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A Brief Lecture on Psychological Disorders by Dr. Brouk

 

Introduction to Psychology

Brain & Behavior

Behavior & Learning

Consciousness and Sleep Disorders

Development

Emotions & Motivation

Memory

Methods in Psychology

Theories of Personality

Psychological Disorders

Causes Psychological Disorders

Therapy & Treatment

Sensation & Perception

Stress

 

 
 
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What Is a Psychological Disorder or a Mental Disorder?

A mental disorder or a psychological disorder indicates abnormality in thoughts, emotions and behavior. Individuals diagnosed with a mental disorder experience unhealthy thoughts, emotions and behavior, suffer from stress and have difficulty adapting to change.

What Is Abnormal?

Abnormality can occur in cognitions (the activities of our minds such as thinking, interpretation, judgment, etc.), emotions (the way we feel), and behavior (the way we act) over a specific period. Generally speaking, abnormality takes place when our thinking, emotions and behavior:

  • Are unhealthy and maladaptive (harmful and inability to adapt to change)
  • Interfere with our daily functioning and responsibilities
  • Are culturally atypical (unusual and uncommon) or go against the social norm (socially unacceptable)
  • Cause us or the people around us distress or discomfort
What Is Abnormal Psychology?

Abnormal Psychology is the scientific study of disturbances in thoughts, emotions and behavior.

What Is the Stigma Associated with Mental Illness?

According to the American Heritage Dictionary, stigma is “a mark or token of infamy, disgrace, or reproach.”

When we stigmatize someone diagnosed with a psychological disorder, we subsequently brand or characterize them as shameful and deserving of disrespect.
The stigma associated with psychological disorders is caused by myths, misinformation, and fear.

Helpful Terms:

  • Abnormal – maladaptive cognitions, emotions and behavior that are at odds with social expectations and cause distress and discomfort to the individual and/or people around them

  • Symptom – a sign of illness or malfunction

  • Syndrome – a collection of symptoms

  • Diagnosis – labeling a disorder based on the presenting symptoms

  • Etiology – the study of causes of a disorder

  • Prevalence – according to Merriam-Webster Dictionary, “the percentage of a population that is affected with a particular disease at a given time”

  • Incidence – according to Merriam-Webster Dictionary, “rate of occurrence"

  • DSM-5 – Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM 5; American Psychiatric Association [APA], 2013)
    DSM 5 is both a categorical and dimensional classification system. It offers detailed information on various types/categories of disorders, and allows for their assessment along a spectrum based on their severity (mild, moderate, and severe).

Anxiety Disorders

Anxiety is a general fear, dread and apprehension that produces bodily responses such as increased heart rate, sweating, shaking, breathing, muscular tension, and respiration. Anxiety prepares us for “fight or flight.” The main symptom of anxiety disorders is anxiety (DSM 5; American Psychiatric Association [APA], 2013)

The newly published Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) has divided previously designated anxiety disorders into anxiety disorders, obsessive-compulsive and post-traumatic stress disorders. Anxiety disorders now include generalized anxiety disorder, panic disorder, agoraphobia, specific phobia disorder, social anxiety disorder, separation anxiety disorder, selective mutism, and substance/medication-induced anxiety disorder (DSM 5; American Psychiatric Association [APA], 2013)

Generalized Anxiety Disorder (GAD)

GAD entails six months or more of persistent high levels of anxiety and excessive worry over many of life’s circumstances, events, and activities (DSM 5; American Psychiatric Association [APA], 2013).

Panic Disorder

Panic disorder involves recurrent and unpredictable panic attacks. A panic attack is a periodic, sudden, and intense episode of fear that reaches a peak within minutes and gradually passes. The individual diagnosed with panic disorder demonstrates a persistent concern or worry about having additional attacks. These symptoms cause significant maladaptive change in behavior related to the attack (DSM 5; American Psychiatric Association [APA], 2013).

Agoraphobia

Agoraphobia requires a fear of being in public places or situations where escape might be difficult, embarrassing, or help might be unavailable in case of a panic attack or incapacitation. Symptoms often lead to avoidance of situations such as being alone outside of the home, traveling in a car, bus, or airplane, or being in a crowded area (DSM 5; American Psychiatric Association [APA], 2013).

Specific Phobia

Specific phobia involves a strong, persistent, and disproportionate fear of some specific object or situation often leading to avoidance (DSM 5; American Psychiatric Association [APA], 2013).

Social Anxiety Disorder

Social anxiety disorder (formerly referred to as social phobia) consists of excessive and persistent fear of social or performance situations in which embarrassment may occur (DSM 5; American Psychiatric Association [APA], 2013).

Separation Anxiety Disorder

Separation anxiety disorder involves excessive anxiety, even panic, whenever the child is separated from home or parents (DSM 5; American Psychiatric Association [APA], 2013).

Selective Mutism

Selective mutism (formerly known as elective mutism) includes persistent failure to speak in specific social situations (such as in school with teachers and playmates) where speaking is expected, despite speaking in other situations (DSM 5; American Psychiatric Association [APA], 2013).

