I'm dr. market Allah and I want to welcome you to the fifteenth chapter of the open Stax psychology textbook today we'll be discussing psychological disorders so what they are how they're diagnosed and classified different perspectives on them and then a number of different disorders so we might begin by asking what a psychological disorder is and it's a condition characterized by abnormal thoughts feelings and behaviors now psychopathology is the study of psychological disorders including their symptoms ideology which means their causes and their treatment and this term psychopathology also refers to the manifestation of a psychological disorder now psychologists work to distinguish psychological disorders from inner experiences in behaviors that are merely situational idiosyncratic or unconventional so perhaps the simplest approach to conceptualizing psychological disorders is to label behaviors thoughts and inner experiences that are atypical distressful dysfunctional and sometimes even dangerous as signs of a disorder so off to the right there you see some popular characters from Winnie the Pooh and Christopher Robin and labeling their disorders now a typical means that it deviates from the norm and can signify the presence of a psychological disorder just because something's atypical however does not necessarily mean it is disorder so for example people with red hair are only four percent of the US population but it's not a disorder it's just a typical there's also an issue of cultural expectations so returning a stranger smile is expected in the United States because the pervasive social norm dictates reciprocation of friendly gestures but cultural expectations in Japan involves showing reserve restraint in a concern for maintaining privacy around strangers I contact in the US and Europe also indicates honesty and attention but in Latin America Asia and African countries it's rude or confrontational so when someone makes eye contact that could be considered appropriate or respectful or brazen an offensive depending on your culture so violating cultural expectations is not in and of itself a satisfactory means of identifying the presence of a psychological disorder what about hallucinations and that's seeing or hearing things that are not physically present in Western societies it's a violation of cultural expectations in a person who reports such inner experiences is readily labeled as disordered in other cultures though hallucinations about the future may be regarded as normal experiences that are positively valued and another important thing to keep in mind is that cultural norms change over time Jerome Wakefield who's pictured there to the right defines psychological disorder as harmful dysfunction and that's the idea that psychological processes such as cognition perception and learning have important functions such as enabling us to experience the world the way others do and engage in rational thought problem solving and communication dysfunction occurs when an internal mechanism breaks down and can no longer perform its normal function but the presence of a dysfunctional own does not determine a disorder the dysfunction must be harmful in that it leads to negative consequences for the individual or for others as judged by the standards of that culture so what about the American Psychological Association what are they weigh in with well they say there are significant disturbances and thought feelings and behaviors and the disturbances reflect some kind of biological psychological or developmental distances lead to significant distress or disability in a person's life so for example the me fear social situations and so they never go out of the house to attend class or get a job and the disturbances do not reflect expected or culturally approved responses to certain events so for example grieving over someone's death that's a culturally approved response so that wouldn't be considered a problem the dsm-5 is all about diagnosis and that's appropriately identifying and labeling a set of defined symptoms and it's crucial because it enables a common language among professionals in the field the Diagnostic and Statistical Manual Mental Disorders is now in its fifth edition so we have at the dsm-5 and that was published in 2013 the first edition was published in 1952 and it classified psychological disorders according to a format which was developed by the US Army during World War two the dsm-5 includes information about what's called comorbidity and that's the co-occurrence of two disorders so for example OCD and depression so 41% of people with obsessive-compulsive disorder also meet the criteria for major depressive disorder now the manual is not static it actually changes over time and a good example is that being gay was considered a disorder until 1973 and so it appeared in the as a disorder in the first two editions and so progress is being made the International classification of diseases or IDC is a second classification system and it's published by the World Health Organization and it's basically European it's been revised several times since approximately ten x categories of psychological disorders are similar in the DSM and the ICD but the DSM contains more explicit disorder criteria in worldwide the ICD is used more for clinical diagnosis and the DSM is used more for research well for centuries psychological disorders were viewed from a supernatural perspective meaning that it was a force beyond scientific