Chapter 15: Psychological Disorders

abnormal psychology

the scientific study of psychological disorders

medical model

approach to understanding and treating mental illness has been a major influence on our thinking and practices in assisting those struggling with mental illness over the past century

Psychological Abnormality

“the four Ds”: deviance, distress, dysfunction, and danger.

Deviance

Behaviour, thoughts, and emotions are considered abnormal when they deviate from a society’s ideas about proper functioning

Distress

To be considered abnormal, behaviours, ideas, or emotions usually must also cause distress or unhappiness

Dysfunction

Abnormal behaviour also tends to interfere with daily functioning, as opposed to behaviour that is simply eccentric but a part of a person’s life

Danger

Some people with psychological dysfunction are more likely to become dangerous to themselves but are less likely to harm others

Eccentrics

a person who deviates from common behaviour patterns or displays odd or whimsical behaviour

International Classification of Diseases (ICD)

the system used by most countries to classify psychological disorders; published by the World Health Organization and currently in its 11th edition

Diagnostic and Statistical Manual of Mental Disorders (DSM)

the leading classification system for psychological disorders in Canada; DSM-5 is the current version

diagnosis

a clinician’s determination that a person’s cluster of symptoms represents a particular disorder

comorbidity

the condition in which a person’s symptoms qualify him or her for two or more diagnoses

Neurodevelopmental disorders

Disorders with their onset in the developmental period before the child enters grade school; usually involve impairments in personal, social, or academic functioning

Neurocognitive disorders

Disorders where the primary clinical deficit is cognitive function. The deficit is acquired in that it reflects a decrease from a previous state of functioning, as in the case of Alzheimer’s disease

Substance-related and addictive disorders

Disorders that involve the activation of reward pathways and reward systems due to substance use or induced by substances; also includes gambling disorder

Schizophrenia-spectrum and other psychotic disorders

Disorders defined by abnormalities in the form of delusions, disordered thoughts or behaviours, or negative symptoms such as avolition (lack of motivation) or loss of communication ability

Depressive disorders

The presence of sad, empty, or irritable mood that typically goes along with physical or cognitive changes

Bipolar and related disorders

Alternating bouts of intense positive affect that are followed or preceded by prolonged periods of sadness and other symptoms of depression; seen as a bridge between depressive disorders and disorders representing the schizophrenia spectrum

Anxiety disorders

Disorders that share features of excessive fear or anxiety and related behavioural disturbances

Obsessive-compulsive disorder (OCD)

a mental disorder associated with repeated, abnormal, anxiety-provoking thoughts and/or repeated rigid behaviours

Trauma and stressor-related disorders

Disorders that reflect exposure to a distressing event or events

Somatic symptoms and related disorders

Disorders with prominent somatic symptoms associated with impairment and distress

Dissociative disorders

Disruption or discontinuity in the typical integration of consciousness, perception, memory, emotion, identity, or body representation

Feeding and eating disorders

Disturbance in eating or eating-related behaviour that impairs physical health and/or psychosocial functioning

Sexual dysfunctions

Disorders with great heterogeneity that usually involve a clinically significant disturbance in the ability to respond sexually or experience sexual pleasure

Gender dysphoria

Persistent distress due to the discrepancy between one’s expressed or experienced gender versus the initially assigned gender

Paraphilic disorders

Disorders that reflect intense and persistent sexual interest other than the stimulation found in normal physically mature and consenting human partners

Sleep-wake disorders

Disorders involving dissatisfaction in the quality, timing, and/or amount of sleep

Disruptive, impulse control, and conduct disorders

Under-controlled behaviours that violate the rights of others and/or bring the person into serious conflict with societal norms or authority figures

Personality disorders

Pervasive and inflexible behavioural patterns that deviate markedly with societal expectations. These disorders often involve a lack of insight about how personal actions cause distress in others

Neuroscience Approaches

Structural or biochemical malfunctions in the brain

Psychodynamic Approaches

Unconscious conflicts often rooted in childhood

Cognitive-Behavioural Approaches

Abnormal behaviours acquired through a tightly interwoven mix of conditioning, modelling, and cognitive principles

Humanistic and Existential Approaches

Distorted views of self that prevent personal growth or decision making

Socio-cultural Approaches

Societal, cultural, social, and family pressures or conflicts

Developmental Psychopathology Approach

Early risk factors combined with poor resilience throughout life stages

causes problems with brain anatomy and chemical functioning

genetics and viral infections

reductionist perspectives

attempt to reduce complex phenomenon to a single cause

biopsychosocial perspective

The biological component involves a focus on genetic and epigenetic factors as well as biochemical influences and differences in brain structure and function.

The psychological component includes interpersonal interactions, personality variables, cognitive and learning histories and development, attitudes, and ability to cope.

