Chapter 15 disorders

Depersonalization

feelings of detachment or unfamiliarty with oneself or aspects of oneself

Derealization

feelings of unfamiliarity or detachment from the world

derealization disorder

a recurring episode of derealization in a disorder

* derealization: feelings of unfamiliarity or detachment from the world

Dissociative fugue

wandering away from home, experience confusion about their identity, or may adopt a new identity

Dysfunction

A characteristics of a disorder: Any impairment, disturbance, or deficiency in behavior.

Ex: Someone with ADHD not being able to concentrate or remember deadlines.

Social Deviance / Atypical

A characteristics of a disorder: Behavior that does not follow socially established norms.

Ex: Talking to someone who isn't there, or wearing unusual clothing.

**violation fo cultural norms does not always mean a disorder*

Comorbidity

Having 2 mental or physical diseases at the same time.

Diagnostic and Statistical Manual of Mental Disorders (DSM)

The handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders.

* International classification of disorders
* Compassionate View of Mental Disorders


* Categories: Anxiety Disorders, Depressive Disorders, and Dissociative Disorders
* Contains overview of disorder, specific symptoms required for diagnosis, prevalence information, and risk factors
* Research purposes

Biopsychosocial Model

A model of health that asserts that biology, psychology, and social factors (nature + nurture + thoughts) interact to determine an individual's health.

Diathesis-Stress Model

A diagnostic model that states that a person may be susceptible to having a psychological disorder (nature) which remains unexpressed until triggered by stress (nurture).

* Psychosocial perspective
* Emphasizes learning, stress, faulty/self-defeating thinking patterns, and environmental factors. 
* Disorders originate from a combination of biological and psychosocial factors. 
* Diathesis- predisposition for a disorder 
* Stress- adverse environmental/psychological events

Specific Phobias

Any of the disorders characterized by extreme and irrational fear of a particular object or situation.

* Acquisition
* Classical Conditioning
* Vicarious Learning/Modeling 
* Verbal Transmission

Acrophobia

Fear of heights.

Claustrophobia

An abnormal fear of narrow, enclosed spaces.

Hematophobia

Fear of blood.

Xenophobia

A fear or hatred of foreigners or strangers.

Agoraphobia

An abnormal fear of open or public places.

* Classified as a separate anxiety order 
* characterized by intense fear, anxiety, and avoidance of situations in which it might be difficult to escape or receive help if one experiences symptoms of a panic attack

Panic Disorder

An anxiety disorder that consists of sudden, overwhelming panic attacks.

* Recurrent and unexpected panic attacks along with at least 1 month of persistent worry about additional panic attacks, consequences of the attacks or changes in behaviour in relation to attacks (avoidance of unfamiliar situations) 
* Panic attacks
* Theories 
* Abnormal norepinephrine activity in the locus coerulus, __which is responsible for our fight of flight response__ 
* Conditioning through subtle bodily sensations resembling those normally occurring when one is anxious or frightened 
* Cognitive: interpretation of normal body sensations as dangerous or catastrophic, causing panic

Panic Attack

Brief, intense episode of extreme fear characterized by sweating, dizziness, light-headedness, racing heartbeat that have not obvious cause.

* dizziness, lightheadedness, shortness of breath, nausea or abdominal distress, chest pain, palpitation, increased heart rate, hot flashes, chills, fear of losing control/going crazy, fear of dying. 
* May be triggered by specific situations 
* Reaches peak within 10 minutes

Night Terror

A sleep disorder characterized by panic attacks during sleep.

Locus Coeruleus

A small area of the brain that seems to be active in the regulation of emotions. Many of its neurons use norepinephrine.

Social Anxiety Disorder

Disorder characterized by an intense fear of social situations.

* treatment that could lessen the chance of negative social outcomes: safety behaviors

Generalized Anxiety Disorder

An anxiety disorder in which a person is continually tense, apprehensive, and in a state of anxiety for 6 months or longer with no specific cause.

