Psychological Disorders Notes

  • Key Theme: Understanding psychological disorders includes considerations of their origins, symptoms, and development, as well as how behavior relates to cultural and social norms.

  • Psychopathology: scientific study of the origins, symptoms, and development of psychological disorders

  • The dividing line between normal and abnormal behavior is often determined by social or cultural context.

    • Strong social stigma

    • Serious departure from the prevailing social and cultural norms

    • Slightly higher rate of violence; only with extreme psychological symptoms

  • Psychological disorder or mental disorder:

    • Pattern of behavioral and psychological symptoms that:

      • Causes significant personal distress

      • Impairs the ability to function in one or more important areas of life, or both

  • DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition); published by the American Psychiatric Association:

    • Describes the specific symptoms and diagnostic guidelines for different psychological disorders.

    • Identifies more than 260 specific psychological disorders

    • Includes symptoms, criteria that must be met to make a diagnosis, and typical course for each mental disorder

Criticisms of DSM-5-TR

  • Limitations

    • Some conditions too typical to be considered disorders

    • Arbitrary cutoffs between people with and without particular disorder and between different diagnosis

    • Gender bias for some diagnosis

    • Possible bias from financial ties of many DSM-5-TR authors to pharmaceutical industry

  • Alternatives

    • Research Domain Criteria (RDoC) (NIMH)

      • Identification of similar genetic risk factors and similar changes in brain, general p factor

    • World Health Organization’s International Classification of Disease (ICD)

Social Media and Diagnosis

  • Differences were found in Instagram photos posted by depressed and non-depressed people.

  • Google searches (“how to kill yourself” or “painless suicide”) are higher in suicidal people.

  • Twitter (X) or Facebook searches for sadness or loneliness predicted depression.

  • Some researchers suggest that social media could eventually revolutionize mental health care if ethical guidelines are implemented.

Prevalence of Psychological Disorders

  • National Comorbidity Survey Replication (NCS-R) (Kessler and colleagues)

    • Psychological disorders are more prevalent than many people believe; high degree of comorbidity.

    • Approximately 26% of Americans experienced symptoms of a psychological disorder during the previous year; 46% experienced symptoms at some point in their lives.

  • SAMHSA (2020)

    • 50 million U.S. adults had psychological disorder.

    • One quarter do not have access to treatment in 2019; trend shared globally.

    • Lack of insurance, low income, lack of access to mental health care

Additional Diagnostic Categories in DSM-5-TR

  • Neurodevelopmental disorders

  • Substance-related and addictive disorders

  • Somatic symptom and related disorders

  • Disruptive, impulse control, and conduct disorders

Anxiety Disorders, Posttraumatic Stress Disorder, and Obsessive–Compulsive Disorder

  • Key Theme: Intense anxiety that disrupts normal functioning is an essential feature of anxiety disorders, posttraumatic stress disorder, and obsessive–compulsive disorder.

  • Anxiety: unpleasant emotional state characterized by physical arousal, feelings of tension, apprehension, and worry

    • Physically alert; mentally alert

  • Anxiety disorders: category of psychological disorders in which extreme anxiety is main diagnostic feature and causes significant disruptions in person’s cognitive, behavioral, or interpersonal functioning

    • Irrational; uncontrollable; disruptive

  • Generalized anxiety disorder (GAD): anxiety disorder characterized by excessive, global, and persistent symptoms of anxiety

    • When one source of worry is removed, another takes its place.

  • Explaining GAD

    • Environmental, psychological, genetic, and other biological factors are probably involved in GAD.

    • Problematic anxiety can be evident from a very early age.

    • Early stressful experiences may contribute.

Panic Attacks and Panic Disorders

  • Panic attack: sudden episode of extreme anxiety that rapidly accelerates in intensity

  • Panic disorder: anxiety disorder in which person experiences frequent and unexpected panic attacks

    • Ataque de nervios

  • Agoraphobia: anxiety disorder involving extreme fear of experiencing a panic attack or other embarrassing or incapacitating symptoms in a public situation where escape is impossible and help is unavailable

Explaining Panic Disorder

  • Triple vulnerabilities model of panic (Barlow)

    • Biological predisposition toward anxiety

    • Low sense of control over potentially life-threatening events

    • Oversensitivity to physical sensations

  • Catastrophic cognitions theory (Hinton & others)

    • Oversensitive to physical sensations and also tendency to catastrophize meaning of their experience

  • Classical conditioning plays a role in both of these models of panic disorder.

Mental Health During the Pandemic

  • Pandemic, most likely in combination with the rising racial tensions and xenophobia, led to an increase in psychological disorders.

