SUPA Psychology Chapter 14: Psychological Disorders (copy) (copy)

i might have generalized anxiety disorder evident in the creation of these flashcards 2 weeks before the test

Medical Model

proposes that it is useful to think of abnormal behavior as a disease. This is the point of view for the terms that refer to abnormal behavior including mental illness, psychological disorder, and psychopathology (pathology refers to manifestations of disease). This has become the dominant way of thinking about abnormal behavior in the 18th and 19th centuries and its influence is strong today.

Strengths of the Medical Model

Represented progress over earlier methods of abnormal behavior which were mostly based on superstition. People who behaved strangely were often thought of as to be possessed or in league with witches or other spirits in the past. This model was a massive positive as victims of these illnesses were viewed with more sympathy and less hatred and fear.

Critics of the Medical Model

Some critics have suggested that the medical model outlived its usefulness. These critics are troubled because medical diagnoses of abnormal behavior pin potentially derogatory labels on people. It creates a social stigma especially when people are labeled as mentally ill. They are viewed as lesser beings to the normal human. Stereotypes like these promote distancing, distain and rejection and is a significant source of stress for people suffering with psychological disorders preventing them from seeking mental health care they need. Also critics have pointed out that abnormal behavior usually involves a deviation from social norms rather than an illness. The medical model posits mental illness also has a degree of immorality or incorrect social behavior such that people who experience these illness symptoms must be treated.

Diathesis Stress Model

Diathesis (vulnerability through genetic/biological predisposition) + stress (trauma, significant life events, daily hassles, general environmental factors) = Expression (or not) of a mental illness.

Increase in Stigma Regarding Mental Disorders

Findings have demonstrated many psychological disorders are at least party attributable to genetic factors making them more similar to physical illnesses which carry less stigma. However, research has shown that stigmatization of psychiatric disorders increased even though evidence that a rise of biogenetic explanations for mental illness decreased the tendency to blame people for their mental problems. But this leads to the view that biogenetic explanations for mental disorders have led to increased tendencies to view these psychological disorders as untreatable, and to view affected individuals in a negative manner contributing to the greater stigma.

Diagnosis

involves distinguishing one illness from another so that treatment can occur.

Etiology

refers to the apparent causation and developmental history of an illness.

Prognosis

is a forecast about the probable course of an illness or what the illness will most likely do to an individual in the future.

Criteria of Abnormal Behavior

Foremost of the criteria for the diagnoses of psychological disorders are threefold and can only be made by mental health professionals. They are Deviance, Dysfunction/Maladaptive Behavior, and Personal Distress. It is hard to draw the line between normal and abnormal behavior however. Two are three criteria may apply to a particular case, but people are often viewed as disordered when only one criterion is met. Diagnoses of psychological disorders often involve value judgements about what represents normal or abnormal behavior and these judgements often reflect cultural values, social trends, political forces, as well as scientific knowledge.

Deviance

One of the 3 main criteria for abnormal behavior diagnoses. People are often said to have a disorder because their behavior deviates from what their society considers acceptable. What constitutes normality varies somewhat from culture to culture, but all cultures have norms. When people violate these standards and expectations, they may be labeled as mentally ill. Most of the population does not exhibit what would be considered strange behaviors certain individuals with psychological disorders might have.

Dysfunction/Maladaptive Behavior

One of the 3 main criteria for abnormal behavior diagnoses. People are judged to have a psychological disorder because their everyday adaptive behavior is impaired. This is a key criterion in the diagnosis of substance use disorders. Alcohol and drug use are not terrible unusual or deviant, however when drugs or alcohol begin to interfere with a person's social or occupational functioning, a substance disorder exists. The maladaptive quality of the behavior makes it disordered.

Personal Distress

One of the 3 main criteria for abnormal behavior diagnoses. The diagnosis of a psychological disorder is based on an individual's report of great personal distress. This is usually the criterion met by people who are troubled by depression or anxiety disorders. Depressed people, for instance, might or might not exhibit deviant or maladaptive behavior. Such people are usually labeled as having a disorder when they describe their subjective pain and suffering to others.

Normality vs Abnormality Blurred Lines

Antonyms such as normal vs abnormal and mental health vs mental illness imply that people can be divided into distinct groups of those who are normal and those who are not. However, those lines are more blurred than people often think and its often difficult to draw a line that clearly separates normality from abnormality. Even "normal" people can experience deviance, dysfunction/maladaptive behavior, and personal distress. People are judged to have psychological disorders only when their behavior becomes extremely deviant, maladaptive, or distressing.  Thus, normality and abnormality exist on a continuum.

Psychodiagnosis and the Classification of Disorders

Researchers do not lump all psychological disorders together so they have created a sound taxonomy of mental disorders which facilitates empirical research and enhances communication among scientists and clinicians. The American Psychological Association devised a extensive classification database for psychological disorders outlined in a book called the Diagnostic and Statistical Manual of Mental Disorders or DSM-5 (5th edition released in 2013).

Issue in the Creation of the DSM-5

The question of whether to reduce the system's commitment to a categorical approach was brought up in the process of the manual's creation. Critics of the DSM have questioned the assumption that people can be reliably placed in nonoverlapping diagnostic categories as there is enormous overlap in various disorders' symptoms making the boundaries of diagnosis blurry. This proved to be a difficult shift leading the DSM-5 to retain a categorical approach, although supplemented the traditional system with dimensional approaches in some areas. Another area of concern with the DSM-5 and it's categorical approach is that the number of specific diagnoses increased exponentially (from 128 in the 1st edition to 541 in the 5th edition). Some of this growth was due to splitting existing disorders, but much of it was due to adding entirely new disorders. Some of the new disorders encompass behavioral patters that are regarded as mundane, everyday adjustment problems, rather than mental disorders. Critics of the DSM argue this approach "medicalizes" everyday problems and casts the stigma of pathology on normal self control issues. Critics also worry about turning everyday problems into mental illnesses which would trivialize the concept of mental illness.

Categorical Approach

The DSM-5 is built on this approach which posits that people can reliably be placed in discontinuous (nonoverlapping) diagnostic categories. An argument against this is that there is enormous overlap among various disorders' symptoms, making the boundaries blurrier than what would be ideal. Some theorists argue a better method would be the dimensional approach because of the issues with the DSM-5. This posits description of disorders in terms of how people score on a limited number of continuous dimensions such as the degree to which they exhibit various characteristics such as depression, anxiety, anger, etc.

Dimensional Approach

Such an approach would describe disorders in terms of how people score on a limited number of continuous dimensions, such as the degree to which they exhibit anxiety, depression, agitation, anger, hypochondria, rumination, etc. The practical logistics of shifting to a dimensional approach however proved to be formidable and controversial. Experts would have to agree about what the dimensions were and how to measure them. These difficulties in regards to shifting systems of disorder classifications led the DSM-5 to retain a categorical approach with supplementation of aspects of the traditional system with dimensional approaches.

