PSY 100Y5PSYCHOLOGICAL DISORDERS LECTURE

DR. KIRK R. BLANKSTEIN

OUTLINE Studying Psychological Problems What’s Abnormal?:

“And you thought you were crazy!” Classification of Disorders:

The Diagnostic and Statistical Manual Prevalence of Disorders in Ontario Causes of Disorders:

The Biopsychosocial Model Video: Review and Introduction to

Specific Disorders The DSM Definition of Mental

Disorders Specific Examples: Anxiety

Disorders and Schizophrenia

AND YOU AND YOU THOUGHT YOU THOUGHT YOU WERE CRAZY!WERE CRAZY!

AND YOU AND YOU THOUGHT YOU THOUGHT YOU WERE CRAZY!WERE CRAZY!

“WHEN I TAKE A SHOWER, I HAVE A FEAR THAT A SNAKE OR SOME KIND OF REPTILE WILL COME UP THROUGH THE PIPES, SO I CLOSE DOWN THE DRAIN. I USUALLY HAVE TO TAKE A MEDIUM TO SHORT SHOWER AS A RESULT AND END UP WITH WATER UP TO MY KNEES, BUT I DEFINITELY MANAGE TO DO AWAY WITH THE SNAKES.”

UNIVERSITY STUDENT,MALE,AGE 22

Davison, Neale, Blankstein, & Flett (2002)

COMPONENTS OF ABNORMALCOMPONENTS OF ABNORMAL BEHAVIORBEHAVIOR

STATISTICAL INFREQUENCY

VIOLATION OF NORMS

PERSONAL DISTRESS

DISABILITY OR DYSFUNCTION

UNEXPECTEDNESS

“BECAUSE THE FIELD IS CONTINUALLY EVOLVING, IT IS NOT POSSIBLE TO OFFER A SIMPLE DEFINITION OF ABNORMALITY THAT CAPTURES IT IN ITS ENTIRETY. THE CHARACTERISTICS PRESENTED CONSTITUTE A PARTIAL DEFINITION, BUT THEY ARE NOT EQUALLY APPLICABLE TO EVERY DIAGNOSIS” (p. 5).

SUMMARY OF THE DSM-IV

DEFINITION OF MENTAL DISORDERS

DEFINING CHARACTERISTICS A BEHAVIORAL OR PSYCHOLOGICAL

SYNDROME (GROUPS OF ASSOCIATED FEATURES) THAT IS ASSOCIATED WITH

PRESENT DISTRESS (PAINFUL SYMPTOMS), ORDISABILITY (IMPAIRMENT IN ONE OR MORE

IMPORTANT AREAS OF FUNCTIONING), OR WITH

A SIGNIFICANTLY INCREASED RISK OF SUFFERING DEATH, PAIN, DISABILITY, OR AN IMPORTANT LOSS OF FREEDOM

CONDITIONS EXCLUDED FROM CONSIDERATION THIS SYNDROME OR PATTERN MUST NOT BE

MERELY:AN EXPECTABLE AND CULTURALLY

SANCTIONED RESPONSE TO A PARTICULAR EVENT (SUCH AS THE DEATH OF A LOVED ONE)

DEVIANT BEHAVIOR (SUCH AS THE ACTIONS OF POLITICAL, RELIGIOUS, OR SEXUAL MINORITIES)

CONFLICTS THAT ARE BETWEEN THE INDIVIDUAL AND SOCIETY (SUCH AS VOLUNTARY EFFORTS TO EXPRESS INDIVIDUALITY)

PSY240L1

CRITICAL CRITICAL THINKINGTHINKING

DO YOU THINK IT IS POSSIBLE TO ELIMINATE SOCIAL VALUES FROM A DEFINITION OF ABNORMAL BEHAVIOR? HOW WOULD YOU ACCOMPLISH THIS GOAL? IS THERE ANY WAY OF DEFINING MENTAL DISORDERS THAT WOULD AVOID VALUE JUDGMENTS ABOUT WHICH BEHAVIORS ARE ADAPTIVE AND WHICH ARE NOT?

PSY240L1

DEFINITIONS

CLASSIFICATIONCLASSIFICATION(or TAXONOMY)(or TAXONOMY)

SYSTEMATIC DESCRIPTION OF THE MAJOR CATEGORIES OR DIMENSIONS OF DISORDERS

(for either scientific or clinical purposes)

DIAGNOSISDIAGNOSISPROCESS OF ASSIGNING AN

INDIVIDUAL TO A CATEGORY OF THE CLASSIFICATION SYSTEM

DSM-IVCoverage of “Mental

Disorders”

49 main headings

41 subcategories

394 total listings within categories

NEWROSES FOR THE NEWROSES FOR THE ‘80s‘80s (New Millennium?)by JOHN V. FLOWERS & BERNARD SCHWARTZ

exampleexample

AFFLICTS THOSE PEOPLE WHO AFFLICTS THOSE PEOPLE WHO HAVE READ TOO MANY SEX HAVE READ TOO MANY SEX MANUALS THAT STRESS MANUALS THAT STRESS PLEASING ONE’S PARTNER, PLEASING ONE’S PARTNER, WITH THE RESULT THAT THEY WITH THE RESULT THAT THEY CANNOT HAVE AN ORGASM CANNOT HAVE AN ORGASM BEFORE THEIR MATE DOES.BEFORE THEIR MATE DOES.

THIS IS NOT A PROBLEM UNTIL THIS IS NOT A PROBLEM UNTIL THEY MEET ANOTHER PERSON THEY MEET ANOTHER PERSON SUFFERING FROM THE SAME SUFFERING FROM THE SAME DISORDER.DISORDER.

