Exam 1

prevalence rate of psychological disorders

Approximately 47% of adults in the United States have suffered from a psychological disorder at some time in their lives. The most commonly reported disorders in the United States are anxiety disorders and depressive disorders. More than 20% of adults will suffer from major depression, and more than 14% will struggle with alcohol dependence at some point in their lives. Anxiety disorders are also common, affecting more than 28% of adults during their lifetimes.

major depressive disorder with peripartum onset

As many as 80% of new mothers develop the "baby blues" within 3 to 5 days of childbirth. These mild mood symptoms (tearfulness, sadness, mood swings, irritability, fatigue) generally subside 2 weeks postpartum—that is, after childbirth. Many of the symptoms of peripartum depression are the same as major depressive disorder; The prevalence of depression with onset in the first 6 months postpartum ranges from 6.5 to 12.9% across studies, peaking at 2 and 6 months after delivery Example: All of the books painted such a rosy picture—the happy mothers breastfeeding, talking with other moms, developing that special bond with their new babies. What is wrong with me? Why do I just want this child to stop crying and go away? I can't bear to have my husband touch me. What kind of a mother am I? All the baby does is scream. Help me! Where's the joy? Why can't I feel what they're feeling?

Psychodynamic Explaination & Treatment for Depression

-focuses on the unconscious processes that we are not fully aware of, that drives our behavior. You don't know why you're depressed. For example, the derpression comes from an event that you don't even know impacts you. -Freudian thinkers think it comes from death/loss. Or loss of an 'object'. An object is someone to whom you are attached. -comes from stress. They say depression comes from stress. 80% of those depressed say they experienced a major stressor before they got depressed. _____________________________ TREATMENT: talk therapy. which is talking about what's going on for you. -it's so you can understand what has affected you. So the therapist tries to uncover why or what happened in your life that brought you to a depressive state. -therapists do not give solutions. They just try to help you understand what you are going through.

Physiological/Biological Explaination & Treatment for Depression

-neurotransmitters levels, genetics, family patterns -certain genes cause imbalances in seratonin levels -Diathesis stress model: The diathesis-stress model asserts that if the combination of the predisposition and the stress exceeds a threshold, the person will develop a disorder. -we know from family and twin studies that depression is in the genes. If a parent has depression, their child is 2-3 times more likely to develop depression than someone with a parent who does not have depression. -if a child is adopted and the adaptive parents did not have depression but the biological parents did, then the child is more likely to have depression. -the concordance rate for monozygotic twins is double the concordance rate of dyzygotic twins. -concordance rate: is the percentage of cases if one has a disorder the other one has it as well. -heritiability rate: the attribution of something to genetic factors -the heritability rate for depression is 37% ---------------------------------------------------------------------- TREATMENT: medication. -the main class of medication for people with depression is anti-depressants AKA SRRI's (select seartonin reuptake inhibitors) -the SSRI's take about 3-6 weeks to take affect. Examples include: a. prozac b. zoloft c. paxil d. lexipro

Cognitive Explaination & Treatment for Depression

-talks about maladaptive thoughts -negative schemas (negative way of thinking). Believe to be stemming from childhood -they say if you keep thinking negatively, you become depressed _________________________________ TREATMENT: challenging their though process, their style

The Learning/ Behavioral Explaination & Treatment for Depression

-this model says, we behave in certain ways beacause we learned to behave in those ways, as a result of conditioning, -talks to the concept of rewards/consequences which is a part of of operant conditioning. Operant conditioning is a method of learning that occurs through rewards and punishments for behavior. -A person makes associations of bad events years later. -Learned helplessness theory: you became depressed when a negative event happens and you feel like it's uncontrollable . a few failures--> helplessness --> no control -->depression -original learned helplessness experiment involved a dog. -being helpless is when there is a chance to get out of a bad situation, you don't, because you think you can't ________________________________ TREATMENT: get the person involved in things that give them pleasure. Ask them what they like to do, and encourage them to engage in them.

Bipolar 1 vs Bipolar 2

1 - manic episodes, depressive episodes common but not required for diagnosis 2 - hypomanic episodes, >1 major depressive episoes required

4 models to understand Etiology

1) Biiological/physiological model: sees the disorders as solely brain/body based 2) Cognitive model: the disorder stems from maladaptive thoughts. Maladaptive thinking may refer to a belief that is false and rationally unsupported—what Ellis called an "irrational belief." 3) Psychodynamic model: surface because of unconscious processes. 'The source is beneath the surface'. 4) Behavioral model( (Learning model): the disorder is based on what you have learned. As a result of that, you behave a certain way.

