Ch$pter 14: Psychologic$l Disorders

– ment$l he$lth workers view psychologic*l disorders *s ongoing p*tterns of

thoughts, feelings, *nd *ctions th*t *re devi*nt, distressful, *nd / or
dysfunction*l
– being defi$nt from most people in oneʼs culture is PART of wh$t it t$kes to
define $ psychologic$l disorder
– it v$ries from culture to culture bec$use some view m$ss killings $s
heroic / he$ring voices $s ok bec$use your t$lking to ure lost
$ncestors
– $lso depends on time, $t $ time —> homosexu$lity w$s defined w$s
defined $s $n illness in 1952, now —> $ccepted
– to be considered disordered, the devi*nt beh*vior h*s to c*use distress to
the person (olympic med$list $rgument)
– they $re more likely to be considered disordered when its ALSO JUDGED
AS A HARMUL DYSFUNCTION
– distr6ction from work or leisure
– dysfunction is the key: $n intense fe$r of spiders is devi$nt, but if it doesnʼt
imp$ir ure life —> not disorder
– B*ck then, people thought th$t the “devil m$de them do it” or they tried to
exorcise the demon from people to expl$in their puzzling beh$vior
– trephin$tion (drilling holes in the skull), be$tings, burnings, c$str$tion,
$nim$l blood tr$nsfusions, pulling teeth
– now, hospit$ls repl$ced $sylums, $nd the medic$l world beg$n to se*rch for
physic*l c*uses of ment*l disorders, *nd for tre*tments th*t would cure
them
– this medic*l model is recogniz$ble in the terminology of the MENTAL
HEALTH MOVEMENT: $ ment$l illness needs to be di#gnosed on the
b$sis of its symptoms $nd cured through ther#py, which m$y inclined
tre#tment in $ psychi$tric hospit#l
– Eric — > Ostroff center for trying to kill himself (gg)
– Biopsychosoci$l Appro$ch —> st$tes th$t this disorder occurs from the
inter$ction of n$tion (genetic $nd physiologic$l f$ctors $nd nurture (p$st $nd
present experiences)
– evidence provided by cert$in cultures $nd specific disorders (cultures
differ in their sources of stress)
– depression *nd schizophreni* occur worldwide, but J$p$n h$s “T6ijin -
kyofusho”, occurs in J$p$n only,“susto” - in L$tin Americ$
– In psychi$try $nd psychology, cl$ssific$tion orders $nd describes symptoms
– its $ims not only to describe the disorder, but to predict its future course,
imply $pprob$te tre$tment, $nd stimul$te rese$rch into its c$uses
 – the current $uthorit$tive scheme for cl$ssifying psychologic$l disorders is
the DSM-IV-TR
– covers both medic$l $nd psychologic$l disorders********
– North Americ$n he$lth insur$nce comp$nies usu$lly require $n ICD
di$gnosis before they p$y for ther$py
– it defines * di*gnostic process $nd describes v$rious disorders w/o
expl$ining its c$uses(they r reli$ble so th$t both psychologists will likely
di$gnose the s$me person w the s$me disorder)
– following these guidelines, clinici$ns $nswer $ series of objective
questions $bout observ$ble beh$viors for di$gnosis
– some critics s$y th$t the DSM l$bels people $nd once we view someone $s
different, they cre$te preconceptions th$t guide out perceptions,
interpret$tions
– * l*bel c*n h*ve “* life *nd *n influence of its own” —> c*uses
misinterpret*tions, wrong disorders di*gnosed
– the stigm$ over l$bels is lifting bec$use the disorders *re dise*ses of the
br*in, not ch*r*cter —> more f$mous ppl coming out
– in re$l life, people with disorders $re more likely to be the victims of violence
or h$rm to $ str$nger r$ther th$n the perpetr$tor
– l$bels c$n bi$s perceptions, ch$nge re$lity, ch$nge the w$y one $cts $round
someone, $nd serve $s SELF FULFILLING PROPHECIES
– BUT they help he*lth profession*ls communic*te *bout their c*ses,
comprehend the underlying c*uses, *nd discern tre*tment progr*ms
– if $nxiety becomes intense $nd persistent, we h$ve one of the $nxiety
disorders, m$rked by distressing or dysfunction$l $nxiety - reducing
beh$viors
– gener*lized *nxiety disorder —> * person is unexpl*in*ble *nd
continu*lly tense + une*sy
– they worry continu$lly, often jittery, $git$ted, $nd sleep deprived
– concentr$tion is difficult $ $ttention switches rom worry to worry,
twitching eyelids, perspir$tion, fidgeting
– person c*nʼt identify *nd therefore c*nnot de*l with or *void its
c*use
– p*nic disorder —> experiences dude episodes of intense dre*d
(p*nic *tt*cks)
– strikes suddenly, wrecks h$voc, $nd dis$ppe$rs like $ torn$do
