Transcript Understanding Anxiety Disorders

PSYCHOLOGY
Mr. Bandy
Blue Valley West High
2014
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Psychological Disorders
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Psychological Disorders
Perspectives on Psychological
Disorders
 Defining Psychological Disorders
 Understanding Psychological
Disorders
 Classifying Psychological Disorders
 Labeling Psychological Disorders
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Psychological Disorders
Anxiety Disorders
 Generalized Anxiety Disorder and
Panic Disorder
 Phobias
 Obsessive-Compulsive Disorders
 Post-Traumatic Stress Disorders
 Anxiety Disorder Explanation
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Psychological Disorders
Depressive Disorders
 Major Depressive Disorders
Bipolar Disorders
 Bipolar Disorder (I and II)
Schizophrenia
 Symptoms of Schizophrenia
 Subtypes of Schizophrenia
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Psychological Disorders
Schizophrenia
 Understanding Schizophrenia
Personality Disorders
Rates of Psychological
Disorders
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Psychological Disorders
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)
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Psychological Disorders
People are fascinated by the exceptional, the
unusual, and the abnormal. This fascination
may be caused by two reasons:
1.
During various moments we feel, think, and act
like an abnormal individual.
2.
Psychological disorders may bring unexplained
physical symptoms, irrational fears, and suicidal
thoughts.
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Psychological Disorders
To study the abnormal is the best way of
understanding the normal.
William James (1842-1910)
1.
26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental
disorder in a given year
2.
Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders,
with severity strongly related to comorbidity
3.
There are 450 million people suffering from psychological disorders (WHO, 2004).
4.
Depression and schizophrenia exist in all cultures of the world.
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Is Attention-Deficit/
Hyperactivity Disorder (ADHD)
a disorder?
 Is it deviant? Do some people have a level of
inattentiveness, impulsiveness, or restlessness that
goes beyond laziness or immaturity?
 Is it distressful? Is the person enjoying being
energetic, or are they frustrated that they can’t sustain
focus?
 Is there dysfunction? Are the symptoms harmless
fun, or do they negatively impact work and
relationships?
• Andrew has led a turbulent life. As a young child, he
skipped school more often than he attended. When he did
attend, he was a frequent behavior problem, often getting
into fights with other boys. He was finally expelled from
school altogether after stabbing another student in his high
school class. Since then he has not held a job for any
length of time. Soon after his expulsion, he began
supplementing his income by breaking into homes and
stealing whatever he could get his hands on. However, he
appears to feel no guilt about this behavior. Although he
has never been in a committed relationship, he has several
children, whom he never sees, due partly to the fact that he
frequently moves from town to town. Despite these
characteristics, Andrew is a colorful and entertaining
person and has a certain charm. If asked, he will tell you
that he is quite happy with his current life-style.
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• Barbara was generally a happy child and had many friends
in high school. She made very good grades and decided to
go on to college and then to law school. After her first year
of law school, she began to notice periods of “feeling
down.” At first she ignored this, but after a year or so,
these episodes began to get worse. When she started
paying more attention, she noticed that the episodes
usually began about a week before her period and ended a
few days after her period began. In addition to feeling
depressed during that time, she also was overly sensitive to
criticism. Often, her appetite would increase, and she
would especially crave sweets. Sometimes she found it
difficult to concentrate on her studies during this time, and
she often lacked the energy to do much of anything except
watch television.
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• Charles is the third of seven children. He attended school in
the suburbs of a large city, where he made average grades.
He dated a bit in high school and had several close friends.
During vacations, he worked in his father’s garage, learning
all he could about automobiles. After high school, Charles
took a job as a mechanic in the garage. However, Charles
was beginning to feel different from his co-workers. He
began to realize that he was attracted to one of his customers,
a man with whom he had gone to school. When Charles
realized this, he became very confused and felt angry with
himself for having such feelings. Although he tried to
convince himself that the feelings would go away over time,
they did not, and Charles finally admitted to himself that he
was a homosexual. Currently, he is in a monogamous
relationship with another man but is afraid to admit his
sexual orientation to friends or family, for fear of their
reaction. He often finds himself preoccupied with trying to 15
find ways to hide his orientation from them.