Substance/Medication-Induced Anxiety Disorder

According to DSM-5 (2013), “Substance/medication-induced anxiety disorder involves anxiety due to substance intoxication or withdrawal or to a medication treatment (DSM 5; American Psychiatric Association [APA], 2013).

Obsessive-Compulsive and Related Disorders

One of the major changes in the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) (2013) is the removal of obsessive-compulsive disorder from anxiety disorders into a new category designated as obsessive-compulsive and related disorders. In addition to obsessive-compulsive disorder (OCD), this category includes four other disorders: excoriation (skin-picking) disorder, hair-pulling disorder (trichotillomania), hoarding disorder, and body dysmorphic disorder. The rational for classifying these disorders in one category is that they share many common characteristics (American Psychiatric Association, 2013).

 

Trauma and Stress Related Disorders

The Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) (2013) classifies acute stress disorder and post-traumatic stress disorder in the trauma and stress related disorders category formerly, under anxiety disorders. This category also includes reactive attachment disorder, disinhibited social engagement disorder, and adjustment disorders (DSM 5; American Psychiatric Association [APA], 2013).

Bipolar Disorders

In the newly published Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5, 2013), bipolar and related disorders are discussed in a category by themselves. This is in contrast to DSM-IV-R, where they were a part of mood disorders (DSM 5; American Psychiatric Association [APA], 2013).

Bipolar I Disorder

According to DSM-5 (2013), individuals diagnosed with bipolar I disorder have met the criteria for at least one manic episode in their lifetime. A manic episode is defined as a distinct period of at least one week, where nearly every day the individual displays extreme elevation in mood, irritability and energy. The symptoms cause major disturbance in the individual's capacity to function in personal, academic, work and social settings (DSM 5; American Psychiatric Association [APA], 2013).

Bipolar II Disorder

According to DSM-5 (2013), individuals diagnosed with bipolar II disorder have met the criteria for at least one or more major depressive episodes (depressed mood, low self-esteem, feelings of hopelessness, fatigue, lack of concentration) and at least one hypomanic episode (such as irritability, elevated mood, grandiosity, lack of need for food or sleep) (DSM 5; American Psychiatric Association [APA], 2013).

Cyclothymic Disorder

Individuals diagnosed with cyclothymic disorder have experienced numerous hypomanic (such as irritability, elevated mood, grandiosity, lack of need for food or sleep) and depressive (depressed mood, low self-esteem, feelings of hopelessness, fatigue, lack of concentration) episodes. The symptoms have lasted majority of the day, more days than not during a two-year period. These symptoms significantly cause disturbance in the individual's capacity to function in personal, academic, work and social settings (DSM 5; American Psychiatric Association [APA], 2013).

Depressive Disorders

According to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5, 2013), “the common feature of all depressive disorders is the presence of sadness, empathy, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function” (DSM 5; American Psychiatric Association [APA], 2013).

Major Depressive Disorder

Individuals diagnosed with major depressive disorder, for at least two weeks, indicate five or more of the following symptoms that suggest a modification from past functioning (DSM 5; American Psychiatric Association [APA], 2013). According to DSM-5 (2013), the diagnostic criteria for major depressive disorder are:

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.

(Note: In children, consider failure to make expected weight gain.)

  • Insomnia or hypersomnia nearly every day.
  • Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Personality Disorders

According to DSM-5 (2013), “a personality disorder is an enduring pattern of inner experience (i.e., thoughts, feelings, and mood) and behavior (i.e., actions and functions) that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment” (DSM 5; American Psychiatric Association [APA], 2013.

Antisocial Personality Disorder

Individuals diagnosed with antisocial personality disorder exhibit deception, disrespect, lack of empathy and remorse, violation of the law, rules, social norms, and people. These symptoms started in adolescence or early adulthood, have persisted over time, and have caused distress and impairment in various aspects of the individual’s life (DSM-5, 2013; Sue, et. al., 2013; Comer, 2014). According to DSM-5 (2013), the diagnostic criteria for antisocial personality disorder are:

A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

  • Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
  • Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
  • Impulsivity or failure to plan ahead.
  • Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
  • Reckless disregard for safety of self or others.
  • Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
  • Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

B. The individual is at least age 18 years.

C. There is evidence of conduct disorder with onset before age 15 years.

D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

Schizophrenia Spectrum Disorders

According to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5, 2013), “Schizophrenia spectrum disorders include schizophrenia, other psychotic disorders, and schizotypal personality disorder.” The symptoms of schizophrenia belong to one or more of the following areas:

  • Delusions – are firmly and constant false beliefs despite disconfirming evidence or logic
  • Hallucinations – are sensory perceptions that are not directly attributable to environmental stimuli
  • Disorganized thinking that results in disorganized speech
  • Abnormal and disorganized motor behavior
  • Negative symptoms, such as lack of emotional expression and lack of motivation
 
 

Common Myths and Misperception

Myth #1: Psychological disorders only affect certain people (the poor and the uneducated) and not people like me or my family.
The fact is that psychological difficulties have no boundaries. They affect everyone regardless of age, gender, education, economics, religion, and ethnicity.
According to the National Institute of Mental Health (NIHM), about 57.7 million Americans ages 18 and older suffer from a diagnosable mental disorder in any given year. Many successful leaders, athletes and artists have had a history of mental illness. For instance, did you know that:

  • Our beloved sixteenth President Abraham Lincoln suffered from depression and suicidal ideation.
  • Lionel Aldridge, a defensive end for Vince Lombardi's Green Bay Packers of the 1960s who played in two Super Bowls, experienced paranoid schizophrenia.
  • Ludwig van Beethoven (composer), Vincent Van Gogh (artist), Isaac Newton (scientist), and Winston Churchill (Prime Minister of Great Britain) all experienced Bipolar Disorder (formerly known as manic-depression).

