Chapter 15: Psychological Disorders

Phobias: Subcategories

1) Agoraphobia 2) Specific phobia 3) Social phobia

Depersonalization

Df: A feeling or an impression of being detached from oneself. People with this have a lot of out-of-body experience. > Feels like you are outside your own body. Most experience at least once in life > Disruptive if occurs constantly.

Criticisms of the DSM Diagnostic Labeling: Treatment access

Resources may only be available to those with formal diagnosis > Only accessible to those who have been 'labeled'

Biopolar Disorder - Subcategories

1) Bipolar I Disorder 2) Bipolar II Disorder 3) Cyclothymia

Explanations for Schizophrenia

1) Family Interactions > More -ve interactions observed with ppl diagnosed. Theory: -ve interaction shown to worsen severity of schizophrenia. 2) Brain Abnormalities > Reduction of grey and white matter. Not as many connections in the nerves in the brain, can explain cognitive difficulty 3) Neurotransmitter Differences > Levels of dopamine too high > Ppl with schizophrenia are heavy smokers. Nicotine raises dopamine level. Looks to be counter-intuitive. > Suggested theory is that they self-medicate to help with the effect of anti-psychotic medication. > Another is that biological factors prone to smoke is similar to the biological factor that explain the development of schizophrenia. 4) Genetic Findings > Genetic similarity increase, so does risk of getting schizophrenia > 50% chance if both parents diagnosed 5) Diathesis-stress model: genetic predispostion to develop problems and environmental stressors could push you above the threshold and develop psychological disorders. Explain why those with lower SES might develop. 6) Neurodevelopmental model: Disturbances in the development of the brain could lead to development of schizophrenia. Factor being studied is malnutrition during pregnancy. Might interfere with development of brain of fetus.

OCD & Related Disorders - Subcategories

1) Hoarding Disorder 2) Trichotillomania 3) Body Dysmorphic Disorder

Explanations for Anxiety Disorders

1) Learning Models 2) Cognitive Model

Depressive Disorders - Subcategories

1) Major Depressive Disorder 2) Dysthymia (Persistent Depressive Disorder)

Personality Disorders - Subcategories

1) Odd and Eccentric behaviour - common feature is social awkwardness and withdrawal 2) Dramatic and Impulsive/emotional behaviour - impulse control and emotion regulation 3) Anxious and Fearful behaviour - people will experience a high level of anxiety overall 4) Paranoid personality Disorder 5) Boderline personality Disorder 6) Narcissistic personality Disorder

Subcategories of Anxiety Disorders

1) Panic Disorder 2) Generalised Anxiety Disorder 3) Phobia

Explanations for DID

1) Posttraumatic model (AKA Trauma-Dissociation Theory) - DID arises from severe abuse in childhood. > Develop difference identities so as to cope with something > Person's own identity is damage and to cope, other identities are developed. > NOT complete explanation as a lot of people who go through traumatic events during childhood don't develop DID 2) Socio-cognitive Model - maybe it's just by talking a lot about it and we are culturally creating this. > People assume the roles with DID > Part of explanation is that some psychotherapists might be imposing the role of someone with DID onto their patients, which could explain why psychotherapists diagnose DID more often than those who don't specialise in diagnosing mental disorders.

Defining Psychological Disorders

4 main criteria are used (in a clinical perspective) as a guideline to determine if a behaviour should be considered abnormal 1) Deviance 2) Distressing 3) Dysfunctional 4) Dangerous ***Abnormality is a social construct and can be influenced by culture. NOT all of the 4 have to be present. They are just indications and guidelines for psychologists to use to help diagnose disorders.

Validity of Psychiatric Diagnoses Rosenhan - "On Being Soe in Insane Places"

> 4 men and 3 women > 12 hospitals around the US. They just faked a single symptom. (Hollow, empty, thud). All diagnosed as insane. Once admitted to the hospital, they went back to normal > They were investigating psychiatric labels. > Field experiment, IV: lack of symptom, DV: staff reaction How long would it take for doctors and nurses to detect their sanity. > Never found out. > This study raised a lot of concern about psychiatric diagnosis. It was obvious that pseudo-patients behaviors were looked at how their label indicates (it was a totally normal behaviour but interpreted in a completely inappropriate way) > Shows that these labels stick to these people. Confederates thought they would stay there for a couple of days but ended up staying for 1 to 2 months. This study and the study that followed after that dignosis of mental disorders are very different from physical disorders. Mental disorders diagnosis is more subjective.

