Chapter 15 – Psychological Disorders

What is a Psychological Disorder?

·      Disturbance in an individual’s cognition, emotion regulation, or behavior that causes distress or suffering and impairs their daily lives

·      Vulnerability-Stress Model

o   Genetic predispositions interact with environmental influences

·      Comorbidity – more than one disorder at once. Some go together more often than others

Lifetime Prevalence of Psychological Disorders

·      Approximately 1/3 will suffer from a psychological disorder in their lifetime

·      Overall rates of disorders are not different among men and women, however…

o   Men are more likely than women to have antisocial personality disorder and abuse alcohol and drugs

o   Women are more likely than men to suffer from mood and anxiety disorders

Defining Normal and Abnormal Behaviors

·      When do we consider behavior to be abnormal?

o   Person suffers from significant pain or distress

o   The source of the problem is within the person, not a normal response to specific life events

o   Problem is not deliberate reaction to social conditions or societal conflicts

·      Some conclusions:

o   Abnormal isn’t just difference from statistical norms

§  What about extremely talented?

o   What is considered normal differs across cultures, and even within cultures over time

o   Normal and abnormal are points on a continuum; it’s hard to determine when the line is crossed

o   Some behaviors are thought to be abnormal not because they cause personal distress, but because they may cause harm to others

Models of Abnormality

·      What causes psychological disorders?

o   Medical Perspective

§  Caused by physical disease

o   Psychological Perspective

§  Caused by a person’s past and present life experiences

o   Sociocultural Perspective

§  Influenced by the culture we live in

o   Many disorders seem to be caused by multiple factors

Diagnosis

·      Process of grouping and naming mental disorders

·      Most mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)

·      Describe common symptoms and criteria for diagnosis

Anxiety Disorders

·      Generalized Anxiety Disorder

o   About 5% of population

o   Suffer from constant undercurrent of anxiety not linked to identifiable source, lasting 6 months or more

o   Often jittery, agitated, and sleep deprived b/c autonomic NS is aroused

o   Sensitive to criticism, have hard time making decisions, dwell on mistakes, worries constantly

o   May suffer from other anxiety disorders too

·      Panic Disorder

o   Suffer from Panic Attacks that recur

o   Overwhelming anxiety and terror

o   Symptoms of extreme sympathetic activation (heart palpitations, shortness of breath)

o   May also experience fear of losing control or even dying

o   May develop agoraphobia as a result of frequent panic attacks

·      Specific Phobia Disorder

o   Intense irrational fear of specific object/situation

o   Object or event. Produces high level of anxiety; person knows it’ irrational; copes by avoidance

·      Social Anxiety Disorders

o   Anxiety in social settings where others might judge them

o   Palpitations, tremors, blushing, sweating

o   Fear embarrassment or rejection

o   Leads to avoidance of these situations, but then they don’t learn to cope, and they may be lonely

·      Obsessive-Compulsive Disorder

o   One’s life is dominated by repetitive thoughts and/or acts

o   Obsessions are persistent intrusions of unwelcome thoughts, images, or impulses that create anxiety – often lead to compulsions

o   Compulsions are irresistible urges to carry out certain acts or engaged in rituals to reduce anxiety

o   Common compulsions are checking, washing, counting, hoarding

o   There is a subjective experience of loss of control and doubt of one’s senses or judgment

Post traumatic Stress Disorder (PTSD)

·      A type of trauma and stressor-related D/O

·      Recurring vivid, distressing memories and nightmares

·      Increase attention to possible threats, social withdrawal, jumpy anxiety

·      Some turn to alcohol to cope

·      Occurs in veterans returning from war, victims of sexual assault, and more

What Causes these Conditions?

