Psychological Disorders

Instructions: Read the following pages and do any assignments highlighted in yellow.

It is common to find students new to psychology who believe the studyof psychological disorders is psychology. These students are oftensurprised to find out that it is only a small piece of what psychologistsstudy.

Moreover, people bring with them preconceived notions regarding psychological disorders. More and more, these notions have been shaped by our own experiences. Most of us know at least one person whose problem has been classified as a mental disorder and who is taking some sort of psychotropic medication to change the problem. Television advertisements, shows, their doctors, and other people they know have provided them with a lot of information, and for the most part they tend to believe what they have been told.

Unfortunately, much of what we have learned from these sources isnot scientifically accurate. For example, most people believe “having amental disorder” is a clear-cut thing. They believe you are either someonewho “has one,” or you are someone who “doesn’t have one.” They alsotend to believe that explaining psychological disorders is far simpler thanexplaining any other kind of behavior. For example, they find it easy to accept it is impossible for us to determine with absolute certainty why someone would play basketball, but at the same time believe when someone acts depressed it is simply because of some neurochemical imbalance.

The facts of the matter are that people’s problems are typically not categorical, but dimensional and complex. People experience problems more or less over the duration of their lives. Sometimes and in some situations these problems interfere more than at other times and situations. Sometimes these problems get classified as “mental disorders,” and sometimes they don’t. In addition, the reasons why people experience problems are highly complex.

Psychological disorders are at least as complex as why people experience or do anything else. It is important for students to understand exactly what is meant by the term abnormal behavior.

Historical Views of Abnormal Behavior

**Watch Psychological Disorders: Crash Course Psychology #28 by copying the entire link below and entering it into your computer’s search bar

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**Once you have completed viewing the video, answer the following questions:1.) What is one historical problem with mental health institutions? ______ __________________________________________________________________________________________________________________________2.) In 2010, the World Health Organization (WHO) estimated that _______ _____________________ people had some kind of psychological disorder.

3.) What are the three characteristics (3 D’s) of abnormal behavior as defined by mental health clinicians? _______________________________ _____________________________________________________________4.) What is the definition the video presenter gives for the word “deviant?” ____________________________________________________ _____________________________________________________________5.) Is deviant behavior fixed and unchanging across time and culture? ___ Explain your answer: ____________________________________________ __________________________________________________________________________________________________________________________6.) What is the name of the manual (instructional book) used by clinicians to standardize the diagnosis and treatment of mental health disorders? __ _____________________________________________________________7.) What is one of the newest disorders in this manual that the video mentioned? ___________________________________________________

A brief history of psychological disorders Archaeologists have found human skulls with holes cut into them, made while the person was still living. There is evidence that many of the people survived this procedure. This process is called trepanning. Trepanning is still done today to relieve pressure of fluids on the brain, but in ancient times the reason may have had more to do with “releasing demons”. Many ancient cultures assumed that an evil spirit possessed everyone who behaved oddly. They drilled holes in their skulls to release those spirits. The ancient Greeks believed that mental illness was the result of imbalances in the body’s fluids. They called these fluids “humors” and categorized them as phlegm, black bile, blood, and yellow bile. For example, when a patient was melancholy, physicians assumed that his or her feelings of sadness and depression resulted from the physical excess of black bile. Likewise, an excess of yellow bile was thought to make a person angry and impulsive. The way they treated a patient was through personal hygiene by adjusting diet, exercise, and the management of the body's evacuations (e.g.: the blood, urine, feces, perspiration, etc.) Hippocrates, a Greek physician, was the first to propose this theory and to explain abnormal behavior as the result of some kind of biological process.

As I am sure you are already aware, early Americans often attributed strange behavior to witchcraft. The unfortunate people, who were labeled as witches were hanged, burned, stoned, or drowned. Even today there is not a universal view of abnormal psychology. For example, in many traditional Asian cultures, mental illness is seen as a shameful thing that brings disgrace to one’s family. Because it may be seen as inheritable or because it may be seen as stemming from something the family’s ancestors did wrong in the past, it may hurt the marriage chances of other family members. For these reasons, many Asian people suffering from disorders that we might label as depression or even schizophrenia will report bodily symptoms rather than emotional or mental ones.

