Chapter 14: Psychological Disorders midterm 3 Flashcards
Is it easy to define abnormality?
NON
Normal and abnormal are subjective terms, meaning that
our views are influenced by personal feelings, opinions, and experiences. Our subjective views are also influenced by gender, race/ethnicity, socioeconomic status, and a number of other factors.
Essentially, the same behavior can be interpreted in……..
and give example of the same behaviour in different situations that could be considered normal and abnormal
different ways based on context and circumstance. For example, Hector’s screams while riding a roller coaster at the amusement park do not cause any heads to turn. However, his screams while sitting at his desk at work will likely cause his co-workers to be concerned. What is normal in one situation can be abnormal in another.
what is a more acceptable definition of abnormal?
Whether referred to as a mental disorder, mental illness, psychological problem, or psychiatric condition, psychological disorders cause significant impairment in an individual’s life (Stein et al., 2010). They keep people from doing the things they need to do and want to do.
The 4 D’s of Psychological Disorders
Deviance
Danger
Dysfunction
Distress
The signs and symptoms of a psychological disorder are assessed by
mental health professionals to determine abnormal behaviors, thoughts, and feelings. Though not without limitations, the Four Ds (deviance, distress, dysfunction, and danger) provide some guidance for these decisions.
describe deviance
Deviance describes a departure from what is normal or usual, and in terms of psychological disorders it refers to behaviors, thoughts, and feelings that are not in line with generally accepted standards
Deviance can be measured against
statistical standards or cultural views
Statistically deviant behaviors occur
infrequently among members of the population,
culturally deviant behaviors go
against societal standards.
Let’s consider underage drinking. In the United States, consumption of alcohol by individuals under the age of 21 is illegal—so it is what kind of the 4Ds?
deviant behaviour
However, almost 40% of youth aged 12–20 years have consumed alcohol in their lifetimes (Center for Behavioral Health Statistics and Quality, 2020). That actually makes underage drinking a pretty common occurrence—so it is definitely not statistically deviant.
true or false
Taken alone, deviance does not fully determine the presence or absence of a psychological disorder.
true
what is distress?
Distress refers to behaviors, thoughts, and feelings that are upsetting and cause pain, suffering, or sorrow
what is dysfunctional behaviors?
thoughts, and feelings are disruptive to one’s regular routine or interfere with day-to-day functioning
explain dangerous behaviors
thoughts, and feelings may lead to harm or injury to self or others.
Another important defining factor of psychological disorders is that they tend to be
consistent over a span of time.
Psychological disorders are
patterns of deviant and dysfunctional behaviors, thoughts, and feelings that cause significant distress, and may even be dangerous.
what is clinical judgment
mental health professionals’ use of previous professional experiences to inform clinical decision making–when assessing psychological disorders.
Our views of what is normal and abnormal are heavily influenced by ______________. Select all that apply.
a
Personal experience
b
Our parents
c
Societal standards
a,b,c
Explanation
Our views on the subjective terms of normal and abnormal are influenced by personal feelings, opinions, experiences, gender, race/ethnicity, socioeconomic status, and other factors. Our individual experiences, those views of our families, and cultural practices determine what we know to be normal behavior.
Maria steals money from the offering plate in church every Sunday. Which of the 4 D’s of abnormal behavior best describes this behavior?
a
Deviance
b
Distress
c
Dysfunction
d
Danger
a
Deviance
Explanation
Most people give to the offering plate on Sundays, as this is the statistical and societal (religious) norm. Maria is a statistical outlier and violates the social contract by taking money from the offering plate. As such, Maria’s behavior is deviant.
Assigning a diagnosis can be helpful for a number of reasons.
First, a diagnostic label may provide an explanation for abnormal behaviors, thoughts, and feelings being experienced. This can be reassuring and can empower the individual to seek out appropriate resources.
Second, diagnostic labels provide a common language for clinicians, researchers, and insurance companies to communicate effectively about psychological disorders, making sure everyone is on the same page about areas of concern (First et al., 2018).
Finally, labels are an efficient means of tracking the rates of psychological disorders and utilization of services (First, 2010). These data are vital for ensuring adequate access and availability of mental health services for everyone who needs them.
labels can be used to…
labels are sticky which means that
to excuse unacceptable behaviors and can lead to lowered expectations or self-fulfilling prophecies about an individual’s functioning.
diagnoses may have a long-lasting impact on self-image and other’s perceptions of the individual.
