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Topic 11: Psychological Disorders

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University of Pittsburgh
PSY 0010
Allan Zuckoff

PSY 0010 – Psychological Disorders – page 1 Defining psych disorders • patterns of thinking, feeling, behaving o uncommon/deviant (abnormal) o violates social norms (unconventional) o irrational (incomprehensible) o biological dysfunction (organic) o subjective distress (suffering) o impairment or disability (maladaptive) • parallel to idea of physical disorder – problem, diagnosis Disorders across time and culture • what is considered a disorder changes o prophets and patriarchs o homosexuality, masturbation o female ambition • some disorders are culture­specific o bulimia nervosa (America/Europe) • some disorders appear to be universal o schizophrenia, psychopathy Diagnosis of disorders • advantages o enables problem identification and prescription of treatments  disorder­specific treatment o enables professionals to communicate with each other o may reduce self­blame in those with disorders • disadvantages o blurs individual differences o can reflect cultural biases o labels can stick and stigmatize  on being sane in insane places (Rosenhan 1973)  once a label is attached to someone, others may see only the label • diagnostic and statistical manual of mental disorders (DSM­5, 2013) o American Psychiatric Association (APA) criteria for mental disorders o lists of symptoms and decision rules on how many symptoms must be  present for a diagnosis o criteria of impairment/distress and duration for a disorder to be present Anxiety disorders • anxiety o feeling: nervous, tense, anxious o thoughts: worry, intrusions o bodily reactions: stress/arousal • generalized anxiety disorder o excessive worry, anxiety for 6+ months PSY 0010 – Psychological Disorders – page 2  spend on average 60% of each day worrying, compared to 18% for  the general population  not about a specific situation o physical, cognitive, emotional symptoms  restlessness, muscle tension, sleep disturbance; trouble  concentrating; irritability • panic disorder o repeated and unexpected panic attacks  rapid escalation of anxiety into terror  physical symptoms: sympathetic arousal and hyperventilation • heart racing, shortness of breath, chest pressure, choking  catastrophic thoughts: dying, heart attack o change in behavior to prevent panic attacks  worry, avoidance • agoraphobia o fear of being in a place or situation from which escape is difficult or  embarrassing, or help is unavailable • social anxiety disorder o marked fear of public appearances in which embarrassment or humiliation  is possible  public speaking, eating, performing, everyday social interactions o anticipation of negative evaluation Causal factors in anxiety disorders • diathesis­stress model o biological vulnerability (predisposition) plus life events and stressors that  trigger this vulnerability • learning theory factors o classical conditioning (Little Albert) o operant conditioning (reinforcement/punishment) o social/observational learning • cognitive factors o catastrophizing: anticipating terrible events despite low probability o anxiety sensitivity (fear of fear): misinterpretation of minor physical  symptoms as dangerous • personality factors  o neuroticism (5 factor theory)  GAD associated with negative emotionality • biological factors o neurotransmitter effects  GABA receptor deficiency and excess limbic (fear) activation o evidence of genetic heritability: 30­40% likelihood associated with genes • life event factors PSY 0010 – Psychological Disorders – page 3 o exposure to childhood violence/deprivation dramatically increases risk of  anxiety disorder  Adverse Childhood Events (ACE) study  abuse, intimate partner violence, drug addiction, criminal behavior  in household o reflected in brain development before age 4 Trauma & stress­related disorders • PTSD o traumatic stressor (catastrophic/horrifying event)  war, attempted murder, rape, natural disasters, death of a loved  one, physical/sexual abuse  directly experienced it, witnessed it, learned of it happening to a  loved one, repeatedly exposed to or reminded of details of it o symptoms at least 1 month after the event  intrusive memories, dreams, flashbacks  avoidance of situations or objects that might trigger recollection of  the event  cognitive symptoms (e.g. distorted blame)  arousal and reactivity • difficulty sleeping, startling easily, irritability/anger,  difficulty concentrating, reckless/destructive behavior • OCD o symptoms of OCD  repeated, length (>1 hr/day) obsessions, compulsions, or both  obsessions: persistent intrusive thoughts, images, or impulses that  are unwanted and inappropriate, and cause marked distress (e.g.  contamination, aggression) • may or may not recognize that fears are  unrealistic/excessive • person attempts to neutralize/suppress them  compulsions: repetitive behaviors or mental acts performed in  response to obsessions, to reduce or prevent anxiety • unrealistic (e.g. checking, counting, mental rituals) o may or may not recognize this o causal factors of OCD  biological factors • evidence of genetic heritability o OCD and the caudate nucleus and limbic system  “worry circuit” • neurotransmitter effects o serotonin, others implicated but causal influence is  not well understood • streptococcal infections (PANDAS) – autoimmune?  Depressive disorders PSY 0010 – Psychological Disorders – page 4 • major depressive disorder o sad/low mood or diminished interest in pleasurable activities for at least 2  weeks o at least 4 of the following  weight/appetite loss/gain  insomnia
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