Unit 8 Study Questions

Page 1

Describe and evaluate the medical model of abnormal behaviour. (pp. 641-642) The medical model proposes that it is useful to think of abnormal behaviour as a disease.Prior to the 18th century, most conceptions of abnormal behaviour was based on superstition, such as "begin possessed by demons, being witches, or victims of God's punishment." Over time, speculative treatments to mental illness paved the way for scientific investigation of the causes and cures of psychological disorders. The use of the following medical terms have proved to be helpful when treating abnormal behaviour: Diagnosis (distinguishing one illness from another), Etiology (the apparent causation and developmental history of an illness), and Prognosis (a forecast about the probable course of an illness).

Explain the most commonly used criteria of abnormality. (pp. 642-643) These are the three most used criterion for assessing abnormal behaviour: (1) Deviance - behaviour deviates from what their society considers acceptable, (2) Maladaptive behaviour - everyday adaptive behaviour is impaired, and (3) Personal distress - individual's report of great personal distress. It is when any of all of these criterion reaches to an extreme is when it is considered an issue, as all people display deviance, maladaptive behaviour, and personal distress.

Summarize the three stereotypes about psychological disorders that are largely inaccurate. (p. 643) These are the three inaccurate stereotypes about psychological disorders: (1) Psychological disorders are incurable - while there are a few people that aren't cured, they are outnumbered by those who do get better, either spontaneously or through formal treatment, and the majority of those diagnosed with a mental disorder return to society to lead normal, productive lives. (2) People with psychological disorders are often violent and dangerous - this stereotype exists because incidents of violence involving mentally ill tend to get focus from the media, but past violence is the strongest predictor of violence, and there is no consistent evidence that psychological disorders are a risk factor for violent behaviour. (3) People with psychological disorders behave in bizarre ways and are very different from normal people - Besides those with relatively severe disorders, people with psychological disorders usually are indistinguishable from those who don't have a disorder. The line between normal and abnormal behaviour can be difficult to draw.

Describe the five diagnostic axes of DSM-IV-TR. Discuss the controversial aspects of this classification system. (pp. 644-645) The DSM-IV employs a multiaxial system of classification, which asks for judgments about individuals on five separate dimensions (axes). Axis I (Clinical Syndromes) is where the clinician records most types of disorders. Axis II (Personality Disorders or Mental Retardation) is a list of long-running personality disorders or intellectual disability (mental retardation). Diagnoses of disorders are made on Axes I and II, either individually or on both. Axis III (General Medical Conditions) is a list of a patient's physical disorders (diabetes, arthritis, etc). Axis IV (Psychosocial and Environmental Problems) is where the clinician makes notations regarding the types of stress experienced by the individual in the previous year. Axis V (Global Assessment of Functioning) is where estimates are made of the individual's current level of adaptive functioning (in social and occupational behaviour, viewed as a whole) and of the individual's highest level of functioning in the previous year. The controversy surrounding the DSM is the fact that it is takes a categorical approach to making a diagnosis. As many disorders have overlapping symptoms, this can affect the quality of treatment a patient can receive if the diagnosis is not completely correct, and with comorbidity (the coexistence of two or more disorders), it is possible that each disorder in the DSM is a variation on one or a few disorders, rather than thousands of particular ones. A dimensional approach hopes to relieve this issue, but as it stands, the DSM-IV (or now DSM-V) is the best device for diagnosing mental illness.

As noted in the Weiten and

McCann (2013) text, the DSM has recently been revised to the DSM-V

(2013). However, as it was not ready for publication by the date of this

textbook, DSM-IV-TR (2000), as described in your textbook, will be used

(as cited, pp. 644-645).

