Behavior Disorders Exam 1

general paresis of the insane

- by the late 1800s, accounted for one-quarter of all psychiatric inpatient hospitalizations

- fatigue, headaches, insomnia, & dizziness

- personality changes, decreased mental faculties, disinhibition, antisocial behavior, mania, and depression

- culminated in delusions, which were often grandiose and involuntary motor symptoms and muscular deterioration, followed by death

toxic masculinity

- traditional masculinity marked by stoicism, competitiveness, dominance and aggression

- associated with risk of injury to oneself

- barrier to mental and physical health treatment

- associated with societal problems (e.g., sexual assault, IPV)

essentialism

a belief that things have a set of characteristics that make them what they are, and that the task of science and philosophy is their discovery and expression; the doctrine that essence is prior to existence

"essential" features of a behavior disorder (not actually - they all fall short)

- abnormality/deviance

- subjective distress

- dysfunction/impairment

abnormal (biological/medical)

- condition or state that is irregular or deviant from typical functioning of an organism

- some biological events can be symptoms of a disorder (e.g., cognitive decline)

- not every abnormal behavior is a symptom of an illness

- some normal behaviors can be symptoms of illness (e.g., feeling sad or anxious)

- abnormality is neither a necessary nor sufficient feature for categorizing a group of co-occuring thoughts, emotions, and actions as a behavior disorder

subjective distress

- individual's verbal and non-verbal reports of pain, suffering, upset, etc.

- not every behavior associated with subjective distress is associated with a disorder (e.g., intense physical activity, reacting to bad news)

- not every disorder is accompanied by subjective distress

- subjective distress is neither necessary nor sufficient for categorizing a group of co-occurring thoughts, emotions, and actions as a behavior disorder

dynsfunction

- abnormality or impairment in the function of a specified bodily organ or system

- behavioral disorders can emerge even when your psychological apparatus is functioning as it should

- dysfunction is not always associated with a behavior disorder

homosexuality in DSM (302.0)

- natural variation: those engaging in homosexual behavior were born different, but it is a natural difference (e.g., left-handedness)

- biological pathology: there is some internal effect that underscores homosexual behavior

- immaturity: homosexual feelings are normal at a young age and seen as part of normal development, with adult homosexuality being a form of developmental arrest

drapetomania

was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that caused black slaves to flee captivity

masturbation as a mental disorder

"Patient with this condition would become haggard, thin, antisocial, hypochondriacal, would lose his spontaneity and cheerfulness and would turn into a timid coward and liar. The final state was one of idiocy, epilepsy, paralysis and even death."

Asperger's disorder

- similar features of autism (e.g., social impairments, restricted range of interests), but differed in specific ways (e.g., no language deficits)

- eventually subsumed under the banner of Autism Spectrum Disorders

- some individuals diagnosed with Asperger's identified strongly with that label

- controversy around getting rid of the label

social constructionism

focus is not on the phenomenon per se, but rather on the social forces that construct it

useful abstractions (social constructionism)

- socially-constructed labels that summarize a constellation of co-occuring events of interest to society

- help us separate behaviors that are to be treated (studied, etc.) and those not to be treated

harmful dysfunction (Wakefield, 1992)

- a definition of behavior disorder comprising a factual component (i.e., dysfunction) and a value component (i.e., harmful)

- the impairment in function is seen to be harmful to the individual and/or society

- must involve break-down or impairment in the natural (i.e., evolutionarily-determined) function of behavior

purpose of classification

- provides nomenclature for practitioners

- descriptive psychopathology, epidemiology, and etiological theories

- sociopolitical functions (e.g., qualifying for disability/treatment)

- the basis for diagnosis, prognosis, and treatment

supernatural model

- abnormal behavior reflects possession of the individual by demons, witchcraft, displeasure of gods, eclipses, planetary gravitation, curses, and sin

- treatments included trephining (holes drilled in their head), magical & religious rituals, threats, bribery, and punishment

moral model

- abnormal behavior is deliberately adopted by the individual much in the manner of criminal behavior