Classification of Psychological Disorders

1) Depressive disorders (mood disorders) a) major depressive disorder (MDD) b) persistent depressive disorder (Dysthymia) c) premenstrual dysphoric disorder (PMDD) d) disruptive mood dysregulation disorder (DMDD) 2) Bipolar spectrum disorders a) Bipolar b) Bipolar II c) Cyclothymia 3) Anxiety Disorders a) generalized anxiety disorder (GAD) b) panic disorder c) Agoraphobia d) social anxiety disorder e) Selective mutism f) specific phobias g) separation anxiety disorder 4) Obsessive Compulsive Disorder a) OCD b) hoarding c) Trichotillomania d) excoriation disorder e) body dysmorphic disorder(BDD) 5) Trauma & Stressor-Related Disorders a) PTSD b) accute stress disorder 6) Eating Disorders a) anorexia b) bulimia c) binge-eating disorder 7) Personality Disorders a) antisocial PD b) borderline PD c) narcissistic PD d) histrionic PD

Dimensional Systems as an Alternative to DSM Classification

3.20 Discuss the potential benefits of dimensional models for understanding abnormal behavior as alternatives to more traditional classification systems. A dimensional model for understanding abnormal behavior suggests that normal and abnormal behavior lie on a continuum and that what are now called disorders are simply extreme variations of normal experience. High rates of comorbidity and variability within a diagnostic category support the utility of a dimensional model. This kind of system allows for better understanding of behaviors that do not fall neatly into any diagnostic category, with functioning rated on a range of dimensions or traits rather than on the presence or absence of a set of symptoms. DETAILED EXPLANATION BELOW: The DSM and ICD are both primarily based on categorical systems that classify sets of symptoms into disorders. One alternative to such categorical diagnostic systems is a dimensional classification of abnormal behavior (see Chapter 1), which suggests that people with disorders are not qualitatively distinct from people without disorders. Rather, a dimensional model for understanding abnormal behavior suggests that symptoms of what are now called disorders are simply extreme variations of normal experience. Proponents of this model suggest that psychiatric illness is best conceptualized along dimensions of functioning rather than as discrete clinical conditions (Widiger & Samuel, 2005). Two features of mental illness that support the value of dimensional approaches are the high frequency of comorbidity and within-category variability (e.g., multiple people with the same diagnosis can have very different sets of symptoms and experiences). The DSM-5 approach allows for the diagnosis of comorbid conditions, an important feature because 45% of those with any mental disorder meet the criteria for two or more disorders (Kessler, Berglund, Demler et al., 2005). Proponents of a dimensional model suggest that this alternative approach would allow for a richer description of patient difficulties across multiple areas of dysfunction. In a dimensional model, for example, a patient's functioning would be rated on a range of dimensions or traits (e.g., introversion, neuroticism, openness, conscientiousness) rather than simply on the presence or absence of a set of symptoms. This type of system also would lead to better understanding of a patient whose symptoms did not fall squarely into any existing category. In many cases, patients report many symptoms of a particular disorder but not enough of them to actually meet diagnostic criteria. In a categorical system, these people are often considered to have subthreshold syndromes. A dimensional approach would allow us to describe all symptoms regardless of whether they actually met specified cutoffs or criteria. The dimensional approach would also allow clinicians to deal somewhat differently with the issue of multiple symptoms within diagnostic categories, known as heterogeneity. Despite the DSM's goal of creating relatively homogeneous diagnostic categories that would allow a "common language" of classification, individuals diagnosed with the same disorder actually may share few common features. For example, two people diagnosed with depression may have very different clinical presentations. While one may have depressed mood, crying, difficulty sleeping, fatigue, and difficulty concentrating, another may have loss of interest in things that used to bring pleasure, decreased appetite and weight loss, slowed motor behaviors, feelings of worthlessness, and recurrent thoughts of death. Both sets of symptoms would meet DSM criteria for major depression, but the primary complaints and targets for treatment would be quite different. Overall, this type of heterogeneity within diagnostic categories can adversely affect both clinical practice and research (Krueger et al., 2005). Dimensional proponents believe that their approach lends itself to an increased amount of relevant clinical information, which can have both clinical and research advantages (Watson, 2005). Arguments against the dimensional model often focus on clinical utility. The categorical system offers a simple approach with a clear diagnostic label that provides an efficient way to share information. Dimensional models are innately more complex. For example, it is much simpler to explain to a patient that she has depression than to discuss with her where her symptoms lie along many dimensions of traits experienced by all people. A simple, easily communicated categorical system also facilitates the nature of clinical decision making (e.g., whether to hospitalize, which medication to use, whether to provide insurance coverage). The complexity of sharing information that is organized along multiple dimensions would make communication with patients extremely difficult; communication across researchers and clinicians trying to share information about common clinical syndromes would also become more difficult. Furthermore, because no single, accepted dimensional theory of psychopathology exists, achieving consensus on the type and number of dimensions required to capture the entire spectrum of mental illness could be quite difficult (Blashfield & Livesley, 1999). Proponents of categorical approaches do concede that boundaries between most diagnoses remain imprecise, and they also acknowledge that psychiatric classification needs further precision. (p. 110)

