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Pschology summary - psychological disorders

Introduction to Psychology (University of Cape Town)

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Chapter 17: Psychological Disorders

Famous people who suffered from mental health disorders:

 Jean-Jacques Rousseau – paranoid symptoms

 Mozart – paranoid (was convinced his food was being poisoned)
 Abraham Lincoln – depression (missed his wedding)
 Winston Churchill – depression (called it his ‘black dog’)

Mental Health Disorders seen as ‘Deviant Behaviours’ in History

 Believed by ancient Chinese, Egyptians and Hebrews

An ancient treatment called trephination: believed that demons needed to be released from
body so they drilled 2cm diameter hole in the skull. This killed many people.

Medieval Times: people with mental disorders= witches. Would throw women in to a pond,
if they sank and drowned, they were pure but if they floated, they would be named witches
and would be executed.

5 Century BC, Greek Physician, Hippocrates: Believed mental health disorders were like
physical disorders and occurred in the brain. By 1800’s, Western culture moved back to this
because of general parensis (severe mental deterioration) was caused by syphilis (a physical
disease)

Defining and Classifying

Vulnerability-stress/ Diathesis-stress model:

Vulnerability Factors: Stressors

Genetic Factors Economic adversity

Biological characteristics Environmental trauma

Psychological traits Interpersonal stresses or losses

Previous maladaptive learning Occupational setbacks or demands

Low social support

One needs a combination of both vulnerability factors and stressors to obtain a mental
disorder.

Defining what is abnormal: relies largely on time and culture i.e. being homosexual was and
still is considered a mental illness in some cultures. Abnormal behaviour- Defined as

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behaviour that is personally distressing, personally dysfunctional and/or culturally deviant

that other people judge it inappropriate or maladaptive.

Diagnosing:

Reliability: High level of professionals must agree on the same method

Validity: Characteristics that occur in many clinical observations and research must be
included in the identifiers within a method.

Two Major Classification Methods:

 The World Health Organisation International Classification of Diseases (ICD-10)

-covers mental illnesses and other disorders, and as such is a more complete
diagnostic classification system (refer to Table 17.1, Page 781 to see categories)
 Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
-covers only mental health problems and is more widely used (refer to Table 17.2 and
Figure 17.6, page 782 for categories)

Consequences of Diagnosing:

Social and Personal: Others use the mental disorder to describe an individual and not their
behaviour and this causes assumptions and others perceptions of the patients to change.
Diagnostic labels are hard to get rid of, even if the symptoms are no longer present. Giving a
person a label can cause them to become what they are labelled as or make them unable to
change what their label says they are. People with mental health disorders often avoid
diagnosis, as they fear the stigma attached to disorders.

Legal: People diagnosed can be detained of committed to a mental institution if they are
dangerous to themselves or others but the circumstances for this differ for different
countries. US judges on competency and insanity. Competency refers to the state of mind of
the person during the trial and if they cannot comprehend the legal proceedings, they can
be institutionalised until competent. Insanity refers to the person’s state of mind when the
crime was committed.

Anxiety Disorders

 Phobic Disorder
 Generalized Anxiety Disorder
 Panic Disorder
 OCD
 PTSD
 Casual Factors

In anxiety disorders, the frequency and intensity of anxiety responses are out of proportion
to the situations that trigger them and the anxiety interferes with daily life.

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Anxiety responses:

 Subjective-emotional component- feelings of tension and apprehension

 Cognitive component- worrisome thoughts and a sense of the inability to cope
 Physiological responses- increased heart rate and blood pressure, muscle tension,
rapid breathing, nausea, dry mouth, diarrhoea and frequent urination
 Behavioural responses- avoidance of certain situations and impaired task
performance.

They occur more often in women and are clinically significant, which means that they
interfere with life functions or cause a person to seek medical or psychological treatment.

Phobic Disorder

Defined as: Strong and irrational fears of certain objects or situations

People who have phobias realise they have them but feel helpless with coping with them so
they rather avoid the phobic object or situation.

Common Types: Agoraphobia- fear of open/public places

Social Phobias- excessive fear of situations where the person may be evaluated or
embarrassed.

Specific Phobias- such as fear of dogs, spiders etc.

