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Chapter 14

PSY 0010 Chapter 14: Psychological Disorders

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PSY 0010
Jennifer Cousins

Psychological Disorders  Mental disorder: a persistent disturbance or dysfunction in behavior, thoughts, or emotions that causes significant distress or impairment  People with mental disorders have problems with their perception, memory, learning, emotion, motivation, thinking, and social processes  In many societies, people with psychological disorders have been feared and ridiculed, and often they were treated as criminals who were punished, imprisoned, or put to death for their “crime” of deviating from the normal  Over the past 200 years ways of looking at psychological abnormalities have mostly been replaced by a medical model o Medical model: abnormal psychological experiences are conceptualized as illnesses that, like physical illnesses, have biological and environmental causes, defined symptoms, and possible cures  First step in conceptualizing abnormal thoughts and behaviors as illness is through diagnosis o In diagnosis, clinicians seek to determine the nature of a person’s mental disorder by assessing signs and symptoms that suggest an underlying illness  Signs: objectively observed indicators of a disorder  Symptoms: subjectively reported behaviors, thoughts, and emotions  Disorder: common set of signs and symptoms  Disease: a known pathological process affecting the body  Diagnosis: a determination as to whether a disorder or disease is present  Knowing that a disorder is present does not necessarily mean that we know the underlying disease process in the body that gives rise to the signs and symptoms of the disorder  Diagnostic and Statistical Manual of Mental Disorders (DSM): a classification system that describes the features used to diagnose each recognized mental disorder and indicates how the disorder can be distinguished from other, similar problems o Each disorder is named and classified as a distinct illness  The use of these detailed lists of symptoms for each of more than 200 disorders listed led to a dramatic increase in the reliability/consistency in diagnosing mental disorders  Comorbidity: the co-occurrence of two or more disorders in a single individual  The medical model for mental disorders suggests that knowing a person’s diagnosis is useful because any given category of mental illness is likely to have a distinctive cause  The medical model also suggests that each category of mental disorder is likely to have a common prognosis o Prognosis: a typical course over time and susceptibility to treatment and cure Disorder: Description: Neurodevelopment Disorders These are conditions that begin early in development and cause significant impairments in functioning, such as intellectual disability, autism spectrum disorder, and attention- deficient/hyperactivity disorder Schizophrenia Spectrum and Other This is a group of disorders characterized by major disturbances in Psychotic Disorders perception, thought, language, emotion, and behavior Bipolar and Related Disorders These disorders include major fluctuations in mood – from mania to depression – and can include psychotic experiences, which is why they are placed between the psychotic and depressive disorders in DSM-5 Depressive Disorders These are conditions characterized by extreme and persistent periods of depressive mood Anxiety Disorders These are conditions characterized by excessive fear and anxiety that are extreme enough to impair a person’s functioning, such as panic disorder, generalized anxiety disorder, and specific phobia Obsessive-Compulsive and Related These are conditions characterized by the presence of obsessive Disorders thinking followed by compulsive behavior in response to that thinking Trauma – and Stressor-Related These are disorders that develop in response to a traumatic event, Disorders such as posttraumatic stress disorder Dissociative Disorders These are conditions characterized by disruptions or discontinuity in consciousness, memory, or identity, such as dissociative identity disorders (formerly called “multiple personality disorder”) Somatic Symptom and Related These are conditions in which a person experiences bodily Disorders symptoms associated with significant distress or impairment Feeding and Eating Disorders These are problems with eating that impair health or functioning, such as anorexia nervosa or bulimia nervosa Elimination Disorders These involve inappropriate elimination of urine or feces Sleep-Wake Disorders These are problems with the sleep-wake cycle, such as insomnia, narcolepsy, and sleep apnea Sexual Dysfunctions These are problems related to unsatisfactory sexual activity, such as erectile disorder and premature ejaculation Gender Dysphoria This is a single disorder characterized by incongruence between a person’s experienced/expressed gender and assigned gender Disruptive, Impulse-Control, and These are conditions involving problems controlling emotions and Conduct Disorders behaviors, such as conduct disorder, intermittent explosive disorder, and kleptomania Substance-Related and Addictive This collection of disorders involves persistent use of substances or Disorders some other behavior despite the fact that such behavior leads to significant problems Neurocognitive Disorders These are disorders of thinking caused by conditions such as Alzheimer’s disease or traumatic brain injury Personality Disorders These are enduring patterns of thinking, feeling, and behaving that lead to significant life problems Paraphilic Disorders These are conditions characterized by inappropriate sexual activity, such as pedophilic disorder Other Mental Disorders This is a residual category for conditions that do not fit into one of the above