Test #1 Lecture Notes Flashcards
What makes us think that John Michler has a behavior disorder?
He seems to have a god complex/sense of superiority
○ There is an abundance of repetition
○ There is odd phrasing within his letter
Descriptive pathology of dementia paralytica
■ Initial symptoms comprised fatigue, headaches, insomnia, and dizziness
■ Progression typically included personality changes, decreased menial
faculties (eg memory loss, attention problems), disinhabilitation, asocial
behavior, mania, and depression
■ Culminated in delusions which were often grandiose (power, immortality)
as well as a host of involuntary motor symptoms (hyperreflexia, seizures)
and muscle deterioration
What is a behavior disorder
behavior, disorder, syndrome
Behavior
○ Inclusive of behavior, affect/emotion, cognition/thought processes, and
interpersonal relationships
● Disorder
○ An abnormal physical or mental condition
disorder is not a great definition, as we will see later, abnormality cab occyr without being disordered
in this case we are discussing something closer to a syndrom. a constellation of signs (something I can observe as a clinician) and symptoms, something they report, which seem to concur and don’t necessarily have a pathogenesis - we don’t know why they happen or they can happen for any number of reasons.
depression and toxic masculinity have a lot of similarities, is toxic masculinity a behavior disorder? why or why not?
like depression it is associated with injury to self and others, it is a barrier to mental and phsycial health treatmenr, it is associated with societal problems, and apa even target it for intervention. yet technically not considred a disorder! this should lead us to ask what is considred a behavior disorder and who has the power to decide what is in and what is out
traditional attempts at defining a behavior disorder
abnormality/ deviance: normal, statistical, social, biological
subjective disorders,
dysfunction/ impairment
traditional attempts statistical and social abnormality
Normality: the average/ mean or mode (statistical normal), can also be social, conforming to the standard or the common type, or person (characteristically normal)
Statistical abnormality: is abnormality necessary or sufficient to say something is a behavior disorder? IQ of 150 is abnormal, but there is no high IQ disorder.
Some normal conditions can be conditions of illness: feeling sad or anxious is pretty normal, yet we find sadness and anxiety all over the diagnostic normal
Socially abnormal behavior: philately - stamp collecting statistically and socially abnormal but seemingly not a disorder
Socially normal behavior: alcohol use, most adults drink and it is uniformly bad for you
traditional attempts: biological abnormality
Biological abnormality: can be within - development of condition that was not previously present or, between organism - condition that does not normally occur across organisms of a given type
An individual was missing a sylvian fissure - part of a brain was structurally different than other human, that person was einstein, high IQ does not make for a behavior disorder
Deja vu: something is glitching in your brain, one of the current theories is that what your are currently experiencing makes it into your long term memory before conscious awareness, not abnormal, but not considered a behavior disorder
Hallucinations: reflect a problem in the body, in some cases this may be characterised as part of a behavior disorder, other times not,
Some normal biological events are symptoms of a disorder
Cognitive decline, starts in your mid 20s, happens to everyone but at some point it becomes impairing
traditional attempts: subjective distress
people with behavior disorders may be in a lot of distress, yet once again this definition falls short.
Intense physical activity
Reacting to bad news
Sometimes really good to have stress and respond to it, we have experiences of subjective stress which fall into behavior disorders, but we also have subjective distress that does not fall into behavior disorders, we also have behavior disorders with no subjective stress
Though certain features of behavior disorder may be accompanied or defined by subjective distress
Subjective distress is neither a necessary nor sufficient feature for categorizing a group of co-occurring thought, emotions, and actions as a behavior disorder. serual killers lack subjectie distress!
They are also not jointly sufficient
traditional attempts: dysfunction
● Dysfunction: some form of abnormality or impairment in the function of a specified bodily
organ or system (e.g. heart attack – a blockage in blood flow prevents the heart from
serving its specific function)
● Malfunction: a function is present, but it’s the wrong one (e.g. cancer – cells are
multiplying, as they do, but are out of control)
○ As an organ or structure of the body; any malfunctioning part or element of a
system
○ In behavior disorders: (e.g. Ted Bundy – misunderstanding of social interactions
and the human experience)
○ Behavior disorders can occur when a system is functioning as it should (e.g.
anxiety disorders – usually rooted in a rational behavior, no brain dysfunction)
○ Also a cultural aspect – not all cultures treat psychosis as a disorder (e.g.
hallucinatory experiences – many cultures do not treat this as dysfunctional, and
in fact some cultures reward this behavior)
Dysfunction: do behavior disorders emerge when your psychological apparatus is functioning as it should?
healthy anxieies are biult the same way unhealthy anxieties are, they just become unhealthy when you fear something that poses no threat. the underlying sustem us normal but not sercing you well
anxiety disorders are conditioned behaviors and the treatment for them us by and large conditional as well
Impairment
In his opinion this comes closest. The state or fact of a faculty or function being weakened or damaged
Impairment of some kind at least seems to be
necessary component of behavior disorders or
At least implies that there is something worthy of clinical attention and perhaps intervention
Impaired with respect to what?
ADHD: in my opinion it is a way in which your brain is wired, not pathological, has some strengths, howereve when you put the brain in certain contexts you might see some impairment. There was no ADHD before school.
