🗓️ Unit 12
Psychological Disorders

PSYC 181 – Intro to Psych

Emma Marshall – Instructor

University of Nebraska-Lincoln

August 12, 2024

What you will learn

Learning Objectives

• Describe the historical and modern approaches to mental health services and treatment

• Understand the problems inherent in defining the concept of psychological disorder

• Describe what is meant by harmful dysfunction

• Identify the formal criteria that thoughts, feelings, and behaviors must meet to be considered abnormal and, thus, symptomatic of a psychological disorder

Therapy & Treatment

Approximately 19% of U.S. adults, and 13% of adolescents (ages 8-15) experience mental illness in a given year. The percentage of adults who received mental health treatment in 2004–2008 is shown below. Adults seeking treatment increased slightly from 2004 to 2008. About one-third to one-half of U.S. adolescents with mental disorders receive treatment, with behavior-related disorders more likely to be treated.

Treatment in the past

Throughout most of history, mental illness was believed to be caused by supernatural forces such as witchcraft or demonic possession. People with mental illnesses at this time were often subjected to cruelty and poor treatment. Treatments aimed at supernatural forces: Exorcism – involving incantations and prayers said over the individual’s body by a priest/religious figure. Trephining – a hole was made in the skull to release spirits from the body. This often lead to death. Execution or imprisonment - many mentally ill people were burnt at the stake after being accused of witchcraft.

18th Century

By the 18th century, people exhibiting unusual behavior began to be institutionalized Asylums – the first institutions created for the specific purpose of housing people with psychological disorders. Focus was ostracizing them from society rather than treatment. Individuals often kept in windowless dungeons, chained to beds, little to no contact with caregivers.

This painting by Francisco Goya, called The Madhouse, depicts a mental asylum and its inhabitants in the early 1800s. It portrays those with psychological disorders as victims.

Phillippe Pinel (Late 1700’s)

Philippe Pinel (Late 1700s) French physician. Argued for more humane treatment of the mentally ill. Suggested that they be unchained and talked to. Implemented in Paris, 1975. Patients benefited and many were able to be released from hospital.

This painting by Tony Robert-Fleury depicts Dr. Philippe Pinel ordering the removal of chains from patients at the Salpêtrière asylum in Paris.

Dorothea Dix (19th Century)

• Social reformer and advocate for indigent insane
• Identified poor state of care
• Instrumental in first American mental asylum

A social reformer who became an advocate for the indigent insane. Investigated the state of care for the mentally ill and poor. Discovered an underfunded and unregulated system that perpetuated abuse of the mentally ill. Instrumental in creating the first American mental asylum - by relentlessly lobbying state legislatures and Congress to set up and fund such institutions.

American Asylums (19th Century)

• Usually filthy
• Limited treatment
• Individuals often institutionalized for decades

American Asylums Usually filthy. Offered little treatment. Individuals were often institutionalized for decades. Treatment: Submersion into cold baths for long periods of time. Electroshock treatment (now called electroconvulsive therapy) – involves a brief application of electric stimulus to produce a generalized seizure. Conditions such us these were common until well into the 20th century.

20th Century

1954 - antipsychotic medications were introduced. Proved successful in treating symptoms of psychosis. Psychosis was a common diagnosis, evidenced by symptoms such as hallucinations and delusions, indicating a loss of contact with reality. 1975 - Mental Retardation Facilities & Community Mental Health Centers Construction Act Provided federal support and funding for community mental health centers. Started the process of deinstitutionalization.

Deinstitutionalization – the closing of large asylums, by providing for people to stay in their communities and be treated locally

Patients were released but the new system was not set up effectively. Centers were underfunded, staff untrained to handle severe mental illnesses. Lead to an increase in homelessness.

Mental Health Treatment Today

Mental illness among the homeless population is still common today. Of the homeless individuals in U.S. shelters, about one-quarter have a severe mental illness (HUD, 2011). Correctional institutions also report a high number of individuals living with mental illness.

Mental Health Treatment

• Most not hospitalized but can still seek treatment

Involuntary treatment therapy that is not the individuals choice

• E.g. condition of parole

Voluntary treatment the person chooses to attend therapy to obtain relief from symptoms

Asylums have since been replaced with psychiatric hospitals and local community hospitals focused on short-term care. Emphasis on short-term stays (average stay is less than two weeks). Due to high costs of psychiatric hospitalization - Insurance coverage often limits length of time individuals can be hospitalized. Individuals are usually only hospitalized if they are an imminent threat to themselves or others. Most people are not hospitalized but can still seek psychological treatment. Involuntary treatment – therapy that is not the individuals choice. E.g. weekly counseling sessions might be a condition of parole. Voluntary treatment – the person chooses to attend therapy to obtain relief from symptoms. Sources of psychological treatment – community mental health centers, private or community practitioners, school counselors, school psychologists or school social workers, group therapy. Treatment providers include psychologists, psychiatrists, clinical social workers, marriage and family therapists.

Types of Treatment

Psychotherapy psychological treatment that employs various methods to help someone overcome personal problems, or to attain personal growth

Biomedical therapy involves medication and/or medical procedures to treat psychological disorders

Most often used in combination with psychotherapy

Psychodynamic psychotherapy talk therapy based on belief that the unconscious and childhood conflicts impact behavior

First form of psychotherapy, developed by Sigmund Freud in the early 20th century. Aimed to help uncover repressed feelings. Techniques: Free association – patient relaxes and then says whatever comes to mind at the moment. Freud theorized that the ego would try to block unacceptable urges or painful conflicts during free association causing the patient to demonstrate resistance. Dream analysis – therapist interprets the underlying meaning of dreams. Transference – patient transfers all the positive or negative emotions associated with their other relationships to the psychoanalyst. Psychoanalysis Today: Psychoanalysis is less popular today but Freud’s perspective has been expanded upon by incorporating modern theories and methodology. Psychodynamic psychotherapy - Talk therapy based on belief that the unconscious and childhood conflicts impact behavior.

