ETIOLOGIES

Intellectual disabilities

⦁ Biological Causes of Intellectual Disability

⦁ Chromosomal Causes

⦁ Metabolic Causes

⦁ Prenatal and Birth-Related Causes

⦁ Consanguity

⦁ Immune dysfunction

⦁ Infectious diseases

⦁ Environmental Hazards

Prenatal and Birth-Related Causes

⦁ Psychological and physical health of the mother

⦁ Poor iodine in diet

⦁ Foetal alcohol syndrome

⦁ maternal infections
 ⦁ Birth complications (anoxia)

Aetiology of Communication Disorders

⦁ Abnormal brain development.

⦁ Exposure to substance abuse or toxins before birth.

⦁ Cleft lip or palate.

⦁ Genetic factors.

⦁ Traumatic brain injuries.

⦁ Neurological disorders.

⦁ Strokes.

⦁ Tumours in the brain area used for communication.

AUTISM SPECTRUM

⦁ Autoimmune and inflammatory diseases

⦁ Family history

⦁ Extremely preterm babies (before 26 weeks of gustation)

⦁ Parent’s age
 ⦁ Viruses and vaccinations

⦁ Child’s sex

⦁ Autoimmune and inflammatory diseases

⦁ Family history

⦁ Extremely preterm babies ( before 26 weeks of gustation)

⦁ Parent’s age

⦁ Viruses and vaccinations

⦁ Child’s sex

ADHD

⦁ The Family Connection

⦁ Food additives (artificial food colours and the preservative, sodium

benzoate.

⦁ TV or video games

⦁ Bad parenting

⦁ Brain injury (brain tumour, a stroke, or disease)

 ⦁ Neurological factors:

 dopamine

 less activity in frontal area

Perinatal and prenatal factors:

 Low birth weight

 Birth complications

 Mother’s substance use

⦁ Toxins in the environment

 Sugar

 food colours

⦁ Psychological factors:

 Parent child relationship (commands, interaction)

 parents' history of ADHD

⦁ Sociocultural causes:

 Family dysfunction

 Social stress

 Rigid, cold, disturbing parents

⦁ Biological causes:

 Cerebellum (movement of body and attention)

ETIOLOGY OF LEARNING DISABILITY

The etiological factors in learning disability are explained by five models.

a. The difference model: This model states that individual differences in cognitive

ability tend to be normally distributed throughout a given population and learning

difficulties result from the natural occurrence of poorly developed cognitive skills.

b. The deficit model: This model postulates learning difficulties that are

associated with organic conditions that interfere with learning. These may include

mixed cerebral dominance, maldevelopment or disease of the brain, vestibular

difficulties and ocular difficulties.

c. The delay model: In this model, learning difficulties are associated with

immaturity in development which eventually will be resolved and academic skills

will develop.

d. The disruption model: This postulates that, extraneous factors such as anxiety

or depression are disrupting the learning process.

e. The personal-historical model: This model suggests that the student has not

acquired the basic skills needed for learning because of environmental factors such

as failure in the teaching or learning process.

ETIOLOGY
DCD

Although there are many theories, it is not yet possible to offer a clear answer

about what causes DCD. As children with DCD can have associated difficulties in

addition to their motor difficulties, it seems unlikely that a single factor will

explain the coordination problems observed in this group of children. Most

recently, researchers have suggested a possible link between the cerebellum and

the challenges seen with DCD, as the cerebellum is critical for developing

automatic movement control and the ongoing monitoring of movements, both of

which are affected in DCD.

STEREOTYPIC MOVEMENT DISORDER

Stereotypic movements are typically first seen within the first three years of life.

The cause of stereotypic movement disorder is unknown, but several factors are

connected to its development. Social isolation, for example, may lead to self-

stimulation in the form of stereotypic movements. Environmental stress, such as

difficulty in school or at home, can trigger stereotypic behavior. There may also be

a genetic component to the condition.

