Module 47: Introduction to Psychological Disorders

epigenetics

"above" or "in addition to" (epi) genetics; the study of the molecular mechanisms by which environments can influence genetic expression (without a DNA change). (pp. 133, 555)

The World Health Organization has launched a reform that aims to transform hospitals worldwide into...

"patient-friendly and humane places with minimum restraints"

What does classification aim to do in psychiatry and psychology?

Classification aims to PREDICT a disorder's future course, SUGGEST appropriate treatment, and PROMPT RESEARCH into its causes.

The biopsychosocial approach emphasizes that mind and body are ____ .

inseparable -negative emotions can trigger physical illness, and physical abnormalities can trigger negative emotions.

Although their rates and symptoms vary by culture, no known society is free of two terrible disorders:

major depressive disorder and schizophrenia

two disorders that occur worldwide

major depressive disorder and schizophrenia

Two major disorders that are found worldwide are schizophrenia and ______ ______ ______ .

major depressive disorder.

A therapist says that psychological disorders are sicknesses, and people with these disorders should be treated as patients in a hospital. This therapist's belief reflects the ______ model.

medical.

Comparing the suicide rates of different groups, researchers have found

national, racial, gender, trait, age, and other group, day-of-the-week/seasonal, and year-by-year differences.

One predictor of psychiatric disorders that crosses ethnic and gender lines is ______ .

poverty.

What may trigger suicidal thinking and behavior?

social suggestion -sharing suicidal thoughts had a ripple effect, spreading suicidal thinking through one's social network -highly publicized suicides and TV programs featuring suicides, fatal auto/private airplane "accidents," exposure to others' suicides all may increase the rates of suicide.

DSM-5

the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; a widely used system for classifying psychological disorders. (p. 555)

medical model

the concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and, in most cases, cured, often through treatment in a hospital. (p. 555)

At what times of life do disorders strike?

-About half of people with a disorder experience their first symptoms by the mid-teens, and three-quarters do so by the mid-twenties. -Among the earliest to appear are the symptoms of antisocial personality disorder (median age 8) and of phobias (median age 10). -Alcohol use disorder, obsessive-compulsive disorder, bipolar disorders, and schizophrenia symptoms appear at a median age near 20. -Major depressive disorder often hits somewhat later, at a median age of 25.

criticisms of DSM-5

-DSM too broad and encompasses possible everyday behavior -diagnostic labels can be subjective

How have definitions of what makes for a "significant disturbance" varied?

-From 1952 to 9 December 1973, "homosexuality" was classified as a psychological disorder. -APA changed it because many viewed same-sex attraction as a natural biological predisposition and not a psychological problem. -Such is the power of shifting societal beliefs.

How many people have a psychological disorder?

-Mental and addictive disorders affected more than 1 billion people globally in 2016. -In the United States, 47 million adults—19%—experienced a mental illness within the last year

What has been discovered as influences to mental disorders?

-The medical perspective has been energized by recent discoveries that many genes together influence the brain and biochemistry abnormalities that contribute to all major disorders. -A growing number of clinical psychologists now work in medical hospitals, where they collaborate with physicians to determine how the mind and body operate together.

What increases vulnerability to mental disorders?

-There are various risk and protective factors for mental disorders. -One predictor crosses ethnic and gender lines: POVERTY.

mental illness

-also called a psychopathology -needs to be diagnosed on the basis of its symptoms -needs to be treated through therapy, which may include time in a psychiatric hospital.

The DSM-5 includes

-diagnostic codes from the World Health Organization's International Classification of Diseases (ICD) -this makes it easy to track worldwide trends in psychological disorders.

epigenetics and vulnerability-stress model

-epigenetics supports the vulnerability-stress model by showing how our DNA and our environment interact -in one environment, a gene will be expressed, but in another, it may lie dormant. -for some, that will be the difference between developing a disorder or not.

Risks of diagnostic labels

-once we label a person, we view that person differently. -labels can be self-fulfilling, and if negative, they can be stigmatizing. -hard to get jobs, and people may fear those as potentially violent.

How can we be helpful to someone who is talking suicide?

1. Listen and empathize. 2. Connection the person with counseling center, National Suicide Prevention Lifeline, Crisis Text Line, etc. 3. Protect someone who appears at immediate risk by seeking help from a doctor/hospital emergency room/911.

Self-injury rates peak higher for _____ in the United States.

