Chapter 15: Psychological Disorders
how does Freud understand anxiety disorders?
Freud suggests that beginning in childhood, people repress intolerable impulses, ideas, and feelings. This submerged mental energy sometimes leaks out in odd symptoms, such as anxious handwashing
learned helplessness,
the hopelessness and passive resignation humans and other animals learn when they experience uncontrollable painful events
explanatory style
who they blame for their failures (if blame self, probably feel stupid and depressed rather than angry)
Chronic schizophrenia:
(also called process schizophrenia) a form of schizophrenia in which symptoms usually appear by late adolescence or early adulthood. As people age, psychotic episodes last longer and recovery periods shorten social withdrawal is often a symptom
Acute schizophrenia:
(also called reactive schizophrenia) a form of schizophrenia that can begin at any age, frequently occurs in response to an emotionally traumatic event, and has extended recovery periods Positive symptoms that respond to drug therapy
suicide differences
- People rarely commit suicide when in depths of depression, energy and initiative are lacking. However, risk increases as they begin rebounding - more women try, more men succeed -Whites and Native Americans kill themselves twice as often as Blacks, Hispanics, and Asians - In late adulthood, rates increase, and highest rate is among 45-64 olds, second highest is 85+ -Global rate of annual suicide rates increased in last half of 20th century -Suicide rates have been higher among rich, nonreligious, and single, widowed, or divorced -Witnessing physical pain and trauma can increase suicide risks -suicide rates are highest in April and May, not over winter holidays -suicide rates tend to go up midweek
does disorder equal danger?
-Most violent criminals are not mentally ill and most mentally ill people are not violent -mentally ill people more likely to be victims -Better predictors of violence are use of alcohol or drugs, previous violence, and gun availability -Few people with disorders who commit violent acts tend to either experience threatening delusions and hallucinated voices that command them to act, or have suffered a financial crisis, lost relationship, or abuse substances
social-cognitive perspective (depressive disorder)
-Social-cognitive perspective explores how many people's assumptions and expectations influence what they perceive -Many depressed people view life through dark glasses of low self esteem that prompts them to magnify bad experiences and minimize good ones -Self-defeating beliefs (emerging from learned helplessness) and negative explanatory style feed their depression - rumination -women respond more strongly to stress (overthink) -cultural influence
criticisms & evidence of DID
CRITICISMS -Large increase in cases in recent years -are personalities unintentionally implanted by overzealous therapists EVIDENCE -Cite findings of distinct body and brain states associated with different personalities -Abnormal brain anatomy and activity can accompany DID -Brain scans show shrinkage in areas that aid memory and detection of threat -Heightened activity in brain areas associated with the control and inhibition of traumatic memories
Martin Seligman
Conducted experiments with dogs that led to the concept of "learned helplessness"
schizophrenia prenatal environment & risk
Mishaps in prenatal development or delivery Risk factors → low birth weight, maternal diabetes, older paternal age, and oxygen deprivation during delivery Famine is also a risk factor Viral infection has an impact on impaired fetal brain development, strengthening US recommendation that pregnant women need a flu shot (page 596)
likelihood of depressive episode terminating?
Most major depressive episodes self-terminate Enduring recovery more likely if: 1) first episode struck later in life 2) there was no prior history of depression 3) people experienced minimal physical or psychological stress 4) and had ample social support
What disorders occur worldwide?
Schizophrenia & major depressive disorder
Disorganized Speech
Word salad, jumbled ideas that don't make sense
Obsessive-compulsive disorder (OCD):
a disorder characterized by unwanted repetitive thoughts (obsessions), actions (compulsions), or both -OCD is more common among teens and young adults than among older people -Although obsessions and compulsions gradually lessen for most, only 1 in 5 completely recovered
Delusion:
a false belief, often of persecution or grandeur, that may accompany psychotic disorders
Dissociative identity disorder (DID):
a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities (formerly called multiple personality disorder)
types of eating disorders
anorexia nervosa, bulimia nervosa, binge eating disorder
Immigrant paradox:
compared with people who have recently immigrated from Mexico, Mexican-Americans born in the United States are at greater risk of mental disorder—a phenomenon known as the immigrant paradox
Rumination:
compulsive fretting; overthinking our problems and their causes
how do people explain anxiety disorders?
