Study Notes on Psychological Disorders
Psychological Disorders Conceptualization and Classification
Learning Objectives
Understand what is meant by the terms psychopathology and psychological disorder.
Explain how psychological disorders are classified.
Identify assessment methods for psychological disorders.
Describe the diathesis-stress model.
Identify biological, situational, and cognitive-behavioral causes of psychological disorders.
Discuss sex differences and cultural differences in psychological disorders.
14.1 Conceptualizing Psychopathology
Psychopathology: Defined as the sickness or disorder of the mind; synonymous with psychological disorder.
Etiology: Refers to the factors and causes contributing to the development of a disorder.
Medical model emphasizes the biological causes of psychological disorders.
14.1 Historical Perspectives on Psychopathology
The view of psychopathology has evolved over time, recognizing both environmental and biological contributions.
Notably, genetics plays a critical role in psychological disorders, especially in conditions like bipolar disorder and schizophrenia.
Psychological Disorders as Maladaptive
Criteria for determining whether behavior is indicative of psychopathology:
Deviates from cultural norms for acceptable behavior.
Is maladaptive for the individual.
Is self-destructive.
Causes discomfort and concern to others.
Prevalence of Psychopathology
Psychological disorders are prevalent and represent a major source of disability in developed countries.
Statistics: Approximately 1 in 5 American adults receives treatment for psychological disorders over a two-year period.
About 1 in 4 Americans over 18 have a diagnosable disorder in any given year.
14.2 Classification of Psychological Disorders
Historically, Emil Kraepelin identified mental disorders based on symptom groups.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) was first published in 1952 by the American Psychiatric Association.
The current version, DSM-5 (released in 2013), describes disorders through observable symptoms and categorizes them into various types.
Table 14.1: DSM-5 Disorders Categories
Categories:
Neurodevelopmental disorders (e.g., Autism spectrum disorder)
Schizophrenia spectrum and other psychotic disorders (e.g., Schizophrenia)
Bipolar and related disorders (e.g., Bipolar I disorder)
Depressive disorders (e.g., Major depressive disorder)
Anxiety disorders (e.g., Panic disorder)
Obsessive-compulsive and related disorders (e.g., Body dysmorphic disorder)
Trauma- and stressor-related disorders (e.g., Posttraumatic stress disorder)
Dissociative disorders (e.g., Dissociative amnesia)
Somatic symptom and related disorders (e.g., Conversion disorder)
Feeding and eating disorders (e.g., Anorexia nervosa)
Elimination disorders (e.g., Enuresis)
Sleep-wake disorders (e.g., Narcolepsy)
Sexual dysfunctions (e.g., Erectile disorder)
Gender dysphoria
Disruptive, impulse-control, and conduct disorders (e.g., Pyromania)
Substance-related and addictive disorders (e.g., Alcohol use disorder)
Neurocognitive disorders (e.g., Delirium)
Personality disorders (e.g., Borderline personality disorder)
Paraphilic disorders (e.g., Exhibitionist disorder)
Comorbidity in Psychological Disorders
Many individuals do not fit neatly into DSM classifications; psychological disorders often overlap.
Example: Depression commonly co-occurs with anxiety or substance abuse; such instances are termed comorbidity.
Common underlying factors are suggested to contribute to the comorbidity of psychological disorders.
Assessment Methods in Psychology
Diagnosing a mental disorder is complex and involves assessment, which examines cognitive, behavioral, or emotional functioning.
Assessment methods include self-reports, psychological testing, observations, and interviews.
Neuropsychological testing may also be utilized to assess brain function through specific tasks.
Neuropsychological Assessment
Clients perform various tasks, such as:
Copying pictures.
Drawing from memory.
Sorting stimuli into categories.
Blindfolded tasks that assess sensory perception by placing blocks into slots.
Rapid finger-tapping tasks that gauge motor skills.
Poor performance may indicate issues with specific brain regions or functions.
Goals of Psychological Assessment
The primary goal of assessment is diagnosis for appropriate treatment.
Understanding the course and prognosis of a disorder is essential for treatment.
Ongoing assessment is crucial for tracking treatment progress and the impact of situational factors on the disorder.
