Psychological Disorders

Abnormal psychology

Scientific study of psychological disorders

• No universal definition of what is abnormal behaviour

• Four Agreed upon features (the four D’s)

Deviance

Behaviour, thoughts, or emotions are unusual

Distress

Unhappiness to the person or close others

Dysfunction

Interference with daily activities

Danger

Most people with disorders are not a danger to themselves or others, but people who put themselves or others at risk may have a disorder

International Classification of Diseases (ICD-10)

System used by most countries to classify psychological disorders; published by the World Health Organization and currently in its tenth edition

Diagnostic and Statistical Manual of Mental Disorders (DMS-V)

Manual used to diagnose mental disorders in North America provides a categorical list of symptoms for mental disorders

Diagnosis

Identifying a disorder by its symptoms and other evidence

Comorbidity

Two or more disorders are present

Classification of Disorders

• Neurodevelopmental Disorders

• Neurocognitive Disorders

• Substance-related and Addictive Disorders

• Schizophrenia-spectrum and other psychotic disorders

• Depressive Disorders

• Bipolar and related disorders

• Anxiety Disorders

• Obsessive-Compulsive and related disorders

• Trauma and stressor-related disorders

• Dissociative disorders

• Feeding and eating disorders

• Sexual dysfunctions

• Gender dysphoria

• Paraphilic disorders

The Neuroscience Model

• Genetic inheritance (no single gene)

• Too few or too many of certain types of neurotransmitters

• Viral infection – effects on brain development

  • Linked to anxiety, mood disorders, and schizophrenia

• Hormones — E.g. cortisol > stress and depression

• Brain structure abnormalities

• Does not take into account additional factors such as stress, experiences

The Cognitive-Behavioural Model

• Disorders are the result of maladaptive learned behaviours and problematic thinking

• Behaviour and thinking interact and influence each other

• Acknowledge that emotions and biological factors also interact with behaviour and cognition

• Behavioural perspective - based on learning principles from classical conditioning, operant conditioning, and modelling

• Maladaptive beliefs and illogical thinking processes

• Selective Perception - See only the negative features of an event

• Magnification - Exaggerating the importance of undesirable events

• Overgeneralization - Drawing broad negative conclusions on the basis of a single insignificant event

The Psychodynamic Model

• Underlying, perhaps unconscious psychological forces cause conflict

• Rooted in Freudian theory

• Fixation

Fixation

Being trapped at an early stage of development due to traumatic childhood experiences

The Socio-cultural Model

A society’s characteristics create stressors for some of its members

• Widespread social change

• Urbanization

• Socio-economic class

• Cultural factors

• Minority groups

• Social networks and supports

• Family systems

• Family systems theory

The Developmental Psychopathology Model

Study how problem behaviours evolve as a function of a person’s genes and early experiences and how these early issues affect the person at later life stages

Risk Factors

Biological and environmental factors that contribute to problem outcomes

Equifinality

The idea that different children can start from different points and wind up in the same outcome

Multifinality

The idea that children can start from the same point and wind up at any number of different outcomes

Depression

• Low, sad state in which people feel overwhelmed

• Most people with a mood disorder suffer only from depression

• Major depressive disorder is more severe than dysthymic disorder

Mania

• Elation and frenzied energy

• People with bipolar disorder or the less severe cyclothymic disorder also experience mania

Major Depressive disorder

a disorder characterized by a depressed mood that is significantly disabling and is not caused by such factors as drugs or a general medical condition

Bipolar Disorder

Periods of mania alternate with periods of depression

Major Depressive Disorder Symptoms Types

Emotional, motivational, behavioural, cognitive

Emotional

Depressed mood

Motivational

Loss of desire to do usual activities, lack of drive

Behavioural

Less active and productive, may move and speak slowly or seem physically agitated

Cognitive

Negative self-evaluation, self-blame, pessimism, guilt, indecisiveness, difficulty

Physical

Headaches, indigestion, constipation, dizzy spells, pain, sleep and eating disturbances

