discussions
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Psychological Disorders
Chapter 14
EXPLORING PSYCHOLOGY DAVID G. MYERS | C. NATHAN DEWALL
Chapter Overview
• Basic Concepts of Psychological Disorders
• Anxiety Disorders, OCD, and PTSD
• Major Depressive Disorder and Bipolar Disorder
• Schizophrenia and Other Disorders
Basic Concepts of Psychological Disorders (part 1)
• Psychological disorders • Syndrome marked by a clinically significant
disturbance in an individual’s cognition, emotion regulation, or behavior (APA, 2013)
• Dysfunctional or maladaptive
• Often accompanied by distress
Basic Concepts of Psychological Disorders (part 2)
• Understanding psychological disorders • Medical model
• Hospitals replaced asylums
• Mental illness are diagnosed on the basis of symptoms, treated through therapy, and cured
• Genetically influenced brain structure and biochemical abnormalities contribute to mental illness
• Biopsychosocial approach • Psychology studies how biological, psychological, and
social-cultural factors interact to produce specific psychological disorders
• Vulnerability-stress model; epigenetics
Basic Concepts of Psychological Disorders (part 3)
Basic Concepts of Psychological Disorders (part 4)
• Classifying disorders and labeling people • Classification aims to predict a disorder’s future
course, suggest appropriate treatment, and prompt research
• American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
• World Health Organization’s International Classification of Diseases (ICD)
• U.S. National Institute of Mental Health’s Research Domain Criteria (RDoC)
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Basic Concepts of Psychological Disorders (part 5)
• DSM-5 changes • Autism and Asperger’s syndrome = autism spectrum
disorder (ASD)
• Mental retardation = intellectual disability
• Hoarding disorder and binge-eating disorder added
• DSM-5 criticisms • Wider net pathologizes everyday life; too broad
• Subjective diagnostic labels
• Biasing power of labels
Thinking Critically About ADHD Normal High Energy or Disordered Behavior
• Why is there controversy over ADHD? • Diagnosis • Symptoms • Skeptics’ versus supporters’ views • Causes • Treatment
• Bottom line • Extreme inattention, hyperactivity, and impulsivity can derail
social, academic, and work achievements • These symptoms can be treated with medication and other
therapies • The debate continues over whether normal high energy is too
often diagnosed as a psychiatric disorder, and whether there is a cost to the long-term use of stimulant drugs in treating ADHD
Basic Concepts of Psychological Disorders (part 6)
• Risk of harm to self and others: Understanding suicide • Suicide risk increases with anxiety and depression
• Risk increases with rebound of these disorders
• Social suggestions may trigger suicide
• Suicide is often unpredictable
Basic Concepts of Psychological Disorders (part 7)
• Researchers report different group suicide rates • National differences
• Racial differences
• Gender differences
• Trait differences
• Age differences and trends
• Day-of-the-week and seasonal differences
• Gun ownership versus no gun ownership
Basic Concepts of Psychological Disorders (part 8)
• Helping someone who is talking about suicide • Listen and empathize
• Connect the person with campus counseling resources or crisis text lines
• Protect someone at immediate risk by seeking help
Basic Concepts of Psychological Disorders (part 9)
• Risk of harm to self and others: Nonsuicidal self-injury (NSSI) • More common in adolescence and among females
• Usually painful, but not fatal
• May cut or burn the skin, hit oneself, insert objects under the nails or skin, or self-administer tattoos
• Tend to experience bullying, harassment, or other stress
• Often self-critical and struggle with a range of other problems
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Basic Concepts of Psychological Disorders (part 10)
Rates of Nonfatal Self–Injury in the United States
Basic Concepts of Psychological Disorders (part 11)
• Why do people hurt themselves? • Find relief from intense negative thoughts through
pain distraction
• Attract attention and possibly get help
• Relieve guilt by punishing themselves
• Get others to change their negative behavior (bullying, criticism)
• Fit in with a peer group
Basic Concepts of Psychological Disorders (part 12)
• Do disorders actually increase risk of violence?
• Can clinicians predict who is likely to do harm?
Basic Concepts of Psychological Disorders (part 13)
• After the 2012 Newtown, Connecticut, slaughter of 26 schoolchildren and adults, and again following the 2018 Parkland, Florida, massacre of 17 youths and adults, people wondered if such tragedies couldn’t be prevented through mental health screenings
Basic Concepts of Psychological Disorders (part 14)
• Reported rates of psychological disorders: WHO study • Cultures vary in 28
country studies
• Lowest rate = Nigeria; highest rate = U.S.
