Psychopathology Midterm Examination
Deviance is a term in psychopathology that refers to the deviation of thoughts, behavior, and emotions from what society considers normal. Societal norms vary. Whatever is considered normal in one society may be deemed abnormal in another. For example, in American society, it is normal for the female gender to put on dresses that do not cover their knees. This is, however, forbidden in Islamic societies, as evident in countries such as Iran and Qatar. In these societies, it is abnormal for women to dress in dresses that do not cover their knees. Conflict with the local communities may ensue when these norms are contravened (Comer & Comer, 2022). It is therefore important that any woman traveling to these countries understands this distinction in societal definitions of normal.
Distress is a term in psychopathology that refers to psychological discomfort that causes interference in the normal activities of an individual. Psychological distress often results in a feeling of negativity towards self and towards the environment. Severe instances of distress have been linked with the presentations of anxiety and sadness. Psychological distress is subjective and whatever constitutes distress in an individual may not be distressful to another. For instance, sky diving is an extreme sport that many people consider dangerous and rather distressful. To these people, this sport is extreme and abnormal and they’d rather avoid it. To skydivers, this is a rather normal event though characterized by bursts of adrenaline. To them, sky diving is more fulfilling and the adrenaline rush is the fun part of it (Comer & Comer, 2022). Understanding the distinction between these two scenarios is important as it enables individuals to appreciate their counterparts who engage in these sporting activities without profiling them as reckless or careless with their lives.
Dysfunction is a term in psychopathology that refers to a disturbance in functionality in an individual. Disturbances in the thought processes, behavior, and emotional regulation all constitute the term dysfunction. Dysfunction can also be constituted by disturbances in psychological, biological, and developmental processes that often underline various psychiatric conditions. Dysfunction often leads to functional disability, with the affected individuals being unable to carry out routine activities such as self-care and social interactions. Dysfunction can be viewed as being unable to conform to societal norms. An individual who fails to undertake one of two responsibilities prescribed to them by society or who indulges in undesirable activities can be viewed as dysfunctional. For example, a father who fails to educate his children because of one reason or another may be considered dysfunctional. In contrast, a person who smokes and drinks alcohol but still can take care of themselves and their families is considered normal (Comer & Comer, 2022). Distinguishing these two scenarios is important as it prevents individuals from being profiled because of their behavior.
Danger, in psychopathology, is a term that defines a violent or dangerous behavior or activity that is directed at an individual or their environment. Behaviors that have the potential to inflict harm to self or others all constitute a danger. Danger can be contextualized as normal or abnormal depending on the implications of the actions involved. A dangerous behavior may sometimes not inflict harm to either the individual or those around them. In this case, the behavior may not constitute danger as defined in psychopathology. Danger can be considered normal in scenarios where one does not pose an immediate danger to themselves or their environment, e.g., when a person is struggling with depression. The same person may be considered to be in danger when they start having suicidal ideation (Comer & Comer, 2022). The distinction between the two scenarios is important as they may inform on when to closely monitor the individuals to prevent them from inflicting harm to themselves.
The theoretical models that best explain abnormality include cognitive-behavioral, biological, socio-cultural, and developmental psychopathology. The biological model of abnormality describes psychological abnormality from a medical or biological perspective. This model posits that human behavior, moods, and emotions are regulated by the brain and the neurochemicals. In this model, a psychological abnormality is attributable to an imbalance of neurochemicals in the brain. These abnormalities, just like physical illness, can be diagnosed and treated appropriately. This theoretical model suggests medical interventions, including pharmacological agents, as a remedy for these abnormalities. Prescription drugs, electroconvulsive therapy, and psycho-surgery are the mainstay modalities of treatment suggested in this model.
