PSY1011:

Psychological Disorders

Lecturer: Dr Darren Haywood

Learning Objectives:
• Explain the cultural context of psychopathology

• Define mental health, mental health problems and mental disorders

• Differentiate between the contemporary approaches to

psychopathology

• Understand the classification and diagnostic categories outlined in the

latest edition of the DSM, and outline the key symptoms of some of the
major psychopathological syndromes
Learning Objective 1:
Explain the cultural context of
psychopathology
What is ‘Psychopathology’?

• Psychopathology: refers to problematic

patterns of thought, feeling or behaviour that
disrupt an individual's sense of wellbeing or
social or occupational functioning.

• Many forms of psychopathology are found

across cultures: Differs in vulnerability and
conceptualization

• Different conceptualisations of ‘Madness’

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Variation

• Prevalence rates and phenotypes vary considerably

• I.e., Cultural factors largely account for why West African people with
schizophrenia are more likely to experience visual hallucinations than their
European counterparts
• Incorrect diagnoses: auditory hallucinations

• What is pathology?
• E.g., European settlers arrived to colonise Australia, they did not recognise
examples of people suffering from what they classified as ‘insanity’ among the
Aboriginal population.
• Lack of recognition among Aboriginal communities lays in the spiritual beliefs
that underpinned those societies.
Mental Illness: Nothing but a cultural construction?

• Definitions of abnormality vary across cultures

• can we really speak of mental illness at all?
• Incorrect diagnoses: auditory hallucinations
• Is mental illness simply a construct used by a society to
brand and punish those who fail to respect its norms?
(Argued in the 60s and 70s by academics such as Thomas
Szasz)

• Labelling Theory
• Turns people into ‘patients’, whose subsequent actions are
interpreted as part of their ‘craziness’
• Self Fulfilling prophecy?
But there is some consistency and importance...

• Many disorders are recognized cross-culturally

• I.e., Anxiety and Depression

• How do we treat or research an issue if...

• We distinguish those who have it from those who do not

• Reflection:
• Can we treat or diagnose patients without
understanding — or sharing — their cultural
backgrounds?
Learning Objective 2:
Define mental health, mental health
problems and mental disorders.
What do these terms mean?

• Mental Health
• A state of emotional and social wellbeing in which individuals realise
their own abilities, can cope with the normal stresses of life, can work
productively and can contribute to their community
• Mental Health Problems
• wide range of emotional and behavioural abnormalities that
affect people throughout their lives.
• I.e., cognitive impairment, anxiety, depressive
symptoms, etc.
• Mental Disorder
• Clinically recognisable set of symptoms and behaviours,
which usually need treatments (including hospitalisation at
times) to be alleviated
• Serious departure from normal functioning
Mental Disorder

What is abnormal behaviour, and what factors influence its

definition?
 Deviance
 Deviating from the majority, violating social norms, or being
statistically infrequent or ‘rare’
 Distress
 Experience of personal suffering or anxiety due to the behaviour
 Dysfunction
 Not being able to perform in daily life

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Prevalence

 In Australia, almost half the population will have a

mental disorder at some point in their life

 High risk groups

- Children and adolescents, older people, Aboriginal and
Torres Strait Islander peoples, rural and remote
populations and people from culturally and linguistically
diverse backgrounds

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Suicide

• Suicide
• In 2020, there were 3139 deaths by suicide in Australia
• Approx. 75% Male
• Leading cause of death for Australians aged 15-44
• However, the most prevalent in older adults groups (+65yo)

• Language
• ‘suicide attempt’ and ‘died by suicide’ rather than ‘suicide
attempt’ and ‘died by suicide’ and ‘took their own life’
• Prevention: 4 steps (Black Dog Institute)
• Ask (i.e., ‘Are you thinking about suicide?’)
• Listen and Stay
• Get Help (i.e., 000, or Lifeline)
• Follow up (check in)
Learning Objective 3:
Differentiate between the contemporary
approaches to psychopathology.
Contemporary Conceptualisations

• Different approaches, different views

• Conceptualize the:
• Nature
• Causes
• maintaining factors
• treatments
• Each approach we’ll discuss is currently used (to
some degree)
• Important to understand for:
• A clinical mutual understanding
• Research interpterion
• Theory interpretation
• Historical underpinnings
Psychodynamic Perspective

• Very important perspective in history

• One of the first to acknowledge the ‘mind’
• Was the dominant perceptive for decades
• Paved the way to more modern approaches (i.e. CBT)
• Importance of the sub and unconscious and personal
experiences
• Developed and popularized by people including Jung and Freud

• Three broad classes of psychopathology

• Neurosis
• Personality Disorders
• Psychosis
Psychodynamic Perspective

• Neuroses
• problems in living, such as phobias, constant self-doubt and
repetitive interpersonal problems such as trouble with authority
figures.
• Personality Disorders
• enduring maladaptive patterns of thought, feeling and
behaviour that lead to chronic disturbances in interpersonal and
occupational functioning
• Psychosis
• gross disturbances involving a loss of touch with reality.