Health historically - Middle Ages (5th - 15th century)

> Church was guardian of medical knowledge. All areas in life controlled by church. > Religious interpretations > Humans have souls and not appropriate objects for scientific investigations. > Dissections was banned. Illness was seen as God's punishment and treatment was by driving evil out by touted methods but was replaced by prayer. > Diagnosis and treatment was guided by astrology

Health historically: Biomedical model (from 19th century)

> Continues to be a very dominant view in medicine today. > Illness always has a physical cause > Reductionism: No description of the role of psychological, social, or behavioural variables in illness (biological factors can explain all illnesses.) ***This isn't true as environmental factors, psychological factors, etc. can influence ones health. > Based on the mind-body dualism theory > Health: absence of disease

Cognitive Model

> Focus on MALADAPTIVE thought patterns and beliefs > Tend to develop when misinterpret a situation to be more threatening than a situation really is and will reinforce panic disorder in LT. ***E.g.: People interpreting a panic attack will think they are going to die an increases their anxiety level and this will cause them to have more panic attacks in the future. If they interpret that they are going crazy, they will also have more anxiety and increases their symptoms. > Anxiety sensitivity - misinterpret minor physical symptoms > Once they identify a panic attack, you will know that you aren't going to die and not going crazy, so re-intepret the situation as attack only last 10 mins, lower chances of attack in future.

Cost of Psychological Disorders

> Mental illness is number one cause of disability in Canada > About 70% of total cost in disability claims goes towards psychological disorders > Causes 500,000 Canadians to miss work on a daily basis > Costs Canada@ least 50 BILLION dollars per year Why cost so much? This is because we are focusing on helping people who are sick and not enough emphasis on prevention measures. Delaying treatment. We have publicly funded healthcare system and it works relatively well for physical illnesses. Don't have the same access to mental health services.

Video - Age of Anxiety

> Our culture makes us feel more anxious than ever before. > Isolation, sense that no one has your back, > A big part of our cultural identity. Higher than depression. > Anxiety in terrorism, crime, etc. The media helps with it. > More and more people with normal anxiety are being diagnosed with an anxiety disorder. > Anxiety occurs on a spectrum. Not all bad. When that fear becomes more disconnected from a situation, that is when you could have an anxiety disorder

Current views: Mind-Body

> Physical health is inextricably interwoven with the psychological and social environment. > Growing interest in more holistic approaches to health and healing in Canada and other Western countries >>> Techniques to restore both physical and psychological balance (e.g., meditation, massage therapy)

Health historically - Renaissance

> The re-birth of scientific inquiry. New ideas were born in this period. > Ban on dissection was lifted. Leonardo Da Vinci (1452 - 1519) > Drawings of human and animal bodies that he dissected René Descartes (1596 - 1650): dualism > The body and the mind are 2 completely separate entities and rarely interact with one another. > Human body as a machine while the mind was an abstract thing that had no influence on the body. > Disease = the machine broke down > Big step backwards in health (in terms of psychological health). Dualism has a negative impact on psychological health treatments.

Explanations for Depressive & Biopolar Disorders

A) Biology Under-activity of neurotransmitter levels > Serotonin > Norepinephrine > Dopamine Significantly stronger genetic component for bipolar disorder then depression > 50% of those with BD have relative with BD > Concordance rate for BD 5x higher among MZ vs. DZ twins. Medication is important in bipolar disorders compared to depressive disorders, especially for cases classified form mild to moderate. Psychotherapy is preferable compared to medication.

Learning Models

A) Classical Conditioning Same principle of Pavolov dog. > Involves a stimulus previously considered as neutral and acquires some property to become frightening so that stimulus will now cause fear. > E.g.: Fear of dogs. B) Modelling > Watching other people. > E.g.: See mum afraid of dogs and brain will then learn to fear dogs > Impt for parents to treat phobia. C) Operant Conditioning > Maintenance of phobia in the LT > Avoidant Behaviours NEGATIVELY REINFORCE anxiety > Brain will register that when dogs aren't around, you are fine but once see a dog, start to become anxious so will see dogs as scary and will maintain phobia.

