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    Chapter 15.doc Chapter 15.doc Document Transcript

    • . Prof. Millie Roqueta CHAPTER 15 SUMMARY Chapter 15 PSYCHOLOGY AND PHYSICAL HEALTH LEARNING OBJECTIVES 1. Describe and evaluate the medical model of abnormal behavior. 2. Explain the most commonly used criteria of abnormality. 3. Discuss the history of the DSM system and describe the five axes of DSM-IV. 4. Summarize data on the prevalence of various psychological disorders. 5. List and describe four types of anxiety disorders. 6. Discuss the contribution of biological factors and conditioning to the etiology of anxiety disorders. 7. Discuss the contribution of cognitive factors, personality traits, and stress to the etiology of anxiety disorders. 8. Describe three types of somatoform disorders. 9. Summarize what is known about the causes of somatoform disorders. 10. Describe three types of dissociative disorders. 11. Summarize what is known about the causes of dissociative disorders. 12. Describe the two major mood disorders and discuss their prevalence. 13. Explain how genetic and neurochemical factors may be related to the development of mood disorders. 14. Explain how cognitive processes may contribute to mood disorders. 15. Explain how interpersonal behavior and stress may contribute to mood disorders. 16. Describe the prevalence and general symptoms of schizophrenia. 17. Describe four schizophrenic subtypes. 18. Explain the distinction between positive and negative symptoms in schizophrenia. 19. Identify factors related to the prognosis for schizophrenic patients. 20. Summarize how genetic vulnerability and neurochemical factors may contribute to the etiology of schizophrenia. 21. Discuss the evidence relating schizophrenia to structural abnormalities in the brain and neurodevelopmental insults to the brain. 22. Summarize how expressed emotion and stress may contribute to schizophrenia. 23. Explain the reasoning underlying the insanity defense, and how often it is used. 24. Explain the legal grounds for involuntary commitment. Abnormal Behavior: Myths and Realities The Medical Model 1. Medical model: proposes that it is useful to think of Applied to abnormal behavior as a disease. Abnormal 2. Basis for many of the terms used to refer to abnormal Behavior behavior (e.g., mental illness, psychological disorder). 3. Prior to 18th century, people who behaved strangely were believed to be possessed by demons, to be witches in league with the devil, or to be victims of God’s punishment. Their disorders were treated with chants, rituals and exorcisms. Mentally ill individuals were often chained, confined to dungeons, tortured, and killed. 4. The rise of the medical model (in 18th, 19th centuries) Page 1
    • Prof. Millie Roqueta brought improvements in treatment. Inasmuch as people were thought to be ill, they were afforded more sympathy and conditions began to improve. It was not until the 20th century, however, that the mentally ill acquired rights. 5. Problems with the medical model a. Thomas Szasz suggests that abnormal behavior usually involves a deviation from social norms rather than an illness b. Results in derogatory labels being applied to people with disorders 6. Putting the model in perspective a. Model is useful as an analogy. b. Diagnosis involves distinguishing one illness from another. c. Etiology refers to the apparent causation and developmental history of an illness. d. Prognosis is a forecast about the probable course of an illness. Criteria of 1. Criteria of abnormal behavior Abnormal a. Three criteria are most frequently used in Behavior determining abnormal behavior: 1) Deviance – behavior must deviate from what the individual’s society considers acceptable. What constitutes normality varies somewhat from one culture to another. 2) Maladaptive behavior – the person’s everyday adaptive behavior must be impaired. The behavior must begin to interfere with the person’s social or occupational functioning. 3) Personal distress – frequently, the diagnosis of a psychological disorder is based on an individual’s report of great personal distress. b. Although two or three criteria may apply in a particular case, people are often viewed as disordered when only one criterion is met. c. Antonyms such as normal versus abnormal and mental health versus mental illness imply that people can be divided neatly into two distinct groups: those who are normal and those who are not. In reality, it is often difficult to draw a clear line between normality and abnormality. Behavior thus Page 2
