Test 4(disorders, therapy, personality)

A psychological disorder is this:

"an exhibited pattern of thoughts, feelings, or behavior that disrupts normal functioning in this world" Add to the definition these 4 Ds: -Disturbance of thought, emotion or behavior -Dysfunction of biological or developmental processes -Distress or disability in functioning in everyday life -Deviant thought, emotion or behavior

Social anxiety disorder

(formerly called social phobia) is characterized by extreme and persistent fear or anxiety and avoidance of social situations in which the person could potentially be evaluated negatively by others The heart of the fear and anxiety in social anxiety disorder is the person's concern that he may act in a humiliating or embarrassing way, such as appearing foolish, showing symptoms of anxiety (blushing), or doing or saying something that might lead to rejection (such as offending others). The kinds of social situations in which individuals with social anxiety disorder usually have problems include public speaking, having a conversation, meeting strangers, eating in restaurants, and, in some cases, using public restrooms the fear, anxiety, and avoidance experienced in social anxiety disorder are highly distressing and lead to serious impairments in life. Adults with this disorder are more likely to experience lower educational attainment and lower earnings (Katzelnick et al., 2001), perform more poorly at work and are more likely to be unemployed (Moitra, Beard, Weisberg, & Keller, 2011), and report greater dissatisfaction with their family lives, friends, leisure activities, and income (Stein & Kean, 2000). As with specific phobias, it is highly probable that the fears inherent to social anxiety disorder can develop through conditioning experiences. 92% of a sample of adults with social anxiety disorder reported a history of severe teasing in childhood,

peripartum onset (commonly referred to as postpartum depression)

, applies to women who experience major depression during pregnancy or in the four weeks following the birth of their child (APA, 2013). These women often feel very anxious and may even have panic attacks. They may feel guilty, agitated, and be weepy. In a horrific illustration, a woman named Andrea Yates, who suffered from extreme peripartum-onset depression (as well as other mental illnesses), drowned her five children in a bathtub Most women with peripartum-onset depression do not physically harm their children, but most do have difficulty being adequate caregivers

The DSM-5 lists two general categories of mood disorders

-Depressive disorders -Bipolar and related disorders

The "perception of threat" may result from:

-Fear of danger -A sense of inability to escape -Fear of embarrassment -Even fear of particular objects

According to the APA (2013), a psychological disorder is a condition that is said to consist of the following:

-There are significant disturbances in thoughts, feelings, and behaviors -The disturbances reflect some kind of biological, psychological, or developmental dysfunction.(For example, the hallucinations observed in schizophrenia could be a sign of brain abnormalities.) -The disturbances lead to significant distress or disability in one's life.(for ex: a person's fear of social situations might be so distressing that it causes the person to avoid all social situations (e.g., preventing that person from being able to attend class or apply for a job)) -The disturbances do not reflect expected or culturally approved responses to certain events.(For example, it is perfectly natural (and expected) that a person would experience great sadness and might wish to be left alone following the death of a close family member. Because such reactions are in some ways culturally expected, the individual would not be assumed to signify a mental disorder.)

Three Anxious-Fearful personality disorders are:

-avoidant personality disorder -dependent personality disorder -obsessive-compulsive personality disorder

Four types of Dramatic-Emotional disorders:

-histrionic personality disorder -borderline personality disorder -narcissistic personality disorder -antisocial personality disorder

Three biological factors have been identified as markers for those vulnerable to anxiety disorders:

-low levels of the neurotransmitter GABA -genetic heritage -personality Low levels of GABA result in excessive activation in brain regions associated with fear, such as the limbic system Highly neurotic people are prone to worry and often tend to be anxious or nervous as part of their personality

There are three distinct clusters of personality disorders:

-odd-eccentric -dramatic-emotional -anxious-fearful

Schizophrenia hallucinations

A positive symptom of schizophrenia is hallucinations. Brain imaging studies show that hallucinations activate the brain in ways similar, but not identical to real external stimulation from the environment. What seems to occur, is that the activity is reduced in the frontal lobe during a hallucination. This means the brain isnt actively monitoring the source of the images as being internally generated by the imagination or externally generated by a real world experience.

International Classification of Diseases (ICD)

A second classification system, the International Classification of Diseases (ICD), is also widely recognized. Published by the World Health Organization (WHO), the ICD was developed in Europe shortly after World War II and, like the DSM, has been revised several times. The categories of psychological disorders in both the DSM and ICD are similar, as are the criteria for specific disorders; however, some differences exist. this tool is also used to examine the general health of populations and to monitor the prevalence of diseases The ICD is in its 10th edition (ICD-10); however, efforts are now underway to develop a new edition (ICD-11) that, in conjunction with the changes in DSM-5, will help harmonize the two classification systems as much as possible (APA, 2013)

ADHD

ADHD is characterized by an inability to: ​-Focus attention for more than a few minutes ​-Remain still and quiet ​-Do careful work An ADHD diagnosis requires a child to exhibit these behaviors before turning 12. Boys are more likely to be diagnosed with ADHD

major depressive disorder

According to the DSM-5, the defining symptoms of major depressive disorder include "depressed mood most of the day, nearly every day" (feeling sad, empty, hopeless, or appearing tearful to others), and loss of interest and pleasure in usual activities (APA, 2013).

Major depressive disorder

Accoridng to the DSM5 to be diagnosed with a major depressive disorder, a person must show at least 5 of the following 9 symptoms for a period of at least 2 weeks: -Depressed mood -Reduced interest in typically daily activities. -Significant changes in body weight (up or down) -Sleep disturbances -Sluggishness or restlessness -Daily fatigue or loss of energy -Feelings of worthlessness -Inability to concentrate -Thoughts of suicide More importantly these symptoms must significantly impact daily functioning in terms of social and work related activities.

