Chapter 14 Psychological Disorders. Abnormal Behavior, continued The medical model applied to...
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Chapter 14 Psychological Disorders. Abnormal Behavior, continued The medical model applied to abnormal behavior –The medical model “proposes that it is
Abnormal Behavior, continued The medical model applied to
abnormal behavior The medical model proposes that it is useful to
think of abnormal behavior as a disease and has become the main way
of thinking about mental illness today. This view is in stark
contrast to how mental illness used to be perceived (see Figure
14.1). Thus, the medical model has brought much needed improvement
in patient care.
Slide 3
Figure 14.1. Historical conceptions of mental illness.
Throughout most of history, psychological disorders were thought to
be caused by demonic possession, and the mentally ill were
candidates for chains and torture.
Slide 4
The medical model, continued Diagnosis involves distinguishing
one illness from another. Etiology refers to the apparent causation
and developmental history of an illness. Prognosis is a forecast
about the probable course of an illness. Abnormal Behavior,
continued
Slide 5
Criteria of Abnormal Behavior 1.Deviance the behavior must be
significantly different from what society deems acceptable.
2.Maladaptive behavior the behavior interferes with the persons
ability to function. 3.Personal distress the behavior is troubling
to the individual.
Slide 6
Psychodiagnosis: The Classification of Disorders The American
Psychological Association (A.P.A.) uses the Diagnostic and
Statistical Manual (now in its fourth revision and referred to as
the DSM-IV) to classify disorders. It provides detailed information
about various mental illnesses that allows clinicians to make more
consistent diagnoses.
Slide 7
Classification of Disorders, continued The multiaxial system
The DSM has five axes or components 1.Axis I: criteria for
diagnosing most disorders. 2.Axis II: specific to personality
disorders. 3.Axis III: patients general medical condition. 4.Axis
IV: psychosocial and environmental problems. 5.Axis V: global
assessment of functioning.
Slide 8
Classification of Disorders, continued Controversies
surrounding the DSM Some argue that The categorical approach to
pathology should be replaced by a dimensional approach. The DSM
medicalizes everyday problems into disorders. e.g. difficulty
controlling gambling becomes pathological gambling disorder.
Slide 9
Prevalence of Psychological Disorders Epidemiology is the study
of the distribution of mental or physical disorders in a
population. Prevalence refers to the percentage of the population
that exhibits a disorder during a specified time period. Research
suggests that there has been a real increase in the prevalence in
disorder (see Figure 14.4). The most common classes are substance
use, anxiety, and mood disorders.
Slide 10
Figure 14.4. Lifetime prevalence of psychological disorders.
The estimated percentage of people who have, at any time in their
life, suffered from one of four types of psychological disorders or
from a disorder of any kind (top bar) is shown here. Prevalence
estimates vary somewhat from one study to the next, depending on
the exact methods used in sampling and assessment. The estimates
shown here are based on pooling data from Wave 1 and 2 of the
Epidemiological Catchment Area studies and the National Comorbidity
Study, as summarized by Regier and Burke (2000) and Dew, Bromet,
and Switzer (2000). These studies, which collectively evaluated
over 28,000 subjects, provide the best data to date on the
prevalence of mental illness in the United States.
Slide 11
Anxiety Disorders, continued Anxiety disorders are a class of
disorders marked by feelings of excessive apprehension and anxiety.
Generalized anxiety disorder is marked by a chronic, high level of
anxiety that is not tied to any specific threat. Phobic disorder is
marked by a persistent and irrational fear of an object of
situation that presents no realistic danger.
Slide 12
Anxiety Disorders, continued Panic disorder is characterized by
recurrent attacks of overwhelming anxiety that usually occur
suddenly and unexpectedly (see following animation sequence).
[Insert Video: Panic Disorder: Symptoms. From CDROM CB 9 th
edition] Agoraphobia is a fear of going out to public places.
