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# Chapter 13: Psychological Disorders

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## William Cockrell

on 3 April 2018

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#### Transcript of Chapter 13: Psychological Disorders

Chapter 13: Psychological Disorders
Normality and determining mental illness
Psychopathology:
the process of determining what is considered a mental illness or disorder.
Psychopathologist:
Not necessarily a therapist. This researcher is more likely both a clinical and statistical psychologist. They create governing bodies to determine what is considered abnormal behavior.
Statistical Abnormality:
this is the most common measurement to determine what is considered abnormal behavior.
If the majority of the society displays the behavior, it is considered normal.
Normal Distribution :
the mathematical and scientific phenomena where scores tend to center around the mean/average with less numbers in the extremes. All scientific research strives for this! It is also a basic assumption in all statistical testing.
A normal distribution always takes the shape of a bell-curve on a visual graph of scores. When research results in an abnormal distribution, researchers have to do additional statistical testing to determine the data is reliable and not due to extraneous variables.
Instructors also want test averages to reflect the normal distribution.
Regression towards the mean:
the statistical law that when multiple scores are submitted, a majority of them will be close to the average instead of many extreme scores.
The mean average of IQ scores is 100. 96% of the American population ranges between a score of 70-130. This is a normal distribution of scores.
When we use the normal distribution to analyze mental illness, both ends of the distribution could be considered abnormal.
Relativity of deviance =
like many aspects of socialization, deviance differs depending on cultural norms and values. What is considered abnormal in one culture may not in a different culture.
Social Nonconformity:
We have to understand that not following social norms does not mean the person is mentally ill. Social noncomformity means that the person may be more.....eccentric, but is completely sane.
Being a social psychologist, I have to stress the importance of context when determining abnormal behavior.
Let's review three paragraphs on pg. 545 in your textbook to get a better understanding.
So what is abnormal behavior then??
Subjective Discomfort:
One aspect of mental illness would be reporting a lot of discomfort OR no discomfort.
Everybody will experience subjective discomfort, we have to remember that it would be a long-term duration of discomfort.
behavior that a person performs which is NOT helpful. Examples include the following behaviors when a person becomes stressed: smoking, drinking, drug abuse, sex, gambling, extreme sports, etc.
Let's use gambling like the textbook does. A person who never gambles wins 1,000 dollars and leaves. This is not maladaptive behavior.
A person who gets stressed and goes straight to the casino is an example of maladaptive behavior.
Insanity:
This is a legal term, not a psychological term! Lawyers and judges use this to define a person. People declared insane are determined by the court as unfit to take care of themselves.
Not Guilty By Reason of Insanity (NGRI) :
court ruling where the crime is dismissed and the person is institutionalized instead of imprisoned.
Less than 1% of cases receive a NGRI ruling in America
Psychological Determinations of Mental Illness
Diagnostic and Statistical Manual of Mental Disorders (DSM) :
this is the very large book that lists all of the mental illnesses acknowledged by the American Psychological Association.
We are currently using the revised 5th edition. They tend to update the DSM at least once a decade.
Mental Disorders:
the description used to explain when somebody experiences an impairment from normal functioning. Meaning they are lacking skills that most average people have.
Psychotic Disorders:
more extreme than mental disorders. The classic description is "detached from reality". Psychosis can form due to genetic history, medical issues (brain trauma/tumors), or substance abuse.
Organic Mental Disorders:
disorders caused by permanent damage to the brain. Yet again, this could be caused by diseases (dementia), injuries (TBI), or substance abuse (LSD).
Almost ALL mental disorders have some genetic or biological component. This is why the DSM does not distinguish between organic and other forms of disorders.
Mood Disorders:
These disorders primarily center around extreme experiences of emotion. Therefore, the person tends to experience
mania
or
depression
. A focus is that they experience extreme forms for longer than normal periods. One of the most common types of disorders.
Anxiety Disorders:
these disorders are described as very high levels of stress, fear, and panic. We lump PTSD and OCD under anxiety disorders.
