Ch 15: Psychological Disorders Flashcards
1
Q
What is a psychological disorder?
A
A syndrome (collection of symptoms) marked by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour.
2
Q
Disturbed thoughts are _________, meaning…
A
Disturbed/dysfunctional thoughts, emotions, or behaviours are MALADAPTIVE, interfering with normal day-to-day life.
3
Q
______ often accompanies dysfunctional behaviours.
A
Distress
4
Q
What is the underlying belief of the medical model of psychological disorders?
A
Belief that brutal treatments may worsen, rather than improve, mental health.
Pinel insisted that madness is NOT demon possession, but a sickness of the mind caused by severe stress and inhumane conditions.
Curing the illness requires “moral treatment” –> Replacing brutality!
5
Q
What is the medical model?
A
The concept that diseases, in this case psychological disorders, have physical causes that can be…
DIAGNOSED on the basis of its symptoms;
TREATED through therapy;
and in most cases, CURED, often through treatment in a hospital.
6
Q
What is the biopsychosocial approach?
A
The mind and body are inseparable! Negative emotions –> Physical illness, and vice-versa
Disorders = Genetic predispositions, physiological states, inner psychological dynamics, social & cultural circumstances
Remember: Our behaviours/thoughts/feelings are formed by the interaction of biological, psychological, and social-cultural influences.
As individuals: Differences in amount of stress experienced, ways of coping with stressors
Within cultures: Differences in sources of stress, traditional ways of coping
7
Q
What are epigenetics?
A
The study of how nurture (environmental influences) influences nature (gene expression), without a DNA change.
8
Q
Which factors are within the biopsychological approach?
A
BIOLOGICAL INFLUENCES
- Evolution
- Individual genes
- Brain structure and chemistry
PSYCHOLOGICAL INFLUENCES
- Stress
- Trauma
- Learned helplessness
- Mood-related perceptions and memories
SOCIAL-CULTURAL INFLUENCES
- Roles
- Expectations
- Definitions of normality and disorder
9
Q
What is the DSM-5?
A
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (fifth edition).
A widely used system for classifying psychological disorders, by employing diagnostic criteria and codes.
10
Q
Why is classification important?
A
It creates order, and describes symptoms/criteria.
To study a disorder, we must first name and describe it!
- Predicts the disorder’s future course
- Suggests appropriate treatment
- Prompt research into its causes
11
Q
What criticism does the DSM-5 face?
A
- New/altered diagnoses are controversial
- Clinician agreement is not always in place
- Brings almost any kind of behaviour within the compass of psychiatry
- The labels are subjective, value judgments: Change our view and our reality –> Self-fulfilling, with biasing power
12
Q
How can we fade the negative reactions associated with labelling?
A
Provide better understanding that many psychological disorders involve diseases of the brain, NOT failures of character.
13
Q
What is ADHD?
A
Attention-deficit/Hyperactivity disorder:
Psychological disorder marked by extreme inattention and/or hyperactivity and impulsivity.
14
Q
Why is there controversy over ADHD?
A
There is a looser criteria for adult ADHD in the DSM-5 –> Increased diagnosis, overuse of prescription drugs
The Y chromosome, a single genetic variation, can bring about this impulsivity.
Today’s environment forces children to sit for long hours.
There may be long-term consequences to the use of stimulant drugs in the treatment of ADHD.
15
Q
What is known about ADHD’s causes and treatments?
A
- Extensive TV watching, video gaming
- Coexists with a learning disorder, or defiant/temper-prone behaviour
- Heritable: Genes, neural pathways
- Can be treated with medication, and psychological therapies
16
Q
Do psychological disorders predict violent behaviour?
A
The vast majority of violent crimes are committed by people with no diagnosed disorder.
Clinical prediction of violence is unreliable!
17
Q
What are the triggers for the few people with psychological disorders who do commit violent acts?
A
- Substance abuse
- Threatening delusions, hallucinated voices commanding them to act
18
Q
How many people have, or have had, a psychological disorder?
A
More than most of us suppose!
-1/4 adult Americans
19
Q
What is the immigrant paradox?
A
Compared with people who have recently immigrated from Mexico, Mexican-Americans born in the US are at greater risk of mental disorder.
20
Q
What increases vulnerability to mental disorders?
A
There is a wide range of risk and protective factors for mental disorders.
However, one predictor, POVERTY, crosses ethnic and gender lines.
21
Q
At what times of life do disorders strike?
A
Usually by early adulthood.
