Ch #15: Psychological Disorders

Question 1

Historical Changes in Mental Health Conceptions
Middle ages (5th to 15th century)

Answer 1

Mental health difficulties attributed to moral retribution, divine intervention and diabolical possession (Demonic Model).
Demonic Model: View of mental illness in which odd behavior, hearing voices, or talking to oneself was attributed to evil spirits infesting the body

Question 2

Renaissance (14th-17th Centuries)

Answer 2

Mental health difficulties can be reversable.
Medical model: Perception that regarded mental illness as being due to a physical disorder requiring medical treatment

Question 3

Enlightenment Era (17th @ 18th Century)

Answer 3

Increased empathy and humane treatments.
Moral treatment was established, which focused on treating those with mental illness with dignity, kindness, and respect

Question 4

19th Century

Answer 4

Improved training and medical treatments, introduction of scientific mental health journals, training programs for physicians and nurses, psychoanalysis.

Question 5

20th Century

Answer 5

Introduction of pharmacological treatments after WW2, De-institutionalization policies, DSM-1 introduced in 1952, Behavioural therapy and cognitive behavioural therapy.
Governmental policy in the 1960s and 1970s that focused on releasing hospitalized psychiatric patients into the community and closing mental hospitals.

Question 6

Statistical Rarity

Answer 6

Cannot rely on statistical rarity to define mental disorder because not all infrequent conditions are pathological (caused by physical/mental disease)

Question 7

Subjective Distress

Answer 7

Most mental disorders, including mood and anxiety disorders, produce emotional pain for individuals afflicted with them. But not all psychological disorders generate distress.

Question 8

Impairment

Answer 8

Most mental disorders interfere with people’s ability to function in everyday life (hurt relationships and jobs). Yet the presence of impairment by itself can’t define mental illness because some conditions, like laziness, can produce impairment but aren’t mental disorders.

Question 9

Biological Dysfunction

Answer 9

Mental Disorders probably result from breakdowns or failures of physiological systems.
Mental disorders, appear to be acquired largely through learning experiences and often require only a weak genetic predisposition to trigger them.

Question 10

DSM-5-TR: Definition of a Mental Disorder

Answer 10

1.Defined as a “clinically significant disturbance” in cognition, emotions regulation and/or behavior.
2.The consequences of which are clinically significant distress or disability - Distress: Painful symptom; Disability: Impairment in one or more important areas of functioning.
3.Must not be merely an expectable response to common stressors or culturally sanctioned response to an event.
4.Reflects an underlying psychological or mental dysfunction
5.Not solely a result of social deviance or conflict with society, unless it results in individual dysfunction.
6.Has diagnostic validity using one or more sets of diagnostic validators. - Prognostic significance, psychobiological disruption, and response to treatment.
7.Has clinical utility - Contributes to better conceptualization of diagnoses, or to better assessment and treatment

Question 11

Physical disorders

Answer 11

based on cluster of symptoms, often a clear etiological (causal) path, often clear physical marker identified in X-ray, lab tests, or scans.

Question 12

Mental disorders

Answer 12

based on cluster of symptoms, etiology (cause) less clear, no clear physical markers for most disorders (except some neurological conditions)

Question 13

Limitations with DSM-5 definition

Answer 13

1.Medical approach to mental health problems
2.Comorbidity: Co-occurrence of two or more diagnoses within the same person
3.Underlying cause can be unknown
4.Relational nature of many disorders
5.Role of social-cultural surroundings

Question 14

Culture-bound syndrome

Answer 14

Psychologist have increasingly recognized that certain conditions are culture-bound, that is specific to one or more societies.
-People in individualistic cultures worry more about what will happen to them as individuals compared to those in collectivist cultures.
-eating disorders are most prevalent in Canada, United States, and Europe, wherein the media focuses more on “thin” body-types.

Question 15

Cultural Universality

Answer 15

Many mental disorders, especially those that are severe, appear to exist in most and perhaps all cultures.
Tribes with no contact to the Western societies, but have developed similar terms to describe disorders.
EX: developmental disabilities, mood disorders, addiction and psychotic disorders

Question 16

Psychiatric diagnoses serve at least two crucial functions

Answer 16

1.Pinpoint the psychological problem a person is experiencing. Once we’ve identified this problem. it’s often easier to select a treatment
2.Psychiatric diagnoses make it easier for mental health professionals to communicate. When a patient is diagnosed by a psychologist it is certain that other psychologist know the patient’s principal symptoms.

