Psychopathology and Prevention
Lecture 1
Global Burden of Disease: quantifying what stops us from living long healthy lives
- first GBD published in 1997, 107 diseases and 10 risk factors from 8 regions
- 2010 big update, 291 diseases and 67 risk factors from 187 countries
- constantly growing
- GBD is for predicting future trends and guiding policy decisions and setting (to make sure the money
goes to priorities)
DALYs: disability adjusted life years
- how many years are lost to disease (via early death or suffering, aka mortality and morbidity)
- allows us to directly compare the burdens of diseases
- underestimate the true burden of disease, as suicide and self-harm are coded as injuries and 93% of
mental disease is non-fatal.
Mental Disorders = 1 category
WHO mental health definition: well-being, realizing own potential, coping with normal stresses of life,
work productively, contribute to community
- 1 in 4 people experience a mental illness at some point
We see a lot more people with mental illness DALYs in the developed world due to a lot of estimation
problems.
- wage gap leads to a gap in treatment for rich and poor
Depression used to be on the top but now anxiety disorders are in terms of prevalence.
Mental and substance abuse disorders:
- 1 billion people
- 5th in GBD 2017
- 2/3 DALYs caused by depressive, anxiety and substance use disorders
- equal between the genders (women higher internalizing, men higher externalizing)
It can be better to look at YLDs: years lived with disability.
- mental and substance abuse disorders have the highest disability burden: 18.7% of YLDs
Not all mental diseases are included in GBD estimate (e.g. personality disorders, chronic pain syndromes
with psychological components like fibromyalgia, or neurological disorders like dementia)
More people are seeking help, and more young people are reporting mental distress. A 52% increase in
MD for ages 12-17, and for ages 18-25 a 63% increase in MD, 71% increase in serious psychological
distress, 47% increase in suicide related outcomes
What is abnormal?
- distress
- cultural norms
,- statistical infrequency
- impaired social functioning
"mental disorders are psychological, biological or developmental dysfunctions associated with personal
distress or substantial impairment in functioning, atypical or unexpected in cultural context"
80s and onwards was revolutionary for the DSM as symptoms were clustered, there was explicit
diagnostic criteria and everything became evidence based.
The DSM 5 removed the multiaxial assessment system.
The ICD 11 is used globally to record medical/psychiatric diagnoses, has more flexible guidance, and
improves worldwide diagnosis and treatment
- In DSM: depression must include 5 or more symptoms during the same 2-week period
- In the ICD: period of daily depressed mood or diminished interest in activities for 2 weeks
Classifications are important for patients in order to identify/demystify their experience and gain access
to treatment. They're also important for professionals in order to gain more funding and attention for
research
Dimensional Approach: not presence or absence but on a continuum. Everyone shares fundamental
characteristics differing in the amount e.g. Big 5
SUMMARY: global burden of disease is large - underestimated - not increasing except in young people -
larger demand for treatment. Abnormality is psychological/biological/developmental dysfunction -
distress or impaired functioning - atypical and unexpected
Classification is DSM5 vs ICD11 vs dimensional approach - needed for communication, treatment and
research - don't be too rigid - look at big picture
Readings
Lancet, 2016
- The global burden of mental illness is underestimated
- 5 main causes of this underestimation:
• overlap between psychiatric and neurological disorders (disorders such as epilepsy are typically
labelled as neurological as opposed to psychiatric. classifications for disorders like this are in flux)
• grouping of suicide and self-harm in a separate category
(this is categorized as injury and is not included in calculations to do with mental illness)
• conflation of all chronic pain syndromes with musculoskeletal disorders
(e.g. somatoform)
• exclusion of personality disorders from the burden calculations
• inadequate consideration of the contribution of severe mental illness to mortality from
associated causes
- Estimated 32.4% of YLDs and 13% DALYS due to mental illness (as opposed to 21.2% and 7.1%)
- Estimated that mental illness first in the global burden of disease in terms of YLDs, and the same as
cardiovascular and circulatory diseases for DALYs.
- 5 types of mental illness in the top 20 causes of GBD: major depression, anxiety disorders,
,schizophrenia, dysthymia, bipolar disorder
- there is a disproportionately weak response globally to mental illness - assistance is well below the
level needed, + there is a difference in availability for people from different socioeconomic groups.
