1 Introduction to Psychological Disorders Module 36

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4 Psychological Disorders Perspectives on Psychological Disorders Overview  Defining Psychological Disorders  Understanding Psychological Disorders  Classifying Psychological Disorders  Labeling Psychological Disorders  Rates of Psychological Disorders

Alice: But I don't want to go among mad people. Cheshire Cat: "Oh, you can't help it, were all mad here.“ Lewis Carroll, Alice's Adventures in Wonderland 5

6 Psychological Disorders I felt the need to clean my room … would spend four to five hours at it … At the time I loved doing it. Then I didn't want to do it any more, but I couldn’t stop … The clothes hung … two fingers apart …I touched my bedroom wall before leaving the house … I had constant anxiety … I thought I might be nuts. Marc, diagnosed with obsessive-compulsive disorder (from Summers, 1996)

7 Defining Psychological Disorders Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions. When behavior is deviant, distressful, and dysfunctional psychiatrists and psychologists label it as disordered (Comer, 2004).

8 Deviant, Distressful & Dysfunctional 1.Deviant behavior in one culture may be considered normal, while in others it may lead to arrest. 2.Deviant behavior must accompany distress. 3. If a behavior is dysfunctional it is clearly a disorder. Carol Beckwith Woodabe clipWoodabe clip at youtube

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10 Understanding Psychological Disorders Ancient Treatments of psychological disorders include trephination, exorcism, being caged like animals, being beaten, burned, castrated, mutilated, or transfused with animal’s blood. John W. Verano

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Bedlam – Bethlehem Royal Hospital “But is there so great Merit and Dexterity in being a mad Doctor? The common Prescriptions of a Bethlemitical Doctor are a Purge and a Vomit, and a Vomit and a Purge over again, and sometimes a Bleeding, which is no great mystery” Alexander Cruden, The London Citizen Exceedingly Injured,

13 The Medical Model Philippe Pinel ( ) from France, insisted that madness was not due to demonic possession, but an ailment of the mind. Dance in the madhouse. George Wesley Bellows, Dancer in a Madhouse, © 1997 The Art Institute of Chicago

14 Medical Model When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders. 1.Etiology: Cause and development of the disorder. 2.Diagnosis: Identifying (symptoms) and distinguishing one disease from another. 3.Treatment: Treating a disorder in a psychiatric hospital. 4.Prognosis: Forecast about the disorder.

15 The Biopsychosocial Approach Assumes that biological, socio- cultural, and psychological factors combine and interact to produce psychological disorders. Takes in to account the mind, body, and the interaction of nature and nurture.

16 Classifying Psychological Disorders The American Psychiatric Association rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe psychological disorders. The most recent edition, is the DSM V.

17 Multiaxial Classification Are Psychosocial or Environmental Problems (school or housing issues) also present? Axis IV What is the Global Assessment of the person’s functioning? Axis V Is a General Medical Condition (diabetes, hypertension or arthritis etc) also present? Axis III Is a Personality Disorder or Mental Retardation present? Axis II Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? Axis I

18 Goals of DSM 1.Describe disorders. 2.Determine how prevalent the disorder is. Disorders outlined by DSM-V are reliable. Therefore, diagnoses by different professionals are similar.

19 Labeling Psychological Disorders 1.Critics of the DSM-V argue that labels may stigmatize or bias or perception of individuals.

We now diagnose as mental disorder attentional and behavioral problems that used to be seen as part of life and of normal individual variation. The most convincing evidence of this comes from a large study with a particularly disturbing finding. A child's date of birth was a very powerful predictor of whether or not he would get the diagnosis of ADHD. Boys born in January were at 70 percent higher risk than those born in December simply because January 1 was the cutoff for grade assignment. The youngest, least developmentally mature kids in the class are much more likely to get the diagnosis. 20

21 Labeling Psychological Disorders 2.Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy.

22 Labeling Psychological Disorders 3.“Insanity” labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes. Theodore Kaczynski (Unabomber) Elaine Thompson/ AP Photo

23 Rates of Psychological Disorders

Wade and Tavris © 2005 Prentice Hall Concerns About the DSM

Medical research has made such enormous advances that there are hardly any healthy people left. –Aldous Huxley …fluctuations in diagnostic rates follow a time course much more consonant with fashion than with toxin. –Allen Frances 25

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27 Rates of Psychological Disorders The prevalence of psychological disorders during the previous year is shown below (WHO, 2004).

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30 Uncommon Psychiatric Syndromes Fregoli syndrome: in which the patient insists that someone who is actually unfamiliar to her is someone whom the patient really knows Asomatognosia: do not recognize a portion of their bodies as their own. Prosopagnosia: are unable to recognize faces, even if they can recognize almost everything else.

31 More… Reduplicative paramnesia: in which patients believe that a physical location has been duplicated Intermetamorphosis: in which the patient believes that people he knows change with one another. Syndrome of Subjective Doubles: in which the patient believes that other people are becoming him. Cotard's syndrome: mistakenly believe that they have lost organs or that they have died and are walking corpses.

32 More more…. Ekbom's syndrome: people are certain that they are infested with insects or worms. Anton's syndrome: a disorder in which a stroke renders a person blind and the patient denies her blindness.

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Bias in Diagnosis Diagnosed as antisocial personality Diagnosed as histrionic personality diagnose men with “male” disorders and women with “female” disorders Ford & Widiger (1989) –antisocial = “male” disorder –histrionic = “female” disorder

Wade and Tavris © 2005 Prentice Hall Concerns About Diagnostic System The danger of overdiagnosis The power of diagnostic labels Confusion of serious mental disorders with normal problems The illusion of objectivity