Chapter 14 Psychological Disorders Stereotypes of Psychological Disorders

Chapter 14: Psychological Disorders

Stereotypes of Psychological Disorders 1. Psychological Disorders are incurable 2. People with Psychological Disorders are often violent & dangerous 3. People with Psychological Disorders behave in bizarre ways Chapter 14: Psychological Disorders 2

Abnormal Behavior • The Medical Model – – – • Diagnosis (Distinguishing) Etiology (Causation & Development) Prognosis (Forecast) What is abnormal behavior? 1. Deviant 2. Maladaptive 3. Causing personal distress • A continuum of normal/abnormal Chapter 14: Psychological Disorders 3

Psychodiagnosis: The Classification of Disorders • American Psychiatric Association (APA) • Diagnostic and Statistical Manual of Mental Disorders – 4 th ed. (DSM - 4) Chapter 14: Psychological Disorders 4

Five Axes • 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 Chapter 14: Psychological Disorders 5

Prevalence, Causes, & Course • Epidemiology (Distribution in the population) • Prevalence (Percent of population who has a disorder) • Lifetime prevalence (Percent of population who at some point in their life will have a disorder) – U. S. about 1/3 (about 45%) Chapter 14: Psychological Disorders 6

Lifetime Prevalence of Psychological Disorders Chapter 14: Psychological Disorders 7

Normality & Abnormality as a Continuum Chapter 14: Psychological Disorders 8

Axis I Clinical Syndromes • • • Anxiety Disorders Somatoform Disorders Dissociative Disorders Mood Disorders Schizophrenic Disorders Chapter 14: Psychological Disorders 9

Clinical Syndromes: Anxiety Disorders (4 Types) • Generalized Anxiety Disorder – “free-floating anxiety” ANS arousal • Phobic Disorder – Specific focus of irrational fear • Panic Disorder and Agoraphobia – Panic. anxiety attacks, terror, chest pain choking – Agoraphobia. Fear of going out into public places 2/3 suffer from it. Females. Late adolescences to Early adults • Obsessive Compulsive Disorder. 2. 5% of population. Onset before 35 – Obsessions. Thoughts – Compulsions. Rituals • Posttraumatic Stress Disorder Chapter 14: Psychological Disorders 10

OCD Common Obsessions and Compulsions Among People With Obsessive-Compulsive Disorder Percentage* Reporting Symptom Thought or Behavior Obsessions (repetitive thoughts) Concern with dirt, germs, or toxins 40 Something terrible happening (fire, death, illness) 40 Symmetry order, or exactness 24 Compulsions (repetitive behaviors) Excessive hand washing, bathing, tooth brushing, or grooming 85 Repeating rituals (in/out of a door, up/down from a chair) Checking doors, locks, appliances, car brake, homework 51 Chapter 14: Psychological Disorders 46 11

Etiology of Anxiety Disorders • Biological factors – Genetic predisposition, anxiety sensitivity – GABA circuits in the brain • Conditioning and learning – Acquired through classical conditioning or observational learning – Maintained through operant conditioning • Cognitive factors – Judgments of perceived threat • Personality – Neuroticism • Stress – a precipitator Chapter 14: Psychological Disorders 12

Twin studies of Anxiety Disorders Chapter 14: Psychological Disorders 13

Conditioning as an Explanation for Phobias Chapter 14: Psychological Disorders 14

Cognitive Factors in Anxiety Disorders Chapter 14: Psychological Disorders 15

Clinical Syndromes: Somatoform Disorders (3 Types) • Somatization Disorder – Physical complaints that appear to be psychological in origin, distinguishing factor is the diversity of complaints. Females. • Conversion Disorder – Significant loss of physical function with no organic basis. • Hypochondriasis – Constantly monitoring physical condition looking for signs of illness, disbelieving doctors. Coexist w/ Anxiety & depression. q Etiology • • Reactive autonomic nervous system Personality factors- Histrionic, High Neuroticism Cognitive factors- Draw catastrophic conclusion about minor complaints The sick role- Helps prevent confronting problems Chapter 14: Psychological Disorders 16

Glove Anesthesia Chapter 14: Psychological Disorders 17

Clinical Syndromes: Dissociative Disorders (3 Types) • Dissociative Amnesia (Stress induced) – Sudden extensive loss of memory of personal information. • Dissociative Fugue – Flight from one’s home & identity accompanies amnesia • Dissociative Identity Disorder (aka: Multiple Personality Disorder) – Coexistence of two or more personalities’ in one person. Each different name, race, gender, & physical mannerism. Unaware of the other personalities q. Etiology • severe emotional trauma during childhood - Controversy: Media creation? Chapter 14: Psychological Disorders 18