Abnormality Across Cultures** Watch Cultural Differences – Mental Health 101 by copying the entire link below and pasting it into your computer’s search bar. You may need to click “CC” below the video for closed captioning to help you better understand what they are saying.

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**After viewing the video, answer the following questions:1.) How do people in India differ from most people in western cultures in the way they view and treat mental health symptoms? ________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2.a.) With what disorder did Pam Ho suffer? _________________________2.b.) What was her explanation for the reason WHY she had this disorder? __________________________________________________________________________________________________________________________3.) What did the doctor say was the link between depression, diabetes, and high blood pressure? ____________________________________________ _____________________________________________________________

4.) Sathnam’s grandmother said her son’s (Sathnam’s father) schizophrenia was caused by what? ____________________________________________5.) What is culture-bound syndrome? _______________________________ __________________________________________________________________________________________________________________________

If you are interested in learning more about the history of treating mental illness, you might want to watch the video below. I am not requiring anyone to watch it because of its length, (58 minutes) but if you are curious, copy and paste the entire link into your computer’s search bar.

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Psychological Disorders as we Understand Them Today in Western Culture

Modern western culture defines psychological culture as a harmful dysfunction in which thoughts, feelings, or behaviors are:

Maladaptive,

Unjustifiable,

Disturbing, and

Atypical

**Look up the definition of the 4 preceding terms and write them.

Understanding DisordersWe understand mental disorders in various ways within our culture. The

way we understand them is broadly influenced by our view of human nature, our view of the nature-vs-nurture debate, and many other factors.

Mental Disorder ModelsThe following are models of mental disorders. Another way of saying

model is schema or our framework for understanding disorders. The Biological/Medical Model- psychological

disorders can be diagnosed based upon their symptoms and, in most cases, treated or cured through therapy. Psychological disorders are similar to a physical illness and stem from genetic and biological sources.

The Psychological Model- explains psychological disorders as a result of thought-related malfunctioning. There are various forms of psychological models:

1. Psychodynamic model - based on the work of Sigmund Freud and his followers. This model explains disorders as the result of repressing (or pushing down, out of conscious thinking) one’s threatening thoughts, memories, or concerns into the unconscious mind.

2. Behaviorist model - defines behavioral disorders as a set of learned responses just like normal behavior is learned.

3. Cognitive model - asserts that abnormal behavior results from a maladaptive thinking pattern

4. Humanist model - stems from humanism, which is more of a philosophy than a science. This model defines dysfunction as that which results from having unmet needs.

The Bio-Psycho-Social Model- (All of the above) It is a modern perspective that assumes biological, psychological, and sociocultural factors combine and interact to produce psychological disorders. This perspective relies heavily upon studies of nature-vs-nurture and their interaction. (Bio=predisposition or hereditary susceptibility to a disorder. Psycho=one’s thoughts and thinking patterns. Social=expectations and influence of culture upon a person.)

**Answer the following questions by putting the correct letter next to the corresponding question it matches best.

__ 1.) Who would be the one most likely to assume that psychological disorders are caused by an imbalance in the fluids of the body?__2.) Which model of abnormality explains abnormal behavior as caused by illogical thinking?__3.)Who might explain the occurrence of a major depressive episode as being the result of a combination of social, biological, and psychological factors?__4.) This is one of the criteria that psychological professionals consider when determining whether a behavior is normal.__5.) This is NOT one of the criteria that psychological professionals consider when determining whether a behavior is normal.__6.) Which model of abnormality sees reinforcement and imitation as way of developing abnormal behavior?__7.) Which model of abnormality explains disorders as caused by physical or genetic disease?__8.) Which model of abnormality would prescribe a treatment plan of finding out what unmet needs a client has and meeting it?

a.) humanistb.) cognitivec.) ancient Greeksd.) bio-psycho-social psychologiste.) Is the behavior maladaptive?f.) Is the behavior a genetically inherited trait?g.) biological h.) psychological

Types of Psychological Disorders

Note: The classification of psychological problems is difficult because the ways humans may experience and express problems are nearly limitless. Thus, classification provides descriptions of the most common ways humans express problems.

