Unit XII Disorders Treatments Psychological Disorders Mental Health

Unit XII: Disorders & Treatments

Psychological Disorders Mental Health Hotline 1 (800)555 -HELP

Stats on Psychological Disorders 1. Roughly 2 million people in the US are in-patients in psychiatric units. They are under lock & key for the most serious disturbances. 2. Over 2. 4 million people in the US are residents in group homes, shared living spaces that provide assistance to transition into a community. 3. Roughly 15% of Americans utilize services for treatment of a psychological disorder. People use medication (such as Xanax for anxiety) or treatment of a therapist. 4. Over 400 million people worldwide are in need of some form of psychological assistance. 5. Depression and schizophrenia exist in all cultures of the world.

• Mark these statements as TRUE or FALSE • Abnormal behaviors are always bizarre • A clear distinction can be drawn between “normal” and “abnormal” behaviors. • As a group, former mental patients are unpredictable and dangerous. • Mental disorders indicate a fundamental deficiency in personality, and are thus shameful. • Because mental illness is so common, there is reason to be fearful of one’s own vulnerability. • Geniuses are particularly prone to emotional disorders. • Most mental disorders are incurable.

What is Abnormal? After each of the descriptions below place an “A” (for abnormal) or an “N” (for normal) based on your analysis of each person. 1. Terry has been having terrible nightmares at least three times a week from which he wakes up shaking and sweating. ______ 2. Vanda has visions and hallucinations that she often uses to guide her important decisions. ______ 3. Alana always covers her face when she goes out in public. ______ 4. Sandy has been plotting to assassinate the governor the next time she appears locally. _______ 5. Even though public transportation is easily accessible, Tom drives to work during a summer ozone alert when the mayor has asked people to use their cars as little as possible. ______ 6. Beth continues to be very upset about her sister’s death, even though the accident that killed her happened two years ago. She still wears dark mourning clothes and cries almost every day whenever she thinks of her sister. ______ 7. Harry is so fearful of crowds that he can no longer ride the bus to work. ______ 8. Luke often urinates on the street. ______

Rate this person using the following scale: 1= Basically OK Psychotherapy is not necessary 2=Mild Disturbance. Psychotherapy should be considered 3= Significant disturbance. Psychotherapy is definitely required 4= Severe disturbance. Hospitalize! n Bob is a very intelligent, 25 year old member of a religious organization that is based on Buddhism. Bob’s working for this organization caused considerable conflict between him and his parents, who are devout Catholics. Recently Bob experiences acute spells of nausea and fatigue that prevent him from working and which have forced him to return home to live with his parents. Various medical tests are being conducted, but as yet no physical causes of his problems have been found.

Rate this person using the following scale: 1= Basically OK Psychotherapy is not necessary 2=Mild Disturbance. Psychotherapy should be considered 3= Significant disturbance. Psychotherapy is definitely required 4= Severe disturbance. Hospitalize! n Jim was vice president of the freshman class at a local college and played on the school’s football team. Later that year he dropped out of these activities and gradually became more and more withdrawn from friends and family. Neglecting to shave and shower, he began to look dirty and unhealthy. He spent most of his time alone in his room and sometimes complained to his parents that he heard voices in the curtains and in the closet. In his sophomore year he dropped out of school entirely. With increasing anxiety and agitation, he began to worry that the “Nazis” were plotting to kill his family and kidnap him.

Rate this person using the following scale: 1= Basically OK Psychotherapy is not necessary 2=Mild Disturbance. Psychotherapy should be considered 3= Significant disturbance. Psychotherapy is definitely required 4= Severe disturbance. Hospitalize! n Mary is a 30 year old musician who is very dedicated and successful in her work as a teacher in a local high school and as a part time member of local musical groups. Since her marriage five years ago, which ended in divorce after six months, she has dated very few men. She often worries that her time is “running out” for establishing a good relationship with a man, getting married, and raising a family. Her friends tell her that she gets way too anxious around men, and that she needs to relax a little in general.