understanding so people who are afflicted were thought to be practitioners of black magic or possessed by spirits and one historian has provided a comprehensive explanation there was a dancing mania epidemic in Europe and he suggested that the Phenom was attributable to a combination of three factors psychological distress social contagion and a belief in supernatural forces a biological perspective says that and people agree on this that most psychological disorders have a genetic component and there's little dispute that some disorders are largely due to genetic factors so many psychological disorders develop not from a single cause but from things that are partly biological and partly psychosocial and so they've developed what's called the diathesis-stress model and diathesis means disorders so the disorders disorder stress model and it integrates biological and psychosocial factors to predict the likelihood of a disorder and it suggests that people with an underlying predisposition for a disorder are more likely than others to develop a disorder when faced with adverse environmental or psychological events well let's now start talking about specific disorders and we'll start with anxiety disorders because that starts with the letter A now ings anxiety involves apprehension avoidance and cautiousness regarding a potential threat danger or a negative event and so anxiety motivates us to take action anxiety disorders occur when the anxiety is excessive and persistent fear and there's related disturbances and behavior anxiety disorders are very common twenty-five to thirty percent of the u.s. population meets the criteria and they're more common in women than men anxiety disorders are the most frequently occurring class of mental disorders and they have a high comorbidity with other things too specific phobias are when a person experiences excessive distressing and a persistent fear or anxiety about a specific object or situation and that's very common - about 12 and a half percent of the u.s. population at some point in their life has a specific phobia phobia is actually a Greek word that means fear so for example a agoraphobia is an intense fear in avoidance situations in which it might be difficult to escape if you experience a panic attack how do we come up with how do people develop phobias some people think it's classical conditioning modeling or verbal transmission and evolutionary theories argue that the brain is predisposed to fear certain things so for example spiders which is arachnophobia Heights snakes and thunder social anxiety disorder is an extreme and persistent fear or anxiety and avoidance of social situations in which the other in which a person could potentially be evaluated negatively by others and again that's about 12% of all Americans across their lifetime anxiety comes from the fear that they might act foolish so anxiety by blushing or doing or saying something wrong and they often have problems with public speaking meeting strangers in eating in restaurants people with social anxiety disorder also engage in what are called safety behaviors and these are mental or behavioral acts that reduce anxiety in social situations by reducing the chance of a negative social outcome so they tend to sit on at the back of the room so they're less likely to be called on in class they wear bland clothing so they don't stand out there's a number of those kinds of behaviors panic disorder is for people who experience recurrent and unexpected panic attacks with at least one month of worry about the attacks now a panic attack is a period of extreme fear or discomfort that develops abruptly and reaches a peak within ten minutes and symptoms include accelerated heart rate sweating trembling choking sensations dizziness but panic attacks are not a disorder panic disorder is though and it impacts about four and a half percent of people so where do these panic attacks come from and we can discuss neurobiological and cognitive theories so one there are the neurobiological theory focuses on the locus core aliyah I'm not and I can't say that and that's the brain's major source of norepinephrine and so it triggers the fight-or-flight response and that activation causes panic cognitive theories argue that people interpret ordinary bodily sensations catastrophic ly and that sets the stage for a panic attack so catastrophic thinking is a real problem generalized anxiety disorder is a relatively continuous state of excessive uncontrollable and pointless worrying apprehension so people worry about routine everyday things and these concerns are unjustified Freud called it free-floating anxiety so people are just anxious all the time in about five-and-a-half percent of people develop that with women being twice as likely and again because with most of these genetic factors play a modest role in the disorder OCD or obsessive compulsive and related disorders these are groups of overlapping disorders that involve intrusive thoughts and repetitive behaviors so someone with obsessive-compulsive disorder experiences thoughts and urges that are intrusive and unwanted and those are the obsessions and/or the need to engage in repetitive behaviors or mental acts which are the compulsions common obsessions that people have are things like germs and contamination so they wash their hands order in symmetry and so they have to like line up pencils that they're all in line together and urges they're aggressive or lustful compulsions include