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Mental disorders are truly varied and can have their origin in a biological, dynamic, systemic or cognitive-behavioral cause. It is important to separate each of these possibilities well and know their characteristics in order to establish an appropriate diagnosis for the patient and offer the most appropriate treatment.
For this reason, in this PsicologíaOnline article, we are going to explain in detail the etiological models of mental disordersincluding a practical case and its analysis.
Introduction to etiological models of mental disorders
There is today a generalized thought about the etiology of abnormal behaviors as the deployment of existing potentialities – to a certain extent – in all individuals, observing that the causes of pathologies manifest themselves by virtue of a pluricausal convergence of conditions biological, psychological and social certain. Starting from the basis that when these elements were adequate in quality and quantity, then the constitution of a healthy person would be possible, and in their absence or abnormal presence the origin of psychopathology would take place.
The specific action and/or reaction in each of the etiological factors inevitably has an impact on the others. It cannot be assured that it is only one of them that sets in motion the mechanism of pathological behaviors, or that an organic failure occurs first and then the psychopathological disorder, nor the psychological trauma and its subsequent biological trace. Everything is interrelated with any of these factors to end up producing an adverse situation, a psychological discomfort and a biological circuit that allows and sustains it. Variables of a quantitative or qualitative aspect are important, as well as their temporality, since they are determining conditions.
For example, short-term stimuli that are not repeated with sufficient frequency tend to produce changes only at a quantitative and not qualitative level; Only by acquiring a certain quantitative value (different depending on the individual characteristics, even highlighting the idiosyncrasy when interpreting the subject), and now persistence over time collaborating on the magnitude, will have its translation in the qualitative aspect. Influencing long-term stimuli, having the ability to even modify genetic codes and affective stimuli.
Theories and explanations help and complement each other to continue investigating the complexity of the human being, some through learning, others through biology, social relationships… and all of them are nothing more than the parts of a whole to find adaptive and healthy mechanisms for human beings. As described below, the biological models They look for etiology in physiology; psychoanalysis and dynamic models in the formation of the self and personality; the cognitive-behavioral models, in learning; and the systemic models in the relationship between the individual and other nearby systems. There are cases in which the biological predisposition indicated by a significant hereditary load reduces the strength of the other variables, such as genetic anomalies, but it seems to be proven that the rest of the spectrum occurs in greater proportion in the disorders described by Psychiatry.
CASE: 45 year old male
Only child of mature parents, (he was born when the mother was 43 years old and the father was 40 years old). The risky pregnancy, with losses and absolute rest for nine months. The stage of His childhood was really dark and unhappy. with a father diagnosed with schizophrenia and who, due to his delusions, kept this child and his wife in absolute silence because he believed that the noises in his head were caused by the two of them. Thus, the boy spent more hours on the street than at home and when he slept he covered his breathing with the bedding, so as not to provoke the anger of his father. In the marital relationship he was known to have infidelities, in which his young son was also a participant. Her mother had to go to work because he had abandoned his job as a representative of a well-known film production company, because they were persecuting him.
The patient’s social relationships were limited to some friends from school and the neighborhood whom he did not take home so as not to create problems. But whose activities were always on the verge of illegality or endangering physical integrity, with several car accidents to their credit.
Currently the circle of friends is changing – in order not to discover his “oddities”, he maintains two childhood friends, one of whom is already losing contact with him due to his supposed adherence to my friendship.
When he was a teenager and after prior warning from the father to his son, he hanged himself at home; He being the first to find it. From here, their compulsive acts that went further and that today persist to the point that their rituals take up more than 6 hours a day. He started by knocking on the doors three times before leaving the house or before entering.
has delusions like their father appearing to them in dreams sitting on the bed and a great need to do things very quickly. He also hears noises that cause him pain.
None of his relationships lasted more than 2 years until his first marriage, which lasted 14 years.
His job stability was intense, he had created a company in a cooperative system and later created several finance and real estate companies in which he continues, his goal was to become the owner of a building in Madrid and not deprive himself of any whim.
