HPS788 STUDENTS ONLY

HPS788 STUDENTS ONLY

Movie and the Disorder Depicted:

Aronofsky, A. (Director). (2010).Black Swan[Film]. Cross Creek Pictures, Protozoa Pictures, Phoenix Pictures, and Dune Entertainment.

A ballet dancer wins the lead in Swan Lake and is perfect for the role of the delicate White Swan - Princess Odette - but slowly loses her mind as she becomes more like Odile, the Black Swan (Summary from Informit).

The film depicts Schizophrenia being experienced by Nina (Natalie Portman)

(Note: The movie is Rated MA. See link below for content advisories.).

FILM LINK (you will need to be signed into your Deakin account to follow this link):

https://search-informit-org.ezproxy-f.deakin.edu.au/doi/10.3316/edutv.808637

HPS788 Assessment Task 2: Mental Health in the Movies

Due by 8pm AEDT Wednesday 14th September 2022. Submitted online via the dropbox in CloudDeakin.

This assignment consists of four separate sections for HPS788, which are submitted together.

Overview

For HPS788, a 2,000 word (10% leeway) assignment worth 45% of the unit grade. This major assignment is made up of four separate sections plus a final reference list:

Part 1: Case formulation

Discuss the 4Ps and the biological, psychological and social factors that contributed to the presentation of symptoms of the disorder experienced by the character in the film.

Part 2: Diagnosis

Discuss which symptoms from the disorder according to DSM-5 criteria 1) are present, 2) are absent, and 3) what additional symptoms were shown that are not part of the particular disorder.

Part 3: Accuracy and Stigma

Drawing on the above sections, add any additional information, discuss the accuracy of the portrayal in the film.

Discuss the messages that the film gives the public about people with the specific disorder, and how these may impact on the public perception of the disorder (consider both positive and negative messages).

Part 4: Treatment (HPS788 Only)

Summarise the research evidence regarding one evidence-based psychological treatment that is available for the disorder, and briefly describe how it works. Based on that, what are some possible strengths or weaknesses of this treatment for the movie character?

Reference list:

An APA formatted reference list should be provided at the end of the document and contain all references used in the assignment.

Appendices

Include a table of four Ps factors, and a table indicating presence or absence of all symptoms.

In the remainder of the document, you will find a more detailed overview of each section including FAQs from previous years that we hope will help guide you. Please ensure that you read and work with the marking rubric when planning and writing your assignment, as you are marked against the sections in this rubric. However, if anything in this document is still unclear please contact us via the cloud discussion board.

Structure of the Assignment

Please note that the word counts here are shown as a guide only (only the overall word count is enforced). Use subheadings to clearly reflect the separate parts of your essay.

Part 1: Case Formulation

This task develops your ability to apply the knowledge of general causes and theoretical explanations of a disorder with respect to a particular case (also reflecting Unit Learning Outcome 1).

Given the knowledge you have gained so far in the unit, you should be able to ascertain/research the biopsychosocial factors that are generally relevant to the disorder. Therefore, in this section you are required to:

The Task: Discuss what biopsychosocial factors might be relevant for Ninas diagnosis of Schizophrenia

You should utilise the basic grid framework that you have used in your seminars to identify what biopsychosocial factors according to the 4 Ps might be specifically relevant for the character in the film (include this table as an Appendix with at least one factor in each box in the grid).

You only need to dot-point these factors in the table.

In the body of the assignment, choose at least two factors for each for the 4Ps that you deem important. For each factor, ensure that you correctly categorise and label them in terms of which of the 4 Ps they are and whether they are biological, psychological, or social in nature. You must also, briefly, justify it in terms of its role in the disorder: i.e., how does it relate to the symptoms or disorder. You will need to provide brief, succinct content here.

The Suggested Word Count: Approximately 500 words

The Suggested Structure:

Predisposing Factors

Precipitating Factors

Perpetuating Factors

Protective Factors

FAQ:

Do we need to reference? No, not unless you are making statements of fact (e.g., Genetics is a known predisposing factor) or you bring research into the discussion yourself (e.g., Past research has shown that). So long as you are theorising (e.g., Genetics may be a predisposing factor) then you do not need to reference.

Do we use headings? Headings are not required as long as the structure is clear. If you use headings, and particularly subheadings, this might actually end up using up words which you could use to improve your marks. However, you can use headings (e.g., predisposing, precipitating etc.) if you wish.

But what if I cant see a factor? Highlight the ones that are shown. You do not have to have biopsychosocial factors for all four Ps if they are not seen in the movie.

Can we use dot points/the table from the seminars? No. Use the table format to develop your answers (include this as an Appendix), but submit your answers written out in paragraph format (as this is how it is done in the real world). Note this section is marked on your text and not what you put in the Appendix (this gets separate marks).

Do we need to be explicit? Yes, you need to explicitly state A predisposing biological factor was. Without this, it will be just a list of factors and the marker will be unable to determine if you have understood the 4Ps.

Do we need to justify factors? This depends a lot on the factor. The marker will be looking to make a determination of if you have understood the model, so if a factor is clearly biological predisposing (e.g., genetic predisposition) then you would not need to justify this. But if it is subject to interpretation as either a different P (e.g., it could be predisposing or perpetuating) or a different biological, psychological or social factor (e.g., it could be psychological or social) then you would need a very brief justification for why you have placed it under that factor. For example, the characters experience of criticism from their parents could be a psychological precipitating and perpetuating factor related to the onset of anorexia. As with the literature review above, there is not necessary a correct place it should be, so long as the marker can see your reasoning.

Will there be a seminar? Yes, use of the four Ps will be discussed and practised in seminars.

Part 2: Diagnosis

Another learning objective of this unit is knowledge of the clinical features of the major disorders and the ability to recognise them (Unit Learning Outcome 2). As such:

The Task: Indicate how the disorder is portrayed within the movie and evaluate its accuracy.

You should discuss the major diagnostic criteria of the disorder; and comment on whether the character shows all possible symptoms, or only some of the possible symptoms of the disorder. You also must discuss whether there are some symptoms displayed in the movie that do not fit with typical presentations of the disorder (this is not uncommon in Hollywood depictions of mental illness). Please note that only those symptoms within Criterion A for schizophrenia need to be discussed. You do not need to discuss Criteria B-F.

You should back up the diagnosis with the relevant symptoms displayed by the character. In other words, explain why the diagnosis is appropriate. Refer to the film to illustrate the symptoms that the character demonstrates, with respect to DSM-5 criteria for the disorder

The DSM-5 criteria can be sourced from the DSM-5 directly, although criteria are generally reproduced in enough detail in your textbook. Heres a link to the online version of the DSM-5 via the Deakin Library:

http://ezproxy.deakin.edu.au/login?url=http://dsm.psychiatryonline.org/book.aspx?bookid=556

If you are referring to a particular point in the movie that a symptom is shown, please also indicate the approximate time this occurred (h:mm) in parentheses [e.g., John is shown hiding his food (1:20)].

Include as an Appendix a completed table of symptoms showing what was included and what wasnt. This is to help you develop your ideas, but only needs to be brief/succinct as an Appendix item. Elaboration is not needed in this appendix.

The Suggested Word Count: Approximately 500 words

The Suggested Structure:

Mention you are using the DSM-5 and provide a reference for this (reference the DSM-5, not your textbook Barlow, Durand, & Hofmann)

Discuss all symptoms of the disorder (ones that are in the movie and explicitly state ones that are not in the movie)

Discuss any additional symptoms (symptoms shown by the character that are not part of the diagnosis of the disorder)

FAQ:

Do we need to write out the DSM-5 criteria? No, please dont!

Once you have alerted the reader you are using the DSM-5 you are free to paraphrase where appropriate and use (A1) or (A2) when referring to symptoms.

For example, John's symptoms meet the criteria for anorexia nervosa as he was severely restricting energy intake, as noted by skipping meals or eating minute portions, and had significantly low body weight (A), feared gaining weight (B) I couldnt stand to be even bigger than I am, its my worst enemy, and a distorted view of his weight, believing he was fat (C).

If symptoms aren't present, mention that briefly too. You could say, e.g., "there was no indication that John was severely restricting energy intake (A), nor did he have a distorted view of his weight (C), even at times telling others how he loved how he looked.

Assume the marker has a copy of the DSM-5 criteria with them, but you need to still orientate them to which symptom you are discussing. The relevant criteria are accessible on the cloud site through links to the DSM-5.

What if I disagree with the diagnosis? Your task is not to dispute the diagnosis we suggest, to specify an alternative diagnosis you believe fits better, nor to discuss comorbidity or differential diagnosis. However, a main part of this task is to evaluate the accuracy. Therefore, you might choose to build an argument for the portrayal being inaccurate if you disagree with the diagnosis.

Do I need to make the characters symptoms meet the criteria for the disorder? No, the task is not to make the persons symptoms meet the criteria (e.g., to twist some scenes in order to ensure that the right number of criteria are demonstrated), but to get you to apply the criteria sets. However, obviously if you cannot get the characters symptoms to meet the criteria for the disorder, you would be arguing that the film did not portray it accurately or did not portray the full reality of the disorder.

Is XXX a symptom? So long as there is a clear argument for why you believe something is or is not a symptom, the marker will be satisfied. In addition, make sure to apply the critical thinking from the Week 1 seminar on abnormality. For example, if you wake someone from a nap and they are drowsy this is not necessarily a clinical symptom indicating fatigue, so you would need to justify to the marker if you felt this was meeting a criterion from the DSM-5. Please note that tutors will not confirm or deny whether specific diagnostic criteria are met. This is because it would undermine the purpose of the assessment, which is for you to learn to identify whether these criteria are met or not.

Timestamps? Yes, for this section, you will need to include timestamps of where symptoms are shown. This is to help the marker go look up that part of the film if you are offering a novel interpretation. This is important in this section so we can go and see what you are seeing (especially if you are being creative).

Is there a seminar? Yes, there will be several seminars discussing skills relevant to this section of the assignment

Part 3: Accuracy and Stigma

The Task: Based on the above sections, add any additional information that you believe important and discuss the accuracy of the portrayal of the disorder in the film. Secondly, discuss important positive and negative messages about the specific disorder shown in the movie and how these messages may increase or decrease specific types of stigma associated with the specific disorder.

The first part of this task involves indicating how accurately the symptoms, cause of the disorder, and other important aspects of the disorder are portrayed. Some of this will be integrated into other sections, but there must be explicit reference to accuracy, and we recommend that you have a separate section to address accuracy clearly and thoroughly.

The second part of this task reflects that a learning objective (Unit Learning Outcome 4) for this unit is a consideration of the stigma that is associated with mental illness, along with public knowledge of the mental disorders (i.e., society's "mental health literacy"). The media has had a strong influence in how we understand mental illness and is the main source of information regarding this for most individuals in society. Note that realism impacts upon this but it goes beyond that (even a realistic portrayal according to the DSM-5 can increase stigma if it focusses exclusively on negative characteristics of a person with the disorder).

You will be expected to draw on specific types of stigma. These are discussed in the Week 5 seminar and information is also in your study guide under that week. Consider Jones and colleagues (1984) six dimensions of stigma and/or Corrigan and Watsons (2002) public stigma or self-stigma. You do not need to canvass all these specific types (there would not be enough room), but you do need to identify the specific types of stigma that are relevant to your observations about the movie (i.e., dont just call it stigma, identify what type of stigma).

The Suggested Word Count: Approximately 500 words

The Suggested Structure:

1) Realism of portrayal (note, that this needs to be apparent overall you can incorporate some of this material into the relevant previous sections if you wish!)

2) Important messages the film indicates about the disorder.

FAQ:

Is stigma related to the movie or stigma in general? This section is specifically

related to the messages this movie sends the public. Many people in the general community get their perceptions of mental illness through films (hence why we give you a movie rather than a case study

How many messages should I write about? This is up to you, but it is better to

include fewer messages with more discussion that to just provide a long list!

Sounds rather opinion based can I use I and do I have to reference? Yes, you can write this section in first person and there is no need to reference in this section. However, if you are justifying your opinion by referring to a specific scene in the film please provide approximate time stamps.

Will there be a seminar on this section? Yes, this section will be covered in a seminar. It is generally obvious if a person has not read the material associated with this seminar so, please do!

Sounds easy. Ill leave this section till an hour before I submit! We would not advise it. This section is actually the lowest marked sections on the assignment in previous years because students often retell the movie without added insights, observations, judgements or critical thinking. It also is very clear if people havent attended the related seminar (or done the reading).

In this section, we expect you to wow us with your critical thinking about how this movie will impact on the public perception on mental health. We as markers have seen the film, so we do not want to read a plot summary! We want you to synthesise and relate information on realism, and for stigma to hear your opinion, thoughts, reasoning, feelings and passion for what messages this movie sent the public and explicitly link this to how it will increase or decrease stigma. In short, be creative and tell us what you think (there are very few times you can do this in psychology). Note that it is critical you have done the seminar for this section, as it provides a framework for how to consider stigma (in terms of types of stigma, such as dangerousness, and targets of stigma such as public and self-stigma)

Overall Task: Spelling, punctuation, grammar, presentation and language, and APA 7th edition formatting and referencing are also worth marks.

Part 4: Treatment

An assumption of the psychiatric classification systems such as the DSM, which are based on so-called medical models, is that diagnosis will inform prognosis and treatment. This reflects a major learning objective for this unit (Unit Learning Objective 3). As such:

The Task:

Briefly summarise one evidence-based psychological treatment for the disorder, including what it is, how it works, and evidence for it (you may also want to consult treatment guidelines such as https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines#:~:text=NICE%20guidelines%20are%20evidence%2Dbased,prevent%20ill%20health or https://www.ranzcp.org/practice-education/guidelines-and-resources-for-practice )

Summarise some strengths and weaknesses of this treatment for this particular client. That is, why might this approach be well-suited for this character, and what about it might not suit them?

The Suggested Word Count: Approximately 500 words

The Suggested Structure:

Summarise the evidence-based psychological treatment and how it might work

Briefly note some strengths and weaknesses of this treatment for the character in the film.

FAQ:

What approach should I take? The first part of this section should read like a literature review. You are expected to demonstrate a level of critical thinking and analysis of the literature (as much as possible within the word limit). However, for this topic, given the word-count, the use of review articles and evidence-based guidelines is fine.

This seems a difficult task in the words I have! This is an advanced task that is only part of the advanced HPS788 unit (if you are in HPS308 and reading this, you have the wrong instructions!). That said, obviously, we are aware that 500 words is quite short so we will be cognisant of that in the marking!

Overall Task: Spelling, punctuation, grammar, presentation and language, and APA 7th edition formatting and referencing are also worth marks.

General FAQ

Are there any suggested readings? You should be writing the assignment based on skills learned in your Seminars. To make sure you have an understanding of what is required, please read the Seminar Guide and if you have missed the seminars, check out the Cloud recordings of the online seminars.

Can I ignore the in-text references in the word count? What is included in the word count? Word count for HPS788 is 2,000 words (with the 10% leeway you can go up to 2,200). There is no penalty for being under, but if you are well below this would be concerned you have not met the requirements of the task. Reference lists at the end of the document, running page headers/page numbers and your title page are not included in the word count, but ALL other text is (including in-text citations, headings and subheadings, tables if you choose to make them; and time references for the movie). At 2,200 words (HPS788) we will stop reading. No words beyond this point will be considered when marking. (This is because unfortunately a group of students in the past deliberately chose to take a marks penalty and write much, much more, which we think was unfair to the other students and to the markers themselves.)

What file types for submission: Most types are OK but please avoid .pages files (Mac users!) as they dont work within the mark-up software (we cant give feedback!).

What are the late penalties? 5% will be deducted from available marks for each day up to five days; where work is submitted more than five days after the due date, the task will not be marked and the student will receive 0% for the task (https://policy.deakin.edu.au/view.current.php?id=00187#major10).

Deakin has a universal assessment submission time of 8 pm AEST. Please note, penalties are based on the overall possible mark (i.e., 5% of the whole 100%) per 24 hour period. So, for example, if an assignment is submitted 30 hours late, that is 2 days, and it would lose 10%. If it received a mark of 75% then 10% would be removed resulting in a final mark of 65%.

How do I get an extension? Theres a form on the cloud site (Tools > Extension Application). These are dealt with centrally (not by the unit chair). If unsure, feel free to email the unit email to discuss (HPS308@deakin.edu.au or HPS788@deakin.edu.au).

How do I reference the DSM? In brief: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).https://doi.org/10.1176/appi.books.9780890425596While it is possible to reference specific sections of the DSM, for this purpose just reference the book overall. More detailed information is athttp://drwilliamdoverspike.com/files/apa_style_-_citing_DSM-5.pdfWhat are the submission requirements? You receive marks for conforming to APA 7th edition style (see https://owl.english.purdue.edu/owl/resource/560/01/ ) and for your writing. This includes:

being double spaced;

including 2.54 cm margins (1-inch) on all sides;being in a 12-point font size (Times New Roman is preferred, or Arial);

if using subheadings, still need to have "topic sentences" in your paragraphs (a useful check here - if you were to remove the subheading, would the paragraph still make sense?);using complete sentences and developed paragraphs (e.g., paragraphs must be at least 3 sentences, and typically are 1/2 to 1 page long in double space format), and do not use dot points.

including page numbers and running head;

including a title page (indicating a title, student number, and word count).

What if I want to pick another film or a disorder outside of the one specified? I really want to talk about my favourite film! You cannot choose another disorder outside of the specified film.

Referencing the film

Technically, you should cite the film every time it is discussed, but this would be excessive. Therefore, we ask you to cite the film on first mention. Use the format from the first page of this document.

See Separate document for Rubric

HPS308/788

Psychopathology

STUDY GUIDE & SEMINAR ACTIVITY GUIDE

FACULTY OF HEALTH

These study materials have been produced for units offered by the Faculty of Health.

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Published by Deakin University, Geelong, Victoria 3217, Australia www.deakin.edu.auCompiled 2022

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Preface

Welcome to the unit HPS308/788 Psychopathology. As the unit chair, I really hope that you find this unit both intellectually stimulating and relevant to your studies.

This unit has two primary aims: Firstly, to encourage you to learn and explore the concepts associated with mental disorders and secondly to increase your understanding and appreciation of the stigma and impact of such disorders on the lives of those affected. In so doing, this unit focuses on introducing abnormal and clinical psychology from a descriptive, theoretical and experimental perspective. In particular, we will focus on theories of psychology that integrate from multiple perspectives - a so-called integrative perspective. Topics covered will include models and theories of abnormal psychology with emphasis on an integrative approach to understanding psychopathology; diagnosis and classification; as well as an examination of the major classes of disorders such as the anxiety, mood, and schizophrenia-related disorders. Where appropriate, there will be a discussion and evaluation of therapeutic interventions and ethical issues pertaining to intervention/s.

This unit and seminar guide indicates all of the examinable material for each week, as well as any required material for activities for seminars that run weekly from Week 1 to Week 10.

All the best in the coming trimester!

Dr David John Hallford (Unit Coordinator).

A note on the textbook and writing psychology repots and assessments

In 2022 we will be using the 8th edition (2018) of the textbook. Although a 9th edition is now released, this happened only weeks before unit starting, and so will retain use of the 8th edition.

