Chapter 15: Psychological Disorders

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Alright, so we're diving deep today and it's a bit of a heavy but fascinating topic, you know, psychological disorders.

We've got this whole chapter we're going to unpack and we want to give you, the listener, a really solid understanding of what these conditions actually are, like, beyond the surface level.

You know what I mean?

Yeah, I think a lot of people hear terms like anxiety or depression thrown around, but to really grasp the nuances, we got to go deeper.

Totally.

So we'll be looking at how they're defined, how we classify them, you know, the different types, the factors involved.

It's a lot, but by the end, you should have a good grasp on the essentials.

Exactly.

We're going to cover anxiety disorders like generalized anxiety, panic disorder, phobias, OCD, PTSD, and then of course we'll get into depressive disorders, bipolar disorder, touch on suicide and self -injury, and then schizophrenia.

And we can even hit on dissociative disorders, personality disorders, and eating disorders.

Wow, that's a pretty comprehensive deep dive.

It is, yeah.

And it's really relevant to so many people's lives, which I think is what makes it so important.

Yeah, absolutely.

And I think it was William James who said,

to study the abnormal is the best way of understanding the normal.

And it really is true.

I love that quote.

It really puts things in perspective, right, because we all have moments where we might experience intense sadness or anxiety, you know, even thoughts or behaviors that seem a little off.

But how do we distinguish those normal fluctuations from something that's actually disorder?

Yeah, that's a key question.

And just to give you a sense of the scale of this, you know, globally, over half a billion people are living with some kind of mental or behavioral disorder.

Wow.

Yeah, that's according to the World Health Organization in 2017.

And if you look specifically at American college students, almost a third of them report having some kind of mental health issue.

That's a lot of people.

It really is.

And some of the big ones like major depressive disorder and schizophrenia, we see those across cultures.

Right.

So that points to something pretty fundamental about, you know, the human experience, human nature, that kind of thing.

Yeah, for sure.

So there are a lot of questions that come up, right?

Like how do our genetics and environment, you know, nature versus nurture, how do those play a role?

And how do we categorize these disorders without, you know, unfairly labeling people?

And what are the actual rates of these disorders?

Like who's affected?

But before we get into all that, let's start with the basics.

What exactly is a psychological disorder?

Okay, so the formal definition from the American Psychiatric Association says it's a syndrome marked by a clinically significant disturbance in an individual's cognition, emotion regulation, or behavior.

Okay.

But what does that really mean in plain English?

Basically it means it's not just everyday worries or feeling a little down.

It has to be something that's really interfering with your life.

It's clinically significant.

Right.

It has to meet a certain threshold.

Exactly.

And then the other key part is that it's dysfunctional or maladaptive.

Like think about someone who likes a clean house.

That's normal.

Right?

But what if their cleaning rituals are so intense that they can't hold a job or maintain relationships?

Right.

Then it becomes a problem.

Exactly.

It's gone beyond a preference and is now interfering with their life.

So it's about the degree, right?

Yeah.

The degree and the impact.

Like there was this lawyer in one of our sources who felt compelled to wash his hands constantly, like dozens and dozens of times a day.

It wasn't just a quirk.

It was impacting his work, his clients, everything.

Wow.

So that's clearly dysfunctional.

Same with sadness, right?

We all get sad sometimes.

But if it's persistent, if it's so intense it stops you from functioning, that's when it might be a depressive disorder.

Okay.

That makes sense.

So we've established what these disorders are,

but how has our understanding of them evolved?

Because I doubt it's always been about clinical significance and dysfunction.

Oh, definitely not.

If we went back in time, like centuries ago, you'd find people attributing unusual behaviors to all sorts of things.

Like what?

Well, you know, planets, spirits, the supernatural.

Imagine someone acting strangely and people would say they were possessed by demons or practicing witchcraft.

Yeah.

And you can guess what kind of treatments came with those beliefs.

Oh, I don't even want to think about it.

Asylums, harsh punishments.

It wasn't pretty.

Right.

That's a whole other deep dive for another time, I think.

So when did things start to change?

Well, a big shift happened with what's called the medical model.

It started viewing psychological disorders more like physical illnesses.

So looking for causes within the body.

Exactly.