15-19 year old females than for same-age males

risk of suicide for those who have been anxious

3x

risk of suicide for those who have been depressed

5x

LOQ 47-1: How should we draw the line between normality and disorder?

According to psychologists and psychiatrists, PSYCHOLOGICAL DISORDERS are marked by a clinically significant disturbance in an individual's cognition, emotion regulation, or behavior. Such dysfunctional or maladaptive thoughts, emotions, or behaviors interfere with daily life, and thus are disordered.

In many countries, the most common tool for describing disorders is ...

American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (now in its 5th edition; DSM-5)

trait differences in suicide rates

Among Swedes, those with obsessive-compulsive disorder are at higher risk of depression, thereby increasing their risk of suicide. Suicidal thoughts may also increase when perfectionist people feel driven to reach a goal or standard—to become thin or straight or rich—and find it unattainable.

What triggered the medical model?

Around 1900, researchers discovered that syphilis, a sexually transmitted infection, invades the brain and distorts the mind. -This discovery triggered an eager search for the physical causes of other mental disorders, and for treatments that would cure them.

biopsychosocial approach to psychological disorders

Biological: -evolution -individual genes -brain structure and chemistry Psychological -stress -trauma -learned helplessness -mood-related perceptions and memories Social-cultural influences -roles -expectations -definitions of normality and disorder

Why is the DSM, and the DSM-5 in particular, considered controversial?

Critics have expressed concerns about the negative effects of labeling by the DSM and other classification systems. Labels have the potential to be both subjective and stigmatizing. Further, critics suggest that the DSM-5 casts too wide a net on disorders, pathologizing normal behavior.

What did Philippe Pinel believe the cure was to mental illness?

Curing the illness requires MORAL TREATMENT, including boosting patients' spirits by unchaining them and talking with them. -worked to replace brutality with gentleness, isolation with activity, and filth with clean air and sunshine.

TRUE OR FALSE: Psychological disorders predict violent behavior.

FALSE -Better predictors of violence are alcohol/drug use, previous violence, gun availability, and brain damage.

TRUE OR FALSE: Having guns in the home makes the household safer.

FALSE: Although U.S. gun owners often keep a gun to feel safer, having a gun in the home makes one less safe, because it substantially increases the odds of a family member dying by suicide or homicide

Philippe Pinel (1745-1826)

French physician who worked to reform the brutal treatment of people with mental disorders -believed that "madness" is not demonic possession, but a sickness of the mind caused by severe stress and inhumane conditions.

age differences in suicide rates

In late adulthood, rates increase worldwide, with the highest rate among those over 70.

year-by-year differences in suicide

In most countries, suicides have been increasing. For example, between 1999 and 2017, Americans' suicidal thoughts and suicide rates both increased nearly 40%.

Is the DSM-5 reliable?

In real-world tests (field trials) assessing the reliability of the DSM-5 categories, some diagnoses fared well and others fared poorly. -Clinician agreement on adult posttraumatic stress disorder and childhood autism spectrum disorder, for example, was near 70%. (If one psychiatrist or psychologist diagnosed someone with one of these disorders, there was a 70% chance that another mental health worker would independently give the same diagnosis.) -But for antisocial personality disorder and generalized anxiety disorder, agreement was closer to 20%.

Benefits of diagnostic labels

Labels help mental health professionals communicate about their cases and study the causes and treatments of disorders. Clients are often relieved to learn that their suffering has a name, and that they are not alone in experiencing their symptoms.

Examples of other disorders that tend to be associated with specific cultures

Latin America - susto: severe anxiety or panic in response to an emotional trauma or fear of black magic. Japanese culture - taijin kyofusho: social anxiety about physical appearance, a readiness to blush, and a fear of eye contact. food-abundant Western cultures: anorexia nervosa and bulimia nervosa Malaysia - amok: sudden outburst of violent behavior.

LOQ 47-5: Do psychological disorders predict violent behavior?

Mental disorders seldom lead to violence, and clinicians cannot predict who is likely to harm others. Most people with disorders are nonviolent and are more likely to be victims than attackers. Better predictors of violence are alcohol or drug use, previous violence, gun availability, and brain damage.

day of the week and seasonal differences in suicide

Negative emotion tends to go up midweek, which can have tragic consequences. A surprising 25% of U.S. suicides occur on Wednesdays. Suicide rates are highest in April and May, and not (as commonly believed) over the winter holidays.

