Abnormal Psychology:
psychological disorders
Part I
Introduction to psychological disorders
• Symptomology refers to identification of the
symptoms.
• Etiology – refers to finding out why people
suffer from a disorder.
Introduction to psychological disorders
• When discussing a disorder, there is data which
assist in the diagnosis:
▫ Prevalence rate – it measures the total number of
cases of the disorder in a given population.
▫ Lifetime prevalence (LTP) – is the percentage of
the population that will experience the disorder at
some time in their life.
▫ Onset age – is the average age at which the disorder
is likely to appear. Knowing the average onset age can
determine how likely it is that a person who begins to
show specific symptoms at a specific age can be
diagnosed reliably.
Introduction to psychological disorders
• Classifications of abnormal behavior:
▫ Anxiety disorders have a form of irrational fear
as a central disturbance. Example: PTSD
▫ Affective disorders are characterized by
dysfunctional moods. Example: Major
Depressive Disorder
▫ Eating disorders are characterized by eating
patterns which lead to insufficient or excessive
intake of food. Example: Bulimia
Depression
• Depression is one of the most common
psychological disorders.
• People who are depressed have very low moods and
low levels of self esteem.
• They lack motivation, and think that everything is
black and that they will never be happy again.
• The cause of depression is inconclusive. Current
research suggests that there are biological,
cognitive, and social factors involved.
• Treatments include drugs and different kinds of
therapy.
Symptoms of major depressive
disorder
• In order to find out why people suffer from
depression, different levels of analysis are used:
▫ Biological factors may include people’s genetic
makeup and biochemical factors.
▫ Cognitive factors may include thought of
hopelessness, pessimistic thinking patterns, or
feelings of low self-esteem.
▫ Social factors may include the stress of poverty,
loneliness, or troubled personal relationships.
Symptoms of major depressive
disorder
• Affective: feelings of guilt and sadness; lack of
enjoyment or pleasure in familiar activities or company
• Behavioral: passivity; lack of initiative
• Cognitive: frequent negative thought; faculty
attribution of blame; low self-esteem; suicidal thoughts;
irrational hopelessness, may also experience difficulties
in concentration and inability to make decisions.
• Somatic: loss of energy, insomnia, or hypersomnia;
weight loss/gain; diminished libido.
These symptoms interfere with normal life activities, like
work and relationships.
Affective disorders: major depressive
order
• Major depressive disorder can be diagnosed
when an individual experiences two weeks of
either a depressed mood or loss of interest
and pleasure.
• In addition, the diagnosis requires the presence
of four additional symptoms, such as
insomnia, appetite disturbances, loss of
energy, feelings of worthlessness, thoughts of
suicide, or difficulty concentrating.
Affective disorders: major depressive
order
• Major depressive disorder is relatively common,
affecting around 15% of the people at some time
in their life (Charney and Weismann 1988)
• Levav (1997) found the prevalence rate of
depression to be above average in Jewish males
– and there is no difference of prevalence
between Jewish men and Jewish women.
Affective disorders: major
depressive order
• Depression tends to be a recurrent disorder,
with about 80% experiencing a subsequent
episode, with an episode typically lasting for
three to four months. The average number of
episodes is four. In approximately 12% of cases,
depression becomes a chronic disorder with a
duration of about two weeks.
Prevalence of Current Depression US
Adults by 2006 and 2008
Age Group
18–24
Percent Experiencing
Depression
11.1 %
25–34
9.3%
35–44
8.7%
45–64
9.6%
65+
6.9%
Prevalence of Current Depression US
Adults by 2006 and 2008
• This study found the following groups to be more
likely to meet criteria for major depression:
• persons 45-64 years of age
• women
• blacks, Hispanics, non-Hispanic persons of other
races or multiple races
• persons with less than a high school education
• those previously married
• individuals unable to work or unemployed
• persons without health insurance coverage
Etiology of major depressive
disorder
• There is now some evidence that changes in the level of
certain neurotransmitters and hormones can
precipitate a depressive episode.
• It is also likely that many cases of clinical depression are
triggered by negative events in a person’s life.
▫ Examples: divorce, the death of a partner or child,
a serious accident, or being fired
• Sometimes depression appears to be a response not to a
particular event, but to long-term circumstances.