14.3 Causes of Psychological Disorders
Psychological disorders have multifaceted causes, including biological, situational, and cognitive-behavioral factors.
Diathesis-stress model: This model suggests an individual may develop a psychological disorder when a predisposed vulnerability (diathesis) meets a stressor or triggering event.
Examples of diathesis include genetic predisposition or childhood trauma, and stressors may exacerbate psychological disorders or onset.
Biological Factors in Psychological Disorders
Biological influences are significant in understanding psychopathology:
Genetic factors impact neurotransmitter levels and receptor sites.
Prenatal factors (e.g., malnutrition, exposure to toxins) can contribute to developmental risks for mental disorders.
Neuroimaging (e.g., PET and fMRI) helps identify brain areas less active or functioning differently in individuals with mental disorders.
Situational Factors in Psychological Disorders
The family systems model highlights that individual problems may reflect family dysfunctions.
The sociocultural model considers the role of culture and social influences in psychological disorders.
Cognitive-Behavioral Factors in Psychological Disorders
The cognitive-behavioral approach asserts that psychopathology arises from maladaptive thought patterns and learned behaviors.
Abnormal behaviors occur by means of classical and operant conditioning principles.
Distorted cognition can lead to maladaptive actions and emotions.
14.4 Gender and Cultural Variations in Psychological Disorders
While some disorders (e.g., schizophrenia and bipolar disorder) are equally prevalent among sexes, others show significant gender differences, such as:
Alcohol dependence is much more prevalent in males.
Anorexia nervosa is significantly more common in females.
Disorders Emphasizing Emotional States
Emotions, when escalated beyond normal levels, can create barriers to normal functioning: work, learning, and leisure.
List of Anxiety Disorders
Defined as disorders characterized by excessive fear and anxiety without true danger, affecting autonomy and health.
Chronic anxiety results in physiological symptoms (e.g., sweating, rapid pulse, elevated blood pressure).
Common Anxiety Disorders:
Generalized Anxiety Disorder (GAD): a diffuse and constant state of anxiety not linked to any particular threat.
Panic Disorder: involves sudden and overwhelming panic attacks followed by persistent concern of future attacks.
Agoraphobia: intense fear of being in situations where escape might be challenging, often leading to home confinement.
List of Specific Phobias:
Specific phobias manifest as intense fears of particular objects or situations (e.g., ophidiophobia - fear of snakes).
14.5 Obsessive-Compulsive Disorders
Characterized by intrusive thoughts (obsessions) and repetitive actions (compulsions) aimed at reducing anxiety.
Obsessions: recurring unwanted thoughts that provoke anxiety (e.g., fear of contamination).
Compulsions: repetitive acts aimed at alleviating obsessions, often providing temporary relief, such as washing and checking.
Causes of Obsessive-Compulsive Disorder
The exact origins are unclear but may involve genetic components, conditioning experiences, and neurobiological factors.
14.6 Posttraumatic Stress Disorder (PTSD)
PTSD arises following exposure to traumatic events, presenting symptoms like flashbacks and nightmares related to the original trauma.
Onset can also be expedited through hereditary predispositions to anxiety and stress sensitivity.
Prevalence of PTSD
Lifetime prevalence is around 7%, with higher incidence rates in women.
14.7 Depressive Disorders
Major Depressive Disorder: characterized by pervasive low mood or lack of interest in activities.
Associated with a high risk of suicide, affecting approximately 7-8% of Americans at any time.
Causes of Depression
Genetic contributions to depression are suggested, with twin studies indicating significant hereditary components.
Monoamine Theory: depression linked to deficiencies in neurotransmitters like serotonin and norepinephrine.
14.8 Bipolar Disorders
Bipolar Disorder involves alternating periods of depression and mania.
Bipolar I Disorder: defined by significant manic episodes lasting at least one week.
Bipolar II Disorder: characterized by less severe hypomanic episodes and major depressive episodes without full-blown mania.
14.9 Schizophrenia
A severe mental disorder characterized by disconnection from reality, manifested through positive symptoms (e.g., hallucinations and delusions) and negative symptoms (e.g., lack of emotion).
Positive Symptoms: added behaviors like delusions and hallucinations.
Negative Symptoms: removed functions including lack of emotional expression and motivation.