“I am bad at basketball… I am impaired with respect ot basketball yet hardly a disorder”
302.0: homosexuality
Prevailing theories suggested that homosexuality was… (stayed in DSM 1 and 2)
Natural variation like left handedness
Biological pathology: there is some internal defect
Immaturity: freud, homosexual feelings are normal at a young age, but at an adult level it is some developmental arrest
most significant catalyst was acitivism to get it removed. not so scientific!
Is homosexuality a disorder
● homosexual behavior between the spider monkeys males reduces internal conflict
between the animals and thus supports their reproductive survival
● Japanese monkey - lesbian behaviors don’t seem to serve an evolutionary function
● Same sex sexual behavior has been observed in Rhesus macaques, gorillas, Japanese
monkeys, chimpanzees, bonobos, and pigtail monkeys
● same sex sexual behaviors play complex roles that fit squarely within evolutionary
theory:
○ Social bonding
○ dominance
○ conflict resolution
○ practice
○ kin selection
● What about asexuality?
○ Observed in in nature: asexual reproduction
○ if something doesn’t fit into evolutionary theory is it a behavior disorder?
● Key point: scientific evidence was not sufficient to remove disorder of homosexuality
(even though the evidence strongly suggested it is not), but ultimately took a vote (by
individuals with significant monetary and theoretical interests) to remove it – disorders
are very financially, theoretically, etc. influenced (in other cases as well)
Drapetomania and Masturbaiton
societally/subjectivley defined. running away from master or masturbating… ● Both are not reals disorders, but it were developed to justify problems
○ Having a cause for something helps people justify their actions, ergo the idea that
masturbation is a disorder
● Norms and values are not scientifically determined or essentialist characteristics of
what something is:
○ Are not objective properties of the phenomena
■ No set characteristics to define what is considered a behavior disorder vs
normal behavior
○ Reflect subjective perspective of the classifier
weed and subjectivity
Weed: just an unwanted plant, not one thing. Totally a function of perspective.
Is a behavior disorder simply a constellation of behaviors and traits that people at large identity as problematic in some way? The lack of an essentialist definition of a behavior disorder then opens the construct up to abuse by those in power
contemporary models
social constructionist (szazz), harmful dysfunction (wakefeild), today
social constructionist model of behavior disorders
Social constructionists: the reason why the common denominator seems to be social forces is because they are. Social forces construct it.
These are just fictions, szasz,
Others see them as fictions, but useful fictions.
Socially constructed labels that summarize a constellation of co-occurring events of interest to society
Are potentially useful, they help us separate behaviors that are to be treated and those not to be treated
has some merit but overall meh imo, complete non-essentialism leads to all our problems, “common unhapiness is now viewed as a treatable condition”
contemporary models: harmful dysfunction
There must be some dysfunction, and there must be a value component, it must be harmful: the impairment must be harmful to the individual an or society. There must be a judgment component. But there must also be more - can’t just be a weed phenomenon, that’s the dysfunction portion: break-down or impairment, lapses in the evolutionary determined function of a behavior.
○ A two component way to define a behavior disorder:
■ 1) a factual component (i.e. dysfunction - impairment in the natural
function of behavior)
■ 2) a value component (harmful – a behavior that is harmful in specific, not
every, contexts)
● Problems with this model
○ Who makes the decisions is unclear
○ Unclear from an evolutionary perspective
■ “Just so hypothesizing”
● Things are a certain way now and at some point in human history,
a certain behavior may have served an adaptive purpose
● People try to find evolutionary evidence to justify present day
behaviors
○ Not every disorder represents dysfunction in a biological/evolutionary sense
■ Ex: anxiety disorders – fear is an evolutionary adaptation
■ In different contexts, these natural adaptations may be seen as a problem
Why do we have a system for classification and diagnosis?
Having a system provides a nomenclature for mental health practitioners
Once we have a system we can do research on those things. Descriptive psychopathology, epidemiology, etiological theories: how did this start and develop over time
Sociopolitical functions: schools, insurance, benefits ect.
The basis for diagnosis, prognosis (other end of etiology, where is this going to go from here), and treatment
what is the ultimate goal of classification and diagnosis
The ultimate goal is utility. The best classification system isn’t necessarily the system that is most true, it must be useful. A classification system must be tailored to the purposes for which it must serve. Hard science is either or, behavior disorders are more dimensional, more a matter of degree. A dimensional system causes a whole host of problems. A classification system must be tailored, the best is useful, not the most correct. 3 and 4 got the job done, even though there were known problems.
veiws of psychopathology over time
supernatural models, moral model, moral model today, biological theories, kraplelin, medical model, neo krapelinians,
supernatural model
Abnormal behavior reflects possession of the individual by demons, witchcraft, and displeasure of gods, eclipses, planetary gravitation, curses, and sin
St. vitus dance: an affliction that seemed to happen during rainier seasons, would lead to uncontrollable dancing and in many cases death. They were not thinking in terms of biology, they were thinking of a witch who cursed a person. It was actually poisoning from a fungus. The hallucinations were also tailored to that time.
