Download Clinical Psychology

Today’s Goals and HW
Goals: 1. To define psychologically abnormal
behavior.
2. Describe historical and cross-cultural views
of abnormality.
3. Describe the classification of psychological
disorders.
Mental Illness - A Brief History of
Psychiatric Centers
• http://www.youtube.com/watch?v=aAVqF3g9i
cY
Psychological Disorders and Treatment
• When should behavior be considered to be
disordered?
• Criteria for “disordered” behavior:
– Deviant (different)
– Distressful (causes distress)
– Dysfunctional (impairs your life and your ability to
function)
• Another set of criteria for “disordered” behavior:
–
–
–
–
Atypical
Maladaptive (poorly adapted to situation, to life, etc.)
Disturbing (either to self or others)
Unjustifiable
“Anne”
Anne is a sixteen-year-old girl living in a medium-sized
city in the Midwest. Her family includes a mother,
father, fourteen-year-old brother, and a great-aunt,
who has lived with the family since Anne was four.
Anne is a junior at City High School and is taking a
college-preparatory program. Her appearance is
strikingly different from the other girls in her class.
She wears tops which she has made out of various
scraps of material. The tops are accompanied by the
same pair of overalls everyday, two mismatched
shoes, and a hat with a blue feather. She is a talented
artist, producing sketches of her fellow classmates
that are remarkably accurate. She draws constantly,
even when told that to do so will lower her grade in
classes where she is expected to take lecture notes.
“Anne”
She has no friends at school, but seems undisturbed by the fact
that she eats lunch by herself and walks alone around the
campus. Her grades are erratic; if she likes a class she often
receives an A or B, but will do no work at all in those she
dislikes. Anne can occasionally be heard talking to herself; she
is interested in poetry, and says she is "composing" if asked
about her poetry. She refuses to watch television, calling it a
"wasteland." This belief is carried into the classroom, where
she refuses to watch any type of video within the lesson,
saying they are poor excuses for teaching. Her parents say
they don’t understand her; she isn’t like anyone in their
family. She and her brother have very little in common. He is
embarrassed by Anne’s behavior, and doesn’t understand her
either. Anne seems blithely unaware of her apparent isolation,
except for occasional outbursts about the meaninglessness of
most people’s activities.
5 minute small group discussion:
• Given the criteria for disordered behavior,
should Anne be considered to be disordered?
• Why or why not?
Overview of mental disorders from
DSM-IV
The Five Axes of DSM-IV
To diagnose and describe a patient using DSM-IV, a clinician rates
the patient on five dimensions or axes.
Axis 1: principle disorder
- problem that requires immediate
attention from a clinician (often what
brings the person in).
Axis 2: personality
disorders/developmental disorder - may
not require immediate care
- may be predisposing the person to
the Axis I problem
- can complicate treatment
Axis 3: general medical
conditions/neurological problems that
may be relevant to the individual's
current or past psychiatric problems
- sometimes psychological problems are
the byproduct of an illness such as
diabetes or heart disease.
Axis 4: "psychosocial and environmental
problems"
- things such as recent life stressors, poverty,
dysfunctional families, and other factors in the
patient's environment
- might impact the person's ability to function.
Axis 5: "Global Assessment of Functioning
Scale."
- overall rating of a person's ability to cope
with normal life over the past year.
- see next slide for scoring
Advantages of DSM-IV
- encourages comprehensive evaluation
- standardized format
- allows psychiatrists, psychologists, and other
mental health care workers to communicate in
a common language that all can understand.
Global Assessment of Functioning (GAF) Scale (DSM–
IV, Axis V)
Code
Description of Functioning
91 - 100
Person has no problems OR has superior functioning in several areas OR is admired and sought
after by others due to positive qualities
81 - 90
Person has few or no symptoms. Good functioning in several areas. No more than "everyday"
problems or concerns.
71 - 80
Person has symptoms/problems, but they are temporary, expectable reactions to stressors.
There is no more than slight impairment in any area of psychological functioning.
61 - 70
Mild symptoms in one area OR difficulty in one of the following: social, occupational, or school
functioning. BUT, the person is generally functioning pretty well and has some meaningful
interpersonal relationships.
51 - 60
Moderate symptoms OR moderate difficulty in one of the following: social, occupational, or school
functioning.
41 - 50
Serious symptoms OR serious impairment in one of the following: social, occupational, or school
functioning.
31 - 40
Some impairment in reality testing OR impairment in speech and communication OR serious
impairment in several of the following: occupational or school functioning, interpersonal relationships,
judgment, thinking, or mood.
21 - 30
Presence of hallucinations or delusions which influence behavior OR serious impairment in
ability to communicate with others OR serious impairment in judgment OR inability to function in
almost all areas.
11 - 20
There is some danger of harm to self or others OR occasional failure to maintain personal
hygiene OR the person is virtually unable to communicate with others due to being incoherent or
mute.
1 - 10
Persistent danger of harming self or others OR persistent inability to maintain personal hygiene
OR person has made a serious attempt at suicide.
Psychotic disorders
• A group of disorders with
psychotic symptoms, ie
the person loses touch
with reality as in
hallucinations or
delusions
• Schizophrenia is the most
common, where the
person has disturbances
in thought and
perception, and bizarre
behaviour
Anxiety Disorders
• Several disorders where
the main symptom is
anxiety, this could be
particular irrational
fears such as in phobias,
or general anxiety.
• Also cover panic
attacks, where the
person suddenly is
overwhelmed by
intense anxiety
Mood disorders
• Disturbances of normal
mood ranging from
extreme depression to
abnormal elation
(‘mania’)
• The condition can be
unipolar (depression) or
bi-polar (alternating
between periods of
depression and mania)
Somatoform disorders
• Somatoform disorders
are problems that seem
to be medical but are
actually psychological.
• This could be pain or
paralysis
• For example, a mother
who loses the use of
her right arm when her
son joins the army
(conversion disorder)
• Also included in this
category is
hypochondriasis – the
erroneous belief that
one has a fatal disease!
Impulse control disorders
• This is when the
individual is unable to
resist an impulse or
temptation, e.g.,
kleptomania involving
compulsive stealing for
no personal gain, or
• Trichotillomania, the
habitual pulling out of
one’s hair for pleasure
or tension relief
Personality disorders
• The person has some
permanent personality
characteristics which
often deviate from
social norms and can
cause distress to others,
for example, a
psychopath may
display superficial
charm and
pathological lying
• Psychopaths feel
no guilt for wrong
actions.
• They may commit
sexual assaults or
violent crimes for
which they feel no
remorse.
Another
personality
disorder is OCPD.
Dissociative disorders
• Dissociative disorders
cause losses or changes
in memory and identity.
• Included in this
category are
dissociative identity
disorder, fugue, and
amnesia
• The cause could be a
traumatic experience
Factitious disorders
• This is when a person
produces physical or
psychological symptoms
in order to assume a
‘sick role’ or gain
financial benefits or
reduced responsibility,
because they are ‘ill’.
• Munchausen’s and
Munchausen’s by proxy
Eating disorders
• The most common are
Anorexia nervosa and
Bulimia nervosa.
• The person has severe
disturbances in eating
behaviour
• False beliefs about body
shape and image
• The reason could be
biological, social, or
psychological.
Coming Soon: DSM-V
• Article: What Counts As Crazy (Time, March
19, 2012)
• How does one use the DSM?
• What changes in DSM-V?
• What additions?
• What controversies?