Criteria for abnormality
statistical rarity
Abnormality itself doesn’t necessarily mean that a person has a disorder. There are several things that are correlated with having a disorder and several things that make it more necessary to diagnose someone as having a disorder.
statistical rarity:
- could define someone’s behaviour or traits as being abnormal because they are statistically rare. However, rarity doesn’t mean that someone has a disorder.
- i.e. not all infrequent conditions, like extraordinary creativity are pathological and some disorders like depression can be quite common.
• deviance from statistical or cultural norms
Criteria for abnormality:
subjective distress
- refers to whether someone is suffering as a result of the symptom or trait.
- It possible that two people could experience the same
symptom, but only one thinks it is a problem or experiences distress/suffering as a result of the symptom. - Is subjective distress sufficient for diagnosis? In some cases, yes.
– If someone is bothered enough by their anxiety to seek treatment, then it is very likely to be diagnosed and treated. (or is in abusive situations) - Is subjective distress required for a diagnosis? No!
– There are some disorders that don’t bother
the people who have them at all. Instead, they bother the people around them. (narcissism. manic episodes associated with Bipolar Disorder)
• person is suffering
• internal
Criteria for abnormality:
impairment
- crucial one for diagnosis
- refers to the impact of symptoms upon the person’s relationships, employment, safety, and health.
- Note that impairment could come from something other than a Psychological disorder, so it’s not the case that if you have problems with relationships or employment that you necessarily have a disorder
• issues with persons life (Danger)
• external
Criteria for abnormality:
biological dysfunction
- some unusual patterns of neurotransmitter function in some disorders, and there are some types of brain damage or dysfunction that are associated with psychological disorders.
- some disorders have no obvious biological dysfunction, so we can’t always use biological evidence when considering a diagnosis.
- also have to be careful to look to see if there is a medical explanation for what we think is a symptom of a Psychological disorder
• physical abnormality (e.g., brain change)
DSM 5: prevalence
percentage of people within a population who have a specific mental disorder.
Example:
• lifetime prevalence is at least 10 percent among females.
— odds are at least 1 in 10 she’ll experience an episode of major depression at some point in her life.
• at least 5 percent among males.
— odds are at least 1 in 20.
DSM 5: comorbidity
co-occurrence of two or more diagnoses within the same person.
This extensive comorbidity raises the troubling question of whether DSM-5 is diagnosing genuinely independent conditions as opposed to slightly different variations of one underlying condition.
DSM 5: categorical vs. dimensional
categorical model:
model in which a mental disorder differs from normal functioning in kind rather than degree.
— is either present or absent, with no in-between.
— Categories differ from each other in kind, not degree.
• Pregnancy fits a categorical model, because a female is either pregnant or she’s not.
dimensional model:
model in which a mental disorder differs from normal functioning in degree rather than kind.
— meaning that they differ from normal functioning in degree, not kind
• Height fits a dimensional model, because although people differ in height, these differences aren’t all or none.
DSM 5: medicalizing normality
is its tendency to “medicalize normality,” that is, to classify relatively mild psychological disturbances as pathological.
— DSM-5 now allows individuals to be diagnosed with major depressive disorder following the loss of a loved one.
— Although this change may be justified by research, critics worry that it will open the floodgates to diagnosing many people with relatively normal grief reactions as disordered.
Anxiety disorders: (be able to tell the different ones apart)
GAD- Generalized anxiety disorder
It tends to be always present and has been described as ‘free floating’ anxiety that isn’t tied to a particular trigger or situation.
- People with GAD tend to always be worried or on edge, but not about anything specific. It’s not hard to imagine how this would lead to subjective distress or impairment that would lead someone to seek treatment.
Anxiety disorders:
panic disorder vs. a panic attack
panic attack
— brief, intense episode of extreme fear characterized by sweating, dizziness, light-headedness, racing heartbeat, and feelings of impending death or going crazy.
- can occur only rarely or on a daily basis for weeks, months, or even years at a time.
- peak in less than 10 minutes.
- some associated with specific situations.
- others come entirely out of the blue = generating fears of the situations in which they occur.
- can occur in every anxiety disorder, as well as in mood and eating disorders.
panic disorder
— repeated and unexpected panic attacks, along with either persistent concerns about future attacks or a change in personal behaviour in an attempt to avoid them.
