chapter15

What is a psychological disorder?

A psychological disorder is a condition characterized by abnormal thoughts, feelings, and behaviors that significantly impair an individual's daily functioning and cause distress.

Explain the Diathesis-Stress Model.

The Diathesis-Stress Model states that psychological disorders develop from a combination of a predisposition (diathesis, often genetic or biological) and environmental stressors. A high diathesis requires less stress to trigger the disorder, while a low diathesis requires more stress.

What is Comorbidity?

Comorbidity refers to the co-occurrence of two or more psychological disorders in the same individual. For example, someone might have both depression and an anxiety disorder.

How does the medical model explain the origins of disordered behavior?

The medical model views psychological disorders as diseases with biological or physiological causes, similar to physical illnesses. It suggests that these disorders have specific symptoms, causes, and treatments, often involving biological interventions like medication.

What are some critiques of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition)?

Critiques of the DSM-5 include:

• Medicalization of normality: Diagnosing normal human problems as disorders.
• Overlapping criteria: Many disorders share similar symptoms, leading to high comorbidity.
• Influence of pharmaceutical companies: Concerns about industry funding influencing diagnostic categories.
• Categorical rather than dimensional approach: It uses categories (either you have it or you don't) rather than dimensions (degrees of a trait), which may not reflect the complexity of mental health issues.
• Lack of cultural sensitivity: Potential for misdiagnosis across different cultures.

What was the significance of the Rosenhan (1973) study?

The Rosenhan (1973) study, 'On Being Sane in Insane Places,' involved 'psuedopatients' faking auditory hallucinations to gain admission to psychiatric hospitals. Once admitted, they stopped faking symptoms but were still treated as mentally ill. The study demonstrated the powerful influence of diagnostic labels and context on perception, highlighting the challenges in distinguishing sanity from insanity within institutional settings.

When is an individual at greatest risk of suicide?

An individual is often at greatest risk of suicide when:

• They have a history of previous suicide attempts.
• They have a mental health disorder, especially depression, bipolar disorder, or substance abuse.
• They express suicidal ideation or plan.
• They experience significant life stressors (e.g., loss, trauma, financial problems).
• They have access to lethal means.
• There's a sudden improvement in mood after a period of severe depression (indicating a potential decision to act).
• They experience feelings of hopelessness, helplessness, or isolation.

What are possible explanations for ADHD overdiagnosis?

Possible explanations for ADHD overdiagnosis include:

• Broadening diagnostic criteria: The DSM criteria have become more inclusive over time.
• Increased awareness: Greater public and professional awareness leads to more screening and diagnosis.
• Academic pressures: Children struggling in school might be diagnosed with ADHD to explain poor performance or qualify for accommodations.
• Variability in diagnostic practices: Inconsistent application of diagnostic criteria by clinicians.
• Cultural factors: Differing expectations for children's behavior and academic performance across cultures.

What are the symptoms of Generalized Anxiety Disorder (GAD)?

Symptoms of GAD include:

• Excessive, uncontrollable worry about multiple events or activities.
• Difficulty controlling the worry.
• Restlessness or feeling on edge.
• Being easily fatigued.
• Difficulty concentrating or mind going blank.
• Irritability.
• Muscle tension.
• Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

What are the symptoms of Obsessive-Compulsive Disorder (OCD)?

Symptoms of OCD involve:

• Obsessions: Recurrent, persistent, intrusive, and unwanted thoughts, urges, or images that cause distress (e.g., fear of contamination, need for symmetry).
• Compulsions: Repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rigid rules (e.g., hand washing, checking, counting) to prevent or reduce anxiety or distress.

What are the symptoms of Post-Traumatic Stress Disorder (PTSD)?

Symptoms of PTSD, following exposure to a traumatic event, include:

• Intrusive symptoms: Recurrent, involuntary, and intrusive distressing memories; dissociative reactions (flashbacks); psychological or physiological distress at exposure to reminders of the event.
• Avoidance: Efforts to avoid distressing memories, thoughts, feelings, or external reminders associated with the event.
• Negative alterations in cognitions and mood: Persistent negative beliefs about oneself, others, or the world; diminished interest in activities; feelings of detachment; persistent inability to experience positive emotions.
• Alterations in arousal and reactivity: Irritable behavior and angry outbursts; reckless or self-destructive behavior; hypervigilance; exaggerated startle response; problems with concentration; sleep disturbance.

What are the symptoms of Peripartum Depression?

Peripartum depression (formerly postpartum depression, now also includes during pregnancy) symptoms are similar to major depression but occur during pregnancy or within the first year after childbirth. They include:

• Persistent sadness, loss of interest or pleasure.
• Intense anxiety or panic attacks.
• Irritability or anger.
• Difficulty bonding with the baby.
• Fatigue, changes in appetite or sleep.
• Feelings of worthlessness, shame, guilt, or inadequacy.
• Thoughts of harming oneself or the baby (rare but serious).

What are the symptoms of Bipolar Disorder?

Bipolar disorder is characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

• Manic/Hypomanic Episode symptoms: Elevated, expansive, or irritable mood; increased activity or energy; decreased need for sleep; inflated self-esteem or grandiosity; more talkative than usual; flight of ideas; distractibility; increased goal-directed activity or psychomotor agitation; excessive involvement in activities that have a high potential for painful consequences.
• Depressive Episode symptoms: Profound sadness, loss of interest or pleasure; changes in appetite or sleep; fatigue; feelings of worthlessness or guilt; difficulty concentrating; thoughts of death or suicide.