Have you ever gone to a clinic and been asked to fill out a form listing all of the symptoms you had? The doctor might have asked you some questions such as: When did your symptoms first begin? Does your throat hurt? Have you had a cough? Have you had any fever? These questions serve a purpose—the physician is trying to figure out what illness you most likely have. If your symptoms are common, the doctor most likely has an idea what it might be. If not, the doctor will refer to a medical manual called The Physician’s Desk Reference. This is a handbook of illnesses that have been separated by symptoms and categorized for easy reference. Now refer back to the first video you watched in this unit (Crash Course Psychology #28). Remember how he discussed The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)? This handbook separates mental disorders into categories and lists symptoms for each similar to the way that The Physician’s Desk Reference does physical disorders. The DSM-5 divides mental disorders into several categories.

Each disorder is described in terms of its symptoms, the typical path the disorder takes as it progresses, and a checklist of specific criteria that must be met in order for the diagnosis for that disorder to be made.

Above you see the major categories listed in the DSM-5. Below is a list of qualifying symptoms that a person with (#3) Bipolar and Related Disorders would have:

(Note: If you are interested in further studying other categories, simply google the group name + DSM5 and click image (e.g.: neurodevelopmental

disorders DSM5>image)

Criticisms of the DSMI.) Biomedical orientation- There are many criticisms of the DSM as a classification tool. First among them is that the system is based on a biomedical model of problems (e.g., the term diagnostic). II.) Categorical vs. dimensional- Another major criticism concerns the categorical nature of classification. Though in reality individual problems are best described dimensionally and are much too complex to simplify easily into one category, the DSM is a categorical system (You are either in or out. You “have it’ or you “don’t have it”). This categorical system is

maintained because it is a traditional form of classification in medicine and because it is easier for clinicians to understand and use. These labels can often come with stigma attached to them. These stigmas can be placed upon us, or we may self-stigmatize ourselves due to the label of mental illness. **Look up the definition of stigma and write it. ______________________ __________________________________________________________________________________________________________________________ Categories are descriptions of problems and not explanations for them. For example, bulimia nervosa describes a problem in which an individual binge eats and is involved in harmful behavior that attempts to self-sooth. It does not mean that a person acts that way because of bulimia nervosa. Psychological disorders are complex and (as stated previously) are explained in different ways by various theoretical approaches.The DSM-5 attempts to address some of these issues by incorporating more dimensional aspects. This has been done in a variety of ways, for example by broadening some categories of disorders (e.g., autism spectrum disorder) and allowing for differentiating between the severity of many problems along with the use of specifiers (e.g., major depressive disorder). Despite these additions, the DSM has essentially maintained its categorical nature.

Important things to remember about the classification of psychological problems:

A. Psychological disorders are classified only if the problems interfere with the person’s life in some “clinically significant” way. B. Psychological problems are complex and have biological, psychological, and sociocultural aspects. So, questions like “Is schizophrenia genetic?” are an oversimplification of the complexities of the problems that together are known as schizophrenia.C. Problems exist at different levels of severity, and the combinations of factors that might produce a problem for one person could be different from the factors that might produce similar problems in others. D. There are also different factors that influence an individual’s experience of psychological disorders. Psychological disorders are defined in relation to culture, social and familial norms, experiences, and values. So, it is important to understand the particular background of an individual to understand the type and severity of the problem a person may be

