Classification & Causation
22 important questions on Classification & Causation
What kind of factors can cause mental disorders?
- biological factors (e.g., genetics, brain anatomy, brain chemistry, hormones, genetics, evolution, etc.)
- psychological factors (e.g., psychodynamic, behavioural, cognitive, humanistic-existential, etc.)
- environmental factors (e.g., social labels and roles, SES, social interactions, family structure, etc
What is the diathesis-stress model?
---> Diathesis = Predisposition/vulnerability toward developing a disorder (a diathesis can be inherited)
---> Other diatheses: oxygen deprivation at birth, cognitive set, poor nutrition, intense fear of becoming fat. ---> stressful conditions needed as trigger
---> Since late 1980s, focus on protective factors (warm/supportive family environment, high self-esteem, school achievement, etc.) - in attempt to stop the development of schizophrenia (p. 77 - 79 abnormal textbook)
What does early trauma lead to?
(see slide 5, p. 5 lecture notes for diagram)
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What do the adrenal glands produce?
What does cortisol and adrenaline do?
- Cortisol = raises the sugar in the bloodstream and prepares the body for fight or flight response
- Adrenaline = raises heart rate and increases blood pressure
Who developed the first classification system?
What are the classification systems?
- Diagnostic Statistical Manual (DSM, APA)
- International Classification of Diseases (ICD, WHO)
(p. 142 abnormal textbook)
What are 5 advantages and 3 disadvantages of classifying mental disorders?
- Nomenclature (a naming system)
- Allows to structure information
- Allows research
- Allows to develop (and generalise) treatment
- Multicultural - same diagnosis all around the world
Disadvantages:
- Loss of (idiosyncratic) information
- Stigma, Stereotyping & Discrimination
- Problem of labelling / Self concept is affected
What are the 2 categories of mental disorders?
Neurosis = person still in touch with reality, less severe, now anxiety disorders (defined in terms of observable features such as excessive anxiety in general or in a particular setting
What are 2 other factors that may be relevant in causing mental disorders?
e.g. anxiety disorders are particularly high in the US
(see slide 1, p. 7 lecture notes, for table full of examples)
(the DSM-IV-TR takes these factors into account)
How does the DSM-IV-TR enhance cultural sensitivity?
- by providing a general framework for evaluating the role of culture and ethnicity
- by describing cultural factors and ethnicity for each disorder
- by listing cultural-bound syndromes in an appendix
Why is it important to take cultural backgrounds into account when classifying mental disorders?
People who have not been acculturated to the environment in which they live can appear more psychologically disturbed on tests and interviews than they really are (Okazaki et al., 2009)
---> advantage of the DSM-IV-TR
(p. 144 abnormal textbook)
When can a diagnosis be classed as accurate?
(e.g. Major Depression and symptoms of insomnia)
What are key changes to the DSM-V in 2013?
- Adding a new category: “mixed anxiety/depression” ---> this is a relatively common disorder
- Adding new grouping: “substance use and addictive disorders” (adding non-substance disorders)
- Adding a new category, “binge eating disorder”
- Removing the category “obsessive-compulsive disorder” under the grouping called “obsessive-compulsive and related disorders”
- Changing the definition of personality disorders
- Only 6 (instead of 10) personality disorders: antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal
- Adding a new category, “autism spectrum disorder” (ASD) (Asperger -> autism)
- Eliminating DSM-IV schizophrenia subcategories: paranoid, disorganized, catatonic, undifferentiated, residual
What can be said about the European system on the classification of mental disorders?
- ICD-10, published by World Health Organization
- Differs from DSM-IV-TR on criteria
- Only transient tic disorder is identical in both systems!
(main categories on slide 4, p. 8 lecture slides)
How can labelling effect treatment choices?
(p. 144 abnormal textbook)
How can labelling affect the diagnosed person?
(p. 144 abnormal textbook)
Can diagnosis and labelling cause harm (by society)?
- People may be viewed and react as mentally disturbed
- Society attaches stigma to abnormality
- Stigma can mark those with mental illness as 2nd class citizens
(p. 144 abnormal textbook)
What are the consequences of labelling?
What are the erroneous beliefs of mental illness?
- psychiatric patients are dangerous
---> unfortunately the erroneous beliefs shape the way we view mental disorders
---> education about mental disorders dispels the stigma (at least this is what it tries to do)
What figures show the power of the mental health stigma?
- 33% would not seek counseling for fear of being labeled “mentally ill”
- 51% would hesitate to see a psychotherapist if a diagnosis were required
- 67% would not tell their employer that they were seeking mental health treatment
- 37% would be reluctant to seek treatment because of confidential concerns
- 41% believe they be able to handle psychological problems on their own
---> American sample: perhaps in the US people are less inclined to seek mental health?
What is meant by prevalence and incidence?
- Prevalence = Number of active cases in a population at a given point in time (e.g. point prevalence, 1-year prevalence, life-time prevalence)
- Incidence = Number of new cases that occur over a given period of time (typically 1 year).
(see slide 4, p. 9 lecture notes for tables and figures of mental disorder occurrence)
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