PSYC 1110 Module 10 Psychological Disorders PDF

1 Chapter 16 ¡Psychological Disorders Maya Obadia PhD Chapter 16 Outline 1. The Scope and Nature of Psychological Disorders 2. Historical Perspectives On Deviant Behaviour 3. Diagnosing Psychological Disorders 4. Anxiety Disorders 5. Mood (affective) Disorders 6. Somatic...

1 Chapter 16 ¡Psychological Disorders Maya Obadia PhD Chapter 16 Outline 1. The Scope and Nature of Psychological Disorders 2. Historical Perspectives On Deviant Behaviour 3. Diagnosing Psychological Disorders 4. Anxiety Disorders 5. Mood (affective) Disorders 6. Somatic Symptom 7. Disorders Dissociative Disorders 8. Schizophrenia 9. Personality Disorders 10. Disorders of Childhood and Old Age © 2020 McGraw-Hill Education Limited 2  The Scope And Nature Of Psychological Disorders What Is “Abnormal”? Defining what is normal and what is abnormal is no easy matter There are measures to apply 1. The personal values of a given diagnostician 2. The expectations of the culture in which a person currently lives 3. The expectations of the person’s culture of origin 4. General assumptions about human nature 5. Statistical deviation from the norm 6. Harmfulness, suffering, and impairment © 2020 McGraw-Hill Education Limited 3  What is Abnormal? Social Construct 3 D’s Distressing Dysfunctional Deviant © 2020 McGraw-Hill Education Limited 4 Historical Perspectives On Deviant Behaviour © 2020 McGraw-Hill Education Limited 5  Historical Perspectives On Deviant Behaviour Demenological View – Abnormal behaviour = result of supernatural forces – Possessed by a spirit Treatment – Trephination - ‘hole in the skull’ © 2020 McGraw-Hill Education Limited 6  Historical Perspectives On Deviant Behaviour Early biological views – Mental illnesses are diseases like physical illness that effect the brain (Hippocrates, 5th Century B.C.) Breakthrough – General paresis - caused by syphilis – Disorders linked to physical causes – Current - physiological & psychological © 2020 McGraw-Hill Education Limited 7  Historical Perspectives On Deviant Behaviour Francisco de Goya His panting reflects the widespread belief that disordered people were possessed by the devil Sabbath portrays the weekly gathering of Satan and the witches he possessed © 2020 McGraw-Hill Education Limited 8  The Vulnerability-Stress Model The Diathesis- Stress Model Each of us has some degree (range) of vulnerability for developing a psychological disorder, given sufficient stress © 2020 McGraw-Hill Education Limited 9  Diagnosing Psychological Disorders Reliability – Means that clinicians using the system should show high levels of agreement in their diagnostic decisions. Validity – Means that the diagnostic categories should accurately capture the essential features of the various disorders © 2020 McGraw-Hill Education Limited 10  The DSM-5: Integrating Categorical and Dimensional Approaches In 2013, the American Psychiatric Association released the DSM-5 The DSM-5: Integrating Categorical and Dimensional Approaches – Detailed behaviour must be present for diagnosis Five axes / dimensions – Assess both person & life situation © 2020 McGraw-Hill Education Limited 11  Dimensions Axis I: Clinical Symptoms – Diagnosis (e.g., depression, schizophrenia, social phobia) Axis II: Developmental & Personality Disorders – E.g., autism, mental retardation (typically first evident in childhood ) – Personality disorders – Long lasting & encompass way of interacting with the world E.g., Paranoid, Antisocial, Borderline Personality Disorders © 2020 McGraw-Hill Education Limited 12  Dimensions Axis III: Physical Conditions – E.g., brain injury or HIV/AIDS that can result in symptoms of mental illness Axis IV: Severity of Psychosocial Stressors – E.g., death of a loved one, starting a new job, college, unemployment, marriage Axis V: Highest Level of Functioning – Level of functioning both at present time & highest level within previous year © 2020 McGraw-Hill Education Limited 13  Dimensions © 2020 McGraw-Hill Education Limited 14  Critical Issues in Diagnostic