• According to Psychodynamic These three are on a

continuum of environmental causes to hereditary causes.
Psychodynamic Perspective

• Psychodynamic Case Formulation

• a set of hypotheses about the patient's personality structure and the
meaning of the symptom

• Three questions:
• What does the patient wish for and fear?
• unconscious conflicts among wishes and fears and efforts to
resolve them

• What psychological resources does the person have at their

disposal?
• ability to function autonomously, make sound decisions,
think clearly and regulate impulses and emotions

• And how do they experience themselves and others?

• object relations; that is, the person's ability to form
meaningful relationships with others and to maintain self-
esteem.
Cognitive–behavioural perspective

• Current leading Perceptive

• integrating an understanding of classical and operant
conditioning with a cognitive–social perspective
• The perspective that underlies CBT
• discrete processes, such as thoughts that precede an anxiety
reaction or physiological symptoms (e.g., racing heart) that
accompany it.

• Behavioural
• Assesses the conditions under which symptoms such as
depression and anxiety arise and tries to discover the
stimuli that elicit them.
• Cognitive
• focuses on irrational beliefs and maladaptive cognitive
processes that maintain dysfunctional behaviours and
emotions.
Biological Approach

• To understand psychopathology, mental health

professionals often move from a mental to a physiological
level
• Potential biological contributions to their symptoms
• All perspectives recognize biological contributions
• Genetic vulnerabilities
• Developmental issues
• Damage
• Neuro-chemetiry
• Neurostructure

• Unfortunately…
• Biological only based research has been largely
unsuccessful
• No consistent biological markers that consistently
account for psychopathology. Only ‘risk’
Biological Approach

• Neural Circuits
• Looks for the roots of mental disorders in the brain's circuitry
• I.e., normal anxiety occurs through activation of neural circuits
involving, among other structures, the amygdala and frontal
lobes
Thus…
• One might expect pathological anxiety to involve heightened or
easily triggered activation of those circuits

• Abnormal circuitry can occur through genetic or environmental

input

• Two primary areas:

• Specific regions of the brain that differ between control =s
and those with a disorder
• And neurotransmitter dysfunction
Diathesis-Stress Model

• Integrates nature and nurture

• proposes that people with an underlying vulnerability (called a
diathesis) may exhibit symptoms under stressful circumstances.
• Diathesis may be biological or environmental
Systems Approach

• A social systems approach looks for the roots of

psychopathology in the broader social context
• explains an individual's behaviour in the context of a social group
• Couple
• Family
• Larger group

• Individual is part of a system

• one part of the system influences what happens in others.
• Diagnosis must consider the system in which the individual
operates
• not incompatible with other perspectives because it operates at
another level of analysis

• E.g., a child who has problems with aggressive behaviour at school

may be part of a broader family system in which violence is a way
of life.
Systems Approach

• Family Systems Model

• Most popular
• Views an individual's symptoms as symptoms of dysfunction in
the family

• Systems theorists refer to the methods family members use to

preserve equilibrium in a family
• Called ‘family homeostatic mechanisms)
• psychological symptoms are actually dysfunctional efforts to cope
with a disturbance in the family.

• E.g., Marital problems Child Symptoms Parents come

together to help the child = Reduced marital problems.

• ‘Family Roles’ the parts individuals play in family interaction and

functioning
Learning Objective 4:
Understand the classification and diagnostic
categories outlined in the latest edition of the DSM,
and outline the key symptoms of some of the major
psychopathological syndromes.
Prehistoric times (8000 BC – 500 BC)

 No understanding of why mental illness (and diseases) occurred

 Mystical view of MI abnormal behaviour attributed to the

supernatural

 Treatment included spells cast by Shamans, conducting exorcisms,

and trephination

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Ancient Greece (500 BC – 500 AD)

 Mental disturbances seen as an outcome of brain disease

 Numerous mental disorders were identified:
– Melancholia; mania; dementia; hysteria; delusions; hallucinations
– Physical origins treatment by physicians

