Psychology Chapter 16 Psychological Disorders PDF

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Chapter 16 Psychological Disorders Summary and important notes...

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Psychology Chapter 16 Psychological Disorders

What is abnormal? 1. 2. 3. 4. 5. 6.

The personal values of a given diagnostician. The expectations of the culture in which a person currently lives. The expectations of the person’s culture of origin General assumptions about human nature Statistical deviation from the norm Distress, dysfunction, and deviance

Abnormal behaviour; behviour that is personally distressful, personally dysfunctional, and/or so culturally deviant that other people judge it to be inappropriate or maladaptive. Distress. People who are excessively depressed, anxious or dissatisfied about life circumstanced may be viewed as disturbed, especially if they seem to have little control over these reactions. Even though these feelings are normal to us, we experience them in points of our lives, distress becomes abnormal when it is disproportionately intense or long-lasting relative to the situation. Dysfunctional. Most behaviours judged as abnormal are also dysfunctional for the individual or society, in that, these behaviours interfere with a person’s ability to work or experience satisfying relationships with other people. They interfere with he well-being of society and many of these behaviours can be seen as maladaptive and self-defeating. Deviance. Society is based on norms, behavioural rules on how to think, feel and behave. Some of these norms are regulated by law and breaking the norm will result in criminal penalty. Breaking other law-binding norms such as thinking out loud by yourself, facing the rear of an elevator or staring intently into strangers eyes, will result in people viewing such person as psychologically disturbed. That Is, deviance, especially when the violations to the norms make others uncomfortable and cannot be attributed to environmental causes, will be viewed as an abnormality. General paresis is a disorder characterized by mental deterioration and bizarre behaviour, resulted from massive brain deterioration caused by STD syphilis. The reason why this was such a breakthrough is because it was the first demonstration that a psychological disorder was caused by an underlying physical malady, rather than being widely regarded as suffering from evil spirts, being possessed, or a witch.

Vulnerability-stress model; a model that explains behaviour disorders as resulting from predisposing biological or psychological vulnerability factors that are triggered by stressor. Each of us has a degree of vulnerability for developing psychological disorder given sufficient stress. These vulnerabilities can be predispositions of a biological basis such as our genotype, over/under activity of neurotransmitter system in brain, hormonal factor, etc. it could also be due to personality factors such as low self esteem or extreme pessimism or to environmental factors such as poverty or experiencing trauma at young age. So some with predisposition of depression or one that experienced trauma early on, may develop psychological disorder if faced with stressors of significant loss later in life.

In order to diagnose psychological disorders, classification is important step toward introducing order into discussions of nature, causes and treatment of psychological disorders. Classification system must meet reliability and validity standards. Reliability; is the consistency with which a measure asses a given characteristics, or different oberevers agree on a given score. This is due to reduce subjective judgments. Validity; is that the diagnostic categories should accuratlely capture the essential features of the various disorders CATEGORICAL AND DIMENSIONAL APPRAOCHES FOR DIAGNOSIS DSM-IV-TR was a categorical system in which people placed within very detailed and specific diagnostic categories. Problem was that criteria was so specific that many people (50%) didn’t fit neatly into categories . people who receive same diagnosis may share certain symptoms but look very different from one another. Categorical system doesn’t provide way for capturing severity of person’s disorder, nor the symptoms that are very important but not severe enough to meet behavioural criteria for disorder. Dimensional system rate relevant behaviours along a severity measure. The major psychiatric classification system in North America is the DSM-5. Reliability (diagnostic agreement) and validity are important issues in diagnostic classification systems.

Social and legal consequences of diagnostic labelling. Once a diagnostic label is asttached to person, becomes easy to label individual rather than behaviour. If someone in your neighbourhood was labelled as “sexual psychopath”, weather his behaviour is accurate of the label or not, that label will most definitely and strongly influence the way one views and interacts with this individual.

