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Chapter 17

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Steve Joordens

CHAPTER 17 – THE NATURE AND CAUSES OF PSYCHOLOGICAL DISORDERS Recent studies identified complex interactions between an individual’s genotype, brain chemistry and childhood environment in the etiology: the causes or origin of a disorder, of psychological disorders Less severe psychological disorders appear more heavily influenced by environmental factors More severe disorders appear to be heavily influenced by hereditary and biological factors that disrupt normal cognitive processes or produce inappropriate emotional reactions CLASSIFICATION AND DIAGNOSIS OF PSYCHOLOGICAL DISORDERS Need for a comprehensive classification system of psychological disorders first recognized by Emil Kraepelin, he made his version in a textbook of psychiatry published in 1988 The Association of Medical Superintendents of American Institutions for the Insane, a forerunner of the APA, later incorporated his ideas into a classification system of its own What is Abnormal? Psychological disorders defined by abnormal behaviour, but that is strictly anything away from normal, including tall people or smart people. But it has taken a pejorative connotation: we use it to refer to characteristics we dislike or fear Psychologists stress that the most important feature of a psychological disorder is not abnormal, but maladaptive Perspectives on the Causes of Psychological Disorders The Psychodynamic Approach Psychological disorders originate in intrapsychic conflict produced by the three components of the mind: id, ego, superego The consequent psychological disorders may involve, among other symptoms, extreme anxiety, obsessive thoughts and compulsive behaviour, depression, distorted perceptions and patterns of thinking and paralysis or blindness to which there is no physical cure The Medical Perspective Based on ideas that psychological disorders are caused by specific abnormalities of the brain and nervous system and that they should be approached for treatment in the same was as physical illness Biological factors are known at least to contribute to the development of psychological disorders including schizophrenia, and bipolar disorder The Cognitive-Behavioural Perspective Holds that psychological disorders are learned maladaptive behaviours learned that can be understood by focusing on the environment and a person’s perception of those factors Therapists from this perspective suggest patients to replace or substitute maladaptive thoughts and behaviours with more adaptive ones The Humanistic Perspective Psychological disorders arise when people perceive that they must earn the positive regard of others They become oversensitive to the demands and criticisms of others and define their personal value primarily in terms of others’ reactions to them. Lack confidence in their abilities and feel as if they have no stable, internal value as a person The Sociocultural Perspective Cultures in which people life play a significant role in the development of psychological disorders Proper treatment requires understanding of cultural issues Cultural variables influence the nature and extent to which people interpret their own behaviours as (ab)normal The Biopsychosocial Perspective No one perspective is adequate in accounting for the origins of psychological disorders, this is not to say any of them are unimportant, different approaches can be combined to form larger perspective Diathesis-stress model: a causal account of psychological disorders based on the idea that psychological disorders develop when a person possesses a predisposition for a disorder and faces stressors that exceed his or her abilities to cope with them Biopsychosocial perspective: a view that the causes of psychological disorders can best be understood in terms of the interaction of biological, psychological, and social factors Biopsychosocial model may use info about thaw way genotypes of people diagnosed with specific psychological disorders differ from those of individuals who do not have Related interest may be info about the chemistry of neural pathways in individuals with the disorder and the correlations between those pathways and the individuals genotype The DSM-IV-TR Classification Scheme Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR): a widely used manual for classifying psychological disorders Provides descriptions of an individual’s psychological condition using 5 criteria called axes Axis 1 – information on major psychological disorders that require medical attention Disorders first appearing in infancy, childhood or adolescence; Delirium, dementia, amnestic, and other cognitive disorders; Psychoactive substance abuse disorders; Schizophrenia and other psychotic disorders; Mood disorders; Anxiety disorders; Somatoform disorders; Factitious disorders; Dissociative disorders; Sexual and gender identity disorders; Eating disorders; Sleep disorders; Impulse control disorders; Adjustment disorders Axis 2 – Personality disorders Axis 3 through 5 – provide info about the life of the individual in addition to the basic classification provided by axes 1 and 2 Axis 3 – describes any physical disorders such as skin rashes or high blood pressure Axis 4 – specifies the severity of stress the person has experienced Axis 5 – describes the person’s overall level of psychological, social, or occupational functioning (determines amount the person’s life has been diminished by the disorder) Comorbid: the appearance of two or more disorders in a specific person Some Problems with DSM-IV-TR Classification Since it is strongly influence by psychiatrists, places emphasis on biological factors which may allow cognitive and environmental determinants to be overlooked Not completely reliable, it is like navigating an unfamiliar city with a crude map Other critics questioned the validity Rosenhan – made up fake symptoms and his group of professional associates and himself were committed to asylums for average 3 weeks; only the