Describe the symptoms associated with five types of anxiety disorders. (pp. 647-650) Anxiety disorders are a class of disorders marked by feelings of excessive apprehension and anxiety. A generalized anxiety disorder is marked by a chronic, high level of anxiety that is not tied to any specific threat (symptoms include anxiety that is non-specific, meaning they could be worried about being worried, and can also manifest into physical symptoms such as trembling, muscle tension, diarrhea, dizziness, faintness, sweating, and heart palpitations). A phobic disorder is marked by a persistent and irrational fear of an object or situation that presents no realistic danger (this anxiety is focused on a specific object or situation, such as spiders and driving. Despite knowing their fears are irrational, they can't calm themselves when faced with phobic stimuli). A panic disorder is characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly (Due to the random nature of panic attacks, many people who have a panic disorder become afraid to leave their own homes [agoraphobia - fear of going out to public places]). An obsessive-compulsive disorder (OCD) is marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) (OCD is defined by obsessions and checking, symmetry and order, cleanliness and washing, and hoarding.) Post-traumatic stress disorder (PTSD) is disturbed behaviour that is attributed to a major stressful event but that emerges after the stress is over (symptoms include re-experiencing the traumatic event in the form of nightmares and flashbacks, emotional numbing, alienation, problems in social relationships, an increased sense of vulnerability, and elevated levels of arousal, anxiety, anger, and guilt).

Comment: As in many disorders, one must consider the

extent of the behaviour involved. That is, what constitutes normal

anxiety and what constitutes abnormal anxiety? Some anxiety is good

because it helps people perform at a higher level; however, too much

anxiety can interfere with performance. Holmes (2001) listed three

determining factors:

the level of anxiety (i.e., low vs. high),

the justification for the anxiety (i.e., low justification vs. high justification), and

the consequences of the anxiety (i.e., low impact vs. high impact).

Discuss the contribution of biological, conditioning, cognitive, and

stress factors to the etiology of anxiety disorders. (pp. 651-653) Biological contributions are based on the moderate genetic component that leaves people predisposed to anxiety disorders. as well, some people are overly sensitive to the physiological effects of anxiety, which can spiral into more anxiety, and a link may exist between anxiety disorders and neurochemical activity in the brain. Conditioning relates to anxiety disorders, as many anxiety responses may be acquired by classical conditioning and maintained through operant conditioning. An originally neutral stimulus (ex. snow) may be paired with a frightening event (ex. avalanche) so that it becomes a conditioned stimulus eliciting anxiety. Cognitive factors are based on the fact that certain styles of thinking make some people more prone to anxiety disorders. They tend to (a) misinterpret harmless situations as threatening, (b) focus excessive attention on perceived threats, and (c) selectively recall information that seems threatening. Anxiety disorders are stress related. Patients with panic disorder had experienced a dramatic increase in stress in the month prior to the onset of their disorder.

Describe the three dissociative disorders, and discuss their etiology. (pp. 653-655) Dissociative disorders are a class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity. Dissociative amnesia and fugue re overlapping disorders characterized by serious mental deficits. Dissociative amnesia is a sudden loss of memory for important personal information that is too extensive to be due to normal forgetting (memory losses may occur for a single traumatic event (ex. house fire) or for an extended period of time surrounding an event). Dissociative fugue is where people lose their memory for their entire lives along with their personal sense of identity (forget their names, families, where they work, where they live, but can remember matters unrelated to their identity [drive a car]). Dissociative identity disorder (DID) involves the coexistence in one person of two or more largely complete, and usually very different, personalities (multiple personality disorder) (the experiences that each personality has is only recalled by that personality, and those with DID usually have a history of mood, anxiety, or personality disorders). Amnesia and fugue is associated with excessive stress, but little is known about this extreme reaction happens in only a small minority of people. There is many arguments about the legitimacy of DID, as there are influxes of patients who appear to have DID after a movie or book is published about it. Little is known about the causes of DID, thus making this a controversial diagnosis.

Comment: There is a question as to whether

Dissociative Identity Disorder (DID) actually exists. Currently, there

is no definitive answer to this question. Reasons to be cautious include

the following:

The lack of empirical evidence for DID should not be used to conclude that it does not exist.

Even if some cases of DID turn out to be faked, we cannot generalize and conclude that all cases are faked.

The objective existence and the phenomenological

existence of DID are different. That is, while we cannot prove

objectively that DID exists, if someone believes that it exists and

behaves as if they have the condition, the disorder exists for them.

Describe the two main mood disorders: major depressive disorder and bipolar disorder. (pp. 656-659) In major depressive disorder, people show persistent feelings of sadness and despair and a loss of interest in previous sources pf pleasure. A central feature of depression is anhedonia - a diminished ability to experience pleasure. Depressed people lack the energy or motivation to tackle the tasks of living. The severity of depressive disorders varies considerably, when those with mild symptoms of depression are diagnosed with dysthymic disorder (chronic depression that is insufficient in severity to justify diagnosis of a major depressive episode). Bipolar disorder (formerly manic-depressive) is characterized by the experience of one or more manic episodes as well as periods of depression. Along with depressive episodes, there are also manic episodes, with a person's mood being elevated to euphoria, as well as optimism, energy and extravagant plans. That is a milder form of mania, as the extremes can massively impair judgment. Cyclothymic disorder is when one exhibits chronic but relatively mild symptoms of bipolar disturbance.

