1. Abnormal Psychology: psychological disorders Part I

2. Introduction to psychological disorders Symptomology refers to identification of the symptoms. Etiology – refers to finding out why people suffer from a disorder.

3. Introduction to psychological disorders When discussing a disorder, there is data which assist in the diagnosis: ▫Prevalence rate – it measures the total number of cases of the disorder in a given population. ▫Lifetime prevalence (LTP) – is the percentage of the population that will experience the disorder at some time in their life. ▫Onset age – is the average age at which the disorder is likely to appear. Knowing the average onset age can determine how likely it is that a person who begins to show specific symptoms at a specific age can be diagnosed reliably.

4. Introduction to psychological disorders Classifications of abnormal behavior: ▫Anxiety disorders have a form of irrational fear as a central disturbance. Example: PTSD ▫Affective disorders are characterized by dysfunctional moods. Example: Major Depressive Disorder ▫Eating disorders are characterized by eating patterns which lead to insufficient or excessive intake of food. Example: Bulimia

5. Depression Depression is one of the most common psychological disorders. People who are depressed have very low moods and low levels of self esteem. They lack motivation, and think that everything is black and that they will never be happy again. The cause of depression is inconclusive. Current research suggests that there are biological, cognitive, and social factors involved. Treatments include drugs and different kinds of therapy.

6. Symptoms of major depressive disorder In order to find out why people suffer from depression, different levels of analysis are used: ▫Biological factors may include people’s genetic makeup and biochemical factors. ▫Cognitive factors may include thought of hopelessness, pessimistic thinking patterns, or feelings of low self-esteem. ▫Social factors may include the stress of poverty, loneliness, or troubled personal relationships.

7. Symptoms of major depressive disorder Affective: feelings of guilt and sadness; lack of enjoyment or pleasure in familiar activities or company Behavioral: passivity; lack of initiative Cognitive: frequent negative thought; faculty attribution of blame; low self-esteem; suicidal thoughts; irrational hopelessness, may also experience difficulties in concentration and inability to make decisions. Somatic: loss of energy, insomnia, or hypersomnia; weight loss/gain; diminished libido. These symptoms interfere with normal life activities, like work and relationships.

8. Affective disorders: major depressive order Major depressive disorder can be diagnosed when an individual experiences two weeks of either a depressed mood or loss of interest and pleasure. In addition, the diagnosis requires the presence of four additional symptoms, such as insomnia, appetite disturbances, loss of energy, feelings of worthlessness, thoughts of suicide, or difficulty concentrating.

9. Affective disorders: major depressive order Major depressive disorder is relatively common, affecting around 15% of the people at some time in their life (Charney and Weismann 1988) Levav (1997) found the prevalence rate of depression to be above average in Jewish males – and there is no difference of prevalence between Jewish men and Jewish women.

10. Affective disorders: major depressive order Depression tends to be a recurrent disorder, with about 80% experiencing a subsequent episode, with an episode typically lasting for three to four months. The average number of episodes is four. In approximately 12% of cases, depression becomes a chronic disorder with a duration of about two weeks.

11. Prevalence of Current Depression US Adults by 2006 and 2008 Age Group Percent Experiencing Depression 18–2411.1 % 25–349.3% 35–448.7% 45–649.6% 65+6.9%

12. Prevalence of Current Depression US Adults by 2006 and 2008 This study found the following groups to be more likely to meet criteria for major depression: persons 45-64 years of age women blacks, Hispanics, non-Hispanic persons of other races or multiple races persons with less than a high school education those previously married individuals unable to work or unemployed persons without health insurance coverage

13. Etiology of major depressive disorder There is now some evidence that changes in the level of certain neurotransmitters and hormones can precipitate a depressive episode. It is also likely that many cases of clinical depression are triggered by negative events in a person’s life. ▫Examples: divorce, the death of a partner or child, a serious accident, or being fired Sometimes depression appears to be a response not to a particular event, but to long-term circumstances.

14. Etiology of major depressive disorder There may be an association between stress and depression, but it is important to realize that many people who are subjected to high stress do not develop a depressive disorder. There are important individual differences in vulnerability. The risk of becoming depressed is related to a number of factors, which can include: ▫Genetic predisposition, personality and early history, cognitive style, coping skills, and the level of social support available.

15. Etiology of major depressive disorder Depression is not caused by a single factor, but stems from a combination of factors, which may include: ▫Genetic vulnerability, neurotransmitter malfunctioning, psychological problems, or particular life events or lifestyle factors, such as misuse of alcohol or drugs. It is not possible for any doctor/psychologist to find the cause of depression in any individual. Treatment aims to alleviate symptoms, and help the individual cope.