Anna is embarrassed that it takes her several minutes to parallel park her car. She usually gets out of the car once or twice to inspect her distance, both from the curb and from the nearby cars. Should she worry about having a psychological disorder?

No. Anna's behavior is unusual, causes her distress, and may make her a few minutes late on occasion, but it does not appear to significantly disrupt her ability to function. Like most of us, Anna demonstrates some unusual behaviors. Since they are not disabling or dysfunctional, they do not suggest a psychological disorder.

How is NSSI self-reinforcing?

People may: -find relief from intense negative thoughts through the distraction of pain. -attract attention and possibly get help. -relieve guilt by punishing themselves. -get others to change their negative behavior (bully, criticism). -fit in with a peer group.

LOQ 47-6: How many people have, or have had, a psychological disorder? What are some of the risk factors?

Psychological disorder rates vary, depending on the time and place of the survey. In one multinational survey, the lowest rate of reported mental disorders was in Nigeria, and the highest rate in the United States. Poverty is a risk factor. But some disorders, such as schizophrenia, can also drive people into poverty. Immigrants to the United States may average better mental health than their U.S. counterparts with the same ethnic heritage (a phenomenon known as the immigrant paradox).

RP-1 A lawyer is distressed by feeling the need to wash her hands 100 times a day. She has little time to meet with clients, and her colleagues are wondering about her competence. Her behavior would probably be labeled disordered, because it is , that is, it interferes with her day-to-day life.

RP-1 dysfunctional or maladaptive.

RP-2 Are psychological disorders universal or culture-specific? Explain with examples.

RP-2 Some psychological disorders are culture-specific. For example, anorexia nervosa occurs mostly in Western cultures, and taijin kyofusho appears largely in Japan. Other disorders, such as major depressive disorder and schizophrenia, are universal—they occur in all cultures.

RP-3 What is the biopsychosocial approach, and why is it important in our understanding of psychological disorders?

RP-3 Biological, psychological, and social-cultural influences combine to produce psychological disorders. This approach helps us understand that our well-being is affected by our genes, brain functioning, inner thoughts and feelings, and the influences of our social and cultural environment.

RP-4 What is the value, and what are the dangers, of labeling individuals with disorders?

RP-4 Therapists and others apply disorder labels to communicate with one another using a common language, and to share concepts during research. Clients may benefit from knowing that they are not the only ones with these symptoms. The dangers of labeling people are that (1) overly broad classifications may pathologize normal behavior, and (2) the labels can trigger assumptions that will change people's behavior toward those labeled.

RP-5 What is the relationship between poverty and psychological disorders?

RP-5 Poverty-related stresses can help trigger disorders, but disabling disorders can also contribute to poverty. Thus, poverty and disorder are often a chicken-and-egg situation; it's hard to know which came first.

national differences in suicide rates

Russia has double the suicide rate of the United States, which has double that of Spain. Within Europe, Lithuanians have been seven times more likely to die by suicide than Greeks.

LOQ 47-4: What factors increase the risk of suicide, and what do we know about nonsuicidal self-injury?

Suicide rates differ by nation, race, gender, age group, income, religious involvement, marital status, and other factors. In most countries, suicide rates have been increasing. Those lacking social support, such as many gay, transgender, and gender nonconforming youth, are at increased risk, as are people who have been anxious or depressed. Isolation and unemployment can also heighten risk. Forewarnings of suicide may include verbal hints, giving away possessions, withdrawal, and preoccupation with death. People who talk about suicide should be taken seriously: Listen and empathize, connect them to help, and protect those who appear at immediate risk. Nonsuicidal self-injury (NSSI) does not usually lead to suicide but may escalate to suicidal thoughts and acts if untreated. People who engage in NSSI do not tolerate stress well and tend to be self-critical and impulsive.

other group differences in suicide rates

Suicide rates have been much higher among the rich, the nonreligious, and the unmarried. Gay, transgender, and gender-nonconforming youth facing an unsupportive environment, including family or peer rejection, are also at increased risk of attempting suicide.

TRUE OR FALSE: Suicide is usually not an act of hostility or revenge.

TRUE: People—especially older adults—may choose death as an alternative to current or future suffering, a way to switch off unendurable pain and relieve a perceived burden on family members. Suicidal urges typically arise when people feel like they don't belong or are a burden to others, when they feel trapped by a seemingly inescapable situation, or when they feel incapable of experiencing joy.