And it put an emphasis on diagnosis,

like pinpointing specific syndromes based on symptoms and then finding treatments.

So less about blaming external forces and more about understanding what's going on inside.

Exactly.

But it's not quite the full picture.

Right.

The prevailing view today is called the biopsychosocial approach.

It acknowledges that there's not just one pause, but it's this interaction of biology, psychology, and social factors.

OK, let's unpack that.

What are the biological factors?

Well, you've got genes, right?

We inherit certain predispositions.

And then there's how our brains function and our neurochemistry, meaning the neurotransmitters in our brains.

So like if someone inherits a gene,

that makes them more susceptible to anxiety.

Right.

But it doesn't mean they'll automatically develop anxiety.

Right.

It depends on other factors.

Exactly.

So what are the psychological factors then?

This is more about individual experiences, things like stress, trauma, even things like learned helplessness.

We have a learned helplessness.

It's this feeling of powerlessness, like when you face repeated negative events and start believing you have no control.

OK, so it's a learner response to a negative environment.

Exactly.

And then there's how our moods affect our thinking and memory, you know?

Right.

How our emotional state colors our perceptions.

Exactly.

So what about the social and cultural influences?

This is about the broader context, like societal expectations, cultural norms, how we define normal versus abnormal behavior.

OK, so like how different cultures view certain behaviors.

Exactly.

For example, the level of stress someone experiences and how they cope with it can be very different depending on their culture.

There are even disorders that seem specific to certain cultures, like susto in Latin America, which involves a fear of black magic.

Oh, well.

Or Taijin Kyofusho in Japan, which is a social anxiety about offending others with your appearance.

Interesting.

And then you have things like eating disorders, which are more common in Western cultures with their emphasis on thinness.

Right.

That makes sense.

But then some disorders like depression and schizophrenia seem to show up across cultures.

Right.

That points to a stronger biological basis.

But even then, the way symptoms manifest and are understood can be influenced by culture.

OK, so it's always this interplay.

Exactly.

Then there's the vulnerability stress model, which says we all have varying degrees of vulnerability to disorders.

So some people are more susceptible than others based on their genes or early life experiences.

Exactly.

And when you add significant stress to the mix, it can trigger a disorder in those who are more vulnerable.

And that's where epigenetics comes in, right?

Yes.

Epigenetics is all about how environmental factors can actually switch genes on or off without changing the DNA itself.

Oh, wow.

So your environment can literally affect how your genes are expressed.

And that plays a role in whether you might develop a disorder.

So it's not just nature versus nurture.

It's nature and nurture.

Precisely.

OK, so we've got this complex interplay of factors.

Now, how do we actually go about classifying psychological disorders?

Why is it important to have a system for that?

Well, just like in any field, having a system of classification brings order to chaos.

Like in biology, you have plants and animals categorized.

It helps us understand and communicate.

Makes sense.

Same with psychological disorders.

We group similar symptoms together, and it gives mental health professionals a common language.

So when you say someone has major depressive disorder, everyone knows what that generally means.

Exactly.

But it goes beyond just description.

OK.

A good classification system should also help us predict how a disorder might progress, what outcomes to expect.

Right.

It can guide treatment choices, like what therapies have worked for similar conditions.

And it's crucial for research, for figuring out the underlying causes.

So we can target our research efforts more effectively.

Exactly.

And here in the U .S., the main tool for this is the DSM -5, right?

Right.

The Diagnostic and Statistical Manual of Mental Disorders.

It's like the Bible for diagnosing mental health conditions.

So it outlines specific criteria for each disorder.

Yep.

Like if someone's having trouble sleeping, DSM -5 has criteria for insomnia disorder.

They need to have trouble falling asleep or staying asleep, or they wake up early and can't go back to sleep.

And this happens at least three nights a week for three months, even though they have enough time to sleep.

And this sleep issue has to cause them distress or make it hard to function during the day.

And it can't be explained by other mental health problems or medical conditions.

They're pretty detailed.

It is.

But the DSM -5 has its critics, you know?

Okay.

What are some of the concerns?

Well, one is that it might be pathologizing everyday life.

Like is it casting the net too wide and labeling normal behavior as a disorder?

Right.

There's been a lot of debate around ADHD, for example.

