Psychological Disorders
Psychological Disorder
	The presence of a constellation of symptoms that create significant distress or impair work, school, family, relationships, or daily living
•	Three factors
–	Distress
–	Disability
–	Danger
Deviant Behavior and Abnormality
•	Importance of context
–	Social norms
–	Cultural beliefs
–	Religious practices
•	Psychosis
•	Hallucinations
•	Delusions
Is mental illness a social construction
•	Labeling theory – sociology
–	Extreme form says that mental illness does not exist aside from labels
•	Thomas Szasz
•	R.D. Laing
–	Less extreme forms
•	Labeling leads to reactions from others
•	Self-definition
•	Acting in role
The problems with diagnosis
•	Often unreliable
•	Conditions do not have definitive symptoms
Labels and Abnormality
•	Labels are somewhat arbitrary
•	Rosenhan “On being sane in insane places”
–	8 pseudopatients claimed to hear voices
–	Admitted to psychiatric hospitals
–	Stopped reporting symptoms
–	Normal behaviors were interpreted as pathological
–	Doctors rarely responded to questions
–	Many real patients were not fooled
Why mental illness is not a social construction
•	Symptoms appear cross culturally
–	In about the same degrees and percentages
–	Although often labeled differently
–	And seen as different causes
•	Heredity implications
•	Brain patterns
Explaining Abnormality
•	The brain
–	Diathesis-stress model
•	The person
–	Classical and operant conditioning
•	The group
–	Labels
Categorizing Disorders
•	Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)
–	Axis I: clinical disorders
–	Axis II: personality disorders and mental retardation
–	Axis III: general medical conditions
–	Axis IV: psychosocial and environmental problems
–	Axis V: global assessment of functioning
Mood Disorders
•	Major depressive disorder
–	Lifetime prevalence
•	Women 20%
•	Men 12%
•	Dysthymia
–	Lifetime prevalence 6%
•	Suicide
–	Attempted by 30% of depressed people
Mood Disorders
•	Bipolar disorder
–	Mania
•	Hypomania
•	Manic episode
•	Prodromal phase
–	Often cycles with depression
–	Formerly called manic depression
–	Lifetime prevalence 1%
Explaining Mood Disorders
•	The brain
–	Hereditary factors
–	Frontal lobe
–	Amygdala
•	The person
–	Attributional style
•	The group
–	Social support network
Major Depression
•	Major depressive disorder
–	Lifetime prevalence
•	Women 20%
•	Men 12%
•	Dysthymia
–	Lifetime prevalence 6%
•	Suicide
–	Attempted by 30% of depressed people
Bi-polar Disorder
•	Mania
–	Manic episode
–	Prodromal (warning) phase
•	Often cycles with depression
•	Formerly called manic depression
•	Lifetime prevalence 1%
Symptoms of Depression
•	Depression varies in severity
•	And most people with less severe cases to not have all symptoms
•	Raises issues again about whether this is a unitary disorder
Symptoms of depressions
•	Sad mood
•	Irritability
•	Fatigue
•	Loss of Interest in sex, eating, social interaction
•	Hopelessness
•	Social inhibition
•	Anhedonia
•	Loss of concentration
Relationships with anxiety
•	Most severely depressed people also have severe anxiety
•	Solomon selections
Positive feedback loops
•	Depression causes poor functioning which further leads to depression
•	Social support systems tend to decay
–	Depressed people are hard to deal with
–	And most friends and family don’t understand how uncontrollable it is
–	Give bad advice and are offended when it isn’t taken
–	Friends disappear and consequent loneliness creates more depression
Depression is not unitary
•	Many interrelated syndromes
•	Hence many potential underlying causes
Explaining Mood Disorders
•	Biological
–	Hereditary factors
–	Serotonin
–	Frontal lobe
–	Limbic system
–	Stress
•	The person
–	Attributional style
•	The group
•	Experiences
Hereditary factors
•	Bi-polar more genetic than uni-polar
•	But both show fairly high concordance rates.