This is the famous couch in Freud’s consulting room. Patients were instructed to lie comfortably on the couch and to face away from Freud in order to feel less inhibited and to help them focus. Today, a psychotherapy patient is not likely to lie on a couch; instead he is more likely to sit facing the therapist (Prochaska & Norcross, 2010).

Play Therapy

Psychoanalytical therapy wherein interaction with toys is used instead of talk; used in child therapy. Used to help clients prevent/resolve psychosocial difficulties & achieve optimal growth. Techniques: Toys, such as dolls, stuffed animals, and sandbox figurines are used to help children play out their hopes, fantasies and traumas. Sandplay or sandtray therapy - children can set up a three dimensional world using various figures and objects that correspond to their inner state (Kalff, 1991).

Therapist observes how child interacts with toys in order to understand the roots of the child’s disturbed behavior. Can be used to make a diagnosis. Nondirective play therapy – children are encouraged to work through problems by playing freely while therapist observes. Directive play therapy – therapist provides structure/guidance by suggesting topics, asking questions, and playing with the child.

Behavior Therapy

• Principles of learning are applied to change undesirable behaviors

Classical Conditioning principles are applied to recondition clients and change their behavior

Counterconditioning Client learns a new response to a stimulus that has previously elicited an undesirable behavior (phobias)

Aversive conditioning uses an unpleasant stimulus to stop an undesirable behavior (addiction)

Principles of learning are applied to change undesirable behaviors. Based on the belief that dysfunctional behaviors can be changed by teaching clients more constructive behaviors. Classical Conditioning Conditioning principles are applied to recondition clients and change their behavior. Counterconditioning - Client learns a new response to a stimulus that has previously elicited an undesirable behavior. Includes aversive conditioning and exposure therapy. Aversive conditioning – uses an unpleasant stimulus to stop an undesirable behavior. Used to eliminate addictive behaviors. Client is repeatedly exposed to something unpleasant, such as a mild electric shock or bad taste while they engage in a specific behavior  client learns to associate the unpleasant stimulus and unwanted behavior. Antabuse (substance that causes negative side effects such as vomiting when combined with alcohol) has been used effectively to treat alcoholism. Exposure therapy – seeks to change the response to a conditioned stimulus. Used to treat fears or anxiety. Client is repeatedly exposed to the object/situation that causes their problem, with the idea that they will eventually get used to it.

Exposure Therapy

Systematic Desensitization

• Type of exposure therapy wherein a calm and pleasant state is gradually associated with increasing levels of anxiety-inducing stimuli

Mary Cover Jones Developed the first type of exposure therapy. An unconditioned stimulus is presented over and over just after the presentation of the conditioned stimulus. Jones’ Study (1924): Aimed to replace Peter’s fear of rabbits with a conditioned response of relaxation. Repeatedly exposed Peter to a rabbit, while he was eating a snack (in a relaxed state). Rabbit started in a cage on the other side of the room and over several days was gradually moved closer to Peter while he ate his snack. After 2 months, Peter was able to pet the rabbit while eating his snack.

Joseph Wolpe (1958) Refined Jones’s techniques and developed the version of exposure therapy used today. Systematic desensitization – type of exposure therapy wherein a calm and pleasant state is gradually associated with increasing levels of anxiety-inducing stimuli.

Fear and relaxation are incompatible – if client can relax around fear-inducing stimuli, the unwanted fear response will eventually be eliminated. Client is taught progressive relaxation – how to relax each muscle group to achieve a relaxed and comfortable state of mind. Progressive relaxation is used while client imagines anxiety-inducing situations. Overtime, progressive relaxation helps the client become desensitized to the anxiety inducing stimuli. Virtual reality exposure therapy – uses a stimulation to help conquer fears when it’s too impractical, expensive or embarrassing to recreate anxiety-inducing situations.

This person suffers from arachnophobia (fear of spiders). Through exposure therapy he is learning how to face his fear in a controlled, therapeutic setting.

Cognitive Therapy

• Developed by Aaron Beck in the 1960’s
• Suggests that how you think determines how you feel and act
• Emotional reactions are the result of your thoughts about the situation rather than the situation itself
• Encourages clients to find more logical ways of interpreting situations and positive ways of thinking
• Cognitive therapists help clients become aware of their cognitive distortions (thinking errors).

Examples: Overgeneralizing – taking a small situation and making it huge. Polarized (“black & white”) thinking – Seeing things in absolutes, ”I am either perfect, or a failure”. (Common in depression). Jumping to conclusions – assuming that people are thinking negatively about you or reacting negatively to you, without evidence. Clients are helped to change dysfunctional thinking patterns by challenging irrational beliefs, focusing on their illogical basis, and correcting them with more logical and rational thoughts/beliefs.

