Understanding Psychological Disorders: Definitions, Classifications, and Clinical Syndromes

1. Chapter 12: DefiningPsychological Disorders Amber Gilewski Tompkins Cortland Community College

2. Abnormal Behavior • The medical model • What is abnormal behavior? • Deviant • Maladaptive -Dysfunctional -Causing personal distress • A continuum of normal/abnormal • Legal definition • Violation of cultural standards

3. Psychodiagnosis:The Classification of Disorders • American Psychiatric Association • Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - 4) FIVE AXES • Axis I – Clinical Syndromes • Axis II – Personality Disorders or Mental Retardation • Axis III – General Medical Conditions • Axis IV – Psychosocial and Environmental Problems • Axis V – Global Assessment of Functioning

4. Problems with DSM-IV • Dangers of overdiagnosis • Comorbidity • Power of diagnostic labels • Mental illness vs. normal problems • Illusion of objectivity • Beliefs change over time -What is “normal”? -Pressures and cultural standards

5. Clinical Syndromes: Anxiety Disorders • Generalized anxiety disorder • “free-floating anxiety” • Phobic disorder • Specific focus of fear • Panic disorder and agoraphobia: recurrent anxiety attacks; may develop fear of going out • Obsessive compulsive disorder • Obsessions- recurrent, unwanted thoughts • Compulsions- actions to calm thoughts • Posttraumatic Stress Disorder: re-experiencing past trauma in nightmares, flashbacks, etc.

6. Etiology of Anxiety Disorders • Biological factors • Genetic predisposition, anxiety sensitivity • GABA circuits in the brain • Conditioning and learning • Acquired through classical conditioning or observational learning • Maintained through operant conditioning • Cognitive factors • Judgments of perceived threat • Personality • Neuroticism • Stress—a precipitator

7. Clinical Syndromes: Somatoform Disorders • Body Dysmorphic Disorder: Preoccupation with a fantasized or exaggerated physical defect in their appearance • Conversion Disorder: loss of physical function with no biological basis • Hypochondriasis: excess concern about developing physical illness

8. Clinical Syndromes: Mood Disorders • Major depressive disorder: extreme sadness, loss of interest, lower self-esteem, somatic concerns, etc. • Dysthymic disorder: milder, chronic form of depression • Bipolar disorder: one or more manic episodes with periods of depression • Cyclothymic disorder: milder, chronic form of bipolar • Etiology • Genetic vulnerability • Neurochemical factors • Cognitive factors • Interpersonal roots • Precipitating stress

9. Clinical Syndromes: Schizophrenia • General symptoms • Delusions and irrational thought • Deterioration of adaptive behavior • Hallucinations • Disturbed emotions • Prognostic factors:more favorable ifonset is sudden and later, good functioning prior to illness, negative symptoms are low, good social supports

10. Subtyping of Schizophrenia • 5 subtypes • Paranoid type: delusions/hallucinations; most common • Catatonic type: rigid or overly active movements • Disorganized type: severe problems in functioning & negative symptoms • Undifferentiated type: unable to be categorized specifically • Residual: past episode, less extreme symptoms • Other models for classification • Positive vs. negative & cognitive symptoms

11. Etiology of Schizophrenia • Genetic vulnerability • Neurochemical factors • Structural abnormalities of the brain • The neurodevelopmental hypothesis • Expressed emotion • Precipitating stress

12. Personality Disorders • Anxious-fearful/inhibited cluster • Avoidant, dependent, obsessive-compulsive • Odd-eccentric cluster • Schizoid, schizotypal, paranoid • Dramatic-impulsive/erratic cluster • Histrionic, narcissistic, borderline, antisocial • Etiology • Genetic/biological predispositions, inadequate socialization in dysfunctional families, sociocultural (fragmented society)

13. Table 14.2 Personality Disorders