PSYC102 - Module 8 (Disorders)

Diathesis-Stress Model*

A person may be predisposed to a psychological disorder that remains unexpressed until triggered by stress

Panic Disorder*

The sudden occurrence of multiple psychological and physiological symptoms that contribute to a feeling of stark terror

• Acute symptoms of an attack only last a few minutes and include shortness of breath, heart palpitations, sweating, dizziness, depersonalization, or derealization

• Diagnosed if one experiences recurrent unexpected attacks and report significant anxiety about having another attack

Agoraphobia*

A specific phobia involving a fear of pubic places

Sodium Lactate Experiments*

• To understand the role that physiological arousal plays in panic attacks, researchers compared the responses of participants w/ and w/o panic disorder to sodium lactate - a chemical that produces rapid, shallow breathing and heart palpitations

• Those w/ panic disorder were acutely sensitive to the chemical, within a few minutes 60-90% experienced a panic attack

• Participants w/o the disorder rarely responded to the sodium lactate w/ a panic attack

• Panic attacks may be conceptualized as “fear of fear”

Conduct Disorder*

A condition in which a child or adolescent engages in a persistent pattern of deviant behaviour involving aggression to people or animals, destruction of property, deceitfulness or theft, or serious rule violations

Medical Student Syndrome

A common experience of perceiving oneself as having the symptoms that one is studying about

Keep in mind:

• Most symptoms of disorders are also commonly present in everyday normal functioning

• The prevalence of most disorders is low (<5% of general population)

• Self-diagnosis ability is very poor, even amongst trained clinical psychologists

Clinical/Medical Disorder

• Syndrome: Collection of symptoms that occur together

• Clinically significant distress or disability: eg. pain or inability to function in important areas of life, such as school, home, or work.

• Not due to common stressors or expected behaviours: eg. grief

• Reflects dysfunction: In psychology, biology, or developmental processes

• Is not due to socially deviant behaviour: except in cases where that deviance is from the dysfunction itself

• Medicalized and can incentivize treatment, even when one doesn’t want any

Common but not necessary features of disorders

• Can be reliably detected from progression over time, response to treatment, family history, etc, often by standardized tests

• Can be differentiated from other similar disorders

• Has clinical utility, helping identify best treatment, helping the patient, etc.

• Having the disorder labelled has more benefits than costs

Stigma

A negative attitude towards people with a disorder, including towards oneself

Neurodiversity

Framework arguing that most disorders are variability in how people naturally function, rather than categories of disorders to be treated

• Rather than treating people to conform to norms of society, expand society to include more variability

DSM-V-TR

A classification system for diagnosing recognized clinical disorders

• Last updated in March 2022 w/ minor changes

• Considered the standard in diagnosing clinical disorders

Features of the DSM-V-TR

1. Developed by researchers: Made by psychiatrists and psychologists who research clinical disorders

2. Regularly updated: Around 8-12 years, allowing to add, take away, or change disorder categories

3. Criteria and Decision Rules: Each disorder has a set of defined features with some degree of flexibility

4. “Atheoretical”/Descriptive: It is a tool for describing/diagnosing, not for explaining why a disorder occurred

Criticisms of DSM

• Categorical disorders: Treats most disorders as categorical (you have it or you do not), when there are variations in severity

• Comorbidity: Co-occurrence of two or more diagnoses within the same person; reduces diagnostic validity, especially if disorders are separable

• Not focusing on causes: By focusing only on symptoms, many different underlying conditions can be diagnosed as the same disorder

• Cultural biases: Deciding what is “impairment in everyday function” is going to vary a lot from culture to culture

Anxiety

A state of apprehension and tension in which a person anticipates upcoming danger, catastrophe, or misfortune

Anxiety Disorders

Disorders in which excessive, irrational, automatic, and impairing anxiety is the primary manifesting symptom

• The most commonly diagnosed clinical disorder

• Have strong family history and are correlated with high neuroticism

• Category includes: Specific phobia, social, generalized, panic disorder, separation, selective mutism, etc

Comorbidity

Specific Phobia Disorders

Marked, persistent, and excessive fear and/or anxiety in presence or anticipation of specific objects, activities, and/or situations (eg. phobias)

• DSM-5-TR sub-classifies phobias into “animal”, “natural environment”, “blood-injection-injury”, “situational”, and ”other” types

• Common for individuals to have multiple phobias

Phobic Disorders

Fear Conditioning

The theory that phobias are caused by associating a particular stimulus with a negative event through trauma

Little Albert Experiment

A 6-month-old infant not previously afraid of white rats was conditioned by pairing a loud noise every time he touched the rat; his fear generalized to other white, furry things

Preparedness Theory

The theory that we are evolutionarily programmed to learn certain things even with very minimal experience

The Garcia Effect

When a rat mildly poisoned once after drinking sugar water they will – upon recovering – never again drink sugar water again (even if they were actually poisoned by something else)