- Repositioning DALYs from self-harm from injuries to mental health, and from neurological disorders
and chronic pain (those which should not be considered musculoskeletal), would increase the number of
DALYs from 11.2 to 13.5% of the total. (those which should not be considered musculoskeletal)
- 14.3% worldwide deaths are attributable to mental disorders - for example, people die decades
younger from non-communicable diseases that are neglected due to mental disorders. This does not
include deaths due to self-harm.
Pomerantz, 2019
- Abnormality = distress, deviance from any cultural norms, statistical infrequency, impaired social
functioning
- DSM has become increasingly empirical and reliable and has been revised, although recently a
dimensional approach has been promoted (especially for personality disorders)
- Wakefield theory: Harmful dysfunctional theory: a disorder is a harmful dysfunction, harmful being
based on social norms and dysfunction being based on failing to perform natural function. So, the
definition is a combination of values and science.
- it is important to define as research will be done and clinicians will use it in their vocabulary. Presence
or absence of diagnostic label has powerful impact on attention one receives from a clinical psychologist
- a definition, and therefore a label and diagnosis, can have both positive and negative effects
- DSM5 says a mental disorder is: a clinically significant disturbance in cognition, emotion regulation or
behaviour with a dysfunction in mental functioning and significant distress."
- The process of defining mental disorders and abnormality is up to debate.
- The DSM is considered the best source for definitions and has been revised several times, however is
subject to controversy. This is because it pathologizes normal aspects of life.
- The DSM uses a categorical approach instead of a dimensional approach, but the dimensional one has
been suggested - looking at it on a spectrum as opposed to y/n.
Lecture 2
Identity = a self-structure, an internal, self-constructed, dynamic organization of drives, abilities, beliefs,
and individual history.
Identity development is relevant to take into account as a risk and protective factor for mental health.
- You can pay attention to an individual's identity statuses (e.g. foreclosure) and identity flexibility (e.g.
growth-oriented style)
- You can pay attention to a group's master narratives and sense of belongingness
Identity Status
Exploration + Commitment = Identity achievement
Exploration - Commitment = Moratorium
Commitment - Exploration = Identity foreclosure
, Neither = Identity diffusion
- the most favourable pattern = from identity exploration to identity achievement
50% of adults show patterns of progressive growth, the other 50% show stable, regressive or unstable
identity patterns
Identity process = how identity content is encoded, elaborated and integrated
- e.g., identity exploration, experiential openness and individual differences in assimilation and
accommodation
Identity Styles:
• Informational identity style: actively seek out, evaluate, using self-relevant info, vigilant decision
making, self-questioning, problem focused coping, positively associated with openness to
experience and introspectiveness.
• Normative identity style: deal with identity questions and decisional situations by conforming to
norms of significant others, overuse of automatic/intuitive processing, rigid. Negatively related
to openness and introspection, positively related to avoidant coping, need for closure,
authoritarian, racist, conservative views.
• Diffuse-avoidant identity style: reluctant to confront personal problems and decisions, intuitive
reasoning, avoidant coping, disengagement
- Everyone can use all 3 styles by late adolescence, but often have a favourite
Wisdom = a multidimensional attribute
general/cognitive, personal/reflective, integrated/affective
- Growth-oriented identity style is the informational style positively predictive of all aspects of wisdom
due to use of contemplation, aka understanding and accepting reality through direct experience and
observation in the present
Individual identity = characteristics used to define oneself (e.g. language, tastes, attire)
Collective/contextual identity = characteristics used to describe a group (e.g. heritage, country,
occupation)
Master narratives = culturally shared stories that communicate standards and expectations for
community. They maintain their rigidity by frequency of use.
- deviations from a master narrative may be, being the only black person in a white town.
- people who elaborate their deviation experiences are more like to be in structurally marginalized
positions in society.
- those who elaborated an empowering alternative to this were more likely to be engaged in identity
processes
- A personal narrative weaves together narratives that surround the person, like master narratives.
- Narrative identity is the broad and integrative story a person works on during emerging adulthood and
continues through life - how Me came to be and where Me is going in a world of work, love and belief
Social group affiliation = identification with and belongingness to a group.
