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NR 601 Week 3 Chapter 16; Psychological Disorders Notes approved

Chapter 16: Psychological Disorders Scope & Nature of Psychological Disorders  26% of population suffers from diagnosable mental disorders  Psychological disorders are 2nd leading cause of disability, exceeding physical illnesses and accidents  Medications used to treat anxiety & depression are among most frequently prescribed drugs What Is Abnormal  Defining normal & abnormal – not easy & depends on o The personal values of a given diagnostician  Too arbitrary o The expectations of the culture in which a person currently lives  Differs based on culture & time (ex. homosexuality was considered mental disease) o The expectations of the person's culture of origin  Differs based on culture & time (ex. homosexuality was considered mental disease) o General assumptions about human nature  Differs based on culture & time (ex. homosexuality was considered mental disease) o Statistical deviation from the norm  Highly intelligent people would be seen as abnormal o Harmfulness, suffering, and impairment (distress, dysfunction & deviance)  Seem to govern decisions about abnormality  Labeling Behaviours as Abnormal o If intensely distressing  Excessively anxious, depressed, dissatisfied or seriously upset at life – long-lasting o If dysfunctional  Interfere with person’s ability to work or to experience satisfying relationships  Interfere with society – Ex. suicide bomber o If deviant  Conduct within every society is regulated by norms  Violation of norms defines criminal behaviour – abnormal  Abnormal Behaviour o Personally distressing, personally or societally dysfunction and/or culturally deviant that other people judge it to be inappropriate or maladaptive  Major Diagnostic Categories o Anxiety disorders  Intense, frequent, or inappropriate anxiety  No loss of reality contact  Includes phobias, generalized anxiety reactions, panic disorders, obsessive-compulsive disorders, and post-traumatic stress disorders o Mood (affective) disorders  Disturbances of mood, including depression and mania (extreme elation and excitement) o Somatoform disorders  Physical symptoms, such as blindness, paralysis, or pain, that have no physical basis and are assumed to be caused by psychological factors  Excessive preoccupations and worry about health (hypochondriasis) o Dissociative disorders  Problems of consciousness and self-identification, including amnesia and multiple personalities (dissociative identity disorder) o Schizophrenic and other psychotic disorders  Severe disorders of thinking, perception, and emotion that involve loss of contact with reality and disordered behaviour o Substance-abuse disorders  Personal & social problems associated with use of psychoactive substances, such as alcohol, heroin, or other drugs o Sexual and gender identity disorders  Inability to function sexually or enjoy sexuality (sexual dysfunctions)  Deviant sexual behaviours, such as child molestation and arousal by inappropriate objects (fetishes)  Strong discomfort with one's gender accompanied by desire to be a member of other sex o Eating disorders  Include anorexia nervosa (self-starvation) & bulimia nervosa (bingeing and purging) o Personality disorders  Rigid, stable, and maladaptive personality patterns, such as antisocial, dependent, paranoid, and narcissistic disorders Historical Perspectives on Deviant Behaviour  Stories in the Bible, Mozart (paranoia), Abraham Lincoln & Winston Churchill (depression), Cameron Diaz (obsessed with germs)  Human societies explained and respond to abnormal behaviour in different ways based on values and assumptions about life at that time  Abnormal as Supernatural o Reflected evil spirit’s attempt to escape from individual bodies o Trephination  To release spirit  Sharp tool was used to chisel a hole about 2 cm in diameter in the skill o Medieval Europe  Demonological model  Disturbed people either were possessed involuntarily by devil or made pact with the devil  Ex. Killing of witches • Bind a woman’s hand and feet and throw her into a lake or pond • Diagnostic test: woman that sank & drowned could be declared pure  Hippocrates o Suggested that metal illnesses were diseases like physical disorders o Site of mental illness was the brain – biological basis o General Paresis  Disorder characterized by mental deterioration and bizarre behaviour, resulted from massive brain deterioration caused by the sexually transmitted disease syphilis  Sigmund Freud o Theory of psychoanalysis – disordered behaviour o Joined by other models based on behavioural, cognitive, and humanistic concepts o Focus on different classes of causal factors o Help to capture complex determinants of abnormal behaviour (especially culture)  Vulnerability-Stress Model (Diathesis-Stress Model) o Every individual has some degree of vulnerability (range: very low to very high) for developing psychological disorders, given sufficient stress o Vulnerability (Predisposition)  Can have biological basis • Genes, neurotransmitter, hair-trigger autonomic nervous system or hormones  Could be due to personality factors • Self-esteem, pessimism  Could be influenced by environmental factors • Poverty • Severe trauma or loss  Cultural factors play a role o Stressor  Recent or current even that requires individuals to cope Diagnosing Psychological Disorders  Reliability o Means that clinicians using the system should show high levels of agreement in their diagnostic decisions o Professionals with different types of training o Psychologists, psychiatrists, social workers, and general physicians—make diagnostic decisions  Validity o Means that diagnostic categories should accurately capture the essential features of the various disorders o Research show that a given disorder has four behavioural characteristics  diagnostic category for that disorder should also have those four features  DSM-IV-TR o Most widely used diagnostic classification system in North America o Has 350 diagnostic categories  contains detailed lists of observable behaviours that must be present in order for a diagnosis to be made o Allows diagnostic information to be represented along five dimensions  take both person and life situation into account o Axis I  Primary diagnosis  Represents the person's primary clinical symptoms o Axis II  Reflects long-standing personality or developmental disorders  Ex. Ingrained, inflexible aspects of personality, that could influence the person's behaviour and response to treatment o Axis III  Notes any physical conditions that might be relevant, such as high blood pressure o Axis IV  Rates the intensity of environmental stressors in the person's recent life o Axis V  Person's coping resources as reflected in recent adaptive functioning DSM-V: Integrating Categorical & Dimensional Approaches  Current classification system is a categorical system o People are placed within specific diagnostic categories o Criteria are so detailed