Psychopathology Overview Flashcards
Maddux and Winstead (2008) proposed that there are 7 conceptions of psychology. List all 7.
- Commonsense conception: pathological phenomena are those that are abnormal
- Maladaptive behavior
- Distress and disability
- Social deviance
- Harmful dysfunction
- DSM definition
- Social constructionism vs. essentialism
Describe the “commonsense conception” of psychopathology (Maddux and Winstead, 2008)
Defined: pathological psychological phenomena are those that are abnormal- statistically different or infrequent
Points: -deviation from statistical psychological normality
- very scientific definition, easy to measure in terms of statistics and standard deviations from the norm
-makes sense to us to only refer to experiences and behaviors that are infrequent, not common ones as pathological
-first determine what is statistically normal, then determine how far away a person is from this norm
-despite efforts, this approach relies on psychometrically sound measures and leaves a lot of room for subjectivity
Describe the “maladaptive behavior” conception of psychopathology (Maddux and Winstead, 2008)
- adaptive vs. maladaptive: not based on statistical norms but on what is effective or ineffective about behavior, if a behavior works for a person, helps them deal with stress, accomplish goals (adaptive)… if it makes the situation worse (maladaptive)
- commonsense appeal but inherent subjectivity
- ability of a behavior to be adaptive or maladaptive depends on the situation
- doesn’t always correlate with statistical rarity
Describe the “distress and disability” conception of psychopathology (Maddux and Winstead, 2008)
- subjective distress, unpleasant or unwanted feelings
- disability is a restriction in ability
- very subjective
- people define their personal distress in many ways, some conditions do not put the person in distress (pedophilia, antisocial PD) OR person might not be experiencing distress, OR person might be experiencing distress outside themselves (What is wrong with everyone else?)
Describe the “social deviance” conception of psychopathology (Maddux and Winstead, 2008)
- deviates from cultural norms
- subjective
- depends greatly on culture
Describe the “harmful dysfunction” conception of psychopathology (Maddux and Winstead, 2008)
- proposed by Wakefield (1992)
- grounded in evolutionary psychology, failure of the mental mechanism to perform the way it was designed by evolution
- acknowledges social norms but grounded in scientific theory
- 2 requirements (see other flashcard for details)
- designed function is defined scientifically and is not a value judgment
- still ends up being a consensus of opinion
- behavior considered more functional if it leads to survival, reproduction
What are the 2 requirements of “harmful dysfunction” conception of psychopathology?
- it is negative or harmful according to cultural values
- it is caused by a dysfunction (the failure of some psychological mechanism to perform a natural function for which it was designed)
Describe the “DSM” conception of psychopathology (Maddux and Winstead, 2008 citing APA 2000)
- clinically significant behavioral or psychological syndrome or pattern that occurs in an individual that is associated with present distress or disability or with a significantly increased risk of suffering, death, pain, disability, or an important loss of freedom
- syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, whatever the cause it must be considered a dysfunction in behavioral, psychological, or biological dysfunction
- neither deviant behavior nor conflicts that are between the individual and society are mental disorders unless the deviance or conflict is a symptom of dysfunction in an individual as described above
- dichotomies vs. dimensional models (see flashcard for details)
What are 6 types of ways to categorize thoughts, actions, or emotions as pathological with the “DSM” conception of psychopathology?
- Unusual (consider culture)
- Socially unacceptable (deviating from norms)
- Demonstrate faulty or poor reality testing
- Induce severe emotional distress
- Maladaptive, self-defeating
- Dangerous or violate the rights of others
Describe the “social constructionism” conception of psychopathology (Maddux and Winstead, 2008)
- an assumption that there are natural categories and that all members of a given category share important characteristics (Rosenblum & Travis, 1996)
- psychopathology and mental disorders are natural entities whose true nature can be discovered and described
Describe the “essentialism” conception of psychopathology (Maddux and Winstead, 2008)
- someone observes a pattern of behaving, thinking, feeling, or desiring that deviates from some social norm or ideal or identifies a human weakness or imperfection that, as expected, is displayed with greater frequency or severity by some people than by others
- A group with influence and power decides that control, prevention, or “treatment” of this problem is desirable and profitable
- The pattern is then given a specific-soundig name, preferably of Greek or Latin origin. New scientific name is capitalized
- Eventually, the new term might be given an acronym ( OCD, ADHD, BDD)
- The new disorder then takes on an existence all its own and becomes a disease-like entity
- As news about “it” spreads, people begin thinking they have “it”
- Medical and mental health professionals begin diagnosing and treating “it,” and clinicians and clients begin demanding that health insurance policies cover the “treatment” of “it”
- The construction is a social process, not a scientific one
- The more “it” is studied, the more people believe “it” really is “something”
How can culture influence pathology?
