Chapter 15: Psychological Disorders

Statistics About Mental Health Problems

  • ~7 million Canadians have mental health problems & illness.
  • In 2010, 17,000 Canadians were admitted to hospital for suicide & self-injury attempts.
  • Use of anti-anxiety & antidepressant medications has increased significantly in the past decade.
  • Mental illness costs Canada at least ~$50 billion annually & $2.5+ trillion over the next 30 years.
  • Japan has one of the highest suicide rates in the world—over double the rate in Canada.
  • In 2004, 1,100+ PTSD pensions were awarded to Canadian veterans. 1-year prevalence of PTSD is 2.8%, with a lifetime prevalence of 7.2%. There were 43 suicides of male soldiers between 2010-2012, & 50 from 2005-2009.


Roméo Dallaire

Canadian Forces General Roméo Dallaire was the command of the United Nations Assistance Mission for Rwanda during the time of the Tutsi genocide. In the end, ~800,000 Tutsis were killed by their Hutu neighbours. Dallaire was restrained by the UN from intervening. In addition, he was unable to get the international community to come to the Tutsis’ aid.

After his return to Canada, Dallaire, who became a senator, began a descent into psychological disturbance & suicide attempts, & was even arrested in Ottawa for being intoxicated under a park bench. The stress of he saw & his inability to do anything led to his diagnosis for PTSD.

Abnormal Behaviour: Myths, Truths & Controversies

Medical Model

The medical model proposes that it is useful to think of abnormal behaviour as a disease. This became the dominant way of thinking about abnormal behaviour during the 18th & 19th centuries. Prior to the 18th century, most conceptions of abnormal behaviour were based on superstition.

Key Terms in the Medical Model

  • Diagnosis - Involves distinguishing one illness from another.
  • Etiology - Refers to the apparent causation & development history of an illness.
  • Prognosis - A forecast about the probably course of an illness.

What do Critics say about the Medical Model?

Critics say the medical model may have outlived its usefulness. They say medical diagnoses of abnormal behaviour pin derogatory labels on people (psychotic or mentally ill) which carry stigma. Research says stigmatization of mental disorders has remained stable or perhaps even increased.

Thomas Szasz asserts that “disease or illness can affect only the body; hence there can be no mental illness”. He says abnormal behaviour is usually a deviation from social norms rather than illness.

What Criteria is Used to Judge Abnormality?

  • Deviance: When behaviour deviates from what their society considers acceptable.
  • Maladaptive Behaviour: When their everyday adaptive behaviour is impaired. For example, alcohol use is not unusual. However, if it begins to interfere with a person’s functioning, a substance-use disorder exists.
  • Personal Distress: When an individual reports great personal distress. Depressed or anxious people, for instance, may not exhibit deviant or maladaptive behaviour but are subjectively distressed.

Diagnoses of abnormality involve value judgments about what represents normal behaviour. Judgments reflect prevailing cultural values, social trends, political forces, & scientific knowledge.

Normality & abnormality exist on a continuum. People are judged to have psychological disorders only when their behaviour becomes extremely deviant, maladaptive, or distressing.

Stereotypes of Psychological Disorders

  • Psychological Disorders are Incurable: Though there are mentally ill people for whom treatment is largely a failure, they are greatly outnumbered by those who eventually improve & lead productive lives.
  • People with Psychological Disorders are Violent: Only a modest association has been found between the 2. This stereotype exists because violence involving the mentally ill get media attention.
  • People with Psychological Disorders Behave Very Different from Normal People: This is true only in a small minority of cases, usually involving relatively severe disorders. People with psychological disorders usually are indistinguishable from those without disorders.
  • David Rosenhan had actors (called pseudopatients) to go to hospitals & tell doctors they heard voices. Except for this, they acted completely normally. All the actors were admitted & hospitalized on average for 19 days!

What is the Diagnostic & Statistical Manual of Mental Disorders (DSM)?

The DSM is a classification system for disorders made by the American Psychiatric Association. It’s on its 5th edition, released in 2013, & is 947 pages long (the first version was 132!).

The preceding version of the DSM, DSM-IV-TR, was released in 2000, which asked for judgments about individuals on 5 dimensions, or axes.

Changes with the DSM-5

  • The axial approach was dropped.
  • Some categories were deleted, some new ones added & others were reorganized.
  • Dimensional ratings were added (e.g., on the severity & intensity of some symptoms). This makes the DSM less categorical & acknowledges comorbidity (coexistence of 2+ disorders in a person).
  • The term mental retardation was changed to intellectual disability. Hypochondriasis was changed to illness anxiety disorder.
  • A new category was added; disruptive mood dysregulation disorder (DMDD). Alan Frances criticized the DSM-5 for pathologizing typical behaviour, because DMDD includes mood shifts & temper tantrums.
  • Before, you would not be diagnosed as suffering from major depressive disorder (MDD) if you depressed for up to 2 months after the death of a significant other. Now, it’s seen as a stressor that might lead to a depressive episode.
  • Before DSM-5, anxiety, obsessive-compulsive disorders & post-traumatic stress disorders were considered together, with the latter 2 being subtypes of anxiety disorders. Now, they’re separated into distinct categories.

