Psychological Disorders Chapter 12. Psychological Disorders I. History of Abnormal Psychology II. What Is Abnormal Behavior? III.What Are Anxiety Disorders?

Psychological DisordersPsychological Disorders

Chapter 12Chapter 12

Psychological DisordersPsychological DisordersI. History of Abnormal PsychologyI. History of Abnormal PsychologyII. What Is Abnormal Behavior?II. What Is Abnormal Behavior?III.III. What Are Anxiety Disorders?What Are Anxiety Disorders?IV.IV. What Are Mood Disorders?What Are Mood Disorders?V.V. What Are Dissociative Disorders?What Are Dissociative Disorders?VI.VI. What Is Schizophrenia?What Is Schizophrenia?VII.VII. What Are Personality Disorders?What Are Personality Disorders?VIII. Eating DisordersVIII. Eating DisordersIX. How Are Violence and Mental IX. How Are Violence and Mental

Disorders Related?Disorders Related?

I. HistoryI. History

• Abnormal PsychologyAbnormal Psychology• 1414thth Century Century

• Inhumane TreatmentInhumane Treatment• AsylumsAsylums• Monasteries: BedlamMonasteries: Bedlam

St. Mary of BethlehemSt. Mary of Bethlehem

• 1515thth Century Century• Witchcraft Witchcraft

HistoryHistory

• 1818thth Century Century• Philippe Pinel ( 1745 – 1826): Philippe Pinel ( 1745 – 1826):

• Humane TreatmentHumane Treatment• La Bicetre AsylumLa Bicetre Asylum

• 1919thth Century: Reform Movement Century: Reform Movement• William Tuke (133 – 1822) EnglandWilliam Tuke (133 – 1822) England• Dorthea Dix (1802 – 1887) AmericaDorthea Dix (1802 – 1887) America

II.II. What Is Abnormal What Is Abnormal Behavior?Behavior?

– Not typical

– Socially unacceptable

– Distressing to the person or others

– Maladaptive

– Result of distorted cognitions

Abnormal PsychologyAbnormal Psychology

Concerned with the assessment, Concerned with the assessment, treatment, and prevention of treatment, and prevention of maladaptive behavior.maladaptive behavior.

Abnormality ModelsAbnormality Models

• Set of related concepts that help scientists organize data and predict behavior

• Form the basis of abnormal psychology– Assessment, treatment, and prevention

of maladaptive behavior

ModelsModels

Religious or SupernaturalReligious or Supernatural: Person is : Person is abnormal because of sinful or demonic abnormal because of sinful or demonic possession, temptation by the devilpossession, temptation by the devil

Statistical DiseaseStatistical Disease: Person is abnormal : Person is abnormal because he or she deviates too far because he or she deviates too far from the norm.from the norm.

ModelsModels

Medical/DiseaseMedical/Disease: Person is abnormal : Person is abnormal because of some physical malfunction because of some physical malfunction in the bodyin the body

PsychologicalPsychological: Abnormality is due to : Abnormality is due to defective strategies or coping with defective strategies or coping with stressful circumstances and stressful circumstances and sociocultural conditionssociocultural conditions

ModelsModels

Psychodynamic:– Based on Freud’s theory of personality

– Abnormal behavior caused by anxiety from unresolved conflicts

Humanistic:

– Abnormal behavior caused when people’s needs are not met

• Due to external circumstances or internal factors

ModelsModels

Behavioral– Abnormal behavior is learned– Thus, it can also be unlearned

• Using traditional learning principles• Replaced with more appropriate behaviors

Cognitive– Thought processes lead to abnormal behavior

• E.g., false assumptions, unrealistic coping• Changing thoughts changes behavior

ModelsModels

Sociocultural: Abnormal behavior develops within and because of context• Some disorders are expressed differently in

different cultures• Some disorders are not expressed at all in

some cultures• Once labeled as abnormal, a person may start

to act that way– Self-fulfilling prophecy

ModelsModels

Evolutionary: Abnormal behavior may once have been normal and adaptive

– Maladaptiveness is crucial for being considered abnormal

Which Model is Best?Which Model is Best?

Some psychologists adhere to one model

Many use different models • Eclectic Approach

– Different models for different disorders

• Biopsychosocial Approach– Acknowledges biological, psychological

and social factors– Combines models

Diagnosing PsychopathologyDiagnosing PsychopathologyThe Diagnostic and Statistical Manual of Mental

Disorders• Current version is a text revision of the 4th

edition (DSM-IV-TR)• Designed to diagnose disorders, improve

reliability, and be consistent with research and experience, insurance/billing purposes

• 17 categories of disorders

The DSM-IV-TRThe DSM-IV-TR

Five dimensions (Five dimensions (AxesAxes) of diagnostic ) of diagnostic informationinformation– Axis I: Clinical Disorders– Axis II: Personality Disorders and Mental

Retardation– Axis III: Current Medical Conditions– Axis IV: Psychosocial or Environmental

Problems– Axis V: Global Assessment of Functioning

III. What Are Anxiety III. What Are Anxiety Disorders?Disorders?

– Generalized feeling of fear and apprehension– May be associated with a specific object or

situation– Often accompanied by physiological arousal– Must occur for a 6 month period

Generalized Anxiety DisorderGeneralized Anxiety Disorder

Persistent anxiety not due to a Persistent anxiety not due to a specific stressorspecific stressor

Panic DisorderPanic Disorder

Characterized by panic attacksCharacterized by panic attacks• Intense anxiety and autonomic arousalIntense anxiety and autonomic arousal• Shortness of Breath, increased heart rate, Shortness of Breath, increased heart rate,

sweatingsweating• Also occur in other anxiety disordersAlso occur in other anxiety disorders

• No identifiable trigger for the panic No identifiable trigger for the panic attacksattacks

Phobic DisordersPhobic Disorders

– Excessive, irrational fear and avoidance of a specific object or situation

– May be maintained by the relief of escaping the feared situation

AgoraphobiaAgoraphobia

– Fear and avoidance of being alone in a place from which escape would be difficult or embarrassing

– In severe cases, the person may not even leave the house

– May occur with our without panic attacks– Difficult to treat

• Cognitive behavioral therapy and / or drug therapy may help

Social PhobiaSocial Phobia

– Fear and avoidance of situations where one might be evaluated or embarrassed

– Fear of public speaking, parties– Very common, though often untreated

Specific Phobia

• Irrational, persistent fear and Irrational, persistent fear and avoidance of a specific object or avoidance of a specific object or situationsituation

