PSYCHOLOGY CHAPTER 15 PSYCHOLOGICAL DISORDERS IRVINE VALLEY COLLEGE

PSYCHOLOGY CHAPTER 15 PSYCHOLOGICAL DISORDERS IRVINE VALLEY COLLEGE FALL 2020 PROFESSOR TRUJILLO

APPROACHES TO THERAPY TODAY • According to the U. S. Department of Health and Human Services (2013), 19% of U. S. adults experienced mental illness in 2012. • For teens (ages 13– 18), the rate is similar to that of adults, and for children ages 8– 15, current estimates suggest that 13% experience mental illness in a given year • According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2008, 13. 4% of adults received treatment for a mental health issue (National Institute of Mental Health [NIMH], n. d. -a)

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15. 1 WHAT ARE PSYCHOLOGICAL DISORDERS? A Psychological Disorder is a condition characterized by abnormal thoughts, feelings, and behaviors. Psychopathology is the study of psychological disorders, including their symptoms, etiology (i. e. , their causes), and treatment. The term Psychopathology can also refer to the manifestation of a psychological disorder. What are the signs of a Psychological Disorder: behaviors, thoughts, and inner experiences that are Atypical, Distressful, Dysfunctional, and sometimes even Dangerous.

15. 1 WHAT ARE PSYCHOLOGICAL DISORDERS? Cultures differ in personal, social, expectations. How can a disorder be conceptualized? One of the more influential conceptualizations was proposed by Wakefield (1992), who defined psychological disorder as a Harmful Dysfunction • Model of psychological disorders resulting from the inability of an internal mechanism to perform its natural function • Example: Janet’s fear of spiders, she avoids all situations in which she suspects spiders to be present and she quit her job last month because she saw a spider in the restroom at work. • Janet’s condition would signify a disorder because (a) there is a dysfunction in an internal mechanism, and (b) the dysfunction has resulted in harmful consequences. western black widow

15. 2 DIAGNOSING AND CLASSIFYING PSYCHOLOGICAL DISORDERS The American Psychiatric Association (APA)- a psychological disorder is a condition that is said to consist of the following: ● There are significant disturbances in thoughts, feelings, and behaviors. ● The disturbances reflect some kind of biological, psychological, or developmental dysfunction. ● The disturbances lead to significant distress or disability in one’s life. ● The disturbances do not reflect expected or culturally approved responses to certain events.

15. 2 DIAGNOSING AND CLASSIFYING PSYCHOLOGICAL DISORDERS Diagnosis refers the determination of which disorder a set of symptoms represents. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5): ● Is an authoritative index of mental disorders and the criteria for their diagnosis published by the (APA). ● DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders. ● It provides a common language for clinicians to communicate about their patients. ● Establishes consistent and reliable diagnoses that can be used in the research of mental disorders. ● Provides a common language for researchers to study the criteria for potential future revisions and to aid in the development of medications and other interventions.

15. 2 DIAGNOSING AND CLASSIFYING PSYCHOLOGICAL DISORDERS The graph shows the breakdown of psychological disorders, comparing the percentage prevalence among adult males and adult females in the United States. Because the data is from 2007, the categories shown here are from the DSM-IV, which has been supplanted by the DSM-5. Most categories remain the same; however, alcohol abuse now falls under a broader Alcohol Use Disorder category.

15. 2 DIAGNOSING AND CLASSIFYING PSYCHOLOGICAL DISORDERS The DSM-5 also provides information about Comorbidity; the co-occurrence of two disorders Obsessivecompulsive disorder and major depressive disorder frequently occur in the same person.

The International Classification of Diseases (ICD), now ICD-11, is widely recognized. ● Published by the World Health Organization (WHO). ● the ICD is used for clinical purposes and is also a tool used to examine the general health of populations and to monitor the prevalence of diseases and other health problems internationally. ● inclusion of new disorders e. g. “gaming disorder”.