Other Classification Systems

  • International Classification of Disease & Health Related Problems (ICD): Developed by the World Health Organization in 1992, the 10th edition of the ICD is the 2nd most commonly used classification system (especially in Europe).
  • Research Domain Criteria Project (RDoC): The National Institute of Mental Health (NIMH) in the United States is developing its own classification system primarily research purposes. The system is to be based on dimensions of observable behaviour & neurobiological measures.

What is Epidemiology? How Common is Mental Illness?

Study of the distribution of mental or physical disorders in a population. In epidemiology, prevalence refers to the percentage of people that exhibit a disorder during a specified period. Lifetime prevalence is the percent of people who endure a specific disorder at any time in their lives.

Studies in 1980 & early 1990 found psychological disorders in ~1/3 of people. Subsequent research found ~44% of the adult population will deal with a psychological disorder at some point. Recent research suggests the lifetime risk of a psychiatric disorder is ~51%.

Across North America, most common types of psychological disorders are:

  1. Substance (alcohol/drugs) use disorders.
  2. Anxiety disorders.
  3. Mood disorders.

Statistics of Mental Illness in Canada

  • 10% of 15+ year olds reported symptoms consistent with one of the major categories of disorders.
  • 5% meet the diagnostic criteria for major depression or bipolar disorder.
  • 5% meet the diagnostic criteria for various anxiety disorders, including panic disorder or agoraphobia.
  • Though statistics of men & women are similar, women suffer from mental illness slightly more.
  • 68% of people who reported symptoms did not seek any assistance.
  • 17% say they have mental health needs, with 33% of them saying their need were not met or only partially met.

Anxiety, Obsessive-Compulsive & PTSD

What is an Anxiety Disorder?

Disorders marked by feelings of excessive apprehension & anxiety, & affects ~19% of people.

What is the Generalized Anxiety Disorder?

A generalized anxiety disorder is marked by a chronic, high level of anxiety that isn’t tied to any specific threat. Sometimes called free-floating anxiety.

Anxious people worry constantly, and worry about how much they worry. They often dread decisions & brood over them endlessly. Commonly accompanied by physical symptoms such as trembling, muscle tension, diarrhea, dizziness, faintness, sweating & heart palpitations.

This disorder tends to have a gradual onset & is more frequent in females than males.

What are Specific Phobias?

A phobia is marked by a persistent & irrational fear of an object/situation that presents no realistic danger. In a specific phobia, an individual’s troublesome anxiety has a specific focus. Though mild phobias are common, phobic disorder occurs when their fears seriously interferes with their life.

Tends to be accompanied by physical symptoms of anxiety, such as trembling & palpitations.

Martin Antony says that 1-5% of Canadians suffer from driving-related anxiety. Phobias tend to be of things that were threats to the lives of our ancestors (heights, snakes, spiders, etc.). Mysophobia is a phobia of germs (commonly known as germaphobia).

What is Panic Disorder? How Common is It?

A panic disorder is characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly & unexpectedly, and is accompanied by physical symptoms of anxiety. The onset of panic disorder typically occurs during late adolescence or early adulthood.

Self-reported data suggests ~34% of undergraduates suffer from non-clinical panic disorder. Studies found a 1-year prevalence rate of 6.4% for panic disorder in Canadian adults, with 2/3 being female.

What is Agoraphobia?

A fear of going out to public places, and is usually a phobic disorder. Recent evidence suggests that agoraphobia is often a complication of panic disorder.

What is Obsessive-Compulsive Disorder (OCD)?

OCD is marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) & urges to engage in senseless rituals (compulsions). Full-fledged OCDs occur in 2–3% percent of people, with this number potentially growing. Most cases of OCD emerge before the age of 35.

Examples of Obsessive-Compulsive Related Disorders

  • Body Dysmporhic Disorder: An individual has an unrelenting preoccupation with what they perceive to be a physical flaw.
  • Excoriation: Skin-picking disorder.
  • Hoarding Disorder: Have difficulty discarding possessions no matter how worthless they are & hoard to the extent that possessions disrupt normal life.

What is Post-Traumatic Stress Disorder (PTSD) & What are its Causes?

PTSD is often elicited by traumatic events, such as a rape, assault, car accident, natural disaster, or witnessing someone’s death. In some instances, PTSD doesn’t surface until months/years after a person’s exposure to severe stress & is tied to memory for the events.

