Psychological Disorders Notes

Basic Concepts of Psychological Disorders

• A syndrome is a collection of symptoms that indicates a clinically significant disturbance in a person's cognitions (thoughts), emotional regulation (feelings), or behavior.

Defining Abnormal Behavior

• Two criteria define abnormal behavior:

  • Distressful: The person's thoughts, feelings, or behaviors cause personal distress to themselves or others, including being a danger to themselves (self-harm, risky behaviors, suicidal) or others.

  • Dysfunctional: The person's thoughts, feelings, or behaviors impair their functioning in areas such as social relationships, job, school work, hygiene, sleeping, eating, driving, or housework.

Dysfunction Assessment Tool

• An assessment tool can be used to determine the extent of dysfunction a person is experiencing due to their psychological condition.

• Major categories for dysfunction:

  • Understanding and communicating

  • Getting around

  • Self-care

  • Getting along with people

  • Life activities (household)

  • Life activities (school/work)

  • Participation in society

• Numeric scores are assigned to each item to measure the difficulty experienced in various life activities over the past 30 days.

Disability Assessment Questions

• Examples of assessment questions:

  • Life activities-Household:

    • D5.1: Taking care of your household responsibilities?

    • D5.2: Doing most important household tasks well?

    • D5.3: Getting all of the household work done that you needed to do?

    • D5.4: Getting your household work done as quickly as needed?

  • Life activities-School/Work:

    • D5.5: Your day-to-day work/school?

    • D5.6: Doing your most important work/school tasks well?

    • D5.7: Getting all of the work done that you need to do?

    • D5.8: Getting your work done as quickly as needed?

  • Participation in society:

    • D6.1: Joining in community activities in the same way as anyone else can?

    • D6.2: Problems because of barriers or hindrances around you?

    • D6.3: Living with dignity because of the attitudes and actions of others?

    • D6.4: Time spent on your health condition or its consequences?

    • D6.5: How much have you been emotionally affected by your health condition?

    • D6.6: How much has your health been a drain on the financial resources of you or your family?

    • D6.7: How much of a problem did your family have because of your health problems?

    • D6.8: How much of a problem did you have in doing things by yourself for relaxation or pleasure?

• Response options range from "None" to "Extreme or cannot do," with corresponding numeric values to calculate a General Disability Score.

Classifying Disorders and Labeling People

• The Diagnostic and Statistical Manual of Mental Disorders-V (DSM-5) is the standard system used in the U.S. to diagnose and classify abnormal behavior.

• Considerations:

  • Benefits and risks of labeling individuals with disorders.

Causes of Disorders

• The biopsychosocial approach suggests that biological, social-cultural, and psychological factors combine and interact to produce disorders.

Risk of Harm to Self and Others: Understanding Suicide

• Worldwide, 800,000 people annually take their own lives.

• The risk for suicide is at least five times higher with a diagnosis of depression and three times higher with an anxiety disorder.

• Suicide is more likely to occur when people are beginning to rebound (when they become capable of following through).

• Suicide is more likely to occur when people feel disconnected from or a burden to others, or when they feel defeated and trapped by an inescapable situation.

Suicide Rates

• Suicide rates vary based on:

  • National differences

  • Racial differences

  • Gender differences

  • Age differences and trends

• Data visualization on Suicide Rates Around the World (2019) is shown with men and women suicide rates.

• Further data visualization is presented on Rate of Suicide by Race/Ethnicity in the United States (2010-2019).

• Presents Deaths by suicide per 100,000 resident population in the United States from 1950 to 2018, by gender.

• Presents Suicide Rate by Age in the United States from 2001 to 2021.

Nonsuicidal Self-Injury (NSSI)

• NSSI includes cutting, burning, hitting oneself, inserting objects under nails or skin, and more.

• These self-injuries are painful but not fatal.

• Reasons for engaging in NSSI:

  • Gain relief from intense negative thoughts through the distraction of pain

  • Ask for help and gain attention for emotional pain

  • Relieve guilt by self-punishment

  • Get others to change their negative behavior (bullying, criticism)

  • Fit in with a peer group

• Individuals engaging in NSSI are typically suicide gesturers, not suicide attempters, but it can escalate to suicidal thoughts.

Disorders and Risk of Violence

• Consideration is given to whether disorders actually increase the risk of violence.

• Consideration is given to whether clinicians can predict who is likely to do harm.