The behavioral model of psychological abnormality asserts that human behavior is a consequence of their environment and not their biology. This theory suggests that psychological abnormality in humans is determined by their life experiences and that these abnormalities are learned processes conditioned to them by their life experiences. This theory suggests unlearning strategies such as desensitization as a remedy to this learned behavior. In this regard, desensitization techniques are considerably recommended in the remedy of most psychological abnormalities. Behaviorists are targeted at tailoring psychopathology toward scientific models that focus on behavioral patterns that can be observed and measured (Miller, 2018). A classical belief of behaviorists is that current psychopathological presentation is due to past exposure to traumatic events and that identification of that traumatic event is key in the management of that patient.
The psychodynamic model of psychological abnormality links mental illnesses to an individual’s psychology. This theory was coined by Sigmund Freud and was targeted at enhancing the understanding of various mental illnesses. The model provides a rather optimistic view that mental illnesses can be treated effectively.
This model asserts that the etiologies of all mental illnesses are psychological, related to the unconscious mind, or result from failure in the defense mechanisms of an individual. The theory further postulates that most adult mental illnesses stem from unresolved conflicts in early childhood. This theory reinforces the need for patient history taking and the establishment of various unresolved conflicts in all patients presenting with mental illnesses. Childhood-related problems such as neglect, abuse, and trauma are implicated in the development of mental illnesses (Miller, 2018). This theory suggests the utilization of psychoanalysis and psychotherapies as the mainstay modalities in the management of mental illnesses.
The biological model of psychological abnormality remains the best. This theoretical model attributes mental illnesses to physical causes. In this regard, this model suggests that all psychopathologies should be diagnosed promptly and then managed appropriately using pharmacological therapies, electroconvulsive therapy, and surgery. Pharmacological therapy with drugs is the mainstay modality of treatment as defined by this theory. Several pharmacological agents that maintain effectiveness in treating mental illnesses have been developed. These drugs have been used for symptomatic relief rather than to cure these disorders. Up to 50% of patients have found considerable benefits from drug therapy (Miller, 2018). It is for this reason that this modality maintains superiority and underpins the significance of this model in defining psychological abnormalities. Other modalities defined in this theory are rarely used and are preserved for cases where other interventions are ineffective.
Clinical interviews are the preliminary step in psychopathology assessment and evaluation. During this process, the clinicians obtain the necessary information required to diagnose the patients. This information includes patient history, symptom presentation, and concerns. Patient history is a detailed piece of health information that gives an overview of the patient and what brought the patient to the clinic. During history taking, the patient’s biodata (name, gender, age, and residence of the patient) are obtained. Patient biodata gives the clinician an overview of whom they are dealing with. Information on the biodata, such as age, can be used to predict the propensity to certain mental health illnesses. Information on gender can also be used to predict the likelihood of some mental illnesses in patients.
Information on the concerns of the patient, their presenting illnesses, and the history of their presenting illnesses are also obtained during history taking. Identification of the presenting complaint is the first step toward patient management. This information gives an insight into whatever the clinicians will have to deal with. The patient’s presenting complaint is an account of how the patient is feeling and their health concerns in their own words. Information on the presenting complaints of the patients coupled with their symptom presentation is necessary for drawing the differential diagnosis list. Symptom presentation of various mental disorders varies, and knowledge of specific symptoms of various mental illnesses is key in the establishment of an accurate diagnosis. Another necessary information during history taking is the familial history of chronic disorders. This information gives insight into the likelihood of the patient developing or presenting with disorders with genetic predispositions. Specific concerns of the patients should also be taken into account during history taking. Concerns such as preferences and tastes, as well as their specific needs, are key in designing therapeutic plans for these patients. All this information can be obtained during the interview process.
The Diagnostic and Statistical Manual for Mental Disorders (DSM) is a diagnostic guide tool that aids mental health professionals in diagnosing mental illnesses accurately. The DSM-5 is the fifth version of this diagnostic manual. This manual list all known mental illnesses and groups them according to their symptom presentation. The DSM 5 is organized sequentially based on the developmental lifespan of various mental illnesses. Disorders that are mainly diagnosed during childhood are detailed first, followed by those diagnosed during adolescence and adulthood. Disorders that are typically diagnosed in late adulthood appear last. This diagnostic manual has 20 chapters. The chapter categorization is based on the similarity of sorts with disorders presenting with similar symptoms placed under one category. The sequence of the chapters in DSM 5 is based on the current level of understanding of symptoms presentation and underlying vulnerabilities associated with these disorders. Examples of chapters in this manual include Neurodevelopmental disorders; Schizophrenia spectrum and other Psychotic disorders; Bipolar and Related disorders; depressive disorders; Anxiety disorders; Obsessive-Compulsive and Related Disorders; Trauma and stressor-related disorders; and Dissociative disorders.
