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5907 results in Health and clinical psychology

Page 197 of 296

  • 5 - Diversity in New Zealand

  • from Section II - Cultural diversity and resources
  • Nadine Pelling, University of South Australia, Lorelle Burton, University of Southern Queensland
  • Book:
    Abnormal Psychology in Context
    Published online:
    06 August 2018
    Print publication:
    01 February 2017, pp 34-53

  • Summary

    Introduction

    Mirroring Chapter 4 on Australia, this chapter outlines the equally diverse nature of New Zealand's population. As will be shown, different historical issues have led to diversity being measured somewhat differently in New Zealand (NZ) – such as a focus on ethnicity as opposed to country of birth − while paradoxically, in NZ the description of people defined by particular countries of birth as “ethnics,” as is often the case in Australia, is never heard. Reflecting a host of underlying definitional problems, the chapter also covers related measurement issues and their methodological implications. Where important to further analysis, these issues are briefly explained. As in the chapter on Australia, this chapter provides background demographic and socio-economic data for use by students, rather than substantive analysis of diversity.

    New Zealand – what is diversity?

    Interest in diversity differs by country. In NZ, diversity typically makes people think of “ethnic group,” that is, whether people are (broadly) Māori, European, Pacific Island, or Asian in origin, while in Australia diversity tends to be thought of in terms of country of birth and generation of migrant. Like age and sex, these are examples of “inherent diversity” (traits people are born with).

    By contrast, diversity gained from experience, such as one's personal, social, and economic characteristics, is termed “acquired diversity.” Acquired characteristics also tend to differ at group level, such as by ethnic group or spatially (e.g., by region), and require methodological consideration when making sub-population comparisons.

    Spatial distribution

    With over 85% of its population living in an urban area NZ, like Australia, has one of the developed world's most urbanised populations. In 2013, two-thirds of NZ's population lived in its 13 cities (one-third in Auckland alone), up from 62% in 1996. Between 1996 and 2013, 90% of population growth was accounted for by just five cities and eight urban districts, while one-third of the overall 67 territorial authority areas declined in size, primarily because of net migration loss at young adult ages. NZ's urbanisation is, however, now slowing – plausibly because the proportion living in an urban area is approaching its maximum.

  • 20 - Substance-related and addictive disorders

  • from Section III - Disorders and psychological practice related items
  • Nadine Pelling, University of South Australia, Lorelle Burton, University of Southern Queensland
  • Book:
    Abnormal Psychology in Context
    Published online:
    06 August 2018
    Print publication:
    01 February 2017, pp 229-242

  • Summary

    Introduction

    Substance-related disorders

    There are two groups of substance-related disorders in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013): substance-induced disorders and substance use disorders (SUDs). Substance-induced disorders include intoxication, withdrawal, and substance-induced mental disorders. SUDs are problematic symptoms that occur when individuals continue to use substances, despite experiencing impairment or distress. Substance-related disorders are listed separately for each of the 11 substance groups (alcohol, caffeine, cannabis, phencyclidine, other hallucinogens, inhalants, opioids, sedatives, hypnotics and anxiolytics, stimulants, tobacco, and other substances). The DSM-5 combines the categories of abuse and dependence into the single disorder of SUD with mild, moderate, and severe subclassifications based on the number of criteria met. Anyone meeting any two of the 11 criteria during the same 12-month period receives a SUD diagnosis. The criteria also include a remission specifier (in early remission, in sustained remission, on maintenance therapy, in a controlled environment).

    Behavioural addictions

    Behavioural addictions, which are characterised by impairment of control rather than physiological dependence, may involve gambling, internet use, video games, shopping, exercise, work, eating, and sex. Behavioural addiction is not included as a diagnostic category in the DSM-5 due to insufficient evidence to establish diagnostic criteria and course descriptions. However, gambling disorder, which was formerly an impulse control disorder known as pathological gambling, is now included as a substance-related and addictive disorder. Gambling disorder is defined as persistent and recurrent problematic gambling behaviour leading to clinically significant impairment or distress. The diagnosis requires endorsement of five of nine criteria within the previous 12 months and includes specifiers for course (episodic, persistent), remission (early, sustained) and current severity (mild, moderate, severe). Moreover, internet gaming disorder (IGD) is included as a condition for further study. IGD is defined as repetitive use of internet-based games, often with other players, which leads to significant issues with functioning. The DSM-5 requires endorsement of five of nine criteria within the previous 12 months and includes current severity specifiers (mild, moderate, and severe).