- Culture can influence the expression and communication of symptoms, which may be different
- need to be sensitive to cultural differences as we may misdiagnose or under diagnose pathology
Nevid (1944) provided two examples of how pathology is defined differently in various cultures. Please describe anxiety.
- ataque de nervios- prominent in Latino culture from Caribbean, also other Latinos, symptoms are trembling, attacks of crying, screaming uncontrollably, verbal or physical aggression, general feature is feeling out of control, episodes happen in response to stressful life event
- sometimes amnesia, but then a return to functioning (APA, 1994)
- more prevalent in women and adolescent girls
- women with little power and disrupted social relations
Nevid (1944) provided two examples of how pathology is defined differently in various cultures. Please describe schizophrenia.
- cultural conception of the self can influence
- emotional climate of the family
- high EE more likely to relapse
- embedded in social and cultural context
- hostile environments, low warmth, caregiver negative
Describe the cultural variations in depression.
- nerves or headache among Hispanic or Mediterranean clients
- imbalance in Asian clients
- problems of the heart in Middle Eastern clients
Describe the cultural variations of alcohol related disorders.
- lower in Asians
- equal in blacks and whites
- higher in male Hispanics
- lower in female Hispanics
Describe the cultural variations of inhalant abuse
-problem for Alaskan natives
Describe the cultural variations of somaticization.
higher in Greek and Puerto Rican men
Describe the cultural variations of schizophrenia.
- African Americans more often diagnosed
- 1% across cultures
Describe the cultural variations of bipolar disorder.
- No ethnic differences found
- 1% across cultures
Describe the cultural variations of bulimia nervosa.
describe as primarily occurring for White individuals
Boys and men are more likely to be diagnosed with the _____, _____, and _____ disorders (related to age); with _______, _______, ______, and ________.
infancy, childhood, and adolescent
substance related, sexual, gender identity, impulsive
Females have higher rates of ______, _______, and ______ personality disorders
borderline, histrionic, and dependent
Girls and women are more likely to be diagnosed with ________, ______, _______, _______, and _____ disorders
depression, anxiety, somticization, dissociative, and eating disorders
Males are higher in ____, _____, _____, _____, _____ personality disorders
paranoid, schizoid, schizotypal, antisocial, and compulsive
What are some possible explanations for sex differences in disorders?
- biased diagnostic standards?
- sexist?
- Western ideals?
Child psychopathology view on culture
Culture shapes the manner in which children express psychological distress: internalizing vs. externalizing problems
_______ and _____ influence whether the problem is brought to the attention of a _________
gender, nationality
mental health professional
From the DSM-IV-TR regarding culture and psychopathology
-“A common misconception is that a classification of mental disorders classifies people, when actually what are being classified are disorders that people have. For this reason, the text of the DSM-IV (as text of DSM-III-R) avoids the use of such expressions as “a schizphrenic” or “an alcoholic” and instead uses the more accurate, but admittedly more cumbersome, “an individual with schizophrenia or and individual with alcohol dependence.”
How did Szasz (1961) define mental illness?