Stereotypic movements may develop with certain medications and typically go

away once the medication is stopped. Stereotypic movements due to severe head

injury may be permanent.
The risk for stereotypic movement disorder is greater among individuals with

severe intellectual disability. In typically developing children, stereotypic

movements can often be suppressed or lessened over time. Among people with

intellectual disability, however, the stereotyped, self-injurious behaviors can last

for many years

SCHIZOPHRENIA

Biological Views

Genetic Factors Following the principles of the diathesis stress

perspective, genetic researchers believe that some people

inherit a biological predisposition to schizophrenia and develop

the disorder later when they face extreme stress, usually during

late adolescence or early adulthood (Riley & Kendler, 2011).

The genetic view has been supported by studies of (1) relatives

of people with schizophrenia, (2) twins with this disorder, (3)

people with schizophrenia who are adopted, and (4) genetic

linkage and molecular biology.

Biochemical Abnormalities

dopamine hypothesis
to explain their findings on schizophrenia: certain neurons that

use the neurotransmitter

dopamine (particularly neurons in the striatum region of the

brain) fire too often

and transmit too many messages, thus producing the symptoms

of the disorder

Abnormal Brain Structure

many people with schizophrenia have enlarged

ventricles—the brain cavities that contain cerebrospinal fluid

studies suggest that some patients with

schizophrenia also have smaller temporal lobes and frontal lobes

than other people, smaller amounts of cortical gray matter, and,

perhaps most important, abnormal blood flow—either reduced

or heightened—in certain areas of the brain

Viral Problems

some investigators suggest

that the brain abnormalities may result from exposure to viruses

before birth. Perhaps

the viruses enter the fetus’ brain and interrupt proper brain

development, or perhaps the

viruses remain quiet until puberty or young adulthood, when,

activated by changes in

hormones or by another viral infection, they help to bring about

schizophrenic symptoms

Psychological Views

The Psychodynamic Explanation

Freud (1924, 1915, 1914)

believed that schizophrenia develops from two psychological

processes:

(1) regression to a pre-ego stage and (2) efforts to reestablish ego

control. He proposed that when their world has been extremely

harsh

or withholding—for example, when their parents have been cold

or

unnurturing or when they have experienced severe traumas—

some

individuals regress to the earliest point in their development, to

the pre-ego state of primary narcissism, in which they recognize

and

meet only their own needs. This sets the stage for schizophrenia.

Their near-total regression leads to self-centered symptoms such

as

neologisms, loose associations, and delusions of grandeur.

Frieda Fromm-Reichmann (1948) elaborated

on Freud’s notion that cold or unnurturing parents may set

schizophrenia in

motion. She described the mothers of people who develop this

disorder as cold, domineering,

and uninterested in their children’s needs

self-theorists, who believe that schizophrenia reflects a

struggling fragmented

self, suggest that biological deficiencies explain the failure of

people with this

disorder to develop an integrated self

The Behavioral View

Behaviorists usually cite operant conditioning and

principles of reinforcement as the cause of schizophrenia. They

propose

that most people become quite proficient at reading and

responding to

social cues—that is, other people’s smiles, frowns, and comments.

People

who respond to such cues in a socially acceptable way are better

able to

satisfy their own emotional needs and achieve their goals (Bach,

2007).

Some people, however, are not reinforced for their attention to

social cues,

either because of unusual circumstances or because important

figures in

their lives are socially inadequate. As a result, they stop attending

to such

cues and focus instead on irrelevant cues—the brightness of light

in a room,

a bird flying above, or the sound of a word rather than its

meaning. As they
attend more and more to irrelevant cues, their responses become

increasingly

bizarre. Because the bizarre responses are rewarded with

attention or

other types of reinforcement, they are likely to be repeated again

and again.