Labelling Social & Personal – Becomes too easy to accept label as description of the individual – May accept the new identity implied by the label – May develop the expected role and outlook © 2020 McGraw-Hill Education Limited 15  Critical Issues in Diagnostic Labelling Legal Consequences – Involuntary commitment – Loss of civil rights – Indefinite detainment Legal Consequences – Competency – State of mind at time of a judicial hearing – Insanity – State of mind at time crime was committed © 2020 McGraw-Hill Education Limited 16  Anxiety Disorders Is not feeling apprehensive about some real threat Definition – Frequency & intensity of responses are out of proportion to situations – Interferes with daily life E.g., Phobias, generalized anxiety disorder, obsessive-compulsive © 2020 McGraw-Hill Education Limited 17  Anxiety Disorders Components of Anxiety Responses © 2020 McGraw-Hill Education Limited 18  Phobic Disorder Strong, irrational fears of objects or situations – Most develop during childhood, adolescence, young adulthood Seldom go away on their own – Can intensify over time Degree of impairment – Depends on how often condition is encountered © 2020 McGraw-Hill Education Limited 19  Phobic Disorder Most Common in Western Society Agoraphobia – Fear of open spaces, public places Social phobias – Fear of certain situations Specific phobias – Fear of specific objects such as animals or situations © 2020 McGraw-Hill Education Limited 20  Generalized Anxiety Disorder State of diffuse, ‘free-floating’ anxiety Not tied to specific situation; condition – Feeling of something is going to happen; don’t know what – 5% of population between 15-45 years © 2020 McGraw-Hill Education Limited 21  Panic Disorder Occur suddenly, unpredictably, intense May occur with or without agoraphobia Fear of future attacks – 3.5% of population © 2020 McGraw-Hill Education Limited 22  Obsessive-Compulsive Disorder (OCD) Obsessions = cognitive component – Repetitive & unwelcome thoughts Compulsions = behavioural component – Repetitive behavioural responses – 2.5% of population © 2020 McGraw-Hill Education Limited 23  Obsessive-Compulsive Disorder (OCD) Neuroscience of OCD Executive dysfunction model – Problem with impulse control and behavioural inhibition – Involvement of prefrontal cortex, caudate nucleus Modulatory control model – Dysfunction in orbitofrontal cortex and associated areas © 2020 McGraw-Hill Education Limited 24  Causal Factors in Anxiety Disorders and OCD Biological Factors – Genetics – MZ twins more similar than DZ twins – GABA – Low levels may cause highly reactive nervous systems Gender Differences – Females exhibit more anxiety disorders than males – Differences emerge as early as seven years old Possible explanations – Sex-linked biological disposition – Less power & personal control for women © 2020 McGraw-Hill Education Limited 25  Causal Factors in Anxiety Disorders and OCD Psychological Factors Psychodynamic Explanations – Neurotic Anxiety Unacceptable impulses threaten to overwhelm ego’s defenses Cognitive Explanations – Maladaptive thoughts & beliefs – Things appraised ‘catastrophically’ © 2020 McGraw-Hill Education Limited 26  Panic Attacks Panic attacks depict a process in which normal manifestations of anxiety are appraised catastrophically, ultimately resulting in a full-blown panic attack © 2020 McGraw-Hill Education Limited 27  Causal Factors in Anxiety Disorders and OCD Learning Explanations – Classical conditioning: Associating an object or situation with pain and trauma – Modeling Learning by watching others © 2020 McGraw-Hill Education Limited 28  Causal Factors in Anxiety Disorders and OCD Sociocultural Factors – Culture defines what is important – Some disorders are ‘culturally bound’ Fear of offending someone; fear of being fat © 2020 McGraw-Hill Education Limited 29  Eating Disorders Anorexia Nervosa Bulimia Nervosa – Intense fear of being – Binge and purge fat – 90% are female – Severely restrict food intake – 90% are female – A potentially life- threatening disorder © 2020 