Intro to Psychology Areas and Applications - Chapter 15: Psychological disorders

Medical model

A framework that brought improvements and proposed that it’s useful to think of abnormal behaviour as a disease, aiming to reduce stigma and improve humane treatment.

Medical model (con’t)

Came into prominence during the 18th and 19th centuries

Medical model (III)

Victims were viewed with more sympathy and less hatred and fear as they were seen as suffers of an illness

Thomas Szasz

A theorist who argued that mental illnesses are not diseases but rather “problems in living”, because disease or illness can affect only the body

Deviance

A criterion for abnormal behaviour where an individual's conduct differs significantly from what society considers acceptable or normal.

Maladaptive behaviour

A criterion for abnormal behaviour occurring when an individual's everyday adaptive functioning is impaired,

e.g. When drug use interferes with social or occupational life.

Abnormal behavior

Is considered a disease no matter how mild or severe according to the medical model

Diagnosis of abnormal behavior

Is subjective

Personal distress

A criterion for abnormal behaviour based on an individual's report of great personal pain and suffering

e.g. Depressed people may or may not exhibit deviant or maladaptive behaviour.

Personal distress (con’t)

Is often seen in depression or anxiety disorders.

Stereotypes of psychological disorders

1. Psychological disorders are incurable

2. People with psychological disorders are often violent and dangerous.

3. People with psychological disorders behave in bizarre ways and are very different from normal people

DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, 5th edition)

The formal classification system for psychological disorders.

Dimensional approach

Describe disorders in terms of how people score on a limited number of continuous dimensions

e.g. The degree to which they exhibit anxiety, depression, agitation, anger, hypochondria, etc

Epidemiology

The study of the distribution of mental or physical disorders in a population.

Prevalence

The percentage of a population that exhibits a disorder during a specified time period.

The lifetime risk of a a psychiatric disorder

51%

The most common types of psychological disorders in North America

1. Substance (alcohol and drugs) use disorders

2. Anxiety disorders

3. Depression

Diagnosis

Distinguishing one illness from another

Prognosis

A forecast about the probable course of an illness

Etiology

The study of the apparent causation and developmental history of an illness.

Anxiety disorders

A class of disorders marked by feelings of excessive apprehension and anxiety

Generalized anxiety disorder (free-floating anxiety)

A disorder marked by a chronic, high level of anxiety that isn’t tied to any specific threat; is more common in females

Generalized anxiety disorder (free-floating anxiety) [con’t]

People worry about minor matters related to family, finances, work, and personal illness, and hope their worrying will help to ward off negative events

Generalized anxiety disorder (free-floating anxiety) symptoms

Is commonly accompanied by physical symptoms such as trembling, muscle tension, diarrhea, dizziness, faintness, sweating, and heart palpitations

Panic disorder

A disorder characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly, often leading to agoraphobia.

Obsessive-compulsive disorder ($OCD$)

A disorder marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions).

e.g. Constant hand-washing, repetitive cleaning of things that are already clean, and endless rechecking of locks, faucets, and such.

Obsessive-compulsive disorder ($OCD$) [con’t]

Obsessions sometimes centre on inflicting harm on others, personal failures, suicide, or sexual acts.

Obsessive-compulsive disorder ($OCD$) [III]

People troubled by obsessions may feel that they have lost control of their mind and they may be plagued by uncertainty

Obsessive-compulsive disorder ($OCD$) [IV]

Some are keenly aware that their obsessions and compulsions are irrational, whereas others are convinced that their behaviour is rational

OCD factor symptoms

• Obsessions and checking

• Symmetry and order

• Cleanliness and washing

• Hoarding

Body dysmporhic disorder

When an individual has an unrelenting preoccupation with what they perceive to be a physical flaw

The trauma- and stressor-related disorders class in the DSM-5

Includes:

• Reactive attachment disorder

• Disinhibited social engagement disorder

• PTSD,

• Acute stress disorder

• Adjustment disorders

Post-Traumatic Stress Disorder ($PTSD$)

A disorder elicited by an acute or chronic stressor, with symptoms such as nightmares, flashbacks, social disconnect, and emotional numbing.