·      Learning

o   Classical Conditioning

§  Fear response linked to formerly neutral objects/events

§  A traumatic event happens unpredictably and uncontrollably, then things that remind us of that cause fear

o   Reinforcement

§  We do something that allows us to avoid or escape a fearful situation

·      Cognition

o   We learn some fears by observing others

o   Some people are hyper-vigilant and are more likely to interpret stimuli as threatening

o   They remember threatening events and cannot switch off intrusive thoughts of these events

·      Biology

o   Fearfulness may run in families

o   Some gene variations associated with anxiety symptoms

o   Neurotransmitter levels can also affect anxiety

o   Traumatic experiences can increase the likelihood that a genetic vulnerability to a disorder will be expressed

o   Biologically prepared to fear threats faced by our ancestors (snakes instead of cars)

·      The Brain

o   Traumatic experiences can alter fear circuits within the amygdala

o   There is an overarousal of brain areas involved in impulse control and habitual behaviors so may overreact to stimuli

o   Anterior cingulate cortex is hyperactive in OCD

Mood Disorders

·      Depression

o   Everyone experiences periods of depression, especially after a traumatic event

o   Someone is clinically depressed if the deep sadness and despair does not have an identifiable cause, and last for 2+ weeks

o   Lifetime prevalence is 10-25% for women and 5-12% for men

·      Depression is characterized by:

§  Sadness, hopelessness

§  Loss of pleasure in food, sex, other pleasurable activities

§  Negative thoughts about oneself-worthlessness, guilt

§  Restlessness and agitation of lethargy, including change in sleep patterns

§  Difficulty concentrating and making decisions

§  Lack of energy and fatigue

§  Recurring. Thoughts of suicide and death

·      Suicide

o   Women are more likely to attempt; men are more likely to succeed

o   75% committed by people who are depressed

o   Actually more vulnerable once they start feeling better

o   Most suicides preceded by remarks about death or leaving, and by behavioral clues

o   46,00 a year in US; half using guns

·      Bipolar Disorder

o   Individual alternates between depression and mania every few days to few months

o   Mania is characterized by energy, enthusiasm, self-confidence

§  They may think they can do anything and become hostile to someone that tries to stop them

o   Evidence for strong genetic component

o   Link between mood disorders and creativity

·      What causes depression?

§  Biological factors

§  Both bipolar and depression run in families

§  If one identical twin has it, 1 in 2 chances for the other twin with depression, 7 in 10 chance for other twin with bipolar

§  Brain activity (energy consumptions and neural firing in many areas, especially the reward centers) decreases in depression and increases in mania

§  NTs Norepinephrine and Serotonin are decreased in depression. Antidepressant drugs increase these NTs

§  High levels of cortisol (stress hormone) during depression

§  Psychological factors

§  Negative childhood experiences predispose?

§  Cognitive focusing on negative events, and self-blame for things that don’t go well in their lives

§  Rumination (fretting, brooding, and overthinking)

§  Learned helplessness (uncontrollable painful events lead to hopelessness and passive resignation to future painful events)

§  All this creates a vicious cycle

Schizophrenic Disorders

·      Affects approximately 1% of population across cultures, equal rates in men and women

·      Schizophrenia does NOT mean split personality, but split mind

§  Refers to split between mind (thoughts, perceptions, beliefs) and reality

·      Two main types of symptoms:

o   Positive symptoms (inappropriate behaviors)

§  Excesses, such as delusions, hallucinations, incoherent speech, inappropriate affect, bizarre behavior)

o   Negative symptoms (absence of appropriate behaviors)

§  Deficits, such as apathy, blunted affect, slow movement and speech, social withdrawal

Main Symptoms of Schizophrenia

·      Incoherent Thinking

o   Individual cannot focus attention and filter out irrelevant stimuli; this may be due to a breakdown in selective attention

·      Disorganized Speech

o   Jumbled ideas create speech that is hard to follow

·      Delusions (false beliefs)

o   Delusions of influence, Delusions of persecution

o   Delusions of grandeur

·      Hallucinations

o   Sensory experiences w/o actual stimulation

o   Auditory hallucinations are the most common

o   Makes it hard to separate imagination from reality

·      Disturbance of Affect (emotional experience)

o   May have flattened affect (almost “robotic”)

o   May have exaggerated/inappropriate emotions that are inappropriate to the situation

·      Bizarre Behavior

o   May withdraw

o   Can’t go about daily activities well

o   Lack self-insight (don’t realize something is wrong with them)

o   Have a hard time interpreting others’ emotions; may have little sympathy and compassion

o   Catatonia

Causes of Schizophrenia?

