Psych 300
influences on DSM 5
empirical research on phenomenology (: the study of the development of human consciousness and self-awareness as a preface to or a part of philosophy): defined by large comittee and they work on the content together -empirical research on aetiology (the study of the causes of diseases. ) -Clinical experience- dealing with people who have mental disorders in a real environment, more realistic reports, -cultural mindset: In adams article mental health community has its own culture-- the ingrained category approach is actually inhibiting the scientific research that could refine diagnoses, in part because funding agencies have often favoured studies that fit the standard diagnostic groups. -historical legacy: the way we think about any concept is influenced from history -Professional and societal politics: funding for research imppossible if you have novel disorder, people don't give money to a chairty if they dont know what it is going to, healthcare payment impossible unless you have diagnosis
emotional components of anxiety disorders
fear, low mood
PTSD as experienced after residential schools
flashbacks- expereienced vividly and there is dissociation- confusion about what happened afterwards -during dissociation there may be relapse behaviours of substance abuse -family breakdown, avoidcance of governmental institutions -beliefs about the person and their own worth are devalued
cognitive similarities between anxiety disorders
focus on bad things that might happen in future, attention, threat oriented, belief of out of control, belief that cannot cope, preoccupation= present when a person is miserable, insight-- aware its irrational
examples of social phobia
giving speech (top fear besides death), going to party, using public washrooms, speaking to authority, strating convos, inviting people to do things, eating in public
isolated cases of social phobia (can live otherwise normally)
giving speech, public washrooms, eating in public
What is ICD?
international classification of diseases- published by global health agency and with a constitutional public health mission, while the DSM is produced by a single national professional association. ICD is available worldwide and published online whereas DSM is produced by APA and provides a large porition of their revenue
-when defining abnormal behaviour what could be added to the list of arousal, fear/ anxiety, reward valuation, attention?
interpersonal communication, memory and learning, aggressiveness and violent behaviour, self perception, impulsiveness, perception, sensation, personality, motivation
Obsessive-Compulsive Disorder
just need obsession or compulsion - Obsessions -Intrusive and recurring thoughts, images, or impulses e.g. contamination doesnt want to have these thoughts! - Compulsions -Repetitive behaviour or mental act that the person feels driven to perform -Functionally (but not necessarily logically) related to obsessions e.g. have to turn radio dial all the way off so mom doesnt die -designed to calm person after compuslion
12% of people have panic attack at some point - what distinguishes it as panic disorder / not disorder?
meaning of bodily sensations changes-fear of fear is key distinction. not present without the disorder.
inter-rater relaibility
one person assessed by multiple clinicians to ensure they arrive at the same diagnosis
psysiological similarites between anxiety disorders
over-response to stimuli
June in class example
panic attacks, alcohol, defelcting to a problem with her neighbours, leading to reprimand at work What is abnormal? fear: terrified with panic attakcs anxiety attachment to others: hard to live with, had divorce says she is hostie--aggression impulsiveness-- drinking as result lacks motivation to get help and go to work perception issues- feels paranoid
Basic Research in Anxiety - what contributes to low anxiety
percieved controllability, predictability, tolerance of uncertainty (roll with it)
Basic Research in Anxiety the cycle of anxiety
percieved threat-- fear, anxiety--- attention to threat cues and around again. (continuous cycle present in anxiety disroder)
Why study anxiety disorders?
tells you where to invest money for the citizens of a country from governmental perspective, develop hypotheses about influences on disorders, action to prevent and intervene on disorders
Cognitive-Behavioural Model of Panic
thoughts influence---> sensations which influence--->behaviours and cycle starts again.