* State of continuous persistent and excessive anxiety/worry about everyday things
* Anxiety must not be part of another disorder and they must exhibit symptoms more days than not in a 6 month period to receive diagnosis

Obsessive Compulsive Disorder (OCD)

A disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions).

* Experience intrusive and unwanted thoughts and urges (obsessive) and/or need to engage in repeated physical or mental acts (compulsive) 
* __Obsessive thoughts__: unwanted, distressing, unintentional 
* __Compulsions__:  repetitive and ritualistic acts used to lessen the distress triggered from obsessions or reduce the likelihood of a feared event

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* Causes of OCD
* Genetic factors 
* A brain region called the orbitofrontal region of the brain is said to play a critical part in causing OCD. It is involved with learning and decision making.
* OCD circuit: consists of several interconnected regions that influence both the emotional value of stimuli as well as the selection of both behavioral and cognitive responses. 
* Also shows heightened activity when provoked, suggesting that abnormalities in this region of the brain could be a cause for OCD.

Body Dysmorphic Disorder

A disorder characterized by the unrealistic perception of physical flaws and a desire to change one's appearance.

Hoarding Disorder

A disorder characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value.

Trichotillomania (Hair Pulling)

A disorder in which the person compulsively pulls at his or her hair, from the scalp, eyebrows, and other body areas.

Obsession

A persistent, unwanted thought or idea that keeps recurring.

Compulsion

Uncontrollable urge to perform an act repeatedly.

Ex: Knock on a door, avoid stepping on sidewalk cracks, wash hands, etc.

Post-Traumatic Stress Disorder (PTSD)

An anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for weeks or months after a traumatic experience.

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* Caused by exposure to, witnessing or experiencing extreme trauma that include serious injury, threatened death, or sexual assault. 
* Symptoms include 
* Distressing and intrusive memories of the trauma 
* __*Flashbacks*__, which is a state that can last for a few seconds to a few days during which the person relives their trauma and acts as if it were happening at that moment. 
* Persistent negative emotions 
* Avoidance of stimuli associated with the event
* Feelings of detachment from others, prone to outbursts, and jumpiness 
* Risk factors include
* Trauma experienced, greater trauma severity, lack of immediate social support, and subsequent life stress. 
* Development and Support
* Social support has been shown to decrease the likelihood of PTSD
* Classical Conditioning may be a cause for the development and maintaining of symptoms 
* Traumatic experience causes extreme fear and anxiety 
* Conditioned stimuli include cognitive, emotional, physiological, and environmental cues
* Traumatic reminders induce extreme fear and anxiety 
* Cognitive factors: 
* Cruicial: Disturbances in memory of the event and negative appraisal of the event and its aftermath 
* Some people may not encode the memory correctly, leading to only bits and fragments of the trauma being encoded. This leads to the inability to see the event in context and meaning .
* Fragments stand out and may trigger the person 
* Negative appraisal may lead to dysfunctional behaviour

Flashback

In people suffering from PTSD, the feeling of reliving a traumatic experience.

Adjustment Disorder

A disorder characterized by unhealthy, emotionally overreactions to a change in life.

Major Depressive Disorder

A mood disorder in which a person feels sad and hopeless for weeks or months.

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* Depressed mood most of the day, nearly every day, loss of interest/pleasure in activities one used to enjoy.
* Episodic: symptoms are present at their full magnitude for a certain period of time before gradually abating.
* Diagnosis requires at least 5 symptoms for 2 weeks that cause significant distress or impair normal functioning, and that are not caused by a substance or medical condition.
* Symptoms:
* Significant weight loss/gain when not dieting, or a decrease/increase in appetite
* Difficulty falling asleep or sleeping too much
* Psychomotor agitation: jumpy, fidgeting, or psychomotor \[r word\]: slow movement, talking softly or very little and often in a monotone.
* fatigue/loss of energy
* Feelings of guilt or worthlessness
* Concentration difficulties and indecisiveness
* Suicidal ideation

Persistent Depressive Disorder (Dysthymia)

Mood disorder involving a persistently depressed mood for at least 2 years, with no absence of symptoms for more than 2 months.