• Immigrant paradox
Basic Concepts of Psychological Disorders (part 15)
Psychological Disorder Percentage
Depressive disorders or bipolar disorder 9.3
Phobia of specific object or situation 8.7
Social anxiety disorder 6.8
Attention-deficit/hyperactivity disorder (ADHD) 4.1
Posttraumatic stress disorder (PTSD) 3.5
Generalized anxiety disorder 3.1
Schizophrenia 1.1
Obsessive-compulsive disorder 1.0
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Basic Concepts of Psychological Disorders (part 16)
• What increases vulnerability to mental disorders? • Wide range of risk and protective factors for mental
disorders
• Predictors of mental health cross ethnic and gender lines
• First symptoms are experienced by age 24 for majority of those studied
Anxiety Disorders, OCD, and PTSD (part 1)
• Anxiety disorders • Generalized anxiety disorder
• Person is continually tense, apprehensive, and in a state of autonomic nervous system arousal
• Panic disorder • Marked by unpredictable, minutes-long episodes of intense
dread in which person may experience terror and accompanying chest pain, choking, or other frightening sensations; often followed by worry over a possible next attack
• Phobia • Anxiety disorder marked by a persistent, irrational fear and
avoidance of a specific object, activity, or situation
Anxiety Disorders, OCD, and PTSD (part 2) Anxiety Disorders, OCD, and PTSD (part 3)
• Obsessive-compulsive disorder (OCD) • Characterized by unwanted repetitive thoughts
(obsessions), actions (compulsions), or both, that persistently interfere with everyday life
• Obsessive thoughts are unwanted and seemingly unending
• Compulsive behaviors are responses to those thoughts
• More common among teens and young adults
• Other OCD-related disorders • Hoarding • Body dysmorphic disorder
• Trichotillomania • Excoriation disorder
Anxiety Disorders, OCD, and PTSD (part 4)
• Posttraumatic stress disorder (PTSD) • Characterized by haunting memories, nightmares,
hypervigilance, avoidance of trauma-related stimuli, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia
• Lingers for four weeks or more after a traumatic experience
• Greater risk for posttraumatic symptoms with higher distress
Anxiety Disorders, OCD, and PTSD (part 5)
• Understanding anxiety disorders, OCD, and PTSD • Psychologists today posit that conditioning, cognition, and
biology are helpful
• Conditioning • Classical conditioning • Stimulus generalization • Reinforcement
• Cognition • Thoughts and memories • Interpretations and expectations
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Anxiety Disorders, OCD, and PTSD (part 6)
• Understanding anxiety disorders, OCD, and PTSD • Biology: Genes
• 17 gene variations are associated with typical anxiety disorder symptoms; others are specifically associated with OCD
• Genes regulate neurotransmitter brain levels that heighten the brain’s alarm center
• Biology: Experience • Experience affects gene expression; epigenetic marks
Anxiety Disorders, OCD, and PTSD (part 7)
• When people were engaged in a challenging cognitive task, those with OCD showed the most activity in the anterior cingulate cortex in the brain’s frontal area (Maltby et al., 2005).
Anxiety Disorders, OCD, and PTSD (part 8)
• Understanding anxiety disorders, OCD, and PTSD • The brain is changed by experiences
• Traumatic fear-learning experiences can leave tracks in the brain and create fear tracks
• Brain area over-arousal involves impulse control and habitual behaviors, especially in the anterior cingulate cortex
• Natural selection shapes some of behaviors that can interfere with daily life when taken to an extreme
Major Depressive Disorder and Bipolar Disorder (part 1)
• Terms to learn • Anxiety
• Depression
• Major depressive disorder
• Bipolar disorder (formerly manic-depressive disorder)
Major Depressive Disorder and Bipolar Disorder (part 2)
• Depression and major depressive disorder • Depression is the leading cause of disability
worldwide (WHO, 2017b)
• Number-one reason why mental health services are sought
• May have a seasonal pattern
• DSM-5 classifies several major depressive disorders
Major Depressive Disorder and Bipolar Disorder (part 3)
The DSM-5 classifies major depressive disorder as the presence of at least five of the following symptoms over a 2-week period of time (minimally including depressed mood or reduced interest) (American Psychiatric Association, 2013).