Neuroscientists Explanation for Major Depressive Disorder

• Genetic predisposition

• Low norepinephrine and serotonin activity

• High cortisol

Socio-cultural Theorists Explanation for Major Depressive Disorder

• Social support

• Stressors

Cognitive-behavioural Theorists Explanations for Major Depressive Disorder

• Learned helplessness

• Attribution-helplessness

  • Global, stable internal vs. Specific temporary, external

• Negative Thinking/dysfunctional attitudes

  • Illogical thinking processes

  • Automatic thoughts

  • The cognitive triad

Bipolar Disorder

• Extreme highs and lows

• Symptoms of mania in five areas of functioning (alternating with depressive symptoms)

Mania Emotional Symptom

Powerful highs and lows

Mania Motivational Symptom

Seek excitement and companionship

Mania Behavioural Symptom

May move and speak quickly

Mania Cognitive Symptom

Poor Judgement and planning, optimism, grandiosity

Mania Physical Symptoms

Energetic, require little sleep

Neuroscientists Explanations for Bipolar Disorder

• Gene abnormalities

• Highly heritable

• Irregularities in ions that allow neurons to communicate

Other causes for Bipolar Disorder

• Stress plus biological predisposition

• Life events - striving, failures

Anxiety Disorder

• Most common group of disorders in Canada (12%)

• Disabling levels of fear or anxiety that are frequent, severe, persistent, or easily triggered

• Most people with one anxiety disorder experience another one as well

Generalized Anxiety Disorder

• Anxiety under most life circumstances; diffuse worry

• Restlessness, edginess, easily tired

• Difficulty concentrating

• Sleep problems

Cognitive-behavioural theorists Explanation for Generalized Anxiety Disorder

• Dysfunctional assumptions

• Intolerance of uncertainty theory

Dysfunctional Assumptions

Assumption that one is in danger

Intolerance of Uncertainty Theory

Unwilling to accept negative events

Neuroscientists Explanation for Generalized Anxiety Disorder

• Malfunctioning GABA feedback system (Neurons don’t stop firing)

• Malfunctioning emotional brain circuit

• Prefrontal cortex, anterior cingulate, and amygdala

Social Anxiety Disorder

• More women than men, more poor people than wealthier people

• 12% of population develop this at some time in their life

• Often begins in late childhood or adolescence

• Severe, persistent fear of embarrassment in social situations

• Fear of talking in public

• General fear of functioning poorly in front of others

Cognitive-behavioural Theorists Explanations for Social Anxiety Disorder

• Dysfunctional cognitions about social situations

• Unrealistically high social standards

• View oneself as socially unattractive

• View oneself as socially unskilled

• Belief that one is in danger of behaving clumsily

• Expect negative consequences for clumsy behaviour

• Belief that one has no control over anxious

Phobias

• 7.7 % of people in Canada suffer from at least one specific phobia in any year

• Persistent, irrational fear of a specific object, activity, or situation

Explanations for Phobias

•Classically conditioned fear

•Avoidance behaviours are reinforced through operant conditioning (negative reinforcement)

•Modelling of fearful behaviour

Ten Most Common Phobias

Spiders - arachnophobia

Heights - acrophobia

Public, social places - agoraphobia

Social situations - social phobia

Flying - aerophobia

Enclosed spaces - claustrophobia

Thunder - brontophobia

Germs - mysophobia

Cancer - carcinophobia

Death - necrophobia

Panic Attacks

Periods of sudden bouts of panic

Panic Disorder

Panic attack plus changes in thinking or behaviour

Explanations for Panic Disorder

• Malfunctioning brain circuit and excess norepinephrine

• Misinterpretation of bodily sensations

• 4% of Canadians over 15 years old have suffered from a panic attack at some point

Obsessive-Compulsive Disorder

• Consists of obsessions and compulsions

• Diagnosed when obsessions or compulsions are severe, viewed by the person as excessive or unreasonable, cause great distress, consume considerable time, or interfere with daily functions

Obsessions

• persistent unwanted thoughts

• Wishes, impulses, doubts, or images

Compulsions

• repetitive, rigid behaviours or mental acts

• Are often responses to obsessive thoughts, performed to reduce or prevent anxiety

