Abnormal Psychology 5.2 Psychological disorders

1. AbnormalPsychology5.2 Psychological disorders DP2 MsLindström

2. Learning Outcomes • Evaluatepsychological research (throughtheories and studies) relevant to the study of abnormalbehaviour • Discuss the interaction of biological, cognitive, and socioculturalfactors in abnormalbehaviour • Discuss symptoms and prevalence of one disorder from two of the following groups: Anxiety disorders (PTSD) and affective disorders (major depression), eating disorders (bulimia) • Analyze the etiologies ( the cause in terms of biological, cognitive, and sociocultural factors) of one disorder from two of the following groups: anxiety disorders, affective disorders, eating disorders (for example: PTSD and unipolar depression) • Discuss cultural and gender variations in prevalence of disorders

3. Psychological Tests On paper: Test by human relations department • Yale- BOCS Manypsychological online tests: • http://www.bbc.co.uk/science/humanbody/mind/index_surveys.shtml • http://www.psychologytoday.com/tests • http://www.healthyplace.com/psychological-tests/ • http://testyourself.psychtests.com/ PTSD TEST online: • http://www.healthyplace.com/psychological-tests/ptsd-test/

4. Introductiontopsychological disorders Symptomology: Refersto the identification of the symptoms. For example by using a diagnostic manual (DSM-IV) FindingoutWHAT the person suffers from Etiology: Moredifficultto do IB coursefocuses on: the biological, cognitive and socioculturalfactors WHYpeoplesuffers from a disorder

5. Data which assist in the diagnosis Prevalence rate: Is the measure of the total number of cases of the disorder in a given population Lifetimeprevalence: Is the percentage of the population thatwillexperience the disorder at sometime in theirlife Onset age: Is the average age at which the disorder is likelytoappear

6. Weare going tostudytwo disorders from two different classifications of abnormalehaviour • Two from: • Anxiety disorders (for example PTSD) • Affective disorder (major depression) • Eating disorder (bulimia) Wewillstudy: Major depression PTSD

7. Major Depression Part of 5.2

8. Major Depression • BelongtoAffective disorders: dysfunctionalmoods • Do be a thinker on p. 149

9. Depression – what type? • Major depressive disorder (also known as recurrent depressive disorder, clinical depression, major depression, unipolar depression, or unipolar disorder • The term unipolar refers to the presence of one pole, or one extreme of mood- depressed mood. This may be compared with bipolar depression which has the two poles of depressed mood and mania

10. is it not… • A depressed mood caused by substances (such as drugs, alcohol, medications) • Major depressive disorder cannot be diagnosed if a person has a history of manic or mixed episodes (e.g., a bipolar disorder) • Further, the symptoms are not better accounted for by bereavement (i.e., after the loss of a loved one)

11. ABCS Symptoms of major depression (p. 149) • Affective: feelings of guilt and sadness, lack of enjoyment or pleasure in familiar activities or company • Behavioural: passivity, lack of initiative • Cognitive: frequent negative thoughts, faulty attribution of blame, low self-esteem, suicidal thoughts, irrational hopelessness, may also experience difficulties in concentration and anability to make decisions • Somatic: loss of energy, insomnia or hypersomnia, weight loss/gain, diminished libido

12. Criteria for major depression in DSM-IV • See handout

13. You should… • Understand that mood disorders are diagnosed based on the extent, severity, and duration of the symptoms.

14. Video Depression • http://www.youtube.com/watch?v=IeZCmqePLzM&feature=fvwrel

15. Depression • The problems that depressed people suffer from can become long-lasting or recurrent and lead to substantial impairments in an individual’s ability to take care of his or her everyday responsibilities. • At its worst, depression can lead to suicide. Almost 1 million lives are lost yearly due to suicide, which translates to 3000 suicide deaths every day. • For every person who completes a suicide, 20 or more may attempt to end his or her life (WHO, 2012).

16. Depression • Tends to be a recurrent disorder, with 80% experiencing a subsequent episode • An episode usually last three to four months • The average number of episodes is four • In app. 12 % of cases depression becomes a chronic disorder (lasting about two years)

17. How common is depression? • According to the World Health Organization, unipolar depressive disorders were ranked as the third leading cause of the global burden of disease in 2004 and will move into the first place by 2030. • Depression is a significant contributor to the global burden of disease and affects people in all communities across the world. • Today, depression is estimated to affect 350 million people.

18. How common is depression? • The World Mental Health Survey conducted in 17 countries found that on average about 1 in 20 people reported having an episode of depression in the previous year. • Kessler et al. 1993 found a lifetimeprevalence for major depression of 21,3 % in womencompared to 12,7 % in men.

