Psychology: From Inquiry to Understanding

Fifth Canadian Edition

Chapter 15
Psychological
Disorders: When
Adaptation Breaks Down

Copyright © 2020 Pearson Canada Inc. 15 - 1

 • https://www.yout
ube.com/watch?
v=wuhJ-
GkRRQc

Psychological
Disorders
Overview
 Canadian Statistics
20% of Canadians will
experience a Mental Illness
in their lifetime (1 In 5). The 50% of all Mental Illnesses
remaining 4 will have a begin by age 14
friend, family member or
colleague who will.

24% of deaths for youth

70% of all Mental Illnesses
aged 15 to 24 are due to
can be diagnosed by age 25
suicide

(CMHA, 2023)
 What Defines a Mental Disorder?
Identify criteria for defining mental disorders
n Statistical rarity
n Genuis or extraordinary creativity –rare
n Schizophrenia - rare
n Depression & anxiety - common
n Subjective distress
n Sometimes there isn’t distress

n Mania, conduct disorder

n Impairment
n Disrupts your life – addiction, paranoia
n Procrastination – yes, but…

n Biological dysfunction
n Neurotransmitters, brain functioning, genetics
n Societal disapproval (be careful about what you pathologize)
n Thomas Szasz – “the myth of mental illness” - mental illnesses
were weaponized as a form of social control and conformity
n E.g., Homosexuality = sexual deviation until 1973 (“sexual
orientation disturbance”)
Historical Conceptions of Mental Illness
Describe conceptions of diagnoses across history and cultures
n Demonic model – view of mental illness in which odd behaviour,
hearing voices, or talking to oneself was attributed to evil spirits
infesting the body (middle ages)
n Malleus Mallificarum, 1486 à
n “How To ID a Witch”
n Exorcisms – still performed
n Trephination (found in Stone age skulls)

n Medical model – perception that mental illness was due to a

physical disorder requiring medical treatment: *Hippocrates’
“humours” (460-370 BC)
n Blood, black bile, yellow bile, phlegm
15th-17th century
nTreat with vomiting, leeches
n Governments began to house troubled individuals in asylums
n Bloodletting and snake pits were often used as treatments to
“shock the system” back into rhythm.
n Lobotomies – still performed, rare and controlled
n Electroshock Therapy (ECT) – severe depression

15-6
 More Modern
Approaches
• Moral treatment – approach to
mental illness calling for dignity,
kindness, and respect for the
mentally ill
• à Mental Hygiene Movement
• 1700s-1800s
• Dorothea Dix (US)
• Phillippe Pinel (France)
(Memoir of Madness)

• 1950s àTHORAZINE!!!
• Game changer for
psychology and psychiatry,
but…...

• Deinstitutionalization – 1960s-70s
government policy that focused on
releasing hospitalized psychiatric
patients into the community and
closing mental hospitals
15-7
Link to watch video à OPTIONAL

https://www.pbs.org/video/the-rise-and-fall-
of-the-asylum-mbvisj/
 The DSM-5-TR
Categories in the DSM

• Diagnostic and Statistical Manual of Mental Disorders (DSM)

is a system that contains the criteria for mental disorders
(1952 – present)
• Currently on fifth edition, DSM-5-TR
• Has 18 different classes of disorders
• Contains diagnostic criteria and decision rules for each
condition
• Warns to ensure we “think organic” first (rule out physical
causes of symptoms first, e.g., hypothyroidism)
• Contains information on prevalence = % of people in a
population with a disorder
 Misconceptions- but we do need
a system (DSM-5-TR)
• Modelled from the ICD-10 (international classification of
diseases in medicine)
• Psychiatric diagnosis is nothing more than pigeonholing
– At least one aspect is the same, but all people, even with
the same diagnosis, are different
• Psychiatric diagnoses are unreliable.
– High interrater reliability (Ch.2)
• Psychiatric diagnoses are invalid.
– pretty good for distinguishing different disorders, predicting
current and future behaviour, etc.
• Psychiatric diagnoses stigmatize people.
– You are not “a schizophrenic” .
– Labels *can* still be negative = “crazy”
 DSM-5-TR Criticisms

