Psychology of Disorders

Statistics and Patterns of Disorders

• Statistics on new cases of a disorder during a given period, such as a year, represent the incidence of the disorder.
• Disorders follow individual patterns, or courses, which can be chronic, episodic, or time-limited.
• The anticipated course of a disorder is called the prognosis.

Historical Conceptions of Abnormal Behavior

• The supernatural tradition posits that agents outside the body and environment influence behavior, thinking, and emotions.
• In ancient China, the focus was on the movement of air or "wind" throughout the body, and unexplained mental disorders were caused by blockages of wind or the presence of cold, dark wind (yin) or warm, life-sustaining wind (yang).
• Hippocrates coined the word hysteria to describe a concept he learned about from the Egyptians, which is now known as the somatic symptom disorders.
• Behavioral and cognitive symptoms of advanced syphilis, a sexually transmitted disease, include delusions of persecution and grandeur.

Etiology

• Etiology is the study of origins and has to do with why a disorder begins and includes biological, psychological, and social dimensions.
• Louis Pasteur's germ theory of disease facilitated the identification of the specific bacterial microorganism that caused syphilis.
• John P. Grey's position was that the causes of insanity were always physical, and therefore, the mentally ill patient should be treated as physically ill.

Generalized Anxiety Disorder (GAD)

• About two-thirds of individuals with GAD are female, but this sex ratio may be specific to developed countries.
• Some people with GAD report onset in early adulthood, usually in response to a life stressor, and the median age of onset is 31.
• GAD is prevalent among older adults, with the largest national comorbidity study finding it most common in the group over 45 years of age.

Treatment of GAD

• Benzodiazepines are often prescribed for GAD, but they can impair cognitive and motor functioning, and produce psychological and physical dependence.
• There is stronger evidence for the usefulness of antidepressants, such as paroxetine and venlafaxine, in the treatment of GAD.
• Cognitive-behavioral therapy (CBT) has been developed for GAD, and results suggest that it can be effective in treating GAD in children and adolescents.

Social Anxiety Disorder (SAD)

• Results of numerous studies suggest that severely socially anxious adolescents can attain relatively normal functioning in school and other social settings after receiving cognitive-behavioral treatment.
• The SSRIs Paxil, Zoloft, and Effexor have received approval from the FDA for the treatment of SAD based on studies showing effectiveness compared with placebo.
• One impressive study found that cognitive therapy was substantially better than the SSRI drug Prozac in treating SAD.

Selective Mutism

• Selective mutism is a rare childhood disorder characterized by a lack of speech in one or more settings in which speaking is socially expected.
• Speech in selective mutism commonly occurs in some settings, such as home, but not others, such as school, hence the term "selective".

Trauma-and Stressor-Related Disorders

• DSM-5 consolidates a group of formerly disparate disorders that all develop after a relatively stressful or traumatic life event.
• Generally, they evidence lack of responsiveness, limited positive affect, and additional heightened emotionality, such as fearfulness and intense sadness.

Obsessive-Compulsive Disorder (OCD)

• In OCD, the danger is usually in an internal thought, image, or impulse that the client attempts to avoid.
• Obsessions are intrusive and mostly nonsensical thoughts, images, or urges that the individual tries to resist or eliminate.
• Compulsions are the thoughts or actions used to suppress the obsessions and provide relief.
• Based on statistically associated groupings, there are four major types of obsessions, each associated with a pattern of compulsive behavior: symmetry, "forbidden thoughts or actions", cleaning and contamination, and hoarding.

PTSD Diagnosis and Characteristics

• PTSD cannot be diagnosed until a month after the trauma.
• Delayed onset PTSD: few or no symptoms immediately or for months after a trauma, but full-blown PTSD develops at least 6 months later.
• Acute stress disorder: a severe reaction that occurs within the first month after the trauma.

Statistics

• 6.8% of the population have experienced PTSD at some point in their life.
• Highest rates of PTSD are associated with experiences of rape, being held captive, tortured, or kidnapped, or being badly assaulted.
• Close exposure to the trauma is necessary to developing PTSD.

Causes

• Intensity of exposure to assaultive violence contributes to the etiology of PTSD.
• Family history of anxiety suggests a generalized biological vulnerability for PTSD.
• Specific characteristics of the serotonin transporter gene increase the probability of becoming depressed.
• Family instability may instill a sense of an uncontrollable, potentially dangerous world.
• Support from loved ones reduces the risk of developing PTSD.
• Positive coping strategies involving active problem solving are protective.

Treatment

• Catharsis: reliving emotional trauma to relieve emotional suffering.
• Imaginal exposure: working through the trauma and emotions associated with it systematically.
• Developing a narrative of the traumatic experience and reviewing it extensively in therapy.

PTSD Symptoms

• Reexperiencing the event through memories and nightmares.
• Flashbacks: sudden, intense memories accompanied by strong emotion.
• Avoiding anything that reminds them of the trauma.
• Inability to remember certain aspects of the event.
• Chronically overaroused, easily startled, and quick to anger.
• Reckless or self-destructive behavior may be a sign of increased arousal and reactivity.
• Dissociative subtype: victims who do not react with reexperiencing or hyperarousal.

Phobias and Psychological Disorders

• Phobias can produce both distress and disability
• Definition of psychological disorder: a combination of personal distress, disability, and dysfunction, and violation of social norms

Early History of Psychopathology

• Studying the history of psychopathology helps us learn from past mistakes and see how concepts and approaches have changed over time
• Many new approaches to treatment have been hailed as successful at first, only to later fall out of favor
• Supernatural explanations were used to explain psychological disorders before the age of scientific inquiry
• Early philosophers, theologians, and physicians believed that disturbed behavior was a result of supernatural causes

Current Approaches in Psychopathology

• Genetic influences: behavior genetics, molecular genetics, and gene-environment interactions
• Neuroscience influences: neurons, neurotransmitters, structure and function of the brain, and the neuroendocrine system
• Cognitive behavioral influences: behaviorism, cognitive science, and the role of the unconscious
• Socioemotional influences: the importance of emotion, sociocultural influences, and interpersonal influences

Diagnosis and Assessment

• Cornerstones of diagnosis and assessment: reliability and validity
• Reliability: consistency of results
• Validity: accuracy of results
• The Diagnostic System of the American Psychiatric Association: DSM-5
• Criticisms of the DSM-5: specific and general criticisms

Research Methods in Psychopathology

• Science, theory, and hypotheses
• Research designs: case study, correlational method, and experiment
• Examples of experimental research: treatment outcome research
• Assessing and implementing treatments in the real world
• Integrating the findings of multiple studies: meta-analysis