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\_________ Canadians experiences mental illness or problems

one in five

almost \____________ Canadians are currently living with mental health problems and illness

7 million

In a recent year, \___________ Canadians were admitted to hospital for suicide and self-injury attempts

17 000

\________ continuing to show higher hospitalization rates for self-injury

women

Canadians who judged their mental health as getting worse during the pandemic were more likely to \______________ to cope compared to those who did not report lower self-perceived mental health

use cannabis, tobacco, and alcohol

The medical model proposes that

it is useful to think of abnormal behaviour as a disease.

Historical conceptions of mental illness- In the Middle Ages and 18th century, people who behaved strangely were sometimes thought to be in league with

the devil or caused by demonic possession.

many psychological disorders are at least partly attributable to \_____________, making them appear more similar to physical illnesses, which carry far less stigma

genetic and biological factors

Diagnosis involves

distinguishing one illness from another.

Etiology refers to

the apparent causation and developmental history of an illness.

A prognosis is

a forecast about the probable course of an illness

criteria in making diagnoses

Deviance, Maladaptive behaviour, Personal distress

stereotypes of psychological disorders

Psychological disorders are incurable, People with psychological disorders are often violent and dangerous, People with psychological disorders behave in bizarre ways and are very different from normal people.

One major issue in the development of the DSM-5 was

whether to reduce the system's commitment to a categorical approach

theorists argue that the traditional categorical approach to diagnosis should be replaced by a dimensional approach because there is a lot of overlap in disorders.

dimensional approach

A dimensional approach would

describe disorders in terms of how people score on a limited number of continuous dimensions

One major alternative to the DSM was developed by

the World Health Organization (WHO classification system)

epidemiology

the study of the distribution of mental or physical disorders in a population.

In epidemiology, prevalence refers to

the percentage of a population that exhibits a disorder during a specified time period.

In North America, the most common types of psychological disorders are

substance (alcohol and drugs) use disorders, anxiety disorders, and depression.

Anxiety disorders are a class of disorders marked by

feelings of excessive apprehension and anxiety

anxiety disorders include

generalized anxiety disorder, specific phobias, panic disorder, agoraphobia, selective mutism, social anxiety disorder, and separation anxiety disorder.

A generalized anxiety disorder is marked by

a chronic, high level of anxiety that is not tied to any specific threat.

generalized anxiety disorder physical symptoms

trembling, muscle tension, diarrhea, dizziness, faintness, sweating, and heart palpitations.

A specific phobia involves

a persistent and irrational fear of an object or situation that presents no realistic danger

A panic disorder is characterized by

recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly.

These paralyzing attacks are accompanied by physical symptoms of anxiety and are sometimes misinterpreted as heart attacks.

panic disorder

agoraphobia

a fear of going out to public places

obsessive-compulsive disorder (OCD) is marked by

persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions).

body dysmporhic disorder

an individual has an unrelenting preoccupation with what they perceive to be a physical flaw

disorders related to OCD

excoriation, hoarding disorder, body dysmporhic disorder

Obsessions sometimes centre on

inflicting harm on others, personal failures, suicide, or sexual acts.

Compulsions usually involve

stereotyped rituals that temporarily relieve anxiety.

This class of dis- order includes reactive attachment disorder, disinhibited trauma- and stressor-related disorders

social engagement disorder, PTSD, acute stress disorder, and adjustment disorders.

Post-traumatic stress disorder (PTSD)

involves enduring psychological disturbance attributed to the experience of a major traumatic event.

one key predictor of vulnerability of PTSD that emerged in a recent review of the relevant research is

the intensity of one's reaction at the time of the traumatic event

compared to PTSD, CPTSD is

a broader disorder

CPTD

includes PTSD criteria along with additional symptoms of affect dysregulation, difficulties in relationships, and negative self-concept

he frequency and severity of post-traumatic symptoms usually decline gradually over time, but

recovery tends to be gradual and in many cases, the symptoms never completely disappear.

