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Chapter 6

Chapter 6 - Psychological Disorders Textbook Notes Psych 1X03

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Joe Kim

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Textbook Notes Psych 1X03 Chapter 6: Psychological Disorders  Four criteria to diagnose and assess psychological disorders; the four D’s o Deviance – refers to the idea that thoughts, emotions and behaviours that we define as abnormal deviate from those deemed acceptable by society  Define abnormality as whether or not the individuals behaviour is accepted by the culture to which that individual belongs  The practices of minor groups are labeled as deviant – not necessarily because they are wrong but because they are different  Includes those who fall both above and below the norm o Distress – accounts for negative feelings of individuals with psychological disorders; feeling anxiety for everyday decisions (such as what to wear)  Eg/ Anxiety disorders  Those who have a psychological disorder may not have distress  Eg/ Sociopaths – feel no remorse or guilt about their wrongful behaviour o Dysfunction – entails a marked impairment in the ability to perform everyday functions  Described as maladaptive – prevent the individual from living a functional, full life  Inability to engage in normal social or occupational functioning o Danger – dangerous or violent behaviour directed at oneself or at others  Labelling Theory o Proposed by Scheff (1970) o The application of a deviant label to an individual can result in changes of self-perception and perception by others, and a decrease in social opportunities o Mental illness stereotypes are learned during socialization and are then reinforced as to create rigid stereotype o “Being Sane in Insane Places” – “pseudo patients admitted into psychiatric hospitals by faking symptoms of schizophrenia (complaining about hearing voices), once admitted they reported being dehumanized and ignored by hospital staff who continued to interpret their behaviour as abnormal and as further evidence of mental illness; when patients took notes while in the ward, hospital staff commented in their records about “peculiar note-taking behaviour”, when discharged, patients were labelled “schizophrenia in remission” – illustrates the serious influence that labelling may have on interpretation of future behaviour Section 1: Classifying Disorders: The DSM-IV  Label – describes a set of symptoms or a syndrome; describes behaviours and the accompanying diagnosis helps to explain and distinguish between labels  Symptom – any characteristic of a persons actions, thoughts or feelings that could be a potential indicator of mental illness  Syndrome – collection of interrelated symptoms manifested by any given individual  Diagnostic and Statistical Manuel of Mental Disorders (DSM) o First diagnostic classification system, materialized in 1952 o Published by the American Psychiatric Association o Provides official guidelines for the diagnosis of psychological disorders  DSM has two main functions o To categorize and describe mental disorders so that clinicians have a common set of criteria or applying a diagnostic label to their patients, thereby reducing ambiguity and subjectivity in diagnoses o Allows researchers and psychologists to use a common language when discussing their cases and research findings  Multiaxial System of classification 0 which required assessment of individuals to be placed on five separate axes describing important mental health factors o Axes I and Axes II – diagnoses of psychological disorders  Axes I – record most disorders; diagnosis are state dependent (the individuals current condition or state of functioning) Textbook Notes Psych 1X03  Axes II – record personality disorders and mental retardation; diagnosis are trait dependent (enduring maladaptive problems with the persons functioning) o Axes III through V – provide additional information on the individuals overall functioning  Axes III – describes current physical conditions; useful because in some cases, medical conditions may cause or contribute to mental illness  Eg/ Diabetes and heart disease  Axes IV – report psychosocial or environmental stressors that may affect diagnosis, treatment or prognosis of disorders on Axis I or Axis II  Eg/ Recent death in the family, divorce, natural disasters  Axis V – global estimate of function (estimate of the individual’s overall functioning); estimates are made on the individuals current level of adaptive functioning (social, occupational and school activities)  Two criteria must be met before a diagnosis can be made o The disordered behaviour must originate from within the person and may not be a reaction to external factors o The disorder must be involuntary, such that the afflicted person cannot control their symptoms  Other Features of the DSM o Epidemiology – the study of the distribution of mental or physical disorders in a