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Psych1000- Chapter 13; Psychological Disorders.docx

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Psychology 1000
Erica Lawson

Chapter 13 Psychological Disorders -22% of the population suffers from a diagnosable mental disorder -Nearly half of all North Americans between the ages of 15 and 54 will experience a psychological disorder at some time in their lives -Psychological disorders are the second leading cause of disability, after heart disease -One adolescent commits suicide every 90 seconds The Demonological View: Abnormal behavior is caused by supernatural forces: *Treatment called trephination is when a sharp tool is used to chisel a hole in the skull in order to “remove the demon/evil spirit” from the person’s body. Medieval Europe: Disturbed people are either a) possessed or b) voluntarily made a pact with the evil forces. *Killed witches (if they threw a woman in the water and she floated then she is possessed because evil spirits rise up, so she must be killed). Early Biological Views: Hippocrates: people with disordered behavior are sick just like with a physical disease (it is their BRAIN that is ill!) and so they are not possessed. Biological view started being widely accepted when: General Paresis (a disorder with mental deterioration and bizarre behavior) was found to have resulted from massive brain deterioration caused by syphilis. Psychological Perspectives: Freud’s Psychoanalysis: Psychological disorders are caused by unresolved conflicts from childhood that make the person vulnerable to certain kinds of life events. These situations cause anxiety and the person tries to cope by using defense mechanisms: Inappropriate or extreme use of the defense mechanisms results in maladaptive patterns of behavior. Neuroses: Disorders that do not involve a loss of contact with reality (obsessions). Psychoses: Freud says that sometimes the anxiety from the unresolved conflicts is so great that people can no longer deal with reality and they withdraw from it (schizophrenia). Behavioral Perspective: Disordered behaviors, just like normal behaviors, are learned through classical and operant conditioning, and modeling. Cognitive Perspective: There are maladaptive and self-defeating thought patterns that are linked to disorders. Humanistic Perspective: Abnormality is the result of environmental forces that frustrate or pervert people’s inherent self-actualization tendencies and search for meaning in life. E.g. Conditions of worth = the development of a negative self-concept and the need to deny or distort certain aspects of experience. E.g. Intense self-Incongruence = breakdown Vulnerability-Stress Model: One way to think about the causal factors (psychological, biological, environmental) is in terms of the relation between vulnerabilities and stress. A vulnerability (a predisposition to a disorder – all of us have them for every disorder whether it is genetic, psychological or environmental) ONLY CREATES A DISORDER WHEN a stressor (some recent or current event that requires the person to cope) combines with vulnerability to trigger the disorder. DEFINING AND CLASSIFYING PSYCHOLOGICAL DISORDERS What is “Abnormal”?! -Judgments differ based on time and culture (e.g. in the 1940s, a women who chose career over family would be considered insane). -1840’s, Senator Calhoun of South Carolina identified slaves from different cultures as “insane”. Medical experts soon defined “Drapetomania” – a new mental disorder that involved an obsessive desire for freedom that drove some slaves to flee from captivity. *This diagnosis applied to any slave who tried to escape more than twice -Recently: political battle whether the following should be a real disorder: Self-defeating/masochistic personality disorder = people who repeatedly involve themselves in hurtful circumstances and relationships. Define “Abnormal” by the “3 D’s”: (one or more of them seem to apply to any behavior regarded as abnormal): Distressing: Behaviors are abnormal is they are intensely distressing to the individual (e.g. depressed) or others, particularly if the individual has little control over the reaction. Dysfunctional: Either for the individual or for society (e.g. behaviors that seem to interfere with the person’s ability to work or experience satisfying relationships), particularly if the individual cannot control such behaviors. Deviance: Society’s judgment of how deviant the behavior is from society’s norms. SO: Abnormal behavior is behavior that is personally distressful, personally dysfunctional, and/or so culturally deviant that other people judge it to be inappropriate or maladaptive. DIAGNOSING PSYCHOLOGICAL DISORDERS Need to have: Reliability: Especially since people of unique professions are qualified to diagnose the same people with wide ranges of disorders, there needs to be a system couched in terms of observable behaviors that can be reliably detecting and minimize subjective judgments. Validity: The diagnostic categories should 1) accurately capture the essential features of the various disorders, and 2) differentiate between the disorders. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM- IV): 1) The most widely used diagnostic classification system in North America. 2) Contains a detailed list of observable behaviors that must be present in order for a diagnosis to be made (over 350 diagnostic categories in it). 