hand washing cleaning checking and ordering and also mental acts like counting or praying I had a former student who he clicked a pen 1 million times when he was in high school and counted every one of the times he clicked it there carried out as a means to minimize the distress obsessions trigger body dysmorphic disorder is when a person is preoccupied with a perceived flaw in their physical appearance that's either non-existent or barely noticeable to other people and it typically involves the skin face or hair it leads to repetitive and ritualistic behavior in mental acts such as constantly looking in a mirror or even cosmetic surgery hoarding disorder is when people cannot bear to part with personal possessions regardless of how valueless or useless they are why because they think they might be useful later or have sentimental value and they built whole reality TV shows about that what are the causes of OCD well family and twin studies argue for a moderate genetic component so the concordance rate between identical twins is 57% the orbital frontal cortex is an area of the frontal lobe involved in learning and decision-making and it becomes hyperactive in people with OCD when they're provoked in how do you provoke them well you make them look at a photo or of a toilet or pictures that are hanging crookedly on a wall PTSD or post-traumatic stress disorder is a disorder that occurs after an extremely stressful or traumatic event such as combat natural disasters sexual assault or auto accidents symptoms often include intrusive or distressing memories of the event and flashbacks in flashbacks are states that can last a few seconds to several days during which the individual relives the event and behaves as if the event were occurring at that moment the risk factors for PTSD are trauma experience and severity the lack of a social support network subsequent life stress and other factors include being female being poor having low intelligence in a history of mental disorders and that's both personally and mental disorders within your family research has shown that social support following a traumatic event can reduce the likelihood of PTSD and some models suggest that symptoms are developed and maintained through classical conditioning so cognitive emotional physiological and environmental cues are essentially serve as conditioned stimuli there's also cognitive factors so disturbances in memory for the event and negative appraisals of the trauma and its aftermath so this thing saying things like it happened because I'm stupid may lead to dysfunctional strategies in dealing with it mood disorders are characterized by severe disturbances in mood and emotions and it's most often depression but also meaning in elation the dsm-5 lists two general categories of mood disorders so depressive and bipolar depressive disorders are when people feel sad discouraged and helpless in bipolar and related disorders include mania as a defining feature and that's a state of extreme elation or agitation major depressive disorder is when you have a depressed mood most of the day nearly every day in a loss of interest and pleasure in your usual activities major depression is considered episodic meaning that the symptoms are present and then they they abate they they go away with time and then they come back risk factors around six and a half percent of the u.s. population experiences major depressive disorder each year and it's more common in women higher rates in North and South America and Europe and Australia it's higher in younger groups of people people who are unemployed divorced or widowed now there are subtypes of depression - in the dsm-5 calls these specifiers these aren't specific disorders but labels used to indicate specific patterns of symptoms or to specify certain periods of time in which the symptoms may be present so seasonal pattern is when a person experiences the symptoms of major depressive disorder only during a particular time of the year and that's usually during the fall in winter and it's sometimes called the winter blues which is that way that signs up their postpartum depression more properly called peripartum onset is for women who experience major depression during pregnancy or in the weeks following the birth of their child and they often feel guilty agitated and weepy persistent depressive disorder is when you have depressed moods most of the day nearly every day for at least two years so people are chronically sad but they don't meet the criteria for major depression bipolar disorder mood states that vacillate between depression and mania and so people go from one extreme to another not within one day but it's a pattern of behavior a manic episode is a distinct period of abnormally and persistently elevated expansive or irritable mood and abnormally or in persistently increased activity or energy lasting at least one week so people can be talkative they should have no sleep they're euphoric and they have a flight of ideas so they abruptly switch from one topic to another one of my professors when I was an undergraduate 30 years ago told the story he had a college roommate who when he was in a manic episode would type out a letter to every member of the US Congress and that was when you had a type each letter individually and he would just go for 48 hours doing that the risk factors are less frequent than major depressive disorder but rates are higher in men than in women what's the biological basis well relatives of