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Chapter 11
psychological disorders
Chapter Outline
I. DEFINING AND DIAGNOSING DISORDER
A. Mental disorders are not the same as abnormal behavior
B. Insanity is a legal term that depends on whether the person is aware of the
consequences of behavior and is able to control it
C. Several criteria for defining mental disorders are currently in use
1. Violation of cultural standards--behavior that conforms to norms in one culture
might be seen as abnormal in another setting
2. Emotional distress--when people suffer from anxiety, fear, anger, depression, or
guilt
3. Maladaptive or harmful behavior--either for the individual or for the community
D. Mental disorder (text definition) = any behavior or emotional state that causes an
individual great suffering or worry; is self-defeating or self-destructive; or is maladaptive
and disrupts the persons relationships or the larger community
E. Diagnosis: Art or science?
1. Cultural factors and subjective interpretations still affect the process of diagnosis
2. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the bible
of psychological and psychiatric diagnosis
a. Primary aim of the DSM is descriptive--to provide clear criteria for diagnostic
categories
b. Classifies each disorder on five axes or factors
(1) Primary clinical problem
(2) Ingrained aspects of the individuals personality
(3) General medical conditions relevant to the disorder
(4) Social and environmental problems that can make the disorder worse
(5) Global assessment of the clients overall functioning
3. Limitations of the DSM
a. It may foster overdiagnosis
b. It may increase the risk of creating self-fulfilling prophecies
c. It may confuse serious mental disorders with normal problems in living
d. Diagnoses reflect prevailing attitudes and prejudice
F. Psychological tests
1. Projective tests
a. Rely on the projection of unconscious conflicts and motivations onto
ambiguous
stimulus materials
b. Good for establishing rapport with clients
c. These tests have low reliability and validity
2. Objective tests or inventories
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4. May account for more than half of serious crimes committed in the U.S.
5. Begin with serious problem behaviors in childhood which continue through
adulthood
D. Biological and social factors
1. Do not respond physiologically to punishments that would affect other people
2. Show a lack of emotional arousal which may suggest a central nervous system
abnormality
3. Problems with impulse control--an inherited characteristic shared by those who are
antisocial, hyperactive, addicted, or impulsive
4. Vulnerability-stress model--holds that brain damage can interact with social
deprivation
and other experiences to produce individuals who are impulsive or violent
V. DRUG ABUSE AND ADDICTION
A. Substance abuse (DSM-IV definition) = maladaptive pattern of substance use leading to
clinically significant impairment or distress
B. The biological model
1. Jellinek argued that alcoholism is a disease over which people have no control-complete abstinence is the only solution
2. Biological model of addiction--when alcoholism begins in adolescence, linked to
impulsivity, antisocial behavior, and violent criminality; does seem to have a hereditary
component
3. It may be that consumption of alcohol causes biological dependence, inability to
metabolize alcohol, and psychological problems
C. Learning, culture, and addiction
1. Learning model says that addiction is not a disease, but a central activity of an
individuals life
2. Arguments in support of the learning model include:
a. Addiction patterns vary according to cultural practices and the social
environment
(1) Alcoholism more likely to occur in societies that forbid children to drink but
condone drunkenness in adults
(a) In cultures with low rates of alcoholism, adults demonstrate correct
drinking
to children, gradually introducing them to alcohol in safe family
settings
(b) In cultures with low rates of alcoholism, alcohol is not used as a rite of
passage into adulthood
(2) Rates of alcoholism may increase when people move from culture of origin
into
a culture that has different drinking rules
b. Policies of total abstinence tend to increase rates of addiction rather than
reducing
them, perhaps by denying people the opportunity to learn to drink
moderately
c. Not all addicts go through withdrawal symptoms when they stop taking a drug
d. Addiction does not depend on the drug alone, but also on the reason the person
is
taking the drug
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(1) Persons taking drugs for chronic pain may be able to discontinue their use
without any problems
(2) People who drink to cope with uncomfortable feelings are more likely to
become
addicted than those who take drugs to enhance positive feelings
D. Debating solutions to addiction
1. A central issue in the debate between biological and learning theories of
alcoholism has been the debate over controlled drinking
a. According to the disease model, total abstinence is the only way to manage the
disease of addiction
b. According to learning theory, controlled drinking is possible
2. Alcoholics Anonymous (disease) model has helped many people, but does not work
for
everyone
3. Best predictors of an addicts ability to learn to control excessive drug use are:
a. Previous severity of dependence on drug,
b. Social stability
c. Beliefs about the necessity of maintaining abstinence
4. Drug abuse and addiction appear to reflect interactions of physiology and
psychology,
person, and culture
VI. DISSOCIATIVE IDENTITY DISORDER
A. Dissociative disorders--disorders in which consciousness, behavior, and identity are
severely split or altered
1. Dissociative states are intense, long lasting, and seem out of ones control
2. Often occur in response to shocking events
B. Dissociative identity disorder (Multiple personalityor MPD)
1. The appearance of two or more identities within one person
2. Two opposing views of MPD exist among mental health professionals
a. A real disorder, common but often underdiagnosed or misdiagnosed--believed to
develop in childhood as a response to trauma
b. A creation of mental health clinicians who believe in it
(1) Research used to support the diagnosis, including claims of physiological
differences between personalities, is seriously flawed
(2) Clinicians are creating it through the power of suggestion--MPD may be the
result of unwitting collusion between clinicians and suggestible clients
(3) The influence of the media
3. Alternative sociocognitive explanation
a. Seen as an extreme form of a normal human process: the ability to present
different
aspects of our personalities to others
b. May be a way for troubled people to understand and legitimize their problems
c. Rewarded by clinicians with attention
VII. SCHIZOPHRENIA
A. Schizophrenia--a psychosis or mental condition involving distorted perceptions of reality
and an inability to function in most aspects of life
B. Symptoms of schizophrenia
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