16. ________________– is the average age at which the disorder is likely to appear. Knowing the average onset age can determine how likely it is that a person who begins to show specific symptoms at a specific age can be diagnosed reliably.

17. Onset age Prevalence rate Symptomology

18. _____________________refers to identification of the symptoms.

19. Prevalence rate Symptomology Onset age

20. Which of the following is not true of depression? 1.Depression is one of the most common psychological disorders. 2.People who are depressed have very low moods and low levels of self esteem. 3.They lack motivation, and think that everything is black and that they will never be happy again. 4.The cause of depression is easily determined. 5.Treatments include drugs and different kinds of therapy.

21. Which of the following is not true of depression? Depression is one of the most common psychological disorders. People who are depressed have very low moods and low levels of self esteem. They lack motivation, and think that everything is black and that they will never be happy again. The cause of depression is easily determined. Treatments include drugs and different kinds of therapy.

22. True or false? Major depressive disorder can be diagnosed when an individual experiences one week of either a depressed mood or loss of interest and pleasure.

23. True False

24. ▫________________disorders are characterized by eating patterns which lead to insufficient or excessive intake of food.

25. ________________disorders are characterized by eating patterns which lead to insufficient or excessive intake of food. anxiety eating affective

26. ▫_________________disorders have a form of irrational fear as a central disturbance.

27. _________________disorders have a form of irrational fear as a central disturbance. anxiety eating affective

28. TRUE OR FALSE It is not possible for any doctor/psychologist to find the cause of depression in any individual.

29. True False

30. True or false Depression is not caused by a single factor, but stems from a combination of factors.

31. True False

32. ▫____________________– it measures the total number of cases of the disorder in a given population.

33. ____________________– it measures the total number of cases of the disorder in a given population. Prevalence rate Symptomology etiology

34. True or false? Treatment aims to cure symptoms, and help the individual cope.

35. True False

36. Which of the following are is not likely to meet criteria for major depression: 1.persons 45-64 years of age 2.women 3.blacks, Hispanics, non-Hispanic persons of other races or multiple races 4.persons with less than a high school education 5.unmarried people

37. Which of the following are is not likely to meet criteria for major depression: persons 45-64 years of age women blacks, Hispanics, non-Hispanic persons of other races or multiple races persons with less than a high school education unmarried people

38. _________________disorders are characterized by dysfunctional moods.

39. Anxiety Affective Eating

40. ________________– refers to finding out why people suffer from a disorder.

41. Symptomology etiology Prevalence rate

42. The Biological level of analysis: genetic and biochemical factors in depression Genetic researchers argue that genetic predisposition can partly explain depression. ▫Nurnberger and Gershon (1982) reviewed the results of seven twin studies and found that major depressive disorder was consistently higher for MZ (identical) twins than for DZ (fraternal) twins.

43. The Biological level of analysis: genetic and biochemical factors in depression Environmental events play a role on depression as well. ▫Long-term stress may result in depression for some people because they have the genetic predisposition which makes them more vulnerable to depression than other people.

44. The Biological level of analysis: genetic and biochemical factors in depression Duenwald (2003) have suggested that a short variant of the 5-HTT gene may be associates with a higher risk of depression. This gene plays a role in the serotonin pathways which scientists think are involved in controlling mood, emotions, aggression, sleep, and anxiety.

45. The Biological level of analysis: genetic and biochemical factors in depression Catecholamine hypothesis aka “the serotonin hypothesis” – suggested by Joseph Schildkraut in 1965. According to this theory, depression is associated with low levels of noradrenaline, making the neurotransmitter serotonin responsible.

46. The Biological level of analysis: genetic and biochemical factors in depression Janowsky et. al (1972) demonstrated that drugs which decrease the level of noradrenaline tend to produce depression-like symptoms. Participants were given a drug called physostigmine became profoundly depressed and experienced feelings of self-hate and suicidal wishes within minutes of taking the drug. The fact that a depressed mood can be artificially induced by certain drugs suggests that some cases of depression may stem from a failure in neurotransmission. Also drugs that increase noradrenaline tend to be effective in reducing the symptoms of depression.

47. The Biological level of analysis: genetic and biochemical factors in depression Delgado and Moreno (2000) found that abnormal levels of noradrenaline and serotonin in patients suffering from major depression. Rampello et. al (2000) found that patients with major depressive disorder have an imbalance of several neurotransmitters, including noradrenaline, serotonin, dopamine, and acetylcholine.

