Week 19: Psychopathology I Flashcards
Learning Objectives:
Identify what the criteria used to distinguish normality from abnormality are.
Understand the difference among the three main etiological theories of mental illness.
Describe specific beliefs or events in history that exemplify each of these etiological theories (e.g., hysteria, humorism, witch hunts, asylums, moral treatments).
Explain the differences in treatment facilities for the mentally ill (e.g., mental hospitals, asylums, community mental health centers).
Describe the features of the “moral treatment” approach used by Chiarughi, Pinel, and Tuke.
Describe the reform efforts of Dix and Beers and the outcomes of their work.
Describe Kräpelin’s classification of mental illness and the current DSM system.
cultural relativist view & Mental illness
The idea is that cultural norms and values of a society can only be understood on their own terms or in their own context.
sociocultural norms and expectations of a specific culture and period has been used as a way to silence or control certain individuals or groups.
View of abnormal behavior has focused instead on whether behavior poses a threat to oneself or others or causes so much pain and suffering that it interferes with one’s work responsibilities or with one’s relationships with family and friends.
Etiology
The causal description of all of the factors that contribute to the development of a disorder or illness.
three general theories of the etiology of mental illness:
- supernatural
- somatogenic
- psychogenic
Each form determines the care and treatment mentally ill individuals receive.
Supernatural theory of etiology
Developing from origins beyond the visible observable universe.
*possession by evil or demonic spirits, displeasure of gods, eclipses, planetary gravitation, curses, and sin.
Somatogenic theory of etiology
Developing from physical/bodily origins.
*disturbances in physical functioning resulting from either illness, genetic inheritance, or brain damage or imbalance.
Psychogenic theory of etiology
Developing from psychological origins.
*traumatic or stressful experiences, maladaptive learned associations and cognitions, or distorted perceptions.
Maladaptive - Developing from psychological origins
Trephination
The drilling of a hole in the skull, presumably as a way of treating psychological disorders.
6500 BC - identified surgical drilling of holes in skulls to treat head injuries and epilepsy as well as to allow evil spirits trapped within the skull to be released
2700 BC - Around 2700 BC, Chinese medicine’s concept of complementary positive and negative bodily forces (“yin and yang”) attributed mental (and physical) illness to an imbalance between these forces. As such, a harmonious life that allowed for the proper balance of yin and yang and movement of vital air was essential
Hysteria
Term used by the ancient Greeks and Egyptians to describe a disorder believed to be caused by a woman’s uterus wandering throughout the body and interfering with other organs (today referred to as conversion disorder, in which psychological problems are expressed in physical form).
Mesopotamian and Egyptian papyri from 1900 BC describe women suffering from mental illness resulting from a wandering uterus
*The uterus could become dislodged and attached to parts of the body like the liver or chest cavity, preventing their proper functioning or producing varied and sometimes painful symptoms. As a result, the Egyptians, and later the Greeks, also employed a somatogenic treatment of strong smelling substances to guide the uterus back to its proper location (pleasant odors to lure and unpleasant ones to dispel).
400 BC that Hippocrates (460–370 BC)
Attempted to separate superstition and religion from medicine by systematizing the belief that a deficiency in or especially an excess of one of the four essential bodily fluids
*blood, yellow bile, black bile, and phlegm—was responsible for physical and mental illness
*did not believe mental illness was shameful or that mentally ill individuals should be held accountable for their behavior.
Hippocrates four categories of mental illness
- epilepsy
- mania
- melancholia
- brain fever
Humorism
A belief held by ancient Greek and Roman physicians (and until the 19th century) that an excess or deficiency in any of the four bodily fluids, or humors—blood, black bile, yellow bile, and phlegm—directly affected their health and temperament.
animistic soul
The belief that everyone and everything had a “soul” and that mental illness was due to animistic causes, for example, evil spirits controlling an individual and his/her behavior.
Greek physician Galen (AD 130–201)
rejected…
agreed…
the notion of a uterus having an animistic soul, he agreed with the notion that an imbalance of the four bodily fluids could cause mental illness.