    • Prof. Millie Roqueta is considered abnormal when it becomes extremely deviant, maladaptive, or distressing. 2. The cultural bounds of normality a. There is considerable continuity across cultures in regard to what is considered abnormal. b. But judgments of abnormality are influenced to some extent by cultural norms and values, which can change over time. c. Key point is that diagnoses of psychological disorders almost always involve value judgments. 3. Normality and abnormality as a continuum a. Normality/abnormality is a matter of degree, not an either-or proposition. Psychodiagnosis: 1. First version of Diagnostic and Statistical Manual of Mental The Classification Disorders (DSM) published in 1952 by American Psychiatric of Disorders Association. 2. Current version, DSM-IV introduced in 1994: a. The multiaxial system 1) Axis I -- clinical syndromes 2) Axis II -- personality disorders 3) Axis III -- general medical conditions 4) Axis IV -- psychological and environmental problems 5) Axis V -- global assessment of functioning 3. Controversies surrounding the DSM a. Validity of the diagnostic categories. b. Inclusion of everyday problems not traditionally thought of as mental illnesses (e.g., extreme clumsiness in children). The Prevalence of 1. Epidemiology: study of the distribution of mental or Psychological physical disorders in a population. Disorders 2. Prevalence: the percentage of a population that exhibits a disorder during a specified time period. 3. Estimates suggest that psychological disorders are more common than most people realize: a. Recent studies suggest that one-third of population may be affected during their lifetimes. b. Most common disorders include anxiety disorders, substance use disorders, and mood disorders. Page 3
    • Prof. Millie Roqueta Anxiety Disorders Generalized 1. Anxiety disorders: a class of disorders marked by Anxiety Disorder feelings of excessive apprehension and anxiety. a. Four principal types, not mutually exclusive: generalized anxiety disorder, phobic disorder, obsessive-compulsive disorder, and panic disorder. b. People with anxiety disorders also exhibit elevated rates of depression. c. Quite common, occurring in about 17% of the population. 2. Generalized anxiety disorder (marked by a chronic, high level of anxiety that is not tied to any specific threat). a. Sometimes called "free-floating anxiety". b. People with this disorder worry constantly about yesterday’s mistakes and tomorrow’s problems. In particular, they worry about minor matters related to family finances, work, and personal illness. They often dread decisions and brood over them endlessly. c. Frequently accompanied by physical symptoms (e.g., trembling, muscle tension, etc.). d. Tend to have a gradual onset and is seen more frequently in females. Phobic Disorders 1. Phobic disorder (marked by a persistent and irrational fear of an object or situation that presents no realistic danger). 2. Mild phobias are extremely common. People are said to have a phobic disorder only when their fears seriously interfere with everyday behavior. 3. Common phobias include agoraphobia (fear of places of assembly, crowds, open spaces), acrophobia (fear of heights), claustrophobia (fear of enclosed places), hydrophobia (fear of water). Panic Disorder 1. Panic disorder: characterized by recurrent attacks of and Agoraphobia overwhelming anxiety that usually occur suddenly and unexpectedly. 2. Agoraphobia: a fear of going out to public places. a. A common complication of panic disorders. More common in women. b. More similar to panic disorder than phobic disorder. Page 4
    • Prof. Millie Roqueta Obsessive- 1. Obsessive-compulsive disorder (OCD) is marked by Compulsive persistent, uncontrollable intrusions of unwanted Disorder thoughts (obsessions) and urges to engage in senseless rituals (compulsions). a. Typical age of onset is early adulthood. b. Obsessions often center on fear of contamination, inflicting harm on others, suicide, or sexual acts. c. Compulsions usually involve stereotyped rituals that temporarily relieve anxiety. d. Prevalence (roughly 2% of population) seems to be increasing, but may be due to changes in clinicians’ and researchers’ diagnostic tendencies. Etiology of 1. Biological factors Anxiety Disorders a. There may be a weak genetic predisposition. b. Associated with inhibited temperament in infants. c. Anxiety sensitivity may make people vulnerable to anxiety disorders. That is, some people are very sensitive to the internal physiological symptoms of anxiety and are prone to overreact with fear when they experience these symptoms. d. Has been linked to neurochemical activity in brain: 1) Neurotransmitters: chemicals that carry signals from one neuron to another. 2) Disturbances in neural circuits using GABA may play role. 2. Conditioning and learning a. Many anxiety responses may be acquired through classical conditioning, maintained through operant conditioning. b. Martin Seligman's concept of preparedness helps explain the tendency to develop phobias of certain objects: 1) Suggests that people may be biologically prepared to acquire some fears more easily than others (e.g., snakes, spiders). 2) Only modest research support. c. Conditioning models have a number of problems. 3. Cognitive factors a. Certain styles of thinking may make some people vulnerable to anxiety disorders. b. Theorists suggest these people tend to: 1) Misinterpret harmless situations as Page 5