19. How common is depression in sweden? • ”Ungefär 5 % av Sveriges befolkning lider av depression. Undersökningar har visat att minst 25 % av alla kvinnor och 15 % av alla män någon gång under livet kommer att drabbas av en depression som kräver behandling. • Det finns studier som talar för att depressioner har blivit vanligare under de senaste 50 åren, och att människor insjuknar i lägre åldrar än tidigare. • Depression är en av Sveriges stora folksjukdomar.” (Läkemedelsverket)

20. How common is depression in Sweden? Depression är mycket vanlig. I Sverige drabbas 35% av befolkningen av depression någon gång i livet. Enligt hittills allmänt spridd uppfattning är kvinnor dubbelt så ofta deprimerade som män, 50% av kvinnorna och 25% av männen får diagnosendepression någon gång i sitt liv. Ny forskning tyder på att depression förekommer lika ofta hos män som hos kvinnor om man inräknar männens annorlundasymtombild och därmed odiagnostiserad depression. • Akademiska sjukhuset, Landstinget i Uppsala län

21. Etiologyof major depression: • Task:6 of youper factor (thatis: biological, cognitive, sociocultural) be ready to present to the rest on Fridaywitha quizafterwardsto test the others Use the book, and the p. 172-173 in Oxford revision guides

22. Sociocultural factors • Which factors do you think play a role here?

23. Sociocultural factors • Poverty or living in a violent relationship have been linked to depression. Stress and lack of social support could also be reasons. • Could the sociocultural factors play a part in why the rates of depression is higher in women? • See Brown and Harris 1978 study about social factors in depression. Read it (p.156) and write a summary stating the aim, procedure and findings.

24. Sociocultural factors • Prince 1968. Earlier reports claimed that there was no depression in Africa and various regions of Asia, but this study found that rates of reported depression rise with Westernisation in the former colonial countries. The negative symptoms of depression (loss of appetite, insomnia, inability to experience sexual pleasure, fatigue) are present but in most non-Western cultures the experience of guilt is mostly absent • ¬ Kleinman (1982) showed that in China somatization served as a typical channel of expression and as a basic component of depressive experience.

25. Cognitive factors • Deals with the role of thinking and negative cognitive schemas • Seligman (1975) ‘Learned helplessness theory’ Seligman (1975) was studying escape learning and found that dogs, forced to stay in a box where they were repeatedly shocked, soon gave up and stopped trying to escape. Moreover, 65% of the dogs didn't try to escape the next day when the box was modified so they could easily escape. They just laid down and whined. They had learned helplessness. Seligman said human depression with its passivity and withdrawal might be due to "learned helplessness."

26. Cognitive factors • Albert Ellis: irrational and illogical cognitions will lead to disturbances of mood (depression) • For example: “I didn’t get the highest score on the test – I must be stupid” • • Aaron Beck: Faulty thinking • Cognitive theory of depression (A cognitive triad , see next slide), a thinking style that gives the person a negative self-schema (a very pessimistic view on oneself and life in general) which makes it very difficult to see anything positive in life. • CBT: cognitive behavioural therapy

28. Beck's Six Types of Faulty Thinking • ARBITRARY INFERENCE - Drawing conclusions about oneself or the world without sufficient and relevant information. Example: A man not hired by a potential employer perceives himself as "totally worthless" and believes he probably will never find employment of any sort. • SELECTIVE ABSTRACTION - Drawing conclusion from very isolated details and events without considering the larger context or picture. Example: A student who receives a C on an exam becomes depressed and stops attending classes even though he has A's and B's in his other courses. The student measures his worth by failures, errors, and weaknesses rathter than by successes or strengths. • OVERGENERALIZATION - Holding extreme beliefs on the basis of a single incident and applying it to a different or dissimilar and inappropriate situation. Example: A depressed woman who has relationship problems with her boss may believe she is a failure in all other types of relationships. • MAGNIFICATION AND EXAGGERATION - The process of overestimating the significance of negative events. Example: A runner experiences shortness of breath and interprets it as a major health problem, possibly even an indication of imminent death. • PERSONALIZATION - Relating external events to one another when no objective basis for such a connection is apparent. Example: A student who raises his hand in class and is not called on by the professor believes that the instructor dislikes or is biased against him. • POLARIZED THINKING - An "all-or-nothing," "good or bad," and "either-or" approach to viewing the world. Example: At one extreme, a woman who perceives herself as "perfect" and immune from making mistakes; at the other extreme, a woman who believes she is totally incompetent.

