Psychological Disorders

Abnormal Behavior: Concepts and Controversies

Learning Objectives

• Describe and evaluate the medical model of abnormal behavior.

• Identify the key criteria of abnormality and discuss the development of the DSM-5.

Abnormal Behavior

Medical Model Applied to Abnormal Behavior

• The medical model proposes that it is useful to think of abnormal behavior as a disease and has become the main method of conceptualizing mental illness today.

• This medical approach contrasts sharply with historical views of mental illness, which often perceived such conditions as moral failings or supernatural phenomena.

• The implementation of the medical model has led to significant improvements in patient care for those with mental illnesses.

Components of the Medical Model

1. Diagnosis:

   • Involves distinguishing one illness from another using specific criteria.

2. Etiology:

   • Refers to the apparent causation and developmental history of an illness, seeking to understand its origins.

3. Prognosis:

   • A forecast about the probable course of an illness, providing insight into the expected outcomes.

Criteria of Abnormal Behavior

• Deviance:

  • Behavior must be significantly different from what society considers acceptable.

• Maladaptive Behavior:

  • Behavior must interfere with the individual’s ability to function effectively in life.

• Personal Distress:

  • The behavior must be troubling to the individual, creating significant discomfort or concern.

Psychodiagnosis: The Classification of Disorders

• The American Psychological Association (APA) utilizes the Diagnostic and Statistical Manual of Mental Disorders, currently in its fifth edition (DSM-5).

• The DSM-5 serves to classify mental disorders and provides comprehensive details about various mental illnesses to help clinicians make consistent, accurate diagnoses.

• Compared to its predecessor (DSM IV), the DSM-5 discontinued the multiaxial system used for diagnosis and tends to remain largely categorical, even after efforts to adopt a dimensional approach, which describes disorders based on the degree (level) of symptoms, such as anxiety.

Anxiety Disorders and Obsessive-Compulsive Disorder

Learning Objectives

• Describe four types of anxiety disorders and obsessive-compulsive disorder.

• Discuss the biological factors and conditioning that contribute to the etiology of these disorders.

• Explain the role of cognitive processes and stress in anxiety-related disorders.

Types of Anxiety Disorders

• Anxiety Disorders: A class of disorders marked by feelings of excessive apprehension and anxiety.

  • Generalized Anxiety Disorder (GAD): Characterized by chronic, high levels of anxiety not focused on any specific threat.

  • Phobic Disorder: Characterized by a persistent, irrational fear of an object or situation that presents no realistic danger.

• Panic Disorder and Agoraphobia:

  • Panic Disorder: Defined by recurrent attacks of overwhelming anxiety that occur suddenly and unexpectedly.

  • Agoraphobia: A fear of being in public places, sometimes resulting from severe panic disorder, leading individuals to avoid leaving home.

• Obsessive-Compulsive Disorder (OCD):

  • Defined by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions).

  • Common obsessions can include fears of contamination or harming others, while compulsions are ritualistic acts that temporarily alleviate the anxiety caused by these obsessions.

  • True OCD disorders occur in approximately 2 to 3% of the population.

Etiology of Anxiety Disorders

1. Biological Factors:

   • Genetic predisposition and inherited temperament may contribute to vulnerability for anxiety disorders.

   • Neurotransmitters like GABA, which help transmit signals between neurons in the brain, may play a role in anxiety management. Medications like Valium work by affecting these neurotransmitter systems.

2. Conditioning and Learning:

   • Classical conditioning may lead individuals to develop fears of certain objects or situations (conditioned response).

   • Operant conditioning reinforces avoidance behaviors, resulting in negative reinforcement, whereby avoiding the feared stimulus reduces anxiety (making avoidance more likely).

   • According to Seligman (1971), humans are "biologically prepared" to fear certain things more than others.

3. Cognitive Factors:

   • Individuals may misinterpret harmless situations as threatening, concentrate excessively on perceived threats, and selectively recall threatening information, thus predisposing them to anxiety disorders.

Dissociative Disorders

Learning Objectives

• Distinguish between two types of dissociative disorders.

• Summarize what is known about the causes of dissociative disorders.

Overview of Dissociative Disorders

• Dissociative disorders are characterized by a disconnection from consciousness, memory, or identity, leading to disruptions in self-perception and sense of identity.

• Dissociative Amnesia: Sudden loss of memory pertaining to personal information that is not normal forgetting.

