PSYCHOLOGICAL DISORDERS

Ch. 16

Introduction to Disorders

Psychopathology: pattern of emotions, behaviors, or thoughts inappropriate to the situation and leading to personal distress or the inability to achieve important goals (also known as psychological disorders, mental illnesses, or mental disorders)

Introduction to Disorders

Early Theories: Afflicted people were possessed by

evil spirits Music or singing was often used to

chase away spirits Trephining: drilling holes in the skull

to let the spirits escape

Introduction to Disorders

History: Early mental hospitals

Barbaric prisons Patients chained and locked away-

seen as criminals Shutter Island

Philippe Pinel- French psychologist who took a more humane look at patients

Introduction to Disorders When diagnosing a psychological

disorder, clinicians look for three classic syndromes:

1. Hallucinations: false sensory experiences that may suggest mental disorder.

Ex: feeling a crawling sensation on your skin, hearing voices when no one has spoken

2. Delusions: extreme disorders of thinking, involving persistent false beliefs.

Ex: Thinking you are the president of the United States (yet you are not)

3. Affective Disturbances: emotional or mood characteristics

those who display no emotion have other possible signs

Introduction to Disorders Indicators of Abnormality: Distress: prolonged levels or unease or anxiety? Maladaptiveness: acting in ways that are

fearful/harmful to one’s well-being? Irrationality: acting or talking in ways that are

irrational or incomprehensible to others Unpredictability: behaving

erratically/inconsistently at one time vs. another Unconventionality and undesirable behavior:

behaving in ways that are statistically rare and violate norms

Introduction to Disorders

Medical Model: Psychological disorders are diseases

of the mind and can be diagnosed on the basis of its symptoms and cured through therapy.

Perceived those with psychological problems as “sick” rather than possessed or immoral Many patients improved or thrived on

rest, contemplation and simple but useful work in asylums

Introduction to Disorders

Biopsychosocial Model: Assumes that all behavior, whether

called normal or disordered, arises from the interaction of nature and nurture

Genetic/physiological factors and past/present experiences

Recognizes that the mind and body are inseparable

Introduction to Disorders

DSM-IV: American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders; widely used system to classifying psychological disorders.

Now updated to the DSM-V in a text revision. Appears this year!

Introduction to Disorders

How are Psychological Disorder diagnosed? (pg. 645)

There are 5 levels (or Axes) that are answered in order to diagnose a disorder:

Axis 1: Is there a Clinical Syndrome present?

Axis 2: Is a personality disorder of mental retardation present?

Introduction to Disorders

Axis 3: Is a general medical condition (i.e. diabetes, hypertension, or arthritis) present?

Axis 4: Are psychosocial or environmental problems (school or housing problems) also present?

Axis 5: What is the global assessment of this person’s functioning? Clinicians assign a code from 0-100. Assessment Scale

Introduction to Disorders

Labeling Psychological Disorders:

Labeling these disorders can create preconceptions that guide our perceptions and our interpretations. Some say it is better to study the roots of specific syndromes than catchall categories.

Introduction to Disorders

Blind Pig Syndrome: diagnosing ourselves. Identifying with symptoms of different disorders.

Some symptoms may apply; however, this does not automatically qualify you as one with a disorder.

Introduction to Disorders

2 Major Classifications: Neurosis: a label for subjective

distress or self-defeating behavior that did not show signs of brain abnormalities or grossly irrational thinking.- Someone who might be unhappy or dissatisfied but not considered dangerously ill or out of touch with reality.

Introduction to Disorders

Psychosis: disorder involving profound disturbances in perception, rational thinking, or affect.- The three signs (hallucinations, delusions, affect [emotions])- Loss of contact with reality

Introduction to Disorders Pros and Cons of Labeling: C- labels affect how others perceive

us; may lead to stigmatization C- biasing power of diagnostic labels

can lead to assumptions of disorders P- helps professionals communicate

about their cases and do research P- helps professionals to comprehend

underlying causes w/ effective treatments

Anxiety Disorders

Disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety These include:

Generalized anxiety disorders Panic disorder Phobias Obsessive-compulsive disorder

Anxiety Disorders

Generalized Anxiety Disorder: disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.

Common, not persistent Continually tense and jittery, worry,

muscle tension, agitation, sleeplessness

Anxiety is free-floating

Anxiety Disorders

Panic Disorder: disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other sensations.