• Behavior therapy is usually Behavior therapy is usually effectiveeffective

Obsessive–Compulsive Obsessive–Compulsive Disorder (OCD)Disorder (OCD)

– Persistent and uncontrollable thoughts and irrational beliefs (obsessions)• Obsessions often focused on maintaining

order and control

– Rituals that interfere with daily life (compulsions)• Compulsions reduce anxiety from the

obsessions• E.g., compulsive hand-washing to relieve

obsessive thoughts about germs

Post Traumatic Stress Post Traumatic Stress Disorder (PTSD):Disorder (PTSD):

Traumatic event is persistently re-Traumatic event is persistently re-experienced, persistent avoidance experienced, persistent avoidance of stimuli associated with the of stimuli associated with the trauma and numbing of general trauma and numbing of general responses, persistent symptoms of responses, persistent symptoms of increased arousal increased arousal

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IV. What Are Mood IV. What Are Mood Disorders?Disorders?

• In mood disorders, disturbances of In mood disorders, disturbances of mood are intense and persistent mood are intense and persistent enough to be clearly maladaptiveenough to be clearly maladaptive

• Extreme & persistent sadness, Extreme & persistent sadness, despair, loss of interest in activitiesdespair, loss of interest in activities

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What Are Mood Disorders?What Are Mood Disorders?

• The two key moods involved are The two key moods involved are maniamania and and depressiondepression

• In In unipolar disordersunipolar disorders the person the person experiences only severe depressionexperiences only severe depression

• In In bipolar disordersbipolar disorders the theperson experiences bothperson experiences bothmanic and depressivemanic and depressiveepisodesepisodes

The Prevalence of Mood The Prevalence of Mood DisordersDisorders

– Higher in industrialized than developing countries• May be due to higher rates of diagnosis

– Twice as likely for women than men• In the U.S., 19–23% of women and 8–

11% of men• May be due to differences in coping style

The lifetime prevalence for bipolar disorder ranges from 0.4–1.6%

Onset and DurationOnset and Duration

• First episode usually occurs before First episode usually occurs before age 40age 40

• Symptoms may last days, weeks, or Symptoms may last days, weeks, or monthsmonths

• May be one or more repeated May be one or more repeated episodesepisodes

• Children and adolescents can be Children and adolescents can be depresseddepressed

• May also experience Anxiety and LonelinessMay also experience Anxiety and Loneliness

Depressive SymptomsDepressive Symptoms

– Poor appetite and weight loss– Sleep disturbance– Loss of energy and interest– Difficulty concentrating– Feelings of worthlessness, guilt– Thoughts of suicide– Inability to experience pleasure

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Unipolar Mood DisordersUnipolar Mood Disorders

• Two fairly common causes of Two fairly common causes of depression that are generally not depression that are generally not considered mood disorders areconsidered mood disorders are• Loss and the grieving processLoss and the grieving process• Postpartum bluesPostpartum blues

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Unipolar Mood DisordersUnipolar Mood Disorders

• The two main categories of mild to The two main categories of mild to moderate depressive disorders aremoderate depressive disorders are• Adjustment Disorder with Depressed Adjustment Disorder with Depressed

MoodMood• Dysthymic Disorder- Not severe as Dysthymic Disorder- Not severe as

major depression - Chronicmajor depression - Chronic

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Major Depressive DisorderMajor Depressive Disorder• Clinical DepressionClinical Depression• The diagnostic criteria for major The diagnostic criteria for major

depressive disorder requiredepressive disorder require• That the person exhibit more symptoms than That the person exhibit more symptoms than

are required for dysthymiaare required for dysthymia• That the symptoms be more persistentThat the symptoms be more persistent

• Subtypes of major depression includeSubtypes of major depression include• Major depressive episode with melancholic Major depressive episode with melancholic

featuresfeatures• Severe major depressive episode with Severe major depressive episode with

psychotic featurespsychotic features• Major depressive episode with atypical featuresMajor depressive episode with atypical features

Depressive SymptomsDepressive Symptoms

Sometimes include delusions

– False beliefs inconsistent with reality

– May induce feelings of guilt, shame, or persecution

Difficulty with reality testing

– Inability to judge demands accurately and respond appropriately

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Major Depressive DisorderMajor Depressive Disorder

• If major depression does not remit If major depression does not remit for more than two years, for more than two years, chronic chronic major depressivemajor depressive disorder is disorder is diagnoseddiagnosed

• Some people who experience Some people who experience recurrent depressive episodes recurrent depressive episodes show a pattern commonly known show a pattern commonly known as as Seasonal Affective DisorderSeasonal Affective Disorder

Biological Bases of Mood Biological Bases of Mood DisordersDisorders

Biological TheoriesBiological Theories

Neurotransmitters

Monoamine theory of major depression• Depression results from problems with

monoamine neurotransmitters– Dopamine, norepinephrine, epinehprine,

serotonin– May be too few of these neurotransmitters– May not bind effectively to receptors

• Drugs that increase binding relieve depression• Not effective for all cases of depression

The Motor NeuronThe Motor NeuronThe SynapseThe Synapse

– Small space between neurons

Cellular LevelCellular Level

The Functioning of NeuronsThe Functioning of Neurons• Communication is an Communication is an

electrochemical processelectrochemical process• Within neurons it is electricalWithin neurons it is electrical• Between neurons it is chemicalBetween neurons it is chemical• A thin membrane around the A thin membrane around the neuron allows the processneuron allows the process

• Partially Partially permeable cell permeable cell membranemembrane– Traps charged

particles inside or outside the neuron

– At rest, the interior carries a negative electrical charge

– The exterior carries a positive electrical charge

– This difference in charges creates a state of polarization

The Function of NeuronsThe Function of Neurons

• Each neuron has a Each neuron has a thresholdthreshold• Level of stimulation required for activationLevel of stimulation required for activation

• When the threshold is reached:When the threshold is reached:

– “Gates” open in cell membrane

– Positive ions rush into cell

– Neuron is depolarized• Relative charge is

reversed– Action potential has

formed


• Action potentialAction potential

– The “spike charge” is an electrical current that travels down an axon

• All-or-none Principle– Either the neuron fires or it doesn’t– Action potential is always the same strength