Disruptive Mood Dysregulation Disorder (DMDD)

7.7) Construct an argument for the inclusion of disruptive mood regulation disorder in DSM-5. Disruptive mood dysregulation disorder (DMDD) is a new disorder making its first appearance in the DSM-5, and it is a controversial diagnosis. This category is reserved for children ages 6 to 18 years who have "severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation" (see "DSM-5: Disruptive Mood Dysregulation Disorder"). Arguments for inclusion of the disorder are to slow the rate of diagnoses of childhood bipolar disorder, which was being overdiagnosed in children with disruptive tendencies. (p. 241)

Prevalence rate for depression

7.9) Describe the prevalence of major depressive disorder in various segments of the population (sex, race, ethnicity, age). Major depressive disorder is the most common psychiatric disorder in the United States. Approximately 16.2 to 19.2% of people over the age of 18 report major depressive disorder at some point in their lifetime, which according to current census statistics equates to 39.3 to 46.6 million U.S. adults. The mean age of onset of major depressive disorder for U.S. adults is 26.2 years, with younger age cohorts reporting earlier age of onset than older cohorts. Dysthymia is less common, affecting approximately 6.4% of the general population.(p. 245)

Validity

A measure must not only be reliable but also valid. Validity refers to the degree to which a test measures what it was intended to measure. Much of what we measure in psychology reflects hypothetical or intangible concepts including self-esteem, mood, and intelligence. (p. 84)

Hypomania

A mild manic state in which the individual seems infectiously merry, extremely talkative, charming, and tireless.

Reliability

Ability of a test to yield very similar scores for the same individual over repeated testings The 3 key concepts to look at when diagnosing: 1) differential diagnosis: when you rule out disorders that are similar and can't be it. 2) reliability: the degree to which any measurement is consistent 3) Validity: is accuracy. Accuracy is when the measurement is true.

Gender ratio for depression

Across cultures, almost twice as many women as men suffer from major depressive disorder.In the United States, lifetime prevalence among adult women is approximately 21.3% vs. 12.7% for adult men -Depressive symptoms are more common among women who have few financial resources, are less educated, and are unemployed (p.245)

attribution theory

Attribution theory is a Social Psychological theory that relates to the way in which people explain their own behavior and that of others. According to this theory, people tend to attribute (or explain) psychological or external causes as the determining factor in behavior. For example, if someone acts mean to you one day, would you attribute the behavior to the person being a jerk (internal attribution) or to the person having a bad day (external attribution)? Attribution theory examines the ways in which people make these attributions. Make sure you review the definition for the Fundamental Attribution Error, which relates directly to this.

cognitive distortions

Cognitive distortions are simply ways that our mind convinces us of something that isn't really true. These inaccurate thoughts are usually used to reinforce negative thinking or emotions — telling ourselves things that sound rational and accurate, but really only serve to keep us feeling bad about ourselves. For example: a person might tell themselves, "I always fail when I try to do something new; I therefore fail at everything I try." This is an example of "black or white" (or polarized) thinking. The person is only seeing things in absolutes — that if they fail at one thing, they must fail at all things. If they added, "I must be a complete loser and failure" to their thinking, that would also be an example of overgeneralization — taking a failure at one specific task and generalizing it their very self and identity.

Cormobidity

Comorbidity refers to the presence of more than one disorder. Shared genetic factors across psychiatric disorders may provide a biological explanation for why individuals may present with more than one disorder. (p. 111). -more than 50% of people who meet the criteria of one disorder will be diagnosed with another disorder. For example, Anti-social personality disorder with drug addiction.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) can also be used in the treatment of bipolar disorder, particularly for severe depressive episodes, extreme or prolonged mania, or catatonia. It is used primarily when medications and psychotherapy are not effective, (p. 267) -shocks the brain through electrodes. It's effective for depression and bipolar.

bipolar disorder

Generally, a person is said to suffer from bipolar disorder when both episodic depressed mood and episodic mania are present. Bipolar disorder consists of dramatic shifts in mood, energy, and ability to function. It is a long-term episodic illness in which mood shifts between the two emotional "poles" of mania and depression. Bipolar disorder is commonly categorized as either bipolar I or bipolar II (see DSM- 5: Bipolar I Disorder). The main difference is the degree of mania. In bipolar I, full-blown mania alternates with episodes of major depression; it also includes a single manic episode with or without periods of depression. In bipolar II disorder, hypomania alternates with episodes of major depression. Hypomania is a mood elevation that is clearly abnormal but not as extremely elevated as frank mania. Behaviorally, a person in a hypomanic state may be overly talkative, excitable, or irritable, but there are no impulsive acts or gross lapses of judgment that are common during mania (e.g., telephoning Washington to tell the president how to run the country). Hypomania is "mild mania" and lasts at least 4 days. More common than bipolar I, bipolar II disorder is defined by having at least one episode of major depression and at least one hypomanic event. Bipolar II can be especially difficult to diagnose because a person experiencing hypomania may associate these episodes with periods of high productivity or creativity and is less likely to report his or her symptoms as distressing or problematic. (p.234)

