Psychological Disorders Chapter 14

Identifying Psychological Disorders: What Is Abnormal?

• Medical model: the conceptualization of psychological disorders as diseases that, like physical diseases, have biological causes, defined symptoms, and possible cures

– Diagnosis of symptoms underlying a syndrome

• DSM provides a reliable way of classifying (operationalizing) mental disorders: psychiatrists and psychologists all want to able to arrive at the same diagnosis. (Its validity is another issue).

Problems with DSM

• Strong medical orientation; only half of 290+ diagnoses have a concrete medical component.

– Can be misleading: causing overprescription of drugs and “victimization” of “I have depression.”

• Reification & naming something is not the same as explaining it.

• Labeling can be damaging: stigmatization, Rosenhan

study: “On Being Sane in Insane Places.”

Physiognomy and Phrenology

Classification of Disorders

• Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; 4th ed., text revision): 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 – Involves disturbances in behavior, thoughts, or emotions – Causes significant distress or impairment. – Stem from internal dysfunction (biological and/or

psychological). – Global Assessment of Functioning (GAF score) – Comorbidity: the co-occurrence of two or more disorders

in a single individual

Table 14.1 Main

DSM-IV-TR Categories of

Mental Disorders

Table 14.2 Global

Assessment of

Functioning (GAF) Scale

Figure 14.1 Comorbidity of Depression and Anxiety

Disorders

Causation of Disorders and the Dangers of Labeling

• An integrated perspective incorporates biological, psychological, and environmental factors.

• Different individuals may experience a similar psychological disorder for different reasons.

• Diathesis-stress model: suggests that a person may be predisposed for a mental disorder that remains unexpressed until triggered by stress

• The intervention-causation fallacy assumes treatment addresses the cause of the disorder. – The brain is likely not the only cause.

• Stigmas are likely attached to labeling people with psychological disorders. – Roughly 70% of sufferers do not seek treatment. – Education does not dispel the stigma. – May result in unnecessary incarceration – May lead to low self-esteem

The Diathesis Stress Model

Culture and Community

• Can people in different parts of the world have different mental disorders?

• The DSM-IV-TR includes a description of culture-bound syndromes that appear only in some cultures.

– Ataque de nervios, ghost sickness, koro, mal de ojo

Anxiety Disorders

Fears & Phobias

Obsessive Compulsive

Disorder

Generalized Anxiety Disorder

Panic Disorder

Anxiety Disorders and GAD

• Anxiety disorder: the class of mental disorder in which anxiety is the predominant feature – Anxiety can be adaptive or maladaptive, when it is

disproportionate to real threats and challenges.

• 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 – Roughly 5% of North Americans suffer

– Occurs more in lower SES groups

Phobic Disorders

• Phobic disorders: disorders characterized by marked, persistent, and excessive fear and avoidance of specific objects, activities, or situations – 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

– Social phobia: a disorder that involves an irrational fear of being publicly humiliated or embarrassed

• Preparedness theory: the idea that people are instinctively predisposed toward certain fears; proposed by Martin Seligman (1942- ) – Evolution, heritability, and temperament argue for biological

predispositions.

• Phobias can also be classically conditioned.

Phobias: Lifetime Prevalence

No Acrophobia Here

Panic Disorder

• Panic disorder: a disorder characterized by the sudden occurrence of multiple psychological and physiological symptoms that contribute to a feeling of stark terror; panic attacks – Approximately 22% of the U.S. population

reports having at least one panic attack.

