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PSYC 1000
Lisa Giguere

PSYCH – Finals Notes Psychological Disorders (Chap 16) What is abnormal? • Most definitions refer to the Three D’s: – Deviance: Thoughts or emotions that fall outside cultural norms – Distress: Intense negative emotional reaction that doesn’t match situation – Dysfunction: Behaviour interferes with individual’s daily functioning Historical perspectives on deviant behaviour • Demenological view: – Abnormal behaviour = results of supernatural forces, Possessed by a spirit – Treatment: Trephination (hole in the skull) • Early biological views: – Mental illnesses are diseases like physical illness that affect the brain (Hippocrates, 5th Century B.C.) – Breakthroughs: • General paresis – caused by syphilis • Disorders linked to physical causes • Current – physiological and psychological • Vulnerability-stress model: – Incorporates biological, environmental, psychological levels – Vulnerability = predisposition to disorders • Biological basis; personality or environmental factors – Predisposition creates disorder only when person is subject to a stressor • Stressor that requires person to cope Diagnosing Psych disorders • Issues: Reliability, validity • DSM-IV-TR – The most complete description of nearly 400 mental disorders & criteria for diagnosing each – Assumes psychological disorders are no different from a physical illness (Symptoms, diagnosis, prognosis) – Diagnostic information is represented along 5 dimensions, or axes, that consider both the person and their life situation: • Axis I: Clinical symptoms - Initial diagnosis (eg: depression, schizophrenia, phobia) • Axis II: Developmental and personality disorders • Developmental disorder: Typically first evident in childhood (Eg: autism, mental retardation) • Personality disorder: Enduring and consistent ways of interacting with the world (Eg: paranoid, antisocial, borderline personality disorders) • Axis III: Physical conditions - Eg: brain injury or HIV/AIDS that can result in symptoms of mental illness • Axis IV: Severity of psychosocial stressors - Eg: death of a loved one, starting a new job, college, unemployment, marriage • Axis V: Highest level of functioning - Level of functioning both at present time and highest level within previous year Models of abnormal behaviour • Biological model: – Assumes psychological disorder is caused by some malfunction in the brain – Treatment geared toward making brain function normally – Most popular model today – Criticized for ignoring the contribution of the environment • Psychodynamic model: – Attributed psychological disturbances to unconscious conflicts that stemmed from unresolved childhood issues – Treatment used hypnosis, dream analysis, free association • Behaviourist model: – Assumed abnormal behaviour is learned – Uses learning principles to treat psychological problems (Phobia = systematic desensitization) • Cognitive model: – Assumes abnormal behaviour is caused by maladaptive thinking patterns – Treat by trying to change maladaptive thinking and replace with ‘good thoughts’ Anxiety disorders • Frequency and intensity of anxiety response is out of proportion to the situation • Anxiety interferes with daily life Four components of the anxiety response: • Phobic disorder: – Strong, irrational fears of objects or situations – Seldom go away on their own (Can intensify over time) – Degree of impairment depends on how often condition is encountered – Most common Western society phobias: • Agoraphobia: Fear of open spaces, public places • Social phobias: Fear of social situations • Specific phobias: Fear of specific objects (eg: spiders, snakes) or situations (heights, closed spaces) • Generalized anxiety disorder: – State of diffuse, free-floating anxiety – Not tied to specific situation: Feeling of something bad about to happen • Panic disorder: – Anxiety response occurs suddenly, unpredictably, and is very intense – May occur with or without agoraphobia: Fear of future attacks • Obsessive-compulsive disorder (OCD): – Obsessions = cognitive component: Repetitive and unwelcome thoughts – Compulsions = behavioural component: Repetitive behavioural response as an attempt to ease the anxiety from the bad thoughts • Biological factors in anxiety disorders: – Genetics: MZ twins more similar than DZ twins, even when adopted – GABA: Low levels may cause highly reactive nervous systems – Gender differences: Females exhibit more anxiety disorders than males by age 7, may reflect sex-linked biological predisposition, or less power and personal control