Biculturalism = hybrid of values and practices to help people become adaptive to cultural demands,
leads to better adjustment
Lecture 1
Global Burden of Disease: quantifying what stops us from living long healthy lives
- first GBD published in 1997, 107 diseases and 10 risk factors from 8 regions
- 2010 big update, 291 diseases and 67 risk factors from 187 countries
- constantly growing
- GBD is for predicting future trends and guiding policy decisions and setting (to make sure the money
goes to priorities)
DALYs: disability adjusted life years
- how many years are lost to disease (via early death or suffering, aka mortality and morbidity)
- allows us to directly compare the burdens of diseases
- underestimate the true burden of disease, as suicide and self-harm are coded as injuries and 93% of
mental disease is non-fatal.
Mental Disorders = 1 category
WHO mental health definition: well-being, realizing own potential, coping with normal stresses of life,
work productively, contribute to community
- 1 in 4 people experience a mental illness at some point
We see a lot more people with mental illness DALYs in the developed world due to a lot of estimation
problems.
- wage gap leads to a gap in treatment for rich and poor
Depression used to be on the top but now anxiety disorders are in terms of prevalence.
Mental and substance abuse disorders:
- 1 billion people
- 5th in GBD 2017
- 2/3 DALYs caused by depressive, anxiety and substance use disorders
- equal between the genders (women higher internalizing, men higher externalizing)
It can be better to look at YLDs: years lived with disability.
- mental and substance abuse disorders have the highest disability burden: 18.7% of YLDs
Not all mental diseases are included in GBD estimate (e.g. personality disorders, chronic pain syndromes
with psychological components like fibromyalgia, or neurological disorders like dementia)
More people are seeking help, and more young people are reporting mental distress. A 52% increase in
MD for ages 12-17, and for ages 18-25 a 63% increase in MD, 71% increase in serious psychological
distress, 47% increase in suicide related outcomes
What is abnormal?
- distress
- cultural norms
,- statistical infrequency
- impaired social functioning
"mental disorders are psychological, biological or developmental dysfunctions associated with personal
distress or substantial impairment in functioning, atypical or unexpected in cultural context"
80s and onwards was revolutionary for the DSM as symptoms were clustered, there was explicit
diagnostic criteria and everything became evidence based.
The DSM 5 removed the multiaxial assessment system.
The ICD 11 is used globally to record medical/psychiatric diagnoses, has more flexible guidance, and
improves worldwide diagnosis and treatment
- In DSM: depression must include 5 or more symptoms during the same 2-week period
- In the ICD: period of daily depressed mood or diminished interest in activities for 2 weeks
Classifications are important for patients in order to identify/demystify their experience and gain access
to treatment. They're also important for professionals in order to gain more funding and attention for
research
Dimensional Approach: not presence or absence but on a continuum. Everyone shares fundamental
characteristics differing in the amount e.g. Big 5
SUMMARY: global burden of disease is large - underestimated - not increasing except in young people -
larger demand for treatment. Abnormality is psychological/biological/developmental dysfunction -
distress or impaired functioning - atypical and unexpected
Classification is DSM5 vs ICD11 vs dimensional approach - needed for communication, treatment and
research - don't be too rigid - look at big picture
Readings
Lancet, 2016
- The global burden of mental illness is underestimated
- 5 main causes of this underestimation:
• overlap between psychiatric and neurological disorders (disorders such as epilepsy are typically
labelled as neurological as opposed to psychiatric. classifications for disorders like this are in flux)
• grouping of suicide and self-harm in a separate category
(this is categorized as injury and is not included in calculations to do with mental illness)
• conflation of all chronic pain syndromes with musculoskeletal disorders
(e.g. somatoform)
• exclusion of personality disorders from the burden calculations
• inadequate consideration of the contribution of severe mental illness to mortality from
associated causes
- Estimated 32.4% of YLDs and 13% DALYS due to mental illness (as opposed to 21.2% and 7.1%)
- Estimated that mental illness first in the global burden of disease in terms of YLDs, and the same as
cardiovascular and circulatory diseases for DALYs.
- 5 types of mental illness in the top 20 causes of GBD: major depression, anxiety disorders,
,schizophrenia, dysthymia, bipolar disorder
- there is a disproportionately weak response globally to mental illness - assistance is well below the
level needed, + there is a difference in availability for people from different socioeconomic groups.
