Chapter 16: Psychological Disorders

Psychological Disorders

* “Abnormal” thoughts, feelings and behaviour
* Not all “abnormal” thoughts, feelings and behaviours are related to this

Abnormal Behaviour

* Behaviour that is personally distressing, personally dysfunctional and/or so culturally deviant that other people judge it to be inappropriate or maladaptive
* May extend beyond personal

Biological Approach

* Sees that psychological disorders are due to organic, internal causes

Medical Model

* The view that psychological orders are medical diseases with biological origins

Psychological Approach

* Focuses on experiences, thoughts, emotions, and personality characteristics to explain psychological disorders

Sociocultural Approach

* Looks at social contexts people live in, which include gender, ethnicity, socioeconomic status, family relationships and culture

The Role of Culture in Psychological Disorders

* Understandings and values of that person
* Experiences and pressaures
* Different expectations form different social groups

Cultural-Bound Syndromes

* Expressions of mental distress that are almost completely limited to specific cultural groups
* Not just geographical location

Windigo Psychosis

* The syndrome is characterized by delusions of becoming possessed by a flesh-eating monster (the windigo) and is manifested in symptoms including depression, violence, a compulsive desire for human flesh, and sometimes actual cannibalism, recognized by Northern Algonquin American groups

Biopsychosocial Model

* Argues that abnormal behaviour can be influenced by biological psychological and sociocultural factors

Vulnerability-Stress-Hypothesis

* A model that explains behaviour disorders as resulting from predisposing biological or psychological vulnerability factors that are triggered by a stressor
* Known as the diathesis-stress model

Vulnerability Factors

* Influenced by biological and psychological factors
* Genetic factors
* Biological characteristics
* Psychological traits
* Previous maladaptive learning
* Low social support

Stressors

* Sociocultural factors
* Economic adversity
* Environmental trauma
* Interpersonal stressors or loses
* Occupational setbacks or demands

The DSM 5

* The Diagnostic and Statistical Manual of Mental Health Disorders
* A handbook used by health care professionals as the authoritative guide to the diagnosis of mental disorders.
* Contains descriptions, symptoms and other criteria for diagnosing mental disorders.

System of the DSM 5

* Integrates a dimensional system in that categorical system
* Dimensional approaches better reflect the uniqueness of the individual over the categorical system

Rates of the DSM 5

* Incident
* New cases per period
* Prevalence
* Total number of people in specific periods of time

Anxiety Disorders

* A group of behavioural disorders in which anxiety and associated maladaptive behaviour are the core of the disturbance
* Focuses on the experience of anxiety
* Most prevalent
* More in women than men

Emotional Symptoms of Anxiety Disorders

* Feelings of tension
* Apprehension

Cognitive Symptoms of Anxiety Disorders

* Worry
* Thoughts about inability to cope

Physiological Symptoms of Anxiety Disorders

* Increased heart rate
* Muscle tension
* Other autonomic arousal symptoms
* Fight or flight

Behavioural Symptoms of Anxiety Disorders

* Avoidance or feared situation
* Decreased task performance
* Increased startle response

Phobias

* Strong and irrational fears of certain objects or situations
* May develop any time in one’s life but mostly in childhood or early adulthood

Agoraphobia

* A phobia centred around open spaces and public places

Social Anxiety Disorder

* A phobia of social situations in which a person might be evaluated and possibly embarrassed

Explanations for Phobic Disorders

* Based on experiences, memories and learned associations
* Classical conditioning
* Evolutionary-based sensitivities
* Fear/disgust-orientated
* Can be gendered
* Women = Higher fear of animals
* Men = Higher fear of heights

Generalized Anxiety Disorder

* A chronic state of diffuse (“free-floating”) anxiety that is not attached to specific situations or objects
* Increased sensitivity to other anxiety-inducing contexts
* Develops in childhood/adolescence

Potential Causes of Generalized Anxiety Disorder

* GABA deficiency and genetics
* Harsh self-standards, overly critical parents, automatic negative self-thoughts, and history of uncontrollable traumas/stressors

Panic Disorder

* An anxiety disorder characterized by unpredictable panic attacks and pervasive fear that others will occur
* Many appear random and not tied to the environment

Potential Causes of Panic Disorder

* Higher lactate (helps with brain metabolism)
* Learning and generalization of fear

Obsessive-Compulsive Disorder

* An anxiety disorder characterized by persistent and unwanted thoughts and compulsive behaviours
* Consists of Obsessions and Compulsions
* Inability to “turn off: intrusive thoughts
* Onset is around the 20s

Obsessions

* An unwanted and disturbing thought or image that invades consciousness and is very difficult to control

Compulsions

* A repetitive act that the person feels compelled to carry out, often in response to an obsessive thought or image

Scrupulosity

* Any immoral behaviour that goes against their religion is wrong and they must repent
* Oversensitive to religion

Executive Dysfunction Model in OCD

* Argues the underlying problem is impulsive control and behavioural inhibition
* Best to explain compulsions

Modulatory Control Mode in OCD

* Argues a lack of control of socially appropriate behaviours
* Best to explain obsessions

Links to OCD

* Lower levels of serotonin, dopamine, and glutamate

Eating Disorders

* Any of a range of mental conditions in which there is a persistent disturbance of eating behaviour and impairment of physical or mental health.

