PowerPoint®Presentation by Jim FoleyPsychological

Disorders© 2013 Worth Publishers

Module 39: Basic Concepts of Psychological Disorders, and Mood Disorders

Topics deserving our understanding and contemplation

Defining Psychological Disorders

Case study: ADHD Biopsychosocial and

Medical models Classifying Disorders The effects of labeling Responsibility for one’s

actions Rates of various Disorders

Major Depressive Disorder

Bipolar Disorder Prevalence and Course

of mood disorders Biological Influences on

Depression Suicide and Self-Injury Social- Cognitive

Factors: Explanatory style

Depression’s vicious self-reinforcing cycle

Why Learn about Psychological Disorders?

Reasons for curiosity: personal familiarity with

psychological symptoms knowing someone else

with the disorder hearing about how

prevalent and socially devastating some disorders have become in society

wanting to learn more about mental health and human nature

Questions to Keep in Mind

Perspectives on Psychological Disorders

Defining psychological disorders

Thinking critically about ADHD

Understanding psychological disorders

Classifying psychological disorders

Labeling psychological disorders

Insanity and responsibility

How do we decide when a set of symptoms are severe enough to be

called a disorder that needs treatment?

Can we define specific disorders clearly enough so that we can know that we’re all referring to the same

behavior/mental state?

Can we use our diagnostic labels to guide treatment rather than to

stigmatize people?

A Psychological disorder is: A significant dysfunction in an individual’s cognitions, emotions, or behaviors.

Disorders are diagnosed when there is dysfunction, behaviors which are considered maladaptive because they interfere with one’s daily life

Disorders are diagnosed when the symptoms and behaviors are accompanied by Distress, suffering.

New definition (DSM 5): “a disturbance in the psychological, biological, or developmental processes underlying mental functioning.”

More Understandings about disorders:

Is Attention-Deficit/Hyperactivity Disorder (ADHD) a real disorder?

ADHD: Impulsivity mixed with Inattention and/or hyperactivity. Can include distractibility, disorganization, fidgeting, difficulty suppressing impulses, and impaired working memory. Is this a disorder? Is it deviant? Do some people have a level of

inattentiveness, impulsiveness, or restlessness that goes beyond laziness or immaturity?

Is it distressful? Is the person enjoying being energetic, or are they frustrated that they can’t sustain focus?

Is there dysfunction? Are the symptoms harmless fun, or do they negatively impact work and relationships?

Understanding the Nature of Psychological Disorders One reason to diagnose a disorder is to make decisions about

treating the problem. Based on older understanding of

psychological disorders, treatments have included: exorcising evil spirits, beatings, caging/restraint, and

Pinel’s New Approach Philippe Pinel (1745-1826) proposed that

mental disorders were not caused by demonic possession, but by stress and inhumane conditions.

Pinel’s “moral treatment” involved gentleness, nature, and social interaction.

Pinel’s interventions improved lives but often did not effectively treat mental illness.

But then…

The Medical Model

Psychological disorders can be seen as psychopathology, an illness of the mind.

Disorders can be diagnosed, labeled as a collection of symptoms that tend to go together.

People with disorders can be treated, attended to, given therapy, all with a goal of restoring mental health.

The discovery that the disease of syphilis causes mental symptoms (by infecting the brain) suggested a medical model for mental illness.

The Biopsychosocial Approach

Cultural Influences on Disorders

Examples: Bulimia Nervosa: binging/purging, in the United StatesRunning amok: violent outbursts, in MalaysiaHikikomori: social withdrawal, in Japan

Culture-bound syndromes are disorders which only seem to exist

within certain cultures; they demonstrate how culture can play a role in both causing and defining

a disorder.

Classifying Psychological Disorders

Why create classifications of mental illness? What is the value of talking about diagnoses instead of just talking about individuals?1. Diagnoses create a

verbal shorthand for referring to a list of associated symptoms.

2. Diagnoses allow us to statistically study many similar cases, learning to predict outcomes.

3. Diagnoses can guide treatment choices.

The Diagnostic and Statistical Manual

It’s easier to count cases of autism if we have a clear definition.

Versions: DSM-IV-TR, DSM-V (May 2013)

The DSM is used to justify payment for treatment.

It’s consistent with diagnoses used by medical doctors worldwide.