Earliest: Antisocial personality disorder (age 8) and phobias (age 10)
Later: Alcohol use disorder, OCD, bipolar disorder, schizophrenia (age 20)
Latest: Major depressive disorder (age 25)
22
Q
What are the hallmarks of anxiety disorders?
A
Distressing, persistent anxiety, or maladaptive behaviours that reduce anxiety.
23
Q
What is generalized anxiety disorder?
A
An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.
- Excessive, uncontrollable worry
- Jitter, agitation, sleep deprivation
- Difficulty in concentration
- “Free-floating” anxiety: Not linked to a specific stressor or threat
24
Q
What is panic disorder?
A
An anxiety disorder marked by unpredictable, minutes-long episodes of intense dread, in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations.
An episode is often followed by worry over a possible next attack.
25
What are the physical symptoms of a panic attack?
- Irregular heartbeats
- Chest pains
- Shortness of breath
- Choking
- Trembling
- Dizziness
26
What are consequences of having recurrent panic attacks?
- Fearing another panic attack, amplifying anxiety symptoms
| - Avoidance of the situation in which the previous panic attacks have struck
27
Which population has a higher risk of panic disorder?
Smokers have at least a doubled risk of panic disorders!
28
What is a phobia?
An anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity, or situation.
29
What are specific phobias?
Focus on animals, insects, heights, blood, close spaces.
30
What is social anxiety disorder?
Shyness taken to an extreme!
An intense fear of other people's negative judgments.
31
What is obsessive-compulsive disorder (OCD)?
A disorder characterized by unwanted repetitive thoughts (obsessions), actions (compulsions), or both.
**Persistently interfere with everyday living, causing distress.
**Anxiety-fueled obsessive thoughts become haunting, compulsive rituals become time-consuming = Impossible effective functioning
32
What are the common obsessions among those with OCD?
- Concern with dirt, germs, toxins
- Something terrible happening (fire, death, illness)
- Symmetry, order, exactness
33
What are the common compulsions among those with OCD?
- Excessive hand washing, bathing, toothbrushing, grooming
- Repeating rituals (in/out of a door, up/down from a chair)
- Checking doors, locks, appliances, car brakes, homework
34
What is post-traumatic stress disorder (PTSD)?
A disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four weeks or more after a traumatic experience.
35
What determines the risk for PTSD symptoms?
The greater one's emotional distress during a trauma, the higher the risk.
36
Why do some people PTSD, while others don't?
- Some people have more sensitive emotion-processing limbic systems, flooding their bodies with stress hormones
- PTSD patients have smaller amygdala --> Brain region governing fear
- Genes and gender
37
What is survivor resiliency?
The ability to recover after severe stress.
38
How do anxious feelings and cognitions arise, according to Freud?
Freud's psychoanalytic theory proposed that, beginning in childhood, people REPRESS intolerable impulses, ideas, feelings.
39
How does conditioning contribute to the feelings and thoughts that mark anxiety disorders, OCD, PTSD?
Recall the "Little Albert" experiment, in which a baby learned to fear furry objects paired with loud noises.
Anxious people are hyperattentive to possible threats;
Panic-prone people come to associate anxiety with certain cues;
Conditioning can multiply the short list of naturally painful and frightening events --> long list of human fears
40
How might conditioning magnify a single painful, frightening event --> full-blown phobia
STIMULUS GENERALIZATION:
Occurs when a person experiences a fearful event, and later develops a fear of similar events.
REINFORCEMENT:
Anything helping us avoid or escape the feared situation can be reinforcing, as it reduces anxiety and gives us a feeling of relief.
41
How does cognition contribute to the feelings and thoughts that mark anxiety disorders, OCD, PTSD?
OBSERVATION: Learning to fear what they fear
| PAST EXPERIENCES: Shape our expectations, influence our interpretations and reactions --> Hypervigilance
42
How does biology contribute to the feelings and thoughts that mark anxiety disorders, OCD, PTSD?
GENES
-There are specific gene variations associated with anxiety, OCD
-Influence disorders by regulating neurotransmitters:
===="Anxiety gene" affecting brain levels of SEROTONIN --> Sleep, mood, attention to negative images
====GLUTAMATE, which in excess, can overactivate the brain's alarm centres
-In PTSD, there can be long-term EPIGENETIC marks
BRAIN
-Experiences paves new brain pathways.
