Psychological Disorders

Learning Objectives

  • Describe the differences between normal and abnormal behavior.

  • Describe how the 4 D's can be used to identify abnormal behavior.

What is “Normal”?

  • Normal behaviors, thoughts, and feelings are:

    • Typical for the social context → nervous for a date

    • Not an interference wi social life or work/school → sickness

    • Not distressing to the individual. → a loved one has passed and you spend 8 months getting over it (you keep pulling yourself back into the cycle and can’t heal)

    • Not dangerous. → ADHD and forgetting

  • Statistical rarity does not equate to abnormality → being left-handed

What Counts as Abnormal Behavior?

  • Where is the line between odd behavior and psychological disorders?

  • Abnormal behavior is often defined by the 4 D’s

  • (a) Deviance from the norm: Assess whether the behavior aligns with cultural/behavioral norms.

    • Example:

      • Acceptable: Pouring Gatorade on a coach after winning a championship.

      • Deviance: Pouring Gatorade on a random person in the street.

  • (b) Dysfunctionality: Does the behavior interfere with one's life?

    • Is the behavior maladaptive?

    • Does it impair the ability to respond appropriately to situations?

    • Example: Fear of flying leading to missing a family funeral.

  • (c) Distress: Does the behavior cause personal distress or lead to physical or emotional pain?

    • Example: Anxious thoughts that prevent sleep.

  • (d) Dangerousness: Does the behavior endanger oneself or others?

    • Most dangerous behaviors are considered abnormal.

    • Examples: Thoughts of self-harm or driving under the influence.

  • Interactions of the 4 D's: The 4 D's build upon one another; dysfunctionality typically requires deviancy, and distress and dangerousness often require dysfunctionality and deviancy to be established.

Review Questions

Which of the following questions is the LEAST important in determining whether a behavior is psychopathological?

  • Is the behavior maladaptive?

  • Is the behavior self-destructive?

  • Is the behavior statistically rare?

  • Does the behavior impair someone’s social relationships?

    • Ex: A behavior being uncommon does not necessarily mean it is a disorder, while the other options relate directly to harm or impairment, which are core criteria for psychopathology.

Gustavo is becoming worried about everything he does on a day-to-day basis and needs to seek advice for all of his decisions. He has even had difficulty deciding if he should get a haircut. Based on information alone, which of the following is present?

  • Deviance

  • Dysfunctionality

  • Distress

  • Dangerousness

    • Ex: His excessive need for reassurance is interfering with basic daily functioning, showing impaired ability to make normal decisions.

DSM (Diagnostic and Statistical Manual of Mental Disorders)

  • Overview: A manual used by mental health professionals to diagnose mental disorders.

  • Ex: What are the typical symptoms of this disorder? Out of these symptoms, at least 3 have to be met

Problems with the DSM

  1. Categorical Approach: Determining whether an individual has a disorder.

    • Does not account for psychological issues that are close to the threshold.

    • Dimensional Approach: Proposed by NIMH's RDoC for research purposes. Used for the severity of symptoms

  2. Comorbidity: The occurrence of multiple disorders together.

    • Many individuals do not fit into a single category, raising treatment choices.

    • Overlapping symptoms (do you diagnose two different disorders, do you treat them differently, etc.)

Assessment of Psychological Disorders

  • Definition: Examination of mental functions and psychological conditions to diagnose disorders.

  • Methods include:

    • Self-reports

    • Observations

    • Interviews

    • Testing

  • All are used to diagnosis → treatment → ongoing assessment (these can be constantly tweaked, and you can even go back and tweak the disorder)

  • Ongoing Assessment: Once diagnosed, treatment is monitored to ensure effectiveness and determine continued presence of the disorder.

Review

Lee has been experiencing extreme anxiety in any social situation and has started drinking in excess to cope. Lee is experiencing _______________.

  • Comorbidity

  • Cross-diagnosis

  • Multidiagnosis

  • Interactive symptoms

    • Ex: Lee is experiencing two mental health problems at the same time—social anxiety and excessive drinking—which is the definition of comorbidity.