conditioning, cognition, and biology
Dissociative disorders:
controversial, rare disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings Result may be a fugue state, a sudden lost of memory or change in identity, often in response to an overwhelmingly stressful situation (protecting us from being overwhelmed by emotion)
Anxiety disorders:
psychological disorders characterized by distressing persistent anxiety or maladaptive behaviors that reduce anxiety
Philippe Pinel
reformer who opposed these treatments, he argued that madness is a sickness of the mind caused by severe stress and inhumane conditions Believed curing mental illness required moral treatment, such as gentleness, activity, conversation, sunshine, etc
influences on psychological disorder?
see picture
Depressed people often explain bad events in terms that are ____?
stable, global, and internal
biology (antisocial personality disorder)
- biological relatives of people with antisocial and unemotional tendencies are at increased risk for antisocial behavior -several genes more common to those with antisocial personality disorder -genetic vulnerability is low arousal in response to threats, even when awaiting aversive events -lower stress hormone levels than average as teenagers, before committing crime -Frontal lobes which control impulses are also less active -Have larger and hyper-reactive dopamine reward system, predisposing impulsive drive -Blunted heart rate & perspiration, less activity in brain areas responding to emotional stimuli when confronted with emotionally evocative photos
Erik Erikson's Psycho Theory of Development
- studies healthy people -stagelike development, where stages need to be resolved in order for ego to be stronger, enabling us to adapt to the world 1. Trust vs. Mistrust - corresponds with Freud's oral stage 2. Autonomy vs. Shame and Doubt -corresponds with Freud's anal stage 3. Initiative vs. Guilt 4. Competence vs. Inferiority 5. Identity vs. Role Confusion 6. Intimacy vs. Isolation 7. Generativity vs. Stagnation 8. Integrity vs. Despair
Influence on eating disorders
-families of those with anorexia tend to be competitive, high achieving, and protective -those with eating disorders often have low self-evaluations, set perfectionist standards, fret about falling short of expectations, and are immensely concerned with how others perceive them -heredity matters, identical twins share disorder more often than fraternal twins -genes that reduce available serotonin adds 30% to a person's risk of anorexia or bulimia Most people with eating disorder improve (⅔ women)
Why do only 5-10% of people develop PTSD after a traumatic event?
Amount of trauma-related emotional distress (higher the distress, the greater the risk for PTSD symptoms) PTSD can also be influenced by more sensitive emotion-processing limbic system that floods bodies with stress hormones Genes & gender influence PTSD -women more likely to develop PTSD -Twins more commonly share PTSD cognitive risk factors
Generalized Anxiety Disorder:
An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal (6 months+) - often accompanied by depressed mood - may lead to physical problems such as high blood pressure -as time passes, emotions tend to mellow. Fairly rare around age 50 -2/3 women -free floating anxiety
The Biopsychosocial Approach
Biological, psychological, and social-cultural influences weave the fabric of our behaviors, thoughts, and feelings emphasizes the body and mind are inseparable (Negative emotions can contribute to physical illness which causes negative emotions) gave rise to vulnerability-stress model
controversies & benefits of labels
CONTROVERSIES - Disruptive mood dysregulation disorder in children→ believed by many as turning tantrums into a mental disorder - Many argue DSM brings almost any kind of behavior within realm of psychiatry - Many criticize broadened definition of ADHD -People argue citing grief after death of loved one as a possible depressive disorder is overblowing a normal reaction -Diagnostic labels can be subjective -View people differently after labeling them, leading to self-fulfilling prophecies -Labels can result person having difficulty finding a place to rent & getting job; may be viewed as dangerous BENEFITS -help mental health professionals communicate about their causes and study the causes and treatments of disorders -help people realizing they are not alone in experiencing symptoms
cognition (anxiety disorders)
Cognition: our thoughts, memories, interpretations, and expectations - By observing others we can learn to fear what they fear -Our past experiences shape our expectations and influence our interpretations and reactions - People with anxiety disorders tend to be hypervigilant, they attend more to threatening stimuli, and more often interpret unclear stimuli as threatening More often remember threatening events
brain abnormalities in schizophrenia
DOPAMINE OVERACTIVITY: -excess number of dopamine receptors which intensify brain signals, creating positive symptoms such as hallucinations and paranoia -drugs that block dopamine receptors often lessen symptoms, while drugs that increase dopamine levels (amphetamines and cocaine) sometimes intensify them ABNORMAL BRAIN ACTIVITY & ANATOMY -some people have abnormally low brain activity in the frontal lobes, areas that help us reason, plan, and solve problems -PET scans of brain activity while people were hallucinating show that when people heard a voice or saw something, their brain became vigorously active in several core regions (thalamus: structure that filters incoming sensory signals and transmits them to the brain's cortex & amygdala: a fear-processing center) -enlarged, fluid-filled ventricles and corresponding shrinkage and thinning of cerebral tissues -inherited
differences between Freud and Erikson's theories?