Agoraphobia may result from severe panic disorder, in which people
hide in their homes out of fear of the outside world.
Slide 13
Anxiety Disorders, continued Obsessive-compulsive disorder
(OCD) is marked by persistent, uncontrollable intrusions of
unwanted thoughts (obsessions) and urges to engage in senseless
rituals (compulsions). Common obsessions include fear of
contamination, harming others, suicide, or sexual acts. Compulsions
are highly ritualistic acts that temporarily reduce anxiety brought
on by obsessions.
Slide 14
Anxiety Disorders, continued Obsessive -compulsive disorder,
continued OCD disorders occur in approximately 2.5% of the
population. Most cases of OCD emerge before the age of 35.
Slide 15
Anxiety Disorders, continued Etiology of anxiety disorders
Biological factors Inherited temperament may be a risk factor for
anxiety disorders. Anxiety sensitivity theory posits that some
people are more sensitive to internal physiological symptoms of
anxiety and overreact with fear when they occur.
Slide 16
Anxiety Disorders, continued Etiology of anxiety disorders,
continued The brains neurotransmitters, or chemicals that carry
signals from one neuron to another, may underlie anxiety. In
particular, drugs that affect the neurotransmitter GABA (e.g.,
Valium) suggest that these chemical circuits may be involved in
anxiety disorders.
Slide 17
Anxiety Disorders, continued Etiology of anxiety disorders,
continued Conditioning and learning Classical conditioning may
cause one to fear a particular object or scenario. Then, avoiding
the fear stimulus is negatively reinforced, through operant
conditioning, by making the person feel less anxious. Seligman
(1971) adds we are biologically prepared to fear some things more
than others, however.
Slide 18
Anxiety Disorders, continued Etiology of anxiety disorders,
continued Cognitive factors Some people are more likely to
experience anxiety disorders because they Misinterpret harmless
situations as threatening. Focus excess attention on perceived
threats. Selectively recall information that seems
threatening.
Slide 19
Anxiety Disorders, continued Etiology of anxiety disorders,
continued Stress as a factor Finally, anxiety disorders may be
linked to excessive stress. Specifically, research (Brown, 1998)
has found that people with anxiety disorders were more likely to
have experienced severe stress one month prior to the onset of
their disorder. Thus, stress may precipitate the onset of anxiety
disorders.
Slide 20
Somatoform Disorders, continued Somatoform disorders are
physical ailments that cannot be fully explained by organic
conditions and are largely due to psychological factors.
Somatization disorder is marked by a history of diverse physical
complaints that appear to be psychological in origin. It occurs
mostly in women. Symptoms seem to be linked to stress.
Slide 21
Somatoform Disorders, continued Conversion disorder is
characterized by a significant loss of physical function with no
apparent organic basis, usually in a single organ system. Common
symptoms include Partial or total loss of vision or hearing.
Partial paralysis. Laryngitis or mutism (inability to speak).
Seizures or vomiting. Loss of function in limbs.
Slide 22
Somatoform Disorders, continued Hypochondriasis (or
hypochondria) is characterized by excessive preoccupation with
health concerns and incessant worry about developing physical
illnesses. People with hypochondria are convinced their symptoms
are real and often become frustrated with the medical
establishment. Hypochondria often occurs along with anxiety
disorders and depression.
Slide 23
Somatoform Disorders, continued Etiology of somatoform
disorders Personality factors Somatoform disorders are more common
in people with histrionic personalities (those who thrive on the
attention that illness brings). Neuroticism also seems to elevate
ones predisposition to somatoform disorders.
Slide 24
Somatoform Disorders, continued Etiology of somatoform
disorders, continued Cognitive factors Some people focus excessive
attention on bodily sensations and amplify them into perceived
symptoms of distress. They also have unrealistically high standards
of good health. Thus, any deviation from perfect health is seen as
a sign of illness.
