Psychological Disorders

1. Perspectives of Psychological Disorders

1. Introduction

• Abnormal psychology (psychopathology): scientific study of mental illness, study the origins of symptoms, developmental course, as well as how to treat and how to prevent mental illness
• Mental illness is more common than people think
• 26% of people surveyed said they had experienced mental illness within the past year
• 46% said they had experienced mental illness up to this point in their life
• 60-70% of people with mental illness do not get help
• Why people don’t get help:

• No money
• Ignorance
• Living in rural areas where help is not available
• Stigma behind mental illness

• Beware of MSS (Medical Student Syndrome)

• Students becoming hyper vigilant about their own symptoms, relating them to disorders they’re studying

1. Defining Psychological Disorders

• Criteria

• Statistical infrequency (CAREFUL: just because something is statistically infrequent, doesn’t mean it’s abnormal)
• Behaviour must be deviant (different than the norms and rules of a specific culture)
• Distressing (the individual is not distressed about their condition)
• Behaviour has to be dysfunctional (harmful to the individual, or to others ← usually disruptive)

1. Understanding Psychological Disorders

• The why?
• 3 Perspectives:

1. The Demonic Model

• People who genuinely believe there is something possessing them, not their mind afflicting them

1. Medical Perspective:

• Renaissance period

• People started to diagnose mental illness
• Believed all symptoms were physiologically and biologically based
• Practices included: Blood Letting (draining 40% of someone’s blood), Scaring the Sickness out (throwing people into snake pits)

• Pinel (a director of science in France)

• Fought for the rights of these mentally ill patients who were being treated terribly
• Promoted moral and ethical treatment of mentally sick people

• Syphilis (if left untreated, can cause severe mental disorders)

• A physical disease that causes mental diseases solidified the medical perspective

• Today:

• Diagnose symptoms
• Use therapy
• Cure the disease

1. The Bio-Psycho-Social Perspective

• Nature and Nurture are examined
• Genes are examined
• Physiological and biological factors are taken into account
• Social and Cultural aspects are also examined
• Anorexia is only found in cultures who worship the skinny female body
• Koro (specific to southeast Asia) is an anxiety disorder that causes males to believe their penis will jab into their own abdomens, killing them

1. Classifying Disorders

• Medical professionals need a single system that can organize and sort everything pertaining to certain disorders
• This system is the DSM-IV-TR

• It organizes, and categorizes info
• Lists symptoms
• Lists criteria that must be met in order to diagnose a mental illness
• Describes the course of an illness
• DOES NOT provide explanations as to why people have certain diseases
• DOES NOT provide treatment options

• The categories are reliable

• A mentally ill patient goes to different hospitals with the same story, leads to a good probability that the medical professionals will agree on a certain disorder
• It clearly lists the observable behaviours that must be present in order to be diagnosed

• Always will be in a state of evolution and devolution (meaning the book is always being revised to ensure accuracy)
• “It takes a village” to revise the DSM (over 60 organizations are involved in the revision of this book)
• Criticism

• The DSM might be culturally biased
• It categorizes but does not talk about dimensions in these categories
• The DSM has too many categories

1. Labeling Psychological Disorders

• Labels encourage stigma
• They have biasing power
• Self-fulfilling prophecy

• When we label people, they may end up behaving in line with the label

• Benefits of labels

• They facilitate communication and research

• Myth Busting!

• Mentally ill people DO NOT look bizarre
• Personal weakness
• People ARE NOT often dangerous (some are but not all mentally ill people are dangerous)
• People ARE ABLE to fully recover (contrary to the belief that many do not recover)
• Some people ARE successful (contrary to conception that mentally ill people have no work, low wages, etc.)