Labeling psychological disorders can be both helpful and harmful. Which of the following is a harmful use of labels?
a
Labels are a way to categorize similar behaviors.
b
Labels are a way of organizing epidemiological data.
c
Labels are a way to excuse unacceptable behaviors.
d
Labels are a way to facilitate communication among mental health providers.
Explanation
Categorizing similar behaviors, organizing epidemiological data, and providing a common language allow for better research and treatment for individual disorders. Excusing unacceptable behavior harms the individual when it prevents that person from receiving proper treatment.
Another concern about labels is the
stigma associated with them
what is stigma?
refers to disapproval, poor treatment, discrimination, or isolation due to being different (Link & Phelan, 2001).
Beliefs that people diagnosed with psychological disorders are ………………….. or that mental illness is a ……………….persist in our society.
dangerous
conscious choice
For much of history, the prevailing view was that psychological disorders were caused by
witchcraft or demonic possession. Relating these conditions to morality and spirituality lent a considerable sense of shame to these disorders, and individuals with mental illness were often punished as criminals.
what is trepanation?
surgical procedure in which a hole was drilled into the human skull to release evil spirits, was practiced for thousands of years
what is eugenics?
A philosophical argument that seeks to improve human society by encouraging reproduction by people with desirable qualities(positive eugenics) and discouraging reproduction by people with undesirable qualities (negative eugenics)
the negative eugenics proposed what?
proposed sterilization of individuals considered to be mentally inferior.
During the nineteenth century, a schoolteacher and author named Dorothea Dix advocated for
more humane treatment of the insane, a now antiquated term for mental illness. As a result of her lobbying, states began to fund specialized institutions to house and treat individuals with psychological disorders.
the governement build institution for mental ilness called
asylum—thus the term insane asylum
By 1890, every state had built one or more of these mental hospitals, and these institutions quickly reached and exceeded their capacity soon after opening (U.S. National Library of Medicine, 2013). Individuals with psychological disorders tended to receive inhumane treatment in these cramped settings.
what is deinstitutionalization
The goals of deinstitutionalization were to reduce admissions to psychiatric hospitals, shorten lengths of stay, and improve the treatment that admitted individuals received.
which organization work hard to to increase awareness and understanding of psychological disorders while combating stigma.
NAMI (National Alliance on Mental Illness)
MHA (Mental Health America)
The use of sterilization to prevent individuals with psychological disorders from procreating is called ________.
a
positive institutionalization
b
positive eugenics
c
negative deinstitutionalization
d
negative eugenics
d
negative eugenics
Explanation
The aim of eugenics is to improve society. Here, people with psychological disorders were/are stigmatized, and having greater numbers of people with psychological disorders was not encouraged. Sterilizing people with psychological disorders is a form of negative eugenics which selects against certain traits, like having a psychological disorder.
Why is Dorothea Dix an important figure in the history of psychology?
a
She wrote the first version of the Diagnostic and Statistical Manual of Mental Disorders.
b
She supported the negative eugenics movement.
c
She advocated for humane treatment of individuals with psychological disorders.
d
She was a pioneer in the implementation of electric shock therapy.
c
She advocated for humane treatment of individuals with psychological disorders.
Explanation
While people with psychological disorders were stigmatized, Dix lobbied to get states to fund institutions for people with psychological disorders to live and receive treatment. Electric shock therapy was not specifically one of the treatments she lobbied for.
The American Psychological Association encourages the use of………………. in verbal and written communications when referring to individuals diagnosed with a psychological disorder (Dunn & Andrews, 2015).
person-first language
This is a deliberate way of communicating and may initially appear to be unnatural or cumbersome. For example, referring to an individual as a person with schizophrenia instead of a schizophrenic implies that the individual is, in fact, a person and possesses attributes in addition to a condition.
Of late, there is debate over the use of person-first language vs. identity-first language. give an example
An example of an identity-first language choice is autistic person rather than person with autism (Vivanti, 2020). Proponents of identity-first language argue that a disorder is an important part of an individual’s makeup, and integrating the disorder with identity can be affirming and validating. While there are strong arguments on both sides, the important thing seems to be respect of the individual.
