Download Pathology

Psychological Disorders
Instructional Objectives
History
1.
Definition of Normal Behaviour
2.
Perspectives
3.
Diagnostic labeling – common disorders
4.
Causal factors of disorders.

History
During the middle ages (1600’s), mental illness was interpreted from a
religious point of view and people with mental illnesses were seen as
influenced by the devil, practicing witchcraft and possessed with demons
If accused of witchcraft all possessions, property and money confiscated
Initially professional theologians identified witches – movement called
Inquisition
Criteria for witches in Malleus Malficarauum: birthmarks, witches float,
feeling a prick from a dull object
Criteria so loose many people were identified as witches
People became very afraid – afraid to cross neighbours, to speak up
against ideas, etc.
Treatment included execution, exorcism, drilling holes in skulls,
beatings, being burned, drowned, castrated
In the 1800,s, medical understandings developed for many mental
illnesses and hospitals started to replace asylums - this was a great
period of reform: Philipe Pinel (1745-1826); Thomas Szaz; RD Lang; David
Cooper
These people saw the mentally ill as having problems with living and
felt that treatment should involve treating them as individuals in need
of help, rather than dumping them in institutions and throwing away the
key
1

Disorder - Definition
Mental health workers label behavior psychologically disordered when it is
atypical, disturbing, maladaptive, unjustifiable, and producing personal
distress, or endangering others
In most instances several of these criteria need to be met in order for a person
to be considered abnormal.
But there are no necessary symptoms – usually the greater the number of
symptoms, the more likely one is to have a disorder
Note: It’s common for students studying mental disorders for the first time to
think that they are afflicted by many of them – this is completely natural – the
same happens to medical students
Atypical – deviating form statistical norms
At least once in each person’s life, they will be able to be classified as
having a mental disorder
Having a mental disorder means 1) having abnormal experiences/perceptions (may
be very difficult for normal people to imagine what constitutes an abnormal
experience)
2) a person’s behaviour must also be significantly different from the social
norms seen in the population
Note: 1) What is considered normal in one society/culture may be considered
abnormal in another – e.g. members of some African cultures think it’s normal to
hear voices, to talk with them and to see visions
2) The concept of normality within a culture can change over time – e.g.
homosexuality used to be considered a disorder, as well as near nudity on a
beach and smoking pot
Problems of labeling as a self-fulfilling prophecy and stigmas associated with
labels (latter in reference for example to schizophrenia)
Disturbing
Behaviour deviates from the norm sufficiently that others find it disturbing
Schizophrenics talking to themselves
Street people hassling you for money
Maladaptive
That the behaviour brings on detrimental physical change in the individual or in
relation to the social group
Substance abuse
Behaviour disruptive to daily life
2
Unjustifiable
That there is no apparent reason for the individual’s e.g. paranoid behaviour
Example of spy who was wrongly diagnosed as paranoid
Personal Distress
If an individual is suffering e.g. anxiety, depression, agitation, insomnia

What is Normal
We think of mental disorder relative to our own experiences (probably we are
being very inaccurate)
We also use our cultural norms as benchmarks for judging abnormal behaviour
Legal definitions include 1) being able to take care of yourself 2) not
destructive to yourself or others
Efficient perception of reality
Ability to exercise voluntary control over behaviour
Self-esteem and self acceptance
Feelings of worthlessness, alienation and lack of acceptance are common in
abnormal persons
An ability to form affectionate relationships
Productivity: a productive contributing individual in society
3
Perspectives on Mental Disorders
Medical (organic or endogenous)
Sickness, genetic/biological cause: tumors, toxins (alcohol, drugs,
environmental exposure), blood chemistry, CNS problems with aging
Treatment: medication, surgery, therapy, ECT
Critics argue that disorders are socially, not medically, defined and that the
labels the medical model assigns may be self-fulfilling.
Functional or Psychological (exogenous)
Psychologists who reject the "sickness" idea typically contend that all behavior
arises from the interaction of nature (genetic and physiological factors) and
nurture (past and present experiences)
No physical cause, lack of knowledge, motivation, result from strong fears,
early childhood experiences, life experiences
Psychodynamic (Psychotherapy) Freud: disorder is early childhood experience,
psychosexual stages of development
Behavioural: Skinner Life experience – history of reinforcement – classical
conditioning and operant learning – treatment: behaviour can be reconditioned
Cognitive: Thinking patterns are maladaptive and can be changed with appropriate
training
Social Cognitive: Thinking patterns in relation to social experience
Bio-psycho-social: genetic factors, physiological states, inner psychological
dynamics, and social circumstances
Phenomenological: Rogers, Maslow, Interrelationship with acquiring life goals
(humanistic therapy)- reaction to mechanistic behavioural viewpoint
Emphasis on one’s own existence – getting in touch with emotions – individual
identification of meaning of life (phenomenological) – persons responsible for
their own lives and can choose how to interpret situations – behaviour not
determined by past experience but by the choices we make
Various perspectives have implications for cause and type of therapy – also
combinations of explanations and therapies are used
4
Identifying and Describing Disorders