Hippocratic oath
Many of Hippocrates’ medical theories are no longer practiced today. However, he pioneered medicine as an empirical practice and came up with the “Hippocratic oath,” which all doctors must swear to before joining the profession (i.e., the promise to never intentionally harm a patient)
asylums
A place of refuge or safety established to confine and care for the mentally ill; forerunners of the mental hospital or psychiatric facility.
*Such institutions’ mission was to house and confine the mentally ill, the poor, the homeless, the unemployed, and the criminal.
1785 Italian physician Vincenzo Chiarughi
removed the chains of patients at his St. Boniface hospital in Florence, Italy, and encouraged good hygiene and recreational and occupational training.
French physician Philippe Pinel (1745–1826) and former patient Jean-Baptise Pussin
traitement morale
“moral treatment”
A therapeutic regimen of improved nutrition, living conditions, and rewards for productive behavior that has been attributed to Philippe Pinel during the French Revolution, when he released mentally ill patients from their restraints and treated them with compassion and dignity rather than with contempt and denigration.
*also unshackled patients, moving them to well-aired, well-lit rooms, and encouraging purposeful activity and freedom to move about the grounds
York Retreat
patients were guests, not prisoners, and where the standard of care depended on dignity and courtesy as well as the therapeutic and moral value of physical work
Benjamin Rush
father of America psychiatry
Promotion of matogenic theory of mental illness led to treatments such as blood-letting, gyrators, and tranquilizer chairs.
Dorothea Dix
worked to change the negative perceptions of people with mental illness and helped create institutions where they could receive compassionate care.
*advocated for the establishment of state hospitals.
Franz Anton Mesmer (1734–1815)
influenced by contemporary discoveries in electricity, attributed hysterical symptoms to imbalances in a universal magnetic fluid found in individuals, rather than to a wandering uterus
Mesmerism
Derived from Franz Anton Mesmer in the late 18th century, an early version of hypnotism in which Mesmer claimed that hysterical symptoms could be treated through animal magnetism emanating from Mesmer’s body and permeating the universe (and later through magnets); later explained in terms of high suggestibility in individuals.
cathardic method
A therapeutic procedure introduced by Breuer and developed further by Freud in the late 19th century whereby a patient gains insight and emotional relief from recalling and reliving traumatic events.
Psychoanalysis
was the dominant psychogenic treatment for mental illness during the first half of the 20th century, providing the launching pad for the more than 400 different schools of psychotherapy found today
biopsychosocial model
A model in which the interaction of biological, psychological, and sociocultural factors is seen as influencing the development of the individual.
Emil Kräpelin on mental illness
published a comprehensive system of psychological disorders that centered around a pattern of symptoms (i.e., syndrome) suggestive of an underlying physiological cause.
syndrome
Involving a particular group of signs and symptoms.
homosexuality as a disorder
Up until the 1970’s, homosexuality was included in the DSM as a psychological disorder. Thankfully, society and clinical understanding changed to recognize it didn’t belong.
Diagnostic and Statistical Manual (DSM).
American Psychiatric Association’s 1952 first publication
1980 DSM-III version that began a multiaxial classification system that took into account the entire individual rather than just the specific problem behavior.
Axes I and II contain the clinical diagnoses, including intellectual disability and personality disorders.
Axes III and IV list any relevant medical conditions or psychosocial or environmental stressors, respectively.
Axis V provides a global assessment of the individual’s level of functioning.
*The most recent version — the DSM-5– has combined the first three axes and removed the last two. These revisions reflect an attempt to help clinicians streamline diagnosis and work better with other diagnostic systems such as health diagnoses outlined by the World Health Organization.
*the number of diagnosable disorders has tripled since it was first published in 1952, so that almost half of Americans will have a diagnosable disorder in their lifetime, contributing to the continued concern of labeling and stigmatizing mentally ill individuals.
DSM vs ICD
(the International Classification of Diseases, 11th revision)
There are some differences between the DSM 5 and ICD-11. For example, Gender Incongruence, that is, a discordance between experienced gender and the assigned sex, is not listed as a mental disorder in the ICD-11, but a condition related to sexual health. In the DSM 5, this phenomenon is termed “gender dysphoria” and considered a mental disorder.
