Chapter 16 - pyschological disorders Flashcards
What is “Abnormal”?
- The personal values of a given diagnostician
- expectations of the culture
- Ppls in that cultures expectations
- General assumptions about human nature
- Statistical deviation from the norm
- Harmfulness, suffering, and impairment
Social Construct 3 D’s is what’s abnormal :
- Distressing to self or others
- Dysfunctional for person or society
- Deviant: violates social norms
Dissociative disorders
Physiologically caused problems of consciousness, identity (amnesia and multiple personalities)
Neurodevelopmental disorders
Begin at childhood like autism or ADHD
Demenological View
- Abnormal behaviour = result of supernatural forces
- Possessed by a spirit
- Treatment: Trephination -‘hole in the skull’
Early biological views of mental illness
• Mental illnesses are diseases like physical illness that effect the brain
Vulnerability-Stress Model
• Aka The Diathesis-Stress Model
• Each of us has some degree (range) of vulnerability for developing a disorder, given sufficient stress
Vulnerability factors
- genetics
- biological characteristics
- psychological traits
- maladaptive learning
- low social support
Reliability
• Means that clinicians using the system should show high levels of agreement in their diagnostic decisions.
Validity
• Means that the diagnostic categories should accurately capture the essential features of the various disorders
DSM-5: Integrating Categorical and Dimensional Approaches
The DSM-5: Integrating Categorical and Dimensional Approaches
- Detailed behaviour must be present for diagnosis
- Five axes / dimensions
- Assess both person & life situation
Dimensions / axis of DSM-5
- Axis I: Clinical Symptoms
- Axis II: Developmental & Personality Disorders
- Axis III: Physical Conditions
- Axis IV: Severity of Psychosocial Stressors
- Axis V: Highest Level of Functioning
Axis I: Clinical Symptoms
• Diagnosis (e.g., depression, schizophrenia, social phobia)
Axis II: Developmental & Personality Disorders
• E.g., autism, intellectual disabilities (typically first evident in childhood )
• Personality disorders
• Long lasting & encompass way of interacting with the world
- E.g., Paranoid, Antisocial, Borderline Personality Disorders
Axis III: Physical Conditions
• E.g., brain injury or HIV/AIDS that can result in symptoms of mental illness
Axis IV: Severity of Psychosocial Stressors
• E.g., death of a loved one, starting a new job, college, unemployment, marriage
Axis V: Highest Level of Functioning
• Level of functioning both at present time & highest level within previous year
• 6 basic dimensions of disordered personality functioning
- Negative Emotionality (anxiety/depression)
- Schizotypy (odd thinking and behaviour)
- Disinhibition (impulsiveness)
- Introversion (intimacy / social avoidance)
- Antagonism (manipulation / aggressive)
- Compulsivity (perfectionist)
(are rated by clinicians to define a set of six personality disorders.)
Borderline type would have what kind of dimension high?
- Negative emotionality
- schizotypy
- disinhibition
Antisocial/ psychopathic type would score high in what dimensions ?
- disinhibition
- antagonism
Critical Issues in Diagnostic Labelling
• Social & Personal
- Becomes too easy to accept label as description of the individual
- May accept the new identity implied by the label
- May develop the expected role and outlook
Critical Issues in Diagnostic Labelling
• Legal Consequences
- Involuntary commitment too mental institutions
- Loss of civil rights (against will)
- Indefinite detainment
- Competency
- State of mind at time of a judicial hearing • Insanity
- State of mind at time crime was committed
Anxiety disorders
- Frequency & intensity of responses are out of proportion to situations
- Interferes with daily life
- E.g., Phobias, anxiety disorder, OCD
Components of Anxiety responses
- emotional symptoms (tension and apprehension)
- cognitive symptoms (worry, lack of efficacy)
- physiological symptoms
- behavioural symptoms
Phobic Disorder
- Strong, irrational fears of objects or situations
* Most develop during childhood, adolescence, young adulthood
Do phobias go away with time?
