Chapter 15 Lectures

Psychological Disorders

Modified: 2024-07-24 9:45 AM CDST

"You are not alone." (p. 509)
- Stanford student Zachary Burton fled to a parking garage fearing he was being chased by "evil people."
  - Calmed down by his mother and girlfriend, he spent 11 days at a hospital diagnosed with bipolar disorder.
  - After, he felt stigmatized by the experience and began a support group.
  - Covid has increased student's psychological distress.
  - But, those affected by psychological disorders can be anyone.
- We should not stigmatize them and remember they are fellow human beings.
DEFINING AND EXPLAINING ABNORMAL BEHAVIOR (p. 510)
- What is Abnormal Behavior?
  - There are many definitions of abnormal behavior, those include:
    - Deviation from central tendency
      - What most people do is normal
    - Deviation from social cultural norms
      - Alan Bates's King of Hearts (anti-war movie)
        
        He plays a young British soldier in WW I who handles the communication pigeons
        
        He is sent ahead to scout a town to see if the Germans are still there
        
        They are not, but the bombardments have liberated the inmates of the local insane asylum
        
        Those inmates are running around the town; one is dressed as the King of Hearts
        
        Bates's character reports back that the town is empty of Germans
        
        Alan Bates's character meets the insane asylum inmates and while they are having tea on a second story porch the Germans and the British soldiers return to town
        
        Each contingent marches through the streets and they spot each other and all are killed
        
        Bates and the inmates witness the deed in horror
        
        The last scene shows Bates, naked and holding his pigeons, reporting to the now functioning insane asylum
        
        The question here: Who is really crazy?
    - Personal distress
      - No matter what others believe, when you are distressed that's not normal
      - Richard Cory poem (Sherwood Anderson) is good example, last line:
        
        "Went home and put a bullet through his head." (in spite of all of the benefits he enjoyed)
    - Being in trouble
      - e.g., trouble at home, work, school, or anywhere, especially when repeated
- Models of Psychopathology
  - Biological/Medical
    - illness
    - patients
  - Behavioral
    - life history
    - maladaptive behaviors
  - Sociocultural
    - acceptable cultural norms
      - waiting one's turn to speak
      - smoking
      - social factors
        
        gender, age, ethnicity, SES (socio-economic status)
    - Context-specific conditions
      - Amok: Malaysia, Phillipines, Africa
      - Anorexia nervosa: USA and Western world
      - Koro: China, SE Asia
  - Biopsychosocial
    - eclectic (borrows from other models)
    - factors interact in a variety of ways
    - vulnerability stress hypothesis (e.g., a certain combination of factors are required to trigger abnormal behavior)
- Demonic Possession
  - In the Middle Ages abnormal behavior was often attributed to demonic possession
    - Such possession could be:
      - voluntary: making a pact with the devil (e.g., the Faustian bargain). Video: Charlie Daniels', Devil went down to Georgia (Lyrics)
        
        Note that this type of possession trades earthly benefits for one's soul
      - involuntary: God punishing a person for sins.
    - Malleus Malificarum (Hammer for Witches) was the first publication on how to deal with possessed people. Treatment was not humane.
    - Mass hysteria was common in the Middle Ages. In some cases entire villages might dance till exhaustion. The Italian song, "La Tarantela" (The Tarantula) often was played over and over. Today it is commonly played at weddings in Italy.
- Classifying Psychological Disorders
  - Diagnoses
    - Nominal fallacy: just naming something is not the same as explaining it.
    - So, just giving an abnormal condition a name is not sufficient, it also must be explained
    - Classification of abnormal behavior
      - Complex
      - No "textbook" cases
      - DSM-5-TR is major classification scheme used in the United States (DSM = Diagnostic and Statistical Manual of the American Psychiatric Association)
      - The DSM is in its fifth revision. Newer versions often change conditions formerly described as abnormal to normal. Homosexuality is one example. It was an abnormal category in the DSM-III, but is no longer so listed.
      - Diagnosis: Diagnosis is important. It is describing a particular condition
      - Prognosis: Prognosis is also important. It predicts the outcome. (Here's my prognosis: You will all die. Of course, the real questions are when and how. Those I cannot predict.)
      - Etiology: The typical conditions surrounding a diagnosis and its prognosis. Examples: Schizophrenia does not usually attack old people. Gall bladder disease is associated more with older women, being pregnant, being overweight, and being a member of a particular ethnic group. Of course, that does not mean that fit young men will not get gall bladder disease. Etiology is statistical, it aids the diagnostician into making a better diagnosis and prognosis.
  - Rosenhan's Study (1973)
    - Sent heathy adults to mental health treatment centers
    - All simply said, "I'm hearing voices." From that point on they only told the truth.
    - All were admitted. (They were pseudopatients)
    - The real patients knew the pseudopatients did not belong there.
    - The pseudopatients faked taking their medications (as did some of the real patients)
    - All pseudopatients were eventually released but labelled, "schizophrenic in remission"
    - Shows how easy it is to be judged as abnormal.
      - Imagine yourself in their position explaining yourself:
      - "I really don't belong here. My major professor sent me here to test whether I'd be admitted. I'm really a graduate student."
        