Explain how genetic and neurochemical factors may be related to the development of mood disorders. (pp. 661-662) Twin studies suggest that genetic factors are involved in mood disorders. Concordance rates average around 65% for identical twins, but 14% for fraternal twins, thus, evidence suggests that heredity can create a predisposition to mood disorders. Correlations have been found between mood disorders and abnormal levels of norepinephrine and serotonin. A neurochemical basis exists for at least some mood disorders.

Explain how hormonal factors, dispositional factors, cognitive

factors, and stress may be related to the development of mood disorders.

(pp. 662-664, 667) Hormal factors in mood disorders has been gaining focus. One of the brain pathways that signals are sent from the hypothalamus to the pituitary gland, then to the adrenal cortex, which releases corticosteroids (the hypothalamic-pituitary-adrenocortical axis). When the hypothalamic-pituitary-adrenocortal axis is over active, large amounts of cortisol is release, thus contributing to depression. Dispositional factors include high levels of perfectionism contributing to depression. As well, sociotrophy (emphasize pleasing others) and autonomy (concerned with independence and achievement) contribute to depression when interpersonal relationships or one's achievement goals are in jeopardy, respectively. Cognitive factors for mood disorders includes Aaron Beck's concept of the negative cognitive triad, which reflects the tendency have negative views of themselves, their world, and their future. As well, Martin Seligman's learned helpless model (and hopelessness theory) asserts that depression is cause by passive "giving up" behaviour produced by exposure to unavoidable aversive events. There is a relatively strong link between stress and the onset of mood disorders, as well as to how people respond to treatment and whether they experience a relapse of their disorder.

Describe the general characteristics (symptoms) of schizophrenia. (pp. 668-670) Schizophrenic disorders are a class of disorders marked by delusions, hallucinations, disorganized speech, and deterioration of adaptive behaviour. Disturbed, irrational thought processes are the central feature of schizophrenic disorders, which include delusions (false beliefs that are maintained even though they clearly are out of touch with reality. Schizophrenia involves a noticeable deterioration in the quality of the person's routine functioning in work, social relationships, and personal care (adaptive behaviour). Perceptual distortions are prevalent, especially hallucinations (sensory perceptions that occur in the absence of a real, external stimulus, or are gross distortions of perceptual input. Disturbed emotions can be carried out in a variety of ways, either showing very little emotional responsiveness, or inappropriate emotional responses (crying at happy cartoon, or laughing at sad news story).

Describe two classification systems for schizophrenic subtypes.

Discuss the limitations of each classification system. (pp. 670-671) Paranoid schizophrenia is dominated by delusions of persecution, along with delusions of grandeur. Those with this disorder believe that they have many enemies who want to harass and oppress them, suspicious of friends or relatives, and are convinced that they are being watched and manipulated in mysterious ways. To make sense of the persecution, they often see themselves as extremely important people (great inventors or religious or political leaders). Catatonic schizophrenia is marked by striking motor disturbances, ranging from muscular ridgidy to random motor activity. They can be motionless for extreme lengths of time, or be hyperactive and incoherent (possible alternate between the two). Disorganized schizophrenia is when a particularly severe deterioration of adaptive behaviour is seen. (emotional indifference, frequent incoherence, virtually complete social withdrawal, aimless babbling and giggling, and delusions based on bodily functions). People who have schizophrenia, but don't fit neatly into these categories are said to have undifferentiated schizophrenia, which is marked by idiosyncratic mixtures of schizophrenic symptoms.

Explain how genetic vulnerability, neurochemical factors, and

structural abnormalities in the brain may contribute to the etiology of

schizophrenia. Describe the neurodevelopmental hypothesis of

schizophrenia. (pp. 672-673) Heredity factors play a role in the development of schizophrenic disorders, because in twin studies, concordance rates average around 48% for identical twins, and that children born to two schizophrenic parents have a 46% probability of developing a schizophrenic disorder. Schizophrenic disorders appear to be accompanied by changes in the over activity of dopamine in the brain. Both reductions in grey and white matter in specific brain regions, as well as enlarged brain ventricles contribute to the emergence of schizophrenia. The neurodevelopmental hypothesis posits that schizophrenia is caused by various disruptions in the normal maturational processes of the brain before or at birth, such as viral infections and malnutrition.