  • Globally, about half of the general public experienced pandemic- related psychological consequences including sleep problems, anxiety, and depression.

  • Inequalities during pandemic

    • Disproportionate toll of COVID-19 on Black and Hispanic people and social unrest associated with BLM movement

Phobias

  • Phobia: persistent and irrational fear of a specific object, situation, or activity

  • Specific phobia: excessive, intense, and irrational fear of a specific object, situation, or activity that is actively avoided or endured with marked anxiety

    • Encountering feared situation or object can provoke a full-fledged panic attack.

    • Approximately 7% of the general population experiences a specific phobia.

    • More than twice as many women as men suffer from specific phobia.

Categories of Specific Phobias
  • Fear of particular situations

  • Fear of features of the natural environment

  • Fear of injury or blood

  • Fear of animals and insects

  • Social anxiety disorder: anxiety disorder involving the extreme and irrational fear of being embarrassed, judged, or scrutinized by others in social situations

    • One of most common psychological disorders

    • More prevalent among women than men

    • Core of social phobia seems to be irrational fear of being embarrassed, judged, or critically evaluated by others

    • Can vary by culture:

      • Japanese men suffer from taijin kyofusho (fear that their own appearance or smell, facial expression, or body language will offend, insult, or embarrass other people).

Explaining Phobias: Learning Theories

  • Basic learning principles: Some phobias can be explained in terms of classical conditioning, operant conditioning, and observational learning.

  • Biological preparation: Certain fears, such as of spiders or heights, have an evolutionary history and may represent a fear of contamination.

Posttraumatic Stress Disorder and Obsessive–Compulsive Disorder

  • Key Theme: Extreme anxiety and intrusive thoughts are symptoms of both posttraumatic stress disorder (PTSD) and obsessive–compulsive disorder (OCD).

Posttraumatic Stress Disorder

  • Posttraumatic stress disorder (PTSD): Core Symptom Clusters

    • Disorder triggered by exposure to highly traumatic event

    • Results in frequent, involuntary, and intrusive memories of the event

    • Avoidance of stimuli and situations associated with the event

    • Negative changes in thoughts, moods, and emotions

    • Persistent state of heightened physical arousal

  • Originally, PTSD was associated with military combat.

    • Can develop in survivors of other extreme trauma

  • Core symptoms have been identified.

  • Likelihood of developing PTSD is linked to personal or family history and/or magnitude of trauma experienced.

Obsessive–Compulsive Disorder

  • Obsessive–compulsive disorder (OCD): disorder characterized by:

    • Intrusive, repetitive, and unwanted thoughts (obsessions) and

    • Repetitive behaviors or mental acts that an individual feels driven to perform (compulsions).

  • Obsessions

    • Repeated, intrusive, and uncontrollable irrational thoughts or mental images that cause extreme anxiety

    • Common: fear of dirt, germs; pathological doubt about having completed a task

  • Compulsions

    • Repetitive behaviors or mental acts that a person feels driven to perform to prevent or reduce anxiety and distress, or to prevent a dreaded event or situation

    • May be overt or covert

Explaining Obsessive–Compulsive Disorder

  • Biological factors

    • Deficiency in serotonin, norepinephrine implicated

    • Drugs that increase availability of these neurotransmitters decrease symptoms.

    • Dysfunction in specific brain areas

      • Areas involved in the fight-or-flight response

      • Frontal lobes, which play a key role in ability to think and plan ahead

      • Heightened neural activity in caudate nucleus involved in regulating movements

Disorders Involving Intense Anxiety

  • Generalized Anxiety Disorder

    • Persistent, chronic, unreasonable worry and anxiety

    • General symptoms of anxiety, including persistent physical arousal

  • Panic Disorder

    • Frequent and unexpected panic attacks, with no specific or identifiable trigger

  • Specific Phobias

    • Intense anxiety or panic attack triggered by a specific object or situation

    • Persistent avoidance of feared object or situation

  • Social Anxiety Disorder

    • Irrational anxiety related to being embarrassed, judged, or scrutinized in social situations

  • Posttraumatic Stress Disorder (PTSD)

    • Anxiety triggered by intrusive, recurrent memories of a highly traumatic experience

  • Obsessive–Compulsive Disorder (OCD)

    • Anxiety caused by uncontrollable, persistent, recurring thoughts (obsessions) and/or urges to perform certain actions (compulsions)

Depressive and Bipolar Disorders

  • Key Theme: In the depressive and the bipolar disorders, disturbed emotions cause psychological distress and impair daily functioning.