Clark's Model of Panic
trigger stimulus (internal or external), leads to bodily sensation, leading to interpretation of sensation as dangerous, fear, fear of fear, back to bodily sensation and cycle continues with apprehension of bodily sensation
dimensional approach:
where does person fall on a continuum of measurement- severity rating
Development of the Modern DSM
• 1980: DSM-III ‣ Major revision included more disorders, symptom checklists--> helpful to improve reliability and prompt clinicians to ask questions • 1998: DSM-IV ‣ Task Force used lit reviews, analyzed old data, collected new data-->helped the reliability and validity. called "Feild trials" where they gave people criteria to diagnose people and give them feedback for DSM • 2000: DSM-IV-TR ‣ Clarified text - few substantive changes • 2013: DSM-5 ‣ tried to reconceptualize mental disorders, campaigning for spectrum of mental disease
Based on prevalence estimates from a large and nationally representative study in the USA... how many people in this class of 75 would have had an anxiety disorder in the past year
• 9 students in this class have had an anxiety disorder within the past year. • 7 of them will not seek treatment. -roughly 12% in the past year
Panic Attack Characteristics
• Abrupt autonomic surge (less than ten minutes quick and intense) • Unexpected (doesnt count if its in reaction to something terrifying) • Uncontrollable • Absence of objective threat = "false alarm"
Development of the DSM: 1960s
• Another round of revisions... • 1969: WHO revised ICD, but just a list of disorders • 1968: APA published DSM-II, with a supplemental glossary of definitions of disorders • These systems were still not compatible.
Additional Features of PTSD
• Anxiety • Depression • Anger • Guilt • Substance abuse • Marital problems • Poor physical health • Suicide attempts • Episodes of explosive violence • Occupational impairment
Features of Worry in GAD
• Apprehensive expectation-- future oriented • Thoughts, more than images • Unproductive • Uncontrollable
Generalized Anxiety Disorder (GAD)
• Chronic, uncontrollable worry (which is irrational e.g. kids will be kidnapped or even menial things like being late for appt.) • Persistent, excessive agitation (involves somatic symptoms like restlessness, difficutly sleeping, on edge) • Chronic - occurs on most days for many months/years • Can interfere with functioning • Lifetime prevalence ~ 5% -people dont often seek treatment- think its just "the way I am" -insidious-- creeps up on them! they have inc in worrying
phobias
• Disruptive, fear-mediated avoidance • Out of proportion to the danger actually posed • Recognized as groundless by the sufferer (aware its irrational)
Weaknesses of DSM-style Categories
• Fosters false sense of discontinuity between normal and abnormal behaviour • Information is lost e.g. 150= normal blood pressure and 151=high blood pressure even though they are only a point apart • Stigmatization of labelling • DSM version of categories has become overly complex, perhaps bloated
Biological Features of OCD
• Genetic diathesis- first degree relatives at risk •signs that enchepalitis, head injuries and brain tumours have been associated with OCD specifically, the Orbitofrontal cortex and Basal ganglia, which could be affected by the trauma -Orbitofrontal cortex activation on OCD patients- perhaps showing overemphasis on their thoughts and basal ganglia- important for motor control may be associated with the compulsions of the disorder • Serotonin- low levels. SRI's are used to treat OCD but not effective in all cases
Associated Features of OCD
• Mental Rituals (compulsion) • Fluctuating Insight- understand its irrational when calm • Family Involvement- family members get involved bc they want to help. They recognized that severe anxiety is involved. • Avoidance • Reassurance-Seeking (e.g. driving around block to make sure they didnt hit someone)
OCD-relevant beliefs
• Over-importance of thoughts • Possible and necessary to control thoughts • Thought-action fusion (having the thought is just as bad as engaging in the action and thinking something makes that thing more likely to happen) • Overestimation of threat • Inflated sense of personal responsibility--if i dont turn that dial ten times then... • Perfectionism, intolerance of uncertainty
Residential Schools in Canada
• Peak was in the 1930s - last one closed in 1996 • Attendance was mandatory for children 7-15 yrs old • "School" is a misnomer-- more like internment camp • Traumatic experiences • family separation, punishment for speaking home language or engaging in cultural activities • sexual abuse • physical abuse: beatings, bondage, confinement • nutritional torture: forced eating of rotten food, vomit, etc. • medical experimentation (e.g., effects of malnutrition) • high death toll -few people educated past grade 6, low educational standards
Strengths of DSM-style Categories
• Permits shorthand communication for involved professionals • Easier allocation of health care services • Testing treatment efficacy • Understanding the aetiology (cause of disease) of psychopathology • Better understanding the phenomenon of each problem • Enhances diagnostic reliability
Social Phobia
• Persistent, irrational fear linked to the possibility of being scrutinized by other people • Subtypes • Generalized (any situation involving scrutinizing could even be eating) • Performance-only (e.g. speech) -fear of displaying anxiety, fear of doing something embaressing * different from low self esteem -debilitating: turn down promotions, stay single • Lifetime prevalence is about 7% - 9% -GAD lifetime prevelance is higher, commorbid with other disorders like depression and substance abuse -onset: early puberty
Panic Attack Symptoms
• Pounding heart • Short of breath • Chest pain/tightness • Dizziness • Paresthesias • Trembling • Sweating/Chills • Nausea • Depersonalization/ Derealization
Unhelpful Coping Styles with PTSD
• Rumination-- no action, just thinking about it • Dissociation • Suppression
PTSD Protective Factors
• Social support • Discussion of feelings and memories • High intelligence • Coping skills? • Search for meaning- what can be learned? Growth from the experience.