Anxiety Disorders

Generalized Anxiety Disorder, Specific Phobia, Panic Disorder, Agoraphobia, OCD, and PTSD. Biology, conditioning, cognition, and stress can contribute to these anxiety dominated disorders. Females tend to experience these disorders more frequently and these disorders generally happen earlier in life but could start later as well.

Generalized Anxiety Disorder

is marked by a chronic, high level of anxiety that is not tied to any specific threat. People with this disorder constantly worry about everything whether it is trivial or not. This anxiety is accompanied by physical symptoms such as trembling, muscle tension, diarrhea, dizziness, fainting, sweating, and heart palpitations. They hope this worrying will prepare them for the worse, but the ret result it they just generate negative emotions and prolonged physiological arousal. It can be very disabling and is associated with an increased risk for a variety of physical health problems. Generalized Anxiety Disorder has a lifetime prevalence of about 5% and is seen twice as much in females as males. Typical onset is midlife, which is later than most anxiety related disorders.

Specific Phobia

involves a persistent and irrational fear of an object or situation that presents no realistic danger. People can develop phobic responses to virtually anything. Certain types of phobias are relatively common including acrophobia (fear of heights), claustrophobia (fear of small, enclosed spaces), brontophobia (fear of storms), hydrophobia (fear of water) and various insect/animal phobias. People troubled by phobias typically realize their fears are irrational, but are still unable to calm themselves down when confronted by a phobic object. These phobic fears are also common as the lifetime prevalence of specific phobias is about 10% and 2/3 of victims are females. Diagnosis for phobias are only merited if individuals' phobias seriously impair their everyday functioning. Most common phobias are 1st fear of Animals, 2nd fear of Heights, and 3rd fear of Blood.

Panic Disorder

is characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly. These paralyzing attacks are accompanied by physical symptoms of anxiety and are sometimes mistaken for heart attacks. After a number of these anxiety attacks victims become apprehensive and hypervigilant, wondering when the next panic attack will occur. About 2/3 of the people diagnosed with this disorder are female and the onset of the disorder typically occurs during late adolescence or early adulthood.

Agoraphobia

Agoraphobia is a fear of going out to public places. This disorder can come stem from individuals who have panic disorder that become increasingly concerned about exhibiting panic in public to the point where they are afraid to leave home. Agoraphobics tend to experience great discomfort in shopping malls, theaters, and restaurants and when using buses, trains and subways. The crux of their problem is that in these situations they fear it may be difficult to escape or get help if they panic. Some agoraphobics manage to venture out with a trusted companion, but they endure crowds with intense dread. Agoraphobia tends to coexist with a variety of other disorders, especially panic disorder.

Obsessive Compulsive Disorder (OCD)

is marked by persistent uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions). Obsessions often center on inflicting harm on others, personal failures, suicide, or sexual acts. People troubled by obsessions may feel they have lost control of their mind. Compulsions usually involve stereotyped rituals that may temporarily relieve the anxiety produced by one's obsessions. Most people with this disorder have multiple obsessions and compulsions. People with OCD vary in regard to how much insight they have into their disorder as some as keenly aware that their obsessions and compulsions are irrational, whereas others are convinced their behavior is rational. Most people can be compulsive or obsessive at times, but full fledged OCD occurs in 2% to 3% of the population with a mean age onset of 19-20. This can be a very severe disorder and is associated with serious social and occupational impairments. Research found OCD is associated with a tenfold risk of suicide, and OCD is unusual among anxiety related problems in that it is seen in males and females in roughly equal numbers. Clinicians are also concerned that Covid-19 increased the risk of OCD due to the rituals and dangers associated with the pandemic.

Posttraumatic Stress Disorder (PTSD)

involves enduring psychological disturbance attributed to the experience of a major traumatic event. This was first recognized as a disorder in the 1970s in the aftermath of the Vietnam War, when a great many veterans were traumatized by their combat experiences. PTSD can be caused by a variety of traumatic events besides war experiences such as assault, car accidents, natural disaster, or witnessing someone's death. Although people assume such events are relatively uncommon, research shows a majority of adults have been exposed to one or more serious traumatic events. Common PTSD symptoms include reexperiencing the event in the form of nightmares and flashbacks; emotional numbing; alienation; problems in social relations; arousal and reactivity symptoms; cognition and mood symptoms; an increased sense of vulnerability; anxiety, anger, guilt, and avoiding feelings or things related to the event. Around 7% to 8% of people are diagnosed with PTSD at some point in their lives, but studies using newer DSM-5 diagnostic criteria have yielded higher estimates.

Etiology of Anxiety Disorders

Anxiety dominated disorders develop out of complicated interactions between biological and psychological factors. The main causes of such anxiety disorders include biological predispositions, conditioning and learning, cognitive based factors, and stress levels in an individual's life. All of these factors could contribute to the development of such anxiety disorders.

Biological Factors (Etiology of Anxiety Disorders)

Studies that assess the impact of heredity/genetics on psychological disorders utilize concordance rates which indicates the percentage of twin pairs or other pairs of relatives who exhibit the same disorder. The results of both twin studies and family studies suggests a moderate genetic predisposition to anxiety disorders. Research also suggests a link may exist between anxiety disorders and neurochemical activity in the brain. Drugs that reduce excessive anxiety appear to alter neurotransmitter activity at synapses that release the GABA neurotransmitter. This suggests GABA may play a role in some types of anxiety disorders. Abnormalities in serotonin neural circuitry have also been implicated in OCD.

Concordance Rates

Indicates the percentage of twin pairs or other pairs of relatives who exhibit the same disorder. Measures how often two people (usually twins or family members) share a specific trait or condition. Investigators look at these concordance rates to assess the impact of heredity on psychological disorders. If relatives who share more genetic similarity show higher concordance rates than relatives who share less genetic overlap, the finding supports the genetic hypothesis.

Conditioning and Learning (Etiology of Anxiety Disorders)

Many anxiety responses can be acquired through classical conditioning and maintained through operant conditioning. An original neutral stimulus can be paired with a frightening event so that it becomes conditioned stimulus eliciting anxiety. Once a fear is acquired through classical conditioning, the person may start avoiding anxiety producing stimulus. The avoidance response is negatively reinforced because it is followed by a reduction in anxiety (operant conditioning). Studies support this by showing a large proportion of people who have phobias can identify a traumatic conditioning experience that probably contributed to their anxiety disorder. The tendency to develop certain phobias of certain objects or conditions can be explained by Seligman's preparedness concept. He believes that classical conditioning creates most phobic responses, but people are biologically prepared by their evolutionary history to acquire some fears more easily than others. This concept of preparedness is highlighted in the evolved module for fear learning where the evolved model is automatically activated by stimuli related to past survival in evolutionary history and that it is relatively resistant to intentional efforts to suppress resulting fears. The tendency for people who have anxiety based disorders to overgeneralize also could worsen such disorders.