• Agoraphobia: an extreme fear of venturing into public places; correlates with panic disorder

Obsessive Compulsives

Obsessions

Anxiety

Compulsions

Reduce

Obsessive-Compulsive 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

– Roughly 1.3% of the population suffers

– Moderate heritability

Mood Disorders and Depressive Disorders

• Mood disorders: mental disorders that have mood disturbances as their predominant feature

• Major depressive disorder: a disorder characterized by a severely depressed mood that lasts 2 wks. or more and is accompanied by feelings of worthlessness and lack of pleasure, lethargy, and sleep and appetite disturbances

• Dysthymia: a disorder that involves the same symptoms as in depression only less severe, but the symptoms last longer, persisting for at least 2 yrs

• Double depression: a moderately depressed mood that persists for at least 2 yrs. and is punctuated by periods of major depression

• Seasonal affective disorder: depression that involves recurrent depressive episodes in a seasonal pattern

• Women experience depression at twice the rate of men, as in postpartum depression

Gender & Depression

(Data from Kessler, et al., 1994)

Prognosis (1 year)

(APA Data, 1994)

Questions

• What is the difference between depression and sadness?

• Why do more women than men experience depression?

Biological and Psychological Factors

• Heritability estimates for major depression range from 33% to 45%.

• Depression may involve norepinephrine and serotonin, and/or diminished activity in the left prefrontal cortex and increased activity in the right prefrontal cortex.

• Aaron Beck (1921- ) noted dysfunctional attitudes and negative mood states in depressed individuals. – Helplessness theory: the idea that individuals who are

prone to depression automatically attribute negative experiences to causes that are internal, stable, and global

– Depressed individuals tend to have depressive biases in thinking and memory.

Figure 14.2 Brain and Depression

Seasonal Affective Disorder

(After Wurtman & Wurtman,1989)

The Real World: Suicide Risk and Prevention

• Suicide is the 11th leading cause of death in the U.S. (and third among high school and college students). – 50% of those who commit suicide do so during a depressive episode.

• There exist a variety of motives for suicide. – May be biological and/or “contagious” (the Werther effect)

• Prediction and prevention is difficult, however warning signs are abundant.

Suicide Attempts

Suicide Deaths

Suicide Methods

Suicide Methods

Bipolar Disorder

• Bipolar disorder: an unstable emotional condition characterized by cycles of abnormal, persistent high mood (mania) and low mood (depression) – Approximately 1.3% of people suffer – Rapid cycling bipolar disorder

• Bipolar disorder has the highest heritability (polygenic) among the psychological disorders.

• Biological causes (specific neurotransmitters) are difficult to substantiate.

• Stressful life experiences often precede episodes.

Dissociative Disorders: Going to Pieces

• Dissociative disorder: a condition in which normal cognitive processes are severely disjointed and fragmented, creating significant disruptions in memory, awareness, or personality that can vary in length from a matter of minutes to many years

• Dissociative identity disorder (DID): the presence within an individual of two or more distinct identities that at different times take control of the individual’s behavior – .5% - 1% of the population suffers; female to male prevalence 9:1

• Dissociative amnesia: the sudden loss of memory for significant personal information

• Dissociative fugue: the sudden loss of memory for one’s personal history, accompanied by an abrupt departure from home and the assumption of a new identity – Dissociative amnesia and fugue usually occur later in life and

memory loss may be temporary.

Schizophrenia: Losing the Grasp on Reality

• Schizophrenia: a disorder characterized by the profound disruption of basic psychological processes, a distorted perception of reality, altered or blunted emotion, and disturbances in though, motivation, and behavior – Occurs in about 1% of the population – Delusion: a patently false belief system, often bizarre and grandiose, that is

maintained in spite of its irrationality. – Hallucination: a false perceptual experience that has a compelling sense of

being real despite the absence of external stimulation – Disorganized speech: a severe disruption of verbal communication in which

ideas shift rapidly and incoherently from one to another unrelated topic – Grossly disorganized behavior: behavior that is inappropriate for the situation

or ineffective in attaining goals, often with specific motor disturbances • Catatonic behavior: a marked decrease in all movement or an increase in muscular

rigidity and overactivity

– Negative symptoms: emotional and social withdrawal, apathy, poverty of speech, and other indications of the absence or insufficiency of normal behavior, motivation, and emotion

• Subtypes include: paranoid, catatonic, disorganized, undifferentiated, and residual

Catatonic Schizophrenia

Table 14.3 Types of

Schizophrenia

Onset Timing

Period of greatest susceptibility

10 20 30 40 50

AGE

Biological and Psychological Factors

• Concordance rates increase greatly with biological relatedness.

