Psychological Disorders

Historical Perspectives on Psychological Disorders

• The Demonological View
  • Abnormal behaviour was claimed to be work of the devil
  • Procedure called trephination drilled hole in skull to release evil spirits
• Early Biological Views
  • Hippocrates suggested that mental illnesses are diseases just like physical disorders
  • Believed that site of illness was the brain
  • Biological emphasis increased after discovery that general paresis (mental deterioration disorder) resulted from brain deterioration
• Psychological Perspectives
  • Freud believed that psychological disorders are caused by unresolved conflicts
    • Disorders that don’t involve a loss of contact with reality (obsessions, phobias, etc.) called neuroses
    • Severe disorders involving a withdrawal from reality called psychoses
  • Vulnerability-stress model – everyone has some degree of vulnerability to developing a disorder
    • Vulnerability can have biological basis, brain malfunction, or hormonal factor
    • Can also arise from personality factors such as low self-esteem
    • Vulnerability often only causes disorder when a stressor combines with it to trigger the appearance of the disorder

Defining and Classifying Psychological Disorders

• What is “Abnormal”?
  • Three criteria seem to govern decisions about abnormality:
    • Distressing – we are likely to label behaviours abnormal if they intensely distress an individual
    • Dysfunctional – most behaviours that are abnormal are dysfunctional for the individual or society
    • Deviance – abnormality of a behaviour is based on society’s judgments of the deviance of it
  • Abnormal behaviour – behaviour that is personally distressful, personally dysfunctional, and/or culturally deviant
• Diagnosing Psychological Disorders
  • Classification must be set up that meets standards of reliability (high levels of agreement in decisions among clinicians) and validity (diagnostic categories accurately capture the essential features of disorders)
  • Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) most widely used diagnostic system
    • Allows diagnostic information to be represented along five dimensions:
      • Axis I – person’s primary clinical symptoms
      • Axis II – long-standing personality or developmental disorders that could influence behaviour and response to treatment
      • Axis III – physical conditions that might be relevant
      • Axis IV – intensity of environmental stressors
      • Axis V – person’s coping resources
• Critical Issues in Diagnostic Labeling
  • Diagnoses can have important legal consequences
  • Law tries to take into account the mental status of individuals accused of crimes
    • Competency – defendant’s state of mind at time of a judicial hearing (not during committing of crime)
    • Insanity – presumed state of mind of defendant at time of crime

Anxiety Disorders

• Anxiety disorders – group of behaviour disorders in which anxiety and maladaptive behaviours are core of the disturbance
  • Frequency and intensity of anxiety responses are out of proportion to situation that triggered them
• Have four components:
  • Subjective-emotional component (feelings of tension and apprehension)
  • Cognitive component (feeling of inability to cope, sense of impending danger)
  • Physiological responses (increased heart rate and blood pressure, muscle tension)
  • Behavioural responses (avoidance of certain situations and impaired task performance)
• Phobic Disorder
  • Phobias – strong and irrational fears of certain situations or objects
    • Most common include agoraphobia (fear of open and public spaces), social phobias, and specific phobias (dogs, snakes, spiders, etc.)
• Generalized Anxiety Disorder
  • Generalized anxiety disorder – a chronic state of diffuse, or “free-floating”, anxiety that is not attached to specific situations or objects
• Panic Disorder
  • Panic disorders – anxiety disorder characterized by unpredictable panic attacks and a fear that another will occur
    • Much more intense than generalized anxiety disorder
  • Many people develop agoraphobia because of fear that they will have an attack in public
• Obsessive-Compulsive Disorder
  • Anxiety disorder characterized by persistent and unwanted thoughts and compulsive behaviours
    • People realize obsessions and compulsions have no value, and want to stop
  • Obsessions – repetitive and unwelcome thoughts, images, or impulses that invade consciousness
  • Compulsions – repetitive behavioural responses that are difficult to resist
  • Genetic link found with Tourette’s, childhood disorder characterized by muscular/vocal tics, facial grimacing, vulgar language
    • Increased activity in frontal lobes, decreased serotonin activity
• Post-Traumatic Stress Disorder
  • A pattern of distressing systems (flashbacks, nightmares, etc.) an anxiety responses that recur after a traumatic experience
  • Four major symptoms:
    • Person experiences severe symptoms of anxiety, arousal, and distress
    • Person relives the trauma in recurrent flashbacks, dreams, and fantasies
    • Person becomes numb to world and avoids stimuli that serves as reminder of the trauma
    • Personal experiences “survivor guilt” in instances where others were killed
• Causal Factors in Anxiety Disorders
  • Genetic factors may create a vulnerability to anxiety disorders
    • Abnormally low levels of GABA activity may cause people to have highly reactive nervous systems that quickly produce anxiety responses in response to stressors
    • Biological preparedness makes it easier to learn to fear certain stimuli, and may explain why phobias seem to centre on certain classes of primal stimuli and not on more dangerous modern ones, such as guns
  • Anxiety is central feature of psychoanalytic conceptions of abnormal behaviour
    • Neurotic anxiety – state of anxiety that arises when impulses from the id threaten to break through into behaviour
      • Form of anxiety disorder determined by how ego’s defense mechanisms deal with neurotic anxiety
  • Cognitive theorists stress role of maladaptive thought patterns and beliefs in anxiety disorders
    • Eliciting stimuli -> physiological responses -> catastrophic appraisals à panic attack
  • Behavioural perspective believes anxiety disorders result from emotional conditioning
  • Culture-bound disorders – behaviour disorders whose specific forms are restricted to one particular cultural context