Cognitive-behavioral Therapy

Unlike other forms of psychotherapy, cognitive behavioral therapy focuses more on present issues rather than on a patient’s past. Rational-Emotive Therapy (RET) - one of the first forms of cognitive-behavioral therapy, founded by Albert Ellis. Cognitive-behavioral therapy (CBT) – works to change cognitive distortions and self-defeating behaviors. (Aims to change both how people think and how they act). Helps clients examine how their thoughts affect their behavior. Combination of cognitive therapy (making individuals aware of irrational, negative thoughts and replacing them with positive ways of thinking) and behavior therapies (teaches people to to practice and engage in more positive, healthy approaches to situations). Uses the ABC model to reveal cognitive distortions (e.g., overgeneralizing, black and white thinking, jumping to conclusions). Action – activating event. Belief about the event. Consequences of the belief.

What are psychological disorders?

Psychopathology the study of psychological disorders, including their symptoms, etiology (causes), and treatment.

Psychopathology – the study of psychological disorders, including their symptoms, etiology (causes), and treatment. Psychological disorder – a condition characterized by abnormal thoughts, feelings, and behaviors. Behaviors, thoughts, and inner experiences that are atypical, dysfunctional, or dangerous are signs of psychological disorders. However, there is no single definition of psychological abnormality or normality. Just because something is atypical, does not mean it is disordered. Red hair is considered unusual, but not abnormal.

DEFINITION OF A PSYCHOLOGICAL DISORDER

Psychological disorder

• a condition characterized by abnormal thoughts, feelings, and behaviors

Cultural Expectations

• Violating cultural expectations
  is not enough by itself
• Social norms vary
  between cultures

Behaviors, thoughts, and inner experiences that are atypical, dysfunctional, or dangerous are signs of psychological disorders.

However, there is no single definition of psychological abnormality or normality.

Just because something is atypical, does not mean it is disordered. Red hair is considered unusual, but not abnormal.

Isla Fischer, (b) Prince Harry, and (c) Marcia Cross are three natural redheads. (credit a: modification of work by Richard Goldschmidt; credit b: modification of work by Glyn Lowe; credit c: modification of work by Kirk Weaver)

Social norms vary between cultures - what is considered appropriate in one culture may be viewed differently in another.

Hallucinations is a violation of cultural expectations in Western Societies. People who report hallucinations are likely to be labeled with a psychological disorder.

However, in some other cultures, certain types of hallucinations are highly valued.

American Psychological Association (APA) Definition

A psychological disorder is a condition that consists of the following:

• Significant disturbances in thoughts, feelings, and behaviors

• Outside of cultural norms

• Disturbances reflect some kind of biological, psychological, or developmental dysfunction.

• Disturbances lead to significant distress or disability in one’s life

  • E.g. difficulty performing appropriate and expected roles.

Despite the many existing definitions, there is no universal agreement on where the boundary between disordered and not disordered is.

THE DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS (DSM)

Diagnosis appropriately identifying and labeling a set of defined symptoms

• Requires classification systems that organize psychological disorders systematically

Diagnostic and Statistical Manual of Mental Disorders: - Published by the American Psychiatric Association. - First published in 1952 and has since undergone numerous revisions. - The first two editions listed homosexuality as a disorder but was removed in 1973. - DSM-5 is the classification system used by most mental health professionals. - Categorizes and describes each disorder. - Diagnostic features – overview of the disorder. - Diagnostic criteria – specific symptoms required for diagnosis. - Prevalence – percent of population thought to be afflicted. - Risk factors. - Provides information about comorbidity (the co-occurrence of two disorders).

DSM Origin Story

PREVALENCE RATES (DSM-IV)

The graph shows the breakdown of psychological disorders, comparing the percentage prevalence among adult males and adult females in the United States.

The DSM-IV, has since been supplanted by the DSM-5. Most categories remain the same; however, alcohol abuse now falls under a broader Alcohol Use Disorder category.

COMORBIDITY (DSM)

Obsessive-compulsive disorder and major depressive disorder frequently occur in the same person.

perspectives on psychological disorders

SUPERNATURAL PERSPECTIVES

Disorders attributed to a force beyond scientific understanding

• Practitioners of black magic (sorcery)
• Possessed by spirits
• Witchcraft

For centuries, psychological disorders were viewed from a supernatural perspective.

Supernatural perspective – psychological disorders attributed to a force beyond scientific understanding. - Practitioners of black magic (sorcery). - Possessed by spirits. - Witchcraft.

Treatments included torture, beatings, and exorcism.

In The Extraction of the Stone of Madness, a 15th century painting by Hieronymus Bosch, a practitioner is using a tool to extract an object (the supposed “stone of madness”) from the head of an afflicted person.

DANCING MANIA

Epidemic in Western Europe (11th-17th centuries) in which groups of people would suddenly begin to dance with wild abandon. - Some would dance for days or weeks, screaming of terrible visions. - Although the cause is unknown, the behavior was attributed by many to supernatural forces.

BIOLOGICAL PERSPECTIVES

View psychological disorders as linked to biological phenomena: - Genetic factors, chemical imbalances, and brain abnormalities. - Supported by evidence that most psychological disorders have a genetic component.

A person’s risk of developing schizophrenia increases if a relative has schizophrenia. The closer the genetic relationship, the higher the risk.

DIATHESIS-STRESS MODEL

Diathesis + Stress → Development of a disorder

Psychosocial Perspective Emphasizes the importance of learning, stress, faulty and self-defeating thinking patters, and environmental factors.

Views the cause of psychological disorders as a combination of biological and psychosocial factors. Diathesis-Stress Model: Integrates biological and psychosocial factors to predict the likelihood of a disorder.