• If the threshold is not reached, the neuron will not fire


• Neuron must recover between firingsNeuron must recover between firings• Refractory PeriodRefractory Period

– No action potentials can occur until resting state is re-established


Neurotransmitters and Neurotransmitters and BehaviorBehavior

– Chemical signal• At the axon terminal, the action potential

causes the release of neurotransmitters

– Communication must cross the synapse between neurons

NeurotransmittersNeurotransmitters

• After binding with an adjacent neuron, After binding with an adjacent neuron, one of two processes occursone of two processes occurs• Breakdown by enzymesBreakdown by enzymes• ReuptakeReuptake back into the releasing neuron back into the releasing neuron

• Neurotransmitters have two effectsNeurotransmitters have two effects• ExcitatoryExcitatory: receiving neuron fires more : receiving neuron fires more

easilyeasily• InhibitoryInhibitory: receiving neuron fires less : receiving neuron fires less

easilyeasily

NeurotransmittersNeurotransmitters

• There are at least 50 different There are at least 50 different neurotransmittersneurotransmitters

• Examples:Examples:• Acetylcholine (Ach)Acetylcholine (Ach)

• ExcitatoryExcitatory• Receptors in skeletal musclesReceptors in skeletal muscles• Involved in memory and learningInvolved in memory and learning• Alzheimer’s disease involves insufficient Alzheimer’s disease involves insufficient

production of acetylcholineproduction of acetylcholine

SerotoninSerotonin

• InhibitoryInhibitory• Involved in sleep regulation, Involved in sleep regulation, appetite, anxiety, and depressionappetite, anxiety, and depression

• Antidepressants affect serotoninAntidepressants affect serotonin• A monoamine neurotransmitterA monoamine neurotransmitter

DopamineDopamine

• InhibitoryInhibitory• Involved in movement, learning Involved in movement, learning and memory, emotions, pleasureand memory, emotions, pleasure

• Also involved in Schizophrenia, Also involved in Schizophrenia, ADHD, Parkinson’s DiseaseADHD, Parkinson’s Disease

NorephinephrineNorephinephrine

• ExcitatoryExcitatory• Involved in arousal, hunger, Involved in arousal, hunger, learning, memory, & mood learning, memory, & mood disorders.disorders.

NeuropeptidesNeuropeptides

• Chemicals similar to Chemicals similar to neurotransmittersneurotransmitters• EndorphinsEndorphins• Inhibitory, Painkillers. Occur Inhibitory, Painkillers. Occur

naturally in the brain & bloodstream. naturally in the brain & bloodstream. Similar to morphine.Similar to morphine.

Selective Serotonin Reuptake Inhibitors

(SSRIs)

Alter levels of specific neurotransmitters in the brain

– Block reuptake of serotonin

– Prolongs action of serotonin at synapse

– Effects usually seen within about 4 week

– Prozac, Zoloft, Paxil, Zyprexa, Luvox, Celexa, Effexor

Side EffectsSide Effects

All Antidepressant drugs have some Side Effects

– Sexual side effects

– Nausea, changes in appetite

– Insomnia, headaches

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Biological Causal Factors Biological Causal Factors (Etiology) in Unipolar (Etiology) in Unipolar

DisorderDisorder

• Family studies and twin studies suggest a Family studies and twin studies suggest a moderate genetic contributionmoderate genetic contribution

• Altered neurotransmitter activity in Altered neurotransmitter activity in several systems is clearly associated with several systems is clearly associated with major depressionmajor depression

• The hormone cortisol also plays a roleThe hormone cortisol also plays a role• Depression may be linked to low levels of Depression may be linked to low levels of

activity in the left anterior or prefrontal activity in the left anterior or prefrontal cortexcortex

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Biological Causal Factors in Biological Causal Factors in Unipolar DisorderUnipolar Disorder

• Disruptions of the following may Disruptions of the following may also play a role:also play a role:• SleepSleep• Circadian rhythmsCircadian rhythms• Exposure to sunlightExposure to sunlight

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Psychosocial Causal Factors Psychosocial Causal Factors in Unipolar Disorderin Unipolar Disorder

• Stressful life events are linked to Stressful life events are linked to depressiondepression

• Diathesis-Stress ModelsDiathesis-Stress Models propose propose that some people have that some people have vulnerability factors that may vulnerability factors that may increase the risk for depressionincrease the risk for depression

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Phase 1Phase 1Alarm ReactionAlarm Reaction

Phase 2Phase 2Stage of ResistanceStage of Resistance

Phase 3Phase 3ExhastionExhastion

The Effects of Severe Stress:The Effects of Severe Stress:General Adaptation General Adaptation

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• Freud believed that depression Freud believed that depression was anger turned inwardwas anger turned inward

• Beck proposed a cognitive model Beck proposed a cognitive model of depressionof depression

Cognitive TheoriesCognitive Theories

Depression results from negative thinking– Aaron Beck’s approach

• Negative views of self, environment and the future

• Magnifies errors and misfortunes• Such cognitive distortions predict

depression across ages and cultures

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• Reformulated Helplessness Theory:Reformulated Helplessness Theory: A A pessimistic attributional style is a diathesis pessimistic attributional style is a diathesis for depressionfor depression

• Hopelessness Theory:Hopelessness Theory: A pessimistic A pessimistic attributional style and one or more negative attributional style and one or more negative life events will not produce depression life events will not produce depression unless one first experiences a state of unless one first experiences a state of hopelessnesshopelessness

• Seligman’s Learned Helplessness: Repeated Seligman’s Learned Helplessness: Repeated trying eventually lead to a person giving uptrying eventually lead to a person giving up

Bipolar DisorderBipolar Disorder

– Previously called manic–depressive disorder– Alternating depression and mania

• Excitement, euphoria, boundless energy• Rapid speech• Inflated self-esteem• Impulsivity

– Much less common than major depression– No gender differences in prevalence– Hypomania

Bipolar DisorderBipolar Disorder

• Usually appears in late adolescence/early adulthood

• Time in and between each phase varies widely from person to person

• Substantial genetic component• Often treated successfully with drugs

– Low compliance with drug treatment because manic phases are often pleasant for the individual

– Untreated bipolar disorder is associated with suicide risk and other maladaptive behaviors

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Bipolar DisordersBipolar Disorders

