Final Exam Psychology

Chapter 15 ● Definition of Psychological Disorder ○ Psychopathology – the study of psychological disorders, including their symptoms, etiology (causes), and treatment. ○ Psychological disorder – a condition characterized by abnormal thoughts, feelings, and behaviors. ■ Behaviors, thoughts, and inner experiences that are atypical, dysfunctional, or dangerous are signs of psychological disorders. ■ However, there is no single definition of psychological abnormality or normality. ○ Just because something is atypical, does not mean it is disordered. Red hair is considered unusual, but not abnormal. ○ Cultural Expectations ■ Violating cultural expectations is not enough by itself to identify a psychological disorder. ■ Social norms vary between cultures - what is considered appropriate in one culture may be viewed differently in another. ● Hallucinations is a violation of cultural expectations in Western Societies. People who report hallucinations are likely to be labeled with a psychological disorder. ● However, in some other cultures, certain types of hallucinations are highly valued. ○ Harmful Dysfunction ■ Wakefield (1992): ■ Proposed a more influential concept in which he defines psychological disorders as a harmful dysfunction . ● Dysfunction occurs when an internal mechanism (e.g., cognition, perception, learning) breaks down and cannot perform its normal function. ■ For a dysfunction to be be classed as a disorder, it must also be harmful – leads to negative consequences for the individual or for others, as judged by the standards of the individual’s culture. ○ American Psychological Association (APA) Definition ■ A psychological disorder is a condition that consists of the following: ■ Significant disturbances in thoughts, feelings, and behaviors. ● Outside of cultural norms.

■ The disturbances reflect some kind of biological, psychological, or developmental dysfunction. ■ The disturbances lead to significant distress or disability in one’s life. ● E.g. difficulty performing appropriate and expected roles. ■ Despite the many existing definitions, there is no universal agreement on where the boundary between disordered and not disordered is. ● The Diagnostic and Statistical Manual of Mental Disorders (DSM) ○ Diagnosis – appropriately identifying and labeling a set of defined symptoms ■ Requires classification systems that organize psychological disorders systematically. ○ Diagnostic and Statistical Manual of Mental Disorders: ■ Published by the American Psychiatric Association. ■ First published in 1952 and has since undergone numerous revisions. ● The first two editions listed homosexuality as a disorder but was removed in 1973. ■ DSM-5 is the classification system used by most mental health professionals. ■ Categorizes and describes each disorder. ● Diagnostic features – overview of the disorder. ● Diagnostic criteria – specific symptoms required for diagnosis. ● Prevalence – percent of population thought to be afflicted. ● Risk factors. ■ Provides information about comorbidity (the co-occurrence of two disorders). ● Prevalence Rates ○ The graph shows the breakdown of psychological disorders, comparing the percentage prevalence among adult males and adult females in the United States. ○ The DSM-IV, has since been supplanted by the DSM-5. Most categories remain the same; however, alcohol abuse now falls under a broader Alcohol Use Disorder category. ● The International Classification of Diseases (ICD) ○ Published by the World Health Organization (WHO).

○ Psychosocial Perspective ■ Emphasizes the importance of learning, stress, faulty and self- defeating thinking patters, and environmental factors. ■ Views the cause of psychological disorders as a combination of biological and psychosocial factors. ○ Diathesis-Stress Model: ■ Integrates biological and psychosocial factors to predict the likelihood of a disorder. ● Diathesis + Stress Development of a disorder ■ People with an underlying predisposition for a disorder (diathesis) are more likely than others to develop a disorder when faced with adverse environmental or psychological events. ■ A diathesis can be a biological or psychological vulnerability. ● Anxiety Disorders ○ Fear vs Anxiety ■ Fear – an instantaneous reaction to an imminent threat. ■ Anxiety – apprehension, avoidance, and cautiousness regarding a potential threat, danger, or other negative content. ● Motivates us to take action, avoid certain things. ● Level and duration of anxiety usually matches the magnitude of the potential threat. However, some people experience anxiety that is excessive, persistent and out of proportion with the actual threat. ○ Anxiety Disorders ■ Characterized by excessive and persistent fear and anxiety, and by related disturbances in behavior. ○ Prevalence: ■ Effects approximately 25%-30% of the U.S. population during their lifetime. ■ More common in women than men. ■ Most frequently occurring class of mental disorders. ● Specific Phobia ○ Involves excessive, distressing, and persistent fear or anxiety about a specific object or situation. ■ People may realize their fear and anxiety is irrational but may still go to great lengths to avoid the stimulus. ○ Prevalence - affects 12.5% of the U.S. population at some point in their lifetime. ■ Common specific phobias include:

● Acrophobia – heights. ● Aerophobia – flying. ● Arachnophobia – spiders. ● Claustrophobia – enclosed spaces. ○ Agoraphobia: ■ Listed as a separate anxiety disorder. ■ Characterized by intense fear, anxiety, and avoidance of situations in which it might be difficult to escape or receive help if one experiences a panic attack. ■ These situations include public transportation, crowds, being outside the home alone. ● Aquisition of Phobia through Learning ○ Rachman (1977): 3 Major Learning Pathways ■ Classical Conditioning. ● Child is bitten by dog (US) dogs become associated with biting (CS) child experiences fear around dogs (CR). ● Conditioned fears develop more readily to fear-relevant stimuli (images of snakes and spiders) than to fear- irrelevant stimuli (images of flowers). ■ Vicarious Learning. ● Child observes cousin react with fear around spiders child later expresses the same fears even though spiders have never presented any danger to him. ■ Verbal transmission of information. ● A child is continuously told that snakes are dangerous child starts to fear snakes. ■ Why are certain types of phobias more common than others? ● One theory argues that because our ancestors associated certain stimuli with danger (e.g., snakes, spiders, and heights), we are evolutionarily predisposed to associate those stimuli with fear. ● Social Anxiety Disorder ○ Characterized by extreme and persistent fear or anxiety and avoidance of social situations in which the person could potentially be evaluated negatively by others, leading to serious impairments in life. ■ Associated with lower educational attainment, lower earning, poor work performance, unemployment. ■ Safety behaviors – mental or behavioral acts that reduce anxiety in social situations by reducing the chance of negative

produces panic-like symptoms in nonhuman primates. ○ Conditioning Theories ■ Panic attacks are classical conditioning responses to subtle bodily sensations resembling those normally occurring when one is anxious or frightened. ○ Cognitive Theories ■ Individuals with panic disorder are prone to interpret ordinary bodily sensations catastrophically, setting the state for panic attacks. ● In some patients, reducing catastrophic cognitions about sensations has proven to be as effective as medication in reducing panic attacks. ● Generalized Anxiety Disorder ○ A relatively continuous state of excessive, uncontrollable, and pointless worry and apprehension. ○ Diagnosis Criteria ■ The diffuse worrying and apprehension is not part of another disorder. ■ Symptoms occur more days than not for at least 6 months. ■ Symptoms are accompanied by any three of the following symptoms: ● Restlessness, difficulty concentrating, being easily fatigued, muscle tension, irritability, and sleep difficulties. ○ Prevalence ■ Affects about 5.7% of U.S. population during their lifetime. ■ Females are 2 times as likely as males to experience the disorder. ○ Comorbidity ■ Comorbid with mood disorders and other anxiety disorders. ○ Cognitive Theories ■ Worry represents a mental strategy to avoid more powerful negative emotions perhaps stemming from earlier unpleasant or traumatic experiences. ● Worrying acts a distraction from remembering painful childhood experiences. ● Longitudinal study found childhood maltreatment was strongly related to development of the disorder during adulthood. ● Obsessive Compulsive Disorder (OCD)

○ Involves thoughts and urges that are intrusive and unwanted (obsessions ) and/or the need to engage in repetitive behaviors or mental acts (compulsions ). ○ Obsessions – persistent, unintentional, and unwanted thoughts and urges that are highly intrusive, unpleasant, and distressing. ○ Common obsessions: ■ Concerns about germs and contamination ■ Doubts ■ Order and symmetry ■ Aggressive or lustful urges ○ Compulsions – repetitive and ritualistic acts, typically carried out primarily as a means to minimize the distress that obsessions trigger or to reduce the likelihood of a feared event. ■ Not performed out of pleasure. ■ The person usually knows these obsessions and compulsions are irrational but suppressing them is extremely difficult. ○ Prevalence ■ Experienced by approximately 2.3% of the U.S. population in their lifetime. ● Body Dysmorphic Disorder ○ Involves a preoccupation with a perceived flaw in the individuals physical appearance that is either nonexistent or barely noticeable to other people. ■ Causes person to think they are unattractive or deformed. ■ Typically involve skin, face, or hair, but can focus on any bodily area. ■ Causes person to engage in repetitive and ritualistic behavioral and mental acts. ● Constantly looking in the mirror. ● Trying to hide the offending body part. ● Comparison with others. ● Cosmetic surgery. ○ Prevalence ■ Affects approximately 2.4% of adults in the U.S. ■ Slightly higher rates in women than in men. ● Hoarding Disorder ○ Involves great difficulty in discarding possessions, regardless of how valueless/useless they are, usually resulting in an accumulation of items that clutter living or work areas. ■ Why are they unable to let go of items?