Some say the criteria are too broad and might end up labeling energetic kids as having a disorder when they don't.

That's a tricky one for sure.

Yeah.

And another area of concern is grief.

Like, after a loved one dies, grief can be incredibly painful and it shares some symptoms with depression.

Right.

But it's also a natural human process.

So is the DSM -5 medicalizing something that's normal and necessary?

I see that's a valid point.

Yeah, there's been some pushback.

And actually, in response to some of these criticisms, the National Institute of Mental Health has this project called the Research Domain Criteria, or RDOC.

What's that?

So unlike the DSM, which groups disorders by symptoms, RDOC tries to classify them based on underlying brain functions and behaviors.

Interesting.

Yeah, it's looking at things like fear, reward learning, attention, memory, social processes, arousal, that kind of stuff.

So more of a biological and dimensional approach.

Exactly.

They're trying to get a deeper understanding of the mechanisms behind mental illness.

Makes sense.

But even with these evolving systems, there are still criticisms about using diagnostic labels at all, right?

Oh, absolutely.

One of the big ones is that they can be subjective.

Like open to interpretation.

Exactly.

They might reflect societal values more than objective science.

And once someone gets labeled, it can affect how others see them and even how they see themselves.

Like a self -fulfilling prophecy.

Yeah, totally.

There was this study by David Rosenhan where healthy people pretended to hear voices to get admitted to a psychiatric hospital.

Oh, I've heard of that.

And then they acted completely normally, but the staff still interpreted their behavior as symptoms of their supposed illness.

Wow, so the label was influencing their perception.

Exactly.

It's like the Pygmalion effect where teachers who were told certain students were gifted actually ended up treating them differently and those students performed better.

Right, because of the expectations.

Exactly.

And with mental health labels, there can be real consequences.

It can be harder to get a job or housing.

And there's this huge stigma still.

Yeah, the stigma is a huge problem.

It prevents people from seeking help.

Glenn Close has spoken a lot about this toxic stigma surrounding mental illness.

She has.

And it's so important that people like her speak out about it.

But you know, on the flip side, labels can also have benefits, can't they?

Yeah, for sure.

Like what?

Well, for one, they help professionals communicate with each other.

It gives them a common understanding of the symptoms and possible treatments.

And they're essential for research.

How can we study something if we don't even have a name for it?

Okay, that makes sense.

And for the person who's struggling,

getting a diagnosis can be validating.

It can be a relief to know they're not alone and that there's a reason for their struggles.

It can give them a way to understand what's going on.

Exactly.

It's like Alice Munderline said, what's the use of their having names if they won't answer to them?

Huh.

That's a good one.

So labels are a tool.

And like any tool, they can be used for good or bad.

Exactly.

Okay, so we've talked about defining these disorders, understanding the factors involved, and the complexities of classifying them.

But one thing that needs to be addressed is this idea that psychological disorders equal danger.

Yeah, it's a harmful stereotype.

Especially after tragic events like the Navy Yard shooting, where the perpetrator had a history of mental health issues.

Right.

It reinforces that misconception that people with mental illness are violent.

But what does the research actually say?

The vast majority of violent criminals don't have a mental illness.

Oh, wow.

And most people with mental illness are not violent at all.

Okay, so the connection isn't as strong as people think.

Not at all.

In fact, people with mental illness are more likely to be the victims of violence.

That's awful.

It is.

And the US Surgeon General has said that there's very little risk of violence from just interacting with someone who has a mental disorder.

Okay, so that's important to remember.

Yeah.

So if mental illness isn't a good predictor of violence, what is?

Yeah, what factors are more reliable?

Things like substance abuse, a history of violence, access to firearms.

Those are much stronger predictors.

And when it comes to mass shootings, it's usually young men.

Right.

Now, there is a small subset of people with mental illness who do become violent.

But there are usually other factors involved, like threatening delusions, hallucinations, telling them to do things, severe stress, substance abuse.

It's never simple.

It's complicated.

It is.

And then there are the legal and ethical questions when someone with a mental illness does commit a crime.

Right.

Like how responsible are they held?

Exactly.

We've seen cases like John Hinckley Jr., who shot President Reagan and was found not guilty by reason of insanity.

