Psychopathology Notes

Anxiety Disorders

  • Generalized Anxiety Disorder (GAD):

    • Emotional-cognitive symptoms: Worrying, anxious feelings/thoughts about many subjects, "free-floating" anxiety.

    • Anxious anticipation interferes with concentration.

    • Physical symptoms: Autonomic arousal, trembling, sweating, fidgeting, agitation, sleep disruption.

    • Intensity and duration differentiate it from normal anxiety.

  • Panic Disorder:

    • Panic attack involves intense dread/terror for minutes.

    • Symptoms: chest pains, choking, numbness, frightening physical sensations (mimic heart attack).

    • Feeling a need to escape.

    • Panic disorder: repeated, unexpected panic attacks, fear of future attacks, and behavioral changes to avoid attacks.

  • Specific Phobia:

    • More than strong fear/dislike.

    • Diagnosed when there is an uncontrollable, irrational, intense desire to avoid the object or situation.

    • Agoraphobia: Avoidance of situations where panic attack is feared, especially if escape/help is difficult.

    • Social Anxiety Disorder: Intense fear of being watched/judged by others. Fear of public appearances (speaking, eating, performing) where embarrassment is possible.

Perspectives on Anxiety

  • Freudian/Psychodynamic:

    • Neurotic anxiety stems from repressed childhood impulses, socially inappropriate desires, and emotional conflicts.

    • These issues are repressed, but manifest as anxiety over losing control.

  • Classical Conditioning:

    • Conditioned response can be overgeneralized to similar objects/situations.

  • Operant Conditioning:

    • Anxiety reduction hypothesis: Leaving an anxiety-inducing situation provides relief, reinforcing avoidance.

    • Compulsive re-checking is reinforced, leading to increased anxious thoughts/behaviors.

  • Observational Learning:

    • Anxiety acquired by observing others' fear/avoidance.

  • Humanistic-Existential Approaches:

    • Rogers: Anxiety results from a faulty self-image; unrealistic self-image is threatened by contradictory information, causing defense mechanisms.

    • Existentialism: Anxiety reflects a lack of meaning in life; fear of living courageously/responsibly leads to feeling lost, causing anxiety.

  • Cognitive:

    • Cognitive errors: Predicting bad events, all-or-nothing thinking.

    • Irrational beliefs (e.g., bad things don't happen to good people).

    • Mistaken appraisals: Magnifying threats/failures (aches to diseases, noises to dangers).

  • Biology:

    • Evolutionary: Ancestors fearing certain items were more likely to survive/reproduce.

    • Genetic Susceptibility:

      • Identical twins (raised separately) develop similar phobias.

      • Some individuals have an inborn high-strung temperament.

      • Linked to genes regulating serotonin (mood) and glutamate (brain's alarm centers).

      • GABA (inhibitory neurotransmitter) deficiency linked to anxiety/depression.

Obsessive-Compulsive and Related Disorders

  • Extreme preoccupation with thoughts and compulsive behaviors causing distress and are maladaptive.

  • Obsessive-Compulsive Disorder (OCD):

    • Obsessions: Intense, unwanted worries, ideas, images that repeatedly appear.

    • Compulsions: Repeatedly strong feeling of needing to carry out an action, even if it doesn't make sense.

    • Disorder criteria: Distress (frustration with inability to control behaviors) and dysfunction (interference with everyday life).

  • Other OCD-Related Disorders:

    • Hoarding Disorder: Excessive accumulation of items interfering with functioning.

    • Body Dysmorphic Disorder: Preoccupation with perceived flaw in physical appearance.

Trauma and Stressor-Related Disorders

  • Psychological reactions following exposure to traumatic/stressful event.

  • Adjustment Disorder:

    • Emotional disturbance caused by ongoing stressors within normal range of experience.

    • Occurs when stable people face excessive stress and have difficulty coping, leading to unhealthy behaviors.

    • Maladaptive responses lasting at least 3 months.

  • Post-Traumatic Stress Disorder (PTSD):

    • Factors: Less control over situation, frequent traumatization, brain differences, less resilience.

    • Cognitive: Negative appraisals, fatalistic beliefs.

    • Early childhood trauma, repeated trauma.

  • Post-Traumatic Stress Disorder (PTSD):

    • Maladaptive reaction to a traumatic experience.

  • Symptoms:

    • repeated intrusive recall of those memories

    • nightmares and flashbacks

    • social withdrawal or phobic avoidance

    • jumpy anxiety or hypervigilance.

