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Psychological DisordersChapter 14

Consider:

List all the disorders you know (clinical names if possible)What movies, books, TV shows (etc.) have you seen that portray clinical disorders?What makes psychological disorders abnormal?

What is “abnormal”? What is “normal”?Characteristics

Statistical devianceCultural devianceEmotional distressDysfunction; maladaptive behavior

Psychological disorder as an illnessMedical modelBiological, cognitive, social, and cultural factors

Labeling effects and Rosenhan et al. (1973) studyHow long until doctors recognize ptnts aren’t “abnormal”?

Classification of disordersDSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders 4th Ed w/ revisionsFive axes:

Axis I: clinical disordersAxis II: personality disordersAxes III – V: medical conditions, environmental problems, global functions

TerminologyDiagnosisPrognosisEtiology: cause of an illnessEpidemiology: prevalence (pp458)

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Psychological disordersAnxiety disordersSomatoform disordersDisorders of moodDissociative disordersSchizophreniaPersonality disorders

Anxiety disordersGeneralized anxiety disorder

Feeling of chronic, excessive apprehensionNot tied to one specific threatPhysical symptoms

Panic disorderSpecific intense fear w/o realistic dangerRecurrent: Interferes with everyday behaviorPanic attacks: unexpected and feared

Anxiety disordersSpecific phobic disorder

Animals – spidersLocations – heightsSocial situations

AgoraphobiaFear of going out to public

Phrenophobia:Fear of going crazy

Epidemiology:Portion of population reporting each phobia (%)

0 5 10 15 20 25

Bugs, snakes, bats

Heights

Water

Storms

Closed places

Public speak

Eat in public

Public transport

Tunnel or bridges

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Obsessive-compulsive disorderObsessions: thoughtsCompulsions: actions

Rituals to temporarily relieve anxietyHand-washingLocking door

Prevalence:Anxiety: 17% OCD: 2.5%

http://www.metacafe.com/watch/84755/true_life_living_with_ocd/

Eating disordershttp://www.anred.com/toc.html

Anorexia nervosaWeighs 85% or less of normal weight Denies dangers of low weightTerrified of becoming fat Can also have depression, anxiety, withdrawal, OCD

Bulimia NervosaBinge-purge cyclesCan have normal body weight

PrevalenceAnorexia: 1% (only 10% of people with anorexia are male)Bulimia: 4%

Newsweek headline 11/05

Fighting Anorexia: No One to BlameThe age of their youngest patients has slipped to 9 years old, and doctors have begun to research the roots of this disease. Anorexia is probably hard-wired, the new thinking goes, and the best treatment is a family affair.

Somatoform disordersSomatization disorder

History of physical complaintsAppear to be psychological origin

Conversion disorderParalysis or weaknessNo clear physical cause and no correspondence to neural substrate“Glove anesthesia”

HypochondriasisExcessive concern over disease

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Disorders of moodE.g.: Abraham Lincoln, Marilyn Monroe, Ernest Hemingway, Winston Churchill, Janis Joplin, Leo TolstoyMajor depressive episode

Persistent feeling of sadness and despairLoss of interest in previous source of pleasureChanges in weight, sleep, activity, energy, concentration

Bipolar disorderDepression plus manic state

Prevalence: Depression: 7 to 17%Bipolar: 1%+

http://mixednuts.net/depression-famous.html

http://en.wikipedia.org/wiki/List_of_people_with_major_depressive_disorder

Vincent Van Gogh

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Etiology of mood disordersTwin studies: Concordance rates

Identical twins: 67%Fraternal twins: 15%

Neurochemical factorsNorepinephrineSerotonin

Cognitive factorsLearned helplessnessRumination of negative thoughts

Dissociative disordersLoose contact with portion of consciousness resulting in disrupting sense of identityDissociative amnesia

Loss of memory for personal informationDissociative fugue

Dissociative amnesia with “flight” or escapeDissociative identity disorder

Coexistence of different personalitiesUsually unaware of multiple personalitiesEach personality has own name, traits, and behaviorsE.g.: Dr. Jekyll & Mr. Hyde; Sybil

Picture of movie “Sybil”

Dissociative identity disorder Dissociative identity disorderIs it a legitimate disorder?Co-occurs with other disordersOrigin unknownAble to be fakedResearch support for existence: Differences in optical tests with distinct personalities!