Understanding Depressive and Bipolar Disorders

  • Emotions violate criteria of normal moods in quality, intensity, and duration.

  • Depressive disorders and bipolar disorders are given distinct DSM-5-TR categories.

  • Both the depressive and bipolar disorders are sometimes called mood disorders or affective disorders.

Major Depressive Disorder

  • Major depressive disorder

    • Mood disorder

    • Characterized by extreme and persistent feelings of despondency, worthlessness, and hopelessness

    • Causes impaired emotional, cognitive, behavioral, and physical functioning

Symptoms of Major Depressive Disorder
  • Symptoms of depression affect the whole person—emotionally, cognitively, behaviorally, and physically.

    • Emotional symptoms: feelings of sadness, guilt, or worthlessness

    • Cognitive symptoms: difficulty thinking, concentrating, and remembering

    • Behavioral symptoms: crying and withdrawal from social activities

    • Physical symptoms: changes in appetite and weight, sleep difficulties (sleeping too much or too little), and diminished sexual interest; anxiety

Diagnosis of Major Depressive Disorder
  • In major depressive disorder, a person must display most symptoms described in DSM-5-TR for 2 weeks or longer.

  • Persistent depressive feelings may or may not be triggered by life events.

    • Bereavement

    • Seasonal affective disorder (SAD)

    • Persistent depressive disorder

Prevalence and Course of Major Depressive Disorder
  • Prevalence: 20 million American adults and 300 million adults worldwide are affected by major depressive disorder.

  • Lifetime prevalence: About 15% of Americans at some point in their lives

  • Gender: Women are about twice as likely as men to be affected by major depression.

    • Women more vulnerable for variety of reasons.

    • Men may be undercounted as expression of depression is different.

  • Cultural differences: occurs globally; similar symptom presentation; difference in ways it is talked about

Bipolar Disorder

  • Bipolar disorder: mood disorder involving periods of incapacitating depression alternating with periods of extreme euphoria and excitement; formerly called manic depression

  • Manic episode: sudden, rapidly escalating emotional state characterized by extreme euphoria, excitement, physical energy, and rapid thoughts and speech

Symptoms of Bipolar Disorder
  • Person experiences extreme mood swings.

  • Episodes of incapacitating depression alternate with shorter periods of extreme euphoria, called manic episodes.

  • Usually, manic episode immediately precedes or follows a bout with major depression.

  • Small percentage of people experience only manic episodes.

  • Disorder involves abnormal moods at both ends of emotional spectrum.

  • Cyclothymic disorder (milder form of bipolar disorder)

    • People experience moderate but frequent mood swings for two years or longer.

    • Mood swings are not severe enough to qualify as either bipolar disorder or major depression.

    • People with it are perceived as being extremely moody, unpredictable, and inconsistent.

Prevalence and Course of Bipolar Disorder
  • Typically occurs in the person’s early twenties; lasts from a few days to a couple of months

  • Commonly recurs every few years; small percentage display rapid cycling

  • Among people who have had at least one depressive episode, only about 9% eventually are diagnosed.

  • No gender differences in prevalence

  • Can often be controlled by medication (lithium)

Explaining Depressive Disorders and Bipolar Disorders

  • Considerable evidence points to the role of genetic factors, biochemical factors, and stressful life events in development of depressive disorders and bipolar disorders.

    • Genetic predisposition

    • Activation of brain structure differences

    • Brain chemistry

    • Stress

    • Cigarette smoking and development of major depression

Depressive Disorders and Bipolar Disorders

  • Major Depressive Disorder

    • Loss of interest or pleasure in almost all activities

    • Despondent mood; feelings of emptiness, worthlessness, or excessive guilt

    • Preoccupation with death or suicidal thoughts

    • Difficulty sleeping or excessive sleeping

    • Diminished ability to think, concentrate, or make decisions

    • Diminished appetite and significant weight loss

  • Persistent Depressive Disorder

    • Chronic depressed feelings that are often less severe than those that accompany major depressive disorder

  • Seasonal Affective Disorder (SAD)

    • Recurring episodes of depression that follow a seasonal pattern, typically occurring in the fall and winter months and subsiding in the spring and summer month

  • Bipolar Disorder

    • One or more manic episodes characterized by euphoria, high energy, grandiose ideas, flight of ideas, inappropriate self-confidence, and decreased need for sleep

    • Usually one or more major depressive episodes

    • In some cases, may rapidly alternate between symptoms of mania and major depressive disorder

  • Cyclothymic Disorder

    • Moderate, recurring mood swings that are not severe enough to qualify as major depressive disorder or bipolar disorder

Eating Disorders: Anorexia, Bulimia, and Binge-Eating Disorder

  • Key Theme: Anorexia nervosa, bulimia nervosa, and binge-eating disorder are psychological disorders characterized by severely disturbed, maladaptive eating behaviors.

