Transcript Chapter 12 - Somerset Academy

Chapter 12
Psychological Disorders
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ISBN: 0-131-73180-7
Copyright © Allyn & Bacon 2007
What is Psychological
Disorder?
The medical model takes a
“disease” view, while
psychology sees
psychological disorder as an
interaction of biological,
cognitive, social, and
behavioral factors
Copyright © Allyn & Bacon 2007
What is Psychological
Disorder?
Psychopathology –
Any pattern of emotions, behaviors, or
thoughts inappropriate to the situation
and leading to personal distress or the
inability to achieve important goals
Synonymous terms include:
Mental illness
Mental disorder
Psychological disorder
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What is Psychological
Disorder?
Three classic signs suggest severe
psychological disorder
• Hallucinations
• Delusions
• Severe affective disturbances
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Indicators of Abnormality
Other signs of a disorder are more subtle,
and a diagnosis depends heavily on
clinical judgment
Distress
Maladaptiveness
Irrationality
Unpredictability
Unconventionality
and undesirable
behavior
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Deviant: being different from most other people in one’s
culture; may vary by context (example – wartime) and time
(example - homosexuality was classified as an illness from
1952 to 1973)
Men of the West Africa Wodaabe tribe put on elaborate makeup
and costumes to attract women. In Western society, the same
behavior would break behavioral norms and might be judged
Distressful: causes the individual stress (pain,
anxiety, sorrow, etc.)
Dysfunction: considered to be disorderly if
it
impairs your everyday life
Early Theories
Abnormal behavior was evil spirits
trying to get out, godlike powers,
movement of stars
Treatments: institutionalized, castration, drilling
holes in skull, removing intestines, transfusion of
animal blood, and more
Medical Model
By the 1800s, we started reforming the way we
looked at mental illness and developed the medical
model
Mental illness needs to be diagnosed on basis of
symptoms and cured through therapy and treatment
Biopsychosocial Approach
considers combination of biological, psychological,
and social factors as contributing to development of
disorders
DSM IV
American Psychiatric
Association’s Diagnostic and
Statistical Manual of Mental
Disorders; a widely used system
for classifying psychological
disorders
Lists symptoms,
examples, etc.
Helps psychologists
diagnose disorders
Used by insurance
companies
People First Language
seeing individuals as people first and not defined by
their disorder
Ex: “a person with schizophrenia,” not “a
schizophrenic”
Labels can negatively affect the way we perceive
people
Example: What emotions come to you when you hear the
words “cancer patient?”
Labels can result in
self-fulfilling
prophecies
Criticisms
Are people with disorders truly mentally ill or are
they just deviating from social norms?
Rosenhan Study: associates were malingering symptoms
of hearing voices.
They were ALL admitted for
schizophrenia.
None were exposed as imposters.
They all left diagnosed with
schizophrenia in remission.
What are some of the questions
raised by this study?
Changing Concepts of
Psychological Disorder:
The Cognitive-Behavioral Approach
Behavioral perspective –
Abnormal behaviors can be acquired
through behavioral learning – operant
and classical conditioning
Cognitive perspective –
Abnormal behaviors are influenced by
mental processes – how people perceive
themselves and their relations with others
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The Biopsychology of Mental Disorder
Although most psychologists have
reservations about the medical model,
they do not deny the influence of biology
on thought and behavior
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How are Psychological
Disorders Classified?
The most widely used
system, found in the DSMIV, classifies disorders by
their mental and behavioral
symptoms
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Overview of DSM-IV
Classification System
DSM-IV –
Fourth edition of the Diagnostic and
Statistical Manual of Mental Disorders;
the most widely accepted classification
system in the United States
Neurotic disorder or neurosis
Psychotic disorder or psychosis
In multiaxial diagnosis, professionals look
at the entire person, not just their
“abnormal” behavior
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Mood Disorders
Major depression –
Form of depression that does not
alternate with mania
Seasonal affective disorder (SAD) –
Believed to be caused by deprivation of
sunlight
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Mood Disorders
Experience extreme or inappropriate emotion.
Females are twice as likely as men to suffer
from these – why do you think this is?
Major Depressive Disorder
Unhappy for at least two weeks
with no apparent cause.
A.K.A. unipolar depression
Depression is the common cold
of psychological disorders. –
what does this mean?
Why does it happen? Slows us
down, diffuses aggression,
restrains risk-taking, etc.
Major Depression
Symptoms of major
depression:
Lethargy
Feelings of worthlessness
Loss of interest in
friends/family/activities
Problems eating or sleeping
Thoughts of suicide
Depression is the #1
reason people seek
mental health
services
Depression Example
Norman, a Canadian college professor,
recalling his depression:
“I despaired of ever being human again. I honestly felt
subhuman, lower than the lowest vermin. Furthermore, I
was self-deprecatory and could not understand why
anyone would want to associate with me, let alone love
me… I was positive that I was a fraud and a phony and
that I didn’t deserve my Ph.D. I didn’t deserve to have
tenure; I didn’t deserve to be a Full Professor… I didn’t
deserve the research grants I had been awarded; I
couldn’t understand how I had written books and journal
articles… I must have conned a lot of people.”