And then Jared Lee Loeffner, who committed a mass shooting, was diagnosed with schizophrenia but sentenced to life in prison.

So there's no easy answer.

No.

It's a complex issue.

OK.

Let's switch gears a bit and talk about the rates of these disorders, like how common are they?

OK.

So how we usually figure this out is through large -scale interviews.

OK.

Researchers use standardized questions to ask people about their symptoms.

And then they apply the diagnostic criteria to see who meets the threshold for a disorder.

Got it.

The World Health Organization did a big study across 28 countries.

And the findings were interesting.

The lowest rates of mental disorders were reported in Nigeria, while the highest were in the U .S.

That's a big difference.

It is.

And there's also this thing called the immigrant paradox.

What's that?

It's where immigrants to the U .S.

from places like Mexico, Africa, and Asia often have better mental health than people of the same ethnicity who were born here.

Really?

Yeah.

Like recent Mexican immigrants have lower rates of mental illness than Mexican -Americans who were born in the U .S.

Why is that?

We're still figuring that out, but it might have to do with things like strong social support networks in immigrant communities or the fact that people who choose to immigrate might be particularly resilient.

Interesting.

So what about the overall rates in the U .S.?

Well, the National Institute of Mental Health estimates that almost one in five American adults has or has had a mental, behavioral, or emotional disorder in the past year.

Wow.

So that's a pretty significant portion of the population.

It is.

And if you break it down, about 7 % of adults have major depressive disorder, almost 19 % have an anxiety disorder, and about 8 % have a substance use disorder.

And then smaller percentages have things like PTSD, ADHD, schizophrenia, and OCD.

So it seems like anxiety is the most common type.

Yeah, it seems that way.

Are there any things that make someone more or less likely to develop a mental disorder?

Absolutely.

There are a lot of risk and protective factors.

Like what?

Well, some risk factors are academic failure, birth complications, child abuse or neglect,

chronic insomnia or pain, family conflict, low birth weight, low socioeconomic status, having a parent with a mental illness or substance abuse problem,

personal loss or trauma, poor work skills, learning or sensory disabilities, problems with social skills, stressful life events, substance abuse, and trauma.

That's a lot.

It is.

But there are also protective factors.

What are those?

Well, regular aerobic exercise is a big one,

and living in a supportive community, achieving financial independence, having good parenting, feeling in control of your life, having high self -esteem, strong literacy skills,

forming secure attachments early on, developing good problem -solving and coping skills, having good social and work skills, and a strong support network of friends and family.

It's like a balance, right?

The risks and the protection.

Exactly.

And poverty is a big risk factor.

People below the poverty line are two and a half times more likely to have a serious mental illness.

Wow.

It's often a vicious cycle.

Schizophrenia, for instance, can lead to poverty because it's hard to hold a job.

And then the stresses of poverty can lead to things like depression and substance abuse.

Right.

So it goes both ways.

Exactly.

There's a really cool study with Native American kids in North Carolina that shows this.

Some families were lifted out of poverty because a casino opened on their land.

Oh, wow.

And the kids in those families had a significant decrease in behavioral problems.

So improving their economic situation had a real impact.

Absolutely.

Now, when do these disorders usually start to show up in people's lives?

Most of them appear by early adulthood.

More than 75 % of people who eventually have a disorder start experiencing symptoms by age 24.

Okay.

Some, like antisocial personality disorder and specific phobias, often show up earlier during childhood or adolescence.

Others, like alcohol use disorder, OCD, bipolar disorder, and schizophrenia, typically have a median onset age around the early 20s.

And then major depressive disorder tends to emerge a bit later, around age 25.

So these are conditions that often arise during key developmental periods.

I have for sure.

All right.

Let's dive into some specific categories, starting with anxiety disorders, OCD, and PTSD.

Okay.

What are the defining features of anxiety disorders?

Well, they're all about, you know, feeling distressed and anxious a lot or engaging in behaviors to try to reduce anxiety.

Like what?

Like social anxiety disorder.

People with this are terrified of being judged in social situations.

I know people like that.

Yeah.

It can be so bad that they avoid social situations altogether.

Right.

But within anxiety disorders, you have different types, like generalized anxiety disorder, panic disorder, and phobias.

