Psychological Disorders
Mental Illness
● Mental disorder may involve:
○ Dysfunctional patterns of cognition, emotionality, and/or
behaviour
○ Considered deviant in the person’s society/culture
● Important criteria in describing mental disorders:
○ Statistical rarity
■ Note, gifted children are statistical anomalies, however are
not considered disordered (generally)
○ Subjective distress
■ Anxiety, depression, etc.
■ Note, antisocial personality disorder may not cause distress
to the person, but is still considered a disorder
○ Impairment
○ Biological dysfunction
○ Deviance
■ Within context of a certain society, not adequate alone to
diagnose
● The Family Resemblance View suggests that mental disorders don’t all
have one thing in common – they share some, but not all, of an
assortment of features
Historical Conceptions of Mental Illness
● General Historical Perspectives
○ Supernatural theories: attribute mental illness to supernatural or
otherworldly causes
■ Evil spirits, angry gods, sin, celestial events, and curses
● Somatogenic theories: attribute mental illness to bodily causes
○ Genetics, abnormal brain structure, brain damage, neurochemical
imbalances, humours, and other alleged physical/physiological
causes
● Psychogenic theories: psychological in origin
○ Trauma, learning, or distorted perception
● Ancient Perspectives
○ Trephanation began ~6500 BCE (at least)
■ Drilling into the head to “release evil spirits,” treating head
trauma, etc.
○ Ancient Chinese Medicine spoke of imbalances of Yin and Yang
○ Physical causes in Egyptian and Greek civilizations (e.g.,
“hysteria”)
■ Uterus detached itself and stuck itself to other organs
■ What
● Middle Ages and The Demonic Model:
○ View of mental illness in which hearing voices, talking to
oneself, and other odd behaviors were attributed to the actions of
evil spirits infesting the body
■ Led to exorcisms and other treatments that didn’t work
○ Later, mentally ill (disproportionately women) were persecuted as
witches
■ Malleus Malleficarum
● The first book to both comprehensively define and
condemn witchcraft. As a result, it became the basis
for many future works on the subject and served to
persuade people of the dangers posed by witches
● Medical Model:
○ View of mental illness as a physical disorder
■ Asylums; unscientific treatments, such as bloodletting and
terror induction
○ Phillippe Pinel (1745-1826) and Dorothea Dix (1802-1887)
promoted moral treatment of people with mental illness
■ Dix investigated and documented the maltreatment of
patients in mental hospitals, leading to mental institutional
reform
● Modern Era
○ Advent of effective medications
○ Deinstitutionalization: Releasing of hospitalized psychiatric
patients and closing of mental hospitals
■ JFK’s Community Mental Health Act
■ Mixed blessing
● Many people who didn’t need to be in asylum were
released
● Destigmatized mental illness to an extent
● People were released en masse without guidance or
treatment for their illnesses
● Lack of support, especially for those who were on
medication
● Raises the question, “how do we effectively and
morally treat those with mental health issues?”
● Culture-Bound Syndromes: mental illnesses that are specific to one or a
few societies
○ May be unique, culture-related expressions of more general
mental illness
○ Severe issues are not demonstrated to be exclusive to any culture
Modern Psychiatric Diagnosis
● Diagnostic and Statistical Manual of Mental Disorders (DSM)
○ Includes diagnostic criteria for all clinically recognized disorders
○ Originated in 1952, now in its 5th edition
● Important Features of the DSM
○ Warns diagnosticians to “think organically” – rule out medical
causes
○ Provides information about the characteristics and prevalence of
disorders
○ Takes biopsychosocial view and recognizes people as more than
their disorders
○ Recognizes diversity in ethnicity/culture, sexual identities, and
socioeconomic backgrounds
■ Cutting may be indicative of a mental disorder, however
certain cultures may do it as a regular practice
■ Western perspectives should not be forced onto other
societies
● Criticism of DSM
○ Are all diagnoses valid?
■ Overpathologization of individuals
■ Certain disorders are less evidence-based than others
○ Comorbidity
■ Distinct issues or a single, underlying condition?