Characteristics of Eating Disorders

  • Eating disorders: category of psychological disorders characterized by severe disturbances eating behavior

  • Eating disorders can include:

    • Serious and maladaptive disturbances in eating behavior,

    • Reduced food intake,

    • Severe overeating, and

    • Obsessive concerns about body shape or weight.

    • 90 to 95% of people who experience an eating disorder are female.

Eating Disorders: Definitions
  • Anorexia Nervosa

    • Severe and extreme disturbance in eating habits and calorie intake

    • Body weight that is significantly less than what would be considered normal for the person’s age, height, and gender, and refusal to maintain a normal body weight

    • Intense fear of gaining weight or becoming fat

    • Distorted perceptions about the severity of weight loss and a distorted self-image, such that even an extremely emaciated person may perceive herself as fat

  • Bulimia Nervosa

    • Recurring episodes of binge eating, which is defined as an excessive amount of calories within a two-hour period

    • The inability to control or stop the excessive eating behavior

    • Recurrent episodes of purging, which is defined as using laxatives, diuretics, self- induced vomiting, or other methods to prevent weight gain

  • Binge-Eating Disorder

    • Recurring episodes of binge eating

    • The inability to control or stop the excessive eating behavior

    • Not associated with recurrent episodes of purging or other methods to prevent weight gain

Anorexia Nervosa

  • Anorexia nervosa eating disorder

    • Excessive weight loss, an irrational fear of gaining weight, and distorted body self-perception

  • Key features

    • Refusal to maintain a minimally normal body weight; intense fear of gaining weight or becoming fat; distorted perception about body size; denial of seriousness of weight loss

  • Effects

    • Similar to that of starvation; BMR, glucose, insulin, and leptin blood level decrease; decreased estrogen or testosterone levels

Bulimia Nervosa

  • Bulimia nervosa eating disorder

    • Binges of extreme overeating followed by self-induced vomiting, misuse of laxatives, or other inappropriate methods to purge excessive food and prevent weight gain

  • Key features

    • Fear of gaining weight; stay within a normal weight range; usually recognize that they have an eating disorder; binges typically occur twice a week, triggered

  • Effects

    • Disruption of electrolyte balance (muscle cramps, irregular heartbeat; erosion of tooth enamel; damage to GI track

Binge-Eating Disorder

  • Binge-eating disorder

    • Engage in bingeing behaviors (DSM-5-TR)

    • Do not engage in purging or other behaviors that rid their bodies of the excess food

    • Experience the same feelings of distress, lack of control, and shame that people with bulimia experience

Causes of Eating Disorders: A Complex Picture

  • Decreases in brain activity of the neurotransmitter serotonin

  • Genetic factors implicated

  • Family interaction patterns

    • Critical comments by parents

    • Parental modeling of disordered eating

  • Western cultural attitudes toward thinness and dieting

  • Perfectionism in childhood; negative self-beliefs; other psychological characteristics

Personality Disorders

  • Key Theme: The personality disorders are characterized by inflexible, maladaptive patterns of thoughts, emotions, behavior, and interpersonal functioning.

What Are Personality Disorders?

  • Personality disorders

    • Inflexible, maladaptive, pervasive pattern of thoughts, emotions, behaviors, and interpersonal functioning

    • Stable over time (long-term) and across situations

    • Deviate from expectations of individual’s culture

    • Occur in about 10% of general population

    • Usually become evident during adolescence or early adulthood

Diagnosing Personality Disorders

  • DSM-5-TR identifies 10 distinct personality disorder.

  • Categorized into 3 basic clusters

    • Odd, eccentric

    • Dramatic, emotional, erratic

    • Anxious, fearful

Personality Disorder Clusters and Specific Disorders
  • Odd, Eccentric Cluster

    • Paranoid Personality Disorder

      • Pervasive but unwarranted distrust and suspiciousness; assumes that other people intend to deceive, exploit, or harm them.

    • Schizoid Personality Disorder

      • Pervasive detachment from social relationships; emotionally cold and flat; indifferent to praise or criticism from others; preference for solitary activities; lacking in close friends.

    • Schizotypal Personality Disorder

      • Odd thoughts, speech, emotional reactions, mannerisms, and appearance; impaired social and interpersonal functioning; often superstitious.