Diathesis + Stress → Development of a disorder

People with an underlying predisposition for a disorder (diathesis) are more likely than others to develop a disorder when faced with adverse environmental or psychological events.

A diathesis can be a biological or psychological vulnerability.

Anxiety

Fear vs Anxiety Fear – an instantaneous reaction to an imminent threat. Anxiety – apprehension, avoidance, and cautiousness regarding a potential threat, danger, or other negative content.

• Motivates us to take action, avoid certain things.
• Level and duration of anxiety usually matches the magnitude of the potential threat. However, some people experience anxiety that is excessive, persistent and out of proportion with the actual threat.

Anxiety Disorders

Characterized by excessive and persistent fear and anxiety, and by related disturbances in behavior.

• Effects approximately 25%-30% of the U.S. population during their lifetime.
• More common in women than men.
• Most frequently occurring class of mental disorders.

SPECIFIC PHOBIA

Involves excessive, distressing, and persistent fear or anxiety about a specific object or situation. - People may realize their fear and anxiety is irrational but may still go to great lengths to avoid the stimulus. - Prevalence - affects 12.5% of the U.S. population at some point in their lifetime.

Common Phobias

Common specific phobias include: - Acrophobia – heights. - Aerophobia – flying. - Arachnophobia – spiders. - Claustrophobia – enclosed spaces.

Agoraphobia: - Listed as a separate anxiety disorder. - Characterized by intense fear, anxiety, and avoidance of situations in which it might be difficult to escape or receive help if one experiences a panic attack. - These situations include public transportation, crowds, being outside the home alone.

ACQUISITION OF PHOBIAS THROUGH LEARNING

• Rachman (1977): 3 Major Learning Pathways

1. Classical Conditioning
   • Child is bitten by dog (US) → dogs become associated with biting (CS) → child experiences fear around dogs (CR)
   • Conditioned fears develop more readily to fear-relevant stimuli (images of snakes and spiders) than to fear-irrelevant stimuli (images of flowers).
2. Vicarious Learning
   • Child observes cousin react with fear around spiders → child later expresses the same fears even though spiders have never presented any danger to him.
3. Verbal transmission of information
   • A child is continuously told that snakes are dangerous → child starts to fear snakes.

Why are certain types of phobias more common than others? - One theory argues that because our ancestors associated certain stimuli with danger (e.g., snakes, spiders, and heights), we are evolutionarily predisposed to associate those stimuli with fear.

SOCIAL ANXIETY DISORDER

Prevalence

• ~ 12% of Americans

Comorbidity

• high rates alcohol abuse disorder (self-medicating)

Risk factors

• Fears of social situations possibly developed through conditioning

• Most report history of severe teasing in childhood

Characterized by extreme and persistent fear or anxiety and avoidance of social situations in which the person could potentially be evaluated negatively by others, leading to serious impairments in life. - Associated with lower educational attainment, lower earning, poor work performance, unemployment. - Safety behaviors – mental or behavioral acts that reduce anxiety in social situations by reducing the chance of negative social outcomes. - E.g., avoiding eye contact or rehearsing sentences before speaking.

Prevalence - experienced by about 12% of Americans during their lifetime.

Comorbidity - high rate of comorbidity with alcohol use disorder. - Individuals may self-medicate to reduce anxiety in social situations.

Risk Factors - Fears of social situations possibly develop through conditioning. - 92% of a sample of adults with social anxiety disorder reported a history of severe teasing in childhood. - Behavioral inhibition – a consistent tendency to show fear and restraint when presented with unfamiliar people or situations.

PANIC DISORDER

Prevalence

• ~ 12% of U.S. population

Comorbidity

• anxiety or major depressive disorders

Panic disorder – recurrent and unexpected panic attacks, along with at least one month of persistent concern about additional panic attacks, worry over the consequences of the attacks, or self-defeating changes in behavior related to the attacks.

Comorbidity - anxiety disorders or major depressive disorder.

Panic attack – a period of extreme fear or discomfort that develops abruptly and reaches a peak within 10 minutes. - Can be expected (in response to an external trigger) or unexpected. - Panic attacks alone are not a disorder.

Some of the physical manifestations of a panic attack are shown. People may also experience sweating, trembling, feelings of faintness, or a fear of losing control, among other symptoms.

• Behavioral inhibition – a consistent tendency to show fear and restraint when presented with unfamiliar people or situations

PANIC DISORDER CAUSES

Genetics

• 43% heritability

Neurobiological Theories

• Locus coeruleus in the brainstem is possibly involved

• Major source of norepinephrine (neurotransmitter that triggers flight-or-flight response)

• Activation is associated with anxiety and fear and produces panic-like symptoms in nonhuman primates

Conditioning Theories Panic attacks are classical conditioning responses to subtle bodily sensations resembling those normally occurring when one is anxious or frightened

Cognitive Theories Individuals with panic disorder are prone to interpret ordinary bodily sensations catastrophically, setting the state for panic attacks.

• In some patients, reducing catastrophic cognitions about sensations has proven to be as effective as medication in reducing panic attacks

GENERALIZED ANXIETY DISORDER

• A relatively continuous state of excessive, uncontrollable, and pointless worry and apprehension.

Diagnosis Criteria

• The diffuse worrying and apprehension is not part of another disorder.

• Symptoms occur more days than not for at least 6 months.