Anxiety-Related Disorders

• Anxiety is a part of life for all individuals.

• Individuals prone to noticing and remembering threatening information may have hyperactive danger-detection systems in the brain.

• This can lead to:

  • Anxiety disorder

  • Obsessive-compulsive disorder (OCD)

  • Posttraumatic stress disorder (PTSD)

Anxiety Disorders

• Anxiety disorders are marked by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.

• Include:

  • Generalized anxiety disorder

  • Panic disorder

  • Specific Phobias

Generalized Anxiety Disorder

• The person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.

• Characterized by:

  • Continual worry, often jittery, on edge, and sleep-deprived

  • Lack of concentration on a task

  • More common in women (two-thirds)

  • Free-floating anxiety (not linked to a specific stressor or threat)

  • Often seen with depression, but usually debilitating even on its own

  • May lead to physical problems (high blood pressure)

Panic Disorder

• An anxiety disorder marked by unpredictable, minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Often followed by worry over a possible next attack.

  • Panic attacks: Sudden episodes of intense dread

  • Physical symptoms accompany the attack: Irregular heartbeat, chest pains, shortness of breath, choking, trembling, dizziness

  • Agoraphobia: Fear or avoidance of public situations from which escape may be difficult (should a panic attack occur).

Specific Phobias

• Anxiety disorder marked by a persistent and irrational fear and avoidance of some object, activity, or situation.

• Specific phobias include a fear of particular animals, insects, heights, blood, or closed spaces.

Obsessive-Compulsive Disorder (OCD)

• Characterized by persistent and repetitive thoughts (obsessions), actions (compulsions), or both

• Occurs when obsessive thoughts and compulsive behaviors persistently interfere with everyday life and cause distress

• More common among teens and young adults than older people

• Twin studies reveal that OCD has a strong genetic basis

Obsessive-Compulsive Disorder Diagnostic Criteria

• A. Presence of obsessions, compulsions, or both:

  • Obsessions are defined by (1) and (2):

    • 1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

    • 2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

  • Compulsions are defined by (1) and (2):

    • 1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

    • 2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

• B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

• D. The disturbance is not better explained by the symptoms of another mental disorder

Common Obsessions and Compulsions Among Adolescents with Obsessive-Compulsive Disorder

• Obsessions (repetitive thoughts):

  • Concern with dirt, germs, or toxins (40%)

  • Something terrible happening (fire, death, illness) (24%)

  • Symmetry, order, or exactness (17%)

• Compulsions (repetitive behaviors):

  • Excessive hand washing, bathing, toothbrushing, or grooming (85%)

  • Repeating rituals (in/out of a door, up/down from a chair) (51%)

  • Checking doors, locks, appliances, car brakes, homework (46%)

Posttraumatic Stress Disorder (PTSD)

• Is characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia lingering for four weeks or more after a traumatic experience.

• Often involves military veterans and survivors of accidents, disasters, and violent and sexual assaults

• Women at higher risk (1 in 10) than men (1 in 20) of developing this disorder, following a traumatic event.

• Most men and women display impressive survivor resiliency.

Posttraumatic Stress Disorder Diagnostic Criteria

• A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

  • 1. Directly experiencing the traumatic event(s).

  • 2. Witnessing, in person, the event(s) as it occurred to others.

  • 3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.

  • 4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

• B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

  • 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).

  • 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).

  • 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.

  • 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

  • 5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

• C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

  • 1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

  • 2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

• D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

  • 1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).

  • 2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad," "No one can be trusted," "The world is completely dangerous," "My whole nervous system is permanently ruined").

  • 3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.

  • 4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).

  • 5. Markedly diminished interest or participation in significant activities.

  • 6. Feelings of detachment or estrangement from others.

  • 7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

• E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

  • 1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.

  • 2. Reckless or self-destructive behavior.

  • 3. Hypervigilance.

  • 4. Exaggerated startle response.

  • 5. Problems with concentration.

  • 6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

• F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.

• G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Somatic Symptom and Related Disorders

• Somatic symptom disorder (formerly somatoform disorder)

  • Symptoms (often stress-related) take a somatic (bodily) form without apparent physical cause.

    • Dizziness, tingling, numbness, blurred vision, etc.

• Illness anxiety disorder (formerly hypochondriasis)

  • Person interprets normal sensations as symptoms of a dreaded disease.

    • Ex. a headache is interpreted as a brain tumor