Chapter 14 Psychological Disorders Abnormal Behavior Historical aspects

Chapter 14 Psychological Disorders

Abnormal Behavior Historical aspects of mental disorders n The medical model n What is abnormal behavior? n – 3 criteria • Deviant • Maladaptive • Causing personal distress n A continuum of normal/abnormal Table of Contents

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Prevalence, Causes, and Course n n n Epidemiology Prevalence - % of population that displays the disorder during a specific period Lifetime prevalence – Diagnosis Etiology – causes Prognosis Table of Contents

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Psychodiagnosis: The Classification of Disorders American Psychiatric Association – published first taxonomy in 1952 n Diagnostic and Statistical Manual of Mental Disorders – 4 th ed. (DSM - IV) n Multiaxial system n 5 axes or dimensions n – – – n n Axis I – Clinical Syndromes Axis II – Personality Disorders or Mental Retardation Axis III – General Medical Conditions Axis IV – Psychosocial and Environmental Problems Axis V – Global Assessment of Functioning Example Figure DSM V – to be published in 2011 -12 Table of Contents

Figure 14. 3 – DSM-IV Fig. 14 -3, p. 555 overview Table of Contents

The DSM multiaxial system Example multiaxial evaluation Table of Contents

Axis I Clinical Syndromes and Axis II Personality Disorders n Anxiety Disorders – Somatoform Disorders – Dissociative Disorders – Mood Disorders – Schizophrenic Disorders – Eating Disorders – n Axis II – Personality Disorders – n n n Table of Contents

Clinical Syndromes: Anxiety Disorders n Generalized anxiety disorder – “free-floating anxiety” n Phobic disorder – Specific focus of fear n Panic disorder and agoraphobia (definition issue) – Physical symptoms of anxiety/leading to agoraphobia n Obsessive compulsive disorder – Obsessions – Compulsions Table of Contents

Etiology of Anxiety Disorders n Biological factors – – Genetic predisposition, anxiety sensitivity – GABA circuits in the brain n Conditioning and learning – Acquired through classical conditioning or observational learning – – Maintained through operant conditioning n Cognitive factors – Judgments of perceived threat – n Personality – Neuroticism n Stress – – A precipitator Table of Contents

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Clinical Syndromes: Somatoform Disorders Somatization Disorder n Conversion Disorder – Figure n Hypochondriasis n – Etiology • • Reactive autonomic nervous system Personality factors Cognitive factors The sick role Table of Contents

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Clinical Syndromes: Dissociative Disorders Dissociative amnesia n Dissociative fugue n Dissociative identity disorder n – Etiology • severe emotional trauma during childhood – Controversy • Media creation? • Sybil • Repressed memories Table of Contents

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Clinical Syndromes: Mood Disorders n Major depressive disorder – Dysthymic disorder n Bipolar disorder (manic-depressive disorder) – Cyclothymic disorder n Etiology – – – Age of onset – Genetic vulnerability – Neurochemical factors Cognitive factors – negative thinking – Interpersonal roots Precipitating stress Table of Contents

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Clinical Syndromes: Schizophrenia n General symptoms – Delusions and irrational thought – Deterioration of adaptive behavior avolition – Hallucinations – any modality but usually auditory – Disturbed emotions – 66% n Prognostic factor – Gradual onset – Sudden onset Table of Contents

Subtyping of Schizophrenia n 4 subtypes – Paranoid type – most common subtype - John Nash – Catatonic type – Disorganized type – Undifferentiated type n New model for classification – Positive vs. negative symptoms Table of Contents

Etiology of Schizophrenia n n n Genetic vulnerability – Neurochemical factors – Dopamine hypothesis – Structural abnormalities of the brain – prefrontal lobe and ventricles – The neurodevelopmental hypothesis – Expressed emotion – Precipitating stress – stress-vulnerability model – Table of Contents

– Genetic vulnerability - schizophrenia Table of Contents

Table of Contents The dopamine hypothesis as an explanation for schizophrenia

Neurological Changes in Schizophrenia Table of Contents

– Neurodevelopment hypothesis of schizophrenia – Expressed emotion and relapse rates in schizophrenia Table of Contents

The stress-vulnerability model of schizophrenia Table of Contents

Personality Disorders Next slide– description and male/female percents n Anxious-fearful cluster n – Avoidant, dependent, obsessive-compulsive n Dramatic-impulsive cluster – Histrionic, narcissistic, borderline, antisocial n Odd-eccentric cluster – Schizoid, schizotypal, paranoid n Etiology – Genetic predispositions, inadequate socialization in dysfunctional families n Prognosis Table of Contents

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Psychological Disorders and the Law n Insanity – M’naghten rule – The insanity defense –– perception versus actual cases n Involuntary commitment – varies by states – danger to self – danger to others – in need of treatment n Culture and pathology – Table of Contents

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John Hinkley, Jr. – assassination attempt of President Reagan in 1981 Table of Contents

Eating Disorders – Issues of weight – n Anorexia nervosa n – Criteria and subtypes: restrictive and binge/purge Bulimia nervosa n Binge eating n History and prevalence n – Age onset – n Etiology – – – Genetics Personality – perfectionism Cultural issues - “perfect” body type and digital photograph Family role Cognitive factors Table of Contents

Age of anorexia nervous in the United States – Lucas et al. (1991) Table of Contents

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