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Chapter 16 - Psychological Disorders.docx

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Western University
Psychology 1000

Chapter 16: Psychological Disorders Scope & Nature of Psychological Disorders  26% of population suffers from diagnosable mental disorders  Psychological disorders are 2 leading cause of disability, exceeding physical illnesses and accidents  Medications used to treat anxiety & depression are among most frequently prescribed drugs What Is Abnormal  Defining normal & abnormal – not easy & depends on o The personal values of a given diagnostician  Too arbitrary o The expectations of the culture in which a person currently lives  Differs based on culture & time (ex. homosexuality was considered mental disease) o The expectations of the person's culture of origin  Differs based on culture & time (ex. homosexuality was considered mental disease) o General assumptions about human nature  Differs based on culture & time (ex. homosexuality was considered mental disease) o Statistical deviation from the norm  Highly intelligent people would be seen as abnormal o Harmfulness, suffering, and impairment (distress, dysfunction & deviance)  Seem to govern decisions about abnormality  Labeling Behaviours as Abnormal o If intensely distressing  Excessively anxious, depressed, dissatisfied or seriously upset at life – long-lasting o If dysfunctional  Interfere with person’s ability to work or to experience satisfying relationships  Interfere with society – Ex. suicide bomber o If deviant  Conduct within every society is regulated by norms  Violation of norms defines criminal behaviour – abnormal  Abnormal Behaviour o Personally distressing, personally or societally dysfunction and/or culturally deviant that other people judge it to be inappropriate or maladaptive  Major Diagnostic Categories o Anxiety disorders  Intense, frequent, or inappropriate anxiety  No loss of reality contact  Includes phobias, generalized anxiety reactions, panic disorders, obsessive-compulsive disorders, and post-traumatic stress disorders o Mood (affective) disorders  Disturbances of mood, including depression and mania (extreme elation and excitement) o Somatoform disorders  Physical symptoms, such as blindness, paralysis, or pain, that have no physical basis and are assumed to be caused by psychological factors  Excessive preoccupations and worry about health (hypochondriasis) o Dissociative disorders  Problems of consciousness and self-identification, including amnesia and multiple personalities (dissociative identity disorder) o Schizophrenic and other psychotic disorders  Severe disorders of thinking, perception, and emotion that involve loss of contact with reality and disordered behaviour o Substance-abuse disorders  Personal & social problems associated with use of psychoactive substances, such as alcohol, heroin, or other drugs o Sexual and gender identity disorders  Inability to function sexually or enjoy sexuality (sexual dysfunctions)  Deviant sexual behaviours, such as child molestation and arousal by inappropriate objects (fetishes)  Strong discomfort with one's gender accompanied by desire to be a member of other sex o Eating disorders  Include anorexia nervosa (self-starvation) & bulimia nervosa (bingeing and purging) o Personality disorders  Rigid, stable, and maladaptive personality patterns, such as antisocial, dependent, paranoid, and narcissistic disorders Historical Perspectives on Deviant Behaviour  Stories in the Bible, Mozart (paranoia), Abraham Lincoln & Winston Churchill (depression), Cameron Diaz (obsessed with germs)  Human societies explained and respond to abnormal behaviour in different ways based on values and assumptions about life at that time  Abnormal as Supernatural o Reflected evil spirit’s attempt to escape from individual bodies o Trephination  To release spirit  Sharp tool was used to chisel a hole about 2 cm in diameter in the skill o Medieval Europe  Demonological model  Disturbed people either were possessed involuntarily by devil or made pact with the devil  Ex. Killing of witches  Bind a woman’s hand and feet and throw her into a lake or pond  Diagnostic test: woman that sank & drowned could be declared pure  Hippocrates o Suggested that metal illnesses were diseases like physical disorders o Site of mental illness was the brain – biological basis o General Paresis  Disorder characterized by mental deterioration and bizarre behaviour, resulted from massive brain deterioration caused by the sexually transmitted disease syphilis  Sigmund Freud o Theory of psychoanalysis – disordered behaviour o Joined by other models based on behavioural, cognitive, and humanistic concepts o Focus on different classes of causal factors o Help to capture complex determinants of abnormal behaviour (especially culture)  Vulnerability-Stress Model (Diathesis-Stress Model) o Every individual has some degree of vulnerability (range: very low to very high) for developing psychological disorders, given sufficient stress o Vulnerability (Predisposition)  Can have biological basis  Genes, neurotransmitter, hair-trigger autonomic nervous system or hormones  Could be due to personality factors  Self-esteem, pessimism  Could be influenced by environmental factors  Poverty  Severe trauma or loss  Cultural factors play a role o Stressor  Recent or current even that requires individuals to cope Diagnosing Psychological Disorders  Reliability o Means