    • easily angered

    • last for at least 4 weeks.

    • Avoiding stimuli that trigger memories from events.

  • Acute Stress Disorder:

    • Symptoms like PTSD, but less intense and of shorter duration.

  • Biological:

    • Genetic/cognitive risk factors.

    • Gender: Women more at risk.

    • Abnormal stress hormone levels (epinephrine, cortisol).

    • Amygdala overactivity.

Dissociative Disorders

  • Dissociation: Separation of consciousness from thoughts, memory, bodily sensations, feelings, or identity as an escape from psychological stress.

  • Dissociative Amnesia:

    • Loss of memory for important personal information without physical cause.

    • Inability to recall selected/any memories.

  • Dissociative Fugue:

    • "Running away" state.

    • repression - brain is blocking them from recalling whatever memory is missing

  • Dissociative Identity Disorder (DID):

    • Person takes on new identity to avoid what previously happened to them.

    • Development of separate personalities.

    • Two or more personalities take turns controlling the person's identity. One or more personalities maybe unaware of each other; if a personality is not aware of each other there are disturbing memory lapses.

  • alternative explanations:

    • dissociative ¨identities¨ might just be an extreme form of playing a role.

    • Wandering away from one's life, memory, and identity, with no memory of these.

    • May be a recent cultural construction in North America.

  • therapist explanation:

    • Usually result of traumatic childhood abuse - usually sexual

  • evidence:

    • different personalities have involved:

      • different brainwave patterns

      • different left-right handedness

      • different visual acuity and eye muscle balance patterns

  • explanations:

    • environmental stress of psychological trauma - a defense mechanism against intolerable anxiety

    • DID - traumatic childhood trauma, usually sexual in nature

    • repression as a result of psychological trauma

Somatic Symptom and Related Disorders

  • Involve physical symptoms with psychological causes.

  • Functional Neurological Symptom Disorder:

    • physical symptoms with no physiological explanation.

      • Physical symptoms with no physiological explanation (e.g., severe pain, paralysis, loss of vision).

      • Previously termed "Conversion disorder."

  • Explanations:

    • Exact causes unclear; genetic/biological factors and family influence may play a role.

  • symptoms must cause significant distress or impairment in functioning

  • Illness Anxiety Disorder:

    • Hypochondria.

    • Preoccupation with having/acquiring a serious disease, even with minor symptoms.

    • Associated with negativity and reinforced behaviors.

  • Risk factors:\n * anxiety

    • depression

    • stress

    • having/being at risk of a medical condition

Schizophrenia Spectrum and Other Psychotic Disorders

  • Withdrawal from reality marked by hallucinations, delusions, disturbed thoughts/emotions, and personality disorganization.

    • hallucinations: illusory perceptions

    • delusions: illusory beliefs

    • Typically develops in late adolescence and gets progressively worse with age.

  • Schizophrenia:

    • Two or more symptoms present for a significant portion of time during a one-month period.

    • Positive Symptoms: Presents behaviors.

      • Hallucinations (especially auditory).

      • Delusions (especially persecutory).

      • Disorganized thought and nonsensical speech.

      • problems with selective attention: difficulty filtering thoughts and choosing which thoughts to believe and to say out loud

    • Negative Symptoms: Reduces behavior.

      • Diminished emotional expression.

      • Reduced social interaction.

      • Anhedonia (no enjoyment).

      • Avolition (less motivation).

      • Catatonia (disturbance of movement - immobility).

  • Course of Schizophrenia:

    • Acute/Reactive: Develop positive symptoms in reaction to stress; recovery is likely.

    • Chronic/Process: Develops slowly with negative symptoms; treatment offers periods of normal life, but no cure. Without treatment, leads to poverty/social problems.

  • abnormal brain structure and activity

  • Understanding Schizophrenia:

    • Abnormal brain structure/activity: Too many dopamine receptors, poor coordination in frontal lobes, thalamus firing during hallucinations, shrinking of brain areas.

  • Biological Risk Factors:
    * low birth weight
    * maternal diabetes
    * older paternal age
    * famine
    * oxygen deprivation during delivery
    * maternal virus during mid-pregnancy impairing brain development
    * smoking
    * genetic factors:
    * If one twin has schizophrenia, there is a 48% chance of the other twin having it as well.

  • social-psychological factors

    • stress-vulnerability model (diathesis-stress): combination of environmental factors and inherited susceptibility - environmental factors ¨turn on¨ genes that put a person at risk.