Somatoform Disorders:
mental disorders that mimic physical illnesses. This is when people have psychological distress and develop stomach ulcers, temporary blindness, paralysis, etc. Phantom Limb Syndrome is an example of somatoform disorders.
Dissociative Disorders:
Similar to psychotic disorders and often occur together. These people have memory loss, distorted memory, multiple personalities, or depersonalization.
Personality Disorders:
disorders that usually appear in adolescence and stay stable throughout a person's lifespan (if left untreated). Usually left undiagnosed compared to other forms.
Sexual and Gender Identity Disorders:
People that experience gender dysphoria are under this category. Sexual Dysfunctions and paraphilias are also in this category.
Substance-related disorders:
Extended and habitual use of most substances will eventually cause some form of psychological distress.
Risk factors of mental illness:
Biology/Heredity, Psychological, Family, and Social conditions.
People First!!!
The current suggestion is to use "people first" terminology.
We do NOT say schizophrenic people, anorexic people, depressed people, anxious people, etc.
We label problems not people
It is more appropriate to say people with schizophrenia, people who are anorexic, people who are depressed, people who are anxious, etc.
Psychologists used to refer to their clients as "patients", but they stopped doing this. The argument is that being called a "patient" labels them as abnormal.
Typically, therapists will refer to their patients as "clients". This may have it's own semantic problems.
As you have all heard, psychological illnesses are still highly stigmatized. This is why many people will never seek help for mental disturbances.
Psychotic Disorders
Psychosis:
as previously mentioned, a detachment from reality. People with psychotic disorders are the easiest to diagnose.
People with moderate to severe psychotic disorders are usually not able to live alone.
Delusions:
the most common symptom of psychotic disorders. Delusions are beliefs that people with psychosis experience. These beliefs are always false and no amount of "evidence" will disconfirm them.
Depressive Delusions:
the faulty belief that they have committed some terrible act (e.g., thinking they have stolen items, broken a law, killed a person, etc).
Somantic Delusions:
Delusions where you are convinced you are dying, decaying, or experiencing illness that is not there. These people may actually
see
their arm rotting,
smell
the decay of their leg, or
feel
the pain associated with tissue loss.
Delusions of Grandeur:
one of the most common delusions. The beliefs that they are very important, invincible, or gifted. Common with mass murderers who have displayed psychotic disorders.
Delusions of Influence:
this one is depicted in movies often. John Nash in
A Beautiful Mind
experienced this type of delusion. The belief that unforseen forces (e.g., aliens, FBI, CIA, etc) are controlling or influencing their lives.
Delusions of Persecution:
often related to delusions of influence. These delusional beliefs revolve around the thoughts that they are always at risk of harm by delusions of influence.
Delusions of Reference:
the belief that media (songs, books, movies, news stations) or other sources have personal or significant meaning. Examples are stalking singers because they believe the music was written for them
Psychosis Continued
Hallucinations:
false sensory information that the person is perceiving. The most common is hearing voices in their head.
This means that hallucinations can either be: sight, sound, taste, touch, or smell. Try to think of an example for each sense.
Neuropsychological research typically demonstrates that when people "hear" voices, the part of the brain responsible for hearing (temporal lobe) is activating. When people "see" things, their occiptal lobe is activating.
Biological influences of psychosis:
anesthesia, lack of temperature sensitivity, hypersensitivity to temperature, hypersensitvity to most senses.
Disturbed Emotions:
psychosis tends to foster exagerrate responses to emotions. This means that people who struggle with psychosis also typically experience mood disorders.
Flat Affect:
The person does not experience any appropriate emotional responses. The other outcome would be the person tends to have the typical "staring off into space" look on their face. This is sometimes referred to as being "catotonic".
People with extreme psychosis typically are unable to complete sentences. A complete loss of verbal communication can often be common without any medical treatment.
Let's review table 13.3 (page 554) at the common signs of psychotic breaks. These are typically symptoms that prelude the person's first severe experience with psychotic symptoms.
http://digital.films.com/PortalPlaylists.aspx?aid=27675&xtid=43679&loid=118404
Organic Psychosis
http://digital.films.com/PortalPlaylists.aspx?aid=27675&xtid=44797&loid=121089
http://digital.films.com/PortalPlaylists.aspx?aid=27675&xtid=39706&loid=63577
As mentioned in class last week, organic psychosis is when we can "pinpoint" the physical cause of the mental illness.