Mood (Affective) Disorders

• Mood disorders – psychological disorders whose core conditions involve maladaptive mood states
• Depression
  • Major depression – mood disorder characterized by intense depression that interferes markedly with functioning
  • Dysthymia – a depressive mood disorder of moderate intensity that occurs over a long period of time but does not disrupt functioning as a major depression does
  • Depression involves cognitive symptoms, motivational symptoms, and somatic (physical) symptoms
• Bipolar Disorder
  • Bipolar disorder – depression alternates with periods of mania
    • Mania – state of highly excited mood and behaviour that is quite the opposite of depression
    • Norepinephrine drops during depression, increases during mania
• Prevalence and Course of Mood Disorders
  • People born after 1960 are ten times more likely to experience depression than are their grandparents
  • Women are twice as likely to suffer from depression
  • After depression, one of three patterns may follow:
    • Half of all cases, depression will never recur
    • Many people show recovery with recurrence some years later (recurring episode is shorter)
    • About ten percent will not recover
• Causal Factors in Mood Disorders
  • Genetic and neurochemical factors are linked to depression
  • Manic disorders may stem from overproduction of neurotransmitters that are underactive in depression
  • Psychoanalysts believe that early traumatic experiences create vulnerability for depression
  • Lewinsohn claims a loss of rewards leads to mood disorders
  • Martin Seligman suggested that overemphasis on individual attainment and lesser commitment to traditional values are likely to react strongly to failure and cause depression
    • Learned helplessness theory – depression occurs when people expect that bad events will occur and that nothing can be done to prevent or cope
  • Depressive cognitive triad (Beck) – triad of negative thoughts that depressed people cannot control or suppress
    • Triad includes the world, oneself, and the future
  • Depressive attributional pattern – tendency of depressed people to attribute negative outcomes to their own inadequacies and positive ones to factors outside of themselves
  • Cultural factors affect ways in which depression is manifested
    • Depression more commonly reported in western nations
    • Feelings of guilt and personal inadequacy in western nations, physical symptoms in African nations

Somatoform Disorders

• Somatoform disorders – a disorder in which a person complains of bodily symptoms that cannot be accounted for in terms of actual physical damage or dysfunction
  • Hypochondriasis – people become unduly alarmed about any physical symptom they detect, and are convinced they are about to have a serious illness
  • Pain disorder – people experience intense pain that either is out of proportion to whatever medical condition they might have or for which no physical basis can be found
  • Conversion disorder – serious neurological symptoms, such as paralysis, loss of sensation, or blindness suddenly occur
    • People often exhibit a lack of concern about their symptoms (la belle indifference)
    • Glove anaesthesia, in which person loses sensation below wrist, is physiologically impossible, since nerves also serve area above the hand
• Differ from psychophysiological disorders, which cause a real medical condition