Individuals have often theorized on the cause, or ______, of mental illness.
etiology
What is the name of the ancient Greco-Roman belief that mental illness was caused by an imbalance in the four bodily fluids?
humorism
The Greek physician Galen was one of the first people to believe that mental illness could have a ______ cause such as stress, in addition to other bodily causes.
psychogenic
What book allows psychiatrists and psychologists to standardize their diagnoses of mental illness?
DSD
Diagnostic and Statistical Manual of Mental Disorders
The idea that the cultural norms and values of a society can only be understood in their own context is known as what?
cultural relativism
Learning Objectives:
Understand the relationship between anxiety and anxiety disorders.
Identify key vulnerabilities for developing anxiety and related disorders.
Identify main diagnostic features of specific anxiety-related disorders.
Differentiate between disordered and non-disordered functioning.
anxiety
A mood state characterized by negative affect, muscle tension, and physical arousal in which a person apprehensively anticipates future danger or misfortune.
*accompanied by bodily symptoms such as increased heart rate, muscle tension, a sense of unease, and apprehension about the future
anxiety disorders
While everyone may experience some level of anxiety at one time or another, those with anxiety disorders experience it consistently and so intensely that it has a significantly negative impact on their quality of life.
biological vulnerabilities
A specific genetic and neurobiological factor that might predispose someone to develop anxiety disorders.
Psychological vulnerabilities
Influences that our early experiences have on how we view the world.
Specific vulnerabilities
How our experiences lead us to focus and channel our anxiety.
Ex.
If we learned that physical illness is dangerous, maybe through witnessing our family’s reaction whenever anyone got sick, we may focus our anxiety on physical sensations. If we learned that disapproval from others has negative, even dangerous consequences, such as being yelled at or severely punished for even the slightest offense, we might focus our anxiety on social evaluation. If we learn that the “other shoe might drop” at any moment, we may focus our anxiety on worries about the future. None of these vulnerabilities directly causes anxiety disorders on its own—instead, when all of these vulnerabilities are present, and we experience some triggering life stress, an anxiety disorder may be the result
GAD
Generalized Anxiety Disorder
Excessive worry about everyday things that is at a level that is out of proportion to the specific causes of worry.
*About 5.7% of the population has met criteria for GAD at some point during their lifetime
*one of most common anxiety disorders
Percentages | GAD - Generalized Anxiety Disorder
1-year prevalence rates
3.1%
Lifetime prevalence rates
5.7%
Prevalence by Gender
67% female
Median age of onset
31 years
Percentages | OCD
1-year prevalence rates
1%
Lifetime prevalence rates
1.6%
Prevalence by gender
55% female
Median age of onset
19 years
Percentages | Panic Disorder
1-year prevalence rates
2.7%
Lifetime prevalence rates
4.7%
Prevalence by gender
67% female
Median age of onset
24 years
Percentages | PTSD
1-year prevalence rates
3.5%
Lifetime prevalence rates
6.8%
Prevalence by Gender
52% female
Median age of onset
23 years
Percentages | Social Anxiety
1-year prevalence rates
6.8%
Lifetime prevalence rates
12.1%
Prevalence by Gender
50% female
Median age of onset
13 years
Percentages | Specific Phobia
1-year prevalence rates
8.7%
Lifetime prevalence rates
12.5%
Prevalence by Gender
60 to 90% female
Median age of onset
7 to 9 years
reinforced
Following the process of operant conditioning, the strengthening of a response following either the delivery of a desired consequence (positive reinforcement) or escape from an aversive consequence.
fight or flight feeling
A biological reaction to alarming stressors that prepares the body to resist or escape a threat.
Panic Disorder (PD)
A condition marked by regular strong panic attacks, and which may include significant levels of worry about future attacks.
