Psychological Disorders Chapter 11 2002 Prentice Hall Psychological

Psychological Disorders Chapter 11 © 2002 Prentice Hall

Psychological Disorders n n n n Defining and diagnosing disorder. Anxiety disorders. Mood disorders. Personality disorders. Drug abuse and addiction. Dissociative identity disorder. Schizophrenia. © 2002 Prentice Hall

Defining and Diagnosing Disorder n n n Dilemmas of definition. Dilemmas of diagnosis. Dilemmas of measurement. © 2002 Prentice Hall

Dilemmas of Definition n Possible Models for Defining Disorders: n n Mental disorder as a violation of cultural standards. Mental disorder as maladaptive or harmful behavior. Mental disorder as emotional distress. Mental Disorder n Any behavior or emotional state that causes an individual great suffering or worry, is self-defeating or self-destructive, or is maladaptive and disrupts the person’s relationships or the larger community. © 2002 Prentice Hall

Diagnostic and Statistical Manual n n n Axis I: Primary clinical problem Axis II: Personality disorders Axis III: General medical conditions Axis IV: Social and environmental stressors Axis V: Global assessment of overall functioning © 2002 Prentice Hall

Explosion of Mental Disorders n n Supporters of new categories answer that is important to distinguish disorders precisely. Critics point to an economic reason: diagnoses are needed for insurance reasons so therapists will be compensated. © 2002 Prentice Hall

Concerns About Diagnostic System n n The danger of overdiagnosis. The power of diagnostic labels. Confusion of serious mental disorders with normal problems. The illusion of objectivity and universality. © 2002 Prentice Hall

Advantages of the DSM n n When the manual is used correctly and diagnoses are made with valid objective tests, the DSM improves the reliability of and agreement among clinicians. The DSM-IV included for the first time a list of culture-bound syndromes, disorders specific to a particular culture. © 2002 Prentice Hall

Projective Tests n n Psychological tests used to infer a person’s motives, conflicts, and unconscious dynamics on the basis of the person’s interpretations of ambiguous stimuli. Rorschach Inkblot Test n A projective personality test that asks respondents to interpret abstract, symmetrical inkblots. © 2002 Prentice Hall A sample inkblot

Objective Tests n Inventories n n Standardized objective questionnaires requiring written responses; they typically include scales on which people are asked to rate themselves. Minnesota Multiphasic Personality Inventory (MMPI) n A widely used objective personality test. © 2002 Prentice Hall

Anxiety Disorders n n n Anxiety and panic. Fears and phobias. Obsessions and compulsions. © 2002 Prentice Hall

Anxiety and Panic n Generalized Anxiety Disorder n n A continuous state of anxiety marked by feelings of worry and dread, apprehension, difficulties in concentration, and signs of motor tension. Panic Disorder n An anxiety disorder in which a person experiences recurring panic attacks, feelings of impending doom or death, accompanied by physiological symptoms such as rapid breathing and dizziness. © 2002 Prentice Hall

Panic Disorder n An anxiety disorder in which a person experiences: n n recurring panic attacks, periods of intense fear, and feelings of impending doom or death; accompanied by physiological symptoms such as rapid heart rate and dizziness. © 2002 Prentice Hall

Posttraumatic Stress Disorder (PTSD) n n n An anxiety disorder in which a person who has experienced a traumatic or lifethreatening event has symptoms such as psychic numbing, reliving the trauma, and increased physiological arousal. Diagnosed only if symptoms persist for 6 months or longer. May immediately follow event or occur later. © 2002 Prentice Hall

Obsessions and Compulsions n Obsessive-Compulsive Disorder (OCD) n n An anxiety disorder in which a person feels trapped in repetitive, persistent thoughts (obsessions) and repetitive, ritualized behaviors (compulsions) designed to reduce anxiety. Person understands that the ritual behavior is senseless but guilt mounts if not performed. © 2002 Prentice Hall