The DSM 5 consists of three major components: The diagnostic classification, the diagnostic criteria set, and the descriptive texts. The diagnostic classification component is the official list of all known mental illnesses. Each diagnosis listed in this section is coded with a diagnostic code derived from the International Classification of Diseases, Tenth Revision, and Clinical Modification (ICDM-10) coding systems. These codes are used by healthcare organizations, researchers, and other institutions for billing for these illnesses and for collecting data on these illnesses. These codes also provide an easier and more efficient way to refer to any of these illnesses.
The diagnostic criteria sets are defined for each mental illness. This criterion indicates the defining symptom for each mental illness as well as the duration in which the symptoms must exist to qualify for a diagnosis. These criteria offer a specific guide to the diagnosis of mental illnesses. They are, however, designed for use by healthcare professionals whose clinical judgment also plays part in the diagnosis of these illnesses (Regier et al., 2018). The descriptive text area of the DSM 5 accompanies each disorder and qualifies these disorders in terms of recording procedures, comorbidities, diagnostic and associative features, prevalence, risk, prognostic features, differential diagnosis, and functional consequences.
Generalized Anxiety Disorder (GAD): GAD is a mental health disorder characterized by worry, fear, and a feeling of being overwhelmed. This disorder is listed in the DSM 5 with symptoms of excessive anxiety, worrying, sleep disturbance, irritability, muscle tension, easy fatiguability, and restlessness. A positive diagnosis of this disorder is made when in the presence of anxiety and 3 of any other symptoms listed for at least 6 months. Gender, stress, substance abuse, genetics, and poor health are the most commonly implicated etiologies and risk factors for the disorder. Pharmacotherapy with drugs and psychotherapy have been used in the management of this disorder (Ströhle et al., 2018). The three most need to know about this disorder is its symptomatic presentation and criteria for its diagnosis, etiologies, risk factors, and treatment modalities.
Panic Disorder: Panic disorder is a mental health disorder characterized by frequent recurrent panic attacks. This disorder is defined in the DSM 5 as intense fear or discomfort that occurs abruptly, peaking within minutes. A positive diagnosis of panic disorder is made in the presence of an attack, followed by a period of concern about having another attack, and accompanied by behavioral changes to avoid a similar situation. Panic disorders differ from panic attacks in that panic attacks can occur in other disorders other than panic disorders, such as anxiety and substance use, and pharmacological interventions have been used in the management of panic disorders (Kim, 2019). The three needs to know are what constitutes a panic disorder, the difference between a panic disorder and panic attacks, and the management of panic disorders.
Obsessive-Compulsive Disorder (OCD): OCD is a mental health disorder characterized by discomforting intrusive thoughts. OCD is listed as a chapter in the DSM 5 encompassing other disorders in the spectrum such as body dysmorphic disorder, hoarding disorder, and obsessive-compulsive disorder, among others. A positive diagnosis is made in the presence of obsessive and compulsive symptoms that are recurrent and result in significant clinical distress and impairment in social and occupational functionalities. Pharmacological therapy with drugs is the mainstay treatment for OCD (Stein et al., 2019). The three needs to know are symptom presentation, treatment modalities, and etiology since bacterial infections with streptococcus have been implicated in this disorder.
