Psychological Disorders

abnormal

is a variable that’s outside the standard limits, people who don’t conform to socila norms

cultural concepts of distress

a pattern of mental illness, distress, and/or symptoms that is unique to a specific ethnic or cultural population and doesn’t conform to standard classification of psychiatric disorder

Koro (culturally bound disorder)

an episode of sudden and intense anxiety that the genitals will recede into the body and possibly cause death

• chinese, malaysian, and indonesian

amok syndrome (culturally bound disorder)

a period of brooding followed by a sudden outburst of indiscriminate murderous frenzy, sometimes provoked by an insult, jealousy, or sense of desperation

• brunei, singapore, malaysia, indonesia, phillippines, timor-leste

ghost sickness (culturally bound disorder)

begins followings the passing of a loved one and includes symptoms of lethargy, nightmares, and feelings of dread and impending doom

• navajo, muscogee/creek

the four/five D’s

• deviance

• distress

• dysfunctional

• dangerous

• duration

deviance

departure of what is normal/usual

• refers to behaviours, thoughts, and feelings that are not in line with generally accepted standards

• culturally based

distress

behaviours, thoughts, and feelings that are upsetting and cause pain, suffering, or sorrow

dysfunctional

behaviours, thoughts, and feelings are disruptive to one’s regular routine or interfere with day-to-day functioning

dangerous

behaviours, thoughts, and feelings may lead to harm or injury to self or others

duration

the interval between the onset of a psychiatric disorder and the administration of the first pharmacological treatment

• to get a diagnosis, the abnormal behaviours need to persist for a specific amount of time

psychological disorders

patterns of deviant and dysfunctional behaviours, thoughts, and/or feelings that cause significant distress, and may even be dangerous, and last for a specific amount of time

history of psychiatry: 1840

first attempt in the US to gather information about mental health

history of psychiatry: 1883 (Emil Kraplin)

published a system of psychological disorders centered around a pattern of symptoms

• 7 categories: mania, melancholia, monomania, paresis, dementia, dipsomania, epilepsy

beginning of diagnostic manuals

1918: American Medico-Psychological Association changes its name to the american psychological association (APA)

• issues the statistical manual for use of institutions for the insane

first diagnostic manual

1921: American Medical Association’s standard Classified Nomenclature of Disease

• APA collaborated with the New York Academy of Medicine to develop psychiatric classifications

• 22 different categories, 21 were psychotic conditions

• meant for diagnosing inpatients with sever psychiatric/neurological disorders

diagnostic manuals

1946: US Army psychiatrists following WW2:

• high proportion of soldiers in combat suffered psychiatric breakdown

• kind of breakdowns they had (clearly response to stressful experiences) weren’t encompassed by existing manuals (in-patients)

• model for the first DSM

DSM-I: 1952

• published by the APA

• unreliable diagnostic tool, but first to focus on clinical use (concepts were NOT scientifically tested)

US army and veterans administration documented psychological distress

Adolf Meyer

emphasized how most mental disorders represented personality reactions to psychological, social, and biological factors

Sigmund Freud

general underlying processes rather than outward symptoms

DSM-II: 1968

193 personality disturbances diagnoses that were unreliable

• based in psychoanalytic theory (combo of internal/external things)

• didn’t pay attention to symptoms of some conditions—more general in outlook

DSM-III: 1980

precise definitions and diagnostic criteria for 228 mental disorders in a multiaxial system

research psychiatry + pharmaceuticals + insurance

multiaxial

a system/method of evaluation, grounded in the biopsychosocial model of assessment, that considers multiple factors in mental health diagnoses

5 axis

Axis I: major mental disorders

Axis II: personality or intellectual disorders

Axis III: medical conditions

Axis IV: psychosocial stressors

Axis V: global assessment of functioning

DSM-III-R: 1987

253 diagnoses including sleep disorders

• Categories renamed, reogrnaized and significant changes in criteria were made

• DSM-III revised due to inconsistencies in the system, diagnostic criteria were unclear

DSM-IV: 1994

383 diagnoses + clinical significance criterion

• categorizes disorders into “classes” (groups similar disorders)

DSM-IV-TR: 2000

383 diagnoses still but improvement in diagnostic descriptions heavily research-based)

DSM-V: 2013

541 diagnoses due to advances in biological and neuroscience

• no longer multiaxial, no more GAF (general assessment of function or axis V)

interrater reliability for the DSM-V

criteria covers a wide range of illness severity

DSM-V-TR: 2022

• identified out-of-date information in the DSM-V

• clarified certain diagnostic criteria

• ensured appropriate attention to risk factors (racism, discrimination)

other diagnostic manuals

• International Statistical Classification of Diseases and Related Health Problems (ICD)