Seasonal Affective Disorder (SAD)

A mood disorder caused by the body's reaction to low levels of sunlight in the winter months.

Bipolar Disorder / Manic Depression

A mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.

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* Often Expereinces mood states that alternate between depression and mania.
* Mania symptoms
* Distinct and abnormal and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least one week
* Lasts most of the day for the manic period 
* Euphoric mood or hostile mood 
* Easilty distracted, talkative, flight of ideas, taking on several tasks at once
* Show little to no need for sleep
* Engagement in pleasurable but harmful activities like shopping sprees, foolish investments or reckless driving 
* Reckless behaviours may be illegal, antisocial or dangerous 
* Subtype:
*  rapid cycling characterized by four manic or a combination of four manic and depressive episodes within a year

Mania

A mood disorder marked by a hyperactive, wildly optimistic state in which a person feels invincible and has little sense of consequences.

Flight of Ideas

Symptom of mania that involves an abruptly switching in conversation from one topic to another.

Delusions, Hallucinations, Disorganized Thinking/Speech, Disorganized Motor Movements, Negative Symptoms

Five Symptoms Associated with Schizophrenia

Delusions

False beliefs held by a person who refuses to accept evidence of their falseness. Ex: Believing someone is out to get you, believing you can fly, etc.

Paranoid Delusions

Delusions characterized by beliefs that others are out to harm them

Grandiose Delusions

Delusions involving beliefs that one holds special power, unique knowledge, or is extremely important

Somatic Delusions

Delusions involving beliefs that one's body is changing in an unusual way, such as growing a third arm

Hallucinations

Perceiving things that are not there, such as hearing voices.

* in schizophrenia: the most common hallucination is auditory
* visual hallucinations are more commonly linked withh substance use diorder and withdrawal
* tactile and olfactory hallucinations are rare

Disorganized Thinking/Speech

A severe disruption of verbal communication in which ideas shift rapidly and incoherently from one to another unrelated topic.

Disorganized Motor Behavior

Highly unusual behaviors and movements, repeated and purposeless movements, and displaying odd facial expressions and gestures.

* includes catatonic

Negative Symptoms

Schizophrenic symptoms that involve behavioral deficits, such as flattened emotions, social withdrawal, apathy, impaired attention, and poverty of speech.

* includes avolition, alogia, asociality, anhedonia

Alogia

reduced speaking

* type of negative symptom in schizophrenia

avolition

lack of motivation to engage in meaningful and self-initiated activties, such as taking bath

* a type of negative symptom in schizophrenia

asociality

social withdrawal or lack of interest in interactions with others

* a type of negative symptom in schizophrenia

Anhedonia

lack of pleasure

* a type of negative ymptom in schizophrenia

Schizophrenia

A psychological disorder characterized by delusions, hallucinations, disorganized speech, disorganized motor movements, and/or diminished, inappropriate emotional expression.

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* **Causes**
* **Genetic basis**
* Studies from research on twins, relatives, and adoptees showed that __schizophrenia had a genetic factor__, and children having a high risk for schizophrenia genetically and being raised in a disturbed household had increased risk of having it
* **Neurotransmitters**
* **Dopamine hypothesis:** during studies that showed an increase in dopamine caused schizophrenia-like symptoms and medications that blocked dopamine reduced the symptoms, this theory suggests that too much dopamine/dopamine receptors play a part 
* **Brain Anatomy**
* Large ventricles, which means less brain mass in other areas, suggesting that schizophrenia may be caused by lack of brain tissue 
* **Events during Pregancy**
* Catching influenza, mother’s stress, and obstetric complications may all increase the risk of developing schizophrenia
* **Marijuana**
* Those with schizophrenia are more likely to use marijuana, and it is a risk factor 
*  *Warning signs include unusual thought content, paranoia, delusions, odd communication, problems in school/work and a decrease in social functioning*

Dopamine Hypothesis of Schizophrenia

Theory that schizophrenia results from excess activity at dopamine synapses in certain brain areas.

