Understanding Psychological Disorders: Key Concepts and

School

University of Toronto**We aren't endorsed by this school

Course

PCL 200

Subject

Psychology

Date

Dec 11, 2024

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Uploaded by SuperSparrow2411

PSY100 Lecture 10: Psychological DisordersDefining Psychological Disorders:-General criteria for a disorderStatistical rarity:UncommonSubjective distress:Associated with low quality of life, poor mental well-beingImpairment:Cognition, emotion regulation and attentionBiological dysfunction:Significant abnormalities in the nervous system-Major perspectives 1:A disorder is an invented classification that may not perfectly capture the full range of the human experienceWe group things together, but our groups may not reflect those naturally existDisorders are likely heterogeneousThere are many subtypes of schizophrenia, not just oneSubtypes may different in cause, features, outcomes, treatment responses and more-Major perspectives 2:Disease model of disordersSomething “causes” the disorder, which in turn leads to the symptomsAny one symptom is a suitable measurementSeverity of symptoms ~ severity of disorderUseful, but not perfectSymptoms variable in number, frequency and intensity“Cause” unclear-Major perspectives 3:Network model of disordersDisorder is an interaction between symptomsMultiple symptoms must be considered at onceRelated: dynamical systemsapproachWhile innovative and promising, also imperfectData collection and analysis is more complexNewer, validity less clear

-Controversies:1.Diagnosis is categorizing people (pigeon-holing)A person does not lose their individuality with diagnosisBetter to use the term “people with XXX”2.Diagnoses are unreliable (experts disagree) Clinicians generally agree (inter-rater reliability ~ 0.8)3.Diagnoses are invalidDiagnoses can predict outcomes4.Diagnoses negatively impact a person’s lifeIn the right context (supportive environment), an effective diagnosis generally improves quality of life-DSM-5 Features:Provides a set of criteria for guiding diagnosis, includes some 300+ disordersUses a biopsychosocial approachBiological factors, psychological factors (thinking patterns) and societal factors (culture)CriticismsNot all disorders meet validity criteriaVagueness may lead to “pathologization” of normal behavior Categorical (binary; either/or) rather than dimensionalConcerns raised about lack of transparency, pace of preparation and conflicts of uninterestPsychological Disorders:-Anxiety Disorders:Generalized Anxiety Disorder (GAD)Exaggerated worry/tension in day-to-day situations (generalized and not specific) May later lead to the emergence of other disordersMore common in females than malesPanic DisorderCharacterized by episodes of intensive fear (w/sweating, dizziness,light headaches, breathing difficulty, heart irregularities)Many people might report a single panic attack each year (e.g. 20% of students have an attack once a year)

In panic disorder, however, the attacks are repeated and unexpectedEmerges early in adulthoodPhobias:Intense, irrational fear of a specific thingMay be outgrowth of panic disorderE.g., agoraphobia(fear of marketplaces or crowded environments) By far the most common of all anxiety disordersoMost phobias are not highly distressing, do not impair quality of life or require treatment~4% of people may suffer from these conditionsRelated to anxiety disorders, but now considered independent, are obsessive-compulsive disorder (OCD)and post-traumatic stress disorder (PTSD)OCD:oObsessionsare persistent thoughts that are unwanted and/or cause stressCentered around topics such as sex, contamination,aggression and religionoCompulsionsare repetitive behaviors undertaken to reduce distress and relieve shame/guiltWashing handsRe-reading sentences-What causes anxiety:Learning/Behaviorist perspective:Life experiences play a role in disordersPairing a stimulus (cars) with an aversive event (car accident) may lead to phobias (fear of driving) via classical conditioningMaintenance of disorder via negative reinforcementoIf cars (S-) make you anxious, you might avoid them (R)oBecause avoiding cars makes you less anxious, you’re motivated to continue avoiding cars (increase in R)Other factors:Possible role of geneticsoAnxiety disorders are heritable (h2 ~ 0.3) and run in families