population o Prevalence – the percentage of a population that exhibits a disorder during a specified time period  Lifetime prevalence – estimate of the percentage of people afflicted by a specific disorder at any given point in time o Comorbidity – the coexistence of two or more disorders at the same time o Prognosis – refers to the forecast about the probable course of an illness o Cultural differences – what seems abnormal to one culture is regarded as normal in another  Eg/ Social phobia in an Asian culture – may develop an excessive fear of offending others in social situations  Eg/ Social phobia in north American culture – may develop an excessive fear of embarrassing themselves  DSM criticism o Whether discrete categories are justifiable and if these diagnostic categories are reliable o Structured categories or along a continuum of severity  Categorical Classification Model – a psychological disorder differs from normal functioning in kind rather than degree (DSM currently)  Eg/ Categorical (not psychological) Pregnancy – either pregnant or not, no middle ground  Problematic because discrete categories insinuate that there is a clear boundary between normality and abnormality  Subclinical cases of disorders that cause severe imparity but do not qualify for the diagnosis of a full-blown psychological disorder may go untreated  Dimensional Classification Model – a psychological disorders differ rom normal functioning in degree rather than kind  Eg/ Blood pressure o High degree of comorbidity among many of its diagnoses  Eg/ Highly common for individuals with mood disorders to also receive a diagnosis of a substance abuse problem and anxiety disorder Section 2: Mood Disorders  Mood Disorders – a class of disorders marked by intense and prolonged emotional disturbances of varied kinds that may spill over to disrupt physical, perceptual, social and thought processes o Episodic in nature; come and go, sometimes scattered among periods of normal functioning o Episodes of mood disturbances typically last between 3 to 12 months  Major Depressive Disorder (MDD) or unipolar depression o Defined by symptoms such as decreased mood, loss of motivation, significant fluctuations in weight, lack of energy and thoughts of suicide Textbook Notes Psych 1X03 o Feelings of emptiness, worthlessness and guilt o Experience neurocognitive deficits – difficulty with memory, attention, decision-making and cognitive speed in general o Occurs twice as frequently in females than makes o Females average age – 17.86 years o Males average age – 18.37 years o Females are more likely to engage in Ruminative Coping – focus their attention on their depressive symptoms and dwelling on personal difficulties or failures o Males are more likely to attempt to distract themselves to escape their depressive feelings o Female adopt a relationship self-regulatory style – they are sensitive to discrepancies between beliefs they hold about themselves and the ideals they perceive others hold for them o Females face more adversity as they are subject to higher likelihoods of victimization (sexual abuse, poverty, gender role constraints)  Bipolar Disorder (BD) o Previously known as manic depressive disorder o Classification of mood disorders that involve cycles between episodes of depression and mania in patients o Mania or manic episodes – characterized by a period of excessively elevated mood; not necessarily happiness  Grandiose, may engage in risky behaviour, may talk rapidly, shift from topic to topic  Described as irritable mood – individuals may become argumentative or violent, particularly when someone attempts to rationalize with them or point out problems with their grandiose ideas  Need for constant stimuli o Neurocognitive deficient which appear more severe than in MDD o Average age – 20 years o No evident gender difference in frequency o Bipolar I – characterized by at least one manic and one depressive episode; typical conception of bipolar, incorporates two extremes o Bipolar II – one hypomanic episode and one depressive episode  Hypomanic episodes are differentiated from full-blown manic episodes in that within hypomania the mood disturbance is not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization and there are no psychotic features (delusions of hallucinations)  Hypomanic episodes may take the form of a dramatic increase in efficiency, accomplishments or even creativity  Heterogeneity and Variability within Mood Disorders o Postpartum Depression – occurs within four weeks of childbirth  Mothers may commit infanticide and kill their own newborns o Seasonal Affective Disorder (SAD) – depression that follows a specific season  Most common season is winter  Phototherapy (therapeutic light) is one form of treatment o Rapid-Cycling – occurrence of four or more mood episodes during the span of 12 months  No specified order or combination, but must be at least four distinct mood states within timeframe Etiology of Mood