It is a common question that people will ask whether it is acceptable to use the previous editions of the textbook.

Generally, the books will be consistent, and certainly the change from the 7th to the 8th is not as large as between the 6th and 7th (as the DSM-5 was introduced), but of course some of the specifics in the text have changed with the additional of new research (particularly on recent treatment trials and on research on emotional regulation), and there are some other updates.

While I would recommend the newer text (8th edition), generally the older one will have consistent information, but note that where they diverge we would of course go with the current edition. As the changes are generally not so obvious (i.e., paragraphs or studies etc. added rather than whole sections removed), unfortunately comparing at the level of specifics in order to inform those with the older text is a bit beyond our capacity, so we won't be able to tell people when there are changes between the editions in practice (i.e., beyond specific questions if they arise on a discussion board). You will see below that in each week there is a reference to which sections of the text are applicable for the 8th edition. I have provided corresponding pages for the 7th edition also.

Note also that the text is examinable (around the stated learning objectives) so you need to have access to a textbook for the duration of the course. Whether you use a hard copy or electronic copy depends on your preference.

On a personal note, I believe the text is well written and a good resource. Depending on your future career, it could be one you could come back to.

For those of you who are new to psychological writing, or simply want a good resource, we recommend the following book which is available online at the Deakin library. It describes writing for lab reports, essays, literature reviews, proposals, presentations, and posters:

Kaufmann, L., & Findlay, B. (2020). How to Write Psychology Research Reports and Assignments (9th ed.). Pearson.

A note on the examinable material

Each section of this study guide contains learning objectives and assigned readings. These assigned readings are examinable in the final exam. They are mostly, but not exclusively from the textbook. The questions in the exam will aim to test whether you have achieved the learning objectives.

Unless directly stated, you should rely on the assigned readings to prepare for the exam. Sometimes there will be information presented within the unit that stray outside of the stated learning objectives and the textbook material. This content will not be examined. For example, a lecturer may discuss a case in-depth to further your learning, or they may discuss hot topics or debates in the field outside of the scope of the direct learning objectives. Students report that the wider and more in-depth material brings the content from this subject to life, keeps them interested, and gives them deeper (and thus better) learning. It also helps people to appreciate and apply the information in the book which can be a little dry (as textbooks tend to be). We understand that people may feel a bit overwhelmed as to the sheer amount of material, but please rest assured that only the assigned readings will be assessed in the exam. To help you learn this content, there are some practice multiple choice items at the end of each topic in this study guide.

Cheat sheet of Examinable Material in the Unit

Week 1: Classification, diagnosis and an integrative approach to psychopathology Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). V.M. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT: Cengage Learning. Chapter 1 (pp. 2-9; 17 in 7th edition), Chapter 2, Chapter 3 (pp. 92-103; 7th ed. pp. 86-97).

Week 2: Anxiety disorders, Trauma and Stressor-Related, and Obsessive-Compulsive and Related Disorders Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT. Cengage Learning: Chapter 5

Week 3: Mood disorder and suicide Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT: Cengage Learning. Chapter 7.

Week 4: Somatic symptom and dissociative disorders

Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT: Wadsworth. Chapter 6.

Week 5: Substance-related and addictive disorders

Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT: Cengage Learning. Chapter 11, pp. 404-442 (7th ed. pp. 396433).

Week 6: Eating disordersBarlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT: Cengage. Chapter 8 excluding obesity and sleep, pp. 295-317 (7th ed. pp. 268-289).

Week 7: Schizophrenia & other psychotic disorders Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT: Cengage Learning. Chapter 13.

Week 8: Personality disorders Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT:Cengage Learning. Chapter 12.

Week 9: Neurodevelopmental disorders Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT: Cengage Learning Chapter 14.

Week 10: Cross-cultural approaches to psychopathology Alarcon, R.D. (2009). Culture, cultural factors, and psychiatric diagnosis: review and projections. World Psychiatry, 8. Only pages 133-138, from the heading Cultural and Cultural Factors in Psychiatric Diagnosis http://ezproxy.deakin.edu.au/login?url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2755270/ (tested 21/5/21)

Hwang, W. (2016). Culturally adapting evidence-based practices for ethnic minority and immigrant families. In N. Zane, G. Bernal, F. L. Leong, N. Zane, G. Bernal, F. L. Leong (Eds.),Evidence-based psychological practice with ethnic minorities: Culturally informed research and clinical strategies(pp. 289-308). Washington, DC, US: American Psychological Association. doi:10.1037/14940-014 http://ezproxy.deakin.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=pzh&AN=2016-02847-014&site=eds-live&scope=site (tested 21/5/21)

Dudgeon, P., Bray, A., DCosta, B., & Walker, R. (2017). Decolonising Psychology: Validating Social and Emotional Wellbeing. Australian Psychologist, 52. Only pages 319-322, from the heading Connection to Body onwards.

https://www-tandfonline-com.ezproxy-b.deakin.edu.au/doi/pdf/10.1111/ap.12294?needAccess=true

The class slides are examinable and are available on Cloud under Week 2. Please note the recording of the class itself is not examinable.

Week 11: Mental health services: legal, ethical, and professional issues Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Belmont, CA: Wadsworth. Chapter 16.

As the book chapter is from the US, you should also read the text below under Week 11 which discusses the Victorian situation, as well as watch the narrated powerpoint on the Mental Health Act 2014 available on Cloud under Week 11 (in this instance, this is examinable material).

Contents

TOC o "1-1" h z u Week 1:Classification, diagnosis and an integrative approach to psychopathology. PAGEREF _Toc107222820 h 8Seminar 1: Introduction to psychopathology PAGEREF _Toc107222821 h 13Week 2:Anxiety disorders, Trauma and Stressor-Related, and Obsessive-Compulsive and Related Disorders PAGEREF _Toc107222822 h 14Seminar 2: Understanding and applying the DSM PAGEREF _Toc107222823 h 21Week 3: Mood disorders and suicide PAGEREF _Toc107222824 h 26Seminar 3: A biopsychosocial approach to formulating psychopathology part 1 PAGEREF _Toc107222825 h 30Week 4: Somatic symptom and dissociative disorders PAGEREF _Toc107222826 h 34Seminar 4: A biopsychosocial approach to formulating psychopathology part 2 PAGEREF _Toc107222827 h 38Week 5: Substance-related and addictive disorders PAGEREF _Toc107222828 h 41Seminar 5: Protective factors and stigma PAGEREF _Toc107222829 h 45Week 6: Eating disorders PAGEREF _Toc107222830 h 50Seminar 6: Stigma PAGEREF _Toc107222831 h 54Week 7: Schizophrenia & other psychotic disorders PAGEREF _Toc107222832 h 55Seminar 7: Assessing psychopathology part 1 PAGEREF _Toc107222833 h 58Week 8: Personality disorders PAGEREF _Toc107222834 h 64Seminar 8: Assessing psychopathology part 2 PAGEREF _Toc107222835 h 70Week 9: Neurodevelopmental disorders PAGEREF _Toc107222836 h 73Seminar 9: Experimental psychopathology PAGEREF _Toc107222837 h 77Week 10: Cross-cultural approaches to psychopathology PAGEREF _Toc107222838 h 78Seminar 10: Cultural context and psychopathology PAGEREF _Toc107222839 h 81Week 11: Mental health services: legal, ethical, and professional issues PAGEREF _Toc107222840 h 82

Classification, diagnosis and an integrative approach to psychopathology.

COMPILED 2022 BY DR DAVID HALLFORD.

Learning objectives

On completion of this topic you should be able to:

define the key elements in the current conceptualisation of abnormality or psychological disorder;describe the scientist-practitioner approach to psychopathology;describe the three major categories of focus underlying the study and discussion of psychological disorders;discuss the limitations to one-dimensional models of psychopathology;discuss the relationships between genes and behaviour, genes and environment, and the nongenomic inheritance of behaviour;describe the major neurotransmitter systems and their involvement in abnormal behaviour;describe how psychosocial factors influence and interact with brain structure and function;describe how the theories of conditioning, learned helplessness, social learning, and prepared learning are used to explain the origins of abnormal behaviour; and

discuss the role of cultural, social, and interpersonal factors in psychopathology.

define the terms idiographic, nomothetic, taxonomy, nosology, and nomenclature;define what is meant by classical categorical, prototypical and dimensional classification approaches;discuss the issues of reliability and validity as they apply to classification systems;discuss the history of classification of psychopathology up to DSM-5

discuss the importance of considering social and cultural factors in the DSM-5; and

critically discuss the process involved in the development of new diagnostic categories.

*Many of these learning objectives (e.g., the role of neurotransmitters, social factors, etc.) will recur and be reinforced as they apply within the specific topics. For example, you will learn about the role of serotonin in depression and the role of social factors in depression. The learning objectives are reflected more generally throughout the text too. For example, biological, psychological, and social factors are discussed with relationship to each disorder, as well as in relation to changes to diagnostic criteria at different points in the book. Please dont feel overwhelmed by the sheer number of learning objectives for this topic, as you will revisit and reinforce your learning of them as you progress through the weeks.

Learning resources

Prescribed text and Examinable Material

Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). V.M. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT: Cengage Learning. Chapter 1 (pp. 2-9; 17 in 7th edition), Chapter 2, Chapter 3 (pp. 92-103; 7th ed. pp. 86-97).

Web sites (not examinable)

The National Institute of Mental Health (NIMH) is a U.S.-based organisation, and their lead federal agency for research on mental disorders. The NIMH is the largest scientific organization in the world dedicated to research focused on the understanding, treatment, and prevention of mental disorders and the promotion of mental health. The website offers information about mental disorders, including epidemiological information and evidence-based treatments. <https://www.nimh.nih.gov/>

Neurosciences on the Internet provides neuroscience resources including Dana Brain Web (information and links for brain disorders and brain diseases), Medical Biochemistry Online Textbook, and Whole Brain Atlas (brain images in health and disease) <http://neuroguide.com/bestbets.html>

The DSM-IV-TR and DSM-5 are available through the Deakin library website. The ICD-11 and 10 are s available at <https://icd.who.int/en>

Study Instructions

882650-5651500PRESCRIBED TEXT AND EXAMINABLE MATERIAL

Please read Barlow, Durand and Hofmann (2018), Chapter 1, pages 2-9 (17 7th edition); Chapter 2; Chapter 3, pp. 92-103 (8697 7th edition).

ACTIVITY

7899405588000

Developing classification systems

This simple activity illustrates that different classification systems can be developed for the same objects. Think about the following list of items: a paper clip, a polystyrene cup, a pencil, a metal ruler, a piece of A4 paper, a plastic knife, and a small plastic container.

Firstly, develop two different methods of classifying these objects based on a categorical approach to classification. Secondly, reclassify the objects according to a dimensional approach.

Several possibilities exist for both of these approaches. Categories might be formed on the basis of function (office materials or stationary versus kitchenware) or the objects material (wood, metal, or plastic/ synthetic). Dimensional categories can be created on the basis of attributes shared by all items such as colour (lightest to darkest) or weight (lightest to heaviest).

What you will recognise is that a single classification approach is not inherent to the objects; there is a degree of arbitrariness associated with the process. In other words, we impose a classification system based on our needs. While information is lost in this process of classification, the simplification may be of value for other purposes. For example, suppose we were trapped in a locked room with these same objects. In this situation, we would be interested in classifying the objects on the basis of their usefulness for helping us escape. Some like the pencil and paper (for writing a note) or the paper clip (picking the lock) might be considered highly useful while others like the polystyrene cup would be classified as being of low usefulness.

Adapted from Williams, M. (1996). Instructors resource guide exploring abnormal psychology. New York: Wiley.

Topic review questions

Therapist Dr X (not her real name) is working with a client who is heavily involved with body-piercing. The client enjoys it, but Dr X thinks the amount is so excessive she considers it abnormal behaviour. She is employing which definition of abnormality?

Dysfunction

Culturally inappropriate or unexpected

Impairment

Distress

Psychological disorders can be described as following a typical course or individual pattern. For example, schizophrenia follows a chronic course while mood disorders such as depression often follow a course described as:

Episodic

Time-limited

Guarded

Insidious

Recent evidence regarding the genetic influence on most psychological disorders has shown that:

Single genes are usually responsible for psychological disorders

Genes that influence psychopathology are usually recessive

There is no evidence that genes influence psychopathology

Multiple genes interact, with each gene contributing a small effect

John has inherited a personality trait that makes him more likely to keep to himself than to socialise. He does not have many friends and spends a lot of time alone. If John developed depression, the model that would probably best explain this situation and the cause of his depression is:

Diathesis-stress

Biological

Reciprocal gene-environment

Interpersonal

You know someone who is uninhibited, impulsive, and overreactive to many events. If you believe brain chemistry is responsible for most behaviour patterns, what would you suggest as the cause?

High levels of serotonin

Low levels of serotonin

High levels of GABA

Low levels of GABA

High levels of 5HT

The GABA system:

Is specific to anxiety

Is located mainly in the thalamus

Reduces arousal and emotional response

Has only one particular type of receptorThe phenomenon of learned helplessness in laboratory animals resembles the human disorder:

Panic disorder

Schizophrenia

Mania

Depression

Though fears are learned, some are more easily learned, or more prepared to be learned than others. The most likely fear-prepared stimulus below would be

Rocks

Guns

Spiders

Electrical outlets

The fact that women are more likely to suffer from insect phobias than men is most likely due to

Biological differences

Differences in neurochemical pathways

Gender roles

Genetic Influences

People who have many social contacts and live their lives continually interacting with others:

Develop more infections and have poorer overall health

Have not been found to differ on any health outcome

Often suffer from psychological disorders such as dependency

Live longer and healthier lives

A classification system for scientific purposes is a _________; for clinical purposes, it is a _______

Taxonomy; nomenclature

Taxonomy, nosology

Nosology; taxonomy

Nomothetic; idiographic

The dimensional approach to diagnosis is characterised by:

Quantification of patients experiences using scales measuring several areas such as anxiety or impulsivity

List of symptoms the patients must experience for the diagnosis to be assigned

Essential elements that all patients must report for the diagnosis to be assigned but allowance for specific nonessential variations as well

A theoretical explanation for the disorders underlying cause shared by all patients experiencing the symptoms

If using the diagnosis depressed allows you as a clinician to determine an effective treatment and give an accurate prognosis, the diagnosis has

Reliability

Criterion validity

Construct validity

Content validity

Concurrent validity

The crucial test as to whether a diagnostic system has a high degree of validity is that it should result in:

An effective treatment planAll clinicians reaching the same diagnosis for the patient

The accurate diagnostic label for the patient

The same diagnostic label regardless of when the patient is evaluated

The inclusion of cultural and social factors helps

The clinician understand the clients disorder from their sociocultural perspective

The culture develop properly

Treatment of culture-specific disorders

Maintain present cultural boundaries

Reify the diagnostic labels

One of the problems with a diagnostic and classification system like the DSM-5 is that:

many presenting problems do not fit neatly into any one category

it attempts to maximize validity at the cost of reliability

diagnosis is difficult because it is hard to tell how much discomfort a particular symptom is causing the patient

the criteria for many mental disorders are almost identical to each other

Mixed anxiety-depression disorder was placed in an Appendix to DSM-IV because, although it had demonstrated some ________, there is insufficient information about this categorys reliability and ________

Predictive validity; construct validity

Reliability; content validity

Construct validity; predictive validity

Content validity; predictive validity

MCQ answers are listed at the bottom of the respective page for every study topic

Seminar 1: Introduction to psychopathologyCOMPILED 2022 BY DR DAVID HALLFORD

Activities

ACTIVITY 1: What is abnormal behaviour?

ACTIVITY 2: Case studies for normal or abnormal behaviour.

No additional materials are needed.

Anxiety disorders, Trauma and Stressor-Related, and Obsessive-Compulsive and Related DisordersCOMPILED 2022 BY DR DAVID HALLFORD

Learning objectives

On completion of topics you should be able to:

define the terms anxiety, fear, and panic;describe the biological, psychological, and social contributions to anxiety, obsessive-compulsive and related disorder, and trauma and stressor related disorders, and their integration;discuss the issue of comorbidity in anxiety and related disorders;name the major anxiety, obsessive-compulsive and related disorders, and trauma and stressor-related disorders listed in the DSM-5 and their distinctive features;describe the clinical features, causes, and treatment of panic disorder and of agoraphobia;describe the clinical features and subtypes, causes, and treatment of specific phobia;describe the clinical features, causes, and treatment of post-traumatic stress disorder;

describe the clinical features, causes, and treatment of obsessive-compulsive disorder;describe the clinical features, causes, and treatment of social anxiety disorder;describe the clinical features, causes, and treatment of generalized anxiety disorder;describe the clinical features, causes, and treatment of body dysmorphic disorder; and

describe the core clinical features of the other disorders within these categories namely separation anxiety disorder; selective mutism, adjustment disorders, attachment disorders, hoarding disorder, trichotillomania (hair pulling disorder), and excoriation (skin picking disorder).

Learning resources

Prescribed text and Examinable Material

Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT. Cengage Learning: Chapter 5

Web sites (not examinable)

The Anxiety Recovery Centre Victoria (ARCVic) is a state-wide Victorian specialist mental health organisation, providing support, recovery and educational services to people and families living with anxiety disorders (including OCD and trauma-related disorders). Their website is <http://www.arcvic.org.au>.

Other community organizations include the Anxiety Disorders Association of Victoria (ADAVIC), who aim to provide grass-roots support, information and resources to help people manage anxiety and depression, < http://www.adavic.org.au/>.

Reconnexion (formerly TRANX) is a not-for-profit organization that aims to address the challenges of anxiety, stress, depression and benzodiazepine (tranquillisers & sleeping pills) dependency and related conditions <http://www.reconnexion.org.au/>.

The Clinical Research Unit for Anxiety Disorders at the University of New South Wales is the premiere centre in Australia for clinically-oriented research on anxiety disorders and their treatment. The site has very detailed information about the disorders and their treatment. In addition, there are detailed client treatment guides. < https://crufad.org/ >.

The US-based National Institute of Mental Healths Anxiety Disorders Education Program site has lots of simple, easy to read information regarding the various anxiety disorders and their treatment.

< https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml >.

MentalHealthOnline (previously titled anxietyonline) is a government-funded eTherapy site that has an automated assessment portal, along with free and minimal-cost therapist-supported CBT-based programs for the anxiety, OCD and Trauma-related disorders. < https://www.mentalhealthonline.org.au/>.

Study instructions

882650-5651500PRESCRIBED TEXT AND EXAMINABLE MATERIAL

882650-5524500ACTIVITY

Please read Barlow, Durand and Hofmann (2018), Chapter 5.

Constructing a fear hierarchy

The purpose of this activity is to practice constructing a fear hierarchy appropriate for use in the systematic desensitisation of a phobia. To complete this activity, review the section in chapter 1 on The Beginnings of Behaviour Therapy on page 25 (p. 22 7th ed.) of your text.

Systematic desensitisation has been shown to be a powerful technique in the treatment of specific phobias. It has also been shown to be effective in the reduction of anxiety associated with social phobia, post-traumatic stress disorder, and agoraphobic avoidance.

