Transcript What Is a Psychological Disorder?

Psychological Disorders
What is normal?
Psychological Disorder (defined)
• To be considered a “disorder”, the behavior
must be:
– maladaptive (harmful) or disturbing to the
individual
– disturbing to others
– unusual to the vast majority of people in that
culture
– irrational, not make sense to the average person
• What is maladaptive, disturbing, unusual,
and irrational depends on
– the culture
– time period
– environmental conditions
– individual person
How do we diagnose?
• DSM-IV-TR
School or Perspective
Cause of Disorder
Psychoanalytic/Psychodynamic
Internal, unconscious conflicts
Behavioral
Reinforcement history/ the
environment
Biomedical
Organic problems, biochemical
imbalances, genetic predispositions
Cognitive
Irrational, dysfunctional thoughts
or ways of thinking
Humanistic
Failure to strive towards one's
potential or being out of touch with
one's feelings
Sociocultural
Dysfunctional society
It’s a Buffet…
Early Theories
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Evil spirits
Music or sing to chase spirits away
Trephining
Make the body uncomfortable
History of Mental Disorders
• Not madmen, but mentally ill
• Treatment involved placement
in hospitals
Early Mental Hospitals
• Barbaric prisons
• Patients chained and
locked away
• Some hospitals even
charged admission for
the public to see the
“crazies”, just like a zoo
Philippe Pinel
• French doctor who was the first to take the
chains off and declare that these people are
sick and “a cure must be found!!!”
Categories of Disorders
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Anxiety Disorders
Somatoform Disorders
Dissociative Disorders
Mood Disorders
Personality Disorders
Schizophrenia
Other Disorders
Anxiety Disorders
Five Anxiety Disorders
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Phobia
Generalized Anxiety Disorder
Panic Disorder
Obsessive-Compulsive Disorder
Post-traumatic Stress Disorder
Phobia
• An intense, irrational fear of specific
objects or things
• There is a phobia for just about anything
– www.phobialist.com
Generalized Anxiety Disorder
• Is chronic (at least 6
months), generalized and
persistent
• Characterized by a
constant, low level of
anxiety
Panic Disorder
• Characterized by sudden, acute episodes of
intense anxiety without an apparent cause
Obsessive-Compulsive Disorder
• OCD
• Different symptoms
– Obsessions: persistent, often unreasonable
thoughts that can’t be dispelled
– Compulsion: persistent act which is repeated over
and over
• Obsessions result in the anxiety, anxiety
reduced when compulsive behavior performed
Common Examples of OCD
Common Obsessions:
Common Compulsions
Contamination fears of germs, dirt, etc.
Washing
Imagining having harmed self or others
Repeating
Imagining losing control of aggressive
urges
Checking
Intrusive sexual thoughts or urges
Touching
Excessive religious or moral doubt
Counting
Forbidden thoughts
Ordering/arranging
A need to have things "just so"
Hoarding or saving
A need to tell, ask, confess
Praying
Post-traumatic Stress Disorder
• Memories of traumatic event cause
intense feelings of anxiety
– Can result in persistent nightmares or
flashbacks
Somatoform Disorders
Hypochondriasis
• Complaints of frequent,
usually small, physical
problems but no evident
problems
• Physical symptoms
usually have
psychological roots
Conversion Disorder
• Certain bodily functions impaired,
but no biological cause found
– Common symptoms reported:
• Paralysis
• Blindness
• Seizures
• Anesthesia (loss of feeling)
Dissociative Disorders
Psychogenic amnesia
• Can’t remember things & no
physiological basis for forgetting
– Organic amnesia is different (2 types of
organic): retrograde & anterograde
Fugue
• Not only forget who the are (psychogenic
amnesia) but usually find themselves in place
with no idea of how they got there
Dissociative Identity Disorder
• Formerly know as Multiple Personality
Disorder (MPD)
• Several distinct personalities
• No limit to number, age, gender of
personalities
• Theory is the personalities are created to cope
with abuse
Mood Disorders
Major Depression
• Symptoms of depression include the following:
– depressed mood (such as feelings of sadness or emptiness)
– reduced interest in activities that used to be enjoyed, sleep disturbances
(either not being able to sleep well or sleeping to much)
– loss of energy or a significant reduction in energy level
– difficulty concentrating, holding a conversation, paying attention, or
making decisions that used to be made fairly easily
– suicidal thoughts or intentions.
