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Chapter 14

Psychological Disorders

Learning Objectives
By the end of this topic, you should be able to answer the following questions:
How do we differentiate eccentric from abnormal behaviour? How are diagnoses of psychological disorders made?
i.e., what criteria are used to diagnose specific psychological disorders?

What are the origins of psychopathology?

i.e., what is the etiology of specific disorders?

What is Abnormal Behaviour?

When does eccentric become clinical? When does extreme or quirky become maladaptive? Abnormal behaviour characterized as:
1. Not typical 2. Maladaptive
Interfereswithpersonsabilitytofunction

Labels and Abnormality

Rosenhan (1973)
8 pseudopatients claimed to hear voices Were admitted to psychiatric hospitals Stopped reporting symptoms
Normal behaviours were interpreted as pathological Doctors rarely responded to questions Many real patients were not fooled

3. Distressing to the person who exhibits itortothepersonsfriendsandfamily 4. Socially unacceptable

Lifetime Prevalence of Psychological Disorders in North America

Diagnosing Psychopathology: The DSM-IV-TR

Diagnostic and Statistical Manual of Mental

Disorders (DSM-IV-TR)
System for diagnosing psychopathology

Goals of the DSM-IV-TR:

To provide a system for diagnosing disorders according to observable behaviour 2. To improve the reliability of diagnoses 3. To make diagnoses consistent with research evidence and practical experience
1.

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Diagnosing Psychopathology: The DSM-IV-TR

Designates 17 major categories of disorders

Diagnosing Psychopathology: The DSM-IV-TR

The DSM-IV-TR employs 5 components or axes:

and more than 200 subcategories

Also cites the prevalence

1. Axis I: Clinical Disorders

Criteria for diagnosing most disorders listed here

of each disorder
The % of the population

displaying the disorder

2. Axis II: Personality Disorders and Mental Retardation 3. Axis III: General Medical Conditions 4. Axis IV: Psychosocial and Environmental Problems 5. Axis V: Global Assessment of Functioning

Before we begin... A Note about Mental Illness

A range of ideas have grown around mental

Anxiety Disorders
Class of disorders marked by feelings of excessive fear and apprehension
May be related to a particular situation/object Often accompanied by increased physiological arousal

illness
Some facts:
Most people do recover from mental illness Few people with mental illness are violent Most people with mental illness bear their pain

privately

Anxiety Disorders
Class of disorders marked by feelings of excessive fear and apprehension Generalized anxiety disorder
Chronic, high level of anxiety that is not tied to any specific threat
Almost continuous anxiety for six months Difficulty concentrating Fatigue

Anxiety Disorders
Class of disorders marked by feelings of excessive fear and apprehension Panic disorder
Characterized by panic attacks
Recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly Occur in conjunction with other anxiety disorders more often than as a separate disorder
Lifetime prevalence 3.5%

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Anxiety Disorders
Class of disorders marked by feelings of excessive fear and apprehension Phobias
An excessive irrational fear and avoidance of specific objects or situations

Anxiety Disorders
Class of disorders marked by feelings of excessive fear and apprehension Phobias
Three different types: 1. Agoraphobia
Fear of going out in public places May result from severe panic disorder, in which people stay at home out of fear of having a panic attack in public Lifetime prevalence 2-6%

Anxiety Disorders
Class of disorders marked by feelings of excessive fear and apprehension Phobias
Three different types: 2. Social phobia
Anxiety involving a fear of and desire to avoid situations where one might be scrutinized by others Lifetime prevalence 13%

Anxiety Disorders
Class of disorders marked by feelings of excessive fear and apprehension Phobias
Three different types: 3. Specific phobia
Animal fears Blood-injection-injury fears Natural environment fears Situation fears Lifetime prevalence 10%

Anxiety Disorders
Class of disorders marked by feelings of excessive fear and apprehension
Obsessive-Compulsive Disorder (OCD)
Persistent, uncontrollable thoughts that cause compulsive rituals that interfere with daily life
Common obsessions include: fear of contamination, repeated doubts, fear for harm of others or self Common compulsions include: checking, washing, ordering/counting, hoarding
Temporarily anxiety brought on by obsessions

Anxiety Disorders
Class of disorders marked by feelings of excessive fear and apprehension Posttraumatic Stress Disorder (PTSD)
Traumatic event
Experience fear and helplessness

Symptoms
Re-experience event Avoidance and emotional numbing Heightened arousal

Lifetime prevalence 2-3%

Lifetime prevalence 8% (among North Americans)

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Etiology of Anxiety Disorders

Biological/Genetic Factors
Inherited temperament may be a risk factor for anxiety disorders
e.g.,Anxiety sensitivitytheory
Some people are more sensitive to internal physiological symptoms of anxiety and overreact with fear when they occur

Etiology of Anxiety Disorders

Environment Factors
Conditioning and Learning
Classical conditioning may cause fear of a particular object or scenario Then, avoidance is negatively reinforced through operant conditioning, by making the person feel less anxious

Thebrainsneurotransmittersmayunderlie anxiety
e.g., gamma-Aminobutyric acid (GABA)

Stress
People with anxiety disorders more likely to have experienced severe stress in the month before onset of symptoms

Mood Disorders
Class of disorders marked by emotional disturbances that may spill over to disrupt physical, perceptual, social, and thought processes May include delusions
False (often negative) beliefs inconsistent with reality

Mood Disorders
Class of disorders marked by emotional disturbances that may spill over to disrupt physical, perceptual, social, and thought processes

