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Defining psychological Disorders
- Unjustifiable thoughts le, feelings, or actions that are persistently:
- deviant, distressful, and Dysfunctional
‘Abnormal’ is a relative term
The American Psychiatric Association
(APA) rendered a Diagnostic and Statistical Manual of Mental Disorders
(DSM) to describe psychological disorders and their prevalence.
The most recent edition describes over 300 psychological disorders compared to 60 in the 1950s.
- Disorders outlined by DSM-IV are reliable, i.e. diagnoses by different professionals are similar. DSM-IV criticized for "putting any kind of behavior
- within the compass of psychiatry."
- Axis I
- Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present?
- Axis II
- Is a Personality Disorder or Mental Retardation present?
- Axis III
- Is a General Medical Condition (diabetes, hypertension or arthritis etc) also present?
- Axis IV
- Are Psychosocial or Environmental Problems (school or housing issues) also present?
- Axis V
- What is the Global Assessment of the person’s functioning?
Labeling: Good or bad
Critics of the DSM argue that labels may stigmatize individuals
Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy
- 'Insanity‛ labels raise moral and ethical questions about how society should treat people who have
- disorders and have committed crimes
Generalized Anxiety Disorder (GAD)
- • Persistent, uncontrollable tenseness & apprehension, with an inability to identify or avoid the cause. Physical symptoms (head/stomach aches, muscle tension, irritability)
- • Has some genetic component. Related genetically to major depression.
- • Childhood trauma also related to GAD.
- • Freud: Results from repression of certain distressing thoughts & feelings
- Intense, irrational fear that interferes with functioning
- • Biological Perspective:Natural Selection led
- ancestors to learn to fear certain things to preserve
- species. Twins more likely to share phobias
- • Learning perspective: Observational learning, and
- Classical conditioning (e.g., dog = CS, bite = UCS)
- • It is not phobic to simply be anxious about something
- Agoraphobia- Phobia of open places.
- Acrophobia- Phobia of heights.
- Claustrophobia- Phobia of closed spaces.
- Hemophobia- Phobia of blood.
Obsessive Compulsive Disorder (OCD)
- • Obsessions - irrational, disturbing thoughts that intrude into consciousness
- • Compulsions - repetitive actions performed to alleviate obsessions
- • Heightened neural/metabolic activity in the frontal lobe areas
- • Affects both genders equally
Common Obsessions and Compulsions
- Obsessions:(repetitive thoughts) concerned with dirt and germs, something terrible happing(fire), symmetry order and exactness
- Compulsions:(repetitive behaviors) excessive hand washing(cleaning), repeating rituals, checking doors(homework locks..)
- • Panic attacks: Minutes-long episodes of intense dread which may include feelings of terror, chest pains, choking, and high physiological arousal
- • More common in women of child-bearing age.
- • Very frightening - sufferers live in fear of having them
- • Agoraphobia(fear or avoidance of situations in which escape might be difficult to help unavailable when panic strikes) often develops as a result
Post traumatic Stress Disorder (PTSD)
- • Following traumatic event, four or more weeks of nightmares, flashbacks, sleeplessness, social withdrawal, jumpy anxiety, irritability
- • Only about 10% of women and 20% of men develop PTSD after traumatic experiences
- • In many cases, surviving a trauma leads to the growth of an individual
- • The“common cold”of psychological disorders. Reported by 5.8% of men & 9.5% of women per year worldwide (WHO, 2002).
- • Symptoms: Sadness,feelings of worthlessness, difficulty concentrating/making decisions, changes in sleep/eating, anhedonia, lethargy, thoughts of dying/suicide
- • MajorDepression:Severe depression that lasts without remission for at least 2 wks
- • Dysthymia:less severe,but lasts at least 2 yrs
- • Can have both at the same time
Bases for Depression
- Bases for Depression
- • Neurotransmitter theories:ex.serotonin (medicine) (norepinephrine0increases arousal and boosts mood(is scarce in depression)
- • Genetic component: rate of depression higher in
- identical (50%) than fraternal (20%) twins.
- • Situational bases:Positive correlation between stressful life events (especially those involving loss) and onset of depression
- • CognitiveBases:
- – Beck‟s theory: depressed people hold pessimistic views of themselves, the world, the future.