·      Diathesis-stress model (Vulnerability-stress model)

o   People with genetic vulnerability who are also exposed to high levels of stress are likely to develop Schizophrenia

o   These stressors might include birth complications, conflict at home, social problems

o   Some indications that social withdrawal and other abnormal behaviors exhibited much earlier than diagnosis

Dissociative Disorders

·      Dissociation- portion of one’s experience becomes separated or detached from one’s identity or conscious memory

·      Characterized by long-term gaps in memory, often in response to severe stress

·      Dissociative fugue state is an extensive memory loss; person may take on a new identity

·      Dissociative Identity Disorder (DID)

o   Person has 2 or more distinct identities

o   Person may not recall what happens when a particular personality is in control

o   Some findings of distinct body and brain states associated with different identities

o   Many report being childhood victims of severe abuse

o   Very controversial. Maybe false memory in response to prompts?

Personality Disorder

·      Someone has a personality disorder if their personality is extremely inflexible, maladaptive, and causes distress (maybe only to others), interferes with social functioning

·      These are controversial

·      Antisocial Personality Disorder characterized by:

o   An apparent lack of a conscience

o   No sense of morality – behave impulsively, lack remorse

o   No concern for others; don’t recognize others’ emotions well

o   Irresponsible, may have hard time keeping a job

o   Usually becomes apparent in childhood; often get in trouble a lot as children, even harming animals and others

o   E.g. “con man”, Ted Bundy, many prisoners

·      Causes of Antisocial Personality Disorder?

o   Less excitable than others, even fearless; low arousal (Cortisol, Sympathetic NS) in response to threats

o   Smaller amygdala

o   Smaller and thinner cortex, frontal cortex less active

o   Hyperactive Dopamine reward system

o   Childhood abuse

o   Family instability

o   Poverty

o   Perhaps genes predispose some to be more sensitive to maltreatment

Eating Disorders

·      Anorexia nervosa

o   Starve themselves

o   Have a distorted body image

o   May exercise excessively

·      Bulimia nervosa

o   Bing eating followed by behaviors to compensate (vomiting, laxative use, fasting, excessive exercise)

o   This can be hard to detect b/c weight fluctuations are within normal range

·      Binge eating disorder

o   Preoccupied with food

o   Binge eat, followed by remorse

o   They don’t purge, fast, or exercise excessively

·      All of these associated with health problems

·      All associated with low body satisfaction, perfectionistic body standards, ruminate about falling short of expectations, others’ judging them

·      Cultural and Gender Components

o   Women overestimate how thin males want them to be

o   Males overestimate how muscular females want them to be be

o   Media

§  Unnaturally thin models and celebrities

§  Social media – only seeing best or altered pictures

Neurodevelopmental  Disorders

·      Intellectual Developmental Disorder

o   Low intellectual functioning

§  IQ of 70 or below; lowest 3% of general population

o   Person has trouble with independent living

§  Conceptual (language, reading, finances, time)

§  Social (interpersonal skills, being socially responsible, following rules and laws, avoiding being victimized)

§  Practical (health and personal care, occupational skill, travel)

o   Example – Down Syndrome (trisomy 21)

Autism Spectrum Disorder

·      Cognitive and Social-Emotional disorder with social deficiencies and repetitive behaviors

o   1 in 54 kids in US

o   4 times more likely in boys

o   Poor communication between brain areas that usually work together to take another’s viewpoint

o   Can be high functioning

o   May have exceptional skill or talent in a specific area

o   May get distracted by irrelevant stimuli

o   Have trouble reading facial expressions, knowing what others are feeling, and understanding how to act in social situations

o   Causes? Genetics, prenatal problems, brain underconnectivity, less mirroring behaviors

o   This is NOT due to childhood vaccinations

Attention Deficit Hyperactivity Disorder

·      Usually seen in childhood

·      Affects 3-7% of children (although the rates are rising) and occurs 3 times as often in boys

·      Results in inattention, impulsivity, and hyperactivity

·      Causes? Lower levels of CNS arousal?

·      Treated with stimulants, e.g. Ritalin, that increase arousal and NE and DA production

·      Is this overdiagnosis?

o   Could it be that we are expecting too much of young kids in the classroom?

o   Maybe some kids are bored and not mentally stimulated?

·      Should we give kids stimulant drugs to treat it?

o   There are some serious side effects

o   There are other ways to treat it