of a traumatic experience (“actual or threatened death, serious injury, or sexual violence”) (APA, 2013). ■ PTSD was first recognized in soldiers who had engaged in combat. ○ Symptoms occur for at least one month. ● Symptoms ○ Intrusive and distressing memories of the event. ○ Flashbacks – states during which individual relives the event and behaves as if it were occurring at that moment. ○ Avoidance of stimuli connected to the event. ○ Persistently negative emotional states. ○ Feelings of detachment from others. ○ Irritability. ○ Proneness toward outbursts. ○ Exaggerated startle response. ● Prevalence - Experienced by approximately 7% of the U.S. population in their lifetime. ● Risk Factors for PTSD ○ Risk Factors ○ Trauma experience. ○ Those involving harm by others carry greater risk than those that do not. ○ Lack of immediate social support. ■ Social Support (comfort, advice, and assistance from relatives, friends, and neighbors) can reduce the risk of developing PTSD. ○ Subsequent life stress. ○ Female gender. ○ Low socioeconomic status. ○ Low intelligence. ○ Personal history of mental disorders. ○ History of childhood adversity. ○ Family history of mental disorders. ○ Personality characteristics – neuroticism and somatization (tendency to experience physical symptoms when one encounters stress). ○ Possession of one or two short versions of a gene that regulates serotonin ● Learning and the Development of PTSD ○ Conditioning Theories

■ Traumatic event (UCS) Extreme fear and anxiety (UCR). ■ Cognitive, emotional, physiological, and environmental cues associated with the traumatic event become conditioned stimuli. ■ Traumatic reminders (CS) Extreme fear and anxiety (CR). ○ Cognitive Theories ■ Two key processes in development and maintenance of PTSD: ■ Disturbances in memory for the event. ● Poorly encoded memories of trauma can become fragmented, disorganized, and lacking in detail. ● Individuals cannot remember event in a way that gives meaning and context. ● May become haunted by these fragments involuntarily triggered by stimuli associated with the event. ■ Negative appraisals of the trauma and its aftermath (e.g., ”I deserve to be raped because I am stupid”). ● May lead to dysfunctional behavioral patterns that maintain symptoms and prevent changes in the problematic appraisals. ● Mood Disorders ○ Characterized by massive disruptions in mood and emotions that can cause a distorted out look on life, and impair ability to function. ○ Depressive Disorders ■ Depression (intense and persistent sadness) is the main feature. ○ Bipolar and Related Disorders ■ Mania (extreme elation and agitation) is the main feature. ■ Manic episode – “a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least one week.” (APA, 2013). ● Major Depressive Disorder ○ Diagnosis Criteria ■ “Depressed mood most of the day, nearly every day” (APA, 2013). ■ Loss of interest and pleasure in usual activities. ■ At least 5 symptoms for at least a two-week period. ■ Symptoms cause significant distress or impair normal functioning and are not caused by substances or a medical