Anxiety Disorders include:
• Specific phobia • Social anxiety disorder • Panic disorder • Generalized anxiety disorder (GAD) • Separation anxiety disorder • Obsessive-compulsive disorder (OCD) spectrum (different in DSM 5) • Post-traumatic stress disorder (PTSD)
agoraphobia
• trnaslation: "fear of the marketplace" • "fear of fear"- fear having the panic attacks where other people would see you and cant get help • common complication of panic • interferes with functioning
psychological principles involved in development of agroaphobia
-neg reinforcement of avoidance -person stops growing as a person because they cannot tolerate any uncertainty
Supernatural theory
A troubled mind was the result of displeasure from God or demons - Greeks Chinese Babylonians and Hebrews believed
Dark ages
Church replaced psysicians
How are early theories of psychopathology and social stigma related ?
Fear
Benjamin rush
Mental disorders caused by too much blood In the brain- treatment: had to let blood out! Also believed that "lunatics" could be cured by being frightened
Prof asks experience with schizophrenia - which aspects are abnormal?
Recurrent, scaring other people, distress, functional interference, violation of social norms
Romeo Dallaire
look up in text***
examples of phobias
storms/ water, fMRI, BII (blood injory and injections). animals -life time prevelance 7-9%
constuct validity
the extent to which scores or ratings on an assessment instrument relate to other variables or behaviours according to some theory or hypothesis
Development of the DSM: Mid-20th century
• 1948: World Health Organization produced ICD--> mental disroder section not well accepted at the time • 1952: American Psychiatric Association produced first DSM
Pre-trauma Personal Factors
• Early parental separation • Family psychiatric history • Previous trauma exposure • Pre-trauma distress
PTSD Risk Factors
• Exposure to trauma • Factors related to the trauma itself • Pre-trauma personal factors • Peri-traumatic psychological factors (around the time of the trauma)
Development of the DSM: Early 19th century
• Medical field developed diagnostic system, and health care improved. • Attempts were made to classify behavioural disorders (UK, France, US). • Classifications were inconsistent and not well accepted.
Risk for Exposure to Trauma
• neuroticism, extraversion • conduct problems • family history of mental illness • pre-existing psychiatric disorders -being male
"Classifications are fictions imposed on a complex world to understand it and manage it.. They must be useful to both researchers and clinicians." Meaning?
-grants and funding for researchers if the disorder is labeled -good tool for clinician and researcher communication, they can work together -if something is put in the DSM it is standardized -distinguishes particular disorder from others
Somalian video
-no proper medical classificiation has been given, just called the man who is mad -Evil spirits inhabiting sons body Family worried that he will commit crime Exorcism practiced Only 20 mental health nurses in Somalia The son is eventually set free from chains
case example: chicken phobia
-patient hoping to travel to specific part of africa where there are many chickens for development work -previous experience: chicken thrust through bus window right beside head- very startled -phobia spread to all poultry and it didnt have to be living- eg in poultry section of store -B/c of upcoming life change see sought treatment -treatment began with exposure to chicken in supermarket on rotissary and in package -then went to chicken house -she could now successfully go on trip -3 month treatment
How is the DSM l or Early ICD problematic if they are just lists of disorders?