Rate this person using the following scale: 1= Basically OK Psychotherapy is not necessary 2=Mild Disturbance. Psychotherapy should be considered 3= Significant disturbance. Psychotherapy is definitely required 4= Severe disturbance. Hospitalize! n Larry, a homosexual who has lived for three years with a man he met in graduate school, works as a psychologist in a large hospital. Although competent in his work, he often feels strained by the pressures of his demanding position. An added source of tension on the job is his not being able to confide in all his co-workers about his private life. Most of his leisure activities are with good friends who belong to the gay community.

It’s All a Matter of Degree

Psychological Disorders People are fascinated by the exceptional, the unusual, and the abnormal. This fascination may be caused by two reasons: 1. 2. During various moments we feel, think, and act like an abnormal individual. Psychological disorders may bring unexplained physical symptoms, irrational fears, and suicidal thoughts.

Defining Psychological Disorders Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions. When behavior is deviant, distressful, and dysfunctional psychiatrists and psychologists label it as disordered (Comer, 2004).

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

WHAT MAKES SOMETHING A PSYCHOLOGICAL DISORDER? Atypical - The behavior is not just quirky; however, it is considered extremely odd. Maladaptive - A psychological disorder makes everyday life difficult for an individual. It typically interferes with the ability to lead a normal life. Unjustifiable - A psychological disorder is not easy to explain to most people. Disturbing – varies with time & culture For example, a person might engage in behavior that calls a great deal of attention to her. The behavior may not make sense to an outsider, but the person with the disorder does not know how to act otherwise.

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. Trephination (boring holes in the skull to remove evil forces)

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. Etiology: Cause and development of the disorder. Diagnosis: Identifying (symptoms) and distinguishing one disease from another. 3. Treatment: Treating a disorder in a psychiatric hospital. 4. Prognosis: Forecast about the disorder.

Theories of Psychopathology - Biological Approach Mental disorders are seen as caused by the combination and interaction of biological, psychological, and socio-cultural factors Ancient Greece (Hippocrates) – imbalance between four humors, or bodily fluids (blood, phlegm, black bile, and yellow bile) Ancient China imbalance of yin and yang Modern view – disturbances in the anatomy and chemistry of the brain and in other biological processes, including genetic influences

Theories of Psychopathology Psychodynamic Approach Ancient Greece – psyche Disorders are a result of the mind’s struggles to resolve inner conflicts or to overcome the effects of stressful events. Freud Disorders are the result of unresolved, mostly unconscious conflicts that begin in childhood Humanistic Approach Disorders appear when a person’s natural tendency toward healthy growth is blocked, usually by a failure to be aware of, and to express, true feelings

Theories of Psychopathology - Behavioral Approach Classical conditioning Responses associated with stimuli as a result of previous experience Example: Phobias Operant conditioning Responses associated with consequences as a result of previous experience Behaviors that have been learned and continue even though they are maladaptive Social-cognitive theorists, also known as social learning theorists see most psychological disorders as resulting from the interaction of past learning and current situations

Theories of Psychopathology - Cognitive-Social Approach What is “appropriate” and “expected” depends on age, gender, and culture, as well as on the particular situation and historical era in which people find themselves Depression higher in women Alcohol abuse higher in men Cultural differences Behaviors that are acceptable in one culture but not in another culture Culture specific disorders

Theories of Psychopathology - Bio-Psycho-Social Perspective Assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders.

How do genetics and environment interact to create psychological disorders? Peanut Butter, Jelly, and the Diathesis-Stress Model The diathesis-stress model emphasizes the joint occurrence of maladaptive behavior and high levels of stress. I need four volunteers to make PB & J Sandwiches.

Psychological Disorders Etiology § DSM-5 § § § American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders a widely used system for classifying psychological disorders presently distributed as DSM-5

DSM-IV-TR Multiaxial Classification Is a Clinical Syndrome (cognitive, anxiety, Axis I mood disorders [16 syndromes]) present? Axis II 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 Axis V person’s functioning?