29. Homework for Monday • Beck's Six Types of Faulty Thinking Know them so well you could perform them…

30. Evaluation • Unclear whether this cognition is the cause of depression or if they are symptoms (or consequence) of depression. • CBT – if it works… • One researcher who claims that it is a link between negative cognitions and depression is Alloy et al. 1999, who conducted a longitudinal prospective study using young Americans for six years. • Chosen based on their thinking style ( positive or negative) • After the six years only 1 % of those in the positive thinking group had developed depression compared to 17% in the negative thinking group.

31. Biological Factors • A large Swedish twin study (Kendler et al. 2006) used 42000 participants (!) • Telephone interviews to diagnose depression on the basis of a) the presence of most of the DSM-IV symptoms or b) having had a prescription for antidepressants. • Results: they found the following concordance rates: 0,44% for MZ females and 0,31% for MZ males Compared to 0,16% for DZ females and 0,11% DZ males • Genetics: Nurnberger and Gershon (1982): Studied results from 7 studies and found: MZ 65%; DZ 14% Concordance is not 100%

32. Biological factors • •Rampello et al (2000): imbalance of several neurotransmitters (dopamine, serotonin, noradrenaline and acetylcholine) • Serotonin hypothesis (low levels of serotonin) • All SSRI (selective serotonin reuptake inhibitor) drugs such as prozac, zoloft and paxil are common sold anti-depressants which should be in favour of those hypotheses, right? • Critisims: Kirsch et al. 2002: effectiveness? Placebo?

33. Interactionist approach • The diathesis-stress model: a model that claims that depression may be the result of a hereditary predisposition, but in interaction with events in the environment.

34. Gender considerations in major depressive disorder

35. Gender considerations • Statistically women are two to three times more likely to become clinically depressed (Williams and Hargreaves 1995) • While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males (WHO, 2008). In fact, depression is the leading cause of disease burden for women in both high-income and low- and middle-income countries (WHO, 2008). • Research in developing countries suggests that maternal depression may be a risk factor for poor growth in young children (Rahman et al, 2008). This risk factor could mean that maternal mental health in low-income countries may have a substantial influence on growth during childhood, with the effects of depression affecting not only this generation but also the next. “Why are so many women depressed?” Read the article (on the course website)

36. Gender studies • Williams and Hargreaves (1995) argue that hormonal changes of the menstrual cycle may have an effect in change of mood even though it cannot be said to directly cause depression. • Cochrane (1995) identifies a number of non-biological explanations of women’s greater susceptibility to depression: ¬ Girls have a greater risk to experience sexual abuse ¬ Learned helplessness as a result of general female gender role ¬ Female-male difference in rate of depression highest between ages of 20-50. These are the years where females have a hard life being mothers, working etc.

37. Gender studies • Harris and Brown (1978): The theory of social factors in depression • It was more common among those women who had experienced at least one severe life event or major difficulty • - social class factor: more common among working class than middle class • . The more children… • Women who were widowed, divorced or separated had higher rates of depression Social stress plays a role!

38. Cultural considerations in major depression

39. Why are There Cultural Differences in Prevalence of Disorders? • Different cultures have different concepts of what is abnormal behavior • Social problems/pressures and cultural differences may lead to a higher prevalence of disorders in some cultures

40. Cultural Differences in Prevalence of Depression • Weisman et al. 1996 • Lifetime prevalence • 19 % Libanon • 1,5 % Taiwan • 3 % Korea • 16,4 % France

41. Different cultures have different concepts of what is abnormal behavior • Okello and Ekblad (2006): In Uganda depression is seen as “illness of thoughts” and not a biological illness. Therefore, it is believed that depressed do not need medicine, unless the disorder is chronic or recurring. • Cooper et al (1972): New York psychiatrists are twice as likely to diagnose patients with schizophrenia than London psychiatrists, who in turn are twice as likely to diagnose mania or depression when shown the same videotaped clinical interviews. • Different countries use different diagnostic tools: E.g. ICD-10, CCMD, DSM-IV-TR • Homosexuality was considered to be abnormal until DSM-III (1980). It is still considered abnormal in many countries. • Unmarried mothers in Britain and political dissidents in the Soviet unions were once confined to institutions for abnormality. The tendency for American black slaves in the 1800s to try flee captivity was considered to be a mental illness.

42. Social problems/pressures and cultural differences may lead to higher a prevalence of disorders in some cultures Chiao& Blinsky (2010): Depression is associated with individualism. • In cultures with high levels of community, religiosity, and traditional family roles, depression is less prevalent (e.g. Wu and Anthony 2000) • (Becker (1995): After the introduction of television in Fiji, eating disorders in women increased)

43. Possible essay question p. 155 • Discuss the interaction of biological, cognitive and sociocultural factors in abnormal behaviour. • See assessment advice • Use 30 minutes to write and answer with the book as help, • Then use 10-15 min. to read and give feedback to someone else’s answer. Hand in.