Social Anxiety Disorder

Excessive anxiety around being judged by others, often to the point that the person avoids all social situations

• Most commonly diagnosed anxiety disorder

• Individuals with this crave social contact, but are worried about humiliation and judgement

• Onset is most often in childhood, with moderate correlations with temperament and neuroticism

Generalized Anxiety Disorder

An anxiety disorder characterized by chronic and excessive worry accompanied by three or more of the following: Fatigue, concentration problems, irritability, muscle tension, and sleep disturbance for more than 6 months

• Seems related to the brain’s ability to inhibit information: Patients suffering from this show significantly higher levels of general brain activity

• Moderately predicted by family history, with environmental effects like stress and trauma being the other main predictors

Obsessive-Compulsive Disorder

A clinical disorder marked by:

• Repetitive, intrusive and irrational thoughts and worries (obsessions)

• Ritualistic behaviors (compulsions) done in an attempt to fight those thoughts

• Obsessions and compulsions impair everyday function, including ability to maintain a job

• About 2-5% lifetime prevalence

• Along with PTSD, it was classified as an anxiety disorder until DSM-5, but is now considered a separate category

Depression

A negative state marked by unhappiness, sadness, pessimism, hopelessness, and lethargy, coupled with changes in eating and sleeping habits, difficulty concentrating, and social withdrawal

Depressive Disorders

Mental disorders whose primary symptom is the presence of impairing depression, accompanied by related changes that significantly affect the individual’s capacity to function

• Category Prevalence: Second most common category of disorders.

• Includes: Major, persistent, premenstrual dysphoric disorder and more

Major Depressive Disorder

A depressive disorder characterized by:

• A severely depressed mood and/or an inability to experience pleasure that lasts for 2 or more weeks

• Accompanied by feelings of worthlessness, lethargy, lack of sleep, inappropriate guilt, and appetite disturbance

• Correlated with increased suicidal ideation and attempted suicide

• Experience depressive episodes rather than a perpetually depressed mood

Persistent Depressive Disorder

Depressed mood for most of the day, for more days than not, over a period of 2 years; less intense than MDD, but more long-term

• Individuals with PDD experience their symptoms for 2 years with no longer than 2 month breaks

• Frequently co-occurs with intermittent major depressive episodes

• Like MDD, often associated with suicidal ideation and attempted suicide

Biology of Depression

• Some depressed individuals have significantly reduced levels of serotonin and norepinephrine, reducing their moods and general arousal activity

• Some depressed individuals have significantly reduced general brain activation

• Heritability for depression is similar to IQ

Cognitive Model of Depression

The theory that one’s automatic thought patterns, inferences, and attitudes increase the risk for depression

• Negative schemas: Depressed individuals are likely to be generally focused on themes of guilt, worthlessness, loss, separation, and rejection

• Biased attention: Depressed individuals might attend more to negative events in the environment, and interpret them as consistent with their schemas

• Biased memory: Depressed individuals recall the past more negatively, are more likely to ruminate, and more likely to blame themselves for outcomes

Helplessness Theory of Depression

Depressed individuals, through repeated trauma, believe they have no control, and that negative events are therefore:

• Stable: Bad things will keep happening forever

• Global: Any bad event is going to affect everything

• Internal: Any bad event is all my fault

Helplessness theory is sometimes considered a schema in cognitive model.

Others consider it a separate theory that explains how past trauma is a strong predictor of future depressive beliefs

Bipolar Disorders

Disorders showing strong switching between moments of extremely positive mood (mania) and extremely depressed mood (depression)

• 1% for lifetime prevalence

• Along with schizophrenia, the most difficult category for treatment

• Types in the DSM-5-TR include: I, II, cyclothymic disorder, etc

Causes of Bipolar Disorders

• Bipolar I and II are highly heritable disorders, with around 85% of variance in prevalence predicted by genes and family history

• The brains of patients with bipolar disorder show profound changes in activity during manic vs. depressive episodes

Schizophrenia and Psychotic Disorders

Category in which delusions, hallucinations, disorganized speech and motor movements, and absence of typical psychological functions are the characterizing features.

