exam 3 Flashcards
What determines mental disorders?
Subjectivity– no one absolute way to determine what is a mental disorder
Social construction– reality is constantly shaped by society and social interactions
Cultural values– certain disorders exist exist exclusively in certain cultures
Two fundamental questions– what determines a mental disorder
What year is it?
Historical contexts
Where am I?
Cultural context– why some cultures think some disorders to be abnormal vs. normal
Deviance (4 d’s)
strays from what we consider the “norm”
Distress (4 d’s)
causes the individual discomfort
Personality disorder are marked by a lack of internal distress
They like the way they are, the distress is coming from those around them
Shows there’s no absolute truths, just a good rule of thumb of what constitutes a mental illness
Disfunction (4 d’s)
interferes with many aspects of their life
Key word is many– has to impact work, school, social, and interpersonal domain of life
Every single mental illness has to meet with this criteria
where subjectivity comes into play
Danger (4 d’s)
harm to oneself, not necessarily others
Data shows people with mental illnesses are more likely to be victimized by violent crime than to be perpetrators
Cultural relativism
there is no one universal standard to measure culture by, and that all cultural values and beliefs must be understood relative to their cultural context
Supernatural– Historical explanations of mental illness
supernatural
Demon possession
Trephination– if they think demons are possessing the brain, drilling holes in people brain would have a way of leaving the brain
People were awake and alert when this was happening
Many people were able to survive this procedure
Biological– Historical explanations of mental illness
“Somatogenesis”– origin of body
Something originating in your body may be perpetuating mental illness
Johann weyer
irst used the phrase “mental illness”
Revolutionary because some of the main perspectives were demonic and witchy, especially for women
Syphilis
propelled current thought about the biological view of mental illness
If infected and left untreated lead to symptoms of psychosis
The mind
“psychogenesis”
Something originating in our mind might be contributing to illness of the mind
Freud– founder of psychoanalysis
Something in unconscious or early childhood experiences could eventually contribute to psychopathology
Buddha– promoted the idea that suffering is the result of our mental activity
“Lunatic asylum”
movement started in europe in the 15th-16th centuries
Torturing patients
First attempt of having a place for people with mental illness but in all actuality it was only a place to torture patients
State and public hospitals
were later established in US for “persons of insane and disordered minds”
Insane asylums
Phillipe pinel– advocated against insane asylums
Tried to create a diagnostic system to help understand what they are experiencing and to treat them
Dorothea Dix
activist for moral treatment
Start treating people with mental illness morally rather than torturing them
Established hospitals that were doing a better job of taking care of people with mental illness
DSM 1
1952
Around 30 pages
Reliability was poor– no consistency
Included comments on etiology– psychoanalytic perspectives (defensive mechanism)
No consideration of biological or cultural reasons
No mention of childhood disorders– ADHD, intellectual disability
Homosexuatlity was included as a sexual deviation disorder
Sociopathic personality disturbance
DSM 2– 1968
Homesexuality declassified as a disorder in a 1973 printing
Replaced it with a new diagnostic code– individuals who are distressed by their homosexuality
Childhood B disorders now included
DSM 3– 1980
Improved specificity and reliability
“Atheoretical”– did not have empirical evidence on these disorders
Mostly based on therapist and psychologist opinions
Acknowledgment of culture
ICD-10– 1993
International classification of diseases
Includes not just mental illness diagnosis but physical diagnosis as well
DSM IV– 1994
First attempt at synching mental health codes
Goal– a worldwide system of nosology for mental disorders
DSM V– 2013
Most recent, many updates
Examples–
Name changed– intellectual disability instead of mental retardation
Autism spectrum disorder– more comcompassing)
ADHD– used to have to exhibit symptoms before the age of 7, but changed it to 13
Gambling disorder added
DSM– pros
Standardization of language and citieria
Reliability– is person going to consistently get the same diagnosis from a different psychologist
Has improved across editions
Direction for treatment
Validation
DSM– cons
Stigmatization
Pathologizing
Reliance on medical model
Presumes that there are diseases or disorder that should be cured
People who have disorders that can be managed but not cured, are “incurable” or “unwell”
No universal idea of mental health
Cultural concepts of mental health
Our idea of what constitutes “normal” vs “abnormal” behavior is shaped by our culture
Therefor, we must be aware of cultural values to better understand mental illness
Biological vs. supernatural– etiology
Western cultures often emphasize biological factors (genetics, neurotransmitters) → medical model
Non western cultures may attribute disorders to supernatural influences (possession, curses, communication with ancestors)
Psychological vs. social– etiology
Western cultures tend to focus on internal and individual factors (feelings, lack of mastery)