Question 17

Labelling theorist

Answer 17

Scholars who argue that psychiatric diagnoses exert powerful negative effects on people’s perceptions and behaviors

Question 18

Diagnostic and Statistical Manual of Mental disorders (DSM)

Answer 18

Diagnostic system containing the American Psychiatric Association (APA) criteria for mental disorders

Question 19

DSM-5 Prevalence

Answer 19

Percentage of people within a population who have a specific mental disorder

Question 20

Categorical model

Answer 20

model in which a mental disorder differs from normal functioning in kind rather than degree (negative)

Question 21

Dimensional model

Answer 21

model in which a mental disorder differs from normal functioning in degree rather than kind

Question 22

Medicalize normality

Answer 22

to classify relatively mild psychological disturbances as pathological

Question 23

Involuntary commitment

Answer 23

procedure of placing some people with mental illnesses in a psychiatric hospital or other facility based on their potential danger to themselves or others, or their inability to care for themselves

Question 24

Anxiety

Answer 24

an emotional state of psychological distress that reflects emotional, behavioral, physiological, and cognitive reactions to threatening stimuli

Question 25

Fear

Answer 25

A behavioural and physiological reaction to an immediate threat, in which the person responds by means of confrontation or escape

Question 26

Worry

Answer 26

A cognitive response to a threat in which the person considers and prepares for future dangers or misfortune

Question 27

somatic symptom disorder

Answer 27

condition marked by physical symptoms that suggest an underlying medical illness, but that are actually psychological in origin

Question 28

illness anxiety disorder

Answer 28

an individual’s continual preoccupation with the notion that they have a serious physical disease

another new diagnosis that is similar to what was previously called hypochondriasis), people become so preoccupied with the idea that they’re suffering from a serious undiagnosed illness that no amount of reassurance can relieve their anxiety.

Question 29

Generalized anxiety disorder (GAD)

Answer 29

continual feelings of worry, anxiety, physical tension, and irritability across many area of life functioning. Persistent worry about a number of events or things that is: -difficult to control, occurs more days than not, present for a least 6-months, associated with restlessness, and/or sleep problems, causes sever distress and/or life impairment.

Question 30

Panic attacks

Answer 30

brief, intense episodes of extreme fear characterized by sweating, dizziness, light-headedness, racing heartbeat, and feelings of impending death or going crazy
-can occur by itself or in the context of an anxiety disorder

Question 31

panic disorder

Answer 31

repeated and unexpected panic attacks, along with either persistent concerns about future attacks or a change in personal behavior in an attempt to avoid them

Question 32

Diagnosis of Panic Disorder

Answer 32

1.to merit a diagnosis, a person must have recurrent and unexpected panic attacks followed by: - a persistent concern over having another panic attack. - worry about the implications of the panic attack, - a significant change in daily routines owing to the fear and/or experiences of panic attacks
2.A person is only diagnosed with panic disorder if it causes significant distress or impairment.

Question 33

Phobia

Answer 33

intense fear of an object or situation that’s greatly out of proportion to its actual threat. Persists for at least 6 months and causes distress or impairment

Question 34

Symptoms of Specific Phobias

Answer 34

• extreme pain manifested in racing heartbeat, shallow breathing, sweaty palms, dizziness, and other bodily symptoms
• Younger children with specific phobia might cry, throw tantrums, freeze or cling to their parents excessively
• people with a specific phobia may start avoiding situations that may cause fear
• fears are usually out of proportion in correspondence to the actual danger brought by the external stimuli

Question 35

Agoraphobia

Answer 35

fear of being in a place or situation from which escape is difficult or embarrassing, or in which help is unavailable in the event of a panic attack

Question 36

symptoms and effects of agoraphobia

Answer 36

• people with agoraphobia tend to avoid public places (e.g., shopping malls) or any other place where exit is difficult (e.g., airplanes).
• panic-like symptoms
• agoraphobia leads to avoidance of feared situations
• agoraphobia restricts people’s social and educational functioning by limiting their ability to attend school and work

Question 37

Social anxiety disorder

Answer 37

intense fear or negative evaluation in social situations. Characterized by marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.
- feared situations may include any social setting where they might be judged, criticized, or negatively evaluated.
- may involve fear of social and/or performance related situations
- lasts as least 6 months and causes distress or impairment
- usually not diagnosed before the age of 10

Question 38

Two process theory of anxiety and phobias
Combines classic conditioning and operant conditioning processes:

Answer 38

1.People acquire phobias by means of classical conditioning
EX: associating giving a class presentation with humiliation.
2.Negative reinforcement of phobia: once the phobia is established, people begin avoiding their feared stimulus.
EX: by avoiding doing the presentation, they experience a reduction in the anxiety that negatively reinforces their fear.