    Australia

    Substance-related disorders

    A national survey by the Australian Institute of Health and Welfare (AIHW, 2014) indicates tobacco use in Australia has steadily declined since 1993; by 2013, 60% of individuals reported they had never smoked. Nearly 80% (78.3%) reported having consumed alcohol in the previous 12 months, with men (82%) reporting higher rates of alcohol consumption than women (76%).

  • 16 - Feeding and eating disorders

  • from Section III - Disorders and psychological practice related items
  • Nadine Pelling, University of South Australia, Lorelle Burton, University of Southern Queensland
  • Book:
    Abnormal Psychology in Context
    Published online:
    06 August 2018
    Print publication:
    01 February 2017, pp 175-188

  • Summary

    Introduction

    Feeding and eating disorders involve disturbed eating and eating-related behaviour, altered food consumption and absorption, and impaired physical and psychosocial health and wellbeing. Feeding and eating disorders include pica, rumination disorder, avoidant/restrictive food intake disorder (ARFID), anorexia nervosa (AN); bulimia nervosa (BN), binge eating disorder (BED), other specified feeding or eating disorder (OSFED), and unspecified feeding or eating disorders (USFED).

    Specific changes to eating disorder diagnoses from the DSM-IV to the DSM-5 include revised diagnostic criteria for AN and BN, recognition of BED, and inclusion of descriptors of OSFEDs and USFEDs. The other major change is the inclusion of ARFID (previously feeding disorder of infancy or early childhood), pica, and rumination disorder; diagnoses that were previously listed under “disorders usually first diagnosed in infancy, childhood, or adolescence” not retained in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013).

  • • AN is characterised by persistent energy restriction, fear of weight gain or persistent behaviours that interfere with weight gain, and disturbed self-perceived weight and shape. Specifiers include restricting type (weight loss achieved via dieting, fasting, and excessive exercise, without recurrent binging or purging) or binge eating/purging type (recurrent episodes of binge eating or purging), in partial or full remission, and severity based on body mass index (BMI) criteria. The DSM-5 changes to diagnostic criteria include removing the term “refusal” in relation to maintaining normal body weight (Criteria A) and requiring amenorrhea (Criteria D).

  • • BN is characterised by recurrent binge eating episodes, inappropriate compensatory behaviours, and overvaluation of weight and shape. Specifiers include in partial or full remission and severity is based on frequency of compensatory behaviours.

  • • BED is characterised by recurrent binge eating episodes which involve eating a large amount of food and experiencing lack of control. Specifiers include in partial or full remission and severity is based on frequency of binge eating.

  • • ARFID is characterised by avoidance or restriction of food intake resulting in failure to meet nutritional and/or energy requirements. There has been refinement of diagnostic criteria from the previous name of feeding disorder of infancy or early childhood. Rumination is characterised by the repeated regurgitation of food after eating, the re-chewed food may be spat out or re-swallowed. Only one of the above diagnoses can be made during a single episode.

  • 6 - Indigenous and bicultural resources

  • from Section II - Cultural diversity and resources
  • Nadine Pelling, University of South Australia, Lorelle Burton, University of Southern Queensland
  • Book:
    Abnormal Psychology in Context
    Published online:
    06 August 2018
    Print publication:
    01 February 2017, pp 54-56

  • Summary

    In 2007 I guest edited a special issue on Indigenous counselling for the journal Counselling, Psychotherapy and Health published by the Australian Counselling Association. This followed the publication of a scholarly review I conducted on Indigenous mental health and substance abuse in 2006 (Pelling, 2006a, 2007). I am, nonetheless, not an expert on Indigenous Australian psychology and recognise my limitations in this area. If competence in any applied area relates to knowledge, self and other awareness, and skill, then I must admit that I am lacking in competence in these important Australian psychological foci (Pelling, 2006b) and similarly am lacking in terms of bicultural New Zealand (NZ) competence.

