Chp 15 Notes

Defining Psychological Disorders

Psychological disorder - a syndrome marked by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior

Disturbed, or dysfunctional thoughts, emotions, or behaviors are maladaptive - they interfere with normal day-to-day life.

Understanding Psychological Disorders

Medical Model
Brutal treatments may worsen, rather than improve, mental health. Philippe Pinel opposed such brutal treatments. He insisted that sickness of the mind is caused by severe stress and inhumane conditions. Curing them requires “moral treatment’” including boosting patients’ moral by unchaining them and talking with them.

Medical model - the concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and in more cases, cured, often through treatment in a hospital

Biopsychosocial Approach
The biopsychosocial approach emphasizes that mind and body are inseparable. Negative emotions contribute to physical illness, and physical abnormalities contribute to negative emotions.

Epigenetics - the study of environmental influences on gene expression that occur without a DNA change

Classifying Disorders & Labeling People

Classification aims to: * Predict the disorder’s future course * Suggest appropriate treatment * Prompt research into causes

DSM-5 - the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; a widely used system for classifying psychological disorders

Such negative reactions about people that have disorders may fade as people better understand that many psychological disorders involve diseases of the brain, not failures of character.

One predictor of mental disorder, poverty, crosses ethnic and gender lines. Usually by early adulthood is when disorders strike.

Anxiety Disorders

Anxiety disorders - psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety

Types:
Generalized disorder - an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal

Panic disorder - an anxiety disorder marked by unpredictable, minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Often followed by worry over a possible next attack. * If the fear is intense enough, people may develop agoraphobia, fear or avoidance of situations in which escape might be difficult when panic strikes.

Phobia - an anxiety disorder marked by a persistent irrational fear and avoidance of a specific object, activity, or situation * Social anxiety disorder is shyness taken to an extreme. People have an intense fear of other people’s negative judgments.

Obsessive Compulsive Disorder (OCD)

OCD - a disorder characterized by unwanted repetitive thoughts (obsessions). Actions (compulsions), or both

Posttraumatic Stress Disorder (PTSD)

PTSD - a disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and or insomnia that lingers for four weeks or more after a traumatic experience

PTSD patients have smaller amygdala - that acorn-shaped brain region that governs fear.

Understanding Anxiety Disorders, OCD, and PTSD

Conditioning
How might conditioning magnify a single painful and frightening event into a full-blown phobia?
2 conditioning processes: * Stimulus generalization - occurs when a person experiences a fearful event and later develops a fear of similar objects * Once fears and anxieties arise, reinforcement helps maintain them. Anything that helps us avoid or escape the feared situation can be reinforcing because it reduces anxiety and gives us a feeling of relief.

Cognition
By observing others, we can learn to fear what they fear.

Biology
Genes
Genes can influence disorders by regulating neurotransmitters. Some studies point to an “anxiety gene” that affects brain levels of serotonin, a neurotransmitter that influences sleep, mood, and attention to negative images. Other studies implicate genes that regulate the neurotransmitter glutamate. With too much glutamate, the brain’s alarm centers become overactive.

The Brain
Traumatic fear learning experiences can leave tracks in the brain, creating fear circuits within the amygdala. These fear pathways create easy inroads for more fear experiences.

Natural Selection

Major Depressive Disorder

Major Depressive Disorder - a disorder in which a person experiences, in the absence of drugs or another medical condition, two or more weeks with five or more symptoms, at least one of which must be either (1) depressed in mood or (2) loss of interest or pleasure

They also display at least two of the following symptoms: * Difficulty with decision-making and concentration * Feeling hopeless * Poor self esteem * Reduced energy levels * Problems regulating sleep * Problems regulating appetite

Bipolar Disorder

Mania - a hyperactive, wildly optimistic state in which dangerously poor judgment is common

Bipolar disorder - a disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania

Understanding Depressive Disorder & Bipolar Disorder

Many behavioral and cognitive changes accompany depression
When depression lifts, behavioral and cognitive accompaniments disappear.

Depression is widespread
Although phobias are more common, depression is the number one reason people seek mental health. Depression is the leading cause of disability worldwide.

Women’s risk of major depression is nearly double men’s
Women are more vulnerable to disorders involving internalized states, such as depression, anxiety, and inhibited sexual desire. Women experience more situations that may increase their risk for depression, such as receiving less pay for equal work, juggling multiple roles, and caring for children.

Most major depressive episodes
Recovery is more likely to be permanent the later the first episode strikes, the longer the person stays well, the fewer the previous episodes, thee less stress experiences, and the more social support received.

Stressful events related to work, marriage, and close relationships often precede depression
As anxiety is a response to the threat of future loss, depression is often a response to past and current loss.

With each new generation, depression strikes earlier (now often in the late teens) and affects more people, with the highest rates in developed countries among young adults

Biological Perspective
Genetic Influences
The risk of major depression and bipolar disorder increase if you have a parent or sibling with the disorder. For bipolar disorders, if one identical twin has it, the chances are 7 in 10 that he other twin will at some point be diagnosed similarly.

To tease out the genes that put people at risk for depression, some researchers have turned to linkage analysis. First, genetics find families in which the disorder appears across several generations. Next, the researchers examine DNA from affected and unaffected family memories, looking for differences.

The Depressed Brain
There is diminished brain activity during slowed down depressive states, and more activity during periods of mania. The left frontal lobe and an adjacent brain reward center become more active during positive emotions. In depressed people, MRI scans found their frontal lobes were smaller than normal. Other studies show the hippocampus, the memory-processing center linked with the brain’s emotional circuitry, is vulnerable to stress-related damage.