Summarize evidence on how stress may be related to the development of

schizophrenia and how family dynamics can influence the course of

schizophrenia. (pp. 674-675) Expressed emotion (EE) is the degree to which a relative of a schizophrenic patient displays highly critical or emotionally over involved attitudes towards the patient. This can cause families to be a source of stress, rather than a source of social support. Stress plays a key role in triggering schizophrenic disorders through various biological and psychological factors influencing individuals' vulnerability to schizophrenia.

Define antisocial personality disorder (APD). Summarize the research on the etiology of this disorder. (pp. 677, 680) Antisocial personality disorder (psychopathy) is marked by impulsive, callous, manipulative, aggressive, and irresponsible behaviour that reflects a failure to accept social norms. People with antisocial personality disorder chronically violate the rights of others. They often use their social charm to cultivate others' liking or loyalty for purposes of exploitation. They rarely feel guilty about their transgressions, and essentially lack an adequate conscience and an empathy for others. The etiology of antisocial personality disorder begins with findings that say that biological factors contribute to the development of APD, with twin studies finding a concordance rate of 67% versus 31% for fraternal twins. The lack of inhibitions that most of us have about violating moral standards suggests that such people night inherit sluggish autonomic nervous systems, leading to slow acquisition of inhibitions through classical conditioning. Dysfunctional family systems result in inadequate socialization, which can be seen through studies that find that those with APD tend to come from homes where discipline is erratic or ineffective, and homes where they experience physical abuse or neglect.

Discuss the effects of culture on pathology. (pp. 684-685) There are two schools of thoughts regarding whether psychological disorders are culturally variable phenomenon. A realistic view asserts that the criteria of mental illness vary across cultures and there are no standards on normality and abnormality (DSM is ethnocentric and limited relevance in other cultures). The pancultural view argues that the criteria of mental illness is similar to other cultures and that standards of normality and abnormality are universal. The debate boils down to two issues: (1) are the psychological disorders seen in western societies found throughout the world? and (2) are the symptom patterns of mental disorders consistent across cultures? Principle categories of disorders (schizophrenia, depression, bipolar, etc.) are identifiable in all cultures. The differences are more apparent in the less severe forms of psychological disorders (generalized anxiety, hypochondria, narcissistic personality), where in other cultures, they are viewed as peculiarities rather than full fledged diagnoses. If a disorder has a strong biological component, the more likely the disorder is expressed similarly in other cultures. The peculiar details may be different. For example, a paranoid schizophrenic symptom often cited is the feeling that thoughts are inserted into one's brain. If it were in a technologically advanced society, it would be through radio waves, but if it were in a less technological society, the thoughts would come from demons. As well, depression in western society is diagnosed through feelings of dejection and low self-esteem, where as in non-western society, depression is diagnosed through somatic symptoms (headaches, fatigue, and backaches).

Explain how Chapter 14 highlights four of Weiten and McCann’s (2013) organizing themes. (pp. 685-686) The four themes that are highlighted in the chapter are the following: Multiple causation (every disorder has multiple causes in terms of onset, for psychological, biological and social factors come into play), genetics and heredity, such as the stress-vulnerability model for mood disorders (vulnerability is based on heredity, and stress is based on environment, mood disorders develop if vulnerability is high and if stress is high, but if one is high and the other is low, then nothing develops), psychology evolves in a sociohistorical context (normality and abnormality, while shaped by empirical research, were also shaped by social trends, economic necessities, and political realities), and psychology is shaped by cultural factors (some aspects of psychological disorders are universal, and some are cultural specific).