    • Prof. Millie Roqueta threatening. 2) Focus excessive attention on perceived threats. 3) Selectively recall information that seems threatening. 4. Personality a. Neuroticism correlated with an elevated prevalence of anxiety disorders. People who score high in neuroticism tend to be self-conscious, nervous, jittery, insecure, guilt prone, and gloomy. b. Mechanisms underlying association are subject of debate. 5. Stress a. Anxiety disorders may be stress related. b. High stress may help precipitate onset of anxiety disorders. Somatoform Disorders Somatization 1. Psychosomatic diseases versus somatoform disorders Disorder a. Psychosomatic diseases: genuine physical ailments caused in part by psychological factors, especially emotional stress. b. Recorded on DSM axis for physical problems (Axis III). 2. Somatoform disorders: physical ailments with no authentic organic basis that are due to psychological factors a. Although their symptoms are more imaginary than real, victims of somatoform disorders are not simply faking illness. Include maladies such as ulcers, asthma, high blood pressure. b. Deliberate feigning of illness for personal gain is called malingering. 3. Somatization disorder is marked by a history of diverse physical complaints that appear to be psychological in origin. a. Occur mostly in women, and often in conjunction with depression or generalized anxiety disorder. b. Victims report an endless succession of minor physical ailments that seem to wax and wane in response to the stress in their lives. c. Over the years, they report a mixed bag of cardiovascular, gastrointestinal, pulmonary, neurological and genitourinary symptoms. Diversity of Page 6
    • Prof. Millie Roqueta victims' complaints is distinguishing feature. Conversion 1. Conversion disorder is characterized by a significant Disorder loss of physical function, with no apparent organic basis, usually in a single organ system. 2. Common symptoms include loss of vision, hearing, paralysis, seizures, vomiting, and loss of feeling or function in limbs. 3. People with conversion disorders are usually troubled by more severe ailments than people with somatization disorders. Hypochondriasis 1. Hypochondriasis: (more widely known as hypochondria) is characterized by excessive preoccupation with health concerns and incessant worry about developing physical illnesses. 2. People tend to over-interpret every conceivable sign of illness. 3. Frequently coexists with other psychological disorders, especially anxiety disorders, depression. Etiology of 1. Inherited aspects of physiological functioning may predispose Somatoform some people to somatoform disorders. Disorders a. Personality factors  Often associated with histrionic personality characteristics. The histrionic personality tends to be self-centered, suggestible, excitable, highly emotional, and overly dramatic. Such people thrive on the attention that they get when they become ill.  Neuroticism may also play a role. b. Cognitive factors  Cognitive theorists assert that some people focus excessive attention on their internal physiological processes and amplify normal bodily sensations into symptoms of distress.  Recent evidence suggests that people with somatoform disorders tend to draw catastrophic conclusions about minor bodily complaints. They also seem to apply a faulty standard of good health, equating health with a complete absence of symptoms and discomfort, which is unrealistic. 2. The sick role a. Some people grow fond of role associated with being sick, Page 7
    • Prof. Millie Roqueta which gets them attention and helps them avoid life's challenges. Dissociative Disorders Dissociative 1. Dissociative disorders (a class of disorders in which Amnesia and people lose contact with portions of their consciousness Fugue or memory, resulting in disruptions in their sense of identity). 2. Dissociative amnesia and fugue a. Dissociative amnesia: a sudden loss of memory for important personal information that is too extensive to be due to normal forgetting.  Memory loss may occur for single traumatic event, or for extended period of time surrounding the event.  Cases have been observed as a result of disasters, accidents, combat stress, physical abuse, etc. b. Dissociative fugue: people experience extensive amnesia and confusion about their identity, coupled with unexpected travel away from their customary home.  People forget their name, their family, where they live, and where they work. They typically wander away from their home area. Dissociative 1. Dissociative identity disorder (the disorder formerly Identity Disorder known as multiple-personality disorder or MPD) involves the coexistence in one person of two or more largely complete, and usually very different, personalities. 2. Various personalities are often unaware of each other and may be different in age, race, gender, and sexual orientation. 3. Most DID patients also have a history of anxiety, mood, or personality disorders. 4. It is a rare disorder, however, it has shown a dramatic increase since the 1970s. It appears that a handful of clinicians have begun over-diagnosing the disorder. Page 8
