Psychological Disorders I.docx

Psychological Disorders I: pp. 605 to 620 Abnormal Behaviour: Myths, Realities, and Controversies The Medical Model Applied to Abnormal Behaviour THE MEDICAL MODEL: proposes that it is useful to think of abnormal behaviour as a disease – this includes mental illness, psychological disorder, and psychopathy - This gradually became the dominant way of thinking about abnormal behaviour during the 18 and 19h th - Before the 18 century, most conceptions of abnormal behaviour were based on superstition. Those that behaved strangely were possessed. Their disorders were treated with chants, rituals, and exoticisms. They were seen as dangerous therefore were chained, put in dungeons, tortured and put to death - Medical model bought more sympathy and less hatred and fear DIAGNOSIS: involves distinguishing one illness from another ETIOLOGY: refers to the apparent causation and developmental history of an illness PROGNOSIS: a forecast about the probable course of an illness Criteria of Abnormal Behaviour In making diagnoses, clinicians rely on a variety of criteria: 1. Deviance o People are often said to have a disorder because their behaviour deviates from what their society considers acceptable 2. Maladaptive behaviour o People are judged to have a psychological disorder because their everyday adaptive behaviour is impaired 3. Personal distress o The diagnosis of a psychological disorder is based on an individual’s report of great personal distress o People are labelled as having a disorder when they describe their subjective pain and suffering to friends, relatives, and metal health professionals Stereotypes of Psychological Disorders - 3 stereotypes that are inaccurate: 1. Psychological disorders are incurable o Vast majority of people that are diagnosed as mentally ill eventually improve and lead normal, productive lives 2. People with psychological disorders are often violent and dangerous o Stereotype exists because incidents of violence involving the mentally ill tend to command media attention 3. People with psychological disorders behave in bizarre ways and are very different from normal people o At first, people with psychological disorders usually are indistinguishable from those without disorders Psychodiagnosis: The Classification of Disorders - A sound system for classifying psychological disorders can facilitate empirical research and enhance communication among scientists and clinicians th - The current 4 edition released in 1994, made us of intervening research to refine the criteria introduced in DSM-III - The current version describes about 3 times as many types of psychological disorders as DSM-I The Prevalence of Psychological Disorders EPIDEMIOLOGY: the study of the distribution of mental or physical disorders in a population PREVALENCE: refers to the percentage of a population that exhibits a disorder during a specified time period o LIFE TIME PREVALENCE: the percentage of people who endure a specific disorder at any time in their lives - 1/5 of the population exhibited clear signs of mental illness at some point in their lives - It was found that psychological disorders occur in 1/3 of the population - 44% of the adult population will struggle with some sort of psychological disorder at some point in their lives - The lifetime risk of a psychiatric disorder is 51% - Overall, 1 in 10 Canadians over 15 years of age reported symptoms consistent with 1 of the categories of disorder listed - 68% of the people who reported symptoms did not seek assistance TOTAL MALES FEMALES NUMBER (%) NUMBERS (%) NUMBERS (%) Major Depression 1 120 000 (4.5) 420 000 (3.4) 700 000 (5.5) Mania Disorder 190 000 (0.8) 90 000 (0.7) 100 000 (0.8) Any mood 1 210 000 (4.9) 460 000 (3.8) 750 000 (5.9) Panic disorder 400 000 (1.6) 130 000 (1.1) 270 000 (2.1) Agoraphobia 180 000 (0.7) 40 000 (0.4) 140 000 (1.1) Social anxiety disorder 750 000 (3.0) 310 000 (2.6) 430 000 (3.4) Any anxiety 1 180 000 (4.7) 440 000 (3.6) 740 000 (5.8) Alcohol dependence 640 000 (2.6) 470 000 (3.8) 170 000 (1.3) Illicit drug dependence 170 000 (0.7) 120 000 (1.0) 50 000 (0.4) Substance dependence 740 000 (3.0) 540 000 (4.4) 200 000 (1.6) - In 1999, 1.5 million hospital days were due to admissions for anxiety disorders, major depression, bipolar disorders, schizophrenia, personality disorders, eating disorders, and suicidal behaviour - Between 1987 and 1999, hospital admission for eating disorders increased by 34% for those under 15 Anxiety Disorders ANXIETY DISORDERS: a class of disorders marked by