Psychological Disorders Lecture Notes

Foundations of Psychopathology and Defining Psychological Disorders* Psychopathology: Defined as the formal study of psychological disorders, encompassing their symptoms, etiology (the study of causes), and various methods of treatment.* Psychological Disorder: A condition characterized by abnormal thoughts, feelings, and behaviors. Key characteristics include experiences and inner thoughts that are atypical, dysfunctional, or dangerous.* The Challenge of Definition: There is no singular, universal definition of psychological normality or abnormality.- Atypicality vs. Disorder: Simply being unusual doesn't constitute a disorder. For example, red hair is considered atypical (represented by natural redheads like Isla Fischer, Prince Harry, and Marcia Cross), but it is not a psychological abnormality.* Cultural Expectations: The violation of social norms alone is insufficient for diagnosis. These norms vary widely between cultures.- Example: In Western societies, reporting hallucinations is typically viewed as a sign of disorder, but in other cultures, certain hallucinations are highly valued and respected.* Harmful Dysfunction (Wakefield, 1992): A highly influential concept proposing that a disorder involves a biological or psychological mechanism that fails to perform its natural function (dysfunction in cognition, perception, or learning).- To be classed as a disorder, the dysfunction must be harmful, leading to negative consequences for the individual or society according to the standards of the individual's culture.* American Psychological Association (APA) Definition: A disorder consists of:- Significant disturbances in thoughts, feelings, and behaviors.- Disturbances that fall outside of cultural norms.- Reflective of biological, psychological, or developmental dysfunction.- Leads to significant distress or disability (e.g., inability to perform expected social or occupational roles).# The Diagnostic and Statistical Manual (DSM) and Classification Systems* Diagnosis: The process of appropriately identifying and labeling a set of defined symptoms using a systematic classification system.* Diagnostic and Statistical Manual of Mental Disorders (DSM):- Publisher: The American Psychiatric Association.- History: First published in 1952; currently in its 5th edition (DSM-5). Notable historical change: Homosexuality was listed as a disorder in the first two editions but was removed in $1973$.- Components of DSM-5 Entries: Includes diagnostic features (overview), diagnostic criteria (specific symptoms), prevalence (percentage of the population affected), risk factors, and comorbidity.* Comorbidity: The co-occurrence of two disorders within the same individual. For example, individuals with Obsessive-Compulsive Disorder have a $41\%$ chance of also suffering from Major Depressive Disorder.* The International Classification of Diseases (ICD):- Publisher: The World Health Organization (WHO).- Usage: Used internationally to monitor general health and disease prevalence. While clinical diagnosis worldwide relies heavily on the ICD, the DSM is preferred for research due to its explicit criteria and explanatory text. In the United States, mental health professionals primarily use the DSM.# Historical and Modern Perspectives on Etiology* Supernatural Perspective: The historical view that psychological disorders were caused by forces beyond scientific understanding, such as black magic (sorcery), witchcraft, or spirit possession.- Treatments: Included exorcism, beatings, and torture.- The Extraction of the Stone of Madness: A $15th$ century painting by Hieronymus Bosch depicting a practitioner attempting to surgically remove a psychological affliction from a patient's head.* Dancing Mania: An epidemic in Western Europe between the $11th$ and $17th$ centuries where groups danced with wild abandon for days or weeks, often citing terrible visions; historically attributed to supernatural forces.* Biological Perspective: Views disorders as linked to genetic factors, chemical imbalances, and brain abnormalities. Research indicates a higher risk for disorders like schizophrenia among close genetic relatives.* Psychosocial Perspective: Emphasizes the role of learning, environmental stress, and self-defeating thinking patterns.* Diathesis-Stress Model: An integrative approach predicting that the development of a disorder results from a combination of a biological or psychological vulnerability (diathesis) and adverse environmental or psychological events (stress).# Anxiety Disorders and Specific Phobias* Anxiety vs. Fear:- Fear: An instantaneous reaction to an imminent, immediate threat.- Anxiety: Apprehension and cautiousness regarding potential future threats. It becomes a disorder when it is excessive, persistent, and out of proportion to the actual danger.* General Prevalence: Anxiety disorders affect $25\%-30\%$ of the U.S. population in their lifetime and are more common in women.* Specific Phobia: Characterized by excessive and persistent fear/anxiety regarding a specific object or situation. Affects $12.5\%$ of the U.S. population.- Common Phobias: Acrophobia (heights), Aerophobia (flying), Arachnophobia (spiders), and Claustrophobia (enclosed spaces).* Agoraphobia: A separate disorder involving intense fear and avoidance of situations where escape might be difficult (e.g., crowds, public transport) if a panic attack occurs.* Phobia Acquisition (Rachman, 1977): Three pathways include:- Classical Conditioning: A child bitten by a dog (US) associates dogs (CS) with biting, leading to fear (CR).- Vicarious Learning: Observing another person's fearful reaction to a stimulus.- Verbal Transmission: Being repeatedly told that a stimulus is dangerous.* Evolutionary Theory: Human ancestors associated stimuli like snakes, spiders, and heights with danger, leading to an evolutionary predisposition for certain phobias.# Social Anxiety, Panic, and Generalized Anxiety Disorders* Social Anxiety Disorder: Extreme fear of being negatively evaluated by others in social settings. Affects $12\%$ of Americans.