Psychological Disorders Classification

Classifying Psychological Disorders

Abnormal Psychology

• Psychology Student Syndrome: Psychology students studying abnormal behavior may become convinced they have a mental disorder.
• Avoid diagnosing psychological conditions without full knowledge or proper certification.
• Abnormal Psychology: The scientific study of abnormal behavior to describe, predict, explain, and change abnormal functioning patterns.
• Defining "normal" and "abnormal" is a subject of much debate.

Clinical Psychology

• Clinical Psychology: The applied field of psychology that seeks to assess, understand, and treat psychological conditions in clinical practice.
• Psychologist: Cannot prescribe meds, supports people through psychotherapy.
• Psychiatrist: Can prescribe meds, identify disorders, generally works inside hospitals.

Psychopathology

• Psychopathology: Scientific study of the nature of disease and its causes, processes, development, and consequences.

What is Normal?

• Defining "normal" and "abnormal" is a subject of much debate.
  • Definitions vary widely by person, time, place, culture, and situation.
• Establishing guidelines is important to identify and help people who are suffering.
• Psychologists generally use the 4 D’s:
  • Deviant: Abnormal behavior, thoughts, and emotions that differ markedly from a society’s ideas about proper functioning.
    • Different, extreme, unusual, perhaps even bizarre.
  • Distress: The person reports feeling pain and discomfort associated with his or her emotions, thoughts, or behaviors.
  • Dysfunctional: Interfering with the ability to conduct daily activities in a constructive way.
    • People cannot care for themselves properly, participate in ordinary social interactions, or work productively.
  • Danger: Abnormal behavior becomes dangerous to oneself or others.
    • Individuals' behavior is consistently careless, hostile, or confused may be placing themselves or those around them at risk.
    • This is the exception rather than the rule.

Diagnostic and Statistical Manual of Mental Disorders

• Diagnostic and Statistical Manual of Mental Disorders: Manual that lists 541 diagnoses, most widely used classification system.
  • DSM-5: Published by American Psychiatric Association in 2013, continues to change & evolve.
  • Production was a 12-year undertaking, and it cost the APA $25$ million to produce.

Diagnosis

• Diagnostic Labels: Health care professionals use labels when communicating about establishing therapy and causes.
  • David Rosenhan (1973): Once labeled, the label itself can determine how professionals perceive and react to a person, and how the labeled persons themselves will begin to act differently.
  • Self-Fulfilling Prophecy: An expectation or belief that can influence your behaviors, thus causing the belief to come true.

Insanity

• Insanity: Legal term pertaining to a defendant's ability to determine right from wrong when a crime is committed.
  • Concept discussed in court to help distinguish guilt from innocence.
  • There’s not "insane" diagnosis listed in the DSM.
  • “Not Guilty by Reason of Insanity” = Treatment facility rather than prison.

Models

• Model: Set of assumptions and concepts that help scientists explain and interpret observations (synonym-paradigm).
  • Medical/Biological Models: View abnormal behavior as an illness brought about by the malfunctions parts of the organism, believe that the most effective treatments are biological ones.
    • Includes genetics, chemical imbalances in the brain, the functioning of the nervous system, etc.
  • Psychodynamic Model: Believe that a person’s behavior, whether normal or abnormal, is determined largely by underlying psychological forces of which he or she is not consciously aware.
    • The forces interact with one another; abnormal symptoms are the result of conflict between the forces.
  • Behavioral Model: Believe that our actions are determined largely by our experiences in life (response to environment).
    • Stimulus, response, and reward influence abnormal behavior.
    • $15\%$ of today’s clinical psychologists report that their approach is mainly behavioral.
  • Cognitive Model: Cognitive processes are at the center of behaviors, thoughts, and emotions.
    • Abnormal behavior is caused by faulty and irrational cognitions.
    • Individuals can overcome mental disorders by learning to use more appropriate cognitions.
  • Eclectic Model: Broad-based approach, trusting a combination of established approaches to diagnose and treat individuals with psychological disorders.
    • Most mental health professionals today do not rely exclusively on one approach.

Stigmas

• Stigma: The societal disapproval and judgment of a person with mental illness because they do not fit their community’s social norms.

Effects of Stigma

• Refusal to receive treatment: Stigma deters people from seeking help.
• Social isolation: Fear of “bringing them down” or “being a burden.”
• Distorted perception of the incidence of mental illness: Leads to fewer diagnoses and fewer people getting help; mental illness seems far less common than it actually is.
• $2$ out of $3$ people living with mental illness suffer in silence.

Selection of Categories of Psychological Disorders

Anxiety Disorder

• Anxiety Disorders: Anxiety is the primary symptom or the primary cause of other symptoms for all anxiety disorders.
  • Anxiety disorders are the most common mental disorder in the United States ($19$ million adults).
  • People with one anxiety disorder usually experience another as well.