for women • Psychological factors in anxiety disorders: – Psychodynamic explanations: • Neurotic anxiety: Unacceptable impulses threaten to overwhelm ego’s defences – Cognitive explanations: • Maladaptive thought patterns and beliefs • Things are appraised ‘catastrophically • Psychological factors in anxiety disorders: – Learning explanations: • Classical conditioning: Associate an object or situation with pain and trauma • Modeling: Learn by watching others – Sociocultural factors: • Culture defines what is important • Some disorders are culturally bound: Fear of offending someone, fear of being possessed, fear of being fat Eating disorders • Anorexia nervosa: – Intense fear of being fat that leads to a severe, food intake restriction to the point of self-starvation • Bulimia nervosa: – Intense fear of being fat that leads to cycles of binging and purging food, either by inducing vomiting or consuming laxatives Mood disorders • Depression: – Frequency, intensity, and duration of symptoms is out of proportion to the situation – Major depression: Unable to function effectively/Intense feelings of depression – Dysthymia: Less intense feelings of depression, Chronic and long-lasting – Four types of symptoms: • Emotional: Negative mood state • Cognitive: Difficulty concentrating, Feelings of inferiority, failure, pessimism • Motivational: Loss of interest and drive • Somatic: Loss of appetite or compulsive eating, Sleep disturbances • Bipolar disorder: – Depression alternates with periods of mania – manic state: Euphoric mood, grandiose cognitions, Rapid speech, Lack of need for sleep • Prevalence of mood disorders: – 1 in 20 North Americans is severely depressed – 1 in 5 North Americans will have a depressive episode of clinical proportions during lifetime – Women twice as likely to suffer from unipolar depression, no differences for bipolar disorder • Course of mood disorders: – 3 major patterns: • No recurrence • Recovery with recurrence (Majority of cases, Symptom free about 3 years) • No recovery (Minority of cases, Manic episodes = 90% recurrence) • Causes of mood disorders: – Biological factors • Genetic factors • Concordance rate higher for MZ than DZ • 50% of bipolar disorder have close relative diagnosed • Neurotransmitters • Underactivity: Norepinephrine, dopamine, & serotonin in depression • Overactivity of neurotransmitters in mania – Psychological factors: • Personality-based vulnerability • Psychodynamic view: Early traumatic losses/rejections create vulnerability • Humanistic view: Define self-worth in terms of individual attainment, React more strongly to failures due to inadequacies, Experience of meaninglessness – Cognitive factors • Depressive cognitive triad: Negative thoughts concerning the world, oneself, & the future • Depressive attributional pattern: Success = factors outside self/Negative outcomes = personal factors • Learned helplessness theory: Depression occurs when people expect that bad events will occur and they think that they can’t cope with them – Learning and environmental factors • Lewinsohn’s behavioural model of cycle of depression: Loss of positive reinforcement produces further decline in reinforcement and social support • May explain why depression tends to run in families: Children of depressed parents often experience poor parenting - Results in failure to develop good coping skills and positive self-concept – Sociocultural factors (Cultural variation) • Prevalence of depressive disorders: Less in Hong Kong & Taiwan than in the West • Feelings of guilt and inadequacy: Highest in North America & Western Europe • Gender difference not found in developing countries • Suicide – Willful taking of one’s life – 3500 per year in Canada (100x more attempts) • Women 3x more attempts than men/Men 3x more ‘success’ than woman – Second most frequent cause of death among high school & college students – Motives • Desire to end one’s life: Despression & hopelessness • Manipulation of others: Parasuicides – cries for help or to coerce others – Warning signs • Verbal or behavioural threat to kill self, History of previous attempts, Detailed plan that involves a lethal method – Prevention • Talk about it with the person • Provide social support and empathy • Help person to consider positive future possibilities • Stay with person and help them seek professional help Somatoform disorders • Physical complaints / disabilities with no known biological cause – Hypochondriasis: Unduly alarmed – Pain disorder: Out of proportion – Conversion disorder: Sudden neurological problems (Eg: glove