Understanding Psychological Disorders

General Points

• Psychological disorders lead to extreme reactions to life's problems and stresses
• The study of disorders has been of interest for over 2,500 years
• These disorders make others uncomfortable and frightened
• Failures in living are due to failures to adapt to life challenges
• Abnormal psychology focuses on maladaptive behavior, causes, consequences, and treatments

Concepts of Abnormality

• Psychological disorders have four common features, called the "four Ds"
• Deviance is behavior that is different, extreme, unusual, or even bizarre
• Distress is behavior that is unpleasant and upsetting to the person and to others
• Dysfunction is behavior that interferes with the person’s ability to carry out daily activities in a constructive way
• Danger is behavior that is possibly dangerous to the person or to others
• Deviance implies deviation from clearly defined norms or standards
• There is no ideal or normal model of human behavior

Deviations from Social Norms

• Abnormal behavior is simply a label for behavior deviant from social expectations
• Abnormal behavior differs markedly from society's ideas of proper functioning
• Each society has norms (stated or unstated rules for conduct)
• Behaviors that break societal norms are called abnormal
• A society's norms grow from its culture (history, values, institutions, habits, etc.)
• A society valuing competition may accept aggressive behavior
• Normality is conformity to social norms

Abnormality as Maladaptive Behavior

• Best way to determine normality of behavior is well-being
• Well-being includes growth and fulfillment
• Conforming behavior can be seen if it interferes with optimal functioning and growth
• Describing behavior as maladaptive implies a problem exists
• Vulnerability in the individual, inability to cope, or exceptional stress in the environment can lead to problems

Psychological Disorders

• Psychological disorder indicates a failure in adaptation

Historical Background

• Psychological disorders have been attributed to supernatural and magical forces
• Exorcism removes evil that resides in an individual, with countermagic and prayer
• Shamans have contact with supernatural forces and are mediums for spiritual communication
• The recurring theme of abnormal psychology is that individuals behave strangely because their bodies & brains are not working properly, known as the biological or organic approach
• Psychological problems are caused by inadequacies in how an individual thinks, feels, or perceives the world, known as the psychological approach
• Philosopher-physicians of ancient Greece, like Hippocrates and Plato, developed the organismic approach
• Galen elaborated on the role of the four humours (blood, black bile, yellow bile, and phlegm) in personal character and temperament
• Imbalances among the humours were believed to cause disorders
• Demonology and superstition gained importance in the explanation of abnormal behavior in the Middle Ages
• The Renaissance Period marked inc. humanism and curiosity about behavior
• Johann Weyer emphasized psychological conflict and disturbed interpersonal relationships
• Abnormal behavior was viewed through the Age of Reason and Enlightenment period with the scientific method
• Scientific attitude contributed to the Reform Movement & compassion for people suffering from psychological disorders
• An aspect of the reform movement was the new inclination for deinstitutionalisation

Classification of Psychological Disorders

• Classifications are useful because they enable users to communicate about disorders
• American Psychiatric Association (APA) publishes manual which describes & classifies psychological disorders
• Current version of the APA manual is the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) which presents clinical criteria indicating the presence or absence of disorders
• The classification scheme officially used in India and elsewhere is the tenth revision of the International Classification of Diseases (ICD-10)
• The ICD-10 Classification of Behavioural and Mental Disorders was prepared by the WHO

Factors Underlying Abnormal Behavior

• There are biological, psychological and interpersonal, and socio-cultural factors
• Biological factors influence all aspects of behaviour
• Factors that can cause abnormal behavior are faulty genes, endocrine imbalances, malnutrition, and injuries
• Researchers found psychological disorders are related to problems in the transmission of messages from one neuron to another
• Tiny space separating a neuron from the next is called a synapse
• Anxiety disorders linked to low activity of the neurotransmitter gamma aminobutyric acid (GABA)
• Schizophrenia linked to excess activity of dopamine
• Depression linked to low activity of serotonin
• Biological factors alone cannot account for mental disorders
• Psychological models provide a psychological explanation of mental disorders
• Psychological and interpersonal factors play a significant role in abnormal behavior

Factors in Abnormal Behavior

• Maternal deprivation (separation from the mother)
• Faulty parent-child relationships (rejection, overprotection, faulty discipline, etc.)
• Maladaptive family structures (inadequate or disturbed family)
• Severe stress