  • Dramatic, Emotional, Erratic Cluster

    • Antisocial Personality Disorder

      • Blatantly disregards or violates the rights of others; impulsive, irresponsible, deceitful, manipulative, and lacking in guilt or remorse.

    • Borderline Personality Disorder

      • Intense, unstable relationships, emotions, and self-image; impulsive; desperate efforts to avoid real or imagined abandonment; feelings of emptiness; self-destructive tendencies.

    • Histrionic Personality Disorder

      • Exaggerated, overly dramatic expression of emotions and attention-seeking behavior that often includes sexually seductive or provocative behaviors.

    • Narcissistic Personality Disorder

      • Grandiose sense of self-importance; exaggerates abilities and accomplishments; excessive need for admiration; boastful, pretentious; lacking in empathy.

  • Anxious, Fearful Cluster

    • Avoidant Personality Disorder

      • Extreme social inhibition and social avoidance due to feelings of inadequacy, and hypersensitivity to criticism, rejection, or disapproval.

    • Dependent Personality Disorder

      • Excessive need to be taken care of, leading to submissive, clinging behaviors; fears of separation; and the inability to assume responsibility.

    • Obsessive–Compulsive Personality Disorder

      • Rigid preoccupation with orderliness, personal control, rules, or schedules that interferes with completing tasks; unreasonable perfectionism.

Antisocial Personality Disorder

  • Central feature is a pattern of blatantly disregarding and violating the rights of others.

    • Difficulty holding job; often end up in criminal justice system

    • Deceiving and manipulating others for their own personal gain

    • Appearing to lack “conscience”

    • More prevalent in men than women

    • High rates of alcoholism and other forms of substance abuse

    • Evidence often seen in childhood or early adolescence (conduct disorder).

      • Cruelty to animals

      • Attacking or harming adults or other children

      • Theft

      • Setting fires and destroying property

Borderline Personality Disorder (BPD)

  • Personality disorder characterized by instability of interpersonal relationships, self-image, and emotions, and marked impulsivity

    • Most serious and disabling of the personality disorders; most commonly diagnosed

    • Moods and emotions are intense, fluctuating, and extreme, often vastly out of proportion

    • Inappropriate and often uncontrollable episodes of anger

  • Relationships with others are chaotic; desperately afraid of abandonment

  • “Cutting” or other acts of self- mutilation, threats of suicide, and suicide attempts are common (10% successful)

What Causes Borderline Personality Disorder?
  • Early views

    • Disruption in attachment relationships in early childhood; neglect or physical, sexual, or emotional abuse in childhood

  • Biosocial developmental theory

    • Combination of biological, psychological, and environmental factors

    • Biological temperament characterized by extreme emotional sensitivity, impulsivity, and tendency to experience negative emotions

    • Caregivers do not teach control of impulses or regulation of emotions.

    • Parents or caregivers shape and reinforce pattern of frequent, intense emotional displays.

    • History of abuse and neglect may be present but is not a necessary ingredient.

The Dissociative Disorders

  • Key Theme: In the dissociative disorders, disruptions in awareness, memory, and identity interfere with the ability to function in everyday life.

  • Dissociative disorders: Extreme and frequent disruptions of awareness, memory, and personal identity impair the ability to function.

  • Dissociative experience: Break or disruption in consciousness during which awareness, memory, and personal identity become separated or divided

  • 2 basic disorders

    • Dissociative amnesia, which can occur either with or without dissociative fugue

    • Dissociative identity disorder, which was previously called multiple personality disorder

Dissociative Amnesia and Dissociative Fugue

  • Dissociative amnesia

    • Partial or total inability to recall important information that is not due to a medical condition

    • Amnesia for personal events and information, rather than for general knowledge or skills

  • Dissociative fugue

    • Suddenly and inexplicably travels away from home, wandering to other cities or even countries

Dissociative Identity Disorder (DID)

  • Dissociative disorder involves extensive memory disruptions.

    • Presence of two or more distinct identities, or “personalities”

    • Formerly called multiple personality disorder.

    • Not all mental health professionals are convinced that dissociative identity disorder is a genuine psychological disorder.

Dissociative Disorders Definitions
  • Dissociative Amnesia

    • Inability to remember important personal information, too extensive to be explained by ordinary forgetfulness

  • Dissociative Amnesia with Dissociative Fugue

    • Sudden, unexpected travel away from home

    • Confusion about personal identity or assumption of new identity

  • Dissociative Identity Disorder

    • Presence of 2 or more distinct identities, each with consistent patterns of personality traits and behavior

    • Behavior that is controlled by two or more distinct recurring identities

    • Amnesia; frequent memory gaps

Explaining Dissociative Identity Disorder

  • Dissociative identity disorder is extreme form of dissociative coping.

