Psychological disorders and their treatments

We’re finally going to cover the topic that most of you probably thought we’d spend all semester on: psychological disorders (this week) and treatment (next week)! When people think of psychology, this is what they think of, but I hope that you now understand that these chapters needed to come after all the rest. One cannot understand psychological disorders and their treatments without understanding why people think the way they do and why people act the way they do. We’ll talk about nature versus nurture and its role in the genetic or environmental root causes of some disorders. We’ll talk about how the various approaches we’ve been talking about (cognitive, behavioral, psychoanalytic, humanistic, etc) influence how we think about these disorders and their treatments. These next two weeks are your opportunity to apply everything we’ve been talking about to understand psychological disorders and their treatments.

This week we’ll cover the following topics in Chapter 13: Psychological Disorders:

· What’s normal, what’s not

· Classifying and explaining psychological disorders

· Anxiety Disorders

· Obsessive-Compulsive Disorder

· Depressive Disorders

· Bipolar Disorders

· Schizophrenia

Useful infographics/tables:

· Infographic 13.1: The DSM-5

· Infographic 13.2: Suicide in the United States

· Table 13.1: Defining Abnormal Behavior

· Many tables are listed below in the notes

Websites that may be useful / interesting:

· American Psychiatric Association (Links to an external site.)

· National Suicide Prevention Lifeline (Links to an external site.), call 1-800-273-8255

· The National Institute of Mental Health (NIMH) (Links to an external site.)

What’s normal, what’s not

As you read through the chapter, you might feel yourself succumbing to the psychological version of intern’s syndrome (Links to an external site.), where you think you should be diagnosed with whatever disorder you happen to be reading about. We all feel sad, anxious, or angry at times. These are normal fluctuations in mood. Psychological disorders are not “normal” fluctuations in mood. Disorders seriously interfere with a person’s life (personal, professional, or day to day interactions) for an extended period of time (DSM defines this time period).

Mental health professionals rely on the three Ds to determine if someone is exhibiting abnormal behavior, as opposed to maladaptive behavior:

 

1. Dysfunction: behavior interferes with daily life and relationships

2. Distress:  behaviors/emotions cause person to feel upset

3. Deviance: degree to which behavior is considered outside the norms of society

According to the American Psychiatric Association (Links to an external site.),

Mental illnesses are health conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.

Mental illness is common. In a given year:

· nearly one in five (19 percent) U.S. adults experience some form of mental illness

· one in 24 (4.1 percent) has a serious mental illness*

· one in 12 (8.5 percent) has a diagnosable substance use disorder

Mental illness is treatable. The vast majority of individuals with mental illness continue to function in their daily lives.

*Serious mental illness is a mental, behavioral or emotional disorder (excluding developmental and substance use disorders) resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. Examples of serious mental illness include major depressive disorder, schizophrenia and bipolar disorder.

So mental illnesses are both common and treatable. This may surprise you because there is a huge stigma against mental health (Links to an external site.). This can lead to devastating consequences because people will not seek help when they really need it. Needing help is not a weakness and is necessary in most cases. A person suffering from a mental illness cannot just get over it, as they are sometimes told. Taking psychoactive medications and/or engaging in talk therapy may be part of getting oneself psychologically well.

According to the Mayo Clinic (Links to an external site.),

Some of the harmful effects of stigma can include:

· Reluctance to seek help or treatment

· Lack of understanding by family, friends, co-workers or others

· Fewer opportunities for work, school or social activities or trouble finding housing

· Bullying, physical violence or harassment

· Health insurance that doesn’t adequately cover your mental illness treatment

· The belief that you’ll never succeed at certain challenges or that you can’t improve your situation

So you can see why it’s important to combat this stigma. The consequences are far reaching and extremely harmful.

Classifying and explaining psychological disorders

In the US, mental health professionals use the Diagnostic and Statistical Manual (Links to an external site.) (DSM) to help diagnose people with particular disorders. It uses a checklist of symptoms to diagnose individuals and to determine the best course of treatment. There are both pros and cons to using the DSM and clinicians are constantly revising, defending, and debunking the use of the DSM.

Given the prevalence of disorders, you might not be surprised to learn that some people can suffer from more than one disorder at a time. This is called comorbidity. It’s similar to suffering from both the flu and cancer – 2 different disorders with different underlying symptoms.

