Serenity

* All the following abstractions are excerpted from <Psychology>, Peter O. Gray, 5th edition

Chapter 16 — Mental Disorders. 

Section 1 — The Concept of Mental Disorder and Its Relation to Culture

Mental disorder presents numerous conceptual, diagnostic, and social challenges.

— Categorizing and Diagnosing Mental Disorders

• To be considered a mental disorder by DSM-IV standards, a syndrome (set of interrelated symptoms) must involve a clinically significant detriment, derive from an internal source, and not be subject to voluntary control. Though these guidelines are useful, "mental disorder" is still a fuzzy concept.

• Classification and diagnosis (assigning a label to a person's mental disorder) are essential for clinical purposes and for scientific study of mental disorders.

• DSM-III and DSM-IV substantially increased reliability (the probability that independent diagnosticians would agree about a person's diagnosis) by using objective symptoms. Validity is a more complex issue.

• Because labeling a person can have negative consequences (e.g., lowering self-esteem or the esteem of others), it is advised that labels be applied only to the disorder, not to the person.

• Beware of medical students' disease — the tendency to relate personally (and falsely) to the disorders described in a textbook.

— Cultural Variations in Disorders and Diagnoses

• Culture-bound syndromes are expressions of mental distress limited to specific cultural groups. Examples are taijin kyofusho (in Japan) and bulimia nervosa (in cultures influenced by modern Western values).

• Culture also affects the types of behaviors or characteristics thought to warrant a diagnosis of mental disorder. Until 1973, homosexuality was officially classed as a mental disorder in the United States.

• The great increase in diagnosis of ADHD (attention deficit/hyperactivity disorder) in the United States may result not just from increased understanding but also from reduced opportunity for and tolerance of rough-and-tumble play and an increased emphasis on school performance.

Section 2 — Causes of Mental Disorders

Though mental disorders have many possible causes, all exert their effects via the brain.

— The Brain's Role in Chronic and Episodic Mental Disorders

• Chronic mental disorders such as Down syndrome, autism, and Alzheimer's disease arise from irreversible brain deficits.

• Down syndrome derives from an extra chromosome 21 that causes widespread brain damage and mental retardation.

• In autism, which involves a severe deficit in social instincts, the brain damage may stem from genes, prenatal toxins, or birth complications.

• Alzheimer's disease, which involves progressive decline in all cognitive function, usually in old age, may result from disruptive effects of amyloid plaques in the brain.

• All the other disorders discussed in the chapter are episodic, meaning that their active manifestations come and go. Causes may include hereditary influences on the brain's biology, environmental assaults on the brain, and effects of learning.

— A Framework for Thinking About Multiple Causes

• Predisposing causes, which make a person susceptible to a mental disorder, include genes, early environmental effects on the brain, and learned beliefs.

• Precipitating causes, which bring on episodes of a disorder, are often stressful life changes or losses.

• Perpetuating causes, which decrease the chance of recovery, include poor self-care, social withdrawal , and negative reactions from others.

— Causes of Sex Differences in Prevalence of Specific Disorders

• Some diagnoses (e.g., anxiety disorder) are much more prevalent in women, and some (e.g., antisocial personality disorder) are much more prevalent in men.

• Such differences may derive from sex differences in (a) the tendency to report or suppress psychological distress; (b) clinicians' expectations of seeing certain disorders more often in one sex than in the other; (c) sex differences in stress associated with differencing social roles; or (d) sex differences in ways of responding to stress.

Section 3 — Anxiety Disorders

Anxiety disorders have fear or anxiety as their primary symptom.

— Generalized Anxiety Disorder

• This disorder, characterized by excessive worry about real or imagined threats, may be predisposed by genes or childhood trauma and brought on by disturbing events in adulthood.

• Hypervigilance — automatic attention to possible threats — may stem from early trauma and may lead to generalized anxiety.

• Levels of generalized anxiety have risen sharply in Western culture since the mid-twentieth century.

— Phobias

• Social phobias involve intense fear of evaluation by others. Specific phobias involve intense fear of specific nonsocial objects (e.g., spiders) or situation (e.g., heights).

• Phobia sufferers usually know that the fear is irrational but cannot control it.

• The difference between a normal fear and a phobia is one of degree.

• Natural selection may have prepared us to fear some objects and situations more than others.

— Obsessive-Compulsive Disorder

• This disorder — involving repetitive, disturbing thoughts (obsessions) and repeated, ritualistic actions (compulsions) — is associated with abnormalities in an area of the brain that links conscious thought to action.

• Obsessions and compulsions are often extreme versions of normal safety concerns and protective actions, which the sufferer cannot shut off despite being aware of their irrationality.

— Panic Disorder

• People with this disorder experience bouts of helpless terror (panic attacks) unrelated to specific events in their environment.

• The disorder may be predisposed and perpetuated by a learned tendency to regard physiological arousal as catastrophic.

• Caffeine, exercise, or other methods to induce high arousal can trigger panic attacks in susceptible people.

— Post-traumatic Stress Disorder

• This disorder is characterized by the re-experiencing — in nightmares, daytime thoughts, and flashbacks — of an emotionally traumatic event or set of events that occurred in the person's life. Other symptoms include sleeplessness, irritability, guilt, and depression.

• Genetic predisposition, repeated exposures to traumatic events, and inadequate social support increase the risk for the disorder.