The social component considers socialization experiences, cultural and social interactions and variables, and life experiences.

diathesis-stress model

The notion that disorders arise from an interaction of internal and external causes

suggests that a person may inherit a genetic predisposition (a diathesis) for a disorder, but that it will remain undeveloped unless triggered by an external (stressful) life event

negative valence systems

Acute threat (“fear”)
Potential threat (“anxiety”)
Sustained threat
Loss
Frustrated non-reward

Positive Valence Systems

Approach motivation
Initial responsiveness to reward
Sustained response to reward
Reward learning

Cognitive Systems

Attention
Perception
Working memory
Declarative memory
Language behavior
Cognitive (effortful) control

Systems for Social Processes

Affiliation/attachment
Social communication
Perception/understanding of self
Perception/understanding of others

Arousal/Modulatory Systems

Arousal
Biological rhythms
Sleep-wake

Cognitive-Behavioural Model

such behaviours and thinking processes interact with and mutually influence each other: people use their particular ways of thinking to explain their behaviours and the events in their lives, behaviours may lead to particular thoughts, various cognitions may trigger certain behaviours

The Behavioural Perspective

how the environment changes a person’s behaviours

classical conditioning

when a previously neutral object becomes paired with an unconditioned stimulus that creates fear

operant conditioning

processes of reward and punishment are abnormal ones

Modelling

we learn by observing others, can also lead to abnormality

illogical thinking processes

processes that turn out to be very common in depression and anxiety disorders

Selective perception
Magnification
Overgeneralization

Selective perception

seeing 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

thought

a key factor in both normal and abnormal behaviour

object relations

believes people are motivated primarily by a need to establish relationships with others, known as objects

The Socio-Cultural Model

The unique characteristics of a given society may create special stresses that heighten the likelihood of abnormal functioning in its members.

family systems theory

a theory holding that each family has its own implicit rules, relationship structure, and communication patterns that shape the behaviour of the individual members

developmental psychopathology

the study of 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 at the same outcome

multifinality

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

conduct disorder

a disorder of childhood and adolescence characterized by repeated violations of others’ rights, displays of aggression, and destructive behaviour

resilience

the ability to recover from or avoid the serious effects of negative circumstances

two primary types of mood disorder

unipolar mood disorder, also called depression, and bipolar disorder, where people move between one extreme mood state to another

depression

a persistent sad state in which life seems dark and its challenges overwhelming

mania

a persistent state of euphoria or frenzied energy

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

a mood disorder in which periods of mania alternate with periods of depression

Major Depressive Episode

A. Five (or more) of the following 9 symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or to another medical condition.

(1) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful) Note: In children and adolescents, can be irritable mood.

(2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day Note: In children this may be a failure to make expected weight gains.

(4) Insomnia or hypersomnia nearly every day

(5) Psychomotor agitation or retardation nearly every day (observable by others)

(6) Fatigue or loss of energy nearly every day

(7) Feelings of worthlessness or excessive or inappropriate guilt nearly every day

(8) Diminished ability to think or concentrate, or indecisiveness, nearly every day

(9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

biological factors that influence major depressive disorder

low activity of norepinephrine and serotonin

learned helplessness

(1) that they no longer have control over the rewards and punishments in their lives, and
(2) that they themselves are responsible for this helpless state

attribution-helplessness theory

when people view events to be beyond their control, they ask themselves why this is so
If they attribute their present lack of control to some internal cause (some deficiency in themselves) that is both global (a deficiency that is wide-ranging) and stable (a deficiency that will continue for a long time), they may well feel helpless to prevent future negative outcomes and they may experience depression. If they make other kinds of attributions, this depressed reaction is unlikely.

negative thinking

dysfunctional attitudes, errors in thinking, the cognitive triad, and automatic thoughts as the keys to the clinical syndrome

cognitive triad

a pattern of thinking in which individuals repeatedly interpret their experiences, themselves, and their futures in negative ways that lead them to feel depressed

automatic thoughts

specific upsetting thoughts that arise unbidden

anxiety disorder

Some people suffer such disabling levels of fear and anxiety that they cannot lead a normal life (see photo). Their discomfort is too severe or too frequent; it lasts too long; or it is triggered too easily.

generalized anxiety disorder (GAD)

an anxiety disorder in which people feel excessive anxiety and worry under most circumstances

social anxiety disorder

an anxiety disorder in which people feel severe, persistent, and irrational fears of social or performance situations in which embarrassment may occur

phobias

persistent and irrational fear of a specific object, activity, or situation

panic disorder

an anxiety disorder characterized by recurrent and unpredictable panic attacks that occur without apparent provocation

obsessive-compulsive disorder

feel overrun by recurrent thoughts that cause anxiety or by the need to perform repetitive actions to reduce anxiety

posttraumatic stress disorder (PTSD)

an anxiety disorder in which fear and related symptoms continue to be experienced long after a traumatic event.

dysfunctional assumptions

people with GAD constantly hold silent assumptions that imply they are in imminent danger

intolerance of uncertainty theory

certain individuals consider it unacceptable that negative events may occur, even if the possibility of occurrence is very small

feedback system

brain and body activities that reduce the level of excitability

brain circuits

networks of brain structures that work together, triggering each other into action with the help of neurotransmitters and producing particular kinds of emotional reactions

circuit that produces anxiety reactions

prefrontal cortex, anterior cingulate, and amygdala

Avoidance behaviour

talking only to familiar persons at meetings or parties

Safety behaviour

holding on to a podium during a classroom presentation so that their hands don’t tremble, or wearing makeup to cover blushing

panic attacks

periodic, short bouts of panic

agoraphobia

a phobia that makes people avoid public places or situations in which escape might be difficult or help unavailable should panic symptoms develop

obsessions

persistent thoughts, ideas, impulses, or images that seem to invade a person’s consciousness

compulsions

irrational repetitive and rigid behaviours or mental acts that people feel compelled to perform to prevent or reduce anxiety

obsessive wishes

repeated wishes that one’s spouse would die

obsessive impulses

repeated urges to yell out obscenities at work or at a place of worship

obsessive images

fleeting visions of forbidden sexual scenes

obsessive doubts

concerns that one has made or will make a wrong decision

acute stress disorder

an anxiety disorder in which fear and related symptoms are experienced soon after a traumatic event and last less than a month

schizophrenia

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