Generalized Anxiety Disorder (GAD)

• Generalized Anxiety Disorder (GAD): Experience excessive anxiety under most circumstances and worry about practically anything.
  • Feeling of “free-floating anxiety”.
  • The anxiety has no definite trigger or starting point; they experience little relief.
  • Symptoms: For $6$ months or more, a person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about multiple matters, edginess, fatigue, poor concentration, irritability, muscle tension, sleep problems.

Panic Disorder

• Panic Disorder: Anxiety disorder marked by recurrent and unpredictable panic attacks.
  • Symptoms: Attacks of intense anxiety along with severe chest pain, tightness of muscles, choking, sweating, other acute symptoms during.
  • Symptoms can last a few minutes to a couple of hours (have no trigger).

Specific Phobia

• Specific Phobia: Intense, irrational fear responses to specific stimuli.
  • Some people with a specific phobia may go to great lengths to avoid the phobic stimulus.
  • When confronted with the object of their phobia, a person will generally enter a state of panic.
• Agoraphobia: Afraid to be in public situations from which escape might be difficult or help unavailable if panic-like or embarrassing symptoms were to occur.
  • Panic attacks in public places.

Obsessive-Compulsive Disorder (OCD)

• Obsessive-Compulsive Disorder (OCD): Compound disorder of thought and behavior.
  • Obsessions are persistent, intrusive, and unwanted thoughts that an individual cannot get out of his or her mind.
  • Compulsions are ritualistic behaviors performed repeatedly.

Hoarding Disorder

• Hoarding Disorder: Characterized by persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress parting with them.

Posttraumatic Stress Disorder (PTSD)

• Posttraumatic Stress Disorder (PTSD): Result of some trauma experienced by the victim. Victims re-experience the traumatic event in nightmares about the event or flashbacks in which they relieve the event.

Mood Disorder

Bipolar Disorder

• Bipolar Disorder: Mood swings alternating between periods of major depression and mania.
  • Rapid cycling is usually short periods of mania followed almost immediately by deep depression, usually for a longer duration.

Manic Episode

• Elated mood
• Increased Energy, Decreased Need for Sleep
• Profound irritability
• Racing thoughts
• Difficulty concentrating, High Distractibility
• Feeling of undue power
• Poor Judgment
• Risky Behavior/ Become Aggressive
• Feelings of self-importance
• Reckless spending of money
• Alcohol and/or drug abuse
• Engaging in unsafe sex
• Psychotic Symptoms

Depressive Episode

• Persistent feelings of Sadness
• Anxiety, Guilt, Anger, Hopelessness
• Lack of interest in things that were once enjoyable
• Disinterest in interacting with others
• Frequent crying episodes
• Feelings of guilt or worthlessness
• Changes in appetite or weight
• Problems with money or concentration
• Headaches, backaches, or digestive problems
• Difficulty sleeping or excessive sleeping
• Thoughts about death or suicide

Major Depressive Disorder

• Major Depressive Disorder: Involves intense depressed mood, reduced interest or pleasure in activities, loss of energy, and problems in making decisions for a minimum of $2$ weeks.
  • Linked to disruptions in the levels or activity of neurotransmitters like serotonin and dopamine.
  • OR can be caused by a traumatic life event or social isolation.

Personality Disorders

• Personality Disorders: Longstanding, maladaptive thought and behavior patterns that are troublesome to others, harmful, or illegal.
  • Impair people’s social functioning; individuals do not experience anxiety, depression, or delusions.

Cluster A Personality Disorders

• Paranoid Personality Disorder “Accusatory”: Pattern of distrust and suspiciousness about other people’s motives; individuals think that others are out to threaten, betray, exploit, or harm.
  • Do not normally confide in other people and frequently misread others.
• Schizoid Personality Disorder “Aloof”: Characterized by persistent avoidance of social relationships and little expression of emotion.
  • Genuinely prefer to be alone, make no effort to start or keep relationships.
  • Withdrawn behavior, considered “cold” (more common in males).
• Schizotypal Personality Disorder “Awkward”: Characterized by extreme discomfort in close relationships, very odd patterns of thinking and perceiving, and behavioral eccentricities.
  • Patients usually experience distorted thinking and avoid intimacy.

