Chp 16.1: Psychological Disorders I

Question 1

DSM V (2013)

Answer 1

This is pretty much the “bible” for the diagnosis of so-called mental disorders in North America

Question 2

all the disorders have unique characteristics that differentiate them, but, according to (DSM V) all have the following caveats : (3)

Answer 2

1. ## must cause distress or social or occupational dysfunction
2. ## not better explained by drugs or other medical conditions
3. not better explained by some other DSM disorder

Question 3

Distress

Answer 3

behaviour is distressing to self or others

Question 4

Dysfunction

Answer 4

behaviours that are dysfunctional for person or society

Question 5

Deviance

Answer 5

behaviours that violate social norms

Question 6

Abnormal behaviour

Answer 6

behaviour that is personally distressing, personally dysfunctional, and/or so culturally deviant so that others judge it to be inappropriate or maladaptive

Question 7

Historical Perspectives on deviant behaviour

Answer 7

• Ancient societies believed that abnormal behaviour is caused by supernatural forces and the work of the devil
• Trephination – drill hole into skull to release spirit, patient dies anyway
• Mental illness wasn’t always considered mental or illness (ex. Physical disease)

Question 8

Vulnerability stress model

Answer 8

• ## each of us has some degree of vulnerability for developing a psychological disorder, given sufficient stress
• The vulnerability can have a biological basis (genotype, neurotransmitter), personal factor (low self-esteem), environmental factors (trauma)
  • Disorder comes from vulnerability interacts with a recent stressor
  • Ex. More likely to develop depression if you are genetically vulnerable and also had a parent lost early in life, then another loved one dies later

Question 9

Diagnosing psychological disorders

Answer 9

• 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 various orders

Question 10

Critical Issues in Diagnostic Labelling

Answer 10

• Social and Personal Implications

- Legal Consequences

Question 11

Social and Personal Implications (Critical Issues in Diagnostic Labelling)

Answer 11

• Treat people differently based on labels

* Perceptions of them change

Question 12

Legal Consequences (Critical Issues in Diagnostic Labelling)

Answer 12

• People in mental institutions lose some civil rights
• Law takes into account mental states of criminals
• Two important legal concepts are competency and insanity
• Competency – refers to a defendant’s state of mind at the time of the hearing (not at time crime was committed)
• Insanity – state of mind of defendant at time crime was committed
- People can be judged as “not criminally responsible on account of mental disorder”
- Legal term, not psychological
-
• New verdict: guilty but mentally ill -> normal sentence for crime but defendant sent to a mental hospital for treatment and then spends rest of sentence in prison

Question 13

Competency (Legal Consequences)

Answer 13

refers to a defendant’s state of mind at the time of the hearing (not at time crime was committed)

Question 14

Insanity (Legal Consequences)

Answer 14

• state of mind of defendant at time crime was committed
• People can be judged as “not criminally responsible on account of mental disorder”
• Legal term, not psychological

Question 15

Anxiety Disorders

Answer 15

• ## these disorders always feature anxiety and/or fear• anxiety is anticipation of future threat, hence more cognitive than emotional
  -
  • Subjective (personal)-emotional – feelings of tension and apprehension
  • Cognitive component – subjective feelings
  • Physiological responses – heart rate, nausea, rapid breathing, etc
  • Behavioural component – avoiding certain tasks
  -
  • Most prevalent psych disorder in North America
  • More common in females

Question 16

Phobic Disorder

Answer 16

• relatively focused fear of an object or situation that is out of proportion to the real threat (e.g. fear of flying)
• likely often based on Pavlovian conditioning
• very common with lifetime incidence of around 15%

Question 17

agoraphobia

Answer 17

fear of open public spaces

Question 18

social anxiety disorder

Answer 18

fear situations where you might be judged or embarrassed

Question 19

Specific phobias

Answer 19

dogs, cats, planes, spiders, etc.
•	animal fears common among women
•	heights in men
•	can develop at any time, but usually when younger
•	rarely goes away without help

Question 20

name 3 phobic disorders

Answer 20

• agoraphobia
• social anxiety
• disorder
  Specific phobias

Question 21

Generalized Anxiety Disorder (GAD)

