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Chapter 16

Chapter 16- Psychological Disorders.docx

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Western University
Psychology 1000
Laura Fazakas- De Hoog

Chapter 16­ Psychological Disorders THE SCOPE AND NATURE OF PSYCHOLOGICAL DISORDERS WHAT IS ABNORMAL? • Use various criteria: 1) personal values of diagnostician, 2) expectations of the culture where person lives, 3) expectations of culture of origin, 4) general assumptions about human nature, 5) statistical deviation from norm 6) harmfulness, suffering and impairment • Judgments about what is normal/abnormal can differ on time and culture • We are likely to label behaviour as abnormal based on: o 1) If it is intensely distressing to individual o 2) Dysfunctional behaviours for either individual or society—interfere w/ person’s ability to work/experience satisfying relationships w/ other people o 3) Deviance of a given behaviour—conduct in society regulated by norms HISTORICAL PERSPECTIVES ON DEVIANT BEHAVIOUR • Importance of cultural factors is important Vulnerability- stress model- a model that explains behaviour disorders as resulting from predisposing biological or psychological vulnerability factors that are triggered by a stressor • Predisposition creates a disorder only when a stressor- recent/current event that requires a person to cope— combines w/ vulnerability to trigger the disorder o Ex. Someone may be primed to develop depressive disorder if faced w/ stress of a significant loss later in life DIAGNOSING PSYCHOLOGICAL DISORDERS Reliability- clinicians using the system should show high levels of agreement in their diagnostic decisions Validity- the diagnostic categories should accurately capture the essential features of the various disorders • DSM-IV-TR: most widely used diagnostic classification in N.America • Contains detailed lists of observable behaviours that must be present in order for diagnosis to be made, allows diagnostic info to be represented along 5 dimensions/axis: DSM-V: INTEGRATING CATEGORICAL AND DIMENSIONAL APPROACHES • Current classification system is categorical, but criteria so detailed people don't always neatly fit • Does not provide way to explain severity of disorder, cannot capture symptoms adaptively important but not sever enough to meet behavioural criteria to meet that disorder • Alternative: dimensional system, relevant behaviours rated along severity measure o Normal adaptive conscientiousness  subclinical  disordered  severely disordered • System may better represent uniqueness of each individual and avoid a one-size-fits-all approach CRITICAL ISSUES IN DIAGNOSTIC LABELLING Social and Personal Implications • Once label attached to person, becomes accurate description of individual rather than of behaviour—likely to affect how we interact w/ a person Chapter 16­ Psychological Disorders Legal Consequences Two important legal concepts: Competency- a legal decision that a defendant is mentally capable of understanding the nature of criminal charges, participating meaningfully in a trial, and consulting with an attorney Insanity- a legal decision that a defendant was so severely at the time a crime was committed that they were incapable of appreciating the wrongfulness of the act/of controlling their behaviour • Many jurisdictions have adopted a verdict of “guilty but mentally ill”—imposes a normal sentence for crime but sends defendant to mental hospital for treatment ANXIETY DISORDERS Anxiety disorders- a group of behaviour disorders in which anxiety and associated maladaptive behaviours are the core of the disturbance Anxiety responses have 4 components: 1. Subjective-emotional component—feelings of tension and apprehension 2. Cognitive component- subjective feelings of apprehension, a sense of impending danger, feeling of inability to cope 3. Physiological response- increased heart-rate + blood pressure, muscle tension, rapid breathing, nausea, dry mouth, etc. 4. Behavioural response- avoidance of certain situations, impaired task performance • Anxiety disorders tend to occur more often in females than males • Interfere significantly w/ life functions/cause person to seek medical/psychological treatment PHOBIC DISORDER Phobias- strong and irrational fears of certain objects/situations • Realize that fears are out of proportion to danger involved, but feel helpless to deal with these fears Agoraphobia- fear of open/public spaces Social phobias- excessive fear of situations in which person might be evaluated and possibly embarrassed Specific phobias- fear of dogs, spiders, snakes • Animal fears- women, heights- men GENERALIZED ANXIETY DISORDER Generalized anxiety disorder- chronic state of diffuse, or “free-floating,” anxiety that is not attached to specific situations/objects • May last for months • Emotionally: tense, jittery, constantly on edge • Cognitively: expects something awful to happen, doesn't know what it is • Physically: mild chronic emergency reaction (sweating, upset stomach) PANIC DISORDER Panic disorder- occur suddenly and unpredictably, much more intense than general anxiety • Occur out of