– * minutes long of intense fe*r th$t something horrible is $bout to
h$ppen —> feel w$shed out (shortness of bre$th, choking
sens$tions)
– phobi*s —> person feels irr*tion*lly *nd intensely *fr*id of * specific
object / situ*tion
– $n irr$tion$l de$r c$uses the person to $void some object, $ctivity, to
situ$tion
 – soci*l phobi*s is intense fe*t of being scrutinized by others, $void
emb$rr$ssing soci$l situ$tions, such $s spe$king up / e$ting out
– obsession compulsive disorder (OCD) —> troubled by repetitive
thoughts or *ctions
– eng$ge in compulsive beh$viors, rigidly check, ordering, $nd cle$ning
before guests $rrive
– crosses the line when it interferes with everyd$y living $nd c$uses the
person distress (DYSFUNCTION IS THE KEY)
– PTSD —> h$d lingering memories, nightm$res, $nd other symptoms for
weeks $fter $ severely thre$ding, uncontroll$ble event (w$r memories —>
soldiers)
– our memories exist in p$rt to protect us in the future $nd there is
biologic$l wisdom in not being $ble to forget our most emotion$l /
tr$um$tic experiences
– PTSD symptoms h$ve been reported by survivors of $ccidents,
sisters, $nd violent / sexu$l $ss$ults
– the gre*ter oneʼs emotion*l distress during the tr*um* —> the
higher the risk of post tr*um*tic symptoms
– suffering c$n le$d to “benefit finding” —> Post tr$um$tic growth
which is the positive psychologic$l ch$nges $s $ result from
struggling with extremely ch$llenging circumst$nces + life crisis
– those who suffice develop gre$ter th$n usu$l sensitivity to
suffering + emp$thy for the who suffer, enl$rged c$p$city for
d$ting
– when b$d events h$ppen unpredict$bly $nd uncontroll$bly, $nxiety often
develops
– link between conditioned fe$r $nd gener$l $nxiety helps expl$in why
$nxious people $re hyper $ttentive to possible thre$ts
– the stimulus gener*liz*tion $nd reinforcement helps m$int$in our
phobi$s $nd compulsion $fter they $rise
– c$n $lso le$rn fe$r through observ$tion$l le$rning —> observing otherʼs fe$rs
– p$rents tr$nsmitting fe$rs to their children
– some people $re more predisposed to $nxiety due to genes, sometimes
fe$rfulness runs in the f$milies
– genes influence disorders by regul*ting neurotr*nsmitters
(glut*m*te —> to much c*n c*use the *l*rm centers of the br*in to
become OVERACTIVE)
– Gener$lized $nxiety, p$nic $tt$cks, PTSD, $nd vine obsessions $re m$nifested
biologic$lly $s $n over $rous$l of br$in $re$s involved in impulse control +
h$bitu$l beh$viors
– The Anterior Cingul*te Cortex, $ br$in region th$t monitors our $ctions
$nd check for errors, seems to be hyper*ctive in those with OCD
– fe$r le$rning experiences c$n tr$um$tize the br$in $nd cre*te fe*r
 –
circuits within the *mygd*l*
– In som*toform disorders, the distressing symptoms t$ke $ som$tic (bodily)
form without physic$l c$uses
– some compl$ints include dizziness, vommiting, blurred vision, $nd
difficulty in sw$llowing
– one type of som*toform disorder is the CONVERSION DISORDER so
c$lled bec$use $nxiety presum$bly is connected into $ physic$l symptom
– lose sense in $ w$y th$t m$kes no neurologic$l sense (sticking pins in
$n $ffected $re$ —> produce no response)
– hypochondri*sis is when people interpret norm$l sens$tions
(stom$ch cr$mps / he$d$ches) $s symptoms of dre$ded dise$ses
—
– dissoci*tive disorders $re those in which conscious $w$reness becomes
sep$r$ted from previous feelings, thoughts, $nd memories
– no longer $ssoci$ted (dis)
– dissoci*tive identity disorder (DID) is in which two or more distinct
identities $re s$id to $ltern$tely control the personʼs beh$vior
– e$ch person$lity h$s its own voice $nd m$nnerisms
– formerly known $s multiple person$lity disorder
– the emotion*l extremes of mood disorders come in two principle forms:
1. m*jor depressive disorder, with its prolonged hopelessness $nd leth$rgy
*nd bipol*r disorder in which $ person $ltern$tes between depression $nd
m$ni$
– $s $nxiety is $ response to the thre$t of future loss, depression mood is often
$ response to p$st $nd current loss
– depression is sort of $ psychic hibern$tion: it slows us down, defuses
$ggression, $nd restr$ins risk t$king
– re$ssess oneʼs life when feeling thre$tened $nd to redirect energy in more
promising w$ys
– So wh$ts the difference between $ blue mood $nd $ disorder?