Erikson reinterprets different sets of tasks that need to be resolved. Freud's tasks were psychosexual tasks (having to do with satisfying id and what those obstacles were at different stages of life, and how you had to resolve them), for Erikson it was task generated by the world we live in that we need to resolve (form relationships, form family, get job, pay dues, obey rules) While Freud's theory was psychosexual (based on appetites), Erikson's was social psycho theory of development (looking through development through tasks social in nature) Erikson's ages are earlier than ages we would say in life whereas Freud's are correct (because Freud's stages are generated by biological changes (biology doesn't change that much) whereas Erikson's theory is based on social changes which have changed a lot (common for people to change jobs, retire much later, etc))
free-floating anxiety
Freud- not linked to a specific stressor or threat
Ego psychologists:
Freudian psychoanalytic theorist who believes in much of orthodoxy of Freud's theory but modify it in such a way as to depict development through the ego Ego seeks to moderate battle between superego and id; adaptive part of psyche
biology (anxiety disorders)
GENES -gene variations associated with anxiety disorder symptoms, genes related to OCD -some genes influence disorders by regulating brain levels of neurotransmitters (including serotonin which influences sleep, mood, and attending to threats & glutamate which heightens activity in the brain's alarm centers) -experience affects gene expression, child abuse, suicidal people, & PTSD leaves epigenetic marks (organic molecules) that attach to chromosomes and turn certain genes on or off, increase likelihood that genetic vulnerability to a disorder will be expressed BRAIN -experiences change our brain, paving new pathways -generalized anxiety disorder, panic attacks, phobias, OCD, and PTSD express themselves biologically as overarousal of brain areas involved in impulse control and habitual behaviors -those with OCD showed most activity in anterior cingulate cortex (double checker) -some antidepressant drugs dampen this fear circuit activity and its associated obsessive-compulsive behavior NATURAL SELECTION -We seem biologically prepared to fear threats faced by our ancestors
biology (depressive disorder)
GENETIC -Depressive disorders and bipolar disorder run in families -evident in linkage analysis BRAIN -diminished brain activity during slowed-down depressive states, and more activity during periods of mania -Depression can cause the brain's reward centers & left frontal lobe to become less active than positive emotions -Neuroscientists have discovered altered brain structures in people with bipolar disorder; decreased white matter (myelinated axons) and enlarged fluid-filled ventricles -Neurotransmitter systems also influence depressive disorders and bipolar disorder [Norepinephrine which increases arousal and boosts mood is scarce during depression and overabundant during mania (reduced by drugs reducing mania) Serotonin is scarce or inactive during depression] -Drugs that relieve depression tend to increase norepinephrine or serotonin supplies by blocking either their reuptake or chemical breakdown -Repetitive physical exercise reduces depression because it increases serotonin which affects mood and arousal NUTRITION -Excessive alcohol use also correlates with depression; depression can increase alcohol use AND alcohol use leads to depression -People who eat heart-healthy "Mediterranean diet" (heavy on vegetables, fish, and olive oil) have comparatively low risk of developing heart disease, stroke, late life cognitive decline, and depression (all associated with inflammation)
what are the types of anxiety disorders?
Generalized anxiety disorder, panic disorder, phobia, PTSD, OCD
how do cultures differ in sources of stress and traditional ways of coping?
