Psychological Disorders

CHAPTER 15: PSYCHOLOGICAL DISORDERS

Chapter Overview

I. Defining and Explaining Abnormal Behavior
  • Abnormal behavior is defined as behavior that is:
    • Deviant: Does not conform to accepted social standards.
    • Maladaptive: Interferes with an individual's ability to function effectively in society, and may present a danger to the individual or others.
    • Personally distressful: Causes long-term discomfort for the individual.
    • Note: Only one of these criteria needs to be present for behavior to be considered abnormal, although typically two or all three factors are present.
A. Theoretical Approaches to Psychological Disorders

  1. The Biological Approach

    • Views psychological disorders as organic and internal, focusing on the brain, genetic factors, and neurotransmitter functioning.
    • Medical model: Defines psychological disorders as medical diseases with a biological origin.

  2. The Psychological Approach

    • Emphasizes the contributions of experiences, thoughts, emotions, and personality characteristics.
    • Behavioral psychologists: Focus on environmental rewards and punishments as determinants of abnormal behavior.
    • Social cognitive psychologists: Highlight observational learning, cognitions, and beliefs in fostering maladaptive behavior.

  3. The Sociocultural Approach

    • Analyzes larger social contexts including cultural norms.
    • Culture's role can be complex and may include mistaken, limiting, or prejudicial norms.
    • Social factors such as gender, ethnicity, socioeconomic status, and family dynamics are significant.
    • Cultural variations complicate cross-cultural comparisons of psychological disorders.

