Psychological Disorders: When Adaptation Breaks Down (Chapter 15 Study Notes)

Psychological Disorders

Introduction

Psychological disorders, also known as mental illnesses, are conditions characterized by abnormal thoughts, feelings, and behaviors that often result in significant distress or impairment. This chapter explores the criteria for defining mental disorders, historical and cultural conceptions, diagnostic systems, and major categories of psychological disorders.

Defining Mental Disorders

Criteria for Mental Disorders

• Psychopathology: The scientific study of mental illness, often seen as a failure of adaptation to the environment.

• Failure Analysis Approach: Understanding mental illness by examining breakdowns in functioning.

• No Clear-Cut Definition: Mental disorders are difficult to define precisely due to their complexity.

Conceptions of Mental Disorders

• Statistical Rarity: Disorders are uncommon in the general population.

• Subjective Distress: Individuals experience significant emotional pain.

• Impairment: Disorders interfere with daily functioning.

• Societal Disapproval: Behaviors are not accepted by society.

• Biological Dysfunction: Underlying biological or physiological problems.

Historical Conceptions of Mental Illness

Middle Ages: Demonic Model

• Mental illnesses viewed as the result of evil spirits inhabiting the body.

• Treatments included exorcisms and witch hunts.

Renaissance: Medical Model

• Mental illness seen as a physical disorder requiring treatment.

• Patients housed in asylums, often overcrowded and understaffed.

• Treatments included bloodletting and snake pits.

Reformers and Moral Treatment

• Reformers like Philippe Pinel and Dorothea Dix advocated for treating patients with dignity and kindness.

• Despite improved treatment, effective therapies were still lacking.

Modern Era

• 1950s: Introduction of chlorpromazine (Thorazine) reduced symptoms of schizophrenia.

• Deinstitutionalization: Policy of releasing patients and closing hospitals in the 1960s and 1970s.

• Mixed results: Some patients improved, others lacked follow-up care.

• Community mental health centers and halfway houses established to address ongoing needs.

Diagnosis Across Cultures

Culture-Bound Syndromes

• Koro: Belief that genitals are shrinking and receding into the abdomen.

• Amok: Episodes of intense sadness followed by uncontrolled violence.

• Taijin kyofushu: Fear of offending others or emitting a bad odor.

Many severe disorders (schizophrenia, alcoholism, psychopathy) are universal across cultures.

Misconceptions About Psychiatric Diagnosis

• Diagnosis is not just "pigeonholing" people.

• Concerns about reliability and validity.

• Stigma: Diagnoses can negatively affect perceptions and behaviors (labelling theory).

Robins and Guze Criteria for Validity

Criteria for Valid Psychiatric Diagnosis

• Distinguishes diagnosis from similar conditions.

• Predicts laboratory test performance (personality, neurotransmitters, brain imaging).

• Predicts family history of psychiatric disorders.

• Predicts natural history (change over time).

• Predicts treatment response.

Robins & Guze Criteria	Findings Concerning the ADHD Diagnosis
Distinguishes a particular diagnosis from other similar diagnoses	Symptoms can't be accounted for by other diagnoses (e.g., substance abuse, anxiety disorders)
Predicts performance on laboratory tests	Likely to perform poorly on concentration tests
Predicts family history of psychiatric disorders	Higher probability of having biological relatives with ADHD
Predicts what happens to the individual over time	Childhood inattention predicts adult impulsivity and overactivity
Predicts response to treatment	Good chance of responding positively to stimulant medications

The DSM-5

Diagnostic and Statistical Manual of Mental Disorders

• Published by the American Psychiatric Association (APA).

• Currently in its fifth edition (DSM-5).

• Contains 18 classes of disorders.

• Provides diagnostic criteria, decision rules, and prevalence information.

• Warns clinicians to "think organic" and rule out physical causes first.

• Uses a biopsychosocial perspective.