• Not all diagnoses meet the Robins and Guze criteria for validity
(e.g., premenstrual syndrome)
– There are over 300 diagnoses in the DSM.
• Not all criteria or decisions rules are based on scientific data (a
committee decides on including “emerging disorders” with little
scientific backing…e.g., internet gaming disorder. )
• High level of comorbidity (e.g., anxiety and depression are
comorbid so…. are they independent disorders or different
variations of one underlying condition?)
• Reliance on categorical rather than dimensional model of
psychopathology (pregnancy – easy: depression – hard)
• Medicalization of normality—depressed after the loss of a loved
one (normal grief reaction)
Is there an
alternative
to the
DSM?
Anxiety Disorders
Describe the many ways people experience anxiety

n The most prevalent of all psychiatric disorders

n Lifetime prevalence rate: 31%
n Average age of onset: 11!
n Substance abuse: 20
n Mood disorders: 30

Anxiety can LOOK like a physical body (soma) disorder:

n Somatic Symptom Disorder (rooted in anxiety) – class of
conditions marked by physical symptoms that suggest an
underlying medical illness, but that are actually psychological in
origin – no physical diagnosis…
n Hypochondriasis (now called Illness Anxiety Disorder) an
individual’s continual preoccupation with the notion that they are
suffering from a serious physical disease
15-13
Anxiety Disorders

• https://www.youtube.
com/watch?v=aX7jn
VXXG5o
Anxiety Disorders
n Generalized anxiety disorder (GAD) – continual feelings of
worry, anxiety, physical tension, and irritability
n Spend on average 60% of each day worrying, compared with
18% in the general population (14 hours a day!)
n Springboard disorder for other anxiety disorders
n panic disorder or phobias
n Panic disorder – repeated and unexpected panic attacks, along
with a change in behaviour to avoid panic attacks
n Nervous feelings escalate to fear/terror
n Can be associated with a specific stimuli or “out of the
blue”
n Can be a one-time thing or daily for weeks, month, years
n About 20-25 percent of college students report at least one
panic attack within a year

Copyright © 2011 Pearson Canada Inc. 15-15

 Anxiety Disorders
Phobias = most common 1:9
n Phobia – intense fear of an object or situation that’s greatly out of
proportion to its actual threat (not just a little apprehension)
n *Agoraphobia – fear of being in a place or situation from which
escape is difficult or embarrassing or where help is unavailable
n Not fear of crowds or public places
n Often develops due to panic disorder
n Specific phobia – intense fear of objects, places, or situations
n Social anxiety disorder (social phobia) – marked fear of public
appearances in which embarrassment or humiliation is possible, such
as public speaking, eating, or performing.
n https://www.youtube.com/watch?v=6KkObSWyhYc

Ablutophobia- Fear of washing or bathing.

Acarophobia- Fear of itching or of the insects that cause itching.
Acerophobia- Fear of sourness.
Amathophobia- Fear of dust.
Amaxophobia- Fear of riding in a car
(http://phobialist.com)
15-16
 *Other
Anxiety-related disorders
• Obsessive-compulsive (OCD) and related
disorders– marked by repeated and lengthy (>1
hour/day) immersion in obsessions, compulsions, or
both. (*Hoarding = not OCD but related)
• Self reinforcing
• Obsessions – persistent ideas, thoughts, or
impulses that are unwanted and inappropriate,
cause marked distress (e.g., contamination,
aggression)
• Compulsions – repetitive behaviours or
mental acts performed to reduce or prevent
stress (e.g., repeated checking, handwashing,
counting,, etc. to prevent anxiety or distress)
• Buys you relief for a short period of time, then
the intrusive thoughts come back.

15-17
 Depressive and
Bipolar Disorders

• https://www.youtube.c
om/watch?v=ZwMlHk
WKDwM
 Mood Disorders
Identify the characteristics of different mood disorders

• Major depressive disorder– state in which a person

experiences a lingering depressed mood or diminished
interest in pleasurable activities (lifetime prevalence-20%; 15-
24; women
• Symptoms: lingering depressed mood, diminished interest in
activities you used to love, weight loss/gain, sleep difficulties
(insomnia/hypersomnia), psychomotor agitation (or feeling like
you are moving slowly, lack of concentration, feelings of
worthlessness, suicidal thoughts or actions (need 5+
symptoms to meet diagnostic criteria)
• (Why common but not the “common cold”?)
v DSM mood disorders: (Table 15.6)
Major depressive disorder, manic episode, bipolar disorder I
and II, dysthymic disorder, hypomanic episode, cyclothymia,
postpartum depression, seasonal affective disorder (SAD),
disruptive mood dysregulation
15-19
 Explanations for Major Depressive
Disorder. Describe the interplay of life events and interpersonal
behavioural, cognitive, and biological factors in producing symptoms of
depression

n Life events – stressful events that represent loss are

closely tied to depression
n Interpersonal model – depressed people seek
excessive reassurance which leads them to being
disliked and rejected (Coyne study)
1. Depressed
1. Depressed
2. Anxious
n 1. 1.. 2. Not depressed
3. Hostile
3. Non-patients

