Chapter 15 Psychological Disorders PDF

Psychological Disorders Psychological Disorders Important questions: How do we define psychological disorders? How can we understand psychological disorders? How should we classify psychological disorders? Psychological Disorders What is “normal”? Human Experiences...

Psychological Disorders Psychological Disorders Important questions: How do we define psychological disorders? How can we understand psychological disorders? How should we classify psychological disorders? Psychological Disorders What is “normal”? Human Experiences Psychological Disorders Grief/Sadness Depression Anxiety Normal Fears Disorders Psychological Disorders A psychological disorder is a syndrome (collection of symptoms) marked by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior Thoughts, emotions, or behaviours that are dysfunctional and or maladaptive and interfere with everyday life Psychological Disorders The dark history of disorders Human beings have a frightening history with treating psychological disorders, or anything well outside established norms Trephination: a surgical procedure that involved drilling or scraping a hole in the skull to release evil spirits thought to be trapped inside Others: Exorcism, Sterilization, Bloodletting, Shock Therapy, Lobotomy, etc. Psychological Disorders The dark history of disorders Wasn’t until the 1970s that homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) version 2 (we now use the DSM-5) What psychologists call disordered by the definition of a “significant disturbance” can change over time Psychological Disorders More recently, the medical model of mental disorders was established Was discovered that syphilis, if untreated, can invade the brain and distort the mind. Researchers then sought to discover the physical causes for other mental disorders. Within this model, mental illness (psychopathology) needs to be diagnosed based on its symptoms, and it needs to be treated through therapy Assumption is that psychopathology is the result of our biology (mental disorders = physical disorders) Psychological Disorders The biopsychosocial approach posts that biological, psychological, and social-cultural factors play significant roles in human functioning in the context of disease or illness Diagnostics Diagnosis Diagnostic classification in psychiatry Prognosis and psychology attempts to order and describe symptoms. Once we have a Disorder diagnosis, we aim to: (cluster of Treatment common Predict the disorder’s future course symptoms) Suggest appropriate treatments Prompt research into underlying causes Understanding Psychological Disorders The most common conventional diagnostic tool is called the Diagnostic and Statistical Manual of Mental Disorders (DSM) Describes disorders and estimates their occurrence Compiled American Psychiatric Association, currently in its fifth edition (2013) Psychological Disorders The DSM-5 is extremely useful but not without controversy Some diagnostic categories fare well in the real world (e.g. clinician agreement on post-traumatic stress disorder and autism spectrum disorder was nearly 70%) Others, like antisocial personality disorder and generalized anxiety disorder had only 20% clinician agreement Some critics suggest that the DSM pathologizes everyday life and that the labels are more reflective of value judgments of people Psychological Disorders Labels can change how we view ourselves or others Labels can skew us towards seeing things that confirm our viewpoint Labels, especially related to mental health, carry stigma Psychological Disorders Rates of Psychological Disorders Mental and addiction disorders have affected more than 1 billion people globally in 2016 (Rehm & Shield, 2019) In the U.S., 47 million adults (19%) experienced mental illness in the last year Roughly 1 in 5 over age 15 In Canada, 5 million aged 15 and older (18%) met the diagnostic criteria for a mood, anxiety, or substance use disorder in in the last year (StatsCan, 2022) Psychological Disorders Psychological Disorder Percentage Depressive disorders or bipolar disorders 9.3 Phobia of specific object or situation 8.7 Social anxiety disorder 6.8 Attention-deficit/hyperactivity disorder (ADHD) 4.1 Posttraumatic stress disorder (PTSD) 3.5 Generalized anxiety disorder 3.1 Schizophrenia 1.1 Obsessive-compulsive disorder 1.0 Percentage of Americans reporting selected psychological disorders in the past year (National Institutes of Mental Health, 2015) Psychological Disorders Rates of Psychological Disorders Rates vary depending on the time and place of the survey (or cultural factors) Not necessarily due to actual differences in prevalence of a disorder – could be diagnostic/stigma related Oddly, those who have recently immigrated are at less risk for mental disorders – called the immigrant paradox Psychological Disorders Risk Factors Protective Factors Academic failure Neurochemical imbalance Aerobic exercise Problem-solving skills Birth complications Parental mental illness Community offering empowerment, Resilient coping with stress and adversity opportunity, and security Caring for those who are chronically ill or Parental substance abuse Economic independence Social and work skills who have a neurocognitive disorder Child abuse and neglect Personal loss and bereavement