Explanations for Depression
Alcohol abuse increases risk
Genetic influence
• If identical twin has Major Depression,
you are 50% likely to have it (compared to
20% if you have a fraternal twin)
• Low amount of neurotransmitters
• Serotonin and Norepinephrine
Mood/arousal boosters
Social/Cognitive differences
• People with depression tend to blame
themselves and have a negative
explanatory style
Mood DisordersDepression
Mood DisordersDepression
 Canadian depression rates
Methods of coping with Depression
Mood Disorders- Suicide
Seasonal Affective Disorder (SAD)
Experience depression
during the winter
months.
Based not on
temperature, but on
amount of sunlight.
Treated with light
therapy.
Bipolar Disorder
Bipolar disorder –
Mental abnormality involving swings of
mood from mania to depression
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Bipolar Disorder
Formally manic depression.
Involves alternating periods
of depression and mania.
Manic episodes involve
feelings of high energy (but
they tend to differ a
lot…some get confident and
some get irritable).
Mark
Twain
Ernest
Engage in risky behavior
during the manic episode.
Charlie Sheen?
Mood Disorders-Bipolar
 PET scans show that brain energy consumption
rises and falls with emotional switches
Depressed state
Manic state
Depressed state
Bipolar I and Bipolar II
Two Main Distinctions
Bipolar I Disorder:
Technically, this should mean Mania/Mixed +
Depression
Actually, this means Mania/Mixed ± Depression
Bipolar II Disorder:
Hypomania + Depression (No mania ever)
It is distinguished from Major Depressive Disorder by the
lifetime history of at last one Manic or Mixed Episode
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Bipolar I Disorder
One or more
manic episode
Manic
or Mixed
Episode
OR
OR
Depressed and
manic episodes
Major
Manic
Depressiveor Mixed
Episode
Episode
Bipolar Disorder
Depressive Symptoms
Manic Symptoms
Gloomy
Elation
Withdrawn
Euphoria
Inability to make decisions
Desire for Action
Tired
Hyperactive
Slowness of thought (lethargic
thinking)
Multiple Ideas
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Bipolar II Disorder
One or more
OR
hypomanic episode
Hypomanic
Episode
OR
Depressed and
hypomanic episodes
Major
Hypomanic
Depressive
Episode
Episode
Bi-Polar I and Bi-Polar II
Hypomania: At first when I'm high, it's tremendous ... ideas are fast
... like shooting stars you follow until brighter ones appear... All
shyness disappears, the right words and gestures are suddenly
there ... uninteresting people, things become intensely interesting.
Sensuality is pervasive, the desire to seduce and be seduced is
irresistible. Your marrow is infused with unbelievable feelings of
ease, power, well-being, omnipotence, euphoria ... you can do
anything ... but somewhere this changes.
Mania: The fast ideas start coming too fast and there are far too
many ... overwhelming confusion replaces clarity ... you stop
keeping up with it … memory goes. Infectious humor ceases to
amuse. Your friends become frightened ... everything is now
against the grain ... you are irritable, angry, frightened,
uncontrollable, and trapped.
(information from webmd.com)
Copyright © Allyn & Bacon 2007
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
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Mood Disorders
The Etiology of Depression
Depression often triggered by stress
However, unlikely that stress alone
causes depression
Some people are more vulnerable to
depression – biological vulnerability;
developmental vulnerability
Biological Perspective
Genetic Influences: Mood disorders run in
families. The rate of depression is higher in
identical (50%) than fraternal twins (20%).
Jerry Irwin Photography
Linkage analysis and
association studies link
possible genes and
dispositions for depression.
Neurotransmitters & Depression
A reduction of
norepinephrine and
serotonin has been
found in depression.
Drugs that alleviate
mania reduce
norepinephrine.
Pre-synaptic
Neuron
Serotonin
Norepinephrine
Post-synaptic
Neuron
The Depressed Brain
PET scans show that brain energy consumption
rises and falls with manic and depressive
episodes.
Courtesy of Lewis Baxter an Michael E.
