Psychology 1001 - Chapter 15

Psychological Disorders

Psychological Disorders Topics

• Defining, Classifying, and Diagnosing Psychological Abnormality

• Models of Abnormality

• Mood Disorders

• Anxiety Disorders

• Schizophrenia

• Other Disorders

Defining, Classifying, and Diagnosing Psychological Abnormality

• Abnormal psychology - scientific study of psychological disorders.

• No universal definition of abnormal behaviour.

• Some suggest, dysfunctional behaviour is too much or too little of a normal behaviour.

Most agree that psychological disorders share four key features (the four Ds)

• Deviance:  behaviors (thoughts or emotions) differ from societal expectations (standards or norms).

• Distress:  behaviors (thoughts or emotions) cause significant distress or unhappiness.

• Dysfunction:  interfere with daily functioning (e.g., work, relationships, self-care).

• Danger*: *Some disorders may lead to self-injury or hostility to others (likely exception rather than the rule).

Psychological Disorders

• Note: Presence of a single key feature, may not imply a psychological disorder.

• Example: deviance alone may be considered “eccentric”, not a psychological disorder.

• Insufficient on its own to merit a diagnosis

Classifying and Diagnosing Psychological Disorders - Symptoms

• Psychological Disorders are classified based on clusters of symptoms.

• Symptom: physical, behavioral, or mental “feature” associated with a disorder.

  • Depression:  

    • Depressed mood (sadness)

    • Lack of motivation (energy)

    • Reduced ability to experience pleasure

    • Suicidal thoughts

    • Inability to concentrate (indecisive)

• Usually a collection of symptoms must be present for period of time.

Classifying and Diagnosing Psychological Disorders - Two Common Classification Systems

International Classification of Diseases (ICD-10)

• System used by most countries to classify psychological disorders.

• Published by the World Health Organization

• Currently in its tenth edition

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

• Manual used to diagnose mental disorders in North America

• 19 major categories

• About 200 mental disorders altogether

Classifying and Diagnosing Psychological Disorders - Comorbidity

Diagnosis with two or more disorders.

• Fairly common

• Examples:  

  • About 50% people with substance abuse disorder have another disorder (e.g., depression or anxiety).

  • 62% of individuals with Generalized Anxiety Disorder also had Major Depression episode.

 

The Neuroscience Model

• Emphasizes biological basis (malfunctioning brain – structures, neurotransmitters, hormones)

• Like “Medical Model” of disease.

• E.g., Overproduction of dopamine (Schizophrenia)

• Presumed causes:  

  • Genetic inheritance

  • Viral infection – effects on brain development (dormancy)

Criticisms of The Neuroscience Model

• Too reductionistic

• Does not take into account psychological or social factors

• Psychological: Personal experiences (learning), personality factors, cognitive processes, coping ability, etc.

• Social: e.g., poverty

The Neuroscience Model - Diathesis-stress model

• Disorders likely arise from interaction of internal genetic predispositions (diathesis) and external stressful events (trigger).

  • May have genes for schizophrenia, but without significant life event, it may never develop.

The Cognitive-Behavioural Model

• Disorders are the result of 1) maladaptive learned behaviours (behavioral component) and 2) problematic thinking (cognitive component):

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

  • Cognitive Perspective:  Patterns of thinking underlie abnormality.

  • Maladaptive beliefs – e.g., I must be liked by everyone or I am worthless.

  • Illogical thinking: If I don’t wash my hands 50 times, I will contract a disease.

  • E.g., Depression:  Selective perception (focus on negative); magnification and over-generalization of importance of negative events.

The Psychodynamic Model

• Rooted in Freudian theory

• Repressed childhood trauma or unresolved conflict

• Fixation at psychosexual stage

The Socio-cultural Model

• A society’s characteristics can lead to disorders for some of its members.

  • E.g., suicide rates in the Canadian Indigenous population are over twice the national average (same for depression).

  • Schizophrenia rates are higher (2X) in urban centres.

Mood Disorders

• Dominant feature is pervasive disturbed mood (general emotional state).