- socially created construct by higher members of society
- can only be used metaphorically, given that an illness must be objectively demonstrate biological pathology
- what a psychiatrist calls pathology is nothing more than a deviation from the consensus reality or common morality
Point 1 Szasz (1961) argues against mental illness.
strictly speaking, disease or illness can affect only the body; hence, there can be no mental illness
Point 2 Szasz (1961) argues against mental illness
“mental illness” is a metaphor. Minds can be “sick” only in the sense that jokes can be “sick” or economies are “sick”
Point 3 Szasz (1961) argues against mental illness
psychiatric diagnoses are stigmatizing labels, phrased to resemble medical diagnoses and applied to persons whose behavior annoys or offends them
Point 4 Szasz (1961) argues against mental illness
those who suffer from an complain of their own behavior are usually classified as “neurotic;” those who behavior makes others suffer, and about whom others complain, is usually classified as “psychotic”
Point 5 Szasz (1961) argues against mental illness
mental illness is not something a person had, but is something he does or is
Point 6 Szasz (1961) argues against mental illness
If there is no mental illness there can be no hospitalization, treatment, or cure for it. Of course, many people may change their behavior or personality with or without psychiatric intervention. Intervention is now called “treatment” if it proceeds in a direction approved by society, “recovery” or “cure.”
Point 7 Szasz (1961) argues against mental illness
the introduction of psychiatric considerations into the administration of the criminal law; for example, the insanity please and verdict, diagnoses of mental incompetence to stand trial, and so forth- corrupt the law and victimize the subject on whose behalf they are ostensibly employed
Point 8 Szasz (1961) argues against mental illness
personal conduct is always rule-following, strategic, and meaningful. Patterns of interpersonal and social relations may be regarded and analyzed as if they were games, the behavior of the players being governed by explicit or tacit game rules
Point 9 Szasz (1961) argues against mental illness
in most types of voluntary psychotherapy, the therapist tries to elucidate the in explicit game rules by which the client conducts himself; and to help the client scrutinize the goals and values of the life games he plays
Point 10 Szasz (1961) argues against mental illness
there is no medical, moral, or legal justification for involuntary psychiatric interventions, they are crimes against humanity
DSM-IV-TR Cluster A Personality Disorders
A. ODD/ECCENTRIC
- Paranoid
- Schizoid
- Schizotypal
DSM-IV-TR Cluster B Personality Disorders
B. DRAMATIC/EMOTIONAL/ ERRATIC
- Antisocial
- Borderline
- Histrionic
- Narcissistic
DSM-IV-TR Cluster C Personality Disorders
C. ANXIOUS/FEARFUL
- Avoidant
- Dependent
- Obsessive Compulsive
General philosophical differences between DSM and psychodynamic (e.g. PDM) (Maxmen & Ward, 1995)
DSM is Aristotlelian, empirical, and descriptive
- PDM is Platonicc, rationaist, and phenomenological
- DSM is nosological; also nomothetic; PDM is idiographic
Advantages of the DSM model
- atheoretical
- provides descriptions and lists of symptoms
- allows clinicians from all frameworks to communicate with each other
- answers the question of what constitutes a disorder
- gives ability to make prognosis
- rooted in empirical study and scientific data
- developed by committees of experts
- both nomothetic and nosological
- combines categorical (Axis I) and dimensional approach (Axis II)
Disadvantages of DSM
- labels people
- self-fulfilling prophecy
- own biases may interfere
- may be disagreement about what equals a clinical thershold
Advantages of PDM
- rich body of theory about internal life of patient
- understanding of possible etiologies, adaptations, and treatments
- answers the “how” the patient is, how they got there, treatment strategies, future predictions
Disadvantages of the PDM
- can be difficult to learn
- divergent in focus
- occasionally contradictory
General Psychoanalytic Drive Model of Pathology 4 components:
- drive
- anxiety/depressive affect
- defense
- superego functioning
General psychoanalytic drive model:
- overwhelming drives or weak defenses can cause illness
- compromise formation is based on conflict between drives and defenses and can cause symptoms and neurosis
- failure in compromise formation can lead to neurosis
- guilt through internalized authority figures and aggressive drive can result in neurosis
Core components consistent in all dynamic theories of pathology (Pine, 1990)
- belief in psychic determinism
- belief that much of mental life is unconscious
- much of who we are is rooted in early life
General cognitive model of pathology:
- maladaptive/ unrealistic beliefs of reality can negatively impact an individual’s behavior and emotions
- cognition and behaviors themselves are the problem, not the cause of the symptoms
- cognitions are learned and genetic and are continued through reinforcement