  • High percentage of DID patients report having suffered extreme physical or sexual abuse.

    • Child “dissociates” from it, creating alternate personalities to experience trauma.

  • Dissociative coping theory is difficult to test empirically.

  • Traumatic memory: Opposite effect occurs to most trauma victims.

Schizophrenia

  • Key Theme: One of the most serious psychological disorders is schizophrenia, which involves severely distorted beliefs, perceptions, and thought processes.

  • Schizophrenia is a psychological disorder that involves severely distorted beliefs, perceptions, and thought processes.

  • It is diagnosed when 2 or more of these characteristic symptoms are actively present for a month, or longer.

Symptoms of Schizophrenia

  • Positive symptoms

    • Symptoms that reflect excesses or distortions of normal functioning, including delusions, hallucinations, and disorganized thoughts and behavior

      • Delusions, or false beliefs; can lead to dangerous behaviors; consistent themes.

      • Hallucinations, or false perceptions; can be indistinguishable from reality.

      • Severely disorganized thought processes, speech occur.

      • Severely disorganized behavior noted.

  • Negative symptoms

    • Symptoms consist of marked deficits or decreases in behavioral or emotional functioning

      • Diminished emotional expression/common symptom; apathy

      • Inability to initiate or persist in simple forms of goal-directed behavior

  • Symptoms can occur in combination and vary across cultures.

The Hallucinating Brain

  • Researcher David Silbersweig and his colleagues (1995) used PET scans to take a “snapshot” of brain activity during schizophrenic hallucinations.

  • The scan shown here was recorded at the exact instant a schizophrenic patient hallucinated disembodied heads yelling orders at him.

  • The bright orange areas reveal activity in the left auditory and visual areas of his brain, but not in the frontal lobe, which normally is involved in organized thought processes.

Hearing and Seeing Within Your Own Mind

  • Brain research demonstrates internal speech,

    • Brain looks nearly identical to actually seeing or hearing something or hearing something.

  • People who experience auditory hallucinations show deficits in brain regions that are consistently associated with self-awareness.

  • Brain imaging also reveals that people with schizophrenia may demonstrate reduced brain activity in prefrontal cortex and increased brain activity in limbic system.

  • Shows an inability to recognize self-based nature of inner speech, which may represent the neurological underpinnings of distressing auditory hallucinations

Culture Differences in Delusions

  • Symptoms of schizophrenia often vary across cultures.

    • Cultural differences in hallucinations and delusions.

    • Content of delusions changes as culture shifts.

    • Recently, delusions are more likely to involve technology and media.

The Prevalence of Schizophrenia

  • Prevalence

    • One million of Americans treated for schizophrenia each year; 21 million globally.

    • Schizophrenia occurs in every society or culture.

The Course of Schizophrenia

  • Course

    • Onset of schizophrenia typically occurs during young adulthood.

    • One-quarter of those who experience an episode recover completely.

    • One-quarter experience recurrent episodes, but with minimal impairment in ability to function.

    • For one-half, schizophrenia becomes a chronic mental illness, and the ability to function may be severely impaired.

    • Better outcomes reported in developing world.

Explaining Schizophrenia

  • Genetic factors: family, twin, and adoption studies

    • Clusters in certain families

    • Risk rises when close relatives have schizophrenia.

    • Chromosome locations associated with genes that influence brain development, memory, and cognition seem related.

    • No specific pattern of genetic variation can be identified as the genetic “cause” of schizophrenia, but presence of certain genetic variations increases susceptibility.

The Immune System: The Viral Infection Theory

  • Viral infection theory: exposure to a viral infection during prenatal development or early infancy affects the developing brain, producing changes that make the individual more vulnerable to schizophrenia later in life

    • Higher likelihood of child schizophrenia

      • Women exposed to flu virus during the first trimester

      • Maternal hospitalization for infection during pregnancy

      • Birth in winter and spring months

Schizophrenia and Abnormal Brain Structures

  • Evidence

    • About 50% of people with schizophrenia show some type of brain structure abnormality.

      • Most consistent finding: enlargement of the ventricles

      • Loss of gray matter tissue and lower overall volume of the brain

    • Not conclusive

      • Some people with schizophrenia do not show brain structure abnormalities.

      • Evidence is correlational.