    However, I have worked with Dwayne Kennedy and Joseph Randolph Bowers to ensure that the current edition of this handbook provides a framework for relating to Australian Indigenous psychology and counselling. Additionally, there are international sources of published information on both Indigenous and bicultural issues relevant to abnormal psychology. Indigenous issues are a focus of the Inter-Agency Support Group (IASG) of the United Nations (UN) and information can be found through the UN main page for those interested in supporting and promoting the mandate of the UN Permanent Forum on Indigenous Issues within the UN forum (UN, 2016).

    Related to Australian psychology, the Australian Psychological Society (APS) has an interest group focusing on Aboriginal and Torres Strait Islander Peoples and Psychology (2016). This APS interest group makes available resources and publications as well as online training. Similarly, the Australian Indigenous Psychologists Association (AIPA) has published various papers including a discussion paper relating to the determinants of Indigenous social and emotional wellbeing (Kelly et al., 2010). Another author in the area of Indigenous psychology is Victoria Hovane (2015). The AIPA provides leadership on issues related to the social and emotional wellbeing and mental health of Aboriginal and Torres Strait Islander peoples in Australia and offers cultural competence workshops (AIPA, 2015, 2016).

    Bicultural NZ psychological information can be found through the New Zealand Psychological Society (NZPsS). The NZPsS has bicultural articles published by year in the New Zealand Journal of Psychology, thus highlighting the importance of bicultural psychology in NZ.

  • 15 - Dissociative disorders and somatic symptoms and related disorders

  • from Section III - Disorders and psychological practice related items
  • Nadine Pelling, University of South Australia, Lorelle Burton, University of Southern Queensland
  • Book:
    Abnormal Psychology in Context
    Published online:
    06 August 2018
    Print publication:
    01 February 2017, pp 154-174

  • Summary

    Dissociative disorders

    Integrating what we see, hear, smell, taste, touch, feel, think, and do into a relatively unified experience is essential for our functioning. Integrating these different psychological, physiological, and behavioural aspects into a web of interacting memories, feelings, and actions fosters a more continuous sense of self (i.e., integration of the personality) and assists smooth and flexible interactions with the self, the environment, and other people. Dissociative disorders are characterised by a failure of this capacity. They are founded in dissociation, a disruption in the ability to bring together aspects of an experience or personality.

    The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) contains three discrete dissociative disorders: dissociative amnesia (DA); depersonalisation/derealisation disorder (DRD); and dissociative identity disorder (DID). There are also two broader categories with less discrete and specific criteria: other specific dissociative disorder (OSDD) and unspecified dissociative disorder (USDD). They are used when someone experiences debilitating symptoms that do not meet the previous discrete diagnoses. The core feature of DA (DSM-5 and ICD shared code F44.0) is the inability to recall information laid down in memory (i.e., encoded) about events one has experienced (e.g., autobiographical). This so-called reversible autobiographical memory loss is more serious and distressing than ordinary forgetfulness and is not caused by neurological injury or substance intoxication. The non-retrieved material is typically stressful in nature, such as the central details of being involved in a car accident where a loved one is killed. The person with DA typically has no problems learning new material or engaging in new or previously learned tasks. Amnesia may be localised, relating to a specific time period in the person's life in which they have little or selective memory (selective amnesia), or more rarely generalised, in which the person has a complete loss of memory for their life history. This total loss is experienced as one-half of the symptom profile for what is called dissociative fugue. Dissociative fugue is a subtype of DA. In addition to generalised amnesia for one's own identity (e.g., losing awareness of one's name, age, and history) it involves purposeful travel away from one's home or work, or wandering in a bewildered daze.

  • 3 - Abnormal psychology overview

  • from Section I - Rationale, structure, and overview
  • Nadine Pelling, University of South Australia, Lorelle Burton, University of Southern Queensland
  • Book:
    Abnormal Psychology in Context
    Published online:
    06 August 2018
    Print publication:
    01 February 2017, pp 6-8

  • Summary

    Defining abnormality

    Abnormality can be defined in a number of ways. However, in terms of psychological difficulties the term “abnormality,” or “psychopathology,” generally refers to a problematic pattern of thought, feeling, and/or behaviour that disrupts one's sense of wellness or functioning either socially or occupationally. A mental or psychological disorder involves a recognisable set of symptoms and signs that cause distress to the individual involved and impair their functioning (Burton, Westen, & Kowalski, 2015). The psychopathological signs and symptoms presented by an individual are “recognisable” when compared with various classification systems and thus are used to make a diagnosis.

