PSYCHOLOGICAL DISORDERS #1:

• DSM-5:

• Manual listing all recognized mental disorders.

• using both categorical (yes/no) and dimensional (spectrum-based) models.

A psychological disorder

involves patterns of thought, emotion, or behavior that cause distress, dysfunction, danger, or deviance.

Diagnosis Pros:

Guides treatment, improves communication, validates experiences.

Diagnosis Cons:

Risk of stigma, labeling, and overdiagnosis.

What percentage of college freshmen screen positive for a mental health disorder before entering college?

Between 1/3 to ½ screen positive for a mental health disorder before starting college.
➡ This highlights the importance of early identification and support in young adults.

When is behavior considered abnormal?

A behavior is often labeled “abnormal” when it meets several of the 4 to 5 D's:

• Deviance

• (unusual behavior),

• Distress

• (emotional suffering),

• Dysfunction

• (interfering with daily life),

• Danger

• harm to self/others),

the 4–5 Ds of abnormality:

• Deviance, Distress, Dysfunction, Danger, Duration (sometimes included)

• Clinical Psychologist (PhD/PsyD):

• Therapy & assessment, not licensed to prescribe.

• Psychiatrist (MD):

• Medical doctor who can prescribe meds and tends to emphasize biological treatments.

• Counselors & Social Workers

• : Offer therapy and community-based support.

Terminology & Framing

• "Mentally ill" vs. "a person with a mental illness": The latter uses person-first language, reducing stigma.

• Internalizing Stress:

• Stress that is directed inward.

• Common in disorders such as depression, anxiety disorders, and eating disorders.

• Externalizing Stress:

• Stress that is expressed outwardly.

• Includes behaviors like aggression, impulsivity, defiance, and substance abuse.

• Seen in conditions such as ADHD, conduct disorder, and oppositional defiant disorder.

Categorical =

yes/no diagnosis;

Dimensional =

range of symptom severity.

>This approach sees mental health symptoms on a continuum or spectrum.

• Rather than placing individuals in categories, it measures the severity or frequency of symptoms.

• Example: Instead of diagnosing depression as present/absent, a dimensional model might score it from mild to severe.

. Schizophrenia

• Definition: A severe brain disorder with symptoms like delusions, hallucinations, and disorganized behavior.

• Schizophrenia Positive Symptoms:

• Hallucinations, delusions, disorganized speech.

• Schizophrenia Negative Symptoms

• : Flat affect, lack of motivation, social withdrawal.

• Flat affect, alogia, avolition.

• Counselors (MA, MSW)

• provide talk therapy and support, often focusing on specific issues or populations.

Schizophrenia The prodromal phase

• includes early warning signs such as withdrawal and unusual thoughts, which can precede full-blown psychosis.

Schizophrenia Prevalence:

• ~1% of the population.

Schizophrenia Genetics:

• ~48% risk if identical twin has it — indicates a strong genetic basis.

Schizophrenia Brain Basis

Brain abnormalities, such as enlarged ventricles and reduced frontal lobe activity, dopamine overactivity.

Schizophrenia Womb Evidence:

Prenatal infections and stress may contribute.

Diathesis-Stress Model

genetic vulnerability combined with environmental stressors can lead to the onset of schizophrenia.

• Schizophrenia Treatment:

• Antipsychotic medications; therapy to support functioning.

• Schizophrenia Prognosis:

• Varies widely, early intervention improves outcomes.

• About 1/3 improve significantly with treatment and live relatively normal lives.

• Another 1/3 show moderate improvement but need ongoing support.

• The remaining 1/3 have chronic symptoms and functional impairment.

What is the role of dopamine in schizophrenia?

The dopamine hypothesis suggests that overactivity of dopamine transmission, particularly in the mesolimbic pathway, is linked to positive symptoms of schizophrenia, such as:

• Hallucinations

• Delusions

  Disorganized thinking

Psychological and Social Influences on Schizophrenia

• Stressful life events can trigger episodes in individuals with a genetic vulnerability (Diathesis-Stress Model).

