disorders

Psychological Disorders

A constellation of symptoms that create significant distress or impairment in work, school, family, relationships, or daily living

Diagnoses/categorization of mental illnesses can be very subjective, often varying between cultures, institutions, individuals, and time periods…
Rosenhan (1973) study: Mentally healthy confederates were admitted with schizophrenia into psychiatric hospitals; they then behaved normally in the hospitals, but their normal behavior was interpreted as pathological

DSM-IV: Official categorization of psychological disorders in U.S.

In 1980, adopted current 5-axis model

Axis I – clinical disorders
Axis II – personality disorders & mental retardation
Axis III – medical (physical) conditions influencing Axis I & II disorders
Axis IV – psychosocial & environmental stress influencing Axis I & II disorders
Axis V – Global Assessment of Functioning score: highest level of functioning patient has achieved in work, relationships, and activities

I. Axis I: Anxiety Disorders: Feelings of excessive fear & anxiety and/or extreme attempts to avoid fear & anxiety

A. Panic Disorder: Sudden, unexpected attacks – overwhelming anxiety; Heart palpitations, difficulty breathing, chest pain, nausea, sweating, dizziness; Fear of dying or losing one’s mind; Can lead to agoraphobia: fear of places which may cause a panic attack

Hypothesized causes: hypersensitivity of locus coeruleus (in brainstem; “alarm system” for fight or flight response) in combination with personal belief that physiological arousal is harmful; high number of stressful childhood/adolescent events

B. Phobias: Simple – intense, irrational fear of a specific object or situation; Social – fear public scrutiny and embarrassment (Most common phobia)

Hypothesized causes: hyperreactivity of amygdala in certain situations involving the feared entity; extreme shyness in childhood perpetuates social phobia into adulthood; classical and operant conditioning (Little Albert); social modeling of others who have phobias

C. Posttraumatic Stress Disorder (PTSD): After a traumatic event (especially crimes, war), symptoms include reexperiencing trauma (dreams, flashbacks), avoidance of anything associated with trauma, and constant state of hypervigilance; Sense of no control over traumatic event – “the world is a dangerous place”; Drug abuse is high w/ PTSD – negative reinforcement (avoidance of symptoms with use)

Hypothesized causes: hypersensitivity of locus coeruleus (“alarm system”) and limbic system; those with lower IQs, fewer cognitive/intellectual resources; belief that world is a dangerous place; lack of family/friend/social support after trauma

D. Obsessive-compulsive disorder (OCD): Obsessions – recurrent, intrusive thoughts; Compulsions – recurrent urges to perform ritualistic actions; Washing: thoughts of contamination; Checking: Did I lock the car? Counting: Count to 100 so that the obsessive thought of disaster will not happen

Hypothesized causes: Malfunction of caudate nucleus of the basal ganglia: not turning off recurrent thoughts; serotonin-based medications reduce symptoms (although “why” is not known); operant conditioning: compulsions relieve anxiety created by obsessions; rejecting families lead to higher stress, which manifests into OCD for rejected person

II. Axis I: Mood Disorders: Emotional disturbances that interfere with normal life functioning

A. Major Depressive Disorder – at least 2 weeks of depressed mood/loss of interest along with several other symptoms, including…Significant weight loss (but not through a diet), Insomnia or hypersomnia, Restlessness or sluggishness, Indecisiveness, lack of concentration, Thoughts of death or suicide

Hypothesized causes: low activity in frontal lobe area that controls emotional centers of brain; markedly different levels of serotonin & norepinephrine than normal levels; negative view of world, self, & future (internal & stable attributions of self-blame); critical & unsupportive families
Suicide: ~ 30% of clinically depressed people attempt suicide

B. Bipolar Disorder: Manic phases, which last at least a week and are characterized by intense agitation and/or elation, are followed by depression episodes; Left untreated, these extreme shifts in mood can progress to a constant state

Hypothesized causes: enlarged amygdala (lymbic system: emotions); abnormal levels of serotonin & norepinephrine; abnormal and continuous exposure to electric lights; critical and unsupportive families

