Psychological Disorders Chapter 16 1 Psychological Disorders Perspectives

Psychological Disorders Chapter 16 1

Psychological Disorders Perspectives on Psychological Disorders § Defining Psychological Disorders § Understanding Psychological Disorders § Classifying Psychological Disorders § Labeling Psychological Disorders 2

Psychological Disorders Anxiety Disorders § Generalized Anxiety Disorder and Panic Disorder § Phobias § Obsessive-Compulsive Disorders § Post-Traumatic Stress Disorders § Anxiety Disorder Explanation 3

Psychological Disorders Mood Disorders § Major Depressive Disorders § Bipolar Disorder § Mood Disorder Explanation Schizophrenia § Symptoms of Schizophrenia § Subtypes of Schizophrenia 4

Psychological Disorders Schizophrenia § Understanding Schizophrenia Personality Disorders Rates of Psychological Disorders 5

Do Now: How would you define abnormal psychology? • Deviates from normal • Deviates from the majority population • Dysfunctional thoughts, feelings, and actions 6

Psychological Disorders To study the abnormal is the best way of understanding the normal. William James (1842 -1910) 1. There are 450 million people suffering from psychological disorders (WHO, 2004). 2. Depression and schizophrenia exist in all cultures of the world. 7

Defining Psychological Disorders Criteria for psychological disorder • atypical- not shared by others in population • disturbing- persistently harmful thought, feelings, and actions • maladaptive -harmful to self or others • unjustifiable-doesn’t make sense to average person When behavior is deviant, distressful, and dysfunctional psychiatrists and psychologists label it as disordered (Comer, 2004). 9

What does it feel like to have a psychological disorder? 10

Psychological Disorders I felt the need to clean my room … spent four to five hour at it … At the time I loved it but then didn't want to do it any more, but could not stop … The clothes hung … two fingers apart …I touched my bedroom wall before leaving the house … I had constant anxiety … I thought I might be nuts. Marc, diagnosed with obsessive-compulsive disorder (from Summers, 1996) 11

Deviant, Distressful & Dysfunctional 1. Deviant behavior in one culture may be considered normal, while in others it may lead to arrest. 3. If a behavior is dysfunctional it is clearly a disorder. Carol Beckwith 2. Deviant behavior must accompany distress. In the Wodaabe tribe men wear costumes to attract women. In Western society this would be considered abnormal. 12

How do psychological disorders differ from insanity? Insanity is a legal definition that person should not be held accountable for crimes due to psychological disorder 13

Psychological well-being defined by Carol Ryff: 6 core dimensions • self-acceptance- acknowledges good and bad qualities • positive relations with others • autonomy-independent and self-controlled • environmental mastery- make use of given opportunities • purpose in life-believes life has meaning and one has goals and a sense to get there • personal growth healthy people see themselves as growing and expanding 14

Understanding Psychological Disorders Ancient Treatments of psychological disorders include trephination, exorcism, being caged like animals, being beaten, burned, castrated, mutilated, or transfused with animal’s blood. John W. Verano Trephination (boring holes in the skull to remove evil forces) 15

Medical Model When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders. 1. 2. 3. 4. Etiology: Cause and development of the disorder. Diagnosis: Identifying (symptoms) and distinguishing one disease from another. Treatment: Treating a disorder in a psychiatric hospital. Prognosis: Forecast about the disorder. 17

Do Now: Review Homework 1) What criteria must be met for an individual to be classified as psychologically disordered? 2) Briefly contrast the medical model and biopsychosocial approach to psychological disorders. 3) Describe one potential danger of using the DSM-IV. 4) Today, the American Psychiatric Association has suggested that nearly 30% of all adults suffer from one or more psychological disorders opposed to 12% in the 1950's. The number of categories of psychological disorders has also increased dramatically from about 60 categories fifty years ago to 400+ today. What do YOU think is the reason for this trend? 18

Classifying Psychological Disorders The American Psychiatric Association rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe psychological disorders. The most recent edition, DSM-IV-TR (Text Revision, 2000), describes 400 psychological disorders compared to 60 in the 1950 s. 20

Multiaxial Classification Axis II Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? Is a Personality Disorder or Mental Retardation present? Is a General Medical Condition (diabetes, Axis III hypertension or arthritis etc) also present? Are Psychosocial or Environmental Problems Axis IV (school or housing issues) also present? What is the Global Assessment of the person’s Axis V functioning? 21