- symptoms continue for a month or more.
- fear of future panic attacks
- often develops in early adulthood.
- associated with a history of fears of separation from a parent during childhood.
Anxiety disorders:
phobias
phobia
— intense fear of an object or situation that’s greatly out of proportion to its actual threat.
- For a fear to be diagnosed as a phobia, it must restrict our lives, create considerable distress, or both.
- the most common of all anxiety disorders.
- One in nine of us has a phobia
4 categories of phobias
1. Natural environment
2. Animals
3. Mutilation/medical treatment
4. Situations - Social fears are just as common.
- widespread in childhood but disappear with age.
Anxiety disorders:
agoraphobia
agoraphobia
fear of being in a place or situation from which escape is difficult or embarrassing, or in which help is unavailable in the event of a panic attack.
- become apprehensive in a host of settings, such as malls, crowded movie theatres, tunnels, bridges, or wide-open spaces.
- most debilitating of the phobias and occurs in about 1 in 20 of us.
- emerges in the mid-teens.
- usually a direct outgrowth of panic disorder.
- most people with panic disorder develop agoraphobia.
- seems to differ across cultures.
Anxiety disorders:
PTSD
posttraumatic stress disorder (PTSD)
— marked emotional disturbance after experiencing or witnessing a severely stressful event.
Symptoms:
- flashbacks are among the hallmark symptoms.
- efforts to avoid thoughts.
- efforts to avoid feelings.
- efforts to avoid places.
- efforts to conversations associated with the trauma.
- recurrent dreams of the trauma.
- increased arousal such as sleep difficulties and startling easily.
- Reminders of the incident can trigger full-blown panic attacks.
- PTSD isn’t easy to diagnose.
- Some of its symptoms, such as anxiety and difficulty sleeping, may have been present before the stressful event.
- some people malinger (fake) PTSD to obtain government benefits.
Classifying:
— new class of “trauma and stressor-related disorders” in which the definition of a traumatic event is broad.
Includes:
- direct exposure to a traumatic event
— rape, wartime combat, or a natural disaster. - indirect exposure to a traumatic event, in which people learn about an event from a friend or relative who experienced threatened or actual death or in which people are exposed repeatedly to distressing details of a traumatic event.
— such as the sexual abuse of an elderly person.
Anxiety disorders:
OCD
obsessions vs. compulsions
obsessive compulsive disorder (OCD)
— condition marked by repeated and lengthy (at least one hour per day) immersion in obsessions, compulsions, or both.
obsession
— persistent idea, thought, or impulse that is unwanted and inappropriate, causing marked distress.
- “unacceptable” thoughts, about such topics as contamination, sex, aggression, or religion. be consumed with fears of being dirty or thoughts of killing others.
- disturbed by their thoughts and usually see them as irrational or nonsensical.
- often label themselves “crazy” or dangerous.
- Despite their best efforts, can’t find a way to make these thoughts stop.
compulsion
— repetitive behaviour or mental act performed to reduce or prevent stress.
- feel driven to perform the action that accompanies an obsession.
Common OCD rituals:
• repeatedly checking door locks, windows, electronic controls, and ovens.
• performing tasks in set ways, like putting on one’s shoes in a fixed pattern.
• repeatedly arranging and rearranging objects.
• washing and cleaning repeatedly and unnecessarily.
• counting the number of dots on a wall or touching or tapping objects.
Mood disorders:
major depressive disorder
Chronic or recurrent state in which a person experiences a lingering depressed mood or diminished interest in pleasurable activities, along with symptoms that include weight loss and sleep difficulties.
- Depressive disorders can bean at any age but are most likely to strike people in their 30s.
- symptoms of depression may develop gradually over days or weeks.
- other cases, surface rather suddenly.
- is recurrent.
- experiences tive or six episodes over the course of a lifetime.
- Dysthymia is a milder chronic version of depression.
• Depression also appears to be linked to low levels of the neurotransmitter norepinephrine.
• diminished neurogenesis (growth of new neurons), which brings about reduced hippocampal volume.
• have problems in the brain’s reward and stress-response systems.
• decreased levels of dopamine, the neurotransmitter most closely tied to reward.
= This finding may help to explain why depression is often associated with an inability to experience pleasure.