15. 3 PERSPECTIVES ON PSYCHOLOGICAL DISORDERS Biological Perspective relates to heritability percentages. Heritability estimates for Schizophrenia. A person’s risk of developing schizophrenia increases if a relative has schizophrenia. The closer the genetic relationship, the higher the risk. The Diathesis-Stress Model integrates biological and psychosocial factors to predict the likelihood of a disorder. A person with a predisposition for a disorder (i. e. , a Diathesis) is more likely than others to develop a disorder when faced with adverse environmental or psychological events (i. e. , Stress). yes

15. 3 PERSPECTIVES ON PSYCHOLOGICAL DISORDERS

15. 3 PERSPECTIVES ON PSYCHOLOGICAL DISORDERS

15. 4 ANXIETY DISORDERS AND OCD Anxiety Disorders are characterized by excessive and persistent fear and anxiety, and by related disturbances in behavior (APA, 2013). Obsessive-compulsive and related disorders are a group of overlapping disorders that generally involve intrusive, unpleasant thoughts and repetitive behaviors. ● Repetitive hand washing and ● Checking (e. g. , that a door is locked) are common compulsions among those with obsessivecompulsive disorder.

OCD CAUSES A brain region that is believed to play a critical role in OCD is the Orbitofrontal Cortex (Kopell & Greenberg, 2008), an area of the Frontal Lobe involved in learning and decision-making (Rushworth, Noonan, Boorman, Walton, & Behrens, 2011) Different regions of the brain may be associated with different psychological disorders.

GENERALIZED ANXIETY DISORDER Generalized Anxiety Disorder (GAD)- a relatively continuous state of excessive, uncontrollable, and pointless worry and apprehension. People with generalized anxiety disorder often worry about routine, everyday things, even though their concerns are unjustified. About 5. 7% of the U. S. population will develop symptoms of generalized anxiety disorder during their lifetime (Kessler et al. , 2005), and females are 2 times as likely as males to experience the disorder (APA, 2013). (credit: Freddie Peña)

15. 4 ANXIETY DISORDERS Anxiety Disorders are characterized by excessive and persistent fear and anxiety, and by related disturbances in behavior (APA, 2013). People with Panic Disorder experience recurrent (more than one) and unexpected panic attacks. Some of the physical manifestations of a Panic Attack. People may also experience sweating, trembling, feelings of faintness, or a fear of losing control, among other symptoms. Signs of a panic attack develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, with most ending within 20 to 30 minutes. Panic attacks can happen anywhere and at any time. Panic Disorder

15. 4 ANXIETY DISORDERS Phobia- a Greek word that means fear. These are persistent, irrational fears. It leads to avoidance behaviors. A person diagnosed with a Specific Phobia (formerly known as simple phobia) experiences excessive, distressing, and persistent fear or anxiety about a specific object or situation (such as animals, enclosed spaces, elevators, or flying) (APA, 2013). Social Anxiety Disorder (formerly called social phobia)-characterized by extreme and persistent fear or anxiety and avoidance of social situations in which the person could potentially be evaluated negatively by others (APA, 2013). social anxiety disorder is common in the United States; a little over 12% of all Americans experience social anxiety disorder during their lifetime (Kessler et al. , 2005). Social Anxiety Disorder

15. 4 DIFFERENT KINDS OF PHOBIAS In the US, around 12. 5% of the population will meet the criteria for a specific phobia at some point in their lifetime (Kessler et al. , 2005).