Psychological Models

• Include the psychodynamic, behavioral, cognitive, and humanistic-existential models
• The psychodynamic model is the oldest and most famous of modern psychological models
• Behavior is determined by psychological forces within the person of which they are not consciously aware
• Symptoms are caused by conflicts between these forces
• Freud formulated three central forces which shape personality: id, ego, and superego
• The behavioral model states that both normal and abnormal behaviors are learned
• Psychological disorders result from learning maladaptive ways of behaving
• Learning can take place by classical conditioning, operant conditioning, and social learning

Models of Conditioning

• Classical conditioning: temporal association in which two events repeatedly occur close together in time
• Operant conditioning: behavior is followed by a reward
• Social learning: learning by imitating others' behavior
• Cognitive model emphasizes psychological factors and states abnormal functioning can result from cognitive problems
• People hold irrational and inaccurate assumptions and attitudes about themselves
• People think illogically and make overgeneralisations

Humanistic-Existential Model

• Focuses on broader aspects of human existence
• Humanists believe that humans are born with a natural tendency to be friendly, cooperative, and constructive, and are driven to self-actualize
• Existentialists believe that humans have the freedom to give meaning to their existence or avoid that responsibility
• People who shirk responsibilities live empty, inauthentic, and dysfunctional lives

Socio-Cultural Models

• In addition to biological and psychosocial factors, war, group prejudice, economic + employment problems, and rapid social change, put stress on most of us
• Family systems can produce abnormal functioning in individual members
• Certain families have an enmeshed structure members are over involved in each other's lives
• There is a belief by socio-cultural theorists that abnormal functioning is influenced by societal labels and roles assigned to troubled people
• If someone breaks the norms of their society they are called deviant and 'mentally ill', and are encouraged to act sick

Diathesis-Stress Model

• Three components include diathesis, vulnerability, and stressors
• When "at risk" persons are exposed to stressors, their predisposition may evolve into a disorder
• Anxiety, depression, and schizophrenia are related to this model

Major Psychological Disorders - Anxiety Disorders

• Anxiety is defined as a diffuse, vague, very unpleasant feeling of fear and apprehension
• Anxiety disorder is common
• Rapid heart rate, shortness of breath, diarrhea, loss of appetite, fainting, dizziness, sweating, sleeplessness, frequent urination, and tremors are all symptoms of anxiety

Types of Anxiety Disorders

• Generalized anxiety disorder which consists of prolonged, vague, unexplained, and intense fears that are not attached to any particular object
• Panic disorder which consists of recurrent anxiety attacks, the person experiences intense terror
• Panic attack denotes an abrupt surge of intense anxiety which rises to a peak when thoughts of particular stimuli are present
• Phobias are irrational fears related to specific objects, people, or situations
• Specific phobias where irrational fears include intense fear of a certain type of animal, or of being in an enclosed space

Types of Phobias

• Social anxiety disorder (social phobia) features intense and incapacitating fear & embarrassment when dealing with others
• Agoraphobia where People develop a fear of entering unfamiliar situations with Symptoms
• Separation anxiety disorders where individuals are fearful and anxious about separation from attachment figures

Obsessive-Compulsive and Related Disorders

• People affected by obsessive-compulsive disorder are unable to control their preoccupation with specific ideas or are unable to prevent themselves from repeatedly carrying out a particular act or series of acts
• Obsessive behavior is the inability to stop thinking about a particular idea or topic
• Compulsive behavior is the need to perform certain behaviors over and over again Trauma- and Stressor-Related Disorders
• Post-traumatic stress disorder (PTSD) symptoms may include recurrent dreams, flashbacks, impaired concentration, and emotional numbing
• Adjustment Disorders and Acute Stress Disorder are also included under this category
• Somatic Symptom & Related Disorders are conditions in which there are physical symptoms in the absence of a physical disease. These include conversion disorders, somatic symptom disorder, and illness anxiety disorder among others
• People with somatic symptom disorder tend to be overly preoccupied with their symptoms and they continually worry about their health and make frequent visits to doctors
• Illness anxiety disorder involves persistent preoccupation about developing a serious illness and constantly worrying about this ability

Dissociative Disorders

• Involves feelings of unreality, estrangement, depersonalisation, and sometimes a loss or shift of identity
• It can be viewed as severance of the connections between ideas and emotions
• Dissociative amnesia is characterised by extensive but selective memory loss that has no known organic cause
• Dissociative fugue unexpected travel away from home and workplace, the assumption of a new identity, and the inability to recall the previous identity
• Dissociative identity disorder, often referred to as multiple personality
• Depersonalisation/Derealisation disorder involves a dreamlike state in which the person has a sense of being separated both from self and from reality