Non western cultures emphasize collective factors (family dynamics, community stressors, discrimination)
Differences in expression of symptoms
Presentation of mental illnesses varies across cultures
Some cultures (east asian cultures) report more of the somatic symptoms (headaches, stomach issues, fatigue)
Other cultures (US and europe) tend to report more of the psychological experiences (sadness, worry)
Stigma and help-seeking
Some cultures report more negative attitudes and beliefs about mental health
Ex– east asian, middle eastern, and some african cultures
Others report more accepting or tolerant attitudes
Ex– western, scandinavian, and pacific islander cultures
Those that harbor more negative attitudes to mental health care may prioritize seeking support from family, friends, or religious leaders, not professional mental health care
Culture-bound syndromes
“Symptoms that are considered to be a recognizable disease only within a specific society or culture”
In the DSM 5, there are 9 “cultural concepts of distress” or culture-bound syndromes included
Important note– these are listed in the appendix of the DSM-5, and providers in the US can’t actually diagnose these
Just a suggestion that culture influences mental health
Personality
“ones characteristic patterns of behaving, thinking, and feeling”
Type approach
sed to express and communicate a set of expected behaviors based on shared characteristic
ENTJ– life’s natural leaders
Trait approach
people have certain basic traits and it is the strength and intensity of those traits that account for personality differences
Psychologist tend to like this one better
Big 5 personality traits
Is personality heritable
Heritability estimate (HE)
How much variation in population due to genetics
Between.42 - .57 for the Big 5
Is personality stable
Not so much in childhood, but increasingly so over lifetime
Meta analysis of 152 longitudinal studies
Trait score correlation over seven years
150 countries included with over 50,000 participants
Personality gets more stable as you get older
Does knowing one’s big 5 profile help us predict behavior?
Yes, but not perfectly
More extreme scores means better predictors
people high on O
oppress to experience
More artistic/creative
More career changes
Less traditional relationships
People high on Extraversion
Less time alone
More night owls
More value on status
People high on N
More jealousy and relationship dissatisfaction
More self-blame
More emotional sensitivity
Infinite “shades” of personality
For example, high N and high A predicts something different than high N and and low A
Perspective also matters
What factors might explain the relationship between poverty and mental illness
Mediator variables– there are some people who are in poverty who do not have a mental illness (and vice versa)
Mediatoes– variables that help to explain the relationship between 2 other variables
Explains why some people in poverty are more at risk for mental illness than others
Without mediators, the relationship between two variables may even disappear
Patel and kilennaman
Poverty can cause insecurity and shame which eventually could lead to mental illness
Feelings of insecurity and being shameful of your life circumstances can explain why people experiencing poverty can have mental illness
What factors might explain the relationship between poverty and mental illness
other examples
Comorbidity– two conditions occurring together
When experiencing poverty you are more likely to face malnutrition, dehydration, etc)
How can you thrive if you don’t have basic needs met
Maslow’s hierarchy of needs
Social change– feelings of isolation and loneliness
Hopelessness
What factors might explain the relationship between poverty and mental illness– education
most consistently related to mental disorders (biggest mediator)
Access to education is a protective factor
plays a big role in access to resources and knowledge of how to navigate those resources
Basic needs being met in schools
Connections
Instills hope– hope for change and a more fulfilling life in the future
Biggest one talked about in the article
Primary prevention
trying to implement or do something to prevent this relationship from ever occurring
What can we do before this even happens
Examples
Nutrition
Better access to education
Literacy programs
Secondary prevention
intervening immediately after an incident/thing occurs
Secondary prevention to prevent it from getting worse
Examples
Therapy
Antipsychotics, mood stabilizers, etc
Intelligence
“mental abilities to learn from our experience, adapt to new situations, understand and handle abstract concepts, and use knowledge to manipulate one’s environment”
Critiques of IQ (how we measure intelligence)
There have been concerns about IQ tests historically
Validity
Cultural applicability– IQ test is standardized to white somewhat educated men in the US
Misuse – are we actually using them for good
War example
Weshler intelligence scale for children (WISC)
how is iq measured?
Measured a couple facets of intelligence
Performance tasks– spatial reasoning, manipulating taks, how fast they can process information
Block design– make image out of different color blocks
Matrix reasoning task– working from left to right or top to bottom to find the rule to see what number goes in the missing square
Maze puzzle
Measure how accurate and quickly they get to the answer
Verbal tasks– how is iq measured?
how well they can verbalize their responses
“How are a horse and cow alike?”