Latin America → susto (severe anxiety, restlessness, and fear of black magic) Japan → taijin kyofusho (social anxiety about appearance, blushing, avoiding eye contact) Eating disorders occur mostly in Western cultures
symptoms of schizophrenia
People with schizophrenia display symptoms that are positive (inappropriate behaviors are present) or negative (appropriate behaviors are absent) Positive → hallucinations, talk in disorganized or deluded way, inappropriate laughter, tears, or rage Negative → toneless, expressionless faces, or mute and rigid bodies
When do symptoms of phobias and major depressive disorder appear?
Phobias = age 10 Major depressive disorders = age 25
Poverty and mental illness
Poverty increases vulnerability to mental disorders, however, mental illnesses can also lead to poverty
what precedes depression?
Stressful events related to work, marriage, and close relationships often precede depression - childhood abuse -moving to new culture -stressful life events
is suicide predictable?
Suicide is unpredictable; most people who possess specific risk factor for suicide will never engage in suicidal behavior --Most suicide attempts fail --Risk is greater among those who have previously attempted suicide
state-dependent memory
Tendency to recall experiences that fit our good or bad mood (If you temporarily put people in a bad or sad mood, their memories, judgements, and expectations suddenly become more pessimistic)
Environmental Triggers for Schizophrenia
There are no environmental causes that will produce schizophrenia in a person who is not related to a person with schizophrenia Warning signs: mother whose schizophrenia was severe and long lasting, birth complications (often involving oxygen deprivation and low birth weight), separation from parents, short attention span and poor muscle coordination, disruptive or withdrawn behavior, emotional unpredictability, poor peer relations and solo play, and childhood physical, sexual, or emotional abuse
why NSSI?
Through NSSI they may: 1. Find relief from intense negative thoughts through a distraction of pain 2. Attract attention and possibly get help 3. Relieve guilt by punishing themselves 4. Get others to change their negative behavior (bullying, criticism) 5. Fit in with a peer group --> Usually does not lead to serious, typically suicidal gestures not attempts --> However, risk factor for future suicide attempts
linkage analysis
Used to tease out the genes that put people at risk for depression
Schizophrenia
a disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression -40% will have periods of a year or more with normal life expectancy with supportive environment and medication, however, only 1 in 7 will have full and enduring recovery -may lead to obesity -worldwide -Typically strikes as young people mature into adulthood (men tend to be struck earlier, more severely, and more often)
Post traumatic stress disorders (PTSD):
a disorder characterized by haunting memories, nightmares, hypervigilance, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four weeks or more after a traumatic experience - Common among survivors of accidents, disasters, and violent and sexual assaults
Bipolar disorder:
a disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania (formerly called manic-depressive disorder) week to week - less common than major depressive disorder but more dysfunctional -potent predictor of suicide -Afflicts as many men as women -Rising diagnosis among adolescents (mood swings)
Major depressive disorder:
a disorder in which a person experiences, in the absence of drugs or another medical condition, two or more weeks with five or more symptoms, at least one of which must be either (1) depressed mood or (2) loss of interest or pleasure 5+ signs of depression -widespread -more women develop depression -more often recall negative information -strikes earlier now -young adults more likely to develop depression than their grandparents -adolescent depression rates have leveled off
Psychotic disorders:
a group of disorders marked by irrational ideas, distorted perceptions, and a loss of contact with reality
Mania:
a hyperactive, wildly optimistic state in which dangerously poor judgement is common -Little need for sleep, fewer sexual inhibitions, positive emotions priest abnormally -Speech is loud, flighty, hard to interrupt, they find advice irritating -In milder forms, mania's energy and flood of ideas can fuel creativity
Antisocial personality disorder:
a personality disorder in which a person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members; may be aggressive and ruthless or a clever con artist -Antisocial = disruptive, not just unsociable -Usually male -Can display symptoms by age 8 -May show lower emotional intelligence - the ability to understand, manage, and perceive emotions -impulsive, fear little
Attention-deficit/hyperactivity disorder (ADHD):
a psychological disorder marked by extreme inattention and/or hyperactivity and impulsivity - more common in boys -genetic -Associated with abnormal brain structure, abnormal brain activity patterns, and future risky or antisocial behavior -Can be treated with stimulant drugs (Ritalin and Adderall), behavior therapy, and aerobic exercise which calm hyperactivity and increase ability to sit and focus