Slide 25
Somatoform Disorders, continued Etiology of somatoform
disorders, continued The sick role Some people learn to like being
sick because It allows one to avoid challenging tasks. Demands
arent placed on sick people. It provides an excuse for failure.
Being sick elicits attention from others.
Slide 26
Dissociative Disorders, continued Dissociative disorders are a
class of disorders in which people lose contact with portions of
their consciousness or memory, resulting in disruptions in their
sense of identity.
Slide 27
Dissociative Disorders, continued Dissociative amnesia &
fugue Dissociative amnesia is a sudden loss of memory for important
personal information that is too extensive to be due to normal
forgetting. It often occurs after a single traumatic event or an
extended period of severe trauma or stress.
Slide 28
Dissociative Disorders, continued Dissociative amnesia &
fugue, continued Dissociative fugue is a disorder in which people
lose their memory for their sense of personal identity. People
suffering from this disorder often wander away from home, do not
know who they are, where they live, or who they know.
Slide 29
Dissociative Disorders, continued Dissociative identity
disorder (DID) involves the coexistence in one person of two or
more largely complete, and usually very different, personalities.
Also known as multiple personality disorder, in which each
personality has its own name, memories, traits, and physical
mannerisms. Transitions between identities can be sudden and the
differences between them can be extreme (e.g., different races or
genders).
Slide 30
Dissociative Disorders, continued Etiology of dissociative
disorders Psychogenic amnesia and fugue are usually the result of
extreme stress. Dissociative identity disorder is a fascinating and
bizarre disorder, and its causes are largely unknown. However, many
clinicians suspect that DID may result from severe emotional trauma
that occurs in childhood.
Slide 31
Mood Disorders, continued Mood disorders are a class of
disorders marked by emotional disturbances that may spill over to
disrupt physical, perceptual, social, and thought processes. Major
depressive disorder is one in which people show persistent feelings
of sadness and despair and a loss of interest in previous sources
of pleasure. Onset can occur at any time, but most cases occur
before age 40. The majority of people with depression (75- 95%)
will experience a repeat episode.
Slide 32
Mood Disorders, continued Major depressive disorder, continued
Depression is one of the most common mental illnesses (the lifetime
prevalence is 16.2%). However, prevalence is tied to gender. Women
are twice as likely to be diagnosed with depression. This does not
appear to be tied to biological differences between men and women
and could result from greater stress and abuse that women
experience.
Slide 33
Mood Disorders, continued Bipolar disorder (once known as
manic- depressive disorder) is marked by the experience of both
depressed and manic periods. Manic periods are characterized by
bouts of extreme exuberance and a feeling of invincibility.
However, this state of elation alternates, sometimes suddenly, with
periods of depression (see Figure 14.10).
Slide 34
Figure 14.10. Common symptoms in manic and depressive episodes.
The emotional, cognitive, and motor symptoms exhibited in manic and
depressive illnesses are largely the opposite of each other. From
Sarason, I.G., & Sarason, B. R. (1987). Abnormal psychology:
The problem of maladaptive behavior (5 th ed., p. 283). Englewood
Cliffs, NJ: Prentice-Hall. 1987 Prentice-Hall. Reprinted by
permission of Prentice-Hall, Inc.
Slide 35
Mood Disorders, continued Mood disorders and suicide 90% of
people who complete suicide suffer from some type of psychological
disorder. Suicide rates are highest for people with mood disorders,
who account for 60% of completed suicides. Lifetime risk for those
with bipolar disorder is 15-20%; it is 10-15% in those who have had
depression.
Slide 36
Mood Disorders, continued Etiology of mood disorders Genetic
vulnerability Concordance rates, or the percentage of twin pairs or
other pairs of relatives that exhibit the same disorder, suggests
there is a genetic basis for mood disorders. Concordance rates for
identical twins is 65-72%, whereas it is only 14-19% for fraternal
twins who share fewer genes but the same environment.