    • Prof. Millie Roqueta Etiology of 1. Dissociative amnesia, fugue usually attributed to excessive Dissociative stress. Disorders a. Relatively little is known about why such an extreme reaction occurs in tiny minority of people. b. Speculation that certain personality traits may make some people more susceptible (e.g., fantasy proneness). 2. Causes of MPD are obscure. a. Some skeptics suggest that people fake the disorder. b. Although some faking occurs, most theorists believe at least some cases are authentic. c. May be associated with severe emotional trauma in childhood. Mood Disorders Major Depressive 1. Mood disorders: a class of disorders marked by Disorder emotional disturbances that may spill over to disrupt physical, perceptual, social, and thought processes a. Tend to be episodic in nature. b. Episodes of disturbance vary greatly in length; typically last several months. c. Click here for Dr. Ivan’s Depression Central, a website that is considered a great resource regarding depression. Also view the American Psychological Association’s Help Center site on depression, along with the many other articles maintained by the APA about specific issues related to depression. 2. Major depressive disorder is marked by persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure a. Negative emotions main symptom. b. Other symptoms include reduced appetite, insomnia, lack of energy. c. A relatively common disorder.  Recent studies indicate that as many as 17% of Americans endure a depressive disorder at some time. Prevalence is increasing, particularly for people born since WW II.  About twice as common in women as in men. Page 9
    • Prof. Millie Roqueta Bipolar Disorder 1. Bipolar disorders (formerly known as manic-depressive disorders) marked by the experience of both depressed and manic periods. 2. Manic episodes characterized by elevated mood, high self- esteem, optimism, energy. 3. Much less common than unipolar depression. 4. Seen equally often in men and women. Etiology of Mood 1. Genetic vulnerability Disorders a. Evidence indicates genetic factors influence likelihood of developing disorder. b. Concordance rate: the percentage of twin pairs or other pairs of relatives that exhibit the same disorder.  Twin studies, which compare identical and fraternal twins, suggest that genetic factors are involved.  Concordance rates average around 67% for identical twins, 15% for fraternal twins. 2. Neurochemical factors a. Correlations found between mood disorders and levels of two neurotransmitters in brain (norepinephrine, serotonin). b. Drug therapies are fairly effective in treatment. 3. Cognitive factors a. Explanatory styles may play a role; pessimistic explanatory style, learned helplessness or a sense of hopelessness may be cognitive styles that contribute to elevated vulnerability to depression. b. Research indicates that people who consistently tend to make internal, stable, and global attributions are more prone to depression. c. Depressed people who ruminate about their depression have elevated rates of depression and tend to stay depressed longer. 4. Interpersonal roots a. Inadequate social skills may put people on road to depression. b. Depressed people tend not to be enjoyable companions: they are often irritable and pessimistic, they complain a lot, and as a result they court rejection from those around them. In turn, rejection and lack of social support may aggravate and depend Page 10
    • Prof. Millie Roqueta a person’s depression. 5. Precipitating stress a. Evidence indicates a moderately strong link between stress and onset of mood disorders. b. Stress may also affect how people with mood disorders respond to treatment. c. Stress may trigger mood disorders in people who are vulnerable. Schizophrenic Disorders General 1. Schizophrenic disorders: a class of disorders marked Symptoms by disturbances in thought that spill over to affect perceptual, social, and emotional processes. a. Estimates suggests it occurs in about 1-1.5% of population (about 4 million people in the U.S.) b. A severe, debilitating disorder. 2. General symptoms a. Irrational thought  Delusions: false beliefs that are maintained even though they clearly are out of touch with reality.  Thinking becomes chaotic. b. Deterioration of adaptive behavior c. Distorted perception  Hallucinations: sensory perceptions that occur in the absence of a real, external stimulus or that represent gross distortions of perceptual input.  Auditory hallucinations are most common. d. Disturbed emotion  Some victims show flattening of emotions.  Others show inappropriate emotional responses.  Some become emotionally volatile. Subtypes 1. Paranoid schizophrenia: dominated by delusions of persecution, along with delusions of grandeur. 2. Catatonic schizophrenia: marked by striking motor disturbances, ranging from muscular rigidity to random motor activity. 3. Disorganized schizophrenia: marked by a particularly Page 11