Post-Traumatic Stress Disorder (PTSD); PTSD is a mental health disorder that results upon exposure to a life-threatening, traumatic event, death, or sexual assault. This disorder has been associated with significant morbidity and mortality as well as in functional impairment. A positive diagnosis of PTSD is made in the presence of a history of exposure to a traumatic event and intrusive symptoms such as distressing nightmares, dissociative reactions, and marked physiologic reactions upon exposure to an event (Miao et al., 2018). The three needs to know about PTSD are what constitutes PTSD, treatment modalities, and its epidemiology. The prevalence of PTSD is higher in specific groups due to increased predisposing factors in these groups. Such groups as war veterans have an increased risk of developing PTSD.
Somatic Symptom Disorder: Somatic symptom disorder is a mental health disorder in which one or more presenting physical symptoms are accompanied by excessive thoughts, emotions, and behavior and is usually distressing or cause dysfunction. This disorder is a new inclusion in the DSM. Risk factors of this disorder include substance abuse, childhood neglect, and sex abuse. Its diagnosis is made in the presence of a distressing physical symptom accompanied by one or more thoughts and related behavior lasting 6 months. Management of this disorder is targeted at symptomatic relief (Thielke, 2018). The three needs to know are the presentation of somatic symptom disorder, its management strategies, and the risk factors associated with the disorder.
Major Depressive Disorder: Major depressive disorder (MDD) is a mental health disorder that is characterized by persistent low or depressed mood, displeasure in routine activities, feelings of worthlessness, and anhedonia. A positive diagnosis of major depressive disorders, as defined by the DSM, is the presence of at least 5 depressive symptoms presenting within two weeks. Pharmacotherapy with antidepressants and psychotherapy are the main treatment modalities for this disorder (Trivedi, 2020). The three needs to know are: what defines depression, complications, and its differential diagnosis since MDD shares symptomatic presentation with other disorders such as bipolar, malignancies, metabolic imbalances, some medications, and nutritional deficiencies. MDD has been implicated in significant morbidity and mortality. The majority of these mortalities are attributable to suicides.
Bipolar Disorder: Bipolar disorder is a complex mental health disorder characterized by depressive, manic, and hypomanic episodes. Bipolar disorder is a chronic disorder that has been implicated in functional disability morbidity and mortality. This disorder is a heritable disorder with a propensity to genetic predisposition. A positive diagnosis of this disorder is made in the presence of mood disturbance that causes social and occupational disturbances. This disorder is managed with mood stabilizers and antipsychotic medications (Culpepper, 2018). The three needs to know are that bipolar is characterized by manic and depressive phases, that bipolar is a heritable mental disorder and the treatment strategies for this disorder.
Research variables in research that have been found to correlate with an increased risk of suicidal ideation and tendencies include country, race, religious affiliations, social environment, marital status, and gender. Suicide tendencies vary from country to country. Suicide rates in the U.S. are relatively higher than suicidal rates in countries such as Germany, England, and China. Globally, suicidal rates are found to be highest in Lesotho, Guyana, Eswatini, and South Korea. Suicidal rates also varied with religious affiliation, and societal belief rates were relatively lower in Muslim, Jewish, and Catholic societies. This may be attributable to their strict condemnation of suicide as an undesirable out of normal behavior.
Suicidal attempts were found to be higher in women. Suicidal attempts in females are up to three times higher in females than in males. However, suicidal mortality rates were up to threefold higher in the male population than in the female. This indicates that more women attempt but do not complete their suicidal attempts as opposed to males. This is because males tend to use more aggressive methods in their suicidal attempts. Race variations are also present. Suicidal rates were highest among non-Hispanic whites. Rates were twice as high in this group than in African Americans, Hispanic whites, and Asian Americans. Suicidal rates were higher in socially isolated individuals. Rates were also higher in persons who are not married.
Suicidal tendencies have been attributable to several psychopathologies. Mental health disorders, adverse childhood experiences, alcohol and substance abuse, as well a family history of suicidal tendencies all showed a positive correlation with suicidal ideation, attempts, and completions (Brådvik, 2018). Mental health disorders are the largest contributory factors to suicidal tendencies. Depressive disorders have been implicated in significant mortalities resulting from suicides. Suicide risk is even higher in the presence of comorbidities with other mental health disorders or in the presence of alcohol and substance abuse. Suicidal tendencies seen in depressive disorders are thought to be associated with the symptomatic presentations of this disorder. In these individuals, considerable disturbances in the thought process are always apparent, coupled with a feeling of worthlessness. Suicide tends to be the last resolve for these individuals.