Major Depressive Disorder (MDD)

In adults, depressed mood is central to major depressive disorder, but in children, the persistent mood disturbance may take the form of irritability or hostility. (p. 239) Major depressive disorder is an episodic illness. During their lifetime, some individuals have only one episode (single episode), but others suffer from multiple episodes separated by periods of normal mood (recurrent). Major depressive disorder is a prevalent psychological disorder: approximately 16.2% of U.S. adults suffer from at least one episode of major depressive disorder in their lifetime and 6.6% over the last 12 months (Kessler et al., 2003). A single episode, according to DSM-5, lasts at least 2 weeks, but episodes can and often do persist for several months. In addition to symptoms that last for 2 weeks, another factor that distinguishes major depressive disorder from sad mood is that the symptoms must affect the person's ability to function in social or work settings. (p. 240)

prevalence rate of bipolar disorder

In the United States, lifetime prevalence is about 0.8% of males and 1.1% of females for bipolar I and 0.9% of males and 1.3% of females for bipolar II.

Normal vs. Abnormal Behavior

In this book, we define abnormal behavior as behavior that is inconsistent with the individual's developmental, cultural, and societal norms and creates emotional distress or interferes with daily functioning. 1.1) Understand why simply being different does NOT mean abnormality. Abnormal behavior is sometimes difficult to define. It is not just behavior that is different because differences can sometimes be positive for the individual and perhaps for society. Being different does not necessarily mean that a person is suffering from a psychological disorder. In some cases, being different can create significant advantages or opportunities for someone. 1.2) Understand why simply behaving differently is NOT the same as behaving abnormally. Behaving differently also does not mean that one is suffering from a psychological disorder. Behavior that is deviant may be different but not necessarily abnormal. New trends often start as deviant but then become accepted by mainstream society. Determining the presence of abnormal behavior requires evaluation of the behavior in terms of its developmental, cultural, and societal contexts. 1.3) Understand why simply behaving dangerously does NOT always equal abnormality. Dangerous behavior may be abnormal, but many individuals who have psychological disorders do not engage in dangerous behavior. In some instances, people who are suffering from psychological disorders may behave in dangerous ways, such as James Eagan Holmes. However, not all people who behave in a dangerous fashion or commit crimes suffer from mental disorders, and the vast majority of people who suffer from mental disorders do not commit crimes. Behaving dangerously is not always the result of a psychological disorder. 1.4) Explain the difference between behaviors that are different, deviant, dangerous, and dysfunctional. Two primary considerations for determining whether a behavior is abnormal are (a)whether it creates dysfunction (interferes with daily activities) (b) and/or emotional distress. When behavior interferes with the ability to achieve goals, hold down a job, or socialize with others, the behavior is referred to as dysfunctional. If one's emotional or cognitive state results in dysfunctional behavior, then the behavior may be considered abnormal. 1.5) identify at least two factors that need to be considered when determining whether a behavior is abnormal. Abnormal behavior is defined as behavior that is inconsistent with the individual's developmental, cultural, and societal norms and creates significant emotional distress or interferes with daily functioning. Behavior must always be considered in context. Context includes culture as defined by both individual and social spheres of influence as well as cultural traditions. It also includes consideration of developmental age, physical and emotional maturity, and SES. What might be considered abnormal in adults may not be considered abnormal in children.

Persistent Depressive Disorder (Dysthymia)

LO 7.6 Define persistent depressive disorder, and distinguish it from major depressive disorder. Persistent depressive disorder, or dysthymia, can best be conceptualized as a chronic state of depression (see "DSM-5: Persistent Depressive Disorder"). The symptoms are the same as those of major depression, but they are less severe. Whereas major depressive disorder is an episodic disorder with patients often achieving euthymia, or normal mood, between episodes, dysthymia is the consistent persistence of depressed mood. By definition, persistent depressive disorder lasts 2 or more years, and the individual is never without symptoms for more than 2 months (American Psychiatric Association, 2013). Although, on a day-to-day basis, the symptoms are typically milder than those of major depressive disorder, because they are so persistent, they may lead to severe outcomes (e.g., social isolation, high suicide risk) that affect not only the sufferer but also extended family and friends. Less severe symptoms may also result in people suffering from persistent depressive disorder for years before seeking treatment. Meanwhile, family and friends may turn away, often mislabeling the person as too moody and difficult. (p. 241) Example: louise was under a constant gray cloud. She felt as if she had lived through the marriage of her daughter and the birth of her first two grandchildren like a zombie. She felt no joy, no wonder, and would rather stay home and cry than visit and play with her grandchildren. When all of the other women at church beamed about the accomplishments of their families, she could only feel guilty for not being part of her own children's lives.