The Diagnostic and Statistical Manual of Mental Disorders
North America: A descriptive approach to classification heavily
based on medical perspective - Most recent update: 2010 Purpose:
Classify
Communicate
Define treatment approaches
Define research directions
In Europe ICD Instrumental Classifications of Disease – in this, disorders are
considered a subcategory of diseases – unlike DSM4 (strictly disorders)
(DSM-IVTR) provides an authoritative classification scheme.
It assumes the medical model and groups some 230 psychological disorders and
conditions into 17 major categories of "mental disorder."
DSM-IVTR describes disorders and their prevalence without presuming to explain
their causes
Although diagnostic labels may facilitate communication and research, they can
also bias our perception of people's past and present behavior and unfairly
stigmatize them.
Criteria or axis of diagnosis:
Primary diagnosis (physical)
Personality type
Physical history (e.g. ulcers)
Recent stress
Recent history of social functioning – family history
Some of the labels
Those who suffer an anxiety disorder may for no reason feel uncontrollably tense
(generalized anxiety disorder), may have a persistent irrational fear (phobic
disorder), or may be troubled by repetitive thoughts and actions (obsessivecompulsive disorder).
Somatoform disorders involve a bodily symptom that has no apparent physical
cause. In hypochondriasis, people interpret normal sensations as symptoms of a
dreaded disease.
Dissociative disorders take the form of amnesia, fugue, or even multiple
personality. Under extreme stress, conscious awareness becomes separated from
previous memories, thoughts, and feelings.
Mood disorders (Affective) include major depressive disorder and bipolar
disorder. Current research on depression is exploring (1) genetic and
5
biochemical influences and (2) cyclic self-defeating beliefs, learned
helplessness, negative attributions, and aversive experiences.
The symptoms of schizophrenia include disorganized thinking, disturbed
perceptions, and inappropriate emotions. Researchers have linked certain forms
of schizophrenia to brain abnormalities. Studies also point to a genetic
predisposition that may work in conjunction with environmental factors.
Personality disorders are characterized by inflexible and enduring behavior
patterns that impair social functioning. The most common is the remorseless and
fearless antisocial personality. Dependent, obsessive compulsive, passive
aggressive
Disorders in Depth
Anxiety Disorders
Generalized anxiety disorder is an anxiety disorder in which a person is
continually tense, apprehensive, and in a state of autonomic nervous system
arousal. The anxiety can escalate into a panic attack an episode of intense
dread, usually lasting several minutes.
A phobic disorder is an anxiety disorder marked by a persistent, irrational fear
of a specific object or situation.
An obsessive-compulsive disorder is an anxiety disorder characterized by
unwanted repetitive thoughts (obsessions) and/or actions (compulsions – person
can’t control these – checking doors, under beds, is the stove turned off,
repetitive behaviours -–counting fence posts, heart beats
Causes
The psychoanalytic perspective views anxiety disorders as the discharging of
repressed impulses. The learning perspective sees them as a product of learned
helplessness or fear conditioning. The biological perspective emphasizes
evolutionary, genetic, and physiological influences.
Somatoform Disorders
Both conversion disorder and hypochondriasis are Somatoform disorders in which
symptoms take a bodily form without apparent physical cause.
The conversion disorder, more common in Freud's day than ours, is marked by very
specific physical symptoms, such as paralysis, blindness, or an inability to
swallow, for which no physiological basis can be found – common in war time
(bombardiers become blind).
Hypochondriasis is a more common disorder in which a person interprets normal
physical sensations such as a headache as symptoms of a dreaded disease.
6
Dissociative Disorders
Amnesia, a Dissociative disorder, is selective memory loss often brought on by
extreme stress.
Fugue is a Dissociative disorder in which flight from one's home and identity
accompanies amnesia.