real patients knew they were faking The Need for Classification Szasz – suggested that we should abandon all attempts to classify and diagnose psychological disorders; saying that labelling has done more harm than good, for example taking away the responsibility for improvement from the person However, proper classification can lead to successful treatment; diseases such as diabetes, syphilis, tetanus, and malaria only had a cure found after they were reliably diagnosed Graves’ disease – characterized by irritability, restlessness, confused and rapid thought processes and occasionally delusions and hallucinations – caused by over secretion of thyroxine, a hormone produced by the thyroid gland – treatment involves prescription of anti-thyroid drugs or surgical removal of thyroid gland, followed by replacement doses of thyroxine Prevalence of Psychological Disorders 11% of Canadians suffer from a psychological disorder or substance abuse problem Clinical versus Actuarial Diagnosis Clinical judgements: diagnoses of psychological disorders or predictions of future behaviour based largely on experts’ experience and knowledge Actuarial (statistical) judgements: diagnoses of psychological disorders or predictions of future behaviour based on numerical formulas derived from analyses of prior outcomes Many health professionals prefer to use the clinical method, but hundreds of studies overwhelmingly show actuarial judgements to be superior The criterion measured in these studies included college grade point average, parole violation, response to particular forms of therapy, length of psychiatric hospitalization and violent behaviour Actuarial more accurate because they are more reliable (based on precise rule that always produces the same judgement, while clinical may allow bias, or new data to change reaction) Disorders Usually Diagnosed in Childhood Attention-Deficit/Hyperactivity Disorder ADHD: a psychological disorder found in childhood characterized by impulsivity, a lack of attention and hyperactivity The symptoms of this ailment must be present before age 7, and are usually present for several years; must be displayed at home and at school; and must interfere with age-appropriate actions Despite high findings of heritability, there is no clear indication of how genes and environment might produce the symptoms Shaw and colleagues – MRI data from 220 children with the disorder over 15 years showed an unusual trend in the developmental course of cerebral cortical thickness Kids with ADHD does not reach maximum thickness until age 10 (kids with out – 7 or 8), and motor cortex matures faster than normal Team of psychologists in Norway proposed a comprehensive theory of its development – insufficiency of dopamine as a modulator in neural pathways involving the neurotransmitters glutamate and GABA Reduced activity in dopaminergic branch of limbic system interferes with normal processes of reinforcement and extinction which leads to symptoms of delay aversion Autistic Disorder Primary symptoms are abnormal development of social interaction and communications, accompanied by pronounced limitations of activity and interests; symptoms that must appear prior to age 3 Persistent abnormality of social interaction includes failure to use nonverbal behaviours such as eye-contact and facial expressions ANXIETY, SOMATOFORM, AND DISSOCIATIVE PSYCHOLOGICAL DISORDERS Often referred to as neurosis, Anxiety, somatoform, and dissociative psychological disorders are strategies of perception and behaviour that have gotten out of hand Characterized by pathological increases in anxiety which may result from an inadequate number of defence mechanisms People who have neurosis experience anxiety, fear, depression and are unhappy, but unlike people who have psychoses, they do not suffer delusions or severely disordered thought processes Neurotic behaviour usually characterized by avoidance rather than confrontation of problems Anxiety Disorder Anxiety disorders have fear and anxiety as their most prominent symptoms Anxiety: a sense of apprehension or doom that is accompanied by many physiological reactions, such as accelerated heart rate, sweaty palms, and tightness in the stomach These are the most common psychological disorders and affect 12% of Canadians Panic Disorder: Description: Panic disorder: unpredictable attacks of acute anxiety that are accompanied by high levels of physiological arousal and that last from few seconds to a few hours Women twice as likely to suffer than men; onset is usually between late teen years and mid-twenties; rarely begins after 40’s Symptoms: shortness of breath, clammy swear, irregularities in heartbeat, dizziness, faintness, and feelings of unreality Anticipatory anxiety: a fear of having a panic attack; may lead to development of phobias Panic attacks can cause a phobia, presumably through classical conditioning Panic Disorder: Possible Causes: Genetic and Physiological Causes Due to the overwhelming nature of physical symptoms, many reject the notion of a psychological disorder insisting their problem is medical Considerable evidence implicates biological influences, and it has a substantial hereditary component Crowe, Noyes, Pauls, Slymen – pattern of panic disorder within family tree suggests it is caused by a single dominant gene People with panic disorder periodically breathe irregularly when awake and asleep; 95% report breathing changes during panic attack, 70% suffered from dyspnea, a disorder with symptoms including breathing discomfort or significant breathlessness Panic attacks can be triggered in those with histories of panic disorder by giving them injections of lactic acid or having them breathe air containing elevated amounts of carbon dioxide Some believe that what is inherited is a tendency to react with alarm to bodily sensations of many different sources that would not disturb most other people Cognitive Causes People with panic disorder focus on negative aspects of environment and expect to be threatened by situational stressors and downplay or underestimate