*diagnosis of PD - the person must not only have unexpected panic attacks but also must experience continued intense anxiety and avoidance related to the attack for at least one month, causing significant distress or interference in their lives.
internal bodily or somatic cues
Physical sensations that serve as triggers for anxiety or as reminders of past traumatic events.
interoceptive avoidance
Avoidance of situations or activities that produce sensations of physical arousal similar to those occurring during a panic attack or intense fear response.
external cues (for panic)
Stimuli in the outside world that serve as triggers for anxiety or as reminders of past traumatic events.
agoraphobia
A sort of anxiety disorder distinguished by feelings that a place is uncomfortable or may be unsafe because it is significantly open or crowded.
four major subtypes of phobia
- blood-injury-injection (BII) type
- situational type (such as planes, elevators, or enclosed places)
- natural environment type for events one may encounter in nature (for example, heights, storms, and water)
- animal type
- (5) OTHER - ex. fears of choking, vomiting, or contracting an illness
BII type phobias - blood-injury-injection
usually experience a marked drop in heart rate and blood pressure and may even faint.
*runs in families more strongly than any phobic disorder
*Specific phobia is one of the most common psychological disorders in the United States, with 12.5% of the population reporting a lifetime history of fears significant enough to be considered a “phobia”
*Most people who suffer from specific phobia tend to have multiple phobias of several types
Social anxiety disorder (SAD)
A condition marked by acute fear of social situations which lead to worry and diminished day to day functioning.
*a diagnosis of SAD, the fear and anxiety associated with social situations must be so strong that the person avoids them entirely, or if avoidance is not possible, the person endures them with a great deal of distress. Further, the fear and avoidance of social situations must get in the way of the person’s daily life, or seriously limit their academic or occupational functioning
SAD performance only
Social anxiety disorder which is limited to certain situations that the sufferer perceives as requiring some type of performance.
social phobia stats
92% of adults in their study sample with social phobia experienced severe teasing and bullying in childhood, compared with only 35% to 50% among people with other anxiety disorders
As many as 12.1% of the general population suffer from social phobia at some point in their lives, making it one of the most common anxiety disorders, second only to specific phobia
conditioned response
A learned reaction following classical conditioning, or the process by which an event that automatically elicits a response is repeatedly paired with another neutral stimulus (conditioned stimulus), resulting in the ability of the neutral stimulus to elicit the same response on its own.
Posttraumatic stress disorder (PTSD)
A sense of intense fear, triggered by memories of a past traumatic event, that another traumatic event might occur. PTSD may include feelings of isolation and emotional numbing.
- a diagnosis of PTSD, exposure to the event must include either directly experiencing the event, witnessing the event happening to someone else, learning that the event occurred to a close relative or friend, or having repeated or extreme exposure to details of the event (such as in the case of first responders). The person subsequently re-experiences the event through both intrusive memories and nightmares. Some memories may come back so vividly that the person feels like they are experiencing the event all over again
*The prevalence of PTSD among the population as a whole is relatively low, with 6.8% having experienced PTSD at some point in their life
*Whereas PTSD was previously categorized as an Anxiety Disorder, in the most recent version of the DSM (DSM-5; APA, 2013) it has been reclassified under the more specific category of Trauma- and Stressor-Related Disorders.
flashback
Sudden, intense re-experiencing of a previous event, usually trauma-related
Obsessive Compulsive Disorder (OCD)
A disorder characterized by the desire to engage in certain behaviors excessively or compulsively in hopes of reducing anxiety. Behaviors include things such as cleaning, repeatedly opening and closing doors, hoarding, and obsessing over certain thoughts.
*a diagnosis of OCD, a person must experience obsessive thoughts and/or compulsions that seem irrational or nonsensical, but that keep coming into their mind. Some examples of obsessions include doubting thoughts (such as doubting a door is locked or an appliance is turned off), thoughts of contamination (such as thinking that touching almost anything might give you cancer), or aggressive thoughts or images that are unprovoked or nonsensical.
*must take up a significant amount of the person’s time, at least an hour per day, and must cause significant distress or impairment in functioning. About 1.6% of the population has met criteria for OCD over the course of a lifetime
thought action fusion
The tendency to overestimate the relationship between a thought and an action, such that one mistakenly believes a “bad” thought is the equivalent of a “bad” action.
Treatments for Anxiety and Related Disorders
Medications (anti-anxiety drugs and antidepressants) have been found to be beneficial for disorders other than specific phobia, but relapse rates are high once medications are stopped and some classes of medications (minor tranquilizers or benzodiazepines) can be habit forming.