Explanations for Depression

A) Life events - stressful events that represent loss are closely tied to depression > Subjective B) Interpersonal Model - depressed people seek excessive reassurance which leads them to being disliked ad rejected. > Study involved students who had to call strangers and have a conversation with the strangers. Students didn't know that the people could have been diagnosed with depression or not. At end of study, they were asked if they wanted to talk to individuals again. Result: Students who talked to people diagnosed with depression didn't want to talk to them again while students who talked to people not diagnosed were more likely to talk to them again. C) Behavioural Model - depressed people have lack of positive reinforcement -- leads them to stop engaging in enjoyable behaviour > Stop doing things and will received less positive reinforcement and cycle continues D) Cognitive model - negative views of self-future, and world (Beck's Cognitive Triad) > Cannot suppress negative thoughts > Recall more failures vs. successes (mood congruent memory) > Negative thoughts related to all these things. Can't suppress negative thoughts overall. Central problem is due to mood congruent memory. This phenomenon is something we all experience. On a day when we are in a good mood, we are more likely to remember good things that happened in the past and vice versa. This explains maintenance of depression as you are always in a bad mood and you will remember more of the negative things that happened in life.

Dysfunctional

AKA = maladaptive behavior Df: When the thoughts, behaviour and emotions will interfere with the person's day to day life > Impair the individual's performance of daily function E.g.: Drug use disorder

Mood Disorders

About 40 - 70% diagnosed with mood disorder will also have anxiety disorders 2 main types: 1) Depressive disorders & 2) Bipolar disorders

Criticisms of the DSM Diagnostic Labeling: Social & Personal

Becomes too easy to accept label as description of the individual > Labels often criticised as very easy to accept it as description of individual. > End up using it to refer to people's identity May accept the new identity implied by the label > Could slow recovery as see it as part of identity instead of disorder. May develop the expected role and outlook

Dysthymia (Persistent Depressive Disorder)

Chronic and symptoms are not as severe compared to Major Depressive Disorder. > Tends to become chronic in 10-20% of individuals (Dysthymia)

Hoarding Disorder

Conceptualised along a continuum for OCD. Df: People have compulsion to acquire new things and can't seem to get rid of them even if don't use them. >>> Must cause distress and affects your life Public perception of people who hoard are that they are lazy. NOT TRUE. > Might be life-long battle.

Dissociative Identity Disorder (DID)

Df: A possible added feature for dissociative amnesia. People forget their own identity, assume new identity. > Quite rare > Some psychologists don't think it should be a diagnosis. > Used to be called multiple personality disorder. It was changed to put an emphasis on CORE problem that people's identity is not unified. > The whole concept of your knowledge of who you are is disrupted. Each identity could have different personalities. > Each identity are known as 'Alter" and they take control of a person's behavior and not at the same time. Each identity could have different genders, ages, personalities, etc. They usually have very opposite personalities (for the Alters). > Typically the Alters aren't aware of each other. > Some people will have just 2 identities but the highest identities reported is about 4,500 different alters.

Bipolar Disorder

Df: Combination of hyper manic episodes and episodes of depression. > Usually a major depressive episode precedes or follows a maniac episode Manic episode: euphoric mood (so good, never felt like that in their life), rapid speech (related to the thoughts in their mind), feels like they have tons of energy and don't feel like the need to sleep Medication controls the symptoms and people miss the episodes of manic attack. Can also be very creative in middle of manic episode Why treat? > Manic episodes comes with very irresponsible and erratic behaviour. E.g.: drive real fast, spending lots of money (have an inflated self-esteem), could become delusional and think they have super powers.

Trichotillomania

Df: Compulsive hair pulling, typically at the head but can be anywhere on the body like eyebrows, eyelashes. > Will have bald spots > Will have major impact on social life and will tend to emerge in childhood. > Can be treated using a similar approach to OCD

Generalised Anxiety Disorder - Anxiety Disorders

Df: Continual feelings of worry, physical tension, and irritability > 3-5% of population > 'free-floating anxiety' > Not tied to specific situation Spend an average of 60% of the day on worrying > Typical person spend 20% of the day on worrying Will have trouble sleeping, tired, lots of tension, irritable > More likely to be women who suffer from GAD Major co-mobidity between GAD and other anxiety disorders like phobias and panic disorders

Dissociative Disorders - Subcategories

Df: Disorders causing problems in identity, consciousness. 1) Depersonalization/deralization Disorder 2) Dissociative Amnesia > with dissociative fugue 3) Dissociative Identity Disorder (DID)

Cyclothymia

Df: Equivalent to bipolar disorders except it is milder and tends to be more chronic. > Similar to dysthymia. > Needs to be occurring for 2 years.