DSM-5 Definition of Mental Disorder A syndrome that causes clinically significant problems with cognitions, emotion regulation, or behavior that results in dysfunctional mental functioning and is associated with significant distress or disability in social, occupational, or other important activities.

ICD-10 and WHODAS Both originate from the World Health Organization ICD-10: International Classification of Diseases Codes for documents such as health records and death certificates Used to capture national morbidity and mortality statistics WHODAS: World Health Organization’s Disability Assessment Schedule A measurement of functioning A system of diagnosis used world wide

20 Classifications of Disorders Neurodevelopmental Schizophrenia Spectrum and Other Psychotic Disorders Bipolar and Related Disorders Depressive Disorders Anxiety Disorders Obsessive-Compulsive and Related Disorders Trauma and Stressor. Related Disorders Dissociative Disorders Somatic Symptom and Related Disorders Feeding and Eating Disorders Elimination Disorders Sleep-Wake Disorders Sexual Dysfunctions Gender Dysphoria Disruptive, Impulse- Control, and Conduct Disorders Substance Related and Addictive Disorders Neurocognitive Disorders Personality Disorders Paraphilic Disorders Other Plus, there is a category for general medical issues and medication induced disorders DSM-5

Dimensional Approach Not a presence or absence of a symptom or particular set of symptoms Recognizes how conditions relate to each other on a continuum of behavior Groupings or clusterings of disorders often happen (comorbidity) Internalizing Factors Those in which anxiety, depressions, and somatic symptoms are prevalent Goes on inside the mind and within the body mild – moderate – severe Externalizing Factors 5 major aspects to consider: Course Severity Frequency Duration Descriptive features Demonstrates disturbances of Unit XII. Disorders and Treatment conduct, impulse control, and substance abuse Exhibits itself to society outside the mind

DSM-5 Focus on Culture and Gender More gender and culturally sensitive by providing varied definitions and further background on both arenas Example: Social Anxiety Disorder Developmental Focus Across the Lifespan incorporates fear of offending others as part of something Asian cultures may experience Begins with Neurodevelopmental Disorders which are noticed at a young age Ends with Neurocognitive Disorders which are noticed at old age Recognizes familial aspects to disorders Recognizes how disorders develop at different stages of life and how they progress across the lifespan Unit XII. Disorders and Treatment

Alternative Personality Model � Retains 6 categories: � Antisocial � Avoidant � Borderline � Narcissistic � Obsessive-Compulsive � Schizotypal � . � A separate category is created: � PD-TS: Personality Disorder-Trait Specific � For people who meet general criteria of a Personality Disorder but do not fit all aspects of any one specified disorder � All other Personality Disorders are relocated within the broader 20 categories, grouped by type of symptoms and characteristics Unit XII. Disorders and Treatment

Psychological Disorders TED Talk: Strange Answers to the Psychopath Test --Jon Ronson--

9 Major Categories of Psychological Disorders ANXIETY, OBSESSIVE-COMPULSIVE, TRAUMA and STRESSOR DISORDERS: Anxiety in general is a combination of physical, cognitive, and psychological symptoms in which a person’s sympathetic nervous system has initiated a fight-or-flight response. Anxiety is very common among people in the US. In general, however, it is situational - we can usually point to the cause of the anxiety. When we cannot identify the cause, it is more problematic. Currently, the DSM-5 defines General Anxiety Disorder or GAD as “anxiety and worry that is excessive and difficult to control and that occurs more days than not for a period of at least 6 months. ” GAD also includes symptoms of fatigue, restlessness, irritability, sleep disturbances, decreased concentration and memory, and muscle tension.

Model of Development of General Anxiety Disorder (GAD) n n GAD has some genetic component Childhood trauma related to GAD More or less constant worry about many issues that SERIOUSLY interferes with functioning Symptoms: headache, stomachache, muscle tension, irritability Genetic predisposition or childhood trauma Hypervigilance GAD following life change or major event

Panic Attack Marked by minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensation. PANIC DISORDER: A panic disorder occurs when someone has uncontrollable panic attacks for an extended period of time (longer than two weeks). The typical panic attack involves shortness of breath, racing heart, and an unfocused feeling of being out of control. The attacks come on rapidly and are debilitating.

