PSYC 102 Textbook (Ch 13, 14)

Ch 13, 14

psychological disorder

syndromes & symptoms

Syndromes = cluster of physical or mental symptoms that are typical of a particular psychological disorder and tend to occur simultaneously

Symptom = physical or mental feature that may be regarded as an indication of a particular condition or psychological disorder

psychopathology

scientific study of psychological disorders or to the disorders themselves

abnormal psychology & clinical psychology

Abnormal psychology: Seeks to characterize the nature and origins of psychological disorders

Clinical psychology: Assessment & treatment of psychological disorders

DSM-5-TR’s qualifications for a psychological disorder (3)

Syndrome must:

• not be an expectable response to common stressors & losses (e.g. loss of loved one)

• not be a culturally approved response to a particular event (e.g. trance states in religious rituals)

• not be a simple deviance from social norms

point prevalence & lifetime prevalence

Point prevalence: percentage of people in a given population who have a given psychological disorder at a particular point in time

Lifetime prevalence: percentage of people in a certain population who will have a given psychological disorder at any point in their lives

D) symptom

Because what Jibril is experiencing is not unexpected given his mom’s cancer, it would not necessarily be considered indicative of a psychological disorder. In addition, Jibril must exhibit additional symptoms before he can be diagnosed with a psychological disorder

clinical assessment & clinical interview

Clinical assessment: procedure for gathering the information that is needed to evaluate a client’s psychological functioning and to determine whether a diagnosis is warranted

Clinical interview: interview where clinician asks the client to describe their problems & concerns

what do clinicians look for in clinical interviews

• pay attention to what clients say are concerns

• look for behaviours that may hint at difficulties that clients are not reporting

• identify discrepencies between what they observe and problems that clients report

self-report measures

standardized clinical assessment tool that consists of a fixed set of questions that the client answers

projective tests

form of clinical assessment where person responds to unstructured or ambiguous stimuli (typically, pictures)

B)

The questions that the psychologist is asking are typical of a clinical interview.

Psychological disorders are defined in 2 major closely related classification schemes. name them

1. International classification of diseases (ICD-11): used to classify the diseases and heath problems recorded in health records and death certificates

2. DSM: used as standard guide in USA and Canada; guides most research on psychological disorders

culture specific disorders

Dhat syndrome - South Asia - severe anxiety about the discharge of semen

Shenjing shuairuo - China - characterized by fatigue, dizziness, and headaches

Ataque de nervios - Latino - feeling out of control, including anxiety, anger, or aggression

DSM-5-TR disorders

• neurodevelopment disorders

  • autism spectrum disorder

• schizophrenia spectrum & other psychotic disorders

  • schizophrenia

• bipolar & related disorders

  • biopolar I disorder

• depressive disorders

  • major depressive disorder

• anxiety disorders

  • social anxiety disorder

• obsessive-compulsive & related disorders

  • OCD

• trauma and stress related disorders

  • PTSD

• dissociative disorders

  • dissociative identity disorder

• somatic symptom & related

  • functional neurological symptom disorder (conversion disorder)

• feeding & eating disorder

  • anorexia nervosa

• elimination disorders

  • enuresis (bed wetting)

• sleep wake disorders

  • insomnia

• sexual dysfunctions

  • erectile disorder

• gender dysphoria

  • gender dysphoria

• disruptive, impulse control and conduct disorders

  • conduct disorder

• substance-related and addictive disorder

  • substance use disorder

• neurocognitive disorders

  • delirium

• personality disorder

  • borderline personality disorder

• paraphilic disorders

  • exhibitionist disorder

C)

The DSM-5-TR includes an appendix listing disorders that seem to appear only in some cultures.

diagnostic labels benefits & drawbacks

PROS:

• improves treatment of psychological disorders (ensures appropriate treatment for patients)

• create uniform framework for health care providers

• facilitate research on psychological disorders

CONS:

• stigma attached to psychological disorders

ways that psychologists combat negative stereotypes about psychological disorders

• be thoughtful with how we refer to people diagnosed with them

  • some individuals prefer person-first language (referring to as a “person diagnosed with autism”) whereas some prefer identity-first language (referring as “an autistic person”)

B)

One important benefit of diagnostic labels is improved treatment of psychological disorders. Having specific labels for different disorders helps to ensure that clients get the appropriate treatment.

