Psychological Disorders - Historical perspectives
Middle Ages
- possessed by demons
- exorcism to cure
- trephination
Bedlam
- St Mary of Bethlehem Priory, Englan 1247
- Operated 5 centuries as institution for mentally ill
- gentry would pay admission to watch
Changing views
- look at mental rather than physical
- more humane approach
Process of diagnosis of psychological disorders
Clinical interview
- current symptoms
- history of symptoms
- impact of symptoms on functioning
- hypothesis testing (testing if other symptoms there)
Collateral info
- data from fam, friends, GP, teachers etc
- beneficial when: person unaware of or concealing symptoms
- shows current mood state
- confidentiality needed
Psychometric assessment
- following symptom exploration
- quantitative measure of condition
- can produce baseline measurement to compare to in future
- e.g. Beck’s depression inventory (BDI), alcohol use disorders identification test (audit)
Classifying Abnormal Behaviour
Classify to:
- assist communication (e.g. between professionals)
- assists research
- assists understanding of causality
- assists treatment selection
- facilitates comparison across time and geographic areas
Guidelines
- American Psychiatric Association:
Diagnostic + Statistical Manual of Mental Disorders (DSM)
- dictionary for psychologists
- most recent = DSM5
- World Health organisation:
International classification of diseases (ICD)
- physical and medical illnesses as well as psych
Criticism
- categories vs dimensions (DSM5 has introduced continuum of severity)
- pejorative labels
- danger of self-fulfillment
- reliability (inconsistency)
Prevalence, Incidence + Comorbidity
Prevalence
- proportion of pop that have condition
Incidence
- frequency in new cases during set amount of time
Comorbidity
- co occurrence of various disorders
- cluster together (life affect)
Biological reasons
- dysfunctions in brain
Anxiety disorders
Excessive fear, anxiety etc out of proportion to environmental factors
Generalised anxiety disorder (GAD)
- persistent and excessive anxiety about multiple things
- present at least 6 months
- restlessness, difficulty concentrating
- must significantly impact daily functioning
Panic Disorder
- Sudden, unexpected intense fear and anxiety
- recurrent and reaches peak within mins
- leads to avoidance of precipitating conditions
- develop agoraphobia (fear of being in places where can’t escape from embarrassment)
Specific Phobia
- Anxiety linked to one specific thing - irrational fear
- heights, spiders, needles
- stops from engaging
- treated by exposure therapy
Social Anxiety Disorder
- Anxiety about social situations
- Scared others will notice symptoms
- Avoid social situations
- Exposure therapy
Anxiety Disorders Aetiology
Biological
- Preparedness to avoid dangerousness (evolutionary e.g. snakes)
- Neurochemistry (decrease gaba, decrease serotonin = increase anxiety)
- Twin studies (if 1 twin has disorder, 35% of identical does, 15% dizygotic does)
Environmental
- Diathesis-stress hypothesis (genetic factors place individual at risk - predisposition - and environmental stress factor triggers genetic influence)
Cognitive
- overestimate likelihood or nature of threat
- underestimate ability to cope
- vicious cycle of anxiety
- selective recall/attention of threat info. (bias to remember pos or neg parts of event)
Mood disorders
- Disturbance in emotion/mood
- ‘Affective’ disorders
Major Depressive Disorder (MDD)
- persistent depressed mood and anhedonia (can’t enjoy things used to)
- reduced appetite, poor concentration, worthless, suicide thoughts/attempts
- symptoms present most of the day, most days, at least 2 weeks
- often recurrent, high relapse
Persistent Depressive Disorder (dysthymia disorder)
- chronically depressed mood
- occurs most days, min 2 years
- sim to MDD but lasts longer
- Symp. less severe
Seasonal Affective Disorder (SAD)
- Depressive syndrome occurs during certain season
Bipolar Disorder
- Same symptoms of MDD but experience both emotional poles of depression and mania