Disorders  Life Events – negative life events can trigger depression o Some people may have an underlying vulnerability that renders them more likely to develop a mood disorder in response to a negative or traumatic experience  Genetic Variability o Concordance rates among identical twins average around 65%, but only 14% for fraternal twins Textbook Notes Psych 1X03 o Heritability likely creates a predisposition for mood disorders – some individuals are more likely to have mood disorders based on their genes; but their environment plays a role in determining whether they actually develop the disorder  Biological and Neurochemical Factors o Irregularities in the amygdala, prefrontal cortex, anterior cingulate and hippocampus o Most studied neurotransmitters – serotonin, norepinephrine and dopamine o Original Theory - Low levels of dopamine and norepinephrine (regulated by serotonin) lead to depression and mania o Actions of drug therapies indicate that it is not solely the change in neurotransmitter level that cause a change in the presentation of depressive and manic symptoms  Dispositional Factors – personality traits may contribute to the emergence and maintenance of depression o Eg/ Perfectionism – wherein individuals set extremely high standards for themselves  Associated with current and chronic depressive symptoms  Three types of perfectionism  Self-oriented perfectionism – setting exceedingly high expectations for oneself  Other-oriented perfectionism – demanding perfection from others  Socially prescribed perfectionism – perceiving that others have expectations of ones self o Most frequently associated with depression o Two personality orientations related to depression (Sidney Blatt and Aaron Beck)  Introjective personality orientation – introjective depression is characterized by feelings of guilt and worthlessness, and a sense that one has failed to live up to the expectations and standards imposed on them  Anaclitic orientation – anaclitic depression is characterized by feelings of helplessness and weakness, individuals often experience intense feelings of abandonment and are desperately dependent on others o Two personality types that can be readily associated with depression (Beck)  Sociotrophy – associated with being inordinately invested in interpersonal relationships individuals are overly concerned with pleasing others and actively avoid conflict in their relationships  Autonomy – autonomous individuals prefer to preserve independence and freedom of choice; engage in solitary activities, place high value on hard work and accomplishments and are often insensitive to the needs of others o Dispositional personality traits and types of generally thought of as vulnerability factors in the emergence and onset of depression that may or may not contribute to the illness depending on exposure to other stressors Interpersonal Model – Cognitive Factors  Scheme Theory (Aaron Beck) – describes the thought processes proposed to be responsible for feelings of depression o Those afflicted by depression are believed to have acquired depressogenetic schemata (a negative schema), characterized by the tendency to see and experience the world in a negative fashion o Negative Cognitive Triad – thinking is biased toward negative interpretations of themselves, the world and their futures; causes depressed individuals to feel depressed o Depressed individuals engage in cognitive biases that perpetuate their feelings of inadequacy and dejection  Selective Abstraction – individuals draw a conclusion from a situation on the bases of one of many elements  Eg/ Student feels worthless when his group fails an assignment, even though he is one of six members of the group  Overgeneralization – occurs when someone makes a broad conclusion drawn on the basis of a single, often trivial, event  Eg/ A waitress is working on a busy night and forgets one drink order and uses this one instance as proof that she is stupid and useless  Learned Helplessness Model (Martin Seligman) Textbook Notes Psych 1X03 o Formulated on animal research – dog in cage receive inescapable electric shock and initially try to escape, but then they give up; when shocks become escapable, the dogs do not try to escape o Individuals with depression engage in a pessimistic explanatory style – they tend to attribute any setbacks they encounter to personal, global and stable causes  Personal – “its my fault”  Global – “this changes everything”  Stable – “things cant change, they will always be this way”  Hopelessness Theory (Martin Seligman) o Individuals with depression expect that desirable outcomes will not happen and that undesirable outcomes will occur, but feel that they cannot change these outcomes  Helplessness vs. Hopelessness o Hopelessness model contents that prior to becoming hopeless individuals have a negative attributional style and experience some unfortunate stressful experience o Only those who already have a pessimistic cognitive