people with major depressive disorder have double the risk of developing it and relatives of people with bipolar have nine times the risk people with mood disorders often have imbalances in certain neurotransmitters particularly norepinephrine and serotonin and so they can take SSRIs which are medications that boost their activity depression is linked to abnormal activity in several regions of the brain especially the amygdala and prefrontal cortex which we've talked about already depressed people are more prone to react emotionally to negative stimuli and have a greater difficulty controlling those reactions what about the daffy is a stress model here well stressful life events can trigger depression and include significant losses such as the death of a loved one divorce or separation in serious health or money problems and so life events such as these often precede the onset of a depressive episode and it's especially important our what are called exit events like divorce or death because it's a it there's a finality to those things likewise individuals were exposed to traumatic stress during childhood such as separation from a parent family turmoil in maltreatment are at a heightened risk for developing depression at any point later in their lives what are some theories of the cognitive theories of depression well these take the view that depression is triggered by negative thoughts interpretations self evaluations and expectations so Aaron Beck and he's pictured there to the right he theorized that depression prone people possess depressive schemas and that's a mental predisposition to think about most things in a negative way and so when they talk about themselves they have a lot of themes of loss and failure and longitudinal studies have supported Beck's theory hopelessness theory postulates that a particular style of negative thinking leads to a sense of hopelessness which then leads to depression rumination is a repetitive and passive focus on the fact that one is depressed and dwelling on depression symptoms and it's much more common in women men let's talk about suicide for a moment it's not mentioned as a disorder in the dsm-5 however suffering from a mental disorder especially a mood disorder poses the greatest risk for suicide around 90% of those who complete their suicide have a diagnosis of at least one mental disorder suicidal risk is especially high among people with substance abuse problems so individuals with alcohol dependence are at ten times greater risk for suicide than the general population withdrawal from social relationships feelings as though that when is a burden to others and engaging in reckless and risk-taking behaviors may be precursors to suicidal behavior the most common months for suicide are April and May and rates are actually lowest during the winter months a lot of people think it's the other way around but that's what the data suggests let's talk about schizophrenia next it's a devastating psychological disorder that's characterized by major disturbances in thought perception emotion and behavior one percent of the population experiences schizophrenia but it's interpreted differently in different cultures schizophrenia does not mean having a split personality that's the associative identity disorder it comes from schizophrenia has been translated as split mind but it's yeah it's considered a psychotic disorder which means that people are not able to function normally when they have it what are some of the symptoms well hallucinations as we talked about these earlier those are perceptual experiences that occur in the absence of external stimuli auditory hallucinations are the most common and often times they provide a running commentary or criticism of what's going on in the person's life they also have delusions which are beliefs that are contrary to reality and are firmly held even in the face of contradictory evidence so paranoid delusions are beliefs that other people are plotting to harm them grandiose delusions are beliefs that one holds special power or unique knowledge there's people throughout history of thought they were Jesus or they thought they were gonna pull in or I even know of cases of people who thought they were Billy Joel who's a pop singer back in the 70s somatic delusions are the belief that something highly abnormal is happening to one's body so for example people insist that their kidneys are being eaten by cockroaches anhedonia is an inability to experience pleasure and so they have no interest in normally fun things it's a bit of trivia Woody Allen he did a movie called Annie Hall which won Best Picture and he didn't want to call it Annie Hall he wanted to call it and had dona what are the causes of schizophrenia well a couple different things which are proposed there's a genetic basis because adoption studies show that adopt these biological relatives have a higher risk for schizophrenia than their adoptive relatives but schizophrenia probably arises from a combination of genetic and environmental factors in terms of neuro Trial neurotransmitters there's the dopamine hypothesis and that argues that an overabundance of dopamine or too many dopamine receptors are responsible for schizophrenia onset in maintenance in terms of brain anatomy the ventricles which are the cavities within the brain in contains cerebral spinal fluid are too big and so schizophrenia is associated with the loss of brain tissue pregnancy you're at an increased risk for schizophrenia