“Where might you see a real rainbow”
“What is an island?”
IQ score distribution
Normal bell curve– most people fall around the average
Average IQ– 100
Standard deviation– 15
Intellectual disability– individuals at or below 70
Childhood IQ and adult mental disorders article
Brought in children around 8 and measured IQ
Brought them back at 32 to see if those same people developed mental disorders
Can IQ as a child predict mental illness as an adult
Longitudinal study
Was intelligence as a child protective or was it predictive?
“Cognitive reserve”– Individual differences in brain structure and how efficient we are at processing the information we are given
How it protects or buffers us against mental illness
How was it measured
WISC– scale used to measure IQ in children
Childhood IQ and adult mental disorders article– results
People with low IQ (at or below 85) are more likely to be diagnosed with mental illness
Negative correlation
Lower childhood IQ had an increased risk of specific disorders
Anxiety, depression, and schizophrenia
Authors predicted it would be related to substance abuse– hypothesis was not supported
High childhood IQ– risk of mania
Childhood IQ and adult mental disorders article– confounders
SES– most strongly predictive
Perinatal insult– experiencing malnourishment or illness in the womb
Low birth weight
Maltreatment– abuse, neglect, trauma
Manitoba study
large, longitudinal, representative sample
Examined poverty and risk for mental illness
Poverty and mental illness
Typically, 2-9x more mental illness across low-ses, with an average of about 3x more mental illness
Poverty is one of the most significant social determinants of health and mental health
Depends on the disorder and the measure used
Directionality
theory 1– social causation
The conditions of poverty precede mental illness
Poverty —> mental illness
Directionality
Theory 2– downward drift
Mental illness preceded the “drift” into lower ses
Mental illness —> poverty
Causation– it’s complicated and bidirectional in nature
Directionality- Hudson 2005
Longitudinal study
34, 112 patient records
Indicator of SES– zip code
Indicator of MI– hospital records
Directionality- Hudson 2005 results
Social causation theory was supported
Poverty —> mental illness
One exception
Downward drift theory was supported in this research for schizophrenia and severe persistent mental illness (SPMI)
Mental illness —> poverty
Directionality- Hudson 2005 mediators
here are some people who are in poverty who do not have mental illness
Vice versa
Mediators– variables that help explain the relationship between 2 other variables
Explains wh some people in poverty are more at risk for mental illness than others
Without mediators, the relationship between two variables may even disappear
Agreeableness
the most environmentally based trait
Golden rule– treat others the way you want to be treated
Openness
most genetically based trait
Lemon juice experiment
People with low extraversion reacted more strongly to the lemon juice
Introverts have higher resting arousal than extroverts
introverts are already over-stimulated on average which is why being in a big setting wants you to escape to lower stimulation
Rock musicians in sydney study
High openness
Medium neuroticism and extraversion
Not super high n because public speaking/performing would be difficult
Not low because it would be hard to connect with people in an emotional way
Average extraversion because its not a guarantee that if you’re extroverted you would be a musician and vice versa
low agreeableness and consciousness
Low c because usually you have people who will be highly conciseness for you– managers, agents, etc
Low agreeableness- may present as kind and approachable but sometimes horror stories of them being col/rude in person
Highest openness scores in the US
Northeast– DC, New York
Parts of florida
Parts of texas
Colorado
seattle/portland
Most of california
People are migrating– open people tend to go to these places that have a lot of stimulation
More likely to continue that cycle if you start a family in one of these areas
Highest neuroticism
in northeast– new york
Highest c and a
south
Southern hospitality
Is personality related to mental health
Neuroticism– consistently connected to negative mental health
Spectrum model
argues neuroticism could be linked to anxiety because they exist on the same spectrum
Being high on the anxiety spectrum means you are probably high on neuroticism
Explains why comorbidity exists– neuroticism is comorbid with anxiety
Vulnerability-predisposition model A
Certain genes or personality traits make you more vulnerable or likely to experience something, which predisposes you to anxiety
Vulnerability predisposition model B
Neuroticism plus a certain stressor (trauma, abuse) is what results in anxiety symptoms
Symptoms might only emerge after they have experienced a certain stressor
Also referred to as diathesis stress model
Neuroticism across the lifespan
N peaks in late teens
Puberty
N somewhat decreases throughout adulthood
Early protective factors for avoiding mental illness
Easy temperament
Suggesting children that are relatively calm and relaxed
Good emotional self-regulation
Good social skills
Article states extraversion is the only protective factor for mental illness
Built in social support and social skills
N is risk factor for mental illness
Personality disorders
“Inflexible and enduring behavior patterns that impair social functioning”
Connects to dysfunction out of the 4 d’s
Cluster a– odd/eccentric
Paranoid pd– lack of trust, suspicious of others, irritable/hostile
Take innocent remarks as a threat/insult
Schizoid pd– cold, uninterested in other people, aloof, anhedonic (lack of pleasure)
Flat affect– limited emotional expression
Overlaps a lot with major depressive disorder and autism
laughing when something really scary happens
Schizotypal– unusual thinking/speech/beliefs, flat/ unusual affect
Believe there thoughts can impact the people around them
Secret messages to them, people can hear what they are thinking
Cluster b– dramatic/impulsive
Borderline personality disorder– fear of abandonment, emptiness, unstable self-image/mood/intrapersonal relationships
Suicidal behavior/ thoughts– requirement for this disorder
More women are diagnosed– is it because the symptoms are more related to femininity or because men don’t normally exhibit these symptoms
Extreme trauma– thought it should not be a personality disorder, but instead complex PTSD
Histrionic personality disorder– seeks attention, overly dramatic, shallow emotions, inaccurate perceptions of relationships
More women tend to be diagnosed– gender bias issue?
