Ch 15 variations in mental health

When Do Behaviors Become Symptoms? Criteria

• Atypical (unusual)

• Maladaptive (dysfunctional)

• Personally distressful (troubling)

• When abnormal behavior persists,

it may lead to the diagnosis of a

psychological disorder.

Biological Approach: Medical Model

• Mental health conditions are medical diseases with a biological origin.

Psychological Approach

Emphasizes experiences, thoughts, emotions, and personality characteristics.

Sociocultural Approach

• Emphasizes social context, including culture.(Amok)

Biopsychosocial Model

• Interaction of biological, psychological, and sociocultural factors.

• Vulnerability-stress hypothesis. Some people are predisposed and are at greater risk for a psychological disorder. ( Abuse or neglect)

Classifying Mental Health Conditions Advantages

• Provides a common basis for communication.

• Helps clinicians make predictions.

Classifying Mental Health Conditions Disadvantages

Stigma (shame, negative reputation).

• May cause others to avoid or to act negatively toward a person.

• Influence a person’s life profoundly.

DSM Classification System: Critiques

• Reflects only the medical model.

• Neglects factors such as poverty, unemployment, and trauma.

• Focuses on weaknesses, ignores strengths.

• Relies too much on social norms and subjective judgments.

• Descriptions are not precise nor distinctive across diagnoses.

Conditions needing more research-internet gaming disorder

• Inability to control gaming behavior and experience

symptoms of withdrawal while trying to quit.

• Effects about 2 to 7% of people

• Impacts more men than women

• Passionate engagement vs. Addiction

Comorbidity

Two or more conditions at the same time.

Etiology.

The causes of conditions.

Risk factors

Characteristics, experiences, or exposures (Correlations)

Final Terms and Cautions

Only trained professionals in psychological disorders can diagnose people.

Neurodevelopmental Conditions

Neurodevelopmental disorders typically appear in childhood and are traced to genetic differences, atypical brain development, or prenatal exposure to substances that adversely affect development.

Neurodevelopmental Conditions

Include

• Autism spectrum disorder.

• Attention deficit/hyperactivity disorder

Autism Spectrum Disorder Key Features

• Deficits in communication/interaction.

• Restrictive/repetitive behaviors, interests

Autism Spectrum Disorder Etiology

• Not caused by parenting styles or vaccinations (illusory correlation, referring to two vivid events occurring at the same time and perceived as linked).

• Genetic and brain differences.

• Etiologically diverse (multiple causes).

• 1 in 54 8 years olds are diagnosed with ASD

Autism Spectrum Disorder

Treatment

• Applied behavior analysis.

Attention Deficit/Hyperactivity Disorder

Main symptoms.

• Inattention.

• Hyperactivity.

• Impulsivity.

Attention Deficit/Hyperactivity Disorder Etiology

• Fetal risk factors (premature, low birth weight, teratogens such as lead)

• Some people have experienced abuse

• Genetics

• Delayed brain maturation ( prefrontal cortex)

• Dysregulation of neurotransmitters ( Dopamine)

Attention Deficit/Hyperactivity Disorder

Treatment

• Stimulant medication

Anxiety and Anxiety-Related Conditions

Disorders involving fears that are uncontrollable,

disproportionate, and disruptive.

Features motor tension, hyperactivity, and apprehensive

expectations and thoughts.

Anxiety and Anxiety-Related Conditions

Includes

• Generalized anxiety disorder.

• Panic disorder.

• Specific phobia.

• Social anxiety disorder.

Generalized Anxiety Disorder Symptoms

Persistent anxiety for an extended period.

• Inability to specify reasons for the anxiety.

• May also experience physical symptoms.

Generalized Anxiety Disorder Etiology

Biological factors.

• Genetic predisposition, GABA deficiency,

respiration, and regulation of the sympathetic

nervous system.

Generalized Anxiety Disorder Etiology

Psychological and sociocultural factors.

• Harsh self-standards, uncertainty, negative

thoughts, and trauma.

Panic Disorder Symptoms

• Recurrent, sudden onsets of intense terror that often occur without warning

and with no specific cause.

• May feel like a heart attack.

Panic Disorder Etiology

Biological factors: genetic predisposition.

• Neurotransmitters (norepinephrine, GABA, and serotonin) .

• Elevated Lactate

• Psychological factors: C O2 conditioned stimulus.