• Bipolar disorders are distinguished Bipolar disorders are distinguished from unipolar disorders by the from unipolar disorders by the presence of presence of manicmanic or or hypomanichypomanic symptomssymptoms

• Some people are subject to cyclical Some people are subject to cyclical mood swings less severe than mood swings less severe than those of bipolar disorder; these are those of bipolar disorder; these are symptoms of symptoms of cyclothymiacyclothymia

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Bipolar Disorders: FeaturesBipolar Disorders: Features

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Bipolar DisordersBipolar Disorders

• People may be diagnosed with People may be diagnosed with Schizoaffective DisorderSchizoaffective Disorder if they if they have a period of illness during have a period of illness during which they:which they:• Meet the criteria for a major mood Meet the criteria for a major mood

disorderdisorder• Exhibit at least two major symptoms Exhibit at least two major symptoms

of schizophreniaof schizophrenia

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Biological Causal Factors in Biological Causal Factors in Bipolar DisordersBipolar Disorders

• There is a greater genetic contribution There is a greater genetic contribution to bipolar disorder than to unipolar to bipolar disorder than to unipolar disorderdisorder

• Norepinephrine, serotonin, and Norepinephrine, serotonin, and dopamine all appear to be involved in dopamine all appear to be involved in regulating our mood statesregulating our mood states

• Bipolar patients may have Bipolar patients may have abnormalities in the way ions are abnormalities in the way ions are transported across the neural transported across the neural membranesmembranes

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Biological Causal Factors in Biological Causal Factors in Bipolar DisordersBipolar Disorders

• Other biological influences may Other biological influences may includeinclude• Cortisol levelsCortisol levels• Disturbances in biological rhythmsDisturbances in biological rhythms• Shifting patterns of blood flow to the left Shifting patterns of blood flow to the left

and right prefrontal cortexand right prefrontal cortex

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Psychosocial Causal Factors Psychosocial Causal Factors in Bipolar Disorderin Bipolar Disorder

• Psychosocial causal factors includePsychosocial causal factors include• Stressful life eventsStressful life events• Personality variables (such as neuroticism Personality variables (such as neuroticism

and high levels of achievement striving) and high levels of achievement striving) • According psychodynamic theorists, manic According psychodynamic theorists, manic

reactions are reactions are an extreme defense an extreme defense against or reaction to against or reaction to depressiondepression

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Sociocultural Factors Affecting Sociocultural Factors Affecting Unipolar and Bipolar DisordersUnipolar and Bipolar Disorders

• The prevalence of mood disorders seems to The prevalence of mood disorders seems to vary considerably among different societiesvary considerably among different societies• The psychological symptoms of The psychological symptoms of

depression are low in China and Japandepression are low in China and Japan• Among several groups of Australian Among several groups of Australian

aborigines there appear to be no suicidesaborigines there appear to be no suicides• In the United States, rates of unipolar In the United States, rates of unipolar

depression are inversely related to depression are inversely related to socioeconomic statussocioeconomic status

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Treatments and OutcomesTreatments and Outcomes

• PsychotherapyPsychotherapy• Cognitive-behavioral therapyCognitive-behavioral therapy• Interpersonal therapyInterpersonal therapy• Family and marital therapyFamily and marital therapy

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• Many patients never seek Many patients never seek treatment, and many of these treatment, and many of these patients will recoverpatients will recover

• Antidepressant, mood-stabilizing, Antidepressant, mood-stabilizing, and antipsychotic drugs are all and antipsychotic drugs are all used in the treatment of unipolar used in the treatment of unipolar and bipolar disordersand bipolar disorders

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• Antidepressant drugs usually require at Antidepressant drugs usually require at least 3 to 4 weeks to take effectleast 3 to 4 weeks to take effect

• Discontinuing the drugs when Discontinuing the drugs when symptoms have remitted may result in symptoms have remitted may result in a relapsea relapse

• Lithium therapy has now become widely Lithium therapy has now become widely used as a mood stabilizer in the used as a mood stabilizer in the treatment of bipolar disordertreatment of bipolar disorder

• Electroconvulsive therapy is often used Electroconvulsive therapy is often used with severely depressed patientswith severely depressed patients

Electroconvulsive Therapy (ECT)Electroconvulsive Therapy (ECT)

Electrical current applied to the head to produce a seizure– Overused in the 1940s and 1950s– Effective in short-term treatment of Severe

Depression not responsive to antidepressants

– Drug treatment and talk therapy needed to maintain long-term change

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• The following forms of The following forms of psychotherapy are also often psychotherapy are also often effective:effective:• Cognitive-behavioral therapyCognitive-behavioral therapy• Interpersonal therapyInterpersonal therapy• Family and marital therapy Family and marital therapy

SuicideSuicide

SuicideSuicide

Suicide is more likely than violence against others– Suicide attempters are unsuccessful

• More likely to be young, female, make less lethal attempts

– Suicide completers are successful• More likely to be White, male, older, and

use more lethal means– Substance abuse increases risk

SuicideSuicide

• 60–70% of people with major depression think about suicide

• Those with antisocial personality disorder or bipolar disorder also at higher risk

• White men over age 75 at highest risk

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Suicide: Who Attempts and Suicide: Who Attempts and Who Commits Suicide?Who Commits Suicide?

• Rates of suicide among children seem Rates of suicide among children seem to be increasingto be increasing

• Rates of suicides for people 15–24 Rates of suicides for people 15–24 tripled between the mid-1950s and mid-tripled between the mid-1950s and mid-1980s1980s

• Conduct disorder and substance abuse Conduct disorder and substance abuse are relatively more common among the are relatively more common among the completers of suicidecompleters of suicide

• Mood disorders are more common Mood disorders are more common among nonfatal attemptersamong nonfatal attempters

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Suicide: Causal FactorsSuicide: Causal Factors

• Genetic factors may play a role in risk Genetic factors may play a role in risk for suicidefor suicide

• Reduced serotonergic activity appears Reduced serotonergic activity appears to be associated with increased riskto be associated with increased risk

• Whites have much higher rates of Whites have much higher rates of suicide than African Americanssuicide than African Americans

• Rates of suicide vary across cultures Rates of suicide vary across cultures and religionsand religions

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Suicide: Suicidal Suicide: Suicidal AmbivalenceAmbivalence

• Some people do not really wish to die Some people do not really wish to die but instead want to communicate a but instead want to communicate a dramatic message concerning their dramatic message concerning their distressdistress

• Research has clearly disproved the Research has clearly disproved the tragic belief that those who threaten to tragic belief that those who threaten to take their lives seldom do sotake their lives seldom do so

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Suicide: Prevention and Suicide: Prevention and InterventionIntervention

• Treatment of the person’s current Treatment of the person’s current mental Disorder(s)mental Disorder(s)

• Crisis interventionCrisis intervention• Preventive programs aimed at Preventive programs aimed at

alleviating the problems of people who alleviating the problems of people who are in high-risk groupsare in high-risk groups

V.V. What Are Dissociative What Are Dissociative Disorders?Disorders?

