XII. Psychological Disorders

A. Who is mentally ill?What is “disordered” behavior?

Psychological disorder: typically includes constellation of cognitive, emotional, and behavioral symptoms that create significant stress (impair work, relationships, etc.)

1. Characteristics of disordered behavior.– Atypical, but...– Disturbing, but particularly worrisome when ...– Maladaptive– Unjustifiable – Involuntary

A. Who is mentally ill?What is “disordered” behavior?

2. Diagnosing disordered behavior.– 230 possible diagnoses.a. Development of the DSM(Diagnostic and Statistical Manual for Mental Disorders)First edition 1952: too subjective.Third edition 1980: created objective criteria.Today - Fourth Edition

- How it is usedImportant today for insurance.

A. Who is mentally ill?What is “disordered” behavior?

ii. The DSM and labeling.

- Can giving people a label be problematic?

- Rosenhan et al., (1973)

- Stigma associated with mental illness.

B. Why are people mentally ill?

1. Historically (1600-1700’s):– Supernatural, witch craft.– Treatment?

Bleeding, magic, drill holes in skull Institutions like zoos

B. Why are people mentally ill?

2. Medical Model– In reaction to maltreatment.– First scientific approach to disorders.

Psychological disorders are caused by physical conditions that can be cured.

(disease not depravity).

B. Why are people mentally ill?

3. Bio-Psycho-Social Perspective

- More contemporary.- Considers more influences.

- Biological (genes, brain chemistry)– Environment (stress, roles, expectations)– Culture

- Reflects the nature/nurture perspective.

C. Anxiety Disorders

1. General Description– experience extreme/intense fear, panic, anxiety– most treatable, best prognosis

2. Generalized Anxiety Disorder– Unfocused, free-floating anxiety– 5% of N. Americans experience disorder at some point in life.– Symptoms: physiological

psychological visual

**Must occur for more days than not for 6 month period.

C. Anxiety Disorders

2. Generalized Anxiety Disorder

Causes:

Genetic predisposition

Hyper-vigilance/Over-arousal in brain

Environment

Can lead to panic attacks, panic disorder.

C. Anxiety Disorders

3. Phobias- Focus anxiety on specific source.- Examples…- Causes: Learning approach:

Classical conditioningObservational learning

Genetic (amygdala)Freud

C. Anxiety Disorders

4. Obsessive Compulsive Disorder

- Trapped in endless cycle of repetitive thoughts (obsessions) and actions (compulsions).

- Possibly 4 million people have OCD at one time in life.

- Examples...

C. Anxiety Disorders

- Symptoms:- Severe, prolonged, disrupts normal living- Consumes more than one hour a day.

- Causes similar to generalized anxiety.- Post-Traumatic Stress Disorder – see text.

D. Dissociative Disorders

1. General Description

- Most controversial of disorders.

- Experience sudden loss of memory or change identity.

- “Dissociate” in response to stressful event.

D. Dissociative Disorders

2. Dissociative Amnesia

- Selective memory loss in response to intolerable psychological stress.

- Cannot remember distant/recent past

name, identity

D. Dissociative Disorders

3. Dissociative Fugue

- Flight from one’s home and identity accompanies memory loss.

(take on complete new identity in different place).

D. Dissociative Disorders

4. Dissociative Identity Disorder

- Previously called multiple personality.

- People have two or more distinct personalities that alternately control behavior.

- Why is this disorder so controversial?

D. Dissociative Disorders

Causes:

- natural, protective response

- often women who were abused as kids

- may be encouraged by inborn, biological capacity

Or - contrived fantasy?

Or - created by therapist?

E. Schizophrenia

1. General Description and Symptoms.

- Accounts for higher % of patient population in mental hospitals than any other disorder.

E. Schizophrenia

1. Symptoms:Disorganized Thinking: no organization, fragmented,

includes delusions.

Disturbed Perceptions: perceive things that aren’t there, hallucinations.

(typically auditory “hear voices”)

Inappropriate Emotions & Actions: Strike out, cry when should laugh, flat affect, movement - rocking, rubbing, motionless

E. Schizophrenia

2. Types of Schizophrenia

Positive - disorganized, deluded, acting out

Negative - mute, catatonic, expressionless

Chronic or Process - develops gradually, long history, recovery doubtful.

Acute or Reactive - develops in reaction to life stress, recovery more likely.

E. Schizophrenia

Causes:Genetic:Many genes involved

Brain:Excess number of dopamine receptors.Abnormal brain tissue.Low brain activity in frontal lobes.

Environment?: need to have predisposition.

F. Mood Disorders

Mood: Prolonged emotional state that colors many (or

all) aspects of thoughts & behavior. Spans from severe sad/bad (depression) to

unbridled elation, happiness (mania).Depression:

- Number one reason people seek mental health services.

F. Mood Disorders

1. Depression

Symptoms:

focused on negative

absence of pleasure, hopelessness

self-blame, worthlessness

affects sleep, speech, movement, eating

F. Mood Disorders

1. Major Depressive Disorder

- 2 levels:

Dysthymic Disorder - sad mood, low energy, difficulty concentrating.

Major Depressive Disorder - more disabling, possibly with suicidal thoughts.

F. Mood Disorders

1. Major Depressive Disorder Causes

- Brain: neurotransmitters

- Genetic: twin studies

F. Mood Disorders

1. Major Depressive Disorder Causes:- Socio-Cognitive Perspective

Influence of interpreting events & coping. Attribution process for negative events:

internal, stable, global Ruminate, develop hopelessness and learned helplessness.

F. Mood Disorders

2. Bipolar Disorder- Was manic depressive disorder.- Alternate between hopelessness (dep) and

overexcitedness (mania).Symptoms:

overtalkative, easily irritated, little need for sleep, loud speech, high opinion of self, reckless, fewer sexual inhibitions

F. Mood Disorders

2. Bipolar Disorder

Causes:

- genetic: 7 in 10 chance for twins.

- brain: neurotransmitters abundant during mania

- environmental influence unclear.

Disorders – rates are increasing– 1 in 6 Americans– Symptoms by age 24

G. Personality Disorders – see text

Inflexible and enduring patterns of behavior that impair one’s social functioning.

1. Histrionic: shallow, attention-getting

2. Narcissistic: unwarranted sense of self-importance, cannot accept criticism, demand for constant attention.

G. Personality Disorders

3. Antisocial: socio or psychopath.

Typically male, lack of conscience.

Lie, steal, fight, unrestrained sexual behavior, fear and feel for few, no guilt.

4. Borderline: unstable identity, relationships, and emotions.

C. Anxiety Disorders 5. Posttraumatic Stress Disorder – see text

- Only anxiety disorder directly tied to experiencing or witnessing traumatic event(s).

- Symptoms:

nightmares, reliving events

sleeplessness, irritability, guilt

emotional numbing, depression

- Importance of social support/genetics.