anaesthesia, psychogenic blindness) Dissociative disorders • Psychogenic amnesia: Extensive but selective memory loss following trauma • Psychogenic fugue: Loss of all personal identity • Dissociative identity disorder: Two or more separate identities, each with own set of memories & thoughts • Dissociative Identity Disorder (DID): – Each identity is unique: May or may not know about each other, One identity may be protector, another a child – Trauma-dissociation theory: DID generally results from severe traumatic experience during early childhood – Is it real? • Evidence for: Different menstrual cycles, different allergies, different eyeglass prescriptions, different brain waves • Evidence against: Unknown in some cultures, Role playing? Schizophrenia • Schizophrenia = ‘split mind’ • Severe disturbances in – Thinking: Delusions = false beliefs – Speech: Disorganized, strange words – Perception: Hallucinations = false perceptions – Emotion: Blunted or inappropriate affect – Behaviour: disorganized • Subtypes – Paranoid: Delusions of persecution; grandeur – Disorganized: Confusion; incoherence – Catatonic: Severe motor disturbances – Undifferentiated: Not easily classified as one of the above • Two main categories – Type 1 schizophrenia • Predominance of positive symptoms (Delusions, hallucinations, disordered speech & thought), Pathological extremes – Type 2 schizophrenia • Predominance of negative symptoms (Lack of emotion, expression, motivation), Absence of normal reactions • Prevalence: – Affects 1% of population, no gender differences – 10% permanently impaired, 65% intermittent periods of functioning, 25% recover • Negative symptoms: – Long history of poor functioning = poor recovery • Positive symptoms: – History of good functioning = better prognosis • Biological factors: – Evidence for genetic component: Twins – higher concordance rate – Neurodegenerative hypothesis: 20-35% show brain atrophy in regions that influence cognitive processing & emotion – Thalamus: Abnormal MRI activity, Routes sensory information – Dopamine hypothesis • Overactivity of dopamine system (too many catchers of dopamine) • Regulate emotion, motivation, cognitive functioning • Associated with positive symptoms • Antipsychotic drugs used for schizophrenia reduce dopamine activity • Psychodynamic perspective: – Extreme use of the defense mechanism regression: Retreat to an earlier, more secure stage in life • Cognitive factors: – Defect in ability to filter out irrelevant information • Sociocultural factors: – Highest in lower socio-economic populations • Social causation hypothesis: Higher levels of stress among low- income • Social drift hypothesis: As functioning deteriorates, drift down socio-economic ladder • Environmental factors: – Stressful life events – Family dynamics: Vulnerability factor & negative reactions from others – Home environments high in expressed emotion: High levels of criticism, High levels of hostility, Overinvolvement in person’s life Personality Disorders • Stable, ingrained, inflexible, & maladaptive ways of thinking, feeling, and behaving • Three clusters of disorders – Dramatic & impulsive behaviours – Anxiety & fearfulness – Odd & eccentric behaviours • Anti-social personality disorder: (ex. Paul Bernardo) – 3 : 1 male – female ratio – Lack a conscience & fail to respond to punishment – Incapable of true emotions – Charming & manipulative – Diagnosis – at least 18 years of age with antisocial behaviour before 15 – Biological factors • Genetic predisposition • Dysfunction in brain structures that govern self-control and emotional arousal? (underaroused state) • MRI findings of subtle differences in prefrontal lobes (impulse control & planning) • Weaker limbic input to frontal cortex (emotions) – Psychodynamic view: Lack of a superego (lack morals, not identifying with same sex parent) – Cognitive explanation: Consistent failure to think about or anticipate long-term negative consequences of actions – Learning explanations • No conditioned fear responses when punished leads to poor impulse control • Modeling of aggression • Parental inattention to children’s needs • Exposure to deviant peers • Borderline personality disorder: – Instability in behaviour, emotion, identity – Emotional dysregulation: Inability to control negative emotions in response to negative life events – Intense and unstable personal relationships =Anger, loneliness, emptiness – Impulsive behaviour: Running away, promiscuity, drug abuse, suicide – Causal factors: • Chaotic personal histories
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