BODY DYSMORPHIC DISORDER AND HOARDING DISORDER Body Dysmorphic Disorder refers to preoccupation with a perceived flaw in her physical appearance that is either nonexistent or barely noticeable to other people (APA, 2013). Research on BBD may shed some light on how visual patterns may influence perception of self and others. Drives the person to engage in repetitive and ritualistic behavioral and mental acts, such as constantly looking in the mirror, trying to hide the offending body part, comparisons with others, and, in some extreme cases, cosmetic surgery. An estimated 2. 4% of the adults in the United States meet the criteria for body dysmorphic disorder, with slightly higher rates in women than in men (APA, 2013). However, Muscle Dysmorphia is more common in men. (credit a: modification of work by the USDA; credit b: modification of work by Bradley Gordon)

BODY DYSMORPHIC DISORDER AND HOARDING DISORDER Hoarding Disorder cannot bear to part with personal possessions, regardless of how valueless or useless these possessions are (APA, 2013). Individuals accumulate excessive amounts of usually worthless items that clutter their living areas. Often, cluttered items are so excessive that a person is unable use the kitchen, or sleep in his bed. People believe the items might be of some later use, or because they form a sentimental attachment to the items (APA, 2013). Sometimes a person may anthropomorphize (attribute human characteristics or behavior) to items. Diagnosis of hoarding disorder is made only if the hoarding is not caused by another medical condition and if the hoarding is not a symptom of another disorder (e. g. , schizophrenia) (APA, 2013). (credit a: modification of work by the USDA; credit b: modification of work by Bradley Gordon)

15. 6 POSTTRAUMATIC STRESS DISORDER Posttraumatic Stress Disorder (PTSD) was first recognized in soldiers who had engaged in combat. It relates to experiencing a profoundly traumatic event leads to a constellation of symptoms that include intrusive and distressing memories of the event, avoidance of stimuli connected to the event, negative emotional states, feelings of detachment from others, irritability, proneness toward outbursts, hypervigilance, and a tendency to startle easily. These symptoms must occur for at least one month. Triggers can include sights, sounds, smells, or thoughts that remind you of the traumatic event in some way. It is accompanied by Flashbacks, a psychological state lasting from a few seconds to several days, during which one relives a traumatic event. According to the National Center for PTSD, about 6 of every 10 men and 5 of every 10 women experience at least one trauma in their lives. Women are more likely to experience sexual assault and child sexual abuse. Men are more likely to experience accidents, physical assault, combat, disaster, or to witness death or injury. (credit: Kevin Stanchfield)

15. 7 MOOD DISORDERS Mood Disorders are characterized by massive disruptions in mood and emotions. Symptoms can range from the extreme sadness and hopelessness of depression to the extreme elation and irritability of mania. The DSM-5 lists two general categories of mood disorders. • Depressive Disorders are a group of disorders in which depression is the main feature. Click here for DSM-5 Criteria for Major Depressive Disorder. • Bipolar and Related Disorders are a group of disorders in which mania is the defining feature. Mania (euphoria) is a state of extreme elation and agitation; may be excessively talkative; others become excessively irritable; may exhibit flight of ideas, abruptly switching from one topic to another Kay Redfield Jamison (born June 22, 1946)

15. 8 SCHIZOPHRENIA Schizophrenia is a devastating psychological disorder that is characterized by major disturbances in thought, perception, emotion, and behavior. About 1% of the population experiences schizophrenia in their lifetime, and usually the disorder is first diagnosed during early adulthood (early to mid-20 s). Delusions are beliefs that are contrary to reality and are firmly held even in the face of contradictory evidence. ● Paranoid Delusions- involve the (false) belief that other people or agencies are plotting to harm the person. ● Grandiose Delusions- beliefs one holds special power, unique knowledge, or is extremely important. ● Somatic Delusion- belief something highly abnormal is happening to one’s body (e. g. , that one’s kidneys are being eaten by cockroaches). ● Other delusions include the belief that one’s thoughts are being removed (thought withdrawal) or thoughts have been placed inside one’s head (thought insertion). John Nash (June 13, 1928 – May 23, 2015) had schizophrenia.

