Chapter 14 PSYC 101 Loeb

What general criteria are used to determine psychopathology?

Deviance, Dysfunction/Maladaptive behavior, and Distress

Deviance

People are often said to have a disorder because their behavior deviates from the societal norm

Dysfunction (maladaptive behavior)

Actions that prevent people from adapting to, adjusting, or participating in different aspects of life (key criterion in diagnosing substance use disorders)

Distress

An individual's report of great personal distress; often diagnosed when they describe their subjective pain and suffering to others

Why is one criterion usually insufficient in determining that someone is mentally ill?

Using a single criterion may be insufficient in determining mental illness because individuals may exhibit one criterion without necessarily meeting others, and context plays a crucial role

Explain the role of subjectivity and why this increases disagreement between clinicians when clinicians diagnose a patient.

- variability and differences in interpretation among clinicians

- clinicians may weigh the importance of certain symptoms differently, leading to variations in diagnosis

- conditions have overlapping symptoms and clinicians may need to make nuanced judgments

- greater consensus for some diagnoses where symptoms are more obvious/common (ex. Depression, bipolar, and schizophrenia) vs. less common/typical (ex. Dissociative identity disorder)

Explain what the DSM-V is. How does this help clinicians to be more accurate in diagnoses?

- The DSM-V is an elaborate system for classifying psychological disorders intended to better standardize diagnoses

- It provides a structured framework for understanding and diagnosing mental disorders

- Helps standardize criteria and diagnosis

- Allows clinicians to communicate with one another

Does the DSM-V completely prevent clinicians from making errors in diagnoses?

No!

- Many individuals with mental health concerns may present with symptoms that align with multiple diagnostic categories

- Clinicians may differ in their interpretation of the severity and significance of symptoms, leading to variations in diagnosis

- Standard criteria does not always consider individual differences, cultural factors, and personal context

- The clinical presentation may not align neatly with the established diagnostic criteria

Prevalence

The proportion of a population who have a specific characteristic in a given time period

Lifetime prevalence

The proportion of a population who, at some point in life has ever had the characteristic

Onset

The time between the first symptom and the development of a diagnosable psychiatric syndrome

Etiology

Understanding the factors or events that contribute to the development or onset of a particular disease; underlying causes, triggers, or mechanisms

Generalized anxiety disorder

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

Associative features: trembling, muscle tension, diarrhea, dizziness, faintness, sweating, and heart palpitations

Specific phobia

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

Panic disorder

characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly

Associative features: palpitations, sweating, shortness of breath, chest pain, nausea, derealization, fear of losing control, fear of dying, chills or hot flashes

Agoraphobia

fear of going out to public places

Tends to coexist with a variety of other disorders, namely panic disorder

Obsessive-Compulsive Disorder (OCD)

marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) OR urges to engage in senseless rituals (compulsions)

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

Compulsions usually involve stereotyped rituals that may temporarily relieve the anxiety produced by one’s obsessions.

Posttraumatic stress disorder (PTSD)

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

High levels of stress & adversity during childhood and intense reactions to the traumatic event itself may increase the chances of developing PTSD

Etiology of Anxiety-Related Disturbances

Disturbances in the neural circuits using GABA --> anxiety disorders and disturbances in serotonin --> OCD

Maladaptive cognitive patterns: (1) misinterpret harm-less situations as threatening, (2) focus excessive attention on perceived threats, and (3) selectively recall information that seems threatening

Conditioning & learning: anxiety responses can be acquired through classical conditioning and maintained through operant conditioning

Dissociative amnesia

A sudden loss of memory for important personal information that is too extensive to be due to normal forgetting

Memory loss can occur for a single traumatic event or for an extended period of time surrounding the even

Dissociative fugue

a temporary state where a person has memory loss (amnesia) and ends up in an unexpected place

Dissociative identity disorder (DID)

involves a disruption of identity marked by the experience of two or more largely complete, and usually very different, personalities.

Expressed amnesia for the other personalities but other memory tests suggest awareness of the other personalities

Associative features: headaches and chronic pain, self-harm behaviors, and hallucinations

Etiology of Dissociative Disorders

Dissociative amnesia is usually attributed to excessive stress, however its unclear why some react so severely to stress

DID may be iatrogenic as some are unable to recognize their multiple personalities without the help of a therapist

A substantial majority of people with DID do report a childhood history of rejection from parents and of abuse or other forms of trauma

Major depressive disorder

people show persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure

Diagnostic criteria (5 or more)

Persistent sadness and/or loss of interest in previously pleasurable things (i.e. anhedonia)

Weight loss or weight gain

Insomnia or hypersomnia

Psychomotor retardation or agitation

Fatigue

Feelings of worthlessness or guilt

Inability to concentrate

Recurrent thoughts of death or suicidal ideation

Etiology of Depressive and Bipolar Disorders

- Genetic vulnerability

- Neurochemical and neuroanatomical factors --> correlations have been found between mood disorders and abnormal levels of norepinephrine and serotonin

- Association between depression and reduced hippocampal volume

- Hyper-reactivity of the amygdala

- Hypo-reactivity of the reward system

- Learned helplessness

- Rumination

- Hindsight bias

- Interpersonal roots: poor social skills → punishing social experiences → worse mood/depression

- Stress: can trigger the onset of depressive disorders however with more occurrences stress plays less of a role

Schizophrenia

a disorder marked by delusions, hallucinations, disorganized thinking and speech, and deterioration of adaptive behavior

Diagnostic criteria (2 or more):

- Delusions: false beliefs that are maintained even though they clearly are out of touch with reality

- Hallucinations: sensory perceptions that occur in the absence of a real, external stimulus or are gross distortions of perceptual input