that clinicians using the system should show high levels of agreement in their diagnostic decisions o Professionals with different types of training o Psychologists, psychiatrists, social workers, and general physicians—make diagnostic decisions  Validity o Means that diagnostic categories should accurately capture the essential features of the various disorders o Research show that a given disorder has four behavioural characteristics  diagnostic category for that disorder should also have those four features  DSM-IV-TR o Most widely used diagnostic classification system in North America o Has 350 diagnostic categories  contains detailed lists of observable behaviours that must be present in order for a diagnosis to be made o Allows diagnostic information to be represented along five dimensions  take both person and life situation into account o Axis I  Primary diagnosis  Represents the person's primary clinical symptoms o Axis II  Reflects long-standing personality or developmental disorders  Ex. Ingrained, inflexible aspects of personality, that could influence the person's behaviour and response to treatment o Axis III  Notes any physical conditions that might be relevant, such as high blood pressure o Axis IV  Rates the intensity of environmental stressors in the person's recent life o Axis V  Person's coping resources as reflected in recent adaptive functioning DSM-V: Integrating Categorical & Dimensional Approaches  Current classification system is a categorical system o People are placed within specific diagnostic categories o Criteria are so detailed and specific that many people don't fit neatly into categories o People who receive same diagnosis may share only few symptoms & look very different o Does not provide a way of capturing severity of the person's disorder o Cannot capture symptoms that are adaptively important but not severe enough to meet behavioural criteria for the disorder  Alternative System: Dimensional System o Relevant behaviours are rated along a severity measure o Based on assumption that disorders are different in degree, rather than kind Critical Issues in Diagnostic Labelling Social & Personal Implications  Diagnostic label is attached to a person  very easy to accept label as accurate description of individual rather than of the behaviour  Difficult to look at person's behaviour objectively  Likely to affect how we will interact with that person Legal Consequences  Individuals judged to be dangerous to themselves or others may be involuntarily committed to mental institutions under certain circumstances o Lose some civil rights & detained if no improvement  Legality o Competency  Refers to a defendant’s state of mind at the time of judicial hearing (not the actual crime)  May be judged to be disturbed – not able to understand nature of trial  Termed ―not competent to stand trial‖ o Insanity  Relates to presumed state of mind of defendant at time crime was committed  May be ―not guilty by reason of insanity‖  Judged to have been so severely impaired during commission of a crime that they lacked the capacity either to appreciate wrongfulness of acts or to control conduct o Adopted “guilty but mentally ill”  Imposes a normal sentence for crime  Sends defendant to mental hospital for treatment Anxiety Disorders  State of tension and apprehension that is a natural response to perceived threat  Frequency & intensity of anxiety responses are out of proportion to situations that trigger them  Responses: 4 components o Subjective-Emotional Component  Feelings of tension and apprehension o Cognitive Component  Subjective feelings of apprehension  Sense of impending danger, & feeling of inability to cope o Physiological Responses  Increased heart rate & blood pressure, muscle tension, rapid breathing, nausea, dry mouth, diarrhea, and frequent urination o Behavioural Responses  Avoidance of certain situations and impaired task performance  Incidence o Refers to the number of new cases that occur during a given period  Prevalence o Refers to the number of people who have a disorder during a specified period of time  Most prevalent of all psychological disorders in North America  Tend to occur more frequently in females than in males  70% of cases – require medical attention Phobic Disorder  Phobias o Strong and irrational fears of certain objects or situations o Realize that their fears are out of all proportion to the danger involved, but they feel helpless to deal with these fears  Most Common Phobias o Agoraphobia  Fear of open and public places o Social phobias  Excessive fear of situations in which the person might be evaluated and possibly embarrassed o Specific phobias  Including fears of dogs, snakes, spiders, airplanes, elevators, enclosed spaces, water, injections, illness, or death  Animal fears – common amount women  Fear of heights – common amount men  Many develop in childhood & adolescence  Seldom go away on their own – may intensify Generalized Anxiety Disorder  Chronic state of diffuse, or ―free-floating,‖ anxiety that is not attached to specific situations or objects  May last for months on end, with signs almost continuously present  Emotionally  jittery, tense, and constantly on edge  Cognitively  expects something awful to happen but doesn't know what  Physically  experiences mild chronic emergency reaction o Sweats, stomach is usually upset, has diarrhea  Find it hard to concentrate, make decisions, and remember commitments Panic Disorder  Occur suddenly and