Psychological Disorders Flashcards
Context in Diagnosis
This is what truly determines whether someone has a particular mental disorder or is just a little different in their way of thinking e.g. if someone is narcissistic and flexing and is also a billionaire compared to those same personality traits exhibited by a homeless man.
Drawing the Line in Disorders
In order to make this distinction we must find what a common experience is and therefore what an abnormal experience might be e.g. is it grief over the death of a loved one vs Persistent Complex Bereavement Disorder or anxiety before public speaking vs Social Anxiety Disorder.
Conceptualising Abnormality
Some of the suggested concepts used for this task are statistical infrequency, violation of social norms (deviant), impact on functioning (dysfunctional) and distressing (to self/others).
Statistical Infrequency
This is based on the concept of a bell curve with 68.3% of the people falling in between 1 standard deviation of the mean and 95% within 2. However this doesn’t necessarily make sense with some people possessing gifts/talents, many people do suffer with certain conditions e.g. depression/anxiety. These exceptions make the point that this concept on its own can’t be used to determine mental disorders.
Violation of Social Norms
Society plays a part in the definition of abnormality, often enshrined in law however societal norms can change over time. This is seen in homosexuality with it being legalised in WA in 1990 and same sex marriage being legalised in 2017 in Australia. This was also seen in the 1900s with hysteria only diagnosed to women concerned with certain normal characteristics which were normal for men but considered abnormal for women which shows the way in which beliefs/ preconceived notions shape diagnosis. There is also differences between cultures e.g. Hindu holy men live similarly to homeless people in Australia however the holy men are respected and seen as noble however the homeless in Australia aren’t.
Impact on Functioning (Dysfunctional)
Most mental health disorders are defined by the impact on function to an individual or society e.g. dislike of crowded places vs not leaving home or germaphobe vs washing hands for hours each day. It is important to consider impacts on work, other activities, relationships and broader society. There are some exceptions however e.g. the death of a loved one or binge drinking on a night out.
Distress to Self/Others
This concept does have some exceptions e.g. during a manic episode people have lots of energy, heightened creativity, decreased need for sleep, euphoria however what goes up must come down and the increased energy leads to risky behaviour which could harm the person or others. Certain behaviours deemed unacceptable/illegal when these behaviours may not be distressing or even dysfunctional for the perpetrator e.g. paedophilia.
Disorders
No single element or characteristic is sufficient to establish a definition of abnormality. This requires a look at several elements, especially deviance from norms, degrees of dysfunction and the distress caused. It is essential that behaviour is viewed within its broader social and cultural context.
Classifying & Diagnosing Disorders
The ‘Diagnostic and Statistical Manual of Mental Disorders’ (DSM-5, 2013) released by the American Psychiatric Association seeks to provide clear, categorical criteria for different mental disorders. This is used as the handbook in many countries e.g. Australia. Another book the ‘World Health Organisation International Classification of Diseases’ (ICD 11) which includes mental disorders and is very similar however not the exact same. Both texts are based on expert consensus not purely objective evidence or biology.
DSM-5
This is the text released by the American Psychiatric Association which helps to diagnose mental disorders. The disorders are classified using a specific ‘checklist’ criteria. Functional impairment and/or distress are required for most disorders however cultural and social context must be considered. There are also exclusion criteria/diagnoses to ensure diagnosis is specific and most correct.
Mental Health Disorders
Almost half (45%) of all Australians will experience mental illness in their lifetime. In any year this is 1/5 people. This costs 60 billion/year with direct economic costs e.g. health services and indirect costs e.g. lost work or productivity. Every day 6 people will die by suicide with women 3x more likely to attempt however men are more likely to die of it.
Vulnerability-Stress Model
A general model of the causes of disorder. The idea is that there is a general amount of stress/difficulty that can be managed which consists of vulnerability (from trauma or genetics) and stress (lonely, workload). There is also a tap which represent things done to lessen the amount of vulnerability or stress. Those with a lot of vulnerability need less stress in order for their bucket to overflow (not be able to cope) however even with a little vulnerability a high stress event may also overflow that bucket.
Depression
The symptoms that make up this disorder involve emotional (sadness), cognitive (concentration, negative thoughts), psychological (fatigue, sleep issues, loss/gain weight) and behavioural/motivational (no engagement with activities or not attending) with these symptoms occurring nearly everyday for at least 2 weeks for a diagnosis to be made. Around 1/7 Australians will experience this some time in their lifetime.