No they intensity
What does the degree of the phobia depend on
Depends on how often condition is encountered
Common phobias
- Agoraphobia : Fear of open spaces, public places
- Social phobias: Fear of certain situations
- Specific phobias: Fear of specific objects such as animals or situations
Phobias can develop at
Any point in the lifespan
Generalized Anxiety Disorder
•State of diffuse, ‘free-floating’ anxiety • Not tied to specific situation; condition
- Feeling of something is going to happen
Panic Disorder
- Occur suddenly, unpredictably, intense
- May occur with or without agoraphobia
- Fear of future attacks
Obsessive-Compulsive Disorder (OCD)
• Obsessions = cognitive component
- Repetitive thoughts
• Compulsions = behavioural component
- Repetitive behaviours
Neuroscience of OCD models
- Executive dysfunction model
* Modulatory control model
Executive dysfunction model
- Problem with impulse control and behavioural inhibition
* Involvement of prefrontal cortex, caudate nucleus
Modulatory control model
• Dysfunction in orbitofrontal cortex and associated areas
Causal Factors in Anxiety Disorders and OCD
• Biological Factors
- Genetics
- MZ twins more similar than DZ twins
- GABA
- Low levels may cause highly reactive nervous systems
Causal Factors in Anxiety Disorders and OCD
• Gender Differences
- Females show more anxiety disorders than males
- Differences emerge as early as seven years old
Possible explanations
• Sex-linked biological disposition
• Less power & personal control for women
Causal Factors in Anxiety Disorders and OCD
• Psychological Factors
• Psychodynamic Explanations
• Neurotic Anxiety: Unacceptable impulses threaten to overwhelm ego’s defenses
Causal Factors in Anxiety Disorders and OCD
• Psychological Factors
• Cognitive Explanations
- Maladaptive thoughts & beliefs
* Things appraised ‘catastrophically’
Panic attacks depict a process in which
normal manifestations of anxiety are appraised catastrophically, ultimately resulting in a full-blown panic attack
Causal Factors in Anxiety Disorders and OCD
• Learning Explanations
- Classical conditioning: Associating an object or situation with pain /trauma
- Modeling: Learning by watching others
Causal Factors in Anxiety Disorders and OCD
• Sociocultural Factors
• Cultures values
•Some disorders are ‘culturally bound’
- Fear of offending someone; fear of being fat
• Anorexia Nervosa
- fear of being fat
- restrict food intake
- life-threatening disorder (mostly females)
• Bulimia Nervosa
- binge and purge
- mostly females
Causes of Anorexia and Bulimia
• Environmental, psychological, biological
• Common in industrialized cultures (beauty equated with thinness)
Causes of Anorexia and Bulimia
• Objectification theory
•Cultural emphasis on viewing one’s body as object
Causes of Anorexia and Bulimia
• Personality factors
- Anorexics - Abnormally high achievement standards
* Bulimics - Depressed, anxious
Causes of Anorexia and Bulimia
• Genetics
• Higher concordance rate among identical twins
Mood (Affective) Disorders
- Depression
- Major depression
- Dysthymia
Depression
• Clinical depression = frequency, intensity, duration of symptoms is out of proportion to situation
Major depression
• Unable to function effectively in life
Dysthymia (chronic depression disorder)
• Chronic disruption of mood, long lasting
Bipolar Disorder
• Depression alternates with mania
Manic state
• Euphoric mood, grandiose cognitions
• Rapid speech
Unipolar disorder
Just depression, no mania
gender difference for bipolar disorder
NONE
Gender differences for unipolar depression
Women twice likely to suffer form it
- Biological Factors
* Depression
• Genetic factors
• Biochemical differences
• Underactivity of norepinephrine, dopamine,
serotonin
Biological Explanations
• Bipolar disorder
- Stronger genetic component than unipolar depression
- 50% have relative with disorder
- Concordance rate is 5 times higher among identical twins compared to fraternal twins
- Manic disorders - overactivity of neurotransmitters?