• Research Domain Criteria (RDoC)

• Psychodynamic Diagnostic Manual (PDM)

• Hierarchical Taxonomy of Psychopathology (HiTOP)

most DSM disorders have 3 diagnostic criteria in common:

1. causes significant distress/affects functioning

2. cannot be attributed to substance use or other medical conditions

3. cannot be better described by another DSM diagnosis

onset

the chronological age or situational period when the symptoms of a disorder first appear in an individual (when does it usually start?)

prognosis

the likely course of a disorder (what will happen next? when will the disorder go into remission?)

risk factors

a set of biological, psychological and social characteristics that increase the likelihood of having the disorder

etiology

the biological, psychological, and/or social causes of a disorder (what causes the disorder? what makes one individual more likely to have the disorder than another?)

comorbidities

other psychological or physical disorders that frequently co-occur with the disorder in question (what other disorders often appear with this one?)

Anxiety disorders

anxiety that interferes with normal functioning is maladaptive (decreases fitness for survival)

• very common (about 30% of Canadians will experience one, but 5% get diagnosed)

• DSM-V recognizes 12 types

generalized anxiety disorder (GAD)

an anxiety disorder in which worries are not focused on any specific threat

• we use GAD as a case study for examining different parts of the DSM

GAD diagnostic criteria

1. excessive anxiety and worry, occuring more days than not for min. 6 months, about more than one event/stressor

2. the individual finds it difficult to control the worry

3. three or more of the following symptoms:

   • restlessness

   • fatigue

   • concentration deficiency

   • irritability

   • muscle tension

   • sleep disturbances

GAD onset

• median age for diagnosis is age 30

  • but patients report having symptoms for a long time prior

• in the population, the level of anxiety is constant throughout the lifespan

  • content of worries change

GAD prognosis

for individuals, severity of symptoms waxes and wanes across lifespan

• full remission is rare

phobic disorders

characterized by marked, persistent, excessive fear of specific objects, activities, or situations

• usually recognizes irrationality of their fear, but cannot control it

preparedness theory

we may be evolutionary adapted to fear certain types of stimulus

• evidence for this hypothesis comes from conditioning

phobic disorder types

specific phobia (12% prevalence):

• animals

• natural environments

• situations

• medical events

• other

social phobia (13% prevalence)

social phobia

maladaptive fear of being publicly humiliated or embarrassed

panic disorder

sudden occurrence of multiple psychological and physical symptoms typically associated with terror

panic disorder symptoms

• shortness of breath

• heart palpitations

• sweating

• dizziness

• derealisation (feelings that the world is unreal)

• fear of death/“losing one’s mind”

panic disorder diagnosis

Panic episodes are relatively common; to be diagnosed, an individual must experience:

• recurrent, unexpected attacks

• significant fear of another attack

moods

are emotional states thta are long-lasting and nonspecific

mood disorders

are mental disorders that have mood disturbances as their prominent feature

manic episode

a distinct period of high energy and increased activity

depressive episode

a distinct period of sad mood and loss of interest or pleasure

major depressive disorder (MDD)

severely depressed mood and/or inability to experience pleasure that lasts two or more weeks and is accompanied by feelings of worthlessness, lethargy, sleep disturbance, and/or appetite disturbance

MDD diagnosis criteria

1. 5 or more of the following symptoms present during the same 2-week period:

   • depressed mood

   • diminished interest

   • significant weight loss/gain

   • insomnia or hypersomnia

   • psychomotor agitation or retardation

   • fatigue

   • feelings of worthlessness/guilt

   • diminished concentration/decisiveness

   • recurrent thoughts of death/suicidal ideation

2. no evidence of a manic episode

MDD onset

may appear at any age, but is most likely to appear in the 20s

MDD prognosis

• 2/5 recover within 3 months

• 4/5 recover within 1 year

• 1/5 do not experience remission

MDD risk factors

• temperamental (neuroticism, or negative affect)

• environmental (childhood experiences, stressful life events)

• biological (neurotransmitter imbalance)

• genetic (family members with MDD are 2-4 times more likely; 40% heritability)

MDD comorbidity

substance-related disorders, panic disorders, obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa

helplessness theory

argues that the way a person thinks about failure makes them more or less likely to be depressed

• attribute failures to internal characteristics

• believe that failures are permanent (stable)