Post-Traumatic Stress Disorder ($PTSD$) causes and timing

Occurs many months or years after a variety of traumatic events

e.g. A rape or assault, a severe automobile accident, a natural disaster, or the witnessing of someone’s death

Complex PTSD

A form of post-traumatic stress disorder that results from prolonged, chronic, and repeated exposure to trauma, especially on children

Complex PTSD sources

Recurrent physical, emotional, and sexual abuse, and chronic neglect

Post-Traumatic Stress Disorder ($PTSD$) predictors

Increased vulnerability is associated with greater personal injuries and losses, greater intensity of exposure to the traumatic event, and more exposure to the grotesque aftermath of the event

Etiology of anxiety and anxiety-related disorders

• Biological factors (e.g. Concordance rate)

• Acquisition via classical conditioning and maintenance through operant conditioning as a result of adverse experiences

• Cognitive and thinking errors

• Stress

• Past childhood experiences

Concordance rate

A statistic indicating the percentage of twin pairs or other pairs of relatives who exhibit the same disorder; in anxiety disorders, this rate is higher for identical twins ($100\%$ genetic relatedness) than fraternal twins ($50\%$).

Executive function

Refers to the basic cognitive processes that underlie self-regulation, planning, and decision-making.

Dissociative disorders

A class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity

Etiology of dissociative disorders

Are unknown because so many theorists do not believe that patients disassociate and it's hard to study

Dissociative amnesia

A sudden loss of memory for important personal information that is too extensive to be due to normal forgetting.

e.g. Forgeting their name, their family, where they live, and where they work

Dissociative amnesia (con’t)

Can occur after a single traumatic event and the excessive stress that comes with it

e.g. A car crash, house fire, combat stress, etc

Dissociative identity disorder ($DID$)

A controversial diagnosis involving the coexistence in one person of two or more largely complete, and usually very different, personalities.

Dissociative identity disorder ($DID$) [con’t]

Each identity has its own name, memories, traits, physical mannerisms, and autonomy

Dissociative identity disorder ($DID$) [III]

DID patients often exhibit somatic symptoms, such as headaches and chronic pain, self-harm behaviours, and hallucinations

Etiology of dissociative identity disorder ($DID$)

Are rooted in severe emotional trauma that occurred during childhood

The DSM-5 bipolar and related disorder class

Includes

• Bipolar I

• Bipolar II,

• Cyclothymic disorder

The DSM-5 depressive disorder class

Includes

• Major depressive disorder

• Disruptive mood dysregulation disorder

• Premenstrual dysphoric disorder

• Persistent depressive disorder

Major depressive disorder ($MDD$)

A mood disorder characterized by persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure.

Major depressive disorder ($MDD$) [con’t]

When people experience emotional extremes at just one end of the mood continuum because they experience periodic bouts of depression.

Anhedonia

A diminished ability to experience pleasure

Depression symptoms

Depressed people lack the energy or motivation to tackle the tasks of living, to the point where they often have trouble getting out of bed

When does the onset of depression take place?

It can occur to anyone at any point in the lifespan, but a substantial majority of cases emerge before age 40

When does the onset of depression take place? (con’t)

An earlier age of onset is associated with more recurrences, more severe symptoms, and a worse prognosis

Depression episodes

5-6 depression moments that last an average of 6 months

How common is depression?

Lifetime prevalence is estimated to be around 13–16 percent; is more common among women due to the unique challenges they face

When do most depressive disorder instances occur?

35 - 40 years of age

Bipolar I disorder

Is characterized by the experience of one or more manic episodes as well as periods of depression.

Manic episode

A state characterized by elation, euphoria, racing thoughts, flight of ideas, hyperactivity, and a decreased need for sleep, all of which go on for days

Bipolar II disorder

individuals suffer from episodes of major depression along with hypomania, in which their change in mood and behaviour is less severe than that seen in full mania

Bipolar I and II disorder statistics

Affects 1% of the population

Seasonal affective disorder (SAD)

A type of depression that follows a seasonal pattern

e.g. Winter depression

Postpartum depression

A type of depression that sometimes occurs within 4 weeks after childbirth.

Suicide and mood disorders

Suicide rates are highest for people with depressive and bipolar disorders

Etiology of depressive and bipolar disorders

• Genetic vulnerability

• Abnormal levels of norepinephrine and serotonin in the brain

• Structural abnormalities (e.g. reduced hippocampal volume, high amygdala activity)

• Cognitive models like learned helplessness, rumination, and hindsight bias

Etiology of depressive and bipolar disorders (con’t)

• Inadequate social skills, which lead to a lack of support and connections

• Stress

• Injuries such as concussions

Schizophrenia (split mind)

A disorder characterized by delusions, hallucinations, disorganized speech, and a deterioration of adaptive behaviour.

e.g. Diminished emotional expression

Schizophrenia (split mind) [con’t]

Usually emerges during adolescence or early adulthood where ~75 percent of cases manifest by the age of 30

Schizophrenia (split mind) statistics

1% of the population suffers from it

The three parts of the brain that are shown to be smaller in those with schizophrenia

• Hippocampus

• Amygdala

• Thalamus.