Legal consequences may also tie up the freedoms of individuals with diagnostic labels, considering their state of mental health. Competency refers to defendant’s state f mind at time of judicial hearing, mot at time crime was committed. The defendant knows very well the nature of criminal charges, understands the processes and so on. People who may be too disturbed may be labelled not competent to stand trial and institutionalized until judged competent. Insanity refers to presumed state of mind of defendant at time the crime was committed. May be declared not guilty by reason of insanity if judged that defendant mental state was so severely impaired during the crime that they lacked capacity to understand what was lawful or not, or could not control their actions

4 COMPONENTS OF ANXIETY 1. Subjective-emotional component; feelings of tension and apprehension 2. Cognitive component; feelings of apprehension, sense of impending danger, feeling of inability to cope. 3. Physiological responses; increased heart rate and blood pressure, muscle tension, rapid breathing, nausea, dry mouth,etc. 4. Behavioural responses; avoidance of certain situations and impaired task performance

Incidence refers to number of new cases that occur during a given period. Prevalence refers to number of people who have a disorder during a specified period of time (both new and previously existing cases.)

Phobia; strong and irrational fears of certain objects or situations. The most common phobias in the West are agoraphobia; fear centered around open spaces and public places, Social anxiety disorder; excessive fear of situations where person may be evaluated and possibly embarrassed, and specific phobias; such as fear of dogs, snakes, spiders, airplanes, etc. Note that phobias may develop any point in lifetime and they seldom go away. They may broaden and intensify over time. Degree of impairment produced by phobia depends in part in how often the phobic stimulus is encountered. Someone with a phobia of flying may be not cause much problems if its once in a while, however, it can cause serious impairment for individuals whose nature of work requires constant traveling.

Generalized Anxiety Disorder; a chronic state of diffuse, or “free-floating” anxiety that is not attached to specific situations or objects. Emotionally they may feel jittery, tense or on edge. Cognitively they expect something awful to happen but don’t know what. Physically, they experience mild chronic emergency reactions such as sweats, upset stomach, diarrhea, etc. even when symptoms are not continuously present for the 6 months required for a formal diagnosis, it can still interfere greatly with daily functioning. Onset tents to occur n childhood and adolescence, and females more likely to be affected by GAD than males. Panic disorders; anxiety disorder characterized by unpredictable panic attacks and a pervasive fear that another will occur, may result into agoraphobia. Unlike GAD, which involves chronic tension and anxiety, panic disorders occur suddenly and unpredictably and many times there is an absence of any identifiable stiumulis. The fear of fear, that is anxiety that something awful will happen, or that one will get another panic attack if they put themselves “out there” can result in agoraphobia and leave indivuals locked up in home. Onset of panic disorders usually appear in late adolescence or early adulthood and affect 6% population over their lifetime.

Obsessive-Compulsive Disorder (OCD); anxiety disorder characterized by persistent and unwanted thoughts and compulsive behaviours. These disorders usually consist of 2 components, cognitive and behavioural. Obsessions; unwanted or disturbing thoughts or images that invades consciousness and is very difficult to control Compulsions; a repetitive act the person feels compelled to carry out, often in response to obsessive thoughts or images. Mother who had obsession with germs would go about her cleaning rituals (compulsion) so that she would temporarily feel better from the anxiety inducing thoughts (obsession) Onset usually occurs in the 20’s Looking at this from inside the brain, many areas are involved in relation to why OCD may occur. Research indicates that obsessions are likely generated through an orbitofrontal-cingulate pathway, while compulsions involve a prefrontal-caudate-thalamus circuit. The thalamus which serves as a major relay station for incoming information, shows that abnormalities within this region are directly related to OCD symptom activity.