Fears and Phobias n Phobia n An exaggerated, unrealistic fear of a specific situation, activity, or object. © 2002 Prentice Hall

Agoraphobia n A set of phobias, often set off by a panic attack, involving the basic fear of being away from a safe place or person. © 2002 Prentice Hall

Theoretical Explanations: n Freudian n n Behaviorist n n Mowrer’s two-factor theory, for instance Social-Cognitive n n Little Hans, for instance “Vicarious learning, ” we learn to fear by watching others experience pain Biological n We are genetically predisposed to fear anything that might have been dangerous to our ancestors © 2002 Prentice Hall

Mood Disorders n n Depression and Bipolar Disorder. Theories of Depression. © 2002 Prentice Hall

Depression n Major Depression n A mood disorder involving disturbances in emotion (excessive sadness), behavior (loss of interest in one’s usual activities), cognition (thoughts of hopelessness), and body function (fatigue and loss of appetite). © 2002 Prentice Hall

Symptoms of Depression n n n n DSM IV Requires 5 of these within the past 2 weeks Depressed mood. Reduced interest in almost all activities. Significant weight gain or loss, without dieting. Sleep disturbance (insomnia or too much sleep). Change in motor activity (too much or too little). Fatigue or loss of energy. Feelings of worthlessness or guilt. Reduced ability to think or concentrate. Recurrent thoughts of death / suicide © 2002 Prentice Hall

Gender, Age, & Depression n Women are about twice as likely as men to be diagnosed with depression. n n True around the world After age 65, rates of depression drop sharply in both sexes. © 2002 Prentice Hall

Bipolar Disorder n Bipolar Disorder: n n A mood disorder in which episodes of depression and mania (excessive euphoria) occur. Commonly known as “manic depression” or “manic depressive disorder” © 2002 Prentice Hall

The Two Sides of the Coin: Manic and Depressive Phases Manic: n Increased energy and activity n Little need for sleep n Euphoria, sometimes excessive n Lack of concentration n Poor judgment n Distractible; racing thoughts n Denial of problems Depressive: n Lasting sad, anxious, empty mood n Pessimistic outlook, feelings of guilt n Decreased energy n Sleep disturbance n Loss of pleasure in old favorite activities n Change in eating habits n Restlessness or irritability © 2002 Prentice Hall

The Bipolar Brain n n Bipolar disorder can have rapid mood swings These wild changes are shown in brain activity (right) © 2002 Prentice Hall

Theories of Depression n n Biological explanations emphasize genetics and brain chemistry. Social explanations emphasize the stressful circumstances of people’s lives. Attachment explanations emphasize problems with close relationships. Cognitive explanations emphasize particular habits of thinking and ways of interpreting events. “Vulnerability-Stress” explanations draw on all four explanations described above. © 2002 Prentice Hall

Vulnerability-Stress Model © 2002 Prentice Hall

Personality Disorders n n Problem Personalities. Antisocial Personality Disorder. © 2002 Prentice Hall

Problem Personalities n Personality Disorder n n Narcissistic Personality Disorder n n Rigid, maladaptive patterns that cause personal distress or an inability to get along with others. A disorder characterized by an exaggerated sense of self-importance and self-absorption. Paranoid Personality Disorder n A disorder characterized by habitually unreasonable and excessive suspiciousness and jealousy. © 2002 Prentice Hall

Antisocial Personality Disorder (APD) n A disorder characterized by antisocial behavior such as lying, stealing, manipulating others, and sometimes violence; and a lack of guilt, shame and empathy. n n Used to be called psychopathy or sociopathy Occurs in 3% of all males and 1% of all females. © 2002 Prentice Hall

DSM Criteria for APD n Must have 3 of these criteria and a history of behaviors n n n n Repeatedly break the law. They are deceitful, using aliases and lies to con others. They are impulsive and unable to plan ahead. They repeatedly get into physical fights or assaults. They show reckless disregard for own safety or that of others. They are irresponsible, failing to meet obligations to others. They lack remorse for actions that harm others. © 2002 Prentice Hall