Cognitive Factors (Etiology of Anxiety Disorders)

Cognitive theorists maintain certain styles of thinking make some people more vulnerable to anxiety disorders. Some people are especially vulnerable to anxiety problems because they tend to misinterpret harmless situations as threatening, focus excessive attention on perceived threats, and selectively recall information that seems threatening. Since human experience is highly subjective, the cognitive view holds that some people are prone to anxiety disorders because they see threat in every corner of their lives. Researchers have also linked OCD to deficits in executive functioning. Executive functioning refers to basic cognitive processes that underlie self-regulation, planning, and decision making.

Stress (Etiology of Anxiety Disorders)

Obviously cases of PTSD are attributed to individuals' exposure to extremely stressful incidents. Various types of anxiety disorders can be stress related. For example, one study showed that individuals with panic disorder had experienced a dramatic increase in stress in the month prior to the onset of their disorder. Other studies found that stress levels are predictive of the severity of OCD patients' symptoms. Thus, there is reason to believe that high stress often helps to precipitate or to aggravate anxiety related disorders.

Dissociative Disorders

are a class of disorders in which people loose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity.  They are the most controversial set of disorders in the diagnostic system with constant debate over the topic. Two dissociative syndromes are dissociative amnesia and dissociative identity disorder, although these are relatively uncommon.

Dissociative Amnesia

is a sudden loss of memory for important personal information that is too extensive to be due to normal forgetting. Memory losses can occur for a single traumatic event or for an extended period of time surrounding the event. Cases of amnesia have been observed after people experienced various disasters or traumatic events. People forget basic personal information that defines their identity. In spite of their wholesale forgetting, they can remember matters unrelated to their identity such as how to drive a car and how to do math and they form memories in a normal fashion. Degrees of extremity are Localized (memory loss that affects specific areas of knowledge or parts of a person's life), Generalized (memory loss that affects major parts of your life and/or identity), and Fugue (generalized amnesia with adoption of a new identity).

Dissociative Identity Disorder (DID)

involves a disruption of identity marked by the experience of two or more largely complete, and usually very different, personalities. Used to be called multiple personality disorder. Individuals with this disorder don't have multiple people in one body rather they fail to integrate incongruent aspects of their personality into a normal whole. People with this disorder feel they have more than one identity and each identity may have its own name, memories, traits, physical mannerisms, and autonomy. In addition DID patients often exhibit somatic symptoms such as headaches and chronic pain, self harm behaviors, and hallucinations. DSM-5 added possession related phenomena where people feel "possessed" by supernatural forces. There are complex memory gaps and amnesias among different personalities which generally report they are unaware of one another although objective measures of memory sometimes suggest otherwise. Alternate personalities often display traits that are foreign to the original personality. Transitions between identities occur suddenly and this disorder is seen more often in women than men. Starting in the 1970s, a dramatic increase was seen in the diagnosis of DID. Some theorists think the disorder used to be underdiagnosed and is still underdiagnosed today, while other theorists think that clinicians have begun over diagnosing the condition.

Etiology of Dissociative Disorders

Dissociative amnesia is usually attributed to excessive stress. However, little is know why this reaction occurs only in a tiny minority of people. Causes of dissociative identity disorder (DID) are vague. Some skeptical theorists believe people with DID come to believe that independent entities within themselves are to blame for their peculiar behaviors, unpredictable moods, and ill advised actions thanks in part to book and movie portrayals of DID. Encouraged by their therapists and a tendency to fantasize, they come to attribute unique traits and memories to imaginary alternate personalities. Many clinicians are convinced that DID is an authentic disorder even though there are skeptics. They maintain there is no incentive for patients or therapists to manufacture cases of multiple personalities and most cases of DID are rooted in severe emotional trauma that occurred during childhood. A majority of people with DID report childhood traumas of various kinds. In sum, little is known about why DID occurs making it a controversial diagnosis.

Depressive and Bipolar Disorders

Major Depressive Disorders and Bipolar disorders fall under this category and they can result in mood dysfunction and suicide.  Many famous people have experienced severe emotional dysfunction or mood disorders. Such mood disorders tend to be episodic which means they come and go interspersed between periods of normality. In earlier versions of the DSM, major depressive disorder and bipolar disorder were lumped together in a category called mood disorders. In DSM-5 they break down mood disorders into depressive and bipolar disorders. The main difference between the two is that people with major depressive disorder experience emotional extremes at just one end of the mood continuum because they experience periodic bouts of depression. People with bipolar disorder generally experience emotional extremes at both ends of the mood continuum going through both depression and mania (excitement and elation). Interestingly enough, although the name for bipolar disorder suggests individuals experience both depression and mania, a minority of people with bipolar disorder do not report episodes of depression.

Major Depressive Disorder

when someone shows persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure. Most common disorder in the depressive disorders category. Negative emotions are at the heart of this syndrome, but other symptoms can also appear.  The most common symptoms of the depression that defines this disorder can be summarized in anhedonia (a diminished ability to experience pleasure). Depression plunges people into feelings o hopelessness, dejection, and boundless guilt. Major depressive disorder is the exact opposite of the overly stimulated/enthusiastic characteristics that define mania. Onset of this disorder can occur at any point in the life span although average age of onset is 30-35 (depression rates are lower in children/adolescents). Estimates show that around 2/3 of people diagnosed with this disorder experience more than one episode over their life. Among those with recurrent depression the average number of episodes is 5 to 6. The average length of these episodes are 6 months in length and an earlier age of symptom onset is associated with a worse prognosis. Although depression tends to be episodic, some endure major depression that lasts years. This persistent depression is associated with a severe impairment of functioning. Depression increases mortality by 50% and is associated with elevated risk for health problems.

Anhedonia

a diminished ability to experience pleasure. Depressed people lack both energy and motivation and often give up things they enjoy (hobbies, favorite foods, friends). Reduced appetite and insomnia are also common. People tend to move sluggishly and talk slowly. Anxiety, irritability and brooding are also observed. Depression plunges people into feelings o hopelessness, dejection, and boundless guilt. 

Bipolar Disorder

is marked by the experience of both depressed and manic periods. The symptoms seen in manic periods are opposite those seen in depression. In these manic periods a person's mood becomes elevated to euphoria. Self esteem, optimism, energy, hyperactivity, lack of sleep, and extravagant plants skyrocket. Judgement is impaired and people engage in reckless behavior. DSM-5 makes a distinction between Bipolar I disorders (full manic episodes), and bipolar II disorder (miler hypomanic episodes marked by shorter duration and less impairment). Manic episodes might sound appealing, but they carry a negative undercurrent of uneasiness, irritability, and anger. And impaired judgement can lead victims to do things they regret and are disturbing. Bipolar disorder is not rare but it is less common than depression. Bipolar I and II disorders affect 1% of the population. Bipolar disorders are also seen equally in males and females and the typical age of onset is the late teens or early twenties.