Agoriphobia

Agoraphobia is a severe type of phobia Agoraphobia is an intense anxiety, fear or panic about being in a place for which escape would be difficult "if necessary" This fear of being unable to escape keeps people at home where they feel safe

anxiety vs fear

Although anxiety is closely related to fear, the two states possess important differences. Fear involves an instantaneous reaction to an imminent threat, whereas anxiety involves apprehension, avoidance, and cautiousness regarding a potential threat, danger, or other negative event

hopelessness theory

Another cognitive theory of depression, hopelessness theory, postulates that a particular style of negative thinking leads to a sense of hopelessness, which then leads to depression A key assumption of this theory is that hopelessness stems from a tendency to perceive negative life events as having stable ("It's never going to change") and global ("It's going to affect my whole life") causes, in contrast to unstable ("It's fixable") and specific ("It applies only to this particular situation") causes, especially if these negative life events occur in important life realms, such as relationships, academic achievement, and the like. Hopelessness theory predicts that people who exhibit this cognitive style in response to undesirable life events will view such events as having negative implications for their future and self-worth, thereby increasing the likelihood of hopelessness—the primary cause of depression

Joint attention and ASD

Another common characteristic of ASD is an inability to share "joint attention" in social situations. "Joint Attention" is the ability to make eye contact with another person and to focus attentional resources on similar stimuli in their environment. Austism encompasses a range of disorders that range from "severe" to what is referred to as "high functioning" A person at the "high functioning" range of ASD, Autism spectrum disorder, may have independent productive lives in spite of their social impairments and narrow focused interests.

Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder, formerly referred to as simply Autism, is characterized by severe language and social impairment and may include repetitive habits and inward focused behavior. Two common characteristics of ASD is sensitivity to sensory stimulation and difficulty integrating For ex: when someone is speaking with us and we watch their mouth move, it matches the words we hear. For some with ASD, the lips of the speaker and the sound of their words are far out of sync.

Prenatal causes for schizophrenia

Because the neural growth rate in childhood brain development is so high, what happens to the mother and fetus is crucial. Any disease or toxic substance experienced by the mother may dramatically affect neural growth in the fetus. If a woman contracts an infection during pregnancy, the risk of the child developing schizophrenia later in life increases greatly. Prenatal exposure to disease and infection, such as the flu, rubella, herpes has also been linked to increased likelihood of child being schizophrenia. One way maternal infections can increase the risk of schizophrenia is by affecting the developmental path of neurons themselves. A widely recognized brain abnormality linked to schizophrenia is a dysfunctional prefrontal cortex and working memory Brain problems may not be limited to physical abnormalities in brain structures, the hippocampus for example, but may include communication pathways between those brain structures.

A Diathesis-Stress Model and Major Depressive Disorders

Clearly, a diathesis-stress interpretation of major depressive disorder, in which certain predispositions or vulnerability factors influence one's reaction to stress, would seem logical. A study by Caspi and others (2003) suggests that an alteration in a specific gene that regulates serotonin (the 5-HTTLPR gene) might be one culprit. These investigators found that people who experienced several stressful life events were significantly more likely to experience episodes of major depression if they carried one or two short versions of this gene than if they carried two long versions. Those who carried one or two short versions of the 5-HTTLPR gene were unlikely to experience an episode, however, if they had experienced few or no stressful life events.

Cognitive Theories of Depression

Cognitive theories of depression take the view that depression is triggered by negative thoughts, interpretations, self-evaluations, and expectations These diathesis-stress models propose that depression is triggered by a "cognitive vulnerability" (negative and maladaptive thinking) and by precipitating stressful life events psychiatrist Aaron Beck, based on clinical observations and supported by research (Beck, 2008). Beck theorized that depression-prone people possess depressive schemas, or mental predispositions to think about most things in a negative way Depressive schemas contain themes of loss, failure, rejection, worthlessness, and inadequacy, and may develop early in childhood in response to adverse experiences, then remain dormant until they are activated by stressful or negative life events. A third cognitive theory of depression focuses on how people's thoughts about their distressed moods—depressed symptoms in particular—can increase the risk and duration of depression. This theory, which focuses on rumination in the development of depression, was first described in the late 1980s to explain the higher rates of depression in women than in men

Brain and depression

Depression is linked to abnormal activity in several regions of the brain (Fitzgerald, Laird, Maller, & Daskalakis, 2008) including those important in assessing the emotional significance of stimuli and experiencing emotions (amygdala), and in regulating and controlling emotions (like the prefrontal cortex, or PFC) Depressed individuals show elevated amygdala activity (Drevets, Bogers, & Raichle, 2002), especially when presented with negative emotional stimuli, such as photos of sad faces Interestingly, heightened amygdala activation to negative emotional stimuli among depressed persons occurs even when stimuli are presented outside of conscious awareness (Victor, Furey, Fromm, Öhman, & Drevets, 2010), and it persists even after the negative emotional stimuli are no longer present Because the PFC can dampen amygdala activation, thereby enabling one to suppress negative emotions (Phan et al., 2005), decreased activation in certain regions of the PFC may inhibit its ability to override negative emotions that might then lead to more negative mood states researchers have noted that depressed individuals have abnormal levels of cortisol, a stress hormone released into the blood by the neuroendocrine system during times of stress. When cortisol is released, the body initiates a fight-or-flight response in reaction to a threat or danger. Many people with depression show elevated cortisol levels Thus, high cortisol levels may have a causal effect on depression, as well as on its brain function abnormalities (van Praag, 2005). Also, because stress results in increased cortisol release (Michaud, Matheson, Kelly, Anisman, 2008), it is equally reasonable to assume that stress may precipitate depression.