Sociocultural factors: Gender differences(women)

Specific Phobia Symptoms

• An irrational, overwhelming, persistent fear of a particular object or situation (for example, spider phobia). Many forms of the disorder.

Specific Phobia Etiology

• Psychological factors: Experiences, memories and learned associations.

• Biological factors: Gender differences, parent with mental health conditions.

Social Anxiety Disorder Symptoms

• Intense fear of being humiliated or embarrassed in social situations.

• Avoid going to places like a birthday party or public speaking

• Shaking, sweating, getting upset before getting into the situation

Social Anxiety Disorder Etiology

Biological factors:

• Genetic characteristics.

• Neural circuitry involving the thalamus and amygdala and cerebral cortex.

• Low Oxytocin levels

Psychological factors:

• Learning experiences in a social context.

Obsessive-Compulsive Disorder Symptoms

Persistent anxiety-provoking thoughts and/or urges to perform repetitive, ritualistic behaviors to prevent or produce a situation.

Obsessive-Compulsive Disorder

• Obsessions: recurrent thoughts.

• Compulsions: recurrent behaviors.

Obsessive-Compulsive Disorder Etiology

Biological factors:

• Genetic predisposition.

• Low levels of neurotransmitters.

• Digestive and “gut” issues.

• Overactivation of frontal cortex or basal ganglia.

Obsessive-Compulsive Disorder Etiology

Neurological factors:

• Hyperactive brain.

Psychological factors: Avoidance learning: Learned to avoid the aversive stimulus and

nothing bad happens

Difficulty dismissing negative thoughts

Obsessive-Compulsive Disorder: Related Disorders

• Hoarding disorder.

• Excoriation disorder (skin picking).

• Trichotillomania (hair pulling).

• Body dysmorphic disorder.

Post-Traumatic Stress Disorder Diagnosis and Symptoms

Symptoms develop as a result of exposure to a traumatic event that overwhelms the person’s abilities to cope, such as natural disasters, war, unnatural disasters, child abuse, or sexual victimization.

PSTD Symptoms include:

Flashbacks.

• Avoidance of emotional experiences.

• Emotional numbness.

• Excessive arousal.

• Difficulties with memory and concentration.

• Sleep difficulties/bad dreams.

• Impulsive behavior.

Dissociative Disorders

Disorders that involve a sudden loss of memory or change in identity.

Dissociation

• Feeling of disconnection from immediate experience.

• Protection from extreme stress or shock.

• Problems pulling together emotional memories.

Dissociative Disorders Includes

• Dissociative amnesia.

• Dissociative identity disorder (D I D).

Dissociative Amnesia

• Amnesia: Inability to recall important events.

• Individuals experience extreme memory loss caused by extensive psychological stress.

• Individuals remember everyday tasks, but not aspects of their own identity and autobiographical experiences.

• Dissociative fugue: Unexpectedly traveling away from home.

• Caused by extremely stressful events.

Dissociative Identity Disorder Diagnosis and Symptoms.

• The same individual possesses two or more distinct

personalities.

• Each personality has unique memories, behaviors, and

relationships.

• Only one personality is dominant at a time

Dissociative Identity Disorder Etiology

• Extraordinarily severe abuse in early childhood.

• More common in women.

• Genetic predisposition. (runs in families)

• Brain abnormalities: Lower cortical thickness and surface area, and lower hippocampus area

Depressive Disorders

Disorders in which individual experiences depression. An unrelenting lack of pleasure in life.

Major depressive disorder (MDD)

Significant depressive episode and depressed characteristics, such as lethargy and hopelessness.

Depressive Disorders Symptoms may include.

Fatigue, sense of worthlessness, and reduced interest.

• Appetite and sleep disturbance.

• Problem in making decisions, recurrent suicidal thoughts and euphoric mood.

Etiology of MDD Biological factors:

• Genetic disposition.

• Underactive prefrontal cortex.

• Regulation of neurotransmitters.

Etiology of MDD Psychological factors:

• Stressful or negative life events.

• Learned helplessness.

• Ruminating on negative, self-defeating

thoughts.

• Pessimistic attributional style.

Etiology of MDD Sociocultural factors:

• Poverty, hopelessness, and alcohol abuse.

• Gender differences.

Bipolar Disorder

Characterized by extreme mood swings that include mania

• Bipolar I—Extreme manic episodes ( euphoria, hallucinations)

• Bipolar II—Milder version (less extreme euphoria)

Bipolar Disorder

Frequency and separation of episodes.

• Usually separated by 6 months to a year.

