PSY 100Y5
PSYCHOLOGICAL DISORDERS LECTURE
DR. KIRK R. BLANKSTEIN
OUTLINE
 Studying Psychological Problems
 What’s Abnormal?:
“And you thought you were crazy!”
 Classification of Disorders:
The Diagnostic and Statistical Manual
 Prevalence of Disorders in Ontario
 Causes of Disorders:
The Biopsychosocial Model
 Video: Review and Introduction to
Specific Disorders
 The DSM Definition of Mental
Disorders
 Specific Examples:
Anxiety Disorders and Schizophrenia
AND YOU
THOUGHT YOU
WERE CRAZY!
 “WHEN I TAKE A SHOWER, I
HAVE A FEAR THAT A SNAKE
OR SOME KIND OF REPTILE
WILL COME UP THROUGH THE
PIPES, SO I CLOSE DOWN THE
DRAIN. I USUALLY HAVE TO
TAKE A MEDIUM TO SHORT
SHOWER AS A RESULT AND END
UP WITH WATER UP TO MY
KNEES, BUT I DEFINITELY
MANAGE TO DO AWAY WITH
THE SNAKES.”
UNIVERSITY
STUDENT,MALE,AGE 22
Davison, Neale, Blankstein, & Flett (2002)
 COMPONENTS OF ABNORMAL
BEHAVIOR
 STATISTICAL INFREQUENCY
 VIOLATION OF NORMS
 PERSONAL DISTRESS
 DISABILITY OR DYSFUNCTION
 UNEXPECTEDNESS
 “BECAUSE THE FIELD IS CONTINUALLY
EVOLVING, IT IS NOT POSSIBLE TO OFFER A SIMPLE
DEFINITION OF ABNORMALITY THAT CAPTURES IT IN
ITS ENTIRETY. THE CHARACTERISTICS PRESENTED
CONSTITUTE A PARTIAL DEFINITION, BUT THEY ARE
NOT EQUALLY APPLICABLE TO EVERY DIAGNOSIS”
(p. 5).
SUMMARY OF THE
DSM-IV
DEFINITION OF MENTAL DISORDERS
DEFINING CHARACTERISTICS
 A BEHAVIORAL OR PSYCHOLOGICAL
SYNDROME (GROUPS OF ASSOCIATED
FEATURES) THAT IS ASSOCIATED WITH
 PRESENT DISTRESS (PAINFUL SYMPTOMS), OR
DISABILITY (IMPAIRMENT IN ONE OR MORE
IMPORTANT AREAS OF FUNCTIONING), OR WITH
A SIGNIFICANTLY INCREASED RISK OF
SUFFERING DEATH, PAIN, DISABILITY, OR AN
IMPORTANT LOSS OF FREEDOM
 CONDITIONS EXCLUDED FROM
CONSIDERATION
 THIS SYNDROME OR PATTERN MUST NOT BE
MERELY:
AN EXPECTABLE AND CULTURALLY
SANCTIONED RESPONSE TO A PARTICULAR
EVENT (SUCH AS THE DEATH OF A LOVED ONE)
DEVIANT BEHAVIOR (SUCH AS THE ACTIONS OF
POLITICAL, RELIGIOUS, OR SEXUAL
MINORITIES)
CONFLICTS THAT ARE BETWEEN THE
INDIVIDUAL AND SOCIETY (SUCH AS
VOLUNTARY EFFORTS TO EXPRESS
INDIVIDUALITY)
PSY240L1
CRITICAL
THINKING
 DO YOU THINK IT IS
POSSIBLE TO ELIMINATE
SOCIAL VALUES FROM A
DEFINITION OF ABNORMAL
BEHAVIOR? HOW WOULD YOU
ACCOMPLISH THIS GOAL? IS
THERE ANY WAY OF
DEFINING MENTAL
DISORDERS THAT WOULD
AVOID VALUE JUDGMENTS
ABOUT WHICH BEHAVIORS
ARE ADAPTIVE AND WHICH
ARE NOT?
DEFINITIONS
CLASSIFICATION
(or TAXONOMY)
SYSTEMATIC DESCRIPTION OF
THE MAJOR CATEGORIES OR
DIMENSIONS OF DISORDERS
(for either scientific or clinical
purposes)
DIAGNOSIS
PROCESS OF ASSIGNING AN
INDIVIDUAL TO A CATEGORY
OF THE CLASSIFICATION
SYSTEM
DSM-IV
Coverage of “Mental Disorders”
 49 main headings
 41 subcategories
 394 total listings
within categories
NEWROSES FOR THE
‘80s (New Millennium?)
by JOHN V. FLOWERS & BERNARD SCHWARTZ
example
 AFFLICTS THOSE PEOPLE WHO
HAVE READ TOO MANY SEX
MANUALS THAT STRESS
PLEASING ONE’S PARTNER,
WITH THE RESULT THAT THEY
CANNOT HAVE AN ORGASM
BEFORE THEIR MATE DOES.
 THIS IS NOT A PROBLEM
UNTIL THEY MEET ANOTHER
PERSON SUFFERING FROM
THE SAME DISORDER.