Examples include: meth psychosis, all forms of dementia, lead poisoning, alcoholism, concussions, etc.
Dementia:
Deterioration of the brain that often coincides with aging. The most common symptoms of dementia are: memory loss, loss of reasoning and judgement, being impulsive, and loss of personality.
Given the brain is atrophying (shrinking), the final symptoms are usually loss of motor control, strokes, circulation problems, and inability to control breathing.
AP0E4 Gene:
Genes responsible for protein production in the brain. Everybody has two AP0E genes that are labeled by number. People with the AP0E2 gene are the least likely to develop Alzheimer's.
People with AP0E4 are very likely to develop Alzheimer's.
Alzheimer's Disease
Most common neurological disorder among elderly people.
Neuritic plaques :
nerve endings that have died and slow down mental processing
Neurofibrillary tangles :
brain, nerve fibers that become twisted and slow down mental processing.
Affects 10% over 65 and 50% over the age of 85. Around 4.5 million people have Alzheimer's in America (Alzheimer's Association, 2004).
Common symptoms are : deficit in recent memory, impairment of judgement, change in personality.
Schizophrenia
Schizophrenia:
one of the "hallmark" forms of psychosis. Very rare disorder that receives a lot of attention. Like all forms of psychosis, the person experiences delusions and hallucinations.
The most common signs that a person is experiencing a schizophrenic break are withdrawal from people, stopping desired activities, and problems maintaining personal habits.
1 out of 100 people are considered schizophrenic.
People with schizophrenia have trouble dealing with multiple stressors simultaneously. There is a link between schizophrenia and attention deficits (NO! people with ADD & ADHD are NOT schizophrenic).
Psychologists used to organize schizophrenia by subtypes:
Disorganized
,
Catatonic
,
Paranoid
, and
Undifferentiated
.
The APA & DSM does not organize by subtypes anymore due to the findings that most people with schizophrenia may experience multiple subtypes.
Looking Through Their Mind
Positive Symptoms:
Symptoms that the general population does NOT have (e.g., hallucinations, delusions, flat affect).
Negative Symptoms:
Characteristics that the general population do have, but people with schizophrenia DO NOT HAVE (multitasking skills, emotional expressions, and empathy).
The three main causes of schizophrenia: environment, heredity, and brain chemistry.
Causes of Schizophrenia
Pregnant women who develop the flu or measles during the 2nd trimester have a higher risk of producing children with schizophrenia.....GET VACCINATED!!!
Malnourished pregnant women may also increase the risk of having schizophrenic children.
Psychological trauma tends to be an factor also. Many people with schizophrenia have experienced childhood abuse, BUT many people with schizophrenia have not experienced abuse.
Heredity is the strongest explanation for schizophrenia. If one identical twin has schizophrenia, the other twin has a 48% chance!
The older the father, the higher the risk of the child developing schizophrenia (we are talking 45+ here). The study I read only examined male participants over the age of 60!!
A schizophrenic brain produces much more
dopamine
than a person without schizophrenia. The other part of this is that the dopamine receptors are more sensitive to amounts of dopamine.
People that take hallucinogenics like LSD, E, and PCP cause the brain to produce extra glutamate. People that overdose on these drugs have too much glutamate in their brain. The extra glutamate causes the people who overdose to experience symptoms of Schizophrenia!
People who have schizophrenia also produce much higher levels of glutamate than people who do not have schizophrenia.
Research also supports the argument that dopamine and glutamate are related. Meaning the increase/decrease in one tends to cause a reaction in the other.
Stress-vulnerability model:
most mental illnesses are a combination of environmental exposure influencing brain chemistry to perform different than most people. In other words, a combination of multiple factors.
Depression and Mood Disorders
The DSM symptoms for depression : sadness, frustration, hopelessness, disturbances in sleep (insomnia or hypersomnia), appetite change, problems focusing, and lack of energy.