Criticisms of DSM-5

• Not all diagnoses meet Robins and Guze criteria for validity.

• Some criteria and decision rules lack scientific basis.

• High comorbidity (multiple disorders in one individual).

• Relies on a categorical model (disorder is distinct from normal functioning) rather than a dimensional model (disorder exists on a continuum).

Mental Illness and the Law

Mental Disorder Defence

• Legal defense: Individuals not held responsible if not of "sound mind" during the crime.

• Insanity defense requires lack of awareness of actions or wrongfulness.

• Successful in less than 1% of cases.

Involuntary Commitment

• Protects individuals and society from those with severe mental disorders.

• Criteria: Clear threat to self/others or inability to care for oneself.

Myths and Realities

Myth	Reality
Careful evaluation of current mental state is sufficient	Determination is based on mental state at the time of the crime
Judgment of incompetence to stand trial is required	Competence to stand trial is separate from insanity defense
Most acquitted escape criminal responsibility	Only about 1% of criminal trials use the defense; most spend years in psychiatric hospitals
Defenses are complicated and frequently used	Most successful defenses are rare and not frequently used
Most people use the defense to avoid jail	Risk of faking mental illness is low; most defendants do not avoid criminal responsibility

Structured Clinical Tests: MMPI

Minnesota Multiphasic Personality Inventory (MMPI)

• Used to assess psychopathology.

• Developed using the empirical method: Items selected based on ability to distinguish criterion groups.

• Contains 567 true-false questions and 10 basic scales.

• Includes three validity scales: L (Lie), F (Frequency), K (Correction).

• Low face validity: Respondents cannot easily guess what is being measured, reducing faking.

• Good validity but some overlap between scales; cannot be sole basis for diagnosis.

Anxiety Disorders

Overview

• Anxiety can be adaptive but may become excessive and inappropriate.

• Among the most prevalent and earliest onset disorders.

Types of Anxiety Disorders

• Somatic Symptom Disorders: Physical symptoms with psychological origins.

• Illness Anxiety Disorder: Preoccupation with having a serious disease despite lack of evidence.

• Generalized Anxiety Disorder (GAD): Continual worry, anxiety, tension, and irritability about many areas; affects about 3% of the population, more common in females and Caucasians.

• Panic Disorder: Repeated, unexpected panic attacks; persistent concern about future attacks and behavioral changes to avoid them.

• Phobias: Intense, irrational fear of specific objects or situations.

  • Agoraphobia: Fear of situations where escape is difficult.

  • Social Anxiety Disorder: Fear of negative evaluation in social situations.

  • Specific Phobia: Fear of particular objects, places, or situations.

• Posttraumatic Stress Disorder (PTSD): Emotional disturbance after experiencing or witnessing a traumatic event; symptoms include flashbacks, avoidance, and increased arousal.

• Obsessive-Compulsive Disorder (OCD): Repeated immersion in obsessions (unwanted thoughts) and compulsions (repetitive behaviors to reduce distress).

Explanations for Anxiety Disorders

• Learning Models: Fears acquired via classical conditioning and maintained by operant conditioning.

• Observational learning and misinformation can also contribute.

• Cognitive Factors: Anxious individuals engage in catastrophic thinking and have anxiety sensitivity.

• Biological Factors: Anxiety is correlated with trait neuroticism and may involve genetic factors; brain imaging and genetic links (e.g., OCD and Tourette's) are informative.

Mood Disorders

Major Depressive Disorder (MDD)

• Most common mood disorder; affects 16% of North Americans.

• Symptoms: Depressed mood, loss of interest, weight loss, sleep difficulties.

• More prevalent in females; most likely to develop in 30s.

• Episodes can be recurrent and cause significant impairment.

Bipolar Disorder

• Characterized by alternating depressive and manic episodes.

• Mania: Elevated mood, decreased need for sleep, high energy, talkativeness, inflated self-esteem, irresponsible behavior.