3) Allows diagnostic information to be represented along 5 dimensions that take both the person and the person’s life situation into account: Axis I: The primary diagnosis = person’s primary clinical symptoms Axis II: Reflects long-standing personality or developmental disorders Axis III: Notes any relevant physical conditions (e.g. high blood pressure) Axis IV: Rates intensity of recent environmental stressors Axis V: Person’s coping resources as reflected in recent adaptive functioning. *NOTE: Criticisms: 1) the criteria are so strict that many people don’t fit into the categories, 2) Axis II may overlap with Axis I and this reduces reliability and validity. CRITICAL ISSUES IN DIAGNOSTIC LABELLING Social and Personal Implications: -People accept the diagnosis as a description of the individual rather than the behavior and act differently towards the person. -The victim of the disorder accepts the label and then acts in that role (self-fulfilling prophecy about oneself) – bad for self esteem and also prevents the person from dealing with the life circumstances that caused it in the first place. Legal Consequences: The law tries to take into account the mental status of individuals accused of crimes: Competency: a defendant’s state of mind at the time of the hearing (not at the time of the crime) so he may be institutionalized until judged competent and then he can talk at his hearing. (The individual is competent if he has sufficient contact with reality that he can understand the legal proceedings). Insanity: the presumed state of mind of the defendant at the time of the crime. *Two murderers had different verdicts when they were both clearly insane. Hinckley: Let off the hook because the law required the prosecution to prove that he was sane (they couldn’t). He shot Ronald Reagan. Dahmer: A guy who killed people and then ate their bodies, was not let off the hook because the burden of proof was shifted to the defence: not able to prove that Dahmer was insane at the time of the crime so he was convicted of murder. Medical Student’s Disease: when people read descriptions of disorders they often see some of these characteristics in themselves. Such a similarity does not mean you have it. BUT If you find that the maladaptive behaviors are interfering with your happiness of personal effectiveness, then seek help. RESEARCH FOUNDATIONS: ON BEING SANE IN INSANE PLACES -8 “pseudopatients” (all were sane) pretended to be insane and that they heard voices that said “hollow”, “empty” and “thud”. -They acted normal the rest of the time and then said they no longer heard voices -Admitted to a hospital after being diagnosed with schizophrenia and no doctors realized that they were indeed sane. Interestingly, many of the mentally ill patients did notice that they were sane and did not say anything. -Hospitals did not believe it. Then were told that sometime during the next three months, one or more pseudopatients would come and they would have to rate each new patient on the likelihood that they were pseudopatients. Doctors claimed that 41 were likely pseudopatients but in reality, NONE were! ANXIETY DISORDERS Anxiety = the state of tension and apprehension that is a natural response to perceived threat Anxiety disorder = the frequency and intensity of anxiety responses are out of proportion to the situations that trigger them, and the anxiety interferes with daily life. NOTE: *Anxiety disorders are the most prevalent of all psychological disorders in North America. *Happens more to females than to males Anxiety responses have 4 components: 1) Subjective-emotional component = feelings of tension and apprehension 2) Cognitive component = worry, thoughts about inability to cope 3) Physiological responses = increased heart rate and blood pressure, muscle tension, rapid breathing, nausea, dry mouth, diarrhea and frequent urination 4) Behavioral responses = avoidance of certain situations, decreased task performance and increased startle response Anxiety disorders take many different forms: 1) Phobic disorders 2) Generalized anxiety disorders 3) Panic disorders 4) Post-traumatic stress disorders 5) Obsessive-compulsive disorders Phobic Disorder: Phobias = strong, irrational fears of certain objects or situations. Can develop at any time (but mostly in childhood/young adulthood) *People with phobias realize that their fears are out of proportion to the situation but they feel helpless to deal with these fears and so they avoid the fearful situation. Agoraphobia: fear of open and public places Social Phobias: fear of situations in which the person might be publicly embarrassed/evaluated Specific Phobias: fear of dogs, snakes, spiders, enclosed spaces, water, injections, illness or death Generalized Anxiety Disorders: -Think that there is an impending disaster but you cannot further specify the nature of this impending disaster, -Generalized anxiety disorder = a chronic state of “free-floating” anxiety that is not attached to specific situations or objects. -Physiological responses: sweat, diarrhea NOTE: Symptoms must be present for 6 months for a formal diagnosis! Panic Disorder: -Occur, suddenly and unpredictably and they are much more intense than generalized anxiety disorders -Feel like they are dying -Many develop agoraphobia because they fear they will have a panic attack in public -First appear in late adolescence or early adulthood -More common = occasional panic attacks (34% of Canadian students have had at least one unexpected panic attack within the previous year but the DSM-IV will not diagnose them as