Abnormal Psychology: Definitions, Disorders, and Etiology

Introduction to Psychological Disorders

Definition of Psychological Disorders: A clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior.
Distinction of Pathological Behavior: These thoughts, emotions, or behaviors are classified as dysfunctional or maladaptive because they interfere with daily functioning or the individual's well-being.
The Four Essential Conditions: For a condition to be considered a psychological disorder, four conditions must be present: * Abnormal: The person and/or others must consider the behavior disturbing. * Unjustifiable: The behavior must be distressing or disabling, or put the individual at an increased risk of suffering or death. Others find the behavior rationally unjustifiable. * Maladaptive: The behavior interferes with normal daily life and adaptation to the environment. * Atypical: The behavior is significantly different from societal norms.

Contextual Influences on Disturbance Definitions

Cultural Context: Cultural norms significantly influence what is considered acceptable behavior. * Example: Public nudity may be viewed as normal in some African cultures, whereas in other societies, it may be deemed inappropriate or result in legal consequences.
Historical Context: Perceptions of behavior shift over time. * Example: Homosexuality was classified as a psychological disorder until December $9$ , $1973$ . As of December $10$ , $1973$ , it was no longer considered a disorder, reflecting evolving societal and professional understanding.

Historical Perspectives and Treatments

Perceived Causes of Disorders: * Celestial influences (e.g., "lunacy" associated with the full moon). * Divine or supernatural intervention. * Possession or influence by malevolent spirits.
Historical Treatments: * Physical Procedures: Trephination (drilling holes in the skull to release spirits), blood transfusions using animal blood, extraction of teeth or segments of the intestines, and genital mutilation. * Rituals and Punishments: Exorcisms, physical restraints (caging), beatings, and burnings.
Case Study: Coffin Birth and Trephination: A medieval grave in Italy contained a pregnant woman with fetal bones between her legs. Researchers concluded it was a "coffin birth" (postmortem fetal expulsion). The woman's skull showed a trephination wound, suggesting a historical attempt to treat a medical condition through cranial surgery.

The Medical Model and the Biopsychosocial Approach

The Medical Model: This perspective asserts that mental disorders have physical causes. * Focus: Searching for physical causes and treatments (cures). * Contemporary Reflection: Mental illness is diagnosed based on presenting symptoms and treated via therapeutic interventions, including inpatient care in psychiatric facilities.
The Biopsychosocial Approach: Emphasizes that the mind and body are inseparable. Disorders result from the interaction of three main factors: * Biological Influences: Evolution, individual genes, brain structure, and chemistry. Includes epigenetics (environmental influences on gene expression). * Psychological Influences: Stress, trauma, learned helplessness, and mood-related perceptions/memories. * Social-Cultural Influences: Roles, expectations, and societal definitions of normality vs. disorder.
Example: Eating Disorders: * Sociocultural: Media and the "ideal" body/thinness. * Psychological: Anxiety and depression. * Biological: Neurotransmitter imbalance.

Classifying Disorders: The DSM-5

Aims of Classification: * Predict the future course of a disorder. * Suggest appropriate treatment strategies. * Prompt research into causes.
Diagnostic and Statistical Manual of Mental Disorders (DSM-5): Published by the American Psychiatric Association (APA). * Contains $157$ diagnoses. * Provides guides for diagnosis and treatment. * Estimates occurrence (e.g., $1$ in $4$ people will develop depression).
DSM-5 Updates and Revisions: * Includes new disorders like Hoarding Disorder and Binge-Eating Disorder. * Modifies existing categories: Asperger's Syndrome was removed as a standalone diagnosis and moved into Autism Spectrum Disorder. * Controversial inclusions: Persistent Complex Bereavement Disorder (characterized by intense grief).
Benefits of Labeling: * Enables communication between mental health professionals. * Facilitates research on causes and treatments. * Clients often feel relief knowing they are not alone.
Criticisms of Labeling: * Labels can be subjective or value judgments masquerading as science. * The "biasing power of labels" can lead to stigma and discrimination.

DSM-5 Diagnostic Criteria Example: Binge Eating Disorder

Criteria A: Recurrent episodes of binge eating. Episode characteristics include: 1. Eating an objectively large amount of food (larger than most people in similar circumstances). 2. A sense of loss of control during the episode.
Criteria B: Associated with at least three of the following: eating rapidly; eating until uncomfortably full; eating when not hungry; eating alone due to embarrassment; feeling disgusted, depressed, or guilty afterward.
Criteria C: Marked distress is present.
Criteria D: Occurs on average at least once a week for $3$ months.
Criteria E: Not exclusive to anorexia nervosa; no inappropriate compensatory behaviors (unlike bulimia).