Imagine you are a client of a psychologist who has a specific fear that you and your therapist are planning to treat with systematic desensitisation. You are to construct a fear hierarchy appropriate to this fear. For this exercise you may wish to use a real fear that you have such as speaking in public, flying, taking exams, or mice, or you may wish to imagine that you have a particular fear.

In either case, construct a fear hierarchy consisting of 1015 scenes ranging from those that cause little anxiety to those that cause the greatest anxiety. Think of the scenes as spanning a range from 0 to 100 on an anxiety-provoking scale (referred to as subjective units of distress or SUDS). Attempt to develop scenes that are evenly spaced across this scale. That is, the first scene should be 10 SUDs, the second 15 SUDs and so on. Make sure that you make the scenes as concrete and specific as possible. For example, if constructing a fear hierarchy for exams, rather than putting down Doing an exam use items such as Sitting in the exam room with the exam paper unopened in front of me.

See after the Topic Review for an example of a hierarchy for a fear of exams.

Adapted from Williams, M. (1994). Instructors resource guide for abnormal psychology

6th ed. New York: Wiley.

Topic review

1.Something might go wrong, and Im not sure I can deal with it, but Ive got to be ready to try. Which aspect of anxiety does this statement represent?

a.Immediate control reaction

b.Fight or flight response

c.Future oriented mood state

d.Panic attack

2.According to Jeffrey Gray, a British neuropsychologist, the behavioural inhibition system (BIS) is activated by danger signals resulting in the experience of anxiety.

a.Ascending from the brain stem

b.Descending from the cortex

c.Arising from both the brain stem and the cortex

d.Within the amygdala only

3.Interoceptive avoidance involves

a.Avoiding busy intersections

b.Avoiding interactions with individuals who are associated with your first panic attack

c.Avoiding situations or activities that might produce physiological arousal that resembles the beginning of a panic attack

d.Avoiding situations or activities that are associated with your first panic attack

eAvoiding blood, injury, or other stimuli from inside the body

4.In Barlows panic control treatment (PCT)

a.Cognitive therapy is used to modify perceptions about the dangerousness of feared situations

b.The client may be taught relaxation and deep breathing skills

c.Exercises are used to elevate the heart rate or spinning to make the patient dizzy so as to expose the client to interoceptive sensations similar to panic

d.All of the above

5.Individuals who display a natural environment phobia

a.Are likely to fear more than one situation or event since these fears seem to cluster together

b.Usually first exhibit such fears in adolescence

c.Typically grow out of it during early adulthood

d.Both a and b

6.Individuals suffering from posttraumatic stress disorder (PTSD) display a characteristic set of symptoms including all of the following EXCEPT

a.Numbing of emotional responsiveness

b.Sudden flashbacks in which the traumatic event is relived

c.Decreased startle response and chronic underarousald.Memories and nightmares of the event

7.________are obtrusive and distressing thoughts, images, or urges, which the individual tries to resist or eliminate, whereas ________ are thoughts or actions designed to suppress those thoughts and provide relief

a.Obsessions; compulsions

b.Compulsions; obsessions

c.Obstructions; suppressions

d.None of the above

8.Which of the following is an example of the treatment technique for OCD called exposure and ritual prevention (ERP)?

a.Carrie has an obsessive fear of contamination which has led to compulsive handwashing rituals. Her therapist is treating her by making her touch dirty laundry but not allowing her to wash for increasingly longer periods of time afterwards.

b.Kerry has an obsessive fear of contamination which has led to compulsive handwashing rituals. Her therapist is treating her by forcing her to wash her hands repeatedly, even when she doesnt feel anxious.

c.Kelly has religious obsessions. She feels that if she doesnt read biblical passages every hour of the day, she will do something evil. Her therapist is treating her by having her attend religious services more frequently so that good thoughts will replace the bad ones.

d.Callie has a doubting obsession. She becomes anxious whenever she drives that she may have hit someone in her car. Her therapist has arranged for Callies car to be fitted with video cameras so she can review her route and check that she has not injured any pedestrians.

9.Which of the following regarding Body Dysmorphic Disorder (BDD) is true:

a.Cosmetic surgery helps individuals with BDD have a long-lasting alleviation of their appearance concerns, but is inaccessible due to its high cost;b.Individuals with BDD tend to have poorer insight into their condition than do people with Obsessive Compulsive Disorder (OCD);

c.BDD is classified as an anxiety disorder, because the concerns within both BDD and Social Anxiety Disorder concern social rejection;d.Treatment studies suggest that medication is the most effective treatment for BDD.

Answers at bottom of page3

Suggested answers

Answer to Activity

Fear Hierarchy for Student with Test Anxiety (Numbers after items are SUDS)

aYour instructor announces on the first day of class that the first exam will be held in

one month. You know that the month will go quickly10

bA week before the exam, you are sitting in class and the instructor reminds the class of

the exam date. You realise you have a lot of studying to do during the week.15

cYou are sitting in the class and the instructor mentions the exam, scheduled for the

next class session, two days away. You realise you still have a lot of pages to read.20

dNow it is one day before the exam. You are studying in the library. You wonder

whether you have studied as much as everyone else in the class.25

eIt is the night before the test. You are in your room studying. You think about the fact

that this exam grade is one-third of your final grade.30

fIt is the night before the exam late evening. You have just finished studying and

gone to bed. Youre lying awake going over your reading in your mind.35

gYou wake up the next morning and your mind flashes to this being exam day. You

wonder if you will remember much of what you read yesterday.40

h It is later in the day, one hour before the exam. You do some last minute scanning of

your lecture notes. You start to feel a little hassled even a little sick. You wish you had

more time to prepare. 50

iIt is 15 minutes before the class time to go the classroom. As you walk, you realise

how important this grade will be. You hope you dont blank out.60

jYou go into the building, stop to get a glass of water, and then enter the classroom.

You look around and see people laughing. You think that they are more confident and

better prepared than you.70

kThe instructor is a little late. You are sitting in class waiting for the teacher to come

and pass out the test. You wonder what will be on the test.75

lThe instructor has passed out tests. You receive your copy. Your first thought is that

the test is so longwill you finish in time?80

mYou start to work on the first portion of the test. There are some questions you arent

sure of. You spend time thinking and then see that people around you are writing. You skip

these questions and go on.85

nYou look at your watch. The class is half overonly 25 minutes left. You feel you have

dawdled on the first part of the test. You wonder how much your grade will be pulled down

if you dont finish.90

oYou work as fast as you can; occasionally worrying about the time. You glance at your

watch five minutes left. You still have a lot of unanswered questions.95

pTime is just about up. There are some questions you had to leave blank. You worry

again about this test being one-third of your grade.100

Adapted from Cormier, W.H., & Cormier, L.S. (1991). Interviewing strategies for helpers:

Fundamental skills and cognitive behavioral interventions (3rd ed.). Pacific Grove, CA: Brooks/Col

Seminar 2: Understanding and applying the DSMActivities

ACTIVITY 1: A critical reflection on the DSM.

ACTIVITY 2: Hands-on practice applying DSM-5 criteria.

Activity 2 Materials

Case 1 Car Wreck^) ^: r7 Z4 `David is a 15 year old high school student referred to deal with stress following a serious motor vehicle accident (MVA), two weeks earlier. Prior to the accident, David was sitting in the front passenger seat when it was hit by a 4WD running a red light. The passenger side of the car was hit with a great impact. When the cars collided there was a very loud noise. Davids friend Mick was driving the car and he hit his head and was unconscious for a period of time. David was concerned that his friend was dead. David could not get out of his side of the car as the door had been crushed by the impact. David was concerned that petrol may be leaking from the car and that it might ignite. Eventually David was able to get out of the car through the back seat driver side door. The driver had contacted emergency services and David and his friend were checked out at the hospital and discharged without serious injury.

Following the accident, David had trouble sleeping each night. He would wake up sweating and feeling terrified after dreaming about being in another accident. At school it was very difficult to concentrate during class, and he reported feeling very anxious when travelling in a car, especially when going through intersections. He had recently obtained his learners permit, however had been avoiding his driving lessons with his parents. He had also been quite irritable and would lose his temper quite easily. Recently David had gone to the movies with some friends, but left quite abruptly telling them he couldnt handle the noise in the cinema.

Unfortunately, David had an exam recently and had not done very well at all due to his concentration difficulties. This prompted a referral to a psychologist for assessment and strategies to assist David to better manage the impact of the MVA. Upon examination by a psychologist, David also reported being very jumpy particularly with regards to loud noises, and that he had trouble getting the image of his unconscious friend out of his mind. He reported strong feelings of anger towards the driver of the 4WD for the accident and the subsequent impact on his life, and that of his friend.

(Adapted from: Pynoos, R.S., Steinberg, A.M., & Layne, C.M. In DSM-5 Clinical Cases Edited by J.W. Barnhill American Psychiatric Publishing, Arlington, VA. 2014 first edition

YOUR TASK: Discuss whether Davids symptoms meet criteria for one of Posttraumatic Stress Disorder (PTSD) or Acute Stress Disorder (ASD). What are the differences between the two? (diagnostic criteria are provided on the following pages).

Diagnostic criteria for 309.81 Posttraumatic Stress Disorder (DSM-5)

Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

Directly experiencing the traumatic event(s)

Witnessing, in person, the event(s) as it occurred to others

Learning that the traumatic event(s) occurred to a close family member, or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.

Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

Note: Criterion A4 does not apply to exposure through electronic media, television, movies or pictures unless this exposure is work related.

Presence of one (or more)of the following intrusive symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event are expressed.

Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children this may be frightening dreams without recognizable content.

Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of the present surroundings). Note: In children, trauma specific re-enactment may occur in play.

Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)

Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

Avoidance of or efforts to avoid distressing memories, thoughts or feelings about or closely associated with the traumatic event(s).

Avoidance of, or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol or drugs).

Persistent and exaggerated negative beliefs or expectations about oneself, others or the world (e.g., I am bad, no-one can be trusted).

Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.

Persistent negative emotional state (e.g., fear, horror, anger, guilt or shame)

Markedly diminished interest or participation in significant activities

Feelings of detachment or estrangement from others

Persistent inability to experience positive emotions (e.g., inability to experience happiness or satisfaction)

Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening since the traumatic event(s) occurred, as evidenced by two (or more) of the following:

Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression towards people or objects.

Reckless or self-destructive behaviorHypervigilance

Exaggerated startle response

Problems with concentration

Sleep disturbance (e.g., difficulty falling asleep or staying asleep or restless sleep)

Duration of the disturbance (Criteria B,C,D, and E) is more than one month

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Diagnostic criteria for 308.3 Acute Stress Disorder (DSM-5)

Exposure to actual or threatened death, serious injury or sexual violation in one (or more) of the following ways:

Directly experiencing the traumatic event(s)

Witnessing, in person, the event(s) as it occurred to others

Learning that the event(s) occurred to a close family member or close friend. Note: in cases of actual or threatened death to a family member or friend, the event(s) must have been violent or accidental.

Experiencing repeated or extreme exposure to aversive details of traumatic event(s) (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse). Note: this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related).

B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:

Intrusion Symptoms

Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.

Recurrent, distressing dreams in which the content and/or affect of the dream are related to the event(s). Note: In children, there may be frightening dreams without recognisable content.

Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings. Note: In children, trauma specific re-enactment may occur in play.

Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolise or resemble an aspect of the traumatic event(s)

Negative Mood

Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction or loving feelings).

Dissociative Symptoms

An altered sense of the reality of ones surroundings or oneself (e.g., seeing oneself from anothers perspective, being in a daze, time slowing)

Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol etc)

Avoidance Symptoms

Efforts to avoid distressing memories, thoughts or feelings about or closely associated with the traumatic event(s)

Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

Arousal Symptoms

Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep)

Irritable behaviour and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.

Hypervigilance

Problems with concentration

Exaggerated startle response

C. Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure.

Note: symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet the disorder criteria.

D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning..

E. The disturbance is not attributable to the physiological effects of asubstance (e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for bybrief psychotic disorderCase 2 AnxietyWatch an interview depicting a case - https://www.youtube.com/watch?v=Ii2FHbtVJzc (up to about 7:30).

Discuss whether Julies symptoms meet symptoms for Panic Disorder and/or Agoraphobia.

Diagnostic criteria for Panic Disorder (DSM-5)

From American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Washington, DC.

Panic Disorder

Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:

Note:The abrupt surge can occur from a calm state or an anxious state.

Palpitations, pounding heart, or accelerated heart rate.

Sweating.

Trembling or shaking.

Sensations of shortness of breath or smothering.

Feelings of choking.

Chest pain or discomfort.

Nausea or abdominal distress.

Feeling dizzy, unsteady, light-headed, or faint.

Chills or heat sensations.

Paresthesias (numbness or tingling sensations).

Derealization (feelings of unreality) or depersonalization (being detached from oneself).

Fear of losing control or going crazy.

Fear of dying.

Note:Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.

At least one of the attacks has been followed by 1 month (or more) of one or both of the following:

Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, going crazy).

A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).

The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).

The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder).

Diagnostic criteria for Agoraphobia (DSM-5)

From American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Washington, DC.

Marked fear or anxiety about two (or more) of the following five situations:

Using public transportation (e.g., automobiles, buses, trains, ships, planes).

Being in open spaces (e.g., parking lots, marketplaces, bridges).

Being in enclosed places (e.g., shops, theaters, cinemas). PUBS

Standing in line or being in a crowd.

Being outside of the home alone.

The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence).

The agoraphobic situations almost always provoke fear or anxiety.

The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.

The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.

The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

If another medical condition (e.g., inflammatory bowel disease, Parkinsons disease) is present, the fear, anxiety, or avoidance is clearly excessive.

The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorderfor example, the symptoms are not confined to specific phobia, situational type; do not involve only social situations (as in social anxiety disorder); and are not related exclusively to obsessions (as in obsessive-compulsive disorder), perceived defects or flaws in physical appearance (as in body dysmorphic disorder), reminders of traumatic events (as in posttraumatic stress disorder), or fear of separation (as in separation anxiety disorder).

Note:Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individuals presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned.

Week 3: Mood disorders and suicideCOMPILED 2022 BY DR DAVID HALLFORD

Learning objectives

At the conclusion of your work in this topic, you should be able to:

outline the general characteristics of depression and mania;describe the features of the depressive disorders and bipolar disorders;describe the most characteristic difficulties associated with childhood and adolescent depression and depression in the elderly;discuss biological dimensions to the aetiology of mood disorders;discuss psychological dimensions to the aetiology of mood disorders;discuss social and cultural dimensions to the aetiology of mood disorders;describe an integrative theory of mood disorders;outline biological and drug therapies for treating mood disorders;outline psychological approaches for treating mood disorders; and

discuss the statistics, causes, risk factors of suicide and the treatment of those at risk of suicide.

*You will notice that many of these learning objectives are repeated in terms of their main foci (features, causes, treatments) across these and subsequent weeks.

Learning resources

Prescribed text and Examinable Material

Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT: Cengage Learning. Chapter 7.

Web sites (not examinable)

The National Depression Initiatives Beyond Blue web site is a detailed site that covers the symptoms and treatment of depression and anxiety. It includes short tests to screen for depression and offers information for consumers, carers, the general public, and health professionals. <http://www.beyondblue.org.au/>.

The Federal Governments Healthdirect page has lots of Australian links to information regarding bipolar disorder and suicide prevention < https://www.healthdirect.gov.au/bipolar-disorder >.

Suicide warning signs and information < https://www.healthdirect.gov.au/warning-signs-of-suicide >.

BluePages is an interactive web site that provides information about depression compiled at the Australian National Universitys Centre for Mental Health Research. <http://www.bluepages.anu.edu.au/>.

Study instructions

882650-5651500PRESCRIBED TEXT AND EXAMINABLE MATERIAL

882650-5524500ACTIVITY

Please read Barlow, Durand and Hofmann (2018), Chapter 7

Learned helplessness

As you will have read, one of the major theories of depression relates to the concept of helplessness. In this activity, you are asked to make an investigation of helplessness and its effects on performance.

Obtain twenty 7 x 13 cm index cards. Take ten of them and on each write five letters (two vowels and three consonants) in a random order. Make sure that these letters do not spell a word regardless of how they are arranged. On each of the other ten cards write five letters (two vowels and three consonants) in a random order that do spell a word when re-arranged in the right order.

Ask four individuals to try to solve these anagram problems. Give them thirty seconds per card. First give them the ten cards with no solutions, then the ten cards for which a solution is possible. Ask another four people to solve the anagram problem, but only present them with the second set of cards.

Make sure to explain the experiment to your subjects upon completion. Summarise the results, showing the number of anagrams that were solved by each group for the second set of cards. What conclusions can you draw?

Adapted from Peterson, C. (1989). Casebook and study guide: Abnormal psychology

(2nd ed.).New York: W.W. Norton.

Topic review questions

1.A 35-year-old individual named Manny has recently formulated an elaborate plan to cure AIDS with vitamin therapy. To provide funding for this cause he has withdrawn all the money from his bank account and purchased thousands of jars of vitamins and small boxes into which to put them. When he appeared at a hospital emergency room loudly demanding names of patients with AIDS, he himself was hospitalised for psychiatric observation.

What is your diagnosis of Manny?

a.Mixed manic episode

b.Major depressive episode

c.Psychotic depressive episode

d.Manic episode

2.The physical or somatic symptoms of major depressive disorder include

a.Changes in appetite or weight

b.Decreased ability to concentrate

c.Increased energy

d.Orgasmic feelings

3.Research studies reported in your textbook indicate that during the 20th century the age of onset for depression:

a.Increased

b.Decreased

c.Stayed about the same

d.Increased for males, decreased for females

4.Jane is diagnosed with Bipolar II disorder. You can expect that she will experience:

a.Full manic episodes

b.Hypomanic episodes

c.Both manic and hypomanic episodes

d.Neither manic nor hypomanic episodes

5.If you have an identical twin who develops Bipolar Disorder:

a.You would be at increased risk of developing bipolar disorder.

b.You would be at increased risk of developing major depressive disorder.

c.Both A and B.

d.Neither A or B.

6.When individuals who are biologically vulnerable to depression place themselves in high risk stressful environments, it is called:

a.Humoral theory

b.The cognitive-behavioural model

c.The reciprocal gene-environment model

d.A stress-depression linkage effect

7.Current research into neurotransmitter systems has produced the permissive hypothesis, which means that:

a.Low levels of serotonin are sufficient to explain the aetiology of mood disorders

b.The norepinephrine system regulates serotonin levels; if norepinephrine is low, depression will occur

c.When serotonin levels are low, other neurotransmitter systems become dysregulated and contribute to mood irregularities

d.The absolute levels of neurotransmitters are more significant in mood regulation than the overall balance of the various neurotransmitters

8.Tricyclic antidepressants seem to have their greatest effect on the noradrenergic system by

a.Directly increasing serotonin

b.Down-regulating norepinephrine

c.Stimulating natural tricyclic compounds

d.Blocking enzymes that break down the neurotransmitters norepinephrine and serotonin

9.Owen is in therapy for depression. His therapist has helped him to identify the role that his marital problems are playing in his depression and is working with him to bring these difficulties to some type of resolution. The therapist is most likely using

a.Interpersonal psychotherapy

b.Systematic desensitisation

c.Cognitive therapy

d.Psychodynamic

10.Evidence for an inherited tendency towards suicidal behaviour comes from research involving:

a.The human genome project

b.Callers to a suicide hotline

c.Adoption and twin studies

d.psychological autopsies

Answers at bottom of page 5

Seminar 3: A biopsychosocial approach to formulating psychopathology part 1COMPILED 2022 BY DR DAVID HALLFORD

Activities

ACTIVITY 1: Learning about the four Ps

ACTIVITY 2: Using the four Ps to formulate a problem using a biopsychosocial approach

ACTIVITY 2 MaterialsRead the case below of Tony and then consider which aspects of his case belong in which box (four Ps table provided at the end of the case notes). For example, you might decide that a particular piece of information reflects a psychologically predisposing aspect. Write that into the appropriate box. Sometimes, a certain event might be viewed as relevant to more than one box. If so, write it in both boxes. If you get time (or later at home), you can also consider the 4 Ps for the case of Tony, below.