- Repositioning DALYs from self-harm from injuries to mental health, and from neurological disorders
and chronic pain (those which should not be considered musculoskeletal), would increase the number of
DALYs from 11.2 to 13.5% of the total. (those which should not be considered musculoskeletal)
- 14.3% worldwide deaths are attributable to mental disorders - for example, people die decades
younger from non-communicable diseases that are neglected due to mental disorders. This does not
include deaths due to self-harm.
Pomerantz, 2019
- Abnormality = distress, deviance from any cultural norms, statistical infrequency, impaired social
functioning
- DSM has become increasingly empirical and reliable and has been revised, although recently a
dimensional approach has been promoted (especially for personality disorders)
- Wakefield theory: Harmful dysfunctional theory: a disorder is a harmful dysfunction, harmful being
based on social norms and dysfunction being based on failing to perform natural function. So, the
definition is a combination of values and science.
- it is important to define as research will be done and clinicians will use it in their vocabulary. Presence
or absence of diagnostic label has powerful impact on attention one receives from a clinical psychologist
- a definition, and therefore a label and diagnosis, can have both positive and negative effects
- DSM5 says a mental disorder is: a clinically significant disturbance in cognition, emotion regulation or
behaviour with a dysfunction in mental functioning and significant distress."
- The process of defining mental disorders and abnormality is up to debate.
- The DSM is considered the best source for definitions and has been revised several times, however is
subject to controversy. This is because it pathologizes normal aspects of life.
- The DSM uses a categorical approach instead of a dimensional approach, but the dimensional one has
been suggested - looking at it on a spectrum as opposed to y/n.
Lecture 2
Identity = a self-structure, an internal, self-constructed, dynamic organization of drives, abilities, beliefs,
and individual history.
Identity development is relevant to take into account as a risk and protective factor for mental health.
- You can pay attention to an individual's identity statuses (e.g. foreclosure) and identity flexibility (e.g.
growth-oriented style)
- You can pay attention to a group's master narratives and sense of belongingness
Identity Status
Exploration + Commitment = Identity achievement
Exploration - Commitment = Moratorium
Commitment - Exploration = Identity foreclosure
, Neither = Identity diffusion
- the most favourable pattern = from identity exploration to identity achievement
50% of adults show patterns of progressive growth, the other 50% show stable, regressive or unstable
identity patterns
Identity process = how identity content is encoded, elaborated and integrated
- e.g., identity exploration, experiential openness and individual differences in assimilation and
accommodation
Identity Styles:
• Informational identity style: actively seek out, evaluate, using self-relevant info, vigilant decision
making, self-questioning, problem focused coping, positively associated with openness to
experience and introspectiveness.
• Normative identity style: deal with identity questions and decisional situations by conforming to
norms of significant others, overuse of automatic/intuitive processing, rigid. Negatively related
to openness and introspection, positively related to avoidant coping, need for closure,
authoritarian, racist, conservative views.
• Diffuse-avoidant identity style: reluctant to confront personal problems and decisions, intuitive
reasoning, avoidant coping, disengagement
- Everyone can use all 3 styles by late adolescence, but often have a favourite
Wisdom = a multidimensional attribute
general/cognitive, personal/reflective, integrated/affective
- Growth-oriented identity style is the informational style positively predictive of all aspects of wisdom
due to use of contemplation, aka understanding and accepting reality through direct experience and
observation in the present
Individual identity = characteristics used to define oneself (e.g. language, tastes, attire)
Collective/contextual identity = characteristics used to describe a group (e.g. heritage, country,
occupation)
Master narratives = culturally shared stories that communicate standards and expectations for
community. They maintain their rigidity by frequency of use.
- deviations from a master narrative may be, being the only black person in a white town.
- people who elaborate their deviation experiences are more like to be in structurally marginalized
positions in society.
- those who elaborated an empowering alternative to this were more likely to be engaged in identity
processes
- A personal narrative weaves together narratives that surround the person, like master narratives.
- Narrative identity is the broad and integrative story a person works on during emerging adulthood and
continues through life - how Me came to be and where Me is going in a world of work, love and belief
Social group affiliation = identification with and belongingness to a group.
Biculturalism = hybrid of values and practices to help people become adaptive to cultural demands,
leads to better adjustment