Depressive Episode

Sad Mood, inability to experience pleasure (anhedonia), and sense of hopelessness. Opposite of a manic episode. Some symptoms include fatigue, loss of energy, insomnia, slowed speech or movement, impaired ability to think and make decisions, slowed thought, excessive worry, guilt, self blame, and social withdrawal.

Manic Episode

Europhobic, enthusiastic mood. Excessive pursuit of pleasurable activities. Unwarranted optimism. Opposite of a depressive episode. Some symptoms include energetic, hyperactive, decreased need for sleep, rapid speech, agitation, increased sociability, grandiose planning, indiscriminate decision making, racing thoughts/easily distracted, inflated self esteem and confidence, and impulsivity.

Hypomania

Episodes of hypomania last at least 4 days. These episodes are not severe enough to significantly affect social or school/work functioning. No psychotic features are present and thus hospitalization is not needed.

Mania

Episodes of mania last at least one week. These episodes cause severe impact on social or school/work functioning. Psychotic features could arise which in turn could lead to a need for hospitalization.

Bipolar I Disorder

At least one full manic (or mixed) episode. More extreme version of Bipolar II disorder. Housed within the larger categorization of bipolar disorder.

Bipolar II Disorder

Never had a manic episodes. At least 1 hypomanic episode and at least 1 major depressive episode. Marked my milder hypomanic episodes with shorter duration and less impairment). Housed within the larger categorization of bipolar disorder. Less extreme version of bipolar I disorder.

Mood Dysfunction and Suicide

A problem associated with most mood disorders is suicide. 90% of people who complete suicide manifest some sort of psychological disorder. Suicide rates are highest for people with depressive and bipolar disorders (they account for 50% to 60% of completed suicides). The likelihood of a suicide attempt increases as the severity of individuals'' depression increases. Suicide is super hard to predict, however the best predictor is when one expresses a sense of hopelessness about the future which is often hard to measure. There is no foolproof way to prevent suicidal persons from taking their lives. Generally suicide presentation comes in the form of taking the suicidal individual's thoughts seriously, providing emotional support, be willing to share their behavior with professionals/parents, and encouraging them to seek help. Experts think suicide may be increased due to the Covid-19 pandemic as people who were already battling these mental health issues might experience worsening symptoms which fuels suicidal ideation. Suicidal risk is elevated by unemployment and by feelings of social isolation factors brought on by the Covid-19 pandemic. Suicide is not inevitable however and people can recover.

Suicide

tenth leading cause of death in the US, accounting for 45,000 deaths and there has been a 25% increase since 2000. Official statistics may underestimate the scope of this problem as suicides are often disguised as accidents. Some estimates say suicide attempts may outnumber completed suicides by as much as 25 to 1. Women attempt suicide 3 times more than men, but men are more likely to actually kill themselves so they complete 4 times as many suicides as women. People with depressive and bipolar disorders are at most risk for suicide compared to most people.

Etiology of Depressive and Bipolar Disorders

There are a number of routes into depressive and bipolar disorders involving interactions between psychological and biological factors. Some of these include Genetic Vulnerability, Neurochemical and Neuroanatomical Factors, Cognitive Factors, Interpersonal Roots, and Precipitating Stress.

Genetic Vulnerability (Etiology of Depressive and Bipolar Disorders)

Evidence strongly suggests that genetic factors influence the likelihood of developing major depression and bipolar disorder. Twin studies have found a large disparity between identical and fraternal twins in concordance rates for mood disorders. The concordance rate for identical twins and the data suggests that the heritability of bipolar disorder is around 65% to 80% whereas the heritability of depression is around 40%. This suggests heredity can create a predisposition or vulnerability to mood disfunction.

Neurochemical and Neuroanatomical Factors (Etiology of Depressive and Bipolar Disorders)

Correlations have been found between mood disorders and abnormal levels of norepinephrine and serotonin in the brain. Low levels of serotonin seem to be a factor underlying most forms of depression. Studies have also shown correlations between mood disorders and structural abnormalities in the brain. The best documented is the association between depression and reduced hippocampal volume (smaller hippocampus), especially in the dentate gyrus of the hippocampus. A relatively new theory of the biological basis to depression says that the human brain continues to generate new neurons in adulthood, but when major life stress causes neurochemical reactions that suppress new neurons from growing depression occurs. Other lines of research have implicated abnormally high reactivity in the amygdala as a factor in depression as the amygdala regulates emotions. Another line of research has sown that depression led to reduced activation in specific areas of the brain that process anticipation and experience of reward and reinforcement.

Cognitive Factors (Etiology of Depressive and Bipolar Disorders)

Many theories emphasize how cognitive processes contribute to depressive disorders. One study proposed depression is caused be learned helplessness (passive giving up produced by exposure to unavoidable aversive events). Roots of depression lie in how people explain negative events they experience. People who exhibit a pessimistic explanatory style are more vulnerable to depression. People with depression who ruminate about depression remain depressed longer than people who try to distract themselves as well. This excessive rumination amplifies depressive episodes by increasing negative thinking. Women tend to ruminate more than men explaining why depression is more prevalent in women. Hindsight bias may also fuel depression. People with depression tend to view negative outcomes as more foreseeable and inevitable than they actually were which may increase emotional impact of negative outcomes. Cognitive models of depression maintain negative thinking is what leads to depression in many people. Negative thinking has been proven to be the more likely cause of depression as a negative explanatory style in one study predicted vulnerability to depression.

Interpersonal Roots (Etiology of Depressive and Bipolar Disorders)

Some approaches to understanding depression emphasize how social difficulties put people on the road to depressive disorders. According to this notion, depression prone people tend to lack the social finesse needed to acquire reinforcers which prevent depression. Lack of reinforcers leads to negative emotions and depression. Researchers have also found correlations between poor socials kills and depression. Depression people also unintentionally court rejection from others because they tend to be irritable, pessimistic, and unpleasant. They also alienate people for asking for reassurance about their relationships and self worth. Complicated and difficult social relations can increase the stress level in one's life too, and depressed people are likely to generate chronic stress for this reason.

Precipitating Stress (Etiology of Depressive and Bipolar Disorders)

Mood disorders sometimes appear mysteriously in people who are leading benign, not stressful lives. For this reason experts used to believe stress had little to do with depression, however evidence today suggests the existence of a moderately strong link between stress and the onset of both major depression and bipolar disorder. Highly aversive stressors appear to be more likely to trigger depression than less severe stressors and the majority. Though most people who experience significant stress do not develop a mood disorder, so one's vulnerability to both stress and mood disorders must play a role. Vulnerability to depression seems to increase as people go through more recurrences of depressive episodes and stress becomes less of a factor in triggering depression as episodes of depression accumulate over the years.

