Psychological Disorders

psychological disorder

syndrome marked by a clinical significant disturbance in an individual’s cognition, emotion regulation, or behavior; often accompanied by distress

psychological disorders can be…

dysfunctional: breakdown or impairment in psychological processes, affecting thinking, emotion, or behavior

OR

maladaptive: actions that hinder a person’s ability to cope with challenges, meet goals, or adjust to their new environment, such as extreme avoidance, excessive rigidity, or self-harm

hospitals

replaced asylums in mental health movement

mental illnesses are diagnosed…

on the basis of symptoms, treated through therapy, and ideally cured

what contributes to all major disorders

genetically influenced brain structure and biochemical abnormalities (imbalanced in key brain chemicals, issues with energy production, genetic predispositions affecting brain chemistry, nutrient deficiencies, and errors in metabolism)

• interact with environmental factors to disrupt mood, cognition, and behavior, leading to psychological disorders

biopsychosocial approach

psychology studies of how biological, psychological, social-cultural, and spiritual factors interact to produce specific psychological disorders; vulnerability-stress model; epigenetics

vulnerability-stress model

explains mental illness as an interaction between a person’s inherent predisposition (vulnerability, often genetic or from early experiences) and life stressors, with coping skills determining if stress tips someone into illness or keeps them in wellness

epigenetics

studies how behaviors, environment (like diet, stress, toxins, and life experiences can turn genes “on” or “off” without changing the DNA sequence itself)

classifying disorders and labeling people

classification aims to predict a disorder’s future course, suggest appropriate treatment, and prompt research

• American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

• World Health Organization’s International Classification of Diseases (ICD)

• US National Institute of Mental Health’s Research Domain Criteria (RDoC)

DSM-5 changes

• autism and Asperger’s syndrome (difficulties with social interaction; communication through body language and eye contact; and repetitive behaviors or intense, narrow interests, but typically with normal language and cognitive development) = autism spectrum disorder (ASD)

• mental retardation = intellectual disability

• hoarding disorder and binge-eating disorder added

DSM-5 criticisms

• wider net pathologizes everyday life; too broad

• subjective diagnostic labels (the personal, often negative, self-perceptions or societal labels individuals apply to themselves or that others project onto them)

• biasing power of labels (stems from their ability to oversimplify, create stereotypes, and influence perception, leading to confirmation bias where people interpret information to fit the label)

risk of harm to self and others: understanding suicide

• suicide risk increases with anxiety and depression

• risk increases with rebound of these disorders

• social suggestions may trigger suicide

• suicide is often unpredictable

different group suicide rates reported by researchers:

national, racial, gender, traits, age & trends, other groups, year-by-year, gun ownership

how to help someone who is talking about suicide

• listen, empathize, and offer hope

• connect the person with campus counseling resources or crisis text lines

• protect someone at immediate risk by seeking help

people who engage in nonsuicidal self-injury (NSSI) may:

• find relief from intense negative thoughts through the distraction of pain

• attract attention and possibly get help

• relieve guilt by punishing themselves

• get others to change their negative behavior (bullying, criticism)

• fit in with a peer group

reported rates of psychological disorders: WHO study

cultures vary in 28 country studies

lowest rate = Nigeria

highest rate = USA

percentage of Americans reporting selected psychological disorders “in the past year”

• depressive disorders or bipolar disorder - 9.3%

• phobia of specific object or situation - 8.7%

• social anxiety disorder - 6.8%

• attention-deficit/hyperactivity disorder (ADHD) - 4.1%

• post-traumatic stress disorder (PTSD) - 3.5%

• generalized anxiety disorder - 3.1%

• schizophrenia - 1.1%

• obsessive-compulsive disorder (OCD) - 1.0%

what increases vulnerability to mental disorders

wide range of risks and protective factors exist for mental disorders'

• poverty, as a predictor of mental health, crosses ethnic and gender lines

• first symptoms are experienced by mid-teens to mid-twenties for majority of those studied

anxiety disorders

psychological disorders characterized by distressing, persistent anxiety, or maladaptive behaviors that reduce anxiety (avoidance, self-medication, compulsive actions, social withdrawal, procrastination, emotional numbing)

three anxiety disorders

generalized anxiety disorder - marked by persistent, excessive, and hard-to-control worry about everyday things, causing distress or interfering with daily life

panic disorders - defined by unexpected, repeated panic attacks—sudden urges of intense fear with severe physical symptoms and feelings of losing control or dying

specific phobias - an intense, irrational, and persistent fear of a particular object or situation that poses little to no actual danger

obsessive compulsive disorders (OCD)

characterized by unwanted repetitive thoughts (obsessions), actions (compulsions), or both that persistently interfere with everyday life

• hoarding - inability to discard possessions, leading to excessive accumulation of items that clutter living spaced and impair daily life

• trichotillomania - hair-pulling disorder where people compulsively pull our their own hair, leading to noticeable hair loss, bald spots, and distress

• body dysmorphic disorder - extreme preoccupation with self-perceived defects in appearance of the body, leading to distress