Tony is a 27-year-old small time heroin user/ dealer. He has lived in a de facto relationship for the past 18 months. He lives in an inner city shared rented accommodation where the other occupants are heroin and multiple drug users. He has never worked in fulltime employment and is in receipt of unemployment benefits. He left school just before his fifteenth birthday. He had not completed Year 9 at this time and had often been truant from school. As a consequence, he was barely literate with little in the way of functional writing and reading skills. He also left home at that time, after running away from home on three prior occasions for varying lengths of time, stealing food to eat, or shoplifting goods to sell in order to purchase food.

His mother was a heavy drinker as was his stepfather. His mother was also addicted to pain medication, after a fall at work had left her with chronic low back pain and unable to work. She and Tonys stepfather frequently fought and Tony himself was often physically beaten by his stepfather. He had no other supports. After leaving home, he lived in squats in Sydney with older adolescents. Although he had used cannabis and alcohol occasionally prior to this time, he soon gave up resisting the offers to use a variety of drugs such as amphetamines, heroin, and alcohol. He also became involved in petty crime, including frequent shoplifting and the occasional burglary with more experienced youths.

By the age of 17, Tony had developed a heroin habit, and occasionally for the next year or two he worked as a male prostitute in the city to support this habit. He stopped this work and began to deliberately enlist and steer potential customers to a dealer, also assisting in the physical transfer of the drugs and the cash. For this, the dealer gave him heroin, as did some of the customers which helped him to maintain his heroin habit without prostituting himself. He was also using pills like Rohypnol and speed occasionally, purchasing these from other users or by attending an inner city medical centre renowned for the ease with which it was possible to gain prescriptions. He also smoked cannabis regularly, but by this time he tended to avoid alcohol, unless he was short of other drugs. He also smoked about 30 cigarettes per day.

By 22 years of age, Tony had started in dealing himself, as a user/ dealer. He did not purchase heroin from the ounce dealer who supplied him. Rather he would do home deliveries for a dealer on his motorbike, being given between 15 and 30 grams of moderately pure heroin each day, and addresses to deliver this to. This delivery run gave him access to a regular supply of heroin. He would cut the heroin with glucose to make good the amount he would keep for himself. Typically in the early days he would keep a gram for himself, divide it into quarters and inject three or four times a day. By the time he was 27 he was using four times as much. He was quite tolerant to this amount of heroin. He would also store some heroin so as to ensure that he had a steady supply, and occasionally shoot up extra.

If Tony missed out injecting for some reason he would soon develop opioid withdrawal symptoms. Even on waking, before his first dose, his body would ache and feel stiff, he would experience stomach cramps, notice his heart pounding, have hot flushes, feel miserable and depressed, tense and occasionally panicky, and he would have a strong craving to use opiates. He would always inject within an hour of waking up. In the past year he had become worried about his use, recognised that it was out of control and wished that he could stop. He frequently spoke about this with Mike, a former user who had been clean for four years and Tonys only nonusing friend. Mike frequently offered to provide Tony with support to help him quit, but only when Tony was determined to quit.

Tony had been unhappy since he was quite young, after suffering the physical and psychological rejection and abuse from his mother and stepfather. Despite having escaped that environment, his depression and unhappiness had increased over the past three to four years as a consequence of his realisation of the extent of the drug problem. He was also aware of the gulf between his lifestyle and the one he would like to have, and that caused him significant anxiety and depression. His unhappiness manifested as quite low self-esteem, feelings of hopelessness about the future, low energy and sleepiness and a poor appetite. This poor mood was a chronic state for Tony and escalated on occasion into a major depressive disorder. Ironically, he used the heroin as a way of managing these feelings.

Tony first came to the attention of the health system when he was admitted to an inner city hospital casualty department unconscious from an apparent drug overdose. In recent weeks, his dealer had been arrested by the police, and because of this his supply of heroin had dried up. He had a small reserve supply but this was gone within a week, and he was forced to buy heroin from other dealers and to attend medical surgeries to get scripts for sedatives and hypnotics, but found it difficult to meet his substantial needs in these ways. He began drinking alcohol heavily. His de facto wife was also affected by the sudden loss of supply and she and Tony began fighting. One day, she suddenly moved out and Tony had no idea where she had gone.

About a week later, he had sunken into depressed state and took 15 Rohypnol tablets (a sleeping pill) and injected the contents of 10 Normison capsules (temazepam, another sleeping pill) and drunk a third of a bottle of gin. Before losing consciousness, he rang his friend Mike who took him to the hospital accident and emergency department. After acute treatment for the overdose, he remained in a drunken and drowsy state and was admitted overnight for observation and tests. While in hospital he was screened for a number of diseases and was subsequently diagnosed as suffering from chronic hepatitis B and C from sharing needles with his wife and others. He was in generally poor state of health, being malnourished, and because of his hepatitis he was at risk of developing cirrhosis and cancer of the liver in later life. After one day in hospital, he was visited by you, the psychologist employed by the drug and alcohol service. At this stage, he was beginning to suffer withdrawal symptoms, but you manage to obtain the detailed history above from him as well as Mike who had stayed with him. Tony states that he has had enough and that he wants to give up the drug use.

Biological Psychological Social

Predisposing Precipitating Perpetuating Protective

Week 4: Somatic symptom and dissociative disordersCOMPILED 2022 BY DR DAVID HALLFORD

Learning objectives

On completion of this topic, you should be able to:

describe the clinical features, causes and treatment of somatic symptom disorder;describe the clinical features, causes and treatment of illness anxiety disorder;describe the clinical features, causes and treatment of conversion disorder;discuss the difficulties involved in distinguishing conversion disorders from true physical disorders, factitious disorder and malingering;define the major features of depersonalization-derealization, dissociative amnesia, and dissociative fugue (a subtype of dissociative amnesia);describe the clinical features of dissociative identity disorder;discuss the various theoretical explanations posited for dissociative identity disorder; and

discuss the treatment of the dissociative disorders.

Learning resources

Prescribed text and Examinable Material

Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT: Wadsworth. Chapter 6.

Web sites (not examinable)

A role-played interview illustrating the experience of someone with illness anxiety disorder <http://www.youtube.com/watch?v=9PAiK8lKjhE>

The documentary; Multiple Personalities: The Search for Deadly Memories; provides an overview of the disorder illustrated by actual cases < http://www.youtube.com/watch?v=B0LNyXsErb8 >.

Study instructions

882650-5651500PRESCRIBED TEXT AND EXAMINABLE MATERIAL

Please read Barlow, Durand and Hofmann (2018), Ch. 6.

882650-5524500ACTIVITY

Imaginary playmates

According to some theories, multiple personality may develop from imaginary playmates that a child invents in stressful situations. The purpose of this exercise is to ascertain the frequency of imaginary playmates and the circumstances under which they come out to play.

Talk to ten people about imaginary playmates they had when they were young. If possible, talk to young schoolchildren who may still have them.

What are the characteristics of these playmates?

Are they similar or different from the people who create them?

What kind of things do people do with imaginary playmates?

Do stressful situations increase the likelihood of imaginary playmates coming out to play?

Adapted from Peterson, C. (1989). Casebook and study guide: Abnormal psychology

(2nd ed.). New York: W.W. Norton.

Topic review

1.All of the following have been implicated in the development and maintenance of somatic symptom disorder and illness anxiety disorder EXCEPT:

a.additional attention one receives when sick

b.a history of abuse

c.the high incidence of disease in the family during the persons childhood

d.learning to worry from family members overly concerned with health

2.Which of the following disorders is not a disorder in the class of somatic symptom and related disorders?

a.Conversion Disorder

b.Illness Anxiety Disorder

c.Panic Disorder

d.Factitious Disorder

3.George has completely lost his sight during the past year but medical experts can find no physical reason for his blindness. This could be an example of:

a.Somatic symptom disorder

b.Illness anxiety disorder

c.Conversion disorder

d.Dissociative fugue

4.The modern view of the causes of conversion disorder is:

a.Completely different from Freuds ideas for the aetiology of this disorder

b.Somewhat similar to the causes that Freud described for this disorder

c.A combination of genetic predisposition and neurobiological deficits

d.Based on social learning theory

5. Anthony and his wife have been having significant marital troubles. Conflicts between them have escalated since Anthonys 14 year old daughter from a previous marriage came to live with them six months ago. About two months ago, Anthony failed to return home from work one evening. Several weeks later, Anthony was located in a nearby town. He seemed disoriented and could not remember who he was. This is an example of .

a.Malingering

b.Localised amnesia

c.Dissociative fugue

d.Generalised amnesia

6.One aspect of the DSM-5 criteria for dissociative identity disorder is

a.Patient awareness of the distinct personalities

b.The individual is completely disconnected from reality

c.Amnesia

d.A history of abuse

7. Evidence that dissociative symptoms may be related to biological factors comes from

a.The experience of a lot of dissociative symptoms among individuals with certain neurological disorders, particularly seizure disorders

b.The extreme suggestibility of dissociative identity disorder sufferers

c.Similarities between posttraumatic stress disorder and dissociative identity disorder

d.Similarities between alters and switches

8. The general treatment plan for dissociative identity disorder patients usually centres around:

a.Integration of the personality fragments

b.Hypnotic regression of the host and each alter

c.Confrontation of the abuser

d.The typical substance abuse treatment model

Answers at bottom of page 4

Seminar 4: A biopsychosocial approach to formulating psychopathology part 2Activities

ACTIVITY 1: More practice using the four Ps to formulate a problem using a biopsychosocial approach.

Activity 1 Materials

Identifying Information. Sam Lawson is a 43-year-old male of Vietnamese descent who works as a forensic banker. He is regularly involved in high pressure cases involving high-profile police cases. Mr. Lawson was casually attired and unshaven, and appeared visibly fatigued, irritable, and impatient throughout the assessment.

Presenting Concern. Mr. Lawson was referred by his partner, Lisa, who was concerned with what he described as volatility, emotional exhaustion, and imminent burnout. On further inquiry, Lisa said she noticed that since Sams last case ended several months ago. He seemed different. In this context, Lisa noted that Sam had begun to avoid discussing his work. He ended conversations with her when the topic of his last case was brought up. He seemed less able to manage his employees in his team and spent most of his work time in his private office. Lisa said Ive seen this before. Ill bet hes having nightmares, too, but youd never get him to admit it. Hes a very closed off person.

By comparison, Mr. Lawson denied that his behaviour has changed and that he did not need to see a shrink. Noting that exhaustion, physical and emotional stress, and vicarious exposure to trauma were a routine part of his job description, Mr. Lawson added that he just needed to rest.

Background, Family Information, and Relevant History. Sam Lawson was born in Ho Chi Minh City, the older of two children to parents who separated during his early infancy. Mr. Lawson and his brother were raised by their father after moving to Australia at age 11, displacing him from family and friends there. His father was a strict parent who believed in corporal punishment, absolute obedience to authority, and fostering competitiveness between the siblings. Mr. Lawson reports that he did not get along with him. Mr. Lawson was a highly competitive and successful athlete during his formative years. He described himself as somewhat of a loner who reached out very selectively to others, but only minimally to his father, with whom he had a distant relationship. He had no contact with his mother after the marital dissolution. Following his graduation from university, Mr. Lawson married Lisa, with whom he had a daughter, Kim.

Over the past several years, Mr. Lawson has experienced several significant life stressors, including directly witnessing the death of a friend, becoming alienated from his daughter, who, he admits found it impossible to maintain a relationship with him; and developing a growing distrust of anyone around him for fear that they would leak information about his work to others. In the course of his work, Mr. Lawson has experienced a high turnover of colleagues, and has been confronted by a deep sense of guilt over his inability to produce clear reports in some cases, leading to inadequate evidence for prosecution. He claims he is not blamed for these outcomes but feels responsible for them.

Problem and Counselling History. From the outset of the meeting, Mr. Lawson made it quite clear that he was not interested in counselling and was only doing this for Lisa. He offered little eye contact, spontaneous information, and only the briefest of responses to questions, particularly those aimed at discerning feelings about himself, the job, and the hardships he has encountered. Mr. Lawson was oriented in all spheres, seemingly had intact memory for both remote and recent events, and was capable of expressing himself articulately when interested in doing so. His anger at being referred by Lisa was palpable as was his seeming willingness to say whatever needed to be said in order to convince the examiner that he was alright. Mr. Lawson described himself as a historically self-reliant individualist who has learned the hard way that it is wise neither to trust nor get close to others. Although he alluded to not valuing himself highly, on direct questioning of this he said I dont know, and dont worry about it.

Mr. Lawson described difficulties falling and remaining asleep, graphic and disruptive dreams in which he and his family were hunted down by criminals seeking revenge, as well as occasional and seemingly random intrusive and similarly themed images during his waking hours. Although he expressed a deep commitment to the importance of his work, he also expressed remorse over job-related losses, at which time he quickly choked back tears. He did admit that sometimes I just dont care what the future holds. Who cares about tomorrow when yesterday and today sometimes are so bad? When the subject of his last case was introduced, he first said he could not recall anything special about it, and then quickly changed the topic.

At one point he wondered aloud if a normal relationship with his daughter would ever be possible or if he would ever be able to enjoy a bond with his newly born grandson, Trevor. On further query about this and other issues, Sam would typically avoid discussing anything sensitive, reporting Im not someone who talks about things. At that point in the interview, Mr. Lawsons cell phone rang and he indicated the need to quickly depart.

Goals for Counselling and Course of Therapy to Date. In a brief follow-up, Mr. Lawson indicated that he was appreciative of the time spent during the interview and that he got enough out of it to hold me for the moment. He denied having significant issues or feelings of depression or anxiety, but did express an interest in making his sleep more efficient and eliminating both the nightmares and intrusive memories that get in the way of doing my job. In that context, he expressed concern that some of his current symptoms could lead to his forcible retirement.

Mr. Lawson agreed to return for a follow-up interview. The primary goals of the follow-up interview will be (a) to confirm clinically significant symptoms of PTSD in the areas of re-experiencing the trauma, avoidance of traumatic stimuli, and increased arousal; and (b) improve Mr. Lawsons motivation for counselling to address these issues and issues of grief and loss.

Differential Diagnostic Impression

Post-Traumatic Stress Disorder

Major Depressive Disorder

Avoidant Personality Disorder Features

Complicated Grief

Week 5: Substance-related and addictive disordersCOMPILED 2022 BY DR DAVID HALLFORD

Learning objectives

On completion of this topic, you should be able to:

describe the clinical features of substance use disorders in DSM-5;outline the short-term effects and long-term consequences of alcohol use;define the other depressant substances (sedatives, hypnotics, and anxiolytics) and the features (i.e., effects) of their use;define stimulants and describe the features of amphetamine and cocaine use disorders;define and describe the features of opioid use disorders;define hallucinogens and describe the features of the use of marijuana and LSD and other hallucinogens;discuss biological, psychological, cognitive, social and cultural factors in the aetiology of substance use and how these contribute to an integrative model of substance related disorders; and

describe and evaluate the various biological, psychosocial, and sociocultural interventions for alcoholism and other substance related disorders.

Learning resources

Prescribed text and Examinable Material

Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT: Cengage Learning..Chapter 11, pp. 404-442 (7th ed. pp. 396433).

Web sites (not examinable)

DrugInfo Clearinghouse is a program of the Australian Drug Foundation. It provides easy access to information about alcohol and other drugs as well as information on drug prevention. < https://adf.org.au/resources/ >.

The Ministerial Drug and Alcohol Forum provides the latest information about the combined state and federal governments approach to managing drug related problem < https://www.health.gov.au/committees-and-groups/ministerial-drug-and-alcohol-forum-mdaf>.

The National Drug and Alcohol Research Councils web site contains up to the minute information about a wide variety of drugs. < https://ndarc.med.unsw.edu.au/ >.

The Alcoholic Anonymous Australia web site provides information about the organisations structure, philosophy, and details about meetings. <http://www.aa.org.au/>.

Study instructions

882650-5651500PRESCRIBED TEXT AND EXAMINABLE MATERIAL

Please read Barlow, Durand and Hofmann (2018), Chapter 11, pp. 404-442 (7th ed. 397433) (not impulse control disorders).

882650-5651500ACTIVITY

Addiction simulation exercise

Adapted from Campbell, T.C. (1999). Addiction simulation exercise: Ice cube addiction. In L.T. Benjamin, B.F. Nodine, R.M. Ernst, & C.B. Broeker (Eds), Activities handbook for the teaching of psychology (Vol. 4). Washington, D.C.: American Psychological Association.

This activity will allow you to experience some of the physical, social, cognitive, and emotional experiences of a person who is dependent on a drug. This is a great exercise and I strongly encourage you to try it. You can stop the exercise at any stage though you will gain the most insight if you follow it for the full 24 hours.

Protocol

1Drug Your drug of choice is ice cubes. You used to be able to get off simply on water, but your addiction has progressed way beyond this. You now need specially processed waterice cubes.

2Craving Thirst is your craving for the drug ice cubes. Every time you drink any liquid you must have an ice cube in it. This will be difficult and requires planning. It applies to all drinking situations including hot drinks and cans.

3Legality Ice cubes are socially unacceptable and illegal. Dont allow regular people to see you or catch you using ice cubes. This applies to friend and family. This will require creative thinking.

4Tracks Wear a piece of coloured wool around your wrist. This is analogous to needle track marks, so it is socially unacceptable for people to see this woollen bracelet.