Seasonal Affective Disorder
• Severe depression every fall and winter followed by normal or
elevated mood in the spring
• Symptoms: intense hunger, weight gain during the winter,
sleeping more.
• Treatment: sunlight (“light therapy”)
Dysthymic Disorder
• Occurs when a person suffers from a mild depression for at
least two years.
– No major depressive bouts occur during this time.
• Treatment
– Similar to Major Depression, treatment could include medication
and/or therapy.
Bipolar Disorder
• Also known as manic depression, is characterized by bouts of
depression (discussed above) alternating with bouts of mania
(an energetic feeling of confidence and power).
• In many cases, the manic periods are more dangerous than the
depressive ones because during mania, the person exhibits
extremely risky behavior.
• Many creative people suffer from bipolar.
• Research shows strong biological component
• Broken down into two types
– Bipolar I
– Bipolar II
• Treatment – medication, most common is Lithium
– Therapy is beneficial to help patient understand the illness & it’s
consequences
Personality Disorders
Antisocial Personality Disorder
• Characterized by a lack of respect for other’s
rights, feelings, and needs, beginning by age
15
• Deceitful, manipulative
• Often lack empathy & remorse
– May be superficially charming
• Behavior often aggressive, impulsive, reckless
and irresponsible
• Once referred to as sociopathy or psychopathy
Histrionic Personality Disorder
• Involves attention-seeking behavior and
shallow emotions
Narcissistic Personality Disorder
• Characterized by an exaggerated sense of
importance, a strong desire to be admired, and
a lack of empathy
Dependent Personality Disorder
• Rely too much on the attention and help of
others
• Need approval – trouble making decisions by
themselves
Paranoid Personality Disorder
• Always feel persecuted
Obsessive-Compulsive Personality
Disorder
• Overly concerned with certain thoughts and
performing certain behaviors, but will not be
debilitated to the same extent that someone
with OCD would
Schizophrenia
schizophrenia video
Positive Symptoms
• “adding on”, NOT “good”
• Examples:
– Delusions
– Hallucinations
– Inappropriate effect
Negative Symptoms
• Involves a loss of something a person
WITHOUT schizophrenia has
• Examples:
– Flat effect
– Catatonia
Types of Schizophrenia
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Paranoid schizophrenia
Disorganized schizophrenia
Catatonic schizophrenia
Undifferentiated schizophrenia
Paranoid Schizophrenia
• Characterized by marked delusions or
hallucinations & relatively normal cognitive
and emotional functioning
• Delusions are usually persecutory, grandiose,
or both
• This subtype usually happens later in life than
the other subtypes
• Prognosis may also be better for this type of
schizophrenia
Disorganized Schizophrenia
• Characterized by disorganized behavior,
disorganized speech, and emotional flatness or
inappropriateness.
Catatonic Schizophrenia
• Characterized by unnatural movement patterns
such as rigid, unmoving posture or continual,
purposeless movements, or by unnatural
speech patterns such as absence of speech or
parroting of other people’s speech.
Undifferentiated Schizophrenia
• Diagnosis given to a patient that does not meet
criteria for paranoid, disorganized, or catatonic
schizophrenia.
Causes of Schizophrenia
• Research suggests that many things may play a
role in the onset of schizophrenia
– genes
– neurotransmitters
– brain abnormalities (structure & injury)
Genetic Predisposition
• Substantial evidence suggests that there is a
genetically inherited predisposition to schizophrenia.
– there is a concordance rate of about 48 percent for identical
twins
– the concordance rate for fraternal twins is considerably
less, about 17 percent.
– Concordance rate refers to the percentage of both people
in a pair having a certain trait or disorder.
• A person who has two parents with schizophrenia has
about a 46 percent chance of developing
schizophrenia.