15-20% of teenagers have had at least one major depressive episode.
A depressive episode would be experiencing at least five of the above mentioned symptoms for two weeks or more.

http://www.ncbi.nlm.nih.gov/books/NBK64063/
http://www.nimh.nih.gov/health/publications/depression/index.shtml
http://www.nimh.nih.gov/health/publications/depression/depression-booklet_34625.pdf
Globally, by adolescence, girls are twice as likely to report depressive symptoms. This could be analyzed two ways. 1) It is more acceptable for girls to report feeling "upset" than boys and 2) Girls may actually experience higher rates of depression due to unequal gender treatment.
Like many other psychological disorders, depression is both due to genetics and parenting (environment).
When examining gender instead of sex, researchers find that people who display feminine characteristics are more prone to depression.
Depression is a serious illness considering the most common outcome, is help is not received, is suicide.
Throughout life, we find that as a person ages, their chance of suicide increases.
This makes sense, considering very few 5 year old children commit suicide, but it is not uncommon for a 65 year old to commit suicide.
Suicide is the third most common cause for death among teenagers. The first is automobile accidents followed by murder.
Classic, historical sociological studies found that
social integration
is one of the most important preventative measures of suicide. The more involved and integrated person is into society, the less likely they are to commit suicide.
Native Americans, at any age, are at high risk of suicide due to continued, blatant discrimination from the American government.
LGBTQ youth are 3 times more likely to attempt suicide than their heterosexual peers.
It is important to remember that antidepressant medications tend to amplify suicidal thoughts in the first week or few days. Many people (not all) who are not helped by antidepressants stop taking them before they even fully enter the system.
The NRA would never want you to believe it, but there is a strong relationship between gun control and suicide among teenagers. What would this be?
We have now progressed to realizing that close ties to a suicide victim tend to need counseling themselves to deal with the bereavement and guilt.
The gendered pattern of suicide method is actually found and valid in many countries.
Research is still inconclusive if the "It Gets Better Project" is actually helpful.
Suicide
Suicide and the Elderly
All behaviors of deviance decrease with age, except committing suicide.
The elderly have relatively high rates of suicide compared to other age groups.
The elderly White male has the highest suicide rate of any group; a White male over the age of 85 is
13 times more likely
to commit suicide than an elderly White female.
When elderly White men become widowers they are at highest risk of suicide (think of previous aspects of elderly males we have talked about)
Classic research by Durkheim categorized suicide into four types : egoistic, altruistic, anomic, and fatalistic.
Schizophrenia and the Brain
CT scans of the brain reveal that people with schizophrenia have atrophied brains (what does atrophy mean?).
Does schizophrenia cause the brain to atrophy or does an atrophied brain cause schizophrenia??
MRI scans in over 100 different studies have found that people with schizophrenia tend to have enlarged ventricles in the brain.
PET scans have revealed that people with schizophrenia tend to have less activity in the frontal lobe of the brain.
This means that we should commonly expect people with schizophrenia to have both atrophy of the brain (reduction in size) as well as enlarged ventricles. People with schizophrenia tend to have brains that are both decayed and inflamed.
The less treatment a person receives, the more significant these brain changes will be. The most extreme brain changes occur when the person has NEVER received treatment.
People with schizophrenia also have a very low amount of grey matter in the brain when compared to people that do not have schizophrenia. You should ask the same question again: does grey matter loss cause schizophrenia or does schizophrenia cause grey matter loss?
Mood Disorders Continued
Mood Disorders:
experiencing disruptions in mood. The most common experiences are depression or anxiety.
Depressive Disorders:
A focus on depression being the most debilitating symptom. Depressive disorders are also considered a mood disorder. These people would be most likely to be diagnosed as clinically depressed.
Bipolar Disorders:
An extreme fluctuation between both Anxiety and Depression. These people are technically experiencing both mood and depressive disorders.
Dysthymic Disorder:
moderate depression that lasts for at least two years.
Clyclothymic Disorder:
people who have moderate anxiety AND depression for at least two years. These people are more likely to be bipolar.