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

Phobias - persistent, irrational fear of a specific object or situation n Intense, irrational fears that may focus on: n n Natural environment—heights, water, lightening Situation—flying, tunnels, crowds, social gathering Injury—needles, blood, dentist, doctor Animals or insects—insects, snakes, bats, dogs

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

OBSESSIVE-COMPULSIVE DISORDER (OCD): Types of Anxiety Disorders OCD involves having obsessive stress or anxiety over a particular event or issue and performing ritualistic or compulsive behavior to ameliorate the stress. Obsessive behavior is fairly common: it becomes a disorder when the compulsive behavior impairs everyday life. OCD involves unwanted repetitive thoughts (obsessions) and/or actions (compulsions) 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)

Obsessive-Compulsive

Obsessive-Compulsive § § PET Scan of brain of person with Obsessive/ Compulsive disorder High metabolic activity (red) in frontal lobe areas involved with directing attention

Movies that have tackled the issue of PTSD POST-TRAUMATIC STRESS DISORDER (PTSD): PTSD occurs when someone has gone through a traumatic event. That event, or the memory of that event, causes the person to continuously reexperience the stress associated with that event. Re-experiencing of the event can take the form of a panic attack. Experiencing or witnessing severely threatening, uncontrollable events with a sense of fear, helplessness, or horror Symptoms: • • • Haunting memories Nightmares Social withdrawal Jumpy anxiety Insomnia

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. All major religions of the world suggest that surviving a trauma leads to the growth of an individual.

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

The Learning/Behavioral Perspective n n Sees anxiety disorders as a product of learned helplessness or fear conditioning Researchers have linked general anxiety with classical conditioning of fear. Observational Learning n We learn fear through observing others. Parents transmit their fears to their children.

The Biological Perspective Considers possible evolutionary, genetic, and physiological influences. n n n Natural Selection - Phobias focus on dangers faced by our ancestors. Compulsive acts typically exaggerate behaviors that contributed to our species’ survival. Genes - Some people seem genetically predisposed to particular fears and high anxiety. Identical twins often develop similar phobias, even when raised separately. Physiology - General anxiety, panic attacks, and even obsessions and compulsions are biologically measurable as an overarousal of brain areas involved in impulse control and habitual behaviors. (PET scans)

9 Major Categories of Psychological Disorders SOMATIC SYMPTOM and RELATED DISORDERS: psychological disorders in which the symptoms take a somatic (bodily) form without apparent physical cause, though they may or may not have a diagnosed medical condition The key feature is EXCESSIVE RESPONSE— marked thoughts, feelings, and behaviors in excess of what would be expected

Types of SOMATIC DISORDERS CONVERSION DISORDER: A person will suffer from a great deal of stress concerning an upcoming event. As a strategy for dealing with the stress, the person will “convert” the stress into some physical ailment. For example, if a person is anxious because she has to give an oral presentation to her class, she might suddenly develop a cause of laryngitis the day before. In such a situation, the stress was “converted” into the problem of not being able to talk. FACTITIOUS DISORDER: It involves an unsubstantiated belief about a person’s illness or the illness of another

9 Major Categories of Psychological Disorders DISSOCIATIVE DISORDERS: A dissociative disorder is one in which there is a break in the connection between reality and perception of reality. In most cases, this gives rise to an inability to deal with reality; what is real and what seems real are not the same.

Dissociative Disorders Amnesia Memories related to a trauma disappear. When you can’t remember somebody being shot in front of you. Fugue Identity Disorder A person will have several personalities that are unique, VERY rare and controversial. Memories related to a trauma disappear and the person starts life all over. The kind of amnesia in movies ie. Jason Bourne.

Dissociative Amnesia n Margie and her brother were recently victims of a robbery. Margie was not injured, but her brother was killed when he resisted the robbers. Margie was unable to recall any details from the time of the accident until four days later.