Researchers and clinicians talk about the  etiology  (Links to an external site.)of a disorder. That is, what are the root causes of a disorder. It should not surprise you of some of the common explanations:

 

1. Biological / medical model

2. Mind / psychological factors

3. Environment / sociocultural factors

4. And the combination of it all, the biopsychosocial (Links to an external site.) model (similar to figure 13.1):

 

Anxiety Disorders

People who suffer from anxiety disorders (Links to an external site.) have extreme anxiety and/or fears that are debilitating. This is not your regular run of the mill anxiety about an upcoming test or a dislike of spiders. This is severe anxiety and fear that leads to changes in the way one interacts with the world. Some examples of anxiety disorders include:

 

· Panic disorder (Links to an external site.) – panic attacks (Links to an external site.) that happen frequently and without a discernible reason are a symptom of this disorder. Panic attacks make a person feel as though they are having a heart attack and that their death is imminent. Sometimes, telling someone that they are not dying, but are instead suffering from a panic attack, can help them to calm down.

· Specific phobias (Links to an external site.) / agoraphobia  (Links to an external site.)- severe fear and anxiousness when confronted with a particular object (i.e., snakes) or situations (i.e., large spaces). Panic attacks are common and are in response to the particular object/ situation.

Obsessive-Compulsive Disorder

People diagnosed with Obsessive-Compulsive Disorder (OCD) (Links to an external site.) suffer from:

 

· Obsessions – repeated thoughts/urges that won’t go away; examples:

· Fear of contamination

· Fear that something wasn’t done right

· Compulsions – actions to get rid of the obsessions; examples:

· Constant hand washing

· Constant checking or repetitive rituals

Depressive Disorders

People with depressive disorders (Links to an external site.) feel profound sadness and despair, often for a long period of time, so much so that it interferes with their everyday life. This is not just “feeling blue”. Table 13.5 lists some of the different types of depressive disorders.

Bipolar Disorder

People with bipolar disorder (Links to an external site.) suffer from extreme highs and lows in emotions. The lows are similar to suffering from a depressive disorder described above. The highs are called  manic episodes / mania (Links to an external site.) and are characterized by extreme energy, euphoria, and confidence.

Schizophrenia

People who suffer from schizophrenia (Links to an external site.) appear to have lost touch with reality in their thoughts, behavior, and feelings. This is called psychosis. Symptoms of schizophrenia (Links to an external site.) (Tables 13.7, 13.8) are categorized as positive or negative. In this case, I don’t mean “good” or “bad”, but rather are symptoms that are present or absent.

· Positive symptoms: distortions of behavior; examples:

· Delusions (Links to an external site.) – strange or false beliefs that a person truly believes; examples include

· delusions of grandeur – “I am so important that God has chosen me for this task to rid the world of evil.”

· delusions of persecution – “The president is after me.”

· Hallucinations (Links to an external site.) – a perceptual experience a person believes is happening, but is not; examples include hearing voices or seeing images.

· Negative symptoms: reduction / absence of expected behaviors; include decreased pleasure, lack of motivation, lack of emotion

Note that people often confuse schizophrenia with dissociative identity disorder (Links to an external site.) (DID). DID is a personality disorder in which a person can exhibit more than one personality. DID is an extremely rare disorder.

Hit reply and type your answers to the following:

1. Why do you believe there is a stigma against mental health? Pick either panic disorder or a specific phobia and describe its symptoms. Imagine talking to someone who held negative views towards a person who sought treatment for one of those disorders. What arguments might you use to change their mind?

2. What are some pros and cons of using the DSM when diagnosing someone with a psychological disorder? What is your opinion?

3. Choose one of the following disorders: OCD, major depressive disorder, or schizophrenia. Use what you learned in the textbook and/or my lecture above, and (a) summarize the symptoms, (b) using the biopsychosocial model, talk about some of the causes (etiology) that may contribute to its appearance (include the biological, psychological, and sociocultural factors).

4. Find a first person account of a person living with a psychological disorder of your choosing (but it can’t be any of the disorders you have already mentioned in your previous answers). You can find either a written artifact – blog, article, news story – or a video. Describe how the person describes living with the disorder and your thoughts on it. Be sure to share where you got the first person account (URL or PDF).