• Symptoms are accompanied by any three of the following symptoms:

  • Restlessness, difficulty concentrating, being easily fatigued, muscle tension, irritability, and sleep difficulties

Prevalence

• Affects about 5.7% of U.S. population during their lifetime
• Females are 2 times as likely as males to experience the disorder

Comorbidity

• Comorbid with mood disorders and other anxiety disorders

GENERALIZED ANXIETY DISORDER CAUSES

Cognitive Theories

• Worry represents a mental strategy to avoid more powerful negative emotions perhaps stemming from earlier unpleasant or traumatic experiences

• Worrying acts a distraction from remembering painful childhood experiences

• Longitudinal study found childhood maltreatment was strongly related to development of the disorder during adulthood. (credit: Freddie Peña)

OBSESSIVE COMPULSIVE DISORDER (OCD)

Prevalence

• ~ 2.3% of U.S. population

Comorbidity

• high rates depression and anxiety disorders

Common Obsessions

• Concerns about germs and contamination

• Doubts

• Order and symmetry

• Aggressive or lustful urges

Involves thoughts and urges that are intrusive and unwanted (obsessions) and/or the need to engage in repetitive behaviors or mental acts (compulsions).

Obsessions – persistent, unintentional, and unwanted thoughts and urges that are highly intrusive, unpleasant, and distressing.

Common obsessions: - Concerns about germs and contamination - Doubts - Order and symmetry - Aggressive or lustful urges

Compulsions – repetitive and ritualistic acts, typically carried out primarily as a means to minimize the distress that obsessions trigger or to reduce the likelihood of a feared event. - Not performed out of pleasure. - The person usually knows these obsessions and compulsions are irrational but suppressing them is extremely difficult.

Prevalence - Experienced by approximately 2.3% of the U.S. population in their lifetime.

Repetitive hand washing and (b) checking (e.g., that a door is locked) are common compulsions among those with obsessive-compulsive disorder.

Other common compulsions include cleaning, ordering, and counting.

OCD CAUSES

Genetics

• 5 times more frequent in first-degree relatives of people with OCD
• Identical twins
• 57% concordance rate
• Fraternal twins - 22% concordance rate
• Genes involved regulate the function of serotonin, dopamine, and glutamate

Conditioning Theories

• Symptoms of OCD are learned responses resulting from both classical and operant conditioning

• Neutral stimulus + unconditioned stimulus → anxiety or distress.

• Once association has been acquired, encounters with the NS trigger anxiety and obsessive thoughts.

• Anxiety and obsessive thoughts continue until a strategy is identified to relieve it

• Relief may be ritualistic behavior or mental activity that reduces anxiety

• Compulsive acts become negatively reinforcing.

OCD Circuit

Orbitofrontal cortex

• involved in learning and decision making
• Becomes hyperactive in people with OCD when provoked with tasks such as looking at photos of a toilet or a pictures hanging crookedly on a wall

OCD Circuit: - Several interconnected regions that influence perceived emotional value of stimuli and selection of behavioral and cognitive responses. - Abnormalities in these areas may produce symptoms of OCD. - Orbitofrontal cortex – involved in learning and decision making. - Becomes hyperactive in people with OCD when provoked with tasks such as looking at photos of a toilet or a pictures hanging crookedly on a wall.

BODY DYSMORPHIC DISORDER

Prevalence

• ~ 2.4% of U.S. population
• slightly higher rates in women than men

Comorbidity

• high rates depression and anxiety disorders

Involves a preoccupation with a perceived flaw in the individuals physical appearance that is either nonexistent or barely noticeable to other people. - Causes person to think they are unattractive or deformed. - Typically involve skin, face, or hair, but can focus on any bodily area. - Causes person to engage in repetitive and ritualistic behavioral and mental acts. - Constantly looking in the mirror. - Trying to hide the offending body part. - Comparison with others. - Cosmetic surgery.

Prevalence - Affects approximately 2.4% of adults in the U.S. - Slightly higher rates in women than in men.

HOARDING DISORDER

Involves great difficulty in discarding possessions, regardless of how valueless/useless they are, usually resulting in an accumulation of items that clutter living or work areas.

Why are they unable to let go of items? - They think items might be useful at a later time. - Sentimental attachment to items.

Excessive clutter prevents the individual using necessary living spaces such as the kitchen or bed.

Diagnosed as long as the hoarding is not a symptom of another disorder.

DEFINITION OF PTSD

Diagnosis Criteria

• Individual was exposed to, witnessed, or experienced the details of a traumatic experience (“actual or threatened death, serious injury, or sexual violence”) (APA, 2013)

• PTSD was first recognized in soldiers who had engaged in combat.

  • Symptoms occur for at least one month

Symptoms Intrusive and distressing memories of the event

• Flashbacks – states during which individual relives the event and behaves as if it were occurring at that moment
• Avoidance of stimuli connected to the event
• Persistently negative emotional states
• Feelings of detachment from others
• Irritability
• Proneness toward outbursts
• Exaggerated startle response.

Prevalence Experienced by approximately 7% of the U.S. population in their lifetime.

RISK FACTORS FOR PTSD

Risk Factors

• Trauma experience

• Lack of immediate social support

• Social Support (comfort, advice, and assistance from relatives, friends, and neighbors) can reduce the risk of developing PTSD

• Subsequent life stress

• Female gender

• Low socioeconomic status

• Low intelligence

• Personal history of mental disorders

• History of childhood adversity

• Family history of mental disorders

LEARNING & THE DEVELOPMENT OF PTSD

Conditioning Theories

• Traumatic event (UCS) → Extreme fear and anxiety (UCR)
• Cognitive, emotional, physiological, and environmental cues associated with the traumatic event become conditioned stimuli
• Traumatic reminders (CS) → Extreme fear and anxiety (CR).