feelings of excessive apprehension and anxiety - Those who develop one anxiety syndrome, often suffer from another at some point in their lives Generalized Anxiety Disorder GENERALIZED ANXIETY DISORDER: marked by a chronic, high level of anxiety that is not tied to any specific threat - Also can be called free-floating anxiety because it is nonspecific - People worry about minor matters - They hope that worrying will help ward off negative effects - They dread decision making - Physical symptoms include trembling, sweating, muscle tension, diarrhea, dizziness, faintness, sweating, and heat palpitations - Seen more frequently in females than males Phobic Disorder PHOBIC DISORDER: marked by a persistent and irrational fear of an object or situation that presents no realistic danger - Physical symptoms include anxiety, trembling and palpitations - 1% to 5% of Canadians suffer significant anxiety related to their driving fears but they are usually very good drivers - Common ones are acrophobia (fear of heights), claustrophobia (fear of small, enclosed places), brontophobia (fear of storms), hydrophobia (fear of water), and various animal/insect phobias Panic Disorder and Agoraphobia PANIC DISORDER: characterized by recurrent attacks of overwhelming anxiety that usually occurs suddenly and unexpectedly - After a number of panic attacks, they become worried when their next attack will occur - Approx. 34% of undergraduates suffer from this disorder AGORAPHOBIA: fear of going out to public places - This is mainly a complication of panic disorder - 2/3 of people who suffer from panic disorder are female - The onset of panic disorder typically occurs during late adolescence or early adulthood Obsessive-Compulsive Disorder OCD: marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) - People troubled with obsessions feel that they have lost control of their mind - Specific types of obsessions tend to be associated with specific types of compulsions (obsession about contamination is paired with cleaning compulsions) - Occurs in roughly 2.5% of the population - Most cases of OCD emerge before the age of 35 - 4 factors seemed to underlie the symptoms: obsessions and checking, symmetry and order, cleanliness and washing, and hoarding Post-Traumatic Stress Disorder - Often elicited by any of a variety of traumatic events, including a rape or assault, a severe automatic events, a natural disaster, or the witnessing of someone’s death - Does not surface until many months or years later after exposure - 7% of people have suffered from PTSD at some point in their lives and occurs more in women (10%) than men (5%) - Common symptoms include re-experiencing the traumatic event in nightmares of flashbacks, emotional numbing, alienation, problems in social relationships, an increased sense of vulnerability, and elevated levels of arousal, anxiety, anger and guilt - Individuals who have especially intense emotional reactions during or immediately after the traumatic even go on to show elevated vulnerability to PTSD Etiology of Anxiety Disorders  Biological factors CONCORDANCE RATE: indicates the percentage of twin pairs or other pairs of relatives who exhibit the same disorder - Twin and family studies show that there is a moderate genetic predisposition to anxiety disorders - Anxiety sensitivity make people vulnerable to anxiety disorders – some are highly sensitive to the internal psychological symptoms of anxiety and are prone to overact with fear when they experience these symptoms - Disturbances in the neural circuits using GABA may play a role in some types of anxiety disorders - Abnormalities in neural circuits using serotonin have been implicated in panic and OCD  Conditioning and learning - An originally neutral stimulus may be paired with a frightening event so it becomes a conditioned stimulus eliciting anxiety - People are biologically prepared by their evolutionary history to acquire some fears much more easily than others – explains why people have phobias of ancient sources rather than modern sources (snakes versus electrical outlet)  Cognitive factors - Some people are more likely to suffer from problems with anxiety because they to: o Misinterpret harmless situations o Focus excessive attention on perceived threats o Selectively recall information that seems threatening  Stress - Patients with panic disorder had experienced a dramatic increase in stress in the month prior to the onset of their disorder - There is an association between stress and the development of social phobias Somatoform Disorders