Causal Factors in Mood Disorders
• Psychodynamic View
• Early traumatic losses / rejections create vulnerability
Causal Factors in Mood Disorders
• Humanistic View
- Define self-worth in terms of individual attainment
- React more strongly to failures; due to inadequacies
- Experience of meaninglessness
Causal Factors in Mood Disorders
Cognitive Processes
- Depressive Cognitive Triad
- Cannot suppress negative thoughts
- Depressive Attributional Pattern
- Learned Helplessness theory
Depressive Cognitive Triad
- Negative thoughts uncontrollable:
- The world
- Oneself
- The future pops into mind constantly
Cannot suppress negative thoughts
• Recall more failures vs. successes
Depressive Attributional Pattern
- Success = factors outside self
* Negative outcomes = personal factors
Learned Helplessness
•People expect bad events will occur and they can’t cope with them
Causal Factors in Mood Disorders
Learning & Environmental Factors
- Learning
- Environmental
Environmental causal factors of mood disorders
• Poor parenting • Many stressful experiences • Failure to develop good coping skills • Failure to develop positive self-concept
Learning causal factors for mood disorders
- Loss of reinforcement
- Depression occurs
- Causes loss of social support
- Deeper depression
Sociocultural Factors in mood disorders
• Cultural Variation
• Prevalence of depressive disorders
- Less in Hong Kong & Taiwan than in the West
• Feelings of guilt & inadequacy
- Highest in North America & Western Europe
• Gender difference not found in developing countries
Somatic Symptom Disorders
• No known biological cause
- Hypochondriasis
- Pain disorder
- Conversion disorder
Hypochondriasis
• Unduly alarmed and convinces they have serious illness
Pain disorder (illness anxiety disorder)
• pain is out of proportion with no physical cause
Conversion disorder
• Sudden neurological problems
Dissociative Disorders
- Psychogenic amnesia
- Psychogenic fugue
- Dissociative identity disorder
Psychogenic amnesia
• Selective memory loss following trauma
Psychogenic fugue
• Loss of all personal identity, establishes new identity
Dissociative identity disorder
• 2 or more separate personalities
Dissociative Identity Disorder (DID)
• Each identity is unique
What Causes Dissociative Identity Disorder?
• Trauma-dissociation Theory
Trauma-dissociation Theory
DID generally results from severe traumatic experience during early childhood
Schizophrenia
•Schizophrenia = ‘split-mind’
- split mind: disconnected emotions and thought patterns
Characteristics of Schizophrenia
• Severe disturbances in
- Thinking
- Delusions = false beliefs • Speech
• Disorganized; strange words
Schizophrenia
• Perception and Emotion
- Perception: Hallucinations = false perceptions
* Emotion: Blunted affect; inappropriate affect
Schizophrenia subtypes
- Paranoid
- Disorganized
- Catatonic
- Undifferentiated
- Type I
- Type II
Paranoid subtype
• Delusions of persecution; significant
Disorganized subtype
• Confusion; incoherence
Catatonic subtype
• Severe motor disturbances, freeze in positions
Undifferentiated subtype
• Not easily classified as one of above
Type I schizophrenia
- Predominance of positive symptoms
- Pathological extremes
- Delusions, hallucinations, disordered speech & thought
Type II schizophrenia
- Predominance of negative symptoms
- Absence of normal reactions
- Lack of emotion, expression, motivation
Negative symptoms
• Long history of poor functioning
• Poor recovery
- lack emotional expression, loss of motivation, absence of normal speech
Positive symptoms
• History of good functioning; better prognosis
- Delusions, hallucinations, and disordered speech and thinking.