Cognitive Theories Two key processes in development and maintenance of PTSD:

1. Disturbances in memory for the event

   • Poorly encoded memories of trauma can become fragmented, disorganized, and lacking in detail

   • Individuals cannot remember event in a way that gives meaning and context

   • May become haunted by these fragments involuntarily triggered by stimuli associated with the event.

2. Negative appraisals of the trauma and its aftermath (e.g., “I deserve to be raped because I am stupid”).

• May lead to dysfunctional behavioral patterns that maintain symptoms and prevent changes in the problematic appraisals

MOOD DISORDERS

• Characterized by massive disruptions in mood and emotions that can cause a distorted out look on life, and impair ability to function

Depressive Disorders Depression (intense and persistent sadness) is the main feature.

Bipolar and Related Disorders Mania (extreme elation and agitation) is the main feature

• Manic episode – “a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least one week.” (APA, 2013).

MAJOR DEPRESSIVE DISORDER

Diagnosis Criteria “Depressed mood most of the day, nearly every day” (APA, 2013)

• Loss of interest and pleasure in usual activities

• At least 5 symptoms for at least a two-week period

• Symptoms cause significant distress or impair normal functioning and are not caused by substances or a medical condition

  • Major depressive disorder is episodic (symptoms are usually present at their full magnitude for a certain period of time and then gradually diminish)

Symptoms

• Weight loss or weight gain/increased or decreased appetite

• Difficulty falling asleep or too much sleep

• Psychomotor agitation or psychomotor retardation

• Fatigue/loss of energy

• Feelings of worthlessness or guilt

• Difficulty concentrating, indecisiveness

• Suicidal ideation – thoughts of death, thinking about/planning suicide, suicide attempt

Prevalence

• Affects around 6.6% of the U.S. population each year and 16.9% of the U.S. population in their lifetime

• More common among women than men

Comorbidity

• Comorbid with anxiety disorders and substance abuse disorders

Risk Factors

• Unemployment

• Low income

• Living in urban areas

• Being separated, divorced, or widowed

SUBTYPES OF DEPRESSION

Seasonal pattern applies to situations in which a person experiences the symptoms of major depressive disorder only during a particular time of year

Peripartum onset (postpartum depression) major depression during pregnancy or in the four weeks following the birth

Persistent depressive disorder (dysthymia) depressed moods most of the day nearly every day for at least two years, as well as at least two of the other symptoms of major depression

• Chronically sad but do not meet all the criteria for major depression

BIPOLAR DISORDER

• Involves mood states that fluctuate between depression and mania

BIPOLAR DISORDER

Symptoms of Mania

• Excessively talkative

• Excessively irritable

• Exhibit flight of ideas – talk loudly and rapidly, abruptly switching from one topic to another

• Easily distracted

• Exhibit grandiosity – inflated but unjustified self-esteem and self-confidence

• Show little need for sleep. - Take on several tasks at once

• Engage in reckless behaviors

Prevalence Onset is typically before the age of 25

• Affects 1 out of 100 people in the U.S. in their lifetime
• 36% of these individuals attempt suicide

Comorbidity anxiety disorder and substance abuse disorder

BIOLOGICAL BASIS OF MOOD DISORDERS

Hormones

• Elevated levels of cortisol (stress hormone) are found in depression

• Cortisol activates the amygdala and deactivates the prefrontal cortex (disturbances connected to depression)

Neurotransmitters

• Mood disorders often involve imbalances in neurotransmitters

  • Particularly serotonin and norepinephrine

  • Many medications work by altering balance

Genetics Major Depressive Disorder: - Relatives have double the risk of developing the disorder. - Identical twins – 50% concordance rate. - Fraternal twins – 38% concordance rate .

Bipolar Disorder: - Relatives have over 9 times the risk. - Identical twins – 67% concordance rate. - Fraternal twins – 16% concordance rate.

Hormones - Elevated levels of cortisol (stress hormone) are found in depression. - Cause or consequence of depression? - A risk factor for future depression. - Cortisol activates the amygdala and deactivates the prefrontal cortex (disturbances connected to depression).

Neurotransmitters - Mood disorders often involve imbalances in neurotransmitters. - Particularly serotonin and norepinephrine. - These neurotransmitters are involved in bodily functions that are disrupted in mood disorders. - Many medications designed to treat mood disorders work by altering neurotransmitter activity in the neural synapse. - Medications for depression – usually increase serotonin and norepinephrine activity. - Medication for bipolar – Lithium, which blocks norepinephrine activity at the synapse.

Brain Anatomy Depression: - Amygdala – important in assessing the emotional significance of stimuli and experiencing emotions. - Depressed individuals react to negative emotional stimuli, such as sad faces, with greater amygdala activation than do non-depressed individuals. - More prone to react emotionally to negative stimuli. - Prefrontal cortex – important in regulating and controlling emotions. - Decreased activation in depressed individuals which may inhibit its ability to override negative emotions. - Greater difficulty controlling emotional reactions.

DIATHESIS-STRESS MODEL & MAJOR DEPRESSIVE DISORDERS

• Stressful life events often precede the onset of depressive episodes

However, not everyone who experiences stressful life events develop depression, suggesting predispositions or vulnerability factors could be involved.