oHowever, no single gene is strongly associated with the disorder (many are likely involved)Possible role of environment is currently debatedoUse of digital technologyoFree play in childhoodoOccupation (see later)oRelationships (see later)Rates of anxiety (and depression) have been risingoEnvironmental changes are viewed as the likely factor-Depression:What is depression?Loss of interest or pleasure in activities normally enjoyedDecreased energy (e.g. fatigue) Feelings of guilt or low self-worthDisturbed sleep, appetite and activity Inability to concentrateThoughts of suicideGlobal burden of depression:~5% of population, higher rates in young cohortsAssociated with lower quality of life, suicide and other poor outcomesSignificant economic costLeading cause of disability worldwideGood news: normally treatable (70 – 80% of cases)Types of Depression:Unipolar depressive disorderoMajor Depressive Disorder (MDD; chronic)oMajor Depressive Episodes (MDE; acute but often recurrent)Post-partum depressionDysthymiaSeasonal affective disorderDepressive episodes also occur in bipolar disorder, but bipolar disorder is considered separatelyWhat causes depression:Epidemiology of Depression1.Gender

More common in women (~2x) though the severity does not differReasons for disparity are complex and the subject of much discussionTaking the biopsychosocial perspective, multiple factorscould be involvedSome forms are related to sex hormones(e.g. post-partum)Prevalence in males may be low due to stigma (“act tough”)Prevalence in females may be high due to socialpressures (e.g. family roles, unpaid labor, societal expectations)2.CommunityBurden of depression is often thought to be higher in Western, developed countriesMany potential reasons for this disparityMore awareness + less stigmaBetter diagnostic criteria + health care system accessBeliefs about the efficacy of emotional regulationValuation of happiness in Western culturesDescription of the disorder within the culture3.Socioeconomic statusLow SES (i.e. low income) increases riskThis relationship holds in Eastern and Western communities, even after controlling for other variablesMost scientists argue that low income leads to depression rather than the contraryRelationship between income + well-being complexLow income may be associated with increased risk for many reasons (e.g. lack of insurance, health care…)4.Occupation:If you don’t have a job, the risk is also higher (nearly x2, according to one poll)Social interaction plays a role but its complex

Frequent and/or difficult interactions (service) increases risk Lack of social interactions (trucking/transport) increases riskStress level (high increases risk)Physical activity (low increases risk)Jobs offer varying degrees of validation (skills), feelings of meaning/status/acceptance, income and access to vital services (e.g. health care)5.Life historyRisk for mental disorders increases with stress frequencyTheoretical Models:The Interpersonal人际关系 model proposed by CoyneoIf you feel down, you look to others for assuranceoOthers respond negatively to your need (hostility + rejection)oPoor interactions increasing need for reassuranceBehavioral models proposed by LewinsohnoLow rate of reinforcement: try many things w/no successoLearned helplessness is a related concept (Seligman)Cognitive model popularized by BeckoCognitive distortions affect the ability to acknowledge reality or interpret it properly (always negative) Best describes people with serious depressionBiological Features of Depression:-Substance Use Disorder (formerly addiction):

What is addiction?One popular definition: ‘complex brain disease in which there is acompulsive engagement in behavior despite knowledge of harmful consequences’The term ‘brain disease’ suggests a perspective where impaired brain function is critically involvedoMatters for treatment, other competing perspectives (e.g. choice perspective) exist‘Behavior’ can refer to many things (drug use, gambling, sex* or video games*)Risk factors for addiction:Stability of home environmentEarly use + peer groupsEducationEmploymentGeneticsGenderoUsage/dependence rates higher in men for many drugs, and overdose rates higher in women for some drugsMental health status:oCo-morbidities frequentTreating Addiction:View of addiction as a “disease of the brain” or a “choice” has implications for treatment/quality of lifeoBeliefs vary by countryHybrid views are favored, extreme views are notoIf addiction is viewed strictly as a choice, policies might be more aggressive and stigma might be greateroIf addiction is viewed strictly as a disease, treatments might be less effectivePrognosis good with treatment; majority recoveroTreatment takes many forms, but is rarely pharmacological (drug-based) in nature-Bipolar Disorder双相情感障碍:Episodes of depressionand elevated mood (mania/hypomania)Previously called manic depressionThey may experience a reduced need for sleep and make poor decisions with little regard for the consequences

