Psychology 2250 Abnormal Psychology Oltmanns and Emery. SD Reeder, Ph.D.

Transcription

1 Psychology 2250 Abnormal Psychology Oltmanns and Emery SD Reeder, Ph.D.

2 Questions 1 - What is the difference between normal and abnormal behavior? 2 - How does culture influence the definition of mental disorders? 3 - How does the impact of mental disorders compare to that of other health problems?

3 Question 4 - Who provides help for people with mental disorders? 5 - Why do scientific methods play such an important role in psychology's approach to the study of mental disorders?

4 Overview Symptoms and signs of mental disorders are known as psychopathology. Pathology of the mind Abnormal psychology is the application of psychological science to the study of mental disorders. The line dividing normal from abnormal tends to move around.

5 Recognizing the Presence of a Disorder Mental disorders are typically defined by a set of characteristics. Psychosis is a condition marked by being out of contact with reality. One symptom by itself is seldom sufficient to make a diagnosis.

6 Recognizing the Presence Syndrome of a Disorder A group of symptoms that appear together and are assumed to represent a specific type of disorder

7 Recognizing the Presence of a Disorder Mental disorders are defined in terms of: Duration or persistence of maladaptive behaviors over time (quality not quantity). Impairment in the ability to perform social and occupational roles.

8 Recognizing the Presence of a Disorder Psychologists and other mental health professionals at present do not have laboratory tests that can be used to confirm the presence of psychopathology. Clinical psychologists must still depend on their observations of others behaviors and descriptions of personal experiences.

9 Defining Abnormal Behavior By what criteria do we decide whether a particular set of behaviors or emotional reactions should be viewed as a mental disorder? Individual experience of personal distress Statistical norms how common or rare is the behavior in the general population?

10 Defining Abnormal Behavior Harmful Dysfunction 2 criteria 1. The condition results from the inability of some internal mechanism to perform its natural function. 2. The condition causes some harm to the person as judged by the standards of the person's culture. Not every dysfunction is harmful or leads to a disorder

11 Defining Abnormal Behavior Harmful Dysfunction The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) definition places primary emphasis on the consequences of certain behavioral syndromes. Mental disorders are defined by clusters of persistent, maladaptive behaviors that are associated with personal distress (e.g., anxiety or depression, impairment in social or occupational functioning).

12 Defining Abnormal Behavior Mental health vs. absence of a disorder People who function at highest levels are described as flourishing. Comprehensive approaches to mental health in a community should address: Efforts to diminish frequency and impact of mental disorders. Emphasizing activities designed to promote flourishing.

13 Defining Abnormal Behavior Culture and Diagnostic Practice Culture Values, beliefs, and practices that are shared by a specific community or group of people Culture has a profound influence on opinions regarding the difference between normal and abnormal behavior (Bass et al., 2012).

14 Defining Abnormal Behavior Culture and Diagnostic Practice There have been many instances in which groups representing particular social values have brought pressure to bear on decisions shaping the DSM. Culture is a dynamic process - it is everchanging and the DSM has changed over its editions to reflect those changes.

15 IS SEXUAL ADDICTION A MEANINGFUL CONCEPT? The symptoms of this disorder presumably include low self-esteem, insecurity, need for reassurance, and sensation seeking. Shares features with other disorders, and thus may not be a distinct diagnosis.

16 Who Experiences Abnormal Behavior? Frequency in and Impact on Community Populations Epidemiology The scientific study of the frequency and distribution of disorders within a population (Gordis, 2008) Incidence The number of new cases of a disorder that appear in a population during a specific period of time

17 Who Experiences Abnormal Behavior? Frequency in and Impact on Community Populations Prevalence The number of active cases (old and new) present in a population during a specific period of time Lifetime prevalence Total proportion of people in a given population who have been affected by a disorder at some point during their lives

18 Who Experiences Abnormal Behavior? Frequency in and Impact on Community Populations Lifetime prevalence and gender difference The National Comorbidity Survey Replication (NCS-R) found that 46% of the surveyed people received at least one lifetime diagnosis. Epidemiological studies consistently find gender differences for many types of mental disorders.

19 Figure 1.1 Frequency of Mental Disorders in the Community Lifetime prevalence rates for various mental disorders (NCS-R data). Courtesy of Thomas F. Oltmanns and Robert E. Emery.