III. Axis I: Somatoform Disorders

A. Psychosomatic; genuine physical ailments caused in part by psychological factors

B. Somatoform: No authentic organic basis; due entirely to psychological factors

Conversion disorders: Loss of function in a single organ; Usually a bit more serious, but doesn’t fit with medical knowledge
Hypochondriasis: Incessant worry about getting sick

IV. Axis I: Dissociative Disorders: Lose contact with part of conscious and/or memory; Result is interruption of sense of identity

A. Dissociative amnesia: Sudden loss of memory for personal info, usually about a traumatic event
B. Dissociative fugue (~ 0.2% of U.S. population): Loss of memory for entire life, including personal identity
C. Dissociative identity disorder (a.k.a. MPD: ~ 1% of U.S. population): Coexistence of 2 or more personalities; Host usually unaware of other personalities; Experienced repeatedly severe physical abuse as a child

V. Axis I: Eating Disorders: 90% of diagnoses are women

A. Anorexia nervosa: Intense fear of gaining weight – constant desire to keep losing weight (weight usually less than 85% of average weight for height); Distorted body image; Loss of menstrual periods (amenorrhea); ~ 10% die from this disorder

Hypothesized causes: family history of OCD; being “perfectionistic”, irrational about expectations for body; operant conditioning: feelings of mastery over body; cultural emphasis on being thin

B. Bulimia Nervosa: recurrent binge eating followed by purging, fasting, and/or intense exercising

Hypothesized causes: lower levels of serotonin (creates feeling of satiety); dieting in some extreme cases can lead to onset; normative influence: approval by peers

VI. Axis 1: Schizophrenic Disorders: Grossly impaired/altered functioning; Social: withdrawn, few friends, usually since childhood
Affect (emotional): flat affect, inappropriate displays; Cognitive: delusions, hallucinations; Motor: tracing patterns in the air or holding one pose for hours; Positive (presence of abnormal behavior) vs. negative (absence of normal functioning) symptoms

A. Catatonic: Bizarre, immobile, or relentless motor behaviors
B. Paranoid: Hallucinations (voices), delusions of persecution and/or grandeur (Jesus), suspicion; Intellect and affect are usually normal
C. Disorganized: Personality deterioration, bizarre behavior (public urination), disorganized speech; Or flat, inappropriate affect (laughter)
D. Undifferentiated: no specific category is appropriate

About 1 in 100 develop schizophrenia worldwide

Hypothesized causes: having relatives with schizophrenia increases risk (but, over 80% w/ a schizophrenic relative do not develop it); impaired frontal lobe functioning (abstract thinking & planning); abnormally high levels of dopamine; complications at birth which lead to oxygen deprivation

VII. Axis 2: Personality Disorders: Stable, inflexible, and maladaptive personality traits, causing distress in normal functioning, especially noticeable over repeatedly interactions

Criticism #1 : too much overlap with Axis I disorders
Criticism #2: only difference with a lot of personality disorders from normal behavior is the quantity of symptoms (i.e., symptoms in moderation are regarded as ‘normal’)

A. Anti-social personality disorder: pattern of disregard for others, violation of the rights of others; Lack of conscience, empathy, remorse; While only 1-2% of U.S. population, ~ 60% of male prisoners are estimated to have this personality disorder;

Hypothesized causes: emotional deprivation, abuse, and inconsistent/poor parenting; underresponsive nervous system: sensation-seeking & unaffected by social rejection, mild punishment, and/or legal consequences

Important Note for all of these disorders: Hypothesized Causes…It is very, very important to know that the causes listed here are merely scientific “guesses”, which often seem to work in tandem with each other to increase likelihood of particular disorder; No one “guess” is likely to cause the disorder in isolation

Diathesis-Stress Model: if it’s in your genes (genetic predisposition), a disorder may not evolve unless environmental stressors occur to trigger the disorder
And, to boot, many of these “guesses” may actually turn out to be consequences rather than causes