Recommended treatments, drilling a hole in your skull to release the demon, magical and religious rituals, threat, bribery and punishment
supernatural model today
there is a current focus on whether spiritual issues should be incorporated into our understanding of mental heath issues and their treatment (biopsychosocial-spiritual), most cliennts are in some waty spiritual or religious - the goals of the two feilds are compatible, religious behavior can be associated with positve outcomes,
locus of control: - If you have control over your own outcomes, put
more effort into their mental health/life/goals overall
→ usually happier and more fulfilled. If you believe
that everything is predestined and predetermined
and do less “work” → tend to be less happy overall.
Moral model
cast atypical behavior as deliberately adopted by the individual similar to criminal behavior.
This would lead to certain treatments, if it is deliberately adopted by the individual, put shame on the family’s house, would hide the person to a life of confinement or put them in jails. Families may also have abandoned them. All these extend from the fact that ot was chosen by the person.
Moral model today: are there disorders of choice?
Malingering: some behavior disorders can be construed as instrumental to the individual, they have secondary gains from the disorder. Malingering is the faking of the disease or disorder for some gains. Most of the people on death row actually met criteria for psychosis but within those settings admitting psychosis makes you a target.
Factitious disorders: munchausen disorder by proxy, people like attention so they make a problem for it, or by proxy they use another individual’s disorder.
Interpersonal theories: some models of depression cite secondary gains as a motivating factor behind system persistence. Some depressed people develop a lifestyle to accommodate it and get used to it. Learned helplessness.
This model does not work great because it is rare.
Objections to the moral model in general
Has a bad reputation. Misses a broader picture. Placing sole responsibility on the individual disregards biological, environment, developmental, and sociocultural determinants of behavior.
Leads to interventions that minimally lack compassion but can also include mistreatment
But, failure to placed any onus of responsibility on the individual is disempowering. Removing personal responsibility from the equation can have problematic implications.
Choices are not set equal across individuals, some things make choices harder for some than others.
If you swing too far in the other direction you get other issues. “The best perspectives are usually the ones that balance viewpoints… dialectic”
Affluenza: not a real thing, was an idea about a disorder that was used in the criminal difference of an uber rich kid who killed people in a car crash. He has not been held responsible for anything, he has no idea of responsibility so we could not hold him accountable to irresponsible behavior.
veiws of psychopathology over time: biological theories
The very notion of a chemical imbalance goes back to galen who proposed their were four humors, flem and bile ect. tells us what you have, the germ of the idea has been around
He offered treatments: different proportions of physical fluids determines your health so we should do things to get those back in order
Phrenology: (same time around moral movement) shape of skull was associated with different personality predispositions and behaviors. Not a great science
Recommended treatments were tied to the physical realm.
There is a clear relationship between physical and mental health. Physical injury can get you fired from work and lead to depression, also, there is a direct relationship in some cases between body and mental states. Exercise intervention and dieting, can help with depression, sleep can help with ocd
Psychotropic medication can help
caveats to biological theories
SRI’s help with depression, we do see after several weeks of ssri’s help, your serotonin levels change immediately, but it is not for a few weeks that you feel better, it is unclear of the change in serotonin is directly responsible for depression to begin with. This is affirming the consequent - logical fallacy. Lack of aspirin does not cause headaches. Mixed success of psychotropic medication may or may not prove this.
Irvin kirsch: took depressed people, gave one third an SSRI, gave a second group a placebo, and the third group got a decrease in serotonin. Everyone got better. Maybe serotonin does not play the role in depression that we think it does.
biological model reductionist fallacy
Reductionist fallacy: if i can relate some phenomena to some more fundamental analysis then this is better? Analysis is scaffolded on what precedes it - usually a connection down and thus tempting to look down. Problem is that each level you go up phenomena start to be created - emergence, it becomes more than a sum of its parts, you then can’t reduce it. If i were to explain the significance of the Mona Lisa as a piece of art, I couldn’t explain it on the quantum level. Our understanding of it must be focused on the level it is at. Lots of reductionist fallacy when it comes to behavior disorders. Depression lights up these areas, non depressed does not so it must be these places cause depression. Correlation is not causation. Biology has gotten a lot of focus, because it seems more fundamental, but that is based on a fallacy. Some disorders are biological, but oftentimes it is not.
Formal classification with regards to the biological sciences.
As biological sciences advanced so too were there efforts in classification.
Many believed biological science had solved classification problems, and that you can use biological taxonomies to classify mental illness.
William Cullen (1769) applied the principles of linnaeus to behavior disorders; leading to a com[;ex scheme involving classes, orders, and genera, and species of disorders
The field at thou time was a mess
Diagnosis ranged from single systems, broad descriptions, or failed attempts to organize disorders based on etiological speculation. Variety of taxonomies and different systems, if the goal is communication and we are all talking different languages it will fail.
prior to emil krapelin
only distinguished on the basis of broad symptom presentation (neurotic vs. psychosis)
Psychosis: represented a severe mental disorder characterized by a break with reality
Neurosis: a milder mental disorder characterized by distortions with reality. Probably better as classified as psychological disorders.
Kraplelin’s Philosophy of classification
Detailed observation, careful description, and precise organization of data.
Psychiatric diseases are mainly caused by biological and genetic disorders
He also went beyond this. The ultimate goal beyond collecting data and even classification. He wanted to be able to classify things in a way that had uti;ity! We are going to need the anatomical pathology: what went wrong in your brain or body that explains these symptoms, he thinks what is causing it is some sort of pathology on the anatomical level.
