Abnormal Psychology Unit 12

Classification and Diagnosis of Mental Disorders

What is considered “abnormal”? Departs from norm - not enough for diagnosis - what is statistically normal in one setting or culture, may not be in another deviant Only depression and schizophrenia appear in all cultures Maladaptive - dysfunctional Causes the individual personal distress Interferes with normal functioning

Distressful – upsetting to the person who is suffering Remember the 3Ds – deviant, distressful, and dysfunctional

Perspectives on Causes of Mental Disorders

Behavioral (Learning) We learn maladaptive behaviors just like we learn everything else, through: Classical conditioning – ex. Phobias Operant conditioning – rewarded in some way we will continue behavior even if reward isn’t obvious Social learning theory – observation, imitation

Psychodynamic Based on Freud’s ideas Caused by intrapsychic conflict Defense mechanisms aren’t adequate Therapy must uncover conflicts

Medical Philippe Pinel ( ) - madness is not demon possession but a sickness of the mind caused by severe stress and inhumane conditions Based on idea that abnormalities of brain and nervous system cause mental disorders Highly influential today

Humanistic Mental disorders come from people believing they must earn positive regard from others to have personal value Often accompanies depression

Sociocultural Culture plays important role in developing mental disorders Culture-bound syndromes

Biopsychosocial Approach Normal and abnormal behavior both come from the interaction of nature and nurture Culture plays a role in the nurture aspect - some disorders are only found in some cultures

Diathesis-Stress Model Genes and early learning experiences produce a predisposition (diathesis) for a particular mental disorder Disorder will only emerge if person is confronted with stressors that exceed coping abilities (poverty linked with psychological disorders)

DSM 5 Diagnostic and Statistical Manual of Mental Disorders, Fifth edition – just came out in 2014 Some new categories created, others revised or eliminated No longer uses a multiaxial system of diagnosis like previous versions

Why do we need to classify? Thomas Szasz - we don’t - labeling shifts responsibility from patient Do need to correctly identify to correctly treat

Problems with these classifications? Most consistent with medical perspective Accuracy of diagnosis difficult Doesn’t explain underlying causes Stigma of being labeled Self-fulfilling prophecy Rosenhan study (1973)

Neurocognitive Disorders Physical problems with the central nervous system are affecting cognitive abilities

Neurocognitive Disorders Alzheimer’s -,memory impairment (dementia) associated with plaque deposits in the brain Parkinson’s – degenerative disease of CNS that causes motor symptoms due to death of dopamine- generating cells Huntington’s – affects muscle coordination and mental abilities – genetic condition that damages brain cells Traumatic Brain Injury (TBI) – physical damage to the brain from external force Others – any disease of the nervous system that can result in cognitive symptoms

Anxiety Disorders Separation anxiety Selective mutism Specific phobia Social anxiety disorder (social phobia) Panic disorder Panic attack specifier Agoraphobia Generalized anxiety disorder Substance/Medication-induced anxiety disorder Anxiety disorder due to another medical condition Other specified anxiety disorder Unspecified anxiety disorder

Anxiety Disorders Learning perspective Classical conditioning of anxiety and phobias Stimulus generalization Operant conditioning - by avoiding stimulus we reduce fear negatively reinforcing avoidance behavior Biological perspective Natural selection - exaggeration of behaviors that enhanced species survival Genes - may affect levels of serotonin and glutamate Brain - overarousal of anterior cingulate cortex, amygdala

Somatic Symptom and Related Disorders (Formerly Somatoform Disorders) Somatic symptom disorder Illness anxiety disorder Conversion disorder Factitious disorder

Feeding and Eating Disorders Pica Rumination disorder Avoidant/restrictive food intake disorder Anorexia nervosa Bulimia nervosa Binge-eating disorder

Obsessive-Compulsive and Related Disorders (used to fall under anxiety disorders) Obsessive-compulsive disorder Body dysmorphic disorder Hoarding disorder Trichotillomania disorder Excoriation disorder

Trauma- and Stressor-Related Disorders Reactive attachment disorder Disinhibited social engagement disorder Posttraumatic stress disorder Acute stress disorder Adjustment disorders

Dissociative Disorders Dissociative identity disorder Dissociative amnesia Depersonalization/derealization disorder

Spanos - is DID genuine disorder or just an extension of our normal personality shifts? Seems to be a North American cultural phenomenon - is it created by therapists? Is is a form of PTSD - protective response to childhood trauma

Depressive Disorders (formerly under mood disorders, now its own category) Disruptive mood dysregulation disorder Major depressive disorder Persistent depressive disorder Premenstrual dysphoric disorder

Bipolar and Related Disorder (formerly under mood disorders, now its own separate category) Bipolar I Bipolar II Cyclothymic disorder

Depressive and Bipolar Biological perspective Genetics Run in families Heritability of major depression 35 to 40% Identical twin similarities hold true even when reared apart Depression - if one has it, 1 in 2 chance the other will at some point in life Bipolar - if one has it, 7 in 10 chance the other will at some point in life A specific gene has not been identified but a chromosome neighborhood has

Depressive and Bipolar Biological perspective Brain Less brain activity during depressed states More brain activity during manic states Frontal lobes 70% smaller than normal in severely depressed Hippocampus (memory-processing center linked to emotions) - vulnerable to stress-related damage Biochemical influences Too little norepinephrine during depression and too much during mania Too little serotonin during depression SSRIs effective because they boost serotonin Exercise also boosts serotonin Boosting serotonin might promote recovery from depression by stimulating neuron growth in hippocampus

Depressive and Bipolar Social-Cognitive Perspective Negative thoughts and negative moods interact Martin Seligman - learned helplessness - rise of Western individualism causes us to blame ourselves for our failures Vicious cycle of depression - rejection and depression feed each other

Schizophrenia Spectrum and Other Psychotic Disorders Schizotypal Delusional Brief psychotic Schizophreniform Schizophrenia Schizoaffective Catatonia

Schizophrenia Usually strikes during late adolescence and early adulthood 1 in 100 affected Men affected earlier and more severely and slightly more often Onset may be sudden or gradual Positive symptoms - present and shouldn’t be - hallucinations and delusions, “word salad”, inappropriate emotions Negative symptoms - absent but should be present - toneless voice, lack of expression, flat affect

Schizophrenia Brain abnormalities Dopamine overactivity and impaired glutamate activity Abnormally low activity in frontal lobes Lack of synchronizing of brain waves in frontal lobes Excess activity in thalamus during hallucinations Excess activity in amygdala in paranoid Enlarged ventricles and shrinkage of cerebral tissues May be caused by problems during prenatal development or childbirth, low birth weight, famine Associated with maternal flu during second trimester

Schizophrenia Genetic factors Runs in families Odds go from 1 in 100 to 1 in 10 if a sibling or parent has schizophrenia Identical twins reared apart - 1 in 2 Psychological factors Early warning signs: Mother whose schizophrenia was severe and long- lasting Birth complications Separation from parents Short attention span Poor muscle coordination Disruptive or withdrawn behavior Emotional unpredictability Poor peer relations and solo play

Personality Disorders Cluster A – paranoid, schizoid, schizotypal Cluster B – antisocial, borderline, histrionic, narcissistic Cluster C – avoidant, dependent, obsessive-compulsive

Personality Disorders Seem to result from combination of genetic predisposition, biological factors, and environmental pressures Traumatic events (including abuse) in early childhood seem to be related to the later development of a personality disorder

Neurodevelopmental Disorders Intellectual disabilities Communication disorders Autism spectrum disorder Attention-deficit/hyperactivity disorder Specific learning disorder Motor disorders