Depressive disorders

Depressive disorders are expressions of disturbances in mood or emotion. The general term "depressive disorders" includes 2 specific diagnosis: -Major depressive disorder -Persistent depressive disorder

Anxiety Disorders

Fear and anxiety create bodily changes, such as increasing heart rate, as a reaction to a danger or threat. However, anxious states in response to "imagined threats", can interfere with everyday functioning Such anxiety states are referred to as an Anxiety disorder A state of continued or excessive anxiety that lasts at least 6 months in duration is referred to as a Generalized Anxiety disorder (GAD). People with GAD may also have difficulty sleeping or concentration

Biological psychological disorder link

Findings such as these have led many of today's researchers to search for specific genes and genetic mutations that contribute to mental disorders. Also, sophisticated neural imaging technology in recent decades has revealed how abnormalities in brain structure and function might be directly involved in many disorders, and advances in our understanding of neurotransmitters and hormones have yielded insights into their possible connections.

Supernatural and Psychological

For centuries, psychological disorders were viewed from a supernatural perspective: attributed to a force beyond scientific understanding. Those afflicted were thought to be practitioners of black magic or possessed by spirits Such beliefs in supernatural causes of mental illness are still held in some societies today; for example, beliefs that supernatural forces cause mental illness are common in some cultures in modern-day Nigeria

harmful dysfunction

However, one of the more influential conceptualizations was proposed by Wakefield (1992), who defined psychological disorder as a harmful dysfunction Wakefield argued that natural internal mechanisms—that is, psychological processes honed by evolution, such as cognition, perception, and learning—have important functions, such as enabling us to experience the world the way others do and to engage in rational thought, problem solving, and communication *Dysfunction occurs when an internal mechanism breaks down and can no longer perform its normal function. But, the presence of a dysfunction by itself does not determine a disorder. The dysfunction must be harmful in that it leads to negative consequences for the individual or for others, as judged by the standards of the individual's culture* The harm may include significant internal anguish (e.g., high levels of anxiety or depression) or problems in day-to-day living (e.g., in one's social or work life).

ICD vs DSM

ICD is more frequently used for clinical diagnosis, whereas the DSM is more valued for research The DSM also includes more explicit disorder criteria, along with an extensive and helpful explanatory text (Regier et al., 2012). The DSM is the classification system of choice among U.S. mental health professionals, and this chapter is based on the DSM paradigm

Risk Factors for Major Depressive Disorder

Major depressive disorder is often referred to as the common cold of psychiatric disorders. It is more common among women than among men, affecting approximately 20% of women and 13% of men at some point in their life Lifetime rates of major depressive disorder tend to be highest in North and South America, Europe, and Australia; they are considerably lower in Asian countries The rates of major depressive disorder are higher among younger age cohorts than among older cohorts, perhaps because people in younger age cohorts are more willing to admit depression Comorbid disorders include anxiety disorders and substance abuse disorders

obsessive-compulsive personality disorder

Manifests by rigid habits and extreme perfectionism in a more general way than the OCD

THE BIOLOGICAL BASIS OF MOOD DISORDERS

Mood disorders have been shown to have a strong genetic and biological basis. Relatives of those with major depressive disorder have double the risk of developing major depressive disorder, whereas relatives of patients with bipolar disorder have over nine times the risk People with mood disorders often have imbalances in certain neurotransmitters, particularly norepinephrine and serotonin These neurotransmitters are important regulators of the bodily functions that are disrupted in mood disorders, including appetite, sex drive, sleep, arousal, and mood. Medications that are used to treat major depressive disorder typically boost serotonin and norepinephrine activity, whereas lithium—used in the treatment of bipolar disorder—blocks norepinephrine activity at the synapses

Genetic and biological factors of Neurodevelopmental disorders

Neurodevelopmental disorders sometimes stem from genetic factors that only manifest when triggered by an environmental event. For ex: if a woman smokes while pregnant and the fetus possesses a particular dopamine (neurotransmitter) gene, the result the child may have impulse control issues. "Head size" can also be an indicator of possible ASD For ex: the brain size of a 5 yr old with ASD is the same size as the brain of a normal 13 yr old

Myth

One of the major criticisms focused on the notion that mental illness was a "myth that justifies psychiatric intervention in socially disapproved behavior" (Wakefield, 1992) Szasz (1961/2010) proclaimed that "disease or illness can only affect the body; hence, there can be no mental illness" (p. 267). First, lay people, politicians, and professionals now often refer to mental illness as mental health "problems," implicitly acknowledging the "problems in living" perspective Szasz described (Buchanan-Barker & Barker, 2009). Also influential was Szasz's view of homosexuality. Szasz was perhaps the first psychiatrist to openly challenge the idea that homosexuality represented a form of mental illness or disease (Szasz, 1965). By challenging the idea that homosexuality represented a form a mental illness, Szasz helped pave the way for the social and civil rights that gay and lesbian people now have (Barker, 2010). His work also inspired legal changes that protect the rights of people in psychiatric institutions and allow such individuals a greater degree of influence and responsibility over their lives