Question 39

catastrophize

Answer 39

people catastrophize when they try to predict terrible or unpleasant events, despite the low probability of these events.

Question 40

Anxiety sensitivity

Answer 40

people with anxiety disorders harbor high levels of anxiety or concern about anxiety-related sensations
- being preoccupied and/or highly sensitive to feelings of stress or discomfort

Question 41

Ambiguity bias

Answer 41

individuals with anxiety problems often interpret ambiguous situations negatively

Question 42

Anxiety: Biological influences

Answer 42

Numerous twin studies show that many anxiety disorders, including panic disorders and phobias, are genetically influenced
Genes affect whether we inherit high levels of neuroticism, which can set the stage for excessive worry.
Family studies show that people with OCD are twice as likely as people without OCD to inherit a specific overactive gene

Question 43

Post-traumatic stress disorder (PTSD)

Answer 43

marked emotional disturbances after experiencing or witnessing a severely stressful event (death of a loved one, serious injury)
Characterized by:
1.Intrusive symptoms
2.avoidance of stimuli associated with the event
3.negative alterations in thoughts or mood
4.alterations in arousal and reactivity that cause distress or impairment, and last at least 1 month

Question 44

Obsessive-Compulsive disorder (OCD)

Answer 44

condition marked by repeated and lengthy (at least one hour per day) immersion in obsessions, compulsions, or both.

Question 45

Obsessions

Answer 45

persistent idea, thought, or impulse that is unwanted and inappropriate, causing marked distress
They usually centre on “unacceptable” thoughts about such topics as contamination, sex, aggression, or religion

Question 46

Compulsions

Answer 46

repetitive behavior or mental act performed to reduce or prevent stress. Individual feels driven to perform in response to an obsession or according to specific and inflexible rules.

Question 47

Major Depressive Disorder (MDD)

Answer 47

Characterized by depressed mood, anhedonia (i.e., loss of pleasure), and other indicators of dysphoria (i.e., feeling of uneasiness and dissatisfaction) that:
1.last for at least 2 weeks
2.cause significant distress or impairment

Question 48

Two primary symptoms of MDD

Answer 48

1.depressed or irritable mood
2.a diminished interest or pleasure in most activities

Question 49

Persistent Depressive Disorder (also called Dysthymia)

Answer 49

Characterized by chronically depressed and/or irritable mood for at least 1 year in children OR 2 years in adults that results in significant distress or impairment.
Other features of the disorder include:
- sleep problems
- overeating or loos of appetite
- decreased energy
- low self-esteem
- poor concentration
- feelings of hopelessness

Question 50

Risk factors for Depression

Answer 50

1. Stressful life events
2. Response-contingent positive reinforcement
   - People may cope with negative experiences by avoiding or withdrawing from potentially pleasant activities
3. Negative attributions
   Learned helplessness: tendency to feel helpless in the face of events we can’t control
   Negative attribution style: the tendency to attribute negative events to internal, stable, and global factors. Positive events are attributed to external, unstable, and situational factors.
4. Cognitive biases and maladaptive thinking (Beck’s Cognitive Theory of Depression)
   - automatic thoughts
   - cognitive biases
   - cognitive distortions

Question 51

Depression: The role of biology

Answer 51

Depression is often associated with low levels of the neurotransmitter serotonin.

People who inherit two copies of a stress-sensitive gene are two and a half time more likely to develop depression following stressful events than people with another version of the gene that is not sensitive to stress.

Many patients with depression have decreased levels of dopamine, the neurotransmitter most closely tied to reward.

Question 52

Bipolar Disorder

Answer 52

Occurs when a person experiences intense emotional states (also called mood episodes) that typically occur during distinct periods of days to weeks.
- A history of at least one manic episode
- Some people have episodes separated by many years and then have series of episodes, one rapidly following the other

Question 53

Manic Episode

Answer 53

experience marked by dramatically elevated mood, decreased need for sleep, increased energy, inflated self-esteem, increased talkativeness, and irresponsible behavior

Question 54

Hypomania episode

Answer 54

less severe manic episodes that last only 4 days in a row, rather than 1 week.