• Eric was born in a rural town in the Midwest. He made
average grades in school and decided after graduation to
purchase a farm in the area and raise corn. He very much
enjoyed this lifestyle and did quite well. One day, while
working in the field, an accident with a combine caused
Eric to be rushed to the hospital. While doctors were able
to save his life, they were not able to save his legs. Eric is
now confined to a wheelchair. It has been a year since the
accident and he is in a great deal of pain, which is partially
controlled by morphine, which his doctor has prescribed.
However, his thinking remains quite rational, and he has
been able to do some work helping with the books at his
parents’ store. He does not enjoy this work and misses his
previous activity. Recently, he confided in his doctor that
he does not feel that his new life is worth living, and he has
decided that he would like to end it all.
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Psychological Disorders
• Psychological Disorder
– a “harmful dysfunction” in which behavior is
judged to be:
• Deviance – behavior that deviates from societies
norms.
• Distress – negative feelings toward themselves
• Dysfunction – maladaptive behavior patterns.
• Danger – usually positively reinforces behavior.
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Defining Psychological Disorders
Mental health workers view psychological
disorders as persistently harmful thoughts,
feelings, and actions.
When behavior is deviant, distressful, dangerour,
and dysfunctional psychiatrists and psychologists
label it as disordered (Comer, 2004).
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Deviant, Distressful & Dysfunctional
Carol Beckwith
1. Deviant behavior
(going naked) in one
culture may be
considered normal,
while in others it may
lead to arrest.
2. Deviant behavior must
accompany distress.
3. 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.
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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.
John W. Verano
Trephination (boring holes in the skull to remove evil forces)
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Medical Perspective
Philippe Pinel (1745-1826) from France, insisted
that madness was not due to demonic possession,
but an ailment of the mind.
George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago
Dance in the madhouse.
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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.
3.
4.
Etiology: Cause and development of the
disorder.
Diagnosis: Identifying (symptoms) and
distinguishing one disease from another.
Treatment: Treating a disorder in a psychiatric
hospital.
Prognosis: Forecast about the disorder.
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Biopsychosocial Perspective
Assumes that biological, socio-cultural, and
psychological factors combine and interact to
produce psychological disorders.
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Classifying Psychological Disorders
The American Psychiatric Association rendered
a Diagnostic and Statistical Manual of Mental
Disorders (DSM) to describe psychological
disorders.
The most recent edition, DSM 5 describes 400
psychological disorders compared to 60 in the
1950s.
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Goals of DSM
1.
2.
Describe (400) disorders.
Determine how prevalent the
disorder is.
Disorders outlined by DSM 5 are reliable.
Therefore, diagnoses by different professionals
are similar.
Others criticize DSM-5 for “putting any kind of
behavior within the compass of psychiatry.”
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Labeling Psychological Disorders
1. Critics of the DSM-IV argue that labels may
stigmatize individuals.
Elizabeth Eckert, Middletown, NY. From L. Gamwell and
N. Tomes, Madness in America, 1995. Cornell University Press.
Asylum baseball team (labeling)
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Labeling Psychological Disorders
2. Labels may be helpful for healthcare
professionals when communicating with
one another and establishing therapy.
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Labeling Psychological Disorders
Elaine Thompson/ AP Photo
3. “Insanity” labels
raise moral and
ethical questions
about how society
should treat people
who have
disorders and have
committed crimes.
Theodore Kaczynski
(Unabomber)
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• Pretend the following description of Tom W. was written by a
clinical psychologist 5 years ago, when Tom was a senior in high
school. Please read it carefully before responding to the question
below.
• Tom W. is of high intelligence, although lacking in true
creativity. He has a need for order and clarity, and for neat
and tidy systems in which every detail finds its appropriate
place. His writing is rather dull and mechanical,
occasionally enlivened by somewhat corny puns and
flashes of imagination of the sci-fi type. He has a strong
drive for competence. He seems to have little feeling and
little sympathy for other people and does not enjoy
interacting with others. Self-centered, he nonetheless has a
deep moral sense.
• Today, Tom is a mental patient in a state hospital. Might that outcome
have been predicted when Tom was a senior in high school? On what
basis?
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Anxiety statistics
Anxiety and anxiety related conditions negatively impact individuals, and our
society:
•40 million people in the U.S. will experience an impairment because of an anxiety
condition this year.
•Only 4 million will receive treatment, and of those, only 400,000 will receive
proper treatment.
•Those who experience anxiety and stress have a very high propensity for drug
abuse and addictions.