Social anxiety disorder and behavioral inhibition

One of the most well-established risk factors for developing social anxiety disorder is behavioral inhibition (Clauss & Blackford, 2012). Behavioral inhibition is thought to be an inherited trait, and it is characterized by a consistent tendency to show fear and restraint when presented with unfamiliar people or situations (Kagan, Reznick, & Snidman, 1988). Behavioral inhibition is displayed very early in life; behaviorally inhibited toddlers and children respond with great caution and restraint in unfamiliar situations, and they are often timid, fearful, and shy around unfamiliar people (Fox, Henderson, Marshall, Nichols, & Ghera, 2005). A recent statistical review of studies demonstrated that behavioral inhibition was associated with more than a sevenfold increase in the risk of development of social anxiety disorder, demonstrating that behavioral inhibition is a major risk factor for the disorder

Suicide

Overwhelmed by hopelessness, devastated by incapacitating feelings of worthlessness, and burdened with the inability to adequately cope with such feelings, they may consider suicide to be a reasonable way out Not only must the person be biologically or psychologically vulnerable, but he must also have the means to perform the suicidal act, and he must lack the necessary protective factors (e.g., social support from friends and family, religion, coping skills, and problem-solving skills) that provide comfort and enable one to cope during times of crisis or great psychological pain Suicide is not listed as a disorder in the DSM-5; however, suffering from a mental disorder—especially a mood disorder—poses the greatest risk for suicide. Around 90% of those who complete suicides have a diagnosis of at least one mental disorder, with mood disorders being the most frequent -Suicide was the 10th leading cause of death for all ages in 2010 -There were 38,364 suicides in 2010 in the United States—an average of 105 each day -Suicide among males is 4 times higher than among females and accounts for 79% of all suicides; firearms are the most commonly used method of suicide for males, whereas poisoning is the most commonly used method for females -From 1991 to 2003, suicide rates were consistently higher among those 65 years and older. -The highest rates of suicide within the United States are among American Indians/Alaskan natives and Non-Hispanic Whites -Suicide rates vary across the United States, with the highest rates consistently found in the mountain states of the west Contrary to popular belief, suicide rates peak during the springtime (April and May), not during the holiday season or winter. In fact, suicide rates are generally lowest during the winter months

posttraumatic stress disorder (PTSD)

PTSD was listed among the anxiety disorders in previous DSM editions. In DSM-5, it is now listed among a group called Trauma-and-Stressor-Related Disorders she be must exposed to, witness, or experience the details of a traumatic experience (e.g., a first responder), one that involves "actual or threatened death, serious injury, or sexual violence" Symptoms of PTSD include intrusive and distressing memories of the event, flashbacks (states that can last from a few seconds to several days, during which the individual relives the event and behaves as if the event were occurring at that moment [APA, 2013]), avoidance of stimuli connected to the event, persistently negative emotional states (e.g., fear, anger, guilt, and shame), feelings of detachment from others, irritability, proneness toward outbursts, and an exaggerated startle response (jumpiness). For PTSD to be diagnosed, these symptoms must occur for at least one month. several factors strongly predict the development of PTSD: trauma experience, greater trauma severity, lack of immediate social support, and more subsequent life stress Factors that increase the risk of PTSD include -female gender -low socioeconomic status -low intelligence -personal history of mental disorders -history of childhood adversity (abuse or other trauma during childhood) -family history of mental disorders -Personality characteristics such as neuroticism and somatization People who experience childhood adversity and/or traumatic experiences during adulthood are at significantly higher risk of developing PTSD if they possess one or two short versions of a gene that regulates the neurotransmitter serotonin (Xie et al., 2009). This suggests a possible diathesis-stress interpretation of PTSD: its development is influenced by the interaction of psychosocial and biological factors.

Panic disorder and panic attacks

Panic Disorder, a type of anxiety disorder, that often results in panic attacks Panic Attacks, are brief episodes of anxiety associated with the perception of a threat Those experiencing a panic attack may sense a feeling of impending doom, resulting in heart palpitations, trembling, sweating, shortness of breath, dizziness, intense dread, nausea and even fear of dying

hoarding disorder

People with hoarding disorder cannot bear to part with personal possessions, regardless of how valueless or useless these possessions are. Although hoarding was traditionally considered to be a symptom of OCD, considerable evidence suggests that hoarding represents an entirely different disorder

Panic Disorder

People with panic disorder experience recurrent (more than one) and unexpected panic attacks, along with at least one month of persistent concern about additional panic attacks, worry over the consequences of the attacks, or self-defeating changes in behavior related to the attacks (e.g., avoidance of exercise or unfamiliar situations) As is the case with other anxiety disorders, the panic attacks cannot result from the physiological effects of drugs and other substances, a medical condition, or another mental disorder. A panic attack is defined as a period of extreme fear or discomfort that develops abruptly and reaches a peak within 10 minutes. Its symptoms include accelerated heart rate, sweating, trembling, choking sensations, hot flashes or chills, dizziness or lightheadedness, fears of losing control or going crazy, and fears of dying According to the DSM-5, the person must experience unexpected panic attacks to qualify for a diagnosis of panic disorder. Unsurprisingly, those with panic disorder fear future attacks and may become preoccupied with modifying their behavior in an effort to avoid future panic attacks. For this reason, panic disorder is often characterized as fear of fear Researchers are not entirely sure what causes panic disorder. Children are at a higher risk of developing panic disorder if their parents have the disorder Neurobiological theories of panic disorder suggest that a region of the brain called the locus coeruleus may play a role in this disorder Located in the brainstem, the locus coeruleus is the brain's major source of norepinephrine, a neurotransmitter that triggers the body's fight-or-flight response. Activation of the locus coeruleus is associated with anxiety and fear, and research with nonhuman primates has shown that stimulating the locus coeruleus either electrically or through drugs produces panic-like symptoms Conditioning theories of panic disorder propose that panic attacks are classical conditioning responses to subtle bodily sensations resembling those normally occurring when one is anxious or frightened Cognitive factors may play an integral part in panic disorder. Generally, cognitive theories (Clark, 1996) argue that those with panic disorder are prone to interpret ordinary bodily sensations catastrophically, and these fearful interpretations set the stage for panic attacks.