Question 55

Depressive Episode

Answer 55

Person experiences symptoms associated with a major depressive episode (e.g., prolonged sadness, despair and fatigue)

Question 56

Biological Risk Factors for Bipolar Disorder

Answer 56

Twin studies suggest that Bipolar Disorder heritability may be as high as 85%

Stressful life events are associated with an increased risk of manic episodes, more frequent relapse, and a longer recovery from episodes

Question 57

Brain imaging studies suggest that people with bipolar disorder experience

Answer 57

Increased activity in structures related to emotion (amygdala).
Decreased activity in structures associated with planning, such as the prefrontal cortex

Question 58

Suicidal self-injury

Answer 58

any action that is self-inflicted and results in injury or the potential for injury, with an intent to die,
- suicide is the second leading cause of death among children and adolescents in the United States, with approximately 7 per 10,000 youth dying by suicide annually

Question 59

Non-suicidal self-injury (NSSI)

Answer 59

any action that is self-inflicted and results in injury or potential for injury, but without intent to die.

Question 60

Risk Factors for Self-harm

Answer 60

1. History of suicidal or self-harm thoughts/behaviors
2. Mental health and substance use problems
   - approximately one-third of children and adolescents with bipolar disorder report a suicide attempt
3. Psychosocial stressors and family problems
   - relationship problems with a parent, friend or romantic relationship
   - school-related problems
   - parents who engage in self-harm behaviors
4. Gender Differences
   - Adolescent girls are twice as likely as boys to have suicidal thoughts or make plans, and three times as likely than boys to attempt suicide.
   - boys are twice as likely as girls to die from suicide because boys select more lethal strategies.

Question 61

Interpersonal-psychological theory of suicide

Answer 61

Perceived burdensomeness - I’m a burden on my parents

Thwarted belongingness - no one cares about me

Capability for suicide - I’m not afraid to die

Question 62

Personality disorders

Answer 62

condition in which personality traits, appearing first in adolescence, are inflexible, stable, expressed in a wide variety of situations, and lead to distress or impairment
When a person’s way of thinking, feeling and behaving deviates significantly from the expectations of their culture and causes:
- distress
- problems functioning
- social conflicts
- maladaptive behaviors

The challenges last for long-periods of time.
- onset usually in adolescence or early adulthood
- problems may first be observed in childhood

Question 63

Borderline Personality Disorder

Answer 63

condition marked by extreme instability in mood, identity, and impulse control.
Tend to be extremely impulsive and unpredictable

Question 64

explanations of borderline personality disorder

Answer 64

traced the roots of BPD to childhood problems with developing a sense of self and bonding emotionally to others.

Question 65

Antisocial Personality Disorder

Answer 65

condition marked by a lengthy history of irresponsible and/or illegal actions
- have a prior diagnosis of conduct disorder

Common signs and symptoms
- exploitation of others
- deceitfulness
- impulsivity
- aggressiveness
- reckless disregard for the safety of self and others, and irresponsibility
- lack of guilt, remorse , and empathy

Question 66

Psychopathy

Answer 66

a personality disorder defined by a collection of interpersonal, affective, and behavioral characteristics.
EX. Manipulation, lack of remorse or empathy, impulsivity, and antisocial behaviors

Most people with psychopathic disorder are not physically aggressive, yet they are at heightened risk for crime compared to the average person
- people with psychopathic personalities are fully aware that their irresponsible actions are morally wrong

Question 67

Psychopathic personality

Answer 67

condition marked by superficial charm, dishonesty, manipulativeness, self-centredness, and risk-taking

Question 68

Antisocial Personality Disorder vs. Psychopathy

Answer 68

Almost all psychopathic offenders can be classified as having ASPD
Most offenders diagnosed with ASPD are not psychopaths
Psychopathy is sometimes considered a severe form of ASPD

Question 69

Dissociative disorders

Answer 69

condition involving disruptions in consciousness, memory, identity, or perception

Question 70

Depersonalization/derealization disorder

Answer 70

condition marked by multiple episodes of depersonalization

Question 71

Depersonalization

Answer 71

feeling like you are observing your own self or living in a dream or movie

Question 72

Derealization

Answer 72

sense that the external world is strange or unreal

Question 73

Dissociative Amnesia

Answer 73

inability to recall important personal information - most often related to a stressful experience - that can’t be explained by ordinary forgetfulness

Question 74

Dissociative fugue

Answer 74

sudden, unexpected travel away from home or the workplace, accompanied by amnesia for significant life events
- often diagnosed when adults report gaps in their memories of childhood abuse
- controversial diagnosis as some people may choose not to recall specific memories or experiences
- may be impacted by head injuries or neurological disease

Question 75

Dissociative Identity Disorder (DID)

Answer 75

condition characterized by the presence of two or more distinct personality states that recurrently take control of the person’s behavior
- these alternate personality states (or “alters”) are often different from the primary or “host” personality.
- females are more likely to receive a DID diagnosis and report more alters than males
- researchers have identified intriguing differences among alters in their respiration rates, brain activity, handedness, skin conductance responses, voice patterns, and handwriting.