Research suggests that 7–8 % of people have suffered from PTSD at some point in their lives, with prevalence being higher among women (10%) than men (5%).

Common symptoms include re-experiencing the traumatic event in the form of nightmares & flashbacks, emotional numbing, alienation, problems in social relationships, increased sense of vulnerability, and elevated levels of arousal, anxiety, anger & guilt.

Factors that predict an individuals’ risk for PTSD: personal injuries & losses, intensity of exposure to the traumatic event, exposure to the grotesque aftermath of the event, intensity of one’s reaction at the time of the traumatic event.

Frequency & severity of post-traumatic symptoms usually decline gradually over time, but the symptoms may never completely disappear.

Etiology of Anxiety & Anxiety-Related Disorders

What is a Concordance Rate?

Concordance rates indicates the percent of twin pairs or other pairs of relatives who exhibit the same disorder.

What are some Biological Factors for Anxiety Disorders?

  • Twin studies & family studies suggest there’s a moderate genetic predisposition to anxiety disorders. Jerome Kagan found 15–20% of infants display an inhibited temperament. Such a temperament is characterized by shyness, timidity & wariness, and has a strong genetic basis. This temperament is a risk factor for anxiety disorders.
  • Research also suggests anxiety sensitivity makes people vulnerable to anxiety disorders, as some people are sensitive to internal physiological symptoms of anxiety & may overreact with fear when experiencing these symptoms. Anxiety sensitivity may fuel an inflationary spiral in which anxiety breeds more anxiety. Anxiety sensitivity may serve as vulnerabilities for panic disorder & depression.
  • Evidence suggests a link exists between anxiety disorders & neurochemical activity in the brain. Disturbances in neural circuits using GABA may play a role in anxiety disorders (which is why Valium alters neurotransmitter activity at GABA synapses). Neural circuits using serotonin are implicated in panic disorders & OCDs.
  • Neurotransmitters: Chemicals that carry signals from one neuron to another.

How does Conditioning & Learning Contribute to Anxiety Disorders?

  • Anxiety responses may be acquired by classical conditioning & maintained by operant conditioning. A neutral stimulus (snow) may be paired with a frightening event (avalanche) that it becomes a conditioned stimulus eliciting anxiety. Once a fear is acquired, the person may start avoiding the anxiety-producing stimulus. Avoidance response is negatively reinforced because it is followed by a reduction in anxiety (operant conditioning).
  • Studies have found many people suffering from phobias can identify a traumatic conditioning experience that likely contributed to their anxiety disorder.
  • Martin Seligman’s concept of preparedness suggests people are biologically prepared by their evolutionary history to acquire some fears more easily than others.
  • Arne Öhman & Susan Mineka’s evolved module for fear learning is automatically activated by stimuli related to survival threats in evolutionary history & relatively resistant to efforts to suppress the fears. Like preparedness.

Criticisms of Learning-Based Contributions to Anxiety Disorders

  • Many people with phobias can’t recall a traumatic conditioning experience that led to the phobia.
  • Many people endure extremely traumatic experiences that should create a phobia but don’t.
  • Phobias can be acquired indirectly, by observing other’s fear response to stimuli or absorbing fear-inducing info.

How Does Cognition Contribute to Anxiety Disorders?

Some people are more likely to suffer from anxiety because they tend to:

  1. Misinterpret harmless situations as threatening.
  2. Focus excessive attention on perceived threats.
  3. Selectively recall information that seems threatening.

How Does Stress Contribute to Anxiety Disorders?

Patients with panic disorder had a dramatic increase in stress in the month prior to the onset of their disorder. Another study found an association between stress & the development of social phobia.

Dissociative Disorders

What are Dissociative Disorders?

A class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity. Includes dissociative amnesia, dissociative identity disorder & depersonalization/derealization disorder.

What is Dissociative Amnesia?

Sudden loss of memory for important personal information that is too extensive to be due to forgetting. May occur for a single traumatic event or for an extended period surrounding the event.

In dissociative fugue, which is a specific of dissociative amnesia people lose their memory for their life & experiences, along with their sense of personal identity, but not other matters (like math).

What is Dissociative Identity Disorder (DID)?

DID involves the coexistence in a person of 2+ largely complete, & usually very different, personalities. Used to be called multiple personality disorder. The various personalities are often unaware of each other. Most DID patients also have a history of anxiety or mood or personality disorders. Dissociative identity disorder is seen more in women than men.

What is the Etiology of Dissociative Disorders?

Dissociative amnesia & fugue are usually attributed to excessive stress.