48. The Biological level of analysis: genetic and biochemical factors in depression Burns (2003) says that although he has spent many years of his career researching brain serotonin metabolism, he has never seen any convincing evidence that depression results from a deficiency of brain serotonin. Lacasse and Leo (2005) argue that contemporary neuroscience has failed to prove that depression results from a deficiency in neurotransmitters. They say the research shows that the brain is very complex and not understood.

49. The Biological level of analysis: genetic and biochemical factors in depression Burns, Lacasse and Leo criticize the serotonin theory because drugs that affect serotonin levels are heavily advertised and the most prescribed in our society for depression and other psychological disorders. Example: Prozac

50. The Biological level of analysis: genetic and biochemical factors in depression The cortisol hypothesis – cortisol is a major hormone of the stress system and the reason for focusing on this is that it has always been obvious to clinicians that stress can predispose an individual to psychological as well as physical disorders. ▫Also, patients with major depressive disorder have high levels of cortisol, which is present in large amounts when individuals are stressed. This shows a link between long-term stress and depression. Studies that show this involve victims of child abuse.

51. The impact of poverty on child depression Fernald and Gunnar (2008) Children between the ages of 2.5 and 6 were identified in a house to house survey in low-income areas of urban Mexico. The Scale was administered to mothers of all children. Salivary cortisol samples were taken in children. The children were administered several cognitive tests. Results revealed that higher levels of maternal depressive symptoms were associated with lower baseline cortisol levels in their children. These low levels indicate that the stress system if :worn out” leaving the children susceptible to depression, autoimmune disease. Socioeconomic status has a huge impact on health – both physical and psychological.

52. Cognitive level of analysis: cognitive factors in depression Cognitive theories of depression suggest that depressed cognitions, cognitive distortions, and irrational beliefs produce the disturbances of mood. Ellis (1962) proposed the cognitive style theory, suggesting that psychological disturbances often come from irrational and illogical thinking. On the basis of dubious evidence or faulty inferences about the meaning of an event, people draw false conclusions, which then lead to feelings of anger, anxiety, or depression. Ellis contends that irrational beliefs – such as “My work must be perfect” – together with “My last essay did not receive the top grade”- can easily lead to self-defeating conclusions- “Since I did not receive the highest grade, I am stupid.”

53. Cognitive level of analysis: cognitive factors in depression Beck (1976) suggested a theory of depression based in cognitive distortions and biases in information processing. Beck’s cognitive distortion theory of depression is based on schema processing where stored schemas about self interfere with information processing. Schemas influence the way people make sense of experiences.

54. Cognitive level of analysis: cognitive factors in depression Beck observed that depressive patients exhibited a negative cognitive triad characterized by: ▫Overgeneralization based on negative events. ▫Non-logical inference about the self. ▫Dichotomous thinking – black and white thinking- and selective recall of negative consequences.

55. Cognitive level of analysis: cognitive factors in depression Beck states that negative cognitive schemas are activated by stressful events. The depressed person tends to overreact. Also if a person has negative expectations about the future, the depression can continue in a vicious circle.

56. Sociocultural level of analysis: social and cultural factors in depression Brown and Harris (1978) carried out a study concerning the social origins of depression in women. The researchers found that 29 out of 32 women who became depressed had experienced a severe life event, but 78% of those who did experience a severe life event did not become depressed. They discovered that life events which resembled previous experiences were more likely to lead to depression. On the basis of this, brown suggested a vulnerability model of depression, based on a number of factors that could increase the likelihood of depression.

57. Sociocultural level of analysis: social and cultural factors in depression Such life events were, for example: ▫Lacking employment away from home ▫Absence of social support ▫Having several young children at home ▫Loss of mother at an early age ▫History of child abuse

58. Sociocultural level of analysis: social and cultural factors in depression Diathesis-stress model – is an interactions approach to explaining psychological disorders. The model claims that depression may be the result of a heredity predisposition, with precipitating events in the environment.

59. Sociocultural level of analysis: social and cultural factors in depression World Health Organization (1983) has looked at cultural considerations linked to depression and identified common symptoms of depression in four countries: Iran, Japan, Canada, and Switzerland ▫Symptoms: sad affect, loss of enjoyment, anxiety, tension, inability to concentrate, ideas of insufficiency, lack of energy, inadequacy, and worthlessness.