Dissociative Fugue • Jay, a high school physics teacher in New York City, disappeared three days after his wife unexpectedly left him for another man. Six months later, he was discovered tending bar in Miami Beach. Calling himself Martin, he claimed to have no recollection of his past life and insisted that he had never been married.

Depersonalization and Derealization Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. Symptoms Having a sense of being unreal. Being separated from the body. Watching yourself as if in a movie.

Dissociative Identity Disorder § § rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities formerly called multiple personality disorder

Dissociative Identity Disorder Pattern typically starts prior to age 10 (childhood) n Most people with disorder are women n Most report recall of torture or sexual abuse as children and show symptoms of PTSD n

Dissociative Identity Disorder (DID) Norma has frequent memory gaps and cannot account for her whereabouts during certain periods of time. While being interviewed by a clinical psychologist, she began speaking in a childlike voice. She claimed that her name was Donna and that she was only six years old. Moments later, she seemed to revert to her adult voice and had no recollection of speaking in a childlike voice or claiming that her name was Donna.

Causes of Dissociative Disorders? n n n Repeated, severe sexual or physical abuse However, many abused people do not develop DID Combine abuse with biological predisposition toward dissociation? n n people with DID are easier to hypnotize than others may begin as series of hypnotic trances to cope with abusive situations

DID Critics argue that the diagnosis of DID increased in the late 20 th century. DID has not been found in other countries. Critics’ Arguments Role-playing by people open to a therapist’s suggestion. Learned response that reinforces reductions in anxiety.

The DID Controversy n Some curious statistics n n n 1930– 60: 2 cases per decade in USA 1980 s: 20, 000 cases reported many more cases in US than elsewhere varies by therapist—some see none, others see a lot Is DID the result of suggestion by therapist and acting by patient?

You. Tube Video: Herschel Walker - DID, Part I

You. Tube Video: Herschel Walker DID, Part 2

9 Major Categories of Psychological Disorders SCHIZOPHRENIA SPECTRUM: Schizophrenia is not, as many people think, the same thing as dissociative identity disorder (or multiple personality disorder). Symptoms: n Disorganized thoughts, Hallucinations – auditory “Hear voices, ” Delusions, Garbled speech, Word salad, Clanging Difficult time dealing with reality and often suffers because one cannot articulate the issue. Equally split between genders, earlier onset with males Louis Wain (1860– 1939) was an English artist best known for his drawings, which consistently featured anthropomorphised large -eyed cats and kittens. In his later years he suffered from schizophrenia, which, according to some psychologists, can be seen in his works.

You. Tube Clip: From "Lord of the Rings, The Two Towers", Gollum shows signs of schizophrenia. You. Tube: Lord of the Rings Scene - Gollem

CATATONIA: Marked by periods of complete immobility called waxy flexibility. The person with catatonic schizophrenia will stop moving and remain in that position for several minutes. During that period of immobility, the person’s arms can be moved, and they will remain in that position until the catatonic phase passes. Some have attributed this immobility to mild epileptic seizures, but we are not certain why this occurs.

Symptoms of Schizophrenia n n Chronic or process schizophrenia is a slow-developing process; recovery is doubtful. Acute or reactive schizophrenia develops rapidly; recovery is much more likely.

Schizophrenia § Delusions § § false beliefs, often of persecution or grandeur, that may accompany psychotic disorders In a psychiatrist's waiting room two patients are having a conversation. One says to the other, "Why are you here? " The second answers, "I'm Napoleon, so the doctor told me to come here. " The first is curious and asks, "How do you know that you're Napoleon? " The second responds, "God told me I was. " At this point, a patient on the other side of the room shouts, "NO I DIDN'T!"

