Psychological Disorders

Question 1

What is Mental Illness?

Answer 1

• Psychopathology (mental illness) is often seen as a failure of adaptation to the environment
  
  • the way they’re functioning isn’t well suited to the environment they’re in?
  • understand mental illness by examining breakdowns in functioning
• mental disorder does not have a clear-cut definition
  
  • there’s not one thing that distinguishes the mentally ill from the psychologically healthy

Question 2

What Defines a Mental Disorder?

Answer 2

• statical rarity
  
  • many psychological disorders are statistically rare (ex. schizophrenia is like 1 in 100)
    
    • some psychological conditions (not disorders) are extremely rare (ex. super high IQ)
  • there’s a fault in this - anxiety (31%) and mood disorders are not rare at all
• subjective distress
  
  • feeling that a person has (being distressed about) the symptoms they are displaying
    
    • ex. OCD - intrusive thoughts & compulsive behaviour
      
      • they tend to find their obsessions very distressing
    • ex. mood disorders are defined by the fact that they are experiencing a lot of distress and unhappiness
  • but this doesn’t apply in all cases
    
    • ex. Bipolar Disorder - characterized by manic episodes (euphoria) it is not distressing to be in this state
    • or people with Schizophrenia or Personality Disorders may not experience distress despite being so detached from reality
• impairment
  
  • many people with psychological disorders have impaired functioning as a result of their disorder
  • ex. it might be hard to get out of bed or engage in hygiene practices or with social anxiety disorder, they might have to alter the places they go
• biological dysfunction
  
  • many psychological disorders are associated with biological aspects
  • PTSD is associated with more mental stimulation?? they’re almost always in fight or flight mode
  • Dopamine might be involved heavily in Schizophrenia
• Family Resemblance View: mental disorders don’t all have one thing in common, rather they share a loose set of features

Question 3

Historical Conceptions of Mental Illness

Answer 3

• Demonic Model: odd behaviour, hearing voices, or talking to oneself is attributed to evil spirts infesting the body
  
  • more of European model of the Middle Ages
    
    • Women were especially persecuted as a result of this - Witch Hunts of 1400s
• Medical Model: mental illness is due to a physical disorder requiring medical treatment
  
  • this lasted until the late 1800s - when they started talking about psychological causes
  • governments began to house troubled individuals in asylums - with horrible conditions
  • inhumane treatments
    
    • ex. bloodletting (withdrawing blood in the body??? because too much made people overly excited)

Question 4

More Modern Approaches

Answer 4

• Moral Treatment - approaches to mental illness calling for ginny, kindness, and respect for the mentally ill
  
  • this movement was quite effective for improving the conditions within asylums
  • between 1800s to 1900s, the asylums were filled with people with Bipolar disorder and Schizophrenia - there was no effective treatment
• Early 1950s - chlorpromazine (Thorazine)
  
  • this was like magic! these drugs helped people to start functioning properly after years of disfunction
• Deinstitutionalization - 1960s-70s government policy
  
  • releasing hospitalized psychiatric patients into the community
  • closing mental hospitals
    
    • problem was there wasn’t enough support for those being released back into the community to help reintegration

Question 5

Psychiatric Diagnosis Today: The DSM-V

Answer 5

• Diagnostic and Statistical Manual of Mental Disorders (DSM-V) fifth edition now
  
  • American Psychiatric Association (APA) criteria for mental disorders (has over 500 psychological disorders)
  • a list of symptoms and a rule for how many of these symptoms must be present for a diagnosis
    
    • and how long the symptoms should be present
  • rule out physical (medical) conditions - ex. hypothyroidism
    
    • hypothyroidism can present many of the same symptoms of depression
  • biopsychosocial approach
    
    • acknowledging that psychological disorders are caused by biological factors + psychological factors + social factors
  • prevalence of mental disorders; cultural relativity
    
    • like how much of population experiences it
    • cultural relativity - some psychological disorders are bound to certain cultures or more prevalent within them

Question 6

Popular Misconceptions about Psychiatric Diagnosis

Answer 6

this is more about psychiatric diagnoses in general and if we’re contributing to a psychological “normal”

• psychiatric diagnosis is nothing more than pigeonholing, sorting people into different “boxes”
  
  • psychiatrists/ psychologists realize that people differ!
    