Diagnosis Criteria for Schizophrenia
The DSM-5 requires two or more symptoms present for a significant period, including at least one of:
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms
Symptoms must cause significant impairment in functioning and persist for at least six months.
Environmental and Genetic Contributors to Schizophrenia
Genetic predispositions, urban birth conditions, and exposure to environmental stresses during gestation are linked to higher susceptibility to schizophrenia.
14.10 Dissociative Disorders
Characterized by disruptions in memory and identity, often triggered by extreme stress.
Dissociative Amnesia: loss of memory typically related to traumatic experiences.
Dissociative Fugue: individuals forget their identity and may travel to new locations, assuming new identities.
Dissociative Identity Disorder (DID): involves two or more distinct identities within a person, often related to severe trauma or abuse.
14.11 Personality Disorders
Personality disorders are maladaptive ways of relating to the world, subdivided into three clusters:
Cluster A: Odd or eccentric behavior (e.g., paranoid personality disorder).
Cluster B: Dramatic, emotional, or erratic behavior (e.g., antisocial personality disorder).
Cluster C: Anxious or fearful behavior (e.g., avoidant personality disorder).
Borderline Personality Disorder:
Characterized by instability in mood and identity with extreme emotional reactions.
Antisocial Personality Disorder:
Engaging in antisocial behavior with a lack of empathy and disregard for social norms.
Etiology of Personality Disorders
Genetic and environmental factors contribute significantly, with traumatic experiences in childhood often playing a crucial role in developing these disorders.
Conclusion
Understanding psychological disorders requires an integration of biological, social, and cognitive perspectives. Thorough assessment methods, attention to cultural contexts, and consideration of various therapeutic approaches are essential for effective treatment and management of these disorders.
Learning Objectives
Understand what is meant by the terms psychopathology and psychological disorder.
Explain how psychological disorders are classified.
Identify assessment methods for psychological disorders.
Describe the diathesis-stress model.
Identify biological, situational, and cognitive-behavioral causes of psychological disorders.
Discuss sex differences and cultural differences in psychological disorders.
14.1 Conceptualizing Psychopathology
Psychopathology: Defined as the sickness or disorder of the mind; synonymous with psychological disorder.
Etiology: Refers to the factors and causes contributing to the development of a disorder.
Medical model emphasizes the biological causes of psychological disorders.
14.1 Historical Perspectives on Psychopathology
The view of psychopathology has evolved over time, recognizing both environmental and biological contributions.
Notably, genetics plays a critical role in psychological disorders, especially in conditions like bipolar disorder and schizophrenia.
Psychological Disorders as Maladaptive
Criteria for determining whether behavior is indicative of psychopathology:
Deviates from cultural norms for acceptable behavior.
Is maladaptive for the individual.
Is self-destructive.
Causes discomfort and concern to others.
Prevalence of Psychopathology
Psychological disorders are prevalent and represent a major source of disability in developed countries.
Statistics: Approximately 1 in 5 American adults receives treatment for psychological disorders over a two-year period.
About 1 in 4 Americans over 18 have a diagnosable disorder in any given year.
14.2 Classification of Psychological Disorders
Historically, Emil Kraepelin identified mental disorders based on symptom groups.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) was first published in 1952 by the American Psychiatric Association.
The current version, DSM-5 (released in 2013), describes disorders through observable symptoms and categorizes them into various types.
Table 14.1: DSM-5 Disorders Categories
Categories:
Neurodevelopmental disorders (e.g., Autism spectrum disorder)
Schizophrenia spectrum and other psychotic disorders (e.g., Schizophrenia)
Bipolar and related disorders (e.g., Bipolar I disorder)
Depressive disorders (e.g., Major depressive disorder)
Anxiety disorders (e.g., Panic disorder)
Obsessive-compulsive and related disorders (e.g., Body dysmorphic disorder)
Trauma- and stressor-related disorders (e.g., Posttraumatic stress disorder)
Dissociative disorders (e.g., Dissociative amnesia)
Somatic symptom and related disorders (e.g., Conversion disorder)
Feeding and eating disorders (e.g., Anorexia nervosa)
Elimination disorders (e.g., Enuresis)
Sleep-wake disorders (e.g., Narcolepsy)
Sexual dysfunctions (e.g., Erectile disorder)
Gender dysphoria
Disruptive, impulse-control, and conduct disorders (e.g., Pyromania)
Substance-related and addictive disorders (e.g., Alcohol use disorder)
Neurocognitive disorders (e.g., Delirium)
Personality disorders (e.g., Borderline personality disorder)
Paraphilic disorders (e.g., Exhibitionist disorder)
Comorbidity in Psychological Disorders
Many individuals do not fit neatly into DSM classifications; psychological disorders often overlap.