Goals of DSM 1. 2. Describe (400) disorders. Determine how prevalent the disorder is. Disorders outlined by DSM-IV are reliable. Therefore, diagnoses by different professionals are similar. DSM-IV has been criticized for “putting any kind of behavior within the compass of psychiatry. ” 24

Labeling Psychological Disorders 1. Critics of the DSM-IV argue that labels may stigmatize individuals. Elizabeth Eckert, Middletown, NY. From L. Gamwell and N. Tomes, Madness in America, 1995. Cornell University Press. Asylum baseball team (labeling) 25

Labeling Psychological Disorders 2. Labels may be helpful for healthcare professionals when communicating prognoses and establishing therapy. 26

Labeling Psychological Disorders 3. “Insanity” labels raise moral and ethical questions Elaine Thompson/ AP Photo Theodore Kaczynski (Unabomber) 27

Anxiety Disorders Feelings of excessive apprehension and anxiety. 1. 2. 3. 4. Generalized anxiety disorders Phobias Panic disorders Obsessive-compulsive disorders 28

Generalized Anxiety Disorder Symptoms 1. Persistent and uncontrollable tenseness and apprehension. 2. Autonomic arousal. 3. Inability to identify or avoid the cause of certain feelings. 29

Panic Disorder Symptoms Minute-long episodes of intense dread which may include chest pains, choking, or other frightening sensations. Anxiety in panic disorder can cause people to avoid social situations 30

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Phobia Marked by a persistent and irrational fear of an object or situation that disrupts behavior. 32

Kinds of Phobias Agoraphobia Acrophobia Claustrophobia Hemophobia Phobia of open places. Phobia of heights. Phobia of closed spaces. Phobia of blood. 33

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Obsessive-Compulsive Disorder Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress. 35

Brain Imaging A PET scan of the brain of a person with Obsessive-Compulsive Disorder (OCD). High metabolic activity (red) in the frontal lobe areas are involved with directing attention. Brain image of an OCD 36

Post-Traumatic Stress Disorder (PTSD)= Four or more weeks of the following symptoms 1. Haunting memories 2. Nightmares 3. Social withdrawal Bettmann/ Corbis 4. Jumpy anxiety 5. Sleep problems 37

Resilience to PTSD Only about 10% of women and 20% of men react to traumatic situations and develop PTSD. Holocaust survivors show remarkable resilience against traumatic situations. 38

Explaining Anxiety Disorders Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety. 39

The Learning Perspective Learning theorists suggest that fear conditioning leads to anxiety. John Coletti/ Stock, Boston Anxiety can become associated with other objects or events (stimulus generalization) and is reinforced through avoidance 40

The Learning Perspective Observational learning. Young monkeys develop fear when they watch other monkeys who are afraid of snakes. 41

The Biological Perspective Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. 42

The Biological Perspective Anterior Cingulate Cortex of an OCD patient. 43 S. Ursu, V. A. Stenger, M. K. Shear, M. R. Jones, & C. S. Carter (2003). Overactive action monitoring in obsessive-compulsive disorder. Psychological Science, 14, 347 -353. Generalized anxiety, panic attacks, and even OCD are linked with brain circuits like the anterior cingulate cortex.

Dissociative Disorder Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. Symptoms 1. Having a sense of being unreal. 2. Being separated from the body. 3. Watching yourself as if in a movie. 44

Dissociative Amnesia- loss of memory for a traumatic event or period of time Dissociative fugue- personal memory loss 45

Do Now: Review Questions 1) What are the main objectives of the DSM-IV? 2) What is the difference between a compulsion and obsession? 2) How does dissociative disorder differ from dissociative identity disorder? 3) Who is most at risk for dissociative disorder? 46

Abnormal Psychology March 22, 2010 AIM: Mood disorders…. 47

Dissociative Identity Disorder (DID) Is a disorder in which a person exhibits two or more distinct and alternating personalities, formerly called multiple personality disorder. http: //www. youtube. com/watch? v=k. LGlu. Mf-c. H 8 Lois Bernstein/ Gamma Liason http: //www. youtube. com/watch? v=7 i. HJf. IH 20 TY Chris Sizemore (DID) 48

United States of Tara http: //www. trailerspy. com/trailer/1730/The-United-States-of-Tara-Pr • http: //www. youtube. com/watch? v=4 Np. Pd 1 i Tv. RA http: //www. sho. com/site/video/brigh tcove/series/title. do? bcpid=1403385 5001 49