He thought if you iron out these details you will get a good sense of etiology
He also then thought we needed a course/ prognosis
His attempt at classification was pretty broad, get all this data, collect it, and hope ith all this information it can cover all these grounds we want to achieve in a classification
He proposed a 15 categories of disorder
He introduced ideas that were not around before hand, schizophrenia, bipolar disorder (at the time manic depressive insanity), and at the time he was the first to corner off the personality disorders. (really now problems in your interpersonal relationships)
His program ultimately fils, and he acknowledged that classifying on some kind of pathological anatomy was nearly impossible, most etiological theories which were rooted in biology were largely speculative. But he did do a good job of catogirizng and orgnizing informagtion was good, but the broader goal was a failure
frueds psychologcial model
Prior it was strictly biological
Freud built and entire psychological system from nothing
- He created a system that accounted for psychological functioning
- Freud was a physician by training so his psychological training was rooted in biology
- He founded it on biology, but another system sits on top of it with emergent qualities
- Our biology impulses give rise to cognitive faculties
- We’re animals that have animal impulses
- We don’t behave like animals because of reason and moral upbringing
- Reasons and society bottle up primal impulses and our impulses go somewhere – Freud
said they went into behavior disorders
- Issues of mental health extended from uniquely psychological processes
psychiatrists and frued
Psychiatrists were referred to as alienists, and at the time flocked to Freud’s ideas
- These were physicians who treated the mentally ill in asylums, but didn’t have proof
- Psychiatry was not taken seriously in the profession due to lack of proof of their
assumptions, but Freud’s ideas takeoff in context of psychiatry
dementia paralytica revisited
- 1913 - Noguchi and Moore figured out dementia paralytica
- Figured out dementia paralytica was syphilis
- Noguchi and Moore isolated syphilitic bacterium in brains of people with syphilis
- The was the first psychological disorder where they found a biological basis
- This is what Kraepelin was hoping for – a biological basis
- Prior to 1913, psychiatry was the laughing stock of the medical community
- Using psychotherapy instead of medicalized treatment was what caused the
medical community to not take it seriously - However, by 1919 psychiatry becomes 3rd most recognized speciality in
medicine after the discovery in 1913 - Major turning point in history of behavior disorders and classification because it
was proof of concept - Behavior disorders have a biological root, but this doesn’t mean there is a biological root
to every behavior disorder
Birth of formal classification (in psychiatry):
we are starting to get traction in this idea of behavior disorders or mental illness, what started as biological pricnicple, now we are in the period where people are taking this more seriously as a branch of medicine. The incorporation of behavior disorders into diagnostic manuals for medical problems. The one that is still used everywhere but america was originaly called the bertillon classification of causes of death, now more than jsut death so diferent name. Around 1900 this was adopted as a diagnostic manual for diseases, following world war two this expanded beyond death and put a section for mental illnesses. Renamed the internal classification of diseases.
orgins of dsm
The dsm 1 and 2 were heavily influenced by freudian theory. They had not biological tech sp they stuck with freud. The dsm one and two were effectively psychological manuals. They were not aligned with the medical model. They differentiated between
Disorders caused by or associated with impairment of brain tissue function and
Disorders of psychogenic origin or without clearly defined physical causes or structural change in the brain
Because they were influenced by the psychodynamic approach the categories reflect reactions to environmental factors then biological or pathological causes. They also did not divide between healthy and unhealthy disorders, it was more of a spectrum, the internal conflicts were a normal part of life that might cause problems, we can help, but does not classify as mentally ill.
They are super subjective and open to interpretation
Criticisms of Psychiatric classification
Diagnostic reloanot;otuy showed highest level of agreement for dsm1 was 42%. This creates problems for clinical practice and generalizability of research findings
Criticism of Psychiatric Classification dsm 1 and 2
- Thomas Szasz claimed mental illness was a myth
- Szasz claimed they only benefited psychiatrists
- Sociologists and psychologists had issues of labeling and stigmatizing
- Diagnosis were shown to be self-fulling prophecies in some cases, these things still
happen - If all it’s doing is creating the problem you’re meant to solve, you have a problem
- People in society were calling attention to mental illness and questioning validity
- People are not agreeing what things are broadly and at granular level
Rosenhan (1973): “on being sane in insane places”
E.g., Sent his undergraduate research assistants to inpatient units and have them fake
hallucinatory experiences. As soon as they were admitted they acted how they normally
would – ultimately they were stuck in the asylum
- People within psychiatry can’t differentiate between normal and abnormal
- What’s happening in the world of behavior disorders requires some degree of scrutiny
The rise of neo kraepelinians
the 1 and 2 were wedded with psychoanalisis. tech and meds were on the rise and succesful, psychoanalysis takes a long time and tech does not. psychiatrits were abandoning the psychological model.
this gave power to the neo-krapelinians who wanted to revert back to a medical/ biological model
DSM3 and Neo krepalinians
by 1978 mental health providers agreed to give the neo’s full control of the dsm3. this resulted in backlash by psychoanalytic and humanistic theorists. the krepes tried to but a definition for behavior disorders in the apendix, the humanists and psychodynamicists lost it and went to go make their own manual with the apa, legal ction was threatened, in the end agreed to make the dsm3 theoretically agnostic
the new DSM3
theoretically agnostic,
* new hierarchical system, before, psychotic vs nuerotic, organic vs non-organic. now, 17 major headings with a more holisitc approach, multi acial system categorizing patients along 5 dimensions, sumptom picture, personality style, medical conditions etc. this helps contextualize
DSM3 Multi-axial system
○ Axis I: ■ Clinical Disorders ● They tend to come and go
○ Axis II: ■ Personality Disorders and Mental Retardation ● These are a part of you
○ Axis III: ■ General Medical Conditions ● General Health Issues
○ Axis IV: ■ Psychosocial and Environmental Problems ● What kind of living situation is this person in?