factors of developing psychological disorders

• early life experience

Diathesis-stress model

disorder results when an individual has both a risk factor AND a high level of stress

learned helplessness

hopeless and passive acceptance of events as beyond an individual’s control

neuroticism

personality trait associated with heightened levels of negative affect

bipsychosocial (BPS) model

A)

Soroya likely inherited a genetic predisposition to mental illness from her mother (the diathesis) and has recently experienced a stressor (the hurricane and the loss of her apartment and belongings).

anxiety

feeling of intense worry, nervousness, or unease

sort the psychological disorders from order of MOST common to LEAST

<dissociative spectrum, anxiety spectrum, schizophrenia>

anxiety spectrum, schizophrenia, dissociative spectrum

2 common types of anxiety related disorders

• specific phobias

  • marked fear of particular objects or situations (e.g. snakes, bridges, lightning, etc.)

• social anxiety disorder

  • intense fear of being watched, evaluated, and judged by others

are women or men more likely to have specific phobias?

• women are more likely to have specific phobias

• women are more likely to have animal phobia

• men & women equally likely to have a mutilation phobia

are men or women more likely to have social anxiety disorder?

all genders are equally affected by social anxiety disorder

when does social anxiety disorder emerge and puts individuals at risk for what?

• childhood or adolescence

• place at elevated risk for depression

panic disorder & panic attacks

Panic disorder - common type of anxiety-related disorder, characterized by occurrence of unexpected panic attacks

• out of the blue, no trigger

Panic attacks - sudden episodes of uncontrollable fear or anxiety accompanied by physical symptoms (heavy breathing, choking, dizziness, tingling hands and feet, sweating, heart palpitations, chest pain)

• people with specific phobias (e.g. fear of snakes) can experience panic attacks upon seeing the phobia stimulus

are men or women more likely to have panic disorders

women are more likely to have panic disorders than men

agoraphobia

fear of being in situations in which help might not be available or escape might be difficult or embarrassing

often accompanies panic disorders

D)

Because Samira’s panic symptoms have no clear trigger, they are of the type associated with panic disorder. Furthermore, they have led to agoraphobia.

generalized anxiety disorder (GAD)

excessive anxiety that isn’t related to any one specific object or situation (unlike specific phobias), and it related to a number of different events or activities

it is continuous, pervasive, and very difficult to control

relatively common

more common in women than men

symptoms (most common to least): unable to relax, difficulty concentrating, tense, frightened, fear of losing control, jumpy, unable to control thoughts, confused, weakness, terrified, hands sweating, heart racing, wobbly, speech blocked, sweating all over, fear of dying, difficulty breathing, hands tremble, nausea, diarrhea, feel like choking, fainting

bodily symptoms: muscle tension, excessive sweating, racing heart, difficulty breathing, diarrhea

pervasive worrying

type of avoidance behaviour

unlike avoidance responses associated with other anxiety disorders, which are behavioural, worry may be a cognitive form of avoidance (where one limits emotional reactivity by jumping from one worry to the next)

B)

This defines the key difference between GAD and other anxiety disorders: It involves worrying about multiple things versus fixating on just one thing.

Obsessive-compulsive disorder (OCD)

Definition: anxiety disorder that manifest itself through obsessions and/or compulsions

Obsessions = unwanted and disturbing thoughts

Compulsions - ritualistic actions performed to control the obsessions (e.g. counting to 100 before walking out the door)

affects genders equally

if untreated, can worsen over time and accompanied by recurrent bouts of depression

emerges early in life

A)

This is a disturbing and unwanted thought and so would be considered an obsession.

comorbidity

occurrence of 2 or more disorders in a single individual at a given point in time

what are 2 types of risk factors that are suggested by the high rate of comorbidity

• General risk factors: make someone vulnerable to more than one of these disorders

• Specific risk factors: make someone vulnerable to one of the disorders but not the others

concordance rate

probability that a person with a particular familial relationship to a patient (e.g. identical twin) has the same disorder as the patient

biological risk factors for behavioural disorders

• genetics

• differences in brain regions

vicarious learning

learning from others’ experiences

C)

Many phobias result from a frightening experience with the feared stimulus.

