Ch. 15 – Psychological Disorders

According to psychologists and psychiatrists, psychological disorders are marked by a clinically significant disturbance in an individual's cognition, emotion regulation, or behavior.

The medical model assumes that psychological disorders are mental illnesses with physical causes that can be diagnosed, treated, and, in most cases, cured through therapy, sometimes in a hospital. The biopsychosocial perspective assumes that three sets of influences..

... - biological (evolution, genetics, brain structure and chemistry), - psychological (stress, trauma, learned helplessness, mood-related perceptions and memories), - social and cultural circumstances (roles, expectations, definitions of "normality" and "disorder" .

.....interact to produce specific psychological disorders.

Epigenetics also informs our understanding of disorders.

The American Psychiatric Association's DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) contains diagnostic labels and descriptions that provide a common language and shared concepts for communication and research. Most U.S. health insurance organizations require a DSM diagnosis before paying for treatment. Some critics believe the DSM editions have become too detailed and extensive.

Others view DSM diagnoses as arbitrary labels that create preconceptions, which bias perceptions of the labeled person's past and present behavior.

A child (or, less commonly, an adult) who displays extreme inattention and/or hyper-activity and impulsivity may be diagnosed with attention-deficit/hyperactivity disorder (ADHD) and treated with medication and other therapy. The controversy centers on whether the growing number of ADHD cases reflects overdiagnosis or increased awareness of the disorder. Long-term effects of stimulant-drug treatment for ADHD are not yet known.

Mental disorders seldom lead to violence, but when they do, they raise moral and ethical questions about whether society should hold people with disorders responsible for their violent actions. Most people with disorders are nonviolent and are more likely to be victims than attackers.

Psychological disorder rates vary, depending on the time and place of the survey. In one multinational survey, rates for any disorder ranged from less than 5 percent (Shanghai) to more than 25 percent (the United States). Poverty is a risk factor: Conditions and experiences associated with poverty contribute to the development of psychological disorders. But some disorders, such as schizophrenia, can drive people into poverty.

Anxious feelings and behaviors are classified as an anxiety disorder only when they form a pattern of distressing, persistent anxiety or maladaptive behaviors that reduce anxiety. People with generalized anxiety disorder feel persistently and uncontrollably tense and apprehensive, for no apparent reason. In the more extreme panic disorder, anxiety escalates into periodic episodes of intense dread. Those with a phobia may be irrationally afraid of a specific object, activity, or situation. Two other disorders (OCD and PTSD) involve anxiety but are classified separately from the anxiety disorders.

Persistent and repetitive thoughts (obsessions), actions (compulsions), or both characterize obsessive-compulsive disorder (OCD).

Symptoms of posttraumatic stress disorder (PTSD) include .... - four or more weeks of haunting memories, nightmares, - social withdrawal, - jumpy anxiety, - numbness of feeling, - and/or sleep problems .

.....following some traumatic experience.

The learning perspective views anxiety disorders, OCD, and PTSD as products of - fear conditioning, - stimulus generalization, - fearful-behavior reinforcement, and - observational learning of others' fears and cognitions (interpretations, irrational beliefs, and hypervigilance). The biological perspective: - considers the role that fears of life-threatening animals, objects, or situations played in natural selection and evolution; - genetic predispositions for high levels of emotional reactivity and neurotransmitter production; and - abnormal responses in the brain's fear circuits.

A person with major depressive disorder experiences two or more weeks with five or more symptoms, at least one of which must be either (1) depressed mood or (2) loss of interest or pleasure. Persistent depressive disorder includes a mildly depressed mood more often than not for at least two years, along with at least two other symptoms. A person with the less common condition of bipolar disorder experiences not only depression but also mania—episodes of hyperactive and wildly optimistic, impulsive behavior.

The biological perspective on depressive disorders and bipolar disorder focuses on genetic predispositions and on abnormalities in brain structures and function (including those found in neurotransmitter systems). The social-cognitive perspective views depression as an ongoing cycle of stressful experiences (interpreted through negative beliefs, attributions, and memories) leading to negative moods and actions and fueling new stressful experiences.

