Chapter Ten: Psychological Disorders

Defining and Diagnosing Disorder

INTRODUCTION

This chapter begins with a description of the criteria for defining mental disorders and how psychologists assess them.

WHAT'S AHEAD

• Why were slaves who dreamed of freedom once considered to have a "mental disorder"?
• What's wrong with using tests such as the famous "inkblot" test to diagnose disorders?
• Why is the standard guide to the diagnosis of mental disorders so controversial?

KEY CONCEPTS

Defining Disorders
Assessing Mental Disorders
Diagnosis: Art or Science?

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Defining Disorders (p.334)

INTRODUCTION

The terms "abnormal behavior" and "mental disorders" are not the same. Specific criteria are necessary to define mental disorder.

KEY CONCEPTS EXPLAINED

Abnormal behavior simply refers to statistically rare behaviors, while some mental disorders (e.g. anxiety and depression) are common.

..Insanity

• A legal term only.
  
  
• Person is not aware of the consequences of their actions and can not control their behavior.

..Criteria for defining "Mental Disorder" as a psychological concept:

1. Violation of cultural standards.
   • Breaking the rules is seen as deviant.
     
     
   • Varies from culture to culture.
     
   • Can serve those in power:
     
     
     • Drapetomania
       
       
       • Defn: "Urge to escape from slavery".
         
         
       • More convenient to maintain the status quo by considering the urge to seek freedom a "mental illness" rather than the intolerable conditions of slavery.
         
         
     • Popophobia - the "urge to avoid classes with pop exam's" could be made into a mental disorder rather than have professors admit that pop exams are cruel and unusual punishment.
       
       
2. Maladaptive behavior.
   
   
   • Negative consequences to self or others.
     
     
3. Emotional distress.

..Working definition of mental illness:

"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 person's relationships or the larger community."

GLOSSARY

	mental disorder

LINKS About the CNS spinal cord

• www link: Mental illness in America.
• www.link: Epidemiology of mental illness.
• wwwlink: Facts about mental illness [caution - irritating geocities site].

Assessing Mental Disorders [p.335]

INTRODUCTION

The person is evaluated (diagnosed) through results of interviews, observations, and psychological tests.

KEY CONCEPTS EXPLAINED

..Projective Tests

• Reveal unconscious motives, feelings and conflicts.
  
  
• Based on psychodynamic theories of behavior and personality. [rewind to psychodynamic theory of personality chapter 2.]
  
  
• Benefits - establish rapport with the patient.
  
  
• Negative Aspects - low reliability and validity.
  
  
• Rorschach Inkblot Test - "What do you see in this inkblot?"
  
  
• Thematic Apperception Test (TAT) - "Make up a story about this picture."
  
  
  • Better reliability and validity when predicting specific motivations.

..Objective Tests

• Standardized questions about behavior and feelings.
  
  
• Some tests assess specific psychological problems.
  
  
• Minnesota Multiphasic Personality Inventory (MMPI).
  
  
  • Organized into hundreds of clinical scales.
    
    
  • "I enjoy reading comic books."
    
    
  • More reliable and valid than projective tests.
    
    
  • Does not adequately handle cultural, ethnic, and socioeconomic differences of people.

GLOSSARY

	projective tests
	Rorschach Inkblot Test
	inventories
	Minnesota Multiphasic Personality Inventory (MMPI)

LINKS about Psychological Tests

• www link: More detailed description of the Rorschach Inkblot Test.
• www.link: History of objective tests.
• wwwlink: Slide show description of the development of the MMPI.

Diagnosis: Art or Science [p.337]

INTRODUCTION

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard guide for diagnosing disorders.

KEY CONCEPTS EXPLAINED

..Aim of DSM.

Provide clear descriptive categories so that we can achieve agreement on the disorder in order that it can be accurately studied and treated.

..Five axes of disorders on the DSM provide a full description of
..the individual's functioning:

1. Axis I: Primary clinical problem.
   
   
2. Axis II: Ingrained aspects of the person's personality.
   
   
3. Axis III: General medical conditions that would affect the disorder.
   
   
4. Axis IV: Social and environmental problems.
   
   
5. Axis V: Global assessment of the person's overall functioning.

..Limitations of the DSM.

1. Danger of overdiagnosis
   
   
   • Creating a diagnostic category fosters making diagnoses of that disorder.
     
     
   • Example: Dissociative disorder. [fast forward to Dissociative Disorder]
     
     
2. The Power of diagnostic labels.
   
   
   • Rosenhan study: People posing as "pseudopatients" offer one ambiguous symptom which gets them diagnosed as mentally disordered (schizophrenic) and admitted to the hospital. The pseudopatients stop faking any symptoms and act normally, but the diagnostic label given to them was so powerful that the staff interpreted even normal behavior as further signs of their mental disorder.
     
     
   • Labels can also create a self-fulfilling prophecy for the individual as they try to conform to the characteristics of the assigned diagnosis. [rewind to self-fulfilling prophecy in chapter 2]
     
     
3. Confuses serious mental disorders with normal problems.
   
   
   • Lumping together everyday disorders (e.g."mathematics disorder" and "caffeine-induced sleep disorder") with true mental illness might suggest everyday problems are comparable to serious disorders.
     
     
4. The illusion of objectivity.
   
   
   • Critics argue that DSM gives the appearance of science and objectivity to an inherently subjective process.
     
     
   • Group consensus decides which diagnoses go into DSM so that cultural bias can creep in.

..Defense of DSM.

• Empirical support for many of the categories.
  
  
• Facilitates proper treatment.
  
  
• Many diagnoses would apply across cultures.

LINKS about DSM

• www link: Sample DSM description of a disorder.
• www link: Normal Person Disorder.
• www link: Criticism of the DSM.

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