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The Nature and Causes of Mental Disorders
Classification and Diagnosis
• What is abnormal?• Departure from the norm
• Causes stress, discomfort, and interferes in lives
Perspectives on the Causes
• Psychodynamic Perspective• Originate from intra-psychic conflict
• Produced by Id, Ego, and Superego
• Therapists make clients more aware of conflict
• Medical Perspective• Originate from abnormalities in the brain and
nervous system
• Treated with drugs
• Cognitive-Behavioral Perspective• Learned maladaptive behavior patterns• Focus on environmental factors, and person
perception of these patterns• Therapists want client to replace with more
adaptive behaviors
• Humanistic Perspective• Originates from thinking one must earn positive
regard from others• Therapists urge to achieve own potential, no
matter what
• Sociocultural Perspective• Cultures play a role
• Perceive actions as abnormal, or normal
• Culture-Bound Syndromes• Mental disorders only seen in certain cultures
– Southeast Asians and Koro
• Treated using folklore
• Diathesis-Stress Model• Previous perspectives combined into one• Genetics and early experience yields
predispositions• Only develop if person has stressor that they
can’t cope with.
DSM-IV Classification• Diagnostic and Statistical Manual IV
• Reliable and universal set of categories to describe a patients psychological condition.
• Assessed on four Axes• Axis I – Major disorders requiring clinical attention• Axis II – Personality disorders• Axis III – Physical disorders• Axis IV – Severity of stress encountered• Axis V – Persons overall level of functioning
– Ratings on 100 pt. Global Assessment of Functioning (GAF) scale
Problems With Classification
• Looks more from the medical perspective
• Questionable reliability
• Langer & Abelson's study• Patients or job applicant
• Assessed patient as worse off
Need For Classification
• Thomas Szasz – no need for classification
• Benefits to patient• Recognition precedes development of treatment
• Different disorders respond to different treatment
• Good prognosis, bad prognosis
Clinical Method vs. Actuarial Method
• Judgments based on an experts experiences
• Knowledge of previous symptoms, and applies to present symptoms
• Applying empirically derived rules
• Relate particular outcomes with particular indications
Which Method (Actuarial or Clinical) is More
ACCURATE?
Actuarial Method
• Reliability is Higher
• Decision is based on a precise formula
• Goldberg (1970)• Studied patients released from mental
institutions
• Found that actuarial method was more accurate
60% – 70% of the time
Anxiety, Somatoform, and Dissociative Mental Disorders
• Neuroses – anxious, fearful, depressed, and generally unhappy
• Almost all realize that they have a problem
Anxiety Disorders• Panic Disorders (description)
• Episodic attacks of acute anxiety
• Physical symptoms
• Anticipatory anxiety – fear of more panic attacks
• Panic Disorders (Causes)• Genetic – appears to be hereditary
• Cognitive - sensitive to risk or danger in environment
Anxiety Disorders
• Phobic Disorders (description)• Irrational fears of specific objects and situations
• Fear makes life difficult
• Agoraphobia – fear of open spaces
• Social Phobia – fear of possible scrutiny or embarrassment
• Specific Phobia – all other phobias
• Early onset more likely to leave
Phobic Disorders (Causes)
• Psychoanalytic theory – stress caused by intolerable unconscious impulses
• Classical Conditioning• Direct – when they are present in an unpleasant
situation
• Vicarious – observing another show fear to an object or animal.
• Some objects more likely to be feared
Phobic Disorder (causes) cont.
• Genetic Causes• Reflective of our evolution
• Chimpanzees are afraid of snakes even though they had never seen them before
• Simple and social families do not run in families
• Stable families with overprotective mothers
Obsessive-Compulsive Disorder (description)
Obsessions
• Thoughts that won’t leave
• Two principle types• Doubt or Uncertainty
• Fear of doing something prohibited
Compulsions
• Behaviors can’t keep from doing
• Four Categories• Counting
• Checking
• Cleaning
• Avoidance
Obsessive-Compulsive Disorder (Causes)
Cognitive Causes
• Reduce anxiety caused by fear of being perceived as incompetent
• Behaviors replace fear or anxiety, thus more fear, more behavior
Genetic Causes
• Associated with Tourette’s Syndrome
• Produced by same gene as previous
• Sometimes occurs after brain damage
Somatoform Disorders
• Somatization disorder (description)• Complaints of physical problems that have no
biological basis
• It is often chronic lasts for decades
• DSM-IV requires a history of complaints
• Hypochondriasis – fear of having major illness
Somatization Disorder (causes)
• Common in poorly educated women in low economic status
• Runs in families
• Closely associated with Antisocial personality disorder
Conversion Disorder (description)
• Physical complaints of neurological problems that have no real basis
• DSM - IV • Must be response to stimulus, avoid activity, or
get sympathy
• Not Faking Illnesses (malingering)• Enjoy talking about illness• Change with time, and knowledge
Conversion Disorder (causes)
• Psychoanalytic – unresolved conflicts displaced into physical symptoms
• Learned – most have already suffered from the disease they are then complaining about
Dissociative DisordersDisruptions in Consciousness
• Freud and massive repression• Psychogenic Amnesia
• Forgets all of past, and starts new one