Social anxiety and drinking

People with social anxiety disorder may resort to self-medication, such as drinking alcohol, as a means to avert the anxiety symptoms they experience in social situations (Battista & Kocovski, 2010). The use of alcohol when faced with such situations may become negatively reinforcing: encouraging individuals with social anxiety disorder to turn to the substance whenever they experience anxiety symptoms. The tendency to use alcohol as a coping mechanism for social anxiety, however, can come with a hefty price tag: a number of large scale studies have reported a high rate of comorbidity between social anxiety disorder and alcohol use disorder

Persistent depressive disorder

Persistent depressive disorder has milder symptoms than major depressive disorder but they last longer. Although, sadness is the emotion most associated with depression, many find the "lack of interest in" or the "lack of ability to feel anything" to be a more disabling aspect of living with depression. Abusive and extremely stressful environments increase risk of depression later in ones life Stressful events, like social reject, can start biological reactions which may result in a developing depression

DSM & DSM-5

Psychologist and pyschiatrists rely on a reference book, Diagnostic Statistic Manual (DSM), to help them identify which symptoms a person exhibits, have been grouped together and categorized as a specific mental disorder. The 5th edition is called the DSM-5 In the DSM-5 the types of psychological disorders that have been identified based on specific criteria, that is symptoms, a person exhibits. The DSM-5 identifies 21 major categories of dysfunctional behavior that describes 350 types of psychological disorders

Post-Traumatic Stress Disorder (PTSD)

Recurring intrusive thoughts of traumatic experience occur with Post Traumatic Stress Disorder (PTSD) It may include both recurring intrusive thoughts and recurring intrusive feelings either while awake or dreaming Flashbacks are vivid events in which a person with PTSD, feels as if they are re-experiencing the traumatic events Symptoms interfere with daily life functioning when a person avoids situations or stimuli that may trigger recollection of the traumatic event people with PTSD are often easily startled and exhibit self-destructive behaviors War vets are at increased risk of suicide not only for PTSD nut also for depression, drug abuse, and suicide

Schizophrenia and diathesis-stress model

Schizonphrenia has been explained using the diathesis-stress model. This diathesis-stress model suggests that people with an underlying predisposition for a disorder (i.e., a diathesis) are more likely than others to develop a disorder when faced with adverse environmental or psychological events (i.e., stress), such as childhood maltreatment, negative life events, trauma, and so on. A As mentioned earlier, schizophrenia occurs as a result of an interaction between biological factors and a stressful or abusive environment. Even though heritability rates are high in schizophrenia, genetic influences occur only after environmental experiences during brain development turn the influencing genes on or off to produce the disorder The more adverse experience, abuse or neglect children experience in their early home lives, the more likely they are to suffer from schizophrenia later in life. The graphic below shows the difference in brain development between a typical 3 yr old child and one that has been deprived of regular social, linguistic and cognitive stimluation. (They have smaller brains when neglected)

DSM-5 Criticism

Some believe that establishing new diagnoses might overpathologize the human condition by turning common human problems into mental illnesses The DSM-5 is also criticized on the grounds that its diagnostic criteria have been loosened, thereby threatening to "turn our current diagnostic inflation into diagnostic hyperinflation" (Frances, 2012, para. 22). For example, DSM-IV specified that the symptoms of major depressive disorder must not be attributable to normal bereavement (loss of a loved one). The DSM-5, however, has removed this bereavement exclusion, essentially meaning that grief and sadness after a loved one's death can constitute major depressive disorder.

rapid subtype of bipolar

Some patients with bipolar disorder will experience a rapid-cycling subtype, which is characterized by at least four manic episodes (or some combination of at least four manic and major depressive episodes) within one year.

Rachman (1977) proposed that phobias can be acquired through three major learning pathways:

The first pathway is through classical conditioning. As you may recall, classical conditioning is a form of learning in which a previously neutral stimulus is paired with an unconditioned stimulus (UCS) that reflexively elicits an unconditioned response (UCR), eliciting the same response through its association with the unconditioned stimulus. The response is called a conditioned response (CR). For example, a child who has been bitten by a dog may come to fear dogs because of her past association with pain. The second pathway of phobia acquisition is through vicarious learning, such as modeling. For example, a child who observes his cousin react fearfully to spiders may later express the same fears, even though spiders have never presented any danger to him. The third pathway is through verbal transmission or information. For example, a child whose parents, siblings, friends, and classmates constantly tell her how disgusting and dangerous snakes are may come to acquire a fear of snakes.