But the causes of DID are obscure. Nicholas Spanos believes people with DID are engaging in role-playing as an excuse for personal failings. Spanos argues therapists subtly encourage the emergence of alternate personalities. According to Spanos, DID is a creation of modern North American culture. Only ¼ of American psychiatrists feel there’s solid evidence for scientific validity of DID diagnosis.

Mood Disorders

What are Mood Disorders?

Class of disorders marked by emotional disturbances of varied kinds that may spill over to disrupt physical, perceptual, social &thought processes. Such disorders tend to be episodic. DSM-5 has 2 separate classes of mood disorders.

  • Bipolar & Related Disorders: Includes bipolar I & bipolar II disorders, and cyclothymic disorder.
  • Depressive Disorders: Includes major depressive disorder (MDD), disruptive mood dysregulation disorder, premenstrual dysphoric disorder & persistent depressive disorder.

What is Major Depressive Disorder (MDD)?

In MDD, people show persistent feelings of sadness & a loss of interest. In addition to the negative mood, a central feature of depression is anhedonia (a diminished ability to experience pleasure). Depressed people often exhibit other disorders. Coexisting anxiety disorders & substance-use disorders are particularly frequent.

A substantial majority of depression cases emerge before age 40. 75-95% of depressed people experience more than one episode in their lifetime (usually ~6) lasting ~6 months. Some people suffer from chronic major depression that may persist for years.

How Common is Depressive Disorder in Canada?

Up to 10% (other estimates put it at ~14%) of Canadians will experience a major depressive episode sometime in their lives, with about 1% suffering from bipolar disorder.

Depression is ~2x as high in women than men. Susan Nolen-Hoeksema says women experience more depression because they’re more likely to be sexual abused, & somewhat more likely to endure poverty, harassment & role constraints. She also says women have a greater tendency to ruminate (dwell on one’s difficulties).

What is Bipolar Disorder?

Bipolar I disorder, formerly known as manic-depressive disorder, it’s characterized by the experience of 1+ manic episodes & periods of depression. In a manic episode, a person’s mood becomes elevated to the point of euphoria. Judgment is often impaired, the person becomes hyperactive, gambles impulsively, spends more money, becomes sexually reckless.

In bipolar II disorder, individuals suffer from episodes of major depression along with hypomania in which their change in mood & behaviour is less severe than those seen in full mania.

People have cyclothymic disorder when they exhibit chronic but relatively mild symptoms of bipolar disturbance.

Manic episodes last ~4 months. Episodes of depression tend to run somewhat longer & most bipolar patients spend more time in depressed states than manic states.

How Common is Depressive Disorder in Canada?

Bipolar disorder affects ~1% of the North American population. Bipolar disorder is seen equally often in males & females. The typical age of onset is in the late teens.

Other Mood Disorders

What is Seasonal Affective Disorder (SAD)?

A type of depression that follows a seasonal pattern, the most common being winter depression. One Canadian study found 11% of surveyed individuals with depression evidenced the SAD subtype, with an overall prevalence in the population of ~3% of Canadians. Rates are even higher among the Inuit in the Canadian Arctic.

There are suggestions that SAD is related to melatonin production & circadian rhythms. A form of treatment is phototherapy, in which individuals are exposed systematically to therapeutic light.

What is Postpartum Depression?

A type of depression that sometimes occurs after childbirth, within ~4 weeks of childbirth. It can include both depression & mania. It occurs inn 10–20% of women who’ve given birth.

Mood Disorders & Suicide

According to the World Health Organization, more people around the world die from suicide than in all armed conflicts. In 2009, there were 3890 reported suicides in Canada. It’s the 9th leading cause of death in Canada overall, but for those between the ages 15-34, it’s the 2nd.

The suicide rate for immigrants is half of native-born Canadians. Women attempt suicide 3x more. But men are more likely to kill themselves, so they complete 4x as many suicides. Suicide rates are highest for people with mood disorders, who account for ~60% of them. Lifetime risk of suicide is 15–20% in people with bipolar disorder & ~10% in depressed people. Smaller elevations in suicide rates are seen among people who suffer from schizophrenia, alcoholism, and substance abuse. There is a link between PTSD & suicide.

Statistics may underestimate the problem since many suicides are disguised as accidents. Moreover, experts estimate suicide attempts may outnumber completed suicides by a ratio of 10:1.

Etiology of Mood Disorders

Genetic Vulnerability

Evidence suggests that heredity can create a predisposition to mood disorders. The influence of genetic factors appears to be stronger for bipolar disorders than for unipolar disorders.

Biological & Neurochemical Factors

Correlations have been found between mood disorders & abnormal levels of 2 neurotransmitters: norepinephrine & serotonin, although other neurotransmitter disturbances may also contribute.