Severity: dependent on how often the person is exposed to the phobic object or situation.

Generalized Anxiety Disorder

Defined as: a chronic state of diffuse, or free-floating, anxiety that is not attached to a
specific object or situation

Onset tends to occur in childhood and adolescence and can last for prolonged amounts of
time. The person feels constantly anxious or fearful but it unsure what they are anxious
about. Can interfere largely with daily functioning. A person might find it hard to
concentrate, make decisions or remember things.

Panic Disorder

Defined as: Anxiety that occurs suddenly, unpredictably and very intensely. With no specific
stimulus. (Panic Attacks)

Can cause less severe panic attacks while sleeping. Can cause agoraphobia or a ‘fear of fear’
as people avoid leaving their house in case they have a panic attack.

Obsessive-Compulsive Disorder (OCD)

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Made up of 2 components:

-Cognitive component: Obsessions that are defined as repetitive and unwelcome thoughts,
images or impulses that invade the consciousness, are often abhorrent to the person and are
very difficult to dismiss or control.

-Behavioural component: Compulsions that are defined as repetitive behavioural responses

that can be resisted only with great difficulty. They are often responses that function to
reduce the anxiety associated with the intrusive thoughts. The behaviours are strengthened
through a process of negative reinforcement because they allow the person to avoid anxiety.

OCD often has co-morbidity which means that most of the time it comes with other
problems/disorders.

Post-Traumatic Stress Disorder (PTSD)

Defined as: a severe anxiety disorder that can occur in people who have been exposed to
traumatic life events.

Symptoms:

1. Person experiences severe symptoms of anxiety, arousal and distress that were not
present before the trauma.
2. Victim relives the trauma recurrently in flashbacks, in dreams and in fantasy.
3. Person becomes numb to the world and avoids stimuli that serve as reminders of the
trauma.
4. Person experiences intense survivor guilt in instances where others were killed and
the person was somehow spared.

PTSD becomes more prevalent in more people as time goes by after a traumatic event.
People are more likely to get PTSD after traumas caused by human actions as opposed to
natural disasters. Women are more likely to suffer from PTSD than are men. PTSD may cause
vulnerability to other disorders later on in life.

Causal Factors of Anxiety

Causes: - Biological factors include both genetic and biochemical processes, possibly
involving the action of neurotransmitters within parts of the brain that control emotional
arousal.

- Psychological. Psychoanalytic theorists believe that neurotic anxiety results from

the inability of the ego’s defences to deal with internal psychological conflicts.
The cognitive perspective stresses the role of cognitive distortions, including the
tendencies to magnify the degree of threat and danger and, in cases of panic
disorder, to misinterpret normal anxiety symptoms in ways that evoke pain. The
behavioural perspective views anxiety as a learned response established through

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classical conditioning or vicarious learning. The avoidance responses in phobias

and compulsive disorders are seen operant responses that are negatively
reinforced through anxiety reduction.
- Environmental such as sociocultural factors which are most dramatically shown
in culture-bound disorders that occur only in certain locales. An example of this
is in Japan where people develop Taijin Kyofushu, a pathological fear of
offending others with things such as body odours or blushing. Another example
is in South-east Asia where men develop koro, a fear of their penis retracting
into their abdomen and killing them because of the fear being publicized and
causing mass hysteria.

Somatoform and Dissociative Disorders: Anxiety Inferred

Anxiety is inferred or assumed present rather than outwardly expressed. The function of the
disorder is to protect the person from strong psychological conflict. Psychodynamic theorists
believe that whatever distress the person may experience in such disorders is less stressful
than the underlying anxiety that is being defended against.

Somatoform Disorders

Defined as: Physical complaints or disabilities that suggest a medical problem but that have
no known biological cause and are not produced voluntarily by the person.

Examples:

Hypochondriasis- become unduly alarmed about any physical symptoms they detect and are
convinced they have or about to acquire a serious illness.

Pain Disorder- experience intense pain that is either out of proportion to whatever medical
condition they might have or for which no physical basis can be found.

