Psychological Disorders

Introduction

Psychological disorders are patterns of behavior or experience that cause distress, impair daily functioning, or increase risks of harm. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the primary tool used to diagnose these conditions. Understanding psychological disorders involves examining their historical context, diagnostic criteria, cultural influences, and their impact on individuals and society, including the justice system.

Historical Conceptions of Mental Illness

Middle Ages

• Demonic Model: Odd behavior was attributed to evil spirits inhabiting the body.

• Treatments: Exorcisms and witch hunts were common.

Renaissance

• Medical Model: Mental illness seen as a physical disorder requiring treatment.

• Asylums: Institutions were overcrowded and understaffed; treatments included bloodletting and "snake pits" (abusive environments).

Reformers

• Phillippe Pinel and Dorothea Dix: Advocated for moral treatment—patients treated with kindness, dignity, and respect.

• Outcomes: Patients allowed to roam and interact, but treatment was not always effective.

The Malleus Maleficarum (1486)

• Superstition: Book discussing witchcraft, often targeting women as witches.

• Impact: Justified torture and executions.

Modern Era

• Medication: Chlorpromazine (Thorazine) developed in the 1950s, decreased symptoms of schizophrenia.

• Deinstitutionalization: Enacted in the 1960s/70s, releasing patients and closing hospitals; results were mixed due to lack of community support.

Diagnosis and Classification

DSM-5

• Official Classification System: Provides diagnostic criteria and decision rules for mental disorders.

• "Think Organic First": Rule out medical or substance-related causes (e.g., hypothyroidism can mimic depression).

Biopsychosocial Approach

• Biological Factors: Brain chemistry, genetics, neurodevelopment, physical health.

• Psychological Factors: Cognitive patterns, emotional regulation, personality, coping skills.

• Social Factors: Environment, culture, family dynamics, schooling, socioeconomic status.

• Prevalence: Data about how common disorders are in a population; considers life stressors and level of functioning.

Diagnosis Across Cultures

• Culture-Bound Syndromes: Some disorders are specific to certain cultures.

• Universal Disorders: Alcoholism, schizophrenia, psychopathy are found worldwide.

• Examples: Taijin Kyofusho (Japanese social anxiety), Malocchio, Calor do corpo/nervo.

• Culture's Influence: Shapes how people express and experience interpersonal anxiety.

Controversial Disorders

Dissociative Identity Disorder (DID)

• Definition: Psychological condition where a person has two or more identity states that take control of behavior.

• Controversy: Notable legal case: William Stanley Milligan, acquitted due to DID.

Expansion and Critique of DSM

• Supporters: Improves communication and reliability among clinicians; helps distinguish disorders precisely.

• Critics: Driven by insurance industry; risk of overtreatment; may remove services from those who truly need them.

Common Psychological Disorders

ADHD (Attention-Deficit/Hyperactivity Disorder)

• Definition: Developmental disorder in children with inappropriate levels of hyperactivity/impulsivity and attention problems.

• Diagnosis: 6 symptoms of inattention OR 6 symptoms of hyperactivity/impulsivity.

• Treatment: Behavioral therapies or pharmaceuticals.

• Prevalence: Higher rates in North America than Europe.

Anxiety-Related Disorders

• Definition: Distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.

• Types: Generalized anxiety disorder, panic disorder, specific phobias, OCD, PTSD.

• Symptoms: Continual worry, physical tension, irritability; often develop after major stressors.

• Prevalence: More common in females and Caucasians.

Panic Disorder

• Definition: Brief, intense episodes of fear with physical symptoms (sweating, dizziness, racing heartbeat).

• Features: Repeated, unexpected panic attacks; concern about future attacks; avoidance behaviors.

• Example: Misinterpreting normal body sensations as dangerous.

Phobias

• Definition: Unrealistic fear of specific situations, activities, or objects.

• Agoraphobia: Fear of being away from a safe person or place.

Obsessive-Compulsive Disorder (OCD)

• Obsessions: Persistent, unwanted thoughts and urges (e.g., germs, doubts, order).

• Compulsions: Repetitive acts to minimize distress or reduce likelihood of feared events (e.g., hand washing).

