Chapter 15-Psychological Chapter 15-Psychological DisordersDisorders

Psychology of Life SkillsPsychology of Life Skills

August 13August 13thth, 2008, 2008

Criteria of Abnormal Criteria of Abnormal BehaviorBehavior

What makes someone ‘abnormal?’What makes someone ‘abnormal?’ Criteria of Abnormal Behavior:Criteria of Abnormal Behavior:

DevianceDeviance Maladaptive BehaviorMaladaptive Behavior Personal DistressPersonal Distress

Viewed as disordered when only one Viewed as disordered when only one criterion met.criterion met.

Continuum:Continuum:

Normal -------------------------- AbnormalNormal -------------------------- Abnormal

Classification of DisordersClassification of Disorders

Five Axes:Five Axes:

I: Clinical Syndromes (anxiety, schizophrenia)I: Clinical Syndromes (anxiety, schizophrenia)

II: Personality Disorders (antisocial personality)II: Personality Disorders (antisocial personality)

III: General Medical Conditions (diabetes)III: General Medical Conditions (diabetes)

IV: Psychosocial & Environmental Problems (stress)IV: Psychosocial & Environmental Problems (stress)

V: Global Assessment of Functioning (scale of 1-100)V: Global Assessment of Functioning (scale of 1-100)

Prevalence of Psychological Prevalence of Psychological Disorders Disorders

44% of adult population will struggle with 44% of adult population will struggle with psych. Disorder at some point in their lifepsych. Disorder at some point in their life

Anxiety DisordersAnxiety Disorders

A class of disorders marked by feelings of A class of disorders marked by feelings of excessive apprehension and anxiety.excessive apprehension and anxiety.

Anxiety DisordersAnxiety Disorders

Generalized Anxiety Disorder (GAD)Generalized Anxiety Disorder (GAD) Chronic, ‘free-floating’ anxietyChronic, ‘free-floating’ anxiety Not tied to a specific threatNot tied to a specific threat

Phobic DisorderPhobic Disorder Persistent and irrational fear of an Persistent and irrational fear of an

object/situation that presents no real danger.object/situation that presents no real danger. Panic DisorderPanic Disorder

Recurrent attacks of overwhelming anxiety—Recurrent attacks of overwhelming anxiety—usually occur suddenly and unexpectedly.usually occur suddenly and unexpectedly.

Anxiety DisordersAnxiety Disorders

Obsessive-Compulsive Disorder (OCD)Obsessive-Compulsive Disorder (OCD) Persistent, uncontrollable intrusions of Persistent, uncontrollable intrusions of

unwanted thoughts (obsessions) and urges to unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions).engage in senseless rituals (compulsions).

Etiology (Cause) of Anxiety Etiology (Cause) of Anxiety DisordersDisorders

BiologyBiology Temperament and sensitivity might make some Temperament and sensitivity might make some

people more vulnerable to anxiety disorders.people more vulnerable to anxiety disorders. Neurotransmitters: GABA and serotonin. Neurotransmitters: GABA and serotonin.

LearningLearning An originally neutral stimulus (dog) paired with An originally neutral stimulus (dog) paired with

frightening event (attack).frightening event (attack). Person then avoids stimulus.Person then avoids stimulus.

Etiology of Anxiety Etiology of Anxiety DisordersDisorders

Cognitive FactorsCognitive Factors Misinterpret harmless situations as threateningMisinterpret harmless situations as threatening Focus excessive attention on perceived threatsFocus excessive attention on perceived threats Selectively recall info that seems threateningSelectively recall info that seems threatening

““The Dr. examined little Emma’s growth.”The Dr. examined little Emma’s growth.”

StressStress

Dissociative DisordersDissociative Disorders

Class of disorders in which people lose Class of disorders in which people lose contact with consciousness/memory.contact with consciousness/memory.

Results in disruption of sense of identity.Results in disruption of sense of identity.

Dissociative DisordersDissociative Disorders

Dissociative AmnesiaDissociative Amnesia Sudden loss of memory—too extensive to be Sudden loss of memory—too extensive to be

normal forgetting.normal forgetting. Dissociative FugueDissociative Fugue

Loss of memory for personal identity.Loss of memory for personal identity. Dissociative Identity DisorderDissociative Identity Disorder

Co-existence in one person of two or more Co-existence in one person of two or more largely complete and different personalities. largely complete and different personalities.

Dissociative Disorders are Dissociative Disorders are Weird!Weird!