DID Critics argue that the diagnosis of DID increased in the late 20 th century. Critics’ Arguments 1. Role-playing by people open to a therapist’s suggestion. 2. Learned response that reinforces reductions in anxiety. 50

Mood Disorders Emotional extremes of mood disorders come in two principal forms. 1. Major depressive disorder-unipolar, “common cold” 2. Bipolar disorder- highs and lows 51

Major Depressive Disorder In a year, 5. 8% of men and 9. 5% of women report depression worldwide (WHO, 2002). Blue mood Major Depressive Disorder Gasping for air after a hard run Chronic shortness of breath 52

Major Depressive Disorder -Signs of depression last at least two weeks -not caused by drugs or medical conditions. Signs: 1. 2. 3. 4. 5. Lethargy and fatigue Change in sleeping patterns Feelings of worthlessness Loss of interest in family & friends Loss of interest in activities 53

Dysthymic Disorder Daily depression lasting two years or more. Blue Mood Dysthymic Disorder Major Depressive Disorder 54

Seasonal Affective Disorder Calendar linked pattern of depression 15 % of all depression cases 55

Bipolar Disorder Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder. Depressive Symptoms Manic Symptoms Gloomy Elation Withdrawn Euphoria Inability to make decisions Tired Slowness of thought Desire for action Hyperactive Multiple ideas 56

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Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. Creativity surges during the manic phase http: //www. youtube. com/watch? v=OQVQOW 1 c 0 DQ Earl Theissen/ Hulton Getty Pictures Library The Granger Collection George C. Beresford/ Hulton Getty Pictures Library Bettmann/ Corbis 58

Explaining Mood Disorders A theory of depression should explain the following: 1. Behavioral and cognitive changes 2. Common causes of depression 59

Theory of Depression 3. Gender differences 60

Theory of Depression 4. Depressive episodes self-terminate. 5. Depression is increasing, especially in the teens. Desiree Navarro/ Getty Images Post-partum depression 61

True or False • Lithuanians are 15 times more likely to commit suicide than Portuguese • Black Americans are nearly 1. 5 times as likely as white Americans to kill themselves • Men are much more likely than women to attempt suicide • The suicide rate is highest among American teenagers • Men are two to four times more likely to die from suicide than woman • Suicide rates are highest among religious, poor populations • People who suffer from depression have a higher likelihood of commiting suicide, and their risk is greatest at the depths of a depressive episode 62

Suicide Each year some 1 million people commit suicide worldwide. 1. 2. 3. 4. 5. Suicide Statistics National differences Racial differences Gender differences Age differences Other differences 63

Do Now: 1. At one time, disordered people were simply warehoused in asylums. These have been replaced with psychiatric hospitals in which attempts were made to diagnose and cure those with psychological disorders. This best illustrates one of the beneficial consequences of: a. psychoanalytic theory. b. the DSM-IV. c. the medical model. d. linkage analysis. 2. People around the world may experience the same genetically based disorder quite differently depending on their own personal expectations and the definitions of abnormality common to their unique culture. This best illustrates the need for: a. association studies. b. the medical model. c. linkage analysis. d. a biopsychosocial approach. 3. Lenore is unexplainably and continually tense and is plagued by muscle tension, sleeplessness, and an inability to concentrate. Lenore most likely suffers from a(n): a. phobia. b. dysthymic disorder. c. obsessive-compulsive disorder. d. generalized anxiety disorder. 5. The avoidance of situations in which help may not be available when panic strikes is most 64 characteristic of:

AIM: How can we explain psychological disorders? 65

Perspectives on causes of mental illness • Psychoanalytical • Behaviorist • Cognitive • Humanistic • Sociocultural • Biomedical 66

Psychoanalytical Internal unconscious conflict due to traumatic events in psychosocial stage Example: OCD due to anal fixation 67

Behaviorist Learned history of reinforcement 68

Cognitive Psychologial disorders emerge as a maladaptive way of thinking 69

Humanistic Being out of touch with one’s feelings Social Cultural Psychological illness is due to social ills or cultural norms 70

Biological Psychological illnesses are the result of genetics or biochemical imbalances. 71

