Chapter 14 Psychological Disorders Abnormal Behavior, continued • The medical model applied to abnormal behavior – The medical model “proposes that it is useful to think of abnormal behavior as a disease” and has become the main way of thinking about mental illness today – This view is in stark contrast to how mental illness used to be perceived (see Figure 14.1) – Thus, the medical model has brought much needed improvement in patient care Figure 14.1 Historical conceptions of mental illness Throughout most of history, psychological disorders were thought to be caused by demonic possession, and the mentally ill were candidates for chains and torture Abnormal Behavior, continued The medical model, continued – – Diagnosis – “involves distinguishing one illness from another” Etiology – “refers to the apparent causation and developmental history of an illness” – Prognosis – “is a forecast about the probable course of an illness” Criteria of Abnormal Behavior Deviance – the behavior must be significantly different from what society deems acceptable Maladaptive behavior – the behavior interferes with the person’s ability to function Personal distress – the behavior is troubling to the individual Psychodiagnosis: The Classification of Disorders • The American Psychological Association (A.P.A.) uses the Diagnostic and Statistical Manual (now in its fourth revision and referred to as the DSM-IV) to classify disorders • It provides detailed information about various mental illnesses that allows clinicians to make more consistent diagnoses Classification of Disorders, continued • The multiaxial system – The DSM has five “axes” or components Axis I: criteria for diagnosing most disorders Axis II: specific to personality disorders Axis III: patient’s general medical condition Axis IV: psychosocial and environmental problems Axis V: global assessment of functioning Classification of Disorders, continued • Controversies surrounding the DSM – Some argue that • The categorical approach to pathology should be replaced by a dimensional approach • The DSM “medicalizes” everyday problems into disorders – e.g difficulty controlling gambling becomes “pathological gambling disorder” Prevalence of Psychological Disorders • Epidemiology is “the study of the distribution of mental or physical disorders in a population” • Prevalence “refers to the percentage of the population that exhibits a disorder during a specified time period” • Research suggests that there has been a real increase in the prevalence in disorder (see Figure 14.4) • The most common classes are substance use, anxiety, and mood disorders Figure 14.4 Lifetime prevalence of psychological disorders The estimated percentage of people who have, at any time in their life, suffered from one of four types of psychological disorders or from a disorder of any kind (top bar) is shown here Prevalence estimates vary somewhat from one study to the next, depending on the exact methods used in sampling and assessment The estimates shown here are based on pooling data from Wave and of the Epidemiological Catchment Area studies and the National Comorbidity Study, as summarized by Regier and Burke (2000) and Dew, Bromet, and Switzer (2000) These studies, which collectively evaluated over 28,000 subjects, provide the best data to date on the prevalence of mental illness in the United States Figure 14.18 Schizophrenia and the ventricles of the brain Cerebrospinal fluid (CSF) circulates around the brain and spinal cord The hollow cavities in the brain filled with CSF are called ventricles The four ventricles in the human brain are depicted here Studies with modern brain-imaging techniques suggest that an association exists between enlarged ventricles in the brain and the occurrence of schizophrenic disturbance Schizophrenic Disorders, continued Etiology of schizophrenia, continued – The neurodevelopmental hypothesis “posits that schizophrenia is caused in part by various disruptions in the normal maturational processes of the brain before or at birth” (Brown, 1999) – Potential disruptions could include • • • Prenatal exposure to a flu virus Severe famine Birth trauma Schizophrenic Disorders, continued Etiology of schizophrenia, continued – Expressed emotion (EE) is “the degree to which a relative of a schizophrenic patient displays highly critical or emotionally overinvolved attitudes toward the patient” • • A family’s EE is a good predictor of the course of a schizophrenic’s illness Patients who return to families high in EE are three to four times more likely to relapse because they add stress Schizophrenic Disorders, continued Etiology of schizophrenia, continued – Precipitating stress itself may trigger the onset of schizophrenia in someone who is already vulnerable to the disease Application: Eating Disorders, continued • Types of eating disorders – Eating disorders “are severe disturbances in eating behavior characterized by preoccupation with weight and unhealthy efforts to control weight” – There are three main types: • • • Anorexia nervosa Bulimia nervosa Binge-eating disorder Application: Eating Disorders, continued Types of eating disorders, continued – Anorexia nervosa “involves intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, and dangerous measure to lose weight” • This is usually achieved by severely limiting caloric intake or by using laxatives and excessive exercise to eliminate food and/or burn calories Application: Eating Disorders, continued Anorexia nervosa, continued – Medical complications from anorexia are serious and can include • • • • • • Amenorrhea (ceasing of menstrual cycles) Gastrointestinal problems Dental problems Osteoporosis (loss of bone density) Low blood pressure Metabolic disturbances that can trigger cardiac arrest Application: Eating Disorders, continued Types of eating disorders, continued – Bulimia nervosa “involves habitually engaging in out-of-control overeating followed by unhealthy compensatory efforts, such as self-induced vomiting, fasting, abuse of laxatives and diuretics, and excessive exercise” – – Unlike with anorexia, patients with bulimia usually maintain a normal weight However, they risk medical problems such as cardiac arrythmias, dental problems, metabolic, and gastrointestinal problems Application: Eating Disorders, continued Types of eating disorders, continued – Binge-eating disorder “involves distress-inducing eating binges that are not accompanied by the purging, fasting, and excessive exercise seen in bulimia” – – Patients with this disorder are often overweight and disgusted with their bodies Excessive overeating is often triggered by stress Application: Eating Disorders, continued • History and prevalence – – – Anorexia has existed throughout