Transcript Lecture Powerpoint: Ch. 15

THIRD EDITION
PSYCHOLOGY
from inquiry to understanding
CHAPTER
15
Psychological
Disorders
WHEN ADAPTATION BREAKS DOWN
Slides prepared by Matthew Isaak
Copyright © 2014, © 2011, © 2009 by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
LO 15.1 Identify criteria for defining mental
disorders.
LO 15.2 Describe conceptions of diagnoses across
history and cultures.
LO 15.3 Identify common misconceptions about
psychiatric diagnoses, and the strengths
and limitations of the current diagnostic
system.
LO 15.4 Describe the many ways people
experience anxiety
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Learning Objectives
LO 15.5 Identify the characteristics of different
mood disorders.
LO 15.6 Describe major explanations for
depression and how life events can
interact with characteristics of the
individual to produce depression
symptoms.
LO 15.7 Identify common myths and
misconceptions about suicide.
LO 15.8 Identify the characteristics of borderline
and psychopathic personality disorders.
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Learning Objectives
LO 15.9 Explain the controversies surrounding
dissociative disorders, especially
dissociative identity disorder.
LO 15.10 Recognize the characteristic symptoms of
schizophrenia.
LO 15.11 Explain how psychosocial, neural,
biochemical, and genetic influences create
the vulnerability to schizophrenia.
LO 15.12 Describe the symptoms and debate
surrounding disorders diagnosed in
childhood.
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Lecture Preview
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Conceptions of mental illness
Anxiety-related disorders
Mood disorders and suicide
Personality and dissociative disorders
Schizophrenia
Childhood disorders
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What is Mental Illness?
LO 15.1 Identify criteria for defining mental disorders.
• Psychopathology (mental illness) is
often seen as a failure of adaptation to
the environment.
• Failure analysis approach tries to
understand mental illness by examining
breakdowns in functioning
• Mental disorder does not have a clear
cut definition.
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What is Mental Illness?
LO 15.1 Identify criteria for defining mental disorders.
• Many different conceptions of mental
illness, each with pros and cons:
– Statistical rarity
– Subjective distress
– Impairment
– Societal disapproval
– Biological dysfunction
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Historical Views of Mental Illness
LO 15.2 Describe conceptions of diagnoses across history and cultures.
• During Middle Ages, mental illnesses
were often viewed through a demonic
model.
• Odd behaviors were the result of evil
spirits inhabiting the body.
• Exorcisms and witch hunts were
common during this time.
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Historical Views of Mental Illness
LO 15.2 Describe conceptions of diagnoses across history and cultures.
• During the Renaissance, the medical
model saw mental illness as a physical
disorder needing treatment.
• Began housing people in asylums –
but they were often overcrowded and
understaffed
• Treatments were no better than before
(bloodletting and snake pits).
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Historical Views of Mental Illness
LO 15.2 Describe conceptions of diagnoses across history and cultures.
• Reformers like Phillippe Pinel and
Dorothea Dix pushed for moral
treatment.
• Treated patients with dignity, respect,
and kindness
• Still no effective treatments, though, so
many continued to suffer with no relief
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Modern Era
LO 15.2 Describe conceptions of diagnoses across history and cultures.
• In early 1950s, a drug was developed
called chlorpromazine (Thorazine).
• Moderately decreased symptoms of
schizophrenia and similar problems
• With advent of other medications,
policy of deinstitutionalization was
enacted
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Figure 15.1 Decline in Psychiatric Inpatients. Over the past several decades, the number of hospitalized
psychiatric patients has gradually declined. (Source:
www.ahrq.gov/legacy/about/annualconf09/vandivort_mark_owens/slide4.jpg)
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Modern Era
LO 15.2 Describe conceptions of diagnoses across history and cultures.
• Deinstitutionalization had mixed
results.
• Some patients returned to almost
normal lives but tens of thousands had
no follow-up care and went off
medications.
• Community mental health centers
and halfway houses attempt to help
this problem.
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Diagnosis Across Cultures
LO 15.2 Describe conceptions of diagnoses across history and cultures.
• Certain conditions are culture-bound.
• Koro involves believing your genitals
are shrinking and receding into your
abdomen.
• Amok is marked by episodes of intense
sadness and brooding followed by
uncontrolled behavior and violence.
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Diagnosis Across Cultures
LO 15.2 Describe conceptions of diagnoses across history and cultures.