What's the difference between those?

Okay.

So generalized anxiety is like this constant excessive worry about all sorts of things.

It goes on for at least six months.

They feel restless, on edge, tired, can't concentrate, have muscle tensions, sleep problems.

Sounds exhausting.

It is.

And the anxiety is free -floating, meaning it's not attached to any specific thing.

Right.

Now panic disorder is different.

It involves panic attacks, which are these sudden bursts of intense fear.

I heard of those.

Yeah.

They come out of nowhere and they peak within minutes.

You get physical symptoms like a racing heart, chest pain, shortness of breath, dizziness.

Scary.

It is.

And afterwards, people are often terrified of having another attack, and that can lead to agoraphobia.

Would you?

Fear of situations where you can't easily escape or get help, like crowds, open spaces, public transportation.

Makes sense.

And then there are phobias.

These are intense, irrational fears of specific things.

Like spiders or heights.

Exactly.

The fear is way out of proportion to the actual danger, and just being near the thing triggers panic.

So they try to avoid it at all costs.

Exactly.

Okay.

Now what about OCD?

How does that fit in?

So OCD is all about obsessions and compulsions.

Like what?

Obsessions are unwanted thoughts that pop into your head and won't go away.

Okay.

And compulsions are repetitive behaviors or mental acts that you feel you have to do.

Like washing your hands over and over.

Exactly.

It can be very time -consuming and distressing,

like someone might be obsessed with contamination and feel compelled to wash their hands constantly.

Even though they know it's excessive, the anxiety is real for them, and the compulsion gives temporary relief.

So it's a cycle.

Yeah.

And it usually starts in the late teens or early twenties and affects about 2 % of people.

For most people, the symptoms do get better over time.

That's good to hear.

Yeah.

Now what about PTSD?

PTSD, or post -traumatic stress disorder, can happen after someone experiences or witnesses a traumatic event.

Okay.

It involves intrusive symptoms like flashbacks, nightmares, and intense reactions to reminders of the trauma.

Makes sense.

They also avoid things that remind them of the trauma, have negative thoughts and feelings, and changes in their arousal and reactivity like being jumpy or having trouble sleeping.

It's important to note that not everyone who goes through a traumatic event develops PTSD.

Right.

Some people are more resilient.

Exactly.

And things like the intensity of the trauma, the level of perceived threat, emotional distress,

genetics, and even gender play a role in who develops it.

Women are generally at higher risk.

Okay.

So a lot of factors are at play.

Yeah.

And there's some debate about whether PTSD is being overdiagnosed in some cases.

There's also some evidence that immediate debriefing after a trauma might not always be helpful and could even interfere with natural recovery.

Interesting.

So with anxiety, OCD, and PTSD, we see this range of experiences linked to anxiety but expressed in different ways.

Now what do we know about the underlying causes?

There are three main perspectives,

conditioning,

cognition, and biology.

Okay.

Let's break those down.

So conditioning is based on learning principles like classical conditioning.

Remember Pavlov's dogs?

Bigly.

Well, it's basically learning to associate a neutral stimulus with a response.

Like in a little Albert experiment, they conditioned a baby to fear a white rat by pairing it with a loud noise.

Oh, right.

So let's say you have a car accident.

You might develop a fear of driving even in different cars because you've associated cars with danger.

Okay.

So that's stimulus generalization.

Exactly.

And then there's operant conditioning where behaviors get reinforced.

Like if avoiding something reduces your anxiety, you're more likely to keep avoiding it.

Makes sense.

Same with compulsions.

The temporary relief reinforces the behavior.

So what about the cognitive perspective?

Well, cognition is all about thoughts, beliefs,

interpretations, expectations.

People with anxiety often have catastrophic thinking, meaning they overestimate the likelihood of bad things happening.

They might also focus more on threats and interpret ambiguous situations negatively.

So their thoughts contribute to their anxiety.

Exactly.

And we can also learn to fear things just by observing others.

Yeah.

There's this study with monkeys, lab -raised monkeys who'd never seen a snake, learned to fear snakes just by watching wild monkeys react fearfully to them.

Wow.

So we can pick up fears from others.

We can.

Okay.

So what about biology?

Well, genes definitely play a role.