experiencing or to determine if they are experiencing a disorder at all. (For example: Have you seen the movie The Invisible Man that was recently released? I haven’t seen the movie, but the trailer for the movie depicts a woman being taken away for mental evaluation because she claims that her ex, whom everyone thinks is deceased, is terrorizing her. This is crazy, right? Not if the premise of the movie is true—he has faked his death after figuring out how to become invisible. Additionally, people’s different ages, cultural/ethnic backgrounds, and sexual orientation can relate to issues of mental health. For example, is it always a sign of mental illness when you hear a person talking to himself or herself? What if that person is a four year old engaging in imaginative play?Another example of this may be the increase in numbers of boys who are diagnosed with attention-deficit hyperactivity disorders. Are they truly exhibiting signs of a disorder, or are they being pressed into the mold of an adult’s idea of how long a young boy (or girl) should be able to sit still? Would it be a sign of mental illness if an 80 year old could not keep moving for four hours at a time even though a 6 year old could? Why then is it a sign of a disorder when a 6 year old cannot sit still in a desk and concentrate for long periods of time? It is important to remember that culture and gender are not specific single causes of psychological problems, but they can play a role in the development, experience, and expression of psychological disorders

Next, we will learn about some of the most commonly reported disorders in the U.S., their symptoms, and their causes.

The most commonly reported disorder in the U.S. is Depression. Depression has several subcategories as illustrated below.

I.) Major DepressionMajor depression is one of the most common mental disorders in the United States. For some individuals, major depression can result in severe impairments that interfere with or limit one’s ability to carry out major life activities.

According to the DSM-5, in order to be diagnosed with Major Depression a person must have:

A period of at least two weeks when they experienced a depressed mood or loss of interest or pleasure in daily activities, and had a majority of specified symptoms, such as problems with sleep, eating, energy, concentration, or self-worth.

No exclusions were made for a major depressive episode symptoms caused by medical illness, substance use disorders, or medication.

Statistics for Depressed Peoples in the United States (2017):

An estimated 17.3 million adults in the United States had at least one major depressive episode. This number represented 7.1% of all U.S. adults.

The prevalence of major depressive episode was higher among adult females (8.7%) compared to males (5.3%).

The prevalence of adults with a major depressive episode was highest among individuals aged 18-25 (13.1%).

The prevalence of major depressive episode was highest among adults reporting two or more ethnicities (11.3%).

**Imagine that you are a psychologist and a teen female has come to you with symptoms of feeling sad off and on for the past year. She says she usually feels sad for 3 or 4 days at a time and has difficulty sleeping. Would you categorize her as being majorly depressed? Why or why not?

Demographic PercentOverall 7.1

Sex Female 8.7Male 5.3

Age18-25 13.126-49 7.750+ 4.7

Race/Ethnicity

Hispanic or Latino* 5.4White 7.9Black 5.4Asian 4.4

NH/OPI** 4.7American Indian/AlaskanNative 8.0

2 or More 11.3

**According to the chart above, which two ethnicities have the highest rates of major depression, other than “2 or more”?___________________ _____________________________________________________________ What age group has the lowest reported incidence of major depression? _____________________________________________________________

Prevalence of Major Depressive Episode Among Adolescents

o An estimated 3.2 million adolescents aged 12 to 17 in the United States had at least one major depressive episode. This number represented 13.3% of the U.S. population aged 12 to 17.

o The prevalence of major depressive episode was higher among adolescent females (20.0%) compared to males (6.8%).

o The prevalence of major depressive episode was highest among adolescents reporting two or more races (16.9%).

While depression is the most common single disorder, the various different anxiety disorders combine to form the largest mental illness category

reported in the U.S.

II.) Anxiety DisordersWhat is it? An underlying issue with all anxiety disorders is a normal fear response has gone out of control. Fear is normal and healthy. If I see a rattlesnake coiled up on my kitchen floor, it is rational and healthy to experience enough fear to get myself quickly away from it! Anxiety disorders are classified when the fear response triggered is out of proportion to the reality of the danger of a situation. Typically, individuals who experience this anxiety understand their fear is irrational but have a difficult time controlling this response. This irrational fear often leads to avoidance of situations or objects that interrupts a person’s life in a significant way.

Trypophobia is an aversion to the sight of irregular patterns or clusters of small holes or bumps such as those found on a sponge. This is an irrational response.

If you stepped outside and saw this tiger looking at you and you were terrified, this would not be classified as an irrational fear.