Slide 37
Mood Disorders, continued Etiology of mood disorders, continued
Neurochemical & neuroanatomical factors Mood disorders are
correlated with low levels of two neurotransmitters in the brain:
1.Norepinephrine. 2.Seratonin. However, it is unclear whether
changes in these chemicals are the cause, or the result, of the
onset of mood disorders.
Slide 38
Mood Disorders, continued Etiology of mood disorders, continued
Neuroanatomical factors, continued Depression is also correlated
with reduced hippocampal volume. The hippocampus, is 8-10% smaller
in depressed, than in normal, subjects (see Figure 14.12). New
theories suggest that neurogenesis may play a central role in the
regulation of mood and depression.
Slide 39
Figure 14.12. The hippocampus and depression. This graphic
shows the hippocampus in blue. The photo inset shows a brain
dissected to reveal the hippocampus in both the right and left
hemispheres. It has long been known that the hippocampus plays a
key role in memory, but its possible role in depression has only
come to light in recent years. Research suggests that shrinkage of
the hippocampal formation due to suppressed neurogenesis may be a
key causal factor underlying depressive disorders.
Slide 40
Mood Disorders, continued Etiology of mood disorders, continued
Cognitive factors Seligman (1974) proposes that depression is
caused by learned helplessness, in which people become passive and
give up in times of difficulty. Learned helplessness is also
related to a pessimistic explanatory style in which people
attribute setbacks to personal flaws.
Slide 41
Mood Disorders, continued Etiology of mood disorders, continued
Nolen-Hoeksema (1991, 2000) also asserts that those who ruminate
about problems put themselves at risk for depression. Finally,
depression may be caused by negative thinking, as shown in Lauren
Alloys (1999) studies (see Figure 14.14).
Slide 42
Figure 14.14. Negative thinking and prediction of depression.
Alloy and colleagues (1999) measured the explanatory style of
first-year college students and characterized them as being high
risk or low risk for depression. This graph shows the percentage of
these students who experienced major or minor episodes of
depression over the next 2.5 years. As you can see, the high-risk
students, who exhibited a negative thinking style, proved to be
much more vulnerable to depression. (Data from Alloy et al.,
1999)
Slide 43
Mood Disorders, continued Etiology of mood disorders, continued
Interpersonal roots Depression has also been correlated with
interpersonal factors, such as poor social skills. It is unclear
what the direction of cause and effect is, with regard to this
correlation. Precipitating stress There is also a link between
stress and the onset of mood disorders.
Slide 44
Schizophrenic Disorders, continued Schizophrenia literally
means split mind. Schizophrenic disorders are a class of disorders
marked by disturbances in thought that spill over to affect
perceptual, social, and emotional processes. Prevalence is quite
low, with only about 1% of the population suffering from this class
of disorders. Schizophrenia is a severe disorder that usually has
an early onset and a poor prognosis.
Slide 45
Schizophrenic Disorders, continued General symptoms
1.Irrational thought Delusions are false beliefs that are
maintained even though they clearly are out of touch with reality.
A common delusion is the belief that ones mind is being controlled
by an external source. Delusions of grandeur are irrational beliefs
that one is extremely important or famous.
Slide 46
Schizophrenic Disorders, continued General symptoms, continued
2.Deterioration of adaptive behavior (e.g., inability to function
at work or home.) 3.Distorted perception Auditory hallucinations
sensory perceptions that occur in the absence of a real external
stimulus or that represent gross distortions of perceptual input
are common symptoms. 4.Disturbed emotion (either flat affect or
inappropriate emotions for a situation).
Slide 47
Schizophrenic Disorders, continued Subtypes 1.Paranoid type
Paranoid schizophrenia is dominated by delusions of persecution
along with delusions of grandeur. People with this type often
believe others are watching and plotting against them. 2.Catatonic
type Catatonic schizophrenia is marked by striking motor
disturbances, ranging from muscular rigidity to random motor
activity.