Answer 21

• AKA worry disorder
- excessive anxiety and worry nearly every day (ned) for at least 6 months
- associated with restlessness or feeling on edgeand difficulty in concentrating
• Chronic “free floating” anxiety that is not attached to specific situations or objects
• Physical and cognitive responses (sweating, on edge)
• Expecting something bad to happen but don’t know what
• Occurs at young age (childhood or adolescence)

Question 22

Panic Attack

Answer 22

• a Panic Attack is characterized by a sudden and unexpected onset of symptoms
• associated with four or more physiological conditions: e.g., perspiration, paresthesias,tachycardia, chest pain, trembling

Question 23

Panic Disorder

Answer 23

• Contrast to generalized since that is chronic
• Sudden, unpredictable and intense panic attacks
• May develop agoraphobia because they are afraid of panic attacks happening in public
• Panic disorder is diagnosed when the patient has a fear of future attack
• Formal diagnosis requires that recurrent attacks do not seem tied to environmental stimuli, followed by psychological or behavioural problems (behavioural changes to avoid future attacks)

Question 24

name the anxiety disorders discussed (3)

Answer 24

• Phobic Disorder
• Generalized Anxiety Disorder (GAD)
• Panic Disorder

Question 25

Obsessive Compulsive Disorder (OCD)

Answer 25

• Usually consists of cognitive and behavioural components
• Obsessions - repetitive and unwelcome thoughts, images, or impulses (cognitive)
• Compulsions - repetitive behavioral responses, like cleaning rituals (behavioral)
• Doing the compulsions prevents great anxiety and panic attacks
• Compulsions reduce anxiety so they are strengthened by negative reinforcement
• Onset early 20s

Question 26

According to DSM-5, all of the following are types of anxiety disorders EXCEPT:

A. phobic disorder
B. obsessive-compulsive disorder
C. generalized anxiety disorders
D. panic disorder

Answer 26

B. obsessive-compulsive disorder

Question 27

What are the three Ds that typically influence judgments regarding abnormal behaviour

Answer 27

distressing
dysfunctional
deviance

Question 28

Mood Disorders

Answer 28

• one of a number of disorders that are characterized by sad, empty, or irritable mood, accompanied by somatic or cognitive changes that diminish the ability to function

Question 29

The Neuroscience of OCD:

Answer 29

• Executive dysfunction model: Underlying problem lies in impulse control and behavioural inhibition
  o Altered activity in prefrontal cortex and involvement of caudate nucleus
  o Not really supported
• Modulatory control model: lack of control of socially appropriate behaviors
  o Increased metabolism in the orbitofrontal and medial prefrontal cortex and cingulate gyrus

Question 30

Biological Factors in Anxiety Disorders and OCD

Answer 30

• Genetics can make you vulnerable to anxiety
• Identical twins have high concordance rate of anxiety (40%) vs fraternal of 4%
• Oversensitive autonomic nervous system
• Over activity of neurotransmitters in emotional responses
• Not enough GABA (inhibitory neurotransmitter) cause highly reactive nervous system capable of producing anxiety responses
• Anxiety more common in women than men, sex linked biological predisposition that shows at age of 7
• Evolutionary preparedness to fear snakes, dogs

Question 31

Psychological Factors in Anxiety Disorders and OCD

Answer 31

• unacceptable impulses threaten to overwhelm the ego’s defenses
• In phobias, neurotic anxiety is displaced onto object of symbolic significance in relation to underlying conflict
o Ex. Someone is scared of horse biting him because horse represents father and biting represents the fact that dad will cut his balls off if he acts on his sexual desire towards mom
• Obsessions are related to an underlying impulse, compulsions are ways of “undoing” these thoughts
o Ex. Washing hands frequently to wash off “dirty sexual desires”
• GAD and panic attacks are when defenses aren’t strong enough to contain the anxiety
• Not supported much since it is so symbolic

Question 32

Cognitive factors in Anxiety Disorders and OCD

Answer 32

• Maladaptive thought patterns
• Patients expect the worst and feel powerless to cope
• Social phobics believe they are more likely to embarrass themselves than others, and believe that the consequences are worse
• Panic attacks are triggered by exaggerated misinterpretation of normal anxiety symptoms (like sweating or dizziness)
• Teaching people that it’s just anxiety, not a heart attack, makes them much better

Question 33

Anxiety as a learned response (behavioural view)