The DSM suggests describing someone not just with a label but with a five-part picture.

Axis I: Is a clinical syndrome present?

Using specifically

defined criteria,

clinicians may select none, one,

or more syndromes.

Axis II: Is a personality

disorder or mental

retardation (intellectual

developmental disorder) present?

Clinicians may or may not also

select one of these two conditions.

Axis III: Is a general

medical condition,

such as diabetes,

arthritis, or hypertension also present?

Axis IV: Are

psychosocial or

environmental problems, such

as school or housing issues, also present?

Axis V: What is the

global assessment of this person’s functioning?

Clinicians assign a code

from 0-100.

The Five “Axes” of Diagnosis

Categories of Diagnoses

Categories of Diagnoses:

The 5 Axes

Critiques of Diagnosing with the DSM

1. The DSM calls too many people “disordered.”

2. The border between diagnoses, or between disorder and normal, seems arbitrary.

3. Decisions about what is a disorder seem to include value judgments; is depression necessarily deviant?

4. Diagnostic labels direct how we view and interpret the world, telling us which behavior and mental states to see as disordered.

Stigma and Stereotypes

Many people think a diagnostic label means being seen as tainted, weak, and weird.

However: these negative views/stigma

come from popular cultural views of mental illness, and not from the DSM.

the DSM may contain the information to correct inaccurate perceptions of mental illness.

Insanity and Responsibility

Jared Loughner shot many people, including a U.S. Representative, in 2011.

Loughner had schizophrenia and substance abuse problems, a combination associated with increased violence.

What is the appropriate consequence?

To what degree, if any, should he be held responsible for his actions?

How common are psychological disorders?

Countries vary greatly in the percentage of people reporting mental health issues in the past year.

Vulnerable factors and ages for developing Mental Disorders

Poverty increases the risk of many mental disorders including aggression and anxiety. Disorders decrease when poverty is lifted.

“Immigrant paradox”: Despite the stress of immigrating, those who immigrate to the U.S.A. have a lower risk of disorders than their children born in the U.S.A.

Many disorders begin to show symptoms by early adulthood.

Developing on average around age 20: OCD, Schizophrenia, Bipolar, Alcohol Dependence.

Showing some signs earlier: Phobias (median age 10) and antisocial personality disorder (some symptoms by age 8)

Developing later than 20: Major Depressive Disorder.

Who is vulnerable to mental disorders?

Age of vulnerability:

Rates of Psychological

Disorders

This list takes a closer look at the past-year prevalence of various mental health diagnoses in the United States.

Mood Disorders: Not just feeling “down;” not just sad about something Major Depressive Disorder: Stuck in dark withdrawal Bipolar Disorder: sometimes fleeing depression into

mania Prevalence and Course of depression: Common, but

for many it goes away Genetic Influences on Depression Suicide and Self-Injury Negative Moods and Negative thoughts: Explanatory

style The vicious cycle: Interaction of bad experiences

depressive thoughts mood changes behavior changes more sad days

Mood Disorders

Major depressive disorder [MDD] is: more than just feeling “down.” more than just feeling sad

about something.

Bipolar disorder is: more than “mood swings.” depression plus the problematic

overly “up” mood called “mania.”

Criteria of Major Depressive Disorders

Depressed mood most of the day, and/or Markedly diminished interest or pleasure in activities Significant increase or decrease in appetite or weight Insomnia, sleeping too much, or disrupted sleep Lethargy, or physical agitation Fatigue or loss of energy nearly every day Worthlessness, or excessive/inappropriate guilt Daily problems in thinking, concentrating, and/or

making decisions Recurring thoughts of death and suicide

Major depressive disorder is not just one of these symptoms.It is one or both of the first two, PLUS three or more of the rest.

Depression is EverywhereDepression shows up in people seeking treatment: Phobias are the most

common (frequently experienced) disorder, but depression is the #1 reason people seek mental health services.

Depression appears worldwide: Per year, depressive

episodes happen to about 6 percent of men and about 9 percent of women.

Over the course of a lifetime, 12 percent of Canadians and 17 percent of USA residents experience depression.

