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Somatic Symptom Disorders Lecture Notes - Classification 1 “Who in the rainbow can draw the line where the violet tint ends and the orange tint begins? Distinctly we see the difference of the colors, but where exactly does the one first blendingly enter into the other? So with sanity and insanity.” Herman Melvile What is Abnormal? 1. Suffering - person or family 2. Maladaptiveness (not being able to function) 3. Irrationality and incomprehensibility (thought disorders) • M'Naghten Rule – legal rather than psychological • Irresistible impulse is a defense by excuse the defendant argues that they should not be held criminally liable because they could not control those actions. • Policeman at the elbow – 4. Unpredictable and loss of control 5. Observer discomfort 6. Statistical infrequency – if 99% of behaviors are X and 1% of behaviors are Y then Y is abnormal. 7. Violation of moral & ideal standards o Connotative norms – based on society- • Anorexia is really only found in US, England and a few western European Cultures • TKS - Taijin kyofusho – Japanese fear of doing something really embarrassing and breaking social norm. Lecture Notes - Classification 2 Elements of Optimal Living - Positive Psychology – Martin Seligman 1. positive attitudes of self (like/accept self) 2. growth & development 3. autonomy (independence) 4. accurate perception of reality (see the world as it really is) 5. environmental competence (“When in Rome …”) 6. Positive interpersonal relationships Adaptation: changing to fit circumstances Adjustment: changing the circumstances Vulnerability: how likely we Resiliency: the ability to function effectively in are to respond maladaptively the face of adversity. to certain situations. Coping: how people deal with difficulties and attempt to overcome them. • Born with? – babies temperament • Learned – how do mommy and daddy react to spilled milk Diathesis *genetic predisposition for a disorder *Environmental stressors trigger it Atypical – catch all Co-morbidity – people can suffer from many disorders Lecture Notes - Classification 3 Diagnosis: a classification statement that places a disorder within a system of conventional groupings based on important similarities in symptoms. Goldwater Rule – unethical to diagnose people: • without meeting them • without their permission o usually talking about famous people Advantages of Classification: 1. What if we don’t have any system? So an imperfect system is better than none 2. useful for statistical purposes – how many people are ill in Maryland 3. Insurance companies will only pay for a diagnosed health condition 4. VALIDITY – more than just a doctor’s opinion based on peer reviewed research • Inter-rater reliability • Intra-rater reliability 5. can contribute to the planning of treatment programs & facilities - public schools conduct disorder and school discipline helicopter parents want their children diagnosed 6. improves communication among caregivers – agreed upon vocabulary Lecture Notes - Classification 4 Disadvantages of Classification: 1. puts a label on a person (stigma) • self-fulfilling prophesy – once a person hears about their disease … 2. diagnostic categories are imperfect and the same label may be assigned to behaviors that appear similar but have different causes and require different treatment – “it’s like nailing jelly to a wall” Inter-rater reliability Intra-rater reliability 3. Describing a condition doesn’t explain causality! The Rosenhan experiment was an experiment into the validity of psychiatric diagnosis conducted by psychologist David Rosenhan in 1973 – he and his colleagues fooled experts and their system so easily it pointed out huge flaws in the system of diagnosis Diagnostic and Statistical Manual of Mental Disorders 1952 – first comprehensive list of disorders - after WWII how should army classify returning soldiers’ mental health 1. their causes 2. their symptoms 3. the possible treatments - notice it does not say cures. Lecture Notes - Classification 5 There is an illness There is no illness Therapist sees illness Reject Null H0 Type I error or Person gets help False alarm error Therapist doesn’t see Type II error or Accept Null H0 illness Person doesn’t get No treatment needed help DSM – 5 "A mental disorder is a syndrome characterized by clinically significant (p< .05) disturbance in an individual's 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 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." Lecture Notes - Classification 6 Physiological