trauma- and stressor-related disorders

Definition: psychological disorders triggered by events that involve actual or threatened death, serious injury, or sexual violation

women are more likely to experience than men (due to women’s greater exposure to interpersonal violence like sexual assault)

dissociation & intrusive symptoms & arousal symptoms & avoidance symptoms (from trauma- or stress-related disorder)

• Dissociation: period of numbness immediately after the trauma - sufferer feels wholly alienated, socially unresponsive, and oddly unaffected by the event

• Intrusive symptoms: after dissociation - recurrent nightmares, flashbacks of the traumatic event

• Arousal symptoms: show that they are maintaining a high state of readiness to guard against harm - e.g. sleep disturbance, agitation, restlessness, pervasive hypervigilance

• Avoidance symptoms: avoid thoughts, activities, people, objects, or locations that related to the traumatic event

acute stress disorder & post-traumatic stress disorder (PTSD)

Acute stress disorder: trauma- or stressor-related disorder that lasts less than one month

PTSD: if symptoms in response to traumatic event persists for one month or more

• women are more likely to develop PTSD than men

T or F: traumatic event always leads to PTSD

False

how do certain individuals with jobs like paramedics, cops, etc. who witness horrific scenes not develop PTSD?

individuals who have high levels of confidence, strong sense of control over situations, and lower feelings of alienation from others at work cope best with traumatic events at work

mood-related disorders (aka affective disorders)

disorders that involve prominent disturbances in a person’s positive and negative feeling states

one common mood-related disorder: major depressive disorder (aka depression)

mood disorder characterized by feelings of sadness or emptiness, as well as anhedonia (= diminished interest in things that usually provide pleasure)

most common in adolescence through middle adulthood, but can also emerge in children and older adults

how does DSM-5-TR suggest diagnosis of depression

only when client experiences depressed mood and/or markedly diminished interest most of the day, nearly every day, for AT LEAST two weeks. . . along with other symptoms, such as significant weight gain or loss, changes in sleep (more or less sleep than usual), feeling restless or slowed down, excessive fatigue, worthlessness, difficulty thinking, recurrent suicidal thoughts → to qualify as depression, symptoms must cause clinically significant distress or impairment

why might women experience more depression (more likely to have major depressive disorder) than men?

women use maladaptive forms of rumination more

rumination = receptively turning emotional difficulties over and over in the mind

gender gap does not emerge until early teenage years for the difference in depression

psychotic delusions

a symptom of major depressive disorder

= unshakable false beliefs

A)

These are all symptoms of depression that have lasted over two weeks and thus indicate a major depressive disorder.

bipolar disorder (formerly called manic-depressive illness)

characterized by manic (excited & energetic) episodes, often in addition to depressive episodes, with normal periods in between

recurrent, not limited to adults (children can also)

episodes may be as short as a few hours or long as several months, and do not need to alternate

depression and mania are NOT mutually exclusive → can occur simultaneously (= mixed states)

hypomania & acute mania

Hypomania: mild level of mania; marked by high spirits, happiness, self-confidence and high level of nervous energy

can develop into mania

Acute mania: feelings of invincibility are replaced by terror as person loses grip on reality, may burst into song, smash furniture, exercise endlessly, rarely sleep, engage in reckless sexual escapades, gamble all their money away

D)

Mania is a step beyond hypomania; while people who suffer from hypomania are likely to feel high energy and excitement, only those who suffer from mania experience feelings of invincibility and a lack of inhibitions.

hypomania → mania → acute mania

who is most at risk for death by suicide in Canada

men, people facing federal prison sentences, Indigenous people

but men are not more likely to die by suicide than women in china and Indonesia

who is most at risk for attempting suicide in Canada

young, unmarried, unemployed women

women are more likely to attempt suicide than men, but when attempt suicide, men are more likely to die (women use methods that offer chance of rescue like swallowing sleeping pills, while men use irreversible methods like shooting themselves)

the risk of suicide is greater among those with _______ than any other psychiatric disorder, even major depressive disorder

bipolar disorder

what neurotransmitter contributes to heightened impulsivity that increases suicide risk

serotonin; people who die by suicide have low levels of neurotransmitter serotonin

neurotransmitters involved in mood-related disorders

• norepinephrine

• dopamine

• serotonin

negative cognitive schema

mental framework where person consistently interprets events negatively

biological, psychological, and social risk factors for mood disorders

Biological:

• genetics

• neurotransmitter excess or shortage

Psychological:

• how a person thinks (e.g negative cognitive schemas)

• explanatory style (how a person explains why bad things happen to them)

Social:

• interpersonal stress

  • e.g. losing a parent as a child increases interpersonal stress

• having a depressed & non responsive caretaker as an infant

• experiencing racism & racial discrimination

major depressive disorder is more common among what economic group

low SES groups → perhaps because they experience more stress

post-partum depression is worse for women who ___________

struggle with low self-esteem and have unrealistic expectations of motherhood

c)

Ayita’s internal (stupid), stable (will fail at being a biology major), and global (no one will want to date me) responses to failing her exam all fit a depressive explanatory style.

schizophrenia

psychological disorder characterized by loss of contact with reality and a breakdown of the normal functions within the mind, leading to bizarre perceptions

does not involve having multiple personalties (which is a feature of dissociative identity disorder)

not common

typically diagnosed in late adolescence or early adulthood

begins earlier in men than women

Symptoms: positive symptoms (thoughts or behaviour not evident in healthy people), delusions (false beliefs that are rigidly maintained despite contradictory evidence), negative symptoms (absence of behaviours usually seen in healthy people)

• positive symptoms:

  • hallucinations (sensory experiences in the absence of any sensory input) -→ hearing the voice of God or the devil

  • disorganized behaviour - unusual actions not seen in healthy individuals → e.g. wearing layers of warm clothing on a hot day

• common delusions:

  • grandiosity → clients believe that they are greatly important, perhaps like a special messenger from God or a prime minister

  • persecution → convinced they are being singled out for punishment or death

  • delusions of reference → convinced a neutral environmental event is somehow directed at them

• negative symptoms:

  • flattening or cessation of behavioural response → e.g. express little emotion, say relatively little

    • catatonic behaviour → standing or sitting frozen for hours on end, sometimes in unusual postures

  • anhedonia → loss of interest in activities expected to be pleasurable

  • withdrawal from other people

A)

One negative symptom of schizophrenia is limited behavioural responses, including speech.

dopamine hypothesis

schizophrenia is associated with abnormally high levels of activity in brain circuits that are sensitive to the neurotransmitter, dopamine

BUT. . . turns out rather than high dopamine, it’s likely because of dopamine imbalances

evidence for dopamine hypothesis

effects of a number of drugs known as classical antipsychotics - drugs that block dopamine receptor

as the dopamine hypothesis predicts, these drugs relieve many schizophrenia associated symptoms

also, people who don’t have schizophrenia but have taken overdoses of amphetamines (= stimulants whose effects include enhancement of dopamine activity) → when taken in large enough doses, the drugs induce a temporary psychosis similar to schizophrenia

structural abnormalities and neurotransmitter abnomalities related to schizophrenia

neurotransmitter:

• excessive dopamine stimulation in limbic circuits

• insufficient dopamine stimulation in cortical circuits

• dysfunction in glutamate transmission in brains

structural:

• enlarged ventricles

• loss of grey matter in prefrontal brain regions

• abnormalities in frontal & temporal lobes

A) abnormalities in dopamine stimulation

Both excessive dopamine stimulation and insufficient dopamine stimulation have been observed in people with schizophrenia.

schizophrenia causes

genetic, prenatal, and psychological risk factors

genetic

prenatal:

• prenatal exposure to influenza

• maternal malnutrition

• birth complications (e.g. diminished oxygen supply to newborn)

psychological:

• low SES

neurodevelopmental disorder

disorder that stems from early brain abnormalities

• various risk factors suggest schizophrenia is a neurodvelopmental disorder

D)

A mother’s malnutrition when pregnant has been found to increase risk for schizophrenia and is not a genetic diathesis.

not criminally responsible on account of mental disorder (NCRMD)

B)

Svetlana’s symptoms pose a danger to her daughter. Seeking a 72-hour hold in a psychiatric department of a hospital for her is likely the best option.

not A) since Svetlana is unwilling to see a doctor, she is also probably going to be unwilling to agree to hospitalization and may need an involuntary 72-hour hold or longer, depending on the physician’s assessment.

not C) since Svetlana has not been charged with a crime; thus, a not criminally responsible on account of mental disorder is not relevant.

autism spectrum disorder

Developmental problems:

• persistent deficits in social communication and interaction

  • struggle to understand how to interact socially

  • deficit in motivation to socially engage with others

  • impairment of Theory of Mind

• restricted or repetitive patterns of interest or behaviour

boys are more likely to have it than girls

D)

People with autism often have a favorite interest to which they devote an unusual amount of time.