style and have experienced a traumatic event will become hopeless Section 3: Anxiety Disorders  Anxiety Disorders – a class of disorders marked by feelings for excessive apprehension and anxiety  29% of people meet diagnosing criteria at some point in their lives Generalized Anxiety Disorder (GAD)  Defined by constant, severe and inescapable anxiety and worry  Feelings of anxiety and apprehension are often uncontrollable and cannot be attributed to a specific target o Involve minor details to life in general; are not specific (eg/ fear of public in social phobia)  Accompanied by physical symptoms o Restlessness, fatigue, nausea, irritability, sleeping problems, difficulty sleeping etc  Progression of symptoms are chronic and worsen at times of stress  More frequent in females than males  Lifetime prevalence rate of 5% Phobic Disorders  Marked by a persistent and irrational fear of an object or situation that presents no realistic danger  Individuals recognize that their fear is irrational, but cannot help themselves  Even imagining the phobic object or situation can trigger feelings of anxiety  Accompanied by physical reactions o Trembling, heart palpitations, muscle tensions etc  Social Phobia o Demonstrate a marked fear of public appearances during which humiliation or embarrassment is possible o Most individuals actively avoid situations where they may have to interact with others and are fearful of being scrutinized or evaluated by others o Some individuals force themselves to endure the social or performance situation with intense anxiety  May lead to a vicious cycle of anticipatory anxiety leading to anxiety symptoms in the feared situation – may lead to actual or perceived poor performance, thus intensifying the fear more so than before o Onset in the mid-teens (typically) o Lifetime prevalence rate 12.1%  Specific Phobia o Characterized by a persistent, intense and irrational fear of specific objects, places or situations (other than social situations) o Individuals avoid the phobic objects and any exposure to the feared target results in an immediate anxiety response o Lifetime prevalence rate 12.5% o Appears more frequently in females than males Textbook Notes Psych 1X03 o First symptoms appear in childhood or early adolescence; occur earlier in females o Diagnosis can be applied if fear or anxious anticipation interferes with ones daily routine or functioning, or if the person experiences distress about having a phobia o Five main categories  Animals (eg/ snakes, dogs, spiders)  Natural environment (eg/ water, lighting storms, heights)  Blood-injury injection (eg/ sight of blood, or an injury, receiving an injection)  Situational (eg/ tunnels, bridges, enclosed spaces)  Other (eg/ vomiting, choking, costumed individuals such as clowns) Obsessive Compulsive Disorder (OCD)  Defines by both obsessions and compulsions  Obsessions – persistent ideas, thoughts or impulses that are unwanted and inappropriate and cause marked distress o Pervasive thoughts and their accompanying anxiety  Compulsions – repetitive behaviours or mental acts performed to reduce or prevent distress o Ritualized behaviours that temporarily relieve anxiety  Occurs in late adolescence or young adulthood; have been cases of childhood onset  Lifetime prevalence 1.6%  Common obsessions o Contamination – concerns about dirt and germs o Pathological Doubt – fear about making wrong decisions or preoccupations about not having completed tasks such as turning off the gas, or locking the doors o Symmetry, exactness or perfectionism – or instance, discomfort when things are not symmetrical, lined up or in their place o Religious – characterized by working about being sacrilegious  Common compulsions o Washing and cleaning – engaging in excessive hand washing rooming showering or avoiding touching objects considered to be contaminated o Checking – multiple checking of stoves, faucets, lights, locks o Arranging – moving various objects around to achieve symmetry o Hoarding – keeping useless items and the inability to throw them out o Counting - counting actions or needing to do things a certain number of times o Repeating – redoing actions until they feel right  Some obsessions and compulsions are paired together o Eg/ Obsession – Contamination (mysophobia); Compulsion – Washing and Cleaning  Some seem to be unrelated o Eg/ Dressed and undressed 20 times to prevent your husband from getting into a car accident Post-Traumatic Disorder  Triggered by a severely traumatic event, wherein sufferers feel intense anxiety associated with particular stimuli related to the incident, causing them to relive the traumatic event  May not surface until months or years after event  Experience must involve intense fear, horror or helplessness to qualify as an extreme stressor  Lifetime prevalence rates 6.8%  Higher frequency in women than men  Symptoms – recurrent and intrusive distressing recollections or dreams of the event, acting or feeling