Anorexia Nervosa

* An eating disorder involving severe and sometimes fatal restrictions on food intake
* Fear of being overweight
* Must maintain the “ideal” body

Effects of Anorexia Nervosa

* Heart strain
* Bone loss
* Stopping menstruation
* Death

Bulimia Nervosa

* An eating disorder involving the bingeing and purging of food, usually by vomiting or laxative use, because of a concern with becoming fat

Effects of Bulimia Nervosa

* Gastric problems
* Eroded teeth
* lower taste sensitivity

Mood Disorders

* Psychological disorder whose core conditions involve maladaptive mood states, such as depression or mania

Most Experienced Psychological Disorders

* Mood and anxiety

Depression

* Persistent sadness and a lack of interest or pleasure in previously rewarding or enjoyable activities.

Major Depressive Disorder

* A mood disorder characterized by intense depression that interferes markedly with functioning

Chronic Depressive Disorder

* A depressive mood disorder of moderate intensity that occurs over a long period of time but does not disrupt functioning as major depression does
* Was called dysthymia

Emotional Symptoms of Depression

* Sadness
* Hopelessness
* Anxiety
* Misery
* Inability to enjoy

Cognitive Symptoms of Depression

* Negative cognitions about self, world, and future

Motivational Symptoms of Depression

* Loss of interest
* Lack of drive
* Difficulty starting anything

Somatic Symptoms of Depression

* Loss of appetite
* Lack of energy
* Sleep difficulties
* Weight loss/gain

Biological Factors in Depression

* Genetic factors
* High BIS (inhibition/avoidance) sensitivity and low BAS (seek out rewards) sensitivity
* Underactivity of norepinephrine, dopamine, and serotonin

Psychological Factors in Depression

* Depressive Cognitive Triad
* Learned Helplessness Theory
* Pessimistic Attribution Style

Depressive Cognitive Triad

* Negative thoughts concerning the world, oneself, and the future that people with depression cannot control or suppress

Learned Helplessness Theory

* A theory of depression that states if people are unable to control life events, they develop a state of helplessness that leads it depressive symptoms

Pessimistic Attribution Style

* The tendency of depressed people to attribute negative outcomes to their own inadequacies and positive ones to factors outside themselves

Sociocultural Factors in Depression

* Overly individualistic thinking and behaviour
* Socioeconomic status
* Ethnicity
* Depression may manifest as somatic symptoms in some cultures vs. others

Bipolar Disorder

* Mood disorders in which intermittent mania appears against a background of depression

Mania

* A state of intense emotional and behavioural excitement in which a person feels very optimistic and energized
* Can be incredibly destructive

Dissociative Disorders

* Disorders that involve a major dissociation of personal identity or memory

Dissociative Amnesia

* A disorder in which a person responds to a stressful event with extensive but selective memory loss

Dissociative Fugue

* A dissociative phenomenon in which a person loses all sense of personal identity and wanders to another place and establishes a new identity

Dissociative Identity Disorder

* A dissociative disorder in which two or more separate identities or personalities coexist within an individual
* Previously called multiple personality disorder
* Host personalities and alters
* The validity of DID diagnosis is debated

Trauma-Dissociation Theory

* A theory that accounts for the development of dissociative identity disorder in terms of dissociation as a defence against severe childhood abuse or trauma
* Defensive personalities

Putnam (1989) research on DID

* 97/100 of those with DID suffered childhood abuse/trauma

Schizophrenia

* A psychotic disorder involving serious impairment of attention, thought, language, emotion and behaviour
* Split mind
* Diagnosis requires a person to misinterpret reality
* Language is disorganized and can contain strange words
* Emotions may have blunted or flat
* The stronger concordance rate for identical twins
* Brain abnormalities

Delusions

* False beliefs that are sustained in the face of evidence that normally would be sufficient to destroy them

Hallucinations

* False perceptions that have a compelling sense of reality

Type I Schizophrenia

* A subtype of schizophrenia with the predominance of positive symptoms
* Good functioning prior to breakdown and a better prognosis for eventual recovery

Positive Symptoms

* Added pathological extremes such as delusions, hallucinations and disordered speech and thinking