Genetic vulnerability: - Alteration in the 5-HTTLPR gene (regulates serotonin). - 1 or 2 short alleles + stressful life events → increasingly likely to experience a depressive episode. - A study on gene-environment interaction in people experiencing chronic depression in adulthood suggests a much higher incidence in individuals with a short version of the gene in combination with childhood maltreatment (Brown & Harris, 2013).

COGNITIVE THEORIES OF DEPRESSION

• Cognitive theories suggest that depression is triggered by negative thoughts, interpretations, self-evaluations, and expectations.

Diathesis-Stress model

• cognitive vulnerability + stressful life events → depression

Aaron Beck (1960s) - Theorized that depression-prone people possess mental predispositions to think about most things in a negative way (depressive schemas). - Depressive schemas – contain themes of loss, failure, rejection, worthlessness, and inadequacy. - May develop in childhood in response to adverse experiences. - Dormant until activated by stressful or negative life events. - Prompt dysfunctional and pessimistic thoughts about the self, world, and the future. - Maintained by cognitive biases which lead us to focus on negative aspects of experiences, interpret things negatively, and block positive memories. - Supported by research. - Lead to the development of cognitive therapies.

COGNITIVE THEORIES OF DEPRESSION

Hopelessness Theory

• Specific negative thinking style → sense of hopelessness → depression

• Negative thinking – refers to a tendency to perceive negative life events as having stable (“It’s never going to change”) and global (“It’s going to affect my whole life”) causes

• Creates view that the life event will have negative implications for the person’s future and self-worth, increasing likelihood of hopelessness

• Hopelessness - expectation that unpleasant outcomes will occur or desired outcomes will not occur, and there is nothing one can do to prevent such outcomes (seen as the primary cause of depression)

Rumination

• Distressed mood → Rumination → increased risk and duration of mood

• Rumination – repetitive and passive focus on the fact that one is depressed and dwelling on depressed symptoms, rather than distracting one’s self from the symptoms or attempting to address them in an active, problem-solving manner

• Described to explain higher rates of depression in women, who are more likely to ruminate, than in men

SUICIDE

Statistics 90% of those who complete suicides have a diagnosis of at least one mental disorder (most frequently mood disorders)

• 10th leading cause of death for all ages in 2010 (an average of 105 each day)

• 4 times higher among males (79% of all suicides) than females

  • Males most commonly use fire arms, females most commonly use poison

Risk Factors

• Substance abuse problems (10 times greater in individuals with alcohol dependence).

• Previous suicide attempts.

• Access to lethal means in which to act (e.g., firearm in the home).

• Precursors – withdrawal from social relationships, feeling like a burden, engaging in reckless and risk-taking behaviors.

• Sense of entrapment (feeling unable to escape feelings or external circumstances).

• Cyberbullying.

• Suicide of a family member.

• Serotonin dysfunction.

SCHIZOPHRENIA

Hallucinations perceptual experience that occurs in the absence of external stimulation

• Auditory hallucinations most common

Delusions beliefs that are contrary to reality

• Paranoid delusions – belief that other people or agencies are plotting to harm them

• Grandiose delusions – belief that one holds special power, unique knowledge, or is extremely important

• Somatic delusions – belief that something highly abnormal is happening to one’s body

• Thought withdrawal/insertion

Disorganized thinking

• disjointed and incoherent thought processes

Disorganized or abnormal motor behavior unusual behaviors/movements

• Catatonic behaviors – decreased reactivity to the environment

Negative Symptoms decreases and absences in certain behaviors, emotions, drives

• Avolition – lack of motivation to engage in self-initiated and meaningful activity
• Alogia – reduced speech output
• Asociality – social withdrawal
• Anhedonia – inability to experience pleasure

SCHIZOPHRENIA CAUSES

Prevalence Affects 1% of the population

Genetics Risk is 6 times greater if one parent has schizophrenia (even if adopted)

Neurotransmitters

• Dopamine hypothesis - an overabundance of dopamine or too many dopamine receptors are responsible for the onset and maintenance of schizophrenia

• Drugs that increase dopamine levels can produce schizophrenia-like symptoms

• Medications that block dopamine activity reduce the symptoms

  • High levels of dopamine in the limbic system → hallucinations and delusions
  • Low levels of dopamine in the prefrontal cortex → negative symptoms

Brain Anatomy

• Enlarged ventricles

• Reduced gray matter in the frontal lobes

• Many show less frontal lobe activity when performing cognitive tasks

Events During Pregnancy

• Obstetric complications during birth

• Mother’s exposure to influenza during the first trimester

• Mother’s emotional stress.

DISSOCIATIVE DISORDERS

• Characterized by an individual becoming split off, or dissociated, from their core sense of self
• Memory and identity become disturbed

Dissociative Amnesia

• Inability to recall important personal information. - Usually follows a stressful or traumatic experience. - Dissociative fugue – individual suddenly wanders away from home, experiences confusion about their identity, and in some cases may adopt a new identity

Depersonalization/Derealization Disorder

• Characterized by recurring episodes of depersonalization, derealization, or both

• Depersonalization - feelings of “unreality or detachment from, or unfamiliarity with, one’s whole self or from aspects of the self”

• Derealization – a sense of “unreality or detachment from, or unfamiliarity with, the world, be it individuals, inanimate objects, or all surroundings”

Dissociative Identity Disorder (formerly multiple personality disorder)

• Individual exhibits two or more separate personalities or identities

• Involves memory gaps for the time during which another identity is in charge

• Individuals tend to report a history of childhood trauma

• Adoption of multiple personalities may serve as a psychologically important coping mechanism for threat and danger.