Sudden but temporary alteration in Sudden but temporary alteration in consciousness, identity, sensorimotor consciousness, identity, sensorimotor behavior, or memorybehavior, or memory

Relatively rare, but very dramaticRelatively rare, but very dramatic

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Dissociative DisordersDissociative Disorders

• A group of conditions involving A group of conditions involving disruptions in a person’s normally disruptions in a person’s normally integrated functions ofintegrated functions of• ConsciousnessConsciousness• MemoryMemory• IdentityIdentity• PerceptionPerception

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• Derealization:Derealization: One’s sense of the One’s sense of the reality of the outside world is reality of the outside world is temporarily losttemporarily lost

• Depersonalization:Depersonalization: One’s sense of One’s sense of one’s self and one’s reality is one’s self and one’s reality is temporarily losttemporarily lost

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• Dissociative AmnesiaDissociative Amnesia:: Failure to recall Failure to recall previously stored personal information previously stored personal information when that failure cannot be accounted for when that failure cannot be accounted for by ordinary forgetting. Not caused by by ordinary forgetting. Not caused by head injury. Affects only certain types of head injury. Affects only certain types of memory. Often associated with a memory. Often associated with a traumatic event. Memory may appear traumatic event. Memory may appear suddenly.suddenly.

• Dissociative FugueDissociative Fugue: Departs from : Departs from home surroundingshome surroundings

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Dissociative DisordersDissociative Disorders• Dissociative Identity Disorder Dissociative Identity Disorder

(DID): (DID): Person manifests two or Person manifests two or more distinct identities or alters more distinct identities or alters that alternate in some way in that alternate in some way in taking control of behaviortaking control of behavior

• RareRare• Usually starts in childhoodUsually starts in childhood

Dissociative Identity Disorder Dissociative Identity Disorder (DID)(DID)

– Formerly known as Multiple Personality Disorder

– The existence of two or more distinct alter within one individual• Each is dominant at different times• Often have different names and unique traits• Principal personality often can not remember

what happens when alternates are in control– “Lost time”

• Stress or crisis brings on shifts

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ControversiesControversies

• Is the disorder real or faked?Is the disorder real or faked?• If the disorder is not faked, how does it If the disorder is not faked, how does it

develop?develop?• Are recovered memories of abuse in Are recovered memories of abuse in

the disorder real or false?the disorder real or false?• If abuse has occurred, did it If abuse has occurred, did it

play a causal role?play a causal role?

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Treatment and Outcomes in Treatment and Outcomes in Dissociative DisordersDissociative Disorders

• No systematic controlled research No systematic controlled research has been conductedhas been conducted

• Possible treatments includePossible treatments include• HypnosisHypnosis• Integration of Separate AltersIntegration of Separate Alters

VI.VI. What Is Schizophrenia?What Is Schizophrenia?

Thought Disorder--NOT multiple personalities

Characterized by:• Bizarre thinking

• Inappropriate emotional response• Lack of reality testing• Deterioration of social and intellectual functioning• Symptoms must begin before age 45• Must be present for at least 6 months

– 1 month more or less continuously• Impaired reality testing and disturbance in functioning

makes schizophrenic disorder a type of psychosis

SchizophreniaSchizophrenia

• PsychosisPsychosis:: Significant loss of contact Significant loss of contact with realitywith reality

• Symptoms:Symptoms:• PositivePositive: Delusions and hallucinations: Delusions and hallucinations• NegativeNegative: Inability to read others’ : Inability to read others’

emotionsemotions

Symptoms of SchizophreniaSymptoms of Schizophrenia

Positive symptoms: Delusions and hallucinations

Negative symptoms: Inability to read others’ emotions

Positive Symptoms in Positive Symptoms in SchizophreniaSchizophrenia

Reflect an excess or distortion in a Reflect an excess or distortion in a normal repertoire of behavior and normal repertoire of behavior and experience such as:experience such as:• DelusionsDelusions• Hallucinations Hallucinations • Disorganized speechDisorganized speech• Disorganized behaviorDisorganized behavior

DelusionsDelusions

Thought Distortions: Disordered thinking – Grandeur: Believe they are someone great (God,

president)– Persecution: People are out to get them.– Reference: People are talking about them.– Thought Broadcasting: People can read their

minds.– Thought Insertion: Others are putting bad

thoughts into their minds.

HallucinationsHallucinations

Perceptual Distortions• Compelling perceptual experiences that

occur without any physical stimulus– Auditory hallucinations (hearing

voices) most common– Voices are perceived as coming

from outside the person– Voices comment on or direct

behavior

HallucinationsHallucinations

•VisualVisual: Seeing things (demons): Seeing things (demons)

•OlfactoryOlfactory: Smelling things : Smelling things (smoke, decaying fish)(smoke, decaying fish)

•TactileTactile: Sensation that : Sensation that something is crawling on or something is crawling on or under the skinunder the skin

Disorganized SpeechDisorganized Speech

• Impaired language use: Impaired language use: Word saladWord salad• Memory deficitsMemory deficits

• Working and long-term memoryWorking and long-term memory• Attention problemsAttention problems

Negative Symptoms in Negative Symptoms in SchizophreniaSchizophrenia

• Reflect an absence or deficit of Reflect an absence or deficit of behaviors that are normally behaviors that are normally presentpresent• Flat or blunted emotional Flat or blunted emotional

expressivenessexpressiveness• Alogia: Poverty of speechAlogia: Poverty of speech• Avolition: Lack of desire, motivation, Avolition: Lack of desire, motivation,

persistencepersistence

Distortions in Emotional Distortions in Emotional ReactionsReactions

Inappropriate affect• Emotional responses that are not

appropriate for the situation• Sometimes there is absence of affect

– Flat affect

• Sometimes a range of emotions are experienced very quickly– Ambivalent affect

Subtypes of SchizophreniaSubtypes of Schizophrenia

Paranoid TypeParanoid Type

Disorganized TypeDisorganized Type

Catatonic TypeCatatonic Type

Undifferentiated TypeUndifferentiated Type

Residual TypeResidual Type

Paranoid SchizophreniaParanoid Schizophrenia

• Delusions of grandeur and / or persecution

• Possibly hallucinations• Both organized around a theme

– E.g., “Aliens are stealing my thoughts.”

