Psychological Disorders

Lecture Notes

  1. Several definitions:
    1. APA: psychological disorder: pattern of behavioral or psychological symptoms that causes significant personal distress and impairs the ability to function in 1 or more important areas of life.
    2. Myers: behavior is atypical, disturbing, maladaptive, and unjustifiable
    3. Involves the presence of at least 2 of the following: distress, maladaptiveness, irrationality, unpredictability, unconventional & statistical rarity, and observer discomfort
    4. Sanity and insanity are legal, NOT psychological terms
  2. Methods of assessment
    1. Projective tests
      1. Projection of unconscious conflicts & motivations onto ambiguous stimulus materials
      2. Positive: good for establishing rapport
      3. Negative: low reliability & validity
    2. Objective tests (inventories)
      1. Standardized questionnaires (usually multiple choice or t/f)
      2. Better reliability & validity than projective tests, but still far from perfect
      3. Cultural & subjective factors still affect the process of diagnosis
      4. What is acceptable in 1 culture may not be in another
    3. Diagnostic & statistical manual of mental disorders, 4th ED (DSM-IV)
      1. The "bible" of psychological & psychiatric diagnosis
      2. Descriptive guidelines: provide clear criteria for diagnostic categories
      3. Five factors or axes
        1. 16 categories of adult psychological disorders
        2. Personality & developmental disorders
        3. Medical conditions that might affect or interact with psychological disorder
        4. Recent social or environmental sources of stress
        5. Global assessment of functioning (GAF): scale ranging from 1 to 100
      4. Critiques
        1. Heavy reliance on medical perspective
        2. Reliability in diagnosis can be problematic
        3. Controversy exists about whether some disorders exist (eg. Pms)
  3. Types of disorders
    1. Anxiety disorders
      1. DEFN: overwhelming anxiety disrupts social or occupational functioning or produces significant distress
      2. Manifestations
        1. Cognitive: thought processes range form generalized worry to overwhelming fear (impending doom)
        2. Behavioral: avoidance of anxiety-producing situation
        3. Somatic: physiological complaints due to activation of SNS (stomach-head aches)
      3. Types (5 types)
        1. Panic disorder
          1. Panic attacks: feelings of terror, pounding heart and difficulty breathing
          2. Usually without cause
          3. Culture influences particular symptoms
        2. Generalized anxiety disorder
          1. Persistent high levels of anxiety and excessive worry with symptoms present for at least 6 months
          2. Similar physiological symptoms as panic disorder
          3. Not as severe
          4. More persistent
        3. Phobia
          1. Persistent, irrational, unrealistic fear of specific objects or situations
          2. 3 subcategories
            1. simple (or specific)
              1. claustrophobia, arachnophobia
            2. Agoraphobia
              1. Fear of open or public places
              2. Most common phobia for which people seek help
            3. Social phobias
              1. Fear situations where one will be observed by others
              2. Eg. Public speaking
        4. Post traumatic stress disorder (PTSD)
          1. Can occur as a result of uncontrollable/unpredictable danger (rape, war, natural disasters, etc.)
          2. Symptoms
            1. Reliving the trauma in thoughts or dreams
            2. "Psychic numbing"
            3. Increased physiological arousal
            4. Symptoms can be immediate or delayed
            5. Symptoms commonly last 10+ years
          3. Not added to DSM until after Vietnam (mid- 70’s)
        5. Obsessive-compulsive disorder (OCD)
          1. Involves patterns of
            1. Obsessions: thoughts, images, or impulses that recur or persist despite one’s efforts to suppress them
            2. Compulsions: repetitive, purposeful, but undesired acts performed in a ritualized manner
          2. People with OCD acknowledge behavior’s senselessness but feel mounting anxiety if the ritual is broken off
          3. Pet scans indicate over activity in the orbital frontal cortex & caudate nucleus (resulting in experiencing a constant state of danger)
