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Chapter 15: Psychological Disorders

Definition of a Psychological Disorder

• Psychopathology: The study of psychological disorders, encompassing symptoms, etiology (causes), and treatment.
• Psychological disorder: A condition characterized by abnormal thoughts, feelings, and behaviors, identified by several key elements:
    - Atypical vs. Disordered: Not all atypical behavior is disordered; context matters.
    - Cultural Influences: Definitions of abnormality vary by cultural norms and expectations.
    - Harmful Dysfunction: For a condition to be classified as a disorder, it must be harmful to the individual or society and considered disordered relative to cultural standards.

American Psychological Association (APA) Definition

• A psychological disorder entails significant disturbances in thoughts, feelings, and behaviors, which:
    - Are outside cultural norms.
    - Reflect biological, psychological, or developmental dysfunctions.
    - Lead to significant distress or disability in daily functioning.
    - Do not correspond to expected cultural reactions to events.
    - The boundary between disordered and not disordered remains ambiguous and is debated among professionals.

Diagnosis

• Diagnosis: The process of identifying and labeling a set of defined symptoms. Effective diagnosis necessitates a classification system for systematic organization of psychological disorders.
• DSM-5 (Diagnostic and Statistical Manual of Mental Disorders): The primary classification system utilized by most mental health professionals in the U.S.
    - Components of DSM-5 include:
      - Diagnostic Features: An overview of each disorder.
      - Diagnostic Criteria: Specific symptoms required for diagnosis.
      - Prevalence Data: Percentage of the population affected by each disorder.
      - Risk Factors: Factors that could contribute to the disorder.
      - Comorbidity: Information on the co-occurrence of disorders.

The International Classification of Diseases (ICD)

• Published by the World Health Organization (WHO), the ICD shares similarities and differences with the DSM:
    - It serves to assess the general health of populations and monitor the prevalence of diseases and health problems on a global scale.
    - Generally used more internationally for clinical diagnosis, while DSM is favored for research purposes.
    - DSM provides explicit disorder criteria and comprehensive explanatory text compared to ICD.

Historical Perspectives on Psychological Disorders

Supernatural Perspectives

• For centuries, psychological disorders were often attributed to supernatural forces.
    - Practices included beliefs in black magic, possession by spirits, and witchcraft.
    - Treatments during this time involved torture, physical harm, and exorcism.

Biological Perspectives

• Biological perspectives link psychological disorders to biological factors, including:
    - Genetic Factors: Evidence showing that many disorders have a genetic component.
      - Example: Individuals with a family history of schizophrenia exhibit higher risks of developing the disorder.
    - Chemical Imbalances: This includes neurochemical dysregulation.
    - Brain Abnormalities: Physical changes or differences in neurological functioning.

Diathesis-Stress Model

• A psychosocial perspective that integrates biological vulnerabilities with psychosocial stressors:
    - Diathesis: An individual’s predisposition to a disorder.
    - Stress: External stressors and life events that may trigger the onset of the disorder.
    - The interaction of diathesis and stress predicts the likelihood of developing a psychological disorder.

Anxiety Disorders

• Fear vs. Anxiety:
    - Fear: An immediate reaction to an imminent threat.
    - Anxiety: More of a prolonged apprehension and cautiousness regarding possible future threats.
    - Motivational Function: Anxiety can motivate individuals to take precautionary actions or avoid potentially harmful situations.
• Prevalence: Anxiety disorders collectively impact about 25%-30% of the U.S. population during their lifetime, with higher prevalence among women than men.

Specific Phobia

• Agoraphobia: Classified as a distinct anxiety disorder marked by intense fear and avoidance of situations where escape may be difficult (e.g., public transportation, crowds).
• Common Specific Phobias:
    - Acrophobia: Fear of heights.
    - Aerophobia: Fear of flying.
    - Arachnophobia: Fear of spiders.
    - Claustrophobia: Fear of enclosed spaces.
• Prevalence: Approximately 12.5% of individuals experience specific phobias during their lifetime.