The best documented correlation is the association between depression & reduced hippocampal volume, with the hippocampus (plays a major role in memory consolidation) being 8-10% smaller. It’s theorized that depression occurs when stress causes neurochemical reactions that suppress neurogenesis, resulting in reduced hippocampal volume.

Hormonal Factors

In times of stress the brain sends signals along 2 pathways. One of these, the hypothalamic-pituitary-adrenocortical (HPA) axis, runs from the hypothalamus to the pituitary gland to the adrenal cortex, which releases corticosteroid hormones. Overactivity along HPA axis due to stress may play a role in depression.

Perfectionism as a Factor

Perfectionism or setting excessively high standards is associated with depression. Paul Hewitt developed a multidimensional perfectionism scale that assesses 3 aspects of perfectionism:

  • Self-Oriented Perfectionism: Tendency to set high standards for oneself.
  • Other-Oriented Perfectionism: Setting high standards for others.
  • Socially Prescribed Perfectionism: Tendency to perceive that others are setting high standards for oneself.

He found links between perfectionism & eating disorders, symptoms of depression, problematic interpersonal relationships & other health problems, including postpartum depression.

Sociotropy & Autonomy Personality Styles as Factors

According to Aaron Beck, 2 personality styles, sociotropy & autonomy, are related to depression.

  • Sociotropic: Sociotropic individuals are especially invested in interpersonal relationships; they’re overconcerned with avoiding interpersonal problems & emphasize pleasing others.
  • Autonomy: Autonomous individuals are primarily oriented toward their own independence & achievement.

Introjective Personality Orientation & Anaclitic Orientation as Factors

Sidney Blatt suggests that these 2 personality variables serve as vulnerability factors for depression:

  • Introjective Personality Orientation: Involves excessive self-criticism.
  • Anaclitic Orientation: Involves overdependence on others.

Cognitive Factors

Cognitive models of depression say that negative thinking is what leads to & maintains depression.

  • According to Beck, depressed people are characterized by a negative cognitive triad, which reflects their tendency to have negative views of themselves, their world & their future. One of the effects of the depressive’s negative schemas is the tendency to selectively attend to negative information about themselves.
  • Learned Helplessness Model: Martin Seligman says depression is caused by learned helplessness—passive “giving up” behaviour produced by exposure to unavoidable aversive events. According to him, people who exhibit a pessimistic explanatory style (tend to attribute setbacks to personal flaws) are especially vulnerable to depression.
  • Hopelessness Theory: Builds on the learned helplessness model, it says that along with a pessimistic explanatory style, other factors (high stress, low self-esteem) contribute to hopelessness & thus depression.
  • Rumination: Susan Nolen-Hoeksema found that depressed people who ruminate about their depression remain depressed longer. Excessive rumination increases negative thinking, impairs problem solving, & undermines social support. Rumination is also associated with increased anxiety & binge eating/drinking.

Interpersonal Roots

Depression-prone people lack the social finesse needed to acquire important reinforcers, such as good friends, top jobs & desirable spouses. Research found links between poor social skills & depression.

Depressed people tend to be depressing, irritable, pessimistic, complain a lot, etc. Thus, they have fewer sources of social support than non-depressed people. Low social support can increase vulnerability to depression.

Sports Concussions & Depression

Depression is a common feature of post-concussion syndrome. Depression rates in head trauma patients are many times higher than in the general population. Athletes who had suffered from concussions & depression showed “reduced activation in the dorsolateral prefrontal cortex and striatum and attenuated deactivation in medial frontal and temporal regions”. Depression levels correlated with the level of neural response in areas typically associated with depression, along with grey matter loss in those areas.

Precipitating Stress

Evidence suggests there’s a moderately strong link between stress & mood disorders. Stress affects how people respond to treatment & whether they experience a relapse of their disorder. The impact of stress varies, in part, because people vary in their degree of vulnerability to mood disorders.

Schizophrenia

What is Schizophrenia?

A disorder marked by delusions, hallucinations, disorganized speech, negative symptoms (e.g., diminished emotional expression), & deterioration of adaptive behaviour. Disturbed thought lies at the core of it, whereas disturbed emotion lies at the core mood disorders.

The DSM-5 includes schizophrenia in the schizophrenia spectrum & other psychotic disorders classification. This category also includes schizotypal disorder, delusional disorder, brief psychotic disorder, schizophreniform disorder & schizoaffective disorder.

How Common is Schizophrenia?

Prevalence estimates suggest that ~1% of the population may suffer from schizophrenia, though might be a little lower. The financial impact of schizophrenia is estimated to exceed the costs of all types of cancers combined.

What are the General Symptoms of Schizophrenia?

Delusions & Irrational Thought

Delusions are false beliefs that are maintained even though they clearly are out of touch with reality. In delusions of grandeur, people maintain that they are famous/important.