**Name an irrational fear/phobia.

A. Examples of anxiety disorders1.) Specific phobia is an irrational fear of some specific object or situation.2.Agoraphobia is literally “fear of the marketplace”; this is a person’s fear of being out in some situation away from safety and being unable to escape

should they experience overwhelming panic or in some other way become suddenly incapacitated. 3.Social anxiety is fear of being humiliated in front of others in one or more social situations.4.Panic disorder is the experience of a sudden severe fear response in the absence of any sort of realistic threat. These “panic attacks” occur suddenly, are of brief duration, can be incapacitating, and lead to worry about experiencing more of them.5.Generalized anxiety disorder is being worried and fearful of many different things, including health, finances, weather, family, etc. The worry is persistent and interferes significantly with the person’s life.B. Causes of anxiety disorders1.Psychological: Classically conditioned (i.e. “learned”) fear responses and negatively reinforced avoidance (or other fear reducing) behaviors.2.Biological: Overactive or underactive parts of the brain and depleted brain chemicals can lead to symptoms of anxiety.

III.) Obsessive–Compulsive and Related DisordersA. Examples of obsessive–compulsive and related disorders1.Obsessive-compulsive disorder: The key aspects of this disorder are: *repetitive thoughts*images or impulses that are unwelcome, produce anxiety, and are difficult to control (obsessions); and *repetitive and often meaningless behaviors that are also difficult to control and that reduce anxiety associated with the obsessions (compulsions). 2.Hoarding disorder: A person with this disorder has persistent difficulty discarding possessions, regardless of their actual value, that leads to an accumulation of items that interfere with functioning.3.Body dysmorphic disorder: This is a person’s preoccupation with a perceived defect or flaw in physical appearance that seems insignificant to others. The person responds to this preoccupation by performing repetitive behaviors (such as checking, grooming, or comparing themselves to others).

B. Causes of obsessive–compulsive and related disorders1.Psychological: *Negative reinforcement of compulsive behaviors (for example, washing hands repeatedly is negatively reinforcing since it removes the anxiety of thinking about germs); *Ego-defense mechanisms of isolation, undoing, and reaction formation; irrational and negative thinking regarding undesired thoughts2.Biological: Overactive parts of the brain. Serotonin, glutamate, and dopamine appear to be the neurotransmitters most correlated with these disorders.

IV.) Bipolar and Related DisordersA. Examples of bipolar disorders:1.) Bipolar disorder: For a person to be classified as exhibiting this disorder, the person must have exhibited a manic episode. A manic episode is characterized by persistently elevated, expansive, or irritable mood and includes such problems as inflated self-esteem, risky behaviors, decreased need for sleep, flight of ideas, and distractibility that lasts for at least 1 week. Manic episodes may include hallucinations and delusions. Depressive episodes may or may not be present. B. Causes of bipolar disorders:1.) Psychological: Manic-defense hypothesis—underlying processes similar to depression, but person denies and defends against them by acting in a manic way, perhaps due to need for approval by others2.) Biological: May be related somewhat to norepinephrine, serotonin, or or other brain chemicals. (Genes seem to play some role in creating vulnerability to these problems.)

V. Schizophrenia Spectrum and Other Psychotic DisordersA. Examples of schizophrenia spectrum and other psychotic disorders:1.Schizophrenia: Schizophrenia consists of several problems associated with several psychological processes including delusions, hallucinations, disorganized speech, grossly disorganized behavior, and negative

symptoms. These problems must persist for at least 6 months and be a significant negative change in the person’s functioning.2.Delusional disorder: The presence of one or more delusions (false beliefs a person holds in spite of evidence to the contrary and in spite of what others believe) (These delusions may be described in many ways, including erotomanic, grandiose, jealous, persecutory, or somatic. )B. Causes of schizophrenia spectrum and other psychotic disorders:1.Psychological: External-personal attributions for negative events, operant conditioning of peculiar behaviors, attempting to make sense out of peculiar perceptual experiences, family stress and dysfunction2.Biological: Biochemical abnormalities (dopamine and perhaps serotonin); abnormalities in frontal and temporal lobes and in brain structures such as the hippocampus, amygdala, and thalamus.