■ Excessively talkative. ■ Excessively irritable. ■ Exhibit flight of ideas – talk loudly and rapidly, abruptly switching from one topic to another. ■ Easily distracted. ■ Exhibit grandiosity – inflated but unjustified self-esteem and self-confidence. ■ Show little need for sleep. ■ Take on several tasks at once. ■ Engage in reckless behaviors. ○ Prevalence ■ Onset is typically before the age of 25. ■ Affects 1 out of 100 people in the U.S. in their lifetime. ■ 36% of these individuals attempt suicide. ○ Comorbidity - anxiety disorder and substance abuse disorder. ● Biological Basis of Mood Disorders ○ Genetics ■ Major Depressive Disorder: ● Relatives have double the risk of developing the disorder. ● Identical twins – 50% concordance rate. ● Fraternal twins – 38% concordance rate . ■ Bipolar Disorder: ● Relatives have over 9 times the risk. ● Identical twins – 67% concordance rate. ● Fraternal twins – 16% concordance rate. ○ Hormones ■ Elevated levels of cortisol (stress hormone) are found in depression. ■ Cause or consequence of depression? ■ A risk factor for future depression. ■ Cortisol activates the amygdala and deactivates the prefrontal cortex (disturbances connected to depression). ○ Neurotransmitters ■ Mood disorders often involve imbalances in neurotransmitters. ● Particularly serotonin and norepinephrine . ■ These neurotransmitters are involved in bodily functions that are disrupted in mood disorders. ■ Many medications designed to treat mood disorders work by altering neurotransmitter activity in the neural synapse. ■ Medications for depression – usually increase serotonin and

norepinephrine activity. ■ Medication for bipolar – Lithium, which blocks norepinephrine activity at the synapse. ○ Brain Anatomy ■ Depression: ■ Amygdala – important in assessing the emotional significance of stimuli and experiencing emotions. ● Depressed individuals react to negative emotional stimuli, such as sad faces, with greater amygdala activation than do non-depressed individuals. ● More prone to react emotionally to negative stimuli. ■ Prefrontal cortex – important in regulating and controlling emotions. ● Decreased activation in depressed individuals which may inhibit its ability to override negative emotions. ● Greater difficulty controlling emotional reactions ● DIATHESIS-STRESS MODEL & MAJOR DEPRESSIVE DISORDERS ○ Stressful life events often precede the onset of depressive episodes. ○ However, not everyone who experiences stressful life events develop depression, suggesting predispositions or vulnerability factors could be involved. ○ Genetic vulnerability: ■ Alteration in the 5-HTTLPR gene (regulates serotonin). ○ 1 or 2 short alleles + stressful life events increasingly likely to experience a depressive episode. ○ A study on gene-environment interaction in people experiencing chronic depression in adulthood suggests a much higher incidence in individuals with a short version of the gene in combination with childhood maltreatment (Brown & Harris, 2013). ● Cognitive Theories of Depression ○ Cognitive theories suggest that depression is triggered by negative thoughts, interpretations, self-evaluations, and expectations. ○ Diathesis-Stress model: cognitive vulnerability + stressful life events 🡪 depression. ○ Aaron Beck (1960s) ○ Theorized that depression-prone people possess mental predispositions to think about most things in a negative way (depressive schemas). ○ Depressive schemas – contain themes of loss, failure, rejection,

■ Somatic delusions – belief that something highly abnormal is happening to one’s body. ■ Thought withdrawal/insertion . ○ Disorganized thinking – disjointed and incoherent thought processes. ○ Disorganized or abnormal motor behavior – unusual behaviors/movements. ■ Catatonic behaviors – decreased reactivity to the environment ○ Negative Symptoms - decreases and absences in certain behaviors, emotions, drives. ■ Avolition – lack of motivation to engage in self-initiated and meaningful activity ■ Alogia – reduced speech output ■ Asociality – social withdrawal ■ Anhedonia – inability to experience pleasure. ● Schizophrenia Causes ○ Prevalence – Affects 1% of the population. ○ Genetics ■ Risk is 6 times greater if one parent has schizophrenia (even if adopted). ○ Neurotransmitters ■ Dopamine hypothesis – an overabundance of dopamine or too many dopamine receptors are responsible for the onset and maintenance of schizophrenia. ● Drugs that increase dopamine levels can produce schizophrenia-like symptoms. ● Medications that block dopamine activity reduce the symptoms. ■ High levels of dopamine in the limbic system hallucinations and delusions. ■ Low levels of dopamine in the prefrontal cortex negative symptoms. ○ Brain Anatomy ■ Enlarged ventricles. ■ Reduced gray matter in the frontal lobes. ■ Many show less frontal lobe activity when performing cognitive tasks. ○ Events During Pregnancy ■ Obstetric complications during birth. ■ Mother’s exposure to influenza during the first trimester. ■ Mother’s emotional stress. ● Dissociative Disorders ○ Characterized by an individual becoming split off, or dissociated, from their core sense of self - Memory and identity become disturbed. ○ Dissociative Amnesia - Inability to recall important personal information