and specific that many people don't fit neatly into categories o People who receive same diagnosis may share only few symptoms & look very different o Does not provide a way of capturing severity of the person's disorder o Cannot capture symptoms that are adaptively important but not severe enough to meet behavioural criteria for the disorder  Alternative System: Dimensional System o Relevant behaviours are rated along a severity measure o Based on assumption that disorders are different in degree, rather than kind Critical Issues in Diagnostic Labelling Social & Personal Implications  Diagnostic label is attached to a person  very easy to accept label as accurate description of individual rather than of the behaviour  Difficult to look at person's behaviour objectively  Likely to affect how we will interact with that person Legal Consequences  Individuals judged to be dangerous to themselves or others may be involuntarily committed to mental institutions under certain circumstances o Lose some civil rights & detained if no improvement  Legality o Competency  Refers to a defendant’s state of mind at the time of judicial hearing (not the actual crime)  May be judged to be disturbed – not able to understand nature of trial  Termed “not competent to stand trial” o Insanity  Relates to presumed state of mind of defendant at time crime was committed  May be “not guilty by reason of insanity”  Judged to have been so severely impaired during commission of a crime that they lacked the capacity either to appreciate wrongfulness of acts or to control conduct o Adopted “guilty but mentally ill”  Imposes a normal sentence for crime  Sends defendant to mental hospital for treatment Anxiety Disorders  State of tension and apprehension that is a natural response to perceived threat  Frequency & intensity of anxiety responses are out of proportion to situations that trigger them  Responses: 4 components o Subjective-Emotional Component  Feelings of tension and apprehension o Cognitive Component  Subjective feelings of apprehension  Sense of impending danger, & feeling of inability to cope o Physiological Responses  Increased heart rate & blood pressure, muscle tension, rapid breathing, nausea, dry mouth, diarrhea, and frequent urination o Behavioural Responses  Avoidance of certain situations and impaired task performance  Incidence o Refers to the number of new cases that occur during a given period  Prevalence o Refers to the number of people who have a disorder during a specified period of time  Most prevalent of all psychological disorders in North America  Tend to occur more frequently in females than in males  70% of cases – require medical attention Phobic Disorder  Phobias o Strong and irrational fears of certain objects or situations o Realize that their fears are out of all proportion to the danger involved, but they feel helpless to deal with these fears  Most Common Phobias o Agoraphobia  Fear of open and public places o Social phobias  Excessive fear of situations in which the person might be evaluated and possibly embarrassed o Specific phobias  Including fears of dogs, snakes, spiders, airplanes, elevators, enclosed spaces, water, injections, illness, or death  Animal fears – common amount women  Fear of heights – common amount men  Many develop in childhood & adolescence  Seldom go away on their own – may intensify Generalized Anxiety Disorder  Chronic state of diffuse, or “free-floating,” anxiety that is not attached to specific situations or objects  May last for months on end, with signs almost continuously present  Emotionally  jittery, tense, and constantly on edge  Cognitively  expects something awful to happen but doesn't know what  Physically  experiences mild chronic emergency reaction o Sweats, stomach is usually upset, has diarrhea  Find it hard to concentrate, make decisions, and remember commitments Panic Disorder  Occur suddenly and unpredictably, and are much more intense  Symptoms of panic attacks can be terrifying not unusual for victims to feel that they are dying  Occur out of the blue and in the absence of any identifiable stimulus  Develop agoraphobia  because of their fear that they will have an attack in public  May fear leaving familiar setting of home  Diagnosis requires recurrent attacks (not tied to environmental stimuli) followed by psychological or behavioural problems o Persistent fear of future attacks or agoraphobic responses  Tend to appear in late adolescence or early adulthood and affect about 6% of population Obsessive-Compulsive Disorder (OCD)  Usually consist of two components (but can occur singly) o Cognitive o Behavioura  Obsessions o Repetitive and unwelcome thoughts, images, or impulses that invade consciousness o Often abhorrent to the person, and are very difficult to dismiss or control o Ex. thoughts & images of contamination  Compulsions o Repetitive behavioural responses – can be resisted only with great difficulty o Often responses to obsessions to reduce anxiety associated with thought o Extremely difficult to control – strengthened through negative reinforcement o Involve  Checking things repeatedly  Cleaning & repeating  Repeating tasks endlessly  Onset typically occurs in the 20s Causal Factors in Anxiety Disorders Biological Factors  Research has shown identical twins have a concordance rate of 40% of anxiety disorders  Research indicates a genetic predisposition – but concordance is not 100%  Vulnerability o Autonomic nervous system that overreacts to perceived threat  high levels of arousal o Hereditary factors may cause overreactivity of neurotransmitter systems involved in emotional responses o Trauma-produced overactivity in emotional systems of right hemisphere (whose activity underlies negative emotional states) may produce vulnerability to PTSD  Neurotransmitters o GABA (gamma-aminobutyric acid)  Inhibitory transmitter that reduces neural activity in amygdala and other brain structures that stimulate physiological arousal  Abnormally low levels of inhibitory GABA activity in arousal areas may cause some people to have highly reactive nervous systems that quickly produce anxiety responses in response to stressors  More susceptible to classically conditioned phobias because they already have a strong unconditioned arousal response in place, ready to be conditioned to new stimuli o Serotonin  May also be involved in the anxiety disorders  Sex Differences o Emerges as early as 7 years of age o Findings suggest a sex-linked biological predisposition for anxiety disorders o Social conditions that give women less power and personal control may also contribute  Evolutionary Factors o Predisposing people to fear certain types of stimuli that might have had survival significance in the past, such as snakes, spiders, storms, and heights o Biological preparedness makes it easier to learn to fear certain stimuli Psychological Factors Psychodynamic Theories  Freud  Neurotic Anxiety o Occurs when unacceptable impulses threaten to overwhelm the ego's