The Cognitive View

According to the cognitive explanation,

however, further features of the disorder emerge when the

individuals attempt to

understand their unusual experiences (Tarrier, 2008; Waters et

al., 2007). When first

confronted by voices or other troubling sensations, these people

turn to friends and

relatives. Naturally, the friends and relatives deny the reality of

the sensations, and eventually

the sufferers conclude that the others are trying to hide the truth.

They begin to
reject all feedback, and some develop beliefs (delusions) that

they are being persecuted

(Perez-Alvarez et al., 2008; Bach, 2007). In short, according to

this theory, people with

schizophrenia take a “rational path to madness”

Sociocultural Views

Social Labeling

society

assigns the label “schizophrenic” to people who fail to conform to

certain norms of

behavior. Once the label is assigned, justified or not, it becomes a

self-fulfilling prophecy

that promotes the development of many schizophrenic

symptoms. Certainly sufferers of

schizophrenia have attested to the power that labeling has had on

their lives:

Family Dysfunction Theorists have suggested for years that

certain patterns
of family interactions can promote—or at least sustain—

schizophrenic symptoms. One

leading theory has focused on double-bind communications.

It says that some parents repeatedly communicate pairs of

mutually contradictory

messages that place children in so-called double-bind situations:

the children cannot

avoid displeasing their parents because nothing they do is right.

In theory, the symptoms

of schizophrenia represent the child’s attempt to deal with the

double binds.

The Role of Family Stress

studies do

suggest that schizophrenia, like a number of other mental

disorders,

is often linked to family. Parents of people with this

disorder often (1) display more conflict, (2) have greater difficulty

communicating with one another, and (3) are more critical of and

overinvolved with their children than other parents.

R. D. Laing’s View One final sociocultural explanation of

schizophrenia continues

to have legions of supporters in the public at large despite the

fact that it is controversial

and largely untested by research. Famous clinical theorist R. D.

Laing (1967,

1964, 1959) combined sociocultural principles with existential

philosophy, arguing that

schizophrenia is actually a constructive process in which people

try to cure themselves of

the confusion and unhappiness caused by their social

environment. Laing believed that,

left alone to complete this process, people with schizophrenia

would indeed achieve a

healthy outcome.

Aetiology of Eating Disorder:

Pica Disorder:

Gastrointestinal Distress:
During incidences in which gastrointestinal distress occurs, individuals engage in

pica as a self-soothing method. Typical gastrointestinal distress is the result of the

exposure to pathogens and toxins within the gastrointestinal tract. Gastrointestinal

distress can also result from mechanical stimulation of the gastrointestinal tract.

Potential explanations for pica behaviors as a method to ease gastrointestinal

distress include a way to control the pH of the gastrointestinal tract. When earth is

consumed by an individual with pica the pH of the gastrointestinal tract will

increase and become more basic, which may result in a soothing effect for the

individual. By consuming substances such as earth, individuals would be able to

reduce the bioavailability of pathogens and toxins in the gastrointestinal tract.

individuals who were experiencing improper pH levels in their digestive tract

would crave specific items such as unripe fruit, certain spices, chalk, clay, or

vinegar in order to correct the pH levels.

Micronutrient Deficiency:

A micronutrient is a required nutrient that must be achieved through the diet in

specified milligrams per day, or trace amounts. A common micronutrient

deficiency that is related to pica is iron. Iron deficiency can result in situations such

as pregnancy, chronic bleeding, improperly balanced diet, and impaired iron

absorption
Neurological Disorder:

The foods that individuals consume can impact the overall health of their bodies.

The many mechanisms that occur within the human body will influence the

behaviors that are acted upon.

Beecroft, Bach, Tunstall, and Howard (1998) conducted a case study focusing

upon an individual who had been engaging in pica for over twenty years. The

individual was a seventy-five year old woman whom had consumed items such as

coins, nuts, wire, plastic, dog fur conditioning powder, and dried flowers. She

equated her desire to consume the listed non-food items to be on the level of a

smoker’s need to have cigarettes. She did not claim to be addicted to consuming

the non-food items, but she needed them in order to ease her feelings of anxiety.

