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PSYA02H3 (961)
Chapter 14

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Steve Joordens

Chapter 14-Psychological Disorders -symptoms reflecting abnormalities of the mind are called psychological or mental disorders -To qualify as a mental disorder, thoughts, feelings, and emotions must be persistent, harmful to the person experiencing them and uncontrollable. -the medical model is the conceptualization of psychological disorders as diseases that , like physical diseases have biological causes, defined symptoms, and possible cures. -Psychological disorders are new because in the past, abnormalities were tied in with supernatural or religion. -In some religions or countries madness is still looked at as being possessed -In many other countries and societies, including our own, people with psychological disorders are feared, ridiculed and often treated as criminals. These ways of looking at psychological orders have been replaced by a medical model. -first step to determine nature of the problem is through diagnosis. Clinicians seek to determine the nature of the patient’s mental disease by assessing symptoms-behaviours, thoughts and emotions suggestive of an underlying syndrome. -medical model should be viewed with some skepticism because every action or thought of abnormality cannot be traced to an underlying disease. Classification of Disorders -psychiatrists are physicians concerned with treatment of mental disorders -in 1952, the first DSM (Diagnostic and Statistical Manual of Mental Disorders) was published followed by a revision in 1968. The current version is the fourth edition -The DSM is a classification system that describes the features used to diagnose each recognized mental disorder and indicates how the disorders can be distinguished from other, similar problems. Each disorder is named and classified as though it were a distinct illness -a major misconception is the idea that a mental disorder can be defined entirely in terms of deviation from the average, the typical, or “healthy”. -The DSM IV-TR takes listed concerns into account by focusing on three key elements that must be present for a cluster of symptoms to qualify as a potential mental disorder. 1. A disorder is manifested in symptoms that involve disturbances in behaviour, thoughts or emotions. 2. The symptoms are associated with significant personal distress or impairment. 3.The symptoms stem from an interal dysfunction (biological, psychological or both). -Psychological disorders exist along a continuum from normal to abnormal without a bright line of separation. The DSM-IV-TR recognizes this by recommending that diagnoses include a global assessment of functioning, a 1 to 100 rating of the person, with more severe disorders indicated by lower numbers and more effective functioning by higher numbers. -There is room for improvement on the DSM so diagnostic categories continue to depend on interpretation based criteria rather than on observable behaviour and diagnosis continues to focus on patient self reports (which are susceptible to censorship and distortion). -The co-occurrence of two or more disorders in a single individual is referred to as comorbidity. Causation of Disorders -The medical model suggests that a specific pattern of causes (or etiology) may exist for different psychological disorders. The medical model also suggests that each category of psychological disorder is likely to have a common prognosis (a typical course over time and susceptibility to treatment and cure). Unfortunately, this basic medical model is an oversimplification and is rarely useful to focus on a single cause that is internal to the person and that suggests a single cure. -an integrated perspective that incorporates biological, psychological, and environmental factors offers the most comprehensive and useful framework for understanding most psychological disorders. The biological side focuses on genetic influences, biochemical imbalances and structural abnormalities of the brain. The psychological side focuses on maladaptive learning and coping, cognitive biases, dysfunctional attitudes and interpersonal problems. Environmental factors include poor socialization, stressful life circumstances, and cultural and social inequities. -The complexity of causation suggests that different individuals can experience a disorder for different reasons. Multiple causes mean there may not be a single cure. -The observation that most disorders have both internal (biological and psychological) and external (environmental) causes has given rise to a theory known as diathesis-stress model which suggests that a person may be predisposed for a psychological disorder that remains unexpressed until triggered by stress. -The diathesis is the internal predisposition which could be genetic is the stress is the external trigger. Even if someone is predisposed, they may never feel the disorder if they never experience the right amount of stress. -Searching for biological causes of psychological disorders in the brain and body also tends to invite a particular error in explanation- the intervention-causation fallacy. This fallacy involves the assumption that if a treatment is effective, it must address the cause of the problem. -Once a patient has been labelled, the label acts as a prison and makes it difficult for the person to return to a normal life as a nonpatient. As a way to help this, they have started using labels to address the condition and not the person (eg. She has bipolar disorder). Anxiety Disorders -Pathological anxiety is expressed as an anxiety disorder, the class of mental disorder in which anxiety is the predominant feature. -People commonly experience more than one type of anxiety disorder at a given time, and there is significant comorbidity between anxiety and depression. - In the DSM there are generalized anxiety disorder, phobic disorders, panic disorder and obsessive compulsive disorder. Generalized Anxiety Disorder -with this disorder, the unrelenting worries are not focused on any particular threat, they are often exaggerated and irrational. -in people suffering from generalized anxiety disorder, chronic excessive worry is accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance. -the uncontrollable worrying produces a sense of loss of control that can erode self confidence that simple decisions seem fraught with dire consequences. -5% of North Americans are estimated to suffer from GAD at some time in their lives. It occurs more commonly in lower- socioeconomic groups than in middle and upper income groups and twice as common in women than in men. -both biological and psychological factors contribute to the risk of GAD -There is a mild to modest level of heritability. Compared with fraternal twins, identical twins have modestly higher concordance rates (the % of pairs that share the characteristic) -some patients respond to prescription drugs, which means neurotransmitter imbalances may play a role in the disorder. Imbalance is not clear -Benzodiazepines – a class of sedative drugs that appear to stimulate the neurotransmitter gammaaminobutyric acid (GABA)- can sometimes reduce the symptoms of GAD. However other drugs