McGraw-Hill Education Limited 30  Causes of Anorexia and Bulimia Environmental, psychological, biological – Common in industrialized cultures (beauty equated with thinness) Objectification theory – Cultural emphasis on viewing one’s body as object © 2020 McGraw-Hill Education Limited 31  Causes of Anorexia and Bulimia Personality factors – Anorexics - Abnormally high achievement standards – Bulimics - Depressed, anxious Genetics – Higher concordance rate among identical twins © 2020 McGraw-Hill Education Limited 32  Mood (Affective) Disorders Depression – Is not a ‘case of the blues’ or ‘having a bad day’ – Clinical depression = frequency, intensity, duration of symptoms is out of proportion to situation Major depression – Unable to function effectively Dysthymia – Chronic disruption of mood © 2020 McGraw-Hill Education Limited 33 Mood (Affective) Disorders © 2020 McGraw-Hill Education Limited 34  Mood (Affective) Disorders Emotional – Negative mood state Cognitive – Difficulty concentrating; feelings of inferiority & failure, pessimism Motivational – Loss of interest & drive Somatic – Appetite loss, compulsive eating, sleep disturbances © 2020 McGraw-Hill Education Limited 35  Bipolar Disorder Depression alternates with mania Manic state – Euphoric mood, grandiose cognitions – Rapid speech © 2020 McGraw-Hill Education Limited 36 Prevalence and Course of Mood Disorders Data from numerous studies indicates – Depression is on the rise in young groups The onset of depression increasing in 15- to 19- year-olds and in the 18 -25 age range – People born after 1960 are Ten times more likely to experience depression than are their grandparents Even though their grandparents have lived much longer © 2020 McGraw-Hill Education Limited 37 Prevalence and Course of Mood Disorders Gender Differences – Women twice as likely to suffer from unipolar depression – Women are most likely to suffer their first episode of depression in their 20s, men in their 40s – No differences for bipolar disorder © 2020 McGraw-Hill Education Limited 38  Causal Factors in Mood Disorders Biological Factors Depression – Genetic factors – Biochemical differences – Underactivity of norepinephrine, dopamine, seratonin © 2020 McGraw-Hill Education Limited 39  Biological Explanations Bipolar disorder – Stronger genetic component than unipolar depression – 50% have relative with disorder – Concordance rate is 5 times higher among identical twins compared to fraternal twins – Manic disorders - overactivity of neurotransmitters? © 2020 McGraw-Hill Education Limited 40  Causal Factors in Mood Disorders Psychological Factors Personality-based vulnerability Psychodynamic View – Early traumatic losses / rejections create vulnerability © 2020 McGraw-Hill Education Limited 41  Psychological Factors Humanistic View – Define self-worth in terms of individual attainment – React more strongly to failures; due to inadequacies – Experience of meaninglessness © 2020 McGraw-Hill Education Limited 42  Cognitive Processes Depressive Cognitive Triad Negative thoughts concerning: – The world – Oneself – The future Cannot suppress negative thoughts – Recall more failures vs. successes © 2020 McGraw-Hill Education Limited 43  Cognitive Processes Depressive Attributional Pattern – Success = factors outside self – Negative outcomes = personal factors Learned Helplessness – People expect bad events will occur and they can’t cope with them © 2020 McGraw-Hill Education Limited 44  Learning & Environmental Factors Learning – Loss of reinforcement – Depression occurs – Causes loss of social support – Deeper depression © 2020 McGraw-Hill Education Limited 45  Learning & Environmental Factors Environmental – Poor parenting – Many stressful experiences – Failure to develop good coping skills – Failure to develop positive self- concept © 2020 McGraw-Hill Education Limited 46  Sociocultural Factors Cultural Variation – Prevalence of depressive disorders Less in Hong Kong & Taiwan than in the West – Feelings of guilt & inadequacy Highest in North America & Western Europe – Gender difference not found in developing countries © 2020 McGraw-Hill Education Limited 47  Applications Understanding And Preventing Suicide Willful taking of one’s life – The World Health Organization estimates that nearly 500 000 people worldwide commit suicide annually, about 1.4 per minute – 4000 per year in Canada For indigenous peoples, the rate is at least double 2nd most frequent cause of death among 15-24 year olds © 2020 McGraw-Hill Education Limited 48  Somatic Symptom Disorders No known biological cause Hypochondriasis – Unduly alarmed Pain disorder – Out of proportion Conversion disorder – Sudden neurological problems © 2020 McGraw-Hill Education Limited 49  Dissociative Disorders Psychogenic amnesia – Selective memory loss following trauma Psychogenic fugue – Loss of all personal identity Dissociative identity disorder – 2 or more separate personalities © 2020 McGraw-Hill Education Limited 50  Dissociative Identity Disorder (DID) Each identity is unique – Own set of memories, ideas, thoughts – One identity may be protector; another a child What Causes Dissociative Identity Disorder? Trauma-dissociation Theory – DID generally results from severe traumatic experience during early childhood © 2020 McGraw-Hill Education Limited 51  Schizophrenia Schizophrenia = ‘split-mind’ Characteristics of Schizophrenia Severe disturbances in – Thinking – Delusions = false beliefs Speech – Disorganized; strange words © 2020 McGraw-Hill Education Limited 52  Schizophrenia Perception – Hallucinations = false perceptions Emotion – Blunted affect; inappropriate affect Behaviour © 2020 McGraw-Hill Education Limited 53  Subtypes of Schizophrenia Paranoid – Delusions of persecution; grandeur Disorganized – Confusion; incoherence Catatonic – Severe motor disturbances Undifferentiated – Not easily classified as one of above © 2020 McGraw-Hill Education Limited 54  Subtypes of Schizophrenia Type I – Predominance of positive symptoms – Pathological extremes – Delusions, hallucinations, disordered speech & thought Type II – Predominance of negative symptoms – Absence of normal reactions – Lack of emotion, expression, motivation © 2020 McGraw-Hill Education Limited 55  Subtypes of Schizophrenia Negative symptoms – Long history of poor functioning – Poor recovery Positive symptoms – History of good functioning; better prognosis © 2020 McGraw-Hill Education Limited 56  Schizophrenia: Biological Factors Genetics – Twins - higher concordance rate Brain – Neurodegenerative Hypothesis – Atrophy & Destruction of neural tissue © 2020 McGraw-Hill Education Limited 57  Schizophrenia: Biological Factors One difference between the brains of schizophrenics and non- schizophrenics is Enlarged ventricles (the butterfly- shaped spaces seen in the middle of the MRIs) in the schizophrenic brain (left). © 2020 McGraw-Hill Education Limited 58  Schizophrenia: Biochemical Factors Dopamine hypothesis – Overactivity of dopamine system – Regulate emotion, motivation, cognitive functioning – Antipsychotic drugs used for schizophrenia reduce dopamine activity © 2020 McGraw-Hill Education Limited 59  Schizophrenia: Psychological Factors Freud – Extreme use of defence mechanism regression (retreat to an earlier, more secure stage in life) – Not generally accepted but life stress is a factor Cognitive – Defect in ability to filter © 2020 McGraw-Hill Education Limited 60  Schizophrenia: Environmental Factors – Stressful life events – Family dynamics – Vulnerability factor & negative reactions from others High in expressed emotion – High levels of criticism – High levels of hostility – Overinvolvement in person’s life © 2020 McGraw-Hill Education Limited 61  Schizophrenia: Sociocultural Factors Social Causation Hypothesis – Higher levels of stress among low-income Social Drift Hypothesis – As functioning deteriorates- drift down socio- economic ladder © 2020 McGraw-Hill Education Limited 62  Personality Disorders Personality disorders – Exhibit stable, ingrained, inflexible, and maladaptive ways of thinking, feeling, and behaving – 10 to 15 percent of adults in the United States, Canada, and European countries may have personality disorders © 2020 McGraw-Hill Education Limited 63  Personality Disorders Six personality disorders in the DSM-5. 