1. Anxiety Disorders

1. Introduction

• Anxiety is normal
• Anxiety is adaptive
• Anxiety can become maladaptive
• Different types of anxiety disorders

1. Generalized Anxiety Disorders (GAD)

• Global, overwhelming, persistent, relentless anxiety
• People who have it are anxious about anything, everything, and nothing

1. Phobias

• Very common
• Focused
• Typically irrational
• Can be disruptive and incapacitating

• Example is Agoraphobia (people who are terrified of being in a public place and not being able to get help if they need it)
• Shyness is common but social phobia is an extreme

• Social phobia is people being absolutely terrified of certain public situations

1. Obsessive Compulsive Disorder

• Lives are dominated and controlled by obsessions and compulsions
• Obsessions are thoughts that are unwanted, uncontrollable, intrusive, and repetitive
• Compulsions are behaviours that a person feels compelled and driven to perform over and over again

1. Post-Traumatic Stress Disorder

• Their nervous systems are easily aroused
• They are easily startled

1. A - Biological Factors

• Genes play a big role
• Natural Selection (we are biologically predisposed to fear the things our ancestors feared)
• Brain:

• Amygdala
• OCD is linked to high levels of activity in the frontal lobes, the caudate nucleus, and the anterior cingulate nuclei
• OCD is linked to low levels of serotonin
• GAD are linked to low levels of serotonin and GABA (a neuron that tells other neurons not to fire)

B – Psychological Factors

• Faulty thinking (people are hyper-vigilant in finding sources of threats rather than safety)
• Maladaptive learning (much of our fears and anxieties are learned through conditioning, observation, modeling)

• Fear Conditioning – we will learn to associate a new stimulus with danger and threat
• Stimulus Generalization (Fear) – your fear is going to extend to stimuli similar to the condition stimulus – EX) one dog bites you, you become afraid of all dogs
• Reinforcement – a positive effect occurs, and continues to feed the fear that you have
• Observational Learning – observe the people around you and if they fear certain things, you may end up fearing those things as well

C – Socio-Cultural Factors

• EX) Taijin Kyofusho – “Social Phobia” specific to Japan

• Fear of embarrassing others, not oneself

  3) Mood Disorders

1. Major Depressive Disorder

• Extreme form of sadness
• Sleep difficulty
• Physical slowness or agitation
• Feelings of worthlessness

1. Dysthymic Disorder

• Double depression (someone who has this disorder and sometimes go into a major depressive disorder)

1. Bipolar Disorder

• People who experience mood disorders at both ends of the continuum
• Symptoms (Manic):

• Increased energy
• Excessive euphoria
• Over-talkative
• Self esteem is super inflated
• Sex drive goes up

• Diagnosis

• 1 week or more + 3 or more symptoms

• Cyclothymic Disorder

• A form of bipolar disorder (it’s bipolar’s little brother)

1. 1 - The Biological Perspective

• The Brain:

• Loss of gray matter linked to depression

• Frontal lobes and hippocampus are smaller in these individuals

• Low levels of activity in left frontal lobe, high levels of activity in right frontal lobe
• Amygdala tends to be hyperactive in people who are depressed
• Neurotransmitters:

• Low levels of dopamine, serotonin, norepinephrine, glutamate (excitatory neurotransmitter)

• Hormonal system

• The system linked and associated with the fight or flight response tends to be overactive in people with depression

• Evolutionary perspective

• Moderate depression can be adaptive
• Nature’s way of saying “stop and unwind”

• Mania:

• Linked and associated with high levels of norepinephrine and glutamate

2 – The Social Cognitive Perspective

• Environmental factors
• Disorder of thinking

• “Cognitive Triad” – people are depressed because they think poorly of themselves, the world, and the future

• Pessimistic explanatory style

• Negative event explained over:

• Internal dimensions
• Stable dimensions
• Global dimensions

• Positive event explained over:

• External dimensions
• Unstable dimensions
• Specific dimensions

• Reciprocal determinism between thoughts and mood

1. The Vicious Cycle of Depression

• Brain Chemisty <-> Cognition
• Cognition <-> Mood
• Brain Chemisty <-> Mood

• Stressful experience → Negative explanatory style → Depressed mood → Cognitive and behavioural changes