Depression Biological Causes
There is a genetic component with 67% of identical twins sharing in it while only 15% of fraternal twins do and it is more common in women. Some biological theories are that serotonin levels being low is the cause (debated now) and based on the behavioural approach system (BAS) (reward-oriented) and behavioural inhibition system (BIS) (pain-avoidant) suggesting those with a higher focus on the BIS are more likely depressed.
Depression Psychological Causes
This mental disorder has some cognitive causes which can involves loss or a period with low positive reinforcement, negative thoughts (about self, future and the world), attribution of success to external factors, attribution of failure as internal as well as learned helplessness theory which suggests that nothing can be done to prevent a negative hopeless future.
Maintaining Depression
When people begin to feel depressed it leads to negative thinking about self, the world and the future. This leads to less energy and lethargy. This lethargy can lead to a reduction of activity and social withdrawal. This social withdrawal leads to a loss of pleasure and achievement which then increases the feelings of depression. A study tested this using smartphones measuring phone calls, usage, user activity, GPS. This showed that researcher could accurately determine their depressive scores based on the data gathered from the smartphone.
Bipolar Disorder
This mental disorder is characterised by a manic state. In the manic stage there is an elevated mood, loud/fast/expressive speech, weight loss, grandiose/delusions, hyperactivity etc. There are 2 types of this disorder with Bipolar I has full manic episodes (more severe) where these manic episodes occur everyday for at least a week which typically requires hospitalisation. Bipolar II has more mild bipolar episodes lasting at least 4 days however the symptoms are the same.
Anxiety Disorders
This is the most common psychological disorder with a rate of 1/3 for women and 1/5 for men over their lifetimes. This can be debilitating but treatments are generally effective. The symptoms can be emotional (fear, apprehension, tension), cognitive (worry and thoughts about an inability to cope), physiological (increased heart rate, muscle tension) and behavioural (avoidance or feared situations, decreased performance).
General Anxiety Disorder (GAD)
This is defined by a broad worry over a number of domains. This is characterised by overreaction in terms of worrying over many different situations e.g. involving school and health and finances etc. In this condition it can be overwhelming and inability to prevent the worry. The symptoms are present for more than 6 months for a majority of the time.
Panic Disorder
This is when many symptoms of anxiety all come about rapidly in one moment. This typically lasts a few minutes and then ceases. This is characterised by panic attacks however panic attacks can occur in people who don’t have any disorders however constant worry about these attacks and their symptoms is what characterises this particular mental disorder. There also random panic attacks that aren’t necessarily triggered by an event which is uncommon for normal people.
Obsessive Compulsive Disorder
This was previously considered an anxiety disorder however it is now classified in its own category, the disorder still contains many anxiety inducing tropes. The disorder is characterised by obsessive and intrusive thoughts about something bad happening (catching a disease or your house being robbed) and in order to avoid these thoughts a behavioural or thought process is taken up to mitigate these feeling temporarily e.g. checking the locks 4x over, organising things etc. These compulsions can be very damaging as if they are very time consuming can negatively impact your life.
Phobias
These are often fears that have an evolutionary advantage but can also be learnt socially with common ones being of snakes, spiders or heights. In social anxiety/phobia is the most common of anxiety disorder which focuses on the judgement of others based on your actions. Agoraphobia is the fear of situations where escape would be difficult e.g. an elevator.
Post-Traumatic Stress Disorder
This isn’t technically an anxiety disorder and instead classified under traumatic stress however a large part of this condition involves anxiety. This is only caused by some sort of trauma typically life threatening e.g. war, near-death experience etc. This can be experienced in person or witnessed e.g. watching someone be attacked. Not all traumatic event cause this. This condition is caused by human actions as opposed to natural events. This occurs due to the overwhelming nature of the trauma which leads to incomplete processing of an event leading to a dwelling on it due to incomplete processing. This leads to avoiding people/places that remind you of the trauma, negative mood (sadness), hopeless thoughts and changes in reactivity (strongly startled). This has to impact the persons life and last longer than 1 month.
Causes of Anxiety Disorders
Genetically it is seen that 40% of identical twins share anxiety disorder while only 4% of fraternal twins do and it can be caused by neurotransmitters e.g. GABA. It can be seen through a learning perspective with classical conditioning e.g. dog bites you = you fear dogs, observational/social learning from parents fears and operant conditioning e.g. avoidance is negatively reinforcing the anxiety. The cognitive perspective is an attentional bias to threats and appraisals of situations. Socio-cultural factors involve not being able to talk about feeling due to the cultural stigma.