Two important changes in
DSM-III, III-R, & IV
 INCREASE IN THE
SPECIFICITY OF
CRITERIA FOR EACH
CLASS OF
DISORDERS
 USE OF A
MULTIAXIAL
DIAGNOSTIC
SYSTEM
DSM-IV:
MULTIAXIAL CLASSIFICATION
AXIS I:
CLINICAL DISORDERS
OTHER CONDITIONS
THAT MAY BE A
FOCUS OF CLINICAL
ATTENTION
AXIS II
PERSONALITY DISORDERS
MENTAL RETARDATION
AXIS III
GENERAL MEDICAL
CONDITIONS (WITH
ICD9CM CODES)
AXIS IV
PSYCHOSOCIAL &
ENVIRONMENTAL
PROBLEMS
AXIS V
GLOBAL ASSESSMENT OF
FUNCTIONING (GAF)
Different Cultures and the
DSM-IV

Brain Fag:
A term initially used in West Africa to refer to
a condition experienced by high school or
university students in response to the
challenges of schooling. Symptoms include
difficulties in concentrating, remembering,
and thinking. Students often state that their
brains are “fatigued.” Additional somatic
symptoms are usually centered around the
head and neck and include pain, pressure or
tightness, blurring of vision, heat, or
burning. “Brain tiredness” or fatigue from
“too much thinking” is an idiom of distress in
many cultures, and resulting syndromes can
Have
youcertain
ever experienced
“brainand
resemble
Anxiety, Depressive,
Somatoform Disorders.
fag”?
Would your family/significant others accept your
attribution to brain fag as a credible explanation for
your own responses to the challenges of university?
CRITICAL
THINKING
Hooked on the Net
“Is ‘Internet Addiction Disorder’
truly the scourge of the info age,
or merely the fanciful notion of
yet another late 20th century
would-be pop psychology
guru?”
EXPLAIN YOUR ANSWER.
(By S. J. Ross, Special to the Star: The
Toronto Star, May 21, 1998, Section
J.)
UNTREATED MENTAL
DISORDER?
 IN 1990, ALMOST 19% (1,218,000)
OF ONTARIONS AGED 15 TO 64
YEARS MET THE CRITERIA
FOR A MENTAL DISORDER
 75% (920,000) DID NOT SEEK
HELP OF ANY KIND FOR THEIR
EMOTIONS, NERVES, MENTAL
HEALTH OR USE OF ALCOHOL
OR DRUGS
 PROPORTION OF PEOPLE NOT
SEEKING HELP HIGHEST FOR
15 TO 24 YEAR OLDS (86%),
MALES (81%) & THOSE LIVING
IN RURAL AREAS (81%)
DISABILITY COSTS
TO SOCIETY
(OFTEN UNRECOGNIZED BECAUSE OF STIGMA ATTACHED
TO SYMPTOMS OF MENTAL DISORDERS & TREATMENT)
LOSS OF PRODUCTIVITY
 IN ONTARIO, THE MONTHLY TOTAL
NUMBER OF DAYS LOST BY THOSE
WITH MENTAL DISORDERS CAN BE
ESTIMATED AT 1,828,200
DISRUPTION OF FAMILY
LIFE
DYSFUNCTIONAL INTERPERSONAL
RELATIONSHIPS CREATE GREATER
HEALTH RISKS FOR ALL WHO ARE
INVOLVED
LOWER QUALITY OF LIFE
TRULY ECONOMICALLY
DISADVANTAGED
PERSONAL MISERY
Psychological
factors
Levels of Analysis in
ASSESSMENT
personality
cognitive style
social skills
Biological
factors
symptoms of
psychopathology
(diagnosis)
brain structure
neurochemistry
hormones
autonomic nervous
system functions
Social factors
marital adjustment
family functioning
peer relationships
work & school
satisfaction
The clinician’s conceptual approach to a person’s problem will
determine the selection of assessment instruments. This figure
lists examples of variables that might be considered within each
broad conceptual level.
WHAT IS NORMAL?
 WHAT TO LOOK FOR:
 DEFINITIONS OF
ABNORMAL
 EXAMPLES
 DIAGNOSIS: THE DSM
 PROS & CONS?
 EXAMPLES OF DISORDERS:
DEPRESSION &
ANXIETY
 CAUSES
 TREATMENT
CRITICAL
THINKING
THINK OF 2 OR 3 BEHAVIORAL
PATTERNS THAT OTHERS
WOULD SAY ARE MOST
CHARACTERISTIC OF YOU.
WHAT BIOLOGICAL, SOCIAL,
AND PSYCHOLOGICAL
FACTORS INFLUENCED THE
DEVELOPMENT OF THESE
BEHAVIORS? EXPLAIN YOUR
ANSWER.
CRITICAL
THINKING
WHAT IS THE APPROPRIATE LEVEL FOR
INTERVENTION WITH PSYCHOLOGICAL
DISORDERS?
DO YOU FAVOR MEDICATION,
PSYCHOTHERAPY, FAMILY TREATMENT, OR
SOCIAL CHANGE?
IN WHAT WAYS DO YOUR VIEWS ABOUT THE
NATURE AND CAUSES OF ABNORMAL
BEHAVIOR INFLUENCE YOUR THOUGHTS
ABOUT TREATMENT?