 Started gathering knowledge through observation and

experimentation (e.g. assessment via interview)

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Middle Ages and Renaissance (5th-17th Century)

 Bizarre thoughts and behaviours seen as evidence of demonic

possession or witchcraft (5th to 15th C- Middle Ages)
– Witch hunts women in particular were persecuted

 Renaissance (17th C) move towards institutional confinement of

those seen as ‘deviant’
– Poorhouses
– Hospitals
– Prisons
– Lunatic/mental asylums

 Lack of humane treatment

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Enlightenment (17th-18th Century)

 The age of reason (intellectual movement)

– Started gathering/ordering knowledge based on observation/facts
(i.e. privileged reason and rationality)
– ‘Madness’ increasingly seen as having an organic basis
 Mental disorder achieved status of an ‘illness’
– Medical classification systems began (nosologies)
– Diagnosed and treated as other somatic ailments
 Change in how ‘mad’ people were treated
– Asylums no longer simply for confinement now a place for
treatment and rehabilitation

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19th Century

 Further progress in the classification of mental disorders

 Emil Kraepelin (German psychiatrist) grouped together diseases
based on common patterns of symptoms over time

 Kraepelin dichotomy:
– Manic depression (now: depression, bipolar disorder)
– Dementia praecox (‘premature dementia’; now: schizophrenia)

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Classifying Disorders

Two mains sources of classification

 DSM
– Diagnostic and Statistical Manual of Mental Disorders
 published by American Psychiatric Association
 Before the 1950s there was no standard way to classify
mental disorders.
 First edition published in 1952
 Previous edition: DSM-IV-TR (fourth edition, revised)
published in 1994, text revised in 2000

 DSM-5
– Current version published in 2013
– Attempts to classify all mental disorders
– Three sections
1. Context and how to use the manual
2. Classification system of all current disorders
3. Other potential disorders that have not yet been classified

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Classifying Disorders

Two mains sources of classification

 ICD-11
– Developed by WHO

– Attempts to classify all physical and mental diseases

– Largely consistent with the DSM-V
 Most DSM-V disorders also contain the matching ICD codes.

– Officially used in Australia’s health system

– ICD-11 in effect as of 2022

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Classifications/ Disorders

There are many classifications of mental illnesses in the current DSM-5,

however we will choose to focus mostly on those listed below (see your
readings for outlines of the other classifications):

 Depressive Disorders & Bipolar and Related Disorders

 Anxiety Disorders
 Obsessive-Compulsive and Related Disorders
 Trauma-and Stressor-Related Disorders
 Schizophrenia Spectrum and Other Psychotic Disorders
 Personality Disorders

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Depressive Disorders &
Bipolar and Related Disorders
Depressive Disorders

 Major Depressive Disorder

– 5+ of these symptoms over the same 2-week period, causing
significant distress or impairment
 Depressed mood
 Diminished pleasure or interest in activities
 Significant weight loss or gain
 Insomnia or hypersomnia
 Psychomotor agitation
 Fatigue/loss of energy
 Worthlessness or guilt
 Diminished ability to think/concentrate
 Recurrent thoughts of death or suicide
– Must cause clinically significant distress or impairment to everyday
functioning (e.g. work, social, etc.)
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Depressive Disorders

 Persistent Depressive Disorder (Dysthymia)

– Depressed mood more often than not for past 2 years, exhibiting
2+ of the following symptoms (without more than a 2 month gap):
 Poor appetite or overeating
 Insomnia or hypersomnia
 Low energy or fatigue
 Low self-esteem
 Poor concentration or difficulty making decisions
 Feelings of hopelessness

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Bipolar and Related Disorders

 Bipolar I Disorder
– Manic episode is a distinct elevated/irritable period with increased
energy lasting at least a week (unless hospitalised first), with 3+:
 Inflated self-esteem or grandiosity
 Decreased need for sleep
 More talkative than normal
 Flight of ideas/racing thoughts
 Distractability
 Increase in goal-directed activity
 Excessive involvement in risky activities/behaviours
– Must also meet criteria for at least one major depressive episode
– Can also experience hypomanic episodes, provided at least one
was manic

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Bipolar and Related Disorders