* during studies that showed an increase in dopamine caused schizophrenia-like symptoms and medications that blocked dopamine reduced the symptoms, this theory suggests that too much dopamine/dopamine receptors play a part

Dissociative Amnesia

Disorder characterized by the sudden inability to recall important personal information, usually of a traumatic or stressful nature.

* Inability to recall important person information , usually following a traumatic or very stressful experience, such as combat, natural disasters or sexual violence 
* Dissociative fugue

Dissociative Identity Disorder (DID)

A rare disorder in which a person exhibits two or more distinct and alternating personalities. Formerly called multiple personality disorder.

* Two or more distinct personalities 
* Memory gaps when another identity is in charge 
* Some may hear voices

Attention Deficit Hyperactivity Disorder (ADHD)

A disorder characterized by restlessness, inattentiveness, and impulsivity.

* Symptoms include hyperactivity, impulsiveness,  lack of attention span, forgetting, disorganization, easily distracted, and failure to follow instructions. 
* Thought to be caused by genetic factors, more specifically genes associated with the regulation of dopamine

Attention Deficit Disorder (ADD)

Disorder in which a person is unable to focus and is easily distracted.

Autism Spectrum Disorder (ASD)

A disorder characterized by deficits in social relatedness and communication skills that are often accompanied by repetitive, ritualistic behavior.

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* Symptoms include deficits in social interaction and communication, as well as repetitive patterns of behavior or interest 
* Isolated, may not recognized social cues or facial expressions, inability to speak, only able to speak one-word phrases, repetitive movements (stimming), great distress in changes in routine 
* Hyperfixation 
* Spectrum: those with autism can display their symptoms in many ways and in different magnitudes
* There is no link of autism with the MMR vaccine
* Autism is a genetic, environmental, and/or biological factors

Specific Learning Disabilities (SLD)

Disorders in which students have normal cognitive functioning and the ability to learn some skills and strategies quickly, but have great difficulty learning other skills and strategies.

Tourette's Disorder/Syndrome

A neurological disorder beginning in childhood that involves stereotypical, repetitive motor movements (tics). These are often accompanied by multiple vocal outbursts such grunting. It is about three times more prevalent in boys than in girls.

Parkinson's Disease

A progressive disease that destroys brain cells and is identified by muscular tremors, slowing of movement, and partial facial paralysis. Most common in older people.

Personality Disorders: Cluster A

Cluster of personality disorders that involve behavior that seems unusual and eccentric to others.

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mnemonic:

a. **weird**


1. accusatory: paranoid (suspicious)
2. aloof: schizoid (voluntary social withdrawal)
3. awkward (schizoid + magical thinking)

b. **wild**


1. bad: antisocial (>/=18 years with a history of Conduct Disorder, Sociopath and Manipulative)
2. borderline: borderline (unstable and afraid of abandonment)
3. flamBoyant: histrionic (attention-seeking and excesion emotionality)
4. best: narcissistic (grandiosity, reacts to criticisms)

c. **worried**


1. Cowardly: Avoidant (Seeks social relationship but avoids social situation; hypersensitive to rejection)
2. Compulsive: Obsessive-compulsive (Inflexible but inefficient)
* Obsessive-compulsive personality disorder: Ego-syntonic (happy with how they are)
* Obsessive-compulsive disorder: Ego-dystoni (wishes they could stop)
3. Clingy: Dependent (Submissive)

Paranoid Personality Disorder

A personality disorder marked by a pattern of distrust and suspiciousness of others.

* cluster A personality disorder

Schizoid Personality Disorder

A personality disorder characterized by persistent avoidance of social relationships and little expression of emotion.