Clinical Syndromes: Mood Disorders 2 Types of Mood Disorders: • Unipolar (extreme emotion at one end of the continuum) • Bipolar (extreme emotions at both ends) • Major depressive disorder. Persistent feeling of sadness, loss of interest, low energy, last for minimum 5 months. For no reason – Dysthymic disorder. Not severe enough to be classified as MDD (718% U. S. , 2 XHigher in Women) • Bipolar disorder (Manic Depressive Disorder) 1 or 2 episodes – Cyclothymic disorder. Milder symptoms 20% have 4 manic or depressive episode a year. • Etiology – – – Genetic vulnerability Neurochemical factors Cognitive factors Interpersonal roots Precipitating stress Chapter 14: Psychological Disorders 19

Episodic Patterns in Mood Disorders Chapter 14: Psychological Disorders 20

Twin Studies of Mood Disorders Chapter 14: Psychological Disorders 21

Negative Thinking & Prediction of Depression Chapter 14: Psychological Disorders 22

Interpersonal Factors in Depression Chapter 14: Psychological Disorders 23

Clinical Syndromes: Schizophrenia- “Split Mind”, fragmented thought process • General symptoms – Delusions and irrational thought (false beliefs) • Delusion of Grander, Persecution, Sin or Guilt, Influence – Hallucinations (false sensations) – Inappropriate emotions & actions • Prognostic factors Chapter 14: Psychological Disorders 24

Subtyping of Schizophrenia • 4 subtypes – Paranoid type. Delusion of persecution & delusion of grandeur – Catatonic type. Motor disturbances, motionlessness or hyperactive, parrotlike repeating of speech & movement of other people – Disorganized type. Severe deterioration of adaptive behavior, emotional indifference complete withdrawal. Delusion center on bodily functions (my brain is melting) – Undifferentiated type. Doesn't fit into the other categories, usually a mixture of the 3. • New model for classification – Positive vs. negative symptoms Chapter 14: Psychological Disorders 25

Course & Outcome of Schizophrenia • Schizophrenia emerges during adolescence, could be sudden or gradual. Milder cases are treated and recover. Chronic illness result in permanent hospitalization. ½ of patients have a reasonable recovery. Males have earlier onset, more hospitalization, and higher relapse rate. 1. 2. 3. 4. 5. Onset sudden Onset later age Adjustment prior was good Proportions of negative symptoms are low Patient has healthier supportive family Chapter 14: Psychological Disorders 26

Etiology of Schizophrenia • • • Genetic vulnerability Neurochemical factors Structural abnormalities of the brain The neurodevelopmental hypothesis Expressed emotion Precipitating stress Chapter 14: Psychological Disorders 27

Schizophernia Lifetime risk of developing schizophrenia for relatives of a schizophrenic 4 0 3 0 2 General Siblings population Children 0 1 Chapter 14: Psychological Disorders Fraternal Children Identical twin of two schizophrenia victims 28

The dopamine hypothesis as an explanation for schizophrenia Chapter 14: Psychological Disorders 29

The neurodevelopmental hypothesis of schizophrenia Chapter 14: Psychological Disorders 30

Personality Disorders • Anxious-fearful cluster – Avoidant. Fear of rejection, humiliation or shame but want acceptance – Dependent. Lack self reliance, passive in decision making, need other’s. – Obsessive-compulsive. Organizing, rules, schedules, serious, not emotional • Dramatic-impulsive cluster – – Histrionic. Overly dramatic, seeking attention Narcissistic. Self importance, lack of empathy Borderline. Unstable self image, impulsive and unpredictable Antisocial. Violates the rights of others, doesn't accept social norms Chapter 14: Psychological Disorders 31

Personality Disorders Continued • Odd-Eccentric cluster – Schizoid. Not capable of forming social relationships, absence of warm tender feelings for others. – Schizotypal. Social deficits & oddities of thinking, perception & communication that resembles schizophrenia – Paranoid. Showing pervasive & unwarranted suspiciousness. Mistrust people, overly sensitive prone to jealousy. • Etiology – Genetic predispositions, inadequate socialization in dysfunctional families Chapter 14: Psychological Disorders 32

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Psychological Disorders & the Law • Insanity (Not a diagnosis, it’s a legal concept). A person cannot be held accountable for their actions because of mental illness. “out of their mind” – M’naghten rule • Involuntary commitment. People are hospitalized in psychiatric facilities against their own will because of what they might do. – danger to self – danger to others – in need of treatment Chapter 14: Psychological Disorders 34

The insanity defense: public perceptions & actual realities Chapter 14: Psychological Disorders 35

Culture & Pathology • Cultural variations – Relativistic View. Mental illness varies across cultures there is no universal standard. DSM only reflect western cultures. • Culture bound disorders – Schizophrenia, Depression & Bipolar are found in all culture. – Anorexia nervosa. Only found in U. S. Chapter 14: Psychological Disorders 36