DSM-5 Personality Disorder definition

an enduring pattern of inner experience and behavior that deviates from social norms and expectations

Key points of Personality Disorders

unusual way of seeing people, the self, and events, affectivity that is exaggerated or inappropriate, inflexible pattern manifest in many situations starting in late adolescence, creates impairment in functioning (especially conflict with others) and/or subjective distress

Main cluster of personality disorders (A)

eccentric

Main cluster of personality disorders (B)

dramatic/impulsive

Main cluster of personality disorder (C)

anxious/fearful

Main clusters of personality disorders (A, B, C)

odd- eccentric, dramatic/impulsive, anxious/fearful

odd- eccentric description

distrustful, socially aloof, unable to connect with others, schizoid, schizotypal, paranoid

dramatic/impulsive description

self-centered, emotional, no impulse control, histrionic, narcissistic, anti-social, borderline

anxious/fearful description

maladaptive efforts to control anxiety, dependent, obsessive-compulsive, avoidant

Cluster A- Paranoid (4%)

suspects (without sufficient basis) that others are exploiting, harming, or deceiving him or her. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. Perceives attacks on his or her character that are not apparent to others and is quick to react angrily. Has recurrent suspicions, without justification regarding the fidelity of spouse or partner.

Cluster B- Narcissistic (up to 6%)

pervasive pattern of grandiosity and need for admiration. Expected to be recognized as superior/ sense of entitlement. Believes that he/she is special and should only associate with other ‘high status’ people. Fantasies of unlimited success. Shows arrogance and lacks empathy

Cluster C- Borderline (2-6%)

20% of psychiatric patients. Frantic efforts to avoid real or imagined abandonment. Emotions spiraled out of control, leading to extremes of anxiety, sadness, rage. Recurrent suicidal behavior, gestures or threats or self mutilating behaviour. Unstable self image or sense of self. Impulsivity in at least two areas (e.g. spending, sex, substance abuse, reckless driving, binge eating)

Cluster C- Antisocial (3%)

behaviors that violate the rights of others without shame or regret. Superficial charm that is deceitful, using lies to con others. Irritable and aggressive indicated by repeated physical fights or assaults. Onset before age 15 (conduct disorder)

Most prominent cause of Antisocial disorder

biological predisposition (amygdala, and frontal lobe abnormalities) combined with neglect abuse poor family background

Cluster C- obsessive-compulsive (8%)

preoccupied with rules, details, organization, to the point where the major point of activity is lost. Perfectionism that interferes with task completion. Excessively devoted to work and productivity to the exclusion of friendships or leisure activities. Reluctant to delegate tasks or to work with others unless they submit exactly to his/her way of doing things

Cluster C- Avoidant (2%)

avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection. Views self as socially inept, inadequate, or inferior to others. Is preoccupied with being criticized or rejected in social situations.

In the past 9 months Andrew has been fired by three different employers. He was unreliable and often missed work, and each employer finally let him go when they found he had been stealing money and materials. Andrew feels no remorse over his actions, but he has managed to convince each of his former employers that he is sorry for his actions. None plan to press any charges. What is the most appropriate personality style

Antisocial

Sophia has always been preoccupied with schedules, lists, and trivial details. She plans everything down to the last detail and becomes very upset if things don’t work out the way she has planned. What is the most appropriate personality style

Obsessive compulsive

Ellen has been feeling both depressed and anxious. She would like to be in a relationship but feels it is out of her reach. She becomes unbearably anxious in new social situations and does not see how she will ever be able to approach or speak coherently to someone of the opposite sex. What is the most appropriate personality style

Avoidant

Lukas does not trust anyone. He is convinced that no one around him is truthful, and everything they say to him is a lie. He is extremely suspicious of other people’s motives, and he often flies into a jealous rage when his wife speaks to other men.What is the most appropriate personality style

Paranoid

Criteria for abnormal

distress is present, behavior is maladaptive, socially deviant

distress is present meaning

person is suffering, unhappy

Maladaptive behavior meaning

impaired functioning

socially deviant meaning

behavior is unusual “not normal”