Results of Major Depressive Disorder

The person suffering from this disorder lives a profoundly miserable existence that often results in unavailability for work or education, abandonment of promising careers, and lost wages; occasionally, the condition requires hospitalization. The majority of those with major depressive disorder report having faced some kind of discrimination, and many report that having received such treatment has stopped them from initiating close relationships, applying for jobs for which they are qualified, and applying for education or training (Lasalvia et al., 2013). Major depressive disorder also takes a toll on health. Depression is a risk factor for the development of heart disease in healthy patients, as well as adverse cardiovascular outcomes in patients with preexisting heart disease

Risk Factors for Bipolar Disorder

The rates are higher in men than in women, and about half of those with this disorder report onset before the age of 25 Around 90% of those with bipolar disorder have a comorbid disorder, most often an anxiety disorder or a substance abuse problem . Unfortunately, close to half of the people suffering from bipolar disorder do not receive treatment Suicide rates are extremely high among those with bipolar disorder: around 36% of individuals with this disorder attempt suicide

SUBTYPES OF DEPRESSION

These subtypes—what the DSM-5 refer to as specifiers—are not specific disorders; rather, they are labels used to indicate specific patterns of symptoms or to specify certain periods of time in which the symptoms may be present. -seasonal pattern -peripartum onset (commonly referred to as postpartum depression) -persistent depressive disorder (previously known as dysthymia)

generalized anxiety disorder:

a relatively continuous state of excessive, uncontrollable, and pointless worry and apprehension A diagnosis of generalized anxiety disorder requires that the diffuse worrying and apprehension characteristic of this disorder—what Sigmund Freud referred to as free-floating anxiety—is not part of another disorder, occurs more days than not for at least six months, and is accompanied by any three of the following symptoms: restlessness, difficulty concentrating, being easily fatigued, muscle tension, irritability, and sleep difficulties Generalized anxiety disorder is highly comorbid with mood disorders and other anxiety disorders (Noyes, 2001), and it tends to be chronic. Also, generalized anxiety disorder appears to increase the risk for heart attacks and strokes, especially in people with preexisting heart conditions a summary of available family and twin studies suggests that genetic factors play a modest role in the disorder Cognitive theories of generalized anxiety disorder suggest that worry represents a mental strategy to avoid more powerful negative emotions

To receive a diagnosis of major depressive disorder, one must experience:

a total of five symptoms for at least a two-week period; these symptoms must cause significant distress or impair normal functioning, and they must not be caused by substances or a medical condition. At least one of the two symptoms mentioned above must be present, plus any combination of the following symptoms (APA, 2013): -significant weight loss (when not dieting) or weight gain and/or significant decrease or increase in appetite; -difficulty falling asleep or sleeping too much; -psychomotor agitation (the person is noticeably fidgety and jittery, demonstrated by behaviors like the inability to sit, pacing, hand-wringing, pulling or rubbing of the skin, clothing, or other objects) or psychomotor retardation (the person talks and moves slowly, for example, talking softly, very little, or in a monotone); -fatigue or loss of energy -feelings of worthlessness or guilt; -difficulty concentrating and indecisiveness; - suicidal ideation: thoughts of death (not just fear of dying), thinking about or planning suicide, or making an actual suicide attempt Major depressive disorder is considered episodic: its symptoms are typically present at their full magnitude for a certain period of time and then gradually abate.

seasonal pattern

applies to situations in which a person experiences the symptoms of major depressive disorder only during a particular time of year (e.g., fall or winter). In everyday language, people often refer to this subtype as the winter blues

diagnosis

appropriately identifying and labeling a set of defined symptoms

Depressive disorders

are a group of disorders in which depression is the main feature Depression is a heterogeneous mood state—it consists of a broad spectrum of symptoms that range in severity. Depressed people feel sad, discouraged, and hopeless. These individuals lose interest in activities once enjoyed, often experience a decrease in drives such as hunger and sex, and frequently doubt personal worth. Depressive disorders vary by degree, but this chapter highlights the most well-known: major depressive disorder (sometimes called unipolar depression).

Bipolar and related disorders

are a group of disorders in which mania is the defining feature Mania is a state of extreme elation and agitation When people experience mania, they may become extremely talkative, behave recklessly, or attempt to take on many tasks simultaneously. The most recognized of these disorders is bipolar disorder

Obsessive-compulsive and related disorders

are a group of overlapping disorders that generally involve intrusive, unpleasant thoughts and repetitive behaviors obsessive-compulsive and related disorders elevate the unwanted thoughts and repetitive behaviors to a status so intense that these cognitions and activities disrupt daily life. Included in this category are obsessive-compulsive disorder (OCD), body dysmorphic disorder, and hoarding disorder.

Personality Disorders

are a type of Psychological Disorder that involves a person's unique and long term behavior patterns Personality disorders are maladaptive inflexible patterns of cognition, emotion and behavior Personality disorders generally develop late in childhood or adolescence and then continue into adulthood

Anxiety disorders

are characterized by excessive and persistent fear and anxiety, and by related disturbances in behavior approximately 25%-30% of the U.S. population meets the criteria for at least one anxiety disorder during their lifetime (Kessler et al., 2005). Also, these disorders appear to be much more common in women than they are in men; within a 12-month period, around 23% of women and 14% of men will experience at least one anxiety disorder (National Comorbidity Survey, 2007). Anxiety disorders are the most frequently occurring class of mental disorders and are often comorbid with each other and with other mental disorders

Mood disorders

are characterized by severe disturbances in mood and emotions—most often depression, but also mania and elation People with mood disorders also experience mood fluctuations, but their fluctuations are extreme, distort their outlook on life, and impair their ability to function.