The orbitofrontal which is the prefrontal lobe directly behind the eyes and the medial (toward the middle) prefrontal cortex are an important relation to OCD because these areas are implicated in the control of soically appropriate behaviours and motivation. If these areas do not function properly, individual may display inappropriate, impulsive behaviours and may fixate on one aspect of the environment. FACTORS THAT MAY PRODUCE SEX DIFFERENCE PREVELANCE OF ANXIETY DISORDERS Social conditions that give woman less power and personal control may contribute, negative life events, self esteem, and social support may also play a role. Evolutionary perspective states that predisposing certain phobias to certain situations based on the likeness of survival. CASUAL FACTORS IN ANXIETY DISORDERS Biological factors Genetic factors may create vulnerability to anxiety disorders. Clinical research suggests that of identical twins that may develop an anxiety disorder, there is a 40% concordance rate of identical twins (one twin has it, so does the other) for anxiety disorders, compared with 4% of concordance with fraternal twins. 61% of pop with panic disorders and 44% with agoraphobia is genetically influenced. Yet note that there is still a good chunk that is not influenced by genetic, which gives way to psychological and environmental factors. David Barlow suggests that vulnerability may take form of autonomic nervous system overreacting to perceived threat which creates high levels of physiological arousal. The Amygdala plays a role in threat-detection in phobias, which results in brief but strong response to feared objects that is not present in non-phobic individuals. Hereditary factors may cause over reactivity of neurotransmitter systems involved in emotional responses. Exposure to stress early in life is also associated with change in various neurotransmitter systems, resulting in increased responsiveness to stress. GABA which is an inhibitory transmitter that reduces neural activity in the amygdala and other brain structures that stimulate physiological arousal, has been shown to be abnormally low in paitents with history of panic attacks (22% lower concentration of GABA in occipital cortex). This hypothesis suggests because GABA is abnormally low, this may cause people to have highly reactive nervous systems that quickly produce anxiety response in response to stressors. Psychological Factors Regarding Psychodynamic theories, Neurotic anxiety; is a state of anxiety that arises when impulses from the id threaten to break through into behaviour. So how the ego’s defence mechanisms deal with neurotic anxiety determines the form of the anxiety disorder. For example, the case of a boy named Han who developed a dear of horses and possibly getten bitten, was viewed by Freud as a boy who had unresolved Oedipus complex (sexual attraction for parent and seen as a conflict with the other parent). The horse represented Han’s father and

the fear of being bitten symbolized Han’s unconscious fear of being castrated by his father if he acted on his sexual desire for his mom. Thus, in this view, compulsions would act as a way of undoing or washing out the “dirt” from the obsession, the dirty id thoughts, in which this anxiety is managed and is a reaction in attempt to hide the underlying conflict.

Cognitive factors Cognitive theorists stress role of maladaptive thought patterns and beleifs in anxiety disorders. They often catastrophize about demands and magnify them into threats. Panic attacks are triggered by exaggerated misinterpretations of normal anxiety symptoms such as heart palpitations, dizziness, and breathlessness. The panic stricken individual appraises these signs that a heart attack is about to occur or psychological loss of control is bound, which then creates more anxiety until process spirals out of control, producing full-blown panic attack. Things that are shown to help panic patents is replacing the appraised “mortal danger” with more benign interpretations such as “its not a heart attack, its just a bit of anxiety.”

Anxiety as a learned response Behavioural perspective states that anxiety disorders result from emotional conditioning. For example, someone who experienced a tramatuic fall, may develop a phobia for heights. Observational learning can also develop anxiety disorders by watching plane crashes or anxiety inducing situations and having a fear that it may happen to them. Biological and cognitive factors may also explain how someone who has a biological predisposion towards intense fear, comes to convince themselves that “sooner or later this will happen to me”, the likelihood of developing a phobia increases. Once anxiety is leaned, it may be triggered by environmental or internal cues such as thoughts or images. Phobic situations tend to be triggered by external factors such as feared objects or situations while panic disorders, anxiety tends to be triggered internally such as bodily sensations. (heartrate increase) People will deal with these anxieties in forms of negative reinforcement.

Sociocultural factors Culture-bound disorders; behaviour disorders whose specific forms are restricted to one particular cultural context.

Ex. Social phobia of Taijin Kyofushu in Japan is characterized by great fear of offending others by emitting offensive odours, blushing, staring inappropriately, or having blemish or improper facial expression. This phobia can be attributed to Japanese cultural value of extreme interpersonal sensitivity and to cultural prohibitions against expressing negative emotions. Anorexia eating disorder that can be attributed to many developed countries in which looking thin has become a cultural obsession.