- late 18th and 19th century

- treatments included locking them away or forcing them to live on the streets

factitious disorder

a mental disorder in which a person repeatedly and deliberately acts as if they have a physical or mental illness when they really do not (e.g., Munchausen Disorder by Proxy)

interpersonal theory

some models of depression cite secondary gains as a motivating factor behind symptom persistence (e.g., as others pick up slack when someone is depressed, they get used to that treatment and don't want to get better)

biological models

- there is a clear relationship between physical and mental health

- established evidence (with caveats) that psychotropic medication can prove useful for a variety of mental health conditions

phrenology

shape of the skull was associated with different personality predispositions and behaviors

chemical imbalance

different proportions of physical fluids determined physical health and temperament

Kraepelin (1856-1926)

- defined syndromes based on clusters of symptoms

- foundation for DSM used today

- classification based on anatomical pathology, etiology, and course/prognosis

- first classification of schizophrenia, manic-depressive, and personality disorders

psychosis

serious mental disorder characterized by a break with reality

neurosis

milder mental disorder characterized by distortions of reality

psychological model

- Freud built an entirely psychological model to account for behavior disorders

- posited that our biological impulses give rise to our motivations, but conflicts with our cognitive faculties (e.g., reason) and societal and individual learning histories create tensions that explain themselves as signs and symptoms

psychiatry in medicine

- early psychiatry focused on treating severe mental illness in the context of asylums

- followed from the assumptions that pathological anatomy, biological dysfunction, etc. was at the root of mental illness

- not regarded highly amongst the medical profession

Noguchi and Moore

- isolated the syphilitic bacterium in the brains of patients with dementia paralytica

- 1st "mental disorder" for which a biological basis was found

- but, just because there's a biological basis for one behavior disorder, doesn't mean that there is one for every disorder

Bertillon classification (1900)

- commissioned by the international statistical institute

- included a section on mental illness

DSM1 and DSM2

- effectively psychological manuals - did not align with medical explanations

- categories reflected broad underlying conflicts or maladaptive reactions to life problems (all disorders considered reactions to environmental events)

- no real differentiation between normal and abnormal behaviors

Rosenhan

- sent his undergraduate RAs to inpatient facilities and had them fake psychological symptoms

- they weren't able to get out even when they started behaving normally again

- concern from sociologists and psychologists about the labeling and stigmatizing effects of psychiatric diagnoses

- diagnoses were considered self-fulfilling prophecies in which patients adopt the behaviors implied by the label

Neo-Kraepelinians

- attempted to reaffirm mental illness as under the purview of psychiatry and reaffirm psychiatry as a branch of medicine

- bestowed the credibility of the medical profession in exchange for influence on the DSM-III

- clashed with humanistic and psychoanalytic movement influential in practice

DSM3

- theoretically agnostic, yet implicitly influenced by the medical model

- new hierarchical system with 17 major headings (e.g., mood disorders, anxiety disorders, etc.)

- multi-axial system categorizing patient along 5 dimensions (more holistic approach)

- adopted diagnostic criteria in contrast to prose descriptions

DSM4 and DSM4-TR

- retained all of the critical features of DSM3, but made some additions

- increased the coverage of disorders (up to 374 diagnoses from 265)

critiques of the DSM

- explicitly theoretical on the conception of mental illness, but implicitly based on disease model

- categorical model: either you are mentally ill or you are mentally healthy

- failure to consider comorbidity

- not therapeutically useful

- dubious process of including, excluding, and defining diagnosis

- political and social processes within and between stakeholders influenced the solutions adopted

coalition for DSM-V reform

- an open letter to the APA proposing to add new disorders with relatively little empirical support

- lowering of diagnostic thresholds

- development of novel scales with little psychometric testing

national institute of mental health (NIMH)

- research domain criteria: a research framework for new ways of studying mental disorder

- didn't want to give out grants for those studying the DSM

- funding studies that would help devise a new system for diagnosing mental illnesses

two factor theory

factor 1: when a stimulus is repeatedly paired with a bad experience, a meaning (fear) is learned which tends to prevent recurrence of that experience

factor 2: when a stimulus is repeatedly paired with a good experience, a meaning (fear decrement or hope) is learned which tends to insure recurrence of that experience

genetic factors (anxiety)

- anxiety disorders do aggregate in families (Hettema, Neale, & Kindler)

- genetics don't necessarily underly anxiety disorders, but some people can inherit an adaptation/liability to make fear associations more easily

lumping

- there really is only one anxiety disorder

- two-factor processes explain the etiology and maintenance of anxiety

- also explains the heterogeneity of anxiety disorders

- high comorbidity amongst anxiety disorders

splitting

- different anxiety disorders have different topographical/descriptive features

- differences result from differences in the signaling stimuli, nature of the conditioned response, etc

proximity to threat

- proximity of the signal to the threat is a major contributor in shaping the topography/descriptive characteristics of the anxiety response

