Psychological Disorders (Ch. 13) Flashcards
what are psychological disorders?
Behavioral or psychological syndromes or patterns that lead to clinically significant distress or disability.
point prevalence
% of people in a given population who have a given psychological disorder at one point in time.
lifetime prevalence
% of people in a given population who have a given psychological disorder at any point in their lives.
what are the impacts of psychological disorders on death rates?
psychological disorders represent 5/10 leading causes of disability and premature death worldwide
what is a clinical assessment?
a procedure used to evaluate a client’s psychological functioning and determine whether a psychological disorder is present
clinical interviews
designed to systematically explore a client’s current mental state, life circumstances, and history
- asks them to describe their problems
- open-ended or structural (can ask questions pertinent to diagnostic criteria)
- can gather insights from looking at hand gestures, facial expressions, etc.
what can therapists use to eval clients besides clinical interviews?
self-report measures and projective tests
self-report measures
fixed set of questions for patient to answer
projective tests
client asked to respond to unstructured/ ambiguous stimuli (usually pictures) requires them to impose their own structure
(ex. Thematic Apperception Test [TAT], client has to make up a story about what is happening)
(ex. Rorschach Inkblot Test, client has to describe what they see in set of inkblots)
are projective tests useful?
general consensus is that the popularity > usefulness
what do we use to diagnose disorders?
Diagnostic and Statistical Manual of Mental Disorders (DSM). It has been revised many times, now at version DSM-5. It is updated to reflect current scientific evidence.
who publishes the DSM?
the American Psychiatric Association
how does the DSM reflect culture-specific disorders?
in addition to the 20 categories of disorders, there is an appendix of some culture-specific ones (however still some specific to only W culture, ex. bulimia nervosa, that is concluded in the overall manual)
how can we make our language more inclusive around people with mental illnesses?
distinguishing between the person and the illness (ex. “people with schizophrenia,” as opposed to “schizophrenics”)
the biopsychosocial model
analysis of psychological functioning is incomplete unless it considers biological, psychological, and social dimensions
panic disorder
anticipation and experience of unexpected panic attacks (sudden episodes of terrifying bodily symptoms – labored breathing, choking, sweating, heart palpitations – and sense of losing control)
are panic attacks specific to panic disorder?
No, they occur in almost all anxiety disorders, but in panic disorders, they are recurrent and unexpected
what is the relationship between panic disorder and agoraphobia?
panic disorders are usually accompanied by agoraphobia (fear of being in situations where help may not be available or escape would be embarrassing/ difficult)
why are panic disorder and agoraphobia usually concurrent?
because people with panic disorders usually fear having an attack in a public place (so stay in side)
worry and generalized anxiety disorder
one common feature of GAD is worry, which some clinicians believe is a cognitive form of avoidance to decrease anxiety responses
OCD (obsessive-compulsive disorder)
obsessions (recurrent unwanted disturbing thoughts) and compulsions (ritualistic actions to control the obsessions)
sometimes people have just one or both
is OCD voluntary?
people usually know the obsessions are irrational but unable to stop and control the compulsions
(ex. an obsession with cleanliness may lead to a compulsion to keep washing their hands)
mental rituals
form of compulsions in an attempt to manage obsessions
trauma and stress-related disorders
psychological disorders triggered by an event involving death (or the threat of), serious injury, sexual violation, etc.
process of trauma and stress-related disorders
- period of numbness/ disassociation (feels alienated, socially unresponsive, oddly unaffected)
- intrusive symptoms emerge (recurrent nightmares/ flashbacks), arousal symptoms (maintaining high states of readiness), avoidance symptoms
acute stress disorder
trauma and stress-related disorders that last less than a month
post-traumatic stress disorder (PTSD)
if acute stress disorder symptoms last longer than one month, it is considered PTSD
why do some people who experience trauma not develop a stress disorder?
unclear, only 1 in 10 individuals who experience highly traumatic events go on to experience PTSD
comorbidity
having one anxiety disorder increases the likelihood of having another at the same time
biological risk factors (diatheses)
genetic profile, propensity to active brain regions (esp those associated with fear learning)
psychological risk factors (stressors)
fear learning (ex. mental associations because of phobia stimulus or vicarious learning – learning from others)
brain regions associated with various disorders
phobias: active amygdala and insula
PTSD: lower activation in the prefrontal regions associated with emotional regulation
panic disorder: instability in autonomic nervous system
OCD: overactivity in anterior cingulate cortex, insula, caudate, putamen
bipolar disorder
manic (excited/ energetic) and depressive episodes with normal time interspaced
hypomania
(mild level of mania) can often feel pleasurable, high-sprits, happiness, nervous energy
but often develops into full-blown mania which can be terrifying and destructive
who does bipolar disorder occur in?
children and adults
what is the lading cause of death worldwide?
suicide, in the US the person at highest risk for death by suicide is male, non-Hispanic White or Native American, adolescent or older adult
men and women and suicide rates?
across most all cultures, women are more likely to attempt suicide (use less lethal things) but men are more likely to die by suicide
is there an association between psychological disorders and suicide?
the overwhelming majority of individuals who commit suicide are thought to have psychological disorders
people who die by suicide have low levels of serotonin (NT) in the prefrontal cortex
bipolar disorder and suicide risk?
most at risk during leave from hospital and period immediately after discharge
what is an effective way to reduce suicide rates?
at the societal level, interventions that focus on educating children about suicide via school-based awareness programs
biological risk factors for mood-related disorders?