What are the symptoms of Schizophrenia?

Symptoms of Schizophrenia often involve a mix of positive, negative, and cognitive symptoms:

• Positive symptoms: (Additions to normal behavior) Hallucinations (e.g., hearing voices), delusions (firmly held false beliefs), disorganized thinking and speech (e.g., word salad), grossly disorganized or abnormal motor behavior.
• Negative symptoms: (Absence of normal behavior) Avolition (lack of motivation), alogia (poverty of speech), anhedonia (inability to experience pleasure), asociality (lack of interest in social interaction), diminished emotional expression (flat affect).
• Cognitive symptoms: Problems with executive function, attention, working memory.

What are the symptoms of Dissociative Identity Disorder (DID)?

Symptoms of DID (formerly Multiple Personality Disorder) include:

• Presence of two or more distinct personality states (or 'alters'), each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
• Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
• Significant distress or impairment in social, occupational, or other important areas of functioning.

What are the symptoms of Antisocial Personality Disorder (ASPD)?

Symptoms of Antisocial Personality Disorder, displayed since age 15 (though diagnosed at age 18), include a pervasive pattern of disregard for and violation of the rights of others, as indicated by three or more of the following:

• Failure to conform to social norms with respect to lawful behaviors.
• Deceitfulness, such as repeated lying, use of aliases, or conning others for personal profit or pleasure.
• Impulsivity or failure to plan ahead.
• Irritability and aggressiveness, often indicated by repeated physical fights or assaults.
• Reckless disregard for safety of self or others.
• Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
• Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

What are the symptoms of ADHD (Attention-Deficit/Hyperactivity Disorder)?

Symptoms of ADHD fall into two main categories:

• Inattention: Difficulty sustaining attention, easily distracted, often does not seem to listen, fails to follow through on instructions, difficulty organizing tasks, often loses things, forgetful in daily activities.
• Hyperactivity and Impulsivity: Fidgets or taps hands/feet, leaves seat when expected to remain seated, runs or climbs in inappropriate situations, unable to play or engage in leisure activities quietly, 'on the go' or driven by a 'motor', talks excessively, blurts out answers, difficulty waiting turn, interrupts or intrudes on others.

What are the symptoms of Autism Spectrum Disorder (ASD)?

Symptoms of ASD include persistent deficits in social communication and social interaction across multiple contexts, and restricted, repetitive patterns of behavior, interests, or activities. These can include:

• Social-communication deficits: Difficulties with social-emotional reciprocity (e.g., abnormal social approach, failure of back-and-forth conversation), nonverbal communicative behaviors (e.g., eye contact, body language), and developing, maintaining, and understanding relationships.
• Restricted, repetitive patterns of behavior, interests, or activities: Stereotyped or repetitive motor movements, use of objects, or speech (e.g., echolalia); insistence on sameness, rigid adherence to routines; highly restricted, fixated interests that are abnormal in intensity or focus; hyper- or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment.

What are the learning factors believed to cause anxiety?

Learning factors contributing to anxiety include:

• Classical Conditioning: Associating a neutral stimulus with a frightening event (e.g., a dog bite leading to fear of all dogs).
• Operant Conditioning: Avoidance of feared situations is negatively reinforced because it reduces anxiety, thus maintaining the phobia.
• Observational Learning/Modeling: Learning fear or anxious responses by observing others (e.g., a child developing a fear of spiders after seeing a parent react with fear).

What are the cognitive factors believed to cause depression?

Cognitive factors contributing to depression include:

• Negative Cognitive Triad (Aaron Beck): Negative views about oneself, the world, and the future.
• Maladaptive Schemas: Deeply ingrained negative patterns of thinking that lead to biased interpretations of events.
• Learned Helplessness (Martin Seligman): The belief that one has no control over negative events, leading to passivity and giving up.
• Ruminative Response Style: A tendency to passively and repetitively focus on symptoms of distress and possible causes and consequences rather than actively taking action.

What are some known causes of Schizophrenia?

The causes of schizophrenia are complex and multifactorial, including:

• Genetic factors: Strong hereditary component; inherited predisposition.
• Neurochemical imbalances: Dysregulation of neurotransmitters, especially dopamine (dopamine hypothesis), but also glutamate and serotonin.
• Brain structural abnormalities: Enlarged ventricles, reduced gray matter, abnormalities in brain connectivity and neural circuits (e.g., prefrontal cortex).
• Prenatal and perinatal factors: Exposure to viruses in utero, birth complications (e.g., oxygen deprivation), maternal stress or malnutrition.
• Environmental stressors: Stressful life events, cannabis use during adolescence, living in urban environments, social adversity, particularly for those with a genetic predisposition.

What are some known causes of Autism Spectrum Disorder (ASD)?

The causes of ASD are predominantly genetic and neurobiological:

• Genetic factors: Strong evidence for genetic links, including inherited genetic mutations or spontaneous mutations; many genes have been implicated.
• Brain differences: Atypical brain development, structure, and connectivity (e.g., differences in brain size, neural circuitry involved in social cognition).
• Environmental factors (interacting with genetic vulnerability): Advanced parental age, certain prenatal exposures (e.g., valproate