that the event is recurring (hallucinations an illusions), difficulty sleeping, feeling detached or estranged from others, attempting to avoid conversation related to the trauma  Occur in only about 10% of people who experience a traumatic event Panic Disorder  Characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly  Involve intense feelings of anxiety coupled with physiological symptoms such as dizziness, shortness of breath, heart palpitations, trembling, chest pains and even a fear of dying  Lifetime prevalence rates 4.7% Textbook Notes Psych 1X03  Age onset is considerably variable – typically late adolescence and early adulthood  Agoraphobia o Individuals who are terrified about when they may experience their next panic attack; fear becomes so overpowering that they become afraid to leave their own homes o Pertains to ones fear of being in a situation or place where escape might be difficult or embarrassing or where help would be unavailable should a panic attack occur o Individuals are able to confront their feared situation when accompanied by a companion Etiology of Anxiety Disorders  Biological Factors o Twin and family studies examining the genetic impact on anxiety disorders found moderate genetic predisposition to anxiety disorders o 30-50% of individual variability in risk to develop any given anxiety disorder derives from genetic variability o Genetic inheritance of neuroticism (tendency to by high strung mood and tense) may be related to the development of anxiety disorders o Research on Anxiety Sensitivity (AS) suggests that individuals are predisposed to a fear of anxiety- related sensations o Individuals with high AS tend to interpret internal physiological symptoms of anxiety with fear o Neurochemical basis to anxiety disorders  Neurotransmitters GABA and serotonin have been implicated in the development and maintenance of these disorders  Behavioural Factors: Conditioning and Learning o Classical Conditioning – anxiety acquired  Many individuals recall an initial incident that marked the beginning of their phobia  Eg/ US – snake biting Cleo’s mom UR – fear of snakes CS – predictive or related cues (the park or anything snake related) CR – fear of snakes and anxiety o Instrumental Conditioning – anxiety maintained  Person avoids feared stimulus and this behaviour is reinforced in fear and anxiety  Eg/ Negative reinforcement occurs each time Cleo actively avoids the park on the way to work o Observational Learning  Parents may pass on their own anxieties to their children  Eg/ If Cleo had witnessed her father scream and cry every time he encountered a snake, it is probable that he may too have developed an intense fear of them despite never having experienced a traumatic experience with snakes  Cognitive Factors o Patterns of thinking may predispose certain individuals to the development of anxiety disorders o Anxious people interpret ambiguous situations in a negative light Section 4: Somatoform disorders  Category of disorders in which psychological problems manifest in physical symptoms that cannot be explained  Literally means ”bodily form”  Physical characteristics do not appear to be the result of a biological cause  Are not faking for personal gain o Malingering – if the purpose is to avoid some responsibility o Facilities disorder – the psychological motivation is to assume the role of a sick person  Spend an average of 2.2 days per year in the hospital o Average of 0.9 days  Somatization Disorder –marked by a history of diverse physical complaints that appear to be psychological in origin Textbook Notes Psych 1X03 o Must present at least four bodily pains, two gastrointestinal complaints, one pseudo neurological symptom and one sexual or reproductive symptom to be diagnosed o Lifetime prevalence rate 0.2-2% in females, less than 0.2% in males o Onset before age 25,but onset of initial symptoms is present in adolescence  Conversion Disorder o Defined by a specific sensory or motor deficit, such as temporary blindness, deafness or paralysis o Freud – physical complaints with no medical explanation were the product of the patients unconscious mind attempting to protect themselves from anxiety o Severe psychological stress typically occur prior to the onset of conversion disorder o Symptoms – impaired coordination or balance, paralysis or localized weakness, blindness, deafness, hallucinations etc o Lifetime prevalence rates variable o 11 to 500 cases per 100,000 people o Females afflicted more often than males o More common rural populations, individuals of lower socioeconomic status, those who are less knowledgeable about medical and psychological concepts  Hypochondriasis o Persistent fear of physical illness and may feel symptoms when none are present o Constantly preoccupied with fears of having a serious disease based on over-interpretation of one or more bodily signs or symptoms o Constantly monitor th
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