● E.g., Depression and Anxiety: those with depression
often exhibit or are diagnosed with anxiety disorders,
raising the question of whether they may be a result
of by a single, underlying cause
○ Categorical Model
■ Model in which a mental disorder differs from normal
functioning in kind rather than degree
● Differences are often on a continuum, rather than
being categorically separate
○ Medicalization of normality
■ Because of the vast diagnostic criteria, people may be
quicker to categorize normal behaviour as a psychological
disorder
Anxiety-Related Disorders
● Anxiety
○ An emotion characterized by feelings of tension, worried
thoughts, and physiological changes (APA)
○ Can be adaptive in many contexts
○ Anxiety disorders are among the most common mental disorders:
31% meet diagnostic criteria at some point in their life time
● Generalized Anxiety Disorder
○ Continual feelings of worry, anxiety, physical tension, and
irritability across many areas of life functioning
○ Can adversely affect work, school, social interactions, and sleep
○ Risk Factors
■ Female, widowed, divorced, low on the socioeconomic
spectrum, drug and alcohol use, genetics
● Panic Disorder
○ Repeated and unexpected panic attacks, along with either
persistent concerns about future attacks or a change in personal
behaviour in an attempt to avoid them
○ Panic Attack: brief, intense episode of extreme fear characterized
by sweating, dizziness, light headedness, racing heartbeat, and
feelings of impending death or going crazy
■ Can result from specific situations or fears or arise ‘out of
nowhere’
○ Onset: late adolescence or early adulthood
○ Risk Factors: female, genetics
○ Prevalence (Canada): 1.6% per year, 3.7% lifetime
● Phobia
○ An intense fear of an object or situation that is greatly out of
proportion to its actual threat
○ Most common anxiety disorders: ~12.5% lifetime prevalence
○ Agoraphobia refers to a fear of being in a palace or situation
from which escape is difficult or embarrassing, or in which help
is unavailable in the event of a panic attack
■ Emerges in mid-teens
■ Often an outgrowth of panic disorder; can occur without
panic disorder (50%)
■ Debilitating: avoidance of public places like grocery stores,
malls, public transportation
■ Onset: Adolescence or early adulthood
■ Risk Factors
● Panic attacks, fear response to panic attacks
● Other phobias
● Sensitivity to anxiety
● Adverse experiences in childhood
● Having a relative with agoraphobia
○ Specific Phobias:
■ Animals and insects
■ Natural environments (storms)
■ Blood and injury
■ Situations (flying, enclosed spaces)
○ Many phobias are prevalent in childhood but fade with age
● Social Anxiety Disorder
○ The intense fear of negative evaluation in social situations
○ Distress causes significant disruptions to daily routine
○ Individual is typically aware that the distress is
excessive/unreasonable (similar to phobias)
○ Onset: childhood or early adolescence
○ Risk Factors: Genetics, lifetime stress
● Post-Traumatic Stress Disorder (PTSD)
○ Marked emotional disturbance after experiencing or witnessing a
severely stressful situation: a lasting reaction to trauma
○ Experience vivid memories, images, emotions pertaining to
traumatic experience → commonly called “flashbacks”
○ Rumination, nightmares, uncontrollable thoughts about the event
○ Attempts to avoid reminders of the trauma (e.g., thoughts, places,
emotions)
○ Risk Factors (beyond exposure to trauma)
■ Duration and Severity of trauma
■ Lack of social support
■ Other life stressors or mental health problems
● Obsessive-Compulsive Disorder
○ Condition marked by repeated and lengthy (at least one hour per
day) immersion in obsessions, compulsions, or both
○ Obsessions: a persistent idea, thought, or impulse that is
unwanted and inappropriate, causing marked distress
○ Compulsion: Repetitive behaviour or mental acts performed to
reduce or prevent stress
○ Onset: adolescence or early adulthood
○ Risk Factors: genetics, childhood development
Explanations for Anxiety-Related Disorders
● Both nature and nurture are thought to contribute to anxiety disorders
● Biology
○ Evolutionary roots of anxiety
○ Anxiety disorders are heritable: twin studies show genetic
influence
■ Trait neuroticism is heritable; genes may also affect
expression of anxiety disorders
○ Structural and functional differences in anxious brains
● Learning
○ Anxiety may be created through positive punishment and
avoidance reinforced through negative reinforcement (operant
conditioning)
● Other Experiential Factors
○ Adverse childhood experiences: may lead to hyperactive stress
response and emotional dysregulation
■ Associated with more anxiety
○ Anxiety sensitivity, a tendency to catastrophize, and appraise
situations negatively
● Anxiety disorders are often extensions of normal human behaviour
Mood Disorders
● Mood
○ A disposition to respond emotionally in a particular way that may
last for hours, days, or even weeks, even at a low level and
without the person knowing what prompted the state
● Moods naturally vary from time to time
● Good moods promote activity and interaction with others; bad moods
promote isolation and a focus on the negative
● Two Basic Categories
○ Depression
○ Bipolar disorder
○ 20% lifetime prevalence
● Major Depressive Disorder
○ Chronic or recurrent state in which a person experiences low
mood, diminished interest in pleasurable activities, low
self-esteem, and other symptoms including weight loss and
difficulty sleeping
○ Feelings of guilt, worthlessness, hopelessness; lack of energy
○ MDD is a major risk factors for self-harm and suicide
○ Onset: can affect people of any age; peaks in late adolescence and
early adulthood
