psych chapter 16 psychological disorders

how common are psychological disorders?

• 1/5 Canadians experience mental illness

• 50% of NA (ages 15-54) will experience a disorder

• 2nd leading cause of disability

• greater burden than all cancers combined

what are key stats about suicide?

• about 4000 Canadians/year

• 24% of deaths (ages 15-54)

• 2nd leading cause of death in youth

• Indigenous rates: 2-3x higher

what are other major impacts of mental illness?

• ¼ people → substance abuse disorder

• economic cost > $120 billion/year

• affects almost everyone directly or indirectly

why is there no single definition of abnormal behaviour?

• depends on:

  • personal values

  • cultural context (current or origin)

  • social norms

  • statistical rarity

what are the 3 D’s of abnormality?

• distress: suffering (not always present)

• dysfunction: interferes with life/work/relationships

• deviance: violates social norms

• abnormal = any combination

what is the DSM-5?

• main diagnostic manual (350+ disorders)

• approaches:

  • categorical → specific diagnoses

  • dimensional → severity scales

• important because it improves accuracy and captures individual differences

what are reliability and validity in diagnosis?

• reliability: same diagnosis across clinicians

• validity: diagnosis reflects real disorder

problems and benefits of diagnosis?

• problems:

  • stigma

  • bias

  • self-fulfilling prophecy

• benefits:

  • increase understanding and support

what did the Rosenhan study demonstrate?

• fake patients admitted as schizophrenic

• staff couldn’t detect normal behaviour

• labels strongly shape perception

early explanations and treatments?

• explanation: supernatural (demon, spirits)

• treatments:

  • trephination - hole drilled in skull to release “evil spirits:

  • witch hunts (100,000 killed)

what is the medical model?

mental illness = brain disease (Hippocrates)

key breakthrough in biological explanation?

general paresis caused by syphilis → proof of physical cause

what is the vulnerability-stress model?

• psychological disorders develop from the interaction between vulnerability and stress

• vulnerability:

  • biological (genetics)

  • psychological (personality, coping style)

  • early experiences (trauma)

• stress:

  • life events or environmental triggers (loss, conflict, major changes)

• a disorder is more likely when high vulnerability + high stress combine

competency vs insanity?

• competency to stand trial:

  • refers to the defendant’s mental state at the time of the trial

  • must be able to understand the proceedings and assist in their defence

• insanity:

  • refers to the defendant’s mental state at the time of the crime

  • argues they were unable to understand or appreciate the wrongfulness of their actions

what are the 4 components of anxiety?

• emotional (fear)

  • subjective feeling of fear or dread

• cognitive (worry)

  • negative thoughts, worry, and anticipation of threat

• physiological (arousal)

  • bodily activation (ex: increased heart rate. sweating, muscle tension)

• behavioural (avoidance)

  • avoiding or escaping anxiety-provoking situations

prevalence of anxiety disorders?

• most common disorders (18.6%)

• higher in females and Indigenous populations

what are phobias?

• persistent, excessive, and irrational fear of a specific object or situation, leading to avoidance and significant distress or impairment

• examples:

  • agoraphobia (open/public spaces)

  • social anxiety (fear of embarrassment)

  • specific phobias (objects/situations)

generalized anxiety disorder (GAD)?

• chronic, excessive, and uncontrollable worry about multiple area of life

• key features:

  • free-floating anxiety (not tied to a specific trigger)

  • persistent worry and tension

  • difficulty controlling the worry

• common symptoms:

  • restlessness or feeling on edge

  • fatigue

  • muscle tension

  • sleep disturbances

  • difficulty concentrating

panic disorder?

• recurrent, unexpected panic attacks with no clear or specific trigger

• panic attacks:

  • sudden surge of intense fear or discomfort

  • symptoms may include:

    • heart palpitations

    • shortness of breath

    • dizziness

    • feeling of losing control or dying

• persistent fear of future attacks and possible behavioural changes

OCD?

• a disorder characterized by obsessions and compulsions, classified in a separate category from anxiety disorders

• obsessions:

  • intrusive, unwanted thoughts, urges, or images

  • cause significant anxiety or distress

• compulsions:

  • repetitive behaviours or mental acts performed to reduce anxiety or prevent a feared outcome

  • often excessive or not realistically connected to the fear

biological causes of anxiety?

• genetic predisposition from family members

• amygdala

  • involved in fear processing

  • overactivity can lead to heightened fear and threat detection

• low GABA (an inhibitory neurotransmitter) → reduced ability to calm neural activity → increased anxiety/arousal

• evolutionary fears (ex: snakes, heights)

psychological causes?

• psychodynamic:

  • arises from unconscious conflicts (ex: internal struggles between desires and fears)

• cognitive:

  • driven by maladaptive thought patterns

  • includes catastrophic thinking, overestimating threats, and underestimating coping ability

behavioural causes?

• learned through conditioning:

  • classical conditioning: neutral stimuli become associated with fear (ex: dog → bite → fear of dogs)

  • observational learning: fear learned by watching others

• maintained by negative reinforcement:

  • avoidance reduces anxiety in the short term, reinforcing the behaviour

  • prevents learning that the situation is actually safe → anxiety persists

socioculture causes?

culture shapes anxiety expression

examples of culture-bound disorders?

• Koro: fear genitals shrinking

• Taijin Kyofusho: fear of offending others

• Windigo: belief of becoming cannibalistic

• Anorexia: Western cultures

anorexia nervosa?

fear of weight gain, severe restriction, distorted body image

bulimia nervosa?