• Depressed mood most of the time
• Dramatically reduced interest or enjoyment in most activities most of the time
• Significant challenges regulating appetite and weight
• Significant challenges regulating sleep
• Physical agitation or lethargy
• Feeling listless or with much less energy
• Feeling worthless, or feeling unwarranted guilt
• Problems in thinking, concentrating, or making decisions
• Thinking repetitively of death and suicide
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Major Depressive Disorder and Bipolar Disorder (part 4)
• Bipolar disorder • Person alternates between the hopelessness and
lethargy of depression and the overexcited state of mania
• Less common but often more dysfunctional than major depressive disorder
• Potent predictor of suicide • No gender differences; increased diagnoses among
adolescents • DSM-5 classification reduced child and adolescent
diagnoses; disruptive mood dysregulation disorder
Major Depressive Disorder and Bipolar Disorder (part 5)
• Creativity and risk for bipolar disorder • Clusters of genes associated with creativity increase
the risk of developing bipolar disorder
• Risk factors for developing bipolar disorder predict greater creativity
Major Depressive Disorder and Bipolar Disorder (part 6)
• Any theory of depression must explain at least the following: • Behaviors and thoughts change with depression • Depression is widespread • Women’s risk of major depressive disorder is roughly
double men’s risk • Most major depressive episodes end on their own • Work, marriage, and relationship stress often precede
depression • Compared with past generations, depression strikes
earlier and affects more people, with the highest rates among young adults in developed countries
Major Depressive Disorder and Bipolar Disorder (part 7)
• Biological perspective • Genes and depression
• In major twin studies, one research team estimated the heritability of major depressive disorder at 40 percent
• Linkage analysis
• The depressed brain • Brain activity slows during depression and becomes more
active during mania • Functional connectivity analyses show poor neural
communication that explain why people with depression struggle with emotion regulation
• Nutritional effects • A heart-healthy diet reduces risk of developing depression;
alcohol misuse can lead to depression
Major Depressive Disorder and Bipolar Disorder (part 8)
• Using aggregated data from studies of identical and fraternal twins, researchers estimated the heritability of bipolar disorder, schizophrenia, anorexia nervosa, major depressive disorder, and generalized anxiety disorder (Bienvenu et al., 2011)
Major Depressive Disorder and Bipolar Disorder (part 9)
• Social-cognitive perspective • Diet, drugs, stress, and other environmental
influences lay down epigenetic marks/molecular genetic tags that can turn certain genes on or off
• Life is seen through a lens of low self-esteem that feeds depression
• Self-defeating beliefs
• Negative explanatory style
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Major Depressive Disorder and Bipolar Disorder (part 10)
• Social-cognitive perspective • Negative thoughts, negative moods, and gender
• Women are twice as vulnerable men to depression • Rumination; overthinking
• Explanatory style
• Self-defeating belief and learned helplessness
• Pessimistic explanatory style • State-dependent memory
• Cultural forces
Major Depressive Disorder and Bipolar Disorder (part 11)
Major Depressive Disorder and Bipolar Disorder (part 12)
• Therapists recognize this cycle and work to help depressed people break out of it • Changing their negative
thinking
• Turning their attention outward
• Engaging them in more pleasant and competent behavior
Schizophrenia and Other Disorders (part 1)
• Schizophrenia • Characterized by
delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression
• Psychotic disorders • Group of disorders
marked by irrational ideas, distorted perceptions, and a loss of contact with reality
Schizophrenia and Other Disorders (part 2)
• Signs of schizophrenia • Disturbed perceptions and beliefs
• Hallucinations; delusions (false beliefs)
• Disorganized speech
• Diminished and inappropriate emotions • Flat affect; impaired theory of mind
• Inappropriate motor behavior; catatonia
• Onset and development • Chronic schizophrenia
• Acute schizophrenia
Schizophrenia and Other Disorders (part 3)
• Understanding schizophrenia: Brain abnormalities • Dopamine overactivity
• Abnormally low brain activity in frontal lobe, thalamus, and amygdala
• Abnormal brain anatomy in ventricles and cerebral tissue; smaller cortex, hippocampus, and corpus callosum; neural connection loss
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Schizophrenia and Other Disorders (part 4)
• Understanding schizophrenia: Prenatal environment and risk • Risk factors
• Low birth weight; maternal diabetes; older paternal age; oxygen deprivation during delivery
• Midpregnancy virus infection and fetal brain development
• Country-specific flu epidemic
• Birth in densely populated areas
• Birth in winter and spring months
• Mother’s flu infection during pregnancy
Schizophrenia and Other Disorders (part 5)
• Schizophrenia is a group of disorders influenced by many genes, each with very small effects
• Lifetime risk of developing schizophrenia varies with one’s genetic relatedness to someone having this disorder
• Across countries, barely more than 1 in 10 fraternal twins, but 5 in 10 identical twins, share a schizophrenia diagnosis (Data from Gottesman, 2001)
Schizophrenia and Other Disorders (part 6)
• Other disorders • Dissociative disorders
• Controversial, rare disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings; fugue state
• Dissociative identity disorder (DID) • Formerly called multiple personality disorder
• Two or more distinct identities—each with its own voice and mannerisms—seem to control the person’s behavior
Schizophrenia and Other Disorders (part 7)
• Understanding dissociative identity disorder • First formal code for the disorder appeared in an
earlier DSM edition
• The current criteria are in DSM-5
• The number of displayed identities increased when DID was publicized
• Could DID be an extension of normal capacity for identity shifts?
• What evidence points to DID as a real disorder?
Schizophrenia and Other Disorders (part 8)
• Personality disorders • Anxiety
• Eccentric or odd behaviors
• Dramatic or impulsive behaviors
Schizophrenia and Other Disorders (part 9)
• Antisocial personality disorder • Sometimes called sociopathy or psychopathy
• Lower emotional intelligence
• Impulsive behavior; feel and fear little
• Understanding antisocial personality disorder: Biological factors • Genetic influences
• Brain structure
• Environmental factors
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Schizophrenia and Other Disorders (part 10)
• Levels of the stress hormone adrenaline were measured in two groups of 13-year old Swedish boys. In both stressful and nonstressful situations, those who would later be convicted of a crime as 18- to 26-year-olds showed relatively low arousal.
Schizophrenia and Other Disorders (part 11)
• Eating disorders • Anorexia nervosa
• Bulimia nervosa
• Binge-eating disorder
Schizophrenia and Other Disorders (part 12)
• Factors influencing eating disorders • Family environment and characteristics
• Heredity
• Cultural and gender components
• Peer effects
• Media influence