Narcissistic Personality Disorder

Df: Inflated self-importance. Unwillingness to recognise other people's need. Symptoms present is more severe and it has to interfere with people's lives. ***Study is looking at narcissism, narcissistic personality disorder is looking at social media. There seems to be a difference in the reason for using social media. People who are narcissist and people who have the disorder tend to use social media as a self-promotion tool. Selfies (apply to men only) posted to FB is correlated to the degree to narcissism. This is interesting as women are more likely to post more selfies to FB but shows no correlation to narcissism.

Phobia - Anxiety Disorders

Df: Intense fear of an object or situation that is greatly out of proportion to its actual threat. > Needs to change the way you do things in daily life and need to produce quite a bit of distress

Specific phobia

Df: Intense fear of objects, places or situations. > Commonly arise in situations of animals, insects, elevators, water, darkness, etc.

Major Depressive Disorder

Df: Lingering sadness or diminished interest in pleasurable activities > Not interested in things that you used to be interested in, is a central symptom > Women are more likely to be diagnosed with anxiety and depressive disorders (twice as likely) > Depression tends to be recurrent. 40% will have a second epidote within 2 years. Symptoms: weight loss, sleep difficulties, fatigue, lack of concentration, feelings of worthlessness

Social phobia

Df: Marked fear of public appearances in which embarrassment or humiliation is possible, such as public speaking, eating or performing.

Dissociative Amnesia

Df: People can't recall crucial information, can be related to one's identity or info related to an important event that occured in their life. > To be considered, it had to be something that shouldn't have been forgotten under natural circumstances. > Commonly diagnosed with PTSD

Body Dysmorphic Disorder

Df: People have intense preoccupation with a slight defect in their physical appearance. > Defect might not even be there, only in their mind. > Preoccupation and associated behaviour must >1 hr/day. > Behaviour will be like compulsive mirror checking to look at defect, excessive reassurance from friends/ family members, excessive grooming, etc.

Dangerous

Df: Potentially dangerous emotions, thoughts or behaviour for the person or people around the person E.g.: Suicidal thought

Panic Disorder - Anxiety Disorders

Df: Repeated and unexpected panic attacks, along with a change in behaviour to avoid panic attacks > Nervous, intense feeling of terror & fear. > HR increase, dizzy, light headed > Common in students (20 - 35%) Need to repeat themselves over one month and behaviour MUST change in relations to attack. > Usually peak in <10 mins. Most will end up in ER for their first panic attack as think it is heart attack > Happens usually in early adult hood.

Personality Disorders

Df: Stable, ingrained, maladaptive patterns of behaviours, emotions and thinking processes in a person *** Some of the main differences is the consistencies of the disturbances. In personality disorder, it is always present, more consistent. Another difference is that the symptoms, while very disruptive, are more mild compared to other disorders discussed. > Less common to diagnosis except for DID.

Distressing

Df: The individual or the people around the individual must be troubled by the illness > E.g.: symptoms of depression

Deviance

Df: Thoughts, behaviours or emotions that deviate from norm of culture. They are statistically rare from the population

Boderline Personality Disorder

Df: extreme instability in mood, identity and impulse control. Characterized by unstable relationships (core of disorder) > Often behaviours are driven by intense fear of abandonment or rejection. ***Similarities with bipolar disorder. > Some of the differences are that borderline personality disorder (stable unstableness), the emotional dis-regulation happens very consistently, unlike bipolar (have a break in theirs) > Relationships are more chaotic with borderline personality disorder compared to bipolar > Age of onset can be used to help identify. The younger the onset, the more likely it is borderline disorder.

Paranoid Personality Disorder

Df: extreme suspiciousness and generalised mistrust of others. > Will tend to be hyper-vigilante, always be scanning, trying to find evidence to confirm the fact that they are right to not trust other people. *** Similar to schizophrenia > Some difference are don't have hallucinations or delusions. Level of conviction is a step below

Agoraphobia

Df: fear of being in a place or situation form which escape is difficult or help not available. > Will start to have panic attacks and will start to worry about public places. > Typically will sit next to door so that they can leave quickly > Most can be treated

Diagnosing Psychological Disorders

Diagnostic and Statistical Manual of Mental Disorders (DSM) > Establishes prevalence of mental disorders > Description of symptoms > Over 350 diagnostic categories ***Based on the biomedical model of health