Neurotransmitter systems also influence depressive disorders and bipolar disorder. Norepinephrine, which increases arousal and boosts mood, is scarce during depression and overabundant during mania.

Recipe for depression: significant life stress + variation of a serotonin-controlling gene

Nutritional Effects
What’s good for the heart is also good for the brain and mind. People who eat a heart-healthy meal have a low risk of developing heart disease, stroke, late life cognitive decline, and depression.

Social Cognitive Perspective
The social cognitive perspective explores how people’s assumptions and expectations influence what they perceive. Depressed people’s negative assumptions about themselves, their situation, and their future lead them to magnify bad experience and minimize good ones.

Rumination - compulsive fretting; overthinking about our problems and their causes

Explaining bad events by depressed people: * Stable - “it’s going to last forever” * Global - “it’s going to affect everything I do” * Internal - “it’s al my fault”

Just like a star

Negative explanations coincide with a depressed mood, and they are indicators of depression.

Recalling experiences that are consistent with one’s current good or bad mood is called state-dependent memory.

Negative stressful events interpreted through a ruminating, pessimistic explanatory style create, a hopeless, depressed state that hampers the way the person thinks and acts. This in turn fuels negative, stressful experiences such as rejection.

Stressful experiences negative explanatory style depressed mood cognitive and behavioral changes

Suicide and Self-Injury
Comparing the suicide rates of different groups, researchers have found: * National differences * Racial differences * Gender differences * Age differences and trends * Other group differences * Day of the week differences

Nonsuicidal Self-Injury
Some people, especially adolescents and young adults, hurt themselves I various ways. They tend to be les able to tolerate emotional distress.
Through NSSI they may: * Find relief from intense negative thoughts through the distraction of pain * Attract attention and possibly get help * Relieve guilt by inflicting self-punishment * Get others to change their negative behavior (bullying, criticism) * Fit in with a peer group

Schizophrenia - a psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression

Symptoms of Schizophrenia

Positive symptoms: experience hallucinations, talk in disorganized and deluded ways, and exhibit inappropriate laughter, tears, or rage

Negative symptoms: may have toneless voices, expressionless faces, or mute and rigid bodies

Disturbed perceptions
Hallucinations: people see, feel, taste, or smell things that exist only in their minds

Disorganized thinking and speech
Delusion - a false belief, often of persecution or grandeur, that may accompany psychotic disorders

Jumble ideas may make no sense even within sentences, forming what is known as word salad.

Selective attention: people with schizophrenia cannot give their undivided attention to something

Diminished and appropriate emotions
Others with schizophrenia lapse into an emotionless flat affect state of no apparent feeling.
Most also have an impaired theory of mind - they have difficulty perceiving facial emotions and reading others’ states of mind.

Onset and Development of Schizophrenia

Chronic schizophrenia - (also called process schizophrenia) a form of schizophrenia in which symptoms usually appear by late adolescence or early adulthood. As people age, psychotic episodes last longer and recovery periods shorten

Acute schizophrenia - (also called reactive schizophrenia) a form of schizophrenia that can begin at any age, frequently occurs in response to an emotionally traumatic event, and has extended recovery periods

Understanding Schizophrenia

Brain Abnormalities
Dopamine Overactivity - a hyper responsive dopamine system may intensify brain signals in schizophrenia, creating positive symptoms such as hallucinations and paranoia

Abnormal brain activity and anatomy - schizophrenia involves not one isolated brain abnormality but problems with several brain regions and their interconnections

Prenatal Environment and Risk - risk factors for schizophrenia include low birth weight, and maternal diabetes, older paternal age, and oxygen deprivation during delivery
More risk of schizophrenia if: * During the middle of their fetal development, their country experienced a flu epidemic. * People born in densely populated areas, where viral diseases spread more readily. * Born during the winter and spring months - after the fall winter flu season. * Mothers report being sick with influenza during pregnancy.

Genetic Factors
Genes do influence schizophrenia but the odds are low.
Some genes influence the effects of dopamine and other neurotransmitters in the brain.

Environmental Triggers * A mother whose schizophrenia was severe and long-lasting * Birth complications, often involving oxygen deprivation and low birth weigh * Separation from parents * Short attention span and poor muscle coordination * Disruptive or withdrawn behavior * Emotional unpredictability * Poor peer relations and solo play * Childhood physical, sexual, or emotional abuse

Dissociative Disorders

Dissociative disorders - controversial, rare disorders in which conscious awareness becomes separated from previous memories, thoughts, and feelings

Dissociative identity disorder - a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities

Personality Disorders

Personality disorders - inflexible and enduring behavior patterns that impair social functioning

Characterized by: * Anxiety such as a fearful sensitivity to rejection that predisposes the withdrawn avoidant personality disorder * Eccentric or odd behaviors, such as the emotionless disengagement of schizotypal personality disorder * Dramatic or impulsive behaviors, such as the attention getting borderline personality disorder, the self focused and self inflating narcissistic personality disorder, and sometimes dangerous antisocial personality disorder

Antisocial personality disorder - a personality disorder in which a person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members; may be aggressive and ruthless or a clever con artist

Eating Disorders

Anorexia nervosa - an eating disorder in which a person (usually an adolescent female) maintains a starvation diet despite being significantly underweight; sometimes accompanied by excessive exercise

Bulimia nervosa - an eating disorder in which a person alternates binge eating (usually of high calorie foods) with purging (by vomiting or laxative use) or fasting

Binge eating disorder - significant binge eating episodes followed by distress, disgust, or guilt, but without the compensatory purging or fasting that marks bulimia nervosa