        Can you guess what the staff member's response might be?
NEURODEVELOPMENTAL DISORDERS (p. 514)
- Austism Spectrum Disorder
  - Characterized by:
    - Persistent deficits in social communication and social interactions in a variety of settings
    - Restrictive repetitive behaviors, interests, and activities
    - 1/54 eight-year olds
    - More males affected
  - Labelled a Spectrum because:
    - Highly variable symptoms
  - Theories
    - Theory of Mind
    - Lower social motivation
    - Heightened sensitivity to stimuli
  - Diagnosis and Signs
    - Language deficits
    - Delay in answering name
    - Not pointing or showing objects to othersn
    - Not looking at faces in conversations
  - Biomarkers found in:
    - Blood
    - Saliva
    - Urine
  - Contraindications
    - Parenting does not cause Autism
    - Vaccines do not cause Autism
  - Risk Factors:
    - Older parental age
    - Maternal obesity
    - Diabetes
    - Hypertension
    - Prenatal exposure to chemicals
- Attention-Deficit/Hyperactivity Disorder (ADHD))
  - Problems in sustaining attention and difficulty in engaging in quiet activities are diagnostic.
  - Symptoms:
    - Inattention
    - Hyperactivity
    - Impulsivity
    - Symptoms must occur before age 12
  - Affects:
    - 6% of individuals
    - More males
    - Left untreated predicts negative outcomes in adults
  - Schooling/Academics
    - 9% of US children diagnosed as ADHC between ages 4 to 17
  - Related to:
    - Being victim of bullying
    - Problems in peer relations
    - Delinquent behavior
    - Adults with ADHD
    - Less educational achievement
    - Relationship difficulties
    - Incarceration
    - Lower SES
  - Treatment: helps (see below)
  - Etiology:
    - Very premature birth
    - Low birth weight
    - Prenatal exposure to alcohol and nicotine
    - Lead exposure in childhood
    - Childhood exposure to:
    - Physical, sexual, verbal abuse
    - Neglected as child
  - Theories:
    - Delayed Maturation Hypothesis
    - Problems in executive function
    - Less brain volume in brain pleasure centers
  - Treatment:
    - Stimulant drugs
    - Caffeine, Ritalin, Adderall
  - Other
    - Exercise
    - Sports
    - Psychotherapy
    - Academic enhancement
    - Driving safety
ANXIETY AND ANXIETY-RELATED DISORDERS (p. 519)
- Symptoms of Anxiety and its Disorders
  - Anxiety accounts for a great many problems in adjustment and mental health
    - Look at the long list of manifestations of anxiety. Do you recognize those in yourself when you are anxious?
    - Phobic Disorder: Phobias are irrational fears and include: fear of spiders (arachnophobia), fear of leaving your home (agoraphobia), and many others. The next chapter will discuss therapies for them.
      - Here is a list of phobias and their technical names
    - Obsessive-Compulsive Disorder: OCD consists of obsessions (intrusive thoughts) and compulsions (urges to carry out actions, often repeatedly). They can range from mild to debilitating. Here is a site with a short video and more information.
      - Related disorders include:
        
        hoarding disorder
        
        excoriation disorder
        
        trichotillomania
        
        body dismorphic disorder
    - Generalized Anxiety Disorder: Remember that list I referred to above. It shows some to the kinds of responses people may have to anxiety. Again, the effects can range from mild to severe. The next chapter will review methods for helping people cope with or reduce their anxiety symptoms.
TRAUMA AND STRESS-RELATED DISORDERS (p. 523)
- Post-Traumatic Stress Disorder (PTSD
  - PTSD: Post-traumatic stress disorder can develop after direful events, oppressive situations, cruel abuse, and disasters.
    - DSM-5 now includes it for those who experience, witness, or hear about traumatic events
    - Symptoms include:
      - flashbacks
      - avoidance of emotional experiences
      - anxiety, nervousness, excessive arousal, and inability to sleep
      - memory and concentration problems
      - impulsive behavior
- Dissociative Disorders
  - Dissociative disorders are very rare and involve problems in memory.
  - In Dissociative Fugue, people may live two or three separate lives simultaneously but only be aware of the one they are currently in. Here is how Psychology Today describes fugue.
  - Dissociative Identity Disorder is also extremely rare. It used to be called Multiple Identity Disorder (MPD). It is characterized by a single person harboring two distinct personalities and switching between them.
INTERSECTION (p. 526)
- Clinical Psychology and Cognitive Psychology: Can Playing Tetris Prevent PTSD?
  - This is a good example of how psychological science works.
    - Someone developed a hypothesis that playing Tetris would reduce intrusive thoughts and, thus, reduce the effects of PTSD.
    - But, subsequent research failed to show such a causal link.
DISORDERS INVOLVING EMOTION AND MOOD (p. 528)
- Mood Disorders
  - Mood disorders carry the risk of suicide.
  - Major Depressive Disorder is characterized by lethargy, abnormally long sleep, loss of enthusiasm for living. Treatment is covered in the next chapter.
  - Bipolar Disorder: Formerly known as manic-depressiver psychosis, the name was changed because not all victims show alternation between mania and depression.
  - The biochemistry of the two mood disorders is different, thus so is the therapy (see the next chapter).
psychological inquiry (p. 532)
- Depression Among Women and Men Across Cultures
  - Look at the graph below:

Why are there such differences in depression between men and women?
What might account for such differences?
Is there a relationship between stigma and seeking therapy?
Why do you think women are more depressed worldwide?

SCHIZOPHRENIA SPECTRUM (p. 533)

Schizophrenia (be sure to read my Extended Encounter in this link)
- Schizophrenia is a very serious disorder in which people think in bizarre and unusual ways.
- Common symptoms include hallucinations (e.g., false perceptions, especially auditory hallucinations--"hearing voices"),
- delusions (thinking that one thing is something else, e.g., being absolutely convinced that a simple whiteboard eraser is a block of marijuana),
- disorganinzed thinking,
- bizarre posture (catatonia), lack of self grooming,
- making up new words (neologisms)
- disinterest in daily activities.

psychological inquiry (p. 535)
- The Association of Genes with Schizophrenia
  - Look at the table below

Group	Percent Risk of Developing Schizophrenia
General Population	1%
First Cousins	2%
Uncles/Aunts	2%
Nephews/Nieces	4%
Grandchildren	5%
Half Siblings	6%
Parents	6%
Siblings	9%
Children	13%
Fraternal Twins	17%
Identical Twins	48%

What is the relationship between percent of shared genes and risk of schizophrenia?
Look at the overlap between fraternal and identical twins. Explain it.
Is there a genetic component to schizophrenia?

PERSONALITY, DISORDERS (p. 537)

Personality Disorders
- Personality Disorders are long-lasting and resistant to treatment. They include a wide variety of forms including: antisocial, borderline, and histrionic.

CRITICAL CONTROVERSY (p. 538)
- Should Personality Disorders Be Understood as Dimensions, Rather than Categories?
  - Notice how psychologists and psychiatrists differed over the classification of personality disorders in revising the DSM-5-TR.
    - Ultimately, the psychiatrists prevailed and no changes were made.
  - However, psychologists pointed out that a change should have been made because:
    - Symptom overlap
    - They may not be categories
    - Many people may not be easily classified
SUICIDE (p. 540)
- 10th leading cause of death overaall in USA and 2nd leading cause of death for adolescents. Middle aged men (aged 45-54)have highest rate of suicide followed closely by the very oldest (aged 85 or more).
- National Suicide Hotline number is:
  - 988
- Facts:
  - females attempt suicide more but are less successful
  - firearms are used in slightly more than half of suicides
  - suicide tends to run in families (genetic factors)
  - 90% of suicides are linked to some diagnosable mental disorder
  - suicide rates in countries and regions with a "culture of honor" are higher (including the American South)
- The 16th hole
  - I was playing golf one Sunday afternoon when an employee approached me.
  - He knew I was a psychologist. He told me he was thinking of killing himself.
  - That put an end to my golf round, naturally.
  - I stayed with him the rest of the afternoon and into the night.
  - I called colleagues and arranged for a place for him in nearby at a clinic.
  - In the end, he decided not to go there because he'd been using recreational drugs recently and did not want that on his record.
  - The precipitating event for his reaction was that his wife decided to leave him the day before.
  - Fortunately, he did not pull the trigger. A firearm would have been his method of choice, he said.
PSYCHOLOGICAL DISORDERS AND HEALTH AND WELLNESS (p. 525)
- some 32% of Americans over 18 will suffer a diagnosable disorder during their lives
- Rosenhan's pseudo patients demonstrated the power of labelling
- Labelling often leads to stigma and discrimination
Sexual and Cross-Cultural
- Sexual Disorders
  - The DSM-5 made many changes in the category of Sexual Disorders. They are still categorized as male, female, or other dysfunctions.
- Cross-cultural psychopathogies
  - Amok
  - Anorexia nervosa
  - taijin kyofusho
  - koro

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