60. Murphy et. al. (1967) conducted by psychiatrists that covered 30 countries. They found additional symptoms such as: ▫Loss of sexual interest ▫Loss of appetite ▫Weight reduction ▫Fatigue ▫Self-accusatory ideas

61. Prince (1968) claimed that there was no depression in Africa and various regions of Asia, but found that the rates of reported depression rose with westernization in the former colonial countries. Kleinman (1982) showed that in China summarization served as a typical channel of expression and as a basic component of depressive experience. The Chinese rarely complain of sadness or depression.

62. Marsella (1979) argues that affective symptoms (sadness, loneliness, isolation) are typical of individualistic cultures. In cultures which are more collectivist have more somatic symptoms as headaches are more common.

63. Gender considerations in major depressive disorder Williams and Hargreaves (1995)Women are two to three times more likely to become clinically depressed than men, and they are likely to experience several episodes of depression. Many researcher argue that the reasons for depression are rooted more in social causes that in biological ones.

64. The theory of social factors in depression Brown and Harris (1978) Brown and Harris (1978) found that in its first onset depression usually happens for a reason, a serious adversity. They interviewed 458 women in South London, and found that 37 of them (8 per cent of the total) had become clinically depressed in the previous year. Of the 37 women who became depressed, 33 (almost 90 per cent) had suffered an adverse life event (such as a bereavement) or a serious difficulty (such as being in a relationship with an abusive husband).

65. The theory of social factors in depression Brown and Harris (1978) This compared with only 30 per cent of the women who did not become depressed suffering such an adversity. In only four of the 37 women who became depressed was their onset of depression unrelated to any adversity. If, when a serious life event or difficulty struck, the women in Brown and Harris’s study lacked a protective factor such as social support from an intimate relationship in their life, their risk of suffering a breakdown was much increased.

66. The theory of social factors in depression Brown and Harris (1978 ) Brown and Harris’s work is a fine example of a piece of social science research that was done really well, and that had an important effect. The finding that most people did not get depressed because there was something wrong with their personality, but because there was something wrong in their lives, transformed how depression was seen by general practitioners and psychiatrists in Britain.

67. Most of the serious life events that cause depression are losses, either of important relationships or roles or of life projects that were fundamental to people’s identities. Protective factors such as social support described by Brown and Harris were parts of people’s lives that enabled them to feel themselves even when substantial losses occurred. For people who were protected in this way, a serious adversity could cause sadness or anger, but seldom the hopeless and disabling despair that put them at risk of abandoning children and spouses in suicide attempts.

68. Social stress plays a role in triggering many depressive episodes, but demonstrates that social factors may increase an individuals vulnerability to depression. Social support may offer protection against the effects of stressful events.

69. Questions!

70. Catecholamine hypothesis aka “the ____________ hypothesis” – suggested by Joseph Schildkraut in 1965.

71. serotionin

72. Nurnberger and Gershon (1982) reviewed the results of seven twin studies and found that major depressive disorder was consistently higher for _________ twins than for _________ twins.

73. MZ; DZ DZ; MZ

74. True or false? Rampello et. al (2000) found that patients with major depressive disorder have an perfect balance of several neurotransmitters, including noradrenaline, serotonin, dopamine, and acetylcholine.

75. True False True or false?

76. Burns (2003) says that although he has spent many years of his career researching brain serotonin metabolism, he has never seen any convincing evidence that depression results from a deficiency of brain serotonin.

77. True False

78. True or false? Janowsky et. al (1972) demonstrated that drugs which decrease the level of noradrenaline tend to produce depression-like symptoms. Participants were given a drug called physostigmine became profoundly depressed and experienced feelings of self-love and suicidal wishes within minutes of taking the drug

79. True False

80. _________________ model – is an interactions approach to explaining psychological disorders. The model claims that depression may be the result of a heredity predisposition, with precipitating events in the environment

81. Medical Diathesis-stress Working

82. The ________________hypothesis – it is a major hormone of the stress system and the reason for focusing on this is that it has always been obvious to clinicians that stress can predispose an individual to psychological as well as physical disorders.

83. serotionin cortisol

84. True or False? Marsella (1979) argues that affective symptoms (sadness, loneliness, isolation) are typical of collectivist cultures. In cultures which are more collectivist have more somatic symptoms as headaches are more common.

85. True False

86. Prince (1968) claimed that there was no depression in _____________and various regions of Asia, but found that the rates of reported depression rose with westernization in the former colonial countries.

87. Africa Australia Canada Unites States