Section 4 — Mood Disorders

Mood disorders involve intense, prolonged moods that can disrupt or threaten life.

— Depression

• Prolonged sadness, self-blame, a sense of worthlessness, and an absence of pleasure are the hallmarks of depression; sleep, appetite, and speed of movement may be affected as well.

• Depression and generalized anxiety are predisposed by the same genes and often occur in the same individuals.

• Genes may predispose individuals to depression by affecting the way they respond to stressful experiences. There is strong evidence that stressful life events, especially those involving losses, can bring on depression.

• A cognitive style involving negative ways of interpreting life events may predispose people to depression. According to the hopelessness theory, people prone to depression attribute negative experiences to stable, global causes.

• Depression may arise from reversible brain changes that occur during periods of psychological distress, possibly induced by pituitary and adrenal hormones.

• Moderate depression may be adaptive. Different forms of moderate, normal depression may be adaptive reactions to different situations.

— Bipolar Disorders

• Bipolar disorders — marked by mood changes in an upward (manic) as well as downward (depressive) direction — are highly heritable.

• Episodes of bipolar disorder may be brought on by stressful life events, but the evidence for this is not as clear as it is for unipolar depression.

• Manic episodes generally involve expansive, euphoric feelings and elevated self-esteem, talkativeness, and energy. Some may experience extreme irritability, suspicion, or destructive rage instead of euphoria.

• Full-blown mania involves poor judgment, bizarre thoughts, and self-harmful or dangerous actions. Milder mania (hypomania), however, may be a time of heightened creativity.

Section 5 — Psychological Influences on Physical Symptoms and Diseases

For psychological reasons, the body may be experienced as unhealthy or even become so.

— Somatoform Disorders

• In somatoform disorders, individuals experience bodily ailments that originate from psychological distress rather than physical disease. Examples are somatization disorder and conversion disorder.

• Somatization disorder — characterized by a history of dramatic complaints about vague aches and pains unrelated to known medical conditions — may be an alternative way of experiencing what others experience as depression. A resistance to psychological diagnoses may underlie cultural and individual tendencies toward somatization.

• In conversion disorder, the person temporarily loses some bodily function (experiencing blindness or paralysis, for example) for psychological reasons. Though rare in Western countries, it may be more common in children than previously recognized. Dramatic cases have been found in people from non-Western cultures who experienced highly traumatic events, such as Cambodian women who survived the Khmer Rouge in the 1970s.

• Neuroimaging shows that the brain activity patterns of people with conversion disorder are unlike those of people pretending to have the physical disorder, but are similar to those of people given a hypnotic suggestion.

— Psychological Factors Affecting Medical Condition

• This diagnostic category refers not to mental disorders, but to the influence of psychological distress on actual medical conditions.

• Widows and (especially) widowers are unusually vulnerable to physical diseases in the months after the death of their spouse. One possible mechanism is decreased self-care, but more direct effects on health are possible.

• Frequent negative emotions (anger, anxiety, sadness) may increase the risk for cardiovascular disease, most likely through changes in autonomic neural activity and hormone secretions.

• Under controlled conditions, emotionally distressed people were more likely than others to develop a cold. In other research, emotional distress was shown to suppress the normal immune response to disease organisms.

• Stress-induced immune suppression may have an evolutionary explanation in the fight-or-flight mechanism that shifts bodily resources to systems needed to handle emergencies.

Section 6 — Schizophrenia

Schizophrenia is a cognitive disorder with wide-ranging symptoms and multiple causes.

— Diagnostic Characteristics

• Schizophrenia is characterized by various symptoms classified as positive or negative.

• Positive symptoms include (a) disorganized, illogical thought and speech; (b) delusions (false beliefs held despite compelling contrary evidence); (c) auditory hallucinations (which may come from the person's own intrusive verbal thoughts); and (d) disorganized behavior or catatonic behavior (behavior that is unresponsive to the environment).

• Negative symptoms include slowed movement, poverty of speech, flattened affect, and the loss of basic drives and the pleasure that comes from fulfilling them.

• Symptoms occur in a great variety of combinations and may change over time in the same person.

— Underlying Cognitive and Neural Deficits

• The fundamental deficits in schizophrenia are cognitive, including problems with attention, working memory, and long-term memory.

• Abnormalities in brain chemistry, such as a decline in the effectiveness of glutamate (the major excitatory neurotransmitter at fast synapses) or unusual patterns of dopamine activity, may help to explain cognitive deficits.

• Structural differences in the brains of people with schizophrenia include enlarged cerebral ventricles and reduced neural mass in some areas. One theory suggests that the normal pruning of neural cell bodies in adolescence may overshoot the mark.

— Genetic and Environmental Causes

• High concordance for schizophrenia indicates high heritability. Some of the specific genes that appear to be involved have effects that are consistent with brain chemistry theories of the disorder.

• Predisposition may also arise from early environmental injury to the brain — including prenatal viruses or malnutrition, birth complications, or early childhood head injury.

• Stressful life experiences and aspects of the family environment can bring on the active phase of schizophrenia or worsen symptoms in predisposed people.

• Recovery from schizophrenia has been shown to occur at higher rates in developing countries than in developed countries. Differences in living conditions, cultural attitudes, and the lower use of antipsychotic drugs in developing countries may play a role.