•
•
•
•
•
65% of North Americans take prescription medications daily, 43% take mood altering prescriptions
regularly.
There were over 3.3 Billion prescriptions filled in America in 2002 (12 times the U.S’s population that’s 12 prescriptions for every man, woman, and child in the U.S. that year).
Paxil and Zoloft (two of the more popular anti-anxiety medications) ranked 7th and 8th in the top ten
prescribed medications in the US (these two medications totaled almost $5 Billion in sales in 2002).
Recreational drugs are also used to cope with anxiety. 42% of young adults in America regularly use
recreational drugs (National Institute on Drug Abuse)
Alcohol is commonly used to cope with anxiety. 72% of Canadians consume alcohol each year.
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16-7 Anxiety Scale
1. F
2. T
3. F
4. F
5. T
6. T
7. T
8. T
9. F
10. T
11. T
12. F
13. T
14. T
15. F
16. T
17. T
18. F
19. T
20. F
21. T
22. T
23. T
24. T
25. T
26. T
27. T
28. T
29. F
30. T
31. T
32. F
33. T
34. T
35. T
36. T
37. T
38. F
39. T
40. T
41. T
42. T
43. T
44. T
45. T
46. T
47. T
48. T
49. T
50. F
Handout 16–7 is the
Taylor Manifest Anxiety
Scale, which attempts to
assess level of anxiety.
The average score for
college students is about
14 or 15 answers that
match the “true” answers
below. An answer of
“true” indicates anxiety
related to that item.
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Giving Fear a Proper Name
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Acrophobia: Heights
Gephyrophobia: Bridges
Aerophobia: Flying
Herpetophobia: Reptiles
Agoraphobia: Open spaces
Mikrophobia: Germs
Ailurophobia: Cats
Murophobia: Mice
Amaxophobia: Vehicles, driving
Numerophobia: Numbers
Anthophobia: Flowers
Nyctophobia: Darkness
Anthropophobia: People
Ocholophobia: Crowds
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Aquaphobia: Water
Ophidiophobia: Snakes
Arachnophobia: Spiders
Ornithophobia: Birds
Astraphobia: Lightning
Phonophobia: Speaking aloud
Brontophobia: Thunder
Pyrophobia: Fire
Claustrophobia: Closed spaces
Thanatophobia: Death
Cynophobia: Dogs
Trichophobia: Hair
Dementophobia: Insanity
Xenophobia: Strangers
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The top ten fears (men and women combined)
In August 2000, Discovery Health Channel commissioned Penn, Schoen, & Berland Associates to conduct a nationally
representative telephone survey of 1000 Americans to answer that question.
1. Fear of snakes
2. Fear of being buried alive
3. Fear of heights
4. Fear of being bound or tied up
5. Fear of drowning
6. Fear of public speaking
7. Fear of hell
8. Fear of cancer
9. Fear of tornadoes and hurricanes
10. Fear of fire
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Anxiety Disorders
• Common and uncommon fears
100
Percentage 90
of people 80
surveyed
70
60
50
40
30
20
10
0
Snakes
Being Mice Flying Being Spiders Thunder Being Dogs
in high,
on an closed in, and
and
alone
exposed
airplane in a
insects lightning In a
places
small
house
place
at night
Afraid of it
Bothers slightly
Not at all afraid of it
Driving Being
Cats
a car
In a
crowd
of people
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Fears
• Top five fears of men?
1. Fear of being buried alive
2. Fear of heights
3. Fear of snakes
4. Fear of drowning
5. Fear of public speaking
• Top five fears of women?
1. Fear of snakes
2. Fear of being bound or tied up
3. Fear of being buried alive
4. Fear of heights
5. Fear of public speaking
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•
•
•
•
•
•
On November 1983, Pearl Pizzamiglio, age 60, was working as a hotel
clerk when Michael Steward handed her a paper bag with a note: “Don’t
say a word. Put all the money in this bag and no one will get hurt.”
Pizzamiglio complied, Stewart fled, and the police were called. Two hours
later Pizzamiglio was dead of heart failure. She had had no history of heart
trouble and a jury, convinced that Stewart had scared her to death, later
convicted him of murder.
On Memorial Day weekend, 1988, Barbara Reyes, 40, was floating on a raft
when a man on a jet ski roared within a foot of her. Panicked, she paddled
to the shore, collapsed, and died. The skier was arrested and charged with
involuntary manslaughter.