if your mother was exposed to influenza during the first trimester let's talk about dissociative disorders now and those are characterized by an individual becoming split off from their core sense of self so it's a psychological rather than a physical cause dissociative amnesia is when a person is unable to recall important personal information usually following an extremely stressful or traumatic experience some people with dissociative amnesia will experience what's called dissociative fugue and that's when individuals suddenly wander away from their home they experience confusion about their identity and sometimes they adopt a new identity and there is a tremendous amount of controversy about how many people actually have that dissociative identity disorder is when people exhibit two or more separate personalities or identities it was formerly called multiple personality disorder and it is also highly controversial many times people may fake symptoms to avoid the consequences of illegal activities and also the number of cases skyrocketed in the 1980s after there was a movie called Sybil which was largely a fabricated story and the numbers of cases went up drastically after people saw the movie people with personality disorders exhibit a personality style that differs from the expectations of their culture is pervasive and inflexible begins in adolescents and causes distress or impairment cluster a disorders are a DAT accent or eccentric behavior cluster B is impulsive overly dramatic highly emotional and erratic behavior in cluster C are nervous and fearful behavior so for example borderline personality disorder is characterized by instability in interpersonal relationships self-image in mood as well as marked impulsivity they cannot tolerate the thought of being alone and make efforts to avoid abandonment their relationships are intense and unstable and genetic factors seem to be important in the development of borderline personality disorder antisocial personality disorder and there's the poster child of it that's oh my gosh I'm blanking on his name Charles Manson that's it people show no regard at all for other people's rights or feelings and so they engage in illegal acts lying to or conning other people they're impulsive they're reckless they're irritable and they're aggressive they tend to see the world as self-serving unkind so they lack empathy and they can appear superficially charming but they attend they attend to accomplish their goals through cruelty it's much more common in males there's a three to one ratio of men to women in adoption studies clearly demonstrate that the development of antisocial behavior is determined by the interaction of genetic factors and adverse environmental circumstances let's finish out with disorders in childhood so neurodevelopmental disorders involve developmental problems in personal social academic and intellectual functioning ADHD or attention deficit hyperactivity disorder is when a child shows a constant pattern of inattention and/or hyperactive and impulsive behavior that interferes with normal functioning boys are three times more likely to have ADHD however such findings might reflect the greater propensity of boys engaging in aggressive and anti-social behavior what are the causes well family and twin studies indicate that genetics play a significant role in the development of ADHD the concordance rate for identical twins is 0.66 people with ADHD show less dopamine activity in key regions of the brain especially those associated with motivation and reward and something to keep in mind ADHD is not caused by bad parenting what about autism well it's characterized by an inability to form close emotional ties with others speech and language abnormalities repetitive behaviors in an intolerance for minor changes in environment in normal routine repetitive patterns of behavior may exhibit or be exhibited in a number of ways so they may rock bang their head or repeatedly drop something and then pick it up they might also learn and memorize every detail about something even though doing so serves no apparent purpose previous editions of the DSM included included something called Asperger's disorder and that's a less severe form of autistic disorder these children tend to have average or high intelligence at a strong vocabulary but had limited were limited in social interaction in social communication but research failed to show that oz burgers was qualitatively different from autism and so it was dropped what are the causes of autism well it's five times more common in boys in rates have increased dramatically since the 1980s the causes remain unknown but appear to be influenced by genetics so the concordance rates in identical twins are between 60 and 90 percent in the late 1990s a medical journal claimed that autism was triggered by the measles mumps rubella vaccine now it was retracted but the effects were long-lasting on attitudes and beliefs and so some people don't vaccinate their children because they're afraid of autism there is no scientific evidence that a link exists between autism and vaccinations so folks please vaccinate your kids well all of your problems are at least all of your APA style problems can be solved by using my learn APA style book in videos so when you want to learn to write correctly or write write consult my book and videos on learn APA style which are about writing in psychology and the social sciences have a great day and thanks for listening