Schizophrenia

is a disorder marked my delusions, hallucinations, disorganized thinking and speech, and deterioration of adaptive behavior. Schizophrenia means split mind, but this refers to the fragmentation of thought processes not a split personality. Schizophrenia is not to be confused with DID. This disorder usually emerges during adolescence or early adulthood. About 75% of the cases manifest by at the age of 30. Prevalence estimates suggest around 1% of the population may be diagnosed with schizophrenia over the course of their lives. This may not sound like much but 1% means in the US alone, several million people will experience this disorder. Schizophrenia is an extremely costly illness for society because it is a severe, debilitating illness that tends to have an early onset and requires hospital care. Individuals diagnosed with schizophrenia have a increased risk for suicide and premature morality from physical diseases.

Schizophrenia Symptoms

Severe symptoms accompany this disorder which wreaks havoc in victim's lives. Some symptoms include delusions and irrational thought, deterioration of adaptive behavior, distorted perception, and disturbed emotion. These symptoms prevent people from living a normal life, keeping up with their hygiene, wearing clothes properly, and operating properly due to voices. Schizophrenic patients tend to be argumentative, aggressive and emotionally volatile.

Delusions and Irrational Thoughts (Schizophrenia symptoms)

Cognitive deficits and disturbed thought processes are the central feature of schizophrenia. Various delusions are common. More typically, affected persons believe their private thoughts are being broadcast to other people, that thoughts are being injected into their mind against their will, or that their thoughts are being controlled by an external force. Delusions of persecution are also seen in some 80% of patients with schizophrenia. These delusions range from brief suspicions about stranger's behavior to elaborate plots attributed to family or friends. In delusions of grandeur, people maintain that they are famous or important. Schizophrenic person's train of thought deteriorates and thinking becomes chaotic rather than logical and linear.

Delusions

are false beliefs that are maintained even though they are out of touch with reality. Delusions of persecution are another factor of delusions which accompany schizophrenia and occur in 80% of patients with the illness. Delusions of grandeur are also another type of delusion that are prevalent with schizophrenic patients.

Deterioration of Adaptive Behavior (Schizophrenia symptoms)

Schizophrenia usually involves a noticeable deterioration in the quality of the person's routine functioning in work, social relations, and personal care. The deterioration is evident to loved ones around the schizophrenic person and it prevents them from living a "normal" life.

Distorted Perception (Schizophrenia symptoms)

A variety of perceptual distortions can occur with schizophrenia, the most common being auditory hallucinations reported in 70% of patients. People with schizophrenia commonly report that they hear voices of nonexistent or absent people talking to them. They range from insulting, running commentary, they may be argumentative, or they may issue commands.

Hallucinations

are sensory perceptions that occur in the absence of real, external stimulus or are gross distortions of perceptual input. People with schizophrenia often experience vivid hallucinations.

Disturbed Emotion (Schizophrenia symptoms)

Normal emotional tone can be disrupted in a variety of ways. Some individuals experience a flattening of emotions (little emotional response). Others show inappropriate emotional responses that don’t fit the situation or what they are saying. People with schizophrenia can also become emotionally volatile which results in acts of aggression. 4 subtypes of schizophrenic disorders are paranoid, catatonic, disorganized, and undifferentiated schizophrenia. However, DSM-5 discarded the 4 subtypes of schizophrenia because there were not many meaningful differences between the 4 in etiology, prognosis, or response to treatment. Also cationic and disorganized subtypes were rarely seen in contemporary clinical practice. Positive and negative symptoms are also distinguishing characteristics of disturbed emotion.

Paranoid Schizophrenia

was thought to be dominated by delusions of persecution, along with delusions of grandeur. Basically the people around the schizophrenic person are thought of a distrustful and suspicious and they think of themselves in a high regard.

Catatonic Schizophrenia

marked by striking motor disturbances, ranging from muscular rigidity seen in a withdrawn state called catatonic stupor to random motor activity seen in a state of catatonic excitement. 2 categories of catatonic schizophrenia are split between little movement to random motor activity.

Disorganized Schizophrenia

was viewed as a particularly severe syndrome marked by frequent incoherence, obvious deterioration in adaptive behavior, and virtually complete social withdrawal. Includes various oddities of behavior much of which is unable to be understood by others (irrelevant, incoherent, illogical).

Undifferentiated Schizophrenia

People who clearly exhibit schizophrenic symptoms but who could not be placed into any of the three categories (Paranoid, Catatonic, or Disorganized Schizophrenia) were said to have undifferentiated schizophrenia, which involved idiosyncratic mixtures of schizophrenic symptoms.

Positive Symptoms and Negative Symptoms (Schizophrenia symptoms)

are another aspect of schizophrenia disturbed emotion. Negative symptoms involved behavioral deficits, such as flattened emotions, social withdrawal, apathy, impaired attention, poor grooming, lack of persistence at work or school, and poverty of speech. Positive symptoms involve behavioral excesses or peculiarities, such as hallucinations, delusions, incoherent thought, agitation bizarre behavior, and wild flights of ideas. Most people with schizophrenia exhibit both types of symptoms, but they very in the degree to which positive or negative symptoms dominate. A relative predominance of negative symptoms is associated with less effective social functioning and poorer overall treatment outcomes.

Etiology of Schizophrenia

The etiology of schizophrenic disorders, although it may not seem as clear as other mental disorders, is not all that different from the etiology of other psychological disorders. The main causes (etiology) of schizophrenia are genetic vulnerability, neurochemical factors, structural abnormalities in the brain, neurodevelopmental hypothesis, expressed emotion, and stress.

Genetic Vulnerability (Etiology of Schizophrenia)

Evidence is plentiful that hereditary factors place a role in the development of schizophrenic disorders. In win studies the concordance rates average around 48% for identical twins, in comparison for 17% in fraternal twins. Studies also show that a child born to two parents with schizophrenia has about a 46% probability of developing a schizophrenic disorder (compared to the probability in the general population of about 1%). Some theorists suggest that genetic factors account for as much as 80% of the variability in susceptibility to schizophrenia. Evidence also suggests that genetic vulnerability may be heightened when it is accompanied by relatively low general intelligence.