Criticisms of the DSM Diagnostic Labeling

Exclusive reliance on a categorical model > Dimensional model may be more appropriate for some disorders (e.g., depression, anxiety) > Many physical disorders are either present or absent. However, for psychological symptoms, they are not present or absent but more of a degree of experiencing a symptom. Not everything based on scientific data > Subjective committee decisions High level of comorbidity among diagnoses > Once you get a diagnosis, you are likely to get a second one. Raises concern on validity of whether the diagnosis is accurate or not. Also raises the question on whether all the disorders should be shared under one idea or not. Reliability and validity of diagnoses

Debate on whether hoarding should be an Addiction problem or and OCD problem

Found that hoarding was more similar to OCD. Differences: > No high typically experience by hoarders > Nature of hoarding is obsessions of collecting more things and a lot of repetitive behaviour > Constant reorganising in house so as to put more

Depression

Have different symptoms. A) Emotional symptoms > Sadness > Hopelessness > Anxiety > Misery B) Cognitive symptoms > Negative cognitions about self, world, and future C) Somatic symptoms > Loss of appetite > Lack of energy > Sleep difficulties > Weight loss/gain D) Motivational symptoms > Loss of interest of activities that used to interest them > Lack of drive > Difficulty starting anything

Differential Diagnosis - Depressive & Bipolar Disorders

Major Depressive Disorder > Suffer from at least on major depressive episode > Sad mood and lost of interest Dysthymia > Milder form of depression and must be for 2 years Bipolar I Disorder > Bipolar I is most severe. Full blown episode of manic episode and typically followed by major depressive episode. Bipolar II Disorder > Suffer from hypomania to lesser extent compared to Bipolar I Cyclothymia > Midler symptoms of Bipolar

Obsessive-Compulsive & Related Disorders

OCD - marked by repeated and lengthy (>1 hr/day) immersion in obsessions, compulsions, or both (2.5% of pop.) > Obsessions - unwanted thoughts that cause marked distress (e.g. contamination, agression) > Compulsions - repetitive behaviours or mental acts performed to reduce distress (e.g. repeated checking) *** Previous DSM used to label it as an anxiety disorder, but now it's own category

Health historically: Dualistic Theory of Mind and Body (Renaissance to Present)

Physicians: guardians of the the body Theologians: caretakers of the mind > Information would become pure thoughts and there will be very little interaction between body and mind and this causes illnesses to only be diagnosed by physical symptoms

Symptoms of Schizophrenia

Positive (excess in behaviour): delusions, hallucinations, disordered speech & thought. Negative (lack of behaviour, absence of a normal rxn): lack of emotion, poverty of speech, motivation, social isolation ***Can fall in both categories. Usually have more of one. > People with primarily -ve symptoms will have more severe diagnosis and will have a worse outcome. > Anti-psychotic medications very effective to treat +ve symptoms but not as good for -ve.

Schizophrenia

Prevalence: 1% of pop. > More common in lower SES DOESN'T have multiple personality/split personality. Not a disturbance in identity but in THINKING, speech, perception, emotion and behaviour. Thinking: Development of delusions such as grandeur, delusion that people are spying on them. Speech: Speech is very disorganized, jump from topics to topics, won't always make sense Perception: Hallucinations that can involve any of the senses. Most common are auditory hallucination, more common than visual and others. Auditory are experienced as voices that can either tell them what to do or criticizing the people. Emotions: Reduction in the range of emotions they experience, have blunted affect. Could also have inappropriate emotions in situations Behaviour: Behaviour can be unusual/erratic/disorganized.

Biopsychosocial model

Primary theoretical model in psychology. Not the primary model used in the healthcare system. The mind and the body work together to determine health and illness > Interplay of biological, psychological and social E.g.: If you had a panic attack for the first time and you go to your family doctor and they used this particular model, they will ask questions that covers the biological, psychological and social and comes up with a solution to address all 3 areas.

Learned Helplessness Theory

Seligman: organisms can learn maladaptive thinking pattens (helplessness) that reinforce depression Initially, the wall was higher up, and the dog can't escape. So the dog learns that the shocks will happen no matter what it does. Later in the study, the wall is lowered and the dog could escape from the shocks but the dogs don't cause of learned helplessness where they think that it's impossible to escape from the shocks. Can see this in life. Don't like your life and you try to change things. Changes doesn't seem to change your life and so you stop trying and you still feel shitty.

Anxiety Disorders

The most prevalent of all psychiatric disorders (12-19%) > Anxiety is not inherently a negative thing. Important adaptive value to anxiety. All symptoms allow for quick responses to danger, can motivate us to find solutions to our problems, etc. > When excessive/inappropriate situation, becomes a problem. > Average age of onset is 11 - 12 years old.