Bipolar I disorder:
these people are how we typically expect bipolar people to act. High amounts of both anxiety and depression. High amounts of anxiety is often called
mania
.
Bipolar II disorder:
these people are most likely to experience depression with less severe forms of mania. A less severe form of mania is
Hypomania
. This is what people with bipolar II disorder experience.
Depression causes withdrawal and isolation whereas mania tends to cause irrational and risky behavior.
Cause and Treatment of Mood Disorders
The primary explanation for almost all mood disorders would be due to faulty neurotransmission.
Mood disorders are the result of either too much or too little of a specific neurotransmitter.
Serotonin, noradrenaline, and dopamine are the three main neurotransmitters that influence a mood disorder.
Most antidepressants are used to either block or excite the production of the neurotransmitters listed above.
Lithium has been used for over 20 years now to treat severe forms of Bipolar disorders. Lithium is VERY effective but people tend to focus on negative side effects of the drug.
Electroconvulsive Therapy:
The therapeutic practice where people with severe forms of schizophrenia or bipolar disorder are given electroshock therapy to reduce the symptoms of depression.
Hollywood has painted electroshock therapy as a very harmful and "evil" procedure. Thousands of people are able to manage their symptoms with electroshock therapy.
http://fod.infobase.com/PortalPlaylists.aspx?wID=100833&xtid=32730&loid=3559
Family Factors that cause stress
Infertility:
the inability to conceive a child after at least one year of not using protection in an attempt to have a child.
Unintended Pregnancy:
A pregnancy that was not planned or one that is not wanted.
Unmarried fathers of unintended pregnancies tend to react the harshest and most negatively. It is not terribly uncommon for the stress to cause the father to terminate the relationship with the expecting mother. Men receive little social punishment for this behavior.
Unemployment always causes a drop in self-esteem and an increase in both anxiety and depression.
Living in poverty will increase your chances of experiencing some form of mental illness. It also increases your chances of never being diagnosed or receiving treatment.
Social factors that are less likely to happen if you are married: attempting suicide, automobile accidents, transmission of syphilis, depression, and anxiety.
Empty Nest Syndrome:
There is no scientific support that when the children leave the house the marriage becomes strained.
Happy relationships tend to become even happier when the children leave!
Postpartum Depression (PPD):
the experience of a new caregiver feeling sad, anxious, angry, and overwhelmed about caring for a newborn. Research is not conclusive on the cause, but it is believed to be chemically influenced by hormones. Can last up to 1 year
Fathers CAN be diagnosed with PPD. This leads us to believe it is not directly linked to the physical birthing procedure. Around 10% of fathers are diagnosed.
http://www.acf.hhs.gov/sites/default/files/cb/cm2012.pdf#page=31
Review the rates of childhood abuse in America
4% of children in America are believed to suffer from child abuse
Like all criminal activity, we have a problem with under-reporting.
What are socially desirable responses to surveys?
The younger the child, the higher the rates of child abuse.
90% of child abusers are men
Child abusers themselves almost always grow up to be abusive to their children.
Child rape and molestation is still the least talked about issue of child abuse.
Child Abuse
Intimate Partner Violence
National Intimate Partner and Sexual Violence Survey:
Survey released yearly by the CDC. As the title implies, this is the most reliable data source to study domestic abuse.
According to the survey: 36% of women and 29% of men have in America have experienced some form of intimate partner violence.
Intimate Partner Violence:
The term researchers use to reference domestic abuse. Typically, IPV is counted as psychological or physical abuse, sexual assault, and stalking.
Intimate Partner Violence has decreased in the past twenty years, but only for men.
This study also reports rape statistics. It is known for it's finding that 12% of girls under 12 have been raped.
Around 20% of the girls under 12 are raped by their father.
Pedophilia:
a sexual attraction to children. Research shows that there is little focus on the sex of the child. Media tends to portray pedophilia only as men raping young boys.
The argument is that these people are attracted to the "innocence" of the child.
Girls are equally likely to be victims of pedophiles, but the media usually focuses on boy victims. This is another reflection of our gendered society.
Pedophiles have the highest recidivism rate. Chemical castration is often an option for repeat offenders.
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