- Disorganized speech/thought: marked by a loosening of word associations or babbling nonsensically

- Grossly disorganized or catatonic behavior

- Negative symptoms:

Affective flattening

Alogia

Avolition

Etiology of Schizophrenia

- Genetic vulnerability

- Low IQ

- Dopamine hypothesis: excess dopamine activity is the neurochemical basis for schizophrenia

- Marijuana use in adolescence (w/ genetics)

- Structural abnormalities

- Neurodevelopmental hypothesis

- Expressed emotion

- stress

Dopamine hypothesis

excess dopamine activity is the neurochemical basis for schizophrenia

elevated dopamine activity in certain areas of the brain may foster positive symptoms and reduced dopamine activity in other neural circuits may foster negative symptoms

Intertwined with disturbances in GABA, serotonin, and glutamate

Structural abnormalities (schizophrenia)

Enlarged ventricles which lead to the decreased volume of both gray and white matters

Synaptic pruning: the selective elimination of synapses by certain types of glial cells; awry in schizophrenic patients

Neurodevelopmental hypothesis

schizophrenia is caused in part by various disruptions in the normal maturational processes of the brain before or at birth

If the problem is negative conditions during prenatal development, why do symptoms show up at a later age?

disruptions during prenatal development might not manifest as symptoms until the affected brain regions are functionally challenged during later stages of development or adolescence.

Expressed emotion

the degree to which a relative of a schizophrenic patient displays highly critical or emotionally overinvolved attitudes toward the patient

Affects the course of the disorder after the onset

Relapse is 3x more likely if the patient returns to family with high expressed emotion

Autism or autism spectrum disorder (ASD)

a neurodevelopmental disorder characterized by deficits in social interaction and communication and restricted, repetitive interests and activities

Diagnostic criteria:

- Social communication and interaction deficits in multiple contexts

- Repetitive/restrictive behavior and/or interests (ex. Special interests and hyperfocus on certain subjects)

Associative features:

- 30-40% of patients may not develop speech while others may have unusual speech patterns such as echolalia

- Possible extreme reactions to relatively minor changes in the environment

- ½ of patients have sub-normal IQ scores

Etiology of ASD

- Most theorists today view autism as a disorder that originates in biological dysfunctions/genetics

- Brain abnormality: ASD is associated with generalized brain enlargement that is apparent by age 2

- May begin during the 2nd and 3rd trimesters of pregnancy

- Studies suggesting mercury involvement has been deemed fraudulent

Antisocial Personality Disorder

-marked by impulsive, callous, manipulative, aggressive, and irresponsible behavior

- Reject widely accepted social norms/exploit others with little to no guilt

-they rarely experience genuine affection for others and sexually they are predatory and promiscuous

Borderline Personality Disorder

- marked by instability in social relationships, self-image, and poor emotional functioning

- Relationships marked by fears of abandonment

- Black and white thinking → alternate between idealizing and devaluing people

- Occurs more frequently in women

- Associated with an increased risk of self-harm and suicide

Narcissistic Personality Disorder

- marked by a grandiose sense of self-importance, a sense of entitlement, and an excessive need for attention and admiration

-Although they seem self-assured and confident, their self-esteem is fragile

-Occurs more frequently in men

Etiology of Personality Disorders

Genetic and environmental factors (similar to other mental disorders)

- Environmental factors vary depending on the type of disorder (ex. early trauma → borderline personality disorder and parental neglect/dysfunctional family → antisocial personality disorder)

Anorexia nervosa

intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, and use of dangerous measures to lose weight

Diagnostic criteria:

-Restriction of energy intake resulting in less than minimally normal weight

-Intense fear of gaining weight

-Disturbed body image/body dysmorphia

Associative features:

-Refusal to acknowledge the maladaptive quality of their behavior

-Often coupled with depression or anxiety

-Medical problems may arise: e.g. amenorrhea, GI issues, low blood pressure, osteoporosis, or metabolic disturbances

-Associated with a 10x likelihood of premature death

Bulimia nervosa

habitually engaging in out-of-control overeating, followed by unhealthy compensatory efforts, such as self-induced vomiting, fasting, abuse of laxatives and diuretics, and excessive exercise

Diagnostic criteria:

-Recurrent binge eating with a sense of lack of control

-Fear of gaining weight

-Recurrent inappropriate compensatory behaviors (ex. laxatives or intense exercise)

Associative features:

-Often maintain a normal weight

vomiting only decreases caloric intake by less than 50%

laxatives and diuretics have minimal impact

-Medical problems: cardiac arrhythmias, dental problems, metabolic issues, and GI issues

-More likely to recognize maladaptive behavior and comply with treatment

Binge-eating disorder

distress-inducing eating binges that are not accompanied by the purging, fasting, and excessive exercise seen in bulimia

Diagnostic criteria:

-Eating a larger-than-normal amount of food in a discrete period of time

-Sense of lack of control over eating

-Often associated with 3 or more of the following:

-Eating more rapidly than normal

-Eating until uncomfortably full

-Eating when not physically hungry

-Eating alone due to embarrassment

-Feelings of disgust, depression, or guilt following a binge

Associative features:

-Frequently individuals with BED are overweight

-Often triggered by stress

-60% of sufferers are female

Etiology of Eating Disorders

- Genetic (some predisposition for anorexia)

- Cultural (beauty standards)

- Familial (learned behavior)

- Cognitive (patients with eating disorders display rigid, all-or-none thinking and many maladaptive beliefs)

Associative features

Additional characteristics, symptoms, or traits that commonly co-occur with a particular condition but are not essential for the diagnosis of that condition

Diagnostic features

Criteria are the essential characteristics or symptoms that must be present for a formal diagnosis of a specific condition to be made