~1% of the global populationOne of the most costly disorders worldwide (top 10)Risk of suicide and self-harm is highRelated to many other traits (particularly creativity), and over-represented in certain parts of the population (creative professionals/artists)-Personality Disorders:Inflexible patterns of behavior that lead to distress in a wide variety of casesEmerge in adolescence, around the same time as personality traits doDifficult to reliably diagnose; less researched than other conditionsCategory includes borderline personality disorder边缘人格障碍, narcissistic personality disorder自恋型人格 and anti-social personality disorder反社会人格-Autism:Symptoms:Poor social interactionoFails to respond to name, poor eye contact, resists cuddling, prefers playing/being aloneoMay not recognize/respond to social cuesRepetitive behaviors/Difficulty switching behaviorsoArranging objects, making sounds, hand flapping, head rolling and body rockingoSpecial interests Slow language developmentoStarts later than age of 2 (remain non-verbal), repetition ofwords/phrases (echolalia), abnormal tone/rhythmThe Spectrum:A heterogeneous group of disorders, defined by a set of symptomsExceptional cognitive abilities are rare (~10%)Strong genetic basis (h2 = 0.6 to 0.7) ~1% population, more common in boys (~3:1)oWhy are boys affected more (~3:1)?Disorder harder to diagnose in women (masking)“Socially appropriate” special interests are encouraged in women, making the disorder lessapparent

Higher genetic load may be required in women (femaleprotective brain theory; controversial)Similar theory proposed for SZ Autism-related genes interact w/sexually dimorphic biological pathwaysEffects of hormones on gene expressionWhy are rates rising?oIncreased awareness and more sensitive diagnosisoInclusion of high-functioning casesoIncreased parental ageoCertain drugs (valproate), nutritional deficiencies, plastic exposure + more-Schizophrenia精神分裂:Symptoms:Features:~0.5 – 1% of the population (similar worldwide)Onset and severity differ by sexoMales ~18 years (earlier, worse outcomes)oFemales ~30 years (later, better outcomes) Associated with disrupted neurotransmission (particularly dopaminergic (DA))

oPositive symptoms are similar to the effects of drugs that increase DA signaling (e.g. amphetamine, L-DOPA)oPositive symptoms reduced by drugs that block DA signaling (DA antagonists; typical antipsychotic drugs such as haloperidol)Major risk factors:Prenatal + postnatal factors; some are “choices” (e.g. drugs), others are “accidents” (e.g. illness).Strong genetic basis (h2 = 0.6 to 0.7)Psychotherapy心理治疗:-Types of therapists:A professional is an individual with specific, intensive training and certification from a recognized institutionClinical psychologists and psychiatrists are a good exampleBroad expertise, awareness of the complex ethical/legal/personal issues that people faceThere are also paraprofessionals, who have agency-specific qualifications that are specific to certain needsCannot formally diagnose or prescribe drugsFill a key gap, people may sometimes need care but be unable to access a professional-The therapist is critical“Good therapists” are viewed as warm, respectful, caring, engaged, empathetic and authentic