Mood disorders; psychological disorders whose core conditions involve maladaptive mood states such as depression or mania Major depression; mood disorder characterized by intense depression that interferes greatly with functioning Chronic depressive disorder; depressive mood disorder of moderate intensity that occurs over long periods of time but does not disrupt functioning as major depression dose. 4 CLASSES OF SYMPTOMS OF DEPRESSION AND MANIA 1. 2. 3. 4.

Emotional Cognitive Motivational Somatic features

Emotional factor shows a negative mood state in depressed people. Activites that used to bring satisfaction and happiness feel dull even those that are biological pleasures such as eating and sex lose their appeal. Cognitive factor, have difficulty concentrating and making decisions. Have low self esteem, believe they are inferior, inadequate and incompetent. Tend to blame themselves when set backs occur, and expect failure even when it has not yet occurred. Depressed people view the future with pessimism and hopelessness. Motivational symptoms involve inability to get started and perform behaviours that might produce pleasure or accomplishments. May not get out of bed in the morning or go to class and study. In extreme cases, may need to be propped out of bed, clothed and fed. Somatic (bodily) symptoms include loss of appetite and weight loss, sleep disturbances and insomnia, all of which lead to weakness and fatigue which adds more depression. May lose sexual desire and responsiveness. Weight gain can also be indicator of depression as person eats compulsively.

Bipolar disorder Mood disorder in which mania, a state of highly excited mood and behaviour that is opposite of depression, appears against a background of depression. In manic state, mood is euphoric and cognitions are grandiose. (ambitious). Person believes there are no limits to what can be accomplished and does not recognize negative consequences of what may ensue if these plans are acted on. Motivationally speaking, manic behaviour is hyperactive, and is engaged in frentic activity. They are very irratible and aggressive when their momentary goals are frustrated in any way. Their speech is rapid, pressured, often as if there is a timer for how many words they can say. They may go on for several days without sleep until exhaustion takes over. Ex. Dental surgeon woke up with the thought that he was the best, had an grandiose plan to remuddle his dental office so that he can work on as many patients as possible. When plans and call backs seemed to be delayed, he took matters with his own hands and started smashing his office with a sledgehammer. When that failed, he destroyed his equipment. Later going to the hospital in which he couldn’t sit still in his chair. Prevalence of depression Woman are twice as likely as men to suffer from depression. Women most likely to suffer first episode of depression in their 20’s, men in their 40’s. bio theories suggest genetic factors, biochemical differences in the nervous system, or monthly premenstrual depression many women experience could increase vulnerability to depressive disorders. Environmental factors such as cultural factors like traditional model in West of expectations for women to be passive and dependant in face of stress or loss and to focus on their feelings, while men more likely to distract by activities or drinking. Following a major depressive episode, about 40% never have a recurrence, approx. 50% do have a recurrence and approx. 10% will suffer chronic (ever-present) depression.

CAUSAL FACTORS IN MOOD DISORDERS Biological factors Genetic factors are linked to depression. Identical twins have concordance rate of 67% for experiencing clinical depression compared with 15% for fraternal twins. Biological relatives were 8 times for likely tan adoptive relatives to also suffer from depression. 2 genetiaclly based tempermant systems are involved in development of mood disorders, the behavioural inhibition system (neuroticism) and the behavioural activation system

(extraversion). The BAS is reward-oriented and activated by cues that predict future pleasure. The BIS is pain-avoidant and generates fear and anxiety. Depression produced by high BIS sensitivity and low BAS activity. Mania is the opposite, whereas there is high BAS activity which results in hyperactive, euphoric, confidence and high activity level until failure where BAS deactivation causes flip-flop feelings into depression. Brain chemistry plays a role In depression. Specifically, a theory that holds that depression is a disorder of motivation caused by underactivity in neurotransmitters of dopamine, norepinephrine and serotonin. These neurotransmitters are involved in the BAS and play important roles that produce reward and pleasure. When these neural transmissions decrease in these brain regions, result is lack of pleasure and motivation, which characterizes depression. Several antidepressant drugs operate by increasing activity of these neurotransmitters which stimulate the neural system...