○ Axis V: ■ Global assessment of functioning ● A rating of how a “pathological” a person is overall
● Not consistent and didn’t provide reliability
DSM3 diagnostic criterea, validity, and reliability
○ Adopted diagnostic criteria in contrast to prose description
■ Makes diagnostic process more clear-cut and explicit
■ Provided very specific guidelines in order to be diagnosed with a behavior
disorder
● This provided reliability but created questionable validity
○ Do these criteria really encapsulate all depressed people?
dsm4 and 4tr
essentially the three with some changes, increased the coerage from 265 to 374
critiques of the dsm
conception of mental illness wat explicitly atheoretical but implicitly based on the medialc model - either you are mentally ill or healthy
comorbidity: co-occurence of different diagnoses, can result from overlapping diagnostic criteria, dsm made a lot of comorbidity, their categories overlapped a lot, 10% of personality disorder patients meet criteria for 4 or more PDs.
Not therapeutically useful: “I agree with for the most part” for a given diagnosis does not imply some specific etiology or necessary form of treatment. Two people can have depression and be treated in opposite manners, can be useful in many ways but trying to treat it just knowing it is depression does little to help
somewhat dubios process for defining diagnosis, had panels of experts, a lengthy consultation process, a comprehensive literature review, reanalyzed extant data, extensive field trials, but… poltical and social processes within and between stakeholders influenced the solutions adopted. Influence who gets on the panel in the first place
The orgin of DSM5
an open letter to apa
■ The proposal to include new disorders with relatively little empirical
support and/or research literature that is relativity recent
● Ex: disruptive mood dysregulation disorder and childhood bipolar
■ The lowering diagnostic thresholds, which may result in diagnostic
expansion and various iatrogenic hazards, such as inappropriate treatment
and stigmatization of normative life processes
● Resulting in overdiagnosis
■ The development of novel scales (e.g. severity scales) with little
psychometric testing rather than utilizing established standards
■ The perplexing personality disorders overhaul, which is an unnecessarily
complex and idiosyncratic system that is likely to have little clinical utility
in everyday practice
● In addition, we are increasingly concerned about several aspects of the
development process. These are:
○ Continuing delays, particularly in the drafting and field testing of the
proposals.
○ The substandard results of the first set of field trials
○ The cancellation of the second set of field trials.
○ The lack of formal forensic review
also hiring of a pr firm
the process of developing the dsm5 is fraught top to bottom
NIH and RDOC
NIH rejects dsm and akes RDoC. It integrates many levels of information (from genomics to
self-report) to better understand basic dimensions of functioning
underlying the full range of human behavior from normal to abnormal.
○ Five formal domains:
■ Negative Valence System: Responses to aversive stimuli
■ Positive Valence System: Responses related to appetitive stimuli,
incentive systems
■ Cognitive Systems: Thought processes (e.g., working memory)
■ Social Processes: Systems that mediate responses to
interpersonal settings
■ Arousal/Regulatory Systems: Systems responsible for generating
activation of neural systems, providing appropriate homeostatic
regulation
● previously, research was funded by NIMH in accordance with the diagnostic
criteria set forth by the DSM
○ By creating RDoC, they are choosing to fund research that will develop
new ways of understanding behavior disorders (outside of the DSM)
● In practice it has had some problems- social processes tend to be overlooked
(tough to get a grant to look at interpersonal processes .. easier when studying
biological processes)
Where from here IMO regarding DSMs
● We need to better define the social, ethical, legal, economic, practical, and
philosophical aspects and processes of defining behavior disorders.
○ This is not solely a scientific matter
○ Decisions about the final product predominantly reflect the opinion of a
small group of academic psychiatrists and psychologists
● In order to advance we need to abandon the medical model:
○ There is not a clear line between mental health and mental illness (cf.,
dimensional models).
○ Behavior disorders do not exist on the inside of a person.
■ Behavior disorders are contextually defined
■ Problems seen as not inherent to a behavior (or set of behaviors),
but as an interaction between a behavior and the environment.
○ current diagnoses really reflect signs and symptoms of a problem but not
the problem itself
■ Depression example: can display symptoms (after effects) but
does not help to understand the actual problem
■ a function of a person’s behavior in a given context (contextually
defined)
● Whether or not your behavior is a problem is defined by the
situation not actually the behavior itself
● a very valid way of treating a disorder may be changing the
context (ADHD children in classrooms)
We need to develop an essentialist account of problems, with particular focus on those stemming from psychological processes
Under what circumstances and in what ways do subjective distress, dysfunction, abnormality and impairment relate to actual problems, as well as for whom, and to what extent to these problems require outside intervention targeting psychological (behavioral, cognitive, etc.) processes.