having panic disorders unless they developed an inordinate fear of having future attacks). Obsessive-Compulsive Disorder: Onset: usually in the 20’s. 2 components: Cognitive component: obsessions are repetitive and unwelcome thoughts, images or impulses that invade consciousness that are very difficult to dismiss or control. Behavioral component: compulsions are repetitive behavioral responses – such as cleaning rituals – that can be resisted only with great difficulty. *Compulsions are often done to reduce the anxiety associated with obsessive thoughts. *Without doing the compulsions, they may experience a panic attack FOCUS ON NEUROSCIENCE: OCD Executive dysfunction model: best equipped to explain compulsions and the neural wiring should be found in the prefrontal-caudate-thalamus circuit. Modularly control model: focused on obsessions and the underlying pathway involves the orbitofrontal cortex and the cingulate. CAUSAL FACTORS IN ANXIETY DISORDERS Biological Factors: Genetics = vulnerability: *Autonomic nervous system that overreacts to perceived threats, creating high arousal *Overreactivity of neurotransmitter systems involved in emotional responses *Overreactivity in the emotional systems in the right hemisphere (negative) 50-60% of the variation in anxiety can be attributed to hereditary factors (high concordance in anxiety for twins, even if reared apart). GABA inhibitory neurotransmitter: reduces neural activity in the amygdala and other brain structures that stimulate physiological arousal. Anxiety victims: have LOW levels of GABA (therefore high anxiety due to a stressor). *Gender difference (more anxiety disorders in females) may suggest a sex-linked biological predisposition Biological preparedness makes it easier for us, according to an evolutionary perspective, to fear certain things over others (explains why more people fear snakes than guns). Psychological Factors: Psychodynamic: Neurotic anxiety occurs when unacceptable impulses threaten to overwhelm the ego’s defenses and explode into action. How the ego’s defense mechanisms deal with neurotic anxiety determines the form of the anxiety disorder. Freud: in phobic disorders, neurotic anxiety is displaced onto some external stimulus that has symbolic significance in relation to the underlying conflict. e.g. Hans has a fear of horses and being bitten. Freud interprets this as his unresolved Oedipus conflict where the horse represents his father and the fear represents him being scared that his father will castrate him if he acts on his sexual desire towards his mother. Freud: Obsessions = related to, but less terrifying than, the underlying impulse. Compulsions = ways of “taking back” or undoing one’s unacceptable urges. E.g. obsessive compulsive cleaning is a way to undo one’s “dirty” sexual impulses. Freud: generalized anxiety and panic attacks are when one’s defenses are not strong enough to control or contain anxiety but are strong enough to hide the underlying conflict. Cognitive factors: Maladaptive thought patterns. *Normal manifestations of anxiety are appraised catastrophically which results in a full- blown panic attack. SO Helping panic patients to replace such “mortal danger” appraisals with more benign interpretations of their bodily symptoms (e.g. “its only a bit of anxiety, NOT a heart attack”), results in a huge reduction in panic attacks. Behavioral perspective: Anxiety disorder result from emotional conditioning. e.g. Classically conditioned fear response OR Observational feared response. IF The individual has a biological predisposition toward intense fear, the likelihood of developing a phobia by observational learning will increase. NOTE Once the anxiety is learned, it may be triggered by cues from the environment or from internal cues, such as thoughts and images. Operant conditioning: behaviors that are successful in reducing anxiety will be negatively reinforced. Sociocultural Factors: Culture-bound disorders are those that occur only in certain places. Koro = Southeast Asian disorder: a man fears his penis will retract into his stomach Taijin Kyofushu = in Japan: pathologically fearful of offending others (e.g. with b.o.). Windingo = North American Indians: fearful of being possessed by monsters who will turn them into homicidal cannibals. Anorexia-nervosa: fear of getting fat EATING DISORDERS: Anorexia nervosa: have intense fears of being fat and severely restrict their food intake to the point of self-starvation. Bulimia nervosa: overly concerned with becoming fat, but instead of starving themselves, they binge eat and the purge (vomiting or laxatives). 90% females. May consume 20,000 calories on a binge (not 2000… 20,000 seriously)! WHY? 1) Cultural norms: e.g. Objectification theory: women are taught to view their bodies as objects. 