• Prenatal and perinatal environments may also have effects.

• Dopamine hypothesis: the idea that schizophrenia involves an excess of dopamine activity – Effects and treatments related to neurotransmitters have

yet to be completely determined.

• Neuroimaging has revealed enlarged ventricles and progressive tissue loss in many cases of schizophrenia.

• Disturbed family environment may affect development and recovery of schizophrenia.

Incidence

Strikes 1/100

Schizophrenic (1%)

Figure 14.3 Average Risk of Developing Schizophrenia

Figure 14.4 Enlarged Ventricles in Schizophrenia

Hot Science: Autism and Childhood Disorders

• Early onset disorders are recognized in the DSM, and some resolve into adulthood while others do not.

• Autistic disorder involves abnormal or impaired development of communication and social interaction, and a markedly restricted repertoire of activities/interest. – Recent increased prevalence

• Variations of the disorder lie along a spectrum, including Asperger’s syndrome.

• Individuals with the disorder may display unique, gifted talents. – Temple Grandin as an example

Personality Disorders: Going to Extremes

• Personality disorder: disorder characterized by deeply ingrained, inflexible patterns of thinking, feeling, or relating to others or controlling impulses that cause distress or impaired functioning – Organized into three clusters: odd/eccentric,

dramatic/erratic, and anxious/inhibited

– 14.8% of the population has a personality disorder.

– Common feature is failure to take others’ perspectives

• Diagnosis is controversial and complicated.

• Peer nomination measures may be more valid assessments.

Table 14.4 Clusters of Personality Disorders

Antisocial Personality Disorder

• Antisocial personality disorder(APD): a pervasive pattern of disregard for and violation of the rights of others that begins in childhood or early adolescence and continues into adulthood – 3.6% of the population suffers; males outnumber females

3:1 – Individuals typically have a history of conduct disorder and

many commit crimes.

• Sociopathology and psychopathology describe people with APD.

• Newer theories suggest internal (biological) causes. – Less sensitive to fear in the brain.

Antisocial Personality Disorder

Marked by a lack of empathy, chronic underarousal, willingness to lie, cheat, steal, and break the law

Where Do You Stand: Genetic Tests for Risk of Psychological Disorders

• In the future, diagnosis of potential psychological disorders may be as simple as providing a saliva sample.

• A genetic diagnosis may provide a nice explanation for a yet unlabelled problem.

• Would you want to know about a predisposition even if it never manifests? This could present added stress or a self-fulfilling prophecy.

Thomas Szasz:

The Myth of Mental Illness

• The concept of "mental illness" is a myth; i.e., these do not exist in reality, but only as a type of explanation for abnormal behavior

• ."Abnormal" behavior is a normative judgment: the only consistent definition of abnormality is one that refers to the average members of a community as a frame of

reference.

The Myth of Mental Illness

• People behave abnormally because either they CANNOT abide by cultural norms, or they CHOOSE not to abide by these norms.

• .The concept of mental illness is incorrect for two reasons:

• ."problems in living" do not have a medical cause, hence are not illnesses, even though such problems may result in physiological changes (eg., stress).

• .reification of mind; mind/body dualism is a false dichotomy: a disease of the brain may have psychological effects, but that does not mean the mind is some separate thing that has diseases.

The Myth of Mental Illness

• Szasz also asks "Whose agent is the psychiatrist?"---on whose behalf is the therapist acting? The client/patient, the community, the medical profession, the government?

• .Szasz argues that psychiatry and psychology should be concerned with problems in living NOT ‘illness’ per se.

• .The concept of mental illness is harmful and unethical, in so far as it is used as a rationale for medical treatments and institutionalization