Type II Schizophrenia

* A subtype of schizophrenia characterized by negative symptoms
* The long history of poor functioning prior to hospitalization and poor outcome following treatment

Negative Symptoms

* The absence of normal reactions such as lack of emotional expression loss of motivation, and absence of normal speech

Dopamine Hypothesis

* The symptom of schizophrenia - particularly positive symptoms - are produced by overactivity of the dopamine system in areas of the brain that regulate emotional expression, motivated behaviour and cognitive functioning

Psychological Factors of Schizophrenia

* An interpersonal withdrawal that has become too stressful to deal with
* Defects in attentional mechanisms that filter out irrelevant stimuli

Environmental Factors of Schizophrenia

* Stressful life events
* Expressed emotion
* May be a cause or response to disordered behaviours

Expressed Emotion

* A family interaction pattern involving criticism, hostility, and overinvolvement that is associated with relapse when formerly hospitalized schizophrenic patients return home

Sociocultural Factors of Schizophrenia

* Lower socioeconomic status
* Social Causation hypothesis
* Social Drift hypothesis

Social Causation Hypothesis

* The higher prevalence of schizophrenia is due to higher levels of stress that low-income people experience

Social Drift Hypothesis

* As people develop schizophrenia, their personal and occupational functioning deteriorates, so they drift down the socioeconomic ladder

Personality Disorder

* Stable, inflexible and maladaptive personality styles

Narcissistic Personality Disorder

* Grandiose fantasies or behaviour, lack of empathy, and oversensitivity to evaluation
* A constant need for admiration

Avoidant Personality Disorder

* Extreme social discomfort and timidity
* The feeling of inadequacy and fearfulness of being negatively evaluated

Schizotypal Personality Disorder

* Odd thoughts, appearances, and behaviour and extreme discomfort in social situations

DSM 5 Personality Disorders

* Antisocial Personality Disorder
* Narcissistic Personality Disorder
* Borderline Personality Disorder
* Avoidant Personality Disorder
* Obsessive-compulsive Personality Disorder
* Schizotypal Personality Disorder

Personality Trait Dimensions

* Negative Emotionally
* Schizotypal
* Disinhibition
* Introversion
* Antagonism
* Compulsivity

Borderline Type Disorder

* Has high trait dimensions of:
* Negative emotionally
* Schizotypy
* Disinhibition

Antisocial/ Psychopathic Type

* Has high trait dimensions of:
* Disinhibition
* Antagonism

Antisocial Personality Disorder

* A disorder involving behaviour that is interpersonally destructive and emotionally harmful and exhibits a lack of conscience
* Exhibit a lack of anxiety or guilt, tends to be impulsive, and unable to delay gratification of needs
* Men are more likely to be diagnosed
* This only occurs in a portion of psychopathic individuals
* Unable to develop a conditioned fear response

Behavioural Clusters Associated with Psychopathy

* 1. Selfishness, callousness, and interpersonal manipulation


* 2. Impulsivity, instability and social deviance

Diagnosis of Antisocial Personality Disorder

* Requires both clusters
* Must be 18 or older
* Requires substantial evidence of antisocial behaviour before the age of 15

Borderline Personality Disorder

* A collection of symptoms characterized primarily by serious instability in behaviour, emotion, identity and interpersonal relationships
* Experience chronic feelings of extreme anger, loneliness and emptiness
* 2/3 diagnosed are women
* Chaotic personal histories
* Shifts from extreme love to extreme hate

Emotional Dysregulation

* An inability to control negative emotions in response to stressful events

Effects of Borderline Personality Disorder

* Engage in self-destructive behaviours
* A high number of suicides
* Most difficult to treat due to clinging dependency, irrational anger, and tendency to use manipulative suicide threats

Splitting

* The failure to integrate positive and negative aspects of another’s behaviour into a coherent whole

Intermittent Explosive Disorder

* Explosive anger or rage at disproportionate types of threats

Women’s Differences in Psychological Disorders

* Higher rates of anxiety disorders and depression
* 2x more likely

Men’s Differences in Psychological Disorders

* Higher rates of intermittent explosive disorder and antisocial personality disorder
* 3 - 4x more likely

Causes for Sex Differences

* Differences in reporting psychological distress
* Clinicians expectations
* Possible biases
* Differences in social roles and experiences
* Differences in ways of responding
* Internalizing (women) vs. externalizing (men)

Histrionic Personality Disorder

* The idea that someone is very theatrical (manipulative)
* Removed from the new DSM
* Wants attention from others
* Higher diagnosis for women

Judgements of Abnormal Behaviour

* Distressing to self or others
* Deviant: violates social norms
* Dysfunctional for a person or society

General Paresis

* Mental deterioration and bizarre behaviour
* Massive brain deterioration