history, but became more common in the th middle of the 20 century Bulimia appears to be a new disorder Young women are much more likely to develop eating disorders, and the gender gap is likely due to the unrealistic cultural standards for weight in Western societies – Still, these are rare conditions, with about 1% developing anorexia and 2-3% developing bulimia Application: Eating Disorders, continued • Etiology of eating disorders – Genetic vulnerability • Twin studies show higher concordance rates for identical twins than fraternal twins, suggesting a genetic predisposition for the disease • However, many other factors influence the development of eating disorders Application: Eating Disorders, continued Etiology of eating disorders, continued – Personality factors • Victims of anorexia tend to be rigid, neurotic, emotionally restrained, and obsessive • • Perfectionism is a risk factor for anorexia In contrast, bulimia is associated with impulsiveness, being overly sensitive, and low self-esteem Application: Eating Disorders, continued Etiology of eating disorders, continued – Cultural values • In Western society, young women are socialized to believe they must be very thin in order to be attractive and the “desirable” weight, as seen in models and actresses, has decreased in recent decades Application: Eating Disorders, continued Etiology of eating disorders, continued – The role of the family • In families where parents are overly involved in children’s lives, adolescents may use anorexia as a way to control the one aspect of their life they feel they can exert control over – their body • Some mothers even contribute to eating disorders by endorsing society’s obsession with being thin Application: Eating Disorders, continued Etiology of eating disorders, continued – Cognitive factors • Individuals with eating disorders often display all-or-none, irrational thinking, and hold beliefs such as – – – “I must be thin to be accepted.” “If I am not in complete control, I will lose all control.” “If I gain one pound, I will become obese.” [...]... complaints that appear to be psychological in origin” – – It occurs mostly in women Symptoms seem to be linked to stress Somatoform Disorders, continued • Conversion disorder – “is characterized by a significant loss of physical function with no apparent organic basis, usually in a single organ system” – Common symptoms include • • • • • Partial or total loss of vision or hearing Partial paralysis... Somatoform Disorders, continued Etiology of somatoform disorders • Personality factors – Somatoform disorders are more common in people with “histrionic” personalities (those who thrive on the attention that illness brings) – Neuroticism also seems to elevate one’s predisposition to somatoform disorders Somatoform Disorders, continued Etiology of somatoform disorders, continued • Cognitive factors... continued • The brain’s neurotransmitters, or “chemicals that carry signals from one neuron to another”, may underlie anxiety • In particular, drugs that affect the neurotransmitter GABA (e.g., Valium) suggest that these chemical circuits may be involved in anxiety disorders Anxiety Disorders, continued Etiology of anxiety disorders, continued • Conditioning and learning – Classical conditioning may... cause one to fear a particular object or scenario – Then, avoiding the fear stimulus is negatively reinforced, through operant conditioning, by making the person feel less anxious – Seligman (1971) adds we are “biologically prepared” to fear some things more than others, however Anxiety Disorders, continued Etiology of anxiety disorders, continued • Cognitive factors – Some people are more likely to experience... sensations and amplify them into perceived symptoms of distress – They also have unrealistically high standards of “good health” Thus, any deviation from perfect health is seen as a sign of illness Somatoform Disorders, continued Etiology of somatoform disorders, continued • The sick role – Some people learn to “like” being sick because • • • • It allows one to avoid challenging tasks Demands aren’t... likely to have experienced severe stress one month prior to the onset of their disorder – Thus, stress may precipitate the onset of anxiety disorders Somatoform Disorders, continued • Somatoform disorders “are physical ailments that cannot be fully explained by organic conditions and are largely due to psychological factors” • Somatization disorder “is marked by a history of diverse physical complaints... of the population Most cases of OCD emerge before the age of 35 Anxiety Disorders, continued • Etiology of anxiety disorders – Biological factors • • Inherited temperament may be a risk factor for anxiety disorders “Anxiety sensitivity” theory posits that some people are more sensitive to internal physiological symptoms of anxiety and overreact with fear when they occur Anxiety Disorders, continued... Laryngitis or “mutism” (inability to speak) Seizures or vomiting Loss of function in limbs Somatoform Disorders, continued • Hypochondriasis (or hypochondria) “is characterized by excessive preoccupation with health concerns and incessant worry about developing physical illnesses” – People with hypochondria are convinced their symptoms are real and often become frustrated with the medical establishment... are more likely to experience anxiety disorders because they • • • Misinterpret harmless situations as threatening Focus excess attention on perceived threats Selectively recall information that seems threatening Anxiety Disorders, continued Etiology of anxiety disorders, continued • Stress as a factor – – Finally, anxiety disorders may be linked to excessive stress Specifically, research (Brown, 1998)... attacks of overwhelming anxiety that usually occur suddenly and unexpectedly” (see following animation sequence) – • [Insert Video: “Panic Disorder: Symptoms” From CDROM CB 9 th edition] Agoraphobia “is a fear of going out to public places” – Agoraphobia may result from severe panic disorder, in which people “hide” in their homes out of fear of the outside world Anxiety Disorders, continued • Obsessive-compulsive ... continued • The medical model applied to abnormal behavior – The medical model “proposes that it is useful to think of abnormal behavior as a disease” and has become the main way of thinking... behavior – the behavior interferes with the person’s ability to function Personal distress – the behavior is troubling to the individual Psychodiagnosis: The Classification of Disorders • The American... candidates for chains and torture Abnormal Behavior, continued The medical model, continued – – Diagnosis – “involves distinguishing one illness from another” Etiology – “refers to the apparent causation