Myth #2: People with psychological difficulties are dangerous and violent.
Fact: The media’s portrayal of people with psychological difficulties is often inaccurate. When reporting crime or mass shooting, the media stresses the history of mental illness. But statistically, individuals diagnosed with mental illness are no more likely to commit a violent act than are people who do not have a mental illness. Unfortunately, they are often harmful to themselves. In the United States, there are twice as many suicides as homicides.

Myth #3: Psychological difficulties are long-term and incurable.
Fact: Most psychological difficulties if treated are temporary, and people will return to their satisfying and productive lives. In a few disorders such as bipolar disorders and schizophrenia, the affected individual may need ongoing care and treatment.

Myth #4: People with psychological difficulties are weak and irresponsible.
Fact: Psychological difficulties are not indicative of character flaws, weakness or laziness. They are legitimate conditions caused by the interaction of our biology and life experiences.

For those touched by mental illness, the consequences of such myths can be worse than the illness itself. They may try to pretend nothing is wrong, and refuse to seek treatment to avoid negative attitudes, disparaging remarks, work problems and discrimination.

A survey showed that many people would rather tell potential employers that they have committed a petty crime and served time in jail, than to admit to being in a psychiatric hospital.

Some mental health professionals believe that the stigma of psychological disorders is the greatest obstacle to recovery. They assert that stigma leads to discrimination and discourages individuals and their families from receiving the help they need and deserve. In many cases, stigma also discourages prevention of psychological disorders.

How Can We Diminish Stigma?
  • Focus on promoting mental health and prevention of mental illness.
  • Educate the public and the media.
  • Encourage seeking treatment, support and advocacy.
  • Emphasize abilities, not limitations.
  • Normalize the topic of mental illness through open and honest discussion.
  • Increase involvement with individuals affected by mental illness, mental health-related activities and causes.

Stigma and Mental Illness by CDC

Stigma has been defined as an attribute that is deeply discrediting.1 This stigmatized trait sets the bearer apart from the rest of society, bringing with it feelings of shame and isolation. Often, when a person with a stigmatized trait is unable to perform an action because of the condition, other people view the person as the problem rather than viewing the condition as the problem.2 More recent definitions of stigma focus on the results of stigma—the prejudice, avoidance, rejection and discrimination directed at people believed to have an illness, disorder or other trait perceived to be undesirable.3 Stigma causes needless suffering, potentially causing a person to deny symptoms, delay treatment and refrain from daily activities. Stigma can exclude people from access to housing, employment, insurance, and appropriate medical care. Thus, stigma can interfere with prevention efforts, and examining and combating stigma is a public health priority.4

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the CDC have examined public attitudes toward mental illness in two surveys.4 In the 2006 HealthStyles survey, only one-quarter of young adults between the ages of 18–24 believed that a person with mental illness can eventually recover (HealthStyles survey [228.5 KB]). In 2007, adults in 37 states and territories were surveyed about their attitudes toward mental illness, using the 2007 Behaviorial Risk Factor Surveillance System Mental Illness and Stigma module. This study found that

  • 78% of adults with mental health symptoms and 89% of adults without such symptoms agreed that treatment can help persons with mental illness lead normal lives.5
  • 57% of adults without mental health symptoms believed that people are caring and sympathetic to persons with mental illness.5
  • Only 25% of adults with mental health symptoms believed that people are caring and sympathetic to persons with mental illness.5

These findings highlight both the need to educate the public about how to support persons with mental illness and the need to reduce barriers for those seeking or receiving treatment for mental illness.

Source: Attitudes Toward Mental Illness—35 States, District of Columbia, and Puerto Rico, 2007

SAMHSA's Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health (ADS Center)

Learn more details on Stigma at SAMHSA or Carter Center.

References

  1. Goffman, E. Stigma: Notes on the Management of Spoiled Identity. Prentice-Hall, Englewood Cliffs, NJ, 1963.
  2. Braithwaite, D. O. “Isn’t it great that people like you get out?”: The process of adjusting to disability. In E. B. Ray (Ed.) Case Studies in Health Communication (pp. 149-160). Hillsdale, NJ: Lawrence Erlbaum Associates;1993.
  3. Link BG, Phelan JC. Conceptualizing Stigma. Annu Rev Sociol 2001;27:363–85.
  4. CDC. Attitudes Toward Mental Illness—35 States, District of Columbia, and Puerto Rico, 2007. MMWR 2010;59(20);619–625. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5920a3.htm.
 
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