  • Depression: sad state in which life seems purposeless and one feels overwhelmed.

  • Mania: state of elation and frenzied energy.

• Two Main Disorders:

  • Unipolar Mood Disorder (Major Depression): persistent depression.

  • Bipolar Disorder: alternate between periods of depression and mania.

• Less severe conditions:

  • Dysthymic disorder (milder depression) and cyclothymic disorder (milder Bipolar).

 

Major Depression - Statistics

• “The common cold of Mental Illness” (in terms of frequency, not seriousness… number one reason people seek mental health services)

• Steady increase since WWII

• Leading cause of disability worldwide: At a given time, 5.8% men; 9.5% women

• Twice as likely in women

• Cultural differences in life-long prevalence: 8%-11% Canadians, 13% Americans; 4% Asian cultures

Major Depression - Five Areas of Functioning Affected

1. Emotional - depressed mood.

2. Motivational - loss of desire to do usual activities, lack of drive.

3. Behavioural - less active and productive, may move and speak slowly or seem physically agitated.

4. Cognitive - negative self-evaluation, self-blame, pessimism, guilt, indecisiveness, difficulty concentrating, thoughts of death or suicide.

5. Physical - headaches, indigestion, constipation, dizzy spells, pain, sleep and eating disturbance, fatigue.

Major Depression - Diagnosis

Diagnosis requires at least 5 of 9 possible symptoms nearly every day for at least 2 weeks:

• Depressed mood most of day

• Diminished interest in pleasure

• Significant weight loss or gain

• Insomnia or hypersomnia

• Psychomotor agitation or retardation

• Fatigue or loss of energy

• Feelings of worthlessness or guilt

• Diminished ability to think or concentrate

• Recurrent thoughts of death (or suicide with or without specific plan)

Explanations for Major Depression - Neuroscience Model

• Genetic predisposition: Identical twins 46%; versus 20% for fraternal twins.

• Low norepinephrine and/or serotonin activity

• High cortisol

Explanations for Major Depression - Cognitive-Behavioural Model

People learn negative behaviors and dysfunctional thinking patterns.

Cognitive-Behavioural Model - Martin Seligman’s Learned Helplessness Theory

• People become depressed when they think they no longer have control over outcomes in their lives.

• First demonstrated in dogs (then rats).

• Attribution-helplessness theory

  • Added that people blame themselves (dispositional attribution).

  • Attribute lack of control to an internal cause (deficiency) that is global and stable.

Cognitive-Behavioural Model - Aaron Beck

• Depression results from negative thinking, dysfunctional attitudes, and illogical thinking processes.

• Automatic thoughts:  habitual, steady train of unpleasant, negative thoughts.

• The cognitive triad: Usually centered around three themes (the person, their experiences, and their future).

Explanations Major Depression - Socio-cultural Model

Emphasizes social forces (“no one is an island”).

• Particularly social isolation (lack of social support or intimacy).

• Higher rates of depression among separated or divorced (3-4 times married).

• Other cultural stressor (unemployment, lack of purposive work).

Bipolar Disorder

• Less common than Major Depression (1% - 2.6% population).

• However, is more dysfunctional (e.g. more lost work) and has higher risk of suicide.  

• Equal numbers of men and women.

Bipolar Disorder - Mania (like depression) Affects Five Areas of Functioning

• Emotional - powerful highs (not normal elation).

• Motivational - seek excitement and companionship.

• Behavioural - may move and speak quickly (pressured speech).

• Cognitive - poor judgment and planning, optimism, grandiosity.

• Physical - energetic, require little sleep.

 

 

Bipolar Disorder - Mania Common signs and symptoms

• Unusually “high” and optimistic OR extremely irritable.

• Unrealistic, grandiose beliefs about one’s abilities or powers.

• Sleep very little sleep and feel extremely energetic.

• Talk so rapidly that others can’t keep up.

• Racing thoughts; jumping quickly from one idea to the next.

• Highly distractible, unable to concentrate.

• Impaired judgment, impulsiveness, reckless.

• Delusions and hallucinations (in severe cases).