Describe the principal eating disorders. Summarize what is known about the causes of eating disorders. (pp. 687-689) Eating disorders are severe disturbances in eating behaviour characterized by preoccupation with weight and unhealthy efforts to control weight. The three main eating disorders are the following: Anorexia nervosa - intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, and dangerous measures to lose weight (subtypes are restricting type anorexia nervosa - drastic reduction in intake of food, literally starving themselves, and binge-eating/purging type anorexia nervosa - attempt to lose weight by forcing themselves to vomit after meals, by misusing laxatives and diuretics, and engaging in excessive exercise). Bulimia nervosa involves habitually engaging in out-of-control overeating followed by unhealthy compensatory efforts, such as self-induced vomiting, fasting, abuse of laxatives and diuretics, and excessive exercise. Those who suffer from bulimia nervosa have a healthier weight than those who suffer from anorexia, as purged food only accounts for half of calories eaten, where as they digest the other half. Binge-eating disorder involves distress-induced eating binges that are not accompanied by the purging, fasting, and excessive exercise seen in bulimia. The prevalence of eating disorders have only been seen since the 1970s, and was initially only found in western, affluent countries, where food was abundant, and the need to be thin was preferred (globalization has brought eating disorders to now affluent cities in countries all over the world). Other aspects of etiology include potential genetic vulnerability, family dynamics, and disturbed, all-or-nothing thinking and maladaptive beliefs.

Describe the relationship between the laws of probability and psychological disorders. (pp. 690-691) The likelihood of anyone having at lease one DSM disorder is estimated to be about 44%. When people initially see this fact, they assume that 44% have bipolar disorder or a schizophrenic disorder, but people overlook all of the other, less severe personality disorders. The "prototype" of those with mental illness is depicted as someone in a straight jacket, or a homeless guy who says he's Jesus. This distortion represents the representativeness heuristic (the estimated probability of an event is based on how similar the event is to the typical prototype of the event). As well, the 44% figure is based on someone having a substance use disorder (24%), or an anxiety disorder (19%), or a mood disorder (15%) or a schizophrenic disorder (1%) (cumulative probabilities), and its based on lifetime prevalence (someone getting a mental disorder at some point within their entire lives, lasting as low as 3 months). If you were to ask about the likeliness of someone having substance-use, anxiety, mood, and schizophrenic disorders (conjunctive probabilities), then that number would have to be less than the smallest percentage available (1% for schizophrenic disorders). If you were to guess the percentage of men surveyed who get a heart attack, and asked the percentage of men surveyed who were 55 years old and had a heart attack, many people would assume that the second percentage was higher than the first. This represents the conjunction fallacy (when people estimate that the odds of two uncertain events happening together are greater than the odds of either event happening alone). Also, when people stereotypically link mental illness to violence, or overestimate how often the insanity defence is used in criminal trials, this represents the availability heuristic (the estimated probability of an event is based on the ease with which relevant instances come to mind.

Comment: If you have difficulty understanding the

relationship between personality, abnormal behaviour, and therapy, the

following theoretical approach might prove useful:

Psychoanalytic/psychodynamic perspective: This

perspective is presented by Freud, Jung, Adler, and Erikson. They share

the belief that people’s behaviour is determined by dynamic forces and

conflicts within the mind. These processes are often unconscious, and it

is assumed that early childhood experiences are largely responsible for

determining an individual’s later behaviours and development. Abnormal

behaviour arises from conflicts between these dynamic forces and the

resulting guilt and anxiety. Individuals are often unaware of why a

behavioural problem exists, because such conflicts involve the

unconscious, and the root causes were established during childhood.

Learning perspective (a.k.a. social learning theory):

This perspective is best presented by Watson and Skinner. They share

the belief that normal and abnormal behaviours are learned the same way.

Processes include classical and operant conditioning, modelling, and

imitation.

Cognitive perspective: This perspective is best

presented by Bandura. It differs from the above two perspectives in that

it emphasizes information processing rather than simple conditioning.

That is, the cognitive perspective considers the person’s information

processing to be abnormal in some way; for example, problems in

receiving, storing, retrieving, or making sense of information.

Humanistic/existential perspective: This perspective

is best presented by Rogers, Maslow, May, and Frankl. It developed in

reaction to the psychodynamic and behaviouristic views. Humanists

believe that abnormal behaviour results from a discrepancy between one’s

real and ideal selves, which causes stress, tension, anxiety, and so

on. Existentialists believe that anxiety results from existential crises

that occur when individuals face difficult decisions about the

directions in their lives.

Biological/physiological perspective: Abnormal

behaviour is understood to be a result of biological or physiological

causes. This perspective assumes that there is an interrelationship

between the body and the brain. Any threat or challenge an individual

perceives in the environment triggers a chain of neuroendocrine events.