Chapter 15 Notes - Psychological Disorders

PSYCHOLOGY: CHAPTER 15 – Psychological Disorders 1. Defining and Explaining Abnormal Behavior Abnormal behavior is statistically unusual or atypical. Three criteria help distinguish normal from abnormal behavior - Abnormal behavior – behavior that is deviant, maladaptive or personally distressful over a relatively long period of time 1) Deviant – behavior doesn’t conform to accepted social standards a. Woman who washes her hands four times an hour and takes seven showers a day is abnormal because behavior is deviant from what’s considered acceptable  content is what determines! 2) Maladaptive – interferes with a person’s ability to function effectively in the world a. Man believes he can endanger people through breathing may avoid people and isolate himself from society 3) Personal distress – engaging in behavior finds it troubling over long period of time a. Woman secretly makes herself vomit after every meal (and it’s unknown by others) but causes her to feel shame and guilt Theoretical Approaches to Psychological Disorders  The Biological Approach - Attributes psychological disorders to organic, internal causes o Focuses on brain, genetic factors and neurotransmitter functioning - Medical model – describes psychological disorders as medical diseases with a biological origin  The Psychological Approach - Emphasizes contributions of experiences, thoughts, emotions and personality characteristics in explaining psychological disorders o Focus on influence of childhood experiences or personality traits  The Sociocultural Approach - Emphasizes social contexts which person lives and culture - Cultural variation when defining normal or abnormal makes it hard to compare different psychological disorder across different cultures o Behavior must take into account norms in their culture of origin  immigrants to Ellis Island judged to be mentally impaired due to their language and customs  The Biopsychosocial Model - Abnormal behavior influenced by biological factors (genes), psychological factors (childhood experiences) and sociocultural factors (gender)  can act alone but often combine together! o None of the factors considered viewed more important than another  ALL significant in producing normal and abnormal behavior o No one gene or experience leading to development of psychological disorder  must consider variety of interacting factors - Vulnerability-stress hypothesis (diathesis-stress model) – suggests that preexisting conditions (genes, personality, experiences) may put a person at risk of developing a psychological disorder – vulnerability combined with stressful experiences lead to psychological disorder Classifying Abnormal Behavior - Stigma – mark of shame that may cause others to avoid or to act negatively toward a person o Labeling a problem can have serious negative implications  The DSM Classification System - The Diagnostic and Statistical Manual of Mental Disorders – created in 1952 - DSM-5 – approved in 2013 and current version that classifies psychological disorders in the United States  Critiques of the DSM - Before published  claimed treats psychological disorders as if they’re medical illnesses (solely looking at biology of person & not experiences) - Neglects poverty, unemployment and trauma - Focuses strictly on problems o Relies too much on social norms and narrowed judgments o Too many new categories added, some that don’t have consistent supported research and leading to increase in people to be labeled with mental disorder o Loosening standards for some existing diagnoses Changes in DSM-5 Major Depressive Disorder Attention-Deficit/ Hyperactivity Disorder (ADHD) Autism Spectrum Disorder Post-Traumatic Stress Disorder (PTSD) Disruptive Mood Regulation Disorder Mild Neurocognitive Impairment In past, those experiencing grief due to deaths have not been considered depressed. Grief exclusion has been dropped. Some of diagnostic requirements been loosened, and age of diagnosis has been changed. May result in those experiencing normal grief to be labeled with depression. Diagnosis of Asperger syndrome, which given to high-functioning individuals, has been dropped. Previously, person had to experience or witness a trauma. Now, can be diagnosed even for those who hear about a trauma. New diagnosis for children with wild mood swings. Those previously diagnosed with Asperger’s may not be diagnosed at all and receive no treatment. Change may lead to huge increase in those with the disorder. New diagnosis for adults experiencing cognitive decline. Many adults experience mild cognitive decline with age, and this may pathologize normal aging. Over diagnosis of ADHD already concern, as is proliferation of drugs used to treat it. Adding diagnoses targeting children is concerning. - Attention-deficit/hyperactivity disorder (ADHD) – common psychological disorder which individual exhibits one ore more of the following: inattention, hyperactivity and impulsivity 2. Anxiety and Anxiety-Related Disorder Anxiety is an unpleasant feeling of fear and dread. Those with high levels of anxiety worry a lot, but don’t necessarily impair their ability to function. - Anxiety disorders – involve fears that are uncontrollable, disproportionate to the actual danger the person might be in and disruptive of ordinary life o Motor tensions (jumpiness), hyperactivity (dizziness, racing heart) and apprehensive expectations and thoughts - Four most common anxiety disorders: 1) Generalized anxiety disorder 2) Panic disorder 3) Specific phobia 4) Social anxiety disorder Generalized Anxiety Disorder - Different from such everyday feelings of anxiety in that sufferers experience persistent anxiety for at least 6 months and unable to specify the reasons for anxiety o Nervous for most of the time and worry a great deal  can suffer from