Person-first language is to ______________ as identity-first language is to ______________.
a
bipolar person; person with bipolar
b
schizophrenic; schizophrenic person
c
person with depression; depressed person
d
alzheimer’s patient; person with Alzheimer’s
c
person with depression; depressed person
Explanation
The person or name of the person is listed before the diagnosis with person-first language in “person with depression.” The diagnosis is depression, and it is listed second as an identifier. Depression is highlighted and appears first in the second part, which is identity-first language rather than the person or person’s name.
what is DSM
Diagnostic and Statistical Manual of Mental Disorders
s a classification system used by mental health professionals in the United States and many other countries. Published by the American Psychiatric Association, the DSM helps clinicians, researchers, health insurance agencies, pharmaceutical companies, and forensic experts make consistent and objective decisions about defining, diagnosing, and treating abnormal behaviors across a variety of clinical settings
whoo uses the DSM?
psychiatrist
psychologist
social worker
how many categories of mental illness were being captured by the Census(American Psychiatric Association n.d.)
7
Explain the DSM-I
The first edition of the manual, published in 1952, was 132 pages long and included 128 diagnoses, many of which reflected the prevailing psychodynamic (i.e., Freudian) view of the time that mental disorders represented disturbances of the personality (Grob, 1991). Homosexuality was included in this volume as a sociopathic personality disturbance
DSM-II
In 1968, the second edition of the DSM was published. In many ways, this version was similar to its predecessor, especially in terms of the psychodynamic perspective. This 119-page volume included 193 diagnoses and maintained a strong focus on personality disturbances. Practitioners complained that DSM-II was an unreliable diagnostic tool; a patient assessed by multiple providers could receive multiple diagnoses because of the lack of detailed descriptions of symptoms (American Psychiatric Association, n.d.). In response to protests by gay rights activists, the sixth printing of DSM-II in 1974 removed homosexuality as a category of mental disorder. However, it was replaced with a category of sexual orientation disturbance, which classified distress brought on by homosexual inclinations as a symptom of a mental disorder (Drescher, 2015).
DSM-II
Published in 1980, DSM-III responded to previous critiques by including precise definitions and explicit diagnostic criteria for mental disorders (Blashfield et al., 2014). Additionally, DSM-III introduced a multiaxial diagnostic assessment system, which provided a more comprehensive view of mental disorders. As a result of these changes, this volume ballooned to 494 pages and included 228 distinct diagnoses. The sexual orientation disturbance category was replaced with ego-dystonic homosexuality, suggesting that individuals identifying as homosexual may experience anxiety and internal conflict regarding their sexual orientation (Spitzer, 1981). However, one’s sexual orientation was no longer considered a mental disorder.
DSM-III-R
In response to research sparked by the release of DSM-III, the manual was updated in 1987 with revisions and corrections. This edition also included more significant changes, such as the inclusion of new diagnostic categories like sleep disorders. DSM-III-R had a total of 253 diagnoses and the page count was now up to 567. After a thorough evaluation of the disorder, ego-dystonic homosexuality was removed from DSM-III-R. Homosexuality was now classified as a sexual disorder not otherwise specified, and one of the indicators was “persistent and marked distress about one’s sexual orientation”
DSM-IV
The fourth edition of the DSM was published in 1994 and was the result of an extensive evaluation of research on mental disorders in the United States (Blashfield et al., 2014). Work groups composed of psychiatrists and psychologists reviewed the literature and analyzed data to determine which diagnostic categories needed changing. As a result, DSM-IV grew to 383 diagnoses across 886 pages. Additionally, the manual included an appendix of 17 diagnostic categories that required further study. Finally, this edition introduced a clinical significance criterion, which required that symptoms cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning” (Spitzer & Wakefied, 1999).
DSM-IV-TR
A text revision of the DSM-IV was published in 2000. The intention of this edition was to provide more comprehensive descriptions of each diagnostic category. No categories were added, though the length increased to 943 pages (Blashfield, 2014).