-problem of standardization, overlap of diagnoses-- problem because treatment should be specific, error variance, book is unhelpful if it is just a list
Internet Gaming Disorder (DSM-5) **not in offical part of the DSM- it is up for debate
1. Preoccupation with internet games 2. Withdrawal symptoms when gaming is taken away (irritability, anxiety, or sadness) 3. Tolerance: need to spend increasing amounts of time engaged in internet games 4. Unsuccessful attempts to control internet games use 5. Loss of interests in previous hobbies as a result of, and with the exception of, internet games 6. Continued excessive use of internet games despite knowledge of psychosocial problems 7. Has deceived family, therapists, or others regarding amount of use 8. Use of internet games to escape or relieve a negative mood 9. Has jeopardized or lost a significant relationship, job, or educational opportunity because of extent of use of internet games
Differential diagnosis:
2 disorders with some common features- splits these into two clear disorder-- DSM provides insight on differential diagnosis
Why study behaviour disorders?
20% of people have mental illness in any given year, it is very prevalent
Stigma In Canada
72% of people would confess cancer 50% mental illness, 27% say they would feel fearful being around someone who is mentally ill, 42% are uncertain whether they would socialize with a friend diagnosed with a mental illness, Only 30% think mental illness hurts the economy, While 89% believe mental illness requires treatment by a professional, 40% said if they felt they were ill, they would try to deal with it themselves.
See notes for historical timelime
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See notes for human rights and mental illness chart
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See study priorities for ch 6
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see study priorities for chapter 4
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Elyn saks
A tale of mental illness She is schizophrenic: a brain disease characterized by hallucinations and delusions She was hospitalized three times and told she wouldn't have bright future Terrible experiences with restraint in hospital She touches on stigma: should be called ppl with schizophrenia not schizophrenics We need to stop criminalizing mental illness- prisons full of mentally ill
Somalian family imtervention
Afraid they will have to pay compensation for son if he breaks law Hiding their son because of stigmatizatiom
Multiaxial System of DSM-IV
Axis I. All diagnostic categories except those on Axis II Axis II. Personality disorders and mental retardation Axis III. General medical conditions Axis IV. Psychosocial and environmental problems Axis V. Current level of functioning-- dimesnional piece put on categorical model -forced clinician to consider a broad range of information
Emil kraeplin
Classification of mental illness based on biological disruption, group of symptoms led to syndrome with underlying physical cause
Behavioural Theory OCD:
Conditioning principles account for OCD behaviour - Initial fear classically conditioned - Compulsions negatively reinforced - Stimulus generalization- gets broader and further away from orignial stimulus
How do phobias develop? And how are people predisposed?
Conditioning: classical conditioning learn stimulus associated with certain maladaptive feeling -operant condition: neg reinforcement- e.g. aversive anxiety is ended when you dont have to go on your date Diatheses: predisposition -parents are socially inept and pass on this to you could be biological or environmental -evidence for general transmission of anxiety -location: e.g. place with lots of earthquakes -personality traits: e.g. neuroticism (emotionally reactive), anxiety sensitivity (fear own anxiety) Special considerations for social phobia -maybe part of stigmatized group
Dorthea dix
Crusader for improved conditions for the mentally ill. Tried to resurrect moral treatment in N.A after she was shocked by poor conditions In prison at which she worked in the 19th century, she personally helped see that 32 mental hospitals were built to take in patients that the private hospitals could not. Unfortunately, this hospitals did not live up to her vision and doctors were more focused on physical rather than psychological aspects of their illnesses
Midle ages
Demons and witches blamed for bad stuff
20th century ideas around mental health
Developmental problems (psychosexual) reinforcement for problematic behaviour, environment : stress, social support, traumatic life events, education
Supernatural treatment- as believed by greeks, hebrews, chinese, babylonians
Exorcism, ostracism : separation from community, trepanning: create hole in head for spirit to leave from
Post-Traumatic Stress Disorder (PTSD)
Extreme response to a severe stressor • Actual or threatened grave physical harm or death • Direct experience or witnessing e.g. combat, violent death of loved one, torture, trapped in mine, residential school
Canadian mental health commission
Housing first- place to live is priority then work on mental health
panic attack thought
I'm having a heart attack • ...or stroke • I'm dying • I'm going to faint • ...or go crazy • ...or embarrass myself
Explain how characteristics of abnormality are used as a set to understand abnormal psychology