• Often little cognitive or other impairments• Higher rates of recovery than other types

Disorganized SchizophreniaDisorganized Schizophrenia

• Severely disturbed thought processes, disorganized behavior, incoherent, inappropriate affect

• Disintegration of normal personality• Total lack of reality testing

Catatonic SchizophreniaCatatonic Schizophrenia

– Impairments in motor activity.• Excited catatonic schizophrenia

– Bursts of violent or excited motor activity– Excessive talking and shouting

• Withdrawn catatonic schizophrenia– Little to no motor or verbal activity at all

(stupor)– Muscular rigidity– Waxy flexibility: molded into different

positions

Residual SchizophreniaResidual Schizophrenia

• In touch with reality despite In touch with reality despite schizophrenic symptomsschizophrenic symptoms

• At least one previous episode At least one previous episode of another typeof another type

Undifferentiated SchizophreniaUndifferentiated Schizophrenia

– All the essential features of a schizophrenic disorder

– Symptoms do not fit easily into one of the other types

Causes of SchizophreniaCauses of Schizophrenia

Biological Factors • Concordance rates

– Degree to which the disorder is shared by two or more individuals or groups

– Higher for identical than fraternal twins• 86% versus 15%

• Neurotransmitters– Dopamine theory of schizophrenia

» Symptoms caused by too much dopamine

Environmental FactorsEnvironmental Factors

– Prenatal malnutrition and infection, birth injuries

– Exposure to lead, poverty, city life– Family factors

• Loss of a parent in childhood• Childhood depression or bipolar disorder

Psychosocial and Cultural Psychosocial and Cultural AspectsAspects

• Many theories about bad families causing Many theories about bad families causing schizophrenia have not stood the test of time schizophrenia have not stood the test of time includingincluding• The idea of the “The idea of the “schizophrenic motherschizophrenic mother””• The double-bind hypothesisThe double-bind hypothesis

• Instead, communication problems may be the Instead, communication problems may be the result of having a schizophrenic in the family result of having a schizophrenic in the family

• Patients with schizophrenia are more likely to Patients with schizophrenia are more likely to relapse if their families are high in expressed relapse if their families are high in expressed emotionemotion

TreatmentTreatment

• Antipsychotic Drugs: Block Dopamine Antipsychotic Drugs: Block Dopamine receptorsreceptors

• Two types of antipsychoticsTwo types of antipsychotics• Conventional (neuroleptics)Conventional (neuroleptics)• Novel Novel

• Patients taking novel antipsychoticsPatients taking novel antipsychotics• Have fewer extrapyramidal (motor Have fewer extrapyramidal (motor

abnormality) side effectsabnormality) side effects• Tend to do better overallTend to do better overall

Psychosocial ApproachesPsychosocial Approaches

• Case ManagementCase Management• Social-Skills TrainingSocial-Skills Training• Cognitive-Behavioral TherapyCognitive-Behavioral Therapy• Other forms of individual treatmentOther forms of individual treatment• Family TherapyFamily Therapy

Family TherapyFamily Therapy

• Provides families with communication Provides families with communication skillsskills

• Reduces high levels of expressed Reduces high levels of expressed emotionemotion

VII. What Are Personality VII. What Are Personality Disorders?Disorders?

Inflexible and long-standing maladaptive Inflexible and long-standing maladaptive behaviors that cause distress and behaviors that cause distress and social/ occupational impairmentsocial/ occupational impairment

Chronic interpersonal difficultiesChronic interpersonal difficultiesThose diagnosed tend to fall into Those diagnosed tend to fall into

stereotypical gender and ethnic stereotypical gender and ethnic categoriescategories

Problems with one’s identity or sense of Problems with one’s identity or sense of selfself

Difficulties Doing Research Difficulties Doing Research on Personality Disorderson Personality Disorders

• ControversialControversial• Can be difficult to diagnoseCan be difficult to diagnose• Those diagnosed tend to fall into Those diagnosed tend to fall into

stereotypical gender and ethnic stereotypical gender and ethnic categoriescategories

Cluster A: Personality Cluster A: Personality DisordersDisorders

• ParanoidParanoid• SchizoidSchizoid• SchizotypalSchizotypal

Characteristics:Characteristics:• Distrustful Distrustful • SuspiciousSuspicious• Socially DetachedSocially Detached

Peculiar thought patterns; oddities of Peculiar thought patterns; oddities of perception and speech that interfere with perception and speech that interfere with communication and social interactioncommunication and social interaction

SchizotypalSchizotypal

Impaired social relationships; inability and lack Impaired social relationships; inability and lack of desire to form attachments to othersof desire to form attachments to othersSchizoidSchizoid

Suspiciousness, mistrust, tendency to see self Suspiciousness, mistrust, tendency to see self as blameless; on guard for perceived attacks as blameless; on guard for perceived attacks by others; odd eccentric, by others; odd eccentric,

ParanoidParanoid

CharacteristicsCharacteristicsDisorderDisorder

Personality Disorders:Personality Disorders:Cluster ACluster A

Cluster B: Personality Cluster B: Personality DisordersDisorders

• HistrionicHistrionic• NarcissisticNarcissistic• AntisocialAntisocial• Borderline Personality DisordersBorderline Personality Disorders

Characteristics:Characteristics:• DramaticDramatic• EmotionalEmotional• ErraticErratic

Lack of moral or ethical development; inability to Lack of moral or ethical development; inability to follow approved models of behavior; follow approved models of behavior; deceitfulness; shameless manipulation of others; deceitfulness; shameless manipulation of others; history of conduct problems as a childhistory of conduct problems as a child