Emotions and Antisocial Personality Disorder n n People with APD were slow to develop classically conditioned responses to anger, pain, or shock. Such responses indicate normal anxiety. © 2002 Prentice Hall

Causes of APD n n n Abnormalities in central nervous system. Genetically influenced problems with impulse control. Brain damage. © 2002 Prentice Hall

Drug Abuse and Addiction n Biology and addiction. Learning, culture, and addiction. Debating the causes of addiction. © 2002 Prentice Hall

Biology and Addiction n The biological model holds that addiction, whether to alcohol or other drugs is due primarily to: n n a person’s biochemistry, metabolism, and genetic predisposition, Most evidence comes from twin studies. © 2002 Prentice Hall

Learning, Culture, and Addiction n n Addiction patterns vary according to cultural practices and the social environment. Policies of total abstinence tend to increase addiction rates rather than reduce them. Not all addicts have withdrawal symptoms when they stop taking a drug. Addiction does not depend on the properties of the drug alone, but also on the reason for taking it. © 2002 Prentice Hall

Failure of the Addiction Prediction n n 75% of US Soldiers who tested “drug positive” in Vietnam reported being addicted during their tour. Fewer reported post. Vietnam drug use (blue bar). Even fewer still showed dependency (green bar). This contradicts what the biomedical model of addiction would predict. © 2002 Prentice Hall

Debating the Causes of Addiction n Problems with drugs are more likely when: n n n A person has a physiological vulnerability to a drug. A person believes she or he has no control over the drug. Laws or customs encourage people to take the drug in binges, and moderate use is neither tolerated nor taught. A person comes to rely on a drug as a method of coping with problems, suppressing anger or fear, or relieving pain. Members of a person’s peer group use drugs or drink heavily, forcing the person to choose between using drugs or losing friends. © 2002 Prentice Hall

Dissociative Identity Disorder n n n Defining identity disorders. The MPD controversy. The sociocognitive explanation. © 2002 Prentice Hall

The Four Dissociative Disorders n n n Dissociative amnesia – loss of memory or personal information, usually of a stressful nature Dissociative fugue – rare; person suddenly leaves and travels; will be confused about identity; will have hazy memories of the event Depersonalization disorder – recurrent feelings of detachment or distance from one’s own body, experience, or self © 2002 Prentice Hall

Dissociative Identity Disorder (DID) n A controversial disorder marked by the appearance within one person of two or more distinct personalities, each with its own name and way of relating to the world or self; commonly known as “Multiple Personality Disorder (MPD). ” n Different from schizophrenia (note: no one calls it “split personality” any more), and not the same as bipolar disorder © 2002 Prentice Hall

More About DID n n Different personalities recurrently take control of the subject’s behaviors Subject exhibits inability to recall important personal information to an extent that is more than ordinary forgetfulness © 2002 Prentice Hall

© 2002 Prentice Hall

History of DID n n n Virtually unknown 35 years ago Became more common in past 20 years Why would this be? n n Fewer than 100 documented cases by mid -20 th Century (Taylor and Martin, 1944) About 40, 000 new cases documented between 1985 and 1995 © 2002 Prentice Hall

The MPD Controversy n First viewpoint – It’s real! n n MPD is common but often unrecognized or misdiagnosed. The disorder starts in childhood as means of coping. Trauma produced a mental splitting. Second viewpoint – Most cases are fake! n n Created through pressure and suggestions by clinicians. Handfuls to tens of thousands since 1980. © 2002 Prentice Hall

Sociocognitive Explanation n DID is an extreme form of our ability to present many aspects of our personalities to others. DID is a socially acceptable way for some troubled people to make sense of their problems. Therapists looking for DID may reward patients with attention and praise for revealing more and more personalities. © 2002 Prentice Hall

The Case of Sybil n n Case of DID, popularized in a novel and two movies Real name was Sybil Isabel Dorsett Set the standard for DID as being rooted in child abuse About 16 different personalities, all with uniquely different personalities and attributes (religious, party girl, British accent, skilled pianist, baby); two were male! © 2002 Prentice Hall