n Behavioral model – depressed people have a lack of

positive reinforcement, and this leads them to stop
engaging in enjoyable behaviours
15-20
Explanations for Major Depressive
Disorder. Aron Beck.
• Cognitive model – depression is caused by negative
views of self, the future, and the world
• Negative Schemas (“Everyone hates me”)
Early experiences of loss, failure, rejection
• Includes cognitive distortions such as
overgeneralization (focus on the ONE negative thing) or
catastrophizing
• The role of BIOLOGY – genes exert a moderate
influence on the risk of developing major depression
(serotonin transporter gene? – studies are inconclusive)
• May be due to low levels of norepinephrine, and/or
dopamine.

15-21
Animal Model of Depression?
Learned Helplessness
https://www.youtube.com/watch?v=CMp9rxN-LP0
Part I. Dogs randomly assigned to 1 of 3 groups:
Group 1: Dogs put into a harness, then released.
Group 2: Dogs attached to harness, administered light shock, pushed
the lever to escape.
Group 3: same as group 2, but dogs couldn’t escape the shock—they
pressed the lever, but it didn’t work….they “learned” there was nothing
they could do to escape it, so they gave up and took the shock.

Part II: dogs placed unharnessed in the same box, light flashed,
shocks administered.
Dogs in group 1 and 2 escaped the shocks by jumping over the
divide. Dogs in Group 3 (Dogs restrained via a harness and unable to
escape shocks in part 1) did not try to escape the shocks, even when
there was a clear path out! They whimpered, cried, and took it…they
accepted there was nothing they could do. Dogs in group 3 became
depressed via learned helplessness.
(*extended to other animals, as well)! (baby elephants)
15-22
 Bipolar Disorder I and II (age of onset
early 20s)
• Both depressive and manic episodes
• Bipolar disorder – condition marked by a history of at least one
manic episode. More than half the time a major depressive episode
comes after a manic episode.
•
Characteristics of a manic episode – experience marked by
dramatically elevated mood (but can be irritability too), decreased
need for sleep, increased energy, high self-esteem, flight of ideas,
pressured speech, incoherent ideas, increase in goal directed
activity, impulsive, excessive involvement in risky activities (can
experience a break in reality--psychosis).

• Increased activity in amygdala (associated with emotions), decreased

activity in prefrontal cortex (associated with planning)
• Increased risk of suicide (as with major depression) Rate =15% higher
than general population

• https://www.youtube.com/watch?v=lU1pS74NTD8 (MAID on Netflix )

15-23
Personality
Disorders
(10 in the
DSM)
 Borderline Personality Disorder
• Mainly women, about 2% of population
• Marked by instability in mood,
fragmented identity, and impulse
control, poor emotion regulation, hard
to calm down, (“stable instability”);
report feeling empty
• Unstable, volatile relationships
– love/hate binary
– anxious attachment
• Self destructive tendencies
– Drug abuse (self-medicate)
– Sexual promiscuity
– Self-harm/Cutting (NNSI) (70%)
– Suicide threats
 Psychopathic Personality
*Not a DSM diagnosis but widely researched
• Condition marked by
superficial charm, dishonesty,
manipulativeness, self-
centeredness, and risk taking
• Overlaps with antisocial
personality disorder (DSM-5)
– ASPD à history of illegal and
irresponsible actions
– Psychopathic à set of
personality traits
• Charming, personable,
engaging
• Guiltless, dishonest,
manipulative, callous, self-
centered, ruthless, risk-takers
• History of conduct disorder
• Primarily males, about 25%
of the prison population
qualifies
• Corporate and political
leaders
 Dissociative Disorders:
The Divided Self
• Dissociative disorders – conditions
involving disruptions in consciousness,
memory, identity, or perception
• Depersonalization disorder –frequent
episodes of observing your body from
the perspective of an outsider
• Derealization disorder - the external
world seems unreal
• Dissociative amnesia – inability to
recall important personal information
• Most often following a stressful
experience
• Dissociative fugue (flight) – sudden,
unexpected travel away from home or
the workplace, accompanied by
amnesia for significant life events (rare!)