Multiple personality is a rare Dissociative disorder in which a person exhibits
two or more distinct and alternating personalities.
Causes
Psychoanalysts see these disorders as defenses against the anxiety caused by the
eruption of unacceptable impulses.
Disorders are viewed as hypnotic like states into which people lapse as a
protective response to traumatic childhood experiences. For example, most people
diagnosed as multiple personality are women, many of whom suffered physical,
sexual, or emotional abuse as children.
Learning theorists see them as behaviors reinforced by anxiety reduction.
Mood Disorders
In major depressive disorder, a person without apparent reason descends for
weeks or months into deep unhappiness, lethargy, and feelings of worthlessness
before rebounding to normality. Poor appetite, insomnia, and loss of interest in
family, friends, and activities are often other important symptoms.
Bipolar disorder is a mood disorder in which a person alternates between the
hopelessness and lethargy of depression and the overexcited state of mania (a
hyperactive, wildly optimistic state).
Causes
The psychoanalytic perspective suggests that depression occurs when significant
losses evoke feelings associated with losses experienced in childhood. For
example, loss of a loved one may evoke the anger once felt toward parents who
were similarly "abandoning" or "rejecting." The unacceptable anger is turned
inward toward the self and, combined with the sense of loss, produces
depression.
The biological perspective emphasizes the importance of genetic and biochemical
influences. Mood disorders run in families, and certain neurotransmitters seem
to be scarce in depression.
The social-cognitive perspective sees depression as a vicious cycle in which (1)
stressful events are interpreted though (2) a pessimistic explanatory style,
creating (3) a hopeless, depressed state that (4) hampers the way a person
thinks and acts. This, in turn, fuels (1) more negative experiences.
7
Schizophrenia Disorders
Schizophrenia is a group of severe psychotic disorders characterized by
disorganized and deluded thinking (including delusions and hallucinations),
disturbed perceptions, and inappropriate emotions and actions
Inability to maintain a train of thought
Can’t concentrate for long periods of time
Social withdrawal
Schizophrenia patients with positive symptoms are disorganized and deluded in
their talk or prone to inappropriate laughter, tears, or rage - overly emotional
Those with negative symptoms - loss of emotional responsiveness -have toneless
voices, expressionless faces, or mute and rigid bodies. Catatonic – rock,
motionless, oblivious, waxy (let you mold limbs)
Chronic, or process, schizophrenia develops gradually, emerging from a long
history of social inadequacy.
Acute, or reactive, schizophrenia develops rapidly in response to particular
life stresses – Paranoid schizophrenia
Researchers have linked certain forms of schizophrenia with brain abnormalities,
such as enlarged, fluid-filled cerebral cavities or increased receptors for the
neurotransmitter dopamine.
A possible cause of these brain abnormalities in the fetus is a mid-pregnancy
viral infection.
Twin and adoption studies also point to a genetic predisposition (44%) that, in
conjunction with environmental factors, may bring about a schizophrenia
disorder.
Personality Disorders
Personality disorders are psychological disorders characterized by inflexible
and enduring behavior patterns that impair social functioning. Although they
sometimes coexist with one of the other psychological disorders, they need not
involve anxiety, depression, or loss of contact with reality.
The most frequent of these disorders is the antisocial personality disorder in
which a person (usually a man) exhibits a lack of conscience for wrong-doing,
even toward friends and family members. This person may be aggressive and
ruthless or a clever con artist.
8
Other Labels
Substance Abuse Disorders (Psychoactive substance)
Psychosexual disorders –
gender identity
Paraphilias (arousal to situations or sexual objects not
considered to usually be part of a sexually arousing situation
sexual dysfunction – no desire for sex
pedophilia
sexual masochism
sexual sadism
transvestic fetishism
necrophilia
zoophilia
telephone scatolgia
9