Conversion Disorder-serious neurological symptoms, such as paralysis, loss of sensation or

blindness, suddenly occur. People with this disorder often acquire la belle indifference, a
strange lack of concern about their symptom and its implications. Some complaints are
physiologically impossible such as glove anaesthesia, where the person loses all sensation
below the wrist. This is impossible because the nerves that serve the hand also serve the
arm. According to Freud, conversion symptoms were symbolic expressions of an underlying
conflict that aroused so much anxiety that the ego kept conflict in the unconscious by
converting the anxiety into a physical symptom. Predispositions include biological and
psychological. People who suffer with this tend to be more suggestible to things such as
hypnosis. It tends to be more common in cultures that discourage open discussion or that
stigmatise psychological disorders.

Dissociative Disorders

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Defined as: A breakdown of normal personality integration, resulting in significant

alterations in memory or identity.

Three forms that these disorders can take:

1. Psychogenic amnesia- a person responds to a stressful event with extensive but

selective memory loss.
2. Psychogenic fugue- a person loses all sense of personal identity, gives up their
customary life, wanders to a new faraway location and establishes a new identity. It
is triggered by a stressful or traumatic life event and may last for hours or even
years. Typically, the person will ‘wake up’ suddenly and remember their old life and
be very confused about their new life.
3. Dissociative identity disorder (DID)- (Also known as multiple personality disorder).
Two or more separate personalities coexist in the same person

In DID, a host personality appears more often than the alters (other personalities) but
each personality has its own integrated set of memories and behaviours. The
personalities may or may not know about the other personalities. They can differ in age
and gender. They can differ mentally, behaviourally and psychologically. Famous books
and movies based on DID- Sybil, The Three Faces of Eve and Psycho.

Causes of DID

According to Frank Putnam’s trauma-dissociation theory, the development of new

personalities occurs in response to severe stress. It often begins in early childhood,
frequently in response to physical or sexual abuse. Abuse in childhood is often a cause
because this is when the identity is established. Putman believes children may engage in
something like self-hypnosis and dissociate from reality. They transfer the trauma on to
someone else (another personality) who can handle it.

After the disorder was publicized in media, there was a much higher occurrence.

Mood Disorders

 Depression
 Bipolar Disorder
 Prevalence and Course
 Causal Factors

Mood disorders include depression and Mania (excessive excitement). They are the most
prevalent disorders alongside anxiety disorders and are often accompanied by anxiety
disorders.

Depression

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Almost everyone experiences depression sometime in their life but in clinical depression
the frequency, intensity and duration are out of proportion to the person’s life situation.
Some people respond to a minor setback with major depression, an intense depressed
state that leaves them unable to function effectively in their lives whereas other people
exhibit dysthymia, a less intense form of depression that has less dramatic effects on
personal and occupational functioning. Dysthymia, although less intense, is often chronic
with only some intervals of normal mood that never last more a few weeks or months.

The core feature of depression is a negative mood state. Most depressed people report
feelings of sadness, misery and loneliness. Activities that used to bring satisfaction and
happiness feel dull and flat. Even biological pleasure such as eating and sex lose their
appeal.

Symptoms:

-Cognitive such as loss of concentration, inability to make decisions, low self-esteem,

pessimistic futures and hopelessness.

-Motivational such as an inability to get started and to perform behaviours that might
produce pleasure or accomplishment. In severe case the person’s movements slow down
and they will walk and talk slowly and with excruciating pain.

-Somatic such as loss of appetite and weight loss in moderate and severe depression
and weight gain as a person eats compulsively in mild depression. Sleep disturbances
(insomnia), Loss of sexual desire and responsiveness.

Bipolar Disorder

When a person experiences only depression, the disorder is called unipolar depression.

Defined as: depression (usually dominant state) which alternates with mania (opposite
of depression).

Manic State: mood is euphoric and cognitions are grandiose. Person sees no limits and
fails to see negative consequences that may occur when grandiose plans are acted on. At
a motivational level, manic behaviour is hyperactive. The manic person engages in
frenetic (frenzied) activity in work, sexual relationships or in other areas of life. Manic
people can become very aggressive and irritable when their momentary goals are
frustrated. Speech is often rapid or pressured. This excitement can cause the person to
not sleep for several days and eventually the mania slows down.