DSM-5
The latest version of the DSM is a 947-page volume that includes 541 diagnoses. We have come a long way from the two categories observed in 1840. It is important to note, however, that in terms of distinct diagnostic categories, that number is closer to 237 (Blashfield, 2014). DSM-5 was the first major overhaul of the manual in 20 years, and similar to DSM-IV, it relied on work groups of mental health professionals to take charge of classifying mental disorders (Sanders, 2011). However, these work groups had a new task of incorporating significant advances in genetics, neuroimaging, molecular biology, cognitive neuroscience, and psychometrics into the traditional classification system. Another important difference in the development process was the launch of the Prelude Project, which posted drafts of DSM-5 online and invited the public to provide feedback.
DSM-III responded to previous critiques by including
precise definitions and explicit diagnostic criteria for mental disorders (Blashfield et al., 2014). Additionally, DSM-III introduced a multiaxial diagnostic assessment system, which provided a more comprehensive view of mental disorders:
Axis I: Major mental disorders (e.g., mood disorders, anxiety disorders)
Axis II: Underlying personality or intellectual disorders that are resistant to change (e.g., antisocial personality disorder, borderline personality disorder, intellectual disability)
Axis III: Medical conditions that may influence the mental disorder (e.g., obesity, type 2 diabetes, multiple sclerosis)
Axis IV: Psychosocial stressors that may influence the mental disorder (e.g., homelessness, interpersonal violence)
Axis V: Global assessment of functioning (scored from 1–100)
in DSM-III, The sexual orientation disturbance category was replaced with
ego-dystonic homosexuality, suggesting that individuals identifying as homosexual may experience anxiety and internal conflict regarding their sexual orientation (Spitzer, 1981). However, one’s sexual orientation was no longer considered a mental disorder.
sexual orientation is
an enduring pattern of romatinc or sexual attraction to others that often begins in early adolescence. Common sexual orientations include gay, lesbian, straight, bisexual, and asexual
In what year was the DSM first published?
1952
Explanation
The World Health Organization published their version of mental disorders in 1946, and the Diagnostic and Statistical Manual of Mental Disorders was published by the American Psychiatric Association six years later in 1952.
Which organization currently publishes the DSM?
a
American Psychological Association
b
World Health Organization
c
American Medical Association
d
American Psychiatric Association
d
American Psychiatric Association
Explanation
Psychiatrists are mental health professionals who use the medical model to help people with psychological disorders, and it’s the American Psychiatric Association that publishes the Diagnostic and Statistical Manual of Mental Disorders.
According to the multiaxial diagnostic system, Axis V referred to a client’s ______________.
a
psychological disorder
b
underlying medical condition
c
global assessment of functioning
d
social stressors
c
global assessment of functioning
Explanation
Axis I refers to the psychological disorder, Axis II refers to personality or intellectual disorders that are more persistent, Axis III refers to underlying medical conditions, Axis IV refers to stressors, and Axis V refers to global functioning estimates.
what is axis I:
Major mental disorders (e.g., mood disorders, anxiety disorders, etc.)
axis II
personality disorders and mental retardation
axis III
general medical conditions
axis IV
psychological and environmental problems
axis V
global assessment of functioning
DSM-5-one major change
One major change is the organization of the manual, which reflects the lifespan. DSM-5 begins with disorders that are typically diagnosed in childhood, proceeds to disorders typically diagnosed in adolescence and young adulthood, and ends with those more typically diagnosed in older adulthood. There are also significant changes to diagnostic categories, including more streamlined categories of autism and schizophrenia spectrum disorders (McCarron, 2013). This version also dropped the multiaxial format initially introduced in DSM-III. Now, instead of five domains of a mental disorder, DSM-5 requires documentation of one domain “with separate notations for important psychosocial and contextual factors (formerly Axis IV) and disability (formerly Axis V).”
arabic rather than roman numerals, incremental uptdates marked by decimals(DSM-5.1), new editions marked by whole numbers(DSM-6)
Which of the following was not a major change to DSM-5?
a
Revision of the multiaxial diagnostic assessment system
b
Shift from use of Roman numerals to Arabic numerals in edition naming
c
Reorganization of content to reflect developmental trajectory
d
Collapsing of autistic disorders into a single spectrum
a
Revision of the multiaxial diagnostic assessment system
Explanation
“Revised” implies that the multiaxial diagnostic assessment system is still in place, but in fact, it was removed and replaced by focusing on one domain and notes other factors and disabilities.