 Bipolar II Disorder
– Hypomanic episode is a distinct elevated/irritable period with
increased energy lasting at least 4 consecutive days, with 3+:
 Inflated self-esteem
 Decreased need for sleep
 More talkative than normal
 Flight of ideas/racing thoughts
 Distractibility
 Increase in goal-directed activity
 Excessive involvement in risky activities/behaviours
– Must also meet criteria for at least one major depressive episode
– These changes need to be observable by others
– Must never have been a manic episode (otherwise it becomes
Bipolar I Disorder)
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Anxiety Disorders
Anxiety Disorders

 Anxiety - a generalized feeling of fear and apprehension; may be

related to a particular event or object and is often accompanied by
increased physiological arousal.
 Fear vs Anxiety: Fear is the emotional response to real or perceived
threat, whereas anxiety is anticipation of future threat
– Both states overlap but differ – fear tends to be associated more
with a flight or fight response
 Anxiety Responses:
– Subjective-emotional – tension and apprehension;
– Cognitive – worrisome thoughts, inability to cope;
– Physiological – increased heart rate and blood pressure, muscle
tension, rapid breathing, nausea, dry mouth etc;
– Behavioural – avoidance of situations; impaired task performance.
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 Anxiety Disorders

 Average age of onset varies, depending on the subtype

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407545/
Anxiety Disorders

 Specific Phobia
– Marked fear or anxiety for an object or situation in which the fear is
almost always immediate, intense, and disproportional to any real
danger. It also needs to be persistent (6+ months) and cause
impairment to functioning
 Social Anxiety Disorder (Social Phobia)
– Marked fear/anxiety about one or more social situations in which
the individual is fearful of being exposed to scrutiny by others, be
negatively evaluated, intensely experienced, and disproportionate
to any actual threat posed
 Panic Disorder
– Recurrent, unexpected panic attacks which evoke an abrupt surge
of intense fear/anxiety, reaching a peak within 10 minutes. At least
one attack must be followed by fear of future attacks or
maladaptive behavioural change.
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Anxiety Disorders

 Agoraphobia
– Marked fear/anxiety about 2+ of the following situations: public
transport, open spaces, enclosed spaces, standing in line/crowds,
and being outside of home alone. Person worries escape will be
difficult and the fear is disproportional to any real threat.
 Generalised Anxiety Disorder (GAD)
– Excessive anxiety/worry for more than 6 months about any number
of issues, and has difficulty controlling this worry. Accompanied by
3+ of the following symptoms: restlessness, easily fatigued,
difficulty concentrating, irritability, muscle tension, sleep
disturbance.

These experiences need to be persistent (e.g. 6+ months), cause

significant distress or impairment to functioning, and are not otherwise
explained by anything else in order to warrant a diagnosis.
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Obsessive-Compulsive and
Related Disorders
Obsessive-Compulsive and Related Disorders

 Obsessive-Compulsive Disorder
– Requires presence of obsessions (i.e. persistent & unwanted
thoughts, urges or images), compulsions (i.e. repetitive behaviours
or mental acts), or both. They must be time consuming, or cause
significant distress or impairment.
– Important to clarify level of insight into disorder (good, poor, absent)
as well as any history or presence of tics

 Body Dysmorphic Disorder

– Preoccupation with 1+ flaws in physical appearance not observable
to others. Individual engages in repetitive behaviours or mental
acts in response, coupled with significant distress or impairment.
– Also important to clarify level of insight

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Trauma-and Stressor-Related Disorders
Trauma-and Stressor-Related Disorders

 Posttraumatic Stress Disorder (PTSD)

A. Exposure to actual or threatened death or serious injury or
sexual violence, in one of the following ways:
 Direct experience
 Witnessing in person
 Learning that the event happened to a close family member or friend
 Experience repeated or extreme exposure to aversive details of event
(e.g. first responders, emergency services)
B. In addition, the individual experiences 1+ of the following:
 Recurrent, intrusive distressing memories of event
 Recurrent, distressing dreams related to event
 Dissociative reactions (e.g. flashbacks) as if the event is reoccurring
 Intense prolonged psychological distress
 Marked physiological reactions to internal or external cues

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Trauma-and Stressor-Related Disorders

 Posttraumatic Stress Disorder (PTSD)

C. Persistent avoidance of stimuli associated with event (can be
thoughts, memories, places or situations, etc.)
D. Negative alterations in cognition and mood associated with event
which begin or get worse after the event, including 2+:
 Inability to remember important aspect of event
 Persistent/exaggerated negative beliefs about oneself
 Persistent, distorted cognitions about cause/consequence, that lead
person to blame themselves
 Persistent, negative emotional state
 Markedly diminished interest or participation in significant activities
 Feelings of detachment or estrangement from others
 Persistent inability to experience positive emotions