She was later hospitalized in a psychiatric unit and presented herself to be a well-

oriented individual. When she was presented with coins at the unit, she presented

herself as evasive towards the coins and the researchers surmised that this action

was due to embarrassment. The researchers assessed her cognitive function

through the administration of various tasks and tests. The results indicated that she

was experiencing a decrease in cognitive function and performance that is

associated with the frontal lobe of the brain. Further scans indicated that she was

experiencing frontotempotal atrophy. Rose, Porcerelli, and Neale (2000) support

the idea that certain brain lesions influence abnormal eating behaviors.
Obsessive-Compulsive Spectrum Disorders:

The engagement of pica behaviors can also be related to obsessive-compulsive

spectrum disorders. When pica is influenced by obsessive-compulsive spectrum

disorders, the behaviors related to pica are seen as involuntary in order to serve as

a self-soothing device to ease tension. Attempts to resist can result in increased

levels of anxiety and distress if not addressed with the obsessive behavior to sooth

the anxiety and distress.

Herguner, Ozyildirim, and Tanidir (2008) conducted a case study regarding an

individual who had been engaging in pica for five years. The individual was a ten

year-old boy who had been consuming carpet and cloth fibers. He described his

activity as irresistible and he would experience a bit of tension before consuming

the fibers. After eating the fibers, he reported feeling more relaxed. He was

assessed for severity of obsessive-compulsive disorder symptoms using the Yale-

Brown Obsessive-Compulsive Scale. His total score was 19, out of a possible total

of 40, which categorize the severity of his obsessive-compulsive disorder

symptoms to be moderate. This patient was prescribed a medication common to

obsessive-compulsive disorder, fluoxetine, for nine months. At a one year follow-

up, he did not demonstrate any pica behaviors. This case study supports the idea

that pica is related to obsessive-compulsive spectrum disorders due to pica-related

behaviors ceasing in response to selective serotonin reuptake inhibitors.

• Dieting:people who diet may attempt to ease hunger by eating nonfood

substances to get a feeling of fullness

• Malnutrition: especially in developing countries, where people with pica

most commonly eat soil or clay

• cultural factors:in families, religions, or groups in which eating nonfood

substances is a learned practice

• parental neglect, lack of supervision, or food deprivation: often seen in

children living in poverty

• developmental problems: such as autism, other developmental disabilities, or

brain abnormalities

• mental health conditions: such as obsessive compulsive disorder and

schizophrenia

• pregnancy: but it's been suggested that pica during pregnancy occurs more

frequently in women who exhibited similar practices during their childhood or

before pregnancy or who have a history of pica in their family.

Rumination Disorder:

Rumination disorder may occur following a viral illness, emotional stress, or

physical injury. It is theorized that while the initial stressor improves, an altered
sensation in the abdomen persists. This ultimately results in the relaxation of the

muscle at the bottom of the esophagus. To relieve this discomfort people with

rumination disorder use abdominal wall muscles to expel and regurgitate foods. As

a result of the relief of symptoms, the person repeats the same response when the

discomfort returns. Overtime the person unconsciously adopts this learned

behavior.

Avoident/Restrictive Food Intake Disorder:

Like other eating disturbances, there is no singular cause of avoidant/restrictive

food intake disorder (ARFID). However, the evolving scientific literature suggests

that this pattern of disordered eating develops from a complex interplay between

genetic, psychological and sociocultural factors.

Genetic factors

Eating disorders are familial illnesses and temperamental traits predisposing

individuals toward developing an illness are passed from generation to generation.

Psychological factors

Anxiety and obsessive compulsive disorder symptoms tend to accompany eating

disturbances, as do co-occurring mood and anxiety disorders.

Sociocultural factors
Cultural pressures to eat clean/pure/healthy as well as increased interests in food

processing, sourcing, packing and the environmental impact can influence food

beliefs and intake.