Bipolar Disorder Etiology

• Strong genetic component

▪ Swings in metabolic activity in

cerebral cortex

• Levels of neurotransmitters: Low Glutamate & Serotonin

• Childhood abuse

Schizophrenia Spectrum

A severe mental health condition characterized by highly disordered thought processes.

Psychosis

A state in which a person’s perceptions and thoughts are fundamentally removed from reality. ( See and hear things that are not there)

Schizophrenia Spectrum Typically diagnosed in early adulthood.

• Age 18 for men.

• Age 25 for women.

• High suicide risk: 4-8 X higher than general population

Symptoms of Schizophrenia Positive Symptoms.

• Hallucinations

• Delusions

• Thought disorders.

• Movement disorders.

Symptoms of Schizophrenia Negative Symptoms.

• Flat affect

Symptoms of Schizophrenia Cognitive Symptoms.

• Attention difficulties and memory problems.

• Impaired ability to interpret information and make decisions.

Causes of Schizophrenia Biological Factors.

• Genetic predisposition. (If a twin has it, 48% more likely to be diagnosed)

• Structural brain differences.(Enlarged ventricles)

• Regulation of neurotransmitters: Dopamine (inhibits the release of glutamate) and glutamate (role in the brain’s capacity to change with experience).

Causes of Schizophrenia Psychological Factors.

• Vulnerability–stress hypothesis: Certain amount of stress level that

interacts with biological risk factor

Causes of Schizophrenia Sociocultural Factors.

• Not a cause of schizophrenia but effects the course of the disorder.

Personality Disorders

Chronic maladaptive cognitive-behavioral patterns.

• 10 personality disorders listed in DSM-5-TR.

• Must be at least 18 to be diagnosed ( must color all aspects of one's life)

Most extensively studied personality disorders:

• Antisocial Personality Disorder.

• Borderline Personality Disorder

Antisocial Personality Disorder Diagnosis and Symptoms

• Guiltless lawbreaking, violence, deceit

• Impulsive, irritable, reckless, irresponsible

• Use others for their own gain

Antisocial Personality Disorder Etiology

• Biological factors (Genetic, brain, and low Autonomic

Nervous System)

• Child abuse contributes

Psychopaths:

Subgroup of people with APD who engage in violent

crimes, and are remorseless

Borderline Personality Disorder Diagnosis and Symptoms

• Instability in interpersonal relationships, self-image, and emotions

• Unstable affect, negative interpersonal relationships, impulsive and self-

destructive behavior.

Borderline Personality Disorder Etiology

• Genetic: Much more common in women, genes play a large role

• Childhood abuse may contribute

• Irrational belief one is powerless, unacceptable, and that others are hostile

Hypervigilance

Constantly on alert looking for threatening information

Splitting

Seeing the world in "either or terms"

Dimensional Approach

Psychopathology for personality is seen on a continuum with typical personality function.

Dimensional approach to Personality

See it as maladaptive personality traits.

For example, Borderline personality disorder would be viewed as having high neuroticism and low on agreeableness and conscientiousness

Dimensional approach to Personality

Some people are left out of the traditional 10 personality disorders.

"Personality Disorder not otherwise specified"

Suicide

Self-injury with the intent to die.

Prevalence

• 12th leading cause of death for Americans

• Second leading cause of death for Americans

aged 10–24.

• Twice as many suicides as homicides.

• For every person who dies by suicide, there are

many more people who are thinking about it or

attempting it.

Suicide

Nationwide Suicide and Crisis Lifeline: 988.

Mental Health First Aide

Factors Contributing to Suicide Biological

• Genetics, neurotransmitters. (low serotonin)

• Chronic poor health.

Factors Contributing to Suicide Psychological

Mental health conditions (90%)

Depression/anxiety substance abuse

Factors Contributing to Suicide Trauma

• Immediate and severe stress.

for example, major loss, unwanted pregnancy

• Interpersonal theory of suicide.

A desire to die (feeling burdensome, not belonging)

acquired capability for suicide

Factors Contributing to Suicide Sociocultural

• Chronic economic hardship

• Gender. More males

Health and Wellness

People diagnosed with mental health conditions may face stigma, stereotypes, prejudice, and discrimination.

Prejudice and discrimination

Negative stereotypes/fear of violence. "schizophrenic"

• Prevent people from sharing what their experiences are

• Discrimination (ADA)

Effect on physical health ( smoking, excessive drinking, and self-medication)