    • Prof. Millie Roqueta severe deterioration of adaptive behavior. 4. Undifferentiated schizophrenia: marked by idiosyncratic mixtures of schizophrenic symptoms. 5. Some researchers have proposed an alternative approach to sub-typing based on predominance of negative versus positive symptoms. a. Negative symptoms involve behavior deficits (e.g., flattened emotions, social withdrawal). b. Positive symptoms involve behavioral excesses or peculiarities (e.g., hallucinations, delusions). Course and 1. Disorders usually emerge during adolescence, early Outcome adulthood. 2. Emergence may be sudden or gradual. 3. Factors related to favorable prognosis: a. Onset was sudden rather than gradual. b. Onset occurred at later age. c. Patient was well adjusted prior to onset. d. Patient has healthy, supportive family to return to. Etiology of 1. Genetic vulnerability Schizophrenia a. Much evidence for role of hereditary factors. b. People seem to inherit genetically transmitted vulnerability to schizophrenia. 2. Neurochemical factors a. Associated with changes in neurotransmitter activity in brain. b. Excess dopamine activity implicated, although evidence is riddled with inconsistencies. 3. Structural abnormalities in brain a. Problems with attention suggest that disorders may be caused by neurological defects. b. Evidence suggests association between enlarged brain ventricles and chronic schizophrenia. This appears to be particularly true for male patients. c. Researchers currently intrigued by finding that thalamus is smaller and shows less metabolic activity in schizophrenic patients. 4. The Neurodevelopmental Hypothesis a. Schizophrenia is produced by a series of disruptions in the normal development of the brain. b. Suspected causes are prenatal exposure to viruses, Page 12
    • Prof. Millie Roqueta malnutrition, and obstetrical complications. 5. Expressed Emotion Theory a. Expressed emotion is degree to which relatives are highly critical, emotionally over-involved. b. Relapse rates are much greater for patients returning to families high in expressed emotion. c. Patients suffering from mood disorders whose families are high in expressed emotion also show elevated relapse rates. 6. Precipitating stress a. Stress seems to play role in triggering the disorder. b. High stress may also trigger relapses. Psychological Disorders and the Law Insanity 1. Insanity is a legal status indicating that a person cannot be held responsible for his or her actions because of metal illness. a. This is an issue because criminal acts must be intentional. b. There is no simple way to establish insanity. c. Most people with psychological diagnoses would not qualify as insane. d. The most widely used rule for establishing insanity is the M’naghten rule, which states that insanity exists when a mental disorder makes a person unable to distinguish between right and wrong. e. People tend to vastly overestimate the use of the insanity defense, it is rarely used, and when used, rarely succeeds. Involuntary 1. In involuntary commitment people are hospitalized in Commitment psychiatric facilities against their will. In order for this to occur, a mental health professional and legal authority must certify that the person is: a. A danger to his or her self b. A danger to others c. In need of treatment due to severe disorientation 2. In emergencies, mental health professionals can order a temporary commitment, but extensive involuntary hospitalization requires court proceedings. Florida’s statute is known as the “Baker Act”, which allows involuntary commitment for 72 hours when the patient is a risk to Page 13