Mental Health Statistics in Australia

Prevalence: $1$ in $5$ Australian adults experience mental illness annually. $14\%$ of children and young people are affected.
Demographic Trends: Highest prevalence in ages $16$ - $24$ ; lowest prevalence in those over $65$ .
Lifetime Impact: Approximately $45\%$ of Australian adults will be affected by mental illness in their lifetime.
Common Illnesses: Anxiety, mood disorders (depression), and substance use disorders.
Anxiety Statistics: * Around $2$ million Australians live with anxiety. * $1$ in $3$ women and $1$ in $5$ men will experience anxiety in their lifetime.
Depression/Suicide Statistics: * Around $1$ million Australians live with depression. * $1$ in $6$ women and $1$ in $8$ men will experience depression in their lifetime. * Nearly $8$ Australians take their own lives every day; $6$ of these are men.
Financial Impact: Healthcare spending on mental health-related services increased from $11.8$ billion in $2018$ - $2019$ to $13.2$ billion in $2022$ - $2023$ .

Risk and Protective Factors

Protective Factors: Positive parent-child relationships, problem-solving skills, resilient coping, self-esteem, social support, aerobic exercise, community empowerment, economic independence, literacy, and feelings of mastery/control.
Risk Factors: Academic failure, birth complications, child abuse/neglect, chronic insomnia/pain, family conflict, low socioeconomic status (poverty), parental substance abuse, personal loss, social incompetence, neurochemical imbalance, and parental mental illness.

Anxiety Disorders

Definition: Marked by distressing, persistent anxiety or dysfunctional anxiety-reducing behaviors.
Categories (DSM-5): 1. Generalized Anxiety Disorder (GAD). 2. Panic Disorder. 3. Phobias. * Note: OCD and PTSD are no longer categorized under Anxiety Disorders. They have their own categories (Obsessive-Compulsive and Related Disorders; Trauma- and Stressor-Related Disorders).
Generalized Anxiety Disorder (GAD): Excessive, uncontrollable worry for $6$ months or more. * State: Continuous tension, apprehension, and autonomic nervous system arousal. * Symptoms: Difficulty concentrating, tension (eyelid twitching, trembling, perspiration), jitteriness, sleep deprivation, and hypervigilance (fixating on threats). * Cause Identification: Usually, the person cannot identify or avoid the cause of the tension; no physical causes.
Panic Disorder: Recurrent, unexpected panic attacks. * Panic Attack Symptoms: Sudden surge of intense fear, chest pain, shortness of breath, choking sensations, dizziness, trembling, and feeling of impending doom. Peaks in $10$ minutes; lasts up to $30$ minutes. * Diagnosis: Persistent concern ( $1$ month+) about future attacks, worry about implications (e.g., undiagnosed medical condition), and behavioral changes (avoidance). * Prevalence: $5\%$ of people have panic disorder.
Phobias: Persistent irrational fear and avoidance of specific objects, activities, or situations. * Types: Trypophobia (holes), Aerophobia (flying), Mysophobia (germs), Claustrophobia (small spaces), Astraphobia (thunder), Cynophobia (dogs), Agoraphobia (open/crowded places), Acrophobia (heights), Ophidiophobia (snakes), Arachnophobia (spiders).

Obsessive-Compulsive Disorder (OCD)

Definition: Characterized by unwanted repetitive thoughts (obsessions), actions (compulsions), or both.
Obsessions: Recurrent, persistent, intrusive, and unwanted thoughts, urges, or images causing distress.
Compulsions: Repetitive behaviors or mental acts performed in response to an obsession to prevent a dreaded event (though often not connected realistically).
Criteria: Must be time-consuming or cause significant distress/impairment.
Demographics: More common among teens and young adults.
Reclassification: Moved to "Obsessive-Compulsive and Related Disorders" because the core feature is the presence of obsessions/compulsions rather than anxiety.

Post-Traumatic Stress Disorder (PTSD)

Definition: Symptoms lingering for $4$ weeks or more after a traumatic experience.
Symptoms: Haunting memories, nightmares, hypervigilance, social withdrawal, jumpy anxiety, numbness, and insomnia.
DSM-5 Criteria for Exposure: Direct experience, witnessing in person, learning of trauma to a close friend/family (if violent/accidental), or repeated extreme exposure to aversive details (e.g., first responders).
Intrusion Symptoms: Flashbacks, intense physiological distress in response to cues.
Negative Alterations: Inability to recall trauma, diminished interest, feeling detached.
Risk Groups: Returning veterans ( $25\%$ of Iraq/Afghanistan vets), survivors of accidents/disasters, and survivors of violent/sexual assault ( $2/3$ of sex workers).