– M*jor Depressive Disorder —> occurs when *t le*st 5 signs of
depression (including leth$rgy, feelings of worthlessness, or loss of
interest in f$mily, friends, $nd $ctivities) l*st two or more weeks $re not
c$used by drugs or $ medic$l condition
– M*ni* is the opposite of depression, the euphoric, hyper$ctive, wildly
optimistic st$te of m*ni*
– $ltern$ting between depression $nd m$ni$ sign$ls bipol*r disorder
– in the m$ni$ st$ge, the person is overt$lk$tive, speech is loud, h$s little
need for sleep, shows FEWER sexu$l inhibitions, $nd needs protection
from own judgement
– A RACING MIND PRODUCES AN UPBEAT MOOD (re$d @ x2 speed)
– wh$t goes up, must come down: the el$ted mood either returns to mood
or plunges into depression
– Any Theory Of Depression must expl$in:
– M*ny beh*vior*l *nd cognitive ch*nges *ccomp*ny depression
– people tr$pped in this mood $re in$ctive $nd feel unmotiv$ted
– sensitive to neg$tive h$ppenings, more often rec$ll neg$tive info.,
$nd expect neg$tive outcomes (everything is b$sic$lly neg$tive)
– Depression is widespre*d
– the c$uses must be common $s well, if the disorder itself is so
common
– Comp*red w men, women *re ne*rly twice *s vulner*ble to m*jor
depression
– the s$me f$ctors th$t put women @ risk for depression, simil$rly put
men $t risk - BUT:
– when wom$n get s$d, they often get s$dder th$n men do $nd they
$re likely to get disorders th$t involve intern$lizing st$tes
– Most, m*jor depressive episode self - termin*te
– most people return to their norm$l st$te without ther$py
– recovery is more likely to be more perm$nent the l$ter the first
episode strikes, the longer the person st$ys well, the fewer previous
episodes, the less stress experiences, $nd the more soci$l support
received
– Stressful events rel*ted to work, m*rri*ge, *nd close rel*tionships
often precede depression
– depression results more often from $ pileup of stresses th$n from $
single loss or f$ilure
– With e*ch new gener*tion, depression is striking e*rlier *nd
*ffecting more people
– rese$rchers m$y $ccept these f$cts w/o $greeing how best to expl$in
them
– norepinephrine which incre$ses $rous$l / boosts mood is over$bund$nt
during m$ni$
– serotonin, is $lso sc$rce during depression
– drugs th$t relieve depression tend to incre$se both of these by blocking
their reupt$ke or their chemic$l bre$kdown
– rese$rch shows how self-defe6ting beliefs $nd $ neg6tive expl6n6tory style
feed depressionʼs vicious style
– self-defe6ting beliefs c$n occur from le$rned helplessness
– with the neg6tive expl6n6tory effect —> expl$in in terms of STABLE (l$st
forever) / GLOBAL ($ffects everything I do) / INTERNAL ($ll my f$ult)
– students who exhibit optimism $s they begin college develop more soci$l
support, $nd contribute to the lowered risk of depression
– depression is seen more in Western cultures due to the rise of individu$lism,
decre$se of commitment to religion
– Depression CYCLE:******************
 – 1. Neg$tive / Stressful events interpreted through (b*d shit h*ppens)
– 2. A Rumin$ting, Pessimistic Expl$n$tory style (fixed mindset)
– 3. Cre$tes $ hopeless depressed st$te (b*d mood)
– 4. H$mpers the w$y the person thinks $nd $cts (*ffects ure d*ily life)
– 1. Fuels Neg$tive experiences such $s rejection (c*uses more b*d
shit to h*ppen)
– schizophreni* me$ns “split mind”, referring to the split from re*lity th$t
shows itself in disorg$nized thinking, disturbed perceptions, $nd
in$ppropri$te emotions + $ctions
– NOT MULTIPLE PERSOANLITY DISORDER
– the thinking of someone w schizophreni$ is fr$gmented, biz$rre, $nd often
distorted by f$lse beliefs c$lled delusions (“Iʼm M$ry Poppins)
– result from * bre*kdown in selective *ttention
– those with schizophreni$ $re not $ble to filter out those other stimuli
so they notice things th$t the rest of us donʼt p$y $ttention to
– const$ntly being bomb$rded by other things (your foot, your tongue,
etc.)
– the person m$y h$ve h*llucin*tions $s well which $re sensory experiences
with no sensory stimul$tion (MOSTLY AUDITORY)
– split from re$lity, l$ugh @ someoneʼs de$th, or l$pse into $n emotionless st$te
of FLAT AFFECT
– c*t*tonic —> rem$in motionless for hours $nd then become $git$ted
– they h$ve $ high level of dop$mine (D4) which c$n intensify br$in sign$ls (the
irrelev$nt ones th$t we c$n filter out)
– most rese*rch studies like it to br*in *bnorm*lities + genetic
predispositions (which p*rts do u remember?)
– fet$l virus infections incre$se the odds th$t the child will develop
schizophreni$
—
– person*lity disorders —> disruptive, inflexible, $nd enduring beh$vior
p$tterns th$t imp$ir oneʼs soci$l functioning
– the most he$vily rese$rched person$lity disorder is the *ntisoci*l
person*lity disorder
– l$ck of conscience becomes pl$in before $ge 15 $s they begin to lie,
stel$, fight, or displ$y unrestr$ined soci$l beh$vior
– they usu$lly $re un$ble to keep $ job, irresponsible p$rent, or become *n
*ss*ultive / crimin*l
– it refers to people who express little regret over viol$ting otherʼs rights
– they h$ve $ fe$rless $ppro$ch on life, little $utonomic system $rous$l