How Mental Health Professionals Use the DSM
The primary purpose of DSM-5 is to help trained mental health professionals diagnose mental disorders, which is the first step in the development of comprehensive and effective treatment plans for these disorders. While DSM-5 may appear to be a series of checklists for determining whether or not an individual meets the criteria for a diagnosis, clinicians are cautioned to carefully develop a case formulation for each individual (American Psychiatric Association, 2013).
what is a case formulation
An explanation of an individual’s mental disorder that is informed by factors such as developmental history, relationship status, physical health, and cultural background.
This information is typically gathered in a clinical interview, which provides a contextual understanding of a patient. Of critical importance is the determination of clinical significance. All mental disorders exist on a continuum of normal to abnormal, and a disorder should only be diagnosed if the symptoms are causing significant distress or impairment in one or more aspects of an individual’s life.
Another less-acknowledged purpose of DSM-5 is to support
the logistics of mental illness. Each mental disorder in the manual is accompanied by a diagnostic and statistical code. These strings of numbers and letters are used for data collection and billing purposes. The codes provide information about a diagnosis as well as specifiers, such as the severity of the disorder or whether the symptoms have occurred one time or many times.
Which of the following describes the DSM-5? Select all that apply.
a
A classification system of psychological disorders
b
A guide to diagnosing psychological disorders
c
A system for billing treatment of psychological disorders
Explanation
The DSM helps clinicians diagnose psychological disorders, includes important characteristics of each psychological disorder, and provides diagnostic and statistical codes that clinics and hospitals can use to bill insurance companies for reimbursement of services.
how many disorders described in the DSM?
500 disorders
The organization is intended to follow a developmental lifespan sequence, with disorders more common to childhood/adolescence coming first and those more common to adulthood coming after.
Neurodevelopmental disorders,
which affect the brain and neurological systems, are typically first seen during infancy and early childhood (Thapar et al., 2017). This group of disorders is marked by impairments and deficits in multiple aspects of a child’s life, including academic ability, social functioning, and behavioral problems. These children are often delayed in reaching milestones for speech and language, motor skills, and learning. They may also exhibit problems with retention of information. Neurodevelopmental disorders tend to co-occur, meaning it is likely that a child meets diagnostic criteria for more than one of these conditions at a time (Dajan et al., 2016).
As a child grows older and learns to compensate for the deficits they experience, the symptoms and behaviors associated with neurodevelopmental disorders may
change or evolve. In fact, the symptoms may fade or seem to disappear. However, many of these disorders persist, in some form, across the lifespan. A neurodevelopmental disorder may be diagnosed based on symptoms that were observed in the past, but the disorder must still cause significant impairment at the time of diagnosis.
The onset of neurodevelopmental disorders is typically during which period of the lifespan?
a
Infancy
b
Adolescence
c
Young adulthood
d
Older adulthood
a
Infancy
Explanation
Because these disorders affect the brain and the rest of the central and peripheral nervous systems, their cognitive and social effects are seen early in infancy.
autism spectrum examples
including Asperger’s syndrome, autism, and pervasive developmental disorder.
This group of neurodevelopmental disorders is characterized by significant social, emotional, behavioral, and communication impairments
Other key features of ASD may include repetitive movements (rocking the body back and forth), insistence on a routine (eating the same food every day, distress when the schedule is not followed), intense preoccupation with a particular interest (fixation on a specific topic, like dinosaurs), and hyper- or hypo-reactivity to sensory input (adverse responses to specific sounds or smells, excessive touching of objects).
Symptoms are typically noticed during the second year of life in the form of delayed language or social development. There are no specific causes of ASD, though twin studies show a strong genetic link
what is a spectrum?
there is a wide range of impairment possible within this diagnosis. One child receiving the diagnosis may exhibit mild symptoms while another may experience severe symptoms.
Schizophrenia Spectrum and Other Psychotic Disorders
Lose touch with reality
•Difficulty thinking clearly, making
good judgments, and
communicating effectively
Another term for disorders in this category is serious mental illness (SMI), which reflects their chronic and debilitating nature (Insel, 2008).
