Identifying Psychological Disorders: What Is Abnormal?
• Medical model: the conceptualization of psychological disorders as diseases that, like physical diseases, have biological causes, defined symptoms, and possible cures
– Diagnosis of symptoms underlying a syndrome
• DSM provides a reliable way of classifying (operationalizing) mental disorders: psychiatrists and psychologists all want to able to arrive at the same diagnosis. (Its validity is another issue).
Problems with DSM
• Strong medical orientation; only half of 290+ diagnoses have a concrete medical component.
– Can be misleading: causing overprescription of drugs and “victimization” of “I have depression.”
• Reification & naming something is not the same as explaining it.
• Labeling can be damaging: stigmatization, Rosenhan
study: “On Being Sane in Insane Places.”
Classification of Disorders
• Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; 4th ed., text revision): a classification system that describes the features used to diagnose each recognized mental disorder and indicates how the disorder can be distinguished from other similar problems – Involves disturbances in behavior, thoughts, or emotions – Causes significant distress or impairment. – Stem from internal dysfunction (biological and/or
psychological). – Global Assessment of Functioning (GAF score) – Comorbidity: the co-occurrence of two or more disorders
in a single individual
Causation of Disorders and the Dangers of Labeling
• An integrated perspective incorporates biological, psychological, and environmental factors.
• Different individuals may experience a similar psychological disorder for different reasons.
• Diathesis-stress model: suggests that a person may be predisposed for a mental disorder that remains unexpressed until triggered by stress
• The intervention-causation fallacy assumes treatment addresses the cause of the disorder. – The brain is likely not the only cause.
• Stigmas are likely attached to labeling people with psychological disorders. – Roughly 70% of sufferers do not seek treatment. – Education does not dispel the stigma. – May result in unnecessary incarceration – May lead to low self-esteem
Culture and Community
• Can people in different parts of the world have different mental disorders?
• The DSM-IV-TR includes a description of culture-bound syndromes that appear only in some cultures.
– Ataque de nervios, ghost sickness, koro, mal de ojo
Anxiety Disorders
Fears & Phobias
Obsessive Compulsive
Disorder
Generalized Anxiety Disorder
Panic Disorder
Anxiety Disorders and GAD
• Anxiety disorder: the class of mental disorder in which anxiety is the predominant feature – Anxiety can be adaptive or maladaptive, when it is
disproportionate to real threats and challenges.
• Generalized anxiety disorder (GAD): a disorder characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance – Roughly 5% of North Americans suffer
– Occurs more in lower SES groups
Phobic Disorders
• Phobic disorders: disorders characterized by marked, persistent, and excessive fear and avoidance of specific objects, activities, or situations – Specific phobia: a disorder that involves an irrational fear of a
particular object or situation that markedly interferes with an individual’s ability to function
– Social phobia: a disorder that involves an irrational fear of being publicly humiliated or embarrassed
• Preparedness theory: the idea that people are instinctively predisposed toward certain fears; proposed by Martin Seligman (1942- ) – Evolution, heritability, and temperament argue for biological
predispositions.
• Phobias can also be classically conditioned.
Panic Disorder
• Panic disorder: a disorder characterized by the sudden occurrence of multiple psychological and physiological symptoms that contribute to a feeling of stark terror; panic attacks – Approximately 22% of the U.S. population
reports having at least one panic attack.
• Agoraphobia: an extreme fear of venturing into public places; correlates with panic disorder
Obsessive-Compulsive Disorder
• Obsessive-compulsive disorder (OCD): a disorder in which repetitive, intrusive, thoughts (obsessions) and ritualistic behaviors (compulsions) designed to fend off those thoughts interfere significantly with an individual’s functioning
– Roughly 1.3% of the population suffers
– Moderate heritability
Mood Disorders and Depressive Disorders
• Mood disorders: mental disorders that have mood disturbances as their predominant feature
• Major depressive disorder: a disorder characterized by a severely depressed mood that lasts 2 wks. or more and is accompanied by feelings of worthlessness and lack of pleasure, lethargy, and sleep and appetite disturbances
• Dysthymia: a disorder that involves the same symptoms as in depression only less severe, but the symptoms last longer, persisting for at least 2 yrs
• Double depression: a moderately depressed mood that persists for at least 2 yrs. and is punctuated by periods of major depression
• Seasonal affective disorder: depression that involves recurrent depressive episodes in a seasonal pattern
• Women experience depression at twice the rate of men, as in postpartum depression
Questions
• What is the difference between depression and sadness?
• Why do more women than men experience depression?
Biological and Psychological Factors
• Heritability estimates for major depression range from 33% to 45%.
• Depression may involve norepinephrine and serotonin, and/or diminished activity in the left prefrontal cortex and increased activity in the right prefrontal cortex.
• Aaron Beck (1921- ) noted dysfunctional attitudes and negative mood states in depressed individuals. – Helplessness theory: the idea that individuals who are
prone to depression automatically attribute negative experiences to causes that are internal, stable, and global
– Depressed individuals tend to have depressive biases in thinking and memory.
The Real World: Suicide Risk and Prevention
• Suicide is the 11th leading cause of death in the U.S. (and third among high school and college students). – 50% of those who commit suicide do so during a depressive episode.
• There exist a variety of motives for suicide. – May be biological and/or “contagious” (the Werther effect)
• Prediction and prevention is difficult, however warning signs are abundant.