• believe that failures are global (apply to many areas of life)

dysthymia / dysthymic disorder

moderate depressive symptoms that last for 2+ years

double depression

when dysthymia is punctuated by episodes of major depression

bipolar disorders

are characterized by cycles of abnormal, persistent high mood (mania) and low mood (depression)

bipolar I

at least one manic episode, possibly with hypomanic and depressive episodes as well

bipolar II

presence of both hypomania and depressive episodes; NO manic episodes

bipolar I diagnosis criteria

1. distinct period of abnormal, persistently elevated mood; increased activity or energy, lasting at least 1 week (manic episode)

2. three or more of the following:

   • inflated self-esteem

   • decreased need for sleep

   • talkative

   • racing thoughts

   • distractibility

   • increase in goal-directed activity or psychomotor agitation

   • excessive involvement in activities with a high potential for painful consequences

bipolar I prevalence

1 in 40 individuals

1:1 betwene women and men

bipolar I onset

mean age of first episode is 18 years

• Onset can occur for the first time in 60s and 70s

bipolar I prognosis

90% who experience a manic episode will experience more of them throughout life

• Full remission is very rare

bipolar I risk factors

• genetic (among the most heritable; coincidence among identical twins = 40-70%)

• environmental (high stress, highly emotionally expressive family, separation/divorce)

• psychological (high neuroticism, high conscientiousness)

bipolar I comorbidity

• anxiety disorders

• substance use disorders

• ADHD

• behavioural disorders

obsessions

are recurrent, unwanted, and intrusive thoughts, fears, urges, or images

compulsions

are behaviours in response to obsession

hoarding disorder

difficulty getting rid of useless possessions

• results in excessive accumulation of items

• areas in living space become unusable and hazardous

trauma

is an emotional response to something shocking or dangerous

stress

is a reaction to life demands

posttraumatic stress disorder (PTSD)

experiencing or witnessing a traumatic event (war, natural disaster, and/or violent crime)

addiction

is repeated and compulsive engagement in rewarding activities

• disregard for negative, long-term outcomes

• can be substance-related or behavioural

substance-related disorders

lead to physiological dependence and tolerance

• substance use disorders (accumulate over long periods of time)

• substance-induced disorders (immediate effects of substance use)

gambling disorder

repeatedly placing bets to risk money and gain more

• chasing a feeling of euphoria

• considered a behavioural addiction

general neurocognitive disorders

neurocognitive disorders are acquires (cognitive deficit not present at birth)

attributable to:

• brain injury

• disease

• substance/medication use

general personality disorder

drastically different characteristics, beliefs, and behaviours

3 categories of behaviours

1. Cluster A: odd and eccentric (social awkwardness)

2. Cluster B: dramatic, emotional, and erratic (impulse control)

3. Cluster C: anxious and fearful (adolescent usually)

borderline persoanlity disorder (BPD)

instability in interpersonal relationships, self-image, and emotion

• intense emotions that quickly change

• thinking in absolutes of all good or bad

biopsychosocial model

risk is determined by interactions of:

• biological makeup

• psychological experiences

• social environment

diathesis-stress model

a model that suggests that the experience of stress interacts with an individual’s pre-existing vulnerability to produce a psychological disorder

diagnostic and statistical manual of mental disorders (DSM)

a system for classification of psychological disorders published by the APA

conduct disorder

a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated

autism spectrum disorder

a disorder characterized by deficits in social relatedness and communication skills that are often accompanied by repetitive, ritualistic behaviour

schizophrenia

a disorder characterized by hallucinations, delusions, disorganized thought and speech, disorders of movement, restricted affect, and avolition or asociality

attention deficit hyperactivity disorder (ADHD)

a disorder characterized by either unusual inattentiveness, hyperactivity with impulsivity, or both

delusions

a false, illogical belief

learned helplessness

a state in which experiencing random or uncontrolled consequences leads to feelings of helplessness and possibly depression

hallucinations

a false perception

panic attack

the experience of intense fear and autonomic arousal in the absence of real threat

agoraphobia

unrealistic fear of open spaces, being outside the home alone, or being in a crowd

body dysmorphic disorder

a disorder characterized by the unrealistic perception of physical flaws

obsessive-compulsive disorder (OCD)

a disorder associated with intrusive obsessions and compulsions

dissociative disorders

a disorder characterized by disruptions in a person’s identity, memory, or consciousness

antisocial personality disorder (ASPD)

a disorder characterized by an unusual lack of remorse, empathy, or regard for normal social rules and conventions