• Taijin kyofushu is a fear of offending
others by saying something offensive or
body odor.
• Many severe mental disorders
(schizophrenia, alcoholism,
psychopathy) appear to be universal
across cultures.
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Psychiatric Diagnosis Today
LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and
limitations of the current diagnostic system.
• Evidence largely contradicts common
misconceptions concerning psychiatric
diagnosis, such as:
– Psychiatric diagnosis is simply
pigeonholing.
– Psychiatric diagnoses are unreliable.
– Psychiatric diagnoses are invalid.
– Psychiatric diagnoses stigmatize people.
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Psychiatric Diagnosis Today
LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and
limitations of the current diagnostic system.
• Diagnostic and Statistical Manual of
Mental Disorders (DSM) is a system
that contains the criteria for mental
disorders.
• Currently on fifth edition (DSM-5)
• Has 18 different classes of disorders
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The DSM-5
LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and
limitations of the current diagnostic system.
• Provides list of diagnostic criteria and a
set of decision rules for each condition
• Warns to "think organic" (rule out
physical causes of symptoms first)
• Contains information on prevalence
and adopts a biopsychosocial
approach
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DSM Criticisms
LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and
limitations of the current diagnostic system.
Some diagnoses may be invalid
High level of comorbidity
Medicalizes normality
Reliance on categorical model of
psychopathology
• Vulnerable to political and social
influences
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•
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Mental Illness and the Law
LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and
limitations of the current diagnostic system.
• Overwhelming majority of people with
schizophrenia are not aggressive or
violent
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Mental Illness and the Law
LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and
limitations of the current diagnostic system.
• Insanity defense requires people to
either:
– Not know what they were doing at time
of crime, or
– Not know what they were doing was
wrong.
• Less than 1% of criminal cases use the
defense successfully.
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Mental Illness and the Law
LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and
limitations of the current diagnostic system.
• Involuntary commitment is a
procedure for protecting us from
certain people with mental disorders
and protecting them from themselves.
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Mental Illness and the Law
LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and
limitations of the current diagnostic system.
• Can only be committed against their
will if they:
– Pose a clear and present threat to
themselves or others.
– Are so impaired they can't care for
themselves.
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Anxiety Disorders
LO 15.4 Describe the many ways people experience anxiety.
• Most anxieties are transient and can be
adaptive.
• They can, though, spin out of control
and become excessive and
inappropriate.
• One of the most prevalent and earliestonset of all classes of disorders.
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Anxiety Disorders
LO 15.4 Describe the many ways people experience anxiety.
• Can also see inappropriate anxiety in
other disorders and problems
• Somatic symptom disorder entails
anxieties about physical symptoms that
interfere with daily living.
• Illness anxiety disorder is the
preoccupation that one has a serious
undiagnosed disease.
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Generalized Anxiety Disorder
LO 15.4 Describe the many ways people experience anxiety.
• Continual feelings of worry, anxiety,
physical tension, and irritability about
many areas
• About 3% of the population; 1/3
develop it after major stressor or life
change
• More prevalent in females and
Caucasians
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Panic Disorder
LO 15.4 Describe the many ways people experience anxiety.
• Repeated, unexpected panic attacks,
along with either:
– Persistent concerns about future
attacks, or
– A change in personal behavior in an
attempt to avoid them.
• Can be associated with specific
situation or come "out of the blue"
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Phobias
LO 15.4 Describe the many ways people experience anxiety.
• Intense fear of an object or situation
that's greatly out of proportion to its
actual threat
• Most common anxiety disorder (11%)
• Comes in different forms, such as:
– Agoraphobia
– Specific or social phobia
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Posttraumatic Stress Disorder
LO 15.4 Describe the many ways people experience anxiety.
• Marked emotional disturbance after you
experience or witness a severely
stressful event
• Symptoms include:
– Flashbacks and recurrent dreams
– Avoiding reminders of the trauma
– Increased physiological arousal
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Obsessive-Compulsive Disorder
LO 15.4 Describe the many ways people experience anxiety.
• Marked by obsessions - persistent
ideas, thoughts, or impulses that are
unwanted and inappropriate and cause
marked distress
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Obsessive-Compulsive Disorder
LO 15.4 Describe the many ways people experience anxiety.
• This distress is relieved by
compulsions – repetitive behaviors or
mental acts.
• Related disorders include body
dysmorphic disorder and Tourette's
syndrome
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Explanations for Anxiety Disorders
LO 15.4 Describe the many ways people experience anxiety.