Narcissistic personality disorder

exhibits an extremely positive and arrogant self-image They will also act very self-centered with an exaggerated sense of self-importance

Exit events triggering depression

exit events—instances in which an important person departs (e.g., a death, divorce or separation, or a family member leaving home)—often occur prior to an episode Exit events are especially likely to trigger depression if these happenings occur in a way that humiliates or devalues the individual.

persistent depressive disorder (previously known as dysthymia)

experience depressed moods most of the day nearly every day for at least two years, as well as at least two of the other symptoms of major depressive disorder. People with persistent depressive disorder are chronically sad and melancholy, but do not meet all the criteria for major depression. However, episodes of full-blown major depressive disorder can occur during persistent depressive disorder (APA, 2013

obsessive-compulsive disorder (OCD)

experience thoughts and urges that are intrusive and unwanted (obsessions) and/or the need to engage in repetitive behaviors or mental acts (compulsions). Obsessions are more than just unwanted thoughts that seem to randomly jump into our head from time to time obsessions are characterized as persistent, unintentional, and unwanted thoughts and urges that are highly intrusive, unpleasant, and distressing Compulsions are repetitive and ritualistic acts that are typically carried out primarily as a means to minimize the distress that obsessions trigger or to reduce the likelihood of a feared event The results of family and twin studies suggest that OCD has a moderate genetic component. The disorder is five times more frequent in the first-degree relatives of people with OCD than in people without the disorder Studies have implicated about two dozen potential genes that may be involved in OCD; these genes regulate the function of three neurotransmitters: serotonin, dopamine, and glutamate A brain region that is believed to play a critical role in OCD is the orbitofrontal cortex (Kopell & Greenberg, 2008), an area of the frontal lobe involved in learning and decision-making In people with OCD, the orbitofrontal cortex becomes especially hyperactive when they are provoked with tasks in which, for example, they are asked to look at a photo of a toilet or of pictures hanging crookedly on a wall (Simon, Kaufmann, Müsch, Kischkel, & Kathmann, 2010). The orbitofrontal cortex is part of a series of brain regions that, collectively, is called the OCD circuit; this circuit consists of several interconnected regions that influence the perceived emotional value of stimuli and the selection of both behavioral and cognitive responses (Graybiel & Rauch, 2000). As with the orbitofrontal cortex, other regions of the OCD circuit show heightened activity during symptom provocation (Rotge et al., 2008), which suggests that abnormalities in these regions may produce the symptoms of OCD (Saxena, Bota, & Brody, 2001). Consistent with this explanation, people with OCD show a substantially higher degree of connectivity of the orbitofrontal cortex and other regions of the OCD circuit than do those without OCD (Beucke et al., 2013).

dependent personality disorder

have a fear of being rejected along with a strong need to be cared for

Cognitive symptoms of schizophrenia

includes problems with working memory, verbal and visual learning, remembering, reasoning and problem solving, disordered speech, and speed of processing information.

The diathesis-stress model

integrates biological and psychosocial factors to predict the likelihood of a disorder. This diathesis-stress model suggests that people with an underlying predisposition for a disorder (i.e., a diathesis) are more likely than others to develop a disorder when faced with adverse environmental or psychological events (i.e., stress), such as childhood maltreatment, negative life events, trauma, and so on. A diathesis is not always a biological vulnerability to an illness; some diatheses may be psychological (e.g., a tendency to think about life events in a pessimistic, selfdefeating way). The key assumption of the diathesis-stress model is that both factors, diathesis and stress, are necessary in the development of a disorder. Different models explore the relationship between the two factors: the level of stress needed to produce the disorder is inversely proportional to the level of diathesis.

Phobia

is a Greek word that means fear A person diagnosed with a specific phobia (formerly known as simple phobia) experiences excessive, distressing, and persistent fear or anxiety about a specific object or situation (such as animals, enclosed spaces, elevators, or flying) Even though people realize their level of fear and anxiety in relation to the phobic stimulus is irrational, some people with a specific phobia may go to great lengths to avoid the phobic stimulus Typically, the fear and anxiety a phobic stimulus elicits is disruptive to the person's life

Psychological disorder

is a condition characterized by abnormal thoughts, feelings, and behaviors.

Phobia

is a persistent and unreasonable fear of a particular object, situation or activity A social phobia, for example, may result from a strong fear of humiliation or embarrassment when around other people or just being very self conscious about ones appearance

Schizophrenia

is a psychotic disorder A psychotic disorder is a psychological disorder of thought and perception. In this case, a person has trouble distinguishing between real and imagined perceptions Schizophrenia involves profound disturbances in thought and emotion. It include problems with perception and hallucinations According to the National Institute of Mental Health (NIMH) approximately 1% of the American population is afflicted with schizophrenia disorder. For a diagnosis of schizophrenia, a person must show at least 2 of the following symptoms for at least 1 month: -Delusions -Hallucinations -Disorganized speech -Very disorganized behavior or being completely immobilized -A lack of speech -Unable to experience emotion The term positive and negative are used when describing symptoms of schizophrenia, to indicate presence or absence of those symptoms. For ex: positive symptoms of schizophrenia refer to hallucinations, delusional thinking and disorganized thought and speech. Negative symptoms refer to a lack of a behavior, such as non-responsiveness, physical immobility, "not" experiencing emotions, holding bizarre poses, "not' speaking or "not" completing tasks.

obsessive compulsive disorder (OCD)

is a type of Psychological Disorder that exhibits both thought and behavioral symptoms An "obsession" is an unwanted thought, word, phrase or image that persistently and repeatedly comes to mind and causes distress. A "compulsion" is a repetitive behavior exhibited in response to uncontrollable urges OCD most often involves, cleaning, checking, or counting types of behaviors, that interfere with everyday functioning

histrionic personality disorder

is characterized by a desire to be the center of attention It includes dramatic, seductive, flamboyant, and exaggerated behavior

avoidant personality disorder

is characterized by an extreme fear of being criticized, low self-esteem and avoiding social interactions

borderline personality disorder

is characterized by out-of-control emotions It includes a fear of being abandoned and switching between idealizing and despising people who are close to them