Explanations for Bipolar Disorder

• Neuroscience

  • Genetics (70% identical twins)

  • Irregularities in ions that allow neurons to communicate

  • Circadian rhythm disturbances

• Other causes

  • Stress plus biological predisposition

 

Bipolar Disorder - External factors (triggers)

• Stress – good or bad

• Substance abuse – stimulants or depressants.

• Seasonal changes – manic in summer months, depressive episodes during the fall, winter, and spring.

• Sleep deprivation – Loss of sleep can trigger an episode of mania.

Bipolar Disorder - “Emotional” Occupations

Whitman, Wolfe, Clemens, Hemingway

Anxiety Disorders

• More common in teens and young adults.

• Affects as many as 2-3% people at one time or another.

• 40 year follow-up study of 144 Swedish people: gradual lessening of symptoms, but only 1 in 5 recovered fully (Skoog & Skoog, 1999)

Anxiety Disorders - Main feature

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

• High prevalence:  12% of Canadian population

• 40 million American adults – about 18% population

Types of Anxiety Disorders

• Generalized anxiety disorder: unexplained and persistent tension and uneasiness.

• Panic disorder: Sudden onset of intense terror.

• Phobias: irrational and intense fear of a specific thing or places.

• Obsessive-compulsive disorder: plagued by persistent anxiety producing thoughts and need to perform repetitive acts.

• Post-traumatic stress disorder

Explanations for Generalized Anxiety Disorder

Cognitive-behavioural

• Carry dysfunctional assumptions (inside)

• E.g.,  Assumption that one is in danger (until proven safe)

• Intolerance of uncertainty theory - unwilling to accept negative events (which invariably occur)

Neuroscience

• Malfunctioning GABA inhibitory system

• Malfunctioning emotional brain circuit (pre-frontal cortex, and hyper-active amygdala)

Phobias

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

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

Explanations

• Two-factor Theory:  

  • Fear results from classical conditioning

  • Avoidance behaviours are reinforced through operant conditioning

• Modeling 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 Disorder

• Panic attacks - periodic sudden bouts of panic

• Panic disorder – unexpected repeated panic attacks

  • May misinterpret panic as a sign of medical emergency

  • Often accompanied by agoraphobia

Explanations

• Malfunctioning brain circuit (amygdala and locus coeruleus leading to increased release of norepinephrine).

• 21% of Canadians over 15 years old have suffered from a panic attack at some point

Obsessive-Compulsive Disorder

• *We misuse this term a lot!

• Obsessions - persistent unwanted thoughts

  • Wishes, impulses, doubts, or images

  • Example:  concern germs, exactness/order

• Compulsions - repetitive, rigid behaviours or mental acts

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

  • Example: excessive washing, repeating rituals (up/down), checking doors

Explanations for OCD

Neuroscience

• Increased amygdala (fear and anxiety components).

• Overactive basal ganglia (repetitive, automatic behaviors).

• Low serotonin activity (anti-depressants seem to alleviate OCD).

Cognitive-behavioural

• Learn that compulsive behaviour relieves distress (through chance).

• Compulsions reinforced through negative reinforcement (removal of aversive obsessions).

Schizophrenia

• If depression is the common cold, schizophrenia is cancer.

• A dreaded affliction affecting about 1% of population; 24 million worldwide (often strikes in early adulthood).

• Schizophrenia means split mind.

• Not split personality but split from reality (psychosis)

• Defined as a serious psychological disorder characterized by disorganized thinking (delusions) and speech, disturbed perceptions (hallucinations), and inappropriate emotions and actions (psychomotor symptoms).

Schizophrenia - Disorganized Thinking and Speech  

• Speech may make no apparent sense.  Is often fragmented, unordered, and bizarre (loose association or derailment).

• This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Mary Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.”

Schizophrenia - Disorganized Thinking

• Thinking may involve delusions: False beliefs of grandeur think they are someone of great importance (e.g., president of United States).

• Often paranoid, delusions center on being persecuted.

  • Someone is out to get them (like CIA) may think others can read their thoughts.