  4. The Biopsychosocial Model

    • Suggests that none of the aforementioned factors is more important than others; rather, all contribute to normal and abnormal behaviors.
Page 2 Summary
II. Attention-Deficit/Hyperactivity Disorder (ADHD)
  • Genetic contributions:
    • Between 40% and 70% of variance in ADHD symptoms is attributed to genetic variability.
    • ADHD is polygenic, linked to interactions of multiple genes.
    • Delayed brain maturation hypothesis: Suggests slower brain development, particularly in the prefrontal cortex.
    • Associated with dysregulation of dopamine neurotransmission.
Treatment for ADHD
  • Stimulant medications: e.g., Ritalin, Adderall.
  • Non-pharmaceutical interventions: Physical exercise, sports training, meditation, academic tutoring/training, and psychotherapy.
III. Anxiety and Anxiety-Related Disorders
General Overview
  • Defined by symptoms such as motor tension, hyperactivity, and apprehensive expectations.
  • Characterized by uncontrollable fears that disrupt normal life.
A. Generalized Anxiety Disorder (GAD)
  1. Persistent anxiety lasting at least 6 months without a clear cause.
  2. Symptoms: Significant worry, fatigue, muscle tension, stomach issues, sleep difficulties.
  3. Biological factors: This includes genetic predisposition related to the neurotransmitter GABA, respiratory abnormalities, and sympathetic nervous system regulation issues.
  4. Psychological and sociocultural factors: Harsh self-standards, automatic negative thoughts, intimate partner violence history, exposure to uncontrollable traumas or stressors.
  5. Treatment: Medications affecting GABA's action and effective psychotherapy.
B. Panic Disorder
  1. Characterized by recurrent, unexpected panic attacks marked by intense terror without a specific trigger.
  2. Symptoms may include severe palpitations, breathlessness, chest pain, trembling, dizziness, and helplessness.
  3. Genetic predisposition is possible, alongside neurochemical imbalances, especially with norepinephrine, GABA, and serotonin.
  4. Lactate levels may be elevated in those with panic disorder.
  5. Classical conditioning research: Indicates that learned associations between bodily cues and fear may contribute to panic attacks; generalization of fear learning is also relevant.
  6. Notably, women have twice the likelihood of experiencing panic attacks compared to men.
C. Specific Phobia
  1. Defined as an irrational, overwhelming, and persistent fear of a specific object or situation.
  2. Phobia exists when avoidance of that object or situation is extreme.
  3. Viewed as an exaggerated descendant of the adaptive functions of fear in survival.
  4. Explanatory models often highlight experiences, memories, and learned associations; however, some individuals may not identify specific experiences tied to their phobias.
D. Social Anxiety Disorder
  1. Also known as social phobia, characterized by an intense fear of humiliation or embarrassment in social settings.
  2. Genetic contributions exist, along with neural circuitry in the thalamus, amygdalae, and cerebral cortex.
  3. Vulnerabilities arise from genetic factors combined with learned social experiences.
E. Obsessive-Compulsive Disorder (OCD)
  1. Characterized by anxiety-laden thoughts and repetitive behaviors one feels compelled to perform as a preventative measure against future situations.
  2. OCD has been placed in a separate category despite featuring anxiety-related symptoms.
  3. Obsessions: Recurrent, intrusive thoughts; Compulsions: Recurrent behaviors.
  4. Some may repeat compulsive behaviors hundreds of times daily.
  5. Most common compulsions include excessive checking, cleaning, and counting.
  6. Failure to enact compulsions may lead to anxiety about impending disasters.
  7. Genetic influence evident in OCD development.
  8. Some link OCD to broader body dysfunctions, including digestive and immune system issues.
  9. Neurotransmitter imbalances include low serotonin and dopamine levels and high glutamate in affected pathways.
  10. Dysfunction in pathways linking frontal cortex, basal ganglia, and thalamus may lead to a sensation of things being "not quite right."
  11. Learning processes like avoidance learning can maintain compulsive actions.
  12. Individuals with OCD often exhibit cognitive biases that lead to overestimating personal threats and struggle to dismiss intrusive thoughts.
F. OCD-Related Disorders
  1. DSM has expanded the scope to include related disorders marked by repetitive behaviors and uncertainty/anxiety.
  2. Examples include:
    • Excoriation disorder (skin picking): Picking at skin, potentially leading to injury, also noted in autism spectrum disorder.
    • Trichotillomania (hair pulling): Compulsive hair pulling from scalp, eyebrows, etc.
    • Body dysmorphic disorder: Obsession with imagined or minimal physical flaws leading to extreme behaviors such as excessive exercise or repeated cosmetic surgery.
IV. Trauma and Stress-Related Disorders
A. Dissociative Disorders
  1. Dissociation: Psychological states where individuals feel detached from immediate experiences.
  2. Dissociative disorders involve memory loss or identity change.
  3. Conscious experiences may become dissociated from existing memories and thoughts.
  4. Notable overlap exists between PTSD and dissociative disorders, often rooted in trauma.
  5. Individuals with dissociative disorders tend to show decreased volume in the hippocampus and amygdalae, affecting emotional memory retrieval.
Dissociative Identity Disorder (DID)
  1. Formerly known as multiple personality disorder, characterized by two or more distinct personalities with unique memories and behaviors.
  2. Dominance of personalities changes, often separated by amnesia.
  3. Linked to severe early childhood abuse, although not all survivors develop DID.
  4. Increased diagnoses coincide with media portrayals; social cognitive theories suggest social contagion influences identity formation.
  5. Some experts advocate viewing DID as a social construct, representing coping mechanisms.
V. Disorders Involving Emotion and Mood
A. Depressive Disorders
  1. Depressive disorders entail persistent feelings of unpleasurable experiences.
  2. Major Depressive Disorder (MDD): Involves major depressive episodes, presenting lethargy and despair for at least 2 weeks, termed a leading global cause of disability.
  3. Symptoms of MDD may include:
    • Prolonged depressed mood.
    • Reduced interest or pleasure in most activities.
    • Significant weight fluctuations or appetite changes.
    • Sleep disturbances (insomnia or hypersomnia).
    • Psychomotor agitation or retardation.
    • Fatigue or energy loss.
    • Excessive feelings of worthlessness or guilt.
    • Cognitive difficulties and recurrent suicidal ideations.
  4. Persistent Depressive Disorder: Exhibits a less extreme, chronic depressed state lasting over 2 months, with accompanying symptoms like hopelessness or sleep problems.
Factors in Depressive Disorders
  • Several overarching factors influencing development include:
    • Biological: Genetics, reduced brain activity in prefrontal cortex, reward processing issues, and decreased serotonin/norepinephrine receptors.
    • Psychological: Behavioral theories like learned helplessness, cognitive patterns of negative/maladaptive beliefs, and rumination tendencies.
    • Attribution styles: A pessimistic style attributes negative events to self and anticipates recurrence; an optimistic style correlates with lower depression rates.
    • Sociocultural: Poor socioeconomic conditions elevate depression risk, particularly for women, who are diagnosed at twice the rate of men.
B. Bipolar Disorder
  1. Characterized by extreme mood fluctuations, with episodes of mania and recurring depressive states.
  2. Bipolar I Disorder: Involves severe manic episodes potentially leading to hallucinations.
  3. Bipolar II Disorder: Features milder mania without hallucinations.
  4. Equally prevalent across genders.
  5. Genetic factors are significant predictors for bipolar disorder, more so than for depression.
  6. Brain imaging indicates subdued cortical activity during depression phases and heightened activity during mania.
  7. Neurotransmitter abnormalities in norepinephrine, serotonin, and glutamate are implicated.
C. Schizophrenia
  • Psychosis: A state of distorted perceptions and thoughts removed from reality.
  • Schizophrenia is characterized by disordered thoughts and heightened susceptibility to suicide (4-8 times higher risk than general population).
A. Symptoms of Schizophrenia

  1. Positive Symptoms: Exhibit distortions/excesses of normal functions:

    • Hallucinations: Sensory experiences in absence of stimuli (most commonly auditory).
    • Delusions: Strong false beliefs not aligned with cultural norms.
    • Thought disorder: Disorganized thoughts leading to incoherent speech or writing, possibly involving neologisms (made-up words).
    • Movement Disorders: Unique mannerisms or behaviors; Catatonia represents an absence of movement or responsiveness.