Cluster B Personality Disorders

• Antisocial Personality Disorder (APD): Characterized by a general pattern of disregard for and violation of other people’s rights (closely linked to criminal behavior).
  • Used to be called sociopaths or psychopaths.
  • Violate other people’s rights without guilt or remorse.
  • Manipulative, exploitive, self-indulgent, irresponsible (more common in males).
• Borderline Personality Disorder: Characterized by repeated instability in interpersonal relationships, self-image, and mood and by impulsive behavior.
  • Unpredictable and prone to boredom (more common in females).
  • Always in conflict with the world around them; suicidal threats and actions are also common.
• Histrionic Personality Disorder: Characterized by a pattern of excessive emotionality (dramatic) and attention-seeking.
  • Tend to overreact and be egocentric (more common in females).
  • Exaggerate physical illnesses, depth of their relationships.
• Narcissistic Personality Disorder: Characterized by a broad pattern of grandiosity, a need for admiration, and a lack of empathy.
  • Unrealistically self-important, manipulative, can’t take criticism, expects special treatment (more common in males).

Cluster C Personality Disorders

• Avoidant Personality Disorder: Characterized by consistent discomfort and restraint in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to negative evaluation/potential rejection/humiliation.
• Dependent Personality Disorder: Characterized by a pattern of clinging and obedience, fear of separation, and an ongoing need to be taken care of.
  • Excessively lacking in self-confidence, subordinates own needs and allows others to make all decisions (more common in females).
• Obsessive-Compulsive Personality Disorder: Characterized by an intense focus on orderliness, perfectionism, and control to the point that the person loses flexibility, openness, and efficiency.
  • Preoccupied with rules, schedules, details, and extremely conventional.

Obsessive-Compulsive Disorder (OCD) vs. Obsessive-Compulsive Personality Disorder (OCPD)

• OCD: Anxiety disorder, repetition of ritualistic actions, ego-dystonic (wishes they could stop).
• OCPD: Ego-syntonic (happy with how they are, don't want to change).

Schizophrenia and Other Disorders

• Schizophrenia: Psychotic disorder in which personal, social, and occupational functioning deteriorates as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities.
  • Literal translation is “split mind,” which refers to a split from reality.
  • Schizophrenia spectrum disorders (collective psychotic disorders).

Psychosis

• Psychosis “Syndrome”: Any disorder in which the affected person has lost contact with reality (break with reality).
  • People usually experience psychosis in episodes (vary in length).
  • Psychosis can be drug-induced or drug-assisted (marijuana, alcohol, cocaine, crack & hallucinogens).
  • The most common psychosis appears in the form of schizophrenia.

Positive vs Negative Symptoms of Schizophrenia

• Positive Symptoms: Characteristics of schizophrenia that are added to a person’s personality, such as hallucinations, inappropriate emotions, delusions VS
• Negative Symptoms: Characteristics taken away from a person’s personality; things that the individual does not do.
  • In some cases, negative symptoms can be misinterpreted as depression or laziness.

Schizophrenia Delusions

• Schizophrenia Delusions: Bizarre or far-fetched belief(s) that are unchanging even after being proven incorrect.
  • Delusions of reference: Believing that hidden messages are being sent to you via newspaper, TV, radio, or magazines.
  • Delusions of grandeur: Believing you are someone very powerful or important, have special abilities, possessions, or powers.
  • Delusions of persecution: Believing that spies, aliens, the government, or even your neighbors are plotting against you (most common).

Schizophrenia Hallucinations

• Schizophrenia Hallucinations: Perceiving a sensory stimuli that no one else is able to perceive, vividly real to the person experiencing it, content is usually negative.
  • Seeing, feeling, tasting, or smelling things that are not there.
  • Most frequently, people with schizophrenia hear voices that tell them what to do, warn of danger, or talk to each other about the individual.

Schizophrenia - Disorganized Speech/Thinking

• Disorganized Speech/Thinking: Combining thoughts or switching from one thought to another “word salad”.
  • Rapidly shift from one topic to another, believing that their incoherent statements make sense.

Schizophrenia - Inappropriate Affect

• Inappropriate Affect: Emotions are unsuited to the situation.
  • The emotions may be merely a response to other features of the disorder.
  • They may smile when making a somber statement or upon being told terrible news, or they may become upset in situations that should make them happy.

Schizophrenia - Catatonia

• Catatonia: A pattern of extreme psychomotor symptoms which may include catatonic stupor, rigidity, or posturing.
  • Stupor: Stop responding to their environment, remaining motionless and silent for a long period of time.
  • Rigidity: Maintain a rigid, upright posture for hours and resist efforts to be moved.
  • Posturing: Awkward bizarre positions for long periods of time.

Schizophrenia - Negative Symptoms

• Flat Affect: Withholding of emotions and exhibiting diminished emotional expression.
  • Their faces are still, eye contact is poor, and voices are monotonous.
  • May have a general lack of pleasure or enjoyment.
• Avolition: Apathy and an inability to start or complete a course of action.
  • People with schizophrenia may withdraw from their social environment and attend only to their own ideas and fantasies.

