Disorders I: General Concepts, Anxiety &
(Abnormal or Clinical Psychology)
We wlll look at a film excerpt from Bellevue: Inside Out
- Connie (The "neuropsychiatrist" and "computer programmer")
- Jamie ("I'm manic-depressive, have HIV, am an alcoholic and a drug addict")
- Brian ("The medications don't work")
Consider the following questions about these three people:
What did you see/hear which was "abnormal"?
How did the people at the hospital treat them?
Abnormal Behavior: Is It A Disease?
Abnormal behavior devil's work
- Belief that the "abnormal" individual acts in that manner because of the influence of evil forces (such as the Devil).
Abnormal behavior disease
- Modern psychiatry & clinical psychology treats abnormal behavior as a disease.
- Diagnosis: distinguishing one illness from another
- Etiology: the cause & developmental history of the illness
- Prognosis: a forecast or prediction about the probable course of the illness
- Social Stigma of mental illness: people feared, rejected, etc.
Thomas Szasz, MD
Deficient Problem Solving
- Abnormal behavior socially unacceptable
- Thomas Szasz, MD: "Abnormal" is a moral judgment about behaviors we don't like.
- Persons who are "abnormal" don't suffer an illness of the mind; illnesses can only be physical
- This is very much a minority viewpoint, but does get us to think
Abnormal Behavior: What Does "Abnormal" Mean?
Psychology uses the term "abnormal" in at least three different ways:
1. Deviance: The behavior(s) deviates or is different from what society considers to be acceptable.
- Men wearing women's clothing but not the reverse
2. Maladaptive Behavior: There is an impairment in daily life which comes from the behavior(s)
- Behavior interferes with social or personal relationships, work, or ability to take care of oneself, e.g., drug usage
3. Personal Distress: The individual reports significant levels of personal pain or distress
- Depression causes sadness, hopelessness, feeling of doom & gloom.
Psycho-diagnosis: Classifying Disorders
- Prior to 1952, there were no commonly-accepted definitions or descriptions of mental disorders in the United States
- 1952 Publication of the first DSM (Diagnostic and Statistical Manual of Mental Disorders) by the American Psychiatric Association. The DSM provides a description of each type of mental disorder (symptoms, prognosis, associated features, etc.)
- Since 1952, there have been a total of seven versions. The latest is the DSM-5, that is, the 5th Edition published in 2013
- DSM-5 defines the general notion of a mental disorder in this way"A mental disorder is a syndrome characterized by clinically significant disturbance in an individualís cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above." (American Psychiatric Association, 2013, p. 20)
√ Mental disorders affect our lives negatively
√ Cultural responses to stress and loss like crying or grieving are not mental disorders
√ The fact that a specific culture doesn't like or approve of a person's political, religious, or sexual behavior does not make that behavior evidence of a mental disorder.
Central Issue in All Anxiety Disorders Fear - Apprehension - Anxiety
Five (5) Types
1. Generalized Anxiety Disorder
- Chronic high levels of anxiety not tied to a specific threat
- Constant worry
- Physical symptoms such as dizziness, diarrhea, trembling, muscle tension
2. Phobic Disorder
- Irrational fear of a specific object or situation which is not actually dangerous
- The Phobia List
Some Common Phobias
Animals = Zoophobia
Closed spaces = Claustrophobia
Crossing bridges = Gephyrophobia
Death or dying = Thantaophobia
Heights = Acrophobia
Snakes = Ophidiophobia
Spiders = Arachnophobia
Storms = Brontophobia
Number 13 = Triskaidecaphobia
3. Panic Disorder & Agoraphobia
- Sudden & overwhelming feelings of anxiety & fear
- Agoraphobia = Fear of going out into public places
4. Obsessive-Compulsive Disorder
4. Post-traumatic Stress Disorder (PTSD)
- Persistent, uncontrollable intrusions of unwanted thoughts (obsessions) or urges to engage in useless rituals (compulsions)
- Obsessions such as fear of harming another or self, failure at work, sexual acts
- Compulsions such as consistent hand washing, checking locks on door, touching objects in a certain order
- Originally recognized as a distinctive disorder during the early 1970s (Vietnam War).
- For the general population, a lifetime prevalence rate of 7-8% (10% among F & 5% among M)
- The diagnosis requires the following elements:
- Exposure to an event involving danger of death or witnessing death of others
- War, terrorism, rape, prison stay, assault, domestic abuse, emergency service responder work (EMT, firefighter, etc.)
- Note that we too often exaggerate what might be a cause of PTSD
- Reliving the event in flashbacks, memories, nightmares, etc.
- Avoidance reactions: emotional numbing, detachment feelings, lack of interest in activities, feeling one has no future, inability to remember aspects of the trauma
- Arousal: concentration difficulties, startle reactions, hypervigilance, irritability & anger, sleep difficulties, dizziness, fainting, heart palpitations
- Symptoms have been present for at least 30 days
- If less than 30 days following event, = "acute stress disorder"
- Symptoms of PTSD may appear weeks or months after the traumatic event. Their failure to appear immediately after the event is not an indication against the diagnosis.
Etiology (= Causes): Where do Anxiety Disorders come from?
- Moderately high level of concordance in identical twins (ca. 35%) compared to fraternal twins (ca. 15%). This suggests some genetic vulnerability.
- May be related to problems in neural circuits using the neurotransmittter GABA which generally inhibits our nervous system's responses. If it is not working properly, the nervous system may become overly excited and reactive to even small matters.
2. Conditioning & Learning: Fears come from experiences in life
- Some studies have found people can identify specific events which gave rise to the phobia
- Martin Seligman's (1971) Preparedness Theory: some people are biologically (often, genetically) more predisposed to develop fears than others
3. Cognitive Factors
- Some individuals may have a thinking style which promotes anxiety disorders through
- Misinterpreting nonthreatening situations as threatening
- Overemphasizing threat
- Selectively recalling threat information
- Research shows that anxious individual are much more likely to evaluate statements as threatening than non-anxious individuals
4. Personality Factors
- High levels of neuroticism (one of the Big 5 traits) often present: nervous, insecure, gloomy, guilty
- Clearly seen in Post-Traumatic Stress Disorder (PTSD)
- Other types of anxiety disorders often preceded by high levels of stress
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th edition. Arlington, VA: American Psychiatric Association.
British Psychological Society [BPS] (2011, June). Responses to the American Psychological Association: DSM-V Development. Retrieved 11/27/2011 from http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5%202011%20-%20BPS%20response.pdf
Post-traumatic stress disorder (2011). PubMed Health: Naitonal Institutes of Health. Retrieved 11/27/2011 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001923/
Seligman, M. E. P. (1971). Phobias and preparedness. Behavior Therapy, 2, 307-321.
This page was originally posted on 11/17/03 and last updated on November 29, 2016