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Flashcards in Lecture 6: Human and animal Deck (27):
1

Who decides who is suffering from a mental disorder?

The DSM

2

Describe homosexuality in terms of the DSM

Homosexuality was in the DSM II as sexual deviations. In 1970 gay rights campaigners demonstrated public demonstrations. APA then discussed but they still insisted that homosexuality was an overwhelming Oedipal conflict. However, some believed this wasn't credible and it was just social, moral and religious prejudice. Then on the 7th reprint of DSM II it was changed to sexual orientation disturbance. Then it was ego dystonic homosexuality in DSM III. When it was revised, the disorder was removed. Social and political values were crucial in its removal (not science) but this was obscured. It was removed because they changed the definition of mental disorder to distress, disability and disadvantage, which homosexuals didn't fall under. So the idea of homosexuality hadn't changed, is this the same for all disorders? Can mental disorders really be independent of social concerns?

3

Describe homosexuality in terms of the DSM

Homosexuality was in the DSM II as sexual deviations. In 1970 gay rights campaigners demonstrated public demonstrations. APA then discussed but they still insisted that homosexuality was an overwhelming Oedipal conflict. However, some believed this wasn't credible and it was just social, moral and religious prejudice. Then on the 7th reprint of DSM II it was changed to sexual orientation disturbance. Then it was ego dystonic homosexuality in DSM III. When it was revised, the disorder was removed. Social and political values were crucial in its removal (not science) but this was obscured. It was removed because they changed the definition of mental disorder to distress, disability and disadvantage, which homosexuals didn't fall under. So the idea of homosexuality hadn't changed, is this the same for all disorders? Can mental disorders really be independent of social concerns?

4

Describe the interactive nature of PTSD

PTSD is debilitating. We must follow scientific evidence for this disorder or else its legitimacy will be undermined. Horrific events at war can trigger acute symptoms in well adjusted individuals but most doctors believed the symptoms would subside after they left the battlefield. This conventional wisdom changed after the Vietnam war antiwar psychiatrists argued that many veterans showed signs of severe stress long after the war (chronic) or they developed the symptoms later on (delayed). There was no place for chronic stress or delayed stress in the DSM so it was put as post-Vietnam syndrome in DSM III, however they didn't want to tie it to a specific event so when they found that other people experienced the same symptoms they changed it to PTSD as this was clear clinical evidence. The ratification of this caused a lot of research into trauma, founding a journal and the international society for traumatic stress studies.

5

Describe the interactive nature of PTSD

PTSD is debilitating. We must follow scientific evidence for this disorder or else its legitimacy will be undermined. Horrific events at war can trigger acute symptoms in well adjusted individuals but most doctors believed the symptoms would subside after they left the battlefield. This conventional wisdom changed after the Vietnam war antiwar psychiatrists argued that many veterans showed signs of severe stress long after the war (chronic) or they developed the symptoms later on (delayed). There was no place for chronic stress or delayed stress in the DSM so it was put as post-Vietnam syndrome in DSM III, however they didn't want to tie it to a specific event so when they found that other people experienced the same symptoms they changed it to PTSD as this was clear clinical evidence. The ratification of this caused a lot of research into trauma, founding a journal and the international society for traumatic stress studies.

6

Describe the DSM criteria for PTSD in 1980

DSM III, 1980: Exposure to a traumatic stressor that evoked significant symptoms of distress in almost everyone, it is outside the range of normal human experience. 3 clusters of symptoms: Re-experiencing (flashbacks), numbing (blunted emotions) and miscellaneous (sleep disturbance, memory impairment etc.).

7

Describe the DSM criteria for PTSD in 1994

1994: Exposure to stresser (Criterion A), symptoms from each of the 3 clusters (Criterion B,C and D), duration criterion (E) and significance and functioning criterion.
A; Must meet 2 criteria, experiencing or witnessing actual or threatened death to oneself or others and one's response involved intense fear, horror and helplessness (in children it's disorganised or agitated behaviour).
B; Intrusive recollection, recurrent recollections as if the trauma was reoccurring causing psycho-physiological reactions
C; Avoidant/numbing, avoiding thoughts, feelings or places associated with the trauma, inability to recall important aspects of the trauma, feeling detached from interests and people.
D; Hyperarousal, Difficulty falling asleep, irritability, outbursts of anger, difficulty concentrating, hyper-vigilance.
E; Duration, symptoms must last for more than a month
F; Functional significance, significant distress or impairment in social, occupational or other areas of functioning