- Exposure-based cognitive behavioral therapies (CBT) are effective psychosocial treatments for anxiety disorders, and many show greater treatment effects than medication in the long term
Exposure-based CBT
aims to help patients recognize and change problematic thoughts and behaviors in real-life situations.
patients are taught skills to help identify and change problematic thought processes, beliefs, and behaviors that tend to worsen symptoms of anxiety, and practice applying these skills to real-life situations through exposure exercises. Patients learn how the automatic “appraisals” or thoughts they have about a situation affect both how they feel and how they behave. Similarly, patients learn how engaging in certain behaviors, such as avoiding situations, tends to strengthen the belief that the situation is something to be feared. A key aspect of CBT is exposure exercises, in which the patient learns to gradually approach situations they find fearful or distressing, in order to challenge their beliefs and learn new, less fearful associations about these situations.
Ex. A person with a fear of elevators would be encouraged to practice exposure exercises that might involve approaching or riding elevators to attempt to overcome their anxiety.
*Typically 50% to 80% of patients receiving drugs or CBT will show a good initial response, with the effect of CBT more durable.
______ is best thought of as a negative mood state that is marked by bodily symptoms, such as accelerated pulse, muscle tension, feeling uneasy, and worries about the future.
Anxiety
When Olivia was a child, she observed how her mother would count calories and restrict her eating. Now Olivia deals with her stressors by avoiding food and staying slender. Olivia’s early experiences being channeled into a food-related anxiety is an example of ______ and ______ vulnerability.
Specific
&
Psychological
Filomena has been seeing a therapist for two weeks. Based on the symptoms, Dr. Sharma believes that Filomena is suffering from generalized anxiety disorder. For how long will the symptoms need to have been present for this diagnosis to be appropriate?
6 months
From a behavioral perspective, the symptoms of generalized anxiety disorder may become inadvertently ______ when a person feels that their worry has led to some sort of positive outcome.
reinforced
Lamar has had panic attacks for some time, and when this happens he usually gets a feeling of tightness and squeezing in his chest. As a result he has stopped wearing compression t-shirts when he works out, and usually wears shirts that are one size too big. This attempt to avoid an internal sensation associated with a panic attack is called ______.
interoceptive avoidance
Anna is invited by her friends to go to a choir performance in a large recital hall. They do not know that she has a terrible fear of such places, because the crowds make her feel trapped. Anna declines to go, but does not tell her friends that she suffers from ______.
agoraphobia
Many children incorrectly believe that if they have angry wishes about a friend or relative, such wishes could amount to actual harm befalling that person. This overestimation of the relationship between one’s thoughts and actual actions is called thought-action ______.
fusion
What kind of treatments have been found to be as good as, if not better than, medication for dealing with a variety of anxiety disorders?
exposure-based cognitive behavioral therapies (CBT)
GAD Generalized anxiety disorder symptoms
- excessive, intrusive worry
- at least six months
- even for no reason
physiological manifestation
- lack of sleep
- sleep too much
diagnosed only when not better explained by some other mental or physical illness, drug effects
GAD lifetime prevalence
Mostly who?
5.7%
females - 67%
GAD median age of onset
31 years old
GAD
- worry as an attempt to control
- what if reinforcements
Greater vigilance to threat
- more sensitive
Panic Disorder (PD)
- unexpected fight or flight response
- false alarms
- the overwhelming urge to escape
- can feel like you’re dying, losing control
- MUST get out of the situation
- may feel dizzy, nauseous
Lasts 5 to 20 minutes
PD lifetime prevalance
mostly who?