Understanding Anxiety Disorders: Etiology

Learning Principles: * Classical Conditioning: Association of anxiety with specific cues (e.g., a room associated with an attack). * Stimulus Generalization: Fear of one event spreads to similar events (e.g., fear of all white lab coats after a painful injection). * Reinforcement (Operant Conditioning): Avoiding fear reinforces and worsens the anxiety.
Cognition: * Observing Others: Young monkeys developed a fear of snakes by watching parents refuse food near them; fear persisted $3$ months later. * Past Experiences: Influence expectations. Hypervigilance leads to interpreting unclear stimuli as threatening (interpreting a creaky floor as a killer vs. wind).
Biology: * Genetics: Genetic predisposition. * Brain: Over-arousal in areas involving impulse control and habitual behaviors. * Natural Selection: Humans are biologically prepared to fear evolutionarily relevant stimuli (spiders, snakes).

Depressive and Bipolar Disorders

Major Depressive Disorder (MDD): A state of hopelessness/lethargy lasting weeks or months. * Criteria: At least $5$ symptoms over a $2$ -week period. Must include depressed mood or loss of interest. * Symptoms: Appetite/weight change, sleep regulation issues, physical agitation/lethargy, listlessness, worthlessness/guilt, concentration problems, thoughts of death.
Persistent Depressive Disorder: Mildly depressed mood more often than not for $2$ years or more, plus at least two other symptoms.
Bipolar Disorder: Alternation between depression and mania. * Mania: Hyperactive, wildly optimistic state. Characterized by loud/flighty speech, little need for sleep, reduced sexual inhibitions, and dangerously poor judgment (reckless spending, unsafe sex).
Theoretical Statistics: * Women's risk for MDD is nearly double men's. * Depression strikes earlier now (late teens) and is most common among young adults in developed countries.

Etiology of Depressive Disorders

Biological Perspectives: * Genetics: Identical twin concordance is $50\%$ for MDD and $70\%$ for Bipolar. * Brain Chemistry: Norepinephrine is scarce during depression and overabundant during mania. Serotonin is scarce or inactive during depression. * Nutrition: Mediterranean diet (anti-inflammatory) reduces risk. Excessive alcohol consumption increases risk.
Social Cognitive Perspective: * Negative Assumptions: Magnifying bad experiences and minimizing good ones regarding self, situation, and future. * Negative Explanatory Style: * Depressed: Stable ("I'll never get over this"), Global ("I can't do anything right"), Internal ("It was my fault"). * Coping: Temporary ("I will get through it"), Specific ("I have family/friends"), External ("It takes two"). * The Vicious Cycle: Stressful experiences $\rightarrow$ Negative explanatory style $\rightarrow$ Depressed mood $\rightarrow$ Cognitive/behavioral changes (fuels further stress).

Suicide and Non-Suicidal Self-Injury (NSSI)

Suicide Statistics: Over $800,000$ attempts worldwide annually. Risk is tripled for those with anxiety and quintupled for those with depression.
NSSI: Includes cutting, burning, hitting oneself, or inserting objects under the skin.
Reasons for NSSI: Relief from negative emotions via distraction of pain, seeking attention for support, self-punishment for guilt, attempting to alter others' behavior (bullying), or peer conformity.

Schizophrenia

Core Characteristics: * Disturbed Perceptions: Hallucinations (false sensory experiences). Most common is auditory (hearing negative/commanding voices), followed by visual, somatosensory, olfactory, and gustatory. * Beliefs: Delusions (false beliefs). Types include Persecution (aliens/enemies) and Grandeur (thinking one is Jesus). * Disorganized Speech: "Word salad" (jumbled, unrelated words). * Emotional Expression: Diminished/Inappropriate. Flat affect (monotone, expressionless) or laughing at tragedy. * Motor Behavior: Catatonia (physical stupor/motionless for hours) or compulsive rocking.
Classification: * Positive Symptoms: Addition of inappropriate behaviors (hallucinations, delusions). * Negative Symptoms: Absence of appropriate behaviors (toneless voice, expressionless face).
Developmental Types: * Chronic (Process): Onset in late adolescence/early adulthood. Characterized by social withdrawal (negative symptoms). Recovery is doubtful. * Acute (Reactive): Begins at any age in response to trauma. Characterized by positive symptoms. Recovery is likely.
Biological Causes: * Elevated dopamine activity. * Brain abnormalities: Reduced frontal lobe activity and accelerated loss of brain tissue. * Genetics: General population risk is $1$ in $100$ . First-degree relative risk is $1$ in $10$ .

Eating Disorders

Anorexia Nervosa: Maintaining a starvation diet despite being significantly underweight. Usually affects adolescent females.
Bulimia Nervosa: Binge eating followed by inappropriate weight-loss behaviors (vomiting, laxatives, fasting, or excessive exercise).
Binge-Eating Disorder: Significant binge episodes followed by distress/guilt but without compensatory behaviors.
Influencing Factors: Low self-evaluation, perfectionist standards, intense concern for others' perceptions, hereditary factors, and cultural/gender components.