Psychological Disorders

General Concepts

  • Medical Model:

    • Defines abnormal behavior as a disease.
    • Emerged as dominant perspective in 18th-19th centuries, replacing superstitious views.
    • Led to improved treatments but faces criticism for promoting stigma.
    • Still influences thinking about psychological disorders.

  • Key Terms within Medical Model:

    • Diagnosis: Distinguishing one illness from another.
    • Etiology: Identifying the causes and developmental history of an illness.
    • Prognosis: Forecasting the probable course of an illness.
    • These terms facilitate communication among clinicians, researchers, and the public about abnormal behavior.

  • Criteria of Abnormal Behavior:

    • Deviance: Behavior deviates from societal norms.
    • Maladaptive Behavior: Impairs daily functioning.
    • Personal Distress: Causes subjective discomfort.
    • Normality and abnormality exist on a continuum.

  • Psychodiagnosis and DSM:

    • Diagnostic and Statistical Manual of Mental Disorders (DSM): A categorical approach to classify disorders.
    • Reliability of categorizing individuals into discontinuous diagnostic categories is questioned.
    • The number of specific diagnoses has exponentially increased.

Anxiety Disorders, OCD, and PTSD

  • Generalized Anxiety Disorder (GAD):

    • Characterized by chronic, high levels of anxiety not tied to a specific threat.
    • Involves constant worry about past mistakes and future problems.
    • Physical symptoms include trembling, muscle tension, diarrhea, dizziness, sweating, and heart palpitations.

  • Specific Disorders:

    • Specific Phobia: Persistent, irrational fear of an object or situation that poses no realistic danger.
    • Panic Disorder: Sudden, unexpected, recurrent attacks of overwhelming anxiety.
    • Agoraphobia: Fear of going out to public places.
    • Obsessive-Compulsive Disorder (OCD): Marked by obsessions (intrusive thoughts) and compulsions (repetitive behaviors).
    • Posttraumatic Stress Disorder (PTSD): Enduring psychological disturbance due to a major traumatic event.

  • Etiology of Anxiety-Related Disturbances:

    • Biological Factors:
      • Concordance Rate: Percentage of twin pairs exhibiting the same disorder.
      • Link between anxiety disorders and brain neurochemical activity may exist.
    • Conditioning and Learning:
      • Anxiety responses acquired through classical conditioning and maintained through operant conditioning.
      • Preparedness: Biological predisposition to acquire certain fears more easily due to evolutionary history.
    • Cognitive Factors:
      • Certain thinking styles increase vulnerability to anxiety disorders.
      • Misinterpreting harmless situations as threatening.
      • Excessive attention to perceived threats.
      • Selective recall of threatening information.
    • Stress:
      • High stress can trigger or worsen anxiety disorders.

Dissociative Disorders

  • Dissociative Disorders:
    • Involve loss of contact with portions of consciousness or memory, causing identity disruptions.
  • Dissociative Amnesia:
    • Sudden memory loss for important personal information, not due to normal forgetting.
    • Often attributed to excessive stress.
  • Dissociative Identity Disorder (DID):
    • Disruption of identity with two or more distinct personalities.
    • Formerly known as multiple-personality disorder.
    • Diagnosis is controversial due to limited understanding of its causes.

Depressive and Bipolar Disorders

  • Major Depressive Disorder:
    • Characterized by persistent sadness, despair, and loss of interest in previous pleasures.
    • Anhedonia: Diminished ability to experience pleasure.
    • Onset can occur at any age, with an average onset between 30-35 years old.
    • Most individuals experience more than one episode.
  • Bipolar Disorder:
    • Mood disorder with both depressed and manic periods.
    • Manic period symptoms are generally the opposite of depressive symptoms.
    • Manic Episode: Mood is elevated to euphoria.
    • Bipolar I Disorder: Involves full manic episodes.
    • Bipolar II Disorder: Involves milder hypomanic episodes of shorter duration.
  • Mood Dysfunction and Suicide:
    • Most individuals who commit suicide suffer from a psychological disorder.
  • Etiology of Depressive and Bipolar Disorders:
    • Genetic Vulnerability:
      • Heredity can predispose individuals to mood dysfunction.
    • Neurochemical and Neuroanatomical Factors:
      • Correlations exist between mood disorders and abnormal levels of neurotransmitters in the brain.
      • Depression is associated with reduced hippocampal volume.
    • Hormonal Factors:
      • Hormonal changes in response to stress may contribute to depression.
    • Cognitive Factors:
      • Negative thinking leads to depression in many people.
      • Pessimistic explanatory style attributes setbacks to personal flaws rather than situational factors.
    • Interpersonal Roots:
      • Social difficulties may lead to depressive disorders.
    • Precipitating Stress:
      • A link exists between stress and the onset of major depression and bipolar disorder.

