CURRENT PARADIGMS IN PSYCHOPATHOLOGY Psikologi Abnormal-Kuliah 2.

CURRENT PARADIGMS IN PSYCHOPATHOLOGY

Psikologi Abnormal-Kuliah 2

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Current Paradigms: Genetic

Heredity plays a role in most behavior Genes

Carriers of genetic information (DNA) Impacted by environmental influences

e.g., stress, relationships, culture Relationship between genes and

environment is bidirectional Nature via nurture (Ridley, 2003)

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Important Genetic Terms

Gene expression Proteins influence whether the action of a

specific gene will occur Polygenic transmission

Multiple gene pairs vs. single gene Heritability

Extent to which variability in behavior is due to genetic factors Heritability estimate ranges from 0.00 to 1.00 Group, rather than, individual indicator

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Environmental Effects

Shared environment Events and experiences that family

members have in common Nonshared environment

Events and experiences that are unique to each family member

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Behavior Genetics

Study of the degree to which genes and environmental factors influence behavior

Genotype Genetic material inherited by an individual Unobservable

Phenotype Expressed genetic material Observable behavior and characteristics Depends on interaction of genotype and

environment

Current Paradigms: Neuroscience

Examines the contribution of brain structure and function to psychopathology Mental disorders are linked to

aberrant processes in the brain. Four mechanisms:

Neurons and neurotransmitters Brain structure and function Autonomic system Neuroendocrine system

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Figure 2.3 The NeuronBasic Unit of the Nervous System

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Neurons and Neurotransmitters

Neurotransmitter Chemicals that allow

neurons to send a signal across the synapse (gap) to another neuron.

Receptor sites on postsynaptic neuron absorb neurotransmitter Excitatory Inhibitory

Reuptake Reabsorption of leftover

neurotransmitter by presynaptic neuron

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Neurotransmitters and Psychopathology

Serotonin and dopamine Depression, mania, and schizophrenia

Norepinephrine Anxiety and other stress related disorders

Gamma-Aminobutyric Acid (GABA) Anxiety

Possible mechanisms Excessive or inadequate levels Insufficient reuptake Excessive number or sensitivity of postsynaptic

receptors

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Figure 2.5 The Process by which a Second Messenger is Released

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Figure 2.6 Brain Structure and Function

Sulci define regions or lobes: Frontal Parietal Temporal Occipital

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Autonomic Nervous System (ANS) Sympathetic Nervous System

Excitatory Heartbeat acceleration, pupil dilation,

gastrointestinal inhibition, electrodermal activity increases

Parasympathetic Nervous System Quiescent Heartbeat deceleration, pupil constriction,

gastrointestinal activation Involved in anxiety disorders, especially

Panic and PTSD

Copyright 2009 John Wiley & Sons, NY

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Neuroscience and Treatment

Psychoactive drugs alter neurotransmitter activity Antidepressants Antipsychotics Benzodiazepenes

A neuroscience view does not preclude psychological interventions


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Evaluating the Neuroscience Paradigm Reductionism

View that behavior can best be understand by reducing it to its basic biological components Ignores more complex views of behavior


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Current Paradigms: Psychodynamic

Fails to contribute to our empirical understanding of the causes of psychopathology Greatest contribution are in treatment


Role of the Unconscious

Contemporary theorists have attempted to study the unconscious scientifically Pathogenic beliefs

Beliefs that occur outside of conscious awareness Trigger maladaptive thoughts and emotions

Implicit memory Cognitive neuroscience paradigm

The unconscious may reflect efficient information processing rather than a repository for troubling material


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Importance of Interpersonal Relationships Object relations theory

Longstanding patterns of relating to others Attachment theory

Type and style of infant’s attachment to caregivers can influence later psychological functioning.

Relational self Individuals will describe themselves

differently depending upon which close relationships are told to think about (Chen et al., 2006)


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Neuroscience and Treatment

Psychoactive drugs alter neurotransmitter activity Antidepressants Antipsychotics Benzodiazepenes

A neuroscience view does not preclude psychological interventions


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Evaluating the Neuroscience Paradigm Reductionism

View that behavior can best be understand by reducing it to its basic biological components Ignores more complex views of behavior


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Current Paradigms: Psychodynamic

Fails to contribute to our empirical understanding of the causes of psychopathology Greatest contribution are in treatment


Role of the Unconscious

Contemporary theorists have attempted to study the unconscious scientifically Pathogenic beliefs

Beliefs that occur outside of conscious awareness Trigger maladaptive thoughts and emotions

Implicit memory Cognitive neuroscience paradigm

The unconscious may reflect efficient information processing rather than a repository for troubling material


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Importance of Interpersonal Relationships Object relations theory

Longstanding patterns of relating to others Attachment theory

Type and style of infant’s attachment to caregivers can influence later psychological functioning.