that do not directly affect GABA levels (like buspirone and antidepressants) can also be helpful in the treatment of GAD. -Condition is prevalent among people who have low incomes, are living in large cities, or are trapped in environments rendered unpredictable by political and economic strife. High rates related to stress for women because women are more likely to live in poverty, experience discrimination, or be subjected to sexual abuse. -Childhood trauma increases likelihood of GAD and this also supports the idea that stressful experiences play a role. Major life changes often immediately precede the development of GAD. However, many people who might be expected to develop GAD don’t, supporting diathesis-stress notion that personal vulnerability must also be a key factor in this disorder. Phobic Disorders -unlike the generalized anxiety of GAD, anxiety in a phobic disorder is more specific. -The DSM describes phobic disorders as characterized by marked, persistent, and excessive fear and avoidance of specific objects, activities, or situations. An individual with a phobic disorder recognizes that the fear is irrational but cannot prevent it from interfering with everyday functioning. -A specific phobia is an irrational fear of a particular object or situation that markedly interferes with an individual’s ability to function. -Specific phobias fall into five categories: 1. Animals 2. Natural environments 3.Situations 4. Blood, injections and injury 5. Other phobias, including illness and death -social phobia involves an irrational fear of being publicly humiliated or embarrassed. It can be restricted to situations such as public speaking, eating in public, or urinating in a public bathroom or generalized to a variety of social situations that involve being observed or interacting with unfamiliar people. Individuals with social phobias try to avoid situations where unfamiliar people might evaluate them, and they experience intense anxiety and distress when public exposure is unavoidable. -It can develop during childhood but typically develops between early adolescence and the age of 25. -11% of men and 15% of females experience social phobia and there are higher rates found among people who are undereducated, have low incomes or both. -phobias are so common in part due to predispositions. -the preparedness theory of phobias maintains that people are instinctively predisposed toward certain fears. (proposed by Martin E. P. Seligman in 1971) is supported by research showing that both humans and monkeys can quickly be conditioned to have a fear response for stimuli such as snakes and spiders but not for neutral stimuli such as flowers -phobias are more likely to form for objects that evolution has predisposed us to avoid. -Temperament can also play a role in phobias. Infants who display excessive shyness and inhibition are at an increased risk for developing a phobic behaviour later in life -Neurobiological factors may also play a role. Abnormalities in the neurotransmitters serotonin and dopamine are more common in individuals who report phobias than among people who don’t. -Individuals with phobias sometimes show abnormally high levels of activity in the amygdale (area linked with the development of emotional associations). -John Watson proved phobias can be classically conditioned (little Albert and the white rat) -The idea that phobias are learned from emotional experiences with feared objects is not a complete explanation for the occurrence of phobias. Most studies find that people with phobias are no more likely than people without them to recall personal experiences with the feared object that could have provided the basis for classical conditioning. The idea that it is a matter of learning provides a useful model for therapy. Panic Disorder -Panic disorder is characterized by the sudden occurrence of multiple psychological and physiological symptoms that contribute to a feeling of stark terror. Acute symptoms last a few minutes and include shortness of breath, heart palpitations, sweating, dizziness, depersonalization (a feeling of being detached from one’s body) or derealisation (a feeling that the external world is strange or unreal), and a fear that one is going crazy or about to die. -According to the DSM, a person has panic disorder only on experiencing recurrent unexpected attacks and reporting significant anxiety about having another attack. -A common complication of panic disorder is agoraphobia, a specific phobia involving a fear of venturing into public places. They are usually not afraid of public places themselves, but of having a panic attack in a public place or around strangers. -There is a modest hereditary component to panic disorder -When subjects were given sodium lactate (a chemical that produces rapid, shallow breathing and heart palpitations) those with panic disorder were found to be very sensitive to the drug, and those without the disorder rarely responded to the drug. -People who experience panic attacks may be hypersensitive to physiological signs of anxiety which they interpret as having disastrous consequences for their well-being. -People who are high in anxiety sensitivity (believe bodily arousal and other symptoms of anxiety can have dire consequences) have an elevated risk for experiencing panic attacks. Panic attacks may be traceable to the fear of fear itself. Obsessive Compulsive Disorder -Anxiety plays a role in obsessive-compulsive disorder, but primary symptoms are unwanted, recurrent thoughts and actions. Anxiety plays a role because the obsessive thoughts typically produce anxiety, and compulsive behaviours are performed to reduce it. -OCD is when repetitive, intrusive thoughts (obsessions) and ritualistic behaviours (compulsions) designed to fend off those thoughts interfere significantly with an individual’s functioning. -Thought suppression can backfire, increasing the frequency and intensity of the obsessive thoughts -The most common obsessions involve contamination, aggression, death, sex, disease, orderliness, and disfigurement. Compulsions usually take the form of cleaning, checking, repeating, ordering/arranging, and counting. -obsessions that plague individuals derive from concerns that could pose a real threat, which supports preparedness theory. Concept of preparedness places phobias in the same evolutionary context as phobias. -There is a moderate genetic heritability for OCD. -One hypothesis for the biological mechanisms that may contribute to OCD implicates heightened neural activity in the caudate nucleus of the brain, a portion of the basal ganglia known to be involved in the initiation of intentional actions. Drugs that increase the activity of the neurotransmitter serotonin in the brain can inhibit the activity of the caudate nucleus and relieve some of the symptoms of OCD. However, this does not indicate that over activity of the caudate nucleus is the cause of OCD. It could also be an effect of the disorder, patients with OCD often respond favourably to psychotherapy and show a corresponding reduction in activity in the caudate nucleus. Mood Disorders -moods are relatively long lasting, nonspecific (no idea what cause
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