Neurochemical Factors (Etiology of Schizophrenia)

Schizophrenic disorders appear to be accompanied by changes in activity of one or more neurotransmitters in the brain. The dopamine hypothesis asserts excess dopamine activity is the neurochemical basis for schizophrenia. Makes sense as drugs that are useful in the treatment of schizophrenia are known to dampen dopamine activity. This hypothesis has become more complex as some researchers believe that elevated dopamine activity in certain areas of the brain may foster positive symptoms and that reduced dopamine activity may foster negative symptoms. Also dopamine dysregulation is intertwined with other neurotransmitter systems including GABA, serotonin, and glutamate. Thus the neurotransmitter factors are extremely complex. Research has also been used to suggest that marijuana use during adolescence may help cause schizophrenia in young people who have a genetic vulnerability to the disorder. There may be a causal link between the two.

Structural Abnormalities in the Brain (Etiology of Schizophrenia)

Individuals with schizophrenia exhibit a variety of deficits in attention, perception, working memory, and speed of information processing.  These suggest that schizophrenia may be caused by neurological deficits. In CT and MRI scans, associations between enlarged brain ventricles and schizophrenic disturbance has been seen. Enlarged ventricles are assumed to reflect degeneration of nearby brain tissue. Consistent with this assumption, meta analysis of similar studies showed that schizophrenia patients found shrinkage in the hippocampus, thalamus, and amygdala. Structural deterioration could be a consequence of schizophrenia or it could be a contributing cause of the illness. Another line of thinking about the structural deterioration of the brain is that it might be a result of synaptic pruning malfunctioning.

Neurodevelopmental Hypothesis (Etiology of Schizophrenia)

The neurodevelopmental hypothesis of schizophrenia asserts that schizophrenia is caused in part by various disruptions in the normal maturational processes of the brain before or at birth. Insults to the brain during sensitive phases of prenatal development or during birth can cause neurological damage that elevates individuals' vulnerability to schizophrenia. Quine a number of studies have shown links between exposure to infections during prenatal development and an increased prevalence of schizophrenia. Prenatal malnutrition, obstetrical complications, and minor physical anomalies are all more common in people with schizophrenia. Relationship between early neurological trauma and schizophrenia.

Expressed Emotion (Etiology of Schizophrenia)

is the degree to which a relative of a schizophrenic patient displays highly critical or emotionally overinvolved attitudes toward the patient. Studies show that a family's expressed emotion is a good predictor of the course of a schizophrenic patient's illness. After release from treatment, schizophrenic patients who return to a family high in expressed emotion show relapse rates 3 times those of patients who return to a family low in expressed emotion. Part of the problem is that families high in expressed emotion cause stress for the individual with schizophrenia.

Stress (Etiology of Schizophrenia)

Many theories of schizophrenia assume that stress plays a key role in triggering schizophrenic disorders. According to this notion, various biological and psychological factors influence individuals' vulnerability to schizophrenia. High stress may then serve to precipitate a schizophrenic disorder in someone who is vulnerable. Stress can also trigger relapses in patients who have made progress toward recovery.

Autism Spectrum Disorder (ASD)

is a neurodevelopmental disorder characterized by deficits in social interaction and communication and restricted, repetitive interest and activities. It is diagnosed almost exclusively during (early) childhood. ASD was originally called infantile autism and in the DSM-5 several related and milder disorders such as Asperger's syndrome were lumped together with classic autism in one category with the variety in symptom presentations envisioned as variations in severity along an autism spectrum. Critics of this lumping together say that it created a diagnostic category characterized by enormous diversity and that the new scheme applied a stigmatizing diagnostic label to some relatively mild conditions.

Autism Spectrum Disorder (ASD) Symptoms

Early symptoms of ASD include minimal eye contact with others and declining social interest and social smiling. Delays in development of language are one of the first concerns in parents. Repetitive body movements and manipulations of objects, as well as hyperactivity to stimuli are other symptoms. Verbal communication can be greatly impaired as about 30% to 40% of children with classic autism fail to develop functional speech.  Among those who develop speech, their ability to initiate and sustain conversation is limited and language is marched by peculiarities such as echolalia which involves rote repetition of others' words. Children with autism can be inflexible and minor changes in enviroment can trigger meltdowns. Some children with ASD exhibit self harm behaviors and about one half of children with autism exhibit subnormal IQ scores. They are easily overwhelmed by crowds, cannot understand emotion well, and have difficulties in social settings all around. Parents of children with ASD become concerned about their child's development at around 15-18 months of age and seek professional consultation by about 24 months. Prevalence of autism was thought to be under 1%, but estimates have noted increases of autism above 1%. Males account for 80% of autism diagnoses. One study reported 20% of individuals with ASD experienced a good outcome (high level of independence), 31% a fair outcome (some independence but support needed), and 48% a poor outcome (needing residential supervision or hospital care). Covid-19 has caused more problems for people with ASD as well.

Etiology of ASD

Autism was originally blamed on bad parenting, but this was discredited. Theorists view autism as a disorder that originates in biological dysfunctions because it appears so early in life. Twin studies and family studies have supported this as they show genetic factors make a major contribution to ASD. Theorists also believe that autism must be attributable to some brain abnormality. Studies have shown that ASD is associated with generalized brain enlargement by age 2 and this brain overgrowth can be seen in many areas in the cortex. The overgrowth begins sometime at the end of the first year and this is when ASD symptoms start to appear. A more recent study showed brain overgrowth may begin during the 2nd and 3rd trimesters of prenatal development and this overgrowth produces disruptions in neural circuits. One hypothesis stated that the mercery in vaccines cause autism, however this was disproven. 

Personality Disorders

are a class of disorders marked by extreme, inflexible personality traits that cause subjective distress or impaired social and occupational functioning. These disorders generally become noticeable during adolescence or early adulthood. Lifetime prevalence of personality disorders was measured to be around 10%. DSM-5 lists 10 personality disorders which are grouped into 3 clusters: anxious-fearful (avoidant, dependent, and obsessive compulsive personality disorder), odd-eccentric (schizoid, schizotypal, and paranoid personality disorder), and dramatic-impulse (histrionic, narcissistic, borderline, and antisocial personality disorder). These contain a diverse collection of maladaptive personality syndromes and some personality disorders are essentially milder versions of more severe disorders but can still impair lives.

Antisocial Personality Disorder

Disregard for others’ needs or feelings, persistent lying, stealing, using aliases, conning others combined with recurring problems with the law. Repeated violation of the rights of others. Aggressive, and often violent behavior. Disregard for the safety of others and wider societal regulations or moral beliefs. Is not constrained what so ever by the judgements or rules society places on individuals. Impulsive behavior, irresponsibility, and lack of remorse for behavior. Dramatic-impulse type of personality disorder.

Borderline Personality Disorder

Impulsive and risky behavior, such as having unsafe sex, gambling or binge eating. Unstable or fragile self image/self esteem with unstable and intense relationships. Up and down moods often as a reaction to interpersonal stress along with suicidal behavior or threats of self injury. Intense fear of being alone or abandoned with ongoing feelings of emptiness. Frequent, intense displays of anger with stress related paranoia that comes and goes. Dramatic-impulse type of personality disorder.