8

Describe the DSM criteria for PTSD in 1994

1994: Exposure to stresser (Criterion A), symptoms from each of the 3 clusters (Criterion B,C and D), duration criterion (E) and significance and functioning criterion.
A; Must meet 2 criteria, experiencing or witnessing actual or threatened death to oneself or others and one's response involved intense fear, horror and helplessness (in children it's disorganised or agitated behaviour).
B; Intrusive recollection, recurrent recollections as if the trauma was reoccurring causing psycho-physiological reactions
C; Avoidant/numbing, avoiding thoughts, feelings or places associated with the trauma, inability to recall important aspects of the trauma, feeling detached from interests and people.
D; Hyperarousal, Difficulty falling asleep, irritability, outbursts of anger, difficulty concentrating, hyper-vigilance.
E; Duration, symptoms must last for more than a month
F; Functional significance, significant distress or impairment in social, occupational or other areas of functioning

9

Describe the DSM criteria for PTSD in 2013

Criterion A: Directly experiencing a traumatic event, witnessing the event occur to others, learning that a violent traumatic event occurred to family members or friends, experiencing extreme or repeated exposure to trauma, not including the media unless it's work related.
Criterion D: Inability to remember an important aspect of the trauma (dissociative amnesia).

10

What are the 4 issues with PTSD

1. Epidemiological studies show there is no clear link between traumatic stressors and developing PTSD. E.g. Galea found that up to 20% of the Manhattan adults developed PTSD but this dropped to 1.7% by Feb, so this could just be temporary distress. Up to 30% of people develop PTSD after trauma (Bonanno 2011)
2. Co-morbidity is common (Yehuda 1995) 98.9% of veterans in the study met the criteria for at least one other disorder in their life, usually alcoholism or depression, so what is causing the symptoms?
3. Criterion F has only been added recently. Breslau 2007; this reduced the PTSD rates dramatically and those who qualified had more severe symptoms.
4. Criterion A has shifted dramatically showing that the idea of trauma isn't fully defined.

11

What are the 4 issues with PTSD

1. Epidemiological studies show there is no clear link between traumatic stressors and developing PTSD. E.g. Galea found that up to 20% of the Manhattan adults developed PTSD but this dropped to 1.7% by Feb, so this could just be temporary distress. Up to 30% of people develop PTSD after trauma (Bonanno 2011)
2. Co-morbidity is common (Yehuda 1995) 98.9% of veterans in the study met the criteria for at least one other disorder in their life, usually alcoholism or depression, so what is causing the symptoms?
3. Criterion F has only been added recently. Breslau 2007; this reduced the PTSD rates dramatically and those who qualified had more severe symptoms.
4. Criterion A has shifted dramatically showing that the idea of trauma isn't fully defined.

12

Discuss the conceptual bracket creep

The definition of it has expanded throughout each version of the DSM. For example, the inclusion of sexual abuse and overhearing sexist jokes. Mcnally questioned whether TV exposure to traumatic stressors will be included in the definition. There are also individual differences so potentially traumatic events are also included. Also, people can be resilient to the effects of trauma.

13

Discuss the history of DID

Before 1875, it was called cataleptic somnambulists, then it was called double consciousness. In 1875, it was changed to double personality and then multiple personality

14

Discuss the history of DID

Before 1875, it was called cataleptic somnambulists, then it was called double consciousness. In 1875, it was changed to double personality and then multiple personality. Not everyone agreed: Freud believed it was a specific form of hysterical neurosis. Babinski believed hysteria was malingering. But then the DSM certificate it and the number of cases dramatically increased.

15

Discuss the dramatic increase of MPD after its inclusion in the DSM

In the early 1980s, there had only ever been 200 cases. There was only 14 cases in over 20 years in the 1940s-60s. After a case appeared in literature between 1969 and 1989 there was more cases in 5 years than there had been in the last two centuries (Putnam 1986). This is because there was more public information about it, other diagnoses were narrowing, there was greater scrutiny of cases if the treatment didn't work and there was increased knowledge of the highly prevalent CSA.
Or because the DSM is elastic enough to accommodate a broad group of patients and the criteria has changed dramatically as it used to be two or more distinct personalities that are complex and integrated with unique behaviour patterns when it was newly included in the DSM III.

16

Discuss the dramatic increase of MPD after its inclusion in the DSM

In the early 1980s, there had only ever been 200 cases. There was only 14 cases in over 20 years in the 1940s-60s. After a case appeared in literature between 1969 and 1989 there was more cases in 5 years than there had been in the last two centuries (Putnam 1986). This is because there was more public information about it, other diagnoses were narrowing, there was greater scrutiny of cases if the treatment didn't work and there was increased knowledge of the highly prevalent CSA.
Or because the DSM is elastic enough to accommodate a broad group of patients and the criteria has changed dramatically as it used to be two or more distinct personalities that are complex and integrated with unique behaviour patterns when it was newly included in the DSM III.