5Obsession Keep an hourly log of your degree of thirst and where your next ice cube is coming from. This will simulate the obsession the drug

dependent person experience

Topic review

1What explains the apparent stimulation, feeling of well-being and outgoing behaviour that occurs as the initial effects of alcohol ingestion?

a.Depression of the inhibitory centres in the brain

b.Activation of the inhibitory centres in the brain

c.Depression of the autonomic nervous system

d.Stimulation of the autonomic nervous system

2Which of the following is an accurate statement about amphetamines and/or amphetamine use disorders?

a.Amphetamines cause a period of depression and fatigue (called crashing which is followed by feelings of elation and euphoria

b.Amphetamines cause an increase in appetite and a decrease in fatigue

c.Amphetamines decrease the availability of dopamine and norepinephrine in the nervous system

d.Amphetamine overdose can cause hallucinations, panic, agitation, and paranoid delusions

3Whether or not alcohol will cause damage to the organs it comes in contact with depends on

a.A persons genetic vulnerability

b.The frequency of a persons drinking

c.The length of drinking binges

d.All of the above

4Although most psychoactive substances interact with specific substances in the brain cells, the effects of _________ are much more complex because several different neurotransmitter systems are affected.

a.Opiates

b.Tranquilisers

c.Alcohol

d.Marijuana

5Zoes friends brought her to the college health clinic late on a Friday night. Although she was euphoric, she was also very agitated and paced the examination room. Her pupils were dilated, her blood pressure was higher than normal, and her pulse was irregular. Zoes friends said she had taken something but that they didnt know what it was. It appears that Zoe has taken

a.Barbiturates

b.Benzodiazepines

c.Sedatives

d.Amphetamines

6Which substances are associated with marked anxiety, ideas of reference, paranoid ideation, and hallucinations?

a.Opioids

b.Stimulants

c.Hallucinogens

d.Depressants

7In behavioural terms certain drugs are considered negative reinforcers because they:

a.Make a person feel good

b.Stop a person feeling pain and other adverse states

c.Have toxic effects on the nervous system

d.Can cause frequent users to become dependent on them

8The pleasure pathways or internal reward centres in the human brain are primarily made up of:

a.Dopamine-sensitive neurons

b.Serotonin-sensitive neurons

c.Both of thesed.Neither of these

9 Which of the following are examples of agonist type treatment for substance abuse?

a.The use of methadone to treat heroin addiction

b.The use of naltrexone for alcohol dependence

c.Both of thesed.Neither of these

10 The main factor that determines who will be successful in Alcoholics Anonymous and who will not isa.The expectancies a person brings to the meetings

b.The extent of a persons social support

c.The extent of a persons spirituality

d.Unknown

Answers at bottom of page 7

Seminar 5: Protective factors and stigmaActivities

ACTIVITY 1: Identifying strengths and protective factors

ACTIVITY 2: Mental illness stigma in the media

Stigma in mental illness as defined by Goffman (1963) as an attribute that is deeply discrediting which leads the stigmatised person to be reduced... from a whole and usual person to a tainted or discounted one (p. 3). The stigmatized are therefore perceived as having a spoiled identity (Goffman, 1963, p. 3). Dudley (2000) defined stigma as stereotypes or negative views attributed to a person or groups of people when their characteristics or behaviors are viewed as different from or inferior to societal norms.

Building from Goffmans (1963) initial conceptualization, Jones and colleagues (1984) identified six dimensions of stigma: concealability (can it be kept secret?), course (is it stable?), disruptiveness (does it strain relationships?), origin (what caused it?), aesthetics (it is displeasing to the senses?), and peril (is it dangerous?). Their list of dimensions is not exhaustive; for any specific condition or characteristic, additional dimensions might be relevant.

In particular, the dimension of peril is important otherwise known as dangerousness. In this instance, the general public perceives those with mental disorders as frightening, unpredictable, and strange. Further, the psychiatric symptoms, awkward physical appearance or social-skills, and labels contribute to social awkwardness and when society attributes, upon a person or group of people, perceived behaviors that do not adhere to the expected social norms, discomfort can be created. This often leads to the generalization of the connection between abnormal behavior and mental illness, which may result in labeling and avoidance.

Another dimension of stigma is origin. Within this dimension, it is often believed in society that mental and behavioral disorders are personally controllable and if individuals cannot get better on their own, they are seen to lack personal effort, are blamed for their condition, and are seen as personally responsible. Concealability, or visibility of the illness, is another dimension of stigma. Research shows that society attributes more stigmatizing stereotypes towards disorders such as schizophrenia, which generally have more visible symptoms, compared to others where the distress or symptoms are more hidden, such as major depression. However, those with concealable symptoms are also more likely to refuse help, self-isolate and not seek support, and report more negative outcomes. Aesthetics concerns the degree to which a person with mental illness elicits an instinctive and affective reaction of disgust.

Course and disruptiveness have some similarities to each other and when compared to the others presented. Course and stability question how likely the person with the disability is to recover and/or benefit from treatment. The disruptiveness dimension assesses how much a mental or behavioral disorder may impact relationships or success in society. While disorders are frequently associated with an increased risk for poverty, lower socioeconomic status and lower levels of education, the stability and disruptiveness of the conditions have implications as to whether an individual will be able to hold down a successful job and engage in healthy relationships, as evidenced by differences in stigma based on social class status. This demonstrates that if disorders are less disruptive, in which case they may be perceived as more stable, they are also less stigmatized. Disorders that are pitied to a greater degree are also often less stigmatized. This also expresses that some flexibility exists within each type of mental or behavioural disorder, as each diagnosed person is not stigmatized to the same extent.

Corrigan and Watson (2002) proposed a further framework in which stigma is categorised as either public stigma or self-stigma (see Table 1). Public stigma is the reaction that the general population has to people with mental illness. Self-stigma is the prejudice which people with mental illness turn against themselves. Within each of these two areas, stigma is further broken down into three elements: stereotypes, prejudice and discrimination. Stigma is a mark of disgrace that sets a person apart. When a person is labelled by their illness they are seen as part of a stereotyped group. Negative attitudes create prejudice, which leads to negative actions and discrimination. Corrigan and Watson also note that media analyses of film and print have identified three common discriminatory messages: people with mental illness are homicidal maniacs who need to be feared; they have childlike perceptions of the world that should be marveled; or they are responsible for their illness because they have a weak character.

Table 1. Comparing and contrasting the definitions of public and self-stigma

Public Stigma Stereotype Negative belief about a group (e.g., dangerousness, incompetence, character weakness)

Prejudice Agreement with belief and/or negative emotional reaction (e.g., anger, fear)

Discrimination Behaviour response to prejudice (e.g., avoidance, withhold employment and housing opportunities, withhold help)

Self-Stigma Stereotype Negative belief about the self (e.g., character weakness, incompetence)

Prejudice Agreement with belief, negative emotional reaction (e.g., low self-esteem, low self-efficacy)

Discrimination Behaviour response to prejudice (e.g., fails to pursue work and housing opportunities)

What is the influence of stigma?As shown in the table below from Byrne (1997; see Table 2), stigma has consequences for the individual, their family and social network, for the course of the illness, and for the outcome of the disorder. Stigma can negatively influence the presentation, detection and treatment of disorder.

Table 2. Consequences of psychiatric stigma and related measures.

At onset of symptoms At Presentation At Diagnosis Post-admission / labelling

Individual Symptoms denied

Failure to present

Declines psychiatry referral

Inc. Substance abuse (self-medication) Declines treatment

Refuses admission

Takes own discharge

Lost to follow-up

Non-compliance

Inc. Substance abuse Self-stigmatization: shame, sense of failure; anticipates rejection; inc. negative automatic thoughts; avoidance behaviour; dec. self-esteem Victimization: staring, jeering and direct prejudice; dec. new social contacts; loss of employment/ education; discrimination when renting. If imprisoned, parole less likely

Family/ Network Untreated family member

Symptoms perceived as laziness

Loss of income

Poor relationships Family must overcome their own prejudices

Family may deny diagnosis

'Doctor shopping'

Rejection of treatments

Stigmatization of the family by mental health professionals: focus of family's weaknesses rather than strengths Local prejudices against the family

Family may become isolated

Inc. scapegoating of individual

Opposition to community facilities

Course of the illness Delay in treatment carries poorer prognosis

Comorbidity: substance abuse

Illness never diagnosed All treatments refused

Choices limited to treating involuntarily or not at all

Missed appointments Psychiatric label makes initial symptoms worse

Intermittent compliance carries poorer prognosis Chronic relapsing illness with a failure of rehabilitation

Homelessness, unemployment and isolation

Inc. suicide risk

Measures of Outcome Time to presentation

Percentage of untreated illness in the community

Comorbidity Failed appointments

Patient drop-out rates

Numbers of voluntary patients Attitude and satisfaction surveys (patients and their families)

Symptom counts over time

Measures of compliance Surveys of patients' experiences: work, education, homelessness, forensic

Community attitude surveys

Relapse rates/suicide statistics

Stigma contributes to the loneliness and distress of individuals with mental illness, and to the discrimination against people with mental illness. Byrne (1997) notes the problems including discrimination in housing, education, and employment; increased feelings of hopelessness. Stigma leads to people being reluctant to seek help or to cooperate with medical treatments, and lowering of self-esteem and self-confidence. Stigma brings experiences and feelings of: shame, blame, hopelessness, distress, misrepresentation in the media, reluctance to seek and/or accept necessary help. At its most extreme, it can contribute to increasing suicidal risk. Families are also affected by stigma, leading to a lack of support. For mental health professionals, stigma means that they themselves are seen as abnormal, corrupt or evil, and psychiatric treatments are often viewed with suspicion and horror.

It is therefore imperative that we work to reduce stigma, and that people working with mental illness are aware of the barriers that stigma and prejudice can pose to effective treatment.

Sane Australia gives the following examples of stigma across multiple domains in their report A life without stigma.

1. General community: I have a dream that one day I wont hold my breath every time I tell a person that I suffer from bipolar disorder, that I wont feel shameful in confessing my mental illness.

2. Health and other services: Sometimes nurses . . . dont encourage you to do something new or tell you not to go for a job. They sow the seeds of doubt.

3. Education: I was diagnosed with OCD when I was 13 and have faced all types of stigma over the years. Mainly classmates making fun of me and the symptoms of my illness. It had a huge effect on my confidence and can be one of the hardest parts of dealing with a mental health problem.

4. Workplace: If someone at a job interview explains a two year gap in their resume by mentioning chemotherapy, they will likely be heralded as a survivor and their chances at the job typically would not be affected. But if the same person, with the exact same qualifications and manner of interacting explains a gap and mentions a psychiatric hospitalization, things may be a little different.

5. Mass media: I was diagnosed with schizophrenia a decade ago and in my search to understand my new illness, the media offered me a skewed vantage point where it appeared schizophrenia was simply a licence for bad behaviour. Now, on the inside looking out, I recognise what an inaccurate portrayal this is, the exception rather than the rule. Like many living with schizophrenia, I was a victim of violence and abuse rather than the perpetrator.

6. Government: The level of funding provided for mental health directly affects the availability and quality of services that are available to provide treatment and support for people with mental illness. As well as improving outcomes and quality of life, effective treatment for mental illness is also important to reduce stigma associated with symptoms of illness.

7. Self-stigma: Self-stigma is a burden. My mental illness diagnosis and treatment left me

with a very difficult feeling of failure. (www.sane.org/images/PDFs/ALifeWithoutStigma_A_SANE_Report.pdf)

References

Byrne, P. (1997). Psychiatric stigma: past, passing and to come. Journal of the royal society of medicine, 90(11), 618-621.

Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World psychiatry, 1(1), 16-20.

Dudley, J. R. (2000). Confronting stigma within the services system. Social Work, 45(5), 449-455.

Goffman, E. (1986). Stigma: Notes on the management of a spoiled identity. New York, NY: Simon & Schuster (Original work published 1963).

Jones, E. E. (1984). Social stigma: The psychology of marked relationships. WH Freeman.

Week 6: Eating disordersCOMPILED 2022 BY DR DAVID HALLFORD

Learning objectives

At the conclusion of your work in this topic, you should be able to:

describe the clinical features and medical complications of bulimia nervosa, anorexia nervosa, and binge eating disorder;discuss the prevalence of eating disorders and the manner in which cultural and developmental factors impact on this;describe the social, biological and psychological factors thought to contribute to the development of eating disorders;discuss the pharmacological treatments of eating disorders;discuss the psychological treatment of eating disorders; and

discuss the prevention of eating disorders.

Learning resources

Prescribed text and Examinable Material

Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach

(8th ed.). Stamford, CT: Cengage. Chapter 8 excluding obesity and sleep, pp. 295-217 (7th ed. pp. 268-289).

Web sites (not examinable)

The web site of the Eating Disorders Foundation of Victoria provides information for both sufferers and their family and friends, as well as details regarding how to access health professionals, and resources such as useful books. The meeting times of the separate fortnightly support groups for sufferers and carers at the Foundations Glen Iris address are also available at the web site. <http://www.eatingdisorders.org.au/>.

This is the web site of the Eating Disorders Association of Queensland. It is quite comprehensive in its content. < https://eatingdisordersqueensland.org.au/>.

The Dying to Be Thin webpage provides approximately 60 minutes of video material concerning the features, causes, and treatment of anorexia and bulimia. You will need QuickTime to view this.

<http://www.pbs.org/wgbh/nova/thin/program_qt.html>

The National Eating Disorders Collaboration brings research, expertise and evidence from leaders in the eating disorders field together in one place < http://www.nedc.com.au/ >.

The Butterfly Foundation for Eating Disorders provides support for those with eating disorders and body image issues < http://thebutterflyfoundation.org.au >.

Self-help books (not examinable)

These books can be ordered online or the first two are available in the Deakin library.

Cooper, P. (2009). Overcoming bulimia nervosa and binge eating: A self-help guide using cognitive behavioral techniques (3rd edition). London: Constable & Robinson.

Fairburn, C. (2013). Overcoming binge eating (2nd. ed). New York: Guilford Press

Treasure, J. & Alexander, J. (2013). Anorexia nervosa: A recovery guide for sufferers, families and friends (2nd ed). London: Routledge.

Study instructions

882650-5651500PRESCRIBED TEXT AND EXAMINABLE MATERIAL

Please read Barlow, Durand and Hofmann (2018), Chapter 8 excluding obesity and sleep, pp. 272-294 (7th ed. pp. 268-289).

882650-5524500ACTIVITY

Treating anorexia

This exercise has been designed to give you an understanding of some of the important concepts and issues involved in the treatment of eating disorders. In the exercise, you will put yourself in the place of the therapist assigned to treat Josies anorexia nervosa. Read the details of her case below and think about how you might address the following issues:

Josies low weight, restricted eating patterns and excessive exercise

Her low motivation to co-operate in treatment

Her disturbed perception of her body

Her relationship with her family

Case details

Josie S. is a fifteen year old female who was referred to the City Hospitals Eating Disorders Unit because she is believed to be suffering from anorexia nervosa. Josie is 150 centimetres tall. In the past 6 months, her weight has dropped from 55 kilograms to 35 kilograms (a BMI of 15.5). She appears emaciated and is physically weak. Josie reached menarche at 11 but has not had a period in 16 weeks. Her parents state that while they thought Josie could have lost a couple of kilograms, they became concerned when she began to refuse to eat any meals at home and exercising for several hours a day. Josie herself reports that she feels fine and doesnt understand what all the fuss is about, as she is still a fat pig. Her parents appear to be very controlling of Josie, set extremely high standards for her, and do not appear to be responsive to her feelings on critical issues.

Adapted from Nicolai, K.M. (1995). Student workbook for Comers Abnormal psychology

(2nd ed.). New York: Freeman

Topic review

1The critical clinical feature/s of bulimia is/are

a.Purging

b.Binge eating

c.Fasting or exercising

d.Binge eating followed by compensatory behaviour

2A common medical complication of anorexia is

a.High blood pressure

b.Cessation of menstruation

c.A rapid heart rate

d.Oily skin

3The increase in the incidence of eating disorders such as anorexia and bulimia has been referred to as a collision between our culture and our physiology. The most accurate interpretation of this statement is that

a.People have become too dependent on media defining what is regarded as beauty

b.Media standards of beauty are increasingly unattainable for the average women

c.Dieting has become so commonplace that it is the norm

d.Societys definitions of beauty merely reflect changes in peoples body shapes and sizes

4Bulimia is

a.More prevalent than anorexia

b.Less prevalent than anorexia

c.As prevalent as anorexia

d.Not been recognised as a distinct syndrome long enough to determine its prevalence

5Susan, a woman of relatively normal weight, sometimes eats huge quantities of junk food with no ability to stop herself. She follows this with long periods of complete fasting. Based on this information, Susan would:

a.Be diagnosed with bulimia

b.Be diagnosed with anorexia

c.Not be diagnosed with any disorder because she is of normal weight

d.Not be diagnosed with bulimia because she is not purging

6The families of anorexia patients are typically characterised by all of the following EXCEPT:

a.Open communication

b.high achievement

c.avoidance of conflict

d.concern with external appearances

7Jill has been in treatment for anorexia for the past two months. Over this time she has gained weight to the point that she is now in the healthy weight range. The fact that she gained weight fairly quickly in treatment means

a.Her prognosis for a full recovery is very good

b.She is probably in need of little, if any more treatment

c.She has completed the most difficult part of treatment

d.Little in terms of how likely she is to recover fully in the long term

8The most recent treatment study regarding the treatment of binge eating disorder indicates that interpersonal psychotherapy is _________ cognitive-behaviour therapy

a.Not as effective as

b.More rapid but not as effective as

c.More effective than

d.Equally effective as

Answers at bottom of page 6

Seminar 6: StigmaActivities

ACTIVITY 1: Identifying dimensions of stigma

Activity 1 Materials: Frame your discussion of the clips below using the dimensions of stigma noted the previous seminar (see content above for Seminar 5):

Concealability: how obvious or detectable a characteristic is to others

Course: whether the difference is life-long or reversible over time

Disruptiveness: the impact of the difference on interpersonal relationships

Aesthetics: whether the difference elicits a reaction of disgust or is perceived as unattractive

Origin: the causes of the difference, particularly whether the individual is perceived as responsible for this difference

Peril: the degree to which the difference induces feelings of threat or danger in others.

Big Bang Theory:https://video.deakin.edu.au/media/t/0_mnb3o9quScrubs:https://video.deakin.edu.au/media/t/0_rxyv4xb2

MatchstickMen:https://video.deakin.edu.au/media/t/0_mc9edbtrGirls:https://video.deakin.edu.au/media/t/0_goit9293Monk Blood Test:https://video.deakin.edu.au/media/t/0_rz61yaulAs Good as it Gets:https://video.deakin.edu.au/media/t/0_z9ccaf2vWeek 7: Schizophrenia & other psychotic disordersCOMPILED 2022 BY DR DAVID HALLFORD

Learning objectives

At the conclusion of your work in this topic, you should be able to:

outline the history of the diagnosis of schizophrenia, including reference to Kraepelin, and Bleuler;describe the major clinical symptoms of schizophrenia and classify them as positive, negative or disorganised symptoms;*discuss evidence related to the developmental course of schizophrenia;critically discuss evidence for genetic transmission, excess dopamine, brain abnormalities and viral infection as causes of schizophrenia;critically discuss evidence for psychological and social influences; and

evaluate the efficacy of biological and psychosocial therapies for schizophrenia.

*Note here that disorganized symptoms are sometimes classified separately, and sometimes under positive symptoms.

Learning resources

Prescribed text and Examinable Material

Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (6th ed.). Stamford, CT: Cengage Learning. Chapter 13.

Web sites (not examinable)

Below are a number of interesting web sites with details of services and facilities to be found in Australia.

For the most recent developments in schizophrenia research, visit the Florey Institutes web site. < https://www.florey.edu.au/schizophrenia >.

Information and services for carers of people with schizophrenia is provided through Wellways (formerly the Mental Illness Fellowship of Victoria). <https://www.wellways.org/ >.

The web site for Orygen (formerly the Early Psychosis Prevention and Intervention Centre) provides information to individuals experiencing psychosis. < https://www.orygen.org.au/ >.