Acquisition of Phobias

• Learning Approaches:
    1. Classical Conditioning: Phobias are often more readily developed from stimuli that are evolutionarily relevant to survival, like snakes or heights.
    2. Vicarious Learning: Phobias can develop through observing others' fearful responses.
    3. Verbal Transmission of Information: Children may internalize fears through verbal messages about dangers (e.g., being told that snakes are dangerous).
• Evolutionary Adaptation Theory: Suggests that humans have evolved to fear certain stimuli that were hazardous to ancestors, thus predisposing modern humans to similar fears.

Social Anxiety Disorder

• Defined by intense fear and avoidance of social situations along with anxiety when being evaluated negatively by others.
• Safety Behaviors: These are mental or behavioral acts that lessen anxiety by reducing the likelihood of negative social outcomes.
• Comorbidity: There is a significant rate of co-occurrence with alcohol use disorder due to self-medication.
• Prevalence: Affects approximately 12% of the population, leading to major impairments in social functioning.

Panic Disorder

• Characterized by recurrent, unexpected panic attacks, lasting at least one month, with persistent worry about these attacks and maladaptive behavioral changes.
• Panic Attack: A sudden episode of intense fear or discomfort that peaks within 10 minutes, which can be triggered by external events or arise unexpectedly.
• Comorbidity with Other Disorders: Often occurs with other anxiety disorders and major depressive disorder.

Causes of Panic Disorder

• Genetics: Heritability is about 43%.
• Neurobiological Factors: Involvement of the locus coeruleus, a major source of norepinephrine in the brain responsible for triggering the fight-or-flight response.
• Conditioning and Cognitive Theories: Panic responses can stem from learned behavior towards anxiety sensations and catastrophic interpretations of physical symptoms.

Generalized Anxiety Disorder (GAD)

• Diagnosis Criteria: Involves excessive anxiety occurring more days than not for at least six months, accompanied by at least three of the defined symptoms:
    - Restlessness.
    - Difficulty concentrating.
    - Easily fatigued.
    - Muscle tension.
    - Irritability.
    - Sleep difficulties.
• Prevalence: Approximately 5.7% of the population experiences GAD.

Obsessive-Compulsive Disorder (OCD)

• Obsessions: Include intrusive and unwanted thoughts, typically causing significant distress.
    - Common obsessions: concerns about germs, doubts, desires for order, aggressive urges.
• Compulsions: These are repetitive behaviors performed to alleviate the distress of obsessions or prevent feared outcomes; they are not aimed at achieving pleasure.
• Prevalence: Affects about 2.3% of the population.

Causes of OCD

• Genetic components, specifically involving serotonin and dopamine regulation.
• Classical and operant conditioning principles contribute to the maintenance of symptoms.
• Affected brain regions include the orbitofrontal cortex and anterior cingulate cortex, which are critical for emotional processing and decision-making.

Post-Traumatic Stress Disorder (PTSD)

• Diagnosis Criteria: Requires exposure to a traumatic event, with symptoms lasting over one month, including:
    - Intrusive memories or flashbacks.
    - Avoidance of stimuli related to the trauma.
    - Negative emotional states and feelings of detachment.
• Prevalence: Affects about 7% of the population, particularly following trauma without adequate support.

Learning & Development of PTSD

• Conditioning Theories: Following trauma, cues become associated with anxiety responses through classical conditioning.
• Cognitive Theories: Propose that disturbances in memory and negative appraisals about the trauma enhance vulnerability and perpetuate PTSD symptoms.

Mood Disorders

• Characterized by significant disruptions in emotional state and functioning:
    - Depressive Disorders: Marked by persistent sadness and loss of interest.
    - Bipolar and Related Disorders: Feature episodes of mania characterized by high energy and activity.

Major Depressive Disorder (MDD)

• Diagnosis Criteria: Must have a depressed mood most days, loss of interest, and at least five symptoms present over two weeks that cause distress or functional impairment.
• Symptoms: Include weight changes, sleep disturbances, energy deficits, feelings of worthlessness, indecisiveness, and suicidal thoughts.