Symptoms of Schizophrenia n Delusions of persecution n Delusions of grandeur n n n ‘they’re out to get me’ paranoia “God” complex megalomania Delusions of being controlled n the CIA is controlling my brain with a radio signal

Symptoms of Schizophrenia n Hallucinations n n hearing or seeing things that aren’t there contributes to delusions command hallucinations: voices giving orders Disorganized speech n n Over-inclusion—jumping from idea to idea without the benefit of logical association Paralogic—on the surface, seems logical, but seriously flawed n e. g. , Jesus was a man with a beard, I am a man with a beard, therefore I am Jesus

Disorganized Symptoms n Disorganized behavior and affect n behavior is inappropriate for the situation n n affect is inappropriately expressed n n n e. g. , wearing sweaters and overcoats on hot days flat affect—no emotion at all in face or speech inappropriate affect—laughing at very serious things, crying at funny things catatonic behavior n unresponsiveness to environment, usually marked by immobility for extended periods

Disturbed Perceptions A schizophrenic person may perceive things that are not there (hallucinations). Frequently such hallucinations are auditory and lesser visual, somatosensory, olfactory, or gustatory.

What Schizophrenia might feel like… 74

Positive and Negative Symptoms Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, deluded ways) that are not present in normal individuals (positive symptoms). Schizophrenics also have an absence of appropriate symptoms (apathy, expressionless faces, rigid bodies) that are present in normal individuals (negative symptoms).

Frequency of positive and negative symptoms in individuals at the time they were hospitalized for schizophrenia. Source: Based on data reported in Andreasen & Flaum, 1991.

Chemical Factors in Schizophrenia 1. Dopamine is a neurotransmitter found in the brain. 2. Schizophrenics have very high levels of dopamine. 3. They report that they feel agitated, talk rapidly, and their thoughts are racing. 4. Some schizophrenics report that lower levels of dopamine make them feel better. 5. Drugs that reduce dopamine reduce symptoms, and drugs that increase dopamine produce symptoms even in people without the disorder. Theory: Schizophrenia is caused by excess dopamine

Genetic Factors n n n 1 in 100 odds of any person being diagnosed with schizophrenia. 1 in 10 chance among those who have an afflicted sibling or parent. 1 in 2 chance among those who have an afflicted identical twin.

Biological Factors Abnormal Brain Morphology Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles. Both Photos: Courtesy of Daniel R. Weinberger, M. D. , NIH-NIMH/ NSC

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

Other Biological Factors n Brain structure and function n Early warning signs n n n enlarged cerebral ventricles and reduced neural tissue around the ventricles PET scans show reduced frontal lobe activity nothing very reliable has been found yet certain attention deficits can be found in children who are at risk for the disorder Father’s age—older men are at higher risk for fathering a child with schizophrenia

Environmental Factors Viral Infection Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development.

Cultural Differences in Schizophrenia n n Prevalence of symptoms is similar no matter what the culture Less industrialized countries have better rates of recovery than industrialized countries n n n families tend to be less critical of the patients less use of antipsychotic medications, which may impair full recovery think of it as transient, rather than chronic and lasting disorder

You. Tube Clip: Inside the World of Childhood Schizophrenia 20/20 abcnews

TED Talk: a schizophrenic’s speech 85

9 Major Categories of Psychological Disorders Personality Disorders: Pervasive pattern of behavior involving difficulty interacting with others. Usually without anxiety, depression or delusions Some of the most misunderstood disorders in psychology. We have neither a complete grasp of the causes nor an adequate strategy for treatment.

Paranoid Personality Disorder Watching for injustice n Pervasive mistrust and suspiciousness of others are the main characteristic n Distrustful even of close family and friends n Reluctant to form close relationships--extreme jealousy n n n Tend to blame others for their own shortcomings A pervasive and unwarranted belief that others intend to harm Expecting to be exploited Interpreting others motives as malevolent Taking remarks out of context and interpreting them to support own frame of reference

Schizoid Personality Disorder: Detached loner n n n n Pervasive indifference toward others Restricted range of emotional expression Unaffected by praise or criticism Few friends or confidants Maintains superficial connections with relatives; even these are aloof and cool No sense of humor Lacks social skills No overtly bizarre behavior, thinking, etc.