- panic: imminent threat

- worry: problem solving to mitigate distal threat

- fight or flight: proximal, but avoidable threat

specific phobias

- marked and out of proportion fear within an environmental or situational context to the presence or anticipation of a specific object or situation

- exposure to the stimulus provokes an immediate anxiety response, which may take the form of a panic attack

- the person recognizes that fear is out of proportion

- the phobic situation is avoided or endured with intense anxiety

- the avoidance or distress interferes significantly with the person's normal routine

problem with two factor theory

- why can't I remember the fear being conditioned?

- infantile amnesia, insidious acquisition, fear responses need no verbal mediation

preparedness theory

- individuals are predisposed to fear certain things due to evolutionary pressures

- uneven distribution of fears: certain stimuli are more often tied to phobias

- rapid acquisition and resistant to extinction

panic disorder

- must have recurrent episodes where at least 4 of the symptoms are present

- at least 1 attack has been followed by 1 month or more of persistent concern about having additional attacks, worry about the implications of the attack, or a significant change in behavior relate to the attacks

initial panic attacks

- setting is very important

- might be the result of impaired functioning, entrapment, negative social evaluation, or unfamiliar locales

Barlow's alarm theory (1998)

- if the panic attack is a true alarm, then the recurrence of panic attacks is less likely

- if the person cannot identify the source of the threat that induced panic (a false alarm), the recurrence of a panic attack becomes more likely

interoceptive conditioning

- fear of fear

- Goldestein & Chambless (1978)

- low levels of bodily sensations (arousal, anxiety, etc.) may become the CS associated with higher levels of anxiety

- general apprehension toward panic paradoxically increases focus on bodily sensations

- cognitive misappraisals of physical symptoms or low levels of anxiety can lead to increased anxiety

agoraphobia

- fear of being in places in which escape might be difficult/help unavailable inc are of a panic attack; or symptom development that might be incapacitating or embarrassing

- marked anxiety in two or more of the following situations: public transportation, open spaces, enclosed spaces, standing in line or being crowded, being outside of the home

- a behavioral response (avoidance) to the anticipation of panic attacks (or other anxiety disorder)

GAD (generalized anxiety disorder)

- excessive anxiety and worry, occurring on more days than not for at least 6 months, about a number of events or activities

- individual finds it difficult to control the worry

- associated with 3 or more of these symptoms: restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance

- KEY FEATURE: chronic and uncontrollable worry that is excessive and unrealistic

SAD (social anxiety disorder)

- marked fear or anxiety about one or more social or performance situations in which the person is exposed to possible scrutiny by others (e.g., social interactions, performing)

- individual fears acting in embarrassing or humiliating ways

- exposure to feared social situation almost invariably provokes anxiety

- median onset is 13 years

temperament (SAD)

- infants with an inhibited temperament more frequently develop into children and adolescents who avoid novel or unfamiliar people, objects, and situations

- adults characterized as inhibited early in life showed greater fMRI signal response within the amygdala when presented with novel versus familiar faces

- environmental overprotectiveness can play a role, too

secure attachment

- template for others as accepting and dependable; template for self

- securely attached children have caregivers who are attentive, responsive, and consistent

insecure attachment

- template for others as critical and unreliable; template for self

- characterized by parents who are harshly critical, conditional, unpredictable, rejecting

childhood peer environments (SAD)

- SAD children more likely to experience negative peer relationships

- avoidance, anxiety behaviors, and social skills deficits all play role in maintaining SAD symptoms

syndrome

constellations of signs and symptoms that co-occur across individuals (e.g., antisocial personality)

the category for MOST psychiatric diagnoses

disorder

a syndrome that cannot be readily explained by other conditions (e.g., OCD)

disease

disorders in which pathology and etiology are reasonably well understood (e.g., Alzheimer's)

functions of psychiatric diagnoses

- offers a convenient vehicle for communication about an individual's condition

- establishes linkages with other diagnoses

- helps us learn new things (e.g., the course, rate of recovery, and treatment response from related conditions)

Szasz

- believed mental illness is a myth and people actually suffer from maladjustment