What Causes Schizophrenia?

• Genetic Link to Schizophrenia: People who have an identical twin with schizophrenia have a likelihood of getting it that is much higher (more than $40\%$) in comparison to about $1\%$ of the general population.
• Dopamine Hypothesis: High fluctuation of levels of dopamine can be responsible for schizophrenic symptoms
  • Potential link between high levels of dopamine and the development of schizophrenic symptoms such as hallucinations and delusions.
• Diathesis-Stress Model: Genetic link + stress!

Somatic Symptom Disorders

Somatic Symptom Disorders

• Somatic Symptom Disorders: Characterized by psychiatric symptoms associated with physical complaints and high anxiety in these individuals about having a disease.
  • People primarily seen in medical settings where patients/clients complain of physical symptoms.

Illness Anxiety Disorder (IAD)

• Illness Anxiety Disorder (IAD): Characterized by a preoccupation with a serious medical or health condition with either no or mild physical (somatic) symptoms such as nausea or dizziness that has persisted for $6$ months.

Conversion Disorder

• Conversion Disorder: Characterized by loss of some bodily function without physical damage to the affected organs or their neural connections.
  • Symptoms usually last as long as anxiety is present.

Other Disorders

Neurodevelopmental Disorders

• Neurodevelopmental Disorders: Groups of disabilities in the functioning of the brain that emerge at birth or during very early childhood and affect the individual’s behavior, memory, concentration, and/or ability to learn.

Attention Deficit/Hyperactivity Disorder (ADHD)

• Attention Deficit/ Hyperactivity Disorder (ADHD): Disorder marked by the inability to focus attention, or overactive and impulsive behavior, or both.
  • ADHD can’t control their impulse to pay attention to something they shouldn’t.

Autism Spectrum Disorder (ASD)

• Autism Spectrum Disorder (ASD): Disorder marked by extreme unresponsiveness to others, severe communication deficits, and highly repetitive and rigid behaviors, interests, and activities.
  • Usually uncomfortable with a shift in routine.

Levels of Autism Spectrum Disorder

• Level 1: Needs support. social and communication skills and repetitive behaviors are only noticeable without support.
• Level 2: Needs substantial support. Patient's social and communication skills and repetitive behaviors are still obvious to the casual observer, even with support in place.
• Level 3: Needs very substantial support. Patient's social and communication skills and repetitive behaviors severely impair daily life.

Intellectual Disability (ID)

• Intellectual Disability (ID): Disorder marked by intellectual functioning and adaptive behavior that are well below average.
  • Previously called mental retardation
  • Low IQ score of $70$ or below.
  • The deficits begin during the developmental period (before the age of $18$).

Neurocognitive Disorders

• Neurocognitive Disorders: Group of disorders in which the primary problem is in cognitive function, impairments in cognitive abilities such as memory, problem solving, and perception.

Delirium

• Delirium: A rapidly developing, acute disturbance in attention and orientation that makes it very difficult to concentrate and think in a clear and organized manner.
  • State of massive confusion.
  • Common in elderly people.

Alzheimer’s Disease

• Alzheimer’s Disease: Fatal degenerative disease in which brain neurons progressively die, characterized by loss of memory, reasoning, emotion, and control of bodily functions.
  • Alzheimer’s strikes $3$ percent of the world’s population by age $75$.
  • Average life expectancy following diagnosis is three to nine years.

Eating & Feeding Disorders

• Eating & Feeding Disorders: Mental disorders defined by abnormal eating habits. May involve either insufficient or excessive food intake to the detriment of an individual’s physical and mental health.
  • People with eating disorders can appear underweight, of healthy weight, or overweight.

Statistics about Eating Disorders

• US Women: $20$ million
• US Men: $10$ million

Anorexia Nervosa (Anorexia)

• Anorexia Nervosa (Anorexia): Life-threatening eating disorder that involves intense fear of weight gain or becoming overweight, distorted perception of one’s weight/body shape, persistent restriction of caloric intake.
  • Primarily affects girls and women.
  • Body dysmorphia: increasing cognitive misperception of being overweight despite evidence to the contrary.
  • The risk of death is greatly increased in individuals with this disease (Anorexia has the highest fatality rate of any mental illness).
  • End of menstrual cycle leading to infertility, bone loss, loss of skin integrity, damage to heart and blood vessels, kidney damage, gastrointestinal damage, hair loss.

Bulimia Nervosa (Bulimia)

• Bulimia Nervosa (Bulimia): Recurrent binge eating followed by compensatory behaviors for the intake of food, such as purging.
  • Bingeing is characterized by eating a large amount of food in a short period of time.
  • A purge can include self-induced vomiting, excessive use of laxatives/diuretics, fasting, or excessive exercise.