Schizophrenic Disorders

  • Schizophrenia:
    • Characterized by delusions, hallucinations, disorganized thinking and speech, and deterioration of adaptive behavior.
    • Onset typically occurs by age 30 in 75% of cases.
    • Affects about 1% of the population.
    • Associated with increased risk of suicide and early death from natural causes.
  • Symptoms:
    • Delusions and Irrational Thought:
      • Delusions are false beliefs maintained despite being out of touch with reality.
      • Thinking becomes chaotic rather than logical.
    • Deterioration of Adaptive Behavior:
      • Decline in the quality of routine functioning in work, social relations, and personal care.
    • Distorted Perception:
      • Hallucinations are sensory perceptions without real external stimuli or gross distortions of perceptual input.
      • Auditory hallucinations are common (reported by about 75% of people with schizophrenia).
    • Disturbed Emotion:
      • Disruption of normal emotional tone.
      • Flattening of emotions.
      • Inappropriate emotional responses.
      • Emotional volatility.
  • Etiology of Schizophrenia:
    • Genetic Vulnerability:
      • Genetic factors may account for up to 80% of the variability in susceptibility to schizophrenia.
    • Neurochemical Factors:
      • Dopamine hypothesis: Excess dopamine activity is the neurochemical basis for schizophrenia.
      • Marijuana use during adolescence and methamphetamine use may be associated with schizophrenia.
    • Structural Abnormalities in the Brain:
      • Enlarged brain ventricles are associated with schizophrenia.
      • Reductions in gray matter and white matter may be seen.
    • The Neurodevelopmental Hypothesis:
      • Schizophrenia is caused partly by disruptions in normal brain maturation processes before or at birth.
    • Expressed Emotion:
      • Critical or emotionally overinvolved attitudes toward the patient by their relatives.
      • Patients with families high in expressed emotions have higher relapse rates.
      • Families become sources of stress rather than social support.
    • Stress:
      • High stress plays a key role in schizophrenia.

Autism Spectrum Disorder

  • Autism Spectrum Disorder (ASD):
    • Childhood disorder characterized by impaired social interaction and communication, and severely restricted interests and activities, usually apparent by age 3.
  • Symptoms:
    • Lack of interest in other people.
    • Impaired verbal communication.
    • Preoccupation with objects or repetitive body movements.
    • Extreme inflexibility.
  • Prevalence:
    • Diagnoses have increased dramatically since the mid-1990s.
    • Males account for about 80% of autism diagnoses.
  • Etiology of ASD:
    • Genetic factors are major contributors.
    • Associated with generalized brain enlargement apparent by age 2.
    • Children with autism have 67% more neurons in the prefrontal cortex.
    • Overgrowth likely produces disruptions in neural circuits.
    • The hypothesis that autism may be caused by mercury in childhood vaccinations has been discredited.

Personality Disorders

  • Personality Disorders:
    • Marked by extreme, inflexible personality traits causing subjective distress or impaired social and occupational functioning.
    • Generally recognizable during adolescence or early adulthood.
    • Grouped into three related clusters: anxious/fearful, odd/eccentric, and dramatic/impulsive.
  • Antisocial Personality Disorder:
    • Marked by impulsive, callous, manipulative, aggressive, and irresponsible behavior.
    • Lack an adequate conscience.
  • Borderline Personality Disorder:
    • Marked by instability in social relationships, self-image, and emotional functioning.
    • Turbulent interpersonal relationships marked by fears of abandonment.
  • Narcissistic Personality Disorder:
    • Marked by a grandiose sense of self-importance, a sense of entitlement, and an excessive need for attention and admiration.
    • Think they are unique and superior to others.
  • Etiology of Personality Disorders:
    • Involve interactions between genetic predispositions and environmental factors.
    • Data from twin and family studies support the influence of heredity.