- thought psychiatric diagnoses were invalid, merely descriptive labels for behaviors we do not like

stigma

- a consequence not of diagnostic labels, but rather of disturbed and sometimes disturbing behavior that precedes labeling (e.g., children react negatively to children with ADHD who have joined their peer group)

- accurate psychiatric diagnoses sometimes reduce stigma, because they provide observers with at least a partial explanation for otherwise inexplicable behaviors

Kendall (biological model)

- basically natural selection, states that disorders are biological or evolutionary disadvantages to the organism (e.g., increased suicide risk with depression or risk of death with anorexia)

- however, being a soldier is not a disorder despite its adverse effect on longevity, and some disorders (like phobias) are not associated with decreased longevity or fitness, but are still mental disorders

harmful dysfunction

- the idea that all disorders are breakdowns of evolutionarily selected systems

- panic disorder reflects the activation of the fight-flight system in situations for which that system was not evolutionarily selected (basically a false alarm)

- HOWEVER, many medical disorders appear to be adaptive defenses (like coughing and sneezing to expel an infections agent) and some psychological conditions appear to be adaptive reactions to perceived threat (e.g., phobias)

Roschian construct

the attempt to define "disorder" explicitly is sure to fail because "disorder" is intrinsically undefinable

monothetic approach

the signs and symptoms are singly necessary and jointly sufficient for a diagnosis

polythetic approach

signs and symptoms are neither necessary nor sufficient for a diagnosis (disadvantage: extensive heterogeneity at the symptom and etiological levels: for example, 256 different symptom combinations are compatible with a diagnosis of BPD)

comorbidity

- co-occurance and covariation among multiple diagnostic categories

- often underestimated in routine clinical practice

- problematic because an ideal classification system yields largely mutually exclusive categories with few overlapping cases - extensive comorbidity may suggest that the current classification system is attaching multiple labels to differing manifestations of the same underlying condition

how did DSM5 overmedicalize normality

by increasing the number of diagnoses and lowering the threshold for a number of existing diagnoses

attenuation paradox

efforts to achieve higher reliability, especially internal consistency, can sometimes produce decreases in validity

categorical approach to classification (DSM)

"there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder"

- there is growing evidence from taxometric analyses that many or even most DSM diagnoses are underpinned by dimensions rather than taxa

self-perpetuating interpersonal cycle (Alden and Taylor)

socially anxious people go into social interactions expecting negative evaluation, and therefore behave in ways that "pull" on other people to evoke responses that maintain social assumptions through safety behaviors or distancing themselves emotionally from others

SAD - performance only

the DSM-5 now lists a different specifier in the diagnostic criteria for assigned to individuals whose anxiety is limited to public speaking or performing in public, and the generalized subtype of social anxiety disorder was removed

alcoholism and SAD

onset of SAD typically predates onset of alcohol dependence, suggesting that SAD is a risk factor for alcohol problems

structures that maintain SAD

- beliefs that social situations are inherently dangerous and that people are inherently critical

- behavioral avoidance and physiological symptoms

- Weeks and colleagues recently demonstrated that the core feature of social anxiety disorder is more accurately described as fear of any evaluation, either negative or positive

social competition (SAD)

persons with SAD formulate a mental representation of the self as seen by others, engaging in negative self-imagery such that their self-image is from this presumed critical observer's perspective

attentional biases (SAD)

- judgement and interpretation bias - socially anxious individuals tend to be their own worst critics and judge themselves more negatively than they judge others and also judge themselves more negatively than they are judged by others

- memory and imagery biases - individuals with SAD preferentially remember socially threatening information relative to neutral information or information that is threatening but lacking personal salience

no-win situation (SAD)

almost any socially relevant information, whether it is negative, ambiguous, or positive, is perceived negatively and interpreted as costly, undoubtedly affecting the quality of social interactions

observer perspective

- predominant for individuals with SAD

- see themselves through the eyes of others, as if viewing themselves on videotape

field perspective

people recall situations as viewed through their own eyes

differentiating factor for children and adolescents (panic disorder)

adolescents are more likely than children to report a fear of going crazy

interoceptive avoidance

strong sensitivity to and avoidance of the internal bodily symptoms associated with anxiety and panic

safety behaviors

behaviors which are intended to avoid disaster - a dysfunctional emotion regulation strategy that can be differentiated by adaptive coping both by the situation in which they occur and by their function, preventing feared outcomes that are unlikely to happen

experimental avoidance

when a person is unwilling to remain in contact with particular private experiences (e.g., bodily sensations, emotions, thoughts, memories, behavioral predispositions)

cognitive features of panic disorders

- strong beliefs and fears of physical or mental harm arising from bodily sensations that are associated with panic attacks