PARTNER POP QUIZ! Relate each scenario to a psychological perspective. 1) Depression results from unreasonably negative ideas that people have about themselves, their worlds, or their futures 2) Twin studies have elucidated the causes of schizophrenia 3) Western cultures have a higher frequency of dissociative identity disorder relative to Eastern cultures 4) Phobic patients avoid or escape a feared situation to reduce anxiety, and thus reinforce phobic behaviors. 5) Negative self-esteem and feelings of worthlessness have been associated with MDD 72

How does each perspective explain mood disorders? • http: //www. learner. org/resources/series 150. html? pop=yes&pid=1638# 73

Depression and Memory Memories are mood congruent. We tend to recall experiences that are consistent with our current mood 74

Biological Perspective Genetic Influences: Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%). Jerry Irwin Photography Linkage analysis and association studies link possible genes and dispositions for depression. 75

Neurotransmitters & Depression A reduction of norepinephrine and serotonin has been found in depression. Drugs that alleviate mania reduce norepinephrine. Pre-synaptic Neuron Norepinephrine Serotonin Post-synaptic Neuron 76

The Depressed Brain PET scans show that brain energy consumption rises and falls with manic and depressive episodes. Courtesy of Lewis Baxter an Michael E. Phelps, UCLA School of Medicine 77

Social-Cognitive Perspective The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles. 78

Depression Cycle 1. Negative stressful events. 2. Pessimistic explanatory style. 3. Hopeless depressed state. 4. These hamper the way the individual thinks and acts, fueling personal rejection. 79

Social Cognitive Theory Depression is due to a pessimistic explanatory Style • Global • Internal • Stable 80

Example Explanatory style plays a major role in becoming depressed. 81

Do Now: Work with a partner. Imagine you just lost all of your savings in the stock market. How would you interpret this tragedy using a stable, global, and internal perspective. 82

Social Cognitive Perspective Aaron Beck has proposed the cognitive triad: depression results from negative ideas people have about themselves, their world, and their futures 83

Social-Cognitive Perspective Seligman argues depression is common among Westerners due to individualism. Learned helplessness can fuel depression. 84

Cognitive Errors of Depressed People Overgeneralization Selective Abstraction Personalization Magnification and Minimization Arbitrary Influence Dichotomous Thinking 85

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Schizophrenia: The Facts • Affects about. 8% of Americans are afflicted • Throughout the world over 24 million people suffer from this disease • Strikes most commonly in early twenties • Affects men and women equally • “split mind” 87

Symptoms of Schizophrenia A group of disorders characterized by the following: 1. Disorganized and delusional thinking. 2. Disturbed perceptions. 3. Inappropriate emotions and actions. 88

Disorganized & Delusional Thinking This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Marry Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday. ” (Sheehan, 1982) Other forms of delusions include, Delusionsbizarre thinking withdelusions distortedof persecution is following me”) or beliefs (“someone despite contrary evidence grandeur (“I am a king”). 89

Disorganized & Delusional Thinking Fragmented and bizarre thoughts are due to selective attention failure 90

Disturbed Perceptions A schizophrenic may experience hallucinations. Frequent: auditory Less frequent: visual, somatosensory, olfactory L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg 91

Inappropriate Emotions & Actions • Apathy showing no emotion at all • -Inappropriate Emotions • Inappropriate Actions • Catatonia remaining motionless for long periods of time 92

Subtypes of Schizophrenia is a cluster of disorders. 93

Positive and Negative Symptoms Positive symptoms inappropriate symptoms (hallucinations, disorganized thinking) not present in normal individuals Negative symptoms absence of appropriate symptoms (apathy, expressionless faces) 94

Chronic and Acute Schizophrenia When schizophrenia is slow to develop (chronic/process) recovery is doubtful. When schizophrenia rapidly develops (acute/reactive) recovery is better. 95

Do Now: Schizophrenic Patient Symptoms • Disorganized thinking • Hallucinations • Disturbed Perceptions • Apathy, expressionless faces (negative symptom) • Extreme mood changes • Catatonia 96

AIM: What are the causes of schizophrenia? 97

Understanding Schizophrenia Brain Abnormalities Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D 4 receptors in the brain. Antipsychotic drugs work by blocking dopamine receptors 98

Brain Abnormalities Negative symptoms are associated with an deficit in glutamate, a neurotransmitter 99

Abnormal Brain Activity Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients. Abnormal activity = a decrease in function and out-of-sync firing Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health Adolescent schizophrenic patients also have brain lesions. 100

Abnormal Brain Morphology Schizophrenia patients may exhibit enlargement of fluid-filled ventricles. Both Photos: Courtesy of Daniel R. Weinberger, M. D. , NIH-NIMH/ NSC 101

