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 Disorders Disruptions 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 Disorders Abnormalities 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