4.7%
mostly females 55%
PD median age of onset
24 years old
Agoraphobia
Excessive fear of having a panic attack and being
unable to escape situation
* Out of proportion with actual threat
* Lasts 6+ months
* Avoidance of panic-inducing or associated situations
* Leaving the house alone
* Waiting in line
* Crowded, public places
* Enclosed spaces (e.g. theaters, lecture halls)
* Public transportation
* Avoidance of situation, want someone with you
- Lifetime prevalence:
1.3% - 4X more common
among women - Average age of onset:
17 yrs - Varies in severity
- Mild: 28%
- Moderate: 31%
- Severe: 41%
Specific Phobeia
Specific Phobia
Irrational fear of specific object/situation
* Target poses no real danger/out of proportion to danger
4 major subtypes
1. Animal: snakes, spiders, dogs
* Most common
2. BII: Blood-injury-injection
* E.g. dentist, injections, blood draw
3. Situational: planes, elevators, enclosed spaces
4. Natural environment: heights, storms, water
+ “Other”: everything else’
e.g. Vomiting, choking, dolls
Lifetime prevalence: 12.5%
* Mostly female (60-90%)
* Median age of onset: 8
yrs
* Predictive of onset of
other anxiety & mood
disorders
* Highly comorbid: 50-80%
* Esp. with social anxiety
disorder (< 60%)
Social Anxiety Disorder
Intense fear & anxiety of everyday social scenarios
* 1:1 conversations
* Eating in public
* Using public restrooms
* Reading on a train
* Giving a presentation
* Asking for help
* Avoided entirely, or endured with difficulty
* Fear of negative evaluation, rejection,
embarrassment
Lifetime Prevalence:
~12.5%
* ~males = females
* Median age of onset:
13 yrs
* High comorbidity: <
90%
* Major depression
(<70%)
* Alcohol use disorder
(50%)
PTSD
- Starts with a traumatic event
- Most common: combat, sexual assault
- War, natural disasters, serious injury
- Followed by
- Intrusive memories, nightmares
- Flashbacks: re-experiencing the event
- Fear, vigilance
- Emotional numbing
- Avoidance of reminders
- Images, smells, situations
Levi-Belz et al., 2024
* N = 710
* Israeli citizens 18yrs+
* Pre vs. post-Oct 7th attacks
* Rates nearly doubled
* Increased risk for:
* Women
* Those present in Gaza envelope
* I.e., location of incursion
- Lifetime Prevalence: 6.8%
- Slightly more among females (52%)
- Women more likely to experience sexual trauma, and at
an earlier age, vs. men - Median age of onset ~ 23 yrs
- As of DSM V: reclassified as “Trauma and Stressor-
related disorders”
OCD
- Irrational, non-sensical intrusive thoughts or
irresistible compulsions - Doubting
- Contamination
- Aggressive
- Compulsions may be linked to quieting the
thoughts - Repetitive, excessive
- E.g. handwashing, checking, ordering, rearranging
Thought-action fusion (TAF)
* Confuse having the thought with enacting it
* A cognitive distortion involving:
1.Likelihood TAF
* Thinking that having the thought makes the event more likely
to happen:
* If I think about my wife’s plane crashing, it makes it more likely that
her plane will crash.
2. Moral TAF
* The belief that thinking is morally equivalent to acting:
* Thinking about hitting my child is as morally wrong as actually doing
it.
- Obsessions/compulsions must
- take up most of one’s time
- At least 1 hr/day
- Cause significant distress or impairment
- Prevalence: 1.6%
- 55% female
- As of DSM V: reclassified as under “Obsessive-
compulsive and related disorders”
Treatment: Medications
Benzodiazepines
* E.g. clonazepam, diazepam, lorazepam
* Act on neurotransmitter GABA, produce feelings of
calmness and may help sleep
* More effective for physiological than psychological
symptoms
* Fast acting, few side effects if used in the short-term
* Long-term side effects
* Impaired memory & cognition, increased anxiety & depression,
increased risk of dementia, hip fractures
* High potential for abuse & addiction
SSRIs/SNRIs
* E.g., Citalopram, Sertraline, Venlafaxine,
* Increase synaptic availability of serotonin and/or
norepinephrine & dopamine (depending on
type/dosage)
* A range of side-effects
* Better for psychological than physical symptoms
Treatment: Therapy
Cognitive Behavioural Therapy (CBT)
* Identify & challenge problematic thoughts, beliefs,
behaviours
* Practice applying new approaches to arousing
situations
* Reduce avoidance/escape, which is self-reinforcing
* Exposure exercises
* Longer-lasting results than meds, but meds can
enhance efficacy of CBT