- – Exaggerate bad experiences & minimize good ones – Negative experiences attributed to internal, stable, global reasons
- Note: Depressive realism or The Sadder-but-Wiser Effect(clear view of the world) depressed ind are more accurate..
The cycle of Depression
Stressful life events combined with a negative explanatory style leads to a hopeless depressed state which hampers the way the individual thinks and acts, triggering more stressful events and fueling depression.(Combination of a stressful event and how they coped with it)
The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide.(increases with age)
Seasonal Affective Disorder (SAD)
- • Cyclic severe depression and elevated mood
- • Seasonal regularity
- • Unique cluster of symptoms
- – intense hunger
- – gain weight in winter
- – sleep more than usual
- – depressed more in evening than morning
- • High carbohydrate intake may help
- • Cycling between severe depression and mania
- (extreme euphoria)
- • No regular relationship to time of year (vs. SAD)
- • Bipolar disorder is severe form, Cyclothymia is less severe form
- • Neurochemical disruptions involve low levels of serotonin & excess norepinephrine
- • Strong heritable component
- • Often treated with lithium
The bipolar brain
- (PET scans show that brain energy consumption rises and falls with manic and depressive episodes.)
- Depressive symptoms: gloomy, withdrawn, inability to make decisions, tired, slowness of thought.
- Manic symptoms: Elation, Euphoria, desire for action, hyperactive, multiple ideas
Somatoform Disorders -
- • Person temporarily loses some bodily function (blindness, deafness, paralyzed portion of body)
- • No physical damage to cause problems (ex. glove anesthesia)
- • Prominent in Freud‟s clients100 yrs ago, rare in western culture now
- • Often see examples in non-Western culture sex posed to traumatic events
Somatoform Disorders -
- • Long history of dramatic complaints are: different medical conditions. Complaints usually vague, undifferentiated (e.g., heart palpitations, dizziness, nausea)
- • Often difficult to determine whether complaints are somatization or undetectable physical disease
- • Kleinman‟s theory: somatization &depression are manifestations of the same problem. Somatization common in cultures critical of depression.
- Conscious awareness becomes separated (dissociated) from previous memories,
- thoughts, and feelings
- • Three types are recognized
- – Dissociative amnesia
- – Dissociative fugue
- – Dissociative identity disorder
Dissociative (psychogenic) Amnesia
- Marian and her brother were recently victims of a robbery. Marian was not injured, but her brother was killed when he resisted the robbers. Marian is unable to recall any details from the time of the accident until four days later
- • Memory loss the only symptom
- • Often selective loss surrounding traumatic events:
- – person still knows identity and most of their past
- • Can also be global
- – loss of identity without replacement with a new one (Contrast this with dissociative fugue)
Dissociative (psychogenic) 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
- • Global amnesia with identity replacement (leaves home, develops a new identity, no recollection of former life)
- • If fugue wears off, old identity recovers and new identity is totally forgotten
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
- • Originally„multiple personality disorder‟ • 2 or more distinct personalities manifested by the same
- person at different times • VERY rare and controversial disorder • Typically starts in childhood, mostly women
Causes of DID
- Repeated, severe sexual or physical abuse (in over 95% of the cases)
- • However, many abused people do not develop DID
- • Stress-vulnerability model: Abuse combined with biological predisposition toward dissociation causes DID
- – people with DID are easier to hypnotize than others
Controversy of DID
- • 1930-60: 2 cases per decade in USA
- • 1980s: 20,000 cases reported
- • many more cases in US than elsewhere
- • varies by therapist - some see none, others many
- • May be a learned response that reinforces reductions in anxiety
- Is DID the result of suggestion by therapist and acting by patient?
- • Comes from Greek meaning “split” and “mind”
- – "split‟ refers to loss of touch with reality, not to "split personality‟
- • Nearly 1 in a 100 suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease (WHO, 2002).
- • Equally split between genders, though males have earlier onset (Age 18-25 vs. 26-45 for women) and show more severe symptoms
Symptoms of Schizophrenia
- Positive symptoms: the presence of inappropriate behaviors (ex. hallucinations, disorganized thoughts)
- Negative symptoms: the absence of appropriate behaviors (expressionless face, rigid body)
Disorganized & Delusional Thinking
- This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars ... I’m Mary Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.”