categories but that are associated with significant distress or impairment, such as unspecified mental disorder due to a medical condition Medication-Induced Movement These are problems with physical movement that are caused by Disorders and Other Adverse Effects medication on Medication Other Conditions that May be the These include problems related to abuse, neglect, relationship, or Focus of Clinical Attention other problems  Most psychologists take an integrated biopsychosocial perspective o Biopsychosocial perspective: explains mental disorders as the result of interactions among biological, psychological, and social factors  On the biological side, the focus is on genetic and epigenetic influences, biochemical imbalances, and abnormalities in brain structure and function  The psychological perspective focuses on maladaptive learning and coping, cognitive biases, dysfunctional attitudes, and interpersonal problems  Social factors include poor socialization, stressful life experiences, and cultural and social inequities  The complexity of causation suggests that different individuals can experience a similar mental disorder for different reasons o Multiple causes means there may not be a single cure  The observation that most disorders have both internal (biological and psychological) and external (environmental) causes have given rise to a theory known as the diathesis-stress model o Diathesis-stress model: suggests that a person may be predisposed for a psychological disorder that remains unexpressed until triggered by stress  Internal predisposition  The stress is the external trigger  Although diatheses can be inherited, it’s important to remember that heritability is not destiny o A person who inherits a diathesis may never encounter the precipitating stress, whereas someone with little genetic propensity to a disorder may still come to suffer from such a disorder given the right pattern of stress  Research Domain Criteria Project (RDoC): a new initiative that aims to guide the classification and understanding of mental disorders by revealing the basic process that give rise to them  Through the RDoC approach, the National Institutes of Mental Health (NIMH) would like to shift researchers away from studying currently defined diathesis-stress model (DMS) categories and toward the study of the dimensional biopsychosocial processes believed, at the extreme end of the continuum, to lead to mental disorders o The long-term goal is to better understand what abnormalities cause different disorders, and to classify disorders based on those underlying causes, rather than on observed symptoms  The RDoC approach similarly aims to shift the focus away from classifying based on surface symptoms and toward an understanding of the processes that give rise to disordered behavior  An important complication in the diagnosis and classification of psychological disorders is the effect of labeling o Psychiatric labels can have negative consequences because many labels carry the baggage of negative stereotypes and stigma, such as the idea that mental disorder is a sign of personal the idea that psychiatric patients are weakness or the idea that psychiatric patients are dangerous  The stigma associated with mental disorders may explain why most people with diagnosable psychological disorders do not seek treatment  Labeling may even affect how labeled individuals view themselves not just as mentally disordered, but as hopeless or worthless o Such a view may cause them to develop an attitude of defeat and, as a result, to fail to work toward their own recovery  Pathological anxiety is expressed as an anxiety disorder o Anxiety disorder: the class of mental disorder in which anxiety is the predominant feature  Among the anxiety disorders recognized in the DSM-5 are phobic disorders, panic disorder, and generalized anxiety disorder  Claustrophobia: an intense fear of enclosed spaces  Phobic disorders: disorders characterized by marked, persistent, and excessive fear and avoidance of specific objects, activities, or situations o An individual with a phobic disorder recognizes that the fear is irrational but cannot prevent it from interfering with everyday functioning  Specific phobia: a disorder that involves an irrational fear of a particular object or situation that markedly interferes with an individual’s ability to function o Specific phobias fall into 5 categories:  Animals  Natural environments  Situations  Blood, injections, or injury  Other phobias, including, choking, or vomiting, and in children, loud noises or costumed characters  Social phobia: a disorder that involves an irrational fear of being publicly humiliated or embarrassed o 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 o Individuals with social phobia try to avoid situations in which unfamiliar people might evaluate them, and such individuals experience intense anxiety and distress when public exposure is unavoidable  Social phobia can develop in childhood, but it typically emerges between early adolescence and early adulthood  The high rates of both specific and social phobias suggest a predisposition to be fearful of certain objects and situations  Preparedness theory: the idea that people are instinctively predisposed toward certain fears o 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 or toy rabbits  Abnormalities in the neurotransmitters serotonin and dopamine are more common in individuals who report phobias than among people who don’t o Individuals with phobias sometimes show abnormally high levels of activity in the amygdala, an area of the brain linked with the development of emotional associations  Social phobia may be due to a person’s subjective experience of the situation rather than an abnormal physiological stress response to such situations o Does not