Comprehensive Notes on Psychological Disorders and Treatment Modalities and Treatments

Defining and Identifying Psychological Disorders

• Psychological disorders represent manifestations in a person’s behavior or thoughts and are studied within the field of abnormal psychology. This field covers common issues like depression, substance abuse, and learning difficulties, as well as rarer, severe conditions like bipolar disorder and schizophrenia.

• The identification of a psychological disorder is based on three primary criteria:   - Dysfunction: A failure for the individual to function effectively in daily life. An example is agoraphobia (fear of open spaces), where a person becomes unable to leave their home, hindering employment and social relationships.   - Distress: The disorder causes significant emotional or physical suffering to the individual or their loved ones, such as the pain associated with depression.   - Deviance: Behavior or feelings that are unusual and not shared by many in a population. For instance, in the United States, having visions is considered a symptom of a disorder, whereas in some other cultures, it may be recognized differently.

• The term insane is a legal term, not a medical one. It is used to differentiate between those who can be held entirely responsible for crimes ($\text{the sane}$) and those who, due to a psychological disorder, cannot be held fully responsible ($\text{insanity}$).

• Defendants who plead Not Guilty by Reason of Insanity ($\text{NGRI}$) are asking the court for acquittal based on psychological factors.

• Psychologists use standardized resources for diagnosis:   - International Classification of Diseases ($\text{ICD}$): Created by the World Health Organization ($\text{WHO}$).   - Diagnostic and Statistical Manual of Mental Disorders ($\text{DSM}$): Created by the American Psychiatric Association ($\text{APA}$). The most recent version, the DSM-$\text{5}$, contains symptoms for all recognized psychological disorders but lacks discussion on treatments or causes (etiologies) due to theoretical disagreements.

Theoretical Perspectives on the Etiology of Disorders

• Psychodynamic/Psychoanalytic Perspective: Locates the source of disturbances in internal, unconscious conflicts often caused by Adverse Childhood Experiences ($\text{ACEs}$).

• Behavioral Perspective: Asserts that psychological problems result from a person's history of reinforcement and the environment. All behaviors are seen as learned.

• Cognitive Perspective: Attributes disorders to irrational, dysfunctional ways of thinking or maladaptive learned associations.

• Humanistic Perspective: Views the root of disorders in a person's feelings, self-esteem, self-concept, or a failure to strive toward one's potential.

• Sociocultural Perspective: Holds that social ills like racism, sexism, ageism, poverty, and the resulting discrimination are the heart of psychological disorders.

• Biological/Biomedical Perspective: Sees disorders as caused by biological factors such as hormonal or neurotransmitter imbalances, differences in brain structure, or genetic abnormalities.

• Biopsychosocial View: Suggests that problems result from the interplay between biological, psychological, and social factors.

• Diathesis-Stress Model: Suggests that environmental stressors provide the circumstances under which a biological predisposition (diathesis) can express itself. This explains why monozygotic (identical) twins do not always suffer from the same disorders.

• Eclectic Approach: Practiced by psychologists who do not subscribe to one single perspective but use ideas from a variety of different viewpoints.

Neurodevelopmental and Neurocognitive Disorders

• Autism Spectrum Disorder: Characterized by deviations from typical social development. Children often seek less social/emotional contact and may be hypersensitive to sensory stimulation. They frequently display intense interest in non-typical objects (e.g., rubber bands) and engage in simple, repetitive behaviors.

• Attention-Deficit/Hyperactivity Disorder ($\text{ADHD}$): Characterized by difficulty paying attention or sitting still. Sufferers may hyperfocus on specific interests while ignoring external requests. It is more frequently diagnosed in boys, leading critics to suggest overdiagnosis in active boys and underdiagnosis in girls who struggle quietly.

• Alzheimer’s Disease: A well-known neurocognitive disorder involving dementia (the deterioration of cognitive abilities), most visibly in memory. The DSM-$\text{5}$ classifies both major and mild forms of neurocognitive disorders.

Anxiety Disorders and Their Etiologies

• Specific Phobia: An intense, unwarranted fear of a situation or object, such as claustrophobia (enclosed spaces), arachnophobia (spiders), or acrophobia (heights).

• Agoraphobia: A fear of open, public spaces that may lead to the inability to leave one's home.

• Social Anxiety Disorder: Formerly social phobia, which is the fear of embarrassing oneself in public settings (e.g., eating at a restaurant).   - Taijin kyofusho: A Japanese-specific social anxiety involving the concern that one's body is displeasing to others.

• Generalized Anxiety Disorder ($\text{GAD}$): Constant, low-level anxiety where the person feels nervous and out of sorts continuously.

• Panic Disorder: Sufferers experience acute episodes of intense anxiety called panic attacks, often without provocation. Anticipation of future attacks increases anxiety.   - Ataque de nervios: Symptoms similar to panic attacks found in Caribbean cultures.