Eating Disorders

  • Eating Disorders:
    • Severe disturbances in eating behavior characterized by preoccupation with weight concerns and unhealthy efforts to control weight.
  • Anorexia Nervosa:
    • Intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, and use of dangerous measures to lose weight.
    • More than half of anorexics suffer from depressive disorders or anxiety disorders.
    • Symptoms: Amenorrhea (loss of menstrual cycle), gastrointestinal problems, low blood pressure, osteoporosis, metabolic disturbances leading to cardiac arrest or circulatory collapse.
  • Bulimia Nervosa:
    • Habitual and excessive overeating, followed by vomiting, fasting, laxatives and diuretics, and exercise.
    • Less life-threatening than anorexia.
    • People with bulimia are more likely to seek treatment for the disorder.
  • Binge-Eating Disorder:
    • Distress-inducing eating binges without the purging, fasting, and excessive exercise seen in bulimia.
    • More common than anorexia or bulimia.
  • Prevalence and Cultural Roots of Eating Disorders:
    • Most people with eating disorders are female (90-95% for anorexia and bulimia, 60% for binge-eating disorder).
    • Eating disorders were unseen outside Western cultures until recently; disparities are cultural, not biological.
    • Prevalence in Western societies: 1% anorexia nervosa, 1.5% bulimia nervosa, 3.5% binge-eating disorder.
  • Etiology of Eating Disorders:
    • Genetic Vulnerability: Some people may inherit a genetic vulnerability.
    • Personality Factors: People with anorexia are often obsessive, rigid, and emotionally restrained; perfectionism is also a risk factor. People with bulimia are often impulsive, overly sensitive, and low in self-esteem.
    • Cultural Values: Media promotes the importance of thinness for attractiveness.
    • The Role of the Family: Mothers may contribute by endorsing the societal message that being thin is important and by modeling unhealthy dieting behavior. There is an association between childhood sexual and physical abuse and an elevated risk.
    • Cognitive Factors: Patients with eating disorders display disturbed thinking, including rigid, all-or-nothing thinking and maladaptive beliefs.

New Directions in the Study of Psychological Disorders

  • Early-Life Stress:
    • Studies link early-life stress to an increased prevalence of psychological disorders; more evidence is needed to establish causality.
  • Genetic Overlap Among Major Disorders:
    • Many disorders share genetic and neurobiological characteristics.
    • Autism and schizophrenia involve similar neurodevelopmental abnormalities.
    • Schizophrenia and bipolar disorder share genetic vulnerabilities and brain abnormalities.
    • Genetic mapping has identified genetic overlap among depression, bipolar disorder, schizophrenia, autism, and ADHD.

Reflecting on the Chapter’s Themes

  • Behavior and mental disorders are determined by multiple causes (psychological, biological, and social factors).
  • Heredity and environment jointly influence behavior.
  • High vulnerability intersecting with high stress may trigger psychological disorders, according to stress-vulnerability theories.
  • Psychology evolves in a sociohistorical context.
  • Empirical research, social trends, prevailing values, and political realities help determine concepts of normality and abnormality.
  • Cultural norms influence what is regarded as abnormal.

Understanding Psychological Disorders and the Law

  • Insanity: Legal status indicating a person cannot be held responsible for actions due to mental illness.
  • Competency: Fitness of a defendant’s capacity to stand trial.
  • Involuntary Commitment: People hospitalized in psychiatric facilities against their will.

Critical Thinking Application

  • Representative Heuristics: Basing probability estimates on similarity to a typical prototype; prevalence estimates vary depending on sampling methods.
  • Conjunction Fallacy: Estimating that odds of two uncertain events happening together are greater than odds of either event happening alone.
  • Availability Heuristic: Basing probability estimates on the ease with which relevant instances come to mind.