• Psychogenic Fugue• Leaves home and starts a new life somewhere
• Multiple Personality Disorder• Two or more separate people within one person• Form of self-hypnosis
Dissociative Disorders Causes
• Responses to severe conflicts or guilt
• Usually advantageous to person
Personality DisordersAbnormalities that impair social functioning
• Antisocial Personality Disorder (psychopaths or sociopath)• Failure to conform to social norms: lying,
stealing, failure at relationships, lack of guilt
• DSM-IV - evidence of three types of Antisocial behavior before fifteen
• Pattern of antisocial behavior where another person was violated
Antisocial Personality Causes
• Physiological causes and learning• Lower signs of fear, unresponsive autonomic
nervous system
• Do not learn to avoid an aversive stimuli, but do learn to avoid a loss of appetitive stimulus
• Genetic – somewhat hereditable
Antisocial Personality Causes
• Environmental• Parenting – ignoring or leaving children
unsupervised develop delinquency
• Cognitive• View world different than well behaved kids
• See others as being hostile
• May be biologically predisposed
Psychoactive Substance Use Disorders
• Psychoactive Substance Dependence and Abuse
• Drug addiction a serious problem• Alcohol – car accidents, fetal alcohol
syndrome, cirrhosis of the liver, increased heart rate of cerebral hemorrhage
• Cocaine – causes psychosis, brain damage, and death
Substance Use Causes
• Genetic and Physiological causes• Susceptibility comes from inability to
metabolize alcohol, or difference in brain
• Brain of steady drinker has under sensitive punishment mechanism
• Binge drinkers have an oversensitive punishment mechanism
• Cognitive Causes
• Develop heavy drug use, by what they believe about the benefit of the drug
• Use is negatively reinforced by the escape it gives to people
Schizophrenic Disorders• Most common psychosis
• Distortions of thought, perception, and emotion; bizarre behavior, and social withdrawal
• Two categories of symptoms• Positive – make known by presence (thought disorders,
hallucinations, and delusions)• Delusions of Persecution, Grandeur, and Control
• Negative – absence of normal behaviors (flattened emotional response, no speech, no pleasure, withdrawal
Types of Schizophrenia• Undifferentiated
• Have delusions, hallucinations, and disorganized behavior, but are not he other types of schizophrenia
• Catatonic• Motor disturbances (catatonic postures, and waxy
flexibility); are aware of what is going on
• Paranoid• Delusions of persecutions, grandeur and control
• Disorganized• Disturbances of thought, word salad (a jumble of words)
Early signs of Schizophrenia
• Bleuler (1950) divided disorder• Reactive – those with a good history of mental
health. Reaction to stressor. Recover.
• Process – those diagnosed as having a mental illness early in life.
• Predictors – being “different” than everyone else.
Possible Causes
• Genetic Causes• Heritability is firmly established. Have tendency
towards illness
• Predisposition towards having schizophrenia
• Physiological Causes (Dopamine Hypothesis)• Over-activity of dopamine synapses using
dopamine as transmitter substance
• Cocaine users
Possible Causes (cont.)
• Physiological causes (neurological disorders)• Drugs alleviate positive symptoms, and not negative• Weinberger and Wyatt (1982) ventricles in brains,
twice as large• Pfefferbaum (1988) sulci were wider• Positive symptoms – dopamine: negative – loss of
brain tissue• Damage may be viral (multiple sclerosis)• Births during winter months; trauma
Possible Causes (cont)
• Cognitive and Environmental Causes• Being raised by a mentally healthy family may
protect against onset
• Raised by dominating, overprotective, rigid, and insensitive to the needs of others type of household.
• Double-blind parent – verbally accepting, rejecting
• Rate of recovery affected by how family deals
Mood Disorders
• Disorders of emotion; affect normal perceptions, thoughts and behaviors
• Bipolar Disorder• Alternating periods of mania (wild excitement)
and depression
• Major Depression• Persistent feelings of sadness, worthlessness, and
changes in behavior, appetite, and sleeping
• Mania• Wild, exuberant, unrealistic activity• Have delusions and hallucinations• Person with mania always has bi-polar
• Depression• Sad, and filled with self-directed guilt, can’t
always say why they are depressed• Five symptoms
• A sad apathetic mood• Feelings of worthlessness and hopelessness• A desire to withdraw from other people• Sleeplessness and a loss of appetite and sexual desire• Change in activity level to laziness, or agitation
Possible Causes
• Cognitive• Caught in a vicious cycle
• Distortion in perception of reality
• Beck’s Cognitive Triad• Negative thoughts about self, present, and future
• Attributional style• Negative to self, positive to others
Possible Causes (cont)• Genetic
• First degree relatives ten times more likely to get a mood disorder
• Physiological (Biochemical Factors)• Electro-convulsive therapy, antidepressant drugs
• Biochemical abnormalities in brain – less activity of serotonin-secreting neurons
• Decrease in activity of 5-HT and NE related to depression, antidepressants increase activity
Possible Causes (cont)
• Physiological (Sleep Cycle)• Enter REM sleep sooner and spend more time
in it during last part of sleep
• Depression triggered environmentally through zeitgeber
• A stimulus synchronizing biological rhythms
• Seasonal Affective Disorder• Depressed in winter seasons
• Sleep depravation helps