Schizophrenia and Atypical Brain Chemistry

  • Imbalances in neurotransmitters

    • Excessive activity of dopamine in the brain

      • Antipsychotic drugs reduce/block dopamine activity in the brain.

      • Drugs that enhance dopamine activity in the brain increase symptoms in those who already have schizophrenia.

    • Imbalances in glutamate and adenosine are related to schizophrenia.

    • However, connection between neurotransmitters and schizophrenia symptoms remains unclear.

Schizophrenia and Psychological Factors: Unhealthy Families

  • A Finnish study found adopted children with a biological schizophrenic mother had a higher rate of schizophrenia when raised in a disturbed, adoptive home (Tienari & others).

  • This graph shows the strong influence of the adoptive family environment on the development of serious mental disorders.

Understanding and Helping to Prevent Suicide

  • Each year almost 700,000 people around the world take their own lives, including almost 50,000 in the United States.

  • More than 35 people attempt suicide for every successful suicide.

  • Suicide is second leading cause of death for young people ages 15 to 34, but highest rate occurs consistently in those aged 75 and above.

Risk Factors Associated with Suicidal Behavior

  • Feelings of hopelessness and social isolation

  • Recent relationship problems (including from being cooped up together during the pandemic) or a lack of significant relationships.

  • Poor coping and problem-solving skills

  • Poor impulse control and impaired judgment

  • Rigid thinking or irrational beliefs.

  • A major psychological disorder, especially major depressive disorder, bipolar disorder, or schizophrenia, especially if untreated.

  • Childhood physical or sexual abuse

  • Prior self-destructive behavior

  • A family history of suicide

  • Presence of a firearm in the home

  • Exposure to bullying, including cyberbullying (Fisher et al., 2012)

  • Unemployment and financial hardship

  • Worry and uncertainty about the future

  • Alcohol or other substance abuse

Understanding and Helping to Prevent Suicide (part 2)

  • Reasons for attempting or committing suicide

    • View of life becomes more pessimistic and negative.

    • View of self-inflicted death become more acceptable and positive.

    • Suicide is viewed as the only escape from painful emotions.

  • Ways to help prevent suicide

    • Actively listen.

    • Do not deny or minimize person’s intentions.

    • Ask person to delay decision.

    • Encourage person to seek professional help.

Term: Psychopathology
Definition: scientific study of the origins, symptoms, and development of psychological disorders


Term: Psychological disorder or mental disorder
Definition: Pattern of behavioral and psychological symptoms that: Causes significant personal distress and impairs the ability to function in one or more important areas of life, or both


Term: DSM-5-TR
Definition: (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition); published by the American Psychiatric Association. Describes the specific symptoms and diagnostic guidelines for different psychological disorders.


Term: Anxiety
Definition: unpleasant emotional state characterized by physical arousal, feelings of tension, apprehension, and worry


Term: Anxiety disorders
Definition: category of psychological disorders in which extreme anxiety is the main diagnostic feature and causes significant disruptions in the person’s cognitive, behavioral, or interpersonal functioning


Term: Generalized anxiety disorder (GAD)
Definition: anxiety disorder characterized by excessive, global, and persistent symptoms of anxiety


Term: Panic attack
Definition: sudden episode of extreme anxiety that rapidly accelerates in intensity


Term: Panic disorder
Definition: anxiety disorder in which a person experiences frequent and unexpected panic attacks


Term: Agoraphobia
Definition: anxiety disorder involving extreme fear of experiencing a panic attack or other embarrassing or incapacitating symptoms in a public situation where escape is impossible and help is unavailable


Term: Phobia
Definition: persistent and irrational fear of a specific object, situation, or activity


Term: Specific phobia
Definition: excessive, intense, and irrational fear of a specific object, situation, or activity that is actively avoided or endured with marked anxiety


Term: Social anxiety disorder
Definition: anxiety disorder involving the extreme and irrational fear of being embarrassed, judged, or scrutinized by others in social situations


Term: Posttraumatic stress disorder (PTSD): Core Symptom Clusters
Definition: Disorder triggered by exposure to highly traumatic event; Results in frequent, involuntary, and intrusive memories of the event; Avoidance of stimuli and situations associated with the event; Negative changes in thoughts, moods, and emotions; Persistent state of heightened physical arousal


Term: Obsessive–compulsive disorder (OCD)
Definition: disorder characterized by: Intrusive, repetitive, and unwanted thoughts (obsessions) and Repetitive behaviors or mental acts that an individual feels driven to perform (compulsions).