Question 76

Possible explanations for DID Posttraumatic model

Answer 76

a history of childhood abuse leads individuals to “compartmentalize” their identity into alters as a means of coping with intense pain.
researchers have not shown that early abuse is specific to DID, as it is present in many other disorders

Question 77

Socio-cognitive model

Answer 77

• argues that people’s expectancies and beliefs account for the origin and maintenance of DID
• the socio-cognitive model holds that the popular media have played a pivotal role in the DID epidemic
• Many individuals do not show DID prior to commencing psychotherapy. Techniques, such as hypnosis, can cause people to experience altered states and identities

Question 78

Schizophrenia

Answer 78

severe disorders of thought and emotion associated with a loss of contact with reality

Question 79

Delusions

Answer 79

strongly held, fixed belief that has not basis in reality (feeling persecuted against or paranoid)

Question 80

Hallucinations

Answer 80

sensory perceptions that occur in the absence of external stimuli
- they can auditory, olfactory, gustatory, tactile, or visual

Question 81

command hallucination

Answer 81

which tell patients what to do, may be associated with a heightened risk of violence toward others

Question 82

disorganized speech

Answer 82

language that skips from topic-to-topic results and/or is incomprehensible

Question 83

disorganized behavior

Answer 83

occurs when self-care, personal hygiene, and motivation often deteriorate

Question 84

catatonic symptoms

Answer 84

motor problems, including extreme resistance to complying with simple suggestions, holding the body in bizarre or rigid posture, or curling up in a fetal position

Question 85

risk factors for schizophrenia: diathesis-stress models

Answer 85

proposes that it is the interaction between genetic vulnerability (diathesis) and stressors that triggers illness.
- high genetic risk factors
- brain structure indicators (enlarged ventricles)
- neurotransmitter differences also found, such as abnormalities in dopamine, glutamate, serotonin and norepinephrine receptors that impact awareness, mood, reward-systems and movement

early warning signs:
- social withdrawal
- thought and movement problems
- lack of emotions
- decreased eye contact

Question 86

Autism spectrum disorders

Answer 86

1.persistent deficits in reciprocal social communication and social interaction
2. restricted, repetitive patterns of behavior, interest, or activities

these symptoms are present in early childhood and impair everyday functioning

deficits may be in verbal communication or with expressive/receptive language
- children’s language skills need not be impaired to be diagnosed with ASD

Question 87

Restricted/repetitive behaviors, interest or activities

Answer 87

stereotypes of repetitive behaviors including speech, movements, or use of objects

excessive adherence to routines or resistance to change

restricted and/or fixated interests.

unusually high or low sensitivity to sensory input

Question 88

ASD symptoms

Answer 88

1. Echolalia: Repeating words or phrases that they hear
2. complex ritualistic and/or compulsive behaviors
3. need for rigid structure and routine
4. cognitive rigidity
5. fascination with idiosyncratic interests and topics

Question 89

Attention deficit/hyperactivity disorder

Answer 89

childhood condition marked by excessive inattention, impulsivity, and activity
Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by

Question 90

Inattention

Answer 90

(6 or more symptoms)
Distractibility, sustaining attention, listening and organization challenges, forgetfulness (losing things), reluctance to engage in tasks that require sustain effort

Question 91

hyperactivity and impulsivity

Answer 91

(6 or more symptoms)
restlessness (fidgety), difficulty staying seated, overly energetic, excessive talking, interrupting others, difficulty waiting turn, careless errors etc..

Question 92

Criteria for ADHD

Answer 92

1.Symptoms must persists for at least for 6-moths
2. clear evidence of interference on life (reduced social, academic, and occupational functioning)
3. symptoms must be present before the age of 12 years
4. symptoms must be present in 2 or more settings
5. symptoms do not occur exclusively during the course of another disorder (e.g., schizophrenia or a psychotic disorder)

Question 93

ADHD specifiers