Module Introduction

Topics covered

• Current Understanding of Psychological Disorders
• Diagnosis of Psychological Disorders
• Biological Perspectives of Psychological Disorders
• Approaches to Therapy for Psychological Disorders ⁽¹⁾

The guilt I felt for having a mental illness was horrible. I prayed for a broken bone that would heal in six weeks. But that never happened. I was cursed with an illness that nobody could see and nobody knew much about. (Andy Behrman, 1965-  )

This module will cover chapters 14, 15 and 16 in the text. The module will cover the topics of psychological disorders and abnormal behavior, therapy and treatment, and the area of health psychology. Most students find this to one of the most, if not the most, interesting when studying psychology. We often observe the causes behavior that is outside of the norm for our society or culture. We may even label our own behavior by one of the labels that suggests madness or insanity. We do these things as human beings yet the reality of psychological disorders is frightening and confusing. ⁽¹⁾

Take a moment and image that you have broken or lost a limb, or perhaps a sense of vision or hearing. We have the power to relate to those illnesses or infirmities because we can see them ow imagine what it would be like to have to live without a certain ability. Now take a moment and imagine hallucinating or being delusional. Imagine thinking differently. Not so easy is it? Perhaps that is one thing that makes understanding psychological disorders or mental illness so difficult. To complicate the issue further, people suffering from anxiety, depression or a host of other disorders, are told to “snap out of it”, “think of something positive”, or “don’t let such a small thing worry you”. When we think or say statements like this, we forget that every thought we have is really physiological – the result of the firing of neurons, the neural transmission, and the quality or effectiveness of this process. In reality, not every thing is “all in your head” and “in your control”. ⁽¹⁾

It is important to define terms you will encounter in this module. A psychological disorder is a “condition characterized by abnormal thoughts, feelings and behavior”. The study of such disorders is called psychopathology and includes causes and symptomology as well as how the disorders is manifested or displayed. It is important to define what is meant by “ abnormal ”.

Anxiety about giving a speech in class is different from the anxiety one might suffer that prevents them from leaving the house. In this example, anxiety that prevents one from leaving their house would be described as abnormal because of the severity of symptoms and the fact that the symptoms affected the person’s ability to function in life.

Why do we diagnose psychological problems? Diagnosis is a basis for understanding and treating both physical and psychological problems. In the 1950’s the American Psychiatric Association (not the American Psychological Association, but with the same initials – APA), began a process for diagnosis called the Diagnostic and Statistical Manual of Mental Disorders (DSM). The first DSM was based on material developed by the U.S. Army during WWII. Since that time, the DSM has undergone multiple revisions and is now in it’s fifth revision known as the DSM 5. Revisions are based on new information about disorders as we research and develop a better understanding of mental health problems. Not only does the DSM 5 allow us to diagnose and treat more effectively, it allows us to look at incidence of problems and allows for change as we gain knowledge about the functioning of the brain and CNS. The ICD (International Classification of Diseases) is produced by the World Health Organization and includes both physical as well as psychological illness. The ICD is also used for diagnosis as well as providing information about incidence of physical and psychological illnesses.

The DSM 5 groups psychological disorders into categories depending on symptomology . The disorders range from those usually first diagnosed in infancy, childhood or adolescence to schizophrenic/psychotic disorders, mood disorders, gender identity disorders, and personality disorders. The DSM 5 also allows for diagnosis with a multi-axial assessment . In this process, the diagnosis also includes information that will affect understanding, prognosis and outcome such as medical condition and environmental problems. This more sophisticated process of diagnosis benefits the patient as well as the service provider as it takes into account personal and life stressors that affect the patient/client and impact outcome with proper intervention.

The text will take you through several diagnoses to help you better understand how the diagnostic/treatment process works. Do not be surprised if you “see yourself” in some of the categories.

Just remember that having some of the symptoms does not mean that you have the disorder. Psychopathology depends on severity and longevity of symptoms as well as whether or not the symptomology impairs or affects ability to function on a day to day basis.

One of the most interesting categories of psychological problems is the personality disorders . In the previous module you studied personality defined as one’s stable and consistent ways of thinking, behaving and relating to the world. With personality disorders, the individual is seen as having a personality that differs greatly from cultural expectations, is rigid and resistant to change, and causes difficulty in relating to the world around them. While people with personality disorder make up a small fraction of the population, they present some of the more interesting symptoms for study. The National Institute of Health (2007) estimates that approximately 9.1 percent of the population has some personality disorder. It is not uncommon for a person with a personality disorder to have symptoms of more than one disorder. It is also common for patients with personality disorders to have symptoms of an anxiety or mood disorder. When two or more diagnoses exist, it is called co-morbidity (co-existing). While the personality disorder may be resistant to change, the anxiety or mood disorder may be treated with psychotherapy and/or medication.

One of the more interesting personality disorders is the anti-social personality disorder . The anti-social is characterized by lack of emotions and inability to relate to other peoples feelings and rights. In many cases, the anti-social patient may present in the criminal population with behaviors ranging from theft to murder. You may be familiar with criminal such as Bernie Madoff , Ted Bundy, or Jeffrey Dahmer . They grab our attention because of the magnitude and/or horror of their crime. It is important to realize that some anti-social persons may learn to live inside of the laws of society and function without arrest. It is also possible for a person to have some of the symptoms of this, or other, disorders without meeting the full criteria for the disorder according to the DSM 5.

This module also addresses the issue of treatment and therapy for psychological disorders. There has long been a stigma attached to these types of illness. Historically the view of psychological/psychiatric disorders, has been blamed on witchcraft, spirits, and possession by demons. The treatment of these problems has ranged from hanging and burning at the stake to institutionalization in harsh conditions, with little or no “treatment” except isolation from society.

Today, illnesses are better understood and treated, however stigma, do some degree, still exists. Community mental health centers and short term hospitalization is available and out-patient therapy is the rule for most disorders. Psychopharmacology had made tremendous advances for the treatment of many disorders and expanded research in the field of psychology and psychiatry has seen the development of more effective therapy. Since Freud’s use of psychoanalysis many years ago, therapy has changed to focus more on cognitions, behavior, education and problem-solving techniques. Short term therapy is utilized more and focuses on coping skills and improving cognitions. Individual, marriage and family, and group therapies are offered to clients needing short-term intervention. For more severe psychiatric illnesses, medications are available with fewer negative side effects, thus allowing the individual to better cope in their environment. For families of the more severe illnesses, education and support is available to help them understand and cope with the family member.

With these changes, our information and ideas about dealing with substance abuse and addictive problems has also changed. With these problems, as with others, the goal is to return the patient to their environment with better coping skills that will allow them to control their addiction. With these problems, family therapy is also recommended. Educated and supported family members have much influence on the outcome for intervention with these and other illnesses.

This module will also cover the topic of Health Psychology, a relatively new area of focus that investigates stress, lifestyle, and the connection of physical and emotional health and well-being. Many physical and psychological illnesses and problems are connected to stress either as a causative factor or one that complicates illness and healing. In studying the connection of stress to illness, it is important to realize that some stress is inevitable and can even be positive. Physical and emotional trauma and life changes are being studied for their relationship to emotional health and well-being. An understanding of stress, and the physiological responses of the body, is important in helping individuals cope with stress and better manage coping skills to lessen the negative impact of stress on the body and mind.

Be sure to access the Links to Learning in this chapter, as well as the supplemental material, to better understand the material presented, as well as to give you different views on mental illness, diagnosis and treatment. ⁽²⁾