• Often complex networks of ideas

  • Elaborate story of how they came to be sought after by the CIA.

Schizophrenia - Disturbed Perceptions

Hallucinations: A sensory experience (perception) in the absence of a sensory stimulus.

• Hearing voices (one or more) most common form

• Voices may harass the person (you’re no good) or may give instructions (that may be followed)… You have to eat it, or the cat will die!

• Seeing things or people (less common)…

 

• Imagine trying to work or function normally hearing voices all day…

 

 

Schizophrenia - John Nash

• A Beautiful Mind

• Professor

• Schizophrenia: Delusions (elaborate paranoid plot) and hallucinations (auditory)

• Awarded a Nobel Prize in Economics (1994)

Schizophrenia - Inappropriate Emotion

• Emotion is split from reality.

• May express emotion inappropriately

• Or, have no emotion (blunted or flat affect)

• Overall result of delusions, hallucination, and inappropriate behaviors results in social isolation… retreat into inner world (greater split from reality)

Schizophrenia - Psychomotor Symptoms

• Unusual or bizarre behaviors or postures

• Catatonic stupor: remain motionless for prolonged periods of time (sometimes bizarre postures)

• Lack of motivation (Avolition)

Schizophrenia - Positive and Negative Symptoms

Psychologists divide symptoms into two categories:

• Positive Symptoms:  Things that are abnormally present:  hallucinations, delusions, bizarre behaviors (emotions and postures).

• Negative Symptoms:  Things that are abnormally absent:   flat emotion, inability to concentrate, poor memory and problem solving,  no care for body (washing, grooming).

 

Schizophrenia - DSM-5 Diagnosis

Two of following five symptoms are required AND at least one symptom must be one of the first three (delusions, hallucinations, disorganized speech):

• Delusions

• Hallucinations

• Disorganized speech

• Disorganized or catatonic behavior

• Negative symptoms

Explanations for Schizophrenia - Genetic Factors (appears strong)

• Overall odds of developing schizophrenia are about 1 in 100

• If a parent or sibling has it, odds go up to 1 in 8

• If an identical twin is diagnosed, odds are 1 in 2 the other will be (reared together or apart).

• Identical Quintuplets, all have Schizophrenia, but to different degrees

Explanations for Schizophrenia - Diathesis-Stress Model

• Biological predisposition plus negative event (stress/trauma).

Explanations for Schizophrenia - Biological Correlates

• Excessive dopamine activity

• Enlarged ventricles, small temporal lobes and frontal lobes, structural abnormalities of the hippocampus, amygdala, and thalamus.

Understanding Schizophrenia - Brain Abnormalities

• Shrinkage of cortex (more shrinkage, worse symptoms).

• Enlargement of fluid filled ventricles.

Other Disorders - Somatic Symptom and Related Disorders

Excessive concerns about physical (somatic) health

• Somatic Symptom Disorder

  • Excessive concern (distress) over physical symptoms.

• Illness Anxiety Disorder

  • Preoccupied with having an illness despite no physical symptoms.

• Conversion Disorder

  • Person develops symptoms suggestive of neurological damage, despite medical tests indicating no abnormalities (e.g., paralysis, blindness, twitching).

  • Rare: 5 in 1000 people (onset with stress)

Other Disorders - Factitious Disorder

• Person takes on physical or psychological symptoms to adopt a patient role.

• May fake or actually harm themselves.

• Factitious Disorder imposed on another: Sometimes one person imposes illness on another (e.g., child)… also called Munchausen by proxy.

Dissociative Disorders

Major disruptions in memory or consciousness (very rare, common in movies).

• 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 (once called multiple personality disorder).

Dissociative Identity Disorder

“Three Faces of Eve” (movie trailer). During 40 years of psychotherapy Chris grappled with numerous personalities who existed in groups of three. The total number included seven artists, 10 poets and a talented seamstress.

Dissociative Disorders - Explanations

• Psychodynamic theorists - repression

• Early Stress - Childhood abuse

• Neuroscience - smaller hippocampus and amygdala, changes in the level of activity in the sensory cortex