Slide 48
Schizophrenic Disorders, continued Subtypes of schizophrenia,
continued 3.Disorganized type In disorganized schizophrenia, a
particularly severe deterioration of adaptive behavior is seen.
Major symptoms include Emotional indifference. Incoherence. Severe
social withdrawal. Aimless giggling and babbling. Delusions
centered on bodily functions.
Slide 49
Schizophrenic Disorders, continued Subtypes of schizophrenia,
continued 4.Undifferentiated type Undifferentiated schizophrenia is
marked by idiosyncratic mixtures of schizophrenic symptoms.
Essentially, symptoms do not fit neatly into one of the
subtypes.
Slide 50
Schizophrenic Disorders, continued Positive versus negative
symptoms An alternative to dividing schizophrenia into four
subtypes has been proposed by Andreasen (1990) and others. There
are only two subtypes with this approach: 1.Schizophrenias with
negative symptoms (behavioral deficits, such as flat affect).
2.Schizophrenias with positive symptoms (hallucinations, delusions,
& bizarre behavior).
Slide 51
Schizophrenic Disorders, continued Course and outcome
Schizophrenia usually emerges during adolescence or early
adulthood. Its course is variable, with three likely outcomes:
1.Patients with milder versions who experience a full recovery.
2.Patients who experience a partial recovery and who are in and out
of treatment facilities. 3.Patients whose symptoms are persistent
and severe, and who require permanent hospitalization.
Slide 52
Schizophrenic Disorders, continued Course and outcome,
continued Patients with a favorable prognosis Have a sudden onset
of the disorder. Experience onset at a later age. Were well
adjusted before the onset. Have a low proportion of negative
symptoms. Do not have a loss of cognitive function. Show good
adherence to treatment. Have a relatively healthy, supportive
family environment to return to.
Slide 53
Schizophrenic Disorders, continued Etiology of schizophrenia
Genetic vulnerability Concordance in identical twins is 48%, versus
17% in fraternal twins, suggesting a genetic basis for the disease
(see Figure 14.17). Neurochemical factors Schizophrenia is also
linked with excess activity in the transmitter Dopamine.
Slide 54
Figure 14.17. Genetic vulnerability to schizophrenic disorders.
Relatives of schizophrenic patients have an elevated risk for
schizophrenia. This risk is greater among closer relatives.
Although environment also plays a role in the etiology of
schizophrenia, the concordance rates shown here suggest that there
must be a genetic vulnerability to the disorder. These concordance
estimates are based on pooled data from 40 studies.
Slide 55
Schizophrenic Disorders, continued Etiology of schizophrenia,
continued Structural abnormalities in the brain CT and MRI
(brain-imaging) scans have shown that patients with schizophrenia
have enlarged brain ventricles (see Figure 14.18). It is unclear,
however, whether this abnormality is the cause, or the result, of
the disorder.
Slide 56
Figure 14.18. Schizophrenia and the ventricles of the brain.
Cerebrospinal fluid (CSF) circulates around the brain and spinal
cord. The hollow cavities in the brain filled with CSF are called
ventricles. The four ventricles in the human brain are depicted
here. Studies with modern brain-imaging techniques suggest that an
association exists between enlarged ventricles in the brain and the
occurrence of schizophrenic disturbance.
Slide 57
Schizophrenic Disorders, continued Etiology of schizophrenia,
continued The neurodevelopmental hypothesis posits that
schizophrenia is caused in part by various disruptions in the
normal maturational processes of the brain before or at birth
(Brown, 1999). Potential disruptions could include Prenatal
exposure to a flu virus. Severe famine. Birth trauma.
Slide 58
Schizophrenic Disorders, continued Etiology of schizophrenia,
continued Expressed emotion (EE) is the degree to which a relative
of a schizophrenic patient displays highly critical or emotionally
overinvolved attitudes toward the patient. A familys EE is a good
predictor of the course of a schizophrenics illness. Patients who
return to families high in EE are three to four times more likely
to relapse because they add stress.