    • it’s not like everyone is treated the same way
• psychiatric diagnoses are unreliable
  
  • for most major mental disorders, inter-rater reliability is high
• psychiatric diagnoses are invalid
  
  • diagnoses often tell us something new about the person (in particular, treatment)
• psychiatric diagnoses stigmatize people
  
  • this causes people to not seek treatment

Question 7

Criticism of the DSM-V

Answer 7

• reliability and validity
  
  • reliability: inter-rater reliability for personality disorders can be low
  • validity: > 300 diagnoses, not all of which meet criteria for validity
    
    • ex. Mathematics Disorder - someone has difficulty with mathematical calculations - doesn’t tell us anything about the individual
• diagnostic criteria often based on scientific evidence (lots of research), but sometimes subjective committee decisions
  
  • when research/ scientific evidence was lacking to determine symptoms of the disorder, they used committee decisions from experts
    
    • always better if it was all based on scientific evidence
• comorbidity (when people are diagnosed with more than one psychological disorder) among diagnoses - same underlying disorder? just expressing itself in different ways?
  
  • if you have x, it’s likely that you have y
    
    • mood disorders are more likely to be diagnosed with anxiety
    • one anxiety disorder usually means you have another disorder
• exclusive reliance on a categorical model (you either have it or don’t - what if we only have 4 instead of 5 symptoms, should we not treat these individuals?)
  
  • disorders differ from normal functioning by degree rather than kind
    
    • there is a continuum of some disorders
• medicalizing normality
  
  • ex. diagnosis of major depression following death of loved one - it’s normal to feel this way!!!
  • as humans, we experience all kinds of different emotions throughout our lives - so do we really need a diagnosis for something that is just a variation of normal functioning

Question 8

Psychiatric Diagnosis Across Cultures

Answer 8

• many mental disorders are specific to certain cultures (culture-bound)
  
  • bulimia nervose vs anorexia nervosa
    
    • bulimia relatively unique to Western cultures; Anorexia more culturally universal
• expression of mental disorders differs across cultures
  
  • ex. social anxiety in North America vs Japan
  • in NA, it’s typically thought of as a fear of personal embarrassment vs in Japan, it’s expressed as a fear of offending others
• many mental disorders are culturally universal (schizophrenia, alcoholism, psychopathic personality)

Question 9

Anxiety Disorders

Answer 9

• most prevalent of all psychological disorders
  
  • 31% of us will meet diagnostic criteria for one or more anxiety disorders (at some time in our life)
  • average age of onset: 11 years (earlier than most disorders)
• Brief review of 5:
  
  • Generalized anxiety disorder (GAD)
  • Panic disorder
  • Phobias
  • Social Anxiety Disorder
  • Obsessive-Compulsive Disorder (OCD)

Question 10

Generalized Anxiety Disorder

Answer 10

• the father of anxiety disorders - other anxieties can come from this
• characterized by continual feelings of worry, anxiety, physical tension, and irritability
• 60% of each day worrying (vs 18%)
• comorbid with other anxiety disorders

Question 11

Panic Disorder

Answer 11

• repeated and unexpected panic attacks
• changes in behaviour to avoid panic attacks (affecting your life)
• 20 - 25% of college students report at least one panic attack within a year
  
  • panic attack: is when you react as if there is a significant/ imminent threat to your life/ health without an actual external stimulus to cause it
    
    • basically behaving like you saw a bear in the woods
    • when something isn’t happening externally, people often think something is wrong with them internally/ physically
• Agoraphobia: fear of being in a place or situation from which escape is difficult or embarrassing
  