The person’s train of thought deteriorates. Thinking becomes chaotic rather than logical & linear.

Deterioration of Adaptive Behaviour

Schizophrenia usually involves a noticeable deterioration in the quality of the person’s routine functioning in work, social relationships & personal care.

Hallucinations

Hallucinations are sensory perceptions that occur in the absence of a real, external stimulus or are gross distortions of perceptual input. The most common are auditory hallucinations, such as hearing voices.

Disturbed Emotions

Some victims show little emotional responsiveness, a symptom called “blunted or flat affect”. They show inappropriate emotional responses that don’t jibe with the situation or what they’re saying.

Positive vs. Negative Symptoms

Nancy Andreasen proposed distinguishing between types of symptoms of schizophrenia:

  • Negative Symptoms: Involves behavioural deficits, such as flattened emotions, social withdrawal, apathy, impaired attention & poverty of speech.
  • Positive Symptoms: Involves behavioural excesses or peculiarities, such as hallucinations, delusions, bizarre behaviour, & wild flights of ideas.

A predominance of positive symptoms is associated with better adjustment prior to the onset of schizophrenia & greater responsiveness to treatment.

What is Known About the Course & Outcome of Schizophrenia?

Schizophrenia usually emerges during adolescence or early adulthood, with 75% of cases manifesting by the age of 30. The emergence of schizophrenia may be sudden, but usually is insidious & gradual. People with schizophrenia tend to fall into three broad groups:

  • Some, presumably those with milder disorders, are treated successfully & enjoy a full recovery. (20-50%)
  • Others have a partial recovery so they may return to independent living. However, they experience regular relapses.
  • A third group endures chronic illness marked by relentless deterioration & extensive hospitalization.

Etiology of Schizophrenia

Genetic Vulnerability

Hereditary factors play a role in the development of schizophrenia. A child born to 2 schizophrenic parents has a ~46% chance of getting schizophrenia (as compared to ~1% in the general population).

Neurochemical Factors

Excess dopamine activity has been implicated as a possible cause of schizophrenia. However, the evidence for this is riddled with inconsistencies, complexities, & interpretive problems.

Marijuana use during adolescence may help to precipitate schizophrenia people who have a genetic vulnerability.

Structural Abnormalities in the Brain

CT & MRI scans suggest an association between enlarged brain ventricles (the hollow, fluid-filled cavities in the brain) & schizophrenic disturbance. But this could also be caused by schizophrenia. Reductions in both grey & white matter in specific brain regions are linked to schizophrenia.

What is the Neurodevelopmental Hypothesis?

It states that schizophrenia is caused in part by various disruptions in the normal maturational processes of the brain before or at birth. Insults to the brain during sensitive phases of prenatal development or during birth can cause subtle neurological damage that elevates individuals’ vulnerability to schizophrenia years later. Research has focused on viral infections or malnutrition during prenatal development and obstetrical complications during the birth process.

A study looked at a new source of disruption during prenatal development: severe maternal stress.

Research suggests that minor physical anomalies (slight anatomical defects of the head, hands, feet, and face) that would be consistent with prenatal neurological damage are more common among people with schizophrenia.

Expressed Emotion

Expressed emotion (EE) is the degree to which a relative of a schizophrenic patient displays highly critical or emotionally overinvolved attitudes toward the patient. Studies show that a family’s expressed emotion is a good predictor of the course of a schizophrenic patient’s illness. After release from a hospital, people with schizophrenia who return to a family high in expressed emotion show relapse rates ~3x that of patients who return to a family low in expressed emotion.

Precipitating Stress

High stress may serve to precipitate a schizophrenic disorder in someone who is vulnerable. High stress can also trigger relapses in patients who have made progress toward recovery. Patients who show strong emotional reactions to events seem to be particularly likely to have their symptoms exacerbated by stress.

Personality Disorders

What are Personality Disorders?

A class of disorders marked by extreme, inflexible personality traits that cause subjective distress or impaired social & occupational functioning. People with these disorders display personality traits to an excessive degree that undermine their adjustment. Usually emerge during late childhood or adolescence & often continue throughout adulthood.

Estimated prevalence rates for each fall in the range of 1–2%.

Diagnostic Problems

Critics say personality disorders overlap too much with other categories of disorder & with each other. This overlap makes it extremely difficult to reliably diagnoses. Support for a shift to a dimensional approach to diagnosis in DSM-5 was particularly strong for the personality disorders.

What is the Antisocial Personality Disorder?

The antisocial personality disorder, also known as psychopathy, is marked by impulsive, callous, manipulative, aggressive & irresponsible behaviour that reflects a failure to accept social norms. They rarely feel guilty, lack conscience, empathy, affection, and fake emotions, sexually predatory, promiscuous, want instant gratification, . People with antisocial personalities chronically violate rights of others & exploit them. Many people with antisocial personalities become involved in illegal activities at an early age & commit offences at a high rate.