the blue and in absence of identifiable stimulus • Many people develop agoraphobia due to their fear that they will panic in public space • Formal diagnosis requires: recurrent attacks not tied to environmental stimuli, followed by psychological/behavioural problems OBSESSIVE-COMPULSIVE DISORDER (OCD) Obsessive-compulsive disorder (OCD)- an anxiety disorder characterized by persistent and unwanted thoughts and compulsive behaviours • Two components: o Obsessions- repetitive and unwelcome thoughts, images, impulses that invade consciousness, are abhorrent to person, very difficult to dismiss/control o Compulsions- repetitive behavioural responses that can only be resisted with great difficulty  Often responses to obsessive thoughts, function to ‘reduce’ anxiety associated w/ thoughts Chapter 16­ Psychological Disorders  Extremely difficult to control CAUSAL FACTORS IN ANXIETY DISORDERS Biological Factors Genetic factors may create vulnerability: • May take form of autonomic nervous system that overreacts to perceived threat, creating high levels of physiological arousal • Hereditary factors may cause overreactivity of neurotransmitter systems involved in emotional responses o Transmitter: GABA—inhibitory transmitter that reduces neural activity in amygdala + other brain structures that stimulate physiological arousal—some believe that abnormally low levels may cause people to have highly reactive nervous systems that quickly produce anxiety responses in response to stressors Psychological Factors Psychodynamic Theories Neurotic anxiety- a state of anxiety that arises when impulses from the id threaten to break through into behaviour • Freud believed neurotic anxiety displaced onto external stimulus that has symbolic significance in relation to underlying conflict • Obsessions + compulsions= ways of handling anxiety o Obsession: underlying impulse, compulsion: way of ‘taking back’ or undoing one’s unacceptable urges • Attacks thought to occur when one’s defenses are not strong enough to control/contain anxiety, but are strong enough to hide underlying conflict Cognitive Factors • Stress role of maladaptive thought patterns and beliefs in anxiety disorders • Anticipate that worst will happen and feel powerless to cope effectively • Panic attacks triggered by exaggerated misinterpretations of normal anxiety symptoms, such as heart palpitations, dizziness, and breathlessness Anxiety as a learned response • Result from emotional conditioning • Fears acquired due to traumatic experiences that produce classically conditioned fear response • Can be acquired through observational learning • Biological dispositions and cognitive factors help determine whether person develops phobia by observing traumatic event • One learned, anxiety may be triggered by cues from environment/by internal cues (thoughts, images) • Phobic reactions: cues tend to be external, relating to feared object/situation. Panic disorders: cues are internal (bodily sensations) • People highly motivated to avoid/escape anxiety b/c it is so unpleasant Sociocultural Factors Culture-bound disorders- behaviour disorders whose specific forms are restricted to one particular cultural context EATING DISORDERS Anorexia nervosa- intense fear of being fat, severely restrict food intake to point of starvation • Despite being emaciated, continue to see themselves as far. 90% female—teens, young adults Bulimia nervosa- overly concerned w/ becoming fat, instead of starvation, binge eat and purge food (inducing vomit/taking laxatives). 90% female Causes of Anorexia and Bulimia • Combo of env’tal, psych., bio. Factors: most common in industrial cultures where beauty = thinness, eating disorders more common among whites than blacks • Anorexics often perfectionists: high achievers often strive to live up to lofty self-standards, and loosing weight becomes a battle for success and control Chapter 16­ Psychological Disorders • Bulimics have low impulse control, lack stable sense of personal identity/self sufficiency: bingeing triggered by life stress, and guilt + self-contempt follow it—purging is means of reducing depression and anxiety trigerred by bingeing • Genetic factors: exhibit abnormal activity of serotonin and other body chemicals that help to regulate eating MOOD (AFFECTIVE DISORDERS) Mood disorders- psychological disorders whose core conditions involve maladaptive mood states, such as depression or mania • Depression and anxiety have high comorbidity (co-occurrence) DEPRESSION Major depression- mood disorder characterized by intense depression that interferes markedly with functioning Dysthymia- a depressive mood disorder of moderate intensity that occurs over a long period of time but does not disrupt functioning as a major depression does • More chronic and long-lasting form of misery, occurring for years on end with intervals of normal mood that never last for longer than a few weeks/months Three other types of symptoms: • The negative mood state is the core feature of depression—commonly report sadness, misery, loneliness, loose capacity to experience pleasure • Cognitive: Have difficulty concentrating and