Narcissistic Personality Disorder

is marked by a grandiose sense of self importance, a sense of entitlement, and an excessive need for attention and admiration. More common in males than females. Individuals with this disorder think they are more special and important than others. They have fantasies about power, success, and attractiveness. Failure to recognize others’ needs and feelings while exaggerating achievements or talents. Expectation of constant praise and admiration with high levels of arrogance. Unreasonable expectations of favors and advantages, often taking advantage of others. These people also envy others or believe that others envy them. Critics argue that the current diagnostic criteria for this disorder focuses too much on the overt, grandiose side of the disorder and not on it's covert, vulnerable side. Dramatic-impulse type of personality disorder.

Histrionic Personality Disorder

Constantly seeking attention while being excessively emotional, often engaging in dramatic or sexually provocative behaviors to gain attention. Speaks dramatically with strong opinions, but few facts or details to back them up. Easily influenced by others combined with shallow and rapidly changing emotions. Excessive concern with physical appearance and these individuals think relationships with others are closer than they actually are. Dramatic-impulse type of personality disorder.

Paranoid Personality Disorder

Pervasive distrust and suspicion of others and their motives. Unjustified belief that others are trying to harm or deceive you. Unjustified suspicion of the loyalty or trustworthiness of others. Hesitancy to confide in others due to unreasonable fear that others will use the information against you. Perception of innocent remarks or nonthreatening situations as personal insults or attacks, and angry or hostile reaction to perceived slights or insults. Tendency to hold grudges, unjustified, recurrent suspicion that sexual partner is unfaithful. Odd-eccentric type of personality disorder.

Schizoid Personality Disorder

Patterns of social detachment and limited emotional expression. Limited range of emotional expression and individuals prefer solitary activities, appear indifferent to praise or criticism, and may seem emotionally cold or detached. Limited range of emotional expression, inability to take pleasure in most activities, inability to pick up social cues, little or no interest in sex. Odd-eccentric type of personality disorder.

Schizotypal Personality Disorder

Peculiar dress, thinking, beliefs, speech or behavior. Odd perceptual experiences, such as hearing voices whispering your name. Flat emotions or inappropriate emotional responses combined with social anxiety and lack of or suspicious response to others. Magical thinking (believing you can influence people and events with your thoughts), and belief that certain causal incidents or events have hidden messages only meant for you. Odd-eccentric type of personality disorder.

Obsessive Compulsive Personality Disorder

Preoccupation with details, orderliness and rules. Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved, such as feeling unable to finish a project because you don’t meet your own strict standards. Desire to be in control of people, tasks and situations, and inability to delegate tasks. Neglect of friends and enjoyable activities because of excessive commitment to work or a project. Inability to discard broken or worthless objects, rigid and stubborn, inflexible about morality, ethics, or values. Tight, miserly control over budgeting and spending money. Anxious-fearful type of personality disorder.

Dependent Personality Disorder

Excessive dependence on others and feeling the need to be taken care of. Submissive or clingy behavior toward others and fear of having to provide self care or fend for yourself if left alone. Lack of self confidence, requiring excessive advice and reassurance from others to make even small decisions. Difficulty starting or doing projects on your own due to lack of self confidence. Difficulty disagreeing with others, fearing disapproval. Tolerance of poor or abusive treatment, even when other options are avalible. Urgent need to start a new relationship when a close one has ended. Anxious-fearful type of personality disorder.

Avoidant Personality Disorder

Too sensitive to criticism or rejection. Feeling inadequate, inferior or unattractive. Avoidance of work activities that require interpersonal contact. Socially inhibited, timid and isolated, avoiding new activities or meeting strangers. Extreme shyness in social situations and personal relationships along with fear of disapproval, embarrassment or ridicule. Anxious-fearful type of personality disorder.

Etiology of Personality Disorders

Personality disorders all involve interactions between genetic predispositions and environmental factors, such as cognitive styles, coping patterns, and exposure to stress.

Eating Disorders

are severe disturbances in eating behavior characterized by preoccupation with weight concerns and unhealthy efforts to control weight. The three syndromes are: anorexia nervosa, bulimia nervosa, and a new syndrome added to the DSM-5 called binge eating disorder.

Anorexia Nervosa

involves intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, and use of dangerous measures to lose weight. Two subtypes have been observed which are restricting type anorexia nervosa (people starve themselves by drastically reducing their intake of food), and binge eating/purging type anorexia nervosa (where individuals attempt to loose weight by forcing themselves to vomit after meals, by misusing laxatives and diuretics, and by engaging in excessive exercise). Overall, individuals with anorexia think they are too fat no matter how frail they become and the only thing that makes them happy is loosing body weight. In light of their minimal eating, people with anorexia often report they think about food a lot. Individuals with anorexia also do not appreciate the maladaptive quality of their behavior. They rarely seek treatment and are usually coerced into treatment by loved ones. Anorexia can lead to amenorrhea (loss of mensural cycle), gastrointestinal problems, low blood pressure, osteoporosis (loss of bone density), and metabolic disturbances. This illness is associated with a tenfold elevation in premature death. Underweight persons are diagnosed with this.

Bulimia Nervosa

involves habitually engaging in out of control overeating, followed by unhealthy compensatory efforts, such as self induced vomiting, fasting, abuse of laxatives and diuretics, and excessive exercise. Eating binges are usually secret and are followed by intense guilt and concern. These feelings motivate the ill advised strategies to undo the effects of overeating. Individuals with this disorder usually maintain normal weight as they absorb a certain level of nutrients from food unlike the underweight anorexic persons. Medical problems associated with this are cardiac arrythmias, dental problems, metabolic deficiencies, and gastrointestinal problems. Individuals with bulimia share characteristics with those with anorexia nervosa, however the notable differences are that bulimia is a much less life threatening condition, individuals with bulimia have more normal appearances than those with anorexia, and people with bulimia are much more likely to recognize their eating behavior is pathological and thus cooperate with treatment more. Bulimia however is still associated with elevated morality rates, although at a lesser degree than those in anorexia.

Binge Eating Disorder

involves distress inducing eating binges that are not accompanied by the purging, fasting, and excessive exercise seen in bulimia. Resembles bulimia, but is less severe and can still cause considerable distress. Individuals tend to be disgusted by their bodies and distraught about their overeating. Their excessive eating is often triggered by stress and this is more common than anorexia and bulimia. However, many individuals with this disorder progress into a diagnosis of bulimia while others develop problems with obesity.