AntisocialAntisocial

Impulsiveness; inappropriate anger; drastic mood Impulsiveness; inappropriate anger; drastic mood shifts; chronic feelings of boredom; attempts at shifts; chronic feelings of boredom; attempts at self-mutilation or suicideself-mutilation or suicide

BorderlineBorderline

Grandiosity; preoccupation with receiving Grandiosity; preoccupation with receiving attention; self-promoting; lack of empathyattention; self-promoting; lack of empathyNarcissisticNarcissistic

dramatic; overconcern with attractivenes; dramatic; overconcern with attractivenes; tendency of irritability and temper outbursts if tendency of irritability and temper outbursts if attention seeking is frustrated, emotionalattention seeking is frustrated, emotional

HistrionicHistrionic

CharacteristicsCharacteristicsDisorder

Personality Disorders: Personality Disorders: Cluster BCluster B

Cluster C: Personality Cluster C: Personality DisordersDisorders

• AvoidantAvoidant• DependentDependent• Obsessive-CompulsiveObsessive-Compulsive

CharacteristicsCharacteristics• AnxiousAnxious• FearfulFearful

Excessive concern with order, rules, and trivial Excessive concern with order, rules, and trivial details; perfectionism; lack of expressiveness details; perfectionism; lack of expressiveness and warmth; difficulty in relaxing and having funand warmth; difficulty in relaxing and having fun

Obsessive-Obsessive-compulsivecompulsive

Difficulty in separating in relationships; discomfort Difficulty in separating in relationships; discomfort at being alone; subordination of needs in order to at being alone; subordination of needs in order to keep others involved in a relationship; keep others involved in a relationship; indecisivenessindecisiveness

DependentDependent

Hypersensitivity to rejection or social derogation; Hypersensitivity to rejection or social derogation; shyness; insecurity in social interaction and shyness; insecurity in social interaction and initiating relationshipsinitiating relationships

AvoidantAvoidant


Personality Disorders: Personality Disorders: Cluster CCluster C

Provisional CategoriesProvisional Categories

Passive-AggressivePassive-Aggressive

DepressiveDepressive

Pervasive depressive cognitions; persistent Pervasive depressive cognitions; persistent unhappiness or dejection; feeling of unhappiness or dejection; feeling of inadequacy, guilt, and self-criticisminadequacy, guilt, and self-criticism

DepressiveDepressive

Negativistic attitudes and passive resistance Negativistic attitudes and passive resistance to adequate performance expressed through to adequate performance expressed through indirect means such as complaining, being indirect means such as complaining, being sullen and argumentative, expressing envy sullen and argumentative, expressing envy and resentment toward those who are more and resentment toward those who are more fortunatefortunate

Passive-Passive-aggressiveaggressive


Personality Disorders:Personality Disorders:Provisional CategoriesProvisional Categories

Causal Factors in Antisocial Causal Factors in Antisocial Personality DisorderPersonality Disorder

• Genetic influencesGenetic influences• Learning of antisocial behaviorLearning of antisocial behavior• Adverse environmental factorsAdverse environmental factors

General Sociocultural Causal General Sociocultural Causal Factors for Personality Factors for Personality

DisordersDisorders

• Is our emphasis on impulse Is our emphasis on impulse gratification, instant solutions, and gratification, instant solutions, and pain-free benefits leading more pain-free benefits leading more people to develop the self-centered people to develop the self-centered lifestyles that we see in more lifestyles that we see in more extreme forms in personality extreme forms in personality disorders?disorders?


• Very difficult to treat (especially Very difficult to treat (especially Cluster A)Cluster A)

• Treatment of the Cluster C disorders Treatment of the Cluster C disorders seems most promisingseems most promising

• DDialectical Behavior Therapyialectical Behavior Therapy (DBT) (DBT) shows promise for treating shows promise for treating Borderline Personality Disorder Borderline Personality Disorder (Cluster B)(Cluster B)

Treatments and Outcomes in Treatments and Outcomes in Psychopathic and ASPDPsychopathic and ASPD

• Treatment of psychopaths is difficultTreatment of psychopaths is difficult• Cognitive-behavioral treatments Cognitive-behavioral treatments

offer some promiseoffer some promise

VIII. Eating DisordersVIII. Eating Disorders

• Psychological disorders that are characterized by Psychological disorders that are characterized by severe disturbances in eating behaviorsevere disturbances in eating behavior

• Anorexia Nervosa: Anorexia Nervosa: • self starvation, refusal to maintain normal bodyself starvation, refusal to maintain normal body• weight, fear of being overweight, life threatening,weight, fear of being overweight, life threatening,• distorted body imagedistorted body image

• Bulimia Nervosa: weight maintained by binge Bulimia Nervosa: weight maintained by binge eating & purgingeating & purging

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Eating DisordersEating Disorders

• The two most common forms of The two most common forms of eating disorders areeating disorders are• Anorexia nervosaAnorexia nervosa• Bulimia nervosaBulimia nervosa

• At the heart of both disorders isAt the heart of both disorders is• An intense and pathological fear of An intense and pathological fear of

becoming overweight and fatbecoming overweight and fat• A pursuit of thinness that is relentless A pursuit of thinness that is relentless

and sometimes deadlyand sometimes deadly

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Anorexia NervosaAnorexia Nervosa

CCharacterized by:haracterized by:• Self starvation Self starvation • Refusal to maintain normal bodyRefusal to maintain normal body• Fear of being overweightFear of being overweight• Distorted body imageDistorted body image• Life threateningLife threatening

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Anorexia NervosaAnorexia Nervosa

• The mortality rate for females The mortality rate for females with anorexia nervosa is more with anorexia nervosa is more than twelve times higher than the than twelve times higher than the mortality rate for females aged mortality rate for females aged 15–24 in the general population15–24 in the general population

130

Bulimia NervosaBulimia Nervosa

CCharacterized by:haracterized by:• Frequent episodes of binge eating Frequent episodes of binge eating

& purging& purging• Lack of control over eatingLack of control over eating• Recurrent inappropriate behavior Recurrent inappropriate behavior

to prevent weight gainto prevent weight gain• Typically of normal weightTypically of normal weight

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Age of Onset and Gender Age of Onset and Gender DifferencesDifferences

• Anorexia nervosa is most likely to Anorexia nervosa is most likely to develop in 15- to 19-year-oldsdevelop in 15- to 19-year-olds