Etiology of major depressive
disorder
• There may be an association between stress and
depression, but it is important to realize that many
people who are subjected to high stress do not develop a
depressive disorder.
• There are important individual differences in
vulnerability .
• The risk of becoming depressed is related to a number
of factors, which can include:
▫ Genetic predisposition, personality and early history,
cognitive style, coping skills, and the level of social support
available.
Etiology of major depressive
disorder
• Depression is not caused by a single factor, but
stems from a combination of factors, which
may include:
▫ Genetic vulnerability, neurotransmitter malfunctioning,
psychological problems, or particular life events or lifestyle
factors, such as misuse of alcohol or drugs.
• It is not possible for any doctor/psychologist to
find the cause of depression in any individual.
• Treatment aims to alleviate symptoms, and
help the individual cope.
• ________________– is the average age at
which the disorder is likely to appear. Knowing the
average onset age can determine how likely it is that
a person who begins to show specific symptoms at a
specific age can be diagnosed reliably.
________________– is the average age at which the disorder is likely to appear. Knowing
the average onset age can determine how likely it is that a person who begins to show
specific symptoms at a specific age can be diagnosed reliably.
Symptomology
Onset age
Prevalence rate
• _____________________refers to
identification of the symptoms.
_____________________refers to identification of
the symptoms.
Onset age
Prevalence rate
Symptomology
• Which of the following is not true of depression?
1. Depression is one of the most common
psychological disorders.
2. People who are depressed have very low moods
and low levels of self esteem.
3. They lack motivation, and think that everything
is black and that they will never be happy again.
4. The cause of depression is easily determined.
5. Treatments include drugs and different kinds of
therapy.
Which of the following is not true of depression?
Depression is one of the most common
psychological disorders.
People who are depressed have very low
moods and low levels of self esteem.
They lack motivation, and think that everything is
black and that they will never be happy again.
The cause of depression is easily
determined.
Treatments include drugs and different
kinds of therapy.
True or false?
• Major depressive disorder can be diagnosed
when an individual experiences one week of
either a depressed mood or loss of interest and
pleasure.
Major depressive disorder can be diagnosed when an individual experiences
one week of either a depressed mood or loss of interest and pleasure.
True
False
▫ ________________disorders are
characterized by eating patterns which lead to
insufficient or excessive intake of food.
________________disorders are characterized by eating
patterns which lead to insufficient or excessive intake of food.
anxiety
eating
affective
▫ _________________disorders have a form
of irrational fear as a central disturbance.
_________________disorders have a form of irrational
fear as a central disturbance.
anxiety
eating
affective
TRUE OR FALSE
• It is not possible for any doctor/psychologist to
find the cause of depression in any individual.
It is not possible for any doctor/psychologist to find the
cause of depression in any individual.
True
False
True or false
• Depression is not caused by a single factor, but
stems from a combination of factors.
Depression is not caused by a single factor, but stems from
a combination of factors.
True
False
▫ ____________________– it measures the
total number of cases of the disorder in a given
population.
____________________– it measures the total number
of cases of the disorder in a given population.
Prevalence rate
etiology
Symptomology
True or false?
• Treatment aims to cure symptoms, and help the
individual cope.
Treatment aims to cure symptoms, and help the individual
cope.
True
False
• Which of the following are is not likely to meet
criteria for major depression:
1. persons 45-64 years of age
2. women
3. blacks, Hispanics, non-Hispanic persons of
other races or multiple races
4. persons with less than a high school education
5. unmarried people
Which of the following are is not likely to meet criteria for
major depression:
persons 45-64 years of age
women
blacks, Hispanics, non-Hispanic persons of
other races or multiple races
persons with less than a high school
education
unmarried people
• _________________disorders are
characterized by dysfunctional moods.
_________________disorders are characterized by
dysfunctional moods.
Anxiety
Affective
Eating
• ________________– refers to finding out
why people suffer from a disorder.
________________– refers to finding out why
people suffer from a disorder.
Symptomology
Prevalence rate
etiology
The Biological level of analysis: genetic and
biochemical factors in depression
• Genetic researchers argue that genetic
predisposition can partly explain depression.
