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Intro to Psychological Disorders OCD General Psych 2 Module 43 November 6, 2003 Class #20 Some definitions of abnormality… Stratton & Hayes (1993) These researchers define abnormality as: Behavior which deviates from the norm Most people don’t behave that way Behavior which does not conform to social demands Most people don’t like that behavior Behavior which is maladaptive or painful to the individual Its not normal to harm yourself What Behaviors Are Abnormal? How do we define what is abnormal? The culture’s perspective The generation’s perspective The individual’s perspective The Culture’s Perspective Deviance Here, we are looking at the degree in which an individual’s behavior differs from cultural norms Standards of acceptability vary from culture to culture But to be considered disordered, the atypical behavior must also be disturbing to other people The Culture’s Perspective Rationally Unjustifiable If someone claims to be hearing mysterious voices and claims to be talking to God (or to a lost relative, etc.) we would likely consider there to be a problem unless they could convince us that the voices were real… The Generation’s Perspective Standards of acceptability also vary from generation to generation Example: Homosexuality The Individual’s Perspective Distress Does the individual feel psychological pain? Disability Does the behavior interfere with the person’s ability to function personally, socially, or occupationally? Many psychologists believe this is the best criterion for determining the normality of behavior – does it foster individual and group well-being? A Little History of Mental Illness… The Good Old Days Trephination An operation performed since Stone Age times A circular section of the skull is carved away, leaving a hole in the skull allowing for “evil spirits” to be released Interestingly, most of these patients survived Some were considered witches… Submerged into water – if they drowned it was felt they weren’t really witches Thousands of women were killed in this manner during 13th-16th century The Age of Enlightenment Physiological Treatment Bleeding Fear Excessive blood in the brain Put in coffin-like box and submerged in water until bubbles from the patient’s breathing had ceased to come to the surface at which point the person was revived… Drugs The use of alcohol, opium, and marijuana were used to try to cure these individuals The Age of Enlightenment Asylums During this time, places where the mentally ill were cared for began to surface Before this, these people were treated as criminals and put in jails or prisons A medical model where psychological disorders were considered to be sicknesses that could be cured through therapy at a psychiatric hospital became the prevailing viewpoint Bedlam Hospital of St. Mary of Bethlehem (established officially in 1500’s) Bedlam – “lunatics” were treated cruelly…if they became too excited they were chained out of harm’s way and often beaten or doused with water Visitors would pay a small fee to be allowed to go in and ridicule the patients for entertainment purposes The crowds would often become very noisy and disorderly themselves – hence, the name Removing the chains… Philippe Pinel Institutes a medical model – that these psychological disorders were sicknesses That psychopathology needs to be diagnosed on the basis of its symptoms and cured through therapy He removed the chains from the mentally ill and his treatment consisted in large part along the lines of a good diet, encouragement, and the least restrictive setting – in general, many of the components of psychotherapy The Modern Era Psychological processes Suggestion and hypnotism Bio-psycho-social Perspective Mental disorders are seen as caused by the combination and interaction of: Biological Factors: Includes physical illnesses and disruptions of bodily processes that may in part be due to genetic predispositions Psychological Factors: Includes psychological processes such as our wants, needs, and emotions; our learning experiences; and our way of looking at the world Sociocultural Factors: Includes the social and cultural context that form the background of the abnormal behavior Diagnostic and Statistical Manual (DSM-IV) The behavior pattern of all psychological disorders were not clearly described until the publication of the APA’s first diagnostic and statistical manual (DSM-I) in 1952 DSM-IV defines 17 major categories of mental disorder Purposes of Diagnostic System Designed to determine nature of client’s problems Once characteristics are understood, problem’s probable course can be predicted and most appropriate method of treatment can be administered Problems With Diagnostic System Some critics believe that now there are too many behaviors are considered to be within “the compass of psychiatry” – only about 60 in DSM-I and now about 400 People’s problems often do not fit neatly in one category The same symptoms appear as part of more than one disorder Possibility of personal bias due to the somewhat subjective nature of diagnostic judgments – some feel these are “value judgments masquerading as a science” Labeling people may be dehumanizing Rosenhan (1973): Does madness lie in the eye of the observer? This study addressed the following question? Do the characteristics of abnormality reside in the patients or in the environments in which they are observed? An astonishing study: On being sane in insane places The brave volunteers… EIGHT sane people! A pediatrician A painter Two housewives One graduate student Three psychologists (including David Rosenhan) What did they do? The procedure Participants telephoned 12 psychiatric hospitals for an urgent appointment (in five USA states) When arriving at admissions they gave false name and address But did give other ‘life’ details correctly What else did they do? They complained of hearing unclear voices … saying “empty, hollow, thud” Said the voice was unfamiliar, but was the same sex as themselves What happened? All were admitted to hospital All but one were diagnosed as suffering from schizophrenia Once admitted the ‘pseudo-patients’ stopped simulating ANY symptoms They had agreed to stay until they convinced the staff they were sane!! What happened on the wards? Took part in all ward activities: The pseudo-patients were never detected All pseudo-patients wished to be discharged immediately