their abilities to cope with them Merely anticipating that something bad is about to happen can precipitate a panic attack Phobic Disorder: Phobic disorder: an unrealistic, excessive fear of a specific class of stimuli that interferes with normal activities. The object of the anxiety is readily identifiable: it may be a snake, an insect, the outdoors or closed spaces The DSM-IV-TR recognizes three types of phobic disorder: agoraphobia, social phobia and specific phobia, most cases of agoraphobia considered to be caused by panic attacks Agoraphobia: a psychological disorder characterized by fear of and avoidance of being alone in public places this disorder is often accompanied by panic attacks Can be severely disabling, merely thinking about leaving the home can cause profound fear, dread, nausea, and sweating Social phobia: a psychological disorder characterized by an excessive and irrational fear of situations in which the person is observed by others Most people with this are only mildly impaired These seem to be a self-perpetuating disorder; even after successful positive interactions with others, people with social phobia still feel less positive and more negative affect than people without the phobia Specific phobia: an excessive and irrational fear of specific things, such as snakes, darkness or heights Often caused by a specific traumatic experience Approximately a third of the population sometimes exhibit phobic symptoms, but females are more likely to develop agoraphobia Phobic Disorder: Possible Causes Psychoanalytic theory attributes phobias to distress caused by intolerable unconscious impulses or to the displacement of objective sources of fear to symbolic Clinical psychologists and behaviour analysts believe that phobias are learned through classical conditioning Environmental Causes – Learning Classical conditioning Same classes of drugs useful in treating panic attacks also reduce the symptoms of agoraphobia, but results that last longest are from behaviour therapy Genetic Causes Ohman – participants in experiments typically assigned to a condition in which they are shown pictures of either a fear-irrelevant stimuli or to a fear-relevant stimuli. Important measure in this line of research is skin conductance -pairing pictures with a mild electric shock resulted in conditioned emotional responses to the fear-relevant but not to the irrelevant, event thought they were presented in such a way the participant could not consciously identify the content -fear-relevant stimuli seemed more resistant to extinction, and the participants showed a special proclivity for conditioned fear to fear-relevant stimuli, and did so without awareness Obsessive Compulsive Disorder (OCD): Description OCD: recurrent, unwanted thoughts or ideas and compelling urges to engage in repetitive ritual like behaviour Obsessions: an involuntary recurring thought, idea, or image Compulsions: an irresistible impulse to repeat some action over and over even though it serves no useful purpose Unlike panic disorder, OCD people have defence against anxiety; their compulsions People with OCD generally recognize their thoughts and behaviours as senseless and wish they would go away Females slightly more likely than males to have this, and it most commonly begins in young adulthood People with this disorder unlikely to marry perhaps because of the common obsessional fear of dirt and contamination or because the shame associated with the rituals they are compelled to perform causes them to avoid social contact Two principal kinds of obsession: obsessive doubt or uncertainty, and obsessive fear of doing something prohibited Often obsessed with thoughts of killing themselves, thought fewer than 1% actually do Radomsky, Ashbaugh, Gelfand – found correlation between checking compulsions and increased levels of trait anger OCD: Possible Causes Can be understood in terms of defense mechanism; cognitive investigators suggest that obsessions serve as devices to occupy the mind and displace painful thoughts Cognitive Causes Cognitive researches point out people with OCD believe they should be competent at all times, avoid any kind of criticism at all costs, and worry about being punished by others for behaviour that is less than perfect If habit becomes firmly established, the obsessive thoughts may persist even after the original reason for turning to them – the situation that produced the anxiety-arousing thoughts – no longer exists Genetic Causes OCD may have genetic origin Nestadt and colleagues – OCD is 5 times more frequent among first-degree relatives of those with the disorder than those who don’t have it OCD is also associated with tourette’s syndrome: a neurological disorder characterized by tics and involuntary utterances, some of which may involve obscenities and the repetitions of other people’s utterances 30-50% who are diagnosed with Tourette’s fit the criteria for OCD There is evidence that elevated glucose metabolic rates in certain areas of the brain are found in people suffering from OCD OCD treated by psychosurgery, drugs and behaviour therapy; one problem in treating this is that people are hesitant to seek treatment Somatoform Disorders: a psychological disorder involving a bodily or physical problem for which there is no physiological basis Somatization Disorder: Description Somatization disorder: a class of somatoform disorder, occurring mostly among women that involves complaints of wide-ranging physical ailments for which there is no apparent biological cause Regier and Colleagues – in sample of 18000 people, 1% of women and no men had it DSM-IV-TR requires the person to have history of complaining of physical ailments for years and must include 13 of 55 symptoms on their list that fall into the following categories: gastrointestinal, pain, cardiopulmonary, pseudoneurological and sexual People with this often make suicide attempts, but they rarely actually kill themselves This resembles hypochondriasis: a somatoform disorder involving p
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