    • Prof. Millie Roqueta him/herself or others. Click here to read the Florida Statute. Discussion 1. What do you think of Thomas Szasz’s criticisms of the medical model of Questions psychological disorders? Do you think it makes sense to treat psychological disorders the same way we treat diseases? Why or why not? 2. What do you think of the process of "labeling" people with psychological disorders? Do you think pinning a potentially derogatory label on a person may do more harm than good? Why do you think psychiatrists and psychologists generally support the use of some classification system for psychological disorders? 3. Recent editions of the DSM include everyday problems that are not traditionally thought of as mental illnesses (e.g., developmental coordination disorder, nicotine dependence disorder). Do you think it's appropriate for these kinds of problems to be included among severe psychological disorders such as multiple-personality disorder and schizophrenia? 4. The textbook mentions transvestic fetishism as an example of a deviant behavior. Why do you think it's acceptable in our society for a woman to dress in men's clothing, but not vice versa? 5. If a person does not pose a threat to anyone else and is not unhappy with his or her behavior, but is socially deviant (e.g., a transvestite), should that person be considered abnormal and mentally ill? 6. What do you think of the notion that normality and abnormality exist on a continuum of behavior? Do you think most people view abnormal behavior as quantitatively or qualitatively different from normal behavior? 7. Many people experience some degree of anxiety when they see a snake or a spider, or when they find themselves in high places. What distinguishes this kind of anxiety from a full-fledged phobia? (Note: This question could be combined with question number 3 above in a discussion focusing on normal versus abnormal behavior.) 8. According to your textbook, the vast majority of people who suffer from panic disorder or agoraphobia are women. Why do you think this is the case? How might an evolutionary psychologist explain this difference? 9. Recent research indicates that infants who show evidence of an inhibited temperament may be at a greater risk of developing anxiety disorders later in life. This finding suggests that the tendency to develop an anxiety disorder may be inborn. What do you think of this notion? Do you think it’s possible for infants with this temperament to grow into normal, anxiety- free adults? Page 14
    • Prof. Millie Roqueta 10. Given that instances of multiple-personality disorder are relatively rare, why do you think it is that this disorder is so frequently portrayed in books and movies? 11. Researchers have suggested that the prevalence of depression is about twice as high in women as it is in men. Why do you think this is the case? Do you think it’s possible that women are simply more likely than men to report instances of depression? 12. According to your textbook, some theorists suggest that inadequate social skills can lead to the development of depression. Do you think it’s possible that poor social skills may be a symptom of depression, rather than a cause? Can you think of a study that could be done that would help resolve this issue? 13. Do you think a person diagnosed with schizophrenia who commits a serious crime (e.g., murder) should be considered not guilty due to “insanity”? Why or why not? Discuss how your view of the insanity plea has been affected by the information you have learned in the course. 14. There is a common misconception that multiple-personality disorder is the same thing as schizophrenia. Can you think of any explanations for this misconception? 15. Some researchers have suggested that eating disorders are particularly common among college women. Why do you think this is the case? 16. Given that cultural values play a predominant role in the prevalence of eating disorders, what steps could we take as a society to reduce the likelihood of young women developing these disorders? 17. It is not uncommon for students in abnormal psychology classes to begin to feel that they have signs of many of the disorders themselves. Did you experience this feeling as you read the material in Chapter 15? Why do you think students tend to have this reaction? Chapter Summary References: Adapted by Roqueta, M. (2002), from Weiten, W., & Lloyd, M. A. (2003), Psychology applied to modern life: Adjustment in the 21st Century. Belmont, CA: Wadsworth/Thomson Learning. Table References: Tables and PowerPoint Slides adapted by Roqueta, M. (2002) from Hutchens PowerPoint Series for Weiten, W., & Lloyd, M. A. (2003), Psychology applied to modern life: Adjustment in the 21st Century. Belmont, CA: Wadsworth/Thomson Learning. Websites:  http://www.mentalhealth.com This site contains comprehensive information regarding all areas of abnormal behavior and clinical psychology.  http://www.vanguard.edu/faculty/ddegelman/amoebaweb/index.cfm?doc_id=859 This site contains a large number of links to sites dealing with psychological disorders.  http://www.pendulum.org/ A web site featuring resources related to Bipolar disorder. Page 15
    • Prof. Millie Roqueta  http://www.schizophrenia.com/ Resources for people with schizophrenia and their families.  http://www.baltimorepsych.com/anxiety.htm Commercial web site for a psychiatry practice, but has a lot of good information on anxiety disorders and is worth checking out.  http://www.nami.org/index.html Official home page of the National Alliance for the Mentally Ill. Page 16