rule out the influence of environments and upbringings on the development of phobic overreactions  Phobias can be classically conditioned  The idea that phobias are learned from emotional experiences with feared objects however, is not a complete explanation for the occurrence of phobias  Panic disorder: a disorder characterized by the sudden occurrence of multiple psychological symptoms that contribute to a feeling of stark terror o The acute symptoms of a panic attack typically last only a few minutes and include shortness of breath, heart palpitations, sweating, dizziness, depersonalization, or derealization, and a fear that one is going crazy or about to die  Because mant of the symptoms mimic various medical disorders, a correct diagnosis may take years in spite of costly medical tests that produce normal results  A common complication of panic disorder is agoraphobia o Agoraphobia: a specific phobia involving the fear of public places  Not afraid of public places, but more of having a panic attack in a public place  Panic disorder is more prevalent among women than men  Generalized anxiety disorder (GAD): a disorder characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance o Called generalized because the unrelenting worries are not focused on any particular threat o The uncontrollable worrying produces a sense of loss of control that can so erode self- confidence that simple decisions seem fraught with dire consequences  Women experience GAD more frequently than men o Biological explanations of GAD suggest that neurotransmitter imbalances may play a role in the disorder o Benzodiazepines that appear to stimulate the neurotransmitter gamma-aminobutyric acid (GABA) can sometimes reduce the symptoms of GAD, suggesting a potential role for this neurotransmitter in the occurrence of GAD  Benzodiazepines: a class of sedative drugs  Many people who might be expected to develop GAD don’t, supporting the diathesis-stress notion that personal vulnerability must also be a key factor in this disorder  Obsessive-compulsive disorder (OCD): a disorder in which repetitive, intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) designed to fend off those thoughts interfere significantly with an individual’s functioning o Anxiety plays a big role in this disorder because the obsessive thoughts typically produce anxiety, and the compulsive behaviors are performed to reduce it o In OCD the obsessions and compulsions are intense, frequent, and experienced as irrational and excessive  OCD is classified separately from anxiety disorders because this disorder and the anxiety disorders are believed to have distinct causes and to be maintained via different neural circuitries in the brain  The obsessions that plague individuals with OCD typically derive from concerns that could pose a real threat, which supports preparedness theory  People with OCD often respond favorably to psychotherapy and show a corresponding rduction in activity in the caudate nucleus  Psychological reactions to stress can lead to a class of mental disorders that the DSM-5 categorizes as “Trauma-and-Stress-Related Disorders”  Posttraumatic stress disorder (PTSD): a disorder characterized by chronic physiological arousal, recurrent unwanted thoughts or images of the trauma, and avoidance of things that call the traumatic event to mind o Psychological scars left by traumatic events are nowhere more apparent than in war o Many soldiers returning from combat will experience symptoms including flashbacks of battle, exaggerated anxiety and startle reactions, and even medical conditions that do not arise from physical damage  Most of these symptoms are normal, appropriate responses to horrifying events, and for most people, the symptoms subside with time  Not everyone who is exposed to a traumatic event develops PTSD, suggesting that people differ in their degree of sensitivity to trauma  Those with PTSD show: o heightened activity in the amygdala  a region associated with the evaluation of threatening information and fear conditioning o decreased activity in the medial prefrontal cortex  a region important in the extinction of fear conditioning o a smaller sized hippocampus  the part of the brain most linked with memory  mood disorders: mental disorders that have mood disturbance as their predominant feature o depression (unipolar disorder) o bipolar disorder (so named because people go from one end of the emotional pole to the other [extreme depression to extreme mania])  major depressive disorder (unipolar depression): “depression” a disorder characterized by a severely depressed mood and/or inability to experience pleasure that lasts 2 or more weeks and is accompanied by feelings of worthlessness, lethargy, and sleep and appetite disturbance  seasonal affective disorder (SAD): recurrent depressive episodes in a seasonal pattern o in most cases, the episodes begin in fall or winter and remit in spring, and this pattern is due to reduced levels of light over the colder seasons o the rate of depression is much higher in women than in men  socioeconomic standing  lower incomes  poverty  sex differences in hormones  greater willingness by women to face their depression and seek out help  higher rates of diagnosis  researchers noticed that drugs that increased levels of the neurotransmitters norepinephrine and serotonin could sometimes reduce depression o depression might be caused by depletion of those neurotransmitters  drugs like Prozac and Zoloft increase the availability or serotonin in the brain  cognitive model of depression: states that biases in how information is attended to, processed, and remembered lead to and maintain depression o researchers proposed a theory of depression that emphasizes the role of people’s negative
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