Alcohol and substance abuse have also been implicated in mortalities attributable to suicide. Alcohol is thought to increase suicidal tendencies through behavioral disinhibitions, impulsiveness, and judgment impairment. Excessive alcohol consumption has been found to correlate to higher suicidality. Alcohol intake has also been used as a coping mechanism for issues involving mental health, suicidal ideation, and trauma. In the long run, the impact is often dire, with considerable mortality being realized.
Adverse childhood experiences have also been implicated in suicidal ideation and tendencies. Research findings reveal a correlation between adverse childhood events and increased propensity to mental health illness and consequent suicidal tendencies. These findings show that the female gender with adverse childhood experiences is more likely to suffer from suicidal tendencies than their male counterparts. Accumulation of these adverse experiences increased adulthood suicidal tendencies up to threefold (Thompson et al., 2018). Mood disorders and anxiety are also associated with suicidal ideation and tendencies. Approximately 30% of all reported suicidal tendencies and ideation are persons with a history of either mood or anxiety disorders. These statistics indicate that there is a correlation between these psychopathologies and suicidal tendencies. The exact cause is, however, yet to be established. These findings can inform the health promotional activities targeted at preserving the lives of all susceptible individuals.
Brådvik, L. (2018). Suicide Risk and Mental Disorders. International Journal Of Environmental Research And Public Health, 15(9), 2028. https://doi.org/10.3390/ijerph15092028
Comer, R., & Comer, J. (2022). Abnormal Psychology-Worth Publishers (2017).pdf. Google Docs. Retrieved 14 May 2022, from https://drive.google.com/file/d/1Ek6pbIxxG5p1XfUsJ6YIFZkw-diRIf6-/view?usp=sharing.
Culpepper, L. (2018). The Diagnosis and Treatment of Bipolar Disorder. The Primary Care Companion For CNS Disorders. https://doi.org/10.4088/pcc.13r01609
Kim, Y. (2019). Panic Disorder: Current Research and Management Approaches. Psychiatry Investigation, 16(1), 1-3. https://doi.org/10.30773/pi.2019.01.08
Miao, X., Chen, Q., Wei, K., Tao, K., & Lu, Z. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1). https://doi.org/10.1186/s40779-018-0179-0
Miller, R. (2018). Theoretical models of abnormal psychology: Approaches to diagnosis, assessment, and development. Not So Abnormal Psychology: A Pragmatic View Of Mental Illness., 61-93. https://doi.org/10.1037/14693-003
Regier, D., Kuhl, E., & Kupfer, D. (2018). The DSM-5: Classification and criteria changes. World Psychiatry, 12(2), 92-98. https://doi.org/10.1002/wps.20050
Ströhle, A., Gensichen, J., & Domschke, K. (2018). The Diagnosis and Treatment of Anxiety Disorders. Deutsches Ärzteblatt International. https://doi.org/10.3238/arztebl.2018.0611
Thielke, S. (2018). Somatic Symptom Disorder and Related Conditions. Deckermed Psychiatry. https://doi.org/10.2310/psych.13029
Thompson, M., Kingree, J., & Lamis, D. (2018). Associations of adverse childhood experiences and suicidal behaviors in adulthood in the U.S. nationally representative sample. Child: Care, Health And Development, 45(1), 121-128. https://doi.org/10.1111/cch.12617
Trivedi, M. (2020). Major Depressive Disorder in Primary Care. The Journal Of Clinical Psychiatry, 81(2). https://doi.org/10.4088/jcp.ut17042br1c
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This is an open book, non-proctored, and non-timed examination. The material covered in this examination comes from your reading assignments for the first four weeks of this class. You must make connections to and properly cite your readings or other reference materials in each of your answers.
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