• Theories on Anxiety:   - Psychodynamic: Anxiety results from unresolved conflicts between the desires of the id, ego, and superego.   - Behavioral: Anxiety is learned through classical conditioning, operant conditioning, or cognitive learning. Example: Pablo, age $\text{3}$, who became terrified of heights after getting lost at the Seattle Space Needle, associated heights with the fear of being lost (classical conditioning).   - Cognitive: Anxiety stems from dysfunctional, irrational thinking, such as an impossibly high standard for personal behavior leading to constant stress.

Somatic Symptom, Dissociative, and Depressive Disorders

• Somatic Symptom and Related Disorders: Occur when a person manifests psychological problems through physiological symptoms without an identifiable physical cause.   - Conversion Disorder: A person reports severe physical problems like paralysis or blindness with no biological traces found. Behaviorists suggest these behaviors are reinforced (e.g., avoiding work).

• Dissociative Disorders: Involve a separation from memories, thoughts, or identity.   - Dissociative Amnesia: Memory loss with no physiological basis (unlike organic amnesia).   - Dissociative Identity Disorder ($\text{DID}$): Formerly multiple personality disorder; a person has several personalities representing different ages and sexes. Often linked to extreme childhood trauma or sexual abuse. Critics question its legitimacy, suggesting it may be roles played due to therapist leading or media influence.

• Depressive (Mood or Affective) Disorders:   - Major Depressive Disorder ($\text{MDD}$): Known as the "common cold" of disorders. Diagnosis requires unhappiness for more than $\text{2 weeks}$ without a clear reason, accompanied by fatigue, appetite loss, and sleep changes.   - Persistent Depressive Disorder: Long-lasting depression that is less severe than MDD.   - Seasonal Affective Disorder ($\text{SAD}$): Depression occurring only during certain seasons (usually winter); often treated with light therapy.

• Cognitive Theories of Depression:   - Aaron Beck’s Cognitive Triad: Depression results from negative ideas about oneself, the world, and the future.   - Attributional Styles: Depressed individuals tend to make internal ("I am bad"), global ("I am bad at everything"), and stable ("I'll always be bad") attributions for negative events.   - Learned Helplessness: Martin Seligman demonstrated this with dogs receiving electric shocks. Dogs who couldn't stop the shocks in Phase $\text{1}$ failed to try and escape shocks in Phase $\text{2}$ even when escape was possible. In humans, this correlates with depression and passivity.

• Biological Components of Depression: Linked to low levels of serotonin or norepinephrine. Acetylcholine receptors in the brain and skin are linked to bipolar disorder.

Bipolar, Schizophrenia, and Personality Disorders

• Bipolar Disorder: Formerly manic depression; involves both depressive and manic episodes. Mania involves high energy, inflated confidence, and risky behavior.   - Bipolar I: Traditional extremes.   - Bipolar II: Involves at least one episode of hypomania (less extreme mania).

• Schizophrenia Spectrum Disorders: Most debilitating; fundamentally involves disordered, distorted thinking.   - Delusions: Beliefs with no basis in reality, such as delusions of persecution (people are out to get you) or delusions of grandeur (believing one has great power).   - Hallucinations: Perceptions in the absence of sensory stimulation (e.g., hearing nonexistent voices).   - Language Issues: Includes neologisms (made-up words), clang associations (nonsense rhyming), and word salad.   - Affect: Can be inappropriate affect (laughing at death) or flat affect (no emotional response).   - Catatonia: Motor problems including catatonic stupor or waxy flexibility (allowing the body to be posed manually).   - Symptom Types: Positive symptoms (behavioral excesses like hallucinations) vs. Negative symptoms (behavioral deficits like flat affect).

• Causes of Schizophrenia:   - Dopamine Hypothesis: High dopamine levels correlate with schizophrenia. Antipsychotics lower dopamine. L-Dopa (used for Parkinson's) can cause schizophrenic-like symptoms if given in excess. Tardive dyskinesia is a side effect of long-term dopamine blockers.   - Genetics: Incidence in the general population is $\text{1 in 100}$, but rises to nearly $\text{1 in 2}$ among identical twins. Abnormalities in brain ventricles and asymmetries are common.   - Double Binds: A cognitive cause where a person receives contradictory messages (e.g., parents demanding studies while complaining about a lack of friends).

• Personality Disorders: Maladaptive behaviors manifesting in early adulthood.   - Cluster A (Suspicious/Eccentric): Paranoid, Schizoid, Schizotypal.   - Cluster B (Impulsive/Dramatic): Antisocial (little regard for others), Borderline (unstable relationships), Narcissistic (self-love), and Histrionic (overly dramatic).   - Cluster C (Anxious): Avoidant (sensitive to criticism), Dependent (rely on others), Obsessive-Compulsive Personality Disorder (perfectionism).

Other Disorder Categories and the Rosenhan Study

• Obsessive-Compulsive Disorder ($\text{OCD}$): Persistent unwanted thoughts (obsessions) lead to repetitive actions (compulsions) to reduce anxiety. Related: Hoarding Disorder and Body Dysmorphic Disorder.

• Post-Traumatic Stress Disorder ($\text{PTSD}$): Involves flashbacks and nightmares after a troubling event.