SOMATOFORM DISORDERS: physical ailments that cannot be fully explained by organic conditions and are largely due to psychological factors - Psychosomatic diseases involve genuine physical ailments caused in part by psychological factors, especially reactions to stress - Deliberate feigning of illness for personal gain is another matter called malingering Somatization Disorder SOMATIZATION DISORDER: marked by a history of diverse physical complaints that appear to be psychological in origin - Occurs mostly in women and coexist with depression and anxiety disorders - Distinguishing feature of this disorder is the diversity of the victims’ physical complaints - Somatization patients are resistant to the suggestion that their symptoms might be result of psychological distress Conversion Disorder CONVERSION DISORDER: characterized by a significant loss of physical function (with no apparent organic basis), usually in a single organ system - Common symptoms include loss of vision, loss of hearing, partial paralysis, severe laryngitis or mutism, and loss of feeling or functioning in limbs - Telltale clues reveal the psychological origins of the illness because the patient’s syndromes are not consistent with medical knowledge about their apparent disease - This tend to have acute onset triggered by stress Hypochondriasis HYPOCHONDRIASIS: characterized by excessive preoccupation with health concerns and incessant worry about developing physical illness - They constantly monitor their physical condition, looking for signs of illness - They often assume that the physician is incompetent and always look for another doctor - They don’t really suffer from physical distress but over interpret every sign of illness - Hypochondria appears alongside other psychological disorders, especially anxiety disorders and depression Etiology of Somatoform Disorders  Personality factors - Prime candidates of those more likely to develop disorders are people with histrionic personality characteristics (self-centered, suggestible, excitable, highly emotional and overly dramatic) - Neuroticism also elevate individuals’ susceptibility  Cognitive factors - People with somatoform disorders tend to draw catastrophic conclusions about minor bodily complaints – they apply a faulty standard of good health, equating health with a complete absence of symptoms which is unrealistic  The sick role - Patients are avoiding facing up to martial problems, career frustrations, family responsibilities - Physical problems can provide a convenient excuse when people fail or worry about failing - Attention from others reinforce complains of physical illness Psychological Disorders II: pp. 620 to 655 Dissociative Disorders DISSOCIATIVE DISORDER: a class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity Dissociative Amnesia and Fugue DISSOCIATIVE AMNESIA: sudden loss of memory of important person information that is too extensive to be due to normal forgetting - Can occur from a traumatic event or for an extended period of time surrounding the event DISSOCIATIVE FUGUE: people lose their memory of their entire lives, along with their sense of personal identity - However they remember maters unrelated to their identity (such as driving) Dissociative Identity Disorder DOSSOCIATIVE IDENTITY DISORDER: involves the coexistence in 1 person of 2 or more likely complete, and usually very different, personalities (also known as multiple personality disorder) - The various personalities are unaware of each other - Transitions between identities often occur suddenly - DID rarely occurs in isolation - Most DID patients have a history of anxiety or mood or personality disorders Etiology of Dissociative Disorders - Its known that stress causes disorders however why is it only portions of the population develops the disorder when everyone faces stress – its believed that those that have certain personality traits are more likely to develop the disorder - Nicholas Spanos believe that people with multiple personalities are engaging in internal role playing to use mental illness as a face saving excuse for their personal failings o Says that DID is a creation of modern culture since multiple personality patients’ symptom presents seem to have been influenced by popular media - Others believe that DID is an authentic disorder – maintained that most cases are rooted in severe trauma that occurred during childhood (rejection from parents and physical and sexual abuse) - A history of child abuse elevates the likelihood of many disorders – especially in females Mood