Mental health clinicians use the DSM criteria to determine whether someone has a psychological disorder or not. However, it does not consider degrees of severity. As such, the DSM takes what type of approach to diagnosis?

  • Evidence-based

  • Dimensional

  • Comorbid

  • Categorical

    • Ex: The DSM uses a yes/no system for diagnosing disorders rather than rating symptoms on a severity continuum, which is a categorical approach.

Learning Objectives

  • Describe anxiety disorders, their risk factors, and causes.

  • Distinguish among various anxiety disorders.

  • Distinguish between the two main types of depressive disorders.

  • Distinguish between Bipolar I and Bipolar II Disorder.

Anxiety Disorders

  • Characteristics: The absence of true danger → You are a straight-A student, but you are scared of not graduating

  • Affects nearly 6% of the US population at a given time.

  • Can have long-term consequences → atrophy of the hippocampus (shrinkage of the hippocampus, which is responsible for memory)

  • Women are diagnosed more frequently than men.

  • What can lead to it → cognitive biases (negative interpretation bias, heightened memory/availability heuristic for negative experiences, tendency to exaggerate the consequences of events, etc.), learned associations, and genetic risk

    • Ex: on the phone with a long-distance friend, and she sounds tired. Someone with this disorder would see it negatively, like she doesn’t like me or I did something wrong.

Generalized Anxiety Disorder (GAD)

  • Description: Individuals are consistently anxious or worried, often about minor matters

  • Main Character: exaggerated worries

  • Often long-lasting and referred to as free-floating anxiety

  • Diagnostic Criteria: At least 3 of the following symptoms:

    • Restlessness

    • Fatigue

    • Concentration problems

    • Irritability

    • Muscle tension

    • Sleep disturbances

Social Anxiety Disorder

  • Characteristics: Fear of negative evaluation by others

  • Leads to avoidance of social situations

  • Anxiety regarding others’ scrutiny/ judgement

    • Common fears: Public speaking, meeting new people, eating in public.

  • Developmental Aspect: One of the earliest forms of anxiety to develop, and likely to lead to other comorbid disorders (two or more at the same time)

  • More social fears/ more pervasive social anxiety is particularly related to increased risk for comorbidities.

Specific Phobia Disorders

  • Definition: Disorders characterized by marked, persistent, and excessive fear/avoidance of certain activities, objects, or situations. *If someone has a specific social fear, such as public speaking, but nothing else, it would be a specific phobia rather than social anxiety*

  • Affects about 9% of American adults.

  • Common Phobias:

    • Fear of snakes (ophidiophobia)

    • Fear of enclosed spaces (claustrophobia)

    • Fear of flying (aerophobia)

    • Fear of inescapable situations (agoraphobia)

Depressive Disorders

  • Main Character: severely depressed mood that lasts 2 weeks or more

    1. Persistently low mood

    2. Anhedonia

    3. Feelings of guilt/worthlessness

    4. Lack of energy

    5. Poor concentration

    6. Appetite changes

    7. Psychomotor agitation/retardation

    8. Sleep disturbances

    9. Suicidal thoughts.

  • Source: An individual must have five of the symptoms mentioned above, of which one must be a depressed mood or anhedonia causing social or occupational impairment, to be diagnosed with MDD. (Bains & Abdijadid, 2023)

  • Affects around 7% of the population per year

Major Depressive Disorder (MDD) vs. Dysthymia

  • MDD: Intense depression; potential treatment options vary.

  • Dysthymia: Persistent but less severe depressive symptoms over a longer duration.

Bipolar Disorders

  • Characteristics: Extreme mood fluctuations from depression to mania developed through a gradual onset.

  • Mania: “positive” mood, including increases in energy and physical activity → someone who was just in their room very sad, is now socializing

  • The “positive” mood in mania is more restless and agitated than true “happiness”

Bipolar I vs Bipolar II

  • Key Differences:

  • Bipolar I: Characterized by intense mania. 

    • To be diagnosed with bipolar I disorder, a person must experience at least one manic episode that lasts for at least a week.