Neurotransmitters
• Some researchers have proposed that
schizophrenia is related to an excess of the
dopamine
• Other researchers have suggested that both
serotonin and dopamine may be involved
• The neurotransmitter glutamate may also play
a role
– Underdevelopment of glutamate neurons results in
the overactivity of dopamine neurons
Brain Structure
• Some researchers have suggested that schizophrenia
may involve an inability to filter out irrelevant
information, which leads to being overwhelmed by
stimuli.
– researchers have looked for brain abnormalities in
schizophrenia patients.
– The brains of people with schizophrenia do differ
structurally from the brains of normal people in several
ways.
– They are also more likely to have abnormalities in the
thalamus and reduced hippocampus volume.
Brain Injury
• Some research suggests that injuries to the brain
during sensitive periods of development can make
people susceptible
– viral infections or malnutrition during the prenatal period
– complications during the birthing process can increase the
later risk of schizophrenia.
• Some researchers have suggested that abnormal brain
development during adolescence may also play a role
in schizophrenia.
Stress and Schizophrenia
• Stress may play a role in people who are
biologically vulnerable to schizophrenia
Summary
What Is a Psychological Disorder?
• Criteria for defining psychological disorders
depend on whether cultural norms are violated,
whether behavior is maladaptive or harmful,
and whether there is distress.
Medical Model
• The medical model describes and explains
psychological disorders as if they are diseases.
Vulnerability-stress Model
• The vulnerability-stress model states that
disorders are caused by an interaction between
biological and environmental factors.
Learning Model
• The learning model theorizes that
psychological disorders result from the
reinforcement of abnormal behavior.
Psychodynamic Model
• The psychodynamic model states that
psychological disorders result from
maladaptive defenses against unconscious
conflicts.
Assessment
• Psychologists use objective and projective
tests to assess psychological disorders.
Classification
• Classification allows psychologists to describe
disorders, predict outcomes, consider
treatments, and study etiology.
• Insanity is a legal term, not a diagnostic label.
The DSM
• Psychologists and psychiatrists use a reference
book called the Diagnostic and Statistical
Manual of Mental Disorders (DSM) to
diagnose psychological disorders.
• The American Psychiatric Association
published the first version of the DSM in 1952.
It has been revised several times, and the
newest version is commonly referred to as the
DSM-IV-TR
DSM
• The DSM-IV uses a multi-axial system of
classification, which means that diagnoses are
made on several different axes or dimensions.
DSM
• The DSM has five axes:
– Axis I records the patient’s primary diagnosis.
– Axis II records long-standing personality problems or
mental retardation.
– Axis III records any medical conditions that might affect
the patient psychologically.
– Axis IV records any significant psychosocial or
environmental problems experienced by the patient.
– Axis V records an assessment of the patient’s level of
functioning.
DSM
Criticisms of the DSM
• Although the DSM is used worldwide and
considered a very valuable tool for diagnosing
psychological disorders, it has been criticized
for several reasons:
DSM
• Some critics believe it can lead to normal
problems of living being turned into
“diseases.”
– For example, a child who displays the inattentive
and hyperactive behavior normally seen in young
children could be diagnosed with attentiondeficit/hyperactivity disorder by an overzealous
clinician.
DSM
• Some critics argue that including relatively
minor problems such as caffeine-induced sleep
disorder in the DSM will cause people to liken
these problems to serious disorders such as
schizophrenia or bipolar disorder.
DSM
• Other critics argue that giving a person a
diagnostic label can be harmful because a label
can become a self-fulfilling prophecy.
– A child diagnosed with attentiondeficit/hyperactivity disorder may have difficulty
overcoming his problems if he or other people
accept the diagnosis as the sole aspect of his
personality.
DSM
• Some critics point out that the DSM makes the
process of diagnosing psychological disorders
seem scientific when, in fact, diagnosis is
highly subjective.
DSM
• In general, psychologists view the DSM as a
valuable tool that, like all tools, has the
potential for misuse. The DSM contains many
categories of disorders, and the following
sections will cover a few of these categories.
DSM
Anxiety Disorders
• A chronic, high level of anxiety may be a sign
of an anxiety disorder.
• Generalized anxiety disorder involves
persistent and excessive anxiety for at least six
months.