- (Sheehan, 1982)
- This monologue illustrates fragmented, bizarre Other forms of delusions include, delusions of
- thinking with delusions. Many psychologists persecution. Many psychologist believe disorganized thoughts occur because of selective attention failure
Subtypes of Schizophrenia
- • Paranoid type: delusions of persecution , of grandeur
- • Catatonic type - unresponsive to surroundings, purposeless movement, parrot-like speech, immobility for extended periods, flat affect (no emotion in face or speech)
- • Disorganized type – delusions and hallucinations with little meaning
- – disorganized speech (word salad, illogical)
- – inappropriate behaviors (ex. wearing sweaters on hot days)
- – inappropriate affect (laughing at very serious things)
Chronic and Acute Schizophrenia
- When schizophrenia is slow to develop (chronic/process) recovery is doubtful. Such schizophrenics usually display negative symptoms.
- When schizophrenia rapidly develops (acute/reactive) recovery is better. Such schizophrenics usually show positive symptoms.
Schizophrenia is a disease of the brain exhibited by the symptoms of the mind
- -Dopamine Over-activity: higher levels of dopamine receptors
- -Abnormal Brain Activity: in the frontal cortex, thalamus, and amygdala.
- -Abnormal Morphological changes: ex. enlargement of fluid-filled ventricles.
Causes of Schizophrenia
- -Cause factors: The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease
- - Viral Infection: Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development.
- - Others? Family interactions? Oxygen deprivation
- during birth?
- Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions.
- Anti-Social Personality Disorder is most common personality disorder (formerly "psychopathic personality disorder‟)
Personality Disorders -
Antisocial Personality Disorder
- Impulsive behavior and a lack of conscience for wrongdoing, even toward friends and family members
- Typically begins in childhood. More common among males
- May be aggressive/ruthless or a clever con artist
- Usually above average in intelligence & charming personality
Levels of Arousal/Brain Activation
PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study, repeat offenders had 11% less frontal lobe activity
Boys who were later convicted of a crime showed relatively low arousal
General Trends in Psychological Disorders
- • Prevalence: 450 million people suffering from psychological disorders worldwide (WHO, 2004). In USA, about 1 in 6. Beware of “Medical Student Syndrome”, remember the 3 D‟s.
- • Age: Young adults most at risk
- • Gender: Women more at risk for anxiety & mood disorders, men more at risk for antisocial personality, suicide, & substance abuse
- • Culture: Some disorders universal (ex. Depression, Schizophrenia), though rates & prognosis for recovery vary (ex. less industrialized countries have better rates of recovery than industrialized countries. Why?), and some are culture specific (ex. Anorexia).
- • Genetics: Higher concordance rates in MZ than DZ42
Gender difference in depression
Women are more susceptible to depression
Explaining the Gender differences
- • Differences in Reporting:men report less psychological distress than women
- – Don‟t admit distress?
- – Tradeoff? Men use more alcohol/drugs and express anger more than distress
- • Differences in social experiences: Women experience more abuse in childhood, in marital relationships, in the workplace, etc.
- – As employment for genders becomes more similar, gender gap in some disorders decreases
- • Bias in diagnosis
- • Predisposing causes:in place before onset. Make one vulnerable
- – Ex. inherited characteristics,
- learned beliefs
- • Precipitating causes:immediate events that bring on the disorder
- – Ex. Loss, stress. May be small if
- predisposition high
- • Maintaining causes: consequences of the disorder keep disorder going once it begins
- – sometimes positive consequences (e.g., attention), often negative consequences (e.g., lack of friends)
Perspectives on Mental Disorders
- • Biological Perspective: brain abnormalities, chemical imbalances, heritability
- • Psychodynamic Perspective: unconscious conflicts and drives, childhood trauma
- • Cognitive Perspective: maladaptive thought patterns cause disorders
- • Behavioral Perspective: learned maladaptive patterns of behavior disorders
- • Sociocultural Perspective: larger culture important to development of mental disorders