•	For bi-polar 50% of patients have at least one parent who is also bi-polar
•	Bi-polar parent has 25% chance of having bi-polar child
The serotonin hypothesis
•	Serotonin circuits are numerous
•	And diffuse
Problems with serotonin hypothesis
•	No one has identified which circuits are responsible for depression
•	And the SSRIs take several weeks to produce effects even though their chemical effect is immediate
•	Possible that depression is due more to number of serotonin receptors
–	Which take time to grow
Brain scan studies
•	Many done with depressed people
•	Good sense of which areas of the brain are affected
–	Some underactive
–	Some overactive
Frontal lobe activity
•	Greatly diminished in depressed people
•	Especially those associated with feelings of agency
•	Self-willed action
Other deficits
•	Parietal and upper temporal lobes
–	Attention
–	Especially to outside world
•	Cingulate cortex
–	Front of brain along bottom edge of cortex
–	Many ties to limbic system
–	Pathways for nonconscious ideas and motivation to frontal lobes
–	Probably an emotional control center
–	Over-excitement leads to mania
–	Also over-activity associated with paranoia and sense that everything is related
The limbic system
Areas of greater activity in depressed
•	Outside edge of prefrontal lobe
–	Associated with pulling information from memory
–	And in normals lights up when have sad thoughts
•	Parts of the thalamus which are connected to amygdala – negative emotions
•	Anterior cingulate – concentration, especially interior thoughts
Thus a possible cycle
•	Amygdala feeds negative thoughts to prefrontal lobes (consciousness)
•	Prefrontal pulls out memories that match the feeling
•	Anterior cingulate fastens on to them and keeps other things from gaining attention
•	Thalamus keeps everything firing away
•	And no sense of purpose or self agency
Are brain scans helpful
•	We already knew that depressed people have the basic symptoms
–	Lack of meaning in life
–	Fasten on negative memories
–	Little attention to outside world
•	So brain activity results not surprising
•	But does provide a kind of model for relationships
–	What causes what
–	And in what order
Stress hypothesis
•	Depression is hereditary
•	Also early abuse and neglect is a huge risk factor
•	Diathesis-stress hypothesis
•	Also explains frequent association of anxiety and depression 
–	And similar treatments
•	Implicates the hypothalamic-pituitary-adrenal axis (HPA)
The normal circuit
•	Fear stimuli come to amygdala  
•	Projects to certain areas of hypothalamus
–	Which releases CRH hormones
•	Which stimulates pituitary gland to release ACTH 
•	Which in turn stimulates the adrenal glands to release Cortisol
•	Evidence of HPA hyperactivity in depressed people
The normal HPA circuit
The failures of inhibitions
•	These circuits are functional for reactions to stress 
–	 fight or flight responses
–	But must be inhibited if stressful stimulus is reduced and after time
•	Normally the hippocampus does this
–	Responds to Cortisol at certain receptors 
–	Inhibits CRH release
Responses to massive or prolonged stress
•	Constant cortisol exposure causes hippocampus neurons to wither and die
•	Hence aren’t effective in inhibiting stress reactions
•	And a vicious cycle of stress making one more vulnerable to additional stress 
Explanation for depression?
•	The biological correlates are in place
–	But only correlates
•	Explains correlation between depression and anxiety
•	And importance of early experience
•	And why depression is a periodic
Cognitive factors
•	The irrationality of depressed explanations
–	Beck
–	Attributional style
•	Positives become negatives and visa versa.
Social factors
•	Loss of social support
•	And often criticism from others who don’t understand
Experiences
•	Onset may be related to depression
–	Sometimes a severe crisis
–	But more often a “life setback” – sometimes quite trivial
•	Begins the cognitive loop
•	And others not sympathetic
•	Resilience
–	Some more vulnerable to bad experiences
–	Hereditary
But problems
•	Does not explain why ordinary people are depressed
•	Or why it is genetic
•	Or why SSRIs and other anti-depressants work
–	Theoretically work on serotonin circuits
–	But some evidence that they also dampen HPA activity
•	No one knows why
•	New drugs under development

Anxiety Disorders
•	Panic disorder
–	Panic attacks
–	Agoraphobia
–	Anxiety sensitivity
–	Lifetime prevalence 3%
Anxiety Disorders
•	Phobias
–	Social phobia
•	Lifetime prevalence 13%
–	Specific phobia
•	Animal fears
•	Blood-injection-injury fears
•	Natural environment fears
•	Situation fears
•	Miscellaneous fears
•	Lifetime prevalence 10%
Anxiety Disorders
•	Obsessive-Compulsive Disorder (OCD)
–	Obsession
–	Compulsion
•	Checking
•	Washing
•	Ordering
–	Lifetime prevalence 3%
Anxiety Disorders
•	Posttraumatic Stress Disorder (PTSD)
–	Traumatic event
–	Fear and helplessness
–	Symptoms
•	Re-experience event
•	Avoidance and emotional numbing
•	Heightened arousal
–	Lifetime prevalence 8% (among Americans)
•	Prevalence strongly affected by environment
Schizophrenia
•	Positive Symptoms
–	Delusions
–	Hallucinations
–	Disordered behavior
–	Disorganized speech
•	Negative Symptoms
–	Flat affect
–	Alogia
–	Avolition
What are the key symptoms?
•	Loose associations
•	Attention – too much mental activity
•	Affect
Schizophrenia
•	Four subtypes
–	Paranoid
–	Disorganized
–	Catatonic
–	Undifferentiated
Explaining Schizophrenia
•	The brain
–	Hereditary
–	Ventricle size
•	The person
–	Emotional dampening
•	The group
–	High expressed emotion
–	Social selection and social causation
Dissociative Disorders
•	Symptoms
–	Identity confusion
–	Identity alteration
–	Derealization
–	Depersonalization
–	Amnesia
•	Dissociative amnesia
•	Dissociative fugue
•	Dissociative identity disorder
Eating Disorders
•	Anorexia nervosa
•	Bulimia nervosa
•	Factors
–	Genetic predisposition
–	Gender
–	Cultural factors
•	Lifetime prevalence 0.5%-4%
Personality Disorders
•	Antisocial personality disorder
•	Avoidant personality disorder
•	Borderline personality disorder
•	Dependent personality disorder
•	Histrionic personality disorder
Personality Disorders
•	Narcissistic personality disorder
•	Obsessive-compulsive personality disorder
•	Paranoid personality disorder
•	Schizoid personality disorder
•	Schizotypal personality disorder
Are the mentally ill violent
•	Common stereotype
•	Good data on schizophrenics – most feared
–	Are slightly more violent
–	But only
•	If violence before hospitalization
•	Substance abuse 
•	Auditory hallucinations
What about the insanity defense?
•	The legal issues
–	Diminished capacity
–	Mental hospital vs. prison?
•	M’Naughton right wrong test?
•	Control over actions?