The exact cause of ARFID is unknown but, as is the case for all eating disorders, a

variety of biological, neurological, genetic, environmental, and sociocultural

factors are likely to be involved. The condition is more likely to affect children

with a history of extreme picky eating or who don’t grow out of a stage of normal

picky eating. Early trauma, including traumatic experiences with food, such as an

episode of choking, can play a role. Those with attention-deficit issues, on the

autism spectrum or with anxiety disorders or intellectual disabilities are also at

higher than normal risk of developing ARFID.

Anorexia Nervousa and Bulimia Nervousa Disorder:

Genetic Factors:

Both Anorexia Nervousa and Bulimia Nervousa run in families. First degree

relatives of young women with anorexia nervousa are more then ten times more

likely then average to have the disorder themselves. Similar results are found for

bulimia nervosa, where first-degree relatives of women with bulimia nervosa are

about four times more likely than average to have the disorder. Relatives of people
with eating disorders are more likely than average to have symptoms of eating

disorders that do not meet the complete criteria for a diagnosis.

In twin studies, research has shown that nonshared/ unique environmental factors

like different interactions with parents or different peer groups, also contribute to

the development of eating disorders. For example, a study of more than 1,200 twin

pairs found that 42 percent of the variance in bulimia symptoms was attributable to

genetic factors but 58 percent of the variance was attributable to unique

environmental factors . Research also suggests that key features of the eating

disorders, such as dissatisfaction with one’s body, a strong desire to be thin, binge

eating, and preoccupation with weight, are heritable . Additional evidence suggests

that common genetic factors may account for the relationship between certain

personality characteristics, such as negative emotionality and constraint, and eating

disorders. The results of these studies are consistent with the possibility that genes

play a role in eating disorders, but studies showing how genetic factors interact

with the environment are needed.

Neurobiological Factors:

The hypothalamus is a key brain center for regulating hunger and eating. Research

on animals with lesions to the lateral hypothalamus indicates that they lose weight

and have no appetite. Thus, it is not surprising that the hypothalamus has been pro-
posed to play a role in anorexia. The level of some hormones regulated by the

hypothalamus, such as cortisol, is indeed abnormal in people with anorexia. Rather

than causing the disorder, however, these hormonal abnormalities occur as a result

of self-starvation, and levels return to normal after weight gain.

Endogenous opioids are substances produced by the body that reduce pain

sensations, enhance mood, and suppress appetite. Opioids are released during

starvation and have been hypothesized to play a role in both anorexia and bulimia.

Starvation among people with anorexia may increase the levels of endogenous

opioids, resulting in a positively reinforcing euphoric state. Furthermore, the

excessive exercise seen among some people with eating disorders would increase

opioids and thus be reinforcing.

Finally, some research has focused on neurotransmitters related to eating and

satiety (feeling full). Animal research has shown that serotonin promotes satiety.

Therefore, it could be that the binges of people with bulimia result from a serotonin

deficit that causes them not to feel satiated as they eat. Animal research has also

shown that food restriction interferes with serotonin synthesis in the brain. Thus,

among people with anorexia, the severe food intake restrictions could interfere

with the serotonin system

More recently, researchers have examined the role of the neurotransmitter

dopamine in eating behavior. Studies with animals have shown that dopamine is

linked to the pleasurable aspects of food that compel an animal to go after food ,

and brain imaging studies in humans have shown how dopamine is linked to the

motivation to obtain food and other pleasurable or rewarding things.

Another study found that women with either anorexia nervosa or bulimia nervosa

had greater expression of the dopamine transporter gene DAT . Recall from

Chapter 2 that a gene is “turned on,” or expressed, as it interacts with different

aspects of the environment. The expression of DAT influences the release of a

protein that regulates the reup- take of dopamine back into the synapse. This study

also found that women with either eating disorder exhibited less expression of

another dopamine gene called DRD2. Other studies have found disturbances in the

DRD2 gene only among women with anorexia. These findings point to the role of

dopamine in eating disorders and will need to be replicated in future studies.