Study instructions

882650-5524500PRESCRIBED TEXT AND EXAMINABLE MATERIAL

Please read Barlow, Durand and Hofmann (2018), chapter 13.

ACTIVITY

Decreasing risk of schizophrenia

For this activity, use the information in Barlow, Durand and Hofmanns chapter on schizophrenia.

Given a new-born child with high-risk genetic vulnerability for schizophrenia, what advice can you offer the parents to minimise chances that the child will develop the disorder? What advice would you add about minimising the likelihood of relapse, should the child later have an episode of schizophrenia?

Topic review

1Alexander told his Year Level Coordinator that his entire class was trying to get him to leave school, and claimed other students were breaking into teachers offices and changing his answers on homework and exams. Alexander is experiencing

a.Hallucinations

b.Delusions of grandeur

c.Disorganised thinking

d.None of the above

2After Steve was asked how his summer holidays were he offers the following reply My summer was great. Yes, great as the wall of China. China is one place I have never been. I sure do like to travel. My brother used to work for a travel agent a long time ago. It sure has been a long time since Ive seen my sister. His reply is an example of

a.Loose associations

b.Catatonia

c.A negative affect

d.Waxy flexibility

3Which of the following statements represents circumstantial evidence for the dopamine theory of schizophrenia?

a.Antipsychotic drugs (neuroleptics) act as dopamine agonists, increasing the amount of dopamine in the brain

b.Antipsychotic drugs can produce symptoms similar to those of Parkinsons disease (a disorder of insufficient dopamine)

c.The drug L-dopa, a dopamine agonist, is used to treat schizophrenic symptoms in patients with Parkinsons disease

d.Amphetamines, which activate dopamine, can lessen psychotic symptoms in persons with schizophrenia

4Which of the following statements contradicts the dopamine theory of schizophrenia?

a.Many people with schizophrenia are not helped by dopamine antagonists.

b.Clozapine, one of the weakest dopamine antagonists, reduces schizophrenia symptoms in those who were not helped by stronger dopamine antagonists

c.Both of these statements contradict the dopamine theory of schizophrenia

d.Neither of these statements contradict the dopamine theory of schizophrenia

5What is the evidence for structural damage in the brains of patients with schizophrenia?

a.All such patients have smaller ventricles in their brain

b.In some patients there is an excess of gray matter in the cerebral cortex

c.The majority of patients have enlarged ventricles in their brains

d.Many patients have increased activity in the frontal lobes of the brain

6The familial communication style called expressed emotion (EE) sometimes used to predict relapse rates in schizophrenia includes all of the following EXCEPT:

a.Overinvolvement

b.Criticism

c.Emotional distance

d.Hostility

7Ruby has been suffering from schizophrenia for two years. Her last therapy session focused on maintaining eye contact when talking to a person, offering the other person positive feedback, and asking the other person questions about his or her interests. This type of therapy

a.Is called milieu therapy

b.Has been shown to have no effect on people with schizophrenia

c.Is aimed at increasing social skills

d.Is no longer used

8 Clozapine is a medication that has been found to

a.Be effective with many people who have not been helped with more traditional neuroleptic medication

b.Block the D2 receptor site better than any other neuroleptic

c.Act on serotonin as well as dopamine systems

d.Both a and c

Answers at bottom of the page8

Seminar 7: Assessing psychopathology part 1COMPILED 2022 BY DR DAVID HALLFORD

Pre-reading

No major pre-reading, although you may wish to view the youtube clips as indicated.

Why are we doing this?

The activities in this class are linked to diagnosis generally, and will help reinforce your knowledge of the presentation of various forms of disorders. One of the skills of becoming a clinical psychologist or mental health worker is being able to observe and describe client presentation; such observation is the basis for the Mental Status Exam that is taught within the postgraduate course. Observation gives important clues for what is going on for a client and gives clues (but clues only) to help a clinician determine a diagnosis.

Please note much of the terms used in an MSE are technical, and designed for very brief descriptions. As such, terms can appear pejorative e.g., loose associations, etc. This is so as to facilitate brief communication and documentation, but we appreciate if you find such terms to be less than complimentary.

What is a mental status exam?As you may have heard in earlier courses, a mental status exam is an systematic inquiry at the time of the interview, combined with a structured record of observations. It is a cross-sectional snapshot of the client's presentation which gives clues as to the client's possible problem. The major headings differ by practitioner, but generally take in:

Appearance, Attitude, and Activity

Mood and Affect

Speech

Thought Process (Thought Form or Form of thought)

Thought Content

Perception

Cognition Orientation, Attention & Concentration, Memory

Insight and Judgment

Of these headings, we are only to discuss the ones related to thought content and thought process in this tutorial.

As noted by Trzepacz and Baker (1993) in their influential book on the MSE: we cannot directly know another person's thoughts, but inferences can be made based on what is said and observed. Assuming that there are no language problems, evaluation of thought form and content is critical to evaluating a client's psychiatric state. Serious disorders of thought form and content, also known as psychotic disorders, are among the most severe and most disabling of the mental illnesses.

A prominent example of when individuals display what is known as thought disorder is in schizophrenia. Individuals with schizophrenia can display any of a variety of disorders of thinking, including what are known as: delusions, loose associations, ideas of reference, and thought blocking. In this sense, disorder is quite literal thoughts are not ordered in the sense of leading to a logical conclusion and being connected together.

As with most psychiatric symptoms, there is no 1-to-1 association between presentation and disorder. While disorders of thought are usually associated with the schizophrenic disorders, they can also occur in a variety of conditions. Severe cases of mania often are associated with hallucinations, delusions (typically grandiose or persecutory in nature), and flight of ideas. Severe depression can be accompanied by delusions (often nihilistic, guilt and unworthiness or somatic in nature). Delirium and advanced dementia usually include delusions (often persecutory), hallucinations, and incoherence. Clients with personality disorder may at times slip into overtly psychotic symptoms, such as hallucinations (included under perception in an MSE) or delusions. Some drug intoxication and withdrawal states include thought disorder and psychosis.

The goal of the clinician is to document an assessment of the client's content, organisation, flow, and production of thought. As the clinician cannot actually know clients' thoughts or thought processes, this assessment is inferred from clients' communication or from direct questioning about what their thoughts are like. Unless clients express their thoughts through speaking, writing, or sign language, their thought processes cannot be described. It is assumed that spoken words closely resemble the underlying thoughts.

Thought Process - Definitions

When individuals show normal thought patterns, they are said to be goal directed and connected. That is, the thoughts lead (or are leading) to a logical conclusion, and each thought is connected to the thought before. It is possible for each thought to be connected together, but not to the overall conclusion (in fact, politicians answers often are of this form they are logical from sentence to sentence but dont actually lead to a conclusion that bears on the interviewers questions!)

The following are technical descriptors with regard to thought form. Descriptors of the connectedness of thoughts listed in order of increasing severity are normal associations; circumstantiality; tangential associations; flight of ideas; loose associations; and word salad or incoherence. Loosening of associations occurs in the context of thought disorder, most often in schizophrenia.

Circumstantiality. Talking at length around a point before finally getting to it, usually in an overly detailed fashion.

Tangentiality. The person changes the topic from the focus of the interview and follows another topic of conversation. It is named after the geometric concept of a line that touches the edge of a circle and then veers off on its own course. Tangential speech is fluent, grammatical, and logically connected, but the content will veer from the original topic into one or more different topic areas without ever returning to the topic at hand (i.e., it is not goal directed). Tangentiality is a much less severe disruption of the structure of thought than is loose associations.

Flight of ideas A disorder in the connectedness of thought processes in which the client's topic of conversation changes repeatedly, tangentially, and quickly, even from one sentence to the next. This is classically seen in mania and therefore, many clinicians consider rapid, pressured speech to be an integral part of flight of ideas. Flight of ideas is on a continuum with loosening of associations at one extreme, and normal flow and connectedness at the other. In flight of ideas the logical connection between ideas is retained, whereas in loosening of associations the logical connection is lost.

Racing thoughts The subjective experience of thoughts moving very quickly from topic to topic. Racing thoughts are reported most often by clients with mania, hypomania, anxiety, hyperthyroidism, and drug intoxication (as with amphetamines).

Loose associations The loss of the normal connectedness in the subject matter of speech. In the thoughts and conversational speech of healthy individuals, sentences and ideas flow logically; during transitions between ideas, the connections are readily apparent and are related to the topic being discussed. With loose associations, the topic may suddenly shift gears, and the commonality of content or meaning may be only "loosely" apparent, with transitions based on rhymes, homonyms, or idiosyncratic mental connections.

Blocking The client's speech and thought are interrupted in mid sentence and do not resume their course. If clients are articulate about what is happening to them, they will often describe that "the idea disappeared from my head."

Derailment Thoughts are disconnected or illogically connected. Speech is difficult to follow because it jumps from one topic to another in a manner analogous to a train derailing or jumping off the tracks. This term also implies severe loosening of associations.

Clang associations A form of loose associations in which statements are connected by sound and not by meaning (e.g., ''station, nation, ablation''). The significance of this must be judged in broad context, because clang associations can occur in poetry, in addition to mental illnesses like mania and other forms of psychosis.

Word salad An extreme and rare form of loosening of associations. Speech consists of a series of unconnected words and neologisms. The speech sounds fluent, but the content is incoherent. Word salad occurs mostly in schizophrenia.

Magical thinking Illogical ideas that ascribe an unrealistic (magical) outcome or powers to an event or idea. This phenomenon is normal in children, for example, youngsters will avoid stepping on the cracks in sidewalk's because it may "break their mothers' backs." It also occurs in clients with obsessive compulsive disorder.

Neologisms The use of novel vocabulary, made up by the client but not recognised by the client as new or nonsense words. For example, "personitations" for medication side effects.

Poverty of speech Little meaningful information is contained in the client's conversation. Most commonly, this is manifested by the absence or near absence of spontaneous comment, and the response to questions with terse or one word answers, even when elaboration is obviously in order. Alternatively, the amount of speech may be normal or even increased, yet be impoverished in content. Such speech is vague, repetitious, and circumstantial.

Thought Content

Thought content is less technically described than thought form, but is key as it concerns what the client is concerned about. For example, if the client is preoccupied with a certain topic, or shows depressive themes or grandiose delusions (e.g., I am a famous inventor when there is no evidence that this is true), this is documented here. Obsessive thoughts, anxious thoughts, and phobic thoughts are also noted here.

Delusions

Delusions are one example of thought content. They are objectively incorrect beliefs that are not culturally determined or shared with a large group and that cannot be shaken by contrary evidence. Systematised delusions are well organised and complex, have multiple elements around a central theme, and are relatively stable over time. Delusions are frequent in psychosis, but certainly can be caused by neurological as well as other psychiatric disorders. There are many subcategories or specifically named delusions, some of which are defined as follows:

Grandiose A deluded belief that one possesses special wealth, powers, skill, influence, or destiny. Thought content that is indicative of unduly inflated self-esteem or exaggerated self-confidence may also be called "grandiose" without indicating that it is delusional. Grandiose delusions are common in mania.

Nihilistic Belief that one is dead or empty or that some calamity is impending or has taken place; for example, the belief that the world is ending, or that God despises oneself.

Paranoid Used most commonly as a synonym for persecutory delusion. Paranoid clients often have persecutory delusions, but may also have grandiose delusions or delusions of reference.

Persecutory The belief that one is being harmed, watched, ridiculed, manipulated, discriminated against or plotted against, by another individual or group.

Somatic A delusion about some bodily abnormality, illness, or special attribute. These delusions may be straightforward convictions of illness, such as cancer or heart failure, but at times are bizarre, such as of snakes eating at organs or electrical wiring in the limbs. They are commonly associated with major depression, mania, and delirium, though more bizarre delusions tend to occur in schizophrenia.

Denial An inability or extreme reluctance to accept some aspect of reality even when it is demonstrated by another. Denial may be encountered in general medical practice: "My chest pain is just indigestion" or "Cigarettes won't hurt me." More severe forms may be seen in the face of a major trauma or in psychotic illnesses..Erotomania A delusional belief that one is loved, perhaps secretly, by some other person.

Ideas of Reference/Delusions of Reference The incorrect ascription of special, individualised meaning to neutral stimuli. Referential thinking often involves inappropriately personalising information from books, television, movies, radio, or newspapers. For example, the client may think that a television program has special meaning for him or that a newspaper article about an unrelated issue actually refers to him.

Example

Thought Process: Janet displayed some disruption of thought connectedness. There was moderate tangentiality; she moved from talking about love of the outdoors to love (intercourse) in the outdoors. A neologism was detected when Janet described herself as a morphadite that could change between having male and female genital parts.

Thought Content: Content centres on grandiose delusional themes consistent with elevated mood. Believes she is working incognito for the Lord as a spy on a mission to fight for the American way, can control the wind, the rain, and the sunshine. that she is a hermaphrodite, like God in heaven. Believes she can get drunk on coffee and Koolade. Shows magical thinking; believes her mother dying at same age as year Janet was born indicates that she is her guardian angel.

DISCLAIMER: While the below task will give you some basic experience in doing MSEs thought sections, help with your understanding of the presentation of psychological disorders, and help with your knowledge of MSEs, as with using the DSM generally you need much formal training under supervision to be competent in such an activity!

Activity 1 Doing MSEs

Your Task:

Watch the following clips and describe - using the framework above - the client's content and form of thought. Note that all descriptors should be backed up by specific examples as in the example. (These clips are quite well-known so Im sure youll see them again in your studies!)

Include under thought form, any disruptions to the connectedness of goal-directed nature of thoughts. Include under thought content, any preoccupations, phobias, obsessions, and delusional content.

Psychiatric Interviews for Teaching: Mania http://www.youtube.com/watch?v=zA-fqvC02oMPsychiatric Interviews for Teaching: Depression http://www.youtube.com/watch?v=4YhpWZCdiZcPsychiatric Interviews for Teaching: Psychosis https://www.youtube.com/watch?v=ZB28gfSmz1Y

References

Trzepacz, P. T., & Baker, R. W. (1993). The psychiatric mental status examination. Oxford University Press

Week 8: Personality disordersCOMPILED 2022 BY DR DAVID HALLFORD

Learning objectives

On completion of this topic, you should be able to:

describe the characteristic features common to all personality disorders;critically evaluate the arguments for and against using a categorical system of classification or a dimensional assessment of personality disorder;describe the clinical features of each DSM-5 personality disorder;discuss issues related to the gender differences in the diagnosis of personality disorders;discuss the differences in the defining features of antisocial personality disorder and psychopathy;consider the relationship between antisocial personality disorder, psychopathy and criminality;critically evaluate the genetic, neurobiological, psychosocial, and developmental theories and research as to the causes of antisocial personality disorder;discuss the treatment and prevention of antisocial personality disorder; and

discuss the clinical features, causes, and treatment of borderline personality disorder.

Learning resources

Prescribed text and Examinable Material

Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT:Cengage Learning. Chapter 12.

Web sites (not examinable)

The Internet Mental Health web site has comprehensive information on issues related to the description, diagnosis, treatment and research of antisocial, borderline, and the other personality disorders. <http://www.mentalhealth.com/>.

BPD Central is US-based support web site for family members who are caring for someone with borderline personality disorder. The site has features such as a broad range of information on the disorder and its treatment, a bulletin board, links and other resources for carers. <http://www.bpdcentral.com/>.

On the managed health care executive web site, there is an interesting albeit older article by Dr Mark Unterberg on personality disorders in the workplace.

< https://www.managedhealthcareexecutive.com/managed-healthcare-executive/content/personality-disorders-workplace >.

Study instructions

882650-5651500PRESCRIBED TEXT AND EXAMINABLE MATERIAL

Please read Barlow, Durand and Hofmann (2018), Chapter 12

882650-5524500ACTIVITY

Identifying personality disorders

Imagine a party where all the people have personality disorders. Here are descriptions of how each one behaves at the party. Your task is to diagnose each person with one of the DSM-5 personality disorders.

Donna danced into the party and immediately became the centre of attention. With sweeping gestures of her arms and dramatic displays of emotion, she boasted about her career as an actress in a local theatre group. During a private conversation, a friend enquired about the rumours that she was having some difficulties in her marriage. In an outburst of anger she denied there were any problems and claimed her marriage was as wonderful and charming as ever. Shortly thereafter, while drinking her second martini, she fainted and had to be taken home.

William wandered into the party but didnt stay long. The negative forces in the room were unsettling to his psychic soul-spot. The few guests he spoke to felt somewhat uneasy being with this aloof space cadet.

Sherry paraded into the party drunk and continued to drink throughout the night. Laughing and giggling, she flirted with several of the men and expressed her deep affection to two of them. Twice during the evening she disappeared for half an hour each time with a different man. After a violent argument with one of them because he took too long getting her a drink, she locked herself in the bathroom and attempted to swallow a bottle of aspirin. Her friends encouraged her to go home, but she was afraid to be alone in her apartment.

Winston spent most of his time talking about his trip to Europe, his fathers yacht and his favourite French restaurants. People were bored around him, but he kept right on talking. He claimed he would get special consideration in his exam grades because his pet budgerigar had died during semester, and pressed one of the guests to let him stay the night at their place, even though it wasnt convenient.

When Mary was invited to the party she felt uncertain about it and had to find someone to go with who would not leave her alone there. She asked her friends what she should wear, and sought their approval of her appearance when she arrived. When in conversation at the party she felt inadequate and always agreed with whatever was being said.

Wayne rolled up to the party for some free grog. When a woman rejected his advances he grabbed her shoulders and shoved her across the room, threatening to Peter arrived at the party exactly on time. He made a point of speaking to each guest for five minutes. He talked mostly about technology and finance, and avoided any enquiries about his feelings or personal life. He left precisely at 10pm because he had work to do at home.

Before entering, Doreen watched the party from outside the window for several minutes. When she did go in, she seemed very uncomfortable, and if people were nice to her she suspected their motives. She tended to find fault with every little thing that others said or did, and was inclined to pick little fights with people. She did not stay long.

Harold wasnt invited to the party. No-one really knows him very well because he rarely talks and shows no interest in other people. Others described him as a cold fish. He typically spends most of his time at home alone, reading.

Jane declined to go to the party because she felt inadequate and that she

couldnt live up to peoples expectations of her. She was afraid that no-one would talk to her and that she wouldnt know what to say to them.

See after the Topic Review for suggested answers.