Can advance to panic attacks Attempt to avoid situations where

attacks have struck

Anxiety Disorders Phobia: anxiety disorder marked by a

persistent, irrational fear and avoidance of a specific object or situation.

Include fears of animals, heights, storms, social situations

Agoraphobia- fear or avoidance of situations in which escape might be difficult or help unavailable when panic strikes- Homebound

Social Phobia- fear of being scrutinized by others, avoiding social interactions such as eating out or going to parties

Anxiety Disorders

Other phobias include triskaidekaphobia (number 13), uxoriphobia (one’s wife), Santa Claustrophobia (getting stuck in chimneys), panphobia (everything), phobophobia (fear of fear), anthophobia (flowers), trichophobia (hair), Pteronophobia (fear of being tickled by feathers)

Anxiety Disorders

Obsessive-Compulsive Disorder (OCD): anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions).

Become a disorder when they are so persistent that they interfere with everyday living and cause distress

As Good as It Gets The Aviator

Anxiety Disorders

Common Obsessions- concern with dirt or germs, something terrible happening, symmetry

Common Compulsions- excessive hand washing or bathing, repeated rituals (in/out of a door), checking locks on doors, appliances, homework

Anxiety Disorders

Post-Traumatic Stress Disorder: anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for weeks or more after a traumatic experience.

Common in combat veterans, accident or disaster survivors, and sexual assault victims

Develop a learned helplessness

Anxiety Disorders

Develop a learned helplessness Civilians exhibit a stress dose-

response relationship Can lead to post-traumatic growth-

victims with challenging crisis lead to report increased appreciation of life, more meaningful relationships, changed priorities, etc.

Coping with PTSD

Explaining Anxiety Disorders The Learning Perspective: Fear conditioning- general anxiety has been

linked with classical conditioning of fear After experiencing a traumatic event, fears

may increase Stimulus generalization occurs when one fear

develops into more broad of fears A fear of heights can lead to a fear of flying Observational Learning- observing others’ fears Parents may transmit their fears off on their

children

Explaining Anxiety Disorders The Biological Perspective: Natural Selection- biologically

prepared to fear threats faced by our ancestors

Most consist of objects (spiders, snakes, closed spaces, the dark, storms, etc.)

Genes- genetics can create predisposed fears and high anxiety

Explaining Anxiety Disorders The Biological Perspective: Vulnerability to anxiety disorders can

rise when a relative is an identical twin Twins may develop similar phobias The Brain- anxiety can be measured as

an overarousal of brain areas involved in impulse control and habitual behaviors

The anterior cingulated cortex monitors actions and checks for errors, is extremely hyperactive in OCD patients

Mood Disorders Mood Disorders: disorders characterized

by emotional extremes Depression is the number 1 reason people

seek mental services Mild depression (as we all experience

occasionally) is adaptive—when times are tough, depression slows us down, forces us to reassess our lives, and evokes support

Depression is considered a mental illness when it ceases to be adaptive—when the behavior interferes with our survival

Mood Disorders Major Depressive Disorder Signs of depression (feelings of

worthlessness, loss of interest in family, friends, and activities, lethargy, change in eating patterns, thoughts of death, inability to concentrate, sense of hopelessness, dissatisfaction with your life) last 2 weeks or more.

Usually goes away (even without treatment, although treatment can speed up recovery) in under 6 months

Mood Disorders Facts About Depression Depression tends to be self-sustaining Women are twice as likely to report

depression than men Stressful events often precede depression Rates of depression have increased with

each generation (not just in America) Depression strikes at a younger age now

than in previous generations (not just in America)

Mood Disorders Indication is that increase is real, and not

just that people are more likely to report depression than before

Young adults (18-24) are at the highest risk for developing depression, particularly those who have been depressed before

Ironically, few people commit suicide in the midst of depression because they lack initiative and energy. Suicide risk is highest when people first start to recover

Mood Disorders Bipolar Disorder: person alternates between periods of

major depression and mania behaviors associated with

manic episodes- excessively talkative over reactive, elated, irritable, little need for sleep,

often say their minds are “racing” and jump around from subject to subject when talking, easily distracted, fewer sexual inhibitions;

VERY high self-esteem and optimism lead to poor judgment (spending a lot of money on a shopping spree, taking unnecessary risks)

in manic episodes, there is a high amount of norepinephrine

Mood Disorders

Bipolar Disorder: occurs in less than 1% of population occasionally associated with

psychosis (such as hallucinations and delusions); severe forms like these are occasionally misdiagnosed as schizophrenia

Mood Disorders For each of the following words, write a

sentence that describes an experience you had that is associated with that respective word…

Train Ice House Meeting Machine Road Rain Tunnel

Mood Disorders

For each experience you wrote down, rate whether the experience was pleasant or unpleasant

After you have rated all experiences, tally the total number of pleasant and unpleasant experiences

Mood Disorders

How have you felt today? Happy? Sad? Somewhat depressed? The number of pleasant vs.

unpleasant experiences you recalled should be related to your mood today.