VI. Gender Dysphoric DisorderA. Characteristics of Gender Dysphoria:

1.) Intense desire to eliminate sex features and typical gender attributes- Adults and teenagers may have a fixation with doing away with primary and secondary gender features such as breasts or penis, and have the thought that they are not being characterized by the right sex. 2.) Emotional pain- significant emotional pain and difficulty is seen in the work place or school, dealing with others, as well as in other vital areas of life. This is thought to be due to incongruence between the gender that the patient sees themselves as, and what their classified gender assignment actually is. Those with gender dysphoria frequently experience a traumatizing disconnect between their desired gender attributes and the inborn attributes of their bodies. Such trauma should be expected when a person tries to live out in their mind what their body contradicts. Even after having gender reassignment surgery, this distress frequently persists. 3.) Often has early childhood onset on symptoms- It is frequently seen in children, though many children do not end up being adults with gender dysphoria. 4.) Intense desire to have the primary or secondary sex features of the other gender- this is accompanied by a profound desire for society to treat them as the other gender.

5.) Unrealistic self evaluation- person has a powerful assurance that they actually possess the characteristic feelings and responses of the other gender and denies “typical” emotions and characteristics that might be associated with their gender. People with genuine cases of dysphoria believe it’s their biological body that is lying. A person in this situation truly believes he or she is a member of the opposite sex.

B. Treatment for Gender Dysphoria: The use of psychotherapy can sometimes help individual with gender dysphoria, but not realiably. Individuals can be taught about self awareness and confidence needed to handle any issues arising in their daily lives. Early diagnosis and treatment decreases the chance for individuals to suffer depression, emotional agony, and to attempt suicide. Even when a person “transitions” by having sexual reassignment surgery and hormone therapy, they still report high rates of anxiety and depression and it is important for them to receive psychological care.

**Match the following questions by pairing them with the corresponding number of the correct term.

___1.) An intense fear of a particular object or situation that may or may not be typically considered to be frightening. ___2.) Mitch believes that he is Napolean Bonaparte in spite of the fact that he is a 23-year-old bus driver living in modern day New York. Mitch most likely is suffering from _____________________________________ ___3.) For the past five weeks, Shari has been on an emotional high which has led to many sleepless nights, extreme outbursts, rude and aggressive behavior, excessive drinking, and spending large amounts of money which she does not have. Shari most likely is suffering from _________________ ___4.) Jeremy used to love to play soccer, working out, and spending time with his friends, but for the past year Jeremy has lost all interest in everything he once loved. He feels tired all the time and feels so sad that he doesn’t even want to eat most of the time. What is the most likely diagnosis that Jeremy will receive from his psychiatrist?

___5.) Mark smells strongly of disinfectant cleaner and says that he avoids touching almost everything outside of his home. He often washes his hands up to 30 hours a day, spending hours on this routine. He also admits to having fears that he would say things that might offend someone. To ease these thoughts, Mark keeps lengthy diaries to record what he says and rereads them periodically throughout the day. Mark’s mental health care provider suspects that Mark is suffering from _______

A. Bipolar Disorder

B. Obsessive-Compulsive Disorder

C. Specific Phobia

D. Major Depression

E. Delusional Disorder

When you have completed all of the highlighted items on the previous pages, you may submit them to me for your final grade for this course. You may send them to me in an email, use Google docs, snap a photo of your work and send it to me in a text via Remind, or if you cannot do any of the above, you may print your work and bring it to school for me. Make sure that however you send it to me that you have your first and last name on your work. Especially if you send it via Remind. Some of you have previously used another name other than your name that is on your PowerSchool. Please be sure to include your given names this time.

This work is due to me by May 20th unless we hear differently between now and then. You do not have to wait until then to complete it. As a matter of fact, I would not recommend that.

If you do not need this class to graduate this year and would prefer to drop it and retake it next year, you must decide by May 8 th .