If social values are inherent to behavior disorders, what processes will lead us to act on the best values and thus produce the best results
What do we mean by best values and or results?
Where do we draw the line between society’s responsibility to accommodate differences and an individual’s responsibility to adapt to their context
Who gets to decide what is and is not in the best interest of an individual and or society
go over notes 2/7
classical and opperant -opperant avoidance reinforfes, classival initial learning
Mowrere’s
two factor theory guy
only applies to fear/anxiety acquisition
i. Whether or not these fears and anxiety are problematic is subjective
1. It must impair a person’s daily life
2. Ask: in the context, does the avoidance behavior make sense? Is it
justified?
a. Context matters
3. In moderation, some of these anxiety/fear behaviors are not that
bad, but in excess they can be problematic
anxiety and hereditary factors
You’re not inheriting the disorder, rather an adaptation
i. Ex: learning fear associations faster than others
genetic factors for anxiety
Hettema, Neale and Kindler (2001):
- Showed that anxiety disorders do aggregate in families
- Heritability estimates (based on large scale twin studies)
were 0.32 for generalized anxiety and 0.43 for panic
disorder
The genes might predispose you to develop fears but it
doesn’t specify what fears it will be
- You inherit traits that are characteristic of anxiety disorder,
not a fear of spiders
- These traits are really adaptive to some
circumstances but are really problematic in other
disorders
- In certain people, there are traits that can both be adaptive and also really harmful
- You aren’t inheriting a disorder, you are inheriting broad traits
- If your family has anxiety disorders, there is a higher chance that you have it, as well
- The ability to form fear associations efficiently is evolutionary sound
- People who make those fear associations more quickly in safe environments may be considered abnormal just because of change in context but back in the day was good
Lumping vs splitting
On the one hand there really is only one anxiety disorder. Two factor process explain the etiology and maintenance of anxiety
Also explains the heterogeneity of anxiety disorders. If it can be experienced, it can become a conditioned stimulus
High comorbidity amongst anxiety disorders
Stimuli differs response is the same
On the other hand some of the differences between the anxiety disorders matter, they have different topographical/descriptive features.
Differences result from differences in the signaling stimuli, nature of the conditioned response, ect
Differences result from differences in the signaling stimuli, nature of the
conditioned response, etc.
- EX: avoidance behaviors in OCD vs phobia
- OCD includes repetitive behaviors, whereas phobias are
strictly avoidant
- OCD includes doubt (EX: I can’t see the germs I’m afraid
of, so I don’t know if I still have them), whereas phobias
are more clear-cut (EX: the dog is not here anymore, and I
can see that)
- OCD is the only anxiety disorder where the criteria
is not that you need to know that your phobia is
irrational
- EX: low insight in certain manifestations of OCD
- EX: chronic hyperarousal in PTSD / GAD
- Chronic - all the time
- hyperasoul - keyed up
GAD
uncertainty is an abstract stimuli and potentially threatening.
- Any deviation from the norm can trigger an anxiety
response → potentially everywhere and can happen
at any time
- Anxiety is related to having feelings of uncertainty but if
there is uncertainty everywhere
proximity of signal to the threat
Proximity of the signal to the threat is major contributor in shaping the
topography/descriptive characteristics of the anxiety response
- EX: the closer a test is, the more anxious a person may become
- There are qualitative differences in animal defensive behavior
depending on the imminence of threat (fanselow & lester, 1995,
blanchard, 1977)
- Fight or flight: proximal, but avoidable threat
- I can still maneuver in a way
- Worry: problem solving to mitigate distal threat
- The threat is not here, so I can still come up with a
plan
- Panic: imminent threat
- Increased oxygen intake to get more energy
- Bracing for impact
specific phobias
- The DSM-5 criteria for a specific phobia is -
- A marked out of proportion fear within an environmental or situational context to
the presence or anticipation of a specific object or situation - Are you getting nervous if you are in the presence of, or will be in the
presence of a scary stimulus - The phobic situation is avoided purposely or endured with intense anxiety or
distress - The distress/anxious anticipation of the feared situation interferes greatly with a
person’s regular routine, or there is clear distress about having the phobia
Phobia acquisition example
- CS (dog) - UCS (pain) → CR (recoil)
- CS (dog) → (FEAR) → CR (avoidance) → (RELIEF)
- Exposure to the phobic stimulus provokes an immediate anxiety response, may
take the form of a situationally bound or situationally predisposed panic attack - Recognizing that the fear is out of proportion, but can’t help the response
- The phobic situation is avoided or else endured with anxiety or distress
- The avoidance, anticipation, or distress in the feared situations interferes with the
person’s normal routine - Once it becomes a problem, it can begin to be considered a disorder
pathways to fear acquisiton
- Direct conditioning
- Modeling (ie, vicarious conditioning)
a. Observation of the aversive stimulus being harmful to others,
associated
b. Eg: most people haven’t had any direct experience with guns, but
everyone tenses up when they see one - Instructional transference
a. Don’t really see this in primates because they lack language quality
i. I can tell people that haven’t experience something that
they’re dangerous, this is how parents give their children
function (sometimes not functional) anxiety
b. We don’t remember these because we usually remember high
salience events, less small conditioned stimuli memories
problems with two factor theory
How come I can’t remember the fear being conditioned?