fatigue, muscle tension, stomach problems and difÏculty sleeping - Biopsychosocial Factors in General Anxiety: o Biological – genetic predisposition, deficiency in GABA (brain brake pedal) and respiratory system abnormalities o Psychological/sociocultural – harsh self-standards, overly strict and critical parents, negative thoughts when stressed and history of uncontrollable traumas or stressors (abusive parents) Panic Disorder - Person experiences recurrent, sudden onsets of intense terror, often without warning and no specific cause o Produce severe palpitations, shortness of breath, chest pains, trembling, sweating, dizziness and feeling helpless  similar to heart attack - Biopsychosocial Factors in Panic Disorer: o Biological – genetic predisposition to disorder, deficiency of norepinephrine and serotonin  Lactate levels in brain increase o Psychological – learning processes  classical conditioning associates bodily cues of respiration and fear play a role Specific Phobia - Anxiety disorder which individual has irrational, overwhelming, persistent fear of a particular object or situation o Fear becomes a phobia when a situation so dreaded, individual goes to extreme lengths to avoid it - Might be viewed, then, as an extreme and unfortunate variant on adaptive process of processing fear Social Anxiety Disorder - Intense fear of being humiliated or embarrassed in social situations - Biopsychosocial Factors in Social Anxiety: o Biological – genes along with thalamus, amygdala and cerebral cortex and deficiency of serotonin Obsessive-Compulsive Disorder - Involves anxiety-provoking thoughts that will not go away and/or urges to perform repetitive, ritualistic behaviors to prevent or produce some future situation o Obsessions – recurrent thoughts o Compulsions – recurrent behaviors - Dwell on normal doubts and repeat behavioral routines  OCD Related Disorders - Hoarding disorder – compulsive collecting, poor organization skills and difÏculty discarding – also cognitive deficits in information-processing speed, decision making and procrastination - Excoriation (skin picking) – particular compulsion, picking at one’s skin to sometimes point of injury - Trichotillomania (hair pulling) – person compulsively pulls at their hair, from scalp, eyebrows and other body areas - Body dysmorphic disorder – distressing preoccupation with imagined or slight flaws in one’s physical appearance – can’t stop thinking about appearance, comparing to others, checking look in mirror Post-Traumatic Stress Disorder - Disorder develops through exposure to traumatic event that has overwhelmed the person’s abilities to cope - Symptoms include: o Flashbacks where individual relives the event as if happening all over again o Avoidance of emotional experiences and emotional numbing o Anxiety, nervousness, excessive arousal and inability to sleep o Impulsive behavior 3. Disorders Involving Emotion and Mood Our emotions tell us how we are doing in life. For some, link between life experiences and emotions is off-kilter. Depressive Disorders - Individual suffers from depression o Depression – unrelenting lack of pleasure in life - Major depressive disorder (MDD) – involves significant depressive episode and depressed characteristics, such as lethargy and hopelessness, for at least 2 weeks o Impairs daily functioning and called leading cause of disability in USA - Symptoms include: o Depressed mood most day o Reduced interest or pleasure in activities once enjoyable o Significant weight loss or gain o Trouble sleeping or too much sleeping o Fatigue/loss of energy o Feeling worthless or guilty o Problems thinking, concentrating or decision making o Recurrent thoughts of suicide - Persistent depressive disorder – includes symptoms such as hopelessness, lack of energy, poor concentration and sleep problems  Biological Factors - Genes, brain structure/function and neurotransmitters o Genes – conjunction with experiences suggesting a vulnerability-stress association o Brain structures – show lower levels of brain activity in prefrontal cortex o Neurotransmitters – problems in neurotransmitter regulation and have few receptors for serotonin and norepinephrine  Psychological Factors - Behavioral view of depression focuses on learned helplessness and in negative circumstances, will stop trying change their situation o Cognitive explanations focus on thoughts and beliefs that attribute to sense of hopelessness o Habitual negative thoughts magnify negative experiences - Course of depression can be influence by not what people think but also how they think  Sociocultural Factors - Women nearly twice as likely as men to be diagnosed with depression  Attributions - Believe that depression is related to a pessimistic attributional style o Individuals explain negative events as having: i. Internal causes  “It’s my fault I failed the exam” ii. Stable causes  “I’m going to fail again and again” iii. Global causes  “failing this exam shows that I won’t do well in any of my courses” - Blaming oneself for negative events and expecting negative events to recur in future Bipolar Disorder - Characterized by extreme mood swings including one or more episodes of mania o Mania – overexcited, unrealistically optimistic state o During manic episode, person feels euphoric - Bipolar I disorder – individuals who have extreme manic episodes during which may experience hallucinations or hearing/seeing things not there - Bipolar II disorder – milder version which individual may experience a less extreme level of euphoria - Factors in Bipolar Disorder: o Genetic influences stronger predictors than depressive disorder 4. Dissociative Disorders - Dissociative disorders – psychological disorders that involve sudden loss of memory or change in identity o Under extreme stress or shock, conscious awareness becomes dissociated (separated or split) from previous memories and thoughts - Related to problems in pulling together emotional memories  hippocampus especially involved Dissociative Amnesia - Type of amnesia characterized by extreme memory loss that stems from extensive psychological stress o Still remember how to do things – only aspects of own identity and past experiences forgotten Dissociative Identity Disorder - Or multiple personality disorder! - Most dramatic, least common and most controversial dissociative disorder – have 2 or more distinct personalities or identities o Each identity has own memories, behaviors and relationships - “Three Faces of Eve” case: o Eve White – original dominant personality and no knowledge of second personality Eve Black o Eve Black – alternating with Eve White for number of years 5. Schizophrenia - Psychosis – state which a person’s perceptions and thoughts are fundamentally removed from reality  within DSM-5, most debilitating psychological disorders - Schizophrenia – severe psychological disorder that’s characterized by highly disordered thought processes o May see things that aren’t there, hear voices in their heads and live in a world of twisted logic  socially isolated Symptoms of Schizophrenia 2) Positive Symptoms - Involved distortion or excess of normal function - “Positive” because reflect something added above/beyond normal behavior o Include hallucinations, delusions, thought disorders and movement disorders - Hallucinations – sensory experiences that occur in the absence of real stimuli o Usually auditory (hearing voices) or visual - Delusions – false, unusual and sometimes magical beliefs that aren’t part of individual’s culture  might think they’re Jesus Christ – difÏcult to change! - Thought disorder – unusual, sometimes bizarre thought processes that are characteristic positive symptoms of schizophrenia  might make up new words or word organization doesn’t make sense - Referential thinking – ascribing personal meaning to completely random events  believe stranger on sidewalk a government agent - Movement disorders – final positive symptom of schizophrenia, involving unusual mannerisms, body movements and facial expressions – may become catatonic o Catatonia – state of immobility and unresponsiveness that lasts for long periods of time 3) Negative Symptoms - Reflect social withdrawal, behavioral deficits and loss/decrease of normal functions - Flat affect – display of little or no emotion - May be lacking in ability to read emotions of others  Structural Brain Abnormalities - Enlarged ventricles – indicates deterioration in other brain tissue - Smaller prefrontal cortex and lower activity in this area of the brain o Hints that emergence of schizophrenic symptoms happens during time when prefrontal cortex becomes fully connected  Neurotransmitter Regulation - Problems regulating dopamine play a role in schizophrenia - Link between dopamine and psychotic symptoms first noticed when L-dopa drug cause some to experience psychosis 6. Personality Disorders - Personality disorders – chronic, maladaptive cognitive-behavioral patterns that are thoroughly integrated into an individual’s personality o Affect person’s sense of self and capacity for relationships with others Antisocial Personality Disorder - Characterized by guiltlessness, law-breaking exploitation of others, irresponsibility and deceit DSM-5 10 Personality Disorders Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Antisocial Personality Disorder Paranoia, suspiciousness and deep distrust of others. Always looking out for danger – social isolation Extreme lack of interest in relationships – emotionally cold and detached from interpersonal life Socially isolated/prone to odd thinking. Elaborate/strange belief systems Manipulative, deceitful and amoral. Lack Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder empathy for others, egocentric Emotionally volatile and unstable. Mood swings, self-criticism, extreme judgments Attention-seeking, dramatic, flirtatious. Inappropriately seductive View themselves as entitled and better than others. Deficits in empathy Socially inhibited and prone to anxiety and shame. Dependent on others for emotional/physical needs. Perceive others as powerful and themselves helpless Conforming rigidly to rules. Orderly in daily life and attachment to moral codes Borderline Personality Disorder - Pervasive pattern of instability in interpersonal relationships, self-image and emotions o People with are impulsive, insecure and emotional  related to selfharming behaviors and suicide - To cope, may engage if maladaptive behaviors  drinking alcohol and using illicit substances - More common in women than men 7. Suicide Thinking about suicide not necessarily abnormal, but attempting or completing the act of suicide is. Biological Factors - Genetic factors appear to play role in suicide (tends to run in families)  the Hemingway family - Low levels of serotonin and serotonin-linked genes - Poor physical health (especially chronic) Psychological Factors - Psychological disorders and traumatic experiences o 90% of those who commit suicide estimated to have diagnosable mental disorder o Most common disorders are depression and anxiety - Immediate/highly stressful situation (losing job, loved one) can lead to suicidal actions Sociocultural Factors - Within cultures, economic conditions and ethnic contexts may contribute to suicide risk o Native American/Alaskan native have higher suicide attempt rates and accounts for 20% deaths among these young people (experience high poverty and substance use) - Linked to culture of honor  individuals more likely to interpret insults as fighting words and to defend their personal honor with aggression - Women three times more likely to attempt suicide than men o Men four times more likely to complete suicide than women