BUT – as they had agreed to before the experiment – they waited patiently until they were diagnosed as ‘fit to be discharged’ How did the ward staff see them? Normal behavior was misinterpreted… Writing notes was described as… “The patient engaged in writing behaviour” Arriving early for lunch described as… “Oral acquisitive syndrome” Behavior distorted to ‘fit in’ with theory The pseudo-patient’s observations… If they approached nurses or attendants with simple requests: 88% ignored them completely – walked away with head averted Only 10% even made eye contact Just 2% stopped for a chat 1283 attempts The pseudo-patient’s observations… If they approached the psychiatrists with simple requests: 71% ignored them – walked away with head averted Only 23% made eye contact Just 2% stopped for a chat 185 attempts How long did they stay in hospital? The shortest stay was 7 days The longest stay was 52 days The average stay was 19 days They were treated in the same way as the real patients... Given total of 2100 medication tablets They flushed them down the toilets Noted that other patients did the same and that this was ignored as long as patients behaved themselves !! DID ANYONE SUSPECT? What do you think – did anyone suspect it was a hoax? On release… The pseudo-patients were diagnosed as Schizophrenia “IN REMISSION” Rosenhan (1973b): The follow up study A teaching & research hospital was told of the first study and warned that … Over the next three months ONE OR MORE pseudo-patient would attempt to be admitted in their hospital as well… What happened? Staff members rated ‘new patients’ on scale 1 10 as ‘how likely to be a fraud’… 193 patients ‘assessed’ 41 rated as a pseudo-patient (by staff) 23 rated as pseudo-patient (by psychiatrist) 19 rated as pseudo-patient (by both) How many of these SUSPECTS were pseudo-patients? NONE No pseudo-patients were sent Staff were rating their regular intake Rosenhan’s conclusion….. “It is clear that we are unable to distinguish the sane from the insane in psychiatric hospitals”… In the first study They were unable to detect ‘sanity’ In the follow up study They were unable to detect ‘insanity’ Rosenhan’s study highlighted… The depersonalisation and powerlessness of patients in psychiatric hospitals That behavior is interpreted according to expectations of staff and that these expectations are created by the labels SANITY & INSANITY A comment… Although, the pseudo-patients described their stay in the hospitals as a negative experience This is not to say that REAL patients have similar experiences Real patients do not know the diagnosis is false & are NOT pretending Some questions… Was this study ethical? Why might the reports of the pseudopatients have been unreliable? The power of labels to stigmatize… Page (1977) Is the room still available for rent? Yes – over 95% of the time I’m just about to be released from the mental hospital and was wondering is the room still available for rent? Yes – only about 25% of the time I’m calling for my brother who is about to be released from jail and was wondering is the room still available for rent? Yes – only about 25% of the time Obsessive-Compulsive Disorder (OCD) To be diagnosed with OCD, a person must have recurrent obsessions and compulsions that are disabling Significantly interfere with a person’s routine, making it difficult to work, or to have a normal social life or relationships Prevalence and Onset Prevalence Life-time prevalence Afflicts 2%-3% of population some time in their lives Group differences No sex differences Knows no geographic, ethnic, or economic boundaries Onset About two-thirds develop the disorder before they are 25 years old and only 15% after the age of 35 Onset after 40 is very rare Obsessions Constant, intrusive, unwanted thoughts causing distressing emotions such as anxiety or disgust Examples: Thoughts of violence (person feels he/she will hurt someone) Thoughts of contamination (germs) Thoughts of uncertainty (did I lock the door?) Compulsions Compulsions are urges to do something to lessen discomfort Rituals are the behaviors in which these people engage in to accomplish this Common OCD Compulsions Cleaning Repeating Feel harm will occur if they don't Completing Fear of germs, etc. Exact order until perfection Being meticulous Exact place for things (ex: appearance of room, etc.) OCD Compulsions Avoiding Exaggerated avoidance of anxiety producing stimuli Counting Compelled to count things (like how many steps it takes to get somewhere) Hoarding Constant collection of useless items Slowness Tasks done extremely slowly Excessive and Ritualized praying May pray literally all day long in a ritualized manner Physiological Explanations Scarcity of serotonin In certain brain structures there are high levels of brain activity (orbital frontal, etc.) Brain damage Genetics Common Treatments for OCD No treatment Cognitive-Behavioral Therapy Antidepressant Medications If you can wait 40 years… Skoog and Skoog (1999) No treatment 83% showed some improvement while 20% showed complete recovery Cognitive-Behavioral Therapy This type of therapy is based on learning (reconditioning specific behaviors) and changing the beliefs (thinking processes) of the individual suffering from OCD… Systematic Expose desensitization them to what is making them anxious at increasing intervals…the idea here is that by facing the thing that they fear a little at a time they will eventually conquer the fear May have to start some off by having them imagine the situation Cognitive-Behavioral Therapy Response prevention Preventing the person from doing the compulsion or mental act Relaxation techniques Cognitive techniques such as self-talk are often combined with the above techniques Cognitive-Behavioral Therapy Effectiveness: 60-80% of those using the cognitivebehavioral treatments improve (show at least a partial reduction in symptoms) Antidepressant Medications Drugs that influence (increase) serotonin levels have been used effectively Prozac, Zoloft, Paxil, Anafranil, etc. Drawbacks: High doses of these drugs may be required in the treatment of OCD It can take several weeks to feel their beneficial effects Additionally, there are potential side effects to consider Prognosis The disease is chronic for most people even with drug treatment Most take medication indefinitely, and about 85% of people relapse within one or two months after discontinuing usage