• Equally common in men and women; highly genetically influenced.

Explanations for Mood Disorders

• Complex interplay of biological, psychological, and social factors.

• Major life events, especially loss, can trigger depression.

• Interpersonal problems and lack of social support can worsen symptoms.

• Behavioral Model: Depression results from low positive reinforcement.

• Beck's Cognitive Model: Negative beliefs and expectations cause depression.

• Learned Helplessness: Feeling helpless in uncontrollable situations; global, stable attributions for failure.

• Genes and neurotransmitter systems (serotonin, norepinephrine, dopamine) play a role.

Suicide

Risk and Misconceptions

• Higher risk in individuals with MDD and bipolar disorder.

• 11th leading cause of death in Canada and the US; 3rd for children/adolescents.

• Prediction is difficult due to low base rates and limited research.

Common Myth	Reality
Talking about suicide increases risk	Open discussion can help prevent suicide
Suicide is always linked to severe depression	Not all suicidal acts stem from depression; hopelessness is a key factor
People who talk about suicide are not serious	Many who die by suicide have previously discussed it

Personality Disorders

Overview

• Personality traits are inflexible, stable, and expressed in many situations, leading to distress or impairment.

• 10 types listed in DSM-5; only a few are well-researched.

Borderline Personality Disorder

• Instability in mood, identity, and impulse control; often self-destructive.

• Mainly affects women; about 2% of the population.

• Relationships alternate between idealization and devaluation.

• Sociobiological model: Overreaction to stress and lifelong emotional regulation difficulties.

Psychopathic Personality

• Superficial charm, dishonesty, manipulativeness, self-centeredness, risk-taking.

• Overlaps with antisocial personality disorder.

• Primarily affects males; about 25% of prison population.

• Possible causes: Deficit in fear, under-arousal, stimulus hunger.

Dissociative Disorders

Types of Dissociative Disorders

• Depersonalization Disorder: Feeling detached from oneself.

• Dissociative Amnesia: Inability to recall important personal information, usually related to stress.

• Dissociative Fugue: Sudden travel away from home/work with amnesia.

Dissociative Identity Disorder (DID)

• Presence of two or more distinct identities (alters).

• Controversial: Differences between alters may be explained by other factors.

• Debate between posttraumatic and sociocognitive models.

• Evidence supports sociocognitive model: Alters often appear after therapy, and treatment increases number of alters.

Schizophrenia

Overview and Symptoms

• Severe disorder of thought and emotion; loss of contact with reality.

• Symptoms: Disturbances in attention, thinking, language, emotion, relationships.

• Delusions: Strongly held, fixed beliefs with no basis in reality.

• Hallucinations: Sensory perceptions without external stimuli.

• Disorganized speech, echolalia, catatonic symptoms.

Explanations for Schizophrenia

• Psychosocial factors can trigger symptoms in genetically vulnerable individuals.

• Family expressed emotion influences relapse.

• Brain abnormalities: Enlarged ventricles, increased sulci size, hypofrontality.

• Neurotransmitter differences: Dopamine, norepinephrine, glutamate, serotonin systems disturbed.

• Highly genetically influenced.

Diathesis-Stress Model

• Interaction between genetic vulnerability (diathesis) and stressors triggers illness.

• Early warning signs: Social withdrawal, thought/movement problems, lack of emotions, decreased eye contact.

Disorders Diagnosed in Childhood

Autistic Spectrum Disorders

• Severe deficits in language, social bonding, and imagination; often accompanied by intellectual disability.

• Increase in diagnoses likely due to changes in diagnostic practices and inclusion of milder forms (e.g., Asperger's Syndrome).

• No scientific link between vaccines and autism.

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Symptoms: Inattentiveness, impulsivity, hyperactivity.

• Diagnosable in 3-7% of school children; more common in males.

• Related to functional problems in children and adults.

• Highly genetically influenced; treatable with stimulant medications.