-Fear circuits created within the amygdala
-OCD: when brain detects something amiss, it generates a mental hiccup --> Obsessions, compulsions;
Elevated and enlarged brain activity during behaviours
-PTSD: Increased amygdala activity when viewing traumatic images
NATURAL SELECTION
- Biological preparedness to fear threats faced by our ancestors
- Compulsive acts exaggerating behaviours contributing to species' survival
43
What does depression resemble?
A sort of psychic hibernation, slowing us down, defusing aggression, helping us let go of unattainable goals, restraining risk taking --> Some degree of sadness can be healthy.
44
When can depression become unhealthy?
When the response it brings become seriously maladaptive, signaling a disorder.
45
What is major depressive disorder?
It occurs when at least five signs of depression last two or more weeks.
Depressed mood or loss of interest/pleasure.
The symptoms must cause near-daily distress/impairment, and not be attributable to substance use or another medical/mental illness.
46
What are the symptoms of depression?
- Depressed mood most of the time
- Dramatically reduced interest or enjoyment in most activities most of the time
- Significant challenges regulating appetite and weight
- Significant challenges regulating sleep
- Physical agitation or lethargy
- Feeling listless, with much less energy
- Feeling worthless; feeling unwarranted guilt
- Problems in thinking, concentrating, making decisions
- Thinking repetitively of death and suicide
47
What is persistent depressive disorder (dysthymia)?
Experiencing a mildly depressed mood more often than not for two years or more, with at least two of the following symptoms:
- Difficulty with decision-making and concentration
- Feeling hopeless
- Poor self-esteem
- Reduced energy levels
- Problems regulating sleep
- Problems regulating appetite
48
What is mania?
A hyperactive, wildly optimistic state in which dangerously poor judgment is common.
49
What is bipolar disorder?
In which a person alternates between the hopelessness and lethargy of depression, and the overexcited state of mania.
50
What characterizes the manic phase of bipolar disorder?
- Little need for sleep
- Fewer sexual inhibitions
- Abnormal persistence of positive emotions
- Loud, flighty, hard-to-interrupt speech
- Find advice irritating
- Reckless behaviours --> Poor judgment
51
For some suffering depressive disorders/bipolar disorder, symptoms may have a ________.
Seasonal pattern.
52
What are some of the facts about depression?
1. Many behavioural and cognitive changes accompany depression.
- Inactivity, lack of motivation.
- Sensitivity to negative events, information.
- Expecting negative outcomes.
- Symptoms of another disorder: Anxiety, substance abuse
2. Depression is widespread!
- Over 350M people...
3. Women's risk of major depression is nearly double men's
4. Most major depressive episodes self-terminate.
- Therapy helps, tends to speed recovery.
5. Stressful events (work, marriage, close relationships) often precede depression.
- Response to past and current loss, trauma.
- Minor daily stressors can leave emotional scars.
- Moving to a new culture can increase depression.
6. With each new generation, depression strikes earlier and affects more people.
- Highest rates in developed countries among young adults.
53
What is the biological perspective of depression?
GENETIC INFLUENCES
- Runs in families: Linkage analysis teases out the genes putting people at risk for depression
- Depression is a complex condition, with many genes working together.
BRAIN
- Diminished brain activity during slowed-down depressive moods, more activity during periods of mania
- Left frontal lobe and adjacent brain reward center = More active during positive emotions
- Depressed individuals have smaller frontal lobes
- The hippocampus (memory-processing centre) is vulnerable to stress-related damage.
NEUROTRANSMITTER SYSTEMS
- Norepinephrine (increases arousal, boosts mood) is scarce during depression, overabundant during mania.
- Serotonin, when coupled with stress, can be a poopy effect!
NUTRITIONAL EFFECTS
- Eat a "Mediterranean diet" :)
- Avoid alcohol in excess
54
How do drugs that relieve depression work?
They increase norepinephrine or serotonin supplies, by blocking either their reuptake or their chemical breakdown.
55
What behaviour can increase serotonin?
Repetitive physical exercise.
56
What is the social-cognitive perspective of depression?
- Diet, drugs, stress, and other life experiences lay down EPIGENETIC MARKS --> Turn certain genes on/off
- People's assumptions and expectations influence what they perceive --> Magnification of bad experiences, dark lenses of low self-esteem
**Self-defeating beliefs, negative explanatory style = Depression's vicious cycle
57
Social-cognitive perspective: How do self-defeating beliefs arise?
From learned helplessness: Hopelessness, passive resignation learned when experiencing uncontrollable, painful events.
58
Why do women experience learned helplessness, thus depression, more frequently?