Effective parenting Chronic insomnia Poor work skills and habits Feelings of mastery and control Chronic pain Reading disabilities Feelings of security Family disorganization or conflict Sensory disabilities High self-esteem Low birth weight Social incompetence Literacy Low socioeconomic status Stressful life events Positive attachment and early bonding Medical illness Substance abuse Positive parent-child relationships Trauma experiences Social support from family and friends Psychological Disorders Uhlhaas et al. (2023) Suicide and Self-Harm Suicide and Self-Injury Suicide Affects 1 million people worldwide (someone dies by suicide every ~40 seconds) Often comorbid with other mental health disorders Three times the risk in those with anxiety disorders Four times the risk in those with depressive disorders Suicide and Self-Injury Research into suicide reveals: National Differences Gender Differences Age Differences Certain countries have much Women more likely to attempt. Rates increase in late higher suicidality rates than Men more likely to succeed. adulthood. Highest over 70. others Racial Differences Day to Day Differences Indigenous Canadians at x3 25% occur on Wednesday, risk to other Canadians more common in May and April Suicide and Self-Injury Ripple of Suicidality Sharing suicidal thoughts often produces a ripple effect through mediums such as social media Following highly publicized suicides and TV programs featuring suicide, rates of suicide can increase One study showed that men exposed to a co-worker's suicide were at 3.5x times risk to take their own lives compared with non-exposed men Suicide and Self-Injury Causes of Suicide Not typically expressed as an act of revenge or hostility – chosen as an alternative to current or future suffering Suicidal urges are most common when people feel like they do not belong or are a burden to others or when feeling trapped by an inescapable situation Suicide and Self-Injury Collateral Damage Family and friends may often believe they should have seen the warning signs Yet, about 9% of people at some point in their lives have thought about suicide – of those, 3% might attempt it and an even smaller fraction will be successful Suicide is very hard to predict: Vast majority of people who have a specific risk factor for suicide will never engage in suicidal behaviour Suicide and Self-Injury What can we do? Listen and empathize Let them speak honestly and openly if they are able. Listen before responding. Gently challenge their reasons, try to identify reason for choosing life in what they say. Try to convey hope. If they are talking to you at all it is likely that they are still unsure about their choice. If someone is imminently in danger of taking their own life: Call emergency medical services/the police (9-1-1); Take them to an emergency room; Contact a local distress centre Suicide and Self-Injury Call 1-888-353-2273 for the Interior Crisis Line Call 1-800-SUICIDE (1-800-784-2433) for the BC Suicide Line Call 310-6789 for the Provincial Mental Health Support Line Suicide and Self-Injury Anxiety Disorders Anxiety Disorders Anxiety disorders are marked by distressing, persistent anxiety or by dysfunctional anxiety-reducing behaviours We all feel anxiety – but it thankfully is not usually intense and persistent Part of our natural danger-/threat-detection system – becoming hyperactive Anxiety Disorders Generalized Anxiety Disorder Anxiety disorder where someone is continually tense, apprehensive, and in a state of autonomic nervous system arousal Excessive and uncontrollable worry that persists for six months or more Their anxiety is often considered “free-floating”, or not tied to any specific stressor or threat Anxiety Disorders Panic Disorder Person experiences sudden episodes of intense dread and often lives in fear of when the next attack might strike Includes significant somatic symptoms: irregular heartbeat, chest pains, shortness of breath, choking, trembling, dizziness etc. In some cases, becomes recurrent – and then anxiety can also be rooted in fear of another attack Anxiety Disorders Specific Phobias Anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity, or situation Depla et al., 2008 Anxiety Disorders Obsessive Compulsive Disorder (OCD) Obsessions (repetitive thoughts) % Reporting Symptom Characterized by persistent and repetitive Concern with dirt, germs, or toxins 40 thoughts (obsessions), actions Something terrible happening (fire, death, 24 illness) (compulsions), or both Symmetry, order, or exactness 17 Obsessive thoughts and compulsive % Reporting behaviors interfere with everyday life and Compulsions (repetitive behaviors) Symptom cause distress. Excessive hand washing, bathing, toothbrushing, or grooming 85 Repeating rituals (in/out of a door, up/down 51 from a chair) Checking doors, locks, appliances, car brakes, 46 homework Anxiety Disorders Obsessive Compulsive Disorder (OCD) People can also develop OCD-related disorders: Hoarding disorder: cluttering of one’s space with acquired possessions that they cannot part with Body dysmorphic disorder: preoccupated with perceived body defects Trichotillomania: hair-pulling disorder Excoriation disorder: skin-picking disorder  Anxiety Disorders Post-Traumatic Stress Disorder (PTSD) Characterized by recurring, vivid, and distressing