Slide 59
Schizophrenic Disorders, continued Etiology of schizophrenia,
continued Precipitating stress itself may trigger the onset of
schizophrenia in someone who is already vulnerable to the
disease.
Slide 60
Application: Eating Disorders, continued Types of eating
disorders Eating disorders are severe disturbances in eating
behavior characterized by preoccupation with weight and unhealthy
efforts to control weight. There are three main types: Anorexia
nervosa. Bulimia nervosa. Binge-eating disorder.
Slide 61
Application: Eating Disorders, continued Types of eating
disorders, continued Anorexia nervosa involves intense fear of
gaining weight, disturbed body image, refusal to maintain normal
weight, and dangerous measure to lose weight. This is usually
achieved by severely limiting caloric intake or by using laxatives
and excessive exercise to eliminate food and/or burn calories.
Slide 62
Application: Eating Disorders, continued Anorexia nervosa,
continued Medical complications from anorexia are serious and can
include Amenorrhea (ceasing of menstrual cycles). Gastrointestinal
problems. Dental problems. Osteoporosis (loss of bone density). Low
blood pressure. Metabolic disturbances that can trigger cardiac
arrest.
Slide 63
Application: Eating Disorders, continued Types of eating
disorders, continued Bulimia nervosa involves habitually engaging
in out-of-control overeating followed by unhealthy compensatory
efforts, such as self-induced vomiting, fasting, abuse of laxatives
and diuretics, and excessive exercise. Unlike with anorexia,
patients with bulimia usually maintain a normal weight. However,
they do risk medical problems such as cardiac arrythmias, dental
problems, metabolic, and gastrointestinal problems.
Slide 64
Application: Eating Disorders, continued Types of eating
disorders, continued Binge-eating disorder involves distress-
inducing eating binges that are not accompanied by the purging,
fasting, and excessive exercise seen in bulimia. Patients with this
disorder are often overweight and disgusted with their bodies.
Excessive overeating is often triggered by stress.
Slide 65
Application: Eating Disorders, continued History and prevalence
Anorexia has existed throughout history, but became more common in
the middle of the 20 th century. Bulimia appears to be a new
disorder. Young women are much more likely to develop eating
disorders, and the gender gap is likely due to the unrealistic
cultural standards for weight in Western societies. Still, these
are rare conditions, with about 1% developing anorexia and 2-3%
developing bulimia.
Slide 66
Application: Eating Disorders, continued Etiology of eating
disorders Genetic vulnerability Twin studies show higher
concordance rates for identical twins than fraternal twins,
suggesting a genetic predisposition for the disease. However, many
other factors influence the development of eating disorders.
Slide 67
Application: Eating Disorders, continued Etiology of eating
disorders, continued Personality factors Victims of anorexia tend
to be rigid, neurotic, emotionally restrained, and obsessive.
Perfectionism is a risk factor for anorexia. In contrast, bulimia
is associated with impulsiveness, being overly sensitive, and low
self-esteem.
Slide 68
Application: Eating Disorders, continued Etiology of eating
disorders, continued Cultural values In Western society, young
women are socialized to believe they must be very thin in order to
be attractive and the desirable weight, as seen in models and
actresses, has decreased in recent decades.
Slide 69
Application: Eating Disorders, continued Etiology of eating
disorders, continued The role of the family In families where
parents are overly involved in childrens lives, adolescents may use
anorexia as a way to control the one aspect of their life they feel
they can exert control over their body. Some mothers even
contribute to eating disorders by endorsing societys obsession with
being thin.
Slide 70
Application: Eating Disorders, continued Etiology of eating
disorders, continued Cognitive factors Individuals with eating
disorders often display all-or-none, irrational thinking, and hold
beliefs such as I must be thin to be accepted. If I am not in
complete control, I will lose all control. If I gain one pound, I
will become obese.