Tendency to RUMINATE, overthink: Staying focused on a problem, in a relentless, self-focused manner. This diverts thinking about other life tasks, increasing negative moods.
Compulsive fretting.
59
Social-cognitive perspective: Why do only some people become depressed?
Their EXPLANATORY style --> Who/what they blame for their failures.
Depressed people explain bad events in terms that are STABLE, GLOBAL, INTERNAL.
*Self-focused, self-blaming
60
Social-cognitive perspective: What is depression's vicious cycle?
Depression is both a CAUSE and an EFFECT of stressful experiences that disrupt our sense of who we are, why we are worthy human beings = Brooding, amplifying negative feelings.
Negative, stressful events interpreted through...
Ruminating, pessimistic explanatory style, creating...
Hopeless, depressed state that...
Hampers the way the person thinks and acts.
And back again!
61
How can individuals break the vicious cycle of depression?
- Reverse self-blame and a negative outlook
- Turn attention outward
- Engage in more pleasant activities, more competent behaviour.
62
What factors increase the risk of suicide?
- National differences
- Racial differences
- Gender differences
- Age differences
- Wealth, religion, marital status, trauma
- Days of the week
63
What can trigger suicide?
Social suggestion, exposure to suicide;
Disconnection from others, feeling like a burden, feeling defeated, trapped
Unattainable goals, standards
64
What can lessen the probability of one committing suicide?
Environmental barriers, such as suicide is often an impulsive act = Restrictions giving time for self-destructive impulses to subside
65
What is non-suicidal self-injury?
Hurting oneself by cutting, hitting, inserting objects.
66
What are characteristics of individuals engaging in NSSI?
- Less able to tolerate emotional distress
- Extremely self-critical
- Poor communication, problem-solving skills
67
Why do individuals engage in NSSI?
- Find relief from intensive negative thoughts, through the distraction of pain.
- Attract attention, possibly get help.
- Relieve guilt by inflicting self-punishment.
- Get others to change their negative behaviour.
- Fit in with a peer group.
68
What is schizophrenia?
A psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression.
69
What are the two primary forms of schizophrenia?
Schizophrenia with positive symptoms: Hallucinations, talking in disorganized and deluded ways, exhibiting inappropriate laughter, tears, rage.
Schizophrenia with negative symptoms: Toneless voices, expressionless faces, mute/rigid bodies.
70
What are the disturbed perceptions experienced by schizophrenics?
HALLUCINATIONS: See, feel, taste, smell things that exist only in their minds.
Often sounds, voices that make insulting remarks, give orders.
= FALSE PERCEPTIONS
71
What is the disorganized thinking and speech experienced by schizophrenics?
DELUSIONS: False beliefs, often of persecution or grandeur.
* *Paranoid tendencies
* *Word salad: Jumbled ideas may make no sense even within sentences
72
What causes the disorganized schizophrenic thinking?
A breakdown in SELECTIVE ATTENTION: Inability to filter out stimuli, giving undivided attention to EVERYTHING coming through.
73
How do schizophrenics exhibit diminished and inappropriate emotions?
- Inappropriate emotions, split off from reality: Excessive, or 'flat state'
- They suffer an impaired theory of mind --> Difficulty perceiving facial emotions and reading others' states of mind.
-Inappropriate motor behaviours: Senseless, compulsive acts.
Others may remain motionless for hours, then become agitated.
74
How does schizophrenia affect one's life?
It profoundly disrupts social and work relationships.
They are preoccupied with illogical ideas, unreal images.
They may suffer from sleep problems.
75
What is chronic (process) schizophrenia?
In which symptoms usually appear by late adolescence or early adulthood
Psychotic episodes last longer, and recovery periods shorten, as people age.
SLOW-DEVELOPING
76
What is acute (reactive) schizophrenia?
Can begin at any age, frequently occurring in response to an emotionally traumatic event. Has extended recovery periods.
RAPID-DEVELOPING
**More positive symptoms, more responsive to treatment.
77
What brain abnormalities are associated with schizophrenia?
DOPAMINE OVERACTIVITY
-Intensifies brain signals, creating positive symptoms such as hallucinations and paranoia
ABNORMAL BRAIN ACTIVITY AND ANATOMY
- Low activity in the frontal lobes, areas that help us reason, plan, solve problems
- Decline in the brain waves that reflect synchronized neural firing in the frontal lobes = Disruption of the integrated functioning of neural networks
- Increased activity in the thalamus (filters incoming sensory signals) and amygdala (fear processing), when experiencing hallucinations and paranoia.