unpredictably, and are much more intense  Symptoms of panic attacks can be terrifying not unusual for victims to feel that they are dying  Occur out of the blue and in the absence of any identifiable stimulus  Develop agoraphobia  because of their fear that they will have an attack in public  May fear leaving familiar setting of home  Diagnosis requires recurrent attacks (not tied to environmental stimuli) followed by psychological or behavioural problems o Persistent fear of future attacks or agoraphobic responses  Tend to appear in late adolescence or early adulthood and affect about 6% of population Obsessive-Compulsive Disorder (OCD)  Usually consist of two components (but can occur singly) o Cognitive o Behavioura  Obsessions o Repetitive and unwelcome thoughts, images, or impulses that invade consciousness o Often abhorrent to the person, and are very difficult to dismiss or control o Ex. thoughts & images of contamination  Compulsions o Repetitive behavioural responses – can be resisted only with great difficulty o Often responses to obsessions to reduce anxiety associated with thought o Extremely difficult to control – strengthened through negative reinforcement o Involve  Checking things repeatedly  Cleaning & repeating  Repeating tasks endlessly  Onset typically occurs in the 20s Causal Factors in Anxiety Disorders Biological Factors  Research has shown identical twins have a concordance rate of 40% of anxiety disorders  Research indicates a genetic predisposition – but concordance is not 100%  Vulnerability o Autonomic nervous system that overreacts to perceived threat  high levels of arousal o Hereditary factors may cause overreactivity of neurotransmitter systems involved in emotional responses o Trauma-produced overactivity in emotional systems of right hemisphere (whose activity underlies negative emotional states) may produce vulnerability to PTSD  Neurotransmitters o GABA (gamma-aminobutyric acid)  Inhibitory transmitter that reduces neural activity in amygdala and other brain structures that stimulate physiological arousal  Abnormally low levels of inhibitory GABA activity in arousal areas may cause some people to have highly reactive nervous systems that quickly produce anxiety responses in response to stressors  More susceptible to classically conditioned phobias because they already have a strong unconditioned arousal response in place, ready to be conditioned to new stimuli o Serotonin  May also be involved in the anxiety disorders  Sex Differences o Emerges as early as 7 years of age o Findings suggest a sex-linked biological predisposition for anxiety disorders o Social conditions that give women less power and personal control may also contribute  Evolutionary Factors o Predisposing people to fear certain types of stimuli that might have had survival significance in the past, such as snakes, spiders, storms, and heights o Biological preparedness makes it easier to learn to fear certain stimuli Psychological Factors Psychodynamic Theories  Freud  Neurotic Anxiety o Occurs when unacceptable impulses threaten to overwhelm the ego's defences and explode into action o How ego's defence mechanisms deal with neurotic anxiety determines form of anxiety disorder o Phobic disorders  neurotic anxiety is displaced onto some external stimulus that has symbolic significance in relation to the underlying conflict  Obsession o Symbolically related to, but less terrifying than, the underlying impulse  Compulsion o Way of ―taking back,‖ or undoing, one's unacceptable urges, as when obsessive thoughts about dirt and compulsive handwashing are used to deal with one's ―dirty‖ sexual impulses  Generalized Anxiety & Panic Attacks o Thought to occur when one's defences are not strong enough to control or contain anxiety, but are strong enough to hide the underlying conflict Cognitive Factors  Stress role of maladaptive thought patterns and beliefs in anxiety disorders  Anxiety-disordered people ―catastrophize‖ about demands and magnify them into threats  Anticipate that worst will happen and feel powerless to cope effectively  Attentional processes are especially sensitive to threatening stimuli  Intrusive thoughts about previous traumatic event are a central feature of PTSD o Presence of such thoughts after trauma predicts later development of PTSD  Social phobics judged both likelihood and costs to be much higher with embarrassing themselves in social settings  Social phobics did not differ in their likelihood and cost judgments in nonsocial situations.  Cognitive processes also play an important role in panic disorders o Panic attacks are triggered by exaggerated misinterpretations of normal anxiety symptoms, such as heart palpitations, dizziness, and breathlessness o Panic-disordered person appraises these as signs that a heart attack or a psychological loss of control is about to occur, and these catastrophic appraisals create even more anxiety until the process spirals out of control Anxiety as a Learned Response  Behavioural Perspective  anxiety disorders result from emotional conditioning  Some fears are acquired because traumatic experiences produce classically conditioned fear response o Ex. Person who has a traumatic fall from a high place may develop a fear of heights (a CR) because the high place (CS) was associated with the pain and trauma of the fall (UCS)  Phobias also can be acquired through observational learning o Ex. Televised images of air crashes can evoke high levels of fear in some