Antisocial doesn’t mean that they shun social interaction. It means they reject social norms!

Seen in 3–6% of males & ~1% of females Occurs much more frequently in males than females.

Robert Hare developed an assessment device, the Psychopathy Checklist-Revised (PCL-R).

Etiology of Antisocial Personality Disorder

  • There’s a genetic predisposition toward these disorders.
  • Hans Eysenck theorizes that such people might inherit relatively sluggish autonomic nervous systems, but evidence is inconsistent.
  • Such people may come from homes where discipline is erratic, where they experience physical abuse & neglect.
  • Such people are more likely to come from homes where at least 1 parent exhibit antisocial traits. These parents presumably model exploitive, amoral behaviour, which children acquire through observational learning.

Disorders of Childhood

How Common are Psychological Illness in Children?

~20% of children & youth in Canada will suffer from psychological illnesses. Children suffer from too much stress, depression, PTSD, OCD & most of the other categories of disorders.

What is Autism Spectrum Disorder (ASD)?

Refers to a developmental disorder characterized by social & emotional deficits, impaired communication, and repetitive & stereotypic behaviours, interests and activities. They often exhibit a pattern called echolalia where they mimic what they’ve heard. Or OCD.

It’s included in the new neurodevelopmental disorders classification, which combined autistic disorder, Asperger’s disorder, etc., into ASD.

Donald Gray Tripplett was the first person diagnosed with autism by Dr. Leo Kanner in 1943. “[T]o get his attention almost requires one to break down a mental barrier between his inner consciousness and the outside world”. Kanner called this autistic aloneness.

What are the Origins of ASD?

Part of the problem may lie with a very limited theory of mind. Theory of mind deals with people’s understanding of other people—their perspectives, intentions, affect, etc.

What is Early Intensive Behavioural Intervention (EIBI)?

EIBI refers to a group of interventions in which, generally, each individual skill is broken down into small steps, with each successful acquisition being reinforced. It’s extremely expensive, costing almost $60,000 per year. Treatment is recommended to be 40 hours per week, 7 days a week & 52 weeks a year.

Etiology of ASD

Most theorists today view ASD as a disorder that originates in biological dysfunctions. Genetic factors make a major contribution to ASD. However, not too much is known about ASD’s causes.

Psychological Disorders & the Law

What is the Insanity Defence?

In Canada, the term is not insanity, it’s “not criminally responsible on account of mental disorder” (NCRMD). The law reasons that people who are “out of their mind” may not be able to appreciate the significance of what they’re doing. In Canadian law, the prosecution must prove actus reus (wrong act) & mens rea (criminal intent). The insanity defence is used to disprove criminal intent.

No simple relationship exists between specific diagnoses of mental disorders & court findings of insanity. Most people with diagnosed psychological disorders would not qualify as insane. According to the M’Naghten rule, insanity exists when a mental disorder makes a person unable to distinguish right from wrong.

How often is it used?

According to Jocelyn Lymburner & Ronald Roesch, use & success of this defence is rarer than most Canadians assume. They suggest it’s typically is used only in cases of the most severely disordered defendants.

What does it mean to be ‘unfit to stand trial’?

Defendants may be found unfit to stand trial if they are judged unable to conduct a defence at any point in the legal proceedings because of a psychological disorder such as schizophrenia. This may be due to their inability to understand the proceedings or possible consequences, or an inability to communicate with their lawyers. If fitness is restored, a defendant may stand trial.

What is the discussion of Automatism about?

The idea is that you shouldn’t be held responsible if you had no control over your behaviour. The conditions that have been recognized in Canadian courts include having sustained physical blows, carbon monoxide poisoning, sleepwalking, etc.

Culture & Pathology

Cultural Differences Surrounding Mental Disorders

  • Legal rules governing mental disorders & involuntary commitment are different to each country.
  • Judgments of normality and abnormality are influenced by cultural norms & values.
  • Stigmas & its effects (willingness to admit to & seek treatment) for mental illness vary by culture.
  • North Americans of Asian descent are unwilling to take concerns to therapists, with this being affected by factors such as the client’s level of assimilation & the ethnicity of the therapist.

2 Views about Psychological Disorders & Culture

  • Relativistic View: Theorists say the criteria of mental illness varies greatly across cultures & there are no universal standards of normality/abnormality. They say, the DSM diagnostic system reflects an ethnocentric, Western, white, urban, middle/upper-class cultural orientation that has limited relevance in other cultures.
  • Pancultural or Universalistic View: Theorists argue that the criteria of mental illness are much the same around the world & that basic standards of normality/abnormality are universal across cultures.