2) Personality characteristics (anorexics = perfectionists; bulimics = low impulse control since binging may reduce stress quickly) 3) Biological predispositions: high concordance rate for twins 4) Exhibit abnormal serotonin levels (and other neurotransmitters that regulate eating). BUT Many researches believe that these physiological changes initially are a response to abnormal eating patterns, but once started, they perpetuate eating and digestive irregularities. e.g. Anorexia: No leptin. But once they start gaining weight they have “leptin rebound” so they have so much leptin before they gain a lot of weight and since leptin makes you full, it is harder for them to keep on gaining weight. e.g. Bulimia: stomach acids expelled into the mouth during vomiting make you less taste-sensitive but from then on, that just makes it easier for them to keep vomiting. MOOD DISORDERS Mood disorders involve depression and mania (excessive excitement). *Most frequent mental disorders together with anxieties Depression: -The frequency, duration and intensity of the depressive symptoms are out of proportion to the person’s life situation -Major depression: leaves you unable to function effectively in your life -Dysthymia: has less dramatic effects on personal and occupational functioning (BUT dysthymia is longer lasting and can occur for years with intervals of normal mood never lasting for more than a few weeks or months). 3 symptoms for depression: 1) Negative mood state: sadness, misery, loneliness, no capacity to feel pleasure (even in activities that used to bring them pleasure) 2) Cognitive symptoms: Difficulty concentrating and making decisions. Low self- esteem. Blame themselves for negative situations. Future = hopeless. 3) Motivational symptoms: Inability to get started/perform behaviors that may lead to accomplishment. 4) Somatic (bodily) symptoms: Loss of appetite (or compulsive eating) and weight loss (or weight gain). Fatigue and insomnia. Bipolar Disorder: Bipolar disorder is when depression alternatives with less frequent states of mania. Mania: no limits on my capabilities, the world is my oyster. Speech is rapid or pressured (must say as many words as possible in the time allotted). No time for sleep – must always be productive. Depression: opposite of mania. PREVALENCE AND COURSE OF MOOD DISORDERS -Chance of depression at least once in your life is 1/5. -Rate of depression in children and teens and adults is the same -People born after 1960 are 10 times more likely to experience depression than their grandparents, even though their grandparents have lived much longer -Women more likely than men to experience depression (genetic factors, biochemical differences in the nervous system, PMS symptoms, environmental pressure to live up to gender standards and focus on feelings more than men) -Depression lasts 5-10 months when left untreated Once a depressive episode has occurred, one of three patterns may follow: 1) Depression will never recur (40% of all cases) 2) 3 years symptom free and then depression of the same magnitude happens again. The time interval between subsequent depressions tends to become shorter over the years (50%) 3) Will not recover (10%) *NOTE: 90% of mania victims have a recurrence of their mania CAUSAL FACTORS IN MOOD DISORDERS Biological: 1) Genetics (twins have a high concordance rate) 2) Brain chemistry (low norepinephrine, dopamine and serotonin because those are associated with motivation and reward and depressed people lack motivation and happiness/joy from reward) 3) Manic disorder = an overproduction of these neurotransmitters Psychological: 1) Personality-based vulnerability: (i)(Freud): Early traumatic losses or rejections create vulnerability for later depression by triggering a grieving and rage process that becomes a part of the individual’s personality. Subsequent losses and rejection reactivate the original loss and cause a reaction to both the new and the old loss! Supported in research: more likely to be depressed after losing a parent at a young age. (ii)(Humanistic): More depression in those born after 1960 BECAUSE it is the “me” generation and there is an overemphasis on individual attainment and people define their self-worth based on that and they are more likely to fail. 2) Cognitive Process: (i) The depressive cognitive triad of negative thoughts concerning (i) the world, (ii) oneself and (iii) the future always pops into their heads. (ii) The depressive attributional pattern: is when they take no credit for successes (blaming the environment) and all the credit for failures (blaming their own characteristics) (iii) The learned helplessness theory: depression occurs when people expect that bad events will occur and there is nothing they can do to stop them 3) Learning and Environmental Patterns: (i) Depression is triggered by a loss or some other event that decreases the amount of positive reinforcement someone gets. SO, as the depression takes hold, people stop performing acts that used to get them this reinforcement such as hobbies and socializing. (ii) Self-fulfilling prophecy: their loved ones begin to lose patience (iii) Cure for depression = forcing themselves to break this vicious cycle by participating in acts that may get them positive reinforcement that will counteract the depression. (iv) People with depressed parents may experience stressful situations throughout their childhood and may fail to develop a positive self- concept and have depression themselves! Sociocultural: -Lower rates of depression in collectivist countries because greater social support -Females more likely than males in North American but this pattern is not apparent in developing countries PSYCHOLOGICAL APPLICATIONS: UNDERSTANDING AND PREVENTING SUICIDE -Suicide = willful taking of one’s own life -1.4 suicides per minute -Suicide rates for teens in North America have tripled since the 1960s -Women make 3x as many suicide attempts as men, but men are 3x as likely to actually kill themselves because 1) higher incidence of depression in women and 2) men’s choice of more lethal weapons -Depression is one of the strongest predictors of suicide. BUT suici
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