Schizotypal Personality Disorder: Peculiarity/eccentricity n n n n n Acutely uncomfortable around others; esp. those who are unfamiliar Deficient in social relationships Reduced capacity for closeness Peculiar in thought, action, appearance Bizarre fantasies and preoccupations Unkempt, mismatched, prefer to dress in strange clothing Digressive or vague in speech Use words differently than others: neologisms Talk to themselves openly

Antisocial Personality Disorder § § § disorder in which the person (usually man) exhibits a lack of conscience for wrongdoing, even toward friends and family members may be aggressive and ruthless or a clever con artist These people consistently come into conflict with the law and show little or no concern, guilt, or anxiety.

Understanding Antisocial Personality Disorder Like mood disorders and schizophrenia, antisocial personality disorder has biological and psychological reasons. Youngsters, before committing a crime, respond with lower levels of stress hormones than others do at their age.

Personality Disorders § PET scans illustrate reduced activation in a murderer’s frontal cortex Normal Murderer

Understanding Antisocial Personality Disorder The likelihood that one will commit a crime doubles when childhood poverty is compounded with obstetrical complications (Raine et al. , 1999; 2000).

Borderline Personality Disorder INTENSE, UNSTABLE, EXTREMES n n Chronic instability of emotions, self-image, relationships Self-destructive behaviors Intense fear of abandonment and emptiness Relationships: * high maintenance; turmoil, chaos * baffling and exhaustive to others * require constant attention to soothing moods and stroking insecurities * extremes of closeness and distance n n Possible history of childhood physical, emotional, or sexual abuse 75% of diagnosed cases are women

Histrionic Personality Disorder “High Drama” n n n Displays a shallow, attention-getting emotionality. Histrionic individuals go to great length to gain others’ praise and reassurance. Constantly seeking *Attention (uncomfortable when not the center) *Reassurance *Approval Flamboyant Inappropriately flirtatious/seductive

Narcissistic Personality Disorder Grandiose entitlement n n n n Exaggerate their own importance, aided by success fantasies. Sees self as unique Feels entitled to admiration, recognition, special privileges; enraged when they don’t get that Excessive and constant need for admiration Oriented toward success and perfection Lacks empathy Relationships: *Must have their own way *Focused on their own needs *Tends to engulf others with their needs *Charms others to get needs met

Avoidant Personality Disorder: Involvement is risky n n n n n Widespread and longstanding discomfort Shy, distant; exaggerates risk that people pose Hypersensitivity to evaluation Feelings of inadequacy Avoid social activities that involve contact with others Stays in corners at parties tongue-tied Always expecting to say something foolish Highly anxious around others and anxious about looking anxious No close friends or confidants; easily slides into dependence after taking a risk on others

Dependent Personality Disorder: Excessive need to be taken care of; limited sense of self n n n n Widespread and longstanding dependency on and submissiveness to others Even routine daily decisions require advice and reassurance Complete passivity; letting others decide Discomfort, fear, and helplessness about being alone; goes to great lengths to avoid being isolated Highly sensitive to disapproval Willingness to go along with others even it conflicts with their own wishes or values Paralyzed by the idea of independent thought/action Drives people away with neediness

Obsessive-Compulsive Personality Disorder: All about order and structure n n n n Perfectionistic and inflexible Focus on detail; order; structure; lists Performance never good enough Stubbornly demanding that others do things their way; very controlling Overly conscientious and concerned with moral and ethical issues Scrupulous to the point of rigidity Judges others and self very harshly; demands perfection Not emotionally expressive; distrusts and disapproves of emotion in others

Neurodevelopmental Disorders n Disorders first noticed and diagnosed in n n Infancy, Childhood, and Adolescence Resulting deficits cause difficulties in personal, social, and academic functioning Global disorders affect us across many arenas of life. Discrete disorders affect us in some particular and specific way 100

Neurodevelopmental Disorders Intellectual Disability formerly termed Mental Retardation IQ of 70 or less, but this is not the only determiner as there must also be cognitive deficits and issues in adaptive functioning that are found in one or more areas: conceptual, social, practical prenatal alcohol exposure is the largest environmental to genetic factor for IDD 101