20 Who Experiences Abnormal Behavior? Frequency in and Impact on Community Populations Comorbidity and Disease Burden - Comorbidity - The presence of more than one condition within the same time period - Disease burden is measured by combining two factors: 1. Mortality, lost years of healthy life 2. Living with a disability

21 Who Experiences Abnormal Behavior? Frequency in and Impact on Community Populations Comorbidity and Disease Burden World Health Organization s Global Burden of Disease Study (Lopez, et al., 2006) Although mental disorders are responsible for only 1% of all deaths, they produce 47% of all disability in economically developed countries and 28% of all disability worldwide.

22 Figure 1.2 Comparison of the Impact of Mental Disorders and other Medical Conditions on People's Lives Disease burden in economically developed countries measured in disability-adjusted life years (DALYs). Source: Murray, CJLM, Lopez, AD, eds The Burden of Global Disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to Vol. 1. Cambridge, MA: Harvard University Press.

23 Who Experiences Abnormal Behavior? Cross-Cultural Comparisons All mental disorders are shaped, to some extent, by cultural factors. No mental disorders are entirely due to cultural or social factors. Psychotic disorders are less influenced by culture than are nonpsychotic disorders. The symptoms of certain disorders are more likely to vary across cultures than are the disorders themselves. (Draguns & Tanaka-Matsumi, 2003)

24 The Mental Health Professions Psychological problems are treated in different settings by various kinds of service providers 40% treated by specialized mental health professionals (psychiatrists, psychologists, and social workers) 34% treated by primary care physicians (likely to prescribe some form of medication) 26% of mental health services delivered by social agencies and self-help groups

25 The Mental Health Professions Psychiatry Branch of medicine concerned with the study and treatment of mental disorders Psychiatrists are medical doctors (MDs) who are licensed to practice medicine and can prescribe medications

26 The Mental Health Professions Clinical psychology Concerned with the application of psychological science to the assessment and treatment of mental disorders Typically completes a Ph.D or Psy.D. Social work Concerned with helping people achieve an effective level of psychosocial functioning Usually hold a master s degree in social work

27 Psychopathology in Historical Context The Greek Tradition in Medicine Hippocrates ( BC) Ridiculed demonological accounts of illness and insanity Believed that health depended on a balance of four bodily fluids. Blood Black bile Phlegm Yellow bile

28 Psychopathology in Historical Context The Greek Tradition in Medicine Hippocrates ( BC) The Hippocratic perspective dominated medical thought in Western countries until the middle of the nineteenth century. Disease was seen as a unitary concept; that is, mental disorders were not distinguished from other types of illness (Golub, 1994).

29 Psychopathology in Historical Context The Greek Tradition in Medicine Some common treatment modalities were the use of bloodletting (cutting to remove blood), purging (induction of vomiting), and the use of heat and cold. Such practices continued into the 19 th century.

30 Psychopathology in Historical Context The Creation of the Asylum During the middle ages, disturbed behavior was considered to be the responsibility of the family, rather than the community or state. Insane asylums established in 1600s and 1700s to house the mentally disturbed, but were little more than human warehouses. The moral treatment movement was championed by such people as Phillipe Pinel, William Tuke, Benjamin Rush, and Dorothea Dix, among others.

31 Psychopathology in Historical Context Worcester Lunatic Hospital: A Model Institution The Massachusetts Lunatic Asylum in Worcester was the first large state mental institution in the United States. Treatment included a blend of physical and moral procedures. Between 1833 and 1845, reported recovery rates varied from 82% to 91%.

32 Psychopathology in Historical Context Lessons from the History of Psychopathology The invention and expansion of public mental hospitals led directly to our current mental health care system. The creation of psychiatry as a professional group laid foundation for heightened public interest and financial support for addressing mental disorders The importance of scientific research

33 Methods for the Scientific Study of Mental Disorders The Uses and Limitations of Case Studies Case study An in-depth look at the symptoms and circumstances surrounding one person's mental disturbance Can provide: An exhaustive catalog of symptoms The manner in which the symptoms emerged The developmental and family history that preceded the onset of the disorder Responses to treatment attempts This forms the basis of hypotheses

34 Methods for the Scientific Study of Mental Disorders The Uses and Limitations of Case Studies Whatever response the person may have shown to treatment efforts Provide information about conditions that have not received much attention Drawbacks Can be viewed from several different perspectives Risky to draw general conclusions

35 Methods for the Scientific Study of Mental Disorders Clinical Research Methods Emphasize the importance of the search for new information Range in complexity from basic to complex, and is addressed in every chapter Depicted in Table 1.4

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