Like predisposing people to anxiety.

Exactly.

Anxiety tends to run in families, and identical twins are more likely to both have an anxiety disorder than fraternal twins.

Okay.

And researchers are trying to pinpoint specific genes that might be involved.

Interesting.

And then there's the brain itself.

Trauma can actually create fear circuits in the amygdala, which is the brain's fear center.

So you become more reactive to perceived threats.

And in these disorders, we often see overactivity in brain areas related to threat detection, impulse control, and habits.

So like the brain's danger detection system is on overdrive.

Exactly.

And some antidepressants that work for these disorders actually dampen activity in these circuits.

Oh, wow.

Yeah, it's pretty amazing.

There's even research on using drugs to block the reconsolidation of traumatic memories, which could help reduce fear.

That's fascinating.

It is.

And then from an evolutionary standpoint, it makes sense that we'd be predisposed to fear certain things.

Like things that were dangerous to our ancestors.

Exactly.

Spiders, snakes, heights, storms.

These were real threats back then.

Right.

And compulsions in OCD can even be seen as exaggerated versions of survival behaviors like grooming becomes hair pulling, washing becomes ritualistic hand washing, checking boundaries becomes checking locks over and over.

So it's like our ancient wiring gone haywire.

In a way.

Yeah.

Okay.

So we've covered anxiety disorders, OCD, and PTSD.

Let's move on to depressive disorders, bipolar disorder, and the topics of suicide and self -injury.

Okay.

These are all about disturbances in mood, right?

How do depressive disorders differ from bipolar disorder?

So depressive disorders are mainly about feeling really down, losing interest in things, and having a bunch of other emotional, cognitive, and physical symptoms that affect your everyday life.

Bipolar disorder is different.

It's marked by extreme shifts in mood, energy, activity levels, concentration, everything.

Like going from super low to super high.

Exactly.

They have periods of intense lows, which are the depressive episodes, and periods of intense highs called manic or hypomanic episodes.

So it's like a roller coaster of emotions.

It can be.

And it's worth mentioning that feeling significantly depressed is more common than people realize.

Really?

Yeah.

Like a significant percentage of college students report feeling so depressed that it was difficult to function.

It's a very real and widespread issue.

It's more than just feeling blue, and there are different types of depressive disorders, right?

Yeah.

The main ones are major depressive disorder and persistent depressive disorder.

What's the difference?

Well, with major depressive disorder, you need to have at least five specific symptoms of depression for at least two weeks.

One of those symptoms has to be either a depressed mood or loss of interest or pleasure in things.

And the other symptoms can include things like changes in appetite or weight,

trouble sleeping or sleeping too much, feeling agitated or slowed down, fatigue, feeling worthless or guilty, trouble thinking or concentrating, and thoughts of death or suicide.

That's a pretty heavy list.

It is.

And persistent depressive disorder or dysthymia is like a milder but more chronic form of depression.

It lasts for at least two years in adults, one year in kids and teens.

So it's less intense but longer lasting.

Right.

And during that time, they have at least two of the following symptoms.

Poor appetite or overeating, insomnia or hypersomnia,

low energy, low self -esteem, difficulty concentrating or feeling hopeless.

Got it.

And you mentioned earlier that depression is really prevalent.

It is.

It's the top reason people seek mental health help.

And it's a major cause of disability worldwide.

Wow.

Yeah.

It's a big issue.

Okay.

And then there's bipolar disorder with its swings between depression and mania.

Right.

What's a manic episode like?

Well, it's a distinct period of being in an abnormally elevated, expansive or irritable mood.

And their energy and activity are also abnormally increased.

This lasts for at least a week or any duration if they need to be hospitalized.

And during this time, they'll usually have other symptoms like inflated self -esteem, needing very little sleep, talking more than usual or feeling pressured to keep talking.

Their thoughts are racing, they're easily distracted, they're engaging in lots of goal -directed activity or doing risky things.

So it sounds like they're almost in overdrive.

Yeah, kind of.

And this can actually lead to problems with relationships, work, finances and even legal issues.

Right.

If their judgment is impaired.

Exactly.

Now, what do we know about what causes depressive disorders and bipolar disorder?

Okay.

So most of the research has focused on...