Narcissistic personality disorder– grandiose self-image, lack of empathy, fantasies about power/success, expect praise
More men are diagnosed– gender bias issue?
Antisocial personality disorder– lack of empathy, violates rights of others, reckless impulsivity
Love interacting with people, but just to manipulate them
ODD/CD are placeholders for APD in early childhood
Cluster c– withdrawn/anxious
Avoidant personality disorder– sensitive to criticism/rejection, isolated, extreme shyness, fear of embarrassment
Dependent personality disorder– overly relies on others, submissive/clingy, lacks confidence in self
Can’t initiate actions without the approval of someone else
Obsessive compulsive
personality disorder– overly focused on details, rules, order, “perfectionist,” needs to be in control, rigid, inflexible views of morality
Dimensional view of personality
Trait approach
Either high on some personality disorder characteristics or low
Now have shifted it toward categorical
Categorical view of personality
Type approach
Either odd or eccentric or not
Created a more rigid system of diagnosing personality disorders
Easier to diagnosis but takes away the dimensional aspect
Gender diverse individuals
Transgender and non-binary folks often experience trauma and discrimination, which can result in mental illness
40% engaged in suicidal behavior
Reminder– homosexuality used to considered mental illness in the DSM until 1987
“Gender dysphoria” is still a required diagnosis for those seeking gender-affirming surgery
Gender bias in diagnosis
Certain diagnostic criteria have been critiqued for being biased towards certain genders
Ex– ADHD in young boys
BPD in women
Runs the risk of overpathologizing certain groups or misdiagnosing others
Borderline personality Disorder( intense fear of abandonment, feelings of emptiness, trauma)
concerns
Diagnosed in women 2-9x more
Potential gender/sex bias
Vagueness of criteria
A lot of criteria that can be subjective
Significant overlap with other Personality Disorders
Also overlap with other categories like PTSD
Danger of overuse
Heavily pathologized
Most people with BPD have extensive and complex trauma history, especially sexual abuse
Is it just a complex form of PTSD?
Not just trauma for one event, but chronic trauma especially from childhood
Sex bias in the diagnosis of borderline personality disorder and posttraumatic stress disorder article
Method
Social workers, psychologist, and psychiatrists were asked to assess a case tailored to include symptoms of both PTSD and BPD
Half received “male” case
Half received “female” case
Sex bias in the diagnosis of borderline personality disorder and post-traumatic stress disorder article results
females were significantly more likely to receive BPD diagnosis tan the male case
Psychiatrist gave BPD diagnosis significantly more
Went against what they were thinking
Thought medical doctors would be the best at exhibiting no bias in the way they diagnosed conditions
Confirmation bias– tendency to wanting to confirm our own beliefs
The more educated you are, the more likely you are to engage in confirmation bias
Age of clinician–
Younger clinicians were more likely to assign BPD
Also a matter of expertise
Experience of clinician–
More years of experience, the more likely you were to give bias diagnosis
Sex bias in the diagnosis of borderline personality disorder and post-traumatic stress disorder article conclusion
Sex bias may be influencing diagnosis of BPD vs PTSD
Key questions– is that more women do actually have BPD or is that this group may be over-diagnosed due to stereotypes and biases?
There is reason to believe both–maybe more women have BPD but we are still over-diagnosing
is BPD just coplexPTSD?
still an ongoing dilemma
some people believe BPD should be removed but others believe there is enough uniqueness in BPD to be its own thing
some people in the middle
