Basic Concepts of Psychological Disorders

Basic Concepts of Psychological Disorders

Learning Objective Question (LOQ) 14-1: How should we draw the line between normality and disorder?

  • Psychological Disorder Definition:

    • A psychological disorder is defined as a syndrome, which is a collection of symptoms, marked by a clinically significant disturbance in an individual's cognition, emotion regulation, or behavior (American Psychiatric Association, 2013). This means that the thoughts, emotions, or behaviors must be dysfunctional or maladaptive, interfering with normal day-to-day life.

    • Example Cases:

    • Someone who is depressed and stays mostly in bed for three months likely has a psychological disorder.

    • A grieving father who cannot resume social activities three months after his child's death poses a question about the line between understandable grief and clinical depression.

  • Key Questions:

    • How should psychological disorders be defined?

    • How do underlying biological factors and troubling environments influence well-being?

    • How do nature and nurture effects interact?

    • How should psychological disorders be classified without stigmatizing or labeling individuals?

    • Are individuals with psychological disorders at risk of harming themselves or others?

    • What are the prevalence rates of psychological disorders and who is vulnerable?

  • Philosophical Reflection:

    • Quote by Herman Melville: "Who in the rainbow can draw the line where the violet tint ends and the orange tint begins?" This reflects the complexity of distinguishing between sanity and insanity.

Understanding Psychological Disorders

LOQ 14-2: Medical Model and Biopsychosocial Approach

  • Historical Context:

    • In earlier times, strange behaviors were attributed to external supernatural forces, like celestial movements or demonic possession, leading to brutal treatments (e.g., genital mutilation, beatings).

    • Philippe Pinel (1745-1826): Reformist who opposed brutal treatments, advocating for moral treatment and humane conditions for those with mental health issues.

  • The Medical Model:

    • Emerged around 1900, following the discovery of syphilis's effects on mental disorder. It emphasized diagnosing mental illnesses based on symptoms and treating them accordingly.

    • Aim to understand the brain and biological factors influencing disorders, with a growing integration of medical and psychological practices.

    • Mental illness classified as psychopathology and treated in psychiatric settings.

  • The Biopsychosocial Approach:

    • This perspective integrates biological, psychological, and social-cultural perspectives as interconnected factors influencing psychological disorders.

    • Examples of Disorder Cultural Specificity:

    • Major depressive disorder and schizophrenia are observed globally, but other disorders may be culture-specific, like susto in Latin America and taijin kyofusho in Japan.

  • Vulnerability-Stress Model:

    • Combines individual vulnerabilities with environmental stressors potentially leading to psychological disorders.

    • Biological Influences Include:

    • Evolutionary factors, individual genes, brain structure, and chemistry.

    • Psychological Influences Include:

    • Stress, trauma, learned helplessness, mood perceptions, and memories.

Classifying Disorders and Labeling People
LOQ 14-3: Classification of Psychological Disorders

  • Purpose of Classification:

    • To create order and predict course and treatment of disorders.

    • Classification of disorders, such as "schizophrenia", provides insight into symptoms and related expectations (e.g., incoherent talk, bizarre beliefs).

  • Diagnostic Tools:

    • The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) is the key text in the U.S. used by clinicians for diagnosing and treating psychological disorders.

    • Provides a structured approach for symptoms and includes diagnostic codes from the WHO's International Classification of Diseases (ICD).

  • Reliability Statistics:

    • Varies among disorders; for PTSD and autism spectrum disorder, clinician agreement is ~70%. In contrast, for antisocial personality disorder and generalized anxiety disorder, agreement is only ~20%.

  • Critiques of the DSM:

    • Overpathologizing: Critics argue that the DSM casts too wide a net, including valid but normal behaviors (like severe grief) within the realm of psychological disorders.

    • Subjective Risks: Diagnostic labels may influence perceptions and behaviors, potentially leading to self-fulfilling prophecies and stigma.

    • Alternative Models: The U.S. NIMH's Research Domain Criteria (RDoC) offers a behavior and brain activity classification framework, enriched by genetics and neuroscience.