Suicide rates differ by nation, race, gender, age group, income, religious involvement, marital status, and (for gay and lesbian youth, for example) social support structure. Those with depression are more at risk for suicide than others are, but social suggestion, health status, and economic and social frustration are also contributing factors.

Environmental barriers (such as jump barriers) are effective in preventing suicides. Forewarnings of suicide may include: - verbal hints, - giving away possessions, - withdrawal, - preoccupation with death, and - discussing one's own suicide. Nonsuicidal self-injury (NSSI) does not usually lead to suicide but may escalate to suicidal thoughts and acts if untreated. People who engage in NSSI do not tolerate stress well and tend to be self-critical, with poor communication and problem- solving skills.

Symptoms of schizophrenia include - disturbed perceptions, - disorganized thinking and speech, and - diminished, inappropriate emotions.

Delusions are false beliefs; Hallucinations are sensory experiences without sensory stimulation Schizophrenia symptoms may be - positive (the presence of inappropriate behaviors) or - negative (the absence of appropriate behaviors).

Schizophrenia typically strikes during late adolescence, affects men slightly more than women, and seems to occur in all cultures. In chronic (or process) schizophrenia, the disorder develops gradually and recovery is doubtful. In acute (or reactive) schizophrenia, the onset is sudden, in reaction to stress, and the prospects for recovery are brighter.

People with schizophrenia have increased dopamine receptors, which may intensify brain signals, creating positive symptoms such as hallucinations and paranoia. Brain abnormalities associated with schizophrenia include enlarged, fluid-filled cerebral cavities and corresponding decreases in the cortex.

Brain scans reveal abnormal activity in the frontal lobes, thalamus, and amygdala. Interacting malfunctions in multiple brain regions and their connections may produce schizophrenia's symptoms.

Possible contributing factors include - viral infections or famine conditions during the mother's pregnancy; - low weight or oxygen deprivation at birth; and - maternal diabetes or - older paternal age

Twin and adoption studies indicate that the predisposition to schizophrenia is inherited. Multiple genes probably interact to produce schizophrenia. No environmental causes invariably produce schizophrenia, but environmental events (such as prenatal viruses or maternal stress) may "turn on" genes for this disorder in those who are predisposed to it.

Possible early warning signs of later development of schizophrenia include both: - biological factors (a mother with severe and long-lasting schizophrenia; oxygen deprivation and low weight at birth; separation from parents; short attention span and poor muscle coordination) and - psychological factors (disruptive or withdrawn behavior; emotional unpredictability; poor peer relations and solo play).

Dissociative disorders are conditions in which conscious awareness seems to become separated from previous memories, thoughts, and feelings. Skeptics note that dissociative identity disorder, formerly known as multiple personality disorder, increased dramatically in the late twentieth century; is rarely found outside North America; and may reflect role playing by people who are vulnerable to therapists' suggestions. Others view this disorder as a manifestation of feelings of anxiety, or as a response learned when behaviors are reinforced by anxiety-reduction.

Personality disorders are disruptive, inflexible, and enduring behavior patterns that impair social functioning. This disorder forms three clusters, characterized by (1) anxiety, (2) eccentric or odd behaviors, and (3) dramatic or impulsive behaviors.

Antisocial personality disorder (one of those in the third cluster) is characterized by a lack of conscience and, sometimes, by aggressive and fearless behavior. Genetic predispositions may interact with the environment to produce the altered brain activity associated with antisocial personality disorder.

In those with eating disorders (most often women or gay men), psychological factors can overwhelm the body's tendency to maintain a normal weight. Despite being significantly underweight, people with anorexia nervosa (usually adolescent females) continue to diet and exercise excessively because they view themselves as fat. Those with bulimia nervosa (usually females in their teens and twenties) secretly binge and then compensate by purging, fasting, or excessive exercise. Those with binge-eating disorder binge but do not follow with purging, fasting, and exercise.

Cultural pressures, low self-esteem, and negative emotions interact with stressful life experiences and genetics to produce eating disorders.