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Trauma-and Stressor-Related Disorders

 Posttraumatic Stress Disorder (PTSD)

E. Marked alterations in arousal, including 2+:
 Irritable behaviour or angry outbursts to others
 Reckless or self-destructive behaviour
 Hypervigilance
 Exaggerated startled response
 Problems with concentration
 Sleep disturbance
F. Lasts more than a month, causing significant distress or impaired
functioning
– Important to keep an eye out for dissociative symptoms (e.g.
depersonalisation or derealisation)

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Schizophrenia Spectrum and
Other Psychotic Disorders
Schizophrenia

 Schizophrenia
– Prevalence rates are anywhere from 0.7-1.5% of the population.
– Was first described by Eugen Bleuler (1911-1950) who identified
the disorder as schizophrenia
 schizo – split and phrenun - mind
 Brain/Biochemical/Genetic Findings
– Brain abnormalities (less activity in frontal lobes [hypofrontality] &
basal ganglia; large cerebral ventricles; increase in size of sulci)
– Neurotransmitter differences (over activity of dopamine at
synapses)
– Treated with antipsychotic medications, focusing on symptoms
– Genetic influences (suggestion that genetic influences produce a
vulnerability so that it is more common if there is a family history.)

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Schizophrenia

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Schizophrenia

 Schizophrenia
– 2+ of the following symptoms present for a significant period during
a 1-month timeframe:
 Delusions
 Hallucinations
 Disorganised speech
 Grossly disorganised or catatonic behaviour
 Negative symptoms
– Significant portion of time since onset, level of functioning is
markedly impaired
– Continuous signs of disturbance for at least 6 months
– Alternative disorders (e.g. schizoaffective disorder) ruled out

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Personality Disorders
Personality Disorders

Cluster Description of Personality Disorders

Behaviour

A Odd, eccentric Paranoid, Schizoid,

Schizotypal

B Dramatic, erratic Antisocial, Borderline,

Histrionic, Narcissistic

C Anxious, fearful Avoidant, Dependant,

Obsessive-Compulsive

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Personality Disorders

 These are longstanding and inflexible patterns of behaviour, usually

emerging in early adulthood (or in some cases, late adolescence)
 Personality disorders are often viewed as the extreme end of
personality traits which have become maladaptive and rigid, often
causing impaired functioning or harm to self or others
 There are three different clusters, which we will discuss below

 Cluster A:
– Paranoid: pervasive distrust and suspiciousness of others
– Schizoid: detachment from social relationships and restricted range of
emotions in interpersonal settings
– Schizotypal: interpersonal deficits marked by discomfort and reduced
capacity for intimate relationships & cognitive or perceptual distortions

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Personality Disorders

 Cluster B:
– Antisocial: disregard for others and violation of their rights
– Borderline: marked impulsivity and instability in relationships, self-image
and affects
– Histrionic: excessive emotionality and attention seeking
– Narcissistic: grandiosity, need for admiration, lack of empathy

 Cluster C:
– Avoidant: social inhibition, feelings of inadequacy, hypersensitivity to
negative evaluation
– Dependent: excessive need to be taken care of, leading to submissive
and clinging behaviours and fear of separation
– Obsessive-Compulsive: preoccupation with orderliness, perfectionism,
and mental and interpersonal control at the expense of flexibility,
openness, and efficiency

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Diagnostics, issues, what does
the future hold?
 Issues with Nosological Diagnosis

 Comorbidity
– For approx. 50% of people that meet the criteria for one disorder
will meet the criteria for a second, and so on

People with disorders

Number of diagnosed disorders

 How do we study any single consistent disorder?

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Issues with Nosological Diagnosis

 Diagnostic Stability
– For example, a high proportion of anxiety disorders transition to a
different anxiety disorder over a six-year period
 Relatively Poor integrator reliability
– Sometimes one clinician will make a particular diagnosis and another
clinician (with the same consumer at the same time) will make a different
diagnosis
 Inherent symptom level heterogeneity
– e.g., 227 unique possible symptom combinations that fulfil the criteria
for a diagnosis of major depressive disorder

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Dimensional Approach

 To combat these issues dimensional approaches have been

established
– View psychopathology through a continuum among a number of higher-
order and lower-level dimensions.
– No categorical diagnosis, based on statistics (factor analysis)

Caspi et al. (2014) Bifactor Model

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Thank you!

PSY1011:
Psychological Disorders

Lecturer: Dr Darren Haywood