History of Abnormal Behavior (independent reading)

Learning Objective Summaries 1.6) Discuss ancient spiritual and biological theories of the origins of abnormal behavior. Historically, spirit possession was among the first proposed causes of abnormal behavior. Ancient theories held that spirits controlled aspects of human behavior and that the biological seat of abnormal behavior was the brain. 1.7) Discuss spiritual, biological, and environmental theories of the origins of abnormal behavior in classical Greek and roman periods. As early as the classical Greek and Roman periods, biological and environmental explanations were given for some of the major psychiatric disorders (depression, schizophrenia). We know from writings from the classical Greek and Roman period that many psychological disorders that exist today were also present then. Hippocrates proposed that abnormal behavior resulted from an imbalance of bodily humors, indicating a biological cause. Other physicians, such as Galen and Avicenna, proposed that psychological factors also played a role. 1.8) Discuss the spiritual, biological, and environmental theories of the origins of abnormal behavior from the middle ages to the renaissance. Such theories fell out of favor in Western Europe shortly afterward, although they continued to flourish in the Middle East. During medieval times, there was a return to theories of spirit possession, and charges of witchcraft were common. This was also the time when people with psychological disorders were locked up in institutional settings with little or no access to care. During the Renaissance period, theories based on biology and environmental factors reemerged in Europe. 1.9) Discuss the spiritual, biological, psychological and sociocultural theories of the origins of abnormal behavior in the nineteenth century. The nineteenth century marked the beginning of humane treatment advanced by leaders such as Pinel, Tuke, Rush, and Dix. During this time, Kraepelin also introduced a system for the classification of mental disorders, and Charcot introduced psychological treatments. 1.10) identify the psychological, biological, and sociocultural models that characterize the twentieth-century models of abnormal behavior. During the twentieth century, biological theories still looked to abnormalities in the mind or brain as the basis for abnormal behavior. Psychological theories predominated, particularly psychoanalysis and behaviorism. Socio-cultural models remind us that behavior exists within a context. Behaviors that are considered problematic or abnormal in one culture may not be viewed that way in a different culture.

premenstrual dysphoric disorder (PMDD)

Many women will verify that there can be mood changes in the days preceding menstruation. However, premenstrual dysphoric disorder (PMDD) is a more severe form of these premenstrual changes that afflicts on average 1.3 to 4.6% of women of reproductive age. PMDD follows a cyclic pattern and typically begins in the late luteal phase of the menstrual cycle. Mood symptoms can vary and include deep sadness or despair, anxiety and tension, anger or irritability, and panic. Changes in sleep, appetite, and libido can also emerge. PMDD not only affects the sufferers but can have significant effects on interpersonal relationships, which can be vulnerable to the extremes of emotionality often associated with the disorder.

dimensional approach

Method of categorizing characteristics on a continuum rather than on a binary, either-or, or all-or-none basis.