■ Usually follows a stressful or traumatic experience. ■ Dissociative fugue – individual suddenly wanders away from home, experiences confusion about their identity, and in some cases may adopt a new identity. ○ Depersonalization/Derealization Disorder - Characterized by recurring episodes of depersonalization, derealization, or both. ■ Depersonalization – feelings of “unreality or detachment from, or unfamiliarity with, one’s whole self or from aspects of the self” (APA 2013). ■ Derealization – a sense of ”unreality or detachment from, or unfamiliarity with, the world, be it individuals, inanimate objects, or all surroundings” (APA, 2013). ○ Dissociative Identity Disorder (formerly multiple personality disorder) - Individual exhibits two or more separate personalities or identities. ■ Involves memory gaps for the time during which another identity is in charge. ■ Individuals tend to report a history of childhood trauma - Adoption of multiple personalities may serve as a psychologically important coping mechanism for threat and danger ● Personality Disorders ○ Characterized by a pervasive and inflexible personality style that differs markedly from the expectations of the individuals culture and causes distress or impairment. ■ Begins in adolescence or early adulthood. ○ Prevalence ■ Slightly over 9% of the U.S. population suffers from a personality disorder. ■ Avoidant and schizoid personality disorders are most frequent. ■ Antisocial and borderline personality disorder are most problematic. ● Personality Disorder Clusters ○ Cluster A ■ Paranoid personality disorder ■ Schizoid personality disorder ■ Schizotypal personality disorder ○ Cluster B ■ Antisocial personality disorder ■ Histrionic personality disorder

■ Observed in 3.6% of the population. ■ More common in males. ● Antisocial Personality Disorder Causes ○ Genetics ■ Personality and temperament dimensions related to this disorder (fearlessness, impulsive antisociality, and callousness) have a genetic influence. ■ Adoption studies suggest antisocial behavior is determined by the interaction of genetic factors and adverse environmental circumstances. ○ Emotional Deficits ■ Individuals with antisocial personality disorder fail to show fear in response to environment cues that signal punishment, pain, or noxious stimulation. ■ Show less skin conductance which may indicate emotional deficits. ○ Brain Anatomy ■ Research has revealed: ■ Less activation in brain regions involved in the experience of empathy and feeling concerned for others. ■ Greater activation in a brain area involved in self-awareness, cognitive function and interpersonal experience. ● ADHD ○ ADHD is a neurodevelopmental disorder. ○ Neurodevelopmental disorders – involve developmental problems in personal, social, academic, and intellectual functioning. ○ ADHD - constant pattern of inattention and/or hyperactive and impulsive behavior that interferes with normal functioning. ○ Prevalence ■ Occurs in about 5% of children. ■ Boys are 3 times more likely to have ADHD than girls. ○ Life Problems ■ Low educational attainment, low socioeconomic status, unemployment, low wages, substance abuse problems, and relationship problems. ○ Symptoms ■ Inattention: ● Difficulty sustaining attention. ● Failure to follow instructions.

● Disorganization. ● Lack of attention to detail. ● Easily distracted and forgetful. ■ Hyperactivity: ● Excessive movement. ● Interrupting and intruding on others. ● Blurting out responses before questions have been completed. ● Difficulty waiting ones turn. ● ADHD Causes ○ Genetics ■ Inattention – 71% heritable. ■ Hyperactivity – 73% heritable. ○ Neurotransmitters ■ Dopamine: ■ Genes involved are thought to include at least two that are important in the regulation of dopamine. ■ Individuals with ADHD show less dopamine activity in key brain regions (especially those associated with motivation and reward. ■ Medications have stimulant qualities and elevate dopamine activity. ○ Brain Anatomy ■ Studies show smaller frontal lobe volume and less activation when performing mental tasks. ■ Frontal lobe inhibits behavior – may explain hyperactive, uncontrolled behavior of ADHD. ● Autism Spectrum Disorder ○ Symptoms ■ Deficits in social interaction (e.g., do not make eye contact, turn head away when spoken to, prefer playing alone). ■ Deficits in communication (e.g., one word responses, difficulty maintaining conversation, echoed speech, and problems using and understanding nonverbal cues). ■ Repetitive patterns of behavior or interests. ○ Prevalence ■ Affects approximately 1 in 88 children in the U.S. ■ 5 times more common in boys. ○ Causes ■ Genetics: ● Identical twins – 60%-90% concordance rates.