Adapted from Suler, J. (2001). John Sulers Teaching Clinical Psychology Site

http://www-usr.rider.edu/~suler/tcp.html

Topic review

1Personality disorders involve enduring patterns of perceiving, relating to, and thinking about the environment and oneself that

a.May cause functional impairment

b.May cause subjective distress

c.Cut across many times and places

d.All of the above

2Many behaviour researchers are convinced that personality disorders merely represent extreme degrees of normal behaviour

a.Thus, it may be that the disorders are merely the levels of behaviour that society has decided not to tolerate

b.As a result, they suggest a dimensional scheme for personality disorder diagnosis

c.They would prefer to rate clients on a series of personality dimensions, but still disagree on which dimensions to use

d.All of the above

3Max is always sure that others are trying to harm him. His perception that the world is a threatening place impacts most of his life. Most likely Max would be diagnosed with the personality disorder called:

a.Histrionic

b.Avoidant

c.Paranoid

d.Antisocial

4A study by Ford and Widiger (1989) suggests that gender differences observed in the prevalence of many personality disorders (histrionic, dependent, antisocial) may be due to

a.Genetic differences

b.Gender specific learned behaviour patterns

c.Gender bias on the part of the diagnosing clinician

d.Cultural scripts that dictate the type of disordered behaviour appropriate for each gender

5. Though some people use the terms psychopathy and antisocial personality disorder interchangeably, the concepts do not overlap precisely. For example:

a.The DSM-5 criteria focus more on personality traits than on observable behaviour

b.The psychopath category allows for more possibility of successful, or at least legal, activity

c.One of the labels does not cover people with increased risk for criminal behaviour

d.All of the above

6. The apparent stimulation-seeking of psychopaths, plus the results of nervous systems measures (such as resting heart rate), give support to the _______________ theory of the origin of antisocial behaviour

a.Cortical immaturity

b.Underarousalc.Overarousal

d.Genetic predisposition

7.The research examining the cause of antisocial personality disorder suggests that:

a.The primary cause is genetics

b.Genetics and environment interact to cause the disorder

c.The primary cause is poor parenting

d.There is no evidence of either a genetic or environmental cause

8Nicole has difficulty maintaining relationships because she goes back and forth from considering them best friends to hating the person. Her romantic relationships are always characterised by incredible loving passion alternating with episodes of intense fighting and she sometimes becomes violent. At times Nicole becomes so upset that she cuts herself and reports that this makes her feel better emotionally. Nicole suffers from __________ personality disorder.

a.Dependent

b.Histrionic

c.Borderline

d.Narcissistic

9Which of the following is the most likely model to explain the cause of borderline personality disorder

a.Biological

b.Early trauma resulting in post-traumatic stress symptoms that are not recognised or dealt with during childhood

c.Stressful life events

d.Biological predisposition interacting with life events such as childhood trauma and later life stressors

10Linehans approach (1987) for treating borderline personality disorder is called dialectical behaviour therapy (DBT) and involves all of the following except

a.Teaching patients to identify and regulate their emotions

b.Re-experiencing past trauma to extinguish fears associated with it

c.Teaching patients to be more vocal in their opinions and wishes

d.Teaching patients to trust in their own responses

11 George dates only extremely desirable women, but is always looking for someone still better. Because he believes he is superior to everyone else, he feels rules do not apply to him. In his current relationship with Kim, she tries almost desperately to please him, to agree with him, and to cater to his whims. Though she is bright and attractive, she usually feels inadequate about herself, and for a long time has relied on others to make even the simplest decisions for her. As he sees her striving, George becomes more cold and uncaring. You might have a number of names for this pairing, but what DSM-5 diagnoses are applicable?

a.George has narcissistic personality disorder, and Kim has borderline personality disorder

b.George has borderline personality disorder, and Kim has histrionic personality disorder

c.George has narcissistic personality disorder, and Kim has dependent personality disorder

d.Both meet the diagnostic criteria for borderline personality disorder (but this still does not constitute a perfect match

Answers at bottom of page.

900430-3746500Answers:1 d 2 d 3 c 4 c 5 b 6 b 7b 8c 9 d 10 c 11c

Answers to Activity

Donna histrionic;Wayne antisocial;William schizotypal;Peter obsessive-compulsive;

Sherry borderline;Doreen paranoid;Winston narcissistic;Harold schizoid;Mary dependent;Jane avoidant

Seminar 8: Assessing psychopathology part 2Trigger Warning

The first exercise shows you two simulated clients, one with bipolar I disorder, and one with bulimia nervosa. Sexual activity is discussed in the first video, which displays manic symptoms, and the second discusses Bulimia Nervosa symptoms. Both simulations are performed by people acting.

Why are we doing this?There are two threads of this seminar. The first is further practice on applying diagnostic criteria, this time to video cases as opposed to the written cases you have seen to date. This should be useful ahead of the assignment.

The second is linked to the learning topic of cultural perspectives on disorders. It is important to gain an understanding of the cultural perspective on aetiology and diagnosis and examine why and how the assessment process needs to take into consideration the cultural background and its influences on a persons behaviour. It is also important to know that we should not only focus on a Western-model of assessment with multicultural clients.

FirstMore practice at diagnostic exercises ahead of the assignmentYour tutor will show you two (simulated) cases from Deakins own training suite regarding

the first portrays a client in the manic phase of Bipolar I Disorder; sexual activity is discussed

The second portrays a client with Bulimia Nervosa

Note both clients are actors, from Deakins Virtual Clinic project for training purposes; developed by Jade Sheen, Jane McGillivray and Clint Gurtman.

Your Task:

Apply the diagnostic criteria on the following pages to the videos.

Please stop at the time periods indicated as they go on to discuss other issues such as suicidality.

Bipolar I Disorder CriteriaFor a diagnosis of bipolar I disorder, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.

Manic Episode

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).

During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:

Inflated self-esteem or grandiosity.

Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).

More talkative than usual or pressure to keep talking.

Flight of ideas or subjective experience that thoughts are racing.

Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.

Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).

Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition.

Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a bipolar I diagnosis.

Note: Criteria AD constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder.

Bulimia Nervosa CriteriaRecurrent episodes of binge eating.

An episode of binge eating is characterized by both of the following:

Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.

A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.

Self-evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of anorexia nervosa.

Specify if:

In partial remission: After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time.

In full remission: After full criteria for bulimia nervosa were previously met, none of the criteria have been met for a sustained period of time.

Specify current severity:

The minimum level of severity is based on the frequency of inappropriate compensatory behaviors (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.

Mild: An average of 13 episodes of inappropriate compensatory behaviors per week.

Moderate: An average of 47 episodes of inappropriate compensatory behaviors per week.

Severe: An average of 813 episodes of inappropriate compensatory behaviors per week.

Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.

Week 9: Neurodevelopmental disordersCOMPILED 2022 BY DR DAVID HALLFORD

Learning objectives

At the conclusion of your work in this topic, you should be able to:

outline the features of attention deficit/hyperactivity disorder;discuss the biological and psychological factors thought to cause attention deficit/hyperactivity disorder;describe the biological and psychosocial treatment of attention deficit/hyperactivity disorder;discuss the clinical features and prevalence of specific learning disorder;describe the genetic, neurobiological and environmental factors associated with the aetiology of specific learning disorder;outline the major approach for treating individuals with specific learning disorder;describe the clinical features of autism spectrum disorder

outline the prevalence of autism spectrum disorder

discuss the psychological, social and biological theories of autism spectrum disorder;outline the various interventions for autism spectrum disorder

define intellectual disability;discuss the biological, genetic and psychosocial causes of intellectual disability; and

outline the treatment options for individuals with intellectual disability.

Learning resources

Prescribed text and Examinable Material

Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Stamford, CT: Cengage Learning Chapter 14.

Web sites (not examinable)

An easy to read Australian web site that offers information about the nature and treatment of autism spectrum disorders, as well as local resources. <http://www.autismvictoria.org.au/home/>.

An interesting web site for this topic, and others in the unit is The US National Institute of Mental Health site. In the Health and Outreach area, there are resources in the area of child and adolescent mental health as well as for many adult disorders such as social phobia, panic and so forth <http://www.nimh.nih.gov/index.shtml>.

Another interesting web site for this topic is the Internet Mental Health site, which comprehensive information about ADHD, autistic disorder and many of the other disorders discussed throughout the unit < http://www.mentalhealth.com/ >.

Study instructions

882650-5651500PRESCRIBED TEXT AND EXAMINABLE MATERIAL

Please read Barlow, Durand and Hofmann (2018), chapter 14.

882650-5524500ACTIVITY

Genetic research: Would you want to know?

Genetic research raises several interesting moral and ethical questions, particularly with regard to the disorders discussed in chapter 14 of your textbook. Consider whether, as parents, you would want to know whether your unborn child would have autism spectrum disorder or ADHD (if such tests were available). Consider also the ethical implications involved if routine genetic testing for developmental disorders becomes the norm. Would such testing be advantageous or potentially harmful? Can you think of any guidelines to govern the use of such procedures?

Adapted from Williams, M.E. (1998). Instructors resource manual Abnormal Psychology

(7th ed.). New York: Wiley.

Topic review

1.Psychological disorders are considered neurodevelopmental disorders when there is a:

a.Change in symptoms over the life-span

b.Genetic component to the disorder

c. Significant dysfunction during childhood

d. General decline in functioning over time

2.Two alternative reasons that have been proposed to explain why children with attention deficit/hyperactivity disorder (ADHD) have problems with academic subjects are:

a.ADHD symptoms directly inhibit school performance or a brain deficit associated with ADHD inhibits academic ability

b.ADHD symptoms directly inhibit school performance or social difficulties make school a negative experience for children with ADHD

c.Social difficulties make school a negative experience for children with ADHD or a brain deficit associated with ADHD inhibits academic ability

d.Dietary factors responsible for ADHD limit school performance or ADHD symptoms directly inhibit school performance

3.What are the two DSM-5symptom clusters for attention deficit/hyperactivity disorder?

a.Hyperactivity and impulsivity

b.Inattention and distraction

c.Inattention and hyperactivity/ impulsivity

d.Impulsivity and distraction

4.Jess is a 14-year old girl with autism spectrum disorder who seems compelled to run around touching each door every time she comes home. If she is prevented from touching each door, Jess has a tantrum. This is an example of:

a.Restricted behaviour pattern

b.Social impairment

c.Ritualistic behaviour

d.Maintenance of sameness

5.When using behavioural treatments for children with autism spectrum disorder, what are the major targets on which you are likely to focus?

a.Shaping and discrimination

b. Ego development and self-esteem

c. Stereotyped and ritualistic behaviours

d. Communication and socialisation

6.Of the following, the most accurate statement regarding the causes of specific learning disorder is that:

a. Genetics is almost always the single cause

b. Learning disorders take many forms and each form may have its own causes

c. The environment appears to have the greatest influence in learning disorders

d. Neurological damage that results from brain trauma may account for most cases of learning disorder

7.The IQ scores used by DSM-5 to define significantly sub-average intellectual functioning is _______, whereas that used by the American Association on Intellectual and Developmental Disabilities is _______.?

a.Approximately 60-65

b.Approximately 70; 7075

c.Approximately 7075; Approximately 70

d.Approximately 6570, Approximately 75

8. Recommended interventions for individuals with intellectual disability are best characterised as:

a.Highly individualised

b.Quite similar for each patient

c.Ineffective

d.Cognitively based

Answers at bottom of page 10

Seminar 9: Experimental psychopathologyCOMPILED 2022 BY DR DAVID HALLFORD

Activities

ACTIVITY 1: Designing an experiment

No additional materials are needed.

Week 10: Cross-cultural approaches to psychopathologyCOMPILED 2022 BY DR DAVID HALLFORD.

Learning objectives

On completion of this topic you should be able to:

Discuss the relevance of the cultural perspective to assessment, diagnosis, and intervention in psychopathology;Discuss why it is essential to assess psychopathology with a cultural lens;

Indicate when and how culture should influence assessment and diagnosis in psychology;Discuss differences in assessment and diagnosis based on cultural background;Discuss the collection of culturally relevant data to guide diagnosis using the DSM-5;Discuss the influence of culture on psychotherapy;

Consider the potential need to deliver psychotherapy differently across cultures

Consider the potential to deliver psychotherapy differently for Indigenous Australians.

Learning resources

Examinable Material

Alarcon, R.D. (2009). Culture, cultural factors, and psychiatric diagnosis: review and projections. World Psychiatry, 8, 131-139. http://ezproxy.deakin.edu.au/login?url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2755270/

Hwang, W. (2016). Culturally adapting evidence-based practices for ethnic minority and immigrant families. In N. Zane, G. Bernal, F. L. Leong, N. Zane, G. Bernal, F. L. Leong (Eds.),Evidence-based psychological practice with ethnic minorities: Culturally informed research and clinical strategies(pp. 289-308). Washington, DC, US: American Psychological Association. doi:10.1037/14940-014 http://ezproxy.deakin.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=pzh&AN=2016-02847-014&site=eds-live&scope=site

Dudgeon, P., Bray, A., DCosta, B., & Walker, R. (2017). Decolonising Psychology: Validating Social and Emotional Wellbeing. Australian Psychologist, 52. Only pages 319-322, from the heading Connection to Body onwards. https://www-tandfonline-com.ezproxy-b.deakin.edu.au/doi/pdf/10.1111/ap.12294?needAccess=true

The class notes and summary, which are available on Cloud under Week 2

Web sites (not examinable)

https://www2.health.vic.gov.au/about/populations/cald-health provides the Vic Health framework for cultural responsiveness for health professionals. Also provides all information relevant to cultural competence.

http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Our_publications/2015/ctgc-ip13.pdf discusses cultural competence in the delivery of health services for Indigenous people.

www.clc.org.au is a website providing you with information on the Aboriginal culture and appropriate ways of communicating and engaging with them.

Study instructions

882650-5651500PRESCRIBED TEXT AND EXAMINABLE MATERIAL

882650-5524500ACTIVITY

Please read the following paper and chapter:

Alarcon, R.D. (2009). Culture, cultural factors, and psychiatric diagnosis: review and projections. World Psychiatry, 8, 131-139. Only pages 133-138, from the heading Cultural and Cultural Factors in Psychiatric Diagnosis

http://ezproxy.deakin.edu.au/login?url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2755270/

Hwang, W. (2016). Culturally adapting evidence-based practices for ethnic minority and immigrant families. In N. Zane, G. Bernal, F. L. Leong, N. Zane, G. Bernal, F. L. Leong (Eds.),Evidence-based psychological practice with ethnic minorities: Culturally informed research and clinical strategies(pp. 289-308). Washington, DC, US: American Psychological Association. doi:10.1037/14940-014

http://ezproxy.deakin.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=pzh&AN=2016-02847-014&site=eds-live&scope=site

Dudgeon, P., Bray, A., DCosta, B., & Walker, R. (2017). Decolonising Psychology: Validating Social and Emotional Wellbeing. Australian Psychologist, 52. Only pages 319-322, from the heading Connection to Body onwards.

https://www-tandfonline-com.ezproxy-b.deakin.edu.au/doi/pdf/10.1111/ap.12294?needAccess=true

(Please note that these readings, and the lecture slides are all directly examinable for this topic. The recorded lecture itself is not examinable)

Consider the influence of culture on assessment and treatment

a. Choose one particular cultural background. Imagine that you will need to assess and diagnose a person from this background for a particular mental illness (e.g., Post Traumatic Stress Disorder). What are the factors that you will consider in order to make a holistic assessment? List all of them. Consider the different types of data you will collect in order to gather further information for the reasons for their illness. Make your assessment of their illness.

b. Considering the assessment, what kind of intervention will be appropriate to assist the person? What factors will you consider in referring them to psychological therapy? How can you ensure that the therapy will reduce their illness?

.

Topic review

1. Micro-cultural data refers to a clients:

a. Strengths and weaknesses.

b. Language, religion and spirituality.

c. Family history, structure and life story.

d. Performance on a psychological test.

2. Some of the difficulties associated with culture being used in diagnosis are that it is:

a. Too broad a concept.

b. Too complex to assess.

c. Heterogenous in nature.

d. All of the above.

3. Anita is resilient in spite of the family violence she has experienced. Her level of resilience could be related to her:

a. Level of family support

b. Help-seeking behaviour

c. Cultural background

d. All of the above.

4. Surface structure adaptations refer to psychotherapies that are conducted:

a. In the clients native language

b. With an ethnically matched psychotherapist

c. By incorporating the clients values and beliefs.

d. A and B.

5. Understanding the dynamic issues of culture and cultural complexities is incorporated into:

a. Culturally adapted cognitive behaviour therapy

b. Formative method for adapting psychotherapy

c. Psychotherapy adaptation and modification framework

d. Client-centred therapy

Answers at bottom of page

Seminar 10: Cultural context and psychopathologyActivities

ACTIVITY 1: Contrasting cultural approaches to psychopathology

ACTIVITY 2: Your own worldview

No additional materials are required

Week 11: Mental health services: legal, ethical, and professional issues

COMPILED 2022 BY DR DAVID HALLFORD

Learning objectives

At the conclusion of your work in this topic, you should be able to:

1discuss the development of the legal conception of insanity, and the multitudinous forces that have contributed to its evolution;2describe the terms civil and criminal commitment and outline the conditions that must be met before such processes can be enacted;3describe the process required for a person to become an involuntary patient in Victoria;4outline the relationship between the psycho-legal constructs of competence to stand trial and insanity;5outline how Australian legal systems have conceptualised insanity;6discuss the existent tensions between mental health professionals ability to predict dangerousness/ risk, and the courts requirements from such experts;7outline the essential facts of the Tarasoff case and the ruling of the court with regard to a therapists duty to warn/ protect;8discuss recent trends in deinstitutionalisation and transinstitutionalisation and their consequences for those with mental illness;9describe the rights of patients (and those of research participants) within an informed consent framework; and

10 discuss the trend towards clinical practice guidelines, and the two axes commonly adopted by regulatory bodies when evaluating interventions.

Learning resources

Prescribed text and Examinable Material

Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal psychology: An integrative approach (8th ed.). Belmont, CA: Wadsworth. Chapter 16.

As the book chapter is from the US, you should also read the text below which discusses the Victorian situation, as well as watch the narrated powerpoint on the Mental Health Act 2014 (in this instance, this is examinable material).

Around the world, different countries, and jurisdictions within them, have their own laws around treatment for mental illness. Within Australia, each jurisdiction (state/territory) also has their own laws. In this topic, we will draw on the Victoria Mental Health Act 2014 as an example of such laws to illustrate how they can operate. Below is a link to the various acts in Australia as collated by the Royal Australian and New Zealand College of Psychiatrists:

https://www.ranzcp.org/practice-education/guidelines-and-resources-for-practice/mental-health-legislation-australia-and-new-zealan

If you are studying outside of Australia, you may wish to look up the laws around mental health treatment in your own state or country. However, only the information below and information pertaining to the Victoria Act will be assessed.

Web sites (not examinable)

A number of relevant Australian web sites relate to issues covered in this topic.

The Australian Psychological Societys web site has information regarding all aspects of professional psychology for both psychologists and potential clients. The following link is for the Code of Ethics. < https://www.psychology.org.au/getmedia/d873e0db-7490-46de-bb57-c31bb1553025/18APS-Code-of-Ethics.pdf >.

This web site that provides full text versions of all Commonwealth and state legislation, including Victorias Mental Health Act 2014. < http://www.legislation.vic.gov.au/ >.

The Mental Health Act 2014 Handbook < https://www2.health.vic.gov.au/mental-health/practice-and-service-quality/mental-health-act-2014-handbook >.

The web site of the Victorian Mental Health Review Board < https://www.mht.vic.gov.au/ >.

Legal Aid Victoria on involuntary admission < https://www.legalaid.vic.gov.au/information-for-lawyers/practice-resources/mental-health-law/assessment-and-treatment-orders >.

Similar information to this introduction is obtainable via the Compulsory Treatment Order factsheet at < https://www2.health.vic.gov.au/Api/downloadmedia/%7B2F7554D5-33CC-45DA-9048-BA9AC926DE38%7D >.

Statistics on treatment orders are available for 2018-2019 via < https://www.mht.vic.gov.au/news/2018-2019-mental-health-tribunal-annual-report-published >.