making decisions. Have low self-esteem, believing they are inferior, inadequate, incompetent. Tend to blame themselves when setbacks occur. Always view future with great pessimism and hopelessness • Motivational: inability to get started and perform behaviours that might produce pleasure/accomplishment. Everything seems like too much of an effort • Somatic: loss of appetite, weight loss. Sleep disturbances (mainly insomnia) occur BIPOLAR DISORDER Bipolar disorder- mood disorder in which intermitted mania appears against a background of depression Mania- a state of intense emotional and behavioural excitement in which a person feels very optimistic and energized • Person believes there are no limits to what can be accomplished + does not recognize the negative consequences that may occur if ‘grand’ plans are acted on. • Behaviour is hyperactive, and person engages in frenetic activity: work, sexual activity, elsewhere • Manic people can become very irritable and aggressive when their momentary goals are frustrated in any way • Speech is often rapid/pressured • Lessened need for sleep PREVALENCE AND COURSE OF MOOD DISORDERS • No age group exempt from depression, however it is on the rise with young group • Prevalence across socioeconomic and ethnic groups is similar, but big sex difference: women are twice as likely to develop unipolar depression that men (in 20s – 40s) • Genetic factors, biochemical differences in the nervous system, or monthly period depression that women get may increase vulnerability to depressive disorders • Manic episodes though less common than depressive reactions are more likely to recur CAUSAL FACTORS IN MOOD DISORDERS Biological Factors • Both genetic and neurochemical factors have been linked to depression • Likely inherited: genetic predisposition to develop and depressive disorder, given certain kinds of environmental factors such as significant losses and low social support • The behavioural inhibition system (neuroticism) and behavioural activation system (extraversion) are heavily involved in development of mood disorders o Behavioural activation system (BAS) is reward-oriented and activated by cues that predict future pleasure  Mania linked to high BAS functioning Chapter 16­ Psychological Disorders  Cues connoting potential reward, achievement gratification, goal attainment triggers BAS activity, leading to manic person’s elevated positive emotions and expectations, high activity level and confidence o Behavioural inhibition system (BIS) is pain-avoidant and generates fear and anxiety  Depression predicted with high BIS sensitivity, low BAS activity • Influential theory: holds that depression is a disorder of motivation caused by underactivity in a family of neurotransmitters that include norepinephrine, dopamine, and serotonin • When neural transmission decreases in brain regions, the result= lack of pleasure and loss of motivation that characterize depression • Bipolar disorder has a stronger genetic basis than unipolar depression • Manic disorders stem from an overproduction of the same neurotransmitters that are underactive in depression Psychological Factors Personality-based vulnerability • Early traumatic losses/rejections create vulnerability for later depression by triggering a grieving and rage process that becomes part of the individual’s personality • The “me” generation (with emphasis on individuality and personal control) has created the perfect environment for development of depression: people define self-worth in terms of individual attainment are likely to respond more strongly to failure Cognitive processes Depressive cognitive triad- negative thoughts concerning 1) the world, 2) oneself, 3) the future that people with depression cannot control/suppress Depressive attributional pattern- the tendency of depressed people to attribute negative outcomes to their own inadequacies and positive ones to factors outside themselves • Low self-esteem operates as a significant risk factor for later depression Learned helplessness theory- a theory of depression that states if people are unable to control life events, they develop a state of helplessness that leads to depressive symptoms • Theorists specificy negative attributions for failure. Chronic depression occurs due to attributions for failure that are: personal, stable, and global • Mania has different pattern of thinking: person is expansive, optimistic and excited Learning an environmental factors • Depression usually triggered by loss, punishing event, or drastic decrease in amount of positive reinforcement that person receives from their environment • Depressed people tend to create additional negative life events through negative moods, pessimism, and reduced functioning. Tend to make people in contact w/ them feel uncomfortable and hostile • Reductions in social support = good predictor of subsequent depression • Depressed people must break vicious cycle by forcing themselves to engage in behaviours that will produce some degree of pleasure, called behavioural activation • Children of depressed parents often expe
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