Answer 33

• Classical conditioning - develop phobia after being bitten by snake or falling from height
• Observational learning - develop fear from watching TV
• Then anxiety can be triggered by environmental or internal stimuli
• Operant conditioning - avoidance (agoraphobia) and compulsions are negatively reinforced
o Behaviours that are successful in reducing anxiety (like compulsion or avoidances) are strengthened by negative reinforcement

Question 34

Sociocultural Factors in Anxiety Disorders and OCD

Answer 34

• some anxiety disorders are culture specific
• Koro - Southeast Asian fear that your penis will retract into stomach and kill you
• Taijin Kyofushu - Japanese social phobia of smelling bad, blushing, staring, having improper expression
• Windigo - Native American fear of monsters who will turn them into homicidal cannibals
• Anorexia is exclusive to developed countries (fear of getting fat)

Question 35

Name the Eating Disorders (2)

Answer 35

• Anorexia nervosa

* Bulimia nervosa

Question 36

Anorexia nervosa

Answer 36

-intense fear of being fat
o Restrict food intake till point of self-starvation
o 90% female an young
o View themselves as fat despite being very skinny
o Bone loss, heart strain, stops menstruation

Question 37

Reliability

Answer 37

means that clinicians using the system should show high levels of agreement in their diagnostic decisions

Question 38

Validity

Answer 38

means that the diagnostic categories should accurately capture the various orders

Question 39

Bulimia nervosa

Answer 39

– also concerned with being fat
o Vomiting, laxatives to avoid gaining weight
o Consume thousands of calories during binges
o Normal body weight but gastric problems, teeth erosion
o More prevalent than anorexia

Question 40

Causes of Anorexia (1)+personality+physiological

Answer 40

• More common in cultures where beauty = thinness

• Consistent with objectification theory -> seeing body as an object
  • Personality :
  Anorexics are perfectionists and high achievers who set high standards for themselves
  o Compared to normal women, they think obesity starts at a lower weight
  o Need for control that stems from their upbringing, losing weight becomes battle for success
• Physiological
  -Physiological changes initially are a response to abnormal eating patterns, but once started, they perpetuate eating and digestive irregularities
• Anorexics leptin levels rebound faster than their weight, so it’s hard for them to gain weight
• Leptin is secreted by fat cells and leptin levels low -> reduces appetite

Question 41

Causes of Bulimia (1)+personality+physiological

Answer 41

Personality
o Bulimics are depressed and anxious, low impulse control
o Lack of personal identity
o Triggered by life stress
o Purging reduces depression and anxiety triggered by binging
• Physiological
-Physiological changes initially are a response to abnormal eating patterns, but once started, they perpetuate eating and digestive irregularities
- Bulimics lose taste buds which makes vomiting more tolerable

Question 42

Mood Disorders

Answer 42

• ## one of a number of disorders that are characterized by sad, empty, or irritable mood, accompanied by somatic or cognitive changes that diminish the ability to function• Disturbance in mood (known as affect) rather than in thought
  • Emotional highs are called “manias”, and lows are called “depression”
  • Have high comorbidity with anxiety disorders (50% of depressed people have an anxiety disorder)

Question 43

Major Depressive Disorder

Answer 43

diagnosed when there is even one Major Depressive Episode characterized by:

(1) *depressed mood “most of the day nearly every day” (motdned)
(2) *loss of interest or pleasure in almost all activities (motdned)
(3) cognitive impairment e.g., diminished ability to think, or indecisiveness (ned)
(4) motivational problems such as fatigue (ned)
(5) somatic problems such as insomnia and loss of appetite (ned)

Question 44

Dysthymia

Answer 44

• a version of depression with less dramatic effects on personal and occupational functioning
• More chronic depression - lasts years on end with week intervals of normal mood

Question 45

Bipolar Disorder

Answer 45

• Depression = unipolar depression
• Bipolar disorder is depression with periods of mania (highly excited, opposite of mania)
• Manic state – euphoric, grandiose plans, no limits as to what can be done
o Can be extremely productive, irritable if goals are frustrated in any ways
o Speech is rapid and unstoppable
o Little sleep due to flurry of activity
o Irritable and aggressive

Question 46

Manic state

Answer 46

euphoric, grandiose plans, no limits as to what can be done

Question 47

Prevalence and Course of Mood Disorders (stats)