• excoriation disorder - repeated picking at one’s own skin which results in areas of swollen or broken skin causing disruption in one’s life

post-traumatic stress disorder (PTSD)

characterized by haunting memories, nightmares, hypervigilance (always on edge), avoidance of trauma-related stimuli, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia

lingers for four weeks or more after a traumatic experience - shorter = acute stress disorder (survivor resilience; post-traumatic growth)

why do some people develop PTSD, while others do not

appearing fine does not mean that they are

• amount of emotional distress

• individual difference in memory processing (people form memories differently and address thoughts/experiences differently/at differing times)

• systemic racism, sexism, and inequality

• sexual assault

• food insecurity

some psychologists believe PTSD has been overdiagnosed

normal stress-related events; debriefing procedures (a guided, reflective process after an event that involves discussing what happened, analyzing actions, and identifying lessons learned)

somatic symptoms of anxiety and related disorders

somatic symptom disorder: person interprets normal physical sensations as symptoms of a disease (experiences intense, excessive distress and anxiety about real physical symptoms, leading to life disruption even when medical tests are normal or symptoms are minor)

illness anxiety disorder: person interprets normal sensations as symptoms of dreaded disease (hypochondria; persistent, excessive fear or belief that one has or is developing a serious illness, despite medical reassurance and lack of evidence)

conditioning with anxiety-related disorders

classical conditioning (Pavlov); stimulus generalization (Watson’s Little Albert); reinforcement (operant conditioning: behaviors shaped by consequences or rewards)

cognition with anxiety-related disorders

thoughts and memories; interpretations and expectations

biology with anxiety-related disorders

gene variations are associated with typical anxiety disorder symptoms or specific disorders (ex: OCD); gene influence is found in regulating brain level of neurotransmitters: serotonin, glutamate (influence mood, memory, and excitation)

experience with anxiety-related disorders

epigenetic marks from trauma or abuse increase genetic vulnerability to certain disorders (ex: PTSD)

other causes of anxiety-related disorders

• the brain is changed by experiences

• traumatic, fear-learning experiences can leave tracks in the brain and create fear circuits

• natural selection shapes some behaviors that can interfere with daily life when taken to an extreme

activity in the brain with anxiety-related disorders

brain area for overarousal involves impulse control and habitual behaviors, especially in the anterior cingulate cortex (altered activity and connectivity involving hyperactivity or reduced function in regulating emotions and threats, links to fear center (amygdala), impacts cognitive control and intrusive thoughts)

when people were engaged in a challenging cognitive task, those with OCD showed the most activity in the anterior cingulate cortex in the brain’s frontal area

anxiety

response to threat of future loss

depression

response to past and current stress

major depressive disorder

• feelings of hopelessness and lethargy lasting several weeks or months

• DSM-5 classifies several major depressive disorders

• challenges regulating appetite, weight, sleep

• much less energy

• feeling worthless

• problems thinking and making decisions

depression is…

the leading cause of disability worldwide

• number one reason why mental health services are sought

• may have a seasonal pattern

bipolar disorder

formerly manic-depressive disorder

feelings that alternate between depression and overexcited hyperactivity (feel like they are bigger than life)

traits of bipolar disorder

• less common, but often more dysfunctional, than major depressive disorder; potent predictor of suicide

• no gender differences; increased diagnoses among adolescents

• DSM-5 classification reduced child and adolescent diagnoses; disruptive mood dysregulation disorder (childhood diagnosis for severe, persistent irritability and frequent, intense temper outbursts, often disproportionate to the situation)

• the higher the high, the lower the next low

creativity and risk for bipolar disorder

• clusters of genes associated with creativity increase the risk of developing bipolar disorder

• risk factors for developing bipolar disorder predict greater creativity

• celebs/artists with bipolar disorder create more/better work in manic episodes they claim

any theory of depression must explain why:

• behaviors and thoughts change with depression

• depression is widespread

• women’s risk of major depressive disorder is roughly double men’s risk (due to hormonal shifts in reproductive years, genetics, ruminate more, different coping styles, higher rates of abuse, economic stress, greater burden of home roles, societal pressure)

• most major depressive episodes end on their own

• work, marriage, and relationship stress often precede depression

• compared with past generations, depression strikes earlier and affects more people, with the highest rates among older teens and young adults

biological perspective with depression

genes and depression - heritability; linkage analysis

the depressed brain - brain activity slows; functional connectivity analyses; two neurotransmitter system (imbalances in serotonin and norepinephrin (mood, sleep, appetite and alertness, energy, focus)

nutritional effects - heart-healthy diet (reduces inflammation, stabilizes blood sugar, and provides NT building blocks, lowering depression risk)

image showing states of bipolar disorder

1st depressed state (May 17th) - little brain activity, some yellow

manic state (May 18th) - major brain activity, lots of yellow, orange, red

2nd depressed state (May 27th) - much less brain activity than first, practically no yellow

what lays down epigenetic marks/molecular genetic tags with depression (social-cognitive)

