Chapter 16: Psychological disorders Slides prepared by Randall E. Osborne, Texas State University-San Marcos, adapted by Dr Mark Forshaw, Staffordshire University, UK 1

Identifying Psychological Disorders: What Is Abnormal? 2

Identifying Psychological Disorders ‘Psychological Disorder’ is a relatively new invention –possessed by demons –God’s punishment –criminal Medical model DSM-5 3

Defining the Boundaries of Normality Deviation from average? DSM-5 — three key elements for symptoms to qualify as a potential mental disorder –manifested in symptoms that involve disturbances in behaviour, thoughts, or emotions –symptoms associated with personal distress or impairment –symptoms stem from an internal dysfunction biological, psychological, or both 4

Defining the Boundaries of Normality Determining the degree to which a person has a mental disorder is difficult Global assessment of functioning European System –ICD-10, published by World Health Organization –Differs from DSM-5 on criteria –Only transient tic disorder is identical in both systems! 5

Classification North American and European clinicians used to divide disorders into just two categories: –psychosis –neurosis 1952 — Diagnostic Manual of Mental Disorders (DSM) published –recognized need to have a consensual diagnostic system 6

Classification DSM-5 - Neurosis — now anxiety disorders - each of the anxiety disorders, then, is defined by observable features such as excessive anxiety in general, in a particular setting, etc. - Comorbidity — diagnosis is also difficult because some people suffer from more than one disorder 7

Classification & Causation The medical model suggests that a diagnosis is useful, because any given category of illness is likely to have a distinctive cause Aetiology of mental disorders Common prognosis In reality, it is too simplistic to think that there is a single cause, internal to the person that has a single cure 8

Classification & Causation Integrated perspective –biological factors –psychological factors –environmental factors Diathesis-stress model — predisposed with a trigger –a diathesis can be inherited (heritability) –stressful conditions, though, needed to trigger 9

Consequences of Labelling Stigma may explain why 70% of people with diagnosable mental disorders do not seek treatment Erroneous beliefs –mental disorder is a sign of personal weakness –psychiatric patients are dangerous –education about mental disorders dispels the stigma 10

Anxiety Disorders: When Fears Take Over 11

Generalized Anxiety Disorder Anxiety disorder Generalized anxiety disorder –Focused on everything and nothing in particular –1 in 50 people at some point in life –benzodiazepines (valium, librium) stimulate GABA 12

Phobic Disorders Specific phobia Social phobia Preparedness theory Temperament Abnormalities in neurotransmitters serotonin and dopamine common 13

Panic Disorder Panic disorder — recurring panic attacks Agoraphobia 8-12% have an occasional panic attack –Usually during intense stress Modest heritability component Those with panic disorder acutely sensitive to sodium lactate (reinforces biological view) 14

Obsessive-Compulsive Disorder Anxiety plays a role Primary symptom is unwanted, recurrent thoughts (obsession) and actions (compulsion) Numbers often take on exaggerated meaning 2.5% prevalence rate e.g. David Beckham’s soft drink cans 15

Obsessive-Compulsive Disorder Most common obsessions involve contamination, aggression, death, sex, disease, orderliness, and disfigurement Most common compulsions involve cleaning, checking, repeating, ordering/arranging, and counting Obsessions typically derive from concerns that could pose a real threat (e.g., contamination, disease) — preparedness theory –but perceived threat is extreme and becomes maladaptive 16

Dissociative Disorders: Going to Pieces 17

Dissociative Disorders Dissociative disorder Dissociative identity disorder 0.5 to 1% prevalence Female-to-male ratio = 9 to 1 Most report history of severe childhood abuse and trauma 18

Dissociative Disorders Cannot result from normal forgetting or brain injury, drugs, or another mental disorder Dissociative amnesia –loss is usually for a traumatic specific event or period of time Dissociative fugue –loss of former identity and assumption of a new identity 19

Mood Disorders: At the Mercy of Emotions 20

Mood Disorders Depressive disorders Much more than sadness –dysfunctional –chronic –outside socially or culturally accepted norms Not the same as sorrow and grief –normal, possibly adaptive, response to a tragic situation 21

Depressive Disorders Major depressive disorder –twice as common in women as men hormones, postnatal depression response style Dysthymia –same symptoms, less severe Recurrent depressive disorder = major depressive disorder + dysthymia Seasonal affective disorder (SAD) 22

Depressive Disorders — Biological Factors Heritability estimates range from 33-45% Drugs that affect noradrenaline and serotonin could reduce depression Diminished activity in left prefrontal cortex and increased activity in right –areas associated with the processing of emotions 23

Depressive Disorders — Psychological Factors Negative cognitive style Helplessness theory –Some people construct social worlds in ways that contribute to and confirm their negative beliefs Depressed low self-esteem individuals seek confirming negative feedback Depressive realism hypothesis –Non-depressed people are actually less realistic than depressed people 24

Bipolar Disorder Bipolar disorder –Higher and lower moods, both phases can be disabling Lifetime risk of 1.3% for both genders –10% have rapid-cycling bipolar disorder –4 or more mood episodes per year Persistent illness –24% relapsed within 6 months –77% have at least one new episode within 4 years 25

Bipolar Disorder Biological factors –high rate of heritability (80% for identical twins) –close relatives also at heightened risk for unipolar depression –bipolar disorder may be polygenic Psychological factors –stressful life experiences –stress + personality 26

Schizophrenia: Losing the Grasp on Reality 27

Schizophrenia –profound disruption of psychological processes, distorted perceptions, altered emotions Symptoms –delusion –hallucination –disorganised speech –grossly disorganised or catatonic behaviour –negative symptoms (e.g., blunted affect) 28

Schizophrenia - Subtypes ICD-10 gives subtypes –Paranoid –Catatonic –Hebephrenic –Undifferentiated –Residual –Simple 29

Schizophrenia Biological factors –symptoms are so severe it suggests “organic” origins –strong heritability –prenatal exposure to toxins Dopamine hypothesis Neuroanatomy –enlarged ventricles –tissue loss in parietal lobe progressing to much of brain 30

Schizophrenia Psychological factors Family environment –extreme conflict –lack of communication –chaotic relationships Expressed emotion –intrusiveness –excessive criticism 31

Personality Disorders: Going to Extremes 32

Personality Disorders Personality disorders –Deeply ingrained, inflexible patterns of thinking, feeling or relating to others, difficulty controlling impulses DSM-5 PDs fall into three clusters: –odd/eccentric –dramatic/erratic –anxious/inhibited 33

Personality Disorders Antisocial personality disorder –history of conduct disorder –sociopath and psychopath –one study of 22,790 prisoners — 47% of men and 21% of women were diagnosed with APD –less activity in amygdala and hippocampus to words that elicit fear in non-APD 34