• Bulimia nervosa is most likely to Bulimia nervosa is most likely to develop in women aged 20-24develop in women aged 20-24

• There are 10 females for every There are 10 females for every male with an eating disordermale with an eating disorder

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Medical Complications Medical Complications

• Anorexia can lead toAnorexia can lead to• Death from heart arrhythmiasDeath from heart arrhythmias• Kidney damageKidney damage• Renal failureRenal failure• AmenorrheaAmenorrhea

• Bulimia can lead toBulimia can lead to• Electrolyte imbalancesElectrolyte imbalances• Hypokalemia (low potassium)Hypokalemia (low potassium)• Damage to hands, throat, and teeth Damage to hands, throat, and teeth

from induced vomitingfrom induced vomiting

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ComorbitityComorbitity

Associated with:Associated with:• Clinical DepressionClinical Depression• Obsessive-Compulsive DisorderObsessive-Compulsive Disorder• Substance Abuse DisordersSubstance Abuse Disorders• Various Personality DisordersVarious Personality Disorders

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PrevalencePrevalence

• The lifetime prevalence of anorexia The lifetime prevalence of anorexia nervosa is around 0.5%nervosa is around 0.5%

• The lifetime prevalence of bulimia is The lifetime prevalence of bulimia is around 1–3%around 1–3%

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CultureCulture

• Eating disorders are becoming a Eating disorders are becoming a problem worldwideproblem worldwide

• The attitudes that lead to eating The attitudes that lead to eating disorders are more common in disorders are more common in Whites and Asians than African Whites and Asians than African AmericansAmericans

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EtiologyEtiology

• Multi-determinedMulti-determined• Runs in familiesRuns in families• Genetic influence has yet to be Genetic influence has yet to be

determineddetermined• Set-point theorySet-point theory (the idea that our (the idea that our

bodies resist marked variation) bodies resist marked variation) may play a rolemay play a role

• SerotoninSerotonin levels may play a role levels may play a role

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Sociocultural FactorsSociocultural Factors

• Fashion magazines idealize extreme Fashion magazines idealize extreme thinnessthinness

• Women often internalize the thin Women often internalize the thin idealideal

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Risk and Causal Factors in Risk and Causal Factors in Eating DisordersEating Disorders

• Nearly all instances of eating Nearly all instances of eating disorders begin with normal dietingdisorders begin with normal dieting

• PerfectionismPerfectionism• Childhood sexual abuse may play a Childhood sexual abuse may play a

rolerole

139

Treatment for Anorexia Treatment for Anorexia NervosaNervosa

• Emergency procedures to restore Emergency procedures to restore weightweight

• Cognitive-behavioral therapyCognitive-behavioral therapy• Antidepressants or other Antidepressants or other

medicationsmedications• Family therapyFamily therapy

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Treatment for Bulimia Treatment for Bulimia NervosaNervosa

• Antidepressants or other Antidepressants or other medicationsmedications

• Cognitive-behavioral therapyCognitive-behavioral therapy• Little is knownLittle is known

ObesitObesityy

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ObesityObesity

• In the United States, 20% of men In the United States, 20% of men and 25% of women are morbidly and 25% of women are morbidly obeseobese

• Obesity is defined on the basis of Obesity is defined on the basis of the body mass indexthe body mass index

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Calculating Body Mass Calculating Body Mass IndexIndex

weight (lbs.)weight (lbs.)

height x height (in.)height x height (in.)x 703 = BMIx 703 = BMI

BMIBMI

HealthyHealthy 18.5-24.918.5-24.9

OverweightOverweight 25-29.925-29.9

ObeseObese 30-39.930-39.9

Morbidly obeseMorbidly obese 40+40+

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ObesityObesity

• Not an eating disorderNot an eating disorder• Habit of overeatingHabit of overeating

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Risk and Causal Factors in Risk and Causal Factors in ObesityObesity

• Genetic inheritanceGenetic inheritance• Hormones involved in appetite and Hormones involved in appetite and

weight regulationweight regulation• Sociocultural influencesSociocultural influences• Family influencesFamily influences• Stress and “comfort food”Stress and “comfort food”

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Pathways to ObesityPathways to Obesity

• Binge eating is a predictor of later Binge eating is a predictor of later obesityobesity

• Social pressure to conform to the Social pressure to conform to the thin idealthin ideal

• DepressionDepression• Low self-esteemLow self-esteem

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Treatment of ObesityTreatment of Obesity

• Methods used to treat obesity include:Methods used to treat obesity include:• Weight-loss groupsWeight-loss groups• MedicationsMedications• Gastric surgeryGastric surgery• Behavioral managementBehavioral management

• Difficult to lose weight and maintain Difficult to lose weight and maintain their new low weighttheir new low weight

• Prevention is importantPrevention is important

IX. How Are Violence and IX. How Are Violence and Mental Disorders Related?Mental Disorders Related?

Diagnoses Associated with Violence– More serious disorders have more risk of

violence– Those with delusions at higher risk– Manic phase of bipolar disorder

• May be easily angered– Paranoid schizophrenia

• Violent actions are an attempt to protect the self in response to delusions

Schizophrenia & HomicideSchizophrenia & Homicide

• Schizophrenia plus alcohol abuse equals higher risk

• Those with substance problems alone more violent than those with schizophrenia alone

• Antisocial personality disorder– Violent and non-violent antisocial behavior

make these individuals dangerous to others

Violence as Risk for Developing Violence as Risk for Developing Mental DisorderMental Disorder

– Child abuse increases risk of a range of mental disorders

– Also increases risk of becoming an abuser– Most abusers do not have a mental disorder

• Poor parenting and environmental stress interact to create abusive parents

Domestic ViolenceDomestic Violence

– Common throughout the world– Married and unmarried partners– Victims are at increased risk for PTSD, eating

disorders, and depression– May explain higher rates of these disorders

among women

RapeRape

Women also more likely to be raped– Date or acquaintance rape more common than

stranger rape– Experiences of male and female victims is

similar• Increase risk for PTSD, anxiety disorders,

depression, suicide, substance abuse– Rapists unlikely to have a mental illness

• Mental disorders less predictive of rape than social factors and attitudes

Documents

Psychological Disorders Chapter 12. Psychological Disorders I. History of Abnormal Psychology II. What Is Abnormal Behavior? III.What Are Anxiety Disorders?