Chapter 14: Psychological disorders

Page 1

What is a Psychological Disorder?

Disorders interfere with our lives

What is a disorder?

It can be difficult to differentiate the line between "normal" behaviors and a psychological disorder

The general rule of thumb is that a psychological disorder:

Disrupts a person's life

Causes significant stress over a long period of time

May be one of these things or even both

Psychopathology is a sickness or disorder of the mind

How to know if someone has a disorder?

Intuition may sometimes be a good indicator; it's important to consider behavior in context

Four criteria

Does it deviate from cultural norms for what is acceptable? Does it vary from how a person is expected to think, feel, or act in a given situation?

Is it maladaptive? Does the thought, feeling or behavior interfere with the person's ability to respond appropriately?

Is it self-destructive? Does it cause the individual personal distress or does it threaten other people in the community?

Does it cause discomfort and concern to others?

The four criteria are important but there are some problems with each one

Psychopathology is more defined as occurring when thoughts, emotions, and/or behaviors cause significant distress, impair good daily functioning, or both

Investigating from four perspectives

Etiology is concerned with the factors that contribute to the development of the disordered thoughts, emotions, and/or behaviors

Identify and assess the symptoms of the disorder to understand what is occurring

Group symptoms into meaningful categories to make a diagnosis

Identify possible treatments

Avoid "medical student syndrome" - the tendency to 'diagnose' someone with a psychological disorder

There are two general ways to view the causes of disorders

What is the diathesis-stress model?

Based on two factors

Someone having an underlying vulnerability - a predisposition (diathesis) to a psychological disorder; can be biological or environmental

Stress; too much stress can bring on the symptoms of a psychological disorder

A family history of at least one psychological disorder raises the possibility of someone being vulnerable to mental health problems

What is the biopsychosocial approach?

Focuses on how biological factors (brain function, neurotransmitter imbalances, genetics) contribute to a psychological disorder

Considers that psychological factors (thoughts, emotions, personality, and learned experiences) influence the development of psychological disorders

Sociocultural factors (family relationships, socioeconomic status, cultural context) are related to the development of psychological disorders

Disordered thoughts, emotions, and/or behaviors can be assessed and categorized

How do you assess symptoms?

Determining whether someone has a psychological disorder is not as straightforward as doing a biopsy or a blood test

Four methods of assessment

Interview - the psychologist asks the client about current symptoms and about recent experiences that might be causing distress

Self-report - can reveal a lot of important information

Observation - watching and paying attention to the client's behavior

Psychological testing - the client performs an action that require abilities such as planning, coordinating, or remembering; an action the person performs poorly might indicate problems with a particular brain region

How are disordered emotions, thoughts, and/or behaviors categorized?

Not all people with psychological disorders experience the same disorder

Disorders of mood (depression) were categorized separately from disorders of thought disturbances (schizophrenia)

The Diagnostic and Statistical Manual of Mental Disorders (DSM) was published in 1952 and has undergone several revisions since then

Disorders are described in terms of observable symptoms; a patient must meet specific criteria to receive a particular diagnosis

An alternative to categorization by type is the dimensional approach

People's symptoms are placed on a continuum based on their severity

Recognizes that many symptoms of psychological disorders are extreme versions of what people often experience

Many psychological disorders can occur together in a state of comorbidity

List of DSM-5 disorders and examples

Neurodevelopmental disorders (autism spectrum)

Schizophrenia spectrum and other psychotic disorders (schizophrenia)

Bipolar and related disorders (Bipolar l disorder)

Depressive disorders (major depressive disorder)

Anxiety disorders (panic disorder)

Obsessive-compulsive and related disorders (body dysmorphic disorder)

Trauma- and stressor-related disorders (Posttraumatic stress disorder)

Dissociative disorders (dissociative amnesia)

Somatic symptom and related disorders (conversion disorder)

Feeding and eating disorders (anorexia nervosa)

Elimination disorders (enuresis - bed wetting)

Sleep-wake disorders (narcolepsy)

Sexual dysfunctions (erectile disorder)

General dysphoria (gender dysphoria in adolescents and adults)

Disruptive, impulse-control, and conduct disorders (pyromania)

Substance-related and addictive disorders (alcohol use disorder)

Nuerocognitive disorders (delirium)

Personality disorders (borderline personality disorder)

Paraphilic disorders (exhibitionist disorder)

At what point are a person's emotions, thoughts, and/or behaviors said to reflect psychopathology?

They disrupt a person's life and/or causes significant stress over a long period of time.

According to the biopsychosocial model, what are the three categories of factors that affect the development of psychopathology?

Biological, psychological, and sociocultural

What are the four assessment methods that can be used to investigate a person's symptoms?