• Paraphilic (Psychosexual) Disorders: Sexual attraction to non-sexual objects or behaviors, including pedophilia (children), zoophilia (animals), fetishism (objects), voyeurism (watching), masochism (suffering pain), and sadism (inflicting pain). Found more commonly in men.

• Eating Disorders:   - Anorexia Nervosa: Significantly low weight, fear of food/fat, distorted body image; primarily affects young women.   - Bulimia: Binge-purge cycle; fear of food but maintenance of more body weight than anorexics.   - Binge-Eating Disorder: Loss of control while eating large quantities; most common in the US.

• Substance-Related and Addictive Disorders: Diagnosed when use of substances or behaviors (gambling) negatively affects life.

• The Rosenhan Study ($\text{1978}$): David Rosenhan and associates sought admission to mental hospitals by faking voices. Once admitted for schizophrenia, they acted normally. None were exposed; they were released with "schizophrenia in remission." The study highlighted how labels stick and influence medical interpretation within institutions.

Foundations of Psychotherapy and Freud's Approach

• General Purpose: All treatments aim to alter behavior, thoughts, or feelings. Biomedical practitioners use "patients," while humanists use "clients."

• Psychodynamic Therapy: Based on Sigmund Freud's psychoanalysis. Uses insight therapies to identify underlying unconscious causes.

• Key Terms/Techniques:   - Symptom Substitution: When treating one symptom leads to the emergence of a new psychological problem because the root wasn't addressed.   - Free Association: Saying whatever comes to mind to bypass the ego's defenses.   - Dream Analysis: Analyzing the manifest content (what is reported) to find the latent content (hidden meaning).   - Resistance: Objects to interpretations that indicate the analyst is nearing the source of the problem.   - Transference: Redirecting strong feelings about other people (like parents) onto the therapist.

Humanistic and Behavioral Therapies

• Humanistic Therapies: Focus on self-actualization and individual goodness. Believe in free will (people control their own destinies) over determinism.   - Carl Rogers' Person-Centered Therapy: Uses unconditional positive regard and is nondirective. Employs active listening to help clients accept themselves.   - Fritz Perls' Gestalt Therapy: Focuses on the "whole" self and present experiences.   - Existential Therapies: Help clients find a sense of purpose.

• Behavioral Therapies: Treat all behaviors as learned via conditioning.   - Applied Behavior Analysis ($\text{ABA}$): Uses reinforcement for developmental disorders.   - Counterconditioning: Replacing an unpleasant response with a pleasant one.   - Systematic Desensitization (Joseph Wolpe): Used for phobias. Steps include reaching a relaxed state, creating an anxiety hierarchy (rank-ordered fears), and pairing relaxation with the hierarchy until the fear is extinguished. Can be in vivo (real life) or covert (imagined).   - Flooding: Facing the most frightening scenario immediately to realize it is irrational.   - Modeling: Learning by observing and imitating others; a melding of cognitive and behavioral ideas.   - Aversive Therapy: Pairing a bad habit with an unpleasant stimulus like an electric shock.   - Token Economy: Rewarding desired behaviors with tokens for items or privileges.

Cognitive, Cognitive-Behavioral, and Somatic Therapies

• Cognitive Therapy: Focuses on cognitive restructuring—challenging maladaptive thinking patterns. Aaron Beck used this for depression to challenge the cognitive triad.

• Cognitive Behavioral Therapy ($\text{CBT}$): Combines cognitive and behavioral methods.   - Rational Emotive Behavior Therapy ($\text{REBT/RET}$): Developed by Albert Ellis; involves confronting dysfunctional thoughts and giving behavioral "homework."

• Group Therapy: Includes Family Therapy (viewing interactions) and self-help groups like Alcoholics Anonymous ($\text{AA}$) which do not involve a therapist.

• Somatic (Biological) Therapies: Use psychopharmacology (chemotherapy) to produce bodily changes.   - Antipsychotics: Thorazine, Haldol; block dopamine; side effect includes tardive dyskinesia.   - Antidepressants: Tricyclics, MAO inhibitors, and SSRIs (Prozac). Increase serotonin activity.   - Lithium: Metal used for the manic phase of bipolar disorder.   - Antianxiety: Barbiturates (Miltown) and Benzodiazepines (Xanax, Valium).   - Electroconvulsive Therapy ($\text{ECT}$): For severe depression. Can be bilateral (more effective but causes memory loss) or unilateral. Involves inducing seizures.   - Psychosurgery: Includes the prefrontal lobotomy (cutting neurons to the frontal lobe), which often resulted in a vegetative state. Today, it is a rare last resort.

Professional Roles and Ethics

• Psychiatrists: Medical doctors who can prescribe medication; favor biomedical models.

• Clinical Psychologists: Have PhDs ($\text{4 or more years}$ of study) plus internships; treat severe problems.

• Counseling Therapists: Master's/Graduate degrees (e.g., school psychologists, marriage therapists); treat less severe issues.

• APA Ethical Guidelines: Principles include respecting rights and dignity, fidelity, integrity, cultural humility, and nonmaleficence (avoiding harm).

• Therapeutic Alliance: The success of therapy heavily depends on the relationship between client and therapist.