  • this is another diagnosis
  • doesn’t develop on its own - typically only in association with Panic Disorder
  • it’s not actually a fear of public places and desire to stay home but fear of having panic attack somewhere where you can’t find somewhere quiet or escape
  • it can be so extreme that you won’t leave your home (how it’s portrayed in the media)

Question 12

Specific Phobias:

Answer 12

• intense fear of an object or situation that’s greatly out of proportion to its actual threat
• like fears of animals or spiders, or blood
  
  • passing out after seeing blood

Question 13

Social Anxiety Disorder:

Answer 13

fear of public appearances in which embarrassment or humiliation is possible (ex. public speaking, eating, performing)

Question 14

Obsessive-Compulsive Disorder (OCD)

Answer 14

• marked by related and lengthy (>1 hour/day) immersion in obsessions, compulsions, or both
• compulsions (behaviours or thoughts)
• obsessions (thoughts)
• ex. someone might have obsessions (intrusive thoughts) about aggressive sex - do not reflect who they truly are and it can be very distressing
• true intrusive thoughts and obsessions are uncontrollable and are often the opposite of what people think and feel
• the obsessions often lead to compulsions - behaviour or thoughts
  
  • this is used to reduce the anxiety of the obsessions
  • ex. if you’re obsessed with contamination, you might develop the compulsion to constantly clean
    
    • it’s sad that people are using the time in their day to deal with this

Question 15

Explanations for Anxiety Disorder

Answer 15

• Learning Models:
  
  • fears arise from learned associations
    
    • from very logical events that happened to us (ex. bitten by dog as a child, fear dogs for the rest of life)
  • ex. classical conditioning (little Albert), operant conditioning (reinforcement/punishment), observational learning (phobias)
    
    • ex. Melody being scared of dogs because Mike is
• Catastrophizing (imagining the worst possible situation) and anxiety sensitivity - the negative misinterpretation of minor physical symptoms
  
  • some people are really aware of how their body is feeling but some people aren’t
  • ex. like when Brim feels a slight something and suddenly he has some crazy next thing
    
    • Illness Anxiety Disorder
• Genetic and biological influences
  
  • twin studies show that many anxiety disorders are genetically influenced
    
    • if someone in the family has depression, it may increase your likelihood of having anxiety
    • anxiety and depression are highly linked
  • personality trait = neuroticism

Question 16

Mood Disorders

Answer 16

• Major Depressive Disorder (MDD)
• Bipolar Disorder
• Suicide

Question 17

Major Depressive Episode: (5 of 9 symptoms)

Answer 17

• depressed mood and/ or diminished interest in pleasurable activities
• weight loss/gain, sleep difficulties, fatigue, lack of concentration, psychomotor retardation or agitation, feelings of worthlessness/ excessive guilt, thoughts of death/ suicide

Question 18

Major Depression:

Answer 18

• 16% of North Americans
• Women > Men (2x more likely)
• severe impairment
• recurrent - 5 to 6 episodes in lifetime
• each episode - 6 months to 1 year

Question 19

Explanations for Major Depressive Disorder

Answer 19

Live Events:
- stressful events that represent loss are closely tied to depression

Interpersonal Model:
- depressed people seek excessive reassurance → disliked and rejected

Behavioural Model:
- lack of positive reinforcement leads people to stop engaging in enjoyable behaviour

Cognitive Model:
- depression is caused by negative views of self, the future, and the world

• Cognitive distortions: overgeneralization, selective abstraction
• learned helplessness
• internal, global, stable attributions

Biology:
- Dopamine: reward motivated behaviour
- Norepinephrine: fight or flight response, stress hormone ad neurotransmitter

Question 20

Bipolar Disorder

Answer 20

Manic Episode:
- dramatically elevated mood, decreased need for sleep, increased energy, inflated self-esteem, increased talkativeness, and impulsive and irresponsible behaviour