people  Once anxiety is learned  may be triggered either by cues from environment or by internal cues o Phobic reactions  cues tend to be external ones relating to the feared object or situation o Panic disorders  cues tend to be internal ones, such as bodily sensations (heart rate) or mental images (image of collapsing and having a seizure in a public place)  People highly motivated to avoid or escape anxiety because it is an unpleasant emotional state  Behaviours that are successful in reducing anxiety o Compulsions or phobic avoidance responses o Strengthened through a process of negative reinforcement Sociocultural Factors  Culture-Bound Disorders o Occur only in certain places o Koro  Men fear that their penis is going retract into their abdomen and kill them o Taijin Kyofushu  Pathologically fearful of offending others by emitting offensive odours, blushing, staring inappropriately or having a blemish or improper facial expression  Attributed to the Japanese cultural value of extreme interpersonal sensitivity and to cultural prohibitions against expressing negative emotions o Windigo  Anxiety disorder found amount North American Indians  Fearful of being possessed by monsters who will turn them into homicidal cannibals o Eating disorders Eating Disorders  Anorexia Nervosa o Have an intense fear of being fat o Severely restrict their food intake to the point of self-starvation o Despite looking scrawny and weighing less than 85% of what would be expected for their age o Continue to view themselves as fat o Often crave food but have what amounts to an eating phobia that can be life-threatening o About 90% of anorexics are female, mostly adolescents and young adults o Causes menstruation to stop, strains heart, produces bone loss, & increases risk of death  Bulimia Nervosa o Overly concerned with becoming fat, but instead of self-starvation they binge eat and then purge the food, usually by inducing vomiting or using laxatives o Bulimics often consume 2,000 to 4,000 calories during binges o About 90% of bulimics are female o Have normal body weight o Repeated purging can produce severe gastric problems and badly eroded teeth Causes of Anorexia and Bulimia  Anorexia & bulimia are more common in industrialized cultures in which beauty is equated with thinness  Many women who immigrate to Western countries are at risk of developing eating disorders  Researchers believe that personality factors influence eating disorders o Anorexics  Often are perfectionists  High achievers who often strive to live up to lofty self-standards  Set harsher standards for their own and other women's bodies.  Losing weight - battle for success & control: Me versus food, & I'm going to win  Describe parents as disapproving and as setting abnormally high achievement standards, and they report more stressful events related to parents o Bulimics  Depressed and anxious  Exhibit low impulse control  Seem to lack a stable sense of personal identity and self-sufficiency  Bingeing is often triggered by life stress, and guilt and self-contempt follow it  Purging may be a means of reducing depression and anxiety triggered by the bingeing  Genetic factors may create a predisposition toward eating disorders o Concordance rates for eating disorders are higher among identical twins than fraternal twins o Concordance higher among first-degree relatives than second- or third-degree relatives o Exhibit abnormal activity of serotonin and other body chemicals that help to regulate eating  Researchers think that physiological changes initially are responses to abnormal eating patterns  Once started, they perpetuate eating and digestive irregularities  Ex. o Leptin is secreted by fat cells and anorexics have low fat mass o Amount of leptin circulating is abnormally low o When anorexics begin to eat more  leptin levels rebound more quickly than their weight gain o Because leptin is a signal that reduces appetite  leptin rebound may make it more difficult for anorexics to keep gaining weight  Ex. o Stomach acids expelled into the mouth during vomiting cause bulimics to lose taste sensitivity o Normally unpleasant taste of vomit becomes more tolerable Mood (Affective) Disorders  Mood Disorders o Involves depression & mania o Most frequently experienced psychological disorders  Anxiety & mood disorders have high comorbidity (co- occurrence) – individuals experience both Depression  Loss & pain occurrences  feel blue, sad, discouraged, apathetic, and passive  Feelings usually fade away after event has passed or as person becomes accustomed to new situation  Clinical Depression o Frequency, intensity, and duration of depressive symptoms are out of proportion to person's life o Respond to minor setback with intense major depression  unable to fun ction effectively o 10% of those over the age of 18 will suffer from major depression in their lifetimes o Dysthymia  Less intense form of depression  Less dramatic effects on personal and occupational functioning  More chronic and long-lasting form of misery  Occurs for years on end with intervals of normal mood that never last more than few weeks or months  Three Types of Symptoms o Cognitive  Difficulty concentrating & making decisions  Usually have low self-esteem (inferior, inadequate or incompetent)  Tend to blame themselves  Expect failure will come and would be caused by their own inadequacies  Great pessimistic & hopelessness o Motivational  Inability to get started & perform behaviours that produce pleasure & accomplishment  Everything seems to be too much effort o Somatic (physical)  Loss of appetite  Weight loss  Sleep distrubances (insomnia)  Fatigue & weakness  Lose sexual desire & responsiveness  Negative Mood State o Core feature of depression o Most commonly report sadness, misery & loneliness Bipolar Disorder  Unipolar Depression o Person experiences only depression  Bipolar Depression o Depression alternates with periods of mania  State of highly excited mood & behaviour  Manic State o Mood is euphoric and cognitions are grandiose o No limits to what can be accomplished and does not recognize negative consequences o Motivational level  hyperactive o Engages in frenetic activity o Can become very irritable and aggressive when their momentary goals are frustrated in any way o Speech is often rapid or pressured o Greatly lessened need for sleep  until exhaustion inevitably sets in and mania slows down Prevalence & Course of Mood Disorders  1/20 North Americans is severely depressed  No age group is exempt from depression o Can appear in 6 months old infants who were separated from mothers for prolonged periods  Rate of depressive symptoms in children & adolescents is as high as adult rate  Studies indicate that depression is on the rise in young groups o People born after 1960 are 10 times more likely to experience depression  Prevalence is similar across socioeconomic and ethnic groups  Men and women do not differ in prevalence of bipolar disorder  Women appear to be about twice as likely as men to suffer unipolar depression  Women are most likely to suffer first episode of depression in 20s, men in 40s  Biological theories suggest an influence due to: o Genetic factors o Biochemical differences in the nervous system o Monthly premenstrual depression  could increase vulnerability to depressive disorders  Environmental theories suggest influence due to: o Traditional sex role expectation for females:  Be passive & dependent in the face of stress or loss  Be focused on emotions o Traditional sex role expectation for males:  Distract themselves through activities such as physical exercise & drinking  Most people who suffer depressive episodes never seek treatment  Depression is that it usually dissipates with time  Typically lasts an average of 5 to 10 months when untreated  Once a depressive episode has occurred – three patterns: o Depression will never recur o Recovery with recurrence  Remain symptom free for several years before experience another episode o Will not recover & remain chronically depressed  Manic episodes o Less common than depressive reactions o Far more likely to recur Causal Factors in Mood Disorders Biological Factors  Genetic Factors o Identical twins have concordance rate of about 67% o Fraternal twins have concordance rate of 15% o Biological relatives were found to be eight times more likely  Genetically based temperament systems involved in mood disorders o Behavioural-Inhibition System (Neuroticism)  Pain-avoidant and generates fear and anxiety  High BIS sensitivity in depression  o Behavioural-Activation System (Extraversion)  Reward-oriented and activated by cues that predict future pleasure  Low BAS activity in depression  High BAS functioning – in mania  Cues connoting potential reward, achievement gratification, & goal attainment trigger activation  Neurotransmitters o Depression  Caused by underactivity in a family of neurotransmitters  Norepinephrine, dopamine, and serotonin  Involved in the BAS  Play important roles in brain circuits that produce reward and pleasure  Neural transmission decreases in brain  result in lack of pleasure & loss of motivation  Highly effective antidepressant drugs operate by increasing activity of these neurotransmitters o Bipolar Disorder  Appears to have a stronger genetic basis than does unipolar depression  50% of patients with bipolar disorder have a parent, grandparent, or child with the disorder  May stem from overproduction of neurotransmitters that are underactive in depression  Lithium chloride  drug most frequently used to calm manics  works by decreasing activity of these transmitters Psychological Factors Personality-Based Vulnerability  Freud believed that early traumatic losses create vulnerability for later depression by triggering a grieving and rage process that becomes part of personality  Subsequent losses reactivate original loss & cause reaction to current event and unresolved past loss  Humanistic Perspective o People define self-worth in terms of individual attainment and have lesser commitment to traditional values of family, religion, and the common good  likely to react more strongly to failure Cognitive Processes  Depressive Cognitive Triad o Negative thoughts concerning (1) the world, (2) oneself, and (3) future seems to pop into consciousness automatically o Report that they cannot control or suppress negative thoughts o Tend to recall most of their failures and few of their successes o Detect pictures of sad faces at lower exposure times and remember them better o Perceptual and memory sensitivity to negative o More likely to distort memories of negative events  Depressive Attributional Pattern o Taking no credit for successes but blaming themselves for failures maintains low self-esteem o Low self-esteem = significant risk factor for later depression  Learned Helplessness Theory o Depression occurs when people expect that bad events will occur and that ther
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