DSM pros and cons

Pros: 1) The use of a common language to describe observed clinical phenomena is critical to both clinical practice and research. The following discharge summary illustrates the use of such a common language as one clinician communicates to another clinician in a distant city as the patient is about to be transferred to that location. (pg 105) 2) Understanding developmental and cultural variables is important when diagnosing disorders. A major departure for the DSM-5 is the use of a developmental perspective by which to understand psychological disorders. disorders. As we noted in Chapter 1, children and adults differ on basic aspects of physical, cognitive, and emotional development, and for any specific disorder, the manner in which the symptoms are expressed also may differ by age. Therefore, when evaluating the presence of a specific disorder, such as depression, it is necessary to understand how specific symptoms may vary by age. Young children, for example, do not really understand the concept of "the future." Therefore, it would be unlikely for a young child with depression to endorse "feeling helpless about the future." DSM-5 acknowledges the existence of developmentally appropriate symptoms for a number of diagnoses. Clinicians have also found that the prevalence of psychological disorders varies by sex. Women, for example, are more often diagnosed with depression and anxiety, whereas men are more often diagnosed with substance abuse. Men and women may actually develop different disorders at different rates, perhaps with different genetic risk factors for certain syndromes. It is also possible that in some cases, a similar underlying difficulty, such as stress, may be expressed differently for men and women. Symptoms and disorders may also be influenced by race and ethnicity. Culture-bound syndromes are defined as sets of symptoms that occur together uniquely in certain ethnic or racial groups. (p. 107-8). 2) Cons: 3.19) Describe some of the limitations and drawbacks of a diagnostic classification system. (1) In our current diagnostic system, not all people with the same diagnosis experience the same symptoms, nor have they necessarily developed them in the same way. (2)Different people with the same disorder also may not respond to the same treatments. (3)Stereotyping by diagnosis also can lead to stigma and inadequate treatment. (4) Finally, our current diagnostic systems may include too many disorders that overmedicalize normal variations in human behavior. (p. 111). DETAILED VERSION BELOW (WITH EXAMPLES): Despite their benefits for diagnosing and treating mental disorders, a diagnostic system has significant limitations. (1)First, because many diagnostic categories require that a person have a specified number of symptoms from a longer list (e.g., four of six symptoms listed might be required for a diagnosis), not all people with the same diagnosis experience the same symptoms. In addition, most diagnostic classifications do not require that the symptoms be connected to a particular etiology (cause); therefore, different patients with the same disorder may have developed the symptoms in different ways. (2) Finally, two people who have the same diagnosis do not necessarily respond to the same treatments. (3) Diagnostic categories also can encourage stereotyped conceptions of specific disorders. For example, imagine that a young woman has a grandfather who was diagnosed with bipolar disorder (see Chapter 6). He had a flagrant case marked by excessive spending, sexual indiscretions, and grandiosity (an inflated sense of one's own importance), leading to several hospitalizations and therapy. Although his granddaughter is beginning to experience less extreme signs and symptoms, she might hesitate to believe that she has the same disorder. In her mind, her symptoms don't fit the stereotype associated with the label of bipolar disorder or the behavior that she saw in her grandfather. Stereotyping by diagnosis can also lead a clinician to premature or inaccurate assumptions about a patient that prevent a thorough evaluation and comprehensive treatment plan. For example, a patient diagnosed with depression may be prescribed an antidepressant without sufficient evaluation of the need for treatments to manage life problems without the use of medication. Similarly, labeling a patient with a diagnosis can lead to self-fulfilling prophecies (e.g., I have bulimia so I'll never be able to eat normally again.) and create stigmas that affect the person's ability to function well at work or in social relationships (e.g., who wants to date a woman with an eating disorder?). (4) Another criticism of the DSM system is that its categories can reflect the beliefs or limited knowledge of an era. A good example was the inclusion of homosexuality as a mental illness before 1974. Because it was classified as a mental disorder, homosexuality was intrinsically defined as something that caused distress and impairment and that should be treated. The classification contributed substantially to the stigmatization of homosexuality, to homosexual persons' beliefs that there was something wrong with them psychiatrically, and to many ill-conceived attempts to change their sexual orientation. Once research began to address homosexuality openly, empirical evidence did not support the claim that homosexuality was a form of mental illness or was inherently associated with psychopathology. After a majority vote, the APA replaced the diagnosis of Homosexuality with Ego-Dystonic Homosexuality in the DSM-III (American Psychiatric Association, 1980), referring to sexual orientation inconsistent with one's fundamental beliefs and personality. However, mental health professionals criticized this new diagnostic category as a political compromise designed to appease psychiatrists who still considered homosexuality pathological (American Psychiatric Association, 2006). In 1986, the diagnosis was removed entirely from the DSM. In the DSM-5 Association, 2013), the only mention of homosexuality is found in the category Sexual Disorders Not Otherwise Specified. This category includes homosexuality that is marked by persistent and marked distress about one's sexual orientation, a category that may still reflect continued stigma. (5)A final criticism of the DSM is that it simply includes too many disorders and that normal variations in human behavior have been overmedicalized by giving them diagnostic labels. Overall, although diagnostic systems that rely on classifying symptoms into disorders provide substantial benefits for patients, clinicians, and researchers, the limitations of these systems need to be considered. Alternative systems for discussing psychological problems that rely on dimensional models rather than categorical classification have been developed. (p 108-9)

Depression with seasonal pattern- (Seasonal affective disorder (SAD))

Seasonal affective disorder. A subtype of major depression that is characterized by depressive episodes that vary by season. Beidel, Deborah C.. Abnormal Psychology (p. 601). Pearson Education. Kindle Edition. Light therapy for major depressive disorder with a seasonal pattern The National Institute of Mental Health psychiatrist Norman Rosenthal first described seasonal affective disorder (SAD) in 1984. Now a specifier in DSM-5 states, "With a seasonal pattern this variant of major depressive disorder afflicts millions of people worldwide, and is characterized by depressive episodes that vary by season. Although some patients experience summer depression, most are affected during December, January, and February. Symptoms of the winter pattern include increased appetite, increased sleep, weight gain, interpersonal difficulties, and a heavy, leaden feeling in one's limbs." Patients with this variant are sometimes treated with light therapy. This involves exposure to an artificial source of bright light, usually a light box, a light visor, or a dawn simulator. (p 272)

Implication of the term abnormal psychology

Some theorists argue that the field of abnormal psychology stigmatizes and demonizes historically oppressed populations and people who exhibit behaviors outside of the cultural norm.

stable vs. unstable, Global vs. specific, Internal vs External,

Stable attributions are those that we think will be relatively permanent, whereas unstable attributions are expected to change over time. Global attributions are those that we feel apply broadly, whereas specific attributions are those causes that we see as more unique to particular events..In an internal attribution, people infer that an event or a person's behavior is due to personal factors such as traits, abilities, or feelings. In an external attribution, people infer that a person's behavior is due to situational factors.