Interview, self-report, observation, and psychological testing

Page 2

How do People Experience Disorders of Emotion?

Anxiety disorders make people fearful and tense

What are anxiety disorders?

Anxiety disorders are characterized by excessive fear in the absence of danger

Anxious people tend to perceive ambiguous situations as threatening, and tend to recall threatening events more easily than nonthreatening ones

More than 1 in 4 Americans will develop some type of anxiety disorder

People who experience anxiety disorders feel fearful, tense, and worried about the future

Anxiety disorders are also responsible for many physical ailments

Five types of anxiety disorders

Specific phobia

Social anxiety disorder

Generalized anxiety disorder

Panic disorder

Agoraphobia

What are the signs of these anxiety disorders?

Specific phobia

Out-of-proportion fear of an object

May be common (fear of snakes) or unusual (fear of long words)

Social anxiety disorder

Fears of being in social situations, public speaking, speaking up in class, meeting new people, and eating in front of others

Generalized anxiety disorder

Anxiety that is always present

Panic disorder

Sudden, overwhelming attacks of terror

People who have the attacks often feel like they are dying

Agoraphobia

Fear of being in situations from which escape is difficult or impossible

Some disorders have unwanted and intrusive thoughts that increase anxiety

What is obsessive-compulsive disorder (OCD)?

Involves frequent intrusive thoughts and compulsive actions

Obsessions are recurrent, intrusive, and unwanted thoughts/urges/mental images that increase anxiety

Intense worry and fears of contamination, accidents, or of one's own aggression

Compulsions are particular acts that the person feels driven to perform over and over again that reduce anxiety

Cleaning, checking, counting

Temporary anxiety relief

OCD often goes through a cycle (anxiety, compulsion, relief, obsession

What is posttraumatic stress disorder (PTSD)?

Severe stress, emotional trauma, and negative reactions long after the danger has passed

Involves frequent and recurring unwanted thoughts related to the trauma

Nightmares, intrusive thoughts, flashbacks

Risk of developing PTSD based on type of trauma experienced (percentage)

Intimate partner or sexual violence - 11.4

Other traumas - 9.2

Unexpected death of loved one - 5.4

War-related trauma - 3.5

Physical violence - 2.8

Other traumas of loved ones or witnessed - 2.4

Accident - 2.0

Depressive disorders consist of sad, empty, or irritable mood

What are the two types of depressive disorders?

Major depressive disorder

Extremely depressed mood

Loss of interest in pleasurable activities

Changes in weight or sleep

Persistent depressive disorder

Mild or moderate depressed mood most days

What are the symptoms of depressive disorders?

The presence of sad, empty, or irritable mood is common

People may also experience bodily symptoms and cognitive problems

What are the factors in depressive disorders?

Biological factors

Depression does have a genetic component

Involves various neurotransmitters that regulate emotion

Certain neural structures may be involved in mood disorders (damage of the prefrontal cortex can lead to depression)

Biological rhythms (More REM sleep)

Psychological factors

Life stressors and how people react to them

Cognitive triad

Learned helplessness

Bipolar Disorders Involve Mania

What is bipolar disorder and what are the two types?

Episodes of greatly elevated mood; can vary in degree and are accompanied by major shifts in energy level, physical activity, and creativity

Bipolar l disorder: Extremely elevated moods

Bipolar ll disorder: Alternating between mildly elevated mood and extremely depressed mood

What are the symptoms of bipolar disorders?

True manic episodes last one week or longer

Characterized by abnormally and persistently elevated mood, increased activity, diminished need for sleep, grandiose ideas, racing thoughts, and extreme distractiability

Page 3

How do people experience disorders of thought?

What is schizophrenia?

Characterized by extreme alterations in thought, perceptions, and/or consciousness

Literally means "splitting of the mind"

People with schizophrenia experience psychosis

Symptoms of schizophrenia

Delusions: False beliefs that reflect breaks from reality

Persecution: Belief that others are persecuting, spying on, or trying to harm you

Referential: Belief that objects, events, or other people have particular significance to you

Grandiose: Belief that you have great power, knowledge, or talent

Identity: Belief that you are someone else

Guilt: Belief that you have committed a terrible sin

Control: Belief that your thoughts and behaviors are being controlled by external forces

Hallucinations: Perceptual disturbances that are experienced without an external source

Auditory

Visual

Olfactory

Bodily

Disorganized speech: Incoherent speech; failing to follow a normal conversational structure

Loosening of associations: frequently changing topics

Clang associations: stringing together words that rhyme but have no other apparent link

Disorganized behavior: Acting strangely

Other negative symptoms