Attention deficit hyperactivity disorder (ADHD)

most common psychological disorder in childhood

boys are more likely to have than girls

can persist into adulthood

Symptoms: impulsive, interrupting conversions, fidget, tap pencils, etc.

difficulty shifting their attention to where it needs to be (rather than focusing in itself)

Treatment: stimulant methylphenidate - enhances dopamine & norepinephrine release

B)

The recent increase in ADHD diagnoses has added to the controversy surrounding its legitimacy.

Dissociative identity disorder (DID) (formerly known as multiple personality disorder)

presence of two or more identities, or distinct personality states within a single person, even with its own style, habits, beliefs, and memories

identifies often differ in interests, their age, sexual orientation, and even morals

interidentity amnesia

led to by the partitioning of memory in each of the identities of DID

B) whether it’s caused by trauma or therapist’s suggestion

There is significant controversy as to the primary cause of DID, as indicated by the distinct causal mechanisms proposed by the post-traumatic and sociocognitive models.

personality disorder (3 criteria)

personality disorders recognized by DSM-5-TR

Cluster A: Odd or eccentric behaviour

• Paranoid - widespread suspiciousness and mistrust of others

• Schizoid - striking detachment from others

• Schizotypal - discomfort with close relationships, cognitive or perceptual distortions, and odd behaviour

Cluster B: Dramatic or emotional behaviour

• Antisocial - consistent disregard and violation of others’ rights

• Borderline - impulsive behaviour & marked instability in relationships, self concept, and affect

• Histrionic - unusual degree of attention seeking and emotionality

• Narcissistic - grandiosity, lack of empathy, need for attention and admiration from others

Cluster C: Anxious or fearful behaviour

• Avoidant - social inhibition & insecurity

• Dependent - excessive need to be taken care of by others

• Obsessive-compulsive - preoccupation with orderliness, perfection, and control

why are personality disorders difficult to diagnose

• client traits are likely to only approximate the prototype, and many clients have traits that are characteristic of more than one of the prototypes

• personality disorders are often comorbid

• can be thought of as merely the extreme of some ordinary pattern

  • e.g. many people are vain, and it is therefore a judgement call whether their vanity is so powerful that it signals narcissism

is antisocial personality disorder more common in men or women

men

what makes people with antisocial personality disorder behave as they do?

they profoundly lack empathy for the suffering of others → genetic & environmental factors

A)

Julio’s odd and eccentric words and behaviours fit the description for Cluster A personality disorders.

trephination

early therapy for mental disorders that involved cutting a hole in the skull, so that demons could be driven out through this “exit”

early treatment methods for psychological disorders

• centrifugal-force bed

• crib for violent patients

• swinging device

• trephination (hole drilling)

general paresis

disorder characterized by broad decline in physical & psychological functioning, culminating in marked personality abnormalities that include delusions concerning one’s own importance or imminent demise → could lead to paralysis without treatment

Important figures in early treatment of psychological disorders: what did they do?

Freud, Dix, Pinel, Kraft-Ebing

• Freud: popularized & innovated use talk therapy as psychological treatment

• Dix: better treatment for those with psychological disorders, leading to expansion of government supported institutions

• Pinel: Lobbied to remove shackles from patients in psychiatric hospitals and given them fresh air and exercise

• Kraft-Ebing: discovered biological bases for some psychological syndromes

who can offer psychological therapies

clinical psychologists, psychiatrists, psychiatric nurses, marriage, family, and child counsellors, school counsellors, mental health counsellors

*some “therapists” practice without a license because titles like “therapist” or “counsellor” are not protected in most jurisdictions

are professional credentials or years of experience good predictors of person’s success in providing psychological therapy

no; findings suggest that who the therapists are, what they do, and how well therapies match clients’ needs may be more important