defences and explode into action o How ego's defence mechanisms deal with neurotic anxiety determines form of anxiety disorder o Phobic disorders  neurotic anxiety is displaced onto some external stimulus that has symbolic significance in relation to the underlying conflict  Obsession o Symbolically related to, but less terrifying than, the underlying impulse  Compulsion o Way of “taking back,” or undoing, one's unacceptable urges, as when obsessive thoughts about dirt and compulsive handwashing are used to deal with one's “dirty” sexual impulses  Generalized Anxiety & Panic Attacks o Thought to occur when one's defences are not strong enough to control or contain anxiety, but are strong enough to hide the underlying conflict Cognitive Factors  Stress role of maladaptive thought patterns and beliefs in anxiety disorders  Anxiety-disordered people “catastrophize” about demands and magnify them into threats  Anticipate that worst will happen and feel powerless to cope effectively  Attentional processes are especially sensitive to threatening stimuli  Intrusive thoughts about previous traumatic event are a central feature of PTSD o Presence of such thoughts after trauma predicts later development of PTSD  Social phobics judged both likelihood and costs to be much higher with embarrassing themselves in social settings  Social phobics did not differ in their likelihood and cost judgments in nonsocial situations.  Cognitive processes also play an important role in panic disorders o Panic attacks are triggered by exaggerated misinterpretations of normal anxiety symptoms, such as heart palpitations, dizziness, and breathlessness o Panic-disordered person appraises these as signs that a heart attack or a psychological loss of control is about to occur, and these catastrophic appraisals create even more anxiety until the process spirals out of control Anxiety as a Learned Response  Behavioural Perspective  anxiety disorders result from emotional conditioning  Some fears are acquired because traumatic experiences produce classically conditioned fear response o Ex. Person who has a traumatic fall from a high place may develop a fear of heights (a CR) because the high place (CS) was associated with the pain and trauma of the fall (UCS)  Phobias also can be acquired through observational learning o Ex. Televised images of air crashes can evoke high levels of fear in some people  Once anxiety is learned  may be triggered either by cues from environment or by internal cues o Phobic reactions  cues tend to be external ones relating to the feared object or situation o Panic disorders  cues tend to be internal ones, such as bodily sensations (heart rate) or mental images (image of collapsing and having a seizure in a public place)  People highly motivated to avoid or escape anxiety because it is an unpleasant emotional state  Behaviours that are successful in reducing anxiety o Compulsions or phobic avoidance responses o Strengthened through a process of negative reinforcement Sociocultural Factors  Culture-Bound Disorders o Occur only in certain places o Koro  Men fear that their penis is going retract into their abdomen and kill them o Taijin Kyofushu  Pathologically fearful of offending others by emitting offensive odours, blushing, staring inappropriately or having a blemish or improper facial expression  Attributed to the Japanese cultural value of extreme interpersonal sensitivity and to cultural prohibitions against expressing negative emotions o Windigo  Anxiety disorder found amount North American Indians  Fearful of being possessed by monsters who will turn them into homicidal cannibals o Eating disorders Eating Disorders  Anorexia Nervosa o Have an intense fear of being fat o Severely restrict their food intake to the point of self-starvation o Despite looking scrawny and weighing less than 85% of what would be expected for their age o Continue to view themselves as fat o Often crave food but have what amounts to an eating phobia that can be life-threatening o About 90% of anorexics are female, mostly adolescents and young adults o Causes menstruation to stop, strains heart, produces bone loss, & increases risk of death  Bulimia Nervosa o Overly concerned with becoming fat, but instead of self-starvation they binge eat and then purge the food, usually by inducing vomiting or using laxatives o Bulimics often consume 2,000 to 4,000 calories during binges o About 90% of bulimics are female o Have normal body weight o Repeated purging can produce severe gastric problems and badly eroded teeth Causes of Anorexia and Bulimia  Anorexia & bulimia are more common in industrialized cultures in which beauty is equated with thinness  Many women who immigrate to Western countries are at risk of developing eating disorders  Researchers believe that personality factors influence eating disorders o Anorexics  Often are perfectionists  High achievers who often strive to live up to lofty self-standards  Set harsher standards for their own and other women's bodies.  Losing weight - battle for success & control: Me versus food, & I'm going to win  Describe parents as disapproving and as setting abnormally high achievement standards, and they report more stressful events related to parents o Bulimics  Depressed and anxious  Exhibit low impulse control  Seem to lack a stable sense of personal identity and self-sufficiency  Bingeing is often triggered by life stress, and guilt and self-contempt follow it  Purging may be a means of reducing depression and anxiety triggered by the bingeing  Genetic factors may create a predisposition toward eating disorders o Concordance rates for eating disorders are higher among identical twins than fraternal twins o Concordance higher among first-degree relatives than second- or third-degree relatives o Exhibit abnormal activity of serotonin and other body chemicals that help to regulate eating  Researchers think that physiological changes initially are responses to abnormal eating patterns  Once started, they perpetuate eating and digestive irregularities  Ex. o Leptin is secreted by fat cells and anorexics have low fat mass o Amount of leptin circulating is abnormally low o When anorexics begin to eat more  leptin levels rebound more quickly than their weight gain o Because leptin is a signal that reduces appetite  leptin rebound may make it more difficult for anorexics to keep gaining weight  Ex. o Stomach acids expelled into the mouth during vomiting cause bulimics to lose taste sensitivity o Normally unpleasant taste of vomit becomes more tolerable Mood (Affective) Disorders  Mood Disorders o Involves depression & mania o Most frequently experienced psychological disorders  Anxiety & mood disorders have high comorbidity (co-occurrence) – individuals experience both Depression  Loss & pain occurrences  feel blue, sad, discouraged, apathetic, and passive  Feelings usually fade away after event has passed or as person becomes accustomed to new situation  Clinical Depression o Frequency, intensity, and