Schizophrenia spectrum and other psychotic disorders have several key symptoms that differentiate them from other psychological diagnoses.
These key features can be grouped as positive symptoms and negative symptoms (National Institute of Mental Health, 2015). Think about positive and negative here in a mathematical sense: addition and subtraction, not good and bad.
Schizophrenia•Positive (Psychotic symptoms)
behaviors that were not present before the onset of the disorder. These symptoms start to appear during the course of the psychotic disorder and are not typically seen in healthy individuals.
Delusions
•Hallucinations
•Thought and speech disorder
•Catatonic behaviour–abnormal motor behaviors
- disorganized thinking
Schizophrenia•negative (Psychotic symptoms)
Diminished emotional expression(flat affect)
Sparse speech and language •Social withdrawal •Avolition •Algolia •Anhedonia
what are delusions?
are strong beliefs that are not founded in reality. These beliefs do not waver, even when confronted with compelling evidence to the contrary. A common example is persecutory delusion, in which an individual may believe they are being followed or harassed by the government.
what is hallucinations
are sensory experiences that do not have a source. For example, an individual may hear voices when no one is speaking. While auditory hallucinations are most common, hallucinations can also be visual, olfactory, gustatory, or tactile (i.e., seen, smelled, tasted, or felt).
Explain disorganized thinking?
can typically be discerned from a person’s speech and may entail switching from one topic to another in a nonsensical way or speaking in a jumbled, incoherent fashion
abnormal motor behaviors
can range from excessive and agitated movements to complete stillness and rigidity of the body.
Negative psychotic symptoms are behaviors typically observed
in healthy individuals that an individual experiencing psychosis does not do. These behaviors start to disappear during the course of a schizophrenia spectrum or other psychotic disorder.
Diminished emotional expression, also known as flat affect, is
reduced expression of emotions through facial expressions, tone of voice, or body language. For example, an individual will maintain a neutral face in response to hearing a funny joke.
avolition
a decreased motivation to start or follow-through on activities such as school, work, or self-care
alogia
a reduction in speech output. In conversation, an individual will reply sparsely, if at all.
Schizophrenia is a disorder that involves a wide range of
emotional, behavioral, perceptual, and cognitive dysfunction. It affects 0.3–0.7% of the population, so it is a fairly rare disorder. While there is a genetic link (Sullivan, 2005), most individuals diagnosed with schizophrenia have no family history of psychosis. Recent research reveals that there are many environmental contributors to schizophrenia, including complications during pregnancy and birth, adverse childhood experiences, and social isolation (Stilo & Murray, 2019). Schizophrenia is diagnosed more among racial/ethnic minority groups and those growing up or living in urban environments, and the incidence of the disorder is slightly higher among men (Tandon et al., 2008). The psychotic features of schizophrenia tend to appear in young adulthood, and the earlier the age of onset, the worse the prognosis tends to be. Onset prior to adolescence is rare, but not unheard of.
Schizophrenia is a heterogeneous clinical syndrome, meaning there are
many different ways the disorder presents. For example, in a group of three people diagnosed with schizophrenia, there may be no overlap in the primary symptoms they exhibit. Nonetheless, most individuals diagnosed with schizophrenia have significant difficulty functioning in their daily activities.
In addition to the positive and negative symptoms described above, an individual diagnosed with schizophrenia may also experience cognitive symptoms.
Cognitive symptoms in schizophrenia can be subtle and are often undetectable without neuropsychological testing. These symptoms affect memory and thought processes.Executive functioning describes the mental skills we use to make decisions based on the information we are presented with. For example, sustained attention helps us to focus and concentrate on the task of driving and our working memory helps us to remember that we should apply our brakes when we see a red traffic light. In schizophrenia, these skills may be impaired, which can lead to confusion and poor decision making.
Samson was recently diagnosed with schizophrenia. His wife insisted that he see a doctor after he continued to announce that he had been elected President of the United States. This behavior is an example of a ______________. Select all that apply.
a
hallucination
b
delusion
c
positive symptom
d
negative symptom
b
delusion
c
positive symptom
Explanation
Positive symptoms occur after the onset of the psychological disorder and include delusions. Samson believed he was the President when he was, in fact, not; his belief was not based in reality.