Bipolar Disorder
• Bipolar disorder: an unstable emotional condition characterized by cycles of abnormal, persistent high mood (mania) and low mood (depression) – Approximately 1.3% of people suffer – Rapid cycling bipolar disorder
• Bipolar disorder has the highest heritability (polygenic) among the psychological disorders.
• Biological causes (specific neurotransmitters) are difficult to substantiate.
• Stressful life experiences often precede episodes.
Dissociative Disorders: Going to Pieces
• Dissociative disorder: a condition in which normal cognitive processes are severely disjointed and fragmented, creating significant disruptions in memory, awareness, or personality that can vary in length from a matter of minutes to many years
• Dissociative identity disorder (DID): the presence within an individual of two or more distinct identities that at different times take control of the individual’s behavior – .5% - 1% of the population suffers; female to male prevalence 9:1
• Dissociative amnesia: the sudden loss of memory for significant personal information
• Dissociative fugue: the sudden loss of memory for one’s personal history, accompanied by an abrupt departure from home and the assumption of a new identity – Dissociative amnesia and fugue usually occur later in life and
memory loss may be temporary.
Schizophrenia: Losing the Grasp on Reality
• Schizophrenia: a disorder characterized by the profound disruption of basic psychological processes, a distorted perception of reality, altered or blunted emotion, and disturbances in though, motivation, and behavior – Occurs in about 1% of the population – Delusion: a patently false belief system, often bizarre and grandiose, that is
maintained in spite of its irrationality. – Hallucination: a false perceptual experience that has a compelling sense of
being real despite the absence of external stimulation – Disorganized speech: a severe disruption of verbal communication in which
ideas shift rapidly and incoherently from one to another unrelated topic – Grossly disorganized behavior: behavior that is inappropriate for the situation
or ineffective in attaining goals, often with specific motor disturbances • Catatonic behavior: a marked decrease in all movement or an increase in muscular
rigidity and overactivity
– Negative symptoms: emotional and social withdrawal, apathy, poverty of speech, and other indications of the absence or insufficiency of normal behavior, motivation, and emotion
• Subtypes include: paranoid, catatonic, disorganized, undifferentiated, and residual
Biological and Psychological Factors
• Concordance rates increase greatly with biological relatedness.
• Prenatal and perinatal environments may also have effects.
• Dopamine hypothesis: the idea that schizophrenia involves an excess of dopamine activity – Effects and treatments related to neurotransmitters have
yet to be completely determined.
• Neuroimaging has revealed enlarged ventricles and progressive tissue loss in many cases of schizophrenia.
• Disturbed family environment may affect development and recovery of schizophrenia.
Hot Science: Autism and Childhood Disorders
• Early onset disorders are recognized in the DSM, and some resolve into adulthood while others do not.
• Autistic disorder involves abnormal or impaired development of communication and social interaction, and a markedly restricted repertoire of activities/interest. – Recent increased prevalence
• Variations of the disorder lie along a spectrum, including Asperger’s syndrome.
• Individuals with the disorder may display unique, gifted talents. – Temple Grandin as an example
Personality Disorders: Going to Extremes
• Personality disorder: disorder characterized by deeply ingrained, inflexible patterns of thinking, feeling, or relating to others or controlling impulses that cause distress or impaired functioning – Organized into three clusters: odd/eccentric,
dramatic/erratic, and anxious/inhibited
– 14.8% of the population has a personality disorder.
– Common feature is failure to take others’ perspectives
• Diagnosis is controversial and complicated.
• Peer nomination measures may be more valid assessments.
Antisocial Personality Disorder
• Antisocial personality disorder(APD): a pervasive pattern of disregard for and violation of the rights of others that begins in childhood or early adolescence and continues into adulthood – 3.6% of the population suffers; males outnumber females
3:1 – Individuals typically have a history of conduct disorder and
many commit crimes.
• Sociopathology and psychopathology describe people with APD.
• Newer theories suggest internal (biological) causes. – Less sensitive to fear in the brain.
Antisocial Personality Disorder
Marked by a lack of empathy, chronic underarousal, willingness to lie, cheat, steal, and break the law
Where Do You Stand: Genetic Tests for Risk of Psychological Disorders
• In the future, diagnosis of potential psychological disorders may be as simple as providing a saliva sample.
• A genetic diagnosis may provide a nice explanation for a yet unlabelled problem.
• Would you want to know about a predisposition even if it never manifests? This could present added stress or a self-fulfilling prophecy.
Thomas Szasz:
The Myth of Mental Illness
• The concept of "mental illness" is a myth; i.e., these do not exist in reality, but only as a type of explanation for abnormal behavior
• ."Abnormal" behavior is a normative judgment: the only consistent definition of abnormality is one that refers to the average members of a community as a frame of
reference.
The Myth of Mental Illness
• People behave abnormally because either they CANNOT abide by cultural norms, or they CHOOSE not to abide by these norms.
• .The concept of mental illness is incorrect for two reasons:
• ."problems in living" do not have a medical cause, hence are not illnesses, even though such problems may result in physiological changes (eg., stress).
• .reification of mind; mind/body dualism is a false dichotomy: a disease of the brain may have psychological effects, but that does not mean the mind is some separate thing that has diseases.
The Myth of Mental Illness
• Szasz also asks "Whose agent is the psychiatrist?"---on whose behalf is the therapist acting? The client/patient, the community, the medical profession, the government?
• .Szasz argues that psychiatry and psychology should be concerned with problems in living NOT ‘illness’ per se.
• .The concept of mental illness is harmful and unethical, in so far as it is used as a rationale for medical treatments and institutionalization