DID in Court – What legal problems can you see? n n n Billy Mulligan – accused of robberies and rape; by the time of trial, 10 of his 23 personalities had surfaced: one had a British accent, one could write fluently in Arabic, one was 16, one was 8… Juanita Maxwell – bludgeoned an elderly woman to death with a lamp, but had no memory of the crime; during trial, the violent alter manifested Critics say that the vast majority of subjects were misdiagnosed, are faking it, or were unwittingly pressured into the state by a too-eager clinician © 2002 Prentice Hall

Psychosis n Symptoms of psychotic disorders: n n Hallucinations Delusions Formal thought disorders Psychotic disorders: n n n Mania or depression with psychosis (Schizoaffective disorder) Drug-induced psychosis Schizophrenia © 2002 Prentice Hall

Schizophrenia n n n Defining schizophrenia and psychosis. Symptoms of schizophrenia. Theories of schizophrenia. © 2002 Prentice Hall

Symptoms of Schizophrenia n n Bizarre delusions. Hallucinations and heightened sensory awareness. Disorganized, incoherent speech. Grossly disorganized and inappropriate behavior. © 2002 Prentice Hall

Delusions and Hallucinations n Delusions n n False beliefs that often accompany schizophrenia and other psychotic disorders. Hallucinations n n Sensory experiences that occur in the absence of actual stimulation Hallucinations are usually tactile, auditory, or visual © 2002 Prentice Hall

Positive Symptoms n Cognitive, emotional, and behavioral excesses n Examples of Positive Symptoms n Hallucinations. n Bizarre delusions. n Incoherent speech. n Inappropriate/Disorganized behaviors. © 2002 Prentice Hall

Negative Symptoms n n Cognitive, emotional, and behavioral deficits Examples of Negative Symptoms n n Loss of motivation Emotional flatness Social withdrawal Slowed speech or no speech, even catatonia © 2002 Prentice Hall

Theories of Schizophrenia n n Genetic predispositions Structural brain abnormalities Neurotransmitter abnormalities Prenatal abnormalities © 2002 Prentice Hall

Genetic Vulnerability to Schizophrenia n The risk of developing schizophrenia (i. e. , prevalence) in one’s lifetime increases as the genetic relatedness with a diagnosed schizophrenic increases. © 2002 Prentice Hall

Structural Brain Abnormalities n Several abnormalities exist, especially when schizophrenia is characterized by primarily negative symptoms: n n Decreased brain weight. Decreased volume in temporal lobe or hippocampus. Enlargement of ventricles. About 25% do not have these observable brain deficiencies © 2002 Prentice Hall

Neurotransmitter Abnormalities n n n Include serotonin, glutamate, and dopamine. Many schizophrenics have high levels of brain activity in brain areas served by dopamine as well as greater numbers of particular dopamine receptors. Similar neurotransmitter abnormalities are also found in depression and alcoholism. © 2002 Prentice Hall

Prenatal Problems or Birth Complications n Damage to the fetal brain increases chances of schizophrenia and other mental disorders. n n May occur as a function of maternal malnutrition, maternal illness. May also occur if brain injury or oxygen deprivation occurs at birth. © 2002 Prentice Hall

Adolescent Abnormalities in Brain Development n n Normal pruning of excessive synapses in the brain occurs during adolescence. In schizophrenics, a greater number of synapses are pruned away. n Many explain why first episode occurs in adolescence or early adulthood. © 2002 Prentice Hall

The Question of Drugs © 2002 Prentice Hall

Cautions About Drug Treatment n n Placebo effect High Relapse and dropout rates. Dosage problems. Long-term risks © 2002 Prentice Hall

Kinds of Psychotherapy n n Psychodynamic therapy. Behavioral and Cognitive therapy. Humanist and Existential therapy. Family therapy. © 2002 Prentice Hall