• Very rare (~1% lifetime prevalence)

• Includes: Schizophrenia, delusional disorder, brief psychotic disorder, and more

• Since the DSM-5, all disorders in this category are on a spectrum

Spectrum

Psychotic disorders are rated in severity (0 – 5 scale) and duration, rather than as binary categories

Positive Symptoms

Symptoms in which abnormal processes are present

Negative Symptoms

Symptoms in which typical processes are absent

Positive Symptoms of Schizophrenia

• Hallucinations: Perceiving things without any external stimulation (auditory hallucinations are most common)

• Delusions: False beliefs that are maintained despite evidence to contrary

• *Disorganized Speech: Disruption of verbal communication in which ideas shift rapidly

• *Disorganized Behaviour: Abnormal motor movements, including catatonia (lack of environmental response)

Negative Symptoms of Schizophrenia

• Flat Affect: Lack of emotion or emotions that are inappropriate for the situation

• Social Withdrawal: Absence of desire for social contact, having friends, or relationships

• Lack of Motivation: Lack of desire to accomplish any goal

• *Problems with Attention and Working Memory: Not able to focus or remember things in the short-term

Biological Basis of Schizophrenia

Brain structure differences:

• Reduced Grey Matter: An indicator of neurons in various brain regions

• Reduced White Matter: Indicator of efficient connections between different brain regions

• Enlarged Ventricles: Hollow regions of the brain filled with fluid expand

Dopamine Hypothesis

The hypothesis that schizophrenia is caused by an overabundance of the neurotransmitter dopamine throughout the brain

• This hypothesis helps explain positive symptoms: Too much dopamine would activate various sensory and motor aspects of the brain, leading to hallucinations, delusions, etc

• However, doesn’t explain all the negative symptoms

Personality Disorders

Disorders characterized by enduring patterns of thinking and behaving that deviates markedly from the norms and expectations of the individual’s culture, are pervasive and inflexible, have onset in adolescence or early adulthood, and lead to distress or impairment

• Category Prevalence: Varies a lot for specific disorders.

• Includes: Schizoid, antisocial, borderline, dependent, and several others

• These are organized in three “clusters” of similar symptoms

Cluster A (Odd/Eccentric)

Personality disorders characterized by social awkwardness and withdrawal, and strange beliefs or manners of speaking or dressing

Cluster B (Dramatic/Erratic)

Personality disorders characterized by problems in impulse control and emotional regulation, including lacking empathy towards others, unstable moods, or attention seeking

Cluster C (Anxious/Inhibited)

Personality disorders associated with feelings of anxiety and discomfort, including in social situations, including oversensitivity to negative comments, perfectionism, lack of self-confidence, etc

Schizoid Personality Disorder (Cluster A)

Detachment from social relationships and restricted range of expression in social situations that is by choice; usually are indifferent to opinions to others, lack friends, and show flat affect

• More common in families with a history of schizophrenia

• Has to be differentiated from early-onset schizophrenia, and mild ASD

Antisocial Personality Disorder (Cluster B)

Pervasive disregard and violation of rights of others, since at least adolescence, with highly impulsive behaviours, aggression and irritability, tendency to deceive others, and lack of remorse

• The DSM-5-TR term for psychopathy/sociopathy

• Some APD clients have dysregulated amygdala and do not experience fear in social situations

• More common with history of child abuse, family history of disorder, and early exposure to violent environments

Borderline Personality Disorder (Cluster B)

Pervasive pattern of unstable interpersonal relationships, self-image, and high impulsivity; frequently includes fear of abandonment, identity disturbance, recurrent suicidal behaviour, and difficulty controlling anger

• People with BPD often go through cycles of revering and attaching themselves to a person, followed by rejecting them

• Often have very active amygdalas, experiencing intense fear from small environmental disturbances

Dependent Personality Disorder (Cluster C)

Pervasive pattern of needing to be taken care by others, separation anxiety, and difficulty making decisions without excessive amount of advice and support from others.

• Unlike BPD, no issues with impulsivity, anger, or fluctuating relationships

• Separation anxiety in childhood appears to be a predictor

• But – unlike adult separation anxiety disorder – concern is not with well-being of others, but fear of inability to take care of themselves

Neurodevelopment Disorders

Category of disorders in which onset in early childhood with significant impairment are the defining feature

• Category Prevalence: varies from rare to common

• Includes intellectual development disorders, communication disorders, autism spectrum disorder, ADHD, and more

• Since the DSM-5, all neurodevelopmental disorders – but especially autism – are conceptualized as falling on a spectrum

Autism Spectrum Disorder

Pervasive and sustained deficits in social communication and interaction, coupled with deficits in non-verbal communication, difficulties in having relationships, and restricted/repetitive patterns of behaviour

• Varies in severity, with some individuals able to function without much support

• Symptoms must begin in early childhood

• Historically tied to issues with ToM, but today conceptualization is broader

Theorized Causes of Autism

• Mostly unknown

• Heritability is high, potentially as high as schizophrenia and bipolar

• Environmental risks include advanced parental age, extreme premature birth, and teratogen exposure

• There is no evidence it’s related to exposure to vaccines

Attention-Deficit/Hyperactivity Disorder (ADHD)

A persistent pattern of inattention and hyperactivity lasting at least 6 months and present prior to age 12; can be predominantly of one type, or combined both

• Symptoms must occur in multiple settings (eg. school and home)

• Can be primarily inattentive, primarily hyperactive, or both

• Prevalence rates for ADHD have been rapidly rising over the last decade, making it a relatively common diagnosis