The 3 D's (distress, disability, deviance)

The 3 D's is what the clinicians ask themselves to see if a patient has a mental disorder. (unofficial method) 1) distress: how upset they are 2) disability: how much it's affecting their function 3) deviance: how different they are from the norm

categorical approach

The DSM and ICD are both primarily based on categorical systems that classify sets of symptoms into disorders. (p. 109)

Changes in DSM-5

The DSM-5, published in 2013, includes 237 diagnoses, a reduction from prior editions, and uses a developmental approach to abnormal behavior. Also, the DSM-5 emphasizes the role of culture and gender in the expression of psychiatric disorders and, in comparison to previous editions, uses more dimensional ratings to classify symptom severity. (p. 106).

The cognitive triad

The cognitive triad are three forms of negative (i.e helpless and critical) thinking that are typical of individuals with depression: namely negative thoughts about the self, the world and the future. These thoughts tended to be automatic in depressed people as they occurred spontaneously.

Categorical vs. Dimensional Approaches to Abnormal Behavior

The current diagnostic system, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), presents a primarily categorical approach to understanding psychological disorders. The DSM assumes that a person either has a disorder or does not, just as one is pregnant or not pregnant. The current DSM is superior to previous diagnostic systems, which were tied to theory but not necessarily to data. However, two issues continue to present problems for a categorical approach: (1) symptoms rarely fall neatly into just one category and (2) symptoms often are not of sufficient severity to determine that they represent a psychological disorder despite distress and impairment. In fact, people in psychological distress rarely have only one psychological disorder (Nathan & Langenbucher, 1999). A woman struggling with an eating disorder often feels depressed as well. Does she have two distinct disorders, or is her depression merely part of her abnormal eating pattern? Making these distinctions is more than just an academic exercise—it affects whether someone receives treatment. It may, for example, determine whether a psychologist decides to refer a depressed patient for medication treatment or just monitors her sadness to see whether it disappears when the eating disorder is successfully treated. The second issue—deciding when one has "enough" of a symptom to have a diagnosis—can be illustrated through the following example. Shyness and sadness are two behaviors that may be personality dimensions rather than a distinct category. When is one "sad enough" or "shy enough" to be diagnosed with a psychological disorder? Is shyness a personality feature or a psychological disorder? Currently, one is considered to have a psychological disorder when the distress is severe enough or when functional impairment results. However, in many instances, this is an artificial distinction and may deny people with moderate distress the opportunity to seek services. Scientifically, a dimensional approach would allow an understanding of how abnormal behavior varies in severity over time, perhaps increasing and decreasing, or how behaviors change from one disorder to another. Researchers continue to investigate the most accurate way to describe abnormal behavior. The DSM-5 emphasizes the need to consider not just the presence of symptoms but also whether those symptoms affect functioning when attempting to understand abnormal behavior. (p. 9)

gender ratio for bipolar disorder

The majority of studies suggest that the risk of developing bipolar I disorder is fairly equal across the sexes (p.235)

learned helplessness

a condition in which a person suffers from a sense of powerlessness, arising from a traumatic event or persistent failure to succeed. It is thought to be one of the underlying causes of depression. For example, a woman who feels shy in social situations may eventually begin to feel that there is nothing she can do to overcome her symptoms. This sense that her symptoms are out of her direct control may lead her to stop trying to engage herself in social situations, thus making her shyness even more pronounced.

cognitive therapy

a treatment method designed to identify and correct distorted thinking patterns that can lead to feelings and behaviors that may be troublesome, self-defeating, or self-destructive

physiological explaination for bipolar

bipolar is a highly genetic disorder. so the strongest model to consider is the physiological model. The hereitablility of bipolar is 60-80%

concordance rates for bipolar

concordance rate for bipolar in fraternal twins is 6%, in identical twins it's 43%. concordance rate: if one has it, the chances are the other one will have it

Specifiers (of Depressive disorders)

different patterns of symptoms that sometimes characterize major depressive episodes which may help predict the course and preferred treatments for the condition. single episode or recurrent mild, moderate, or severe with: 1) seasoned onset: sets in the winter months and goes away in the spring time. Due to the changes in the amount of sunlight. Alters sleep cycle. 2) psychotic fetaures: the person is not based in reality. They may hear voices, think someone is following them, etc. This is not schizophrenia, it's just part of severe depression. 3) peripartum onset: dips in mood, this could occurs during and after pregnancy

abnormal psychology

is the branch of psychology that studies unusual patterns of behavior, emotion and thought, which may or may not be understood as precipitating a mental disorder. Although many behaviors could be considered as abnormal, this branch of psychology typically deals with behavior in a clinical context.

