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Introduction to psychological disorders

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Anna Madill

on 31 October 2016

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Transcript of Introduction to psychological disorders

Classification and Models of Mental Disorder
Central tenets of the social model
1) Mental disorder is often triggered by life events (such as a relationship breakdown) that appear to be independent of the disorder
2) Social forces linked to class, occupational status, and social role are the precipitants of mental disorder
3) People with mental disorder often become and remain disordered because of societal influences

A hierarchy of models

Lecture 1
Classification and Models of Mental Disorder
Professor Anna Madill
School of Psychology
University of Leeds

PSYC 2503/3403 Psychological Disorders
 

Learning objectives

After this lecture and your own independent reading you should be able to:
1) understand the DSM system for classifying mental disorders
2) explain the different models of mental disorder and their inter- relationships


Reading
Comer, R. J. Fundamentals of Abnormal Psychology. Relevant chapters
Tyrer. P. & Steinberg, D. Models for Mental Disorder.


Critical thinking

Is it necessary for society to deem some forms of behaviour and experience abnormal?


1) Statistical infrequency
The remaining criteria help us decide which infrequent characteristics are abnormal.
2) Unexpectedness of response
3) Norms violation
4) Personal distress
5) Disabling

All these criteria are flawed in isolation but taken together offer a useful framework.


What is ‘abnormality’?: Family resemblances approach



Diagnosis
The identification of disease by means of its signs
(what is observed) and symptoms (what the patient describes).


Classification
1939 World Health Organisation added mental disorder to the
International List of Causes of Death
1948 List expanded to include classifications of abnormal
behaviour (International Classification of Diseases)
1952 American Psychiatric Association first published DSM
(Diagnostic and Statistical Manual)
1980 DSM-III
1993 ICD-10
1994 DSM-IV
2000 DSM-IV-TR (Text revision- few changes to
diagnostic categories or criteria- added info on rates,
development, treatments)
2013 DSM-5

Advantages
Helps determine clinical features
Systematises diagnosis
Shared understandings

Disadvantages
Stigmatises
Pigeon holing
Natural versus constructed categories
see Hearing Voices Network

Classifying mental disorder

Biological (or Disease)

Behavioural (or Learning)

Cognitive

Psychodynamic (or Psychoanalytic)

Social

Models of mental disorder

Benefits of the biological model
Research into role of heritability
Role of neurotransmitters
Efficacy of some biological treatments

Problems with the biological model
Passive patient
Problem situated within patient’s body
A biological treatment ≠ biological cause
Relapse

Central tenet of the biological model
Mental disorder is a consequence of physical and/or chemical changes
or deficits in the brain and/or body.

COGNITIVE-BEHAVIOURAL MODEL
BEHAVIOURAL MODEL
COGNITIVE MODEL
1) Behaviour constitutes the main features of mental disorder
2) The origin and persistence of dysfunctional behaviour can be understood through the science of learning theory
3) The application of learning theory removes maladaptive behaviour and, in so doing, cures the disorder

Classical conditioning: learning through association
Operant conditioning: learning through consequences
Modelling: learning through copying

Central tenets of the behavioural model

Benefits

Scientific
Clear concepts
Effective treatment (particularly for anxiety disorders)



Problems

Symptom substitution
Therapies crude and mechanistic
Poor explanatory model
Mental processes
Benefits and problems of the behavioural model
People’s view of their world is determined by their thinking (cognition)

Cognition influences symptoms, behaviour and attitudes

Impaired (dysfunctional) cognition creates mental disorders

Significant change in mental disorder needs to involve significant change in cognition


Central tenets of the cognitive model

Benefits
Clear concepts
Scientific
(depression: ‘I have always been a failure’
anxiety: ‘What if I can’t cope’)
Effective treatment (particularly in combination with behavioural elements)
Problems

Poor explanatory model
Changed thinking ≠ changed behaviour
Individualistic
Benefits and problems of the cognitive model
Central tenets of the psychodynamic model
1) The focus is the pattern of feelings
2) We are unaware of many influential feelings









3) A technically structured approach is needed to tap unconscious feelings
4) Important feelings manifest in emotional reactions to the therapist known as transference








5) As important, are the therapist’s reactions to the patient, known as counter-transference
6) The therapist attempts to be objective and non-judgemental






7) Troubling feelings, inconsistencies, irrationalities are part of the universal balancing act involved in being human: it is imbalance that underlies emotional disorder
8) Unconscious processes are influential in all relationships







9) Unconscious feelings find an important part of their expression in symbols: such as in dreams
Benefits

Enduring contribution
Emphasis on childhood experiences
Idea of unconscious influencing behaviour

Problems
Based on anecdotal evidence, not objective or scientific
Findings based on small group of middle class Viennese
Power of therapist
Insight into problems ≠ problem resolution

Benefits and problems of the psychodynamic model
The
next
model
is
wait for it...
Draws attention to the role of society and of traumatic events
Is it the job of the mental health professional to fight social ills?
Benefits and problems of the social approach
Central tenets of an integrated model of mental disorder
1) We each have several levels of functioning
2) When mental disorder
develops it can affect
one or more levels
3) At different times in
the course of the disorder the predominant level of dysfunction may change
4) Each model links specifically to one level of function
5) Successful treatment involves matching the
main level of
disturbance with
the appropriate
model and its philosophy
of management: multi-disciplinary approaches
Can be used alongside the stress-vulnerability model:

1) A predisposition (diathesis/vulnerability) to mental disorder is triggered by environmental, or life, disturbance (stress)

2) The predisposition could be at a biological, cognitive, and/or
emotional level
Matching models with the treatment of elderly Mr Smith who is still feeling very low several months after the death of his wife.

Biological model
Prescribe medication

Behavioural model
Reward outgoing social behaviour

Cognitive model
Encourage functional thinking

Psychodynamic model
Facilitate exploration of feelings

Social model
Provide support and care
Increasing
severity
Psychiatrist
Psychotherapist
Social
Worker
Full transcript