  • Bipolar II: Characterized by a pattern of major depressive episodes and at least one hypomanic episode (a less severe form of mania), without ever having experienced a full manic episode.

    • It is a distinct diagnosis from Bipolar I and is not a milder form of the illness; it often involves more chronic depression

  • Implications: Type I has more impairing mania, while type II has more impairing depression.

Review 

In the current understanding of psychological disorders, __________ is thought to be a normal response to stress but is problematic when it is __________.

  • Depression; severe

  • Social anxiety; experienced with close friends and family

  • Anxiety; experienced excessively in the absence of a true threat

  • Panic; experienced more than once a week

    • Ex: Anxiety itself is normal, but it becomes disordered when the fear response is excessive and not tied to a real danger.

Sherecce and Marin both have social anxiety disorder. Sherecce’s fears include public speaking and speaking up in meetings. Marin’s fears include public speaking, meeting new people, and eating in public. Who is more likely to develop a substance abuse problem, and why?

  • Sherecce, because her anxiety is more pervasive

  • Marin, because he has more social fears

  • Neither, because neither the quantity nor the pervasiveness of social fears predicts substance use

  • Marin, because his anxiety is more debilitating

    • Ex: Having a greater number of feared social situations predicts higher impairment and a higher likelihood of coping through substance use.

Which of the following best describes the relationship between panic attacks and agoraphobia?

  • Having panic attacks is unrelated to the development of agoraphobia.

  • People with agoraphobia experience panic attacks in situations from which escape is difficult or impossible.

  • Both panic attacks and agoraphobia result from specific phobias in childhood.

  • More severe panic attacks are associated with reduced occurrence of agoraphobia.

    • Ex: Agoraphobia typically develops when individuals begin avoiding places or situations where they fear panic attacks might occur and escape would be hard.

In the past week, Samara has been extremely excited. She has rarely slept, she invested all her savings in a risky start-up company, and she thinks she is going to be a millionaire by next year. Samara does not have a history of depressive episodes. Samara is most likely to be diagnosed with which disorder?

  • Bipolar I

  • Bipolar II

  • Schizophrenia

  • Agoraphobia

    • Ex: Samara is exhibiting a full manic episode (extreme euphoria, risky behavior, and decreased need for sleep) without a history of depression, which meets criteria for Bipolar I disorder.

Learning Objectives

  1. Identify common symptoms and potential causes of OCD.

  2. Understand common symptoms, early predictors, and potential causes of schizophrenia.

  3. Differentiate between positive and negative symptoms of schizophrenia.

Obsessive-Compulsive Related Disorders

  • Definition: Involves frequent intrusive thoughts and compulsive actions.

  • Components:

    • Obsessions: Intrusive thoughts leading to anxiety; persistent, unwanted, intrusive thoughts, images, or urges that cause distress 

    • Compulsions: Repetitive actions performed to alleviate the anxiety from obsessions.

    • Ex: a fear of germs (obsession) can lead to overhandwashing (Compulsion)

  • Subcategory of OCD: 

    • Pure Obsession: intrusive, unwanted thoughts (obsessions) without any visible or observable compulsive behaviors → thoughts of harming oneself or others, engaging in sexual acts that go against personal morals, like pedophilia, or blasphemous ideas

  • Classical and Operant Conditioning in OCD

  • Genetic and environmental triggers → Children growing up with infectious diseases can develop this

Schizophrenia

  • Characteristics: Alterations in thought, perceptions, or consciousness; reduction of brain tissue/function in in frontal and temporal regions

  • People with this have too much dopamine

  • It can occur in around 1/200 people

  • 5 Predictors

    • Family history

    • High social impairment

    • High suspicion/paranoia

    • A history of substance abuse (especially marijuana)

    • History of unusual thoughts

The Role of Genetics in Schizophrenia

  • Risk Factors: Lifetime risk of developing schizophrenia increases with genetic closeness to a sufferer (i.e., identical twins are at higher risk compared to unrelated individuals).

