psychopathology
Answer:
PTSD is classified as an anxiety disorder, but some experts on psychology deal with this
disorder within the context of Health Psychology and other stress related disorders. The
diagnosis of PTSD requires that a person had been exposed to a traumatic event that led to a
response of intense fear, helplessness or horror. A traumatic event could be a personal
experience or witnessing of, or otherwise being confronted with, actual or threatened death or
serious injury, or threat to the physical integrity of self or others. The diagnosis of PTSD further
requires that a person presents with a set of symptoms following exposure to a traumatic event
as described above.
The person would have to meet a certain minimum amount of each of the 3 categories of
symptoms:
● Re-experiencing the traumatic event
● Avoiding associated stimuli, or emotional numbing and detachment
● Hypervigilance and chronic arousal
A large number and range of events can serve as traumas. In South Africa, with its “culture of
violence”, human-made traumas such as rape, domestic violence, crime and accidents (e.g.
mining disasters) are relatively common. In a research study where women who survived
intimate partner violence were looked at, PTSD was found to be significantly associated with
their shame, guilt, distress and guilt cognitions.
Making a psychological diagnosis when anxiety is evident is not always clear-cut. Anxiety is part
of the human existence and is often a normal adaptive and positive response. Anxiety can also
serve as a drive that leads to functional behaviour, for example, preparing the body for the
fight-or-flight response. Most people feel some anxiety sometimes while others feel anxiety most
of the time. Assessing PTSD may also be a challenge as anxiety features not only in anxiety
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disorders, but in many other psychological disorders as well. It is not always clear which one of
the abnormal behaviours is the cause and which is the result. Another difficulty with identifying a
disorder is that the symptoms of various disorders overlap. For instance, many individuals who
have experienced a panic attack may subsequently develop phobic avoidance behaviour, or
individuals with obsessive thoughts might also be considered chronic worriers.
The question that needs to be asked is: “When is a trauma- or stressor-related response
abnormal?” A trauma- or stressor-related response is considered abnormal if it leads to negative
consequences, for example, poor job or academic performance, social withdrawal or anhedonia
(loss of experiencing pleasure). Culture also plays an important role in the manifestation of
anxiety symptoms and whether or not the phenomenon is considered problematic to them and
those around them. Cultural norms that surround different groups may also explain the
variability in presenting with a disorder, admitting to symptoms, and being distressed by
symptoms. In psychology, culture can be taken to refer broadly to the traditional and
communicated meanings and practices, common values, beliefs and behaviours within groups
who share an identity. How psychological events are interpreted within a patient’s cultural
framework will also have an impact on the presentation.
In terms of understanding such diverse populations as in South Africa, we often talk of
collectivist versus individualist cultural perspectives. Collectivist individuals often have a strong
fear of rejection whereas individualist people may be more prone to loneliness. In line with
international trends, the anxiety disorders are reported to be the most common of the mental
disorders in South Africa. Locally, concern has been expressed about the assumed universality
of the PTSD diagnosis cross-culturally. In SA, McDermott confirms that, in order to be most
effective, practitioners need to respond to Abnormal behaviour in patients by using assessment
and treatment frameworks that acknowledge both Western and indigenous constructs of
meaning. Ongoing research into the local prevalence of anxiety disorders as well as the unique
presentation of culture bound syndromes is needed. Unfortunately high crime statistics and
South Africa's “culture of violence” leave people at greater risk of experiencing stressors or
traumas likely to play a role in the development of psychological difficulties.
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Answer:
Co-dependency refers to psychological behavioural problems that cause people with addictions
and those in their lives to engage in mutually destructive habits and maladaptive coping
strategies. The term has been around for nearly 40 years and was originally used in context with
alcoholism. Codependent people who are not addicted are often referred to as enablers.
Codependent behaviours typically manifest as a way to maintain a sense of balance or status
quo, but have deeper psychological implications. This relationship can occur between two
people, such as a husband/wife, or can affect the family unit as a whole. Although
co-dependency most often affects a member of the immediate family, it can also involve friends
or co-workers of the person afflicted with alcohol or drug dependence. Typically, a person
struggling with addiction will become exceedingly focused on obtaining and using drugs to the
exclusion of important responsibilities and relationships. Enablers often compulsively maintain
associations with children or partners who abuse drugs despite the suffering and lack of
compensation that characterize these relationships. They compensate for the drug abusers’
behaviour, believing they are doing this out of love, when in fact, they are merely reinforcing and
strengthening the abuser’s destructive habits.
The codependent person is often unhappy with him/herself; however, he or she gets satisfaction
from taking care of someone else’s needs. Micromanaging many aspects of the drug abuser’s
life is a way for the enabler to control a situation that is out of his or her control.
Common Traits in Co-dependent People:
● Low self-esteem and feelings of inadequacy
● Guilt and perfectionism
● Obsessive thoughts about other people or relationships
● Poor or ineffective communications skills
● The inability to be truthful about one’s feelings
● Engaging in risky, dangerous or illegal behaviours
● Buying drugs for a significant other
● Getting involved with addicts, chronic underachievers or emotionally abusive people
● Sacrificing one’s own needs to take care of the addict, which can mean managing all
aspects of his or her life other than drug use
● Problems being emotionally intimate with a significant other
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Enabling Behaviour and Consequences:
● Taking on added responsibilities such as extra work in the home
● Making excuses at the loved one’s place of employment, e.g., for absences
● Lying to others when the addictive person does not attend important events
● Changing or cancelling personal plans
● Expressing a desire to change behaviour without being able to do so
Co-dependency and addiction frequently go hand in hand, however, it is possible to change the
relationship dynamic. It typically takes a crisis in order for the enabler to realize that he or she
also has a problem. Sometimes the hospitalization of the drug user will spark this realization,
while in other cases, drug rehab is where unhealthy relational habits are uncovered. Family
therapy is an integral part of rehab, offering all impacted members the opportunity to uncover
why they are contributing to the problem and learn how to develop healthier coping and
communications skills.
Answer: (a)
Five or more symptoms must be present during the same two weeks.
1. depressed mood
2. diminished interest or pleasure in activities
3. significant weight loss or weight gain
4. insomnia or hypersomnia
5. psychomotor agitation or retardation
6. fatigue
7. feelings of worthlessness or excessive guilt
8. unable to think or concentrate
9. current thoughts of death (not fear of death)
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Answer: (b)
Cultural factors need to be an area of focus when defining depression. Western societies
typically ascribe the causes of mood disorders to internal states (biological or psychological)
whereas non-western societies tend to ascribe the causes to external forces, like social conflict,
envy, witchcraft or sorcery.
During the colonial period in Africa, there was a general assumption that depression was rare
among African people. It was found that in South Africa, only people with socially disruptive
behaviour came to the attention of mental health care services. Black South African patients
were predominantly diagnosed with schizophrenia while white patients predominantly with a
mood disorder. For this reason, the South African community seem to view the main cause of
disorders such as depression and panic disorder as having a weak character, and therefore do
not seek help.
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Depression also takes on different forms. Guilt seems to be a less common feature in West
Africa than in Britain, and that hallucinations may be a core feature of depression in West Africa.
This then leads to patients being misdiagnosed with a psychotic disorder.
It is probably true that all depressed patients experience the same amount of somatic discomfort
and guilt, but that the expression of this may be over- or under-emphasised by prevailing
cultural factors. Contextual factors may also be significant in depression. Research has found
differences in prevalence rates of depression in two districts in Uganda which they ascribe to
different levels of conflict in the country.
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