- Infantile amnesia: We can’t really remember the first few years of life,
although we did learn and experience things. Generally not understood. Inorder to have memories you need to have a general understanding to hang
them on. Haven’t made a mental framework for themselves yet.
- Insidious acquisition: in line with the notion of multiple ways of fear
acquisition. The process is insidious (gradually and unnoticed by us), slow,
unaware yet although the amygdala is recording the associations. Low
magnitude multiple experiences, unaware that you’re being conditioned.
- Fear responses need no verbal mediation (thought): Just because you
cannot remember it happening, does not mean it is not happening. Don’t
need to be aware that fear acquisition is taking place for it to be taking
place, most fears are developed insidiously, mental knowledge is
unnecessary for fears to be learned.
Preparedness theory:
often offered as an additional theory of fear acquisition with an
evolutionary advance, makes a lot of evolutionary assumptions (whereas two-factor
theory does not)
- Individuals are predisposed to fear certain things over others due to evolutionary
pressures
there is an evolutionary reason for these phobias
Individuals are predisposed to fear certain things due to evolutionary pressures, spider and snake phobias because they are potentially dangerous, somewhere in our evolutionary past this seemed relevant and we have the gene for spider phobia. certain stimuli are more often tied to phobias, If I were to try and condition someone to have a spider phobia, it is a lot easier than to condition to someone to have a pillow phobia, same goes for dropping that pillow phobia or snake phobia
preparedness theory patterns
- Uneven distribution of fears within the human population: certain
stimuli are more often tied to phobias (e.g. more snake and spider phobias
than pillow phobias, snakes and spiders could kill you, pillows cannot) - Prepared/primed/conditioned to fear “scary” things just by living
and experiencing the world - Rapid acquisition and resistance to extinction: fear of stimuli that is
“dangerous” is harder to get rid of than fear of non-deadly things - Easier to acquire a fear of deadly things than a fear of non-deadly
things → suggests some type of evolutionary basis - There are conditioning experiences that have already been had just
by being exposed everyday things (EX: scary movies) - Eg: lots of people are afraid of heights (preparedness theory says that it’s because
if you aren’t, you fall and die) - Anxiety is formed based on our experiences, but there could be differences
between people’s acquisition
Panic Disorder
recurrent and unexpected panic attacks. PANIC ATTACKS ARE CHARACTERIZED BY AN ABRUPT SURGE OF INTENSE FEAR OR PHYSICAL
DISCOMFORT, REACHING A PEAK WITHIN A FEW MINUTES, IN WHICH AT LEAST 4 OF THE
FOLLOWING SYMPTOMS ARE PRESENT
RECURRENT AND UNEXPECTED (“OUT OF THE BLUE”) PANIC ATTACKS*
* AT LEAST ONE OF THE ATTACKS HAS BEEN FOLLOWED BY 1 MONTH (OR MORE)
OF 1 (OR MORE) OF THE FOLLOWING:
* PERSISTENT CONCERN ABOUT HAVING ADDITIONAL ATTACKS
* WORRY ABOUT THE IMPLICATIONS OF THE ATTACK OR ITS CONSEQUENCES (E.G.,
LOSING CONTROL, “GOING CRAZY”)
* A SIGNIFICANT CHANGE IN BEHAVIOR RELATED TO THE ATTACKS
These are the formal symptoms in DSM:
- Palpitations, pounding heart, tachycardia
- Sweating
- Muscle trembling, shaking
- Shortness of breath, sensations of smothering
- Choking sensations
- Chest pain or discomfort
- Nausea, abdominal distress (r/o - felt very sick) r/o refers to rule out
- Dizzy, lightheaded, instability, feeling faint
- Derealization, depersonalization (r/o - blurred vision)
- Fears of losing control or going crazy (r/o terrified, apprehensive)
- Fear of dying (r/o - terrified, apprehensive)
- Numbness, tingling sensations (r/o - felt weak)
- Chills, hot flushes
- Derealization/depersonalization
- Dissociative experiences - Conscious experience becomes unchained from other
elements of physical being
- Derealization - Dreamlike
- Depersonalization - Looking at self from outside
why is there a link from panic attacks to agoraphobia
Usually they are very anxious about having another attack and the anxiety of having another attack leads to attacks.
That is why there is a link to agoraphobia, having a panic attack while out is very scary, it is a lot better at home, and I am less likely to experience an attack because I am less likely to have one
setting for panic attack is critical
If you can identify why you have had a panic attack you are less likely to have another
Barlows alarm theory: if the panic attack is a true alarm, then the recurrence of panic attack is less likely. If the person cannot identify the source of the threat that induced panic (a false alarm), the recurrence of a panic attack becomes more likely.