• Family dynamics, particularly high levels of expressed emotion (EE)—such as criticism, hostility, or over-involvement—can increase relapse rates.

• Urban upbringing, poverty, social isolation, and trauma (e.g., childhood abuse) are associated with increased risk.

• Substance use, especially cannabis in adolescence, may increase the likelihood or severity of psychotic episodes in vulnerable individuals.

• Unipolar depression (Major Depressive Disorder):

• Persistent low mood, loss of interest.

• Bipolar Disorder:

• Alternates between depression and mania.

Major Depression Symptoms:

Sadness, sleep/appetite changes, worthlessness, lasting ≥2 weeks.

Major depressive disorder lifetime risk?

16%

Bipolar 1

featuring full manic episodes

Bipolar 2

involving hypomania and major depression.

Hypomania: mania but it is not severe enough to cause major impairment in functioning or require hospitalization.

• The biological basis of mood disorders

>Includes genetic risk, neurotransmitter imbalances, and structural brain differences, particularly in the HPA axis response.

• One of the most heritable mental illnesses.

Mood Disorders Types:

• Unipolar depression (Major Depressive Disorder): Persistent low mood, loss of interest.

• Bipolar Disorder: Alternates between depression and mania.

What are the symptoms of a major depressive episode?

To meet criteria for a major depressive episode, five or more of the following symptoms must be present for at least two weeks, with at least one being either depressed mood or loss of interest/pleasure:

• Depressed mood most of the day

• Markedly diminished interest or pleasure in activities

• Significant weight loss or gain, or appetite changes

• Insomnia or hypersomnia

• Psychomotor agitation or retardation

• Fatigue or loss of energy

• Feelings of worthlessness or excessive guilt

• Difficulty concentrating or indecisiveness

• Recurrent thoughts of death or suicide

What is required to make a firm mood disorder diagnosis?

A licensed mental health professional must identify that the symptoms:

• Last for at least two weeks

• Cause significant distress or impairment

• Are not due to a medical condition or substance use

What is the course of a major depressive episode?

• Episodes can last several months if untreated.

• Many people experience recurrent episodes over their lifetime.

What is the rate of remission? (mood disorder)

• EPISODIC

• About 50% of individuals recover within 6 months with treatment.

• Remission can be complete (no symptoms) or partial (symptoms reduced but not gone).

What percentage are later diagnosed as bipolar?

• About 10–15% of individuals initially diagnosed with MDD may later receive a bipolar disorder diagnosis, especially if they experience a manic or hypomanic episode.

What is a major clinical concern for individuals with depression?

• Suicide is a major concern. MDD is a leading risk factor for suicidal thoughts and behaviors.

How do the rates of depression differ across gender identities?

• Women are about twice as likely as men to be diagnosed with depression.

• Nonbinary and transgender individuals may experience higher rates of depression due to social stressors and discrimination.

In what way does depression have a biological basis?

• Genetic risk (family history)

• Neurotransmitter imbalances (especially serotonin, norepinephrine, dopamine)

• Brain structure and function differences (e.g., reduced activity in the prefrontal cortex)

What is distinctive about the HPA axis response in unipolar depression?

• The Hypothalamic-Pituitary-Adrenal (HPA) axis is often hyperactive in depression.

• This results in elevated cortisol levels, which can affect mood, cognition, and immune function.

What thinking patterns are characteristic of depression?

• Negative cognitive triad (Beck): negative views about the self, world, and future

• Cognitive distortions, such as:

  • Overgeneralization

  • Catastrophizing

  • Black-and-white thinking

What is learned helplessness?

• A theory that suggests depression can result from a sense of powerlessness and lack of control over negative events.

• Originally demonstrated in animal studies where animals stopped trying to escape after repeated failures.