Term: Obsessions
Definition: Repeated, intrusive, and uncontrollable irrational thoughts or mental images that cause extreme anxiety


Term: Compulsions
Definition: Repetitive behaviors or mental acts that a person feels driven to perform to prevent or reduce anxiety and distress, or to prevent a dreaded event or situation


Term: Major depressive disorder
Definition: Mood disorder; Characterized by extreme and persistent feelings of despondency, worthlessness, and hopelessness; Causes impaired emotional, cognitive, behavioral, and physical functioning


Term: Bipolar disorder
Definition: mood disorder involving periods of incapacitating depression alternating with periods of extreme euphoria and excitement; formerly called manic depression


Term: Manic episode
Definition: sudden, rapidly escalating emotional state characterized by extreme euphoria, excitement, physical energy, and rapid thoughts and speech


Term: Cyclothymic disorder
Definition: (milder form of bipolar disorder); People experience moderate but frequent mood swings for two years or longer; Mood swings are not severe enough to qualify as either bipolar disorder or major depression; People with it are perceived as being extremely moody, unpredictable, and inconsistent.


Term: Eating disorders
Definition: category of psychological disorders characterized by severe disturbances eating behavior


Term: Anorexia nervosa eating disorder
Definition: Excessive weight loss, an irrational fear of gaining weight, and distorted body self-perception


Term: Bulimia nervosa eating disorder
Definition: Binges of extreme overeating followed by self-induced vomiting, misuse of laxatives, or other inappropriate methods to purge excessive food and prevent weight gain


Term: Binge-eating disorder
Definition: Engage in bingeing behaviors (DSM-5-TR); Do not engage in purging or other behaviors that rid their bodies of the excess food; Experience the same feelings of distress, lack of control, and shame that people with bulimia experience


Term: Personality disorders
Definition: Inflexible, maladaptive, pervasive pattern of thoughts, emotions, behaviors, and interpersonal functioning; Stable over time (long-term) and across situations; Deviate from expectations of individual’s culture; Occur in about 10% of the general population; Usually become evident during adolescence or early adulthood


Term: Paranoid Personality Disorder
Definition: Pervasive but unwarranted distrust and suspiciousness; assumes that other people intend to deceive, exploit, or harm them.


Term: Schizoid Personality Disorder
Definition: Pervasive detachment from social relationships; emotionally cold and flat; indifferent to praise or criticism from others; preference for solitary activities; lacking in close friends.


Term: Schizotypal Personality Disorder
Definition: Odd thoughts, speech, emotional reactions, mannerisms, and appearance; impaired social and interpersonal functioning; often superstitious.


Term: Antisocial Personality Disorder
Definition: Blatantly disregards or violates the rights of others; impulsive, irresponsible, deceitful, manipulative, and lacking in guilt or remorse.


Term: Borderline Personality Disorder
Definition: Intense, unstable relationships, emotions, and self-image; impulsive; desperate efforts to avoid real or imagined abandonment; feelings of emptiness; self-destructive tendencies.


Term: Histrionic Personality Disorder
Definition: Exaggerated, overly dramatic expression of emotions and attention-seeking behavior that often includes sexually seductive or provocative behaviors.


Term: Narcissistic Personality Disorder
Definition: Grandiose sense of self-importance; exaggerates abilities and accomplishments; excessive need for admiration; boastful, pretentious; lacking in empathy.


Term: Avoidant Personality Disorder
Definition: Extreme social inhibition and social avoidance due to feelings of inadequacy, and hypersensitivity to criticism, rejection, or disapproval.


Term: Dependent Personality Disorder
Definition: Excessive need to be taken care of, leading to submissive, clinging behaviors; fears of separation; and the inability to assume responsibility.


Term: Obsessive–Compulsive Personality Disorder
Definition: Rigid preoccupation with orderliness, personal control, rules, or schedules that interferes with completing tasks; unreasonable perfectionism.


Term: Dissociative disorders
Definition: Extreme and frequent disruptions of awareness, memory, and personal identity impair the ability to function.


Term: Dissociative amnesia
Definition: Partial or total inability to recall important information that is not due to a medical condition; Amnesia for personal events and information, rather than for general knowledge or skills


Term: Dissociative fugue
Definition: Suddenly and inexplicably travels away from home, wandering to other cities or even countries


Term: Dissociative Identity Disorder (DID)
Definition: Presence of two or more distinct identities, or “personalities”


Term: Positive symptoms
Definition: Symptoms that reflect excesses or distortions of normal functioning, including delusions, hallucinations, and disorganized thoughts and behavior


Term: Negative symptoms
Definition: Symptoms consist of marked deficits or decreases in behavioral or emotional functioning