OCD-Related Disorders

• Hoarding disorder

• Excoriation disorder (skin picking)

• Trichotillomania (hair pulling)

• Body dysmorphic disorder

Mood Disorders

• Includes: Depression and bipolar disorder.

• Prevalence: Common in adults; higher in women and people in poverty.

• Genetic Susceptibility: Inherited risk; twin studies show biological vulnerability.

Major Depression

• Symptoms: Periods of sadness, feelings of worthlessness, hopelessness, social withdrawal, cognitive/physical sluggishness.

• Additional Features: Negative thinking, lethargy, insomnia, appetite changes, digestive issues.

• Diathesis: Biological or psychological vulnerability to a disorder.

Sociocultural and Environmental Risk Factors

• Unsafe or stressful living conditions

• Social media comparison and exclusion

• Poverty, instability, lack of support

Bipolar Disorder

• Definition: Extreme shifts in mood, motivation, and energy; periods of mania and depression.

• Manic Episodes: High energy, racing thoughts/speech, impulsive behavior, increased sexual drive, aggression.

• Risks: Difficult to treat; increased risk of suicide.

Warning Signs of Suicide

• Discussing suicide or preparing for death

• Trouble eating or sleeping

• Extreme alcohol or drug use

• Recent serious loss

• Unnecessary risks or suicide attempts

• Giving away possessions

• Isolation, loss of interest, dramatic behavior changes

Schizophrenia

• Definition: Significant breaks from reality, lack of integration of thoughts and emotions, problems with attention and memory.

Symptoms

• Positive Symptoms: Added experiences (hallucinations, delusions, thought disorder, movement disorder/catatonia).

• Negative Symptoms: Missing/reduced behaviors (disorganized behavior, lack of emotional reaction, social withdrawal).

Brain and Biological Factors

• Large ventricles (fluid-filled spaces)

• Slight loss of brain tissue

• Differences in hippocampus and amygdala

• Reduced activity in frontal lobe, emotion, and memory regions

• Neurotransmitter imbalances: dopamine overactivity (positive symptoms), glutamate underactivity (negative symptoms)

Environmental Causes

• Extreme stress

• Cannabis use

• Low socioeconomic status

• Minority status and isolation

• Prenatal issues

Personality Disorders

• Definition: Unusual patterns of behavior that are maladaptive, distressing, and resistant to change.

Borderline Personality Disorder

• Intense emotional swings

• Unstable sense of self

• Impulsivity

• Fear of abandonment

• Maladaptive coping (self-harm, substance abuse)

• Rooted in emotional insecurity and early difficult life experiences

Antisocial Personality Disorder

• Profound lack of empathy and emotional connection

• Disregard for others' rights; impulsive or violent behavior

• Resistant to treatment

• Conduct disorder as precursor

• Linked to frontal lobe dysfunction

Psychopathy

• Interpersonal/emotional deficits (lack of remorse)

• Social deviance (impulsivity)

• Underactive response to stress

• Amygdala abnormalities

• Less grey matter

• Reduced response to aversive stimuli

Uncommon Psychiatric Syndromes

• Capgras's Syndrome: Belief that a close person has been replaced/cloned.

• Ekbom's Syndrome: Delusions of infestation.

• Munchausen Syndrome: Faking illness or self-harm to gain attention.

Mental Illness and the Justice System

Legal Implications

• Psychological problems can lead to legal issues.

• Fitness to stand trial and insanity defense are key legal concepts.

• Mental health issues may preexist or develop within the justice system.

Insanity Defense

• NCRMD: Not criminally responsible by reason of mental disorder.

• Insanity: Legal definition; mental illness negates "mens rea" (guilty mind).

• Actus reus: Guilty action.

• Mens rea: Guilty mind.

Case Examples

• William Stanley Milligan: Acquitted due to DID.

• Devon Fowler (2023): Police response to mental health crisis may involve force rather than de-escalation.

Additional info: The notes provide a comprehensive overview of psychological disorders, their history, diagnosis, cultural context, and legal implications. Key terms and examples are expanded for clarity and academic completeness.