Dissociative Disorders

• Dissociative disorders – disorders which involve a major dissociation of personal identity or memory
• Take on three different forms:
  • Psychogenic amnesia – a person responds to a stressful event with extensive but selective memory loss
  • Psychogenic fugue – a person loses all sense of personal identity, gives up their customary life, wanders to a new faraway location, and establishes a new identity
    • Triggered by a highly stressful event or trauma
    • May last from several hours to several years
  • Dissociative identity disorder – two or more separate personalities coexist in the same person
    • A primary/host personality appears more often than others
    • Personalities may or may not know of existence of others
    • Can differ in gender, age
    • Trauma-dissociation theory – development of new personalities occurs in response to severe stress

Schizophrenia

• Schizophrenia – a psychotic disorder that involves severe disturbances in thinking, speech, perception, emotion, and behaviour
  • Literally means “split mind”
• Characteristic of Schizophrenia
  • Diagnosis requires that a person misinterprets reality and exhibits disordered attention, thought, and perception
  • Delusions – false beliefs that are sustained in the face of evidence that normally would be sufficient to destroy them
  • Hallucinations – false perceptions that have a compelling sense of reality
  • Emotions can be affected in several ways:
    • Some have blunted affect, manifesting less emotion that others
    • Some have flat affect, showing almost no emotion at all
    • Some have inappropriate affect, expressing a wrong emotion to a situation
• Subtypes of Schizophrenia
  • Four major subtypes of schizophrenia:
    • Paranoid type – people believe that others mean to harm them, and delusions of grandeur, in which they believe they are enormously important
    • Disorganized type – central features are confusion and incoherence, together with severe deterioration of adaptive behaviour
    • Catatonic type – shows striking motor disturbances, ranging from muscular rigidity to random or repetitive movements
    • Undifferentiated type – exhibit some symptoms and thought disorders of other categories, but not enough to be diagnosed in a category
  • Two main categories on basis of two classes of symptoms:
    • Type I schizophrenia – predominance of positive symptoms (delusions, hallucinations, and disordered speech)
      • Called positive because they represent pathological extremes of normal processes
    • Type II schizophrenia – predominance of negative symptoms (lack of emotional expression, loss of motivation, and absence of normal speech)
• Causal Factors in Schizophrenia
  • Strong evidence for a genetic predisposition, though specific genes are still unknown
  • Can be caused by destruction of neural tissue
    • Mild to moderate brain atrophy often observed
  • Dopamine hypothesis – symptoms of schizophrenia are produced by overactivity of dopamine system in areas that regulate emotional responses, motivated behaviour, and cognitive functioning
  • Freud believed that schizophrenia represented an extreme example of defense mechanism regression
  • Hospitalized schizophrenics are more likely to relapse if they return to a home environment that is high in a factor called expressed emotion (high levels of criticism, hostility, and overinvolvement)
  • Social causation hypothesis attributes higher prevalence of schizophrenia to higher levels of stress that low income people experience
  • Social drift hypothesis proposes that as people develop schizophrenia, their personal and occupational functioning deteriorates, so they drift down the socio-economic ladder into poverty
  • Prevalence is not different throughout cultures, though chance of recovery is greater in developed countries

Personality Disorders

• Personality disorders – stable, inflexible, and maladaptive personality styles
• Anti-Social Personality Disorder
  • Seem to lack a conscience
  • Display a perplexing failure to respond to punishment
• Causal Factors
  • Has genetic and physiological factors
  • Psychodynamic theorists claim people lack conscience due to underdeveloped superego
  • Poorer emotional classical conditioning found in those with anti-social disorder

Disorders of Childhood and Old Age

• Childhood Disorders
  • Externalizing disorders – directed toward the environment in the form of behaviours that are disruptive and often aggressive
    • Attention-deficit/hyperactivity disorder (ADHD) – problems take form of attentional difficulties, hyperactivity-impulsivity, or a combination of the two that results in impaired functioning
      • Much more common in boys
    • Oppositional defiant disorder (ODD) – children consistently behave in a disobedient, defiant, and hostile manner
    • Conduct disorder – children violate important social norms and show disregard for others
  • Internalizing disorders – involve maladaptive thoughts and emotions
• Dementia in Old Age
  • Dementia – the gradual loss of cognitive abilities that accompanies brain deterioration and interferes with normal functioning
  • Progressive atrophy of brain tissue occurs
  • Can occur at any point in life, but elderly are at greater risk
  • If began after age 65, called senile dementia
  • Alzheimer’s dementia – leading cause of dementia in elderly, accounting for 60% of senile dementias