Legal, Ethical, and Professional Issues (examinable)

Legal issues

In Victoria, the key legal guidelines pertaining to persons with psychological disorders are contained in the Mental Health Act 2014 (Vic).

This legislation provides a statutory framework for the administration of services to people requiring treatment or care for a mental illness in Victoria. According to the Act, mental illness is defined as a medical condition characterised by a significant disturbance of thought, mood, perception, or memory. Approximately 60,000 Victorians are registered with the public mental health services (Victorian Department of Human Services, 2008).

A central focus of the Act is the protection of individual rights and a recovery-oriented approach to the provision of services within public mental health settings. The Mental Health Act 2014 outlines, and is based upon the following mental health principles:

(a)persons receiving mental health services should be provided assessment and treatment in the least restrictive way possible with voluntary assessment and treatment preferred;(b)persons receiving mental health services should be provided those services with the aim of bringing about the best possible therapeutic outcomes and promoting recovery and full participation in community life;(c)persons receiving mental health services should be involved in all decisions about their assessment, treatment and recovery and be supported to make, or participate in, those decisions, and their views and preferences should be respected;(d)persons receiving mental health services should be allowed to make decisions about their assessment, treatment and recovery that involve a degree of risk;(e)persons receiving mental health services should have their rights, dignity and autonomy respected and promoted;(f)persons receiving mental health services should have their medical and other health needs, including any alcohol and other drug problems, recognised and responded to;(g)persons receiving mental health services should have their individual needs (whether as to culture, language, communication, age, disability, religion, gender, sexuality or other matters) recognised and responded to;(h)Aboriginal persons receiving mental health services should have their distinct culture and identity recognised and responded to;(i)children and young persons receiving mental health services should have their best interests recognised and promoted as a primary consideration, including receiving services separately from adults, whenever this is possible;(j)children, young persons and other dependents of persons receiving mental health services should have their needs, wellbeing and safety recognised and protected;(k)carers (including children) for persons receiving mental health services should be involved in decisions about assessment, treatment and recovery, whenever this is possible;(l)carers (including children) for persons receiving mental health services should have their role recognised, respected and supported.

In particular, the second point deserves focus. Persons receiving mental health services should be provided those services with the aim of bringing about the best possible therapeutic outcomes and promoting recovery and full participation in community life. As a result, treatment plans need to take these issues into account (See: https://www2.health.vic.gov.au/mental-health/practice-and-service-quality/mental-health-act-2014-handbook/recovery-and-supported-decision-making).

One of the central tenets of the Mental Health Act 2014 is that people who are deemed to be mentally ill should be treated in the least restrictive environment possible (see s.10). Obviously the least restrictive environment in which to receive treatment is as a voluntary patient living in a private dwelling in the community. However, the Act recognises that, while a diagnosis of mental illness (alone) is insufficient grounds to deprive someone of their right to liberty, there are times when it may be necessary to qualify this right. In these cases, the Act allows for a variety of responses along the continuum of restrictiveness (McDonnell & Bartholomew, 1997). The most severe of these options is to make the person an involuntary patient. In total, 4,912 Treatment Orders were made in 2014-2015 (while 417 were revoked), with around half of these being Community (2,588) and half being inpatient (2,324). In 2017-2018, nearly half (45.8%) of public hospital overnight hospitalisations with specialised care were patients with an involuntary mental health legal status (see AIHW report)

Consistent with its emphasis on individual rights, and as noted above, the Act also lists a number of behaviours that are not legitimate grounds for a diagnosis of mental illness. These include (but are not limited to; these are summarized here):

1expressing or refusing to express a particular religious or political belief;2engaging in or refusing to engage in a particular religious or political activity;3expressing a particular philosophy or sexual preference;4engaging in sexual promiscuity, immoral or illegal conduct;5being intellectually disabled;6taking drugs or alcohol; or

7having an anti-social personality.

Although it has been subject to an array of amendments since its enactment, the Act is very much reflective of the rights ethos that permeated Victorian legal and health care policies in the 1980s. In this sense, a central focus of the Act is the protection of individual rights, with different sections addressing issues such as the right to confidentiality, informed consent, and accountability mechanisms. There is insufficient space to cover each of these issues, so this discussion will be limited to one important aspect, that of receiving compulsory treatment.

Process of becoming a Compulsory Patient

The process of assigning the status of Inpatient Treatment Order involves a number of clinical and legal stages. Note that anyone under an Assessment Order or Treatment Order is considered a Compulsory Patient. Patients should be given a statement of rights at key stages of the process, including when making the Assessment Order and the Temporary Treatment Order.

First, an individual may be made subject to an Assessment Order. An important point is that the decision to make an assessment order may be made by an authorized person which includes a registered medical practitioner, a mental health practitioner (registered psychologist, nurse, social worker or occupational therapist) working for a public mental health service, or a court (which is termed a Court Assessment Order). In doing so, the professional must be satisfied that the person meets the criteria for an assessment order. This would be either for an assessment in the community (community assessment order; preferable) or in a designated inpatient service (inpatient assessment order). Assessment orders last up to 72 hours (or 24 hours after the person is received at the mental health service).

The criteria are:

1the person appears to have a mental illness,

2because the person appears to have a mental illness, the person appears to need immediate treatment to prevent

(i) serious deterioration in the person's mental or physical health; or

(ii) serious harm to the person or to another person; and

3if the person is made subject to an Assessment Order, the person can be assessed; and

4there is no less restrictive means reasonably available to enable the person to be assessed.

(Note that all criteria must be met. The and that links conditions in such legislation is very important)

The police, ambulance service or psychiatric service are empowered to transport the person, even against their will, to a public psychiatric hospital (involuntary patients cannot be admitted to private hospitals), according to the Protocol for the transport of people with a mental illness 2014. However, the least restrictive option should always be used, with police transport the last resort.

Having been admitted to hospital under this recommendation, the Act places further requirements on the service to ensure the protection of the rights of the individual. The person must be assessed by a psychiatrist within 24 hours. This psychiatrist cannot be the practitioner who made the recommendation, or the doctor who made the admission assessment.

At this assessment, under section 5 of the Act, a person may then be placed under a Temporary Treatment Order provided they meet treatment criteria following assessment by the psychiatrist:

1the person has a mental illness,

2because the person has mental illness, the person needs immediate treatment to prevent

(i) serious deterioration in the person's mental or physical health; or

(ii) serious harm to the person or to another person; and

3the immediate treatment will be provided to the person if the person is subject to a Temporary Treatment Order or Treatment Order; and

4there is no less restrictive means reasonably available to enable the person to receive the immediate treatment.

The psychiatrist is also asked to make note of all of (paraphrasing):

The potential patients views and preferences, and recovery preferences

The person may have also expressed their views or wishes in an advance statement which is a statement that has previously been made by the person, in the event that their mental health deteriorates in the future

The views of the nominated person, guardian, carer (if affected), parent (if under 16), and

The views of the Secretary to the Department of Human Services if the person is the subject of a custody/guardianship order.

If the practitioner is satisfied the person meets all criteria, they can make the person subject to a temporary treatment order, which remains in place for up to 28 days.

However, the mechanisms to protect the rights of the individual do not end at this point. A treatment and recovery plan must be developed by day 15 of the Temporary Treatment Order. Within 28 days, the person must be assessed by the Mental Health Tribunal in order for their Temporary Treatment Order to be replaced by a Treatment Order per se (the psychiatrist must apply for this 10 days prior to the expiry of the temporary order). The tribunal (previously called the Mental Health Review Board) was established under the previous Act as an independent quasi-legal body to balance the rights of the mentally ill, their need for treatment and freedom, and the interests of the broader community (Health Department of Victoria, 1992). The Board consists of three members: a lawyer, a psychiatrist or registered medical practitioner, and a member of the general community. Having received an application, the Board convenes a meeting and reviews the written report of the psychiatrist responsible for the care of the patient regarding the need for continuing detention of the person. The Board then interviews the medical practitioner and the patient. The patient, having had access to the report as well as their file, is allowed to present their arguments against continued detention and their views on treatment. They are also able to question the medical officer in the presence of the Board. Furthermore, they are entitled to have legal representation at the meeting. If the Board decides that continued involuntary status is no longer justified, the person is free to self-discharge from hospital. The Board may also change the conditions and/or length of an existing arrangement. For more information on patient rights and the Tribunal process, see https://www.mht.vic.gov.au/ and particularly http://www.mht.vic.gov.au/how-prepare-your-tribunal-hearing.

Another feature of the Mental Health Act 2014 deserves a brief mention. It is possible for people to be under a Community (Temporary) Treatment Order (CTO), which is consistent with the notion of the least restrictive alternative. A patient on a CTO is able to reside in the community, but is mandated to attend consultations with mental health services and, in the majority of cases, to take prescribed medication. The same criteria apply to a CTO as to involuntary admission, and CTOs are most often prescribed for persons who, without ongoing treatment and monitoring, would be likely to deteriorate in their mental state (and possibly) become a danger to themselves or others. For example, a person with schizophrenia may develop paranoid delusions of persecution that manifest in violence unless they receive continuing treatment. A CTO may be granted if the person refuses to comply with medication due to a lack of insight into their disorder. If the person fails to comply with treatment, then the CTO may be revoked and they would be returned to hospital.

Although CTOs are regarded as an important component of a rights based and deinstitutionalisation-driven governmental agenda, Victorian research has raised numerous concerns about their administration and practical expression (e.g., see McDonnell & Bartholomew, 1997). Not the least of these objections is the transinstitutional role that such legislative initiatives play (see discussion in Barlow, Durand and Hofmann).

Ethical issues

While the Mental Health Act 2014 provides a legal framework for the care of people with mental illness, it is obvious that it does not apply to all persons with psychological or emotional difficulties. However, if a person presents to a psychologist seeking assistance, there are other legal and ethical issues that have to be considered.

From a legal point of view, all psychologists are required to be registered. Requiring psychologists and the other health professionals to be registered provides protection to clients in a variety of ways. First, no person may refer to themselves a psychologist unless they are registered with the Psychologists Registration Board of Australia. This means they have fulfilled the academic and supervisory requirements of the Board. Second, the board may choose not to register someone who is not of good character or someone who has committed an indictable offence, has an alcohol or drug problem, or is unfit to practice due to physical or mental incapacity. Third, the Board may suspend or deregister a psychologist whose conduct is deemed to be unethical or unacceptable. Such provisions mean that the public is protected from potential harm from individuals who either dont have the required training or who are unfit to practice for physical, mental, or ethical reasons.

Conduct considered unacceptable by the Board might be deemed so for one of two reasons: because it is illegal (e.g., fraud or assault), or because it is unethical (e.g., having sexual contact with a client). Psychologists are expected to adhere to the practices deemed to be ethical for their profession. These principles have been set out in the Australian Psychological Societys Code of Ethics (2007).

According to the APS Code of Ethics, the guidelines were developed to safeguard the welfare of consumers of psychological services [and] the integrity of the profession (APS, 2007, p. 1). The Code covers a broad range of behaviours, such as avoiding dual relationships (e.g. not treating students or employees), maintaining adequate records, maintaining confidentiality, and refraining from sexual contact with clients. Failure to comply with these guidelines could result in a psychologist being suspended or expelled from the APS. The Psychologists Registration Board provides a Code of Behaviour that covers many of the same issues as the APS code. Failure to comply with this code could lead to suspension or deregistration (although, it must be acknowledged that these options are only utilised in the most serious of cases). Therefore, sexual contact with a client might result in a psychologist not only being expelled from the professional society (the APS), but also being unable to practice as a psychologist because of a loss of registration.

A major feature of both Codes is that of the need to ensure client confidentiality. However, both state that it is permissible to breach such confidentiality under certain circumstances. One such situation may be in a court setting where the psychologist is forced to divulge such material. Another is where, as the APS Code of Ethics states, failure to disclose may result in clear risk to the client or others (APS, 2007, p. 1). Because of such limitations, clients need to be informed of the legal and other limits to confidentiality. As you will see in this topic, balancing the principle of confidentiality versus the duty to protect/ warn is a complex issue.

Other issues

Unlike diagnostic issues (that are internationalised by instruments such as DSM and ICD), legal concepts often differ widely across jurisdictions. With this in mind, a number of general observations can be made regarding the content in chapter 16 of the text.

1. The legal verdict of guilty by mentally ill, is not available in Australian jurisdictions. For this reason, pre-trial assessments and expert testimony assume an even larger significance.

2. Many Australian jurisdictions have dedicated legislation regarding the issues of competence to stand trial and the insanity defence. In Victoria, the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 bases its definition of mental impairment (its term for insanity) on the MNaghten rule. In Tasmania at the time of the trial of Martin Bryant, the perpetrator of the Port Arthur massacre, both the MNaghten Rule and the irresistible impulse principle (based on a ruling from an 1834 trial in Ohio that people could not be held responsible if they are compelled to commit a criminal act because of impulses they are unable to resist) (Nevid, Rathus, & Greene, 2003) applied. Therefore, the evolution of US legal authority in these areas remains highly relevant and often very influential to Australian assessments of these psycho-legal constructs (see Birgden & Thomson, 1999, for a detailed account).

3. The issues inherent in assessments of how dangerous someone (called risk evaluations) are universal. Practitioners have a notoriously poor record of being able to predict high-risk behaviour with any accuracy over long periods of time, and the role of mental illness as a contributor to a persons dangerousness has been highly contentious. Contemporary thought on this matter is that, depending on diagnosis and symptomatology, a diagnosis of mental illness usually places an individual in a higher risk category than someone with no such symptoms. It is important to note though, that mental illness alone constitutes insufficient grounds for a dangerousness prediction.

4. Clinical Practice Guidelines are becoming more common in Australian jurisdictions. The body that increasingly oversees the construction of these is the National Health and Medical Research Council (NH&MRC).

Study Instructions

PRESCRIBED TEXT

AND EXAMINABLE

MATERIAL

Please read Barlow, Durand and Hofmann (2018), chapter 16, and the text in this chapter (this is directly examinable material) as well as watch the narrated powerpoint on the Mental Health Act 2014.

882650-5524500ACTIVITY

Confidentiality vs the duty to protect

On page 591 (581 7th ed.) your text briefly discusses the difficulties arising from the conflict between two ethical principles; the clients right to confidentiality and the therapists responsibilities in cases where the client might be of risk to themselves or others. This obligation is referred to as the duty to warn or protect and as your text describes, it arises from the Tarasoff case.

Recently this conflict between confidentiality and the duty to warn has arisen in the area of counselling people who are HIV-positive. Consider the following vignette:

Vignette

You are a counsellor working in an HIV/ AIDS clinic. The clinic offers confidential testing for HIV, and your job is to present the results of HIV tests to clients and discuss their reactions. One day, a couple comes to the clinic to hear the results of their HIV tests. You are to meet with the man to go over his results, while another counsellor meets with his girlfriend.

It turns out that the man (your client) is HIV positive. When you meet with him and discuss his diagnosis, you discuss the modes of transmission of the virus and the importance of safe sex. You also encourage him to disclose the diagnosis to any former and current sexual partners, and he assures you he will do so.

As the man leaves your office, you observe him greeting his girlfriend in the waiting room. His girlfriend hugs him and says, Thank God, Im negative. Your client responds, Thats great; so am I. They walk off arm in arm.

As the counsellor, what would you do? Is the mans confidentiality more important than the duty to warn the girlfriend that she may be in danger? What action would you take?

Most people when confronted with this dilemma feel that the counsellor should break confidentiality. However, a number of arguments might be offered to counter this:

1The mans initial response to his girlfriend in a public waiting room may not be his final one. He may have decided to disclose his HIV-positive status in a more private location when they can discuss its implications more fully.

2If people are not guaranteed confidentiality, they will not get tested for HIV, and this will increase the risk of transmission and delay treatment.

3Given that information about safe sex is widely available, people involved in sexual relationships have a responsibility to protect themselves regardless of their knowledge of a persons HIV status

4It could be argued that because the counsellor is not a medical practitioner, it is outside of their area of competency to accurately assess the degree to which the couples sexual practices places the girlfriend at risk.

Adapted from Williams, M. (1998). Instructors resource manual Abnormal Psychology (7th ed.). New York: Wiley.

No Week 11 seminar.

Topic review

1The laws that state the conditions under which people not accused of a crime can be legally committed to a mental hospital, even against their will, are:

a.Criminal commitment laws

b.Hospitalisation laws

c.Civil Commitment laws

d.Civil laws

2The MNaghten rule decreed that:

a.People who are mentally ill are not responsible for their criminal behaviour

b.People are not responsible for criminal behaviour if they are not aware of what they are doing or that it is wrong

c.Mentally ill people in need of treatment may be involuntarily admitted to mental hospitals

d.Mentally ill people may be involuntarily admitted to mental hospitals if they are judged to be dangerous to self or others

3Dr Leroy has a client who has talked about killing people. Dr Leroy is not certain whether these threats should be brought to the attention of potential victims. What should Dr Leroy do?

a.Warn the potential victims

b.Notify the police

c.Maintain the clients confidentiality and privacy

d.Ask colleagues for a second opinion

4Which of the following is a FALSE statement in regard to prediction of dangerousness?

a.Mental health professionals can predict with high reliability if a particular person will become violent.

b.Generally speaking, persons with a previous history of violence are more likely to be dangerous than individuals without a past history of violence.

c.Generally speaking, persons with a previous history of substance abuse are more likely to be dangerous than individuals without a past history of drug or alcohol abuse.

d.Research suggests that mental health professionals are better at determining relative risk than determining dangerousness on a case-by- case basis.

5Which of the following is NOT a right of research participants?

a.To be informed about the purpose of the study

b.To be informed of their performance on any tests conducted on them in the course of the research

c.To refuse to participate after agreeing to do so

d.To remain anonymous in the results and records of the research

6The first major consideration on the clinical utility axis is feasibility, which asks all of the following questions EXCEPT:

a.Will the person accept the intervention?

b.Will clients comply with the requirements?

c.Has research shown the treatment to be effective?

d.Is the treatment relatively easy to administer?

7Whether a particular intervention is effective with different patients, in different settings, or with different therapists is referred to as:

a.Generalisability

b.Feasibility

c.External validity

d.Clinical replication

8In Victoria, which of the following statements is FALSE:

a.The first step of being a compulsory patient is being placed on an Assessment Order;

b.Patients rights and contribution to decision making is important throughout the process;c.Following the Assessment Order, patients are placed on a Treatment Order that can last up to 12 months;d.Patients are able to be placed in either the community or an inpatient setting for a Treatment Order, depending on what is judged to be the least restrictive option that will help them.

Answers at bottom of page 11

Answer for Activity: Example of a counsellors response

Probably the most prudent course for the counsellor to take is to discuss the case with a colleague to formulate a plan, then arrange for an appointment as soon as possible with the man. At this appointment, the counsellor could inform the man about overhearing the conversation and discuss the issues regarding the mans reluctance to disclose. The counsellor might offer to have a joint session with the couple to assist the process. If the man is resistant to such suggestions, the counsellor could inform him of the ethical dilemma and the possible need to breach the mans confidentiality. The point could be made that such a revelation would almost certainly be better for the couples long-term future coming from the man rather than from a third party.