Prevalence and Course of Mood Disorders

No age group is exempt from depression. It appears in infants as young as 6 months who
have been separated from their mothers form extended periods. In some studies, the rate of
depression symptoms in children and adolescents is just as high as the adult rate. The

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National Institute for Health and Clinical Excellence estimates that up to 75% of cases of
depression may be undetected.

1 in 33 young people suffer with depression. Only 1 in 4 of these people are detected and
treated. Suicide is the 3rd leading cause of death in 15-24 year olds and the 6th in 5-14 year
olds.

Prevalence of depression is similar across socio-economic and ethnic groups. Men and
women do not differ in prevalence of bipolar disorder but unipolar depression is more
common in women than men.

Depression does not reoccur 40% of the time but if it does the time between each episode
will shorten until the person is left with chronic depression.

Mania is very unlikely to be reoccurring.

Casual Factors in Mood Disorders

Causes: - Biological Factors include both genetic and neurochemical factors. One prominent
biochemical theory links depression to an under activity of neurotransmitters, such as
norepinephrine, dopamine and serotonin, that activate brain areas involved in pleasure and
positive motivation. Drugs that relieve depression increase activity of these transmitters.
Bipolar seems to have an even stronger genetic component than does unipolar depression.

-Psychological and Environmental. Personality-based vulnerability- Psychoanalytic theorists

view depression as a long-term consequence of traumatic losses and rejections early in life
that create a personality vulnerability. Cognitive Processes- Depressed people victimise
themselves through their own beliefs that they are inadequate. They also believe that
whatever happen to them is bad and that negative things will continue happening because
of their personal defects. This forms the depressive cognitive triad of depressive thoughts
concerning 1) the world, 2) oneself and, 3) the future. These thoughts occur automatically
and are very difficult to suppress. Depressed people also seem to remember more
depressing events. Depressed people exhibit depressive attributional pattern whereby they
blame themselves for bad happenings and they credit outside factors for the good
happening. Learned helplessness theory holds that depression occurs when people expect
that bad events will occur and that there is nothing they can do to prevent them. Learning
and environmental factors- The behaviour approach focuses on the vicious cycle in which
depression-induced inactivity and aversive behaviours reduce reinforcement from the
environment and thereby increase depression still further. Depressed people tend to make
others feel anxious, depressed and hostile and this can lower the amount of social support
they receive. Behavioural theorists believe that to begin feeling better, depressed people
must break this cycle by initially forcing themselves to engage in behaviours that are likely to
produce some degree of pleasure. Eventually, positive reinforcement produced by this
process of behavioural activation will counteract the depression. Environmental factors may

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include that children of depressed parents often experience poor parenting and many
stressful experiences. As a result, they fail to develop good coping skills and a positive self-
concept making them more vulnerable to depression.

-Sociocultural Factors. Places that have high social support such as Hong Kong and Taiwan
tend to have lower prevalence of depressive disorders. Cultural factors such as feelings of
guilt and personal inadequacy seem to be more predominant in North America and Western
European countries, whereas somatic symptoms of fatigue, loss of appetite and sleep
difficulties are more often reported in Latin, Chinese and African cultures. Women are more
likely to be depressed than men in developed countries but not in developing ones.

Schizophrenic Disorders

Defined as: severe disturbances in thinking, speech, perception, emotion and behaviour. It is
one of the psychotic disorders, all of which involve some loss of contact with reality, as well
as bizarre behaviours and experiences.

Characteristics: They are identified by the way the suffered has problems, or distortions of
perception an thinking, and by the way they show inappropriate or unclear emotions. The
person may hallucinate visually and/or auditorily, they may share secrets that they would
not ordinarily share, sounds and colours may see different, they may have a belief that
everyday situations have a meaning (usually sinister towards them) that they do not actually
have and their mood is affected usually they seem careless about things around them or
they may be catatonic or ‘not present’. Sometimes people recover completely with
treatment and other times they do not. It is equally prevalent in men and women. The
schizophrenic thought disorder sometimes entails delusions, false beliefs that are sustained
in the face of evidence that normally would be sufficient to destroy them. Perceptual
disorganisation and disordered though become more pronounced as people progress in
schizophrenia. Unwanted thoughts intrude the consciousness. Some experience
hallucinations, false perceptions that have a compelling sense of reality. Sometimes their
language consists of made-up words. Some have blunted affect, less sadness, joy and anger
or have flat affect, showing no emotion at all whereas others have inappropriate affect,
show they wrong emotions for happy or sad situations.