Ability to instill hope/positivity is another valued traitNo clear relationship between experience + outcomesTrait matching with therapist (female-female, ethnicity-ethnicity) is often preferred, but benefits are unclear-Insight Therapies:1.Psychoanalytic therapies精神分析疗法:Abnormal behaviors in mental health disorders may stem fromearly and/or traumatic experiencesEmphasis on the unconscious and the analysis of:othoughts and feelings that patients avoid (repressed)owishes and fantasiesorecurring themes and patternsotherapeutic interactionBelief that insight into unconscious material is required for meaningful changes in behavioroBring unconscious processing into conscious awarenessProcedures:oFree association and Interpretation“What’s the first thing that comes to mind when I mention X?”First answers given, or answers given repeatedly, may be meaningful in ways the person does not realizeTherapist may propose explanationsoDream analysisDreams may represent subconscious desires that contribute to the current mental stateWish fulfilment theory of dreamingoDebate over role of insight in therapy efficacy2.Humanistic Therapies:Related to perspectives of Rogers and MaslowOften called client-centered (older term) or person-centered (newer term) therapyEmphasis on insight, positivity and achieving self-actualization through choice (free will)Therapist should be authentic, unconditionally positive and empathic (three critically important traits)Less structured (client decides how time is spent)

-Behavioral Therapies:Whereas insight therapies focus on general awareness, behavioral therapies focus specifically on current behaviors the client sees as problematicStrategies to treat the behavior often included:More data-driven, comprehensive assessments sometimes included (e.g. psychological/physiological tests and interviews given)Emphasis on principles of learning and reinforcementExamples: Systemic desensitization:oFears may result from conditioning (CS + unpleasant stimulus, CS becomes cue for unpleasant stimulus)oTreatment involves re-pairing CS with positive stimulus (e.g. one that causes relaxation)Aversion therapies:oReduce a bad behavior by paring it with a bad outcome (e.g. Disulfiram/Antabuse in the treatment of alcoholism)Extinction Therapy/FloodingToken economiesCognitive behavioral therapy (CBT):May be used to treat depression and anxietyVery popular, used by ~40% of clinical psychologists-Acceptance-Based Therapies:“Third wave” of therapyBehavioral therapies are considered the first wave, cognitive therapies the second waveFocuses on embracing thoughts and feelings, without feeling ashamed about themThough this seems similar to the humanistic therapies mentioned earlier, acceptance-based therapies are different in that acceptance is the primary focusGrowing in popularityPromise in treating anxiety, depression and addictionAcceptance and Commitment Therapy (ACT), Mindfulness-Based approaches and Dialectic Behavioral Therapy arguably all fall into this categoryMindfulness Meditation:

Trait mindfulness is said to involve “Paying attention in a particularway: on purpose, in the present moment, and nonjudgmentally”Mindfulness is emphasized in the activity of mindfulness meditationMindfulness meditation + programs incorporating it have been used to treat mental health disordersoMost supported for anxiety, pain + depressionBiomedical Treatments:-Includes drugs, brain stimulation and surgery (anything that directly affects biology)-May be more effective for certain individuals, but risk for side effects is generally greater-Not always intended to be used alone, usually should be paired with other psychotherapy methods-BMT of Depression:Drugs(moderate/severe cases)SSRIs (Selective Serotonin Reuptake Inhibitors)Concerns of over-prescription + withdrawalTranscranial magnetic stimulation (TMS)More accessible (though not more effective)KetamineRapid effect (for those whom it works)Newer (c. 2019), side effects unclearElectroconvulsive therapyPsychosurgery (removal of cingulate)-BMT of Other Disorders:AnxietyDrugs increasing GABAAreceptor activity are anxiolytic (e.g. benzodiazepines)However, SSRIs are most commonly usedBipolar disorderLithium, valproate, anticonvulsants and antipsychoticsSchizophreniaFirst generation/conventional antipsychotics (block D2 receptors)Second generation antipsychotics have multiple actions (e.g. block5-HT2 receptors)

-Concerns:Side effects generally more significant than for therapySome treatments non-reversible (e.g. psychosurgery)Though some treatments are more convenient than psychotherapy, they are also more costly (e.g. drugs) Common misconception that all disorders are a ‘simple chemical imbalance’ may lead people to prefer drugs and avoid other treatments that could be beneficialMost effective approach likely involves biomedical treatments andpsychotherapy together-Ineffective Therapies:Why ineffective therapies looks good:Spontaneous remissionPlacebo effectSelf-serving biasRegression to the meanRetrospective re-writing of the past