Positive symptoms

Behavioural excesses or peculiarities seen in schizophrenia, such as hallucinations, delusions, and bizarre social behaviour.

Negative symptoms

Behavioural deficits seen in schizophrenia including flattened/disturbed emotions, social withdrawal, apathy, poor grooming, and poverty of speech.

Paranoid schizophrenia

Dominated by delusions of persecution, along with delusions of grandeur

Catatonic schizophrenia

Striking motor disturbances, ranging from the muscular rigidity seen in a withdrawn state to random motor activity

Disorganized schizophrenia

A particularly severe syndrome marked by frequent incoherence, obvious deterioration in adaptive behaviour, and virtually complete social withdrawal

Undifferentiated schizophrenia

Involves idiosyncratic mixtures of schizophrenic symptoms

Etiology of Schizophrenia

• Genetic factors

• Drug usage

• Structural abnormalities and neurological defects in the brain (e.g. smaller hippocampus, thalamus, and amygdala)

• Stress

Dopamine hypothesis

An etiological theory for schizophrenia asserting that the disorder is caused by overactivity at dopamine synapses, potentially due to an overabundance of $D_2$ receptor sites.

Dopamine hypothesis (con’t)

• Elevated dopamine activity in certain areas of the brain may foster positive symptoms

• Reduced dopamine activity in other neural circuits may foster negative symptoms

Neurodevelopmental hypothesis

The theory that schizophrenia is caused by subtle neurological damage insults to the brain during prenatal development or at birth

e.g. Viral infection or malnutrition, which disrupt maturational processes.

Expressed emotion (EE)

The degree to which a relative of a schizophrenic patient displays highly critical or emotionally over-involved attitudes toward the patient

e.g. Families are probably more sources of stress than of social support

Personality disorders

A class of mild disorders marked by extreme, inflexible personality traits that cause subjective distress or impaired social and occupational functioning.

Personality disorders (con’t)

Generally become recognizable during adolescence (teens) or early adulthood, with the lifetime prevalence in the vicinity of 10 percent

The three related clusters of personality disorders

• Anxious/fearful

• Odd/eccentric

• Dramatic/impulsive

Antisocial personality disorder

A disorder characterized by chronically violating the rights of others, failing to accept social norms, and exploitive, reckless behaviour.

Antisocial personality disorder (con’t)

Is marked by impulsive, callous, manipulative, aggressive, and irresponsible behaviour that makes them a bad person by definition

Antisocial personality disorder (III)

Suffers have a lack of guilt and conscience, and they can tolerate little frustration, and they pursue immediate gratification

Etiology of antisocial personality disorder

Parental neglect

Borderline personality disorder

Marked by instability in social relationships, self-image, impulse control, and emotional functioning; is more common in females

Borderline personality disorder (con’t)

Is also associated with an elevated risk for self-injurious behaviour, such as cutting or burning oneself, and with an increased risk for suicide

Etiology of borderline personality disorder

Early trauma

Narcissistic personality disorder

Marked by a grandiose sense of self-importance, a sense of entitlement as well as superiority, and an excessive need for attention and admiration; is more common in males

Etiology of personality disorders

They’re influenced by heredity, and the data from twin and family studies support this line of reasoning

e.g. Antisocial personality disorder include dysfunctional family systems; erratic discipline; parental neglect; exposure to violence in one’s community; and the influence of exploitive peers

Autism spectrum disorder ($ASD$)

A neurodevelopmental disorder involving significant social and emotional deficits along with repetitive, stereotypic behaviours, and activities

Autism spectrum disorder ($ASD$) [con’t]

Children suffering from autism were seen to exhibit three types of deficits:

• Impairment in social interaction

• Impairment in communication

• Repetitive, stereotyped behaviours/interests/activities

• Great inflexibility and resistance to change

Autism spectrum disorder ($ASD$) diagnosis

Earlier versions of the DSM assumed that all children with autism were diagnosed by the age of 3.

Long term outcomes for Autism

• 20% of individuals with autistic disorders experienced a good outcome (a high level of independence),

• 31% a fair outcome (some independence, but support and supervision are needed),

• 48% a poor outcome (needing residential supervision or hospital care

Etiology of Autism

Most theorists today view autism as a disorder that originates in biological and genetic dysfunctions, but with few specific reasonings.