Cognitive Behavioural Factors:

Cognitive behavioural theories of anorexia nervosa emphasize fear of fatness and

body-image disturbance as the motivating factors that powerfully reinforce weight

loss. Many who develop anorexia symptoms report that the onset followed a period
of weight loss and dieting. Behaviours that achieve or maintain thinness are

negatively reinforced by the reduction of anxiety about becoming fat.

Dieting and weight loss may be positively reinforced by the sense of mastery or

self-control they create. Some theories also include personality and sociocultural

variables in an attempt to explain how fear of fatness and body-image disturbances

develop. For example, perfectionism and a sense of personal inadequacy may lead

a person to become especially concerned with his or her appearance, making

dieting a potent reinforcer. Similarly, seeing portrayals in the media of thinness as

an ideal, being overweight, and tending to compare oneself with especially at-

tractive others all contribute to dissatisfaction with one’s body.

Another important factor in producing a strong drive for thinness and a disturbed

body image is criticism from peers and parents about being overweight.

People with bulimia nervosa are also thought to be overconcerned with weight gain

and body appearance; indeed, they judge their self-worth mainly by their weight

and shape. They also have low self-esteem, and because weight and shape are

somewhat more controllable than are other features of the self, they tend to focus

on weight and shape, hoping their efforts in this area will make them feel better

generally. They try to follow a pattern of restrictive eating that is very rigid, with

strict rules regarding how much to eat, what kinds of food to eat, and when to eat.
Research methods from cognitive science have been used to study how attention,

memory, and problem solving are impacted in people with eating disorders. Using

cognitive tasks such as the Stroop task and the dot probe test, research shows that

people with anorexia and bulimia focus their attention on food-related words or

images more than other images. People with anorexia nervosa and people who

score high on restrained eating remember food words better when they are full but

not when they are hungry. Other studies have found that college women with

eating disorder symptoms pay attention to and better remember images depicting

other people’s body size more than images depicting emotion. Thus, women with

eating disorders pay greater attention not only to their own bodies, food, and

weight but also to other women’s bodies, food, and shapes. This bias toward food

and body image may make it harder for women with eating disorders to change

their thinking patterns.

Not only does the fear of being fat contribute to eating pathology, but more

recently the celebration of extreme thinness via websites, blogs, and magazines

may also play a role. Websites that are “pro-Ana” (short for anorexia) or “pro-mia”

(short for bulimia) and other “thinsperation” websites and blogs have developed a

following of women who seek support and encourage- ment for losing weight,

often to a dangerously low level. These sites often post photos of female celebrities
who are extremely thin as inspiration. Some of these women have publicly

discussed their struggles with eating disorders, but others have not.

Gender Influence:

We have discussed the fact that eating disorders are more common in women than

in men. One primary reason for the greater prevalence of eating disorders among

women is likely due to the fact that Western cultural standards about thinness have

changed over the past 50 years, today reinforcing the desirability of being thin for

women more than for men. Another sociocultural factor, though, has remained

remarkably resilient to change namely, the objectification of women’s bodies.

Women’s bodies are often viewed through a sexual lens; in effect, women are

defined by their bodies, whereas men are esteemed more for their

accomplishments. According to objectification theory the prevalence of

objectification messages in Western culture (in television, advertisements, and so

forth) has led some women to “self-objectify,” which means that they see their

own bodies through the eyes of others.

Ethnic Differences:

In the United States, it was reported at one time that the incidence of anorexia

was eight times greater in white women than in women of colour. More recent

studies do not support this contention. Indeed there is a somewhat greater

incidence of eating disturbances and body dissatisfaction among white women than

black women, but differences in actual eating disorders, particularly bulimia, do

not appear to be as great. In addition, the greatest differences between white and

black women in eating disorder pathology appear to be most pronounced in college

student samples; fewer differences are observed in either high school or nonclinical

community samples

Socioeconomic status is also important to consider. The emphasis on thinness and

dieting has spread beyond white women of upper and middle socioeconomic status

to women of lower socioeconomic status, as has the prevalence of eating disorder

pathology.