○ Has risen in the 100 years
● Bipolar Disorder
○ A condition marked by a history of at least one manic episode,
and which causes intense shifts in mood, energy levels, thinking
patterns, and behaviour
■ Cycle between depression and mania
○ Manic Episode
■ Experience marked by dramatically elevated mood,
decreased need for sleep, increased energy, inflated
self-esteem, increased talkativeness, and irresponsible
behavior
○ Hypomania
■ Less severe form of mania (Bipolar 2)
○ Onset: Early 15-25 years of age, can be earlier of later
○ Risk factors
■ Genetics (heritable); stressors and substance use can impact
the course of disorder
● Suicide in Canada
○ Approximately 4500 deaths per year
○ 3x more men than women
○ Second leading cause of death in youth and young adults (15-34)
● Risk Factors for Suicide and Vulnerable Groups
○ Mental Illness: Major Depressive Disorder and Bipolar disorder
are associated with higher rates of suicide
○ First Nations and Inuit youth
○ Low socioeconomic status, substance abuse, unemployment,
chronic stress, hopelessness
○ Men are more likely to die, and women are more likely to attempt
Personality Disorders
● Personality Disorder
○ Condition in which personality traits, appearing first in
adolescence, are inflexible, stable, expressed in a wide variety of
situations, and lead to distress or impairment
○ Least reliably diagnosed psychological disorders
○ Interpretations of abnormality depend on context
● Borderline Personality Disorder
○ Condition marked by extreme instability in mood, identity, and
impulse control
○ “Stable instability”
○ Maladaptive behaviours: self-harm, recklessness, self-sabotage,
substance abuse
○ Onset: Late adolescence to early adulthood
○ Risk Factors/Causes
■ Genetics; female (maybe), childhood abuse, other mental
illness
● Psychopathic Personality
○ A condition marked by superficial charm, dishonest,
manipulativeness, self-centeredness, and risktaking
○ Lack of empathy and guilt (callous)
○ Not listed in DSM-5, but has received much attention in research
○ Linked with Antisocial Personality Disorder, a condition marked
by a lengthy history of irresponsible and/or illegal actions
○ People are often attracted to and seek out these individuals (at
least in the short term)
○ Onset: Typically in childhood as a conduct disorder
○ Risk Factors/Causes
■ Deficit in fear response, genetics, brain biology, trauma,
male, substance use
Dissociative Disorders
● Dissociative disorders:
○ Involve disruptions in consciousness, memory, identity, or
perception
○ Have contentious diagnoses/disorders
● Depersonalization/derealization Disorder
○ A state of mind in which the self appears unreal. Individuals feel
estranged from themselves and usually from the external world,
and thoughts and experiences have a distant, dreamlike character
○ Condition marked by multiple episodes of depersonalization
○ Derealization: the sense the external world is strange or unreal
● Dissociative Amnesia
○ Inability to recall important information – most often related to
stressful experience – that can’t be explained by regular
forgetfulness
● Dissociative Identity Disorder (DID)
○ Condition characterized by the presence of two or more distinct
personality states that recurrently take control of the person’s
behaviour
Schizophrenia
● Schizophrenia:
○ Severe disorder of thought and emotion associated with a loss of
contact with reality
○ Delusions: Strongly held, fixed beliefs that have no basis in
reality
○ Hallucinations: Sensory perception that occurs in the absence of
an external stimulus
○ Disorganized Speech: Incoherent speech, ideas shift from one
subject to the next, “loose associations,” irrelevant responses
○ Grossly disorganized behaviour
○ Catatonia
○ Onset: Mid-20s for men, late-20s for women
○ Risk Factors/Causes:
■ Genetics, structural/neurotransmitter/functional differences,
environmental triggers
Childhood Disorders
● Autism Spectrum Disorder
○ A category that includes autism and Asperger’s syndrome
○ Characterized by a range of symptoms and abilities, varying in
social interaction, communication, intellectual functioning, and
behaviour
■ Autistic Disorder: Marked by varying degrees of deficits in
language, social bonding, and imagination, coupled with
intellectual impairment
○ Onset: Around 2 years of age
■ Signs can appear earlier
■ About 54% are diagnosed before age 5
○ RiskFactors/Causes: genetics (not just a single gene), male,
becoming pregnant after 35, gestational diabetes, some
medications during pregnancy, preterm birth
● Controversy
○ There has been a massive increase in diagnosed ASD cases:
787% increase from 1998-2018
○ The public questioned environmental factors, such as vaccines
○ The most likely explanation is the change in diagnostic practices,
which led to more sensitive diagnoses
● Attention-Deficit/Hyperactivity Disorder
○ Marked by excessive inattention, impulsivity, and activity
○ Can result in problems with regulating behaiour, mood, activity
levels; affects ability to pay attention/concentrate and follow
directions
○ Some symptoms imporve into adolescence (hyperactivity), but
others remain (inattention) resulting in a variety of negative
outcomes
○ Onset: Typically diagnosed in childhood
○ Risk Factors/Causes
■ Genetics (high heritability), structural, functional, and
chemical differences in brains
● Controversy
○ Concerns about over and under-diagnosis of ADHD in childhood
○ Some concern that naturally energetic, but not dysfunctional,
children will receive diagnosis; other issues may cause attentional
problems (e.g. nutritional issues; health problems)
○ Some researchers suggest that ADHD may not be diagnosed in
people who need or could benefit from treatment