Based – biological reductionism • Every condition is the result of underlying brain pathology ▪ Good – data driven, empirical ▪ Bad - psych is more complex then medicine Section I – introduction to DSM, how it is organized and how it is different from previous versions Section II – descriptions of diseases and dysfunctions Section III – “living document” what should be studied, possible new categories Internet addiction? Non-Suicidal Self-Injury (cutting) – not suicide, often an attempt to deal with emotional pain. Catharsis? control? OCD ICD-11 is the 11th revision of the International Statistical Classification of Diseases and Related Health Problems • No category is discreet • More emphasis on culture (international) Very few “real” difference between the DSM and the ICD Lecture Notes - Classification 7 Section II: diagnostic criteria and codes 1. Neurodevelopmental disorders Ex. Autism spectrum disorder, ADHD Ex. Intellectual Disability Disorder 2. Schizophrenia spectrum and other psychotic disorders Ex. Hearing voices 3. Bipolar and related disorders 4. Depressive disorders Ex. Dysthymia (Eeoyre) 5. Anxiety Disorders Ex. Phobias, Panic disorders 6. Obsessive-compulsive and related disorders Ex. Hording 7. Trauma- and stressor-related disorders 8. Dissociative disorders Ex. Dissociative Identity Disorder 9. Somatic symptom and related disorders 10. Feeding and eating disorders Ex. anorexia 11. Sleep–wake disorders 12. Sexual dysfunctions 13. Gender dysphoria 14. Disruptive, impulse-control, and conduct disorders 15. Substance use and other addicted disorders Ex. Gambling, internet? 16. Neurocognitive disorders Lecture Notes - Classification 8 Ex. Alzheimers 17. Paraphilic disorders Ex. fetish 18. Personality disorders Ex. Sociopath Anxiety Disorders ELEMENTS OF ANXIETY: 1. Cognitive Elements & expectations of impending harm 2. Somatic Elements Normal Anxiety vs. Pathological Goosebumps, muscle Anxiety: tension, increase heart 1. Anxiety is irrational (it is provoked rate by threats that are exaggerated or 3. Emotional subjective: dread, nonexistent) terror, queasiness, tight 2. response is out of proportion to the stomach actual importance of the situation 4. Behavioral (escape, 3. anxiety is uncontrollable: person avoidance, freezing, decrease cannot shut off alarm reaction appetite) 4. anxiety is disruptive: it interferes with relationships, jobs, academic performance, or everyday activities 1. Generalized Anxiety Disorders : Frequent experience of anxiety, worry, and apprehension more intense and longer lasting than the anxiety experienced by the average person. but still has adequate contact with reality and is rarely incapacitated enough to require institutionalization. Professional help really works here ☺ Lecture Notes - Classification 9 2. Panic Disorder: having reoccurring panic attacks. The frequency and duration can very. • the attacks themselves are quite unpleasant • fear of having an attack can interfere 3. Specfic Phobias: • Mild Phobias: many people are fearful of certain objects or situations, but may not experience incapacitating terror and anxiety Acro - heights • Clinical Phobias: severe and irrational fear due to a Hema - blood Keno -empty specific stimulus rooms o does it cause suffering Cyno – dogs o does it cause interference Aero – flying o Entomo - bugs Very easily treatable ☺ Gamo - marriage • Encountering the feared situation or object can Ophdo – snakes provoke a full-fledged panic attack. Xeno – strangers Garbage disposal spiders drains folding knives mice Melissa - bees • Agoraphobia (flexible definition) fear of having a panic attack in a public place from which it might be difficult to escape or get help. - Types of situations avoided include crowds, standing in line, stores or elevators, public transportation - Result: many become prisoners in their own homes, unable to beyond their front door. • Social phobia • Selective mutism • Separation anxiety Neurodevelopmental Disorders: Tourettes Syndrome Lecture Notes - Classification 10 Autism Spectrum Disorder What does spectrum mean? Asperger’s – no longer in the DSM “Aspies” Usually males – why? 75% Male intelligence? Hyper intra-wiring but hypo inter-wiring Symptoms – each person is different Savant – less than 10% of people with ASD Social cues Emotional regulation “Obsessions” with details and specific interests Sensory sensitivity Repetitive or self-soothing Intellectual Disability (Intellectual Developmental Disorder) Used to be called mental retardation
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