Panic disorder is fear of having another one
Panic disorder and two factor theory
Factor 1: (panic disorder) stimuli, events or situations s are paired with the physiological sensations corresponding to a panic attack the cs may trigger the panic and anxiety when encountered again. Out of the blue onset potentially results from subtle and non-perceptible changes in the physical state or
Goldstein and chambless (1978): interoceptive conditioning, fear of fear, low levels of bodily sensations (arousal, anxiety) may become the cs associated with higher levels of anxiety
General apprehension toward panic paradoxically increases focus on bodily sensations
Cognitive misappraisal of physical symptoms or low levels of anxiety
Lead to increased anxiety
Factor 2: agoraphobia (behavioral response to factor 1): what do you do if you have out of the blue uncontrollable panic in uncontrolled places
Conceptualized as a fear of being in places in which escape might be difficult/ help unavailable in case of a panic attack; or symptom development that might be incapacitating or embarrassing
Marked anxiety in two or more
Public transportation
Open spaces
Enclosed spaces
Standing in line or being crowded
Being outside of the home
Agoraphobia is a behavioral response (avoidance) to the anticipation of panic attacks (or other anxiety disorder)
comorbidity/preexsiting conditions
GAD with Panic for Dennis
GAD
Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance)
Individuals find it difficult to control the worry, attempts to distract or move away lead them back to chronic worry
Associated with three or more of the following six symptoms (they all feed into each other)
Restlessness or feeling keyed up or on edge
Being easily fatigues
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance
core feature of GAD
Key feature of GAD is that the individual experiences chronic and uncontrollable worry that is excessive (in response to a minor event) and unrealistic (unfounded concerns)
Worry “descriptively, worry involves a predominance of negative valenced verbal activity”
Eysenk (1992): worry has three primary functions
Problem solving: attention to potential threats or challenges and prompting individuals to generate solutions or strategies to address them
Motivation: prompting individuals to take action or engage in behaviors aimed at preventing or resolving perceived threats or difficulties
Emotional processing: allows individuals to process and regulate their emotions in response to stressful or uncertain situations
Etiology of GAD
Two factor theory (after initial learning experiences that conditioned stimulus elicits fear which is aversive physiological arousal, whether that results in fff response depends on other factors): it potentially originated from a learning history in which negative events were likely to occur and that they were uncontrollable or unpredictable
Early traumatic experiences: death of a parent, injury and illness, physical and sexual abuse
Early attachment problems: evidence suggests GAD patients had unpleasant, negative, alienating and rejecting family environments
the cs is often times situational ambiguity or uncertainty which provokes physiological arousal
worry as a conditioned response
For both anxious and nonanxious individuals, worry is an adaptive mechanism underlying problem-solving
A cognitive attempt to avoid future aversive events
Problem solving provides short term relief of fear: research suggests that induced worry (when we induce worry people start to show a decrease in arousal, takes the anxiety away, when we try to shock them their response is already buffered for they are expecting something bad and they are ready for it so we see less reactivity, when you worry it makes you feel less stressed out and when bad things happen you are more prepared) reduces fear responses (at the physiological level) and buffers physiological reactivity to fear-eliciting images
Alleviating the fear response reinforces the behavior (ie increases probability of future use given the cs)
SAD
A marked fear or anxiety about one or more social or performance
situations in which the person is exposed to possible scrutiny by others
(such as social interactions, performing)
■ Individuals fears acting in embarrassing or humiliating ways (showing
symptoms of anxiety)
■ Exposure to feared social situation almost invariable provokes anxiety
■ Feared social or performance situations are avoided or endured with
intense anxiety or distress
■ The fear or anxiety is out of proportion to the actual threat posed by the
social situation and to the sociocultural context
■ Fear causes significant distress or impairment in the person’s normal
routine, occupation, social activities/relationships, or there is marked
distress about phobia
■ Fear, anxiety, or avoidance is persistent (typically lasting for 6 months or
more)
SAD: course and onset
Median age of onset is 13 years, with onset occurring between 8 and 15
for about 75% of cases
● Late onset trends tend to be rare, but can happen following a
stressful or humiliating event or after life changes that require new
social roles
● Clients report suffering from shyness/fear of evaluation for most of
their lives
Temperament - genetic factor playing a role in SAD
extrovert vs introvert, people are born to varying degrees in terms of these personality characteristics or general temperament. Individuals that are prone to develop sad or have developed sad present early on with a shy temperament, they may be preexposed to developing sad.
Infants with an inhibited temperament more frequently develop into children and adolescents who avoid novel or unfamiliar people, objects, and situations
Some infants are excited about novel stimuli, others were immediately apprehensive or fearful, those with a more inhibited temperament carried through to other encounters in their life they were more prone to avoid novel or unfamiliar things throughout life
Adults characterized as inhibited early in life showed greater fmri signal response within the amygdala when presented with novel versus familiar faces. Even after multiple exposures we can still see apprehension. Inhibited temperament does not nec, mean to dev sad
Are these considered disorders, no? Fear of novelty can be adaptive. Thus it is in the gene pool
One of the offshoots of this is that it makes these individuals more likely to develop sad
Genetic and enviornmental factors in SAD
Attachment style: children develop working models of self and other through earliest interactions with caregivers. We have a evolutionarily determined system to gravitate toward our parents and vice versa, gives us an expectation of how we will be treated
Secure attachment: template for others as accepting and dependable; template for self. Securely attached children have caregivers who are attentive, responsive, and consistent
Insecure attachment: template for others as critical and unreliable; template for self. Characterized by parents who are harshly critical, conditional, unpredictable, rejecting
These set the schema for life and bad schemas with people can lead to sad from a young age
Widiger and Sankis (2000) suggest using this term rather than “harmful dysfunction
dyscontrolled maladaptivity
This is when bodily sensations become conditioned and elicit further arousal
interoceptive conditioning