Subtypes of Schizophrenia

1. Paranoid schizophrenia- delusions of persecution, in which people believe that

others mean to harm them, delusions of grandeur, in which they believe they are
enormously important. Suspicion, anxiety, or anger may accompany the delusions
and hallucinations may also occur.
2. Disorganised Schizophrenia- confusion and incoherence with severe deterioration of
adaptive behaviour, such as personal hygiene, social skills and self-care. Thought
disorganisation is often so extreme that it is difficult to communicate with these

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individuals. Their behaviour often appears silly and childlike, and their emotional
responses are highly inappropriate. They are usually unable to function on their own.
3. Catatonic Schizophrenia- striking motor disturbances ranging from muscular rigidity
to random repetitive movements. They sometimes alternate between stuporous
states, in which they seem oblivious to reality, and agitated excitement, during which
they can be dangerous to others. While in a stuporous state, they may exhibit waxy
flexibility, in which their limbs can be moulded by another person into grotesque
positions they will then maintain for hours.
4. Undifferentiated Schizophrenia-assigned to people who exhibit some of the traits
from a subcategory but not enough to be diagnosed

Positive symptoms- delusions, hallucinations and disordered speech and thinking

Negative symptoms- absence of normal reactions such as lack of emotional expression, loss
of motivation and an absence of speech.

Causal Factors in Schizophrenia

Biological Factors:

Genetic Predisposition

Brain Abnormalities-according to neurodegenerative hypothesis, destruction of neural tissue

can cause Schizophrenia.

Biochemical factors- according to the dopamine hypothesis, the symptoms (especially

positive) are produced by over activity of dopamine.

Psychological Factors:

Psychoanalytic theorists regard schizophrenia as a profound regression to a primitive stage

of psychosocial development in response to unbearable stress, particularly within the family.
Cognitive theorists focus on the thought disorder that is central to schizophrenia. One idea is
that people with schizophrenia have a defect in their attentional filters, so that they are
overwhelmed by internal and external stimuli and become disorganised. Deficiencies may
also exist in the executive functions needed to organize behaviour.

Environmental Factors:

Stressful life events do often precede a schizophrenic episode, but researchers have not
been successful in identifying a family pattern related to the onset of schizophrenia.
However, expressed emotion is a family variable related to relapse among formerly
hospitalised schizophrenic individuals.

Sociocultural Factors:

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This accounts for the higher incidence of schizophrenia at lower socio-economic levels
include the social causation hypothesis, which attributes schizophrenia to the higher levels
of life stress that poor people experience, and the competing social drift hypothesis, which
attributes the relation to the downward drift into poverty as the disorder progresses.
Schizophrenia does not appear to differ across cultures.

Personality Disorders:

Defined as: people who exhibit stable, ingrained, inflexible and maladaptive ways of
thinking, feeling and behaving.

Personality disorders are an important part of the DSM system because they increase the
likelihood of acquiring several Axis 1 disorders, particularly anxiety, depression and
substance abuse problems. REFER to Table 17.3 Page 820, for different types of personality
disorders.

Antisocial Personality Disorder

Defined as: a lack of emotional attachment to other people. Although they often verbalise
feelings and commitments with great commitments, their behaviours indicate otherwise.
They often appear intelligent and charming, and have the ability to rationalize their actions
so that it appears reasonable and justifiable. They are good at manipulating others and
talking their way out of trouble.

Males are 3:1 times more likely than woman to have this disorder.

They also display a perplexing failure to respond to punishment because of their lack of
anxiety. The threat of punishment does not deter them from engaging in self-defeating of
illegal acts repeatedly. As a result, some of them develop imposing prison records.

Diagnosing: They must be over 18 years old however they must have displayed symptoms
before 15 years old such as habitual lying, early and aggressive sexual behaviour, excessive
drinking, theft, vandalism and chronic rule violations at home and at school.