Really?Really? How often have you:How often have you:

Suddenly realized when driving, that you don’t remember what Suddenly realized when driving, that you don’t remember what has happened during all or part of the trip?has happened during all or part of the trip?

Found that you can’t remember whether or not you have just Found that you can’t remember whether or not you have just done something or perhaps had just thought about doing it?done something or perhaps had just thought about doing it?

Realized when you are listening to someone talk that you didn’t Realized when you are listening to someone talk that you didn’t hear part or all of what the person said?hear part or all of what the person said?

Causes of Dissociative Causes of Dissociative DisordersDisorders

Personality traits like fantasy-proneness?Personality traits like fantasy-proneness? Patients faking?Patients faking? Clinicians creating?Clinicians creating? A dissociative reaction to trauma?A dissociative reaction to trauma?

Mood DisordersMood Disorders

A class of disorders marked by A class of disorders marked by disturbances in emotion/mood.disturbances in emotion/mood.

Tend to be episodic (come and go)Tend to be episodic (come and go) Typically last 3-12 monthsTypically last 3-12 months UnipolarUnipolar: Emotional extremes involving : Emotional extremes involving

depression.depression. BipolarBipolar: Emotional extremes of both : Emotional extremes of both

depression and mania. depression and mania.

Mood DisordersMood Disorders

Major Depressive Disorder (MDD)Major Depressive Disorder (MDD) Persistent feelings of sadness and despair and Persistent feelings of sadness and despair and

loss of interest in previous sources of pleasure.loss of interest in previous sources of pleasure. Multiple episodesMultiple episodes

Bipolar DisorderBipolar Disorder Marked by the experience of both depressed Marked by the experience of both depressed

and manic periods (alternating cycles).and manic periods (alternating cycles). 1—2.5% of population affected.1—2.5% of population affected.

Causes of Mood DisordersCauses of Mood Disorders

Genetic VulnerabilityGenetic Vulnerability Strong evidence for biological componentStrong evidence for biological component Twin studiesTwin studies

Neurochemical FactorsNeurochemical Factors Norepinephrine and serotoninNorepinephrine and serotonin

Cognitive FactorsCognitive Factors Learned HelplessnessLearned Helplessness Pessimistic Explanatory Style Pessimistic Explanatory Style Hopelessness Theory Hopelessness Theory Cause and Effect?Cause and Effect?

Causes of Mood DisordersCauses of Mood Disorders

Interpersonal RootsInterpersonal Roots Inadequate social skillsInadequate social skills

StressStress

Most likely an Most likely an interactioninteraction of factors! of factors!

Schizophrenic DisordersSchizophrenic Disorders

Class of disorders marked by disturbances Class of disorders marked by disturbances in thought that affect perceptual, social, in thought that affect perceptual, social, and emotional processes.and emotional processes.

1% of population affected.1% of population affected.

Schizophrenic DisordersSchizophrenic Disorders

General SymptomsGeneral Symptoms Irrational ThoughtIrrational Thought Deterioration of Adaptive BehaviorDeterioration of Adaptive Behavior Distorted PerceptionDistorted Perception Disturbed EmotionDisturbed Emotion

Schizophrenic DisordersSchizophrenic Disorders

Two classes of symptoms:Two classes of symptoms: PositivePositive: Hallucinations, delusions, bizarre : Hallucinations, delusions, bizarre

behavior.behavior. NegativeNegative: Flattened emotions, social : Flattened emotions, social

withdrawal, apathy.withdrawal, apathy.

Causes of SchizophreniaCauses of Schizophrenia

Genetic VulnerabilityGenetic Vulnerability Strong evidence from twin studiesStrong evidence from twin studies

NeurochemicalNeurochemical Too much dopamineToo much dopamine

Brain AbnormalitiesBrain Abnormalities Enlarged ventricles Enlarged ventricles Frontal LobesFrontal Lobes

NeurodevelopmentalNeurodevelopmental Disruptions to the brain before or at birthDisruptions to the brain before or at birth

Discussion Question:Discussion Question:

Recent editions of the DSM include Recent editions of the DSM include everyday problems that are not traditionally everyday problems that are not traditionally thought of as mental illnesses (e.g., thought of as mental illnesses (e.g., developmental coordination disorder, developmental coordination disorder, nicotine dependence disorder). Do you think nicotine dependence disorder). Do you think it's appropriate for these kinds of problems it's appropriate for these kinds of problems to be included among severe psychological to be included among severe psychological disorders such as multiple-personality disorders such as multiple-personality disorder and schizophrenia?disorder and schizophrenia?