      4. Explanations
        1. Learning perspective
          1. Anxiety linked with classical conditioning: fear and stimulus
          2. Avoidance relieves fear through negative reinforcement
        2. Cognitive
          1. Observational learning produces fear resulting in anxiety
          2. Eg. Dad fears dogs, child learns through observation
        3. Biological
          1. Fears representing old threats (heights, spiders) may have an evolutionary basis & contributed to species survival
          2. Genetic predisposition in families to fears/high anxiety (disorders tend to run in families)
        4. Biopsychosocial
          1. Biological & learning component
          2. Both influenced by culture
    2. Somatoform disorders
      1. Soma = Greek for "body"
      2. Expression of psychological distress through physical symptoms
      3. Somatization disorder
        1. Multiple physical complaints with no organic explanation
        2. Onset before age 30
      4. Conversion disorder
        1. Dramatic specific physical disability with no physical cause (eg. blindness, leg paralysis).
        2. Patients believe impairment exists, but may show less distress than with a real loss
      5. Hypochondriasis
        1. Persistent preoccupation with health.
        2. Interpreting insignificant symptoms as serious illness
      6. Explanation
        1. Constitute only about 5% of all treated disorders
        2. Traditional view: sufferers repress emotions associated with forbidden urges and instead express symbolically as physical symptoms
        3. New: sufferers "convert" psychological stress into medical conditions
    3. Mood (affective) disorders
      1. Prevalence
        1. Most common of all psychological disorders (at 12 million us/ year)
        2. More common among women
        3. Greatest risk of developing major depression: 15-24 & 35-44
      2. Major depression: enough to disrupt ordinary functioning
        1. "Common cold" of psychological disturbances: depression
        2. Symptoms
          1. Emotional: sadness, hopelessness, guilt, emotional "disconnectedness" from other people
          2. Behavioral: unsmiling, downcast demeanor, slowed movements/speech, spontaneous crying, lose of interest in usual activities
          3. Cognitive; difficulty thinking, concentrating, remembering, negativity & pessimism, suicidal thoughts or preoccupation with death
          4. Physical: change in appetite, loss of sleep, vague aches/pains, loss of energy or restlessness
      3. Other depressed mood disorders
        1. Dysthymic disorder: chronic low-grade depression. Milder than major depression (does not seriously impair one’s ability to function)
        2. Seasonal affective disorder (SAD): depression fall/winter
        3. Mania: opposite of depression
          1. Abnormally high state of exhilaration
          2. Emotional symptoms: euphoria, excitement (being "on top of the world")
          3. Behavioral symptoms: out of character energy, rapid speech, spending sprees/illegal acts, disrupted sleep pattern
          4. Cognitive symptoms: inflated self-esteem, delusions of grandeur, easy disorder distractability, hallucinations
        4. Bipolar: alternating episodes of major depression & mania
          1. Previously known as "manic depression"
        5. Cyclothymic disorder: milder but chronic form of bipolar disorder
          1. Moderate but frequent mood swings
          2. People are perceived as extremely moody
      4. Explaining affective disorders
        1. Biopsychological
          1. Genetic predisposition for mood disorders
          2. Neurotransmitters seratonin & norepinephrine: low levels may lead to depression; high levels (of norepinephrine): mania
          3. Drugs to help relieve low/high levels
        2. Behavioral
          1. Depressed people lack social skills to gain social "reinforcement"
          2. Vicious cycle
        3. Cognitive: stresses that the way people think can result in depression
          1. Perfectionists: irrational self-demands unable to be met
          2. Focusing on negative problems
          3. Internal: "it’s all my fault"
          4. Stable: "nothing can change to improve the situation"
          5. Global: "it’s a major, all encompassing problem"
          6. Learned helplessness: efforts to control environment or avoid pain fail: depression
        4. Social: focus on peoples’ lives
          1. Marriage/employment: lower depression
          2. History of abuse/violence: higher depression
        5. Biopsychosocial: looks at chemistry-cognition-mood circuit
            1. "Vulnerability-stress" explanation
    4. Dissociative disorders
        1. Disturbances or changes in memory, consciousness, or identity
      1. May occur after a stressful or psychologically traumatic event: no organic cause
      2. Disorders
        1. Dissociative amnesia: partial or total loss of important personal info
        2. Dissociative fugue: confusion over personal identity: assumes a partial or complete new identity. Often moves, takes on new ID & life until he/she wakes up with no memory of fugue state.