Maintenance of Anxiety
Anxiety leads to an increased scanning for danger, physical symptoms intensify, attention narrows and shifts to self. This increased scanning leads to more perceived threats leading to escape or avoidance which provides short-term relief. This short-term relief increases the physical symptoms of anxiety, more worry, loss of confidence about coping and increased use of escape and avoidance which leads to anxiety. This is operant conditioning that avoidance leads to better short term however leads to the reliance of safety behaviours.
Safety Behaviours
These are actions taken in order to better cope with some anxiety which provides short term relief e.g. disinfecting a house when you are a germaphobe. In a study that made normal people and germaphobes all engage in this behaviour it saw that at the endo f the study there was an increased threat overestimation and fear of contamination even in normal people showing that safety behaviour increase anxiety.
Psychosis
These are a cluster of symptoms which are present in a range of disorder such as schizophrenia, bipolar I disorder, delusion disorder, borderline personality disorder, extreme depression dementia etc. and also caused by certain medications, drugs and trauma. The symptoms can be hallucinations, delusions and disorganisation which is typically preceded by a prodromal period where there is a hint of the symptoms coming through e.g. noticing a change in regular thought where a small change is occurring as a precursor to the full symptoms.
Psychosis Symptoms
This can be hallucinations (auditory, visual, tactile etc.) which are sensory perceptions that don’t match what is actually happening physically. Delusions including paranoia is another symptom which are strongly held beliefs with no evidence or contrary evidence (grandeur, persecution, religious etc.). Disorganisation is the difficulty in carrying out normal thought, speech and activity/behaviour.
Causes of Psychosis
There is a genetic vulnerability and environment, psychological and socio-cultural factors which combine in order to bring about the symptoms. These factors can also combine with certain triggers such as substance use, periods of stress or change, lack of sleep and illness to bring about symptoms.
Marijuana & Psychosis
A study showed that people with a history of cannabis use were 50% more likely to experience this in a group of 100,000 in the UK, people with high genetic risk for psychosis, the rate went up to 60% likely to experience these symptoms. This could suggest a possible causal effect of marijuana use however could also be that people with risk for these symptoms could self medicate with marijuana.
Eye Movement & Psychosis
People who experience this condition typically have dysfunctional eye movements. In this study eye-tracking was used at baseline then followed by people at clinical high risk of experiencing these symptoms (prodromal period) and a control group. The eye movement abnormalities predicted who would develop these symptoms 3 years later with reasonable accuracy. This means that eye tracking tests could help identify people who are healthy but likely to develop these symptoms and help them before this occurs.
Psychosis Prognosis
The recovery rate from the first episode of these symptoms is 58% and services are focused on early intervention during the prodromal phase or after the first episode.
Schizophrenia
This is a conditions in which there are positive (presence of problematic behaviours) and negative (absence of healthy behaviour) symptoms. Positive symptoms include most of the symptoms of psychosis as well as bizarre behaviours. Negative symptoms include flat affect (no emotion in fact), reduced social interaction, anhedonia (no feeling of enjoyment), avolition (less motivation/initiative), alogia (less speaking), catatonia (less moving). This condition is chronic (requires constant help) with 1/7 chance of recovering with elevated risk of suicide and accident. There is an earlier onset in mean (early 20s) compared to women (late 20s).
Schizophrenia Causes (Biological)
These factors are seen from twin studies that 48% of identical twins compared to 17% of fraternal twins experience this condition. There is a dopamine hypothesis which states that dopamine (brain neurotransmitter) at too high levels would elevate the symptoms of this condition which treatment for this did assist with positive symptoms but not negative ones. There are also observed brain differences with cerebral volume (2% smaller) and ventricle sizes (26% larger) of people with the condition.
Schizophrenia Causes (Sociocultural)
These factors include relative constancy across cultures (rates, symptoms etc.) however the symptoms may have different cultural significances. There is also higher rates of this condition is lower socio-economic groups. The social causation hypothesis states that people in lower socio-economic groups there is more stress which can increases chances of developing this conditions whereas the social drift hypothesis states that those with the condition will impair your functional abilities causing you to drop in socio-economic class.
Schizophrenia Causes (Environmental)
Some factors that may cause this condition are stressful life events and other impacts such as the support and care that is experienced when dealing with symptoms.
Personality Disorders
An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individuals culture. This pattern is manifested in 2 or more of the following areas which are cognition (ways of seeing and interpreting self, other people or events), affectivity (range, intensity, lability, appropriateness of emotions) and interpersonal functioning (impulse control and working with others).