15. 8 SCHIZOPHRENIA Disorganized Thinking -refers to disjointed and incoherent thought processes, person might ramble, exhibit loose associations or talk in a way that is so disorganized and incomprehensible that it seems as though the person is randomly combining words. ● Tangentiality: responding to others’ statements or questions by remarks that are slightly related or unrelated to what was said or asked. Disorganized or Abnormal Motor Behaviorunusual behaviors and movements: unusually active, child-like behaviors (giggling and self-absorbed smiling), engaging in repeated and purposeless movements, or displaying odd facial expressions and gestures. ● Catatonic Behaviors- show decreased reactivity to the environment, such as posturing, in which the person maintains a rigid and bizarre posture for long periods of time.

15. 8 SCHIZOPHRENIA Positive Symptoms Hallucinations Delusions Disorganized Thinking Abnormal Motor Behavior Negative Symptoms Affective deficits- lack of facial expression, eye contact, gestures, and variations in voice pattern. Communicative deficits- speech lacking in quantity or information. Relational deficits- lack of interest in social activities and relationships. Avolition deficits- severe lack of motivation or initiative to accomplish purposeful tasks.

15. 8 SCHIZOPHRENIA The Dopamine Hypothesis- an overabundance of dopamine or too many dopamine receptors are responsible for the onset and maintenance of schizophrenia. ● Abnormalities in dopamine vary by brain region and thus contribute to symptoms in unique ways. ● This overabundance of dopamine in the limbic system may be responsible for some positive symptoms, whereas low levels of dopamine in the prefrontal cortex might be responsible primarily for the negative symptoms. ● Serotonin may be involved; newer antipsychotic medications work by blocking serotonin receptors.

15. 9 DISSOCIATIVE DISORDERS Dissociative Disorders are a group of DSM-5 disorders in which the primary feature is that a person becomes dissociated, or split off, from his or her core sense of self, resulting in disturbances in identity and memory. Depersonalization Disorder: people feel detached from the self (depersonalization), and the world feels artificial and unreal (derealization). Dissociative Amnesia: inability to recall important personal information, usually following an extremely stressful or traumatic experience Dissociative Identity Disorder (formerly known as multiple personality disorder): A person exhibits two or more distinct, well-defined personalities or identities and experiences memory gaps for the time during which another identity emerged. Sensationalism and over dramatizations may harm the public perception of people with mental illness.

The Compassionate View of Psychological Disorders Please keep in mind: ● Psychological Disorders represent extremes of inner experience and behavior. ● People with psychological disorders are far more than just embodiments of their disorders. ● We do not call people schizophrenics, bulimics, or dyslexics, these are labels that objectify people. ● A psychological disorder is not what a person is; it is something that a person has!

15. 10 PERSONALITY DISORDERS The DSM-5 recognizes 10 Personality Disorders, organized into 3 different clusters. Slightly over 9% of the U. S. population suffers from a personality disorder, with avoidant and schizoid personality disorders the most frequent (Lezenweger, Lane, Loranger, & Kessler, 2007). Cluster A disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. • People with these disorders display a personality style that is odd or eccentric. Cluster B disorders include antisocial personality disorder, histrionic personality disorder, narcissistic personality disorder, and borderline personality disorder. • People with these disorders usually are impulsive, overly dramatic, highly emotional, and erratic. Cluster C disorders include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder (which is not the same thing as obsessive-compulsive disorder). • People with these disorders often appear to be nervous and fearful. Table provides a description of each of the DSM-5 personality disorders:

15. 11 DISORDERS IN CHILDHOOD The DSM-5 categorizes disorders in childhood as related to Neurodevelopmental Disorders involve developmental problems in personal, social, academic, and intellectual functioning (APA, 2013). Attention Deficit/Hyperactivity Disorder is a childhood disorder characterized by inattentiveness and/or hyperactive, impulsive behavior. Autism Spectrum Disorder is a childhood disorder characterized by deficits in social interaction and communication, and repetitive patterns of behavior or interests.

FIGURE 15. 20 In terms of their exposure to immunogens in vaccines, overall, there is not a significant difference between children with autism spectrum disorder and their age-matched controls without the disorder (De. Stefano et al. , 2013).