• key features:

  • binge eating: consuming a large amount of food in a short time, often with loss of control

  • purging: vomiting, laxatives

  • body weight: typically normal or slightly above/below average

• medical complications:

  • gastrointestinal issues (stomach rupture, acid reflux)

  • tooth erosion and enamel damage

  • electrolyte imbalances, dehydration, heart problems

binge eating disorder?

• key features:

  • loss of control during eating episodes

  • eating large amounts of food in a short period of time

  • marked distress or guilt/shame after binges

  • often leads to overweight/obesity

• consequences:

  • obesity-related complications (diabetes, hypertension)

  • emotional distress, depression, or anxiety

causes of eating disorders?

• cultural:

  • thinness ideal

  • objectification

• psychological:

  • anorexia nervosa: perfectionism, need for control, rigid thinking

  • bulimia nervosa: impulsivity, emotional dysregulation, depression

  • binge eating disorder: emotional coping, impulsivity

• biological:

  • genetic predisposition: family and twin studies show heritability

  • neurotransmitter issues: serotonin dysregulation affecting mood and appetite

• maintenance:

  • leptin imbalance → disrupted hunger/satiety signalling

  • reduced taste sensitivity → may reinforce overeating or restriction

• treatment outcomes:

  • eating disorders are difficult to treat

  • only about 50% recover fully

what is depression?

• major depression: severe symptoms that interfere with daily functioning and are out of proportion to life events

• dysthymia (persistent depressive disorder): chronic, less severe depression lasting 2+ years, often with periods of major depression

• 4 symptom categories of depression:

  • emotional: sadness, hopelessness, guilt, irritability

  • cognitive: negative thoughts, poor concentration, indecisiveness

  • motivational: loss of interest or pleasure, decreased initiative

  • somatic: sleep disturbances, appetite changes, fatigue

what is bipolar disorder?

• mania:

  • elevated or irritable mood

  • grandiosity, inflated self-esteem

  • decreased need for sleep

  • impulsivity and high energy

• types of bipolar disorder:

  • bipolar I: full-blown mania, may include depressive episodes

  • bipolar II: hypomania (less severe mania) + major depressive episodes

  • cyclothymia: mild mood swings between hypomania and mild depression, chronic but less severe

causes of mood disorders?

• biological:

  • genetics: high heritability, 67% twin concordance for major depression

  • neurotransmitters:

    • depression - decreased serotonin, norepinephrine, dopamine

    • mania: increased norepinephrine/dopamine

• cognitive:

  • negative triad (Beck): negative views of self, world, future

  • learned helplessness: belief that one has no control over outcomes → depression

• behavioural:

  • loss of reinforcement: decreased pleasurable activities → withdrawal cycle

  • reduced engagement with rewarding experiences maintains depressive symptoms

what is suicide?

• risk factors:

  • depression

  • previous attempts

  • substance abuse

  • isolation

• warning signs:

  • hopelessness, withdrawal, giving away possessions

• prevention:

  • ask directly, support, stay with person, get help

somatic symptom disorders?

• physical symptoms without medical cause

• types:

  • illness anxiety, pain disorder, conversion disorder (experience serious neurological symptoms like paralysis, blindness, or seizures without a known medical explanation)

what is schizophrenia?

• a severe psychotic disorder affecting thinking, perception, emotion, and behaviour

• symptoms:

  • positive (added): hallucinations, delusions, disorganized thinking or speech

  • negative (missing): flat affect, anhedonia, lack of motivation, social withdrawal

• causes:

  • genetics: 48% twin concordance

  • neurotransmitters: dopamine excess

  • brain abnormalities: structural and functional differences (ex: enlarged ventricles, reduced prefrontal cortex activity)

  • stress: environmental triggers can exacerbate symptoms

• subtypes:

  • paranoid: most common; intense delusions and auditory hallucinations

  • disorganized: disorganized speech, thoughts, behaviour; flat or inappropriate emotions

  • catatonic: extreme motor abnormalities (stupor or erratic/repetitive movements)

  • undifferentiated: symptoms present but do not clearly fit other subtypes

dopamine hypothesis and expressed emotion?

• dopamine hypothesis: excessive dopamine drives positive symptoms while deficient dopamine is associated with negative symptoms and cognitive deficits

• expressed emotion: measures quality of family environment, higher levels of criticism, hostility, or emotional involvement will lead to higher relapse chances

what are personality disorders?

• enduring, rigid, and maladaptive patterns of thinking, feeling, and behaving that cause distress or impair functioning

• antisocial personality disorder:

  • lack of empathy, disregard for others

  • manipulative or deceitful behaviour

  • often engages in criminal or impulsive acts

• borderline personality disorder:

  • emotional instability and intense mood swings

  • impulsivity and self-destructive behaviours

  • fear of abandonment, unstable relationships

childhood disorders?

• prevalence: 18-22% of Canadian youth experience a mental disorder

• ADHD:

  • key features: inattention, hyperactivity, impulsivity

  • may impact academic performance, social interactions, and behaviour regulation

• autism spectrum disorder:

  • key features:

    • social deficit (difficulty with eye contact, social reciprocity)

    • communication issues (verbal and nonverbal)

    • repetitive behaviours or restricted interests

dementia?

• gradual decline in cognitive functioning that interferes with daily life, memory, reasoning, and decision-making

• most common cause: Alzheimer’s disease (60% of cases)

• causes:

  • brain deterioration: shrinkage of neurons and brain regions (especially hippocampus)

  • neurotransmitter deficits: loss of acetylcholine

  • amyloid plaques and neurofibrillary tangles