Bipolar Disorder:
- history of at least one manic episode
- more than half the time a major depressive episode precedes or follows a manic episode
- highly heritable (around 85%)
- increased activity in amygdala, decreased activity in prefrontal cortex
- genes that increase sensitivity of dopamine receptors and decrease sensitivity of serotonin receptors

Question 21

Suicide

Answer 21

• not a psychological disorder, but many disorders associated with higher risk of suicide
• suicide is the 10th leading cause of death in Canada & USA: 3rd leading cause of death for children, adolescents, and young adults
• 3x as many males succeed but 3x as many females attempt it
• for each completed suicide, there are an estimated 8 to 25 attempts
• difficult to predict who will commit suicide and why

Risk Factors:
- previous attempt - single best predictor of suicide (30-40% of all suicides have at least one prior attempt)
- major depression, bipolar disorder, anxiety disorders, schizophrenia, borderline personality disorder
- hopelessness
- member of LGBTQ+ community (stigma)
- substance abuse
- unemployment
- chronic, painful, or disgusting physical illness
- recent loss of a loved one; being divorced, separated or widowed
- family history of suicide

Question 22

Personality Disorders

Answer 22

• 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
• 10 listed in the DSM-5, but only a few have been well-researched

Question 23

Borderline Personality Disorder

Answer 23

• marked by instability in mood, identity, and impulse control, often highly self-destructive
• mainly women, about 2% of population
• in relationships, alternate between worshipping and hating partners
• in sociobiological model, individuals with BPD overreact to stress and experience lifelong difficulties regulating their emotions

Question 24

Psychopathic Personality

Answer 24

• condition marked by superficial charm, dishonesty, manipulativeness, self-centredness, and risk-taking
• overlaps with antisocial personality disorder
  
  • condition marked by a lengthy history of irresponsible and/or illegal actions
• primarily males, about 25% of the prison population qualifies
• causes are largely unknown, but may stem in part from a deficit in fear
  
  • without fear, punishment might be ineffective
  • behaviour is much more difficult to control as a result
• alternatively, people with the disorder may be perpetually under-housed and experiencing stimulus hunger
  
  • may explain high rates of risk-taking behaviour in this group

Question 25

Schizophrenia

Answer 25

- disturbances in attention, thinking, language, emotion, and relationships - <1% of population - severe impairment in functioning - typical onset in mid (men) to late (women) 20s - **2 (or more) of the following symptoms. At least one must be 1, 2, or 3:** 1. **Delusions:** strongly held, fixed beliefs that have no basis in reality (*psychotic symptom)* - themes of persecution, grander, related to body, sexuality/ romance 2. **Hallucinations:** sensory perception that occur in the absence of an external stimulus - mostly auditory, but can also be gustatory, tactile, or visual 3. **Disorganized Speech:** language jumps from topic to topic 4. Grossly disorganized or catatonic behaviour (motor problems): - resistance to comply with simple suggestions - waxy flexibility: holding the body in rigid postures - curling up in the fetal position 5. negative symptoms (ie. diminished emotional expression)

Question 26

Explanations for Schizophrenia

Answer 26

- family interactions play a role, but are not a cause of schizophrenia - criticism, hostility, and over-involvement (high **expressed emotion**) can induce relapse (varies across ethnic groups) - brain abnormalities - increased size of ventricles and sulci in brain - decreased hemispherical symmetry - decreased activation of the amygdala, hippocampus, and frontal lobe - **Dopamine Hypothesis** - antipsychotic drugs block dopamine receptor sites - amphetamine blocks dopamine reuptake (ie. more dopamine activity) = worsens symptoms of schizophrenia - abnormalities in dopamine receptors - **Genetic Findings:** - highly heritable - as genetic similarity increases, so does the risk of getting schizophrenia - **Diathesis-Stress Models:** - interaction between genetic vulnerability (diathesis) and stressors that triggers illness - Early warning signs of schizophrenia vulnerability have been identified, including: - social withdrawal - thought and movement problems - lack of emotions - decreased eye contact