Example: Depression commonly co-occurs with anxiety or substance abuse; such instances are termed comorbidity.
Common underlying factors are suggested to contribute to the comorbidity of psychological disorders.
Assessment Methods in Psychology
Diagnosing a mental disorder is complex and involves assessment, which examines cognitive, behavioral, or emotional functioning.
Assessment methods include self-reports, psychological testing, observations, and interviews.
Neuropsychological testing may also be utilized to assess brain function through specific tasks.
Neuropsychological Assessment
Clients perform various tasks, such as:
Copying pictures.
Drawing from memory.
Sorting stimuli into categories.
Blindfolded tasks that assess sensory perception by placing blocks into slots.
Rapid finger-tapping tasks that gauge motor skills.
Poor performance may indicate issues with specific brain regions or functions.
Goals of Psychological Assessment
The primary goal of assessment is diagnosis for appropriate treatment.
Understanding the course and prognosis of a disorder is essential for treatment.
Ongoing assessment is crucial for tracking treatment progress and the impact of situational factors on the disorder.
14.3 Causes of Psychological Disorders
Psychological disorders have multifaceted causes, including biological, situational, and cognitive-behavioral factors.
Diathesis-stress model: This model suggests an individual may develop a psychological disorder when a predisposed vulnerability (diathesis) meets a stressor or triggering event.
Examples of diathesis include genetic predisposition or childhood trauma, and stressors may exacerbate psychological disorders or onset.
Biological Factors in Psychological Disorders
Biological influences are significant in understanding psychopathology:
Genetic factors impact neurotransmitter levels and receptor sites.
Prenatal factors (e.g., malnutrition, exposure to toxins) can contribute to developmental risks for mental disorders.
Neuroimaging (e.g., PET and fMRI) helps identify brain areas less active or functioning differently in individuals with mental disorders.
Situational Factors in Psychological Disorders
The family systems model highlights that individual problems may reflect family dysfunctions.
The sociocultural model considers the role of culture and social influences in psychological disorders.
Cognitive-Behavioral Factors in Psychological Disorders
The cognitive-behavioral approach asserts that psychopathology arises from maladaptive thought patterns and learned behaviors.
Abnormal behaviors occur by means of classical and operant conditioning principles.
Distorted cognition can lead to maladaptive actions and emotions.
14.4 Gender and Cultural Variations in Psychological Disorders
While some disorders (e.g., schizophrenia and bipolar disorder) are equally prevalent among sexes, others show significant gender differences, such as:
Alcohol dependence is much more prevalent in males.
Anorexia nervosa is significantly more common in females.
Disorders Emphasizing Emotional States
Emotions, when escalated beyond normal levels, can create barriers to normal functioning: work, learning, and leisure.
List of Anxiety Disorders
Defined as disorders characterized by excessive fear and anxiety without true danger, affecting autonomy and health.
Chronic anxiety results in physiological symptoms (e.g., sweating, rapid pulse, elevated blood pressure).
Common Anxiety Disorders:
Generalized Anxiety Disorder (GAD): a diffuse and constant state of anxiety not linked to any particular threat.
Panic Disorder: involves sudden and overwhelming panic attacks followed by persistent concern of future attacks.
Agoraphobia: intense fear of being in situations where escape might be challenging, often leading to home confinement.
List of Specific Phobias:
Specific phobias manifest as intense fears of particular objects or situations (e.g., ophidiophobia - fear of snakes).
14.5 Obsessive-Compulsive Disorders
Characterized by intrusive thoughts (obsessions) and repetitive actions (compulsions) aimed at reducing anxiety.
Obsessions: recurring unwanted thoughts that provoke anxiety (e.g., fear of contamination).