5 Traits of Personality
These are neuroticism (tendency to experience negative emotions), extraversion (sociability being outgoing), conscientiousness (preparation and planning), agreeableness (experience with others), openness to experience (trying new things).
DSM-5 Personality Disorder
The criteria for this condition in the DSM-5 is stability/duration, inflexibility, maladaptiveness and functional impairments and subjective distress. With all of these criteria this condition can only be diagnosed after 18 when it is said that personality is stabilised. Due to the categorical nature of DSM-5 there is a separation between whether some does or doesn’t meet the criteria for the condition however there is a debate as to whether the diagnosis should be dimensional (somewhere on a scale based on severity).
Personality Disorder Clusters
A: this is the odd eccentric group which includes paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.
B: this is the dramatic and unpredictable group which includes antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder.
C: this is the anxious and fearful group which includes avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder.
Borderline Personality Disorder
This was originally conceptualised as a border between psychosis (considered untreatable at the time) and neurosis (considered treatable). Symptoms include unstable identity, relationships, emotions and behaviours. 2/3 diagnosed with this condition are women and it effects 2% of the population. It is highly linked (comorbidity) with substance use, eating disorders, mood and anxiety disorder which shows a lack of emotional regulation.
Borderline Personality Disorder Diagnosis
In order for diagnosis of this condition 5 or more of the patterns must be met. The patterns include frantic attempts to avoid real or imagined abandonment, unstable and intense interpersonal relationships, persistently unstable self image, self-damaging impulsivity, recurrent suicidal behaviour or self harm, affective instability (intense emotional change), chronic feelings of emptiness, inappropriate anger or lack of anger management, transient stress related paranoid thinking or dissociation.
Borderline Personality Disorder Causes
This can be from emotional vulnerability. This often results from early interpersonal stress, sexual and physical abuse and inconsistent/incompatible parenting. The trauma often occurs early on before a sense of self has properly developed. They may learn to hyper-attuned to the emotions of others without being able to understand their own emotions well. There is less development of their inner self with feelings of emptiness. The symptoms such as self-harm or substance abuse are used to cope with the intense feelings caused by the condition.
Antisocial Personality Disorder
This is the most societally destructive personality disorder. This is very similar to psychopaths. People who are diagnosed with this condition in adulthood are often diagnosed with conduct disorder as children. This is a pervasive pattern of disregard for the consequences and the rights of others. The symptoms include exploitation and manipulation of others, lack of concern or remorse for others, irresponsible behaviour and disregard of social norms, difficulty sustaining long-term relationships, inability to control anger, lack of guilt or learning from mistakes, blaming other for their problems and repeatedly breaking the law.
Antisocial Personality Disorder Causes
The heritability is between 0.4 and 0.5 (medium to high correlation) with an absence of guilt and anxiety earlier in life. Emotional under-arousal and poor behavioural inhibition which corresponds to dysfunction in the amygdala and prefrontal cortex. Typically parenting was aggressive or inattentive/neglectful especially in earlier years which impacts on early development which may be from the role models of their parents.
Bias In Diagnosis for Personality Disorder
A study gave clinicians a case study with all the same features with half of the clinicians given a male as the subject and the other half a female. They were asked to rate the case study of personality traits and give a diagnosis. There was evidence of bias with females being diagnosed with histrionic and males being diagnosed with antisocial forms showing a gender bias. Less bias was observed using trait ratings which doesn’t require the same global decision and provides more precise descriptions.
Obsessive Compulsive Personality Disorder
This is seen with symptoms of perfectionistic traits showing great attention to detail or correct behaviour making them extremely careful, conscientious, diligent, meticulous and strict. They are penurious meaning unwilling to spend money or use resources. They are pedantic where they are excessively concerned with more details or rules which leads to exacting, dogmatic, hypercritical and nit picky behaviour which affects interpersonal and personal functions.
Legal Issues in Diagnoses
Mental impairment can absolve responsibility for crimes in court however personality disorder isn’t included for this as it is seen as how the person is which is debated however the mental health of a defendant may be considered in sentencing. The defense of mental impairment vs competency to stand trial which is the argument between whether they were mentally unwell during the crime or whether they are fit to strand trial.
Diagnoses
The benefits of this are communication between clinicians, researchers and patients to understand what is happening and the detail of a condition, it allows for distinction between treatments and can validate the patients feeling in saying it isn’t their fault but due to the effects of a disease. The concerns with out current system is the stigma and overidentification of disorders, loss of information about the severity of the condition, comorbidity (people think conditions are the same) and heterogeneity.