1. Depression Cont.

• Most common disorder is depression
• Women are twice as likely to have depression
• It can be self-terminating
• Depression is on the rise and is occurring earlier than ever before

4) Schizophrenia

1. Intro

• Huge variations
• Loss of touch with reality
• “Cancer” of mental illness
• Profound changes
• 1/100 men get it earlier and worse

1. Positive Symptoms (Symptoms that are prevalent)

• Delusions (false beliefs)
• Hallucinations (perceptions without sensations
• Disorganized speech (quarter/half sentences – don’t finish their thoughts) “word salad” is random words strung together and sufferers think they’ve created a sentence
• Catatonia people who suffer this stay in one physical position and can’t get out of it
• Disorganized behaviours (ineffective or inappropriate at times)
• Disorganized emotions
• Disorganized thinking (difficulty separating fact from fiction)
• Attention (everywhere, all over the place, “ADD” of sorts)

Negative Symptoms (Symptoms that provide the absence of)

• Flat affect (no matter what is said to them, an uninterested reaction occurs, i.e. “flat”
• Speech becomes very slow and very monotonous – extreme cases people end up with Alogia (speech is almost absent)
• Abolition (absence of motivation)
• Attention deficits

1. Subtypes of Schizophrenia

1. Type 1 (Reactive) Schizophrenia

• Positive symptoms
• Acute onset (develops quickly)
• Good prognosis
• Favourable response to medication

1. Type 2 (Process) Schizophrenia

• Negative symptoms
• Chronic (develops slowly)
• Prognosis is poor
• Poor response to medication
• Men get it more often → don’t know why

1. Understanding Schizophrenia

1. Genetic Factors

• No relative with schizophrenia – 1/100 chance to get it yourself
• Relative with schizophrenia – 1/10 chance to get it yourself
• 1 in 2 chance of identical twin having it, if other does
• Adoption studies show that an adoptive child with no schizophrenia, with adoptive parents that have it, risk is still 1/100
• Chromosomes 6, 7, 13, 22 show abnormalities that are linked and associated with schizophrenia
• Genes that have an effect:

• GRM3
• GAD1
• SNP4
• DISC1

• Some people with schizophrenia tend to have chunks of DNA that are missing – others have chunks added to their existing DNA
• HERV-W (a retrovirus) believed to be associated with schizophrenia
• Over 25% of schizophrenia are linked with the father’s age (men in their 40’s/50’s are 3x more likely to give their children schizophrenia, than 20 year olds)

1. Environmental Factors

• Complications at birth increase risk for schizo
• If the mother gets pregnant during famine/starvation – increases risk for child having shcizo
• Low birth weight linked/associated with a number of negative outcomes INCLUDING risk for schizo – stronger for boys than for girls
• If mom takes painkillers during pregnancy, it increases the risk of schizo by 5x
• Women with herpes, their children 5x more likely to get schizo
• Influenza during 2nd trimester – children 2x likely to get schizo
• Influenza during 1st trimester – children 7x likely to get schizo
• Head injury before age of 10 increases risk for schizo
• Smoking marijuana can lead to increased risk (if smoked before the age of 18)
• See interactions D.5

1. Brain Abnormalities

• Link between abnormal neurotransmitters and schizo
• Increased dopamine activity is linked and associated with positive symptoms
• Decreased dopamine activity is linked with negative symptoms
• Decreased glutamate levels lead to negative symptoms
• Abnormal interactions between dopamine and glutamate can lead to schizo
• GABA abnormalities can lead to higher chance of schizo
• Structure/function of brain (some cases of schizo linked with):

• Enlarged ventricles
• Smaller frontal lopes
• Smaller hippocampus
• Abnormal connections between frontal lobes and hippocampus
• Orientations of neurons in hippocampus are abnormal (normal setup is parallel orientations – abnormal they are crossed)
• Inappropriate connections in utero (the inappropriate connections between neurons occur in the womb)
• White matter in the brain (healthy teens developed normally after 5 years – early onset schizo teens developed abnormally) the slower the development of white matter, the more symptoms suffered
• Loss of gray matter (healthy teens developed normally, schizo teens had a lot of destroyed tissue)