Two Two important changesimportant changes inin

DSM-III, III-R, & DSM-III, III-R, & IVIV

INCREASE IN THE INCREASE IN THE SPECIFICITY OF SPECIFICITY OF CRITERIA FOR EACH CRITERIA FOR EACH CLASS OF CLASS OF DISORDERSDISORDERS

USE OF A USE OF A MULTIAXIAL MULTIAXIAL DIAGNOSTIC DIAGNOSTIC SYSTEMSYSTEM

DSM-IV:DSM-IV:MULTIAXIAL CLASSIFICATIONMULTIAXIAL CLASSIFICATION

AXIS I: CLINICAL DISORDERSOTHER CONDITIONS

THAT MAY BE A FOCUS

OF CLINICAL ATTENTION

AXIS II PERSONALITY DISORDERSMENTAL RETARDATION

AXIS III GENERAL MEDICAL CONDITIONS (WITH

ICD9CM CODES)

AXIS IV PSYCHOSOCIAL & ENVIRONMENTAL

PROBLEMS

AXIS V GLOBAL ASSESSMENT OF FUNCTIONING (GAF)

Different Cultures and the

DSM-IV

Brain Fag:Brain Fag:A term initially used in West Africa to

refer to a condition experienced by high school or university students in response to the challenges of schooling. Symptoms include difficulties in concentrating, remembering, and thinking. Students often state that their brains are “fatigued.” Additional somatic symptoms are usually centered around the head and neck and include pain, pressure or tightness, blurring of vision, heat, or burning. “Brain tiredness” or fatigue from “too much thinking” is an idiom of distress in many cultures, and resulting syndromes can resemble certain Anxiety, Depressive, and Somatoform Disorders.

Have you ever experienced “brain fag”?Would your family/significant others accept your attribution to brain fag as a credible explanation for your own responses to the challenges of university?

CRITICAL THINKING

Hooked on the Net

“Is ‘Internet Addiction Disorder’ truly the scourge of the info age, or merely the fanciful notion of yet another late 20th century would-be pop psychology guru?”

EXPLAIN YOUR ANSWER.(By S. J. Ross, Special to the Star: The

Toronto Star, May 21, 1998, Section J.)

UNTREATED MENTAL DISORDER?

UNTREATED MENTAL DISORDER?

IN 1990, ALMOST 19% (1,218,000) OF ONTARIONS AGED 15 TO 64 YEARS MET THE CRITERIA FOR A MENTAL DISORDER

75% (920,000) DID NOT SEEK HELP OF ANY KIND FOR THEIR EMOTIONS, NERVES, MENTAL HEALTH OR USE OF ALCOHOL OR DRUGS

PROPORTION OF PEOPLE NOT SEEKING HELP HIGHEST FOR 15 TO 24 YEAR OLDS (86%), MALES (81%) & THOSE LIVING IN RURAL AREAS (81%)

DISABILITY COSTSDISABILITY COSTSTO SOCIETYTO SOCIETY

(OFTEN UNRECOGNIZED BECAUSE OF STIGMA ATTACHED

TO SYMPTOMS OF MENTAL DISORDERS & TREATMENT) LOSS OF PRODUCTIVITY

IN ONTARIO, THE MONTHLY TOTAL NUMBER OF DAYS LOST BY THOSE WITH MENTAL DISORDERS CAN BE ESTIMATED AT 1,828,200

DISRUPTION OF FAMILY LIFE DYSFUNCTIONAL INTERPERSONAL

RELATIONSHIPS CREATE GREATER HEALTH RISKS FOR ALL WHO ARE INVOLVED

LOWER QUALITY OF LIFE TRULY ECONOMICALLY

DISADVANTAGED

PERSONAL MISERY

Psychological factors

personality

cognitive style

social skills

symptoms of psychopathology (diagnosis)

Biological factors

brain structure

neurochemistry

hormones

autonomic nervous system functions

Social factors

marital adjustment

family functioning

peer relationships

work & school satisfaction

The clinician’s conceptual approach to a person’s problem will determine the selection of assessment instruments. This figure lists examples of variables that might be considered within each broad conceptual level.

Levels of Analysis in

ASSESSMENT

WHAT IS NORMAL?WHAT IS NORMAL?

WHAT TO LOOK FOR:WHAT TO LOOK FOR: DEFINITIONS OF DEFINITIONS OF

ABNORMALABNORMAL EXAMPLESEXAMPLES

DIAGNOSIS: THE DSMDIAGNOSIS: THE DSM PROS & CONS?PROS & CONS?

EXAMPLES OF DISORDERS: EXAMPLES OF DISORDERS: DEPRESSION & DEPRESSION &

ANXIETYANXIETY CAUSES TREATMENT

CRITICAL THINKING

THINK OF 2 OR 3 BEHAVIORAL PATTERNS THAT OTHERS WOULD SAY ARE MOST

CHARACTERISTIC OF YOU.

WHAT BIOLOGICAL, SOCIAL, AND PSYCHOLOGICAL FACTORS INFLUENCED THE DEVELOPMENT OF THESE BEHAVIORS? EXPLAIN YOUR ANSWER.

CRITICALCRITICAL THINKING THINKING

WHAT IS THE APPROPRIATE LEVEL FOR INTERVENTION WITH PSYCHOLOGICAL DISORDERS?

DO YOU FAVOR MEDICATION, PSYCHOTHERAPY, FAMILY TREATMENT, OR SOCIAL CHANGE?

IN WHAT WAYS DO YOUR VIEWS ABOUT THE NATURE AND CAUSES OF ABNORMAL BEHAVIOR INFLUENCE YOUR THOUGHTS ABOUT TREATMENT?