What do psychologists use to classify abnormal behavior

DSM-V

Why classify abnormal behavior (medical model)

simplify and create order, research, plan treatment

The older distinction of classifying abnormality

neurotic vs. psychotic

Neurotic

distressing problem but person is still coherent and can function socially (once acute phase of disorder is treated)

Psychotic

more bizarre, involving delusions or hallucinations. Individual has impaired thought processes and cannot function socially. Treatment is long term. E.g. schizophrenia

Fear is

normal reaction to a known external source of danger

Phobias

are abnormal reactions

In anxiety the individual is frightened but the source of danger is

not known, not recognized, or inadequate to account for symptoms

Most common phobias

animals, heights, blood, flying

Generalized anxiety disorders (5%)

symptom felt continuously for atleast 6 months. Excessive worry, restlessness, sleep disturbances

Panic disorder (11%) presence of recurrent and unexpected panic attacks

intense dread, chest pain, choking, fear of going crazy or dying, shaking, nausea, shortness of breath, feeling dizzy or out of breath, rise within minutes and subside fairly quickly

Social anxiety (3-13%)

marked fear in social situations where individual is exposed to possible scrutiny. Afraid of humiliation or embarrassment that will lead to rejection. Social situations are avoided or endured with intense fear. Causes distress and or impairment in functioning.

Post traumatic stress disorder (7-8%)

threat or death or serious injury to self or others. Re-experiencing traumatic event. Avoidance of stimuli associated with the trauma. Difficulties with sleep, concentration, irritability

Obsessive-compulsive disorder (2%)

having obsessions and compulsions

Obsessions

persistent uncontrollable thoughts

Compulsions

rituals, behaviors that reduce anxiety

Four different themes of OCD

obsessions and checking, order and symmetry, cleanliness and washing, hoarding.

Case example of OCD

Howie Mandel

What percentage of the population will experience a psychological disorder at some time in their lives?

approximately 50%

Tak feels like he has been worrying constantly for the past four months. He is worried about making his car payments, losing his job, and how his children are doing in school. He has also started to experience dizziness and occasional heart palpitations. Which disorder is most consistent with these symptoms?

generalized anxiety disorder

Selena constantly thinks about climbing up the stairs to the roof of her building and jumping into the street below. These thoughts bother her, and she wishes they would stop. What is illustrated by this example?

obsession

What is the term used to describe the behaviour of checking your alarm clock 20 times before going to sleep?

compulsive

Michele was giving a presentation to her class when suddenly the roof collapsed. Michele was not injured herself, but she watched helplessly as her classmates were pinned under mounds of rubble. She saw horrific injuries, and several of her classmates were killed in the accident. If Michele develops symptoms of a mental disorder, what disorder is it most likely to be?

post-traumatic stress disorder

Multiple personality disorder (very rare)

presence of at least 2 distinct personalities within the same individual. Leads to sudden changes in identity and consciousness. Each personality has its unique style/ gap in memory. Dissociative process related to severe abuse in early childhood.

Depression

depressed mood, vegetative symptoms (weight, sleep), loss of energy, loss of concentration, suicidal

Depression women (%)

20%

Depression men (%)

10

Why depression is more common in women

more likely to report symptoms/ different expression in men, exposure to higher levels of early trauma, ruminative cognitive style/ silencing the self

Seasonal affective disorders (SAD)

depressive symptoms related to shorter winter days. Treatable with CBT and light therapy

Biological predisposition

concordance rates in twins (identical %):65%

Biological predisposition

concordance rates in twins (fraternal %) 15%

Cognitive perspective of depression (Beck)

Negative (dysfunctional) beliefs about self

Cognitive perspective of depression (Seligman)

attribution theory

attribution theory

internal stable, global attributions for negative events

Diathesis stress models

interaction between personality and negative life events, dependency/ self criticism

Bipolar disorder

periods of depression that alternate with manic episodes

Mania

abnormally elevated mood, inflated self esteem, pressure of speech, increase energy, decreased need for sleep, over-activity, lack of inhibition and impaired judgment