• Learning models focus on acquiring
fears via classical conditioning, then
maintaining them through operant
conditioning.
• Can also learn fears by observing
others or by hearing misinformation
from others.
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Explanations for Anxiety Disorders
LO 15.4 Describe the many ways people experience anxiety.
• Anxious people tend to think about the
world in different ways from nonanxious people.
– Catastrophic thinking - predicting
terrible events despite low probability
– Anxiety sensitivity – a fear of anxietyrelated symptoms
• Many anxiety disorders are genetically
influenced through level of neuroticism.
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Mood Disorders
LO 15.5 Identify the characteristics of different mood disorders.
• Over 20% of Americans will experience
a mood disorder.
• Major Depressive Disorder (MDD) is the
most common, at 16%.
• More prevalent in females, most likely
to develop in 30s
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Mood Disorders
LO 15.5 Identify the characteristics of different mood disorders.
• Depression symptoms can develop
gradually or suddenly, but are often
recurrent.
• Average episode lasts 6 months to 1
year; most people experience 5-6
episodes
• Can cause extreme functional
impairment across all areas
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Sample MDD Symptoms
LO 15.5 Identify the characteristics of different mood disorders.
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Feeling blue or irritable
Sleep difficulties
Fatigue and loss of energy
Weight changes
Thoughts of death or suicide
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Explanations for MDD
LO 15.6 Describe major explanations for depression and how life events can interact with
characteristics of the individual to produce depression symptoms.
• Complex interplay of biological,
psychological, and social influences
• Life events such as loss of something
that is dearly valued can set stage for
depression.
• Depression can create interpersonal
problems, which cause lack of social
support.
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Explanations for MDD
LO 15.6 Describe major explanations for depression and how life events can interact with
characteristics of the individual to produce depression symptoms.
• Behavioral model sees depression
resulting from a low rate of positive
reinforcement in the environment.
• Beck's cognitive model holds that
depression is caused by negative
beliefs and expectations.
– Cognitive triad, negative schemas,
cognitive distortions
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Explanations for MDD
LO 15.6 Describe major explanations for depression and how life events can interact with
characteristics of the individual to produce depression symptoms.
• Learned helplessness - tendency to
feel helpless in the face of events we
can't control
• People with depression attribute failure
internally and have global, stable
attributions.
• Genes exert a moderate influence on
MDD; role of serotonin, norepinephrine,
and dopamine
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Bipolar Disorder
LO 15.5 Identify the characteristics of different mood disorders.
• Both depressive and manic episodes
• Elevated mood, lowered need for sleep,
high energy, talkativeness, inflated
self-esteem
– Also show highly irresponsible behavior
• Equally common in men and women
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Bipolar Disorder
LO 15.5 Identify the characteristics of different mood disorders.
• Produces serious problems in social and
occupational realms
• Very heavily genetically influenced, but
stressful life events can cause episode
onset
– These can be negative or positive
events
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Suicide
LO 15.7 Identify common myths and misconceptions about suicide.
• Major depression and bipolar disorder –
higher risk for suicide than most
disorders
• More than 30,000 people commit
suicide in US each year (11th leading
cause of death).
• Risk factors include previous suicide
attempts and feelings of hopelessness
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Table 15.5
Common Myths and Misconceptions
About Suicide.
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Personality Disorders
LO 15.8 Identify the characteristics of borderline and psychopathic personality disorders.
• Should only be diagnosed when:
– Personality traits first appear by
adolescence
– Traits are inflexible, stable, and
expressed in a wide variety of situations
– Traits lead to distress or impairment
• Show substantial comorbidity with
other psychological disorders, like
mood and anxiety disorders
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Borderline Personality Disorder
LO 15.8 Identify the characteristics of borderline and psychopathic personality disorders.
• Mainly women; about 2% of population
• Marked by instability in mood, identity,
and impulse control; self-destructive
tendencies
• In sociobiological model, individuals
with BPD overreact to stress and
experience lifelong difficulties with
regulating their emotions.
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Psychopathic Personality
LO 15.8 Identify the characteristics of borderline and psychopathic personality disorders.
• Condition marked by superficial charm,
dishonesty, manipulativeness, selfcenteredness, and risk taking
• Overlaps with antisocial personality
disorder
• Primarily males; about 25% of the
prison population qualifies
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Psychopathic Personality
LO 15.8 Identify the characteristics of borderline and psychopathic personality disorders.