duration of depressive symptoms are out of proportion to person's life o Respond to minor setback with intense major depression  unable to fun ction effectively o 10% of those over the age of 18 will suffer from major depression in their lifetimes o Dysthymia  Less intense form of depression  Less dramatic effects on personal and occupational functioning  More chronic and long-lasting form of misery  Occurs for years on end with intervals of normal mood that never last more than few weeks or months  Three Types of Symptoms o Cognitive  Difficulty concentrating & making decisions  Usually have low self-esteem (inferior, inadequate or incompetent)  Tend to blame themselves  Expect failure will come and would be caused by their own inadequacies  Great pessimistic & hopelessness o Motivational  Inability to get started & perform behaviours that produce pleasure & accomplishment  Everything seems to be too much effort o Somatic (physical)  Loss of appetite  Weight loss  Sleep distrubances (insomnia)  Fatigue & weakness  Lose sexual desire & responsiveness  Negative Mood State o Core feature of depression o Most commonly report sadness, misery & loneliness Bipolar Disorder  Unipolar Depression o Person experiences only depression  Bipolar Depression o Depression alternates with periods of mania  State of highly excited mood & behaviour  Manic State o Mood is euphoric and cognitions are grandiose o No limits to what can be accomplished and does not recognize negative consequences o Motivational level  hyperactive o Engages in frenetic activity o Can become very irritable and aggressive when their momentary goals are frustrated in any way o Speech is often rapid or pressured o Greatly lessened need for sleep  until exhaustion inevitably sets in and mania slows down Prevalence & Course of Mood Disorders  1/20 North Americans is severely depressed  No age group is exempt from depression o Can appear in 6 months old infants who were separated from mothers for prolonged periods  Rate of depressive symptoms in children & adolescents is as high as adult rate  Studies indicate that depression is on the rise in young groups o People born after 1960 are 10 times more likely to experience depression  Prevalence is similar across socioeconomic and ethnic groups  Men and women do not differ in prevalence of bipolar disorder  Women appear to be about twice as likely as men to suffer unipolar depression  Women are most likely to suffer first episode of depression in 20s, men in 40s  Biological theories suggest an influence due to: o Genetic factors o Biochemical differences in the nervous system o Monthly premenstrual depression  could increase vulnerability to depressive disorders  Environmental theories suggest influence due to: o Traditional sex role expectation for females:  Be passive & dependent in the face of stress or loss  Be focused on emotions o Traditional sex role expectation for males:  Distract themselves through activities such as physical exercise & drinking  Most people who suffer depressive episodes never seek treatment  Depression is that it usually dissipates with time  Typically lasts an average of 5 to 10 months when untreated  Once a depressive episode has occurred – three patterns: o Depression will never recur o Recovery with recurrence  Remain symptom free for several years before experience another episode o Will not recover & remain chronically depressed  Manic episodes o Less common than depressive reactions o Far more likely to recur Causal Factors in Mood Disorders Biological Factors  Genetic Factors o Identical twins have concordance rate of about 67% o Fraternal twins have concordance rate of 15% o Biological relatives were found to be eight times more likely  Genetically based temperament systems involved in mood disorders o Behavioural-Inhibition System (Neuroticism)  Pain-avoidant and generates fear and anxiety  High BIS sensitivity in depression  o Behavioural-Activation System (Extraversion)  Reward-oriented and activated by cues that predict future pleasure  Low BAS activity in depression  High BAS functioning – in mania  Cues connoting potential reward, achievement gratification, & goal attainment trigger activation  Neurotransmitters o Depression  Caused by underactivity in a family of neurotransmitters  Norepinephrine, dopamine, and serotonin  Involved in the BAS  Play important roles in brain circuits that produce reward and pleasure  Neural transmission decreases in brain  result in lack of pleasure & loss of motivation  Highly effective antidepressant drugs operate by increasing activity of these neurotransmitters o Bipolar Disorder  Appears to have a stronger genetic basis than does unipolar depression  50% of patients with bipolar disorder have a parent, grandparent, or child with the disorder  May stem from overproduction of neurotransmitters that are underactive in depression  Lithium chloride  drug most frequently used to calm manics  works by decreasing activity of these transmitters Psychological Factors Personality-Based Vulnerability  Freud believed that early traumatic losses create vulnerability for later depression by triggering a grieving and rage process that becomes part of personality  Subsequent losses reactivate original loss & cause reaction to current event and unresolved past loss  Humanistic Perspective o People define self-worth in terms of individual attainment and have lesser commitment to traditional values of family, religion, and the common good  likely to react more strongly to failure Cognitive Processes  Depressive Cognitive Triad o Negative thoughts concerning (1) the world, (2) oneself, and (3) future seems to pop into consciousness automatically o Report that they cannot control or suppress negative thoughts o Tend to recall most of their failures and few of their successes o Detect pictures of sad faces at lower exposure times and remember them better o Perceptual and memory sensitivity to negative o More likely to distort memories of negative events  Depressive Attributional Pattern o Taking no credit for successes but blaming themselves for failures maintains low self-esteem o Low self-esteem = significant risk factor for later depression  Learned Helplessness Theory o Depression occurs when people expect that bad events will occur and that there is nothing they can do to prevent or cope with them o Depressive attributional pattern plays a central role o Specify what the negative attributions for failure are like o Suggest that chronic and intense depression occurs as result of negative attributions for failure that are personal (It's all my fault), stable (I'll always be this way), & global (I'm a total loser) Learning & Environmental Factors  Depression is usually triggered by a loss  People stop performing behaviours that previously provided reinforcement (hobbies and socializing)  Tend to generate added negative events through negative moods, pessimism, & reduced functioning  Tend to make those who come in contact with them