Suppose two people, one young and one old, came into your clinic, each complaining about a lack of sleep, changes in appetite, a lack of energy, and feeling down. What would you say to them?

If you evaluate them in identical ways, you might be headed for trouble. Just as we have seen in other chapters that older and younger adults may think differently or view themselves differently, the mean­ing of their symptoms and complaints may also differ, even though they appear to be the same. This point is not always incorporated into views of psychopathology. For example, some approaches assume that the same underlying cause is respon­sible for abnormal or maladaptive behavior regard­less of age and that the symptoms of the mental disease are fairly constant across age. Although such

Disorders

50

| 18-29 years I | 30-44 years

40

Щ 45-59 years Q 60 years and up

Source: Kessler, Ronald C., Berglund, Patricia, Demler, Olga, Jin, Robert, Merakangas, Kathleen, & Walters, Ellen. (2005). Arch Gen Psychiatry, 62, 593-602. Copyright © 2005 by American Medical Association. All rights reserved.

models often are used in clinical diagnosis, they are inadequate for understanding psychopathology in old age. Viewing adults’ behavior from a life-span developmental forces perspective makes a big dif­ference in how we approach psychopathology. Let’s see why.

Biological Forces. Various chronic diseases, func­tional limitations, and other ailments can change behavior. Because health problems increase with age (see Chapters 3 and 4), we must be more sensitive to them when dealing with older adults. In addition, genetic factors often underlie impor­tant problems in old age. For example, the evidence is growing that Alzheimer’s disease has a genetic component.

Physical problems may provide clues about underlying psychological difficulties; for example, marked changes in appetite may be a symptom of depression. Moreover, some physical problems may present themselves as psychological ones. For exam­ple, extreme irritability can be caused by thyroid problems, and memory loss can result from certain vitamin deficiencies. In any case, physical health
and genetic factors are very important dimensions to take into account in diagnosing psychopathology in adults and should be among the first avenues explored.

Psychological Forces. Psychological forces across adulthood are key for understanding psychopa­thology. As we saw in Chapters 6, 7, and 8, several important changes in attention, memory, and intel­lectual performance must be considered carefully in interpreting behavior. Normative changes with age in these abilities can mimic certain mental disorders; likewise, these changes can make it more difficult to tell when an older adult has a given type of psychopathology.

In addition, the nature of a person’s relationships with other people, especially family members and friends, is a key dimension in understanding how psychopathology is manifested in adults of dif­ferent ages. Important developmental differences occur in the interpersonal realm; for example, younger adults are more likely to be expanding their network of friends, whereas older adults are more likely to be experiencing losses. Chapter 11

summarizes developmental changes in key rela­tionships that may influence adults’ interpretation of symptoms.

Sociocultural Forces. The social norms and cultural factors we all experience also play a key role in help­ing define psychopathology. They influence people’s behaviors and affect our interpretation of them. For example, an older woman who lives alone in a high-crime area may be highly suspicious of other people. To label her behavior “paranoid” may be inappropriate because her well-being may depend on maintaining a certain level of suspicion of others’ motives toward her. Because customs differ across cultures, behaviors that may be normative in one culture may be viewed as indicating problems in another. In short, we must ask whether the behavior we see is appropriate for a person in a particular setting.

Life-Cycle Factors. How one behaves at any point in adulthood is strongly affected by one’s past experiences and the issues one is facing. These life-cycle factors must be taken into account in evaluating adults’ behaviors. For example, a mid­dle-aged woman who wants to go back to school may not have an adjustment disorder; she may simply want to develop a new aspect of herself. Some might interpret her behavior as an inability to cope with her current life situation when that is not the case at all; rather, she has a rational evaluation of her life and realizes, for example, that she needs a degree to advance in her pro­fession. Likewise, an older man who provides vague answers to personal questions may not be resistant; he may simply be reflecting his genera­tion’s reluctance to disclose one’s inner self to a stranger. Most important, the meaning of particu­lar symptoms may change with age. For example, problems with early morning awakenings may indicate depression in a young adult but may sim­ply be a result of normal aging in an older adult (see Chapter 3).