Traits that the PCL-R assesses :

 Glib and superficial charm

 Grandiose estimation of self
 Need for stixc vxcxcxzz\xcxcxcxcxzcxz\cxcxv æmulation
 Pathological lying
 Cunning and Manipulativeness
 Lack of remorse of guilt
 Shallow affect (superficial emotional responsiveness)
 Callousness and lack of empathy
 Parasitic Lifestyle

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 Poor behavioural controls

 Sexual promiscuity
 Early behavioural problems
 Lack of realistic long-term goals
 Impulsivity
 Irresponsibility
 Failure to accept responsibility for own actions
 Many short-term marital relationships
 Juvenile delinquency
 Revocation of conditional release
 Criminal versatility

The practitioner gives each of the 20 traits a score out of two.

Causal Factors

Biological Factors:

Genetic Predisposition

Dysfunction in the brain structures that govern emotional arousal and behavioural self-
control.

Lower heart rates when under stress

Neurological deficits in the prefrontal lobe-the seat of executive functions such as reduced
autonomic activity.

Psychological and Environmental Factors:

Psychoanalysts view the disorder as a failure to develop the superego, which might
otherwise restrain the individual’s self-gratification.

Learning explanations focus on the failure of punishment to inhibit maladaptive behaviours

and exposure to aggressive, uncaring models.

Borderline Personality Disorder (BPD)

Defined as: a collection of symptoms characterized primarily by serious instability in

behaviour, emotion, identity and interpersonal relationships. They have intense and unstable
personal relationships and experience chronic feelings of extreme anger, loneliness and
emptiness, as well as momentary losses of personal identity. They often engage in impulsive
behaviour such as running away, promiscuity, binge eating and drug abuse and their lives are
often marked by repetitive self-destructive behaviours, such as self-mutilation and suicide
attempts that seem designed to call forth ‘saving’ response from other people in their lives.

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It is highly associated with a number of other disorders, including mood disorders, PTSD and
substance related disorders.

Causal Factors

Borderline clients tend to have chaotic personal histories marked by interpersonal strife,
abuse and inconsistent parenting. Parents of many borderline clients are described as
abusive, rejecting and non-affirming. As they mature, the behaviours of BPD tend to evoke
negative reactions and rejection from others, affirming their sense of worthlessness and
their view of the world as malevolent.

Psychoanalysts focus on the dramatic changes of borderline individuals in their relationships

with others, their extreme love and clinging dependence to intense hatred or feelings of
abandonment. This change is called splitting and is a failure to integrate positive and
negative aspects of another’s behaviour.

Cases of BPD seem to increase in societies that are unstable and rapidly changing, leaving
people with a sense of emptiness, problems with identity and fears of abandonment.

Childhood Disorders

Attention Deficit/Hyperactivity Disorder

Autistic Disorder

Causal Factors

Attention Deficit/Hyperactivity Disorder (ADHD)

Defined as: problems that take the form of inattention, hyperactivity/impulsivity, or a

combination of the two.

It is four times more frequent in boys than in girls.

Overall, adults with ADHD carried over from childhood have more occupational, family,
emotional and interpersonal problems.

There is a suspected genetic basis for a predisposition.

Some professionals believe that ADHD is not an actual disorder.

Autistic Disorder

Defined as: a long-term disorder characterized by extreme unresponsiveness to others, poor

communication skills, and highly repetitive and rigid behaviour patterns. It appears in the
first 3 years of life and is life-long. More than two thirds are mentally retarded whereas the
rest have average or above average IQs.

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80% of children diagnosed are male.

Lack of social responsiveness to others is a central feature of autism. Autistic infants typically
do not reach out to or even make eye contact with their parents. They seem no t to care
who is around them. Autistic children do not engage in normal play with either adults or
peers.

Language and communication difficulties are also common, with half of autistic people not
developing language. The language that does develop is often strange, involving repetition
of words of phrases without recognition of meaning. Many engage in echolalia, the exact
echo of phrases spoken by others.

Sameness and routine are very important. Autistic children become extremely upset at even
minute changes. The movement of a piece of furniture even slightly or the change of one
word in a song may evoke a tantrum. Some theorists believe that sameness is an attempt to
avoid over-stimulation.

It is very rare, but some autistic people have super-intelligence.

Causal Factors of Autism

There seem to be biological underpinnings but the nature of these causal factors is not fully
understood.

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