When we are in certain moods, we remember these events as more pleasant or unpleasant depending on our mood during that time.

Mood Disorders Biological Perspective mood disorders run in families twin studies indicate genetic

influence on the disease decreased levels of norepinephrine,

serotonin, and dopamine are all associated with depression

drugs that alleviate mania reduce norepinephrine levels

Mood Disorders Biological Perspective: drugs that alleviate depression

increase levels of one or all three: “tricyclic”—class of anti-depressants

that increase levels of all 3 “SSRI’s”—(selective serotonin

reuptake inhibitors) increase serotonin specifically (Prozac, Zoloft, Paxil)

Mood Disorders

Physical exercise (which reduces depression) increases serotonin levels

Frontal lobe activity is decreased in depressed patients and increased in manic patients

Mood Disorders Social Cognitive Perspective: depression causes negative

thinking AND negative thinking causes depression.

Self –defeating beliefs (we believe we are worthless, we begin to act like we are worthless)

May arise from learned helplessness

Mood Disorders

Attributions—depressed people are more likely to explain bad events in terms that are stable (it’s going to last forever), global (it affects everything), and internal (it’s my fault)

Mood Disorders

Depression is less common in collectivist cultures—possibly because of social supports or maybe because people are less likely to feel individually responsible for bad events

Depressed people respond to bad events in an especially self-focused, self-blaming way women tend to overthink.

Mood Disorders

Mood-Congruent Memory- (negative mood causes negative thoughts) Interesting experiment- after

losing their basketball game, fans were more likely (than after a win) to predict not only that the team would fare poorly in future games, but also that they would fare poorly at several tasks (throwing darts, solving puzzles, getting a date)

Dissociative Disorders

disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings.

May sense themselves to being separated from their body

Can occur when situations become overly stressful

Dissociative Disorders

Dissociative Identity Disorder: rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities (also known as Multiple Personality Disorder)

Two or more distinct identities that alter behavior

Cause memory impairment

Dissociative Disorders

Opposite characters, conversations, and feelings

Skeptics believe that it was created in a certain social context (these multiple personalities show up after beginning therapy)

Psychoanalysts view the disorder as a defense against anxiety (Freud’s defense mechs.) while learning theorists see the behaviors as reinforcers to reduce anxiety

Dissociative Disorders

Dissociative Amnesia: psychologically induced loss of memory for personal information, such as one’s identity or residence.

Ex: Sybil, Jason Bourne

Dissociative Disorders

Dissociative Fugue: similar to amnesia, but with addition of “flight” from one’s home, family, and job

Traveling to distant locations, taking up new lives and identities

May be predisposed by heavy alcohol use

The Man With No Past

Dysthymic Disorder

Dysthymic Disorder: a long-term, low-level depression; while not debilitating, is characterized by low self-esteem and a sense of hopelessness all day almost every day for at least 2 years. People with dysthmia may also experience low energy, indecisiveness, insomnia or excessive excessive sleeping, and a change in appetite.

Somatoform Disorders

Experiencing physical symptoms of a disease for which there is no apparent physical cause

Known as hysteria in Freud’s time

Somatoform Disorders

Two Types: Conversion Disorder—psychological

loss of a specific voluntary body function (thought to be an attempt to avoid a conflict); example- a woman who lives in terror of blurting out things that she does not want to say may lose the power of speech

Band of Brothers

Somatoform Disorders

Hypochondriasis—becoming preoccupied with imaginary ailments; unrealistically interpret normal aches and pains as symptoms of a more serious illness.

Somatoform Disorders

Body Dysmorphic Disorder: imagined physical defect in appearance

Factitious Disorder: falsely producing symptoms in order to solely play the sick role (Munchausen By Proxy syndrome)

Schizophrenia

Schizophrenia: group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate and actions.

