Topic 13: Psychological Disorders

Introduction to Psychological Disorders

Psychological disorders, also known as mental disorders, are patterns of behavior or experience that cause distress, impair day-to-day functioning, or increase the risk of harm. The study of these disorders is essential for understanding human behavior, mental health, and the intersection with societal systems such as the justice system.

Defining Mental Illness

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) defines mental disorders as patterns of behavior or experience that cause distress, impair functioning, or increase risk of harm. However, this definition is not perfect, as some maladaptive behaviors may not be mental illnesses, and some individuals may not clearly meet these criteria but still be considered mentally ill.

• Maladaptive behaviors can include actions that are harmful or interfere with daily life but are not always classified as mental illness (e.g., substance abuse, risky behaviors).

• Some individuals may experience significant psychological distress without meeting all DSM criteria.

Historical Conceptions of Mental Illness

Understanding mental illness has evolved over centuries, from supernatural explanations to medical models and modern biopsychosocial approaches.

Demonic Model (Middle Ages)

• Mental illness was often attributed to possession by evil spirits.

• Treatments included exorcisms and witch hunts.

Medical Model (Renaissance)

• Mental illness began to be seen as a physical disorder requiring treatment.

• People were housed in asylums, which were often overcrowded and understaffed.

• Treatments included bloodletting and the use of "snake pits."

Moral Treatment (1700s–1800s)

• Reformers like Phillippe Pinel and Dorothea Dix advocated for treating patients with dignity and kindness.

• Patients were allowed more freedom and interaction, but effective treatments were still lacking.

Modern Era

• The development of chlorpromazine (Thorazine) in the 1950s marked the beginning of effective pharmacological treatments for disorders like schizophrenia.

• Deinstitutionalization in the 1960s and 70s led to the closure of many psychiatric hospitals, with mixed results due to lack of community support.

Diagnosis Across Cultures

Cultural context shapes the expression and understanding of mental disorders. Some conditions are culture-bound, while others (e.g., schizophrenia, alcoholism) are universal.

• Malocchio (Italy): Headaches, fatigue, and anxiety attributed to envy or the "evil eye."

• Calor do corpo/nervos (Portugal/Brazil): Fatigue and anxiety explained by bodily imbalance or "nerves."

• Taijin Kyofusho (Japan): Social anxiety focused on the fear of offending others, reflecting collectivist cultural values.

The DSM-5 and the Biopsychosocial Model

The DSM-5 is the official classification system for mental disorders, providing diagnostic criteria and decision rules. The biopsychosocial model considers biological, psychological, and social factors in understanding mental illness.

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

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

• Social factors: Environment, culture, family dynamics, socioeconomic status.

Explosion of Diagnoses in the DSM

Supporters argue that precise distinctions improve communication and reliability among clinicians. Critics claim the expansion is driven by insurance needs and may lead to over-treatment or removal of services from those in need.

Applications of Psychological Disorders

ADHD (Attention-Deficit/Hyperactivity Disorder)

ADHD is a developmental disorder characterized by inappropriate levels of hyperactivity, impulsivity, and problems maintaining attention. Diagnosis requires at least six symptoms of inattention or hyperactivity/impulsivity. Treatment includes behavioral therapies and pharmaceuticals. Prevalence has increased significantly in North America, raising questions about over-medication of normal childhood behavior.

Anxiety-Related Disorders

Anxiety disorders are characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety. While transient anxiety can be adaptive, excessive anxiety is maladaptive.

• Generalized Anxiety Disorder (GAD): Continual worry, tension, and irritability about many areas of life. More common in females and Caucasians.

• Panic Disorder: Repeated, unexpected panic attacks with intense fear and physical symptoms.

• Phobias: Unrealistic fear of specific situations, activities, or objects (e.g., agoraphobia).

• Obsessive-Compulsive Disorder (OCD): Intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) to reduce distress.

• OCD-Related Disorders: Hoarding, excoriation (skin picking), trichotillomania (hair pulling), body dysmorphic disorder.