PERSONALITY DISORDERS

• Characterized by a pervasive and inflexible personality style that differs markedly from the expectations of the individuals culture and causes distress or impairment
• Begins in adolescence or early adulthood

Prevalence

Slightly over 9% of the U.S. population suffers from a personality disorder

• Avoidant and schizoid personality disorders are most frequent
• Antisocial and borderline personality disorder are most problematic

Cluster A

• Paranoid personality disorder

• Schizoid personality disorder

• Schizotypal personality disorder

Cluster B

• Antisocial personality disorder

• Histrionic personality disorder

• Narcissistic personality disorder

• Borderline personality disorder

Cluster C

• Avoidant personality disorder

• Dependent personality disorder

• Obsessive-compulsive personality disorder

BORDERLINE PERSONALITY DISORDER

• Characterized by instability in interpersonal relationships, self-image, and mood, as well as marked impulsivity

Symptoms

• Cannot tolerate the thought of being alone – will make frantic efforts to avoid abandonment or separation

• Relationships are intense and unstable

• Unstable view of self – might suddenly display a shift in personal attitudes, interests, career plans, and choice of friends

• May be highly impulsive and may engage in reckless and self-destructive behaviors

• May sometimes show intense and inappropriate anger

• Can be moody, sarcastic, bitter and verbally abusive

Prevalence

• afflicts 1.4% of the U.S. population.

Comorbidity

• anxiety, mood, and substance use disorders.

Causes Core personality traits such as impulsivity and emotional instability show a high degree of heritability

• Many individuals report childhood abuse

ANTISOCIAL PERSONALITY DISORDER

• Characterized by complete lack of regard for other people’s rights or feelings
• Diagnosis requires individual to be at least 18 years old

ANTISOCIAL PERSONALITY DISORDER

Symptoms

Repeatedly performing illegal acts=

• Lying to or conning others

• Impulsivity and recklessness

• Irritability and aggressiveness

• Failure to act in responsible ways

• Lack of remorse

• Overinflated sense of self

• Superficial charmLack ability to empathize

Prevalence

• Observed in 3.6% of the population
• More common in males

ANTISOCIAL PERSONALITY DISORDER CAUSES

Genetics

• Personality and temperament dimensions related to this disorder (fearlessness, impulsive antisociality, and callousness) have a genetic influence

• Adoption studies suggest antisocial behavior is determined by the interaction of genetic factors and adverse environmental circumstances

Emotional

• Deficits Individuals with antisocial personality disorder fail to show fear in response to environment cues that signal punishment, pain, or noxious stimulation

• Show less skin conductance which may indicate emotional deficits

Brain Anatomy

Research has revealed:

• Less activation in brain regions involved in the experience of empathy and feeling concerned for others

• Greater activation in a brain area involved in self-awareness, cognitive function and interpersonal experience

ADHD

• constant pattern of inattention and/or hyperactive and impulsive behavior that interferes with normal functioning

Symptoms

Inattention:

• Difficulty sustaining attention

• Failure to follow instructions

• Disorganization

• Lack of attention to detail

• Easily distracted and forgetful

Symptoms

Hyperactivity:

• Excessive movement

• Interrupting and intruding on others

• Blurting out responses before questions have been completed

• Difficulty waiting ones turn

Prevalence

• Occurs in about 5% of children

• Boys are 3 times more likely to have ADHD than girls

Life Problems

• Low educational attainment

• low socioeconomic status

• unemployment

• low wages

• substance abuse problems

• relationship problems

ADHD CAUSES

Genetics

• Inattention – 71% heritable

• Hyperactivity – 73% heritable

Neurotransmitters Dopamine:

• Genes involved are thought to include at least two that are important in the regulation of dopamine

• Individuals with ADHD show less dopamine activity in key brain regions (especially those associated with motivation and reward)

• Medications have stimulant qualities and elevate dopamine activity

Brain Anatomy

• Studies show smaller frontal lobe volume and less activation when performing mental tasks

• Frontal lobe inhibits behavior

  • may explain hyperactive, uncontrolled behavior of ADHD

AUTISM SPECTRUM DISORDER

Symptoms

• Deficits in social interaction (e.g., do not make eye contact, turn head away when spoken to, prefer playing alone)

• Deficits in communication (e.g., one word responses, difficulty maintaining conversation, echoed speech, and problems using and understanding nonverbal cues)

• Repetitive patterns of behavior or interests

Prevalence

• Affects approximately 1 in 88 children in the U.S.

• 5 times more common in boys

Genetics:

• Identical twins – 60%-90% concordance rates

• Fraternal twins – 5%-10% concordance rates

• Genes involved are those important in the formation of synaptic circuits that facilitate communication between different areas of the brain

Environment:

• Factors that contribute to new mutations (e.g. pollutants)

Symptoms Deficits in social interaction (e.g., do not make eye contact, turn head away when spoken to, prefer playing alone). Deficits in communication (e.g., one word responses, difficulty maintaining conversation, echoed speech, and problems using and understanding nonverbal cues). Repetitive patterns of behavior or interests. Prevalence Affects approximately 1 in 88 children in the U.S. 5 times more common in boys. Causes Genetics: Identical twins – 60%-90% concordance rates. Fraternal twins – 5%-10% concordance rates. Genes involved are those important in the formation of synaptic circuits that facilitate communication between different areas of the brain. Environment: Factors that contribute to new mutations (e.g. pollutants).