* cluster A personality disorder

Schizotypal Personality Disorder

A personality disorder involving a discomfort with, and reduced capacity for, close relationships, as well as cognitive or perceptual distortions and eccentricities of behavior.

* cluster A personality disorder

Personality Disorders: Cluster B

Cluster of personality disorders that feature emotional, dramatic, or erratic behaviors.

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mnemonic:

a. **weird**

b. **wild**

c. **worried**

Antisocial Personality Disorder

A personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. May be aggressive and ruthless or a clever con artist.

* cluster B personality disorder


* Diagnosis requires 18 years of age 
* Seemingly no moral compass
* Lack of empathy, impulsive, and reckless, irritable and aggressive 
* Sense of over self-importance, arrogance

Borderline Personality Disorder

A personality disorder characterized by lack of stability in interpersonal relationships, self-image, and emotion; impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal gestures.

* cluster B personality disorder


* Instability in interpersonal relationships, mood and self image. Impulsive 
* Cannot tolerate being alone 
* Instability is view of self can cause changes in personal attitudes, interests, career plans, and choice of friends
* Causes: genetic, some characteristics seem to be heritable, those with borderline personality disorder also report higher childhood physical, emotional and sexual abuse, so the environment is also crucial.

Histrionic Personality Disorder

A personality disorder characterized by excessive emotionality and preoccupation with being the center of attention, emotional shallowness, and overly dramatic behavior.

* cluster B personality disorder

Narcissistic Personality Disorder

A personality disorder characterized by exaggerated ideas of self-importance and achievements, preoccupation with fantasies of success, and arrogance.

* cluster B personality disorder

Personality Disorders: Cluster C

Cluster of personality disorders that are based on anxiety and/or fear.

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mnemonic:

a. **weird**

b. **wild**

c. **worried**

Avoidant Personality Disorder

A personality disorder characterized by consistent discomfort and restraint in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to negative evaluation.

* cluster C

depersonalization disorder

Recuring episodes of depersonalization, which is the feelings of detachment or unfamiliarity or detachment from the world

Dependent Personality Disorder

A personality disorder characterized by a pattern of clinging and obedience, fear of separation, and an ongoing need to be taken care of.

* cluster C

Obsessive-Compulsive Personality Disorder

A personality disorder characterized by preoccupation with orderliness, perfection, and control

psychological diorders

Exhibiting atypical, distressful, dysfunctional, or dangerous behaviors thoughts and inner experiences could be used to conceptualize someone as having a psychological disorder

* APA Definition: 
* Significant disturbances in thoughts feelings and beahviour 
* The disturbances reflect some kind of biological, psychological, or developmental dysfunction
* Stress/disability in one’s life 
* Disturbances do not reflect expected/culturally approved responses to an event

Psychopathology

study of psychological disorders

* includes etiology

Etiology

study of causes for psychological disorders

Dysfunctional

internal mechanism breaks down

* Must be harmful in order to be characterized as a disorder

International classification of disorders 

Categories and criteria similar to DSM 

* Used in clinical settings and to measure prevalence of diseases and general health of populations

Compassionate View of Mental Disorders

A view that states that psychological disorders are just more extreme inner experiences and behaviour 

* People are more than their disorders.

Supernatural perspective

a POV that viewed psychological disorders as an attribute to a force beyond scientific understanding

* Often mental illnesses were attributed to dark spirits or witchcraft

Biological Perspectives 

A perspective that states that there is a link with psychological disorders with biological factors such as genetics, brain abnormalities, and chemical imbalances

* Genetics, brain abnormalities, neurotransmitters and hormones may all play a role in causing psychological disorders

diathesis

predisposition for a disorder

Anxiety disorders 

a disorder characterized by  persistent and excessive anxiety/worrying 

* Anxiety vs Fear
* Fear is an instanteous reaction to a threat, while anxiety involves apprehension, avoidance and cautiousness regarding a potential threat

Safety Behaviours

mental or physical acts that reduce anxiety by reducing the chances of negative social outcomes 

* Avoiding eye contact, rehearsing sentences before speaking, talking only briefly, avoiding talking about oneself,  assuming roles with little social interaction, asking people many questions to avoid focus on oneself, selecting a position to avoid contact with others, wearing bland neutral colors to avoid attention, and  avoiding substances or activities that may worsen symptoms

mood disorder

a disorder is charactertized by disturbances in mood and emotion. 

