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Chapter 16

Chapter 16: Psychopathology

Critical Thinking Activities

How Are Mental Disorders Conceptualized and Classified?

Diagnosing Mental Illness
In this activity Lana describes her experience of the symptoms of obsessive-compulsive disorder(OCD). Students then answer a series of follow-up questions.

In this activity, you will consider how a clinical psychologist might arrive at a diagnosis. Be assured that the process in the real world is considerably more complicated than can be presented here. Our goal is to provide a very brief overview of the process for instructional purposes.

Lana has been diagnosed with obsessive-compulsive disorder (OCD). According to the DSM-IV, patients with OCD can be obsessive, compulsive, or both.

To be diagnosed as obsessive, the patient must have all of the following symptoms:
  • Recurring and persistent thoughts, impulses, or images that are unwanted and intrude into everyday thoughts.
  • These recurring thoughts, impulses, or mental images are not merely excessive worries about real problems.
  • The individual has made an effort to suppress these unwanted thoughts, urges, or images.
  • The individual must realize that the unwanted thoughts are a reflection of the mind and not a reasonable reaction to the world.
To be diagnosed as compulsive, the individual must have all of the following symptoms:
  • The individual feels an overwhelming need to repeat specific physical behaviors (such as locking a door) or mental behaviors (such as counting things).
  • The compulsive behavior is a response to a set of strict, self-imposed rules that the individual must follow.
  • Performing these ritualistic behaviors reduces distress or eliminates an impending sense of doom.
  • The compulsive behaviors are not related in any realistic way to the dangers of the real world.
In this activity, your task is to listen to Lana as she describes her problem and to decide which of the diagnostic criteria for OCD Lana expresses. You may need to rewatch the video several times as you consider the behavior of the patient and her expression of the symptoms of OCD.



[this movie requires the Flash 6 plug-in]

Transcript:
I count a lot. It's like I'll get out of my car, I'll shut the door, know I locked it—just because I know that's the way I am—I know I locked it. And I'll still have to go back and check it. Sometimes I'll go back nine, twelve times. I even have a certain number that I have to use. Uh, at one time it was even numbers I would switch around and do it maybe six times or, you know, twelve times. And now it's three times, nine times.

It's like a doubt or something . . . something that's almost like a little voice inside saying, "You didn't lock your car" or "go back and check it to be sure." And then I'll get inside and I'll get ready to go to bed and I'll lay down, comfortable, and then all of a sudden I'll think, "Did I lock my door?" Even though I'll know and I'll remember checking it over and over again, it's like I'll still have to get up or I can't go to sleep. It's like mentally I can't go on through the day if I don't go through and do my routine of things. It's miserable. It never goes away. It's like there's a little voice going. It's like my mind's going, "You've got to do this, you've got to do this. This is going to happen if you don't do it."
1. Did Lana exhibit all the criteria behaviors for the diagnosis? Which ones did you see? Which ones did you not see? What do you make of the fact that many patients do not demonstrate every criterion for a specific diagnosis?
2. A major theme in psychological science is that behavior is an adaptive response to the demands of the world. The clinical application of that concept is referred to as the Diathesis-Stress Model (p. 638, Figure 16.3). What would the Diathesis-Stress model predict about Lana's predisposition to OCD? What evidence might you look for to support such a hypothesis? What environmental circumstances might exacerbate or reduce the severity of Lana's symptoms?
3. A major theme in psychological science is that we can best understand behavior when we view it as a phenomenon that crosses several levels. Your text describes OCD in some detail. What evidence do you see that OCD represents a phenomenon caused by disrupted function at several levels of analysis? Be explicit in describing any evidence for each level of analysis you choose to discuss in reference to OCD.
4. Suppose Lana had said that she was happy with the way she is, was experiencing no discomfort because of her compulsions or obsessive thoughts, and did not see a need for treatment even though she was spending hours each day dealing with her compulsions. Would you still consider her to be ill? Why or why not? Are there some careers or situations where a mild case of OCD would be considered to be an advantageous trait and not a behavioral problem? Explain your answer.

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