LOQ 47-3: How and why do clinicians classify psychological disorders, and why do some psychologists criticize diagnostic labels?

The American Psychiatric Association's DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) contains diagnostic labels and descriptions that provide a common language and shared concepts for communication and research. Critics of the DSM say it casts too wide a net, pathologizing normal behaviors. A complementary approach to classification is the U.S. National Institute of Mental Health's Research Domain Criteria (RDoC) project, a framework that organizes disorders according to behaviors and brain activity along several dimensions. Any classification attempt produces diagnostic labels that may create preconceptions, which bias perceptions of the labeled person's past and present behavior.

LOQ 47-2: How do the medical model and the biopsychosocial approach influence our understanding of psychological disorders?

The MEDICAL MODEL assumes that psychological disorders have physical causes that can be diagnosed, treated, and often cured through therapy, sometimes in a hospital. The biopsychosocial perspective assumes that disordered behavior comes from the interaction of biological characteristics, psychological dynamics, and social-cultural circumstances. This approach has given rise to the vulnerability-stress model, in which individual characteristics and environmental stressors combine to increase or decrease the likelihood of developing a psychological disorder, a model supported by EPIGENETICS research.

immigrant paradox

The surprising fact that immigrants tend to be healthier/have less risk for mental disorders than U.S. born residents of the same ethnicity. -This was first evident among Mexican Americans.

What is an example of a culturally-related psychological disorder?

There are various culture-linked disorders, including susto (in Latin America), taijin kyofusho (in Japan), amok (in Malaysia), and eating disorders (in food-abundant Western cultures).

newer classification approach that builds on the DSM

U.S. National Institute of Mental Health's Research Domain Criteria (RDoC) project -RDoC framework organizes disorders according to behaviors and brain activity, aiming to study them with "the power of modern research approaches in genetics, neuroscience, and behavioral science."

Does NSSI lead to suicide?

Usually not Those who engage in NSSI are typically suicide gesturers, not suicide attempters

racial differences in suicide rates

Within the United States, Whites and Native Americans die by suicide roughly twice as often as Blacks, Hispanics, and Asians. -The rate among Indigenous Canadians is triple that of other Canadians (Kumar & Tjepkema, 2019).

gender differences in suicide rates

Women and girls are much more likely than men to consider or attempt suicide. But worldwide, men are twice as likely to actually die by suicide. The methods men use, such as firing a bullet into the head, are more lethal. In the United States, for example, only 13% of all suicide attempts end in death—but for those using firearms, that number rises to 90%.

Do rates of psychological disorder vary by place?

YES, cultures vary. -Lowest rate of reported mental disorders was in Nigeria, and the highest rate was in the U.S. -Immigrants to the U.S. from Mexico, Africa, and Asia averaged better mental health than their U.S.-born counterparts with the same ethnic heritage (immigrant paradox)

vulnerability-stress model

a biopsychosocial assumption that individual dispositions combine with environmental stressors to influence psychological disorder.

psychological disorder

a syndrome (collection of symptoms) marked by a clinically significant disturbance in an individual's cognitions, emotion regulation, or behavior. (p. 553) -such thoughts, emotions, or behaviors are dysfunctional or maladaptive: they interfere with normal day-to-day life. -often accompanied by distress.

nonsuicidal self-injury (NSSI)

act of deliberately cutting, burning, puncturing, or otherwise significantly injuring one's skin with no intent to die

Some disorders may share ______ , while differing in the _____ .

an underlying dynamic (such as anxiety); symptoms (an eating problem or type of fear)

Many psychologists reject the disorder-as-illness view and instead contend that other factors may also be involved—for example, the person's level of stress and ways of coping with it. This view represents the ______ approach. a. medical b. epigenetics c. biopsychosocial d. diagnostic

c.

The symptoms of __________ appear around age 10; __________ tend[s] to appear later, around age 25. a. schizophrenia; bipolar disorders b. bipolar disorders; schizophrenia c. major depressive disorder; phobias d. phobias; major depressive disorder

d.

Two criteria for psychological disorder

dysfunctional or maladaptive (interfere with day-to-day life)

People with disorders are more likely to be _____ than ______ .

victims; perpetrators of violence

________ (Women/men) are more likely than _______ (women/men) to die by suicide.

women; men.