  • Impact of Labels:

    • Stigma: Labels can lead to stigmatization and altered perceptions. For instance, a labeled individual might face discrimination in employment or housing.

    • Public Understanding: Representation in media can aid in reducing stigma (e.g., portrayals of Tony Stark and characters resembling psychological issues).

Understanding Suicide
LOQ 14-4: Factors Increasing Suicide Risk and Nonsuicidal Self-Injury (NSSI)

  • Statistics of Suicide:

    • An average of 800,000 deaths by suicide occur globally each year (WHO, 2018), with significant increases in rates amongst various demographics.

    • Protective measures and intervention strategies are critical.

  • Risk Factors Include:

    • Anxiety tripled the risk, depression increased it fivefold. Suicidal thoughts typically increase when individuals rebound from severe depression.

    • Demographic Differences:

    • National differences, racial differences, gender differences (e.g., men die by suicide at a higher rate, even though women often consider it more).

    • Traits such as perfectionism increase thoughts of suicide under unmet expectations.

    • Vulnerable groups include LGBTQ+ individuals facing rejection and older adults.

  • Understanding Status:

    • Suicidal thoughts arise due to feelings of being a burden or perceived helplessness, triggered by life challenges or isolation.

    • Importance of recognizing warning signs and involving support mechanisms.

  • Nonsuicidal Self-Injury (NSSI):

    • Engaging in self-harm behaviors often for emotional relief and distraction. Not directly leading to suicide but is a risk factor for it, especially when coexisting with disorders.

Does Disorder Equal Danger?
LOQ 14-5: Are Psychological Disorders Predictors of Violent Behavior?

  • Public Perception:

    • Stigma exists linking psychological disorders with violent behavior, though reality reveals that most violent offenders do not have mental disorders.

  • Clinical Predictions:

    • Unreliable; predicting violence based on mental health status yields inconsistent results. Substance abuse and past violent behavior are stronger predictors of violence.

  • Victimhood versus Perpetration:

    • Individuals with disorders are often more likely to be victims rather than perpetrators of violence.

    • The potential for interventions focusing on substance abuse and education rather than solely on mental health diagnostics.

Rates of Psychological Disorders
LOQ 14-6: Prevalence of Psychological Disorders

  • Global and National Statistics:

    • Mental and addicto disorders affected over 1 billion people worldwide as of 2016. In the U.S., approximately 19% (47 million adults) experienced mental illness in the past year (SAMHSA, 2018).

  • Specific Disorders (see Table 14.2):

    • ^### Psychological Disorder Prevalence:

    • Depressive disorders or bipolar disorders: 9.9%

    • Phobia: 9.1%

    • Social anxiety: 7.1%

    • ADHD: 4.4%

    • PTSD: 3.6%

    • Generalized anxiety disorder: 2.7%

    • Schizophrenia: <0.5%

    • Obsessive-compulsive disorder: 1.2%

  • Risk Factors for Mental Disorders (see Table 14.3):

    • Risk Factors: Academic failure, birth complications, child abuse, chronic illnesses, low socioeconomic status, parental mental illness, etc.

    • Protective Factors: Aerobic exercise, effective parenting, high self-esteem, problem-solving skills, etc.

  • Development Across Life Stages:

    • Onset of symptoms tends to occur by adolescence (mid-teens). By mid-twenties, 75% experience symptoms of some disorder, with varying onset ages for different conditions (e.g., antisocial personality disorder at age 8, phobias at age 10, etc.).

Terms and Concepts to Remember

  • Psychological Disorder: A syndrome marked by clinically significant cognitive, emotional, and behavioral disturbances.

  • Medical Model: The perspective that mental disorders are diseases that need to be diagnosed and treated medically.

  • Epigenetics: The study of how environmental factors influence gene expression, potentially contributing to the spectrum of psychological disorders.

  • DSM-5: The Diagnostic and Statistical Manual of Mental Disorders, fifth edition; a tool for diagnosing and classifying psychological disorders.