feel anxious, depressed, and hostile  People begin to lose patience  diminishes social support  Behavioural theorists believe that to begin feeling better = break vicious cycle o By initially forcing to engage in behaviours that are likely to produce some degree of pleasure o Positive reinforcement by process of behavioural activation will counteract depressive affect  Environmental Factors o Children of depressed parents often experience poor parenting and many stressful experiences o May fail to develop good coping skills and a positive self-concept o Vulnerable later in life to stressful events that can trigger depressive reactions Sociocultural Factors  Prevalence, symptom pattern, and causes reflect cultural variation  Compared with Western nations - prevalence is far lower in Hong Kong and Taiwan o Strong connections to family help to reduce negative impact of loss and disappointments  Feelings of guilt and personal inadequacy seem to predominate in North America and Europe  Somatic symptoms of fatigue, loss of appetite, & sleep difficulties are more often reported in Latin, Chinese, and African cultures  Women are about twice as likely to report feeling depressed in technologically advanced countries – not in other countries Somatoform Disorders  Involve physical complaints or disabilities that suggest a medical problem  No known biological cause and are not produced voluntarily by the person  Hypochondriasis o Unduly alarmed about any physical symptom they detect and are convinced that they have or are about to have a serious illness  Pain Disorder o Experience intense pain that either is out of proportion to whatever medical condition they have or for which no physical basis can be found  Differ from psychophysiological disorders o Cause or contribute to a real medical condition o Such as ulcer, asthma, hypertension or cardiac problem o Peptic ulcers  Stress-produced outpouring of peptic acid into stomach produce lesions in stomach wall  Result pain therefore is actual physical damage  Conversion Disorder o Serious neurological symptoms (paralysis, loss of sensation, or blindness) suddenly occur o Electrophysiological recordings & imaging indicate sensory & motor pathways in brain are intact o Often exhibit la belle indifference  Strange lack of concern about symptom and its implications o Complaint itself is physiologically impossible o Ex. Glove Anaesthesia  Person loses all sensation below the wrist  Hand is served by nerves that also provide sensory input above the hand, making glove anaesthesia anatomically impossible o Relatively rare o Occur more frequently under wartime conditions (soldier)  Psychogenic blindness o Rare in general population o Cambodian refugees who escaped from their country  Eyes appear intact and electrophysiological monitoring shows that visual stimuli register in visual cortex  Freud • Symbolic expression of underlying conflict that aroused anxiety that ego kept conflict in the unconscious by converting anxiety into a physical symptom  May involve a combination of biological and psychological vulnerabilities  Tend to run in families not clear whether reflects role of genetic factors or environmental  People may experience internal sensations more vividly than others or may focus more attention o Person being self-absorbed in own body sensations set stage for apprehension about body  Tends to be much higher in cultures that discourage open discussion of emotions or that stigmatize psychological disorders Dissociative Disorers  Normal Integration o Personality unity & coherence o Facets of self are integrated so that people act, think & feel with some degree of consistency o Memory plays a role – connects past & present  Involve a breakdown of this normal integration, resulting in significant alterations in memory or identity.  Three forms: o Psychogenic Amnesia  Person responds to a stressful event with extensive but selective memory loss  Some people can remember nothing about their pasts  Others can no longer recall specific events, people, places, or objects, although other contents of memory, such as language and cognitive or motor skills remain intact o Psychogenic Fugue  Person loses all sense of personal identity, gives up his or her customary life, wanders to a new faraway location, and establishes a new identity  Triggered by a highly stressful event or trauma, and it may last from a few hours or days to several years  Ends when the person suddenly recovers his or her original identity and “wakes up,” mystified and distressed at being in a strange place under strange circumstances o Dissociative identity disorder (DID)  Formerly called multiple personality disorder  Most striking and widely publicized  most controversial  Two or more separate personalities coexist in the same person  Primary, or host personality appears more often than the others (called alters)  Each personality has its own integrated set of memories and behaviours  Personalities may or may not know about existence of others  Can differ in age and gender, with one being male, another female  Voice changes, and even changes in right- and left-handedness  Severe allergies when one personality is present but no allergies when the others are active  Female patients have different menstrual cycles for each female personality  Patients can need eyeglasses with different prescriptions for different personalities Causes of Dissociative Identity Disorder  Frank Putnam's Trauma-Dissociation Theory o Development of new personalities occurs in response to severe stress  Usually begins in early childhood  frequently in response to physical or sexual abuse  In response to trauma and helplessness to resist it  children may engage in something akin to self-hypnosis and dissociate from reality  Create alternate identity to detach themselves from trauma  transfer what is happening to someone else who can handle it, and to blunt the pain  Protective functions served by new personality remain separate in the form of an alternate personality rather than being integrated into the host personality  Critics question how often it actually occurs, and others question its very existence Schizophrenia  Most serious and, in many ways, the most puzzling and difficult to treat  Psychotic disorder - involves severe disturbances in thinking, speech, perception, emotion, & behaviour  Term means “split mind”  which often has led people to confuse schizophrenia with DID Characteristics of Schizophrenia  Diagnosis  requires evidence that a person misinterprets reality and exhibits disordered attention, thought, or perception  Withdrawal from social interaction is common, communication is strange or inappropriate, personal grooming may be neglected, and behaviour may become disorganized  Schizophrenic thought disorder sometimes includes delusions  Delusions o False beliefs sustained in face of evidence that normally would be sufficient to destroy them  Delusion of Persecution o Schizophrenic person may believe that his