Compulsions: repetitive acts aimed at alleviating obsessions, often providing temporary relief, such as washing and checking.
Causes of Obsessive-Compulsive Disorder
The exact origins are unclear but may involve genetic components, conditioning experiences, and neurobiological factors.
14.6 Posttraumatic Stress Disorder (PTSD)
PTSD arises following exposure to traumatic events, presenting symptoms like flashbacks and nightmares related to the original trauma.
Onset can also be expedited through hereditary predispositions to anxiety and stress sensitivity.
Prevalence of PTSD
Lifetime prevalence is around 7%, with higher incidence rates in women.
14.7 Depressive Disorders
Major Depressive Disorder: characterized by pervasive low mood or lack of interest in activities.
Associated with a high risk of suicide, affecting approximately 7-8% of Americans at any time.
Causes of Depression
Genetic contributions to depression are suggested, with twin studies indicating significant hereditary components.
Monoamine Theory: depression linked to deficiencies in neurotransmitters like serotonin and norepinephrine.
14.8 Bipolar Disorders
Bipolar Disorder involves alternating periods of depression and mania.
Bipolar I Disorder: defined by significant manic episodes lasting at least one week.
Bipolar II Disorder: characterized by less severe hypomanic episodes and major depressive episodes without full-blown mania.
14.9 Schizophrenia
A severe mental disorder characterized by disconnection from reality, manifested through positive symptoms (e.g., hallucinations and delusions) and negative symptoms (e.g., lack of emotion).
Positive Symptoms: added behaviors like delusions and hallucinations.
Negative Symptoms: removed functions including lack of emotional expression and motivation.
Diagnosis Criteria for Schizophrenia
The DSM-5 requires two or more symptoms present for a significant period, including at least one of:
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms
Symptoms must cause significant impairment in functioning and persist for at least six months.
Environmental and Genetic Contributors to Schizophrenia
Genetic predispositions, urban birth conditions, and exposure to environmental stresses during gestation are linked to higher susceptibility to schizophrenia.
14.10 Dissociative Disorders
Characterized by disruptions in memory and identity, often triggered by extreme stress.
Dissociative Amnesia: loss of memory typically related to traumatic experiences.
Dissociative Fugue: individuals forget their identity and may travel to new locations, assuming new identities.
Dissociative Identity Disorder (DID): involves two or more distinct identities within a person, often related to severe trauma or abuse.
14.11 Personality Disorders
Personality disorders are maladaptive ways of relating to the world, subdivided into three clusters:
Cluster A: Characterized by odd or eccentric behavior. Individuals often appear peculiar and may struggle with social relationships. This cluster includes:
Paranoid Personality Disorder: Pervasive distrust and suspiciousness of others' motives.
Schizoid Personality Disorder: Detachment from social relationships and a restricted range of emotional expression.
Schizotypal Personality Disorder: Acute discomfort in close relationships and eccentricities of behavior or thought.
Cluster B: Characterized by dramatic, emotional, or erratic behavior. Individuals often display impulsive actions, intense emotions, and difficulties in interpersonal relationships. This cluster includes:
Antisocial Personality Disorder: Involves a pervasive pattern of disregard for and violation of the rights of others, often demonstrating a lack of empathy and engaging in manipulative or deceitful behaviors.
Borderline Personality Disorder: Marked by instability in interpersonal relationships, self-image, and affects, along with marked impulsivity and extreme emotional reactions.
Histrionic Personality Disorder: Characterized by excessive emotionality and attention-seeking behavior, often theatrical and provocative.
Narcissistic Personality Disorder: Defined by grandiosity, a constant need for admiration, and a lack of empathy.
Cluster C: Characterized by anxious or fearful behavior. Individuals tend to be shy, insecure, or overly dependent. This cluster includes:
Avoidant Personality Disorder: Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
Dependent Personality Disorder: A pervasive and excessive need to be taken care of, leading to submissive and clinging behavior.
Obsessive-Compulsive Personality Disorder: Preoccupation with orderliness, perfectionism, and control at the expense of flexibility and efficiency.
Etiology of Personality Disorders
Genetic and environmental factors contribute significantly, with traumatic experiences in childhood often playing a crucial role in developing these disorders.
Conclusion
Understanding psychological disorders requires