15-28
Four Patients with Schizophrenia
https://www.youtube.com/watch?v=AVAbNL8mrgk
Schizophrenia—Crash course

• https://www.youtube.com/watch?v=uxktav
pRdzU
Schizophrenia
Recognize the characteristic symptoms of
schizophrenia (the “cancer” of mental illness)
<1% of population but ½ the inpatient pop. In N. America

n Disturbances in thinking, language, emotion, and

relationships, often confused with DID (it’s NOT DID!)
n Psychotic symptoms – serious distortions of reality
n *Delusions – strongly held, fixed beliefs that have no basis in reality
(e.g., persecution)
n Hallucinations – sensory perceptions that occur in the absence of an
external stimulus (Mostly auditory, but can also be gustatory, tactile, or visual)
n Disorganized speech – language jumps from topic to topic (word
salad)
n *Disorganized Behaviors – hygiene, motivation, inappropriate
emotional response, sensitivity to temperature.
n Catatonia – motor problems / waxy flexibility
• Resistance to comply with simple suggestions, holding the body in rigid
postures, parrot-like repetition (echolalia)

15-31
 Explanations for Schizophrenia
n Family interactions play a role, but are not a cause of
schizophrenia
n Criticism, hostility, and over-involvement (high expressed
emotion = EE) can induce relapse (varies across ethnic
groups)
n Brain abnormalities
n Increased size of ventricles and sulci in the brain
n Decreased size of temporal and frontal lobes
n Decreased hemispherical symmetry
n Decreased activation of the amygdala and hippocampus
n Neurotransmitter differences (ßwatch me)
n Dopamine hypothesis – excess dopamine is root of problem
(e.g., Parkinson’s Disease; Tx: L-dopaà increases concentrations
of dopamine in the brainà schizophrenia like side effects).
q Amphetamine – blocks reuptake of dopamine = worsens
symptoms in patients
n Txà decrease dopamine concentrations in specific dopamine
receptor sites.
15-32
 Explanations for
Schizophrenia
• Genetic findings
• Highly genetic
• As genetic similarity
increases, so does
the risk of getting
schizophrenia

• Diathesis-stress
models
• Mental disorders
are a joint product
of a genetic
vulnerability
(diathesis), and
stressors that
trigger this
vulnerability
15-33
 Childhood Disorders
Autism Spectrum Disorders (ASD)
• Neurodevelopmental disorder that is characterized
by difficulties in social communication and interaction
(relating to others/maintaining relationships may be
difficult, may not make eye contact or engage in non-
verbal communication, may struggle with reciprocity,
may be more comfortable alone)
• Restricted, repetitive patterns of behaviours,
interests and activities (stereotyped motor
movements [stimming], struggles with change,
hypersensitive to sensory stimuli, echolalia [parroting
words/phrases), can become hyper fixated on idea,
object, etc.

Attention-Deficit/Hyperactivity Disorder
• ADHD – 3-7% of school-aged children (more
males than females)
• Inattention (trouble concentrating, making
mistakes, forgetful)
• Hyperactivity and Impulsiveness (fidgeting,
impulsive)
 Prevalence
• In March 2018, the National Autism
Spectrum Disorder Surveillance
System (NASS) released the most up-
to-date Canadian prevalence rate: 1 in
66 Canadian children and youth (ages 5-
17) are diagnosed with Autism Spectrum
Disorder (ASD).

• According to the Canadian Medical

Association Journal, approximately 1 -
2% of the Canadian population is on the
autism spectrum which means there
are approximately 135,000 people
with autism in Ontario.
Immunizations and Autism: The
Most Damaging Medical Hoax
of the Last 100 years
• Late 1990s, UK study led by Andrew
Wakefield claimed to find that the combined
MMR vaccine caused Autism.

• Speculated it was a side effect of the vaccine,

ingredients in the vaccine, or chemicals the
vaccine was stored in.

• Led to a reduction of MMR vaccinations across CONCLUSION:

the UK, Canada, US, etc. (and resurgence of THERE IS NO
MMR diagnoses)
ASSOCIATION
BETWEEN MMR
• In February 2010à study retracted from the
VACCINATION AND
Lancet, for evidence of data tampering, ethical
violations, and improper research practices, AUTISM
and stripped of his MD.
Immunizations and Autism: The Most
Damaging Medical Hoax of the Last 100 years

Subsequent research showed no link between vaccines and autism

(Europe, US, Japan – no replication)

• MMR vaccination rate stayed constant or even declined, but

Autism soared.

• Dutch government banned thimerosal, but prevalence of autism still

skyrocketed

• Parents fell prey to an illusory correlation

They noticed symptoms after administering vaccines, so the
vaccines must have caused the symptoms!

• Increase is most likely due to changes in diagnostic practices

(more liberal diagnostic criteria) and CDA and ADA laws
(accommodations)
Mental Health Resources
(CMHA, 2023)