suicide (indendent reading summary)

learning Objective Summaries 7.12)Clarify the differences among suicidal ideation, suicide attempts, and death by suicide. Thoughts of death, also known as suicidal ideation, may take different forms. Passive suicidal ideation is a wish to be dead but does not include active planning about how to commit suicide. Active suicidal ideation includes thoughts about how to commit the act, including details such as where, when, and how. Suicidal acts are evaluated based on lethality and intent. Some acts, occasionally called parasuicides, are behaviors such as superficial cutting of the wrists or overdoses of nonlethal amounts of medications. These acts are unlikely to result in death. Suicide attempts could result in death by suicide. 7.13) list factors associated with suicide, and detail the relationship between depression and suicidal ideation and behavior. Males are more likely to attempt suicide and females are more likely to report suicidal ideation. Youth from socioeconomically disadvantaged backgrounds and those who are drifting (being generally disconnected from school, work, and family) are at increased risk. The presence of major depressive disorders and bipolar disorder increases risk of suicide. 7.14) Explain the relation between mental illness and suicide attempts in children. More than 90% of children who commit suicide have a psychological disorder, most often major depressive disorder. Suicidal ideation and attempts are also higher in children in adolescents with anxiety disorders, eating disorders, oppositional defiant disorder, and ADHD. 7.15) Identify risk factors associated with suicide attempts and death by suicide. The strongest predictor of suicide is a history of suicide attempts. Family history of suicide, the presence of psychiatric illnesses, behaviors such as impulsivity and pathological aggression, and genetic factors may also influence risk. 7.16) Discuss approaches to understanding factors associated with death by suicide. A psychological autopsy can attempt to re-create the thoughts, circumstances, and triggers that led to suicide. A structured interview that addresses potential precipitants and stressors, motivation, lethality, and intentionality can reconstruct motives and circumstances. 7.17) Evaluate the current understanding of the preventability of suicide. Suicide hotlines are common but anonymous, so evaluation of efficacy is not possible. Approaches to decrease risk of suicide by reconnecting youth may reduce ideation and attempts. Physically limiting access to suicide methods, such as detoxification of domestic and motor gas, restricting access to firearms, banning highly lethal pesticides, limiting access to jump sites, bridge guards, and reducing quantitiesof pharmaceuticals available for a single purchase, may help to reduce suicide attempts and completions 7.18) Discuss approaches to treatment after suicide attempts. Serious suicide attempts require immediate medical care; however, prolonged psychological care beyond the effects of the attempt is sometimes necessary. All individuals who attempt suicide should receive follow-up psychiatric care.

mania

mania is high mood that is clearly excessive and is often accompanied by inappropriate and potentially dangerous behavior, irritability, pressured or rapid speech, and a false sense of well being (p 231)

Treatment for Bipolar Disorder

medication. (mood stabalizers) and IPSRT ((interpersonal and social rhythm therapy) 3 most common medications for bipolar: 1) Lithium 2) Ability 3) Depakote -need to take mood stabalizers during all phases even in the normal phase. -many patients in the manic phase (40-60%) are non-med compliant during the manic phase IPSRT ((interpersonal and social rhythm therapy): -treatment for bipolar wheremmood is improved by giving structure in their life -stabiliy in their day to day life, stabalizes their mood

SSRIs

selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. They can ease symptoms of moderate to severe depression, are relatively safe and typically cause fewer side effects than other types of antidepressants do. How SSRIs work SSRIs treat depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain nerve cells (neurons). SSRIs block the reabsorption (reuptake) of serotonin into neurons. This makes more serotonin available to improve transmission of messages between neurons. SSRIs are called selective because they mainly affect serotonin, not other neurotransmitters. the SSRI's take about 3-6 weeks to take affect. Examples include: a. prozac b. zoloft c. paxil d. lexipro

diathesis-stress model

suggests that a person may be predisposed for a mental disorder that remains unexpressed until triggered by stress

DSM

the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; a widely used system for classifying psychological disorders. The following chapters will examine many different types of abnormal behavior. As a guide, the behaviors are considered using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Association, 2013), commonly known as the DSM-5. This diagnostic system uses an approach that focuses on symptoms and the scientific basis for the disorders, including their clinical presentation (what specific symptoms cluster together?), etiology (what causes the disorder?), developmental stage (does the disorder look different in children than it does in adults?), and functional impairment (what are the immediate and long-term consequences of having the disorder?). The DSM system uses a categorical approach to defining abnormal behavior. A categorical approach assumes that a person either has a disorder or does not, just as one is pregnant or not pregnant. Although this method is somewhat controversial