brain is being turned to glass by ray guns operated by his enemies from outer space  Delusion of Grandeur o Jesus Christ is a special agent of his  Fierce battle that goes on inside my head in which conflicts become unresolvable  Perceptual disorganization & disordered thought become more pronounced as people progress  Unwanted thoughts constantly intrude into consciousness  Some experience hallucinations o False perceptions that have a compelling sense of reality o Auditory hallucinations (typically voices speaking to the patient) are most common o Visual and tactile hallucinations may also occur  Language o Often disorganized and can contain strange words o Contains word associations that are based on rhymes or other associations rather than meaning  Emotions could have o Blunted Affect  Manifesting less sadness, joy, and anger than most people o Flat Affect  Showing almost no emotion at all  Voices are monotonous, their faces impassive o Inappropriate Affect  Ex. Cries during television comedies  Ex. Angry when justice is done  Ex. Frightened when someone compliments him  Ex. Roars with laughter on reading that a young child was burned in a tragic fire Subtypes of Schizophrenia  Four Major Types o Paranoid Type  Delusions of Persecution • In which people believe that others mean to harm them  Delusions of Grandeur • In which they believe they are enormously important  Suspicion, anxiety, or anger may accompany delusions  Hallucinations may also occur in this subtype o Disorganized Type  Confusion and incoherence, together with severe deterioration of adaptive behaviour  Disorganization often is so extreme that it is difficult to communicate with them  Behaviour often appears silly & childlike  Emotional responses are highly inappropriate  These people are usually unable to function on their own o Catatonic Type  Striking motor disturbances - range from muscular rigidity to random or repetitive movements  Sometimes alternate between • Stuporous States o Seem oblivious to reality o Exhibit waxy flexibility  Limbs can be moulded by another person into grotesque position that will then maintain for hours • Agitated Excitement o Can be dangerous to others  Undifferentiated Type • People who exhibit some of symptoms and thought disorders • Do not have enough of the specific criteria to be diagnosed in those categories  Two Major Categories (based on symptoms) o Type I Schizophrenia  Characterized by a predominance of positive symptoms • Delusions, hallucinations, and disordered speech and thinking • Represent pathological extremes of normal processes o Type II schizophrenia  Features negative symptoms  Absence of normal reactions • Lack of emotional expression, loss of motivation, & absence of normal speech o Different symptoms = different brain functioning, life history & prognosis  Negative Symptoms • Associated with long history of poor functioning prior to hospitalization • Poor outcome following treatment  Positive Symptoms • Especially with paranoid schizophrenia • Associated with good functioning prior to breakdown • Better prognosis for eventual recovery, particularly if symptoms came on suddenly and were preceded by a history of relatively good adjustment  Prevalence o Only effects 1-2% of population o 10% of those remain permanently impaired o 65% show intermittent periods of normal functioning o 25% recover from disorder o Equal in females & males – appears early in males Causal Factors in Schizophrenia Biological Factors Genetic Predisposition  Strong evidence - specific genes involved and roles not unknown  Closer biological relationship = greater risk for developing the disorder during one's lifetime  Identical twins have higher concordance rates than fraternal twins  Higher concordance with biological parents than with adoptive parents Brain Abnormalities  Brain scans have indicated a number of structural abnormalities in brains  Neurodegenerative Hypothesis o Destruction of neural tissue can cause schizophrenia  MRI studies  shown mild to moderate brain atrophy o General loss or deterioration of neurons in cerebral cortex & limbic system o Enlarged ventricles (cavities that contain cerebrospinal fluid) o Thalamus  reveals abnormalities  Accounts for disordered attention & perception reported o Cerebral cortex  Gets garbled or unfiltered information from thalamus o Structural differences more common in patients  Exhibit the negative-symptom pattern  Poorer chance of recovery  Atrophy is centred in regions that influence cognitive processes and emotion Biochemical Factors  Dopamine o Major excitatory transmitter substance – may play a key role  Dopamine Hypothesis o Symptoms—particularly positive symptoms—produced by overactivity of dopamine system in areas that regulate emotional expression, motivated behaviour, and cognitive functioning o More dopamine receptors on neuron membranes, and receptors seem to be overreactive  Antipsychotic drugs used are directly related to effectiveness in reducing dopamine synaptic activity  Other neurotransmitter systems are probably involved Psychological Factors  Freud o Viewed schizophrenia as a retreat from unbearable stress and conflict o Extreme example of the defence mechanism of regression  Person retreats to an earlier & more secure stage of psychosocial development in face of overwhelming anxiety  Other Psychodynamic Thinkers o Retreat from interpersonal world that has become too stressful to deal with o Belief that life stress is a causal factor is generally accepted today  Cognitive Theorists o Defect in attentional mechanism that filters out irrelevant stimuli, so that they are overwhelmed by both internal and external stimuli o Sensory input becomes a chaotic flood, and irrelevant thoughts and images flash into consciousness  Stimulus overload produces distractibility, thought disorganization, & sense of being overwhelmed  Linked to deficits in the executive functions of the frontal lobe Environmental Factors  Stressful life events seem to play an important role  Events tend to cluster in the 2 or 3 weeks preceding the “break” when acute signs of disorder appear  Highly vulnerable person may require little in the way of life stress to reach the breaking point  Psychotic individuals reacted to stressors with more intense negative emotions  emotional overreactivity may be a vulnerability factor  More emotionally reactive & more reactive = more likely to respond to stressful life events with increase in psychotic symptoms  Family dynamics - origins of schizophrenia  Children of biologically normal parents raised by schizophrenic adoptive parents do not show an increased risk of developing schizophrenia  Biological vulnerability factor must be present if stressful familial events are to cause damage  Research - difficulty pinpointing family factors that contribute to initial appearance o Previously hospitalized schizophrenics are more likely to relapse if they return to home environment that is high in a factor called expressed emotion  Expressed