Relational self Individuals will describe themselves

differently depending upon which close relationships are told to think about (Chen et al., 2006)


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Factors Common to Paradigms

Emotion Components

Expressive Experiential Physiological

Most psychopathology includes disturbances of one or more component e.g., flat affect in schizophrenia

Cultural factors influence ideal affect (Tsai, 2007)


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Factors Common to Paradigms

Sociocultural Factors Culture, ethnicity, gender, & social

relationships May increase vulnerability to

psychopathology e.g., women more likely to experience depression

than men May also serve as a buffer

e.g., social support Some disorders specific to certain cultures

Hikikomori in Japanese culture


Table 2.2 Lifetime Prevalence Rates of DSM-IV-TR Disorders among Different Ethnic Groups


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Diathesis-Stress

Integrative model that incorporates multiple causal factors (Zubin & Spring, 1977)

Diathesis Underlying predisposition

May be biological or psychological Increases one’s risk of developing disorder

Stress Environmental events

May occur at any point after conception Triggering event

Psychopathology unlikely to result from one single factor


Diagnosis Multiaksial

DSM (Diagnostic and Statistical Manual of Mental Disorder) published by American Psychiatric Association (APA)

In Indonesia, mental disorder diagnosis classify in PPDGJ (Pedoman Penggolongan dan Diagnostik Gangguan Jiwa) based on DSM and ICD (International Classification of Diseases) published by WHO

Diagnosis Multiaxial

Classification in DSM (1994) are description, atheoretical, and multiaxial more comprehensif (Millon & Davis, 2000)

DSM-IV-TR includes five axes = multiaxial classification system, by requiring judgements on each of the five axes, forces the diagnostician to consider a broad range of information

5 Axes in DSM-IV-TR Axes I:

Clinical Disorder Other conditions that may be a focus of clinical

attention Axes II:

Personality Disorder Mental Retardation

Axes III: General Medical Condition Axes IV: Psychosocial and environmental

problems Axes V: Global Assesment of Functioning

(GAF) Scale

GAF Scale

Consider psychological, social, and occupational functioning on a hypothetical continuum of mental heal/illness. Do not include impairment in functioning due to physical (or environment) limitations.

0 : Inadequate information1-10 : Persistent danger of severely hurting self

or others/ persistent inability to maintain minimal personal hygiene

51-60 : moderate symptoms/moderate difficulty in social, occupational, or school functioning

91-100: No symptoms, superior functioning in a wide range of activities

Diagnosis Multiaxial

Axes I : (296.23) Severe major depression, without psychotic feature

Axes II : (301.6) Personality disorder, defence mechanism denial

Axes III : noneAxess IV : Occupational ProblemAxes V : GAF=35 (current)

Current issues related to DSM-V Disorder that might include in DSM-V

Behavioral Addiction Definition: excessive use sex, shopping, or

computers may signal addiction. These behavior can be taken to such extremes that they easily mimic the behaviors of drug addicts.

Binge Eating Disorder Definition: individuals who binge are unable to

control periods of overeating and feel guilty or disgusted with themselves. They often become obese. Some eat alone to avoid feelings of shame.

Complicated Grief Definition: after the death of someone

close, grief and sadness normally begin to dissipate within six months. But some people continue to mourn for much longer.

Current issues related to DSM-V

Disorder that might exclude in DSM-V The Paraphilia: Intense sexual urges involving

animals, children, nonconsensual sex, suffering, or humiliation are classified as paraphilias – a term that was thought to be relatively non judgmental when it replaced “perversions” in 1980.

Gender Identity Disorder: Since the DSM-III appeared in 1980, individual who wish to be of the opposite sex-and who are uncomfortable with their own-have been diagnosed with Gender Identity Disorder.

Current issues related to DSM-V

CURRENT PARADIGMS IN PSYCHOPATHOLOGY Psikologi Abnormal-Kuliah 2.

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