Discussion Question:Discussion Question:

If a person does not pose a threat to If a person does not pose a threat to anyone else and is not unhappy with anyone else and is not unhappy with his or her behavior, but is socially his or her behavior, but is socially deviant (e.g., a transvestite), should deviant (e.g., a transvestite), should that person be considered abnormal that person be considered abnormal and mentally ill?and mentally ill?

Chapter 16-Psychotherapy

What is Psychotherapy?

• An umbrella term including many types of therapies/treatments.

• Three Main Elements:– Helping Relationship (treatment)– Professional with special training (therapist)– Person in need of help (client)

Who Seeks Therapy?

• 15% of US population/year• Two most common problems:

– Anxiety– Depression

• Women more likely to seek therapy than men.• Many people who need therapy don’t receive

it.

Who Provides Treatment?

• Psychologists– Clinical and Counseling – Must have doctoral degree

• Psychiatrist– Must go to medical school (M.D.)– Emphasize drug therapies

• Psychiatric Social Workers• Psychiatric Nurses• Counselors

INSIGHT THERAPIES

• Involve verbal interactions intended to enhance clients’ self-knowledge and thus promote healthful changes in personality and behavior.

Client-Centered Therapy

• Proponent: Carl Rogers• Goal: Foster self-acceptance and personal

growth.• Techniques:

– Genuineness– Unconditional Positive Regard – Empathy– Clarification

Cognitive Therapy

• Proponent: Aaron Beck• Goal: Change the way clients think.• Techniques:

– Detect automatic negative thoughts– Subject automatic thoughts to reality testing– ‘Thought Records’—Homework!

THOUGHT RECORD

Evaluating Insight Therapies

• Insight therapy superior to no treatment or placebo treatment, and effects are relatively durable.

• Problems with Evaluating Therapy:– Allegiance Effect– Mechanisms of Action/Common Factors

BEHAVIOUR THERAPY

• Involve the application of the principles of learning to direct efforts to change client’s maladaptive behaviors.

• Two Premises:– All behavior is a product of learning.– What has been learned can be unlearned.

• Goal: To change behavior.

Systematic Desensitization

• Proponent: Joseph Wolpe• Goal: Reduce clients’ anxiety through

counterconditioning. • Techniques:

1) Build an anxiety hierarchy2) Deep muscle relaxation3) Work through the hierarchy while remaining

relaxed.

Aversion Therapy

• Goal: To reduce a particular maladaptive behavior.

• Technique: Pair behavior with a stimulus that elicits an undesirable response.

Evaluating Behavior Therapies

• Place a large emphasis on measuring outcomes

• Insight vs. Behavioral:– Differences are small– Modestly favour behavioral

BIOMEDICAL THERAPIES

• Psychopharmacotherapy: Treatment of mental disorders with medication.

Antipsychotic Drugs

• Used to reduce psychotic symptoms, like mental confusion and hallucinations.

• Reduce symptoms in 70% of people.• Side Effects:

– Drowsiness– Tremors, muscle problems

• Newer ‘atypical antipsychotics’ have fewer side effects.

Antidepressants

• Gradually elevate mood to bring people out of depression.

• Prior to 1987:– Tricyclics– MAO Inhibitors

• Today:– SSRIs (Prozac, Paxil, Celexa)– Effective in 2/3 of patients– Link with suicide?

Evaluating Drug Therapies

• ‘Pretend’ Cure/Band-Aid?• Overprescribed?• Side effects worse than disorder?• Influence of pharmaceutical agencies on

research.

“The Toronto Affair”

• David Healy• Offered a job in 2000 at CAMH, Toronto.• Invited for job talk on November 30, 2000.• Ghost Writing• December 7, 2000: Job offer retracted.• Eli Lilly supports 52% of CAMH mood/anxiety

budget. • Academic Freedom?• Healy filed lawsuit• http://www.pharmapolitics.com/

Trends/Issues in Treatment

• Blending Treatments—eclectic approach• Multicultural Sensitivity

Discussion Question”

• What do you think would be the benefits and disadvantages of group therapy? Is it possible that it could somehow support the symptoms rather than recovery? Would you prefer to be in group therapy or individual?

Discussion Question:

• One of the main assumptions of behavior therapies is that behavior is a product of learning. On the surface, this seems like a straightforward and reasonable assumption, but do you think that some psychological disorders may develop as a result of genetic factors rather than learning? Why or why not?

Final Exam on Monday, August 18th

• Any Questions let me know.