Emotion o High levels of criticism, hostility and overinvolvement o Can cause patients to relapse Sociocultural Factors  Prevalence highest in lower socioeconomic populations  Social Causation Hypothesis o Attributes the higher prevalence of schizophrenia to the higher levels of stress that low-income people experience, particularly within urban environments  Social Drift Hypothesis o Personal and occupational functioning deteriorates, so that they drift down the socioeconomic ladder into poverty and migrate to low-cost urban environments  May be a “culture-free” disorder  Likelihood of recovery is greater in developing countries than in developed nations Personality Disorders  Exhibit stable, ingrained, inflexible, and maladaptive ways of thinking, feeling, and behaving  Typical behaviour patterns do not work  unresolved conflicts tend to re-emerge  likely to intensify inappropriate ways of coping, and emotional controls may break down  10 personality disorders are divided into three clusters o Dramatic and impulsive behaviours o Anxiety and fearfulness o Odd and eccentric behaviours  Equally distributed among men and women  Most frequently encountered were avoidant, paranoid, histrionic, and obsessive-compulsive  Most destructive = antisocial personality disorder Dramatic/Impulsive Cluster  Antisocial Personality Disorder o Severe irresponsible & antisocial behaviour beginning in childhood and continuing past age 18 o Impulsive need gratification & lack of empathy for others; often highly manipulative and seem to lack conscience  Histrionic Personality Disorder o Excessive, dramatic emotional reactions and attention seeking o Often sexually provocative o Highly impressionable and suggestible o Out of touch with negative feelings  Narcissistic Personality Disorder o Grandiose fantasies or behaviour, lack of empathy, and oversensitivity to evaluation o Constant need for admiration from others; proud self-display  Borderline Personality Disorder o Pattern of severe instability of self-image, interpersonal relationships, and emotions, often expressing alternating extremes of love and hatred toward the same person o High frequency of manipulative suicidal behaviour Anxious/Fearful Cluster  Avoidant Personality Disorder o Extreme social discomfort and timidity o Feelings of inadequacy and fearfulness of being negatively evaluated  Dependent Personality Disorder o Extreme submissive and dependent behaviour o Fears of separation from those who satisfy dependency needs  Obsessive-Compulsive Personality Disorder o Extreme perfectionism, orderliness, & inflexibility o Preoccupied with mental and interpersonal control Odd/Eccentric Cluster  Schizoid Personality Disorder o Indifference to social relationships & restricted range of experiencing and expressing emotions  Schizotypal Personality Disorder o Odd thoughts, appearance, and behaviour, and extreme discomfort in social situations  Paranoid Personality Disorder o Unwarranted tendency to interpret behaviour of people as threatening, exploiting, or harmful Antisocial Personality Disorder  Referred to as psychopaths or sociopaths  Most interpersonally destructive and emotionally harmful individuals  Males outnumber females three to one  Seem to lack a conscience  Exhibit little anxiety or guilt and tend to be impulsive and unable to delay gratification of their needs  Flourish in politics and business  charisma, manipulativeness, false sincerity, & deceiving others  Two behavioural clusters o Consists of selfishness, callousness, and interpersonal manipulation o Impulsivity, instability, and social deviance  Diagnosis likely to require both behaviour clusters o Subclinical psychopaths  Only have the first cluster o Can cause considerable harm because of loose moral standards, ability to deceive others, and lack of empathy o Exhibit lack of emotional attachment to other people  Appear very intelligent and charming  Have ability to rationalize inappropriate behaviour so that it appears reasonable and justifiable  Punishment does not deter them from engaging in self-defeating or illegal acts again and again  Habitual lying, early and aggressive sexual behaviour, excessive drinking, theft, vandalism, and chronic rule violations at home and school Casual Factors Biological Factors  Consistently higher rates of concordance for antisocial behaviour in identical twins  Heritability is between 0.40 and 0.50  Dysfunction in brain structures that govern emotional arousal & behavioural self-control (amygdala & prefrontal cortex) o Result in behavioural impulsiveness & chronically underaroused state that impairs avoidance learning, causes boredom, and encourages a search for excitement  Lower heart rates, particularly when under stress  Subtle neurological deficits in prefrontal lobes - associated with reduced autonomic activity  Respond with less arousal & greater impulsiveness to both pleasurable and unpleasant stimuli Psychological & Environmental Factors  Psychodynamic theorists regard antisocial people as lacking a conscience  Psychoanalytic theory - lack anxiety and guilt because they did not develop an adequate superego o Restraints on the id are reduced - resulting in impulsive and hedonistic behaviour  Cognitive theorists  Consistent failure to think about or anticipate the long-term negative consequences of their acts o Behave impulsively, thinking only of what they want at that moment o Goal: help them develop cognitive controls (executive functions) to think before acting o Learning through modelling may also play an important role  Often come from homes in which parents exhibit aggression & inattentive to children's needs  Exposure to deviant peers has an influence  Learning theorists  believe that poor impulse control occurs because of impaired ability to develop conditioned fear responses when punished o Correspond with lower physiological arousal & amygdala activity identified with brain recordings o Results in deficit in avoidance learning Borderline Personality Disorder  May occur in 3 to 5% of the general population  2/3 diagnosed are women  Used to be diagnosed as Intermediate level of disturbance between neurotic and psychotic  Symptoms o Serious instability in behaviour, emotion, identity, and interpersonal relationships o Emotional dysregulation  inability to control negative emotions in response to stressful life events, many of which borderline individuals themselves cause o Experience chronic feelings of extreme anger, loneliness, & emptiness o Momentary losses of personal identity o Impulsive behaviour (running away, promiscuity, binge eating, and drug abuse) o Repetitive self-destructive behaviours - self-mutilation & suicide attempts  causes “saving” response from other people o Associated with mood disorders, PTSD, and substance-abuse disorders o Predicted recurrent problems in academic achievement and social relationships  Difficult to treat because of clinging dependency, irrational anger, and tendency to engage in manipulative suicide