Interpersonal model: Depression as a social disorder
James Coyne hypothesized that depression creates interpersonal problems.
- When people become depressed, he argued, they seek excessive reassurance, which in turn leads others to dislike and reject them.
- depression is a vicious cycle.
- People with depression often elicit hostility and rejection from others, which in turn maintains or worsens their depression.
- As Constant worrying, mistrust, fears of rejection and abandonment, and socially inappropriate behaviours can also be a social turnoff to many people.
Behavioral model: Depression as a loss of reinforcement
Peter Lewinsohn’s behavioural model proposes that depression results from a low rate of response-contingent positive reinforcement.
- when people with depression try different things and receive no payoff for them, they eventually give up.
- affording them little opportunity to obtain reinforcement from others.
- This view implies a straightforward recipe for breaking the grip of depression: pushing ourselves to engage in pleasant activities. Sometimes merely getting out of bed can be the first step toward conquering depression
Cognitive model: Depression as a disorder of thinking
• Theory that depression is caused by negative beliefs and expectations.
• cognitive triad: negative views of oneself, the world, and the future.
• habitual thought patterns, called negative schemas, presumably originate in early experiences of loss, failure, and rejection.
• Activated by stressful events in later life, these schemas reinforce people with depression’s negative experiences.
• also suffer from cognitive distortions, which are skewed ways of thinking.
— selective abstraction, in which people come to a negative conclusion based on only an isolated aspect of a situation.
Mood disorders:
bipolar disorder I
Presence of one or more manic episodes.
• depressive episodes to manic episodes
episodes often produce serious problems in social and occupational functioning, such as substance abuse and unrestrained sexual behaviour.
• among the most genetically influenced of all mental disorders.
• genes that increase the sensitivity of the dopamine receptors.
• decrease the sensitivity of serotonin receptors may boost the risk of bipolar disorder.
• at least some genetic overlap between psychotic symptoms in bipolar disorder and schizophrenia.
• people with bipolar disorder experience increased activity in structures related to emotion, including the amygdala.
• decreased activity in structures associated with planning, such as the prefrontal cortex.
•
- Cyclothymia is a milder chronic version of Bipolar Disorder.
Mood disorders:
bipolar disorder II
Patients must experience at least one episode of major depression and one hypomanic episode.
Learned helplessness
tendency to feel helpless in the face of events we can’t control.
- argued that it offers an animal model of depression.
- striking parallels between the effects of learned helplessness and depressive symptoms: passivity, appetite and weight loss, and difficulty learning that one can change circumstances for the better.
• But we must be cautious in drawing conclusions from animal studies because many psychological conditions, including depression, may differ in animals and humans.
• Seligman and his colleagues argued that persons prone to depression attribute failure to internal as opposed to external factors, and success to external as opposed to internal factors.
Mood disorder vs Mood episode
In order to diagnose most mood disorders, you must establish the existence of mood episodes.
- A mood episode is the experience of severe mood symptoms for a prolonged period of time (a
week or two, or longer).
Mood episode:
depressive
Symptoms?
Correspond to which mood disorders?
includes the symptoms: depressed mood, loss of interest in things that used to be important, loss of appetite, fatigue or insomnia, agitation, and feelings of worthlessness or guilt. Some very severe versions include loss of contact with reality. Diagnosis of major depression occurs with long-lasting or recurring depressive episodes. This could lead to both subjective distress and impairment.
- fall and winter can trigger depressive episodes.
- May correspond to bipolar disorder I.
Mood episode:
manic
Symptoms?
Correspond to which mood disorders?
Markedly inflated self-esteem or grandiosity, greatly decreased need for sleep, much more talkative than usual, racing thoughts, distractibility, increased activity level or agitation, and excessive involvement in pleasurable activities that can cause problems (like unprotected sex, excessive spending, reckless driving).
- triggered by negative and positive life situations.
- It may even include a loss of contact with reality, where the person believes that they are supernatural or royalty, or smarter than everyone else in the world.
- Many people in manic states feel great, but some feel very irritable and angry. A manic episode might not have ‘subjective distress’ associated with it, but it could certainly lead to impairment.
- spring or summer may initiate manic or hypomanic episodes.
- Bipolar I includes manic episodes, and may also
include depressive episodes or mild depressive symptoms that alternate with the manic episodes