“Schizophrenia” means ‘split or broken mind’

Inside the life of a schizophrenic

Schizophrenia

Confused and disconnected thoughts, emotions, perceptions

Nearly 1 in 100 people will develop Typically strikes late in

adolescence Can appear suddenly (acute) or

gradually (chronic); chronic schizophrenia associated with lower rates of recovery

Schizophrenia Symptoms (may be some of all)

Disorganized thinking Delusions “word salad”—jumping from one

idea to another in totally nonsensical patterns

Schizophrenia

Paranoia Hallucinations (most commonly

auditory) Inappropriate reactions (laughing

when mother dies, “flat affect”) Inappropriate motor behavior

(from compulsive acts to catatonia)

Schizophrenia

Paranoid—preoccupied with hallucinations or delusions

Disorganized—disconnected speech or behavior; inappropriate emotions

Catatonic—immobility, parrotlike repeating of another’s speech or movement

Schizophrenia

Undifferentiated—varied symptoms of the different categories

Residual—withdrawal after hallucinations and delusions have disappeared (in remission, or dormant)

Schizophrenia

Common Misconceptions about Schizophrenia:

MYTH: Schizophrenia refers to a "split personality" or multiple personalities.

FACT: Multiple personality disorder is a different and much less common disorder than schizophrenia. People with schizophrenia do not have split personalities. Rather, they are “split off” from reality.

Schizophrenia

MYTH: Schizophrenia is a rare condition.

FACT: Schizophrenia is not rare; the lifetime risk of developing schizophrenia is widely accepted to be around 1 in 100.

Schizophrenia

MYTH: People with schizophrenia are dangerous.

FACT: Although the delusional thoughts and hallucinations of schizophrenia sometimes lead to violent behavior, most people with schizophrenia are neither violent nor a danger to others.

Schizophrenia

MYTH: People with schizophrenia can’t be helped.

FACT: While long-term treatment may be required, the outlook for schizophrenia is not hopeless. When treated properly, many people with schizophrenia are able to enjoy life and function within their families and communities. http://www.helpguide.org/mental/schizophrenia_symptom.htm

Schizophrenia

Causes of Schizophrenia: Freud believed schizophrenia to be a

result of defective parenting or repressed childhood trauma

Viewed today as a fundamental brain disorder/group of disorders

Slow developing schizophrenia, known as process schizophrenia, results in an unlikely recovery

Schizophrenia

Brain Abnormalities- Imbalances in brain chemistry Drugs such as cocaine may stimulate

dopamine production in the brain

Schizophrenia

Dopamine Overactivity- Excess receptors of dopamine- such high

levels may intensify brain signals, creating positive symptoms such as hallucinations- or paranoia

Dopamine-blocking drugs have little effect on persistent negative symptoms of withdrawal

Glutamate (directs neurons to pass along an impulse) may be impaired to cause symptoms

Schizophrenia

Positive vs. Negative Symptoms :

Positive Symptoms are when there are symptoms PRESENT! Ex: The evidence of symptoms such as

delusions or the ‘word salad’ Negative Symptoms are when there

are no symptoms present. Ex: the withdrawal of hallucinations or

delusions

Schizophrenia

Abnormal Brain Activity and Anatomy-

Chronic schizophrenics have abnormal activity in multiple brain areas Low brain activity in frontal lobes

(critical for reasoning, planning, problem solving)

Decline in brain waves that reflect synchronized neural firing in the frontal lobes

Schizophrenia

Activity in thalamus and amygdala when hallucinating

Enlarged, fluid-filled areas with a shrinkage of cerebral tissue

Schizophrenia

Maternal Virus During Midpregnancy-

Midpregnancy viral infections that may impair development: Flu epidemic Viral-populated area Born during winter and spring months Blood drawn during pregnancy

Schizophrenia

Genetic Factors- 1 in 10 diagnosis whose sibling or

parent has the disorder 1 in 2 if sibling is an identitcal twin Adopted children have lower risk

(unless biological parent is diagnosed)

Schizophrenia

Nutritional or oxygen deprivation at birth may influence disease

Diasthesis-Stress Hypothesis: genetic factors place the individual at risk while environmental stress factors transform this potential into the actual disorder

Schizophrenia

Psychological Factors- Environmental causes have not been

discovered “high risk” children Tendency to withdraw socially and

behave oddly Separation of parents

Schizophrenia

Short attention span/poor muscle coordination

Emotionally unpredictable Poor peer relations/solo play