2 UNIT Diagnosis of abnormal behaviour.

Diagnosis of abnormal behaviour.

The World Health Organization’s definition of health 

• a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Mental health 

• state of well-being 

mental health let individuals

• realize his or her own potential

• cope with the normal stresses of life,

• work productively

• make a contribution to the community.

Mental health is related to

optimal development of the individual based on age, living conditions, & culture

cristicms of WHO definition of mental health

• People in good MH are often sad, unwell, angry or unhappy, 6 this is part of a fully lived life for a human being.

• many challenging life situations in which well-being may even be unhealthy

• the equivalence between MH & well-being/functioning has not been accepted.

• Working productively and fruitfully is often not possible for contextual reasons 

• several concerns when positive feelings and function are seen as factors for MH

• components represented are not mandatory aspects - they may just contribute to the state of equlibrium

Mental health is

• dynamic state of internal equilibrium - enables individuals to use their abilities in harmony with universal values of society.

• Basic cognitive and social skills = ability to recognize, express and modulate one’s own emotions

• empathize with others → flexibility and ability to cope & function in social roles

• harmonious relationship between body and mind (internal equlibrium)

Dynamic state of internal equilibrium (mental health)

• Different life epochs require changes in the achieved equilibrium

• Mentally healthy people may experience appropriate human emotions while possessing sufficient resilience 

Universal values

• respect & care for oneself & other living beings (environment & freedom)

• connectedness between people

Four perspectives from which you can understand the relationship between "normality" and "mental health”

• Adjustment-maladjustment

• Health-disease

• Statistical normality-statistical abnormality

• Welfare-discomfort

Adjustment-maladjustment

• closely linked to reproduction (biological or social)

• are of ideological, philosophical or religious nature.

• Individuals must confirm to universal rules 

• Normal: who adjusts to the dominant rules/ does not show serious problems/ does not give serious problems → if not? abnormal

• Interventions aim to achieve the adaptation through educational-instructional strategies or of restrictive type

Health-disease

• Linked to a biomedical perspective 

• human seen as organismic machine that will break down as alteration of functional type because of some external entity

• universal & objective existence of the disease defined as diagnosable entity intervented though standardized ideal method

• Nosotaxies describes → diagnostic criteria by which one can determine the existence of some kind of disease

• Biological or neuro-biochemistry alteration

• psychopharmacology as basic treatment

Nosotaxies describes

diagnostic criteria by which one can determine the existence of some kind of disease

Statistical normality-statistical abnormality

• statistical perspective → mathematical criteria 

• explains mental health through placement of individuals with regards to means and standard deviations

• behaviour is determined within expected ranges (social perspective) or scientifically defined (health perspective)

• the behaviour that frequently occur in a population are normal / infrequent behaviour is abnormal 

• impact individuals through normalization strategies determined by the mean - diminishment in prevalence and incidences

Welfare-discomfort

•  Broad anthropologic view

• mental health is existential, subjective & ideographic concept

• assessment that the subject makes of his life through hedonic view (seeking pleasure, avoidance of suffering) or eudaimonic (realization of virtue)

Welfare allows the subject to be

• a subjective experience of intrapersonal, interpersonal, social & environmental integration.

• suffering + displeasure is indicated as rupture to the subject himself

Interventions of welfare-discomfort intended to

• build an individual happily integration with himself → enthusiastic, efficient, productive, with initiative & imagination, spontaneous, calm & free.

concepts of normality & abnormality

• failure to function adequately

• deviation from ideal mental health

• statistical infrequency

• deviation from social norms

• the mental illness criteria

The relationship between mental health and normality

• not possible to think of an unambiguous relationship between normality & mental health

• multiple meanings determined by factors that are of contextual, historical, political, economic & cultural nature.

• includes different anthropological & epistemological elements

• distinct conceptual possibilities & radically different interventions.

The Illness-Wellness Continuum

• states that many degrees of wellness as well as illness → neutral point in the middle

• different degrees of health → people move on a continuum ranging from great to illness or disability.

• e.g. many fall somewhere in the middle, they’re generally in good health, with occasional problems

neutral point in the middle of Illness-Wellness Continuum

• no visible illness

• 

Wellness

• is a dynamic process

• impacted by the active pursuit of activities, choices & lifestyles that lead to a state of holistic health.

mental health continuum model

• everyone has mental health

• mental well-being: emotions, thoughts, problem-solving ability

In the course of a lifetime - Mental health

• Some people will experience mental illness

• Everyone will struggle or have a challenge with their mental well-being

Abnormal behaviour

does not necessarily indicate mental illness

The mental health continuum model photo

mental health continuum model

• Mental well-being can also be plotted along a vertical line or a continuum → reflects the whole range of experiences related to mental well-being

• top of the line → flourishing or thriving

• bottom of the line → languishing or, simply, surviving

• the bottom is reflecting feelings of emptiness, loneliness and lack of vitality

optimal mental health + no mental illness symptom

• People can be flourishing in absence of symptoms of mental illness

poor mental health + serious mental illness

• Individuals might show poor mental health when struggling with mental illness

Serious mental illness + optimal mental health (flourishing)

• Possible to be flourishing with symptoms of a serious mental illness.