diet, drugs, stress, and other environmental influences can turn certain genes on or off through tags

social-cognitive perspective and depression

life is seen through a lens of low self-esteem that feeds depression

• self-defeating beliefs

• negative explanatory style (cognitive pattern of explaining negative events as being permanent, pervasive, and personal)

negative thoughts, negative moods, and gender related to depression

women are twice as vulnerable as men to depression

• rumination; overthinking

• explanatory style

• self-defeating beliefs and learned helplessness (state where someone feels powerless to change a negative situation after experiencing repeated uncontrollable stressors)

pessimistic explanatory style - state-dependent memory (recall phenomenon where you remember info better if your internal physical or emotional state is the same during retrieval as it was when you first learned it)

cultural forces (influence how symptoms are expressed (physical vs. emotional), interpreted (weakness vs. illness), stigmatized, and whether people seek treatment)

breakup with a romantic partner and depression

1. stable (I’ll never get over this) - global (without my partner, I can’t seem to do anything right) - internal (our breakup was all my fault) - depression

2. temporary (this is hard to take, but I will get through this) - specific (I miss my partner, but thankfully I have family and other friends) - external (it takes two to make a relationship work and it wasn’t meant to be) - successful coping

therapists recognize cycle and work to help depressed people break out of it

1) stressful experiences 2) negative explanatory style 3) depressed mood 4) cognitive and behavioral changes

• changing their negative thinking

• turning their attention outward (outside of the cycle)

• engaging them in more pleasant and competent behavior

schizophrenia

disorder characterized by delusions (set of beliefs not rooted in reality), hallucinations, disorganized speech (word salad), and/or diminished, inappropriate emotional expression

psychotic disorders

group of disorders marked by irrational ideas, distorted perceptions, and a loss of contact with reality

signs of schizophrenia

disturbed perceptions and beliefs (hallucinations; delusions (false beliefs))

disorganized speech

diminished and inappropriate emotions

• flat affect (reduced or absent outward display of emotion, despite potentially feeling emotions internally); impaired theory of mind (difficulty in understanding that others have their own distinct thoughts, beliefs, and intentions)

• inappropriate motor behavior; catatonia (abnormal motor, behavioral, and speech patterns (stupor, agitation, posturing, repetition)

onset and development

• chronic schizophrenia (persists of a long period, ongoing symptoms, diagnosed late teens - early 30s)

• acute schizophrenia (substance-induced, caused by trauma or trauma)

brain abnormalities with schizophrenia

• dopamine overactivity

• abnormally low brain activity in frontal lobe, thalamus, and amygdala

• abnormal brain anatomy in ventricles and cerebral tissue; smaller cortex, hippocampus, and corpus callosum; neural connection loss

prenatal environment and risk with schizophrenia

risk factors

• low birth weight; maternal diabetes; older paternal age; oxygen deprivation during delivery

midpregnancy virus infection and fetal brain development

• country-specific flu epidemic

• birth in densely populated areas

• birth in winter and spring months

• mother’s flu infection during pregnancy and fetal-virus infections

lifetime risk of developing schizophrenia varies…

with one’s genetic relatedness to someone having the disorder

across countries…

barely more than 1 in 10 fraternal twins, but 5 in 10 identical twins, share a schizophrenia diagnosis

schizophrenia caused by…

multiple genes (polygenic)

dissociative disorders

controversial, rare disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings; dissociative fugue state (person loses their sense of identity and personal history, accompanied by unexpected traveling or wandering, adopting a new identity as a coping mechanism for severe stress or trauma

dissociative identity disorder (DID)

two or more distinct identities, each with its own voice and mannerisms, seem to control the person’s behavior (formerly known as multiple personality disorder)

understanding dissociative identity disorder

first formal code for the disorder appeared in an earlier DSM edition; current criteria are in DSM-5

personality disorders tend to form three clusters

anxiety (ex: avoidant personality disorder - marked by extreme shyness, feelings of inadequacy, intense sensitivity to criticism, leading people to avoid social interaction, new activities, and close relationships)

eccentric or odd behaviors (ex: schizotypal personality disorder - marked by eccentric behaviors, odd beliefs, distorted thinking, and significant discomfort in social relationships, often involving paranoia or magical thinking without psychosis like schizophrenia)

dramatic or impulsive behaviors (ex: borderline personality disorder (extreme fear of being rejected), narcissistic personality disorder, antisocial (psychopath) personality disorder)

antisocial personality disorder

• sometimes just called sociopathy or psychopathy

• usually male; can display symptoms by age 8

• lower emotional intelligence

• impulsive behavior; feel and fear little

eating disorders

anorexia nervosa - 10-15% below weight; try to keep their weight as low as possible; restriction

bulimia nervosa - regular, often secretive bouts of overeating follow by self-induced purging (throwing up, taking laxatives, extreme exercise)

binge-eating disorder - eating a large amount of food in a short amount of time and you can’t control what or how much you are eating

understanding eating disorders

family environment and characteristics

heredity

cultural and gender components

peer effects

media influence