV-TR
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Behavioral, psychological, or biological dysfunctions that are unexpected in their cultural
context and associated with present distress or impairment in functioning or with increased
risk of suffering, death, pain, disability, or an important loss of freedom.
What Is Abnormal?
Mental health workers view psychological disorders as ongoing patterns of thoughts, feelings, and
actions that are deviant, distressful, and dysfunctional (Comer, 2004).
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Deviance
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Statistical infrequency
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Norm violation
Distress
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Personal suffering
Dysfunction
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Impaired functioning
A Practical Approach for Identifying Abnormal Behavior
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Content of the behavior
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Sociocultural context in which it occurs
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Consequences for that person and for others
Explaining Psychological Disorders: What causes abnormality?
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Biopsychosocial Model
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Biological factors—the medical model
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Psychological processes
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Sociocultural contexts
The Medical Model (The Neurobiological Model)
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Disorders stem primarily from an underlying illness that can be diagnosed, treated, and cured
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Biological factors cause mental illness
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Physical illnesses
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Disruptions or imbalances in bodily processes
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Genetic influences
The Medical Model: Early History
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Hippocrates: psychological disorders resulted from imbalances among four humors
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Ancient Chinese: psychological disorders resulted from an imbalance of yin and yang
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Medical model gained prominence in Western cultures after the middle ages
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Rise of hospitals for the insane
Biological Tradition: Hippocrates and Galen
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Humoral theory of disorders: The balance of four bodily fluids affect behavior and personality
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Sanguine (red like blood; cheerful),
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black bile (melancholic person),
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yellow bile (choleric person; hot tempered),
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phlegm (apathy and sluggish)
Wondering womb syndrome
Medical Model
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Emil Kraepelin (1856-1926): First formal diagnosis and classification of psychological
disorders, each with a different age of onset, course, and cause
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Formation of first state mental hygiene committee
The Medical Model: Early Treatments; Middle Ages through the Renaissance (from 500 BC up to
16th C.)
Shock patients to normal or restraining treatment
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Physical restraints
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Laxative purges
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Bleeding of “excess” blood
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Induced vomiting
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Cold baths
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Fasts
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Spinning chairs
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The Crib – movement limited
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Rush/Restraining Chair where the movements and sensory stimuli were restricted
Nineteenth Century: Moral Treatment
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The removal of patients from “warehouse” asylums into specialized facilities devoted to the
care and treatment of the mentally ill
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Advocacy for a more humane treatment
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The use of respect, kindness, religion, and vocation
Key founders: Philippe Pinel, William Tuke, Benjamin Rush, Dorothea Dix, and Emil Kraepelin
More Humane Treatments: 18th-19th Centuries
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More humane living conditions for those with mental illness and treatment options…
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Benjamin Rush, France
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William Tuke, Great Britain
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‘Mental disorders have organic causes’… mental disorders are disease.
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Dorothea Lynde Dix, Clifford Beers – worked to improve treatment of those mentally ill
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Kraepelin: First formal classification of psych disorders, first state mental hygiene movement
The Psychological Model
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Emphasizes psychological factors:
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Wants
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Needs
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Emotions
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Learning experiences
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Attachment history
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World view
The Psychological Model: Approaches to Psychological Disorders
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Sigmund Freud’s psychodynamic explanation: Unresolved, mostly unconscious conflicts
between inborn impulses and the limits placed on those impulses by society
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Social-cognitive (social learning) explanation:
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Interaction of past learning and current situations
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Emphasizes the roles of learned expectations, schemas, and other mental processes
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Humanistic psychology explanation:
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Natural tendency toward healthy growth is blocked and perceptions of reality
become distorted
The Sociocultural Perspective
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Sociocultural factors include:
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Gender, age, and marital status
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Physical, social, and economic situations
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Cultural values, traditions, and expectations
Sociocultural factors influence:
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What is labeled abnormal
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Who displays what kind of disorder
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Likelihood of treatment
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Overall prevalence of disorders
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Form of abnormality
The Sociocultural Perspective: Effects of Sociocultural Factors
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Create differing stressors, social roles, opportunities, experiences, and avenues of expression
for different groups of people
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Help shape the disorders and symptoms to which certain categories of people are prone
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Affect responses to treatment
The Sociocultural Perspective: Culture-General Disorders
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Culturally influenced symptoms; e.g., Depression
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In Western cultures, emotional and physical experiences are viewed separately, so
symptoms appear as emotional distress
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In China and Japan, emotional and physical experiences are seen as one, so
symptoms may appear as stomach or back pain
The Sociocultural Perspective: Culture-Specific Disorders
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Ataques de nervios (attacks of nerves) among Puerto Rican, Guatemalan, Mexican, and
Dominican women
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Kyol goeu among Khmer refugees
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Koro among Southeast Asian, southern Chinese, and Malaysian men
The Diathesis-Stress Model: An Integrative Explanation
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Biological, psychological, and sociocultural factors can predispose us toward a disorder
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A certain amount of stress is needed to trigger that disorder
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If major stressors don’t occur—or if the person has adequate coping skills—
symptoms may never appear, or may be relatively mild
The Diathesis-Stress Model: An Integrative Explanation
Strength of diathesis creates vulnerability
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People with a strong diathesis may succumb to relatively mild stress
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People with weaker diathesis may not show signs of a disorder until stress becomes extreme
or prolonged
Classifying Psychological Disorders
How many psychological disorders have been identified?
Classifying Psychological Disorders
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Reasons for classification:
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Describe the nature of a problem
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Predict the course of a problem
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Choose or suggest the most appropriate method of treatment
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Stimulate research on the causes and treatment of mental disorders
Classification Systems
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In North America
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The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
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Published by the American Psychiatric Association
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The most recent edition, DSM-IV-TR (Text Revision, 2000), describes more than 300
psychological disorders compared to 60 in the 1950s.
Outside North America
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International Classification of Diseases (ICD-10)
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International Classification of Impairments, Disabilities and Handicaps (ICIDH-2)
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Published by the World Health Organization
DSM-IV Classification System
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Axis I: Diagnosed mental disorder
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Axis II: Personality disorders/intellectual disability
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Axis III: Relevant medical conditions
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Axis IV: Psychosocial and environmental problems
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Axis V: Current level of psychological, social, and occupational functioning
How Good is the Diagnostic System? Interrater Reliability
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High for some disorders; e.g., anxiety disorders, affective disorders, schizophrenia
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Low for others; e.g., somatoform disorders, Axis II personality disorders
How Good is the Diagnostic System? Validity
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Stronger for some diagnoses; e.g., schizophrenia, depression
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Weaker for others; e.g., ADHD, somatoform disorders
Problems with the Diagnostic System
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Mixed disorders are common
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Same symptoms seen in different disorders
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Subjective nature of criteria judgments
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Possibility of bias in diagnosis
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Insufficient attention to sociocultural variables
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Labeling can be dehumanizing