memories and nightmares - Associated with hypervigilant threat- detection Most common in survivors of rape, war, terror attacks, torture, and after refugee displacement Greater the distress, greater the risk https://www.naavets.org/the-link-between-ptsd-and-substance-abuse-2/ Anxiety Disorders Somatic Symptom Disorder Disorder in which symptoms take a somatic (bodily) form without an apparent physical cause Often end up being seen by a physician rather than a psychologist for their initial symptoms Related to Illness anxiety disorder (formerly hypochondriasis) – interpretation of normal sensations as symptoms of a dreaded disease Anxiety Disorders Understanding Anxiety: Conditioning Through classical conditioning, our fear response can become linked with formerly neutral objects and events Even a single frightening event can become a full-blown phobia due to stimulus generalization (classical conditioning) Reinforcement (operant conditioning) helps maintain learned fears and anxieties Anxiety Disorders Understanding Anxiety: Cognition Our thoughts, memories, interpretations, and expectations can also result in anxieties/fear Observational learning is powerful in avoiding threatening/fearful stimuli People with anxiety disorders often display hypervigilance (elevated threat detection) One study showed that 9/10 of the worries people with anxiety disorders perceive are baseless – and often not as detrimental as expected when they do occur Anxiety Disorders Understanding Anxiety: Biology Genes: Genetic predisposition to anxiety, OCD, and PTSD Brain: Trauma linked to new fear pathways, hyperactive danger detection, impulse control, and habitual behavior areas of brain (e.g. ACC) Natural selection: Biological preparedness to fear threats; easily conditioned and difficult to extinguish Depressive Disorders Depressive Disorders While anxiety is a response to a threat from future, depression is a response to current and past events For those who suffer from major depressive disorder the experience of hopelessness and lethargy often lasts several weeks or months Depressive Disorders Diagnosing Major Depressive Disorder Major Depressive Disorder: (At least 5 of the following over a 2-week period) Depressed mood most of the time Person experiences, in the Dramatically reduced interest or enjoyment in most activities most of the absence of drugs or another time medical condition, 2 or more Significant challenges regulating appetite and weight weeks with five or more Significant challenges regulating sleep symptoms, at least one of which Physical agitation or lethargy must be either (1) depressed Feeling listless or with much less energy mood or (2) loss of interest or pleasure. Feeling worthless, or feeling unwarranted guilt Problems in thinking, concentrating or making decisions Thinking repetitively of death and suicide Depressive Disorders Persistent Depressive Disorder: Diagnosing Persistent Depressive Disorder (At least 2 of the following symptoms) Also called dysthymia Feeling hopeless Mildly depressed mood more often than Poor self-esteem not for 2 years or more Reduced energy levels Also display at least two of the following Problems regulating sleep symptoms Problems regulating appetite Depressive Disorders Bipolar Disorder: Disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania; formerly called manic-depressive disorder Mania: A hyperactive, wildly optimistic state in which dangerously poor judgment is common Benjavisa Ruangvaree Depressive Disorders Characterizing depression: People with depression become inactive, isolated and hopeless People with depression feel sadness even when nothing bad happens People suffering from depression are predisposed to interpret neutral stimuli more negatively, recall and expect more negative occurrences Depressive Disorders Characterizing depression: Gender Differences Depression is widespread but women's risk for MDD is twice as high as men’s Women seem more vulnerable to disorders involving internal states and men more vulnerable to those involving external states Depressive Disorders Characterizing depression: Developmental Differences Depression often increases throughout the teenage years Depression is striking earlier and more often than in past generations (highest rates being among older teens and young adults) Depressive Disorders Characterizing depression: Onset The onset of depression is often preceded by a significant loss or trauma, such as the loss of a loved one, divorce, physical assault, or job loss Moving to a new culture increases the risk for depression (especially for younger people who have yet to fully develop a self-identity) Depressive Disorders Understanding Depression: Genetics Risk increases if family member has disorder. Twin studies: Estimated heritability of major depression is 37 percent. Many genes work together and produce interacting small effects that increase risk for depression. Depressive Disorders Understanding Depression: Brain Activity Brain activity is often diminished in depression (and more active during mania) Decreases the activity of reward centres The activity of the neurotransmitters norepinephrine and serotonin seem to be decreased PET Scans show energy consumption rates during different emotional states; Baxter & Phelps, UCLA Depressive Disorders Understanding