1. Anti-Social Personality Disorder 2. Narcissistic personality disorder 3. Borderline personality disorder 4. Avoidant personality disorder 5. Obsessive-compulsive personality disorder 6. Schizotypal personality disorder © 2020 McGraw-Hill Education Limited 64  Antisocial Personality Disorder The most destructive to society Exhibit little anxiety or guilt Tend to be impulsive Unable to delay gratification of their needs Actual antisocial behaviour Violent psychopaths have occurs in only a portion of frequently been psychopathic individuals represented on the screen © 2020 McGraw-Hill Education Limited 65  Causal Factors Biological factors – Genetic predisposition – Dysfunction in brain structures that govern self- control and emotional arousal? – MRI - differences in prefrontal lobes – Weaker limbic input to frontal cortex Psychodynamic view – Lack of a superego © 2020 McGraw-Hill Education Limited 66  Causal Factors Learning explanations – No conditioned fear responses when punished – Modeling of aggression – Inattention to children’s needs – Exposure to deviant peers Cognitive – Consistent failure to think about or anticipate long-term negative consequences of acts © 2020 McGraw-Hill Education Limited 67  Borderline Personality Disorder Instability in behaviour, emotion, identity Emotional dysregulation – Inability to control negative emotions Intense and unstable personal relationships – Anger, loneliness, emptiness Impulsive behaviour – Running away, promiscuity, drug abuse © 2020 McGraw-Hill Education Limited 68  Borderline Personality Disorder: Causal Factors Chaotic personal histories Treated malevolently – View others as less than helpful – Parents – abusive, rejecting, non-affirming Biological factors © 2020 McGraw-Hill Education Limited 69  Disorders Of Childhood And Old Age Over 20% of children aged 2-5 diagnosed with a DSM disorder 2 receiving particular attention: – Attention Deficit/Hyperactivity Disorder – Autism © 2020 McGraw-Hill Education Limited 70  Childhood Disorders Attention Deficit/Hyperactivity Disorder Attentional difficulties – Hyperactivity-impulsivity – 7-10% of North American children – Genetic predispositions – Brain scans = no consistent differences with normals – Why? Multifaceted disorder and interplay of environmental factors © 2020 McGraw-Hill Education Limited 71  Childhood Disorders Autistic Spectrum Disorder – Extreme unresponsiveness to others – Poor communication skills – Lack of social responsiveness – Repetitive and stereotyped behaviours – Some exhibit savant abilities © 2020 McGraw-Hill Education Limited 72  Childhood Disorders Autistic Spectrum Disorder – In 2000, it was estimated that autism affects about one in every 2000 children, – About 80 percent of them boys © 2020 McGraw-Hill Education Limited 73 Autistic Spectrum Disorder: Causal Factors Biological basis – Brains – larger by 5-10% (age 18 months – 4 yrs) – Abnormal development in cerebellum Genetic factors – May be 4-6 major genes – 20-30 others involved No scientific evidence of link to vaccines © 2020 McGraw-Hill Education Limited 74  Dementia in Old Age Gradual loss of cognitive abilities Accompanies brain deterioration – E.g., Alzheimer’s, Parkinson’s, Huntington’s, Creutzfeldt-Jakob Diseases Senile Dementia – Dementia that begins after age 65 – 2:1 female-male ratio – Onset is typically gradual © 2020 McGraw-Hill Education Limited 75  Dementia in Old Age Alzheimer’s Disease – 60% of dementias – Deterioration in frontal, temporal lobes – Plaques in brain – Destruction of acetylcholine © 2020 McGraw-Hill Education Limited 76  Chromosomes and Genes Chromosome – Molecule of DNA – Contains many genes Genes – Contain genetic blueprint Every Cell Has 46 Chromosomes (23 pairs) – Exception: egg and sperm – 23 chromosomes – Form new cell with 46 chromosomes © 2020 McGraw-Hill Education Limited 77