Phelps, UCLA School of Medicine
Systems Approach
Anxiety Disorders
Generalized anxiety disorder –
Characterized by persistent and
pervasive feelings of anxiety, without any
external cause
Panic disorder –
Marked by panic attacks that have no
connection to events in a person’s
present experience
Agoraphobia –
Fear of public places/open spaces
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Anxiety Disorders
Phobias–
A group of anxiety disorders involving a
pathological fear of a specific object or
situation
Preparedness hypothesis –
Notion that we have an innate tendency,
acquired through natural selection, to
respond quickly and automatically to
stimuli that posed a survival threat to our
ancestors
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Anxiety Disorders
Obsessive-compulsive disorder –
Condition characterized by patterns of
persistent, unwanted thoughts and
behaviors
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Somatoform Disorders
Somatoform disorders –
Psychological problems appearing in the
form of bodily symptoms or physical
complaints
Conversion disorder –
Somatoform disorder marked by
paralysis, weakness, or loss of sensation,
but with no discernable physical cause
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Somatoform Disorders
Glove Anesthesia
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Somatoform Disorders
Hypochondriasis –
Somatoform disorder involving excessive
concern about health and disease
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Dissociative Disorders
Dissociative disorders –
Group of pathologies involving
“fragmentation” of the personality
Dissociative
amnesia
Dissociative
fugue
Depersonalization
disorder
Dissociative
identity disorder
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Dissociative Disorders
Dissociative
amnesia
Dissociative fugue
Depersonalization
disorder
A psychologically
induced loss of
memory for
personal
information
Dissociative
identity disorder
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Dissociative Disorders
Dissociative
amnesia
Dissociative fugue
Depersonalization
disorder
Dissociative
amnesia with the
addition of “flight”
from one’s home,
family, and job
Dissociative
identity disorder
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Dissociative Disorders
Dissociative
amnesia
Dissociative Fugue
Depersonalization
disorder
Dissociative
identity disorder
Abnormality involving
the sensation of
mind and body
having separated
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Dissociative Disorders
Dissociative
amnesia
Dissociative Fugue
Depersonalization
disorder
Dissociative
identity disorder
Condition in which the
individual displays
multiple identities
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Eating Disorders
Anorexia nervosa –
Eating disorder involving persistent loss
of appetite that endangers an individual’s
health – stemming from psychological
reasons rather than organic causes
Bulimia –
Eating disorder characterized be eating
binges followed by “purges,” induced by
vomiting or laxatives; typical initiated as a
weight-control measure
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Schizophrenic Disorders
Schizophrenia –
Psychotic disorder involving distortions in
thoughts, perceptions, and/or emotions
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Major Types of Schizophrenia
Disorganized
Catatonic
Paranoid
Undifferentiated
Residual
Positive
Negative
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Major Types of Schizophrenia
Disorganized
Catatonic
Paranoid
Features incoherent
speech,
hallucinations,
delusions, and
bizarre behavior
Undifferentiated
Residual Type
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Major Types of Schizophrenia
Disorganized
Catatonic
Involves stupor or
extreme excitement
Paranoid
Undifferentiated
Residual Type
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Major Types of Schizophrenia
Disorganized
Catatonic
Paranoid
Undifferentiated
Residual Type
Prominent feature:
combination of
delusions and
hallucinations
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Major Types of Schizophrenia
Disorganized
Catatonic
Paranoid
Undifferentiated
Residual Type
Persons displaying a
combination of
symptoms that do not
clearly fit in one of the
other categories
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Major Types of Schizophrenia
Disorganized
Catatonic
Paranoid
Undifferentiated
Residual Type
Individuals who have
had a past episode of
schizophrenia but are
free of symptoms
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Major Types of Schizophrenia
Positive
Schizophrenia
Negative
Schizophrenia
Any form in which the
person displays
active symptoms
(e.g. delusions,
hallucinations)
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Major Types of Schizophrenia
Positive
Schizophrenia
Negative
Schizophrenia
Any form distinguished
by deficits, such as
withdrawal and
poverty of thought
processes
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Possible Causes of Schizophrenia
Evidence for the causes of schizophrenia
has been found in a variety of factors
including genetics, abnormal brain
structure, and biochemistry
Diathesis-stress hypothesis –
Genetic factors place the individual at
risk, but environmental stress factors
transform this potential into an actual
schizophrenic disorder
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Personality Disorders
Personality disorders –
Conditions involving a chronic, pervasive,
inflexible, and maladaptive pattern of
thinking, emotion, social relationships, or
impulse control
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Personality Disorders
Narcissistic personality disorder –
Characterized by a grandiose sense of
self-importance, a preoccupation with
fantasies of success and power, and a
need for constant attention
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Personality Disorders
Antisocial personality disorder –
Characterized by a long-standing pattern
of irresponsible behavior indicating a lack
of conscience and a diminished sense of
responsibility to others
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Personality Disorders
Borderline personality disorder –
An unstable personality given to
impulsive behavior
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Adjustment Disorders and Other
Conditions That May Be a Focus
of Clinical Attention
Mild depression
Physical
complaints
Parent-child
problems
Bereavement
Marital
problems
Academic
problems
Job problems
Malingering
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Developmental Disorders
Autism –
A developmental disorder marked by
disabilities in language, social interaction,
and the ability to understand another
person’s state of mind
Dyslexia –
A reading disability, thought by some
experts to involve a brain disorder
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Developmental Disorders
Attention-deficit hyperactivity disorder –
A developmental disability involving short
attention span, distractibility, and extreme
difficulty in remaining inactive for any
period
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Shyness
Shyness, a distressing pattern of avoiding
or withdrawing from social contact is
treatable, but it is not a DSM-IV disorder
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What are the Consequences
of Labeling People?
Ideally, accurate diagnoses
lead to proper treatments, but
diagnoses may also become
labels that depersonalize
individuals and ignore the
social and cultural contexts in
which their problems arise
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The Plea of Insanity
Insanity –
A legal term, not a psychological or
psychiatric one, referring to a person who
is unable, because of a mental disorder
or defect, to confirm his or her behavior
to the law
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End of Chapter 12
Copyright © Allyn & Bacon 2007