  • If both parents have it or a twin → 45%

  • One parent or fraternal twin → 13%

  • Sibling → 10%

The Role of the Environment

  • Environmental factors can trigger schizophrenia in genetically predisposed individuals (i.e., exposure to teratogens, pathogens, or marijuana during adolescence).

  • Kid with a genetic risk

    • Raised in a dysfunctional family → high risk

    • Raised in a healthy family → lower risk

Symptoms of Schizophrenia

  • Positive Symptoms (have to be present): Those that are not typically present in a healthy individual and are considered "added" to their behavior or experience.

    • Delusions

    • Hallucinations

    • Disorganized speech

    • Grossly disorganized/catatonic behavior

  • Negative Symptoms: A diminished or absent expression of normal behaviors and emotions.

    • Flat affect → significant reduction in emotional expression, resulting in a dull or flat voice, limited facial expressions, and motionless body language

    • Lack of motivation

Types of Delusions

  • Definitions: False beliefs based on incorrect inferences about reality

  • Types:

    • Persecutory: Belief of being persecuted, harmed, or spied on.

    • Referential: Belief that neutral objects, events, or other people have particular significance directed at oneself

    • Grandiose: Belief in having extraordinary powers or talents.

    • Identity: Belief of being a famous or significant individual.

    • Guilt: Belief of having committed a terrible act.

    • Control: Belief that one's thoughts/behaviors are being controlled externally.

Hallucinations

  • Definition: False sensory perceptions without an external source:

    • Auditory (most common)

    • Visual

    • Olfactory → smells

    • Somatosensory → feeling 

Review

Eleanor has been diagnosed with schizophrenia. Which of the following is a likely delusion that Eleanor might experience?

  • Eleanor thinks that she can vividly see her imaginary friend.

  • Eleanor believes that she can save people with her superhuman ability to fly.

  • Eleanor often hears voices that criticize and belittle her.

  • Eleanor is routinely under the impression that she has misplaced $10.

    • Ex: Delusions are false beliefs strongly held despite evidence to the contrary; believing she can fly is a classic example of a grandiose delusion seen in schizophrenia.

Speech in people with schizophrenia…

  • Is similar to the language of people with dissociative disorders..

  • Is usually very simple, like the language of a 4-year-old.

  • Can shift rapidly between topics with no apparent logic.

  • Is typically delayed in its development by about five years

    • Ex: People with schizophrenia often exhibit disorganized speech, such as loose associations or tangential thinking, where conversation jumps unpredictably between topics.

A famous comedian refuses to shake hands whenever he meets someone because he fears catching a disease from them. The avoidance of shaking hands is a(n) __________, and the belief that he will catch a disease is a(n) __________.

  • Compulsion; obsession

  • Compulsion; compulsion

  • Obsession; compulsion

  • Obsession; obsession

    • Ex: The hand-washing or avoidance behavior is a compulsion (an action performed to reduce anxiety), while the persistent fear of catching a disease is an obsession (a distressing, intrusive thought).

Which of the following statements is accurate regarding potential causes of obsessive-compulsive disorder (OCD)?

  • Environmental factors, like certain bacterial infections, can trigger OCD in children

  • There is little evidence supporting a genetic component to OCD

  • OCD has been linked to classical but not operant conditioning

  • OCD has been linked to operant but not classical conditioning

    • Ex: Research shows that infections such as streptococcal infections can sometimes trigger sudden-onset OCD in children, highlighting an environmental factor.

Which of the following best supports the idea that obsessive-compulsive disorder is related to operant conditioning?

  • Tom’s brother never locks doors, so Tom checks the locks compulsively to be as different as possible from his brother.

  • Tom sees his mother compulsively check the door locks, so he engages in the same behavior.

  • Tom experiences relief whenever he checks the locks, so he checks the locks whenever he is anxious.

  • Tom believes that checking the locks compulsively will keep his family safe.

    • Ex: Operant conditioning explains behavior that is reinforced; checking the locks reduces anxiety (negative reinforcement), which increases the likelihood the behavior will be repeated.