- Safety Behaviors: Acts taken to reduce anxiety, such as avoiding eye contact or rehearsing speech.- Risk Factors: Behavioral inhibition (consistent fear around strangers) and a history of severe teasing (reported by $92\%$ of a sample).* Panic Disorder: Recurrent, unexpected panic attacks and at least one month of concern about future attacks. - Panic Attack: A peak of extreme fear within $10$ minutes. Physical symptoms include sweating, trembling, and faintness.- Causes: $43\%$ heritability; neurobiological theories focus on the locus coeruleus (norepinephrine source); cognitive theories focus on catastrophic interpretations of bodily sensations.* Generalized Anxiety Disorder (GAD): Continuous, uncontrollable, and pointless worry. - Symptoms: Must occur for at least $6$ months and include three of: restlessness, fatigue, concentration difficulty, irritability, muscle tension, or sleep issues. - Prevalence: Affects $5.7\%$ of the U.S. population; females are $2$ times as likely to have it. - Causes: May act as a mental distraction from painful childhood experiences or maltreatment.# Obsessive-Compulsive and Related Disorders* Obsessive-Compulsive Disorder (OCD):- Obsessions: Intrusive, unwanted, and distressing thoughts (e.g., germs, order, aggressive urges).- Compulsions: Ritualistic acts to minimize distress (e.g., hand washing, checking, counting). - Etiology: High heritability ($57\%$ for identical twins). Involves the OCD Circuit, specifically hyperactivity in the orbitofrontal cortex.* Body Dysmorphic Disorder: Preoccupation with a nonexistent or minor physical flaw. Affects $2.4\%$ of U.S. adults. Leads to repetitive behaviors like mirror checking or seeking cosmetic surgery.* Hoarding Disorder: Persistent difficulty discarding items due to sentimental attachment or perceived future utility, leading to cluttered living spaces that prevent normal activity.# Posttraumatic Stress Disorder (PTSD)* Criteria: Exposure to a traumatic event (actual/threatened death, serious injury, or sexual violence) followed by symptoms lasting over one month.* Symptoms: Flashbacks (reliving the event), intrusive memories, avoidance of reminders, irritability, and exaggerated startle response.* Risk Factors: Severity of trauma, lack of social support, female gender, low intelligence, or possession of short versions of a serotonin-regulating gene.* Etiology:- Learning: Reminders of the trauma become conditioned stimuli triggering fear.- Cognitive: Fragmented memories and negative appraisals (e.g., self-blame) maintain the disorder.# Mood Disorders: Depression and Bipolar Disorder* Major Depressive Disorder (MDD): Characterized by "depressed mood most of the day, nearly every day."- Symptoms: Loss of interest/pleasure, weight/appetite changes, psychomotor agitation/retardation, suicidal ideation. Affects $16.9\%$ of Americans in their lifetime.- Subtypes: Seasonal pattern, Peripartum onset (during/after pregnancy), and Persistent Depressive Disorder (dysthymia: sadness lasting $2$ years).* Bipolar Disorder: Fluctuations between depression and mania. - Mania Symptoms: Flight of ideas, grandiosity, reckless behavior, and decreased need for sleep. - Suicide Risk: $36\%$ of individuals with Bipolar Disorder attempt suicide.* Biological Basis: Imbalances in serotonin and norepinephrine. MDD involves increased amygdala activation (negative emotion) and decreased prefrontal cortex activation (emotion regulation).* Cognitive Theories of Depression:- Aaron Beck: Depressive schemas (negative themes of loss/failure) triggered by stress.- Hopelessness Theory: Perceiving negative events as stable ("never changing") and global ("affects everything").- Rumination: Repetitive focus on symptoms of distress, more common in women.# Schizophrenia and Dissociative Disorders* Schizophrenia Symptoms:- Hallucinations: Perceptual experiences without stimuli (auditory most common).- Delusions: Beliefs contrary to reality (Paranoid, Grandiose, Somatic).- Negative Symptoms: Avolition (lack of motivation), Alogia (reduced speech), Asociality (withdrawal), and Anhedonia (lack of pleasure).* Schizophrenia Causes: Affects $1\%$ of the population. Linked to dopamine overabundance (dopamine hypothesis), enlarged ventricles, and birth complications (influenza exposure).* Dissociative Disorders:- Dissociative Amnesia: Inability to recall info, sometimes involving dissociative fugue (wandering away and identity confusion).- Depersonalization/Derealization: Feelings of detachment from self or the world.- Dissociative Identity Disorder (DID): Two or more distinct personalities; often a coping mechanism for childhood trauma.# Personality and Neurodevelopmental Disorders* Personality Disorders: Inflexible styles beginning in adolescence.- Cluster A: Paranoid, Schizoid, Schizotypal.- Cluster B: Includes Borderline (instability in relationships/mood) and Antisocial (lack of remorse, superficial charm, lack of empathy).- Cluster C: Includes Avoidant.* Attention-Deficit/Hyperactivity Disorder (ADHD): Interfering patterns of inattention (disorganization, forgetfulness) and/or hyperactivity (blurting out, interrupting). Occurs in $5\%$ of children; $3$ times more common in boys.* Autism Spectrum Disorder (ASD): Defined by social deficits (no eye contact), communication deficits, and repetitive behaviors. Affects $1$ in $88$ children; heritability is $60\%-90\%$ for identical twins.# Questions & Discussion* Redheads and Abnormality: The transcript uses natural redheads to illustrate that being atypical is not the same as being disordered.* Child Vaccinations: Page $52$ notes the existence of a resource regarding vaccinations and autism, though specific clinical data on the link is not detailed in the slides.* Suicide Statistics: Suicide is the $10th$ leading cause of death in the U.S. ($2010$). Males complete suicide at $4$ times the rate of females, often utilizing firearms, while females more commonly use poison.