    There are two main classifications systems used to make mental health related diagnoses: the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (5th ed.; DSM-5; 2013) and the International Statistical Classification of Diseases and Related Health Problems 2010 Edition (ICD-10) (World Health Organisation, 2011). An examination of the pros and cons of both classifications is beyond the scope of this handbook. Therefore, the DSM-5 will simply be described in terms of structure and use as this is the classification system that was focused on when structuring this handbook.

    DSM-5 overview

    The DSM-5 is the current edition of the Diagnostic and Statistical Manual of Mental Disorders in use and outlines recognisable sets of symptoms and signs that distress individuals and impair their functioning, most often focused on for treatment and support. The DSM-5 itself presents material in sections, including background regarding the development of the DSM-5, with the bulk of material being related to the diagnostic criteria for the various disorders.

    The DSM-5 provides applied clinicians with an organising framework as well as a common language regarding signs and symptoms and thus diagnoses that can assist communication and assist and guide research and treatment. The information presented in the DSM-5 includes how various cognitive, emotional, and/or behavioural signs and symptoms cluster together in the diagnoses described. The use of a diagnosis thus creates a shared understanding with other practitioners familiar with the diagnostic classification system used. Therefore, communication between practitioners is made more efficient.

  • 23 - Paraphilic disorders

  • from Section III - Disorders and psychological practice related items
  • Nadine Pelling, University of South Australia, Lorelle Burton, University of Southern Queensland
  • Book:
    Abnormal Psychology in Context
    Published online:
    06 August 2018
    Print publication:
    01 February 2017, pp 266-275

  • Summary

    Introduction: paraphilias and paraphilic disorders

    A distinctive feature of paraphilic disorders is that they are diagnosed largely in forensic settings. Indeed, paraphilic disorders are related to criminal activity to varying degrees, depending on the particular disorder. For example, acting on paedophilic sexual arousal results in criminal sexual activity with children, whereas fetishistic sexual arousal may result in sexual behaviour between consenting adults. However, fetishism may also involve criminal activity; for example, stealing feminine articles of clothing.

    Atypical patterns of sexual arousal have been familiar to practitioners of psychiatry and psychology since Richard von Krafft-Ebing's landmark work Psychopathia Sexualis in the late 19th century. The European psychiatrist described numerous cases of fetishism, sadism, masochism, and other sexual behaviour. Atypical sexual arousal was known as sexual deviation in the second edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-II), but the term paraphilia replaced it in subsequent editions. The current edition, Diagnostic and Statistical Manual of Mental Disorders: (5th ed.; DSM-5; American Psychiatric Association, 2013), retains the term “paraphilia,” but introduces the additional term of “paraphilic disorder.”

    With the intent of reducing stigma associated with atypical sexual arousal, the DSM-5 defines the term “paraphilia” as an intense, persistent sexual interest other than in genital stimulation or preparatory sexual fondling with physically mature, consenting human partners. In itself, this would not constitute a disorder. However, a paraphilic disorder is a paraphilia that is accompanied by clinically significant distress or impairment. Therefore, the DSM-5's paraphilic disorders require two criteria to be met for a diagnosis. Criterion A is the paraphilia component, which requires an atypical focus of sexual arousal and an arousal pattern that is recurrent, intense, and persists for a minimum of 6 months. Criterion B is a harm component, which requires the presence of distress, impairment in functioning, or the involvement of non-consenting persons. Some paraphilic disorders include a third criterion which is specific to that paraphilia.

    The DSM-5 lists eight specific paraphilic disorders: voyeuristic, exhibitionistic, frotteuristic, sexual masochism, sexual sadism, paedophilic, fetishistic, and transvestic. There are two additional residual disorder categories: other specified paraphilic disorder and unspecified paraphilic disorder.

Page 197 of 296