▫ Nurnberger and Gershon (1982) reviewed the
results of seven twin studies and found that
major depressive disorder was consistently higher
for MZ (identical) twins than for DZ (fraternal)
twins.
The Biological level of analysis: genetic and
biochemical factors in depression
• Environmental events play a role on
depression as well.
▫ Long-term stress may result in depression for
some people because they have the genetic
predisposition which makes them more
vulnerable to depression than other people.
The Biological level of analysis: genetic and
biochemical factors in depression
• Duenwald (2003) have suggested that a short
variant of the 5-HTT gene may be associates
with a higher risk of depression. This gene plays
a role in the serotonin pathways which
scientists think are involved in controlling mood,
emotions, aggression, sleep, and anxiety.
The Biological level of analysis: genetic and
biochemical factors in depression
• Catecholamine hypothesis aka “the serotonin
hypothesis” – suggested by Joseph Schildkraut in
1965. According to this theory, depression is associated
with low levels of noradrenaline, making the
neurotransmitter serotonin responsible.
The Biological level of analysis: genetic and
biochemical factors in depression
• Janowsky et. al (1972) demonstrated that drugs which
decrease the level of noradrenaline tend to produce
depression-like symptoms. Participants were given a
drug called physostigmine became profoundly depressed
and experienced feelings of self-hate and suicidal
wishes within minutes of taking the drug.
• The fact that a depressed mood can be artificially
induced by certain drugs suggests that some cases of
depression may stem from a failure in
neurotransmission. Also drugs that increase
noradrenaline tend to be effective in reducing the
symptoms of depression.
The Biological level of analysis: genetic and
biochemical factors in depression
• Delgado and Moreno (2000) found that
abnormal levels of noradrenaline and
serotonin in patients suffering from major
depression.
• Rampello et. al (2000) found that patients with
major depressive disorder have an imbalance
of several neurotransmitters, including
noradrenaline, serotonin, dopamine, and
acetylcholine.
The Biological level of analysis: genetic and
biochemical factors in depression
• Burns (2003) says that although he has spent many
years of his career researching brain serotonin
metabolism, he has never seen any convincing
evidence that depression results from a deficiency of
brain serotonin.
• Lacasse and Leo (2005) argue that contemporary
neuroscience has failed to prove that depression results
from a deficiency in neurotransmitters. They say the
research shows that the brain is very complex and not
understood.
The Biological level of analysis: genetic and
biochemical factors in depression
• Burns, Lacasse and Leo criticize the serotonin
theory because drugs that affect serotonin levels
are heavily advertised and the most
prescribed in our society for depression and
other psychological disorders. Example: Prozac
The Biological level of analysis: genetic and
biochemical factors in depression
• The cortisol hypothesis – cortisol is a major
hormone of the stress system and the reason for
focusing on this is that it has always been
obvious to clinicians that stress can predispose
an individual to psychological as well as physical
disorders.
▫ Also, patients with major depressive disorder have high levels of
cortisol, which is present in large amounts when individuals are
stressed. This shows a link between long-term stress and
depression. Studies that show this involve victims of child
abuse.
The impact of poverty on child depression
• Fernald and Gunnar (2008) Children between the ages of 2.5 and
6 were identified in a house to house survey in low-income areas of
urban Mexico. The Scale was administered to mothers of all
children. Salivary cortisol samples were taken in children. The
children were administered several cognitive tests. Results revealed
that higher levels of maternal depressive symptoms were associated
with lower baseline cortisol levels in their children. These low levels
indicate that the stress system if :worn out” leaving the children
susceptible to depression, autoimmune disease. Socioeconomic
status has a huge impact on health – both physical and
psychological.
Cognitive level of analysis: cognitive factors in
depression
• Cognitive theories of depression suggest that depressed
cognitions, cognitive distortions, and irrational beliefs produce
the disturbances of mood.
• Ellis (1962) proposed the cognitive style theory, suggesting that
psychological disturbances often come from irrational and
illogical thinking. On the basis of dubious evidence or faulty
inferences about the meaning of an event, people draw false
conclusions, which then lead to feelings of anger, anxiety, or
depression. Ellis contends that irrational beliefs – such as “My work
must be perfect” – together with “My last essay did not receive the
top grade”- can easily lead to self-defeating conclusions- “Since I did
not receive the highest grade, I am stupid.”