17

Discuss the inclusion of MPD in the DSM

tuyuyuf

18

Describe homosexuality in terms of the DSM

Homosexuality was in the DSM II as sexual deviations. In 1970 gay rights campaigners demonstrated public demonstrations. APA then discussed but they still insisted that homosexuality was an overwhelming Oedipal conflict. However, some believed this wasn't credible and it was just social, moral and religious prejudice. Then on the 7th reprint of DSM II it was changed to sexual orientation disturbance. Then it was ego dystonic homosexuality in DSM III. When it was revised, the disorder was removed. Social and political values were crucial in its removal (not science) but this was obscured. It was removed because they changed the definition of mental disorder to distress, disability and disadvantage, which homosexuals didn't fall under. So the idea of homosexuality hadn't changed, is this the same for all disorders? Can mental disorders really be independent of social concerns? Clinicians are unable to be independent from culture

19

Discuss the dramatic increase of MPD after its inclusion in the DSM

In the early 1980s, there had only ever been 200 cases. There was only 14 cases in over 20 years in the 1940s-60s. After a case appeared in literature between 1969 and 1989 there was more cases in 5 years than there had been in the last two centuries (Putnam 1986). This is because there was more public information about it, other diagnoses were narrowing, there was greater scrutiny of cases if the treatment didn't work and there was increased knowledge of the highly prevalent CSA.
Or because the DSM is elastic enough to accommodate a broad group of patients and the criteria has changed dramatically as it used to be two or more distinct personalities that are complex and integrated with unique behaviour patterns when it was newly included in the DSM III. This could be because of increased knowledge or over application.

20

Discuss the inclusion of MPD in the DSM

It was first included in the DSM III. Then, in the revised version, it became less restrictive; personality states that are relatively enduring and each take full control at some point. In the DSM IV it was changed to DID and there was more criteria; distinct identities or personality states, at least two take full control, an inability to recall important personal information, the disturbance isn't due to substance or a medical condition. It's now the inability to form one core identity.

21

Other than the literature case, what was the other reason for the increase of MPD?

The book called Sybil about someone with 16 personalities and how they were successfully treated. It was tied to a history of abuse. However, Schreiber made the account more colourful and this was seen as factual. This study is now totally discredited. Nathan 2011 found a letter written by Sybil explaining that she lied about it all. Wilbur argued that this denial was a metaphor.

22

Other than the literature case, what was the other reason for the increase of MPD?

The book called Sybil about someone with 16 personalities and how they were successfully treated. It was tied to a history of abuse. However, Schreiber made the account more colourful and this was seen as factual. This study is now totally discredited. Nathan 2011 found a letter written by Sybil explaining that she lied about it all. Wilbur argued that this denial was a metaphor.

23

Is MPD real?

We shouldn't be asking it. We label people as having it and displaying symptoms for it but what causes these behaviours, that is the real question. Maybe a history of repressed childhood trauma or there is somebody else in there that wants to talk.

24

What does the socio-cultural model believe about MPD?

That it's a socially constructed disorder resulting from inadvertent therapist cueing, also media influences and socio cultural expectations regarding its presumed clinical features. The evidence for this viewpoint: Number of patients and personalities has dramatically increased which coincides with public awareness, treatments define the alters as distinct personalities, these increase during therapy and most patients show no signs of DID before therapy. Also, most diagnoses are from a small number of therapists, overt features are easily faked, it's spreading to more countries as it gets more publicised. Many ridiculous split personalities have been reported. Experts may have created the disease and cure.

25

What does the socio-cultural model believe about MPD?

That it's a socially constructed disorder resulting from inadvertent therapist cueing, also media influences and socio cultural expectations regarding its presumed clinical features. The evidence for this viewpoint: Number of patients and personalities has dramatically increased which coincides with public awareness, treatments define the alters as distinct personalities, these increase during therapy and most patients show no signs of DID before therapy. Also, most diagnoses are from a small number of therapists, overt features are easily faked, it's spreading to more countries as it gets more publicised. Many ridiculous split personalities have been reported. Experts may have created the disease and cure.

26

Why do we need to know whether MPD is real or not?

Because Milligan, a serial rapist, was hospitalised after claiming he had MPD. There are legal culpabilities like one trial made all of the alters swear the oath, at least 20 cases have claimed to have MPD.

27

Discuss interactive vs natural explanations

Hacking said that many mental disorders are best construed as interactive rather than natural. Interactive kinds are affected by the process of classification, compared to natural kinds. Have the changes in PTSD criteria cause more people to seek compensation for their trauma? Did DID become popular because culture authorised people told them how to express their unhappiness? If a rare case is labelled then many other cases can be labelled in the same way and many experts will begin training for it; it's either mistaken or underdiagnosed, there is no middle ground this is the problem with labelling.