        3. Depersonalization disorder: feelings of unreality concerning the self and the environment
          1. Characterized by intensity and anxiety provoked by symptoms
          2. Most young adults have experienced some symptoms
        4. Dissociative identity disorder
          1. Formerly called multiple personality disorder (MPD)
          2. Existence of 2 or more distinct personalities with in 1 person
          3. Original personality is unaware of other personalities, but they are conscious of original (and often each other)
          4. Each personality has its own identity, name, behavior patterns
          5. Controversial: research has been called into question
          6. Usually associated with severe childhood abuse
      3. Explanations
        1. Dissociation is relatively common response to traumatic experience
        2. But in people with dissociative disorders, however, the symptoms are much more extreme and frequent, and severely disrupt everyday functioning
        3. Some suggest disociative identity disorder is a diagnostic fad
    5. Personality disorders
      1. Characteristics
        1. Long standing chronic, inflexible, maladaptive patterns of perceptions, thought, and behavior that seriously impair an individual’s ability to function personally or socially
        2. Usually recognizeable by adolescence
        3. Least reliably judged (as a group)
      2. Examples (more in text)
        1. Narcissistic personality disorder
        2. Antisocial
          1. Lack of conscience, morality, emotional attachment, empathy, guilt
          2. Occurs in 3-5% of males, <1% of females
          3. May account for more than ½ of serious crimes in the US
          4. Show a lack of emotional arousal: may suggest a CNS abnormality
      3. Theories of causation
        1. Freud: problem in development of superego (conscience)
        2. Learning theory: childhood "teaches" how to relate to others. If not reinforced for good behavior (only for bad) may develop antisocial tendencies. Alternatively, role models act aggressively
        3. Cognitive theorists: antisocial people see other peoples’ behavior as threatening even when it is not faulty interpretation reinforces behavior
        4. Biological views: heredity possible role: little or low level autonomic system arousal
        5. Biopsychosocial: if fearlessness is channeled in productive directions, heroism or adventurism may result
    6. Schizophrenia
      1. Group of severe disorders characterized by
        1. Breakdown of personality
        2. Withdrawal from reality
        3. Disturbed emotions
        4. Disturbed thought
      2. Vague description led to over diagnosis. DSM-IV tightens standards. The following must be manifested
        1. Delusions
        2. Auditory hallucinations
        3. Marked disturbance of speech, affect, or thinking
        4. Deteriorations from former functioning level
        5. Symptoms last at least 6 months and are currently present for 1 month
      3. Symptoms
        1. Positive symptoms (meaning an excess or distortion of normal functioning)
          1. 1, 2, 3 above; extremely high or low motor activity levels, odd gestures
        2. Negative symptoms (meaning restriction or reduction of normal functioning)
          1. Flat affect: little emotion
          2. Inability to feel pleasure
          3. Lack of motivation
          4. Lack of speech
          5. Cessation of personal hygiene
      4. Types
        1. Paranoid schizophrenia
          1. Strongly held delusions of persecution or grandeur
          2. Rarely displays obviously disorganized behavior
          3. Acts upon delusions, resulting in behavior at seems reasonable to the individual but not others
          4. Onset occurs late in life (30’s) than other types of schizophrenia
        2. Disorganized schizophrenia
          1. Inappropriate behavior and affect
          2. Odd movements
          3. Disconnected emotional states
          4. Incoherent language: "word salads": words/ideas jump from 1 subject to another with little coherence
        3. Catatonic schizophrenia
          1. Frozen, rigid motor behavior or posture
        4. Undifferentiated schizophrenia
          1. Mixed (undifferentiated) set of symptoms
          2. Involves thought disorders and features from other types of schizophrenia
      5. Onset/progression
        1. Men/women equally affected
        2. Approx 1% of world’s pop.
        3. Men <25, women between 25-45 yrs old
        4. Tends to be a gradual onset
        5. Sudden onset: better prognosis for recovery
        6. Promodal phase
        7. Active phase
        8. Residual phase
          1. Symptoms no longer prominent
          2. Some remaining functional impairment
      6. "Rules of thirds"
        1. 1/3 recover
        2. 1/3 helped by drugs but retain some symptoms
        3. 1/3 not helped by drug therapy
      7. Explanations
        1. Biological
          1. Genetic factors play role increased risk; but 90% have no schizophrenic parent
          2. Abnormal brain chemistry or structure
            1. Excess dopamine; drug therapy blocking dopamine works in some cases
            2. Abnormalities in frontal lobe, temporal lobe, basal ganglia
            3. Deceased brain volume/weight, reduced # of neurons in certain areas
            4. Men are more likely to have thalamus abnormalities
        2. Prenatal
          1. Damage to fetal brain
          2. Malnutrition
          3. Viral infection
        3. Combination of factors: genetically predisposed people may be more vulnerable to factors such as disturbed family environments and stress