Answer 47

• 1/5 chance of happening in your life of depression
• 1 in 20 people in North America are severely depressed
• Can happen at any age (even 6 months)
• More common in younger generation
• No age group is exempt - happens to children as much as adults
• Depression is on the rise in young groups
• People born after 1960 are 10x more likely to experience it than their grandparents
• Similar across socioeconomic and ethnic groups, but major sex difference
• Women are twice as likely to have unipolar depression, and have it earlier than men (20 vs. 40)
• BUT they do not differ in bipolar disorders
o Reason for this might be biological factors in genetics and menstruation
o May be sex role expectation
• Depression usually dissipates with time (5-10 months)
• 50% depression doesn’t recur
• Some recover then recur
• 10% don’t recover
• Manic episodes very rare (less than 1%) but 90% they recur

Question 48

Biological Factors in Mood Disorders (Genetic)

Answer 48

Genetic factors
• Twins have a high concordance rate of 67% for experiencing clinical depression
• Biological relatives are 8x more likely than adoptive relatives to also suffer from depression
• Predisposition to develop depressive disorder is inherited, given certain losses and low social support shared by relatives

Question 49

Biological Factors in Mood Disorders (neurochemical)

Answer 49

neurochemical factors
• Behaviour activation system (BAS) is reward oriented
• Behaviour inhibition system (BIS) is pain avoidant and generates fear and anxiety
• Depression – high BIS low BAS
• Mania – high BAS (extraversion), BAS deactivation leads to depression again
• Depression – underactivity of neurotransmitter including norepinephrine, dopamine, and serotonin (involved in BAS – reward and pleasure)
• Antidepressants work by increasing the activity of these neurotransmitters
• Bipolar disorder is strongly genetically linked (50% have relative with it) – much more than unipolar depression
• Concordance 5 times higher in identical twins than fraternal
• Manic – overproduction of same neurotransmitters involved in depression
• Drug used to calm manic episodes decrease activity of them

Question 50

Psychological Factors in Mood Disorders

Answer 50

• Freud believed that early loses/rejections create vulnerability for later depression
• Brown and Haris found that women who lost their mom before age 11 were 3x more likely to become depressed because of a recent loss than women who didn’t
• Humanistic (Seligman) - me” generation – overemphasis on personal control which makes us more vulnerable to depression
o Because define self-worth in terms of individual attainment and not family, common good
o So they are more likely to react more strongly to failure and view negative events as reflecting their own inadequacies

Question 51

Cognitive processes in mood disorders

Answer 51

• Depressed people victimize themselves through their own beliefs that they are defective, worthless, and inadequate
• They also believe that whatever happens to them is bad, and that negative things will continue to happen to them because of their personal defects
• Depressive cognitive triad - negative beliefs about the world, oneself, the future
• Remember their failures, not successes
• Depressed people detect pictures of sad faces at lower exposures, and remember them better – showing perceptual and memory sensitivity to the negative
• Depressive attributional pattern - bad things are personal, good things are situational (opposite of self-severing bias)
o They take credit for bad things, but take no credit for success  low self esteem
• Learned helplessness theory - depression happens when people expect bad events and believe that there is nothing they can to prevent them or cope with them
o Negative attributions are personal, stable and global: Its my fault, I’ll always be this way, I’m a total loser
• Manic cognitions involve autonomy (focus on self), high performance standards, and self-criticism when goals are not obtained

Question 52

Depressive cognitive triad

Answer 52

negative beliefs about the world, oneself, the future

Question 53

Depressive attributional pattern

Answer 53

bad things are personal, good things are situational (opposite of self-severing bias)
o They take credit for bad things, but take no credit for success -> low self esteem

Question 54

Learned helplessness theory

Answer 54

• depression happens when people expect bad events and believe that there is nothing they can to prevent them or cope with them
  o Negative attributions are personal, stable and global: Its my fault, I’ll always be this way, I’m a total loser

Question 55

Learning and environmental factors in mood disorders

Answer 55

• Depression triggered by a loss, punishing event, or decrease in amount of positive reinforcement
• Patients stop doing hobbies and socializing
• Generate additional negative events through mood, pessimism, reduced functioning
• Cause people around them to feel anxious, depressed, which reduces social support
• Behavioral theorists say: break the cycle by doing things that make you somewhat happy
• Environmental factors explain why depression tends to run in families
o Children of depressed parents experience poor parenting and stressful experiences (explain why it runs in families)