• Dissociative Identity Disorder (DID): Previously known as multiple personality disorder; characterized by the presence of two or more distinct identities within the same individual, with each identity having its own distinct name, memories, traits, and physical characteristics. Transitions between identities may be abrupt and drastic.

Etiology of Dissociative Disorders

• Dissociative amnesia and fugue often stem from extreme stress or trauma.

• DID is largely theorized to result from severe emotional trauma occurring during childhood, though many aspects of its causes are still poorly understood.

Mood Disorders

Learning Objectives

• Describe depressive and bipolar disorders, their prevalence, and relationship to suicide risk.

• Explain genetic, neurochemical, and neuroanatomical factors contributing to these disorders.

• Discuss cognitive processes, interpersonal factors, and stress in the development of mood disorders.

Overview of Mood Disorders

• Mood disorders include distinct disorders categorized in DSM-5; within this category, mood disorders present unique symptoms.

• Major Depressive Disorder: Characterized by constant feelings of sadness, despair, and loss of pleasure in previous interests.

  • Onset can occur at any age but most frequently presents before age 40.

  • Lifetime prevalence is estimated around 13% to 16%.

  • Prevalence rates indicate women are twice as likely to be diagnosed compared to men, potentially due to heightened life stressors.

• Bipolar Disorder (Manic-Depressive Disorder): Characterized by periods of both manic and depressive states.

  • Manic episodes are characterized by extreme elation and a sense of invincibility. These manic states can abruptly switch to episodes of depression.

Symptoms of Mood Disorders

• Depressive episodes showcase:

  • Emotional symptoms: persistent gloomy mood, diminished ability to feel pleasure, sense of hopelessness.

  • Behavioral symptoms: fatigue, insomnia, slowed speech/movement, social withdrawal.

  • Cognitive symptoms: impaired decision-making abilities, excessive guilt, worry, and negative self-perception.

• Manic episodes exhibit:

  • Euphoric mood, unrestrained pursuit of pleasure, grandiosity, impulsivity, and rapid speech.

Mood Dysfunction and Suicide

• Ninety percent of individuals who die by suicide have some psychological disorder, with bipolar and depressive disorders responsible for 50-60% of such cases.

• Males complete suicide four times more than females, though females attempt suicide three times more often.

Etiology of Mood Disorders

1. Genetic Vulnerability:

   • Concordance rates provide evidence of genetic contribution to mood disorders; for identical twins, the rate is 65-72%, compared to 14-19% for fraternal twins due to fewer shared genes.

2. Neurochemical Factors:

   • Correlation identified between mood disorders and low levels of neurotransmitters like norepinephrine and serotonin. The precise nature of the relationship (cause vs. effect) remains unclear.

   • Neuroanatomical Factors:

     • Depression correlates with reduced hippocampal volume in individuals, proposing neurogenesis may play a significant role in mood regulation.

3. Cognitive and Interpersonal Factors:

   • Seligman's learned helplessness theory suggests that depression may result from a cycle of passive responses to challenges, related to pessimistic explanatory styles.

   • Interpersonal relationships impact mood disorders; deficient social skills increase vulnerability to depression due to decreased availability of support.

Schizophrenic Disorders

Learning Objectives

• Describe prevalence and symptoms of schizophrenia.

• Explain genetic vulnerability, neurochemical factors, and structural abnormalities contributing to schizophrenia.

• Summarize neurodevelopmental insults, expressed emotion, and stress relating to schizophrenia onset.

Overview of Schizophrenic Disorders

• Schizophrenia translates to "split mind" and is defined as a class of disorders characterized by disruptions in thought processes that influence perception, emotion, and social interactions.

• Prevalence rates for schizophrenia are approximately 1% of the population; typically visible during adolescence or early adulthood with a generally poor prognosis.

Symptoms of Schizophrenia

1. Irrational Thoughts: Delusions are fixed beliefs conflicting with reality; examples include a belief in external mind control or delusions of grandeur.

2. Deterioration of Adaptive Behavior: Inability to perform daily or social functions.

3. Distorted Perception: Hallucinations are sensory experiences without external stimuli.

4. Emotional Disturbances: These include flat affect or emotions inappropriate to the context.

Classification of Schizophrenia

• The DSM-IV categorized schizophrenia into four types which were discarded in DSM-5. A more modern classification identifies positive symptoms (hallucinations, delusions) and negative symptoms (behavioral deficits).