* Often depression, but may also be mania/elation 
* Fluctuations in mood are extreme, distort their outlook on life, and impair their ability to function 


* DSM Categories 
* Depressive; depression is main feature. Depression is persistent and intense sadness. Feelings of discouragement and hopelessness may also occur. 
* Loss in interest in activities, less hunger/sex drive 
* A broad spectrum of symtoms that range in severity 
* Bipolar and related disorders: often have mania as a main feature. Mania is intense feelings of agitation and elation.
* Biological basis
* Strong genetic predisposition


* Diathesis-Stress Model & MDD
* Stressful life events can lead to depression, as well as numerous biological factors 
* Traumatic childhoods increase risk of development 
* Alteration in a gene that is in involved in the regulation of serotonin may also be a factor 
* Cognitive Theories about Depression
* Triggered by negative thoughts, interpretations, self evaluations, and expectations 
* Aaron Beck: Depression prone people have a mental predisposition to think about things in a negative way
* Themes of loss, failure, rejection, worthlessness, inadequacy 
* May result from childhood experiences 
* Hopelessness Theory: particular style of negative thinking leads to hopelessness 
* Hopelessness is defined as the expectation that negative things will occur or that desired outcomes will not occur. 
* Assumes that hopelessness stems from a tendency to believe that negative life events as being stable and global. 
* Stable: unable to chance 
* Global: affects everything 
* Third theory focuses on rumination and how people’s thoughts on their depression can increase the duration and risk 
* Rumination: the passive and repetitive thinking about one’s depression and dweling on it rather than distracting oneself or trying to actively treat it 
* Suicide

Episodic

symptoms are present at their full magnitude for a certain period of time before gradually abating

* major depresive disorder is usually handled as episodic, ut many live with it as chronic

Peripartum onset/postpartum

a type of depression experienced by women during pregnancy or up to 4 weeks after giving birth

aaron beck

the person who stated that Depression prone people have a mental predisposition to think about things in a negative way

* Themes of loss, failure, rejection, worthlessness, inadequacy 
* May result from childhood experiences

Hopelessness Theory

the theory that claims that a particular style of negative thinking leads to hopelessness 

* Hopelessness is defined as the expectation that negative things will occur or that desired outcomes will not occur. 
* Assumes that hopelessness stems from a tendency to believe that negative life events as being stable and global. 
* Stable: unable to chance 
* Global: affects everything

rumination

the passive and repetitive thinking about one’s depression and dweling on it rather than distracting oneself or trying to actively treat it

* this is associated with a theory taht focuse on rumination adn how people’s throught on their depresion can increase the duration and risk

suicide

death as a result of injurious behaviour with the intention of death

thought insertion

a type of deluion that the person believes that one’s thought are being placed inside their head

Thought withdrawal

a type of delusion that the person believes that one’s thoughts are being removed

Catatonic

decreased reactivity to the environment

* also a disorder that disrupts a person’s awareness of the world around them


* included in disorganized/abonrmal motor behavior

flat affect

a lack of emotional responsiveness

* may be elated or depressed, but otehrs cant tell
* may be uncaring and unresposnive, but you still feel an emotion

\*there is a diconnect between emotions and how you express them

inappropriate affect

Display of emotions that are unsuited to the situation; a symptom of schizophrenia.

cland associations

rhythmic/rhyming patterns associated with psychotic speech

neologisms

Made-up words that typically have only meaning to the individual who uses them.

The Cognitive Triad

Aaron Beck, Depression comes from people having unreasonably negative ideas about themselves, their world, and their future.