- Shrinking and thinning of cerebral tissue
- Smaller cortex and corpus callosum, and thalamus
78
What prenatal events are associated with increased risk of developing schizophrenia?
- Low birth weight
- Maternal diabetes
- Older paternal age
- Oxygen deprivation during delivery
- Famine
- Midpregnancy viral infection, impairing fetal brain development
79
Do genes influence schizophrenia? What can we conclude from twin studies?
There may be an inherited predisposition!
Identical twins, which share both genes AND prenatal environment (aka germs), are more likely to both develop schizophrenia.
Adopted children have an elevated risk if BIOLOGICAL parent(s) are diagnosed.
80
What genes could predispose schizophrenia-inducing brain abnormalities?
- Genes influencing the effects of dopamine and other neurotransmitters in the brain
- Genes influencing MYELIN production: fatty substance that coats the axons of nerve cells and lets impulses travel at high speed through neural networks.
Schizophrenia is influenced by MANY genes, and epigenetics plays a role too!
81
What are some warning signs for schizophrenia?
- Mother whose schizophrenia was severe and long-lasting
- Birth complications: Oxygen deprivation, low birth weight
- Separation from parents
- Short attention span, poor muscle coordination
- Disruptive, withdrawn behaviour
- Emotional unpredictability
- Poor peer relations, solo play
- Childhood physical, sexual, emotional abuse
82
What are dissociative disorders?
Controversial, rare disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings.
Leads to a fugue state: sudden loss of memory or change in identity.
83
What is dissociative identity disorder (DID)?
A rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities.
Each personality has its own voice and mannerisms, controlling one's behaviour at different times.
84
What concerns have skeptics raised about DID?
- Could it be an extension for our normal capacity for personality shifts = More extreme versions?
- Why does the disorder have such a short and localized history?
- Is it a cultural phenomenon? A disorder created by therapists, in a particular social context?
85
What features/symptoms accompany DID?
Switches in...
- Handedness
- Visual acuity
- Eye-muscle balance
Abnormal brain anatomy and activity
- Shrinkage in areas that aid memory and detection of threat
- Heightened activity in areas associated with the control and inhibition of traumatic memories
86
DID symptoms are ways of...
Coping with anxiety.
- Defenses
- Anxiety reduction
87
Some clinicians include dissociative disorders under the umbrella of which other disorders?
PTSD
88
What are personality disorders?
Inflexible and enduring behaviour patterns that impair social functioning.
89
What are the three clusters of personality disorders?
Anxiety - fearful sensitivity to rejection - predisposing the withdrawn AVOIDANT personality disorder
Eccentric/odd behaviours - emotionless disengagement of SCHIZOTYPICAL personality disorder
Dramatic/impulsive behaviours, such as the attention-getting BORDERLINE-PERSONALITY disorder, the self-focused and self-inflating NARCISSISTIC personality disorder, the callous/dangerous ANTISOCIAL personality disorder.
90
What is antisocial personality disorder?
In which a person (usually a man) exhibits lack of conscience for wrongdoing, even toward friends and family members;
May be aggressive and ruthless, or a clever con artist.
May show lower emotional intelligence, an ability to understand, manage, perceive emotions.
Impulsive behaviours, with little fear and feelings. This can lead to violent, horrifying consequences!
91
Antisocial personality disorder is woven of ___________ and __________ strands.
Biological and psychological
- Little autonomic nervous system arousal to aversive events
- Lower stress hormone levels
- Fearlessness, dominance
- Child abuse
- Smaller emotion-controlling amygdala
- Less active frontal lobes
- Genes predisposing some children to be more sensitive to maltreatment
92
What is anorexia nervosa?
An eating disorder in which a person, usually an adolescent female, maintains a starvation diet despite being significantly underweight.
Sometimes, it is accompanied by excessive exercise.
93
What is bulimia nervosa?
An eating disorder in which a person alternates binge eating, usually of high-calorie foods, with purging (vomiting, laxative use) or fasting.
Weight fluctuations are within or above normal ranges.
94
What is binge-eating disorder?
Significant binge-eating episodes, followed by distress, disgust, or guild, without the compensatory purging/fasting that marks bulimia.
95
What causes eating disorders?
- Family environment
- Low self-evaluations, perfectionistic standards, concerns about appearance
- Heredity: Availability of serotonin and estrogen
- Culture
- Gender
- Peer influences