Disorders MOOD DISORDERS: a class of disorders marked by emotional disturbances of varied kinds that may spill over to disrupt physical, perceptual, social, and thought process - Mood disturbances often come and go, interspersed among periods of normality that typically last 3-12 months - People with unipolar disorder experience emotional extremes at just 1 end of the mood continuum - People with bipolar disorder are vulnerable to emotional extremes at both ends of the mood continuum Major Depressive Disorder MAJOR DEPRESSIVE DISORDER: people show persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure - Depressed people often give up activities that they used to find enjoyable - Alterations in appetite and sleep patterns are common - People with depression often lack energy - Anxiety, irritability, and broodings are commonly observed - Depression plunges people into feelings of hopelessness, dejection, and boundless guilt - Coexisting anxiety disorders and substance-use disorders are particularly frequent - Majority of cases emerge before the age of 40 - Median duration of depressive episodes is 5 months - 10% of Canadians will experience a major depressive episode sometime in their lives, while 1% will suffer from bipolar - Age cohorts born since World War II appear to have an elevated risk for depression - Prevalence of depression is twice as high in women as it is in men – but in childhood the prevalence is the same o Women tend to adopt a self-regulatory style that is relational in nature o Women experience more depression because they are more likely to be victims of sexual abuse and more likely to endure poverty, harassment and role constraints o Women have greater tendency because they dwell on one’s difficulties - When people have a mild symptoms of depression they’re given a diagnosis of: DYSTHYMIC DISORDER: consists of chronic depression that is insufficient in severity to justify diagnosis of a major depressive episode Bipolar Disorder BIPOLAR DISORDER: characterized by the experience of one or more manic episodes as well as periods of depression - Their judgement is often impaired - Those in manic periods gamble impulsively, spend money frantically, or become sexually reckless - Manic states can be seen as addictive because of the surges of energy, therefore a lot of productivity and creativity - Bipolar affects 1-2.5% of the North American population - It is seen equally in both females and males - Age of 25 is the median age of onset - Approx. 20% of bipolar patients exhibit a rapid-cycling pattern (they go through 4 or more manic or depressive episodes within a year) Characteristics Manic Episode Depressive Episode Emotional Elated, euphoric, very sociable, Gloomy, hopeless, socially impatient at any hindrance withdrawn, irritable Cognitive Characterized by racing thoughts, Characterized by slowness of flight of ideas, desire for action, and thought processes, obsessive impulsive behaviour; talkative, self- worrying, inability to make confident; experiencing delusions of decisions, negative self-image, self- grandeur blame, and delusions of guilt and disease Motor Hyperactive, tireless, requiring less Less active, tired, experiencing sleep than usual, showing increased difficulty sleeping, showing sex drive and fluctuating appetite decreased sex drive and decreased appetite CYCLOTHYMIC DISORDER: when they exhibit chronic but relatively mild symptoms of bipolar disturbance Diversity in Mood Disorders SEASONAL AFFECTIVE DISORDER: a type of depression that follows a seasonal pattern POSTPARTUM DEPRESSION: a type of depression that sometimes occurs after childbirth - Symptoms can include both depression and mania - Occurs in about 10-20% of women who have given birth - Some that have bipolar or major depressive disorder, their symptoms may show a regular relationship with the season of the year (example – winter depression) - 11% of those surveyed have depression had the SAD subtype – with overall prevalence in the population of 3% of Canadians - There are higher rates of SAD in the Inuit that is related to melatonin production and circadian rhythms - Treatment may exposure to a therapeutic light for those suffering from SAD known as phototherapy Mood Disorders and Suicide - It is one of the top 3 causes of death in people between the age of 15 and 34 - Stats may underestimate the scope of the problem since many suicides are disguised as accidents - Suicide attempts may be outnumbered by complete suicides by a ratio of 20:1 - Women attempt suicide 3 times more often than men -