Neuroscientists Explanation for OCD

• Low serotonin activity

• Overactive orbitofrontal cortex and caudate nuclei

• Eruption of troublesome thoughts and actions

• Cingulate cortex, thalamus, and amygdala may activate the OCD impulses

• Amygdala drives the fear and anxiety components of the OCD response

Cognitive-behaviourist Theorists Explanations for OCD

Learning that compulsive behaviour relieves distress

Post-Traumatic Stress Disorder (PTSD)

• Persistent depression, anxiety after a traumatic

• Lasts more than a month, may begin shortly after or years after the event

• 9.2% of Canadians experience PTSD in their lifetime, twice as common in women than men

• Characteristics:

•Hyperalertness

• Easily startled

• Sleep disturbance

• Guilt, anxiety, depression, difficulty with

concentration

Acute Stress Disorder (ASD)

Lasts less than a month and begins within four weeks of the event

Explanations for PTSD - Biological Factors

• Increased cortisol and norepinephrine

• Damaged hippocampus, amygdala

Explanations for PTSD - Personality

View negative events as outside ones control

PTSD Explanation - Childhood Experiences

Poverty, parents separate, abuse, etc.

PTSD Explanations

Social and Family support

Psychosis

• Loss of contact with reality

• E.g. schizophrenia

Schizophrenia

mental disorder characterized by disorganized thoughts, lack of contact with reality, and sometimes hallucinations

Schizophrenia Positive Symptoms

• Pathological excesses

• Delusions - false beliefs

• Hallucinations - false sensory perceptions

• Disorganized thinking and speech, loose associations or derailment

• Inappropriate affect

Schizophrenia Negative Symptoms

• Pathological deficits

• Poverty of speech

• Flat affect

• Loss of volition

• Social withdrawal

Schizophrenia Psychomotor Symptoms

• Strange movements

• Catatonia—extreme psychomotor symptoms

• Stupor – stop responding to environment: remain motionless

• Rigidity – upright posture, resisting to be moved

• Posturing – awkward bizarre positions (squatting)

• Waxy flexibility – maintain postures into which they have been placed

Neuroscientists Explanations for Schizophrenia

Genetic predisposition

• Identical twins - 48% concordance rate

• Fraternal twins - 17% concordance rate

• Biochemical abnormalities - excessive dopamine activity

• Brain Structure - enlarged ventricles, small temporal lobes and frontal lobes, structural abnormalities of the hippocampus, amygdala, and thalamus

Diathesis-stress model

Biological predisposition plus negative event

Somatic (physical) Symptom and related disorders

Excessive thoughts, feelings, and behaviours related to somatic symptoms

Somatic Symptom Disorder

• Symptoms cause distress and significant disruption in life

• Excessive health-related anxiety

• Concern has lasted over 6 months

• Frequently no medical explanation is available

Illness Anxiety Disorder

• preoccupied with having a illness despite a lack of symptoms

• Engage in excessive care-seeking for over 6 months

• Engage in excessive illness behaviours

Factitious Disorder

Deliberately assume physical or psychological symptoms to adopt the patient role. May lie about symptoms or deliberately make themselves ill

Explanations for other disorders

• Classical conditioning and modelling

• Misinterpretation of bodily cues

Dissociative Disorders

Major disruptions in memory

Dissociative Amnesia

Unable to remember important information about a traumatic event; wartime, natural disaster

Derealization Disorder

Person feels detached from their body

Dissociative Identity Disorder

Two or more distinct personalities

Psychodynamic Theorists Explanations for Dissociative Disorders

Repression

Neuroscience Explanations for Dissociative Disorders

Smaller hippocampus and amygdala changes in the level of activity in the sensory cortex

Personality Disorders

Rigid patterns of experience and behaviour causing distress or difficulty

Antisocial Personality Disorder

Disregards and violates the rights of others, impulsive, reckless, self-centred; linked to criminal behaviour

Explanations for Antisocial Personality Disorder

Modelling, operant conditioning; low serotonin activity, deficient functioning in the frontal lobes, lower arousal to stress and less anxiety.

Borderline Personality Disorder

Unstable mood, self-image, high volatility

Explanation for Borderline Personality Disorder

Biosocial theory—child has difficulty identifying and controlling emotions, and the emotions are punished or disregarded