Anti-social personality disorder

is characterized by very impulsive, ruthless, and callous behavior towards others It is a serious and potentially dangerous disorder

body dysmorphic disorder

is preoccupied with a perceived flaw in her physical appearance that is either nonexistent or barely noticeable to other people These perceived physical defects cause the person to think she is unattractive, ugly, hideous, or deformed. These preoccupations can focus on any bodily area, but they typically involve the skin, face, or hair

Rumination

is the repetitive and passive focus on the fact that one is depressed and dwelling on depressed symptoms, rather that distracting one's self from the symptoms or attempting to address them in an active, problemsolving manner Women are more likely than men to ruminate when they are sad or depressed (Butler & Nolen-Hoeksema, 1994), and the tendency to ruminate is associated with increases in depression symptoms (Nolen-Hoeksema, Larson, & Grayson, 1999), heightened risk of major depressive episodes (Abela & Hankin, 2011), and chronicity of such episodes

Psychopathology

is the study of psychological disorders, including their symptoms, etiology (i.e., their causes), and treatment

When people with social anxiety disorder are unable to avoid situations that provoke anxiety, they typically perform safety behaviors:

mental or behavioral acts that reduce anxiety in social situations by reducing the chance of negative social outcomes. Safety behaviors include avoiding eye contact, rehearsing sentences before speaking, talking only briefly, and not talking about oneself -assuming roles in social situations that minimize interaction with others (e.g., taking pictures, setting up equipment, or helping prepare food) -asking people many questions to keep the focus off of oneself -selecting a position to avoid scrutiny or contact with others (sitting in the back of the room) -wearing bland, neutral clothes to avoid drawing attention to oneself -avoiding substances or activities that might cause anxiety symptoms (such as caffeine, warm clothing, and physical exercise)

bipolar disorder (commonly known as manic depression)

often experiences mood states that vacillate between depression and mania; that is, the person's mood is said to alternate from one emotional extreme to the other (in contrast to unipolar, which indicates a persistently sad mood). To be diagnosed with bipolar disorder, a person must have experienced a manic episode at least once in his life; although major depressive episodes are common in bipolar disorder, they are not required for a diagnosis According to the DSM-5, a manic episode is characterized as a "distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least one week," During a manic episode, some experience a mood that is almost euphoric and become excessively talkative, sometimes spontaneously starting conversations with strangers; others become excessively irritable and complain or make hostile comments. The person may talk loudly and rapidly, exhibiting flight of ideas, abruptly switching from one topic to another. These individuals are easily distracted, which can make a conversation very difficult. They may exhibit grandiosity, in which they experience inflated but unjustified self-esteem and self-confidence For example, they might quit a job in order to "strike it rich" in the stock market, despite lacking the knowledge During a manic episode, individuals usually feel as though they are not ill and do not need treatment. However, the reckless behaviors that often accompany these episodes—which can be antisocial, illegal, or physically threatening to others—may require involuntary hospitalization (APA, 2013).

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

published by the American Psychiatric Association (2013 The DSM-5 includes many categories of disorders (e.g., anxiety disorders, depressive disorders, and dissociative disorders). Each disorder is described in detail, including an overview of the disorder (diagnostic features), specific symptoms required for diagnosis (diagnostic criteria), prevalence information (what percent of the population is thought to be afflicted with the disorder), and risk factors associated with the disorder. The DSM-5 also provides information about comorbidity; the co-occurrence of two disorders. For example, the DSM-5 mentions that 41% of people with obsessive-compulsive disorder (OCD) also meet the diagnostic criteria for major depressive disorder The DSM has changed considerably in the half-century since it was originally published. The first two editions of the DSM, for example, listed homosexuality as a disorder; however, in 1973, the APA voted to remove it from the manual Although DSM-5 is longer than DSM-IV, the volume includes only 237 disorders, a decrease from the 297 disorders that were listed in DSM-IV. The latest edition, DSM-5, includes revisions in the organization and naming of categories and in the diagnostic criteria for various disorders (Regier, Kuhl, & Kupfer, 2012), while emphasizing careful consideration of the importance of gender and cultural difference in the expression of various symptoms (Fisher, 2010).

Distressing behavior"

refers to action that lead to discomfort, pain or anguish either in the person directly or in others

"Deviant behavior"

refers to actions that are simply different from what most others would do. By itself, deviant behavior is not "disturbed" behavior. Deviant behavior is considered "disturbed behavior" only when it is dysfunctional. Most people suffering from psychological disorders do not pose a risk to others or themselves.

Neurodevelopmental disorders

refers to disorders that occur in childhood They include intellectual and learning disabilities. Attentional deficit hyperactivity disorder (ADHD) is a type of neurodevelopmental disorder

comorbidity

the co-occurrence of two disorders.

Odd-Eccentric

three major types: -Schizoid -Schizotypal -Paranoid People with the Schizoid personality disorder are emotionally aloof, avoid close relationships, and are reclusive and humorless Those who are diagnosed as Schizotypal, also live isolated lifestyles but in addition, they have very odd thoughts, perceptual distortions and hold odd beliefs People with Paranoid personality disorder are highly suspicious and mistrustful of other people. They may often test the loyalty of their friends because they believe others are trying to harm them

"dysfunctional behavior"

to be considered "disturbed", it must result in a person being unable to function in the world.