• It is possible to have mental health having a mental disorder (feel well despite suffering from any clinical condition).

• 

Poor mental health (languishing) + no mental illness symptoms

• possible to be languishing without symptoms of a serious mental illness.

• → have poor mental health without a diagnosis/ in absence of mental illness.

  

The mental health continuum model photo of possibilities

important part of good mental health

• ability to look at problems or concerns realistically

• living & coping well despite problems.

Mental illnesses are often

• episodic → times of ill, & times of better health

Mental illness can affect

• anyone, at any time—& each person responds to it differently.

does seem to impact certain groups of people more often:

• women

• youth

• disabilities/chronic illnesses

• refugees

• aborginal people

With right support & tools

•  anyone can live well

different kind of mental illnesses

• each one can cause different symptoms or affect someone’s life in very different ways.

• affecting a person´s emotions, thoughts & behaviours (how they view; themselves, others & their interaction)

What makes a condition as an illness 

• duration & impact on life 

4 basic dimensions of mental health & well-being

• thoughts, emotions, behaviours & body reactions → holistic interplay

thoughts dimension

• the way we think something has a big impact on mental health

body reaction dimention

changes in body functions → heart-rate, breathing, digestion, brain chemicals, hormones

Behaviour dimension

• helpful & harmful actions

• observable

emotions dimensions

• the way someone feels

• pleasant & unpleasant

Mental disorders comprise 

• a broad range of problems with different symptoms

• many of them can be successfully treated

Characteristics of mental disorders

• combination of disturbed thoughts, emotions, behaviour & relationships with others.

examples of mental disorders 

• depression

• anxiety

• conduct disorders in children

• bipolar disorders

• schizophrenia

According to DSM-5  - a mental disorder is

• syndrome

• characterized; clinically significant alteration of an individual's cognitive state, emotional regulation or behaviour

• reflecting → dysfunction in the psychological, biological or developmental processes underlying mental functioning.

according to DSM-5 - mental disorder is Usually associated with 

• significant distress in social, occupational, or other important activities.

not defined as mental disorders related to DSM-5

• expectable or culturally approved response to a common stressor or loss (death)

• Socially deviant behaviour (political, religious) conflicts that are primarily between the individual & society [unless, deviance or conflicts results from dysfunction]

Criteria for defining mental disorders

• Psychological dysfunction leading to distress, impairment in functioning, deviant (not typical/cultural expected)

• Patterns of thoughts, feelings, or actions are deviant, distressful, & dysfunctional

Patterns refers to

• collection of symptoms

clinically significant

• Symptoms that are severe enough to interfere with a person's daily life

The 5 D´s in psychopathology 

• Distress

• Dysfunction 

• Deviance

• Danger

• Duration

Distress

• Existence of marked personal suffering/ extreme anguish or pain

• the individual is extremely upset

• extent to issue distresses the individual

distress in extreme cases can lead to

suicide

is distress a psychopathological condition?

• no sufficient condition

• !!!only a Necessary condition !!!

why is distress only a NECESSARY condition in psychopathological condition

• Suffering is inevitable & inherited experience

• Some disorders do not cause the perception of suffering in one's own → thus, distress is missing

Distress: an example

• Hypochondriasis

Hypochondriasis

• preoccupation with the fear of having idea of a serious disease, based on the misinterpretation of an individual’s bodily symptoms

• somatoform disorder → elements of anxiety disorder

• more medical resources compared to term of their prognoses

How to treat Hypochondriasis

• Effective treatments all centred on decreasing the amount of distress experienced by the individual with the disorder

• one can lower the anxiety and distress level, a positive outcome may be more likely.

Dysfunction

• Impact on a person’s ability to manage day-to-day tasks & relationships.

• significant

• interfere in the individual’s life in some major way, & across different life domains.

Example of dysfunction

• severe depression or anxiety → prevent from going to work/ school

• Major Depressive Disorder, Recurrent, without Psychotic Features

• characterized by 2 or more episodes of MDD

symptoms related to dysfunction in MDD

• negative impact (dysfunction) in multiple areas of the individual’s life.

• impact relationships with others negatively

• decrease in pleasure in almost all of the activities of life

• insomia (sleeping issue) affecting daily tasks

• nergy loss and lack of motivation to do common tasks, e.g. personal hygiene

• Interfere ability to complete tasks at home and work.

What makes the individuals condition dysfunctional? 

• experience some dysfunction in almost every area of life & severe dysfunction in many areas.

• increased number of sick days

 women with depression & their children

• Children have higher rates of dysfunction in school, less socially competent, lower self-esteem

Leading cause of disability among people 18 to 44 years 

• depression

relationship between distress & dysfunction

• not always linear,

• they don’t necessarily happen together

• possible → great deal of dysfunction and very little distress or

  vice versa.

Deviance

• Atypical or not culturally accepted/ expected.

• Differing from the social norm/ deviated from the average or what is frequent or a typical developmental pathway.