Depression: Lifestyle choices Physical exercise, such as jogging, can reduce depression A healthy diet is associated with a wide variety of health benefits including lower rates of depression Excessive alcohol use correlates with rates of depression (depression can increase alcohol use but more often alcohol abuse leads to depression) Depressive Disorders Understanding Depression: Social-Cognitive Perspective Depressed people view their self and the world negatively. Those who are depressed magnify bad experiences and minimize good ones. Engage in self-defeating beliefs, negatively explanatory style, and rumination: compulsive fretting, overthinking our problems and their causes Depressive Disorders Understanding Depression: Social-Cognitive Perspective Depressed people tend to respond to bad events in a self-focused and self- blaming way Explain events in terms that are stable, global, and internal Depressive Disorders Understanding Depression: Social-Cognitive Perspective This thinking style becomes a vicious cycle Depression becomes both a cause and an effect that disrupts our sense of self and why we matter Schizophrenia & Dissociative Disorders Schizophrenia Schizophrenia is a psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression Schizophrenia Negative Symptoms Appropriate behaviours that are not present Social isolation and withdrawal Positive Symptoms Lack of enjoyment (anhedonia) Cognitive Symptoms Lack of motivation Inappropriate behaviours that Flat affect Symptoms that may not be are present observable Hallucinations Working memory impairment Delusions Sensory processing issues Disorganized Speech Attentional deficits  https://www.craiyon.com/image/xELZpygvSLyCmxsp-wLcYg Schizophrenia Hallucinations and delusions are most prominent symptoms of schizophrenia Hallucinations: When people hear, feel, taste or smell things in the absence of a sensory stimulus. Hallucinations are false perceptions. Delusions: Firm belief in something that is untrue. Delusions are false beliefs. Schizophrenia Development of Schizophrenia Typical onset of schizophrenia is around 15-25 years of age, but this window can extend into the 40s (especially in women) Adapted from Jones, 2013 Schizophrenia Development of Schizophrenia When schizophrenia is a slow-developing process, we call it chronic schizophrenia (or process schizophrenia) Symptoms usually manifest in late adolescence or early adulthood Worsens with age When previously healthy people develop schizophrenia rapidly following a life stress, we call it acute schizophrenia (or reactive schizophrenia) Can begin at any age – often in response to an emotionally traumatic event Schizophrenia Understanding Schizophrenia: Brain Abnormalities Excessive dopamine receptors might lead to a hyperactive dopamine system Drugs that stimulate dopamine receptors can worsen schizophrenia symptoms Drugs that block dopamine have some efficacy in preventing psychotic symptoms Xu & Yang (2022)  Wikipedia Commons Schizophrenia Understanding Schizophrenia: Brain Abnormalities Enlarged ventricles Decreased synaptic connectivity Decreased synchronous neural firing (especially in the frontal lobes) Suddath et al. (1990) Schizophrenia Children in utero during epidemics have a higher risk of developing schizophrenia (E.g. Influenza epidemic of 1918) Schizophrenia Children conceived during periods of famine develop schizophrenia at twice the normal rate (E.g Great Chinese Famine, 1958-1962) Schizophrenia Israeli mothers exposed to terror attacks during pregnancy increased the risk of schizophrenia in their children Schizophrenia Prenatal events that activate the mother's immune system seem to increase one’s risk for developing schizophrenia Other risk factors include obstetrics complications, maternal prenatal nutrition, prenatal infections, birth weight, oxygen May also mediate other known risk factors such as birth month (winter months) and urbanicity (population density) Schizophrenia Yet many children are exposed to maternal immune events and do not develop schizophrenia. Genetics also play an important role.  Schizophrenia Cell Nucleus Interneuron Perineuronal Net 3D Render I studied the role of perineuronal nets in schizophrenia (Peri = to surround, neuronal = neurons, nets = lattice-like structure  Schizophrenia Mauney et al. (2013) Paylor et al. (2016) Perineuronal nets are disrupted in schizophrenia (and in a wide variety of animal models of schizophrenia Schizophrenia Developmental Studies Prenatal Infection Pharmacological Studies Brain Imaging Behaviour  Schizophrenia Perineuronal nets (Peri = to surround, neuronal = neurons, nets = lattice-like structure Schizophrenia (5 min) https://www.youtube.com/watch?v=K2sc_ck5BZU Dissociative Disorders Dissociative Disorders occur when conscious awareness becomes separated (dissociated) from prior memories, thoughts, and feelings Dissociative identity disorder (DID) is a rare disorder in which a person exhibits two or more distinct personalities Formerly called multiple personality disorder Personality Disorders Personality Disorders Personality disorders are inflexible, enduring patterns of behaviour that interfere with social functioning. Typically, cluster in three categories: Anxiety related, such as avoidant personality disorder, where people exhibit a fearful