- more likely to interpret bodily sensations in a catastrophic fashion

- sometimes demonstrate memory abnormalities

neuroticism (related to panic)

proneness to experience negative emotions in response to stressors

negative affectivity (related to panic)

the tendency to experience an array of negative emotions across a variety of situations, even in the absence of objective stressors (higher-order factor that distinguishes individuals with anxiety and/or depressive disorders from controls with no mental disorder)

prediction

- refers to a contingency (cause-effect) awareness of events in the environment, as well as outcome prediction by virtue of one's own responding, and control refers to control over emotions and outcomes via one's own attention and behaviors

- Mineka, Gunnar, Champoux (1986): demonstrated that infant monkeys who were granted control over toys and food habituated more quickly to novel stimuli, demonstrated more exploratory behavior in a novel playroom, and demonstrated enhanced coping responses during separation from peers compared to infants without control

parental overprotectiveness (related to panic)

the presence of child behavior symptoms accounted for the relationship between parental protectiveness and child anxiety symptoms, suggesting that parental overprotectiveness may stem from other child symptoms (anxious mothers criticize and catastrophic more, and display less warmth and autonomy granting toward their children)

Schwartz (2012)

demonstrated that greater parental aggression predicted higher adolescent anxiety and depression anxiety - thus, maladaptive parental behaviors such as overinvolvement and aggression may characterize parents of children with significant psychopathology or distress rather than children with anxiety disorders or panic in particular

stress-diathesis model

- a psychological theory that attempts to explain a disorder as the result of an interaction between a predispositional vulnerability and a stress caused by life experiences

- the tendency to experience cardiac symptoms and shortness of breath may develop into full-blown panic when instances occur in threatening contexts or following life stressors, when the sensations are more likely to be perceived as threatening

- high levels of stressful life events interacted with a sub scale of anxiety sensitivity (the physical concerns sub scale) to predict panic attacks in the past week and agoraphobic avoidance

GAD cognitions

- more future-oriented than anxiety-related thoughts in other anxiety disorders (e.g., panic and social phobia)

- indistinguishable in content from those reported by nonclinical settings, but increased frequency and intensity of worry

- inability to control the worry

stressful life event

- Blazer, Hughes, and George (1987)

- the presence of at least one stressful life event defined as unexpected, negative, and very important was associated with an increased risk of developing GAD symptoms - this association was more dramatic for men who had experienced more than four stressful life events

negative problem orientation (GAD)

dysfunctional attitudes and low confidence about one's own ability to solve problems

time management (GAD)

worry has no relationship with time management behaviors, but does have a negative relationship with time structure and purpose (e.g, possessing the notion that one's time use has purpose, being present-focused, demonstrating persistence when completing tasks) therefore, worry as seen in GAD is likely influenced by the thoughts and feelings individuals have toward their problem-solving abilities and the perception that they are not using their time for purpose

responses to chronic worry (GAD)

individuals with GAD reported a greater use of worry (e.g., thinking more about minor problems) and punishment (e.g., shouting at oneself) strategies than did non anxious controls, and less use of distraction and social control strategies

probability overestimation (GAD)

thinking a feared consequence is more likely to occur than it really is

catastrophizing (GAD)

assuming that an outcome will be much less manageable than it really is

cognitive avoidance theory of worry

- proposes that worry is an attempt at cognitive avoidance - the verbal activity of worry distracts individuals from the full experience of fear (e.g., feared imagery, sensations of arousal, etc.)

- studies show that worry is primarily a verbal and linguistic activity rather than an imagery-based process, and tends to be less concrete and more abstract than other types of thought, making it less likely o activate emotional processing

- college students who meet criteria for GAD report more use of worry to distract themselves from emotional topics than control participants

Newman and Ilea (2011)

- their contrast avoidance model draws on evidence that worry does not necessarily enable avoidance of negative emotional experiences; instead, individuals with GAD use worry to avoid sharp increases in negative emotions, also known as negative contrast

- posited that the chronic distress associated with worry helps individuals prepare for negative events and precludes an increase in distress should the negative outcome occur - the contrast between anxiety-related distress and relief is heightened when the anticipated negative outcome fails to occur