Binge Eating:

While the exact cause of BED is unknown, there are a variety of factors that are

thought to influence the development of this disorder. These factors are:

• Biological: Biological abnormalities, such as hormonal irregularities or

genetic mutations, may be associated with compulsive eating and food addiction.

• Psychological: A strong correlation has been established between depression

and binge eating. Body dissatisfaction, low self-esteem, and difficulty coping with

feelings can also contribute to binge eating disorder.

• Social and Cultural: Traumatic situations, such as a history of sexual abuse,

can increase the risk of binge eating. Social pressures to be thin, which are

typically influenced through media, can trigger emotional eating. Persons subject

to critical comments about their

bodies or weight may be especially vulnerable to binge eating disorder.

They try to follow a pattern of restrictive eating that is very rigid, with strict rules.

regarding how much to eat, what kinds of food to eat, and when to eat. These strict

rules are inevitably broken, and the lapse escalates into a binge. After the binge,

feelings of disgust and fear of becoming fat build up, leading to compensatory

actions such as vomiting (Fairburn, 1997). Although purging temporarily reduces

the anxiety from having eaten too much, this cycle lowers the person’s self-esteem,

which triggers still more bingeing and purging, a vicious circle that maintains

desired body weight but has serious medical consequence. Several additional

conditions have been found to further increase the eating of restrained eaters after a

preload, most notably various negative mood states, such as anxiety and depression

(e.g., Herman et al., 1987). The increased consumption of restrained eaters is

especially pronounced when their self-image is threatened (Heatherton, Herman, &

Polivy, 1991) and if they have low self-esteem (Polivy et al., 1988). Finally, when

restrained eaters are given false feedback indicating that their weight is high, they

respond with increases in negative emotion and increased food consumption

(McFarlane, Polivy, & Herman, 1998). The eating pattern of people with bulimia

or binge eating disorder is similar to, but more extreme than, the behavior

highlighted in the studies of restrained eaters. People with bulimia nervosa or binge

eating disorder typically binge when they encounter stress and experience negative

affect.

Etiology of gender dysphoria

Gender development is complex and there are many possible variations that cause

a mismatch between a person’s biological sex and their gender identity, making the

exact cause of gender dysphoria unclear.

Occasionally, the hormones that trigger the development of biological sex may not

work properly on the brain, reproductive organs and genitals, causing differences

between them. This may be caused by:

 additional hormones in the mother’s system – possibly as a result of taking

medication

 the foetus’ insensitivity to the hormones, known as androgen insensitivity

syndrome (AIS) – when this happens, gender dysphoria may be caused by

hormones not working properly in the womb

Gender dysphoria may also be the result of other rare conditions, such as:

  Congenital adrenal hyperplasia (CAH) – where a high level of male

hormones are produced in a female foetus. This causes the genitals to

become more male in appearance and, in some cases, the baby may

be thought to be biologically male when she is born.

 intersex conditions – which cause babies to be born with the genitalia of

both sexes (or ambiguous genitalia). Parents are recommended to wait until

the child can choose their own gender identity before any surgery is carried

out.

DISSOCIATIVE DISORDERS

• Childhood abuse

• Sexual or physical abuse during childhood

• Posttraumatic model

• Socio-cognitive model

Etiology of substance-related disorder

• Developmental process

Positive attitude > experimentation > regular use >

heavy use > Dependence or abuse

• Positive attitude: other family members

• Regular use: due to peers

• Applicable in many cases but does not account for all cases of substance

abuse or dependence

Biological view

Genetic predisposition

• Breeding experiment on certain animals

• Twin studies

• Genes do their work via the environment

• Twin study in Finland found that heritability for alcohol problems among

adolescents was higher among those teens who had a large number of

peers who drank compared to those who had a smaller number of peers

who drank (Dick, Pagan, Viken, et al., 2007).