  2. Negative Symptoms: Represent loss or reduction of normal functions:

    • Flat affect: Limited emotional range, showing no expressions.
    • Difficulty interpreting and responding to emotions of others and lack of initiative in goal-directed behaviors.

  3. Cognitive Symptoms: Involve executive functioning impairments, such as attention difficulties and memory retention challenges.

B. Causes of Schizophrenia

  1. Biological Factors:

    • Evidence supports genetic links to schizophrenia.
    • MRI findings identify enlarged brain ventricles, decreased frontal cortex size, and activity.
    • Genetic predispositions often manifest prior to symptoms.
    • Dopamine dysregulation and specific glutamate receptor abnormalities are implicated.

  2. Psychological Factors:

    • Vulnerability-Stress Hypothesis: Proposes interplay of biological predisposition and environmental stressors in disorder onset.

  3. Sociocultural Factors:

    • Background influences course but not the cause of schizophrenia.
    • Outcomes tend to improve in developing nations due to support systems; warm family dynamics and community inclusion are beneficial.
VI. Personality Disorders
  • Defined as enduring, maladaptive cognitive and behavioral patterns integrated into individuals’ personalities, affecting their self-concept and relationships.
  • The DSM-5-TR identifies 10 personality disorders, and some theorists advocate for dimensional understanding instead of strict categorization.
A. Antisocial Personality Disorder (ASPD)
  1. Distinguished by a lack of guilt, lawbreaking behavior, exploitation, and irresponsibility.
  2. Characteristic features include:
    • Non-conformity to societal norms.
    • Deceitfulness and manipulation for personal gain.
    • Impulsivity and aggression.
    • Irresponsibility in personal and professional settings.
    • Lack of remorse for causing others harm.
  3. ASPD is correlated with criminal behavior but not all ASPD individuals are criminals.
  4. Genetic influences are significant, complemented by brain differences linked to empathy deficits.
  5. Individuals with ASPD often experience low stress in aversive situations, facilitating their capacity for deception, even on polygraphs.
  6. Psychopaths: A subset of ASPD with tendencies toward severe violence and remorselessness; research indicates their brain shows less empathy-related gray matter.
  7. Treatment is challenging, as individuals often manipulate mental health professionals.
VII. Suicide
  • Suicide ranks as the 12th leading cause of death in the U.S. and is the second leading cause for ages 10-24.
  • For every completed suicide, numerous individuals contemplate or attempt ending their lives.
A. Biological Factors
  1. Genetic predispositions extending to depression-related characteristics.
  2. Research correlates low serotonin levels with increased suicide risk.
  3. Chronic physical conditions are significant risk factors.
B. Psychological Factors
  1. Roughly 90% of suicide cases are linked to psychological disorders, predominantly depression and anxiety.
  2. Trauma history elevates risk; especially prevalent in combat veterans with PTSD.
  3. Substance abuse and acute stressors also contribute.
  4. Interpersonal theory of suicide (Thomas Joiner): Proposes suicide requires both (1) a desire to die and (2) acquired capability.
C. Sociocultural Factors
  1. Global suicide rates vary based on cultural attitudes towards suicide.
  2. Chronic socioeconomic hardship is a strong indicator of suicide rates in youth, with poverty posing a significant threat.
  3. Cultural honor influences, with higher rates in areas emphasizing reputation damaging events.
  4. Males have a higher likelihood of completing suicide, often via firearm use.
VIII. Classification of Personality Disorders
  • Cluster A: Odd or eccentric behaviors.
  • Cluster B: Dramatic, emotional, and erratic behaviors.
  • Cluster C: Fearful or anxious behaviors.
A. Examples of Personality Disorders
  1. Paranoid Personality Disorder: Suspiciousness and mistrust of others.
  2. Dependent Personality Disorder: Excessive reliance on others for decisions, seeking support.
  3. Histrionic Personality Disorder: Excessive emotionality and attention-seeking.
  4. Narcissistic Personality Disorder: Grandiosity and need for admiration, coupled with lack of empathy.
  5. Antisocial Personality Disorder: Patterns of deceitfulness and violation of societal norms.
IX. Agoraphobia
  • Defined as fear of being alone or in open/public spaces
  • Symptoms include feelings of vulnerability, dizziness, or weakness, with treatment often challenging due to the immense avoidance.