Viral Infection Increased rates of schizophrenia in individuals whose mothers contracted a viral infection (flu) during their fetal development. 102

Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 1991). 0 10 20 30 40 50 Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated 103

Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries. 104

Psychological Factors Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed Courtesy of Genain Family Genain Sisters These genetically identical sisters all suffer from schizophrenia. 105

Warning Signs Early warning signs of schizophrenia include: 1. A mother’s long lasting schizophrenia. 2. Birth complications, oxygen deprivation and low-birth weight. 3. Short attention span and poor muscle coordination. 4. Disruptive and withdrawn behavior. 5. Emotional unpredictability. 6. Poor peer relations and solo play. 106

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Do Now: How would you characterize a personality disorder? 108

AIM: What are the different personality disorders? 109

Personality Disorders Maladaptive ways of behaving that negatively affect a person’s ability to function Three clusters in the DSM IV 110

Categories of Personality Disorders 1) Eccentric (Odd) 2) Anxiety (Avoidant) 3) Erratic (Dramatic) 111

Odd-Eccentric 1) Paranoid Personality Disorder fear persecution, distrustful, and suspicious 112

Odd-Eccentric 2. Schizoid Personality Disorder: detachment from relationships with restricted range of emotions 113

Odd-Eccentric 3. Schizotypal Personality Disorder a. Unusual perceptions b. Strange thoughts and behaviors c. Odd nonverbal behavior http: //www. youtube. com/watch? v=7 Yv. AYIJSSZY 114

Avoidant Disorders 1. Avoidant Personality Disorder a. avoid social interactions for fear of being ridiculed or disliked b. extreme sensitivity to negative evaluation 2. Dependent Personality Disorder rely too much on the help of others 115

Dramatic-Erratic Disorders 1. Narcissistic Personality Disorder a. self-preoccupied b. grandoise self-importance c. feeling of entitlement d. lack of insight into other’s feelings e. rely on weak friends for self-worth 116

Dramatic-Erratic 2. Histrionic- overly dramatic, need for attention 3. Borderline Personality- unstable emotions and relationships, often suicidal 117

4. Antisocial Personality Disorder A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, Also known as a sociopath or psychopath. 118

Causes of Antisocial Personality Disorder Reduced Arousal in response to stress Reduced activity in the frontal lobes. 119 Normal Murderer

Do Now: 1) What are three types of personality disorders? Odd/Eccentric= paranoid, schizotypal Anxiety/Avoidant= avoidant, dependent Dramatic/Erratic= narcissistic, histrionic, borderline, antisocial 121

Somatoform Disorders: patients experience disease symptoms with no identifiable physical cause 122

Somatoform Disorders 1. Somatization Disorder- experience pain, neurological and gastrointestinal problems 2. Hypochondriasis- preoccupation with a fear of serious disease http: //www. youtube. com/watch? v=VJr 7 ew. KHY 4 123

Somatoform Disorders 3. Conversion Disorder: a. symptoms that affect voluntary motor functioning or sensory functioning b. in response to anxiety http: //www. youtube. com/watch? v=i. Auc 2 x. A M 7 -8&feature=related 124

Somatoform Disorders 4. Body Dysmorphic Disorder affected person is excessively preoccupied by a perceived defect in his or her physical features 125

Causes of Somatoform Disorders Psychodynamic perspective- outward manifestation of unresolved unconscious conflicts Behaviorist explanation- reinforcement for behavior- attention, work avoidance 126

Childhood Disorders Two Categories: 1) Internalizing- behavior is withdrawn and anxious Example: Separation Anxiety Disorder 2) Externalizing (4 -10%) behavior is aversive to people in the child’s environment Example: ADHD 127

Developmental Disorders Attention-Deficit Hyperactive Disorder (ADHD) 1) Inattention 2) Hyperactivity 3) Impulsivity ADHD is treated with central nervous system stimulants, such as Adderal and ritalin. 128

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Autism • • • Social Isolation Inappropriate Emotional Expression Movement Disturbances Poor Speech Development Resistant to change in routine Abnormal responses to stimuli 130

Rates of Psychological Disorders 131

Rates of Psychological Disorders The prevalence of psychological disorders during the previous year is shown below (WHO, 2004). 132

Risk and Protective Factors Risk and protective factors for mental disorders (WHO, 2004). 133

Risk and Protective Factors 134