• To become dependent on alcohol, a person usually has to be able to drink a

lot
 • Asians have a low rate of alcohol problems because of physiological

intolerance caused by an inherited deficiency in enzymes involved in

alcohol metabolism, called alcohol dehydrogenases or ADH.

• About three-quarters of Asians experience unpleasant effects like flushing

(blood flow to the face) from small quantities of alcohol, which may protect

them from becoming dependent on alcohol.

Neurobiological Factors

• Dopamine pathways in the brain are importantly linked to pleasure and

reward.

• Research with both humans and animals shows that nearly all drugs,

including alcohol, stimulate the dopamine systems in the brain

• People dependent on drugs or alcohol have a deficiency in the dopamine

receptor DRD2 (Noble, 2003).

• People take drugs to feel less bad and to avoid the bad feelings associated

with withdrawal

• Incentive sensitization theory

According to this theory repeated exposure to drugs of abuse leads to increasing

sensitivity of the brain to their attractiveness or desirability which can persist

even in the absence of continued exposure to the drug, or with continued

exposure, in the absence of pleasure from use of the drug, thus explaining relapse

after long abstinence.

Psychological Factors

Mood alteration

• Main psychological motives for using drugs is to alter mood

• It enhances positive moods

• diminishes negative ones

• Some people may use drugs to reduce negative affect, whereas others may

use drugs to increase positive affect when they are bored (Cooper, Frone,

Russell, et al., 1995)

Expectancies about Alcohol and Drug Effects

• People may drink after stress not because it actually reduces tension but

because they expect it to do so

 • Studies have shown that people who expect alcohol to reduce stress and

anxiety are those likely to be frequent users (Rather, Goldman, Roehrich, et

al., 1992; Sher, Walitzer, Wood, et al., 1991; Tran, Haaga, & Chambless,

1997).

Personality Factors

• Personality include high levels of negative affect, sometimes called negative

emotionality; a persistent desire for arousal along with increased positive

affect; and constraint, which refers to cautious behavior, harm avoidance,

and conservative moral standards.

Somatic symptoms and related disorders

Somatic symptoms disorder

• Genetic and biological factors

such as an increased sensitivity to pain

• Family influence

which may be genetic or environmental, or both

• Personality trait of negativity

which can impact how you identify and perceive illness and bodily symptoms

• Decreased awareness of or problems processing emotions

causing physical symptoms to become the focus rather than the emotional issues

• Learned behavior

The attention or other benefits gained from having an illness; or "pain behaviors"

in response to symptoms, such as excessive avoidance of activity, which can

increase your level of disability

• A history of physical or sexual abuse

• A history of having a serious illness as a child

• A poor ability to express emotions

• A parent or close relative with the disorder. Children might learn this

behavior if a parent is overly concerned about disease and/or overreacts to

even minor illnesses

Illness anxiety disorder

• Belief
You may have a difficult time tolerating uncertainty over uncomfortable or

unusual body sensations. This could lead you to misinterpret that all body

sensations are serious, so you search for evidence to confirm that you have a

serious disease.

• Family. 

You may be more likely to have health anxiety if you had parents who worried too

much about their own health or your health.

• Past experience. 

You may have had experience with serious illness in childhood, so physical

sensations may be frightening to you. Childhood abuse (physical, sexual,

emotional)

Conversion disorder

(functional neurological symptom disorder)

• PSYCHODYNAMIC VIEW

 Repression

 Reversal of affect
 Sexual trauma

 Emotional conflict

 Primary gain and secondary gain

• BEHAVIOURAL VIEW

• COGNITIVE VIEW

 Developing a more adaptive pattern of communication

• MULTICULTURAL VIEW

 Westerners and non-westerners

• MALADAPTIVE PERSONALITY TRAITS

• HISTORY OF CHILDHOOD ABUSE AND NEGLECT