Cognitive level of analysis: cognitive factors in
depression
• Beck (1976) suggested a theory of depression
based in cognitive distortions and biases in
information processing. Beck’s cognitive
distortion theory of depression is based on
schema processing where stored schemas about
self interfere with information processing.
Schemas influence the way people make sense
of experiences.
Cognitive level of analysis: cognitive factors in
depression
• Beck observed that depressive patients
exhibited a negative cognitive triad
characterized by:
▫ Overgeneralization based on negative events.
▫ Non-logical inference about the self.
▫ Dichotomous thinking – black and white
thinking- and selective recall of negative
consequences.
Cognitive level of analysis:
cognitive factors in depression
• Beck states that negative cognitive schemas are
activated by stressful events. The depressed
person tends to overreact. Also if a person has
negative expectations about the future, the
depression can continue in a vicious circle.
Sociocultural level of analysis: social and
cultural factors in depression
• Brown and Harris (1978) carried out a study
concerning the social origins of depression in women.
The researchers found that 29 out of 32 women who
became depressed had experienced a severe life event,
but 78% of those who did experience a severe life event
did not become depressed. They discovered that life
events which resembled previous experiences were more
likely to lead to depression. On the basis of this, brown
suggested a vulnerability model of depression, based on
a number of factors that could increase the likelihood of
depression.
Sociocultural level of analysis: social and cultural
factors in depression
• Such life events were, for example:
▫
▫
▫
▫
▫
Lacking employment away from home
Absence of social support
Having several young children at home
Loss of mother at an early age
History of child abuse
Sociocultural level of analysis: social and
cultural factors in depression
• Diathesis-stress model – is an interactions
approach to explaining psychological disorders.
The model claims that depression may be the
result of a heredity predisposition, with
precipitating events in the environment.
Sociocultural level of analysis: social and cultural factors
in depression
• World Health Organization (1983) has
looked at cultural considerations linked to
depression and identified common symptoms of
depression in four countries: Iran, Japan,
Canada, and Switzerland
▫ Symptoms: sad affect, loss of enjoyment,
anxiety, tension, inability to concentrate, ideas of
insufficiency, lack of energy, inadequacy, and
worthlessness.
• Murphy et. al. (1967) conducted by
psychiatrists that covered 30 countries. They
found additional symptoms such as:
▫
▫
▫
▫
▫
Loss of sexual interest
Loss of appetite
Weight reduction
Fatigue
Self-accusatory ideas
• Prince (1968) claimed that there was no
depression in Africa and various regions of
Asia, but found that the rates of reported
depression rose with westernization in the
former colonial countries.
• Kleinman (1982) showed that in China
summarization served as a typical channel of
expression and as a basic component of
depressive experience. The Chinese rarely
complain of sadness or depression.
• Marsella (1979) argues that affective symptoms
(sadness, loneliness, isolation) are typical of
individualistic cultures. In cultures which are
more collectivist have more somatic symptoms
as headaches are more common.
Gender considerations in major
depressive disorder
• Williams and Hargreaves (1995)Women are
two to three times more likely to become
clinically depressed than men, and they are
likely to experience several episodes of
depression.
• Many researcher argue that the reasons for
depression are rooted more in social causes that
in biological ones.
The theory of social factors in depression
Brown and Harris (1978)
• Brown and Harris (1978) found that in its first onset
depression usually happens for a reason, a serious
adversity. They interviewed 458 women in South
London, and found that 37 of them (8 per cent of the
total) had become clinically depressed in the previous
year. Of the 37 women who became depressed, 33
(almost 90 per cent) had suffered an adverse life event
(such as a bereavement) or a serious difficulty (such as
being in a relationship with an abusive husband).
The theory of social factors in
depression
Brown and Harris (1978)
• This compared with only 30 per cent of the
women who did not become depressed suffering
such an adversity. In only four of the 37 women
who became depressed was their onset of
depression unrelated to any adversity. If, when a
serious life event or difficulty struck, the women
in Brown and Harris’s study lacked a protective
factor such as social support from an intimate
relationship in their life, their risk of suffering a
breakdown was much increased.