1. Psychological Factors

• There is no single psychological factor we can link to schizophrenia on it’s own
• We can find psychological factors interacting with other factors though

1. Interactions

• All in the family

• Expressed emotions:

• The extent to which family members use criticism and hostility to deal with issues
• Over involvement, etc.
• If cured schizo patients return to families who are high in expressed emotions, 60-75% of them relapse

• Nature & Nurture:

• Adopted children were recruited to participate in a study – some had bio moms with schizo, some didn’t
• Expectation is that children with moms who have schizo have a higher chance of getting it – children with bio moms who have schizo, that were raised in healthy adoptive homes severely decreased their risk for schizo
• Children who were raised in “broken” homes had a higher risk to develop it (both cases of bio moms with/without schizo)

• A combination of factors (for the first time ever):

• Show that being exposed to a viral infection
  + having chronic and severe stress ← show a serious increase for risk of schizo

• GOOD NEWS

• 25% of people get one episode, but then move on from it
• Another 25% get re-occurring episodes but can move on from it

• BAD NEWS

• 50% of people have it chronically and are in/out of hospitals constantly

5) Personality Disorders

1. Introduction

• Typical ways of thinking, believing, feeling are inflexible, rigid, maladaptive, dysfunctional
• Organized into 3 clusters:

1. Anxious/Fearful Behaviours

• Example – “Withdrawn avoidant personality disorder”

• People that yearn for interpersonal relationships, but avoid them like the plague
• These people tend to have strong feelings of being inadequate

1. Odd or Eccentric Behaviours

• Example – “Schizoid personality disorder”

• People who suffer have pervasive detachment from the social world
• No interest in interpersonal relationships – including family members and sexual intimacy
• Very casual interactions with people
• Usually are loners, emotionally flat and cold, seem to be indifferent to both praise and criticism

1. Dramatic, emotional, erratic, or impulsive behaviours

• Histrionic Personality Disorder

• Emotional expressions are overly dramatized/exaggerated - “Drama Queens”
• Self-centered
• Behaviour/appearance inappropriate in terms of seduction/sexiness
• Low tolerance for frustration
• Insecure and shallow

• Narcissistic Personality Disorder

• Inflated sense of self importance
• No one else has the qualities they possess
• Super self-absorbed
• Difficulty feeling any concern for others
• Disregard other people’s feelings
• Excessive need for admiration
• Boastful and pretentious

• Borderline Personality Disorder

• Mostly women have it
• Main characteristic is instability (mood/emotions)
• Self image is unstable
• Tend to seek lots of attention from others
• Very common for them to have bouts of rage and anger
• Have pervasive feelings of emptiness
• Terrified of abandonment and feeling alone
• Very self-destructive
• Self mutilation
• Suicide attempts
• Reckless behaviours (gambling, sexual promiscuousness)
• People with this disorder tend to have a destructive attachment – abusive/neglectful caregivers
• Areas of the brain that determine the intensity of negative emotions are HYPERACTIVE
• Areas we use to control some random stuff are underactive

• Antisocial Personality Disorder

• 6% of male population are diagnosed, 1% of female population are diagnosed
• PERVASIVE pattern of manipulating, exploiting, disregarding or violating the rights of others
• Behaviours are often criminal
• No conscience, empathy, passion, guilt, etc.
• They fear very little
• They see people as mere objects
• All serial killers are psychopaths, not all psychopaths are serial killers
• Seems to be a genetic component to be a psychopath BUT there are also environmental factors that come into play as well
• Some studies seem to indicate that it’s an interaction between nature and nurture that is linked with psychopathy
• Genetic deficiencies + Maltreatment = Increased Risk for Psychopathy