Question 56

Sociocultural Factors in mood disorders

Answer 56

• Found in all cultures, but its prevalence, symptoms, and causes reflect cultural variation
• Much less depression in collectivistic culture because of strong connections to family
• In North American, depression = guilt/personal inadequacy
• In Chinese/African/Latin cultures, depression = fatigue, loss of appetite, sleep problems
• Women are more likely to be depressed than men in technologically advanced countries BUT not in developing countries
• White people more likely than black people to be depressed

Question 57

Suicide

Answer 57

• The lifting of depression may provide the energy needed to complete the suicidal act, without affecting the person’s underlying sense of hopelessness and despair
• People tend to kill themselves when they start to feel a bit better from depression
• Two motivations: ending one’s life and manipulating other people into doing what you want
• Parasuicide: attempt that does not end in death

Question 58

Somantic Symptom Disorders

Answer 58

• AKA somatoform disorders
• Physical complaints or disabilities that suggest medical problem, but which have no known biological cause and are not produced voluntarily by the person
• Complaints of physical symptoms that are not physiologically possible
eg. Pain disorder, • Hypochondriasis
• Differ from psychophysiological disorders - psychological factors cause or contribute to a real medical condition (ulcer, asthma, blood pressure)
• Psychodynamic perspective: ego represses conflict by converting anxiety into physical symptom
o Ex. Girl develops paralysis in arm to restrict her from hitting her dad

Question 59

Pain disorder

Answer 59

• experience intense pain for no reason or out of proportion

Question 60

Hypochondriasis

Answer 60

• being alarmed about any physical symptom, convinced they have serious illness

Question 61

Dissociative Disorders (DDs)

Answer 61

• DDs include Dissociative Amnesia,
  Dissociative Fugue, and Dissociative Identity Disorder (DID)
• ## all involve disruptions of memory and personal identity• Ordinarily, personality has unity and coherence, and the many facets of the self are integrated so that people act, think, and feel with some degree of consistency
  • Memory plays a critical role in this by connect past with present

Question 62

Dissociative amnesia

Answer 62

• person responds to a stressful event with extensive but selective memory loss of specific events, people, objects, etc. BUT language and motor skills still in tact

Question 63

Dissociative fugue

Answer 63

– very rare, person loses all sense of personal identity, gives up customary life, wanders to a new faraway location, and establishes a new identity
o Typically ends what person suddenly remembers original identity, mystified

Question 64

Dissociative identity disorder (DID)

Answer 64

• the primary personality is often passive, guilty, and depressed
• the other identities tend to be very different
• the personalities often compete for control and often outright deny the existence of the other personalities
• “switches” are often stress related
• a female often has at least one male (protector?) personality
• protector can become persecutor
• the alters can differ in age, gender, behaviour can differ mentally, behaviourally, and even physiologically

Question 65

Diagnosis requirement for DID

Answer 65

(1) the formation of two or more distinct personality states, accompanied by marked discontinuity in sense of self
(2) gaps in episodic memory beyond mere forgetfulness

Question 66

What Causes Dissociative Disorder?

Answer 66

• Trauma-dissociation theory
o new personalities occur in response to severe stress, usually in childhood about physical/sexual abuse
o in childhood because personalities aren’t well establish so easy to dissociate
o Form of self-hypnosis, dissociate themselves from reality in response to trauma into a different personality that can handle the trauma
o Very rare and it is unknown to many cultures, controversial whether it exists
o In the 80‘s, after it was publicized in books, DID became much more common. Was this due to patient/therapist expectancies?
o DID is not usually discovered until adulthood, because adults assume the personalities are just the kid being a kid
o Spanos: “DID is extreme form of roleplaying”

Question 67

Bill tends to worry a lot. He is frequently thinking about how other people may think less of her him or may do things that will embarrass or humiliate him. These thoughts serve to keep Bill anxious a great deal of the time and best demonstrate the ____________ component of anxiety.

Answer 67

cognitive

Question 68

Imagine that you’re playing a game of darts. You’re aiming for the ‘bullseye’ (ie. the centre of the board) but keep missing. All of your darts land closely clustered together, just below the board itself. With respect to reliability and validity, which of the following statements best describes the pattern?

Answer 68

Low validity, high reliability