His wife asked him to visit a specialist when he was 34 years old and his rituals and his impulsiveness for cleanliness, order and control of all the members of his family and the members of his company were already desperate, in addition to having been consuming cocaine for a long time – since he was 29 years old – even a year before leaving home he occasionally took this substance. He did not step on the white stripes of the zebra crossing, before crossing a traffic light he added up all the license plates of the cars that were stopped and if they did not add up to an odd number he would not cross – to the point that one day the police called his home to have them come. to pick him up because someone had seen him stopped at a traffic light on Genova Street for more than an hour and a half without crossing; He chose a word that had been said or that he had thought and repeated it an odd number that began with 3 and had no end. If he couldn’t repeat them he made us repeat it with tricks like asking in different ways. He had a real obsession with having fun, he didn’t want to know anything about diseases, the medicine cabinet was full of latest generation medications just in case, he fumigated all his clothes with bactericides, he shopped compulsively, he was excessively concerned about his physical appearance – even that of family members, he He was in charge of buying everyone’s clothes – he needed adulation permanently; This was one of the calming things about him, another the infidelities and feeling recognized.
He only felt relief when he achieved his intended purpose and then another ritual began. He never accepted his illness, it was just extravagant manias and if he displeased him he showed quite a bit of hostility and distrust.
He did not obtain the Business degree due to the lack of the English subject, which he never took. His work is related to the world of finance and investments and represents a very high stress level.
From their marriage, a son was born who is 7 years old and after the initial joy caused him a lot of anxiety and fear. Undergoing treatment at the imposition of his wife, he breaks off the relationship because he begins a new one.
Today he is 43 years old, he abandoned psychotherapy and never took medication.
Analysis of the practical case
First note that it is a anxiety disorder and, therefore, reading related to this type of disorders will always be useful for the correct understanding of OCD. The criteria for the diagnosis of obsessive-compulsive disorder of the DSM-IV (APA, 1994): · 300.3 Obsessive-compulsive disorder.
TO. Obsessions or compulsions: The multiple already described
Obsessions are defined by:
(1) Recurrent and persistent thoughts, impulses or images that are experienced, at some time during the disturbance, as intrusive and inappropriate, and cause marked anxiety or discomfort. In recent years he became tired and felt anxious about not being able to stop them.
(2) The thoughts, impulses, or images are not simply excessive worries about problems in everyday life. He was interested in death, in the appearances of faces on walls.
(3) The person attempts to ignore or suppress such thoughts or impulses or neutralize them with some other thought or action. With compulsive actions.
(4) The person recognizes that the obsessive thoughts, impulses or images are a product of their own mind (not imposed as occurs in thought insertion). He knew that only a few people had these thoughts and that they were created by himself.
Compulsions are defined by:
(1) Repetitive behaviors (e.g., washing hands, tidying, checking) or mental actions (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or in accordance with rules that must be rigidly applied. Those already mentioned.
(2) Behaviors or mental actions are aimed at neutralizing or reducing discomfort or some feared event or situation; However, these behaviors or mental actions are not realistically connected to what they are intended to neutralize or prevent, or they are clearly excessive.
B. At some point during the course of the disorder, the person recognizes that obsessions or compulsions are excessive or irrational. Although he tried to hide them, when he detected them he could not stop talking about them and contrasting them with the behavior of others, always in a mocking tone as if it were a friendly attitude.
C. Obsessions or compulsions produce marked discomfort; loss of time (in general, the individual spends more than an hour a day on them); either significantly interferes with routine habitual of the individual, with his professional activity, with his social activities or his relationships with others.
OCD implies a loss of control, on the part of the patient, of their thoughts and even their behaviors. This fact is also experienced in a paradoxical way, as the patient recognizes such thoughts and/or behaviors as a product of himself. This leads to certain complications, such as the patient failing to recognize the excessive nature of his obsessions or compulsions, in short, having little awareness of the illness (an aspect to which the DSM-IV explicitly draws attention). ).
The etiology of OCD It is multifactorial with an interaction, greater or lesser, of factors…