The theory of social factors in depression
Brown and Harris (1978)
• Brown and Harris’s work is a fine example of a
piece of social science research that was done
really well, and that had an important effect. The
finding that most people did not get depressed
because there was something wrong with their
personality, but because there was something
wrong in their lives, transformed how
depression was seen by general practitioners and
psychiatrists in Britain.
• Most of the serious life events that cause depression are
losses, either of important relationships or roles or of
life projects that were fundamental to people’s identities.
Protective factors such as social support described by
Brown and Harris were parts of people’s lives that
enabled them to feel themselves even when substantial
losses occurred. For people who were protected in this
way, a serious adversity could cause sadness or anger,
but seldom the hopeless and disabling despair that put
them at risk of abandoning children and spouses in
suicide attempts.
• Social stress plays a role in triggering many
depressive episodes, but demonstrates that
social factors may increase an individuals
vulnerability to depression. Social support may
offer protection against the effects of stressful
events.
Questions!
• Catecholamine hypothesis aka “the
____________ hypothesis” – suggested by
Joseph Schildkraut in 1965.
Catecholamine hypothesis aka “the ____________
hypothesis” – suggested by Joseph Schildkraut in 1965.
serotionin
Nurnberger and Gershon (1982) reviewed the results
of seven twin studies and found that major
depressive disorder was consistently higher for
_________ twins than for _________ twins.
Nurnberger and Gershon (1982) reviewed the results of seven twin studies and
found that major depressive disorder was consistently higher for _________
twins than for _________ twins.
• MZ; DZ
DZ; MZ
True or false?
• Rampello et. al (2000) found that patients with
major depressive disorder have an perfect
balance of several neurotransmitters, including
noradrenaline, serotonin, dopamine, and
acetylcholine.
Rampello et. al (2000) found that patients with major depressive disorder have an
perfect balance of several neurotransmitters, including noradrenaline, serotonin,
dopamine, and acetylcholine.
True or false?
True
False
True or false?
• Burns (2003) says that although he has spent
many years of his career researching brain
serotonin metabolism, he has never seen any
convincing evidence that depression results from
a deficiency of brain serotonin.
Burns (2003) says that although he has spent many years of his career researching
brain serotonin metabolism, he has never seen any convincing evidence that
depression results from a deficiency of brain serotonin.
True
False
True or false?
• Janowsky et. al (1972) demonstrated that drugs
which decrease the level of noradrenaline tend to
produce depression-like symptoms. Participants
were given a drug called physostigmine became
profoundly depressed and experienced feelings
of self-love and suicidal wishes within minutes
of taking the drug
Janowsky et. al (1972) demonstrated that drugs which decrease the level of noradrenaline tend to produce
depression-like symptoms. Participants were given a drug called physostigmine became profoundly depressed
and experienced feelings of self-love and suicidal wishes within minutes of taking the drug
True
False
• _________________ model – is an
interactions approach to explaining
psychological disorders. The model claims that
depression may be the result of a heredity
predisposition, with precipitating events in the
environment
_________________ model – is an interactions approach to explaining
psychological disorders. The model claims that depression may be the result of a
heredity predisposition, with precipitating events in the environment
Medical
Diathesis-stress
Working
• The ________________hypothesis – it is a
major hormone of the stress system and the
reason for focusing on this is that it has always
been obvious to clinicians that stress can
predispose an individual to psychological as well
as physical disorders.
The ________________hypothesis – it is a major hormone of the stress system and the reason for
focusing on this is that it has always been obvious to clinicians that stress can predispose an
individual to psychological as well as physical disorders.
serotionin
cortisol
True or False?
• Marsella (1979) argues that affective symptoms
(sadness, loneliness, isolation) are typical of
collectivist cultures. In cultures which are more
collectivist have more somatic symptoms as
headaches are more common.
Marsella (1979) argues that affective symptoms (sadness, loneliness, isolation) are
typical of collectivist cultures. In cultures which are more collectivist have more
somatic symptoms as headaches are more common.
True
False
• Prince (1968) claimed that there was no
depression in _____________and various
regions of Asia, but found that the rates of
reported depression rose with westernization in
the former colonial countries.
Prince (1968) claimed that there was no depression in _____________and
various regions of Asia, but found that the rates of reported depression rose with
westernization in the former colonial countries.
Africa
Australia
Canada
Unites States