Depression: The “Common Cold” of Disorders?Although both are “common” (occurring frequently and pervasively), comparing depression to a cold doesn’t work. Depression: is more dangerous because of

suicide risk. has fewer observable symptoms. is more lasting than a cold, and is

less likely to go away just with time. is much less contagious.And…depressive pain is beyond sniffles.

Seasonal Affective Disorder [SAD] Seasonal affective disorder is more than simply

disliking winter. Seasonal affective disorder involves a recurring

seasonal pattern of depression, usually during winter’s short, dark, cold days.

Survey: “Have you cried today”? Result: More people answer “yes” in winter.

Percentage who cried

Men Women

August 4 7

December 8 21

Bipolar Disorder Bipolar disorder was once

called “manic-depressive disorder.”

Bipolar disorder’s two polar opposite moods are depression and mania.

Mania refers to a period of hyper-elevated mood that is euphoric, giddy, easily irritated, hyperactive, impulsive, overly optimistic, and even grandiose.

Contrasting SymptomsDepressed mood: stuck feeling

“down,” with:Mania: euphoric, giddy, easily

irritated, with: exaggerated pessimism social withdrawal lack of felt pleasure inactivity and no initiative difficulty focusing fatigue and excessive desire to

sleep

exaggerated optimism hypersociality and sexuality delight in everything impulsivity and overactivity racing thoughts; the mind

won’t settle down little desire for sleep

Many famous and successful people have lived with the ups and downs of bipolar disorder. Some speculate that the depressive periods gave them ideas, and the manic episodes gave them creative energy. Any evidence of mood swings here?

Bipolar Disorder and Creative Success

Bipolar Disorder in Children and Adolescents Does bipolar disorder

show up before adulthood, and even before puberty?

Many young people have cycles from depression to extended rage rather than mania.

The DSM-V may have a new diagnosis for some of these kids: disruptive mood dysregulation disorder.

Understanding Mood DisordersWhy are mood disorders so pervasive, especially among women?

Women, starting in adolescence, appear to ruminate more, have deeper sadness then men, encounter more stressors, and report their depression more readily.

Understanding Mood DisordersCan we explain…

Why does depression often go away on its own?

the course/development of reactive depression? Often, time heals a mood disorder, especially when the mood issue is in reaction to a stressful event. However, a significant proportion of people with major depressive disorder do not automatically or easily get better with time.

Understanding Mood Disorders

Biological aspects and explanations

Social-cognitive aspects and explanations

EvolutionaryGenetic

Brain /Body

Negative thoughts and negative mood

Explanatory style The vicious cycle

An Evolutionary Perspective on the Biology of Depression

Depression, in its milder, non-disordered form, may have had survival value.

Under stress, depression is social-emotional hibernation. It allows humans to: conserve energy. avoid conflicts and other

risks. let go of unattainable

goals. take time to contemplate.

Biology of Depression: GeneticsEvidence of genetic influence on depression:1. DNA linkage analysis reveals depressed gene regions2. twin/adoption heritability studies

Biology of Depression: The Brain Brain activity is diminished in depression and increased in mania. Brain structure: smaller frontal lobes in depression and fewer

axons in bipolar disorder Brain cell communication (neurotransmitters):

more norepinephrine (arousing) in mania, less in depression reduced serotonin in depression

Suicide and Self-Injury

Every year, 1 million people commit suicide, giving up on the process of trying to cope and improve their emotional well-being.

This can happen when people feel frustrated, trapped, isolated, ineffective, and see no end to these feelings.

Non-suicidal self-injury has other functions such as sending a message, distracting from emotional pain, giving oneself permission to feel, or self-punishment.

Depressive Explanatory

Style

Low Self-Esteem

Learned Helplessness

Rumination

Discounting positive information and assuming the worst about self, situation, and the future Self-defeating

beliefs such as assuming that one (self) is unable to cope, improve, achieve, or be happy

Depression is associated with:

Stuck focusing on what’s bad

Understanding Mood Disorders: The Social-Cognitive Perspective

Depressive Explanatory Style

Mood/result that goes along with

these views:

How we analyze bad news predicts mood.

Assumptions about the problem

The problem is:

The problem is:

The problem is:

Problematic event:

Depression’s Vicious CycleA depressed mood may develop when a person with a

negative outlook experiences repeated stress.

The depressed mood changes a person’s style of thinking and interacting in a way that makes stressful experience more likely.