Both views appear to have some merit.

Are the Same Disorders Found around the World?

Most investigators agree that the principal categories of serious psychological disturbance are identifiable in all cultures. Such bipolar illness, schizophrenia & depression.

Relatively mild types of pathology that don’t disrupt behaviour in obvious ways appear to go unrecognized in many societies. Syndromes such as generalized anxiety disorder, hypochondria & narcissistic personality disorder are viewed in some cultures as “run of the mill” peculiarities.

What are Culture-Bound Disorders?

Abnormal syndromes found only in a few cultural groups. Koro, is an obsessive fear that one’s penis will withdraw into one’s abdomen, is seen only among Chinese males in Malaya & other regions of southern Asia. Windigo, which involves an intense craving for human flesh & fear that one will turn into a cannibal, is seen only among Algonquin cultures. Pibloktoq is a type of Arctic hysteria associated with the Inuit. The eating disorder anorexia nervosa was largely seen only in affluent Western cultures.

In DSM-5, 16 questions are used to examine 4 domains: cultural definition of the problem; cultural perceptions of cause, context & support; cultural factors affecting self-coping & past help seeking; & cultural factors affecting current help seeking.

Are Symptoms of Psychological Disorders influenced by Culture?

The more a disorder has a strong biological component, the more it tends to be expressed in similar ways across varied cultures. However, even in severe, heavily biological disorders, cultural variations in symptom patterns are seen. Delusions are a common symptom of schizophrenia in all cultures, but the specific delusions that people report are tied to their cultural heritage.

Of the major disorders, symptom patterns are probably most variable for depression. For example, profound feelings of guilt & self-deprecation lie at the core of depression in Western cultures. In non-Western cultures, depression tends to be expressed in terms of somatic symptoms, such as complaints of fatigue, headaches & backaches, more than psychological symptoms, such as low self-esteem.

Extra

Featured Study: Does Negative Thinking Cause Depression?

This study is known as the Temple–Wisconsin Cognitive Vulnerability to Depression Project.

Method

5000+ first-year students university students responded to 2 measures of negative thinking. Students who scored in the highest quartile on both measures were characterized as having a high risk for depression & those who scored in the lowest quartile on both measures were characterized as having a low risk for depression. Randomly selected subsets of these 2 groups were invited for additional screening to eliminate anyone who was currently depressed or suffering from any other major psychological disorder. The final sample consisted of 173 students in the high-risk group & 176 students in the low-risk group.

They were then interviewed for 5. The results are for the first 2.5 years.

Results

A major depressive disorder emerged in 17% of the high-risk students in comparison to only 1% of the low-risk students. The high-risk subjects also displayed a much greater incidence of minor depressive episodes.

Comment

This study used a prospective design, which moves forward in time, testing hypotheses about future outcomes. Previous studies, which are not as effective in teasing out causation, used retrospective designs, which look backward in time from known outcomes.

Personal Application: Understanding Eating Disorders

What are Eating Disorders?

Severe disturbances in eating behaviour characterized by preoccupation with weight & unhealthy efforts to control weight. 90–95% of people with eating disorders are female, especially young girls.

Anorexia nervosa involves intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, and dangerous measures to lose weight. Affects ~1% of young girls. 2 types:

  • Restricting Type Anorexia Nervosa: People drastically reduce their intake of food, sometimes starving.
  • Binge-Eating/Purging Type Anorexia Nervosa: Individuals attempt to lose weight by forcing themselves to vomit after meals, by misusing laxatives and diuretics & by engaging in excessive exercise.

Bulimia nervosa involves habitually engaging in out-of-control overeating followed by unhealthy compensatory efforts, such as self-induced vomiting, fasting, abuse of laxatives and diuretics, and excessive exercise. Affects 2-3% of young girls.

Binge-eating disorder involves distress-inducing eating binges that are not accompanied by the purging, fasting & excessive exercise seen in bulimia.

Etiology of Eating Disorders

There appears to be a genetic vulnerability to eating disorders. Cultural pressures on young women to be thin clearly help foster eating disorders. Unhealthy family dynamics, certain personality traits, and disturbed thinking can also contribute to the development of eating disorders.

Critical Thinking Application - Statistics Regarding Mental Illness

What is the Representativeness Heuristic?

The estimated probability of an event is based on how similar the event is to the typical prototype of that event. For example, media portray the mentally ill in straitjackets so we assume it’s not common. Overall prevalence of psychological disorders is ~44%.

What is the Conjunction Fallacy?

Occurs when people estimate that the odds of 2 uncertain events happening together are greater than the odds of either event happening alone.

What is the Availability Heuristic?

The estimated probability of an event is based on the ease with which relevant instances come to mind.


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