Prevalence and Cultural Roots of Eating Disorders

Eating disorders have been viewed as a produce of modern Western culture. Until recent decades, this disorder was not seen outside Western cultures remain rare in countries where food insecurity is predominant. Advances in communication have exported Western culture and thus eating disorders have started to show up in non-western cultures (especially affluent Asian countries). There are large gender gaps in the likelihood of developing eating disorders. About 90% to 95% of those with anorexia nervosa and bulimia are female, and about 60% of those with binge eating disorder are female. The appears to be the result of cultural pressures rather than biological factors. Western attractiveness emphasizes slenderness more for females than males, and women experience greater pressure to be physically attractive. Eating disorders usually affect young women with the onset age being 15-19 for anorexia nervosa and 15-21 for bulimia. Research suggests 1% develop anorexia nervosa, 1.5% develop bulimia, and about 3.5% exhibit binge eating disorder. Evidence suggests another 2% to 4% of people struggle with serious eating problems that do not qualify for a formal diagnosis and people with these disorders often manifest other psychological disorders.

Etiology of Eating Disorders

Eating disorders are caused by multiple determinants that work interactively. Genetic Vulnerability suggests that some people may inherit a genetic vulnerability to eating disorders (anorexia nervosa, binge eating disorder, and bulimia) with genetics stronger in anorexia. In personality, traits of negativity, negative emotionality, and neuroticism are associated with elevated risks of eating disorders. People with eating disorders also find it difficult to regulate emotion (especially negative ones). In regards to cultural values, western society tends to foster body negative images and thus increased risk of developing eating disorders. The role of the family also plays a role as mothers can often model unhealthy habits for their daughters and there is an association between childhood sexual and physical abuse and an elevated risk for eating disorders. Lastly, cognitive factors such as maladaptive beliefs and all-or-none thinking are examples of disturbed thinking which leads to eating disorders. Additional research is needed to determine whether distorted thinking is a cause or symptom of eating disorders.

The Role of Early Life Stress in Adult Disorders

Connection between stress and various disorders was largely limited to how adverse events in adolescence or adulthood might contribute to provoking the onset of certain disorders soon after the stress. However, in recent years there has been a surge of research on how severe stress in childhood can increase individuals' vulnerability to various disorders many years later. Studies have linked early forms of childhood trauma with increase prevalence of mental disorders. These studies aren’t completely convincing as there has been not enough evidence to establish causality, but the sheer amount of evidence suggests a real connection between childhood trauma which can cause individuals to be more likely to experience mental disorders later in life. One line of thinking is that advisory during childhood may alter critical features of the developing brain structure and the reactivity of the HPA axis that regulates hormonal responses to stressors.

Genetic Overlap Among Major Disorders

Depression, bipolar disorders, schizophrenia, and autism have all been viewed as independent disorders however recent findings suggest they may share more lineage than most experts would have guessed. One study noted that autism and schizophrenia appear to involve similar neurodevelopmental abnormalities, and recently discovered genetic mutations elevate the risk for both disorders. Another research line demonstrated that schizophrenia and bipolar share genetic vulnerabilities; and abnormalities in prefrontal white matter. Yet another study reported genetic overlap between schizophrenia and alcohol dependence. One study that used genetic mapping technology to quantify the hereditary covariation among depression, bipolar disorder, schizophrenia, autism, ADD, and ADHD. The findings suggest that the genetic overlap between schizophrenia and bipolar disorder is high; the overlap between schizophrenia and depression is moderate; the overlap between depression and bipolar disorder is moderate, and there is some overlap between autism and schizophrenia, but it is relatively low. These disorders may be related disorders existing on a spectrum.

Four Unifying Themes of Psychological Disorders

multifactorial causation, the interplay of heredity and environment, the sociohistorical context in which psychology evolves, and the influence of culture on psychological phenomena. Development of mental disorders involves interplay from a variety of psychological, biological, and social factors. There is also an interaction of genetics and experience as evident in stress vulnerability models for disorders. Vulnerability is these disorders is also dependent on heredity while stress is a function of the environment. Psychology also evolves in a sociohistorical context where social trends, prevailing values, and political realities playing a large role combined with the empirical research. Cultural norms are also a factor.

Insanity

is not a diagnosis; rather is a legal status indicating that a person cannot be held responsible for his or her actions because of mental illness. This is an issue because criminal acts must be intentional and not done because the individual convicted cannot control themselves such as in the case of insanity where the defendant claims they lack intent. No simple relationship exists between specific diagnosis of mental disorders and court judgements of insanity, which is also called criminal responsibility. The vast majority of people with diagnosed psychological disorders would not quality as insane (only those with severe disturbances that display delusional behavior). Many courts apply the McNaughten rule, insanity exists when a mental disorder makes a person unable to distinguish right from wrong which can be difficult to evaluate. Insanity is used very infrequently and polls show the public believes 37% of felony cases use the insanity defense while the number is closer to 1%. Another study of 60,000 indictments in Baltimore found only 190 defendants pleaded insanity. Of those only 8 were successful.

Competency

(or fitness in some states) refers to a defendant's capacity to stand trial. To be competent, the defendants must be able to understand the nature and purpose of legal proceedings and be able to assist their attorney. If they are not able, they are declared incompetent and cannot be brought to trial unless they are competent. Difference between competency and insanity is that insanity refers to the defendant's mental state at the time of the alleged crime. Competency refers to a defendant's mental state at the time of the trial. The legal system can often be extremely delayed and insanity cannot even become an issue unless the defendant is competent enough to stand trial. Far more people are found to be incompetent than insane and no single relationship exists between specific diagnosis and being declared incompetent. If someone is declared incompetent or insane, they are turned over to the mental health system for treatment However this can change from case to case where many factors determine what kind of treatment and for how long a defendant who is declared incompetent or insane must undergo.

Involuntary Commitment

The issue of insanity only surfaces in criminal proceedings, but far more people are affected by civil proceedings relating to involuntary commitment. Involuntary commitment is when people are hospitalized in psychiatric facilities against their will. Although the standards vary from state to state generally people who experience involuntary commitment are dangerous to themselves (usually suicidal), dangerous to others (potentially violent), or are unable to provide for their own basic care. In some situations psychologists and psychiatrists can authorize temporary commitment (for 24-72 hours). Longer terms can only be issued in court. Short term predictions about which patients are likely to become violent are largely inaccurate with 75% of the general public influenced by news reports linking psychological disorders to violence when in reality they only account for 5% to 10% of violent crime. People with serious mental illness are somewhat more likely to be violent than the general population. 2.9% of people with serious mental illness committed violent acts, compared with 0.8% of people without mental disorders. Any involuntary commitment involves the detention of people for what they might do in the future, not necessarily for what they did do. This detention goes against the grain of the American legal principle that people are innocent until proven guilty.

Medical Students' Syndrome

beginning medical students often erroneously believe they or their friends have whatever diseases they are currently learning about. Realistically speaking it is quite likely that you know many people with psychological disorders with data from one study suggesting the likelihood of anyone having at least one DSM disorder during their life is around 44%, still students overestimate the prevalence of such disorders.