Major Depressive Disorder

Persistent feelings of sadness & despair, loss of interest in previous sources of pleasure, sleep and appetite difficulties

May be triggered by a specific event or have no identifiable cause Suicide

Attempted by 30% of depressed people

Lifetime prevalence of 16.2%

2x more common in women in North America
Affects ~ 1.3 million Canadians each year Onset is typically before age 40

Symptoms may last days

months

Mood Disorders
Class of disorders marked by emotional disturbances that may spill over to disrupt physical, perceptual, social, and thought processes

Etiology of Mood Disorders

Genetic/Biological Factors Concordance rates suggest there is a genetic basis for mood disorders
% of twin pairs or other pairs of relatives that exhibit the same disorder

BipolarDisorder(formerlymanicdepression)
People with the disorder vary between 2 extremes: 1. Manic phase
Rapid speech, inflated self-esteem, impulsiveness, euphoria, decreased need for sleep

Concordance rates for identical twins = 65 72% Concordance rates for fraternal twins = 14%
Share fewer genes but the same environment

2. Depressed phase Moody and sad, feelings of hopelessness

Lifetime prevalence 1%

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Etiology of Mood Disorders

Genetic/Biological Factors
Neurochemical Factors
Mood disorders are correlated with low levels of two neurotransmitters in the brain:
1. Norepinephrine 2. Seratonin

Etiology of Mood Disorders

Environmental Factors
Cognitive Factors
Becksnegativetriad
Depressed people have negative views of themselves, the environment, and the future

Learned Helplessness
Behaviour of giving up exhibited by people and animals exposed to negative consequences over which they feel they have no control

BUT findings are correlational

Unclear whether changes in these chemicals are the cause, or the result, of the onset of mood disorders

Stress linked to onset of mood disorders

Schizophrenia
Class of disorders marked by disturbances in thought that spill over to affect perceptual, social, and emotional processes

Types of Schizophrenia
The DSM classifies schizophrenia into 5 types:
1. Paranoid type
May be alert, intelligent, responsive However, thoughts are characterized by delusions and hallucinations often organized around a theme
Delusions of grandeur Delusions of persecution

Lifetime prevalence of 1%
Positive symptoms
Delusions Hallucinations (auditory) Disordered behaviour Disorganized speech

Negative symptoms
Flat affect Alogia
Brief, slow responses

Avolition
Inability to initiate goaldirected behaviour

Delusions and hallucinations impair ability to deal with reality

Types of Schizophrenia
The DSM classifies schizophrenia into 5 types:
2. Catatonic type
Characterized by striking motor disturbances, ranging from muscular rigidity to random motor activity

Types of Schizophrenia
The DSM classifies schizophrenia into 5 types:
3. Disorganized type
A particularly severe deterioration of adaptive behaviour is seen
Emotional indifference Incoherence Severe social withdrawal Aimless giggling and babbling. Delusions centered on bodily functions

Major symptoms include:

Two subtypes:
Excited: Shows excessive activity Withdrawn: Lacks responsiveness and alertness

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Types of Schizophrenia
The DSM classifies schizophrenia into 5 types:
4. Residual type
Show some symptoms of schizophrenia but remain in touch with reality

Course and Outcome of Schizophrenia

Schizophrenia usually emerges during adolescence or early adulthood Patients with a favorable prognosis:
Have a sudden onset of the disorder Experience onset at a later age Were well adjusted before the onset Have a low proportion of negative symptoms Do not have a loss of cognitive function Show good adherence to treatment Have a relatively healthy, supportive family to return to

5. Undifferentiated type
Exhibit all essential features of schizophrenia but do not fit neatly into one of the other categories

Etiology of Schizophrenia
Biological/Genetic Factors
Neurochemical Factors
Linked with excess activity in the transmitter Dopamine
Neurotransmitter released when we experience pleasure

Etiology of Schizophrenia
Biological/Genetic Factors
Structural Abnormalities in the Brain
Brain imaging scans have shown that patients with schizophrenia have enlarged brain ventricles (fluid-filled holes in the brain)
Unclear, however, whether this abnormality is the cause, or the result, of the disorder

Genetic Vulnerability
Concordance in identical twins is 48% Concordance in fraternal twins is 17%

Etiology of Schizophrenia
Environmental Factors
Disruptions in the normal maturational processes of the brain before or at birth may contribute in part to schizophrenia
Potential disruptions could include:
Prenatal exposure to a flu virus Severe famine Birth trauma

What Are Personality Disorders?

Axis II includes personality disorders
Applies to people with behaviours that are:
Inflexible Maladaptive Long-standing Cause stress or social or occupational difficulties

Stress may interact with genetic vulnerability to trigger the onset of schizophrenia

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Types of Personality Disorders

Antisocial Personality Disorder
Are self-centred and irresponsible Deceitful Show reckless disregard for safety of self and others Impulsivity and anger control issues Lack of remorse 1-2% of North Americans diagnosed Approximately 60% of men in prison have it

Types of Personality Disorders

Borderline Personality Disorder
Unstable and intense relationships alternating between extremes of idealization and devaluation
Frantic efforts to avoid real or imagined abandonment

Persistently unstable self-image Affective instability

Chronic feelings of emptiness Inappropriate, intense anger

Impulsivity2areasthatarepotentiallyself-damaging
Recurrent suicidal behaviour, gestures, or threats, or selfmutilating behaviour

Summary
Psychopathology is prevalent and it is often not apparent to others that a person suffers from mental illness. The diagnostic criteria for psychological disorders are based on specific, observable behaviours. Psychological disorders arise as a result of both biological/genetic and environmental factors.

Questions?