Etiology of Schizophrenia

1. Genetic Vulnerability:

   • Concordance rates demonstrate genetic components; 48% for identical twins, 17% for fraternal twins.

2. Neurochemical Factors:

   • Linked with excess dopamine activity, while studies suggest a correlation between marijuana use during adolescence and schizophrenia onset.

3. Structural Brain Abnormalities:

   • Imaging studies have revealed enlarged brain ventricles in individuals with schizophrenia, though the causative relationship is not fully understood.

4. Neurodevelopmental Hypothesis:

   • Suggests that disruptions during brain maturation processes before or at birth could contribute to onset; factors include prenatal exposure to viruses and obstetrical complications.

5. Expressed Emotion (EE):

   • The emotional climate within family environments influences patient outcomes; high EE correlates with higher relapse likelihood and triggers episodes in vulnerable individuals.

Autism Spectrum Disorder

Learning Objectives

• Describe symptoms and prevalence of autistic spectrum disorder.

• Explain biological factors contributing to autism's development.

Overview of Autism Spectrum Disorder

• Characterized by profound attention deficits in social interaction and communication, alongside restricted interests and activities.

Symptoms and Prevalence

• Symptoms include a lack of interest in others, avoidance of eye contact, delayed speech, echolalia, and rigidity in routines.

• Current prevalence is about 1% among children, reflecting a fourfold increase since the 1990s, often attributed to increased awareness.

• With early interventions and treatment, 15-20% of individuals can achieve functional independence.

Etiology

• Biological origins are widely accepted among researchers due to autism's early emergence.

• Studies indicate genetics play a role, while the widely circulated notion linking the "mercury vaccine" to autism has been discredited.

Personality Disorders

Learning Objectives

• Discuss nature and organization of personality disorders.

• Describe symptoms of antisocial, borderline, and narcissistic personality disorders.

Overview of Personality Disorders

• Defined as marked by extreme, inflexible personality traits leading to distress or impaired functioning. Ten personality disorders are categorized into three clusters: anxious/fearful, odd/eccentric, and dramatic/impulsive.

Specific Personality Disorders

• Antisocial Personality Disorder: Characterized by impulsive, manipulative, aggressive, and irresponsible behaviors.

• Borderline Personality Disorder: Identified by instability in relationships, self-image, and emotional functioning.

• Narcissistic Personality Disorder: Features an inflated sense of self-importance, entitlement, and obsessive need for admiration.

Etiology of Personality Disorders

• Involves both genetic and environmental factors, impacting each disorder differently: e.g., antisocial personality may relate to erratic parental behavior, while borderline personality may develop from experiences of abuse.

Application: Understanding Eating Disorders

Learning Objectives

• Describe the history, prevalence, and gender distribution of eating disorders.

• Explain contributing factors including genetics, personality traits, cultural influence, family dynamics, and disturbed thinking.

Types of Eating Disorders

• Defined as severe disturbances in eating behavior, primarily concerned with weight control. Main types include:

  1. Anorexia Nervosa:

  • Characterized by intense fear of weight gain, body image distortion, and severe weight loss.

  • Subtypes: restricting type and binge-eating/purging type.

  1. Bulimia Nervosa:

  • Involves cycles of uncontrollable eating followed by compensatory behaviors.

  • Patients often maintain a normal weight, differing from anorexia despite facing various health risks.

  1. Binge-Eating Disorder:

  • Distress over binge-eating not followed by purging behaviors.

Prevalence and History

• Anorexia's presence is historical yet surged in incidents post mid-20th century, while bulimia became prevalent in the 1970s. Eating disorders predominantly affect young women, who represent 90-95% of cases.

Etiology of Eating Disorders

1. Genetic Factors:

   • Higher concordance rates in identical twins indicate genetic predispositions.

2. Personality Traits:

   • Anorexia is often linked with traits like rigidity and perfectionism, while bulimia ties more closely to impulsivity and low self-esteem.

3. Cultural Values:

   • Societal pressure on women to attain unrealistic thinness contributes significantly to the onset of eating disorders.

4. Family Influence:

   • Overly involved parents may create environments leading adolescents to control their bodies when they feel powerless in other life aspects.

5. Cognitive Factors:

   • Individuals often exhibit all-or-none thinking, where control over weight equates to acceptance, leading to disordered eating behaviors.