  • Negative Symptoms:

    • diminished emotional expression

    • reduced social interaction

    • anhedonia (no feeling of enjoyment)

    • avolition (less motivation, initiative, focus on tasks)

    • catatonia (disturbance of movement - immobility)

  • Schizoaffective Disorder:

    • Periods of major depressive or manic episodes concurrent with some schizophrenia symptoms, lasting at least 2 weeks.

  • Delusional Disorder:

    • Psychosis marked by severe delusions of grandeur, jealousy, persecution, etc.

  • Brief Psychotic Disorder:

    • Presence of one or more psychotic symptoms for at least 1 day but less than a month.

  • Substance-Induced Psychotic Disorder:

    • Delusions/hallucinations developed during/after substance intoxication/withdrawal.

Personality Disorders

  • Enduring, maladaptive behavior patterns impairing social functioning.

  • Deeply rooted unhealthy habits of personality.

  • Types may overlap.

  • Three clusters: Anxious, Eccentric/Odd, and Dramatic.

  • Anxious Type:

    • Ruled by fear of social rejection and withdrawal.

    • Example: Avoidant Personality Disorder.

  • environmental factors:

    • dysfunctional childhood ex. excessive pampering, unrealistically high expectations, abuse/neglect, family instability

  • biological factors:

    • genetic susceptibility

    • borderline type: brain chemicals that help regulate mood such as serotonin may not function properly

  • Eccentric/Odd Type:

    • Diminished emotional expression, no social attachments, social withdrawal.

    • Schizoid Personality Disorder: No interest in social relationships, detached, solitary, emotionally cold.

    • Paranoid Personality Disorder: Mistrust and suspicion, unforgiving, perceive others as out to get them.

  • Dramatic Type:

    • Histrionic P.D.:

      • attention-seeking

      • dramatic

      • want to be center of attention

    • Narcissistic Personality Disorder: Wanting admiration, arrogant, self-centered, lacks empathy.

  • Antisocial Personality Disorder (APD):

    • Acting impulsively without regard for others' needs/feelings.

    • Amoral, lacks conscience, violates rights, deceitful, reckless, aggressive, violent.

    • Views others as prey; can be charming con-artists.

  • moody

    • show symptoms of depression (suicidal thoughts and self-injurious behavior

    • instability with regard to their mood & relationships

  • About half of children with persistent antisocial behavior develop lifelong APD.

  • Biological Risk Factors

    • Risk factors include: lower levels of stress hormones and low physiological arousal in stressful situations such as awaiting receiving a shock.

    • fear conditioning is impaired ➔ reduced prefrontal cortex tissue leads to impulsivity.

Bipolar and Depressive Disorders (Mood Disorders)

  • Criteria of Major Depressive Disorder:

    • Depressed mood most of the day.

    • Markedly diminished interest/pleasure.

    • Significant appetite/weight changes.

    • Insomnia or disrupted sleep.

    • Lethargy or physical agitation.

    • Fatigue or loss of energy.

    • Worthlessness or guilt.

    • Problems in thinking/concentrating.

    • Recurring thoughts of death/suicide.

  • Bipolar Disorder:

    • Cycles between depression and mania (hyper-elevated mood: euphoric, giddy, hyperactive, impulsive, grandiose).

    • Disruptive mood dysregulation disorder (for young people with depression to extended rage).

  • Persistent Depressive Disorder:

    • Moderate depression persisting for at least 2 years.

  • Biological Perspective:

    • Evolutionary: Depression as withdrawal from stressors, signaling for help, avoiding distracting situations.

    • Genetic: Predisposition.

      • If one twin has BPD, the other twin has an 85% chance of also having it.

    • Brain/Body: Diminished brain activity in depression, increased in mania; smaller frontal lobes in depression, fewer axons in bipolar disorder; neurotransmitter imbalances.

      • brain cell communication (neurotransmitters): ➔ more norepinephrine (arousing) in mania, less in depression ➔ reduced serotonin in depression

  • Premenstrual Dysphoric Disorder:

    • Mood swings/depressive symptoms in week prior to menses.

  • Social-Cognitive Perspective:

    • Depressed individuals exhibit:

      • low self esteem: discounting positive information and assuming the worst about self, situation, and the future

      • learned helplessness: self-defeating beliefs such as assuming that one (self) is unable to cope, improve, achieve or be happy

      • depressive explanatory style: how we analyze bad news

      • rumination: stuck focusing on what´s bad