Mood Disorders

Mood disorders include depression and bipolar disorder, affecting nearly 10% of adults in Canada and the US. Depression is more common in women and those living in poverty, with genetic and environmental risk factors.

• Major Depression: Marked by sadness, hopelessness, social withdrawal, cognitive and physical sluggishness.

• Bipolar Disorder: Involves extreme shifts in mood, motivation, and energy, with periods of depression and mania.

Risk Factors for Depression

• Genetic vulnerability (e.g., twin studies).

• Stress-diathesis model: interaction between genetic predisposition and life stress.

• Sociocultural and environmental factors: neighborhood conditions, social networks, social media.

Schizophrenia

Schizophrenia is characterized by significant breaks from reality, disorganized thinking, and problems with attention and memory. Symptoms are classified as positive (hallucinations, delusions), negative (absence of adaptive behavior), and disorganized behavior/cognition.

• Brain structure: Larger ventricles, loss of brain tissue, differences in hippocampus and amygdala.

• Brain activity: Reduced activity in frontal lobes and emotion/memory regions.

• Neurotransmitters: Dopamine overactivity (positive symptoms), glutamate underactivity.

• Environmental factors: Extreme stress, low SES, minority status, prenatal environment, cannabis use.

Personality Disorders

Personality disorders are enduring patterns of behavior that are maladaptive, distressing, and resistant to change. They are grouped into three clusters:

• Cluster A: Odd or eccentric behavior (e.g., paranoid, schizoid).

• Cluster B: Dramatic, emotional, erratic behavior (e.g., antisocial, narcissistic, borderline).

• Cluster C: Anxious, fearful, inhibited behavior (e.g., avoidant).

Borderline Personality Disorder

• Intense emotional swings, unstable sense of self, impulsivity, difficult relationships, fear of abandonment.

• Often rooted in emotional insecurity and early adverse experiences.

Antisocial Personality Disorder (APD) and Psychopathy

• Lack of empathy, disregard for others' rights, impulsivity, often resistant to treatment.

• Linked to frontal lobe dysfunction, abuse, and trauma.

• Psychopathy includes extreme antisocial traits, under-reactivity to stress, amygdala and frontal lobe abnormalities.

Uncommon Psychiatric Syndromes

• Capgras's syndrome: Belief that a loved one has been replaced by a double.

• Ekbom's syndrome: Delusions of infestation.

• Munchausen syndrome: Fabrication of medical symptoms leading to unnecessary treatment.

Mental Illness and the Justice System

Intersection of Mental Health and Law

Mental illness can influence legal responsibility and outcomes in the justice system. The insanity defense (NCRMD: Not Criminally Responsible by Reason of Mental Disorder) is a legal, not psychological, concept. Criminal guilt requires both actus reus (guilty action) and mens rea (guilty mind). Mental illness can negate mens rea.

NCRMD in Canadian Law

• No person is criminally responsible for an act committed while suffering from a mental disorder that rendered them incapable of appreciating the nature and quality of the act or knowing it was wrong (S. 16 Canadian Criminal Code).

• Outcomes after NCRMD: Absolute discharge, conditional discharge, or detention in a hospital, decided by a Review Board.

• Myths: NCRMD is rarely used, not a loophole, most cases are non-violent, and those found NCRMD are often detained longer than if found guilty.

Mental Illness in the Correctional System

• High prevalence of mental illness among incarcerated individuals (2–3 times higher than general population).

• Prisons often lack adequate mental health services; conditions can worsen mental health (e.g., solitary confinement).

• Segregation and solitary confinement have profound psychological and neurological effects, including hallucinations, cognitive disabilities, and increased suicide risk.

Advocacy and Support

• Organizations such as the John Howard Society, Fred Victor, Elizabeth Fry Society, Addictions and Mental Health Ontario (AMHO), CMHA, and CAMH work to support individuals with mental illness and advocate for systemic change.