threats and gestures as efforts to control the therapist Causal Factors  Personal histories marked by interpersonal strife, sexual & physical abuse, & inconsistent parenting  Rejection from others  Splitting o Sudden & vitriolic shifts from extreme love & clinging dependence to intense hatred or feelings of abandonment reflect a cognitive process o Failure to integrate positive & negative aspects of another's behaviour into a coherent whole  May react as if other person had two separate identities  Reacting to at the moment totally determines how she or he relates or feels  Close relatives of those with BPD are five times more likely to have it  Abnormality in neurotransmitter systems or areas of the brain that contribute to emotional self-regulation  Cases of BPD seem to increase in societies that are unstable and rapidly changing Disorders of Childhood & Old Age Childhood Disorders  Although many childhood disorders are the subject of current research, two are receiving particular attention  Attention deficit/hyperactivity disorder  most frequently diagnosed childhood disorder  Autism  becoming more common Attention Deficit/Hyperactivity Disorder  May take the form of inattention, hyperactivity/impulsivity, or a combination of the two  Ratings by teachers & parents indicate 7 to 10% of children meet DSM-IV-TR criteria for the disorder  ADHD - most common childhood disorder o Occurs at least four times more frequently in boys than in girls o Boys more likely to exhibit aggressive and impulsive behaviours o Girls are more likely to be primarily inattentive o Critics: may be labelled and medicated inappropriately (Carlson, 2000). o Problems persist into adolescence and, for 30 to 50%, into adulthood  Causes of ADHD are unknown o Genetic factors are probably involved  Concordance rates are higher in identical twins  Biological parents are more likely to have it  EEG studies of brain structures & neurotransmitters  failed to reveal consistent differences between people with ADHD and control groups  Inconsistent parenting is involved Autistic Disorder  Long-term disorder  Extreme unresponsiveness to others, poor communication skills, & highly repetitive & rigid behaviour  Affects about 5 in every 10,000 children - 80% diagnosed of them boys  Usually appears in first three years of life  form of unresponsiveness & lack of interest in others  Tends to be a long-term disorder  Approx. 70% remain severely disabled into adulthood and cannot lead independent lives o More than 2/3 have mental retardation o IQs below 70 and frequently below 35 o Rest have normal to above-average intelligence  Lack of social responsiveness to others o Typically do not reach out to or even make eye contact with their parents o Seem not to recognize or care who is around them o Do not engage in normal play & often do not even acknowledge presence of peers & adults  Language & communication difficulties are common o Half: not developing language o Language developed is strange – involves repetition of words or phrases o Engage in echolalia  exact echoing of phrases spoken by others  Become extremely upset at even minute changes  Have repetitive and stereotyped behaviour patterns and interests  Spend time spinning objects, playing with objects (jar tops), flicking their fingers, or rocking bodies  Some engage in self-injurious behaviours, such as banging heads against sharp objects or biting chunks of flesh out of their bodies (have to be restrained)  Some exhibit extraordinary savant abilities o Calendar calculation o Could tell you in an instant what day of the week your birthday will fall on in 2039 o Can perfectly reproduce any song or commercial after hearing it once Causal Factors  Psychodynamic Explanation o Speculated that children had been driven into own worlds by cold & ungiving family environment o Parents (especially mother) described as “refrigerator parents” - thawed out just to conceive o No evidence  Biological Basis o Inconclusive what effects it o Widespread anomalies in structures & functioning of brain have been found in autistic children o Brain-imaging shows that brains are 4-10% larger at 18 months o Evidence of accelerated pruning of neural connections during early life o Prefrontal cortex development is abnormal (coordinates movement & shifting attention)  Genetic Factors o Studies suggest there may be 4-6 major genes & 20-30 others that contribute to lesser degree o Different genes may be involved for boys than for girls o Siblings are 200 times more likely to have disorder - concordance is highest in identical twins ( o Multiple interacting genes o Relatives – don't have disorder but have unusual personality characteristics that parallel autism, including aloofness & very narrow and specialized interests  Theory of Mind o Refers to awareness of what others are thinking & how they may be reacting internally o Poorly developed awareness of characteristics of other’s thinking o Poor comprehension of others' emotional responses, such as expressions of distress o Severely impair language & social development  Possible role of children’s vaccinations – no evidence as of yet Dementia in Old Age  Gradual loss of cognitive abilities - accompanies brain deterioration & interferes with normal functioning  Progressive atrophy, or degeneration, of brain tissue occurs as a result of disease or injury  Can occur at any point in the lifespan  elderly people are at greater risk  Most common: Alzheimer's, Parkinson's, Huntington's & Creutzfeldt-Jakob diseases  Complications from high blood pressure & stroke may also be causes  Senile Dementia o Dementia begins after age 65 o Rate 8% - Female-to-male ratio of about two to one o Prevalence rates were 2.4% between ages 65 and 74 o 11% for those between 75 and 84 o 34.5% for those 85 and older o More than half of those over age 65 living in institutions had dementia  Onset typically gradual  Symptoms o Memory impairment (especially for recent events) o Poor judgment o Confusion  episodes of distress o Language problems o Disorientation may appear gradually or sporadically o Make nonsensical remarks, lose procedural ability to perform familiar tasks o Can undergo marked personality change o Show combinations of depression, anxiety, agitation, paranoid reactions, & disordered thinking Alzheimer’s Disease  Leading cause of dementia in the elderly  Caused by deterioration in frontal & temporal lobes, including hippocampus, subcortical structure involved in memory  Diagnosis o Observing and interviewing patient o Postmortem microscopic examination of brain tissue  Tangled clumps of neurons & patches of disintegrating nerve cell branches: plaques  Destruction of cells that produce acetylcholine (neurotransmitter involved memory)  Symptoms o May not recognize even close family members o May lose ability to speak, walk, and control bladder and bowel functions o Experience considerable stress and environment becomes more confusing

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