• Having a specific phobia means becoming
anxious when exposed to a specific
circumstance.
• Social phobia is characterized by anxiety in
social or performance situations.
• A person with panic disorder experiences
recurrent, unexpected panic attacks.
• Agoraphobia involves anxiety about having
panic attacks in difficult or embarrassing
situations.
• Obsessive-compulsive disorder entails
obsessions, compulsions, or both.
• Post–traumatic stress disorder is a set of
psychological and physiological responses to a
highly traumatic event.
• Biological factors implicated in the onset of
anxiety disorders include genes, different
sensitivity to anxiety, the neurotransmitters
GABA and serotonin, and brain damage.
• Conditioning and learning may contribute to
the development of phobias.
• Neuroticism is associated with anxiety
disorders.
Mood Disorders
• Mood disorders are characterized by marked
disturbances in emotional state, which cause
physical symptoms and affect thinking, social
relationships, and behavior.
• Mood disorders may be unipolar or bipolar.
• People with dysthymic disorder have
depressed mood for at least two years.
• Major depressive disorder involves at least
one period with significant depressive
symptoms.
• Bipolar disorders involve at least one period
with manic symptoms and usually depressive
periods as well.
• Biological influences on mood disorders
include genes, the neurotransmitters
norepinephrine and serotonin, and brain
abnormalities.
• Cognitive characteristics of depressed people
include learned helplessness; a pessimistic
worldview; hopelessness; a tendency to
make internal, stable, global attributions;
and a tendency to ruminate.
• Depression may be related to experiences of
loss.
• The onset and course of mood disorders may
be influenced by stress.
Somatoform Disorders
• Somatoform disorders are characterized by
real physical symptoms that cannot be fully
explained by a medical condition, the effects
of a drug, or another mental disorder.
• A person with somatoform disorder has many
different, recurrent physical symptoms.
• Conversion disorder involves symptoms that
affect voluntary motor functioning or sensory
functioning.
• People with hypochondriasis constantly fear
that they may have a serious disease.
• People with histrionic personality traits may
be more likely to develop somatoform
disorders.
• Several cognitive factors may contribute to
somatoform disorders.
Dissociative Disorders
• Dissociative disorders are characterized by
disturbances in consciousness, memory,
identity, and perception.
• Dissociative fugue involves sudden and
unexpected travel away from home, failure to
remember the past, and confusion about
identity.
• People with dissociative identity disorder fail
to remember important personal information
and have two or more identities or personality
states that control behavior.
• Dissociative identity disorder is a controversial
diagnosis. Psychologists disagree about why
its prevalence has risen since the 1980s.
• Severe stress may play a role in the onset of
dissociative disorders.
Personality Disorders
• Personality disorders are stable patterns of
experience and behavior that differ noticeably
from patterns that are considered normal by a
person’s culture.
• Histrionic personality disorder is
characterized by attention-seeking behavior
and shallow emotions.
• People with narcissistic personality disorder
have an exaggerated sense of importance, a
strong desire to be admired, and a lack of
empathy.
• Antisocial personality disorder begins at age
fifteen and includes a lack of respect for other
people’s rights, feelings, and needs.
• Abnormalities in physiological arousal, a
genetically inherited inability to control
impulses, and brain damage may be involved
in the development of antisocial personality
disorder.
• Environmental influences are also likely to
influence the development of antisocial
personality disorder.
Schizophrenia
• Schizophrenia is a psychotic disorder that
includes positive and negative symptoms.
• There are several subtypes of schizophrenia.
• The paranoid type is characterized by marked
delusions or hallucinations and relatively
normal cognitive and emotional functioning.
• The disorganized type involves disorganized
behavior, disorganized speech, and emotional
flatness or inappropriateness.
• The catatonic type is characterized by
unnatural movement or speech patterns.
• A diagnosis of undifferentiated type applies
if diagnostic criteria are not met for any of the
above three subtypes.
• Research suggests that genes,
neurotransmitters, and brain abnormalities
are involved in the onset of schizophrenia.
• Stress may help to induce schizophrenia in
people who are already biologically vulnerable
to the disorder.