- manic episode = elevated mood, excessive happiness, racing thoughts, lack sleep, lots of talking
Mood disorders Aetiology
Biological
- Neurochemistry (serotonin and noradrenaline: low = depressed, high = mania)
- Twin studies ( if 1 twin has disorder, 65% MZ do, and 15% DZ do)
Cognitive
- Beck’s negative triad (negative views about self, world and future)
- Cognitive distortions (automatic/implicit processing of +ve info in a -ve way, mem bias for sad events, rumination)
- Learned helplessness
- Pessimistic attribution style (bad things happen cause I’m bad, good things happen by chance)
Environmental
- Diathesis-stress hypothesis
- Early childhood and fam environment (disruptive, hostile, -ve -> -ve life impact)
- severe stressors, -ve life events
- social isolation, lack of intimate relationships
Schizophrenia
Disturbance in nearly every aspect of human psych (thoughts, feelings, behav, perception, language, emotion)
- Positive symptoms: presence of abnormal behaviour (hallucinations, delusions, disordered thought/speech, loosening of associations)
- Negative symptoms: deficit of normal behaviours (flat/blunted affect, apathy, social withdrawal, intellectual impairment)
Schizophrenia positive symptoms
Hallucinations
- visual, auditory, tactile
- gross distortion or occur in absence of external stimuli
- auditory most common
Delusions
- false beliefs maintained even though out of touch with reality
- persecution: others trying to harm themselves
- grandeur: believe have great power/knowledge/talent
- identity: believe are someone else (Jesus, Queen)
- guilt: believe have committed terrible sin
- control: believe thoughts/behav controlled by external source
Loosening of Associations
- conscious thoughts move along associative lines, not controlled, logical, purposeful
- reflected in speech
Schizophrenia Aetiology
Biological
- Neurochemistry: Excessive dopamine in brain
- Twin studies: if 1 twin has, 48% Mizogenic also has, 17% dizogenic twin has
Environmental
- Diathesis-stress hypothesis: some ppl with high genetic vulnerability may develop regardless of environ.; some ppl at risk may never develop; if not predispositioned, wont get
- birth complications (viruses, malnutrition)
- stressful life events
- child abuse
- expressed emotion within family
Obsessive compulsive disorder
Obsessions
- intrusive, repeated, distressive thoughts/ideas/urges
Compulsion
- repetitive behav/mental acts person feels forced to carry out
4 major types
- checking
- fear of leaving stove on -> keep checking - Contamination
- obsess with cleanliness -> clean self/environment - Hoarding
- thoughts/fears of needing something -> collecting - Intrusive thoughts
- thoughts of antisocial behaviours -> compulsive (dangerous behaviour)
Personality disorders
- enduring maladaptive pattern of thought, feeling, behaviour
- pattern inflexible and stable across situations
- extreme forms of personality that disturbs functioning (social, occupational)
- starts in adolescence/early childhood
Personality disorders Types
Paranoid PD
- suspicious, mistrusts loyalties, grudges, wont confide
Borderline PD
- unstable relationships, poor sense of identity, impulsive, suicidal thoughts
Antisocial PD
- disregard rights of others, deceitfulness, lack of remorse/empathy, disregard for safety, law violations
Narcissistic PD
- grandiose, self-important, arrogant, lack empathy, envious
Dependent PD
- submissive, clingy, feels helpless when alone
Dissociative disorders
- Disruptions in consciousness, memory, sense of identity, perception
- Basically remove conscious state
- Associated with amnesia
Dissociative Identity disorder
- aka multiple personality disorder
- min 2 personalities exist within 1 person
- generally reflect trauma/abuse
- other personalities help cope
Eating disorders
Anorexia Nervosa
- refusal to maintain body weight
- intense fear of gaining, even though often under
- distorted body image
- food restriction, excessive exercise, vomiting
- health implications
Bulimia Nervosa
- binge and purge syndrome
- vomiting, laxatives
- feelings of relief -> depression and feeling out of control