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SchizophreniaDistorted thought and perceptionSymptoms

Delusions and irrational thoughtDeterioration in routine functioningHallucinationsDisturbed emotion

Categories of symptomsPositive: addedNegative: removed

Prevalence: 1 to 1.5% (1 out of 100 people!)

Types of schizophreniaParanoid type

Delusions of grandeur, persecution, and jealousyCatatonic type

Frozen or rigid postureExtreme resistance

Disorganized typeInappropriate behavior and emotionsIncoherent language

Undifferentiated typeMix of other typeshttp://www.mtv.com/videos/true-life-full-episode-i-have-schizophrenia-three-people-deal-with-severe-mental-illness/1586145/playlist.jhtml

Paranoid Schizophrenia

http://www.schizophrenia.com/famous.htm

http://www.npr.org/templates/story/story.php?storyId=1136856

SchizophreniaJohn Hinckley, Jr.: attempted to assassinate President Reagan

To Jodi Foster: “Over the past seven months I've left you dozens of poems, letters and love messages in the faint hope that you could develop an interest in me. Although we talked on the phone a couple of times I never had the nerve to simply approach you and introduce myself. [...] the reason I'm going ahead with this attempt now is because I cannot wait any longer to impress you.”

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Schizophrenia

SchizophreniaDopamine hypothesisEnlarged ventriclesLoss of gray matter in frontal and parietal lobes

http://www.schizophrenia.com/

Personality disordersChronic, enduring pattern of behaviorAnxious/fearful

Dependent personality disorder

Odd/eccentricSchizoid and schizotypal personality disorderParanoid personality disorder

Dramatic/impulsiveHistronic and narcissistic personality disorderBorderline personality disorderAntisocial personality disorder

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Antisocial personality disorderPsychopath or sociopath (previous terms)Disregard for rights of others

Fail to conform to social norms/lawsRepeated lyingImpulsiveAggressiveRecklessLack of remorse

Prevalence: 2 to 5% (5:1 male:female ratio)Other statistics:

80% abuse drugs and/or alcohol~ 65-80% legal offenders have ASPD

ASPD: Ted Bundy

Hare’s Psychopath Checklist

Scoring: 0-absent; 1-maybe; 2-definitely thereInterpersonal

Superficial charm, grandiose, pathological lying, manipulative

AffectiveLacks remorse, shallow affect, callous, no responsibility

LifestyleParasitic lifestyle, lacks goals, impulsivity, irresponsibility

AntisocialPoor behavioral control, early juvenile delinquency

Hollywood ASPDHigh intelligenceSomewhat vein, stylish

SuccessfulCalm, calculating, in control

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Etiology: ASPDTwin concordance rates

Identical: 50%Fraternal: 20%

Neurochemical factorTestosteroneSerotonin

Brain functions:Frontal lobeLimbic system

Social-CognitiveRejectionHarsh parenting

Deficient arousalLow resting HRSlow EEGLess fear/anxietyDiminished startle

Borderline personality disorderAffect

DepressionIntense anger (quick mood shifts)Fear of abandonment

CognitionImpaired perception of selfDistorted thoughts: Magical thinking, omnipotence

ImpulsiveSelf-destructive behaviorSubstance abuseSexual deviance

RelationshipsIntense, unstable personal relationships

Borderline personality disorder List of psychological disorders discussedAnxiety disorders

Phobic disordersObsessive-compulsive

Eating disordersAnorexiaBulimia

Dissociative disordersDissociative amnesiaDissociative fugueDissociative identity disorder

Substance abuse disorders

Somatoform disordersConversion disorderHypochondriasis

Disorders of moodMajor depressionBipolar disorder

SchizophreniaPersonality disorders

Borderline personality disorderAntisocial personality disorder

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MoviesBeautiful mindPatch AdamsWhat about BobMementoDeuce BigalowGirl interruptedAs good as it getsMe, myself and IreneClockwork OrangeMulholland DriveSecret Window

MonkHerosHouseLaw and OrderCSILifetime tvMTV true lifeOne who flew over the cockoo’s nest