PSY 100Y5 PSYCHOLOGICAL DISORDERS LECTURE DR. KIRK R. BLANKSTEIN

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PSY 100Y5PSYCHOLOGICAL DISORDERS LECTUREDR.
KIRK R. BLANKSTEIN

• OUTLINE
• Studying Psychological Problems
• Whats 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

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Studying Psychological Disorders
FOCUS
TREATMENT/ OUTCOME
CAUSATION
DESCRIPTION
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AND YOU THOUGHT YOU 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

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Davison, Neale, Blankstein, Flett (2002)

• COMPONENTS OF ABNORMAL
• BEHAVIOR
• 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).

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SUMMARY OF THE DSM-IVDEFINITION OF MENTAL
DISORDERS

• DEFINING CHARACTERISTICS
• A BEHAVIORAL OR PSYCHOLOGICAL SYNDROME (GROUPS
  OF ASSOCIATED FEATURES) THAT IS ASSOCIATED WITH
• PRESENT DISTRESS (PAINFUL SYMPTOMS), OR
• DISABILITY (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

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CRITICAL THINKING

• 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

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DEFINITIONS

• CLASSIFICATION
• (or TAXONOMY)
• SYSTEMATIC DESCRIPTION OF THE MAJOR CATEGORIES OR
  DIMENSIONS OF DISORDERS
• (for either scientific or clinical purposes)
• DIAGNOSIS
• PROCESS OF ASSIGNING AN INDIVIDUAL TO A CATEGORY
  OF THE CLASSIFICATION SYSTEM

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DSM-IVCoverage of Mental Disorders

• 49 main headings
• 41 subcategories
• 394 total listings within categories

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NEWROSES FOR THE 80s (New Millennium?)by JOHN
V. FLOWERS BERNARD SCHWARTZexample
postmature ejaculation

• ? AFFLICTS THOSE PEOPLE WHO HAVE READ TOO MANY
  SEX MANUALS THAT STRESS PLEASING ONES PARTNER,
  WITH THE RESULT THAT THEY CANNOT HAVE AN ORGASM
  BEFORE THEIR MATE DOES.
• ? THIS IS NOT A PROBLEM UNTIL THEY MEET ANOTHER
  PERSON SUFFERING FROM THE SAME DISORDER.

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Two important changes inDSM-III, III-R, IV

• INCREASE IN THE SPECIFICITY OF CRITERIA FOR EACH
  CLASS OF DISORDERS
• USE OF A MULTIAXIAL DIAGNOSTIC SYSTEM

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DSM-IVMULTIAXIAL CLASSIFICATION

• AXIS I CLINICAL DISORDERS
• OTHER CONDITIONS THAT MAY BE A
  FOCUS OF CLINICAL ATTENTION
• AXIS II PERSONALITY DISORDERS
• MENTAL RETARDATION
• AXIS III GENERAL MEDICAL CONDITIONS (WITH
  ICD9CM CODES)
• AXIS IV PSYCHOSOCIAL ENVIRONMENTAL
  PROBLEMS
• AXIS V GLOBAL ASSESSMENT OF FUNCTIONING (GAF)

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Different Cultures and theDSM-IV

• 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?
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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.)

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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)

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DISABILITY COSTSTO 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

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Levels of Analysis in ASSESSMENT
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 clinicians conceptual approach to a persons
problem will determine the selection of
assessment instruments. This figure lists
examples of variables that might be considered
within each broad conceptual level.
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WHAT IS NORMAL?
VIDEO

• WHAT TO LOOK FOR
• DEFINITIONS OF ABNORMAL
• EXAMPLES
• DIAGNOSIS THE DSM
• PROS CONS?
• EXAMPLES OF DISORDERS DEPRESSION
  ANXIETY
• CAUSES
• TREATMENT

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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.

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CRITICAL 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?