sensitivity to rejection Eccentric or odd behaviors, such as is seen in schizotypal personality disorder Dramatic or impulsive behaviors like borderline personality disorder, narcissistic personality disorder, or antisocial personality disorder Personality Disorders Cluster A Cluster B Cluster C Odd, eccentric Dramatic, unpredictable Anxious, fearful behaviours behaviours behaviours Paranoid personality Antisocial personality Avoidant personality disorder disorder disorder Schizoid personality Borderline personality Dependent personality disorder disorder disorder Schizotypal personality Narcissistic Personality Obsessive compulsive disorder disorder personality disorder  Gollum Personality Disorders Cluster A: Schizoid vs. Schizotypal Share some commonalities with schizophrenia but lack prominent hallucinations and delusions Schizoid disorder: withdraw, detachment in social relationships, blunted affect, preference for solitary activities Schizotypal disorder: odd or eccentric beliefs, magical thinking, may experience transient or mild psychotic symptoms, eccentric behaviour and appearance Luna Lovegood Willy Wonka Personality Disorders Cluster B: Antisocial Personality Disorder Lack of conscience for wrongdoing, even toward friends and family members; impulsive, fearless, irresponsible More common in males, beginning in childhood but often prominent during teenage years – subsides in some of those who suffer as they age Sometimes called sociopaths or psychopaths – lack in the ability to understand, manage, and perceive emotions (emotional intelligence) Personality Disorders Ted Bundy (1946-1989) Described as having outward charm and charisma with little true personality Capable of distinguishing right from wrong, but with minimal effect on his behaviour, an absence of guilt or remorse “Guilt doesn’t solve anything, really…. It hurts you, I guess I am in the enviable position of not having to deal with guilt” – Ted Bundy Personality Disorders Cluster C: Avoidant Personality Disorder Excessive social anxiety and inhibition, fear of intimacy and rejection, feelings of inadequacy and inferiority Very often comorbid with anxiety disorders such as panic disorder (and agoraphobia) or social anxiety disorder Eating Disorders Eating Disorders Anorexia nervosa A person (most often adolescent females) maintains a starvation diet despite being significantly underweight. Attempt to lose weight but the diet becomes habitual, even when far below a healthy weight. Nouvelle Iconographie de la Salpêtrière (1990) Eating Disorders Bulimia nervosa Cycles of repeated episodes of binge eating (usually of high-calorie foods) with purging (by vomiting or laxative use), fasting, or excessive exercise. Unlike anorexia, marked by weight fluctuations around normal ranges – making it harder to identify Binge-Eating Disorder Significant binge eating, followed by distress, disgust, or guilt but without the purging, fasting, or excessive exercise that marks bulimia nervosa Eating Disorders Cultural pressures, low self-esteem, and negative emotions interact with stressful life experiences and genetics to produce eating disorders. Neurodevelopmental Disorders Neurodevelopmental Disorders Neurodevelopmental disorders are defined by central nervous system abnormalities, typically in the brain. The result is altered thinking and behavior, starting in childhood, that can manifest as intellectual limitations or as psychological disorders. Historically this category includes intellectual disability, autism spectrum disorder, and others New theories might include a broader range of syndromes and disorders (e.g. schizophrenia) Neurodevelopmental Disorders Intellectual disability: A condition of limited mental ability, indicated by an intelligence test score of 70 or below (criteria 1) and difficulty adapting to the demands of life (criteria 2) Often has a known physical cause (e.g. down syndrome can result in intellectual disability due to an extra copy of chromosome 21) Neurodevelopmental Disorders Autism spectrum disorder (ASD): A disorder that appears in childhood and is marked by significant limitations in communication and social interaction and by rigidly fixated interests and repetitive behaviors Neurodevelopmental Disorders One suspected source of ASD is poor communication amongst brain regions the try to take on or understand another's viewpoint As children grow, they spend more time looking into each other’s eyes – those with ASD do not Display impaired theory of mind Difficulty inferring and remembering other’s thoughts and emotions Neurodevelopmental Disorders At a biological level, this may be in part due to a decrease in the functionality of mirror neurons in those living with ASD “Broken mirror theory” Mirror neurons: neurons that fire both when an organism acts and when they observe the same action carried out by another Neurodevelopmental Disorders Autism spectrum disorder (ASD) can have varying levels of severity Diagnosed in about three boys for every girl Prenatal environmental factors as well as genetics can increase risk for developing ASD Paternal age seems to carry significant risk (men over 40 are far more likely to have a child with ASD than those under 30) Twin studies show that if one twin has ASD, there is a 50-70% chance the other will as well See you next class!