Psychological disorder:
a syndrome marked by a clinically significant disturbance in an individual's cognition, emotion regulation, or behavior. These thoughts, emotions, and behaviors are maladaptive or dysfunctional; they interfere with normal day to day life
Phobia:
an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity, or situation
Panic disorder:
an anxiety disorder marked by unpredictable, minutes long episodes of intense dread in which a person may experience terror and accompanying chest pain, choking, or other frightening sensations; often followed by worry over a possible next attack People may develop agoraphobia- fear or avoidance of public situations from which escape might be difficult
Anorexia nervosa:
an eating disorder in which a person (usually an adolescent female) maintains a starvation diet despite being significantly underweight; sometimes accompanied by excessive exercise
Bulimia nervosa
an eating disorder in which a person's binge eating (usually of high-calorie foods) is followed by inappropriate weight-loss promoting behavior, such as vomiting, laxative use, fasting, or excessive exercise -Easier to hide, weight fluctuations -Mostly women in their late teens or early twenties
vulnerability-stress model,
argues that individual characteristics combine with environmental stressors to increase or decrease the likelihood of developing a psychological disorder (supported by epigenetics)
environmental impacts of antisocial disorder
biological risk factors at birth (premature birth), come from family backgrounds marked by poverty and family instability Childhood maltreatment + gene that altered neurotransmitters balance predicted antisocial problems
when do disorders usually strike?
early adulthood
persistent depressive disorder (dysthymia)
experienced a mildly depressed mood more often than not for two years or more and display at least 2 symptoms Difficulty with decision making and concentration Feeling hopeless Poor self-esteem Reduced energy levels Problems regulating sleep Problems regulating appetite
Personality disorders:
inflexible and enduring behavior patterns that impair social functioning 3 CLUSTERS: 1. anxiety 2. eccentric or odd behaviors 3. dramatic or impulsive behavior
what are the types of depressive disorders?
major depressive disorder bipolar disorder
what may cause disorganized thinking in scizophrenia?
may be a breakdown in selective attention; our ability to give our undivided attention to one set of sensory stimuli while filtering out others (Schizophrenics are often easily distracted by tiny unrelated stimuli)
catatonia;
motor behavior of remaining still for hours to senseless, compulsive actions such as continually rocking)
neo-Freudians
next generation who believed in main tenets of Freud's theory
Binge-eating disorder:
significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory behavior that marks bulimia nervosa
genetic factors of schizophrenia
some people seem to be genetically predisposed to schizophrenia, shown by twin studies Epigenetic factors influence whether genes will be expressed; viral infections, nutritional deprivation, and maternal stress can turn on the genes that put us at high risk for schizophrenia 103 genome locations linked with the disorder; some influenced the effects of dopamine and other neurotransmitters in the brian, others the production of myelin, the substance that lets impulse travel through neural networks Adopted children have elevated risk if biological parent is diagnosed with schizophrenia, don't if adopted parent has schizophrenia
depression's cycle
stressful experiences, negative explanatory style, depressed mood, cognitive and behavioral changes stressful experiences interpreted through (2) a ruminating, pessimistic explanatory style create (4) a hopeless, depressed state that (4) hampers the way the person thinks and acts. This in turn, fuels (1) further stressful experiences such as rejection.
Generativity:
sustaining, giving, providing for next generation or species as whole
DSM-5:
the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders; Fifth Edition; a widely used system for classifying psychological disorders
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
Epigenetics:
the study of environmental influences on gene expression that occur without a DNA change
hallucinations
they see, feel, taste, or smell things that exist only in their minds (often voices making insulting remarks or giving orders) false perceptions
conditioning (anxiety disorders)
through classical conditioning our fear responses can become linked with formerly neutral objects and events Stimulus generalization occurs when a person experiences a fearful event and later develops a fear of similar events Reinforcement (enabling us to avoid or escape a feared situation) helps maintain learned fears and anxieties
criticisms of Freud
too negative, views human nature as illogical too id driven should study happy, successful people rather than those with neurotic symptoms
how do psychodynamic and learning perspectives interpret DID?
way to cope w/ anxiety Psychodynamic explanation → symptoms are defenses against anxiety generated by unacceptable urges Learning perspective → symptoms are behaviors that have been reinforced by relieving anxiety