If a person meets several characteristics they may be abnormal Some criteria are more important eg recurrent Don't require that all criteria are met for diagnosis
Psychogenesis theories: Charcot
Initially had somatogenic point of view that was altered by his students who showed that they could induce hysteria in a woman by hypnotizing her.. he then shifted to a psychogenic (psychological) point of view. Hypnotizing- thought mental illness was due to mental not physical malfunction
Romanov report
Mental health in Canada lobbying for same attention as physical health. Proposed sweeping changes to medicare and made many recommendations to improve mental health conditions-> wanted medicare to include limited number of home care services and drug treatments and national drug agency
Factors Related to the Trauma
Most people who experience major trauma do not develop PTSD. • Perceived threat to life • Initial reaction of dissociation • Intentional perpetration (person did it to inflict harm-- intentional vs. earthquake)
1486 pope innocent malleus maleficarum
People burned alive to rid them of demons
Asylums
People viewed like they were in a zoo for entertainment
Diagnostic Features of PTSD
Re-experiencing the traumatic event (distressing/ vivid memories or flashbacks, dreams/ nightmares, preoccupation- in thoughts all the time, emotional upset) • Avoidance of stimuli associated with the event or emotional numbing (depends on the situation how "easy" it is to avoid triggering stimuli) • Disturbances in cognitive or affective experiences related to the trauma (amnesia, thoughts that a stronger person wouldn't have let this happen, emotional distress and estrangement from others) • Agitation (appears as irritability or wreckless behaviour, large startle response, hypervigilance, difficulty sleeping)
Hippocrtes
Regarded as the father of modern medicine. Said that ilnesses had natural causes. Thought mental illness is an imbalance in humours the liquids of body (black bile, yellow bile, blood, phlegm). Brain thought to be location of consciousness, it is linked to madness. Rejected the idea that God sent disease as punishment General paresis (deterioration of mental and physical health) and syphilis shown to be connected by organism that causes people to go mad Treatment was hypnosis, medication, ECT
The enlightnement
Rejected superstition and abuses of church and made more science based
Somatogenesis theories
Soma is body so physical problem disturbing thoughts and behaviour
What is abnormal?
Statistical infrequency: does not happen often and only one side of the bell curve is accurate- not abnormally positive Violation of social norms: makes others anxious, threatens them, outside of prevailing cultural norms Personal distress and suffering ( some cases not all, eg alcoholics who think it doesnt affect their lives) Functional interference: everyday functioning is impaired like with work or social relationships Unexpected responses to envinmental stressors e.g. anxiety disorder is diagnosed when anxiety is is unexpected and out of proportion to the situation--> like worrying constantly about your financial situation
differential treatment for 3 categories of demonolgy, moral treatment, somatogenesis
Theories of mental illness: demonology-exorcism and shouting spirit out of body Moral treatment- restoring personhood Somatogenesis: medication
Franz Anton Mesmer
Thought that hysteria caused by particular distribution of universal magnetic fluid in the body. Magnetic fluids could be influenced by other people and change their behaviour Hysterical disorders- body defies physical rules and organs can be floating around different parts of body Used hypnosis to cure his patients
Philippe pinnel
Treated patients at La Bricrete, asylum in Paris, as sick humans instead of animals. Took off chains from patients and let them be free Majority of drugs used was opium His practice led to more moral treatment in the US and rest of Europe
cognitive features of social phobia
Unrealistic performance standards-- must be perfect • Attentional bias-- only paying attention to negative feedback e.g. giving a speech and seeing only people sleeping • Self-focused attention- focused on self and imperfections more than is noticeable e.g. slight sweating or raised heart beat • Post-event processing- dwell on imperfections of importance
Internet gaming disorder- should it be a disorder?
Which characteristic would need more research before you could rely on it to decide? What would need to be established? -statistical infrequency, disability/ dysfunction, violation of norms, unexpectedness, personal suffering/ distress
DSM ll with simple glossary- what could be added?
add symptoms and characteristics, differential diagnosis, prevelence, population, course, aggrevating conditions, associated characteristics (functioning)
what does rule out mean?
another disease often confused with the current one can be 'ruled out'- there is a notification to the clinician
What is most common disorder in DSM?
anxiety disorder
behavioural similarites between anxiety disorders
avoidance
categorical approach: does person X have cancer or not
check yes or no
What is diagnosis currently based on? What did adam purpose that is different?
cognitive, emotional, behavioural abberations Physiological tests- like blood tests, fMRI to detect disorder