Brains in schizophrenia
• Neurodegenerative Hypothesis:
- Atrophy & Destruction of neural tissue
- abnormal thalamus (negative symptoms)
Schizophrenia: Biochemical Factors • Dopamine hypothesis
- Overactivity of dopamine system
- Regulate emotion, motivation, cognitive functioning
- Antipsychotic drugs used for schizophrenia reduce dopamine activity
Schizophrenia: Psychological Factors • Freud
- Extreme use of defence mechanism regression (retreat to an earlier, more secure stage in life)
- Not generally accepted but life stress is a factor
Schizophrenia: Psychological Factors
• Cognitive
• Defect in ability to filter
Schizophrenia: Environmental Factors
- Stressful life events
- Family dynamics
- Vulnerability factor & negative reactions from others
High in expressed emotion
• High levels of criticism
• High levels of hostility
•Overinvolvement in person’s life
Schizophrenia: Sociocultural Factors
- Social Causation Hypothesis
* Social Drift Hypothesis
Social Causation Hypothesis
• Higher levels of stress among low-income
Social Drift Hypothesis
• As functioning deteriorates- drift down socio-economic ladder
Personality disorders
• Exhibit stable, ingrained, inflexible, and maladaptive ways of thinking, feeling, and behaving
Six personality disorders in the DSM-5.
- Anti-Social Personality Disorder
- Narcissistic personality disorder
- Borderline personality disorder
- Avoidant personality disorder
- Obsessive-compulsive personality disorder
- Schizotypal personality disorder
Antisocial Personality Disorder
• most destructive to society
• shows little anxiety or guilt
• impulsive
• cant delay gratification of their needs
• Actual antisocial behaviour occurs in only a
portion of psychopathic individuals
Causal Factors for antisocial personality disorder
• Biological factors
- Genetic predisposition
- Dysfunction in brain structures that govern self-control and emotional arousal?
- MRI - differences in prefrontal lobes
- Weaker limbic input to frontal cortex
Causal Factors for antisocial personality disorder
• Psychodynamic view
Lack of a superego
Causal Factors for antisocial personality disorder
• Learning explanations
- No conditioned fear responses when punished
- Modeling of aggression
- Inattention to children’s needs
- Exposure to deviant peers
Causal Factors for antisocial personality disorder
• Cognitive
• Consistent failure to think about or anticipate long- term negative consequences of acts
Borderline personality disorder
- Instability in behaviour, emotion, identity
- Emotional dysregulation: Inability to control negative emotions
- Intense and unstable personal relationships: Anger, loneliness, emptiness
- Impulsive behaviour: Running away, promiscuit
Causal Factors for BPD
• Chaotic personal histories
• Treated malevolently
- View others as less than helpful
* Parents – abusive, rejecting, non-affirming
Attention Deficit/Hyperactivity Disorder
• Attentional difficulties
• Hyperactivity-impulsivity
• 7-10% of North American children
• Genetic predispositions
• Brain scans = no consistent differences with normals
• Why? Multifaceted disorder and interplay of
environmental factors
Autistic Spectrum Disorder
- Extreme unresponsiveness to others
- Poor communication skills
- Lack of social responsiveness
- Repetitive and stereotyped behaviours
- Some exhibit savant abilities
Childhood Disorders: Causal Factors
• Biological basis
- Brains – larger by 5-10% (age 18 months – 4 yrs)
* Abnormal development in cerebellum
Childhood Disorders: Causal Factors
• Genetic factors
- May be 4-6 major genes
- 20-30 others involved
- No scientific evidence of link to vaccines
Dementia in Old Age
• Gradual loss of cognitive abilities
• Accompanies brain deterioration
- E.g., Alzheimer’s, Parkinson’s, Huntington’s, Creutzfeldt-Jakob Diseases
Senile Dementia
- Dementia that begins after age 65
- 2:1 female-male ratio
- Onset is typically gradual
Alzheimer’s Disease
- 60% of dementias
- Deterioration in frontal, temporal lobes
- Plaques in brain
- Destruction of acetylcholine