- genetic profile
- abnormalities in 3 NT (norepinephrine, dopamine, serotonin)
- dysregulation in emotion-generative brain regions (more activation in limbic system region (subgenual cinglate cortex), associated with MDD). (less activation in PFC, more activation in the amygdala, associated with BPD)
psychological risk factors for mood-related disorders
- dysfunctional patterns of thinking (negative cognitive schema or negative explanatory style, high levels of interpersonal stress)
social risk factors for mood-related disorders
- interpersonal stress
- having a depressed cartetaker
dopamine hypothesis
early theory on cause of schizophrenia
- believed that elevated levels of dopamine is associated with schizophrenia
+ found that imbalance in dopamine is a more likely cause
what evidence was used to justify the dopamine hypothesis?
classical antipsychotics blocks dopamine receptors and was effective in relieving schizophrenia
(explaining schizophrenia) dysfunction in glutamate transmission
increasing glutamate (NT) activity has lowered the impact of schizophrenia
(explaining schizophrenia) abnormalities in frontal/ temporal lobes
- loss of grey matter in prefrontal cortex
- enlarged ventricles
causes of schizophrenia
- genetics (twin & adoption studies suggest genetic basis)
- prenatal risk factors (diatheses): poor maternal health during pregnancy (malnutrition, etc.) and birth complications
- low SES (particularly poverty)
schizophrenia as a neurodevelopmental disorder
now viewed as a neurodevelopmental order (meaning it stems from early brain abnormalities)
civil commitment laws
people can be hospitalized against their will due to mental limitations associated with a psychological disorder
1. individual must have a mental illness (definition varies by state, but someone close to them usually initiates proceedings and client is able to defend themselves)
2. danger to themselves or others or unable to care for themselves
stigma around mental illness
stigma that they are violent because of a mental illness
not guilty by reason of insanity
not responsible for their criminal behavior, if at the time of the event they had a psychological disorder, they were unable to
1. understand their actions were wrong
2. behave as they know they should
autism spectrum disorder
- persistent deficits in social communication and interaction
- restricted/ repetitive patterns of interest or behavior
what does “spectrum” mean for autism
there are variations in the degree of impairment
prevalence of autism spectrum disorder
- it is 4x more likely in boys
- usually diagnosed in childhood
- increased in prevalence in the last two years –> some controversy
why have autism diagnoses increased in the past few years?
expanded criteria, increased awareness, diagnostic substitution (misdiagnosing as intellectual disorder)
some deficits of children with autism
- some children don’t speak or produce high-pitched noises
- trouble with pronouns (identifying themselves as “I”)
- can’t hold “joint attention” (attention shared with someone)
- less motivation to socially interact and less empathy
why does autism occur?
difficulties with theory of mind (diminished motivation to engage in social interaction), brain abnormalities
ADHD (attention-deficit/ hyperactivity disorder)
children with ADHD are impulsive and hyperactive, have difficulting shifting their focus to where it needs to be (fidget)
most common psychological disorder in childhood
who is most likely to have ADHD
- boys 2x more likely to have it
- often doesn’t occur in adulthood
ADHD treatment
- Adderall (amphetamine and dextroamphetamine) and Ritalin (methylphenidate) are stimulants that enhance the release of dopamine and norepinephrine –> activate inhibitory circuits and help symptoms of ADHD
controversy in ADHD diagnosis
- is it just a label for kids who don’t adapt well to a crowded classroom?
- great prevalence rate in different US states (bc diff methods)
Disassociative Identity Disorder (DID)
(used to be called multiple personality disorder)
presence of two or more distinct personality states/ identities within a single person (each with own style, habits, beliefs, and memories)
why the massive increase in diagnosis of DID?
could be because therapists encouraged suggestible clients, and they developed signs/ symptoms of the syndrome
hard to make a conclusion bc
1. little is known about the disorder (thought memory partitioning- interidentity amnesia- but no evidence of that)
2. double over well-documented cases (“Sybil,” ex. a therapist wrote a book on her and her DID, but transcripts show the therapist suggested DID and Sybil was in love with her therapist)
how does DID arise?
ongoing controversy, unclear whether to cope with serious trauma or bc of therapists’ suggestion
personality disorder
enduring pattern of inner experience and behavior that
1. largely deviates from cultural norms and expectations
2. inflexible and pervasive across a broad range of personal and social situations
3. leads to “clinically significant distress/ impairment in functioning”
personality disorders recognized by the DSM-5
A: odd or eccentric behavior (paranoid, schizoid, schizotypal)
B: dramatic or emotional behavior (antisocial borderline, histrionic, narcissistic)
C: anxious or fearful behavior (avoidant, dependent, obsessive-compulsive)
difficulties in diagnosis
- no “pure” form of a personality disorder
- overlapping symptoms
- comorbid (likely to have 2 personality disorders in the same person)
- hard to define threshold of when it becomes a personality disorder and not just eccentric personality trait
antisocial personality disorder
lack of empathy: pervasive patter of disregard for and violation of the rights of others (diagnosed in someone at least 18 years)
(at least 3 of the things below)
1. repeated action, could be arrested
2. deceit (for pleasure or profit)
3. impulsivity/ lack of planning
4. repeated physical fights/ assaults
5. disregard for own/ others’ safety
6. irresponsibility and repeated failure to honor work and financial obligation
7. lack of empathy and response for harming others
future of people with antisocial personality disorder?
- overrepresented in prison populations but depends on IQ (range of incarceration to stress depending on life circumstances and IQ)
what does antisocial personality disorder look like cognitively?
low in prefrontal gray matter volume and structural abnormalities in amygdala
