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Psychology applied to modern life adjustment in the 21st century, 11e chapter 14

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

1. Deviance – the behavior must be significantly different from what society
deems acceptable.

2. Maladaptive behavior – the behavior interferes with the person’s ability to
function.

3. 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

1. Axis I: criteria for diagnosing most disorders.
2. Axis II: specific to personality disorders.
3. Axis III: patient’s general medical condition.
4. Axis IV: psychosocial and environmental problems.
5. 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 1 and 2 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.


Anxiety Disorders, continued



Anxiety disorders “are a class of disorders marked by feelings of excessive
apprehension and anxiety”.



Generalized anxiety disorder “is marked by a chronic, high level of anxiety
that is not tied to any specific threat”.



Phobic disorder “is marked by a persistent and irrational fear of an object of
situation that presents no realistic danger”.


Anxiety Disorders, continued



Panic disorder “is characterized by recurrent 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 disorder (OCD) “is marked by persistent,
uncontrollable intrusions of unwanted thoughts (obsessions) and urges to
engage in senseless rituals (compulsions)”.



Common obsessions include fear of contamination, harming others, suicide, or
sexual acts.



Compulsions are highly ritualistic acts that temporarily reduce anxiety brought
on by obsessions.


Anxiety Disorders, continued
Obsessive -compulsive disorder, continued




OCD disorders occur in approximately 2.5% 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
Etiology of anxiety disorders, 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 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) has found that people with anxiety
disorders were more 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
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.
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.



Hypochondria often occurs along with anxiety disorders and depression.


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



Some people focus excessive attention on bodily 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 placed on sick people.
It provides an excuse for failure.
Being sick elicits attention from others.


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