• Causes are largely unknown, but may
stem in part from a deficit in fear
• Alternatively, they may be perpetually
underaroused and experiencing
stimulus hunger.
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Dissociative Disorders
LO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity
disorder.
• Involve disruptions in consciousness,
memory, identity, or perception
• Examples include depersonalization
disorder, derealization disorder,
dissociative amnesia, and
dissociative fugue.
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Dissociative Identity Disorder
LO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity
disorder.
• Characterized by presence of two or
more distinct identities (alters)
• Intriguing differences between alters
shown, but could be easily explained in
other ways
• Primary controversy surrounds issue of
posttraumatic vs sociocognitive
models
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Dissociative Identity Disorder
LO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity
disorder.
• Little evidence to support the
posttraumatic model
• Support for sociocognitive model
includes:
– Most DID patients don't show alters
prior to therapy
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Dissociative Identity Disorder
LO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity
disorder.
• Support for sociocognitive model
includes:
– Treatment reinforces idea person has
alters
– Treatment tends to increase number of
alters seen
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Schizophrenia
LO 15.10 Recognize the characteristic symptoms of schizophrenia.
• Severe disorder of thought and emotion
associated with a loss of contact with
reality
• Symptoms include disturbances in
attention, thinking, language, emotion,
and relationships.
• Less than 1% of population, but over
half of people in mental institutions
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Schizophrenia
LO 15.10 Recognize the characteristic symptoms of schizophrenia.
• Symptoms include:
– Delusions – strongly held, fixed beliefs
with no basis in reality (a psychotic
symptom)
– Hallucinations – sensory perceptions
in the absence of external stimuli
– Disorganized speech (word salad) and
behavior (echolalia, catatonia)
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Schizophrenia
LO 15.11 Explain how psychosocial, neural, biochemical, and genetic influences create the
vulnerability to schizophrenia.
• Psychosocial factors play a role in
schizophrenia, but only trigger it in
persons with genetic vulnerabilities.
• Family members can influence whether
patients relapse (expressed
emotion).
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Schizophrenia
LO 15.11 Explain how psychosocial, neural, biochemical, and genetic influences create the
vulnerability to schizophrenia.
• Brain abnormalities:
– Enlarged ventricles
– Increased sulci size
– Hypofrontality
– Neurotransmitter differences in
dopamine, norepinephrine, glutamate,
and serotonin
• Significant genetic element
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Figure 15.5 Schizophrenia Risk and the Family. The lifetime risk of developing schizophrenia is largely a
function of how closely an individual is genetically related to a person with schizophrenia. (Source: Feldman,
1991)
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Vulnerability to Schizophrenia
LO 15.11 Explain how psychosocial, neural, biochemical, and genetic influences create the
vulnerability to schizophrenia.
• Diathesis-stress models propose that
disorder is a joint product of a genetic
vulnerability (diathesis) and stressors
that trigger it
• Early warning signs of schizophrenia
vulnerability:
– Social withdrawal
– Thought and movement problems
– Lack of emotions, decreased eye contact
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Autism Spectrum Disorders
LO 15.12 Describe the symptoms and debate surrounding disorders diagnosed in childhood.
• Autistic disorder and less severe
Asperger's disorder
– Autistic disorder – severe deficits in
language, social bonding, and
imagination; often accompanied by
mental retardation
• Dramatic increase in prevalence since
early 1990s reflects more liberal
diagnostic criteria.
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Figure 15.6 The Autism Epidemic in America from 1992 to 2008. The fact that autism diagnoses have
been skyrocketing isn't controversial—but the reasons for the increase are.
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ADHD and Early-Onset Bipolar Disorder
LO 15.12 Describe the symptoms and debate surrounding disorders diagnosed in childhood.
• Primary problems include inattention,
impulsivity, and hyperactivity
• Diagnosable in 3-7% of school children;
more males than females (3:1)
• Related to numerous functional
problems in both children and adults
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ADHD and Early-Onset Bipolar Disorder
LO 15.12 Describe the symptoms and debate surrounding disorders diagnosed in childhood.
• Highly genetically influenced; can be
successfully treated with stimulant
meds
• Rates of "early-onset bipolar disorder"
have skyrocketed over last 20 years.
– 0.42% to 6.67% from 1990 to 2003
• Most likely reflects severe ADHD
symptoms, not bipolar disorder
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