Autism Spectrum n The DSM-5 integrates four disorders into the broader category/spectrum n n n Autistic disorder Asperger’s disorder Childhood disintegrative disorder PDD-NOS DSM-IV had 2, 027 ways to meet the diagnostic criteria; DSM-5 has 11 Two major diagnostic criteria n n Deficits in social communication and interaction Restricted and repetitive behaviors, interests, and activities (RRBs) 102

ADD and ADHD n Attention-Deficit/Hyperactivity Disorder n n n Issues regarding impulsivity, inattentiveness, and hyperactivity with several symptoms in each category Adults: may suffer even if not diagnosed in childhood; about 4. 4% of adults, those who are diagnosed in childhood and continue to have the disorder (between 30 -50%) are 5 times more likely to commit suicide than ADHD adults who did not have it in childhood Adults: need 5 symptoms in the areas of impulsivity, inattentiveness, or hyperactivity n Onset of symptoms prior to age 7—need 5 to be diagnosed n For onset of symptoms between 7 -12—need 6 to be diagnosed 103

Neurocognitive Disorders n Deficits in cognitive functioning that are acquired rather than developmental n n n delirium dementia amnestic n n While these do develop over time in humans, it is toward the end of our life spans Also evaluated on a spectrum of mild, moderate, severe 104

Neurocognitive Disorders n Symptoms need to demonstrate a significant decline in level of functioning before being diagnosed n 6 cognitive domains considered: n executive functioning n learning and memory n complex attention n language n perception n motor skills 105

9 Major Categories of Psychological Disorders DEPRESSIVE and BRIPOLAR DISORDERS: A mood disorder results in an inability to control or stabilize mood. In a disorder of this type, a patient will have trouble emerging from a depressed state or will lack the ability to maintain mood at a constant level. Characterized by emotional extremes.

Major Depressive Disorder Depression is the “common cold” of psychological disorders. 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

Major Depressive Disorder Major depressive disorder occurs when signs of depression last two weeks or more and are not caused by drugs or medical conditions. 1. 2. 3. 4. Signs include: Lethargy and fatigue Feelings of worthlessness Loss of interest in family & friends Loss of interest in activities

Symptoms of Major Depression

Dysthymic Disorder n n n Chronic, low-grade depressed feelings that are not severe enough to be major depression May develop in response to trauma, but does not decrease with time Can have co-existing major depression

Seasonal Affective Disorder Cyclic severe depression and elevated mood n Seasonal regularity n Unique cluster of symptoms n n n intense hunger gain weight in winter sleep more than usual depressed more in evening than morning

Depressive Disorders

Depressive Disorders § The vicious cycle of depression can be broken at any point

Bipolar Disorders § § § § a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania formerly called manic-depressive disorder Onset usually in early twenties Mood changes more abrupt than depression No gender differences in rate of bipolar Can be controlled with lithium (medication) Manic Episode § a mood disorder marked by a hyperactive, wildly optimistic state

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

Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase. Whitman Wolfe Clemens Hemingway

§ PET scans show that brain energy consumption rises and falls with emotional switches Depressed state Altering any one component of the chemistrycognitionmood circuit can alter the others Manic state Depressed state

Explaining Depressive and Bipolar Disorders n Neurotransmitter theories (Biology) n n dopamine norepinephrine serotonin Genetic component n more closely related people show similar histories of mood disorders

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

Situational Bases for Depression n n Positive correlation between stressful life events and onset of depression n Does life stress cause depression? Most depressogenic life events are losses n spouse or companion n long-term job n health n income

Cognitive Bases for Depression n A. T. Beck: depressed people hold pessimistic views of n n themselves the world the future Depressed people distort their experiences in negative ways n n exaggerate bad experiences minimize good experiences

Cognitive Bases for Depression n Hopelessness theory n n n depression results from a pattern of thinking person loses hope that life will get better negative experiences are due to stable, global reasons n e. g. , “I didn’t get the job because I’m stupid and inept” vs. “I didn’t get the job because the interview didn’t go well”