Omar Torrijos, Panama’s former dictator, reportedly amused himself by
killing a prisoner with an unloaded gun; blanks, apparently, were enough to
frighten the victim to death.
An elderly man sitting on his lawn collapsed and died when a car jumped
the curb and seemed to head straight for him.
An 45-year-old man reportedly died of fright as he stepped to the dais to
give a speech.
In the year of 1840, Emperor Louis of Bavaria is said to have died of fright
at the sight of solar eclipse.
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Anxiety Disorders
Feelings of excessive apprehension and anxiety.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Separation anxiety
Selective mutism
Generalized anxiety disorders
Specific Phobias
Panic disorders
PTSD
Social anxiety disorders
Agoraphobia
Substance/medication induced anxiety
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GAD: Generalized
Anxiety Disorder
 Emotional-cognitive
symptoms include
worrying, having anxious
feelings and thoughts about
many subjects, and
sometimes “free-floating”
anxiety with no attachment
to any subject. Anxious
anticipation interferes with
concentration.
 Physical symptoms include
autonomic arousal,
trembling, sweating,
fidgeting, agitation, and
sleep disruption.
Panic Disorder:
“I’m Dying”
A panic attack is not just an
“anxiety attack.” It may include:
 many minutes of intense dread
or terror.
 chest pains, choking,
numbness, or other frightening
physical sensations. Patients
may feel certain that it’s a heart
attack.
 a feeling of a need to escape.
Panic disorder refers to repeated
and unexpected panic attacks, as
well as a fear of the next attack,
and a change in behavior to avoid
panic attacks.
Specific Phobia
A specific phobia is more than just
a strong fear or dislike. A specific
phobia is diagnosed when there is
an uncontrollable, irrational,
intense desire to avoid the some
object or situation. Even an image
of the object can trigger a reaction-“GET IT AWAY FROM ME!!!”-the uncontrollable, irrational,
intense desire to avoid the object
of the phobia.
Phobia
Marked by a persistent and irrational fear of an
object or situation that disrupts behavior.
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Kinds of Phobias
Agoraphobia
Acrophobia
Claustrophobia
Hemophobia
Phobia of open places.
Phobia of heights.
Phobia of closed spaces.
Phobia of blood.
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Post-Traumatic Stress Disorder
Four or more weeks of the following symptoms
constitute post-traumatic stress disorder
(PTSD):
1. Haunting memories
2. Nightmares
3. Social withdrawal
Bettmann/ Corbis
4. Jumpy anxiety
5. Sleep problems
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
Which People get
PTSD?
Those with less control in the




situation
Those traumatized more frequently
Those with brain differences
Those who have less resiliency
Those who get re-traumatized
Resilience and PostTraumatic Growth
Resilience/recovery
after trauma may
include:
 some lingering,
but not
overwhelming,
stress.
 finding strengths
in yourself.
 finding connection
with others.
 finding hope.
 seeing the trauma
as a challenge that
can be overcome.
 seeing yourself as
a survivor.
Other Anxiety Disorders
• Separation Anxiety: is persistent fear or
anxiety about harm coming to attachment
figures and events that could lead to loss of
or separation from attachment figures and
reluctance to go away from attachment
figures, as well as nightmares and physical
symptoms of distress
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Other Anxiety Disorders
• Social Anxiety: fearful or anxious about or
avoidant of social interactions and situations
that involve the possibility of being
scrutinized
• Selective Mutism: consistent failure to
speak in social situations in which there is
an expectation to speak (e.g., school) even
though the individual speaks in other
situations.
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16-7 Anxiety Scale
1. F
2. T
3. F
4. F
5. T
6. T
7. T
8. T
9. F
10. T
11. T
12. F
13. T
14. T
15. F
16. T
17. T
18. F
19. T
20. F
21. T
22. T
23. T
24. T
25. T
26. T
27. T
28. T
29. F
30. T
31. T
32. F
33. T
34. T
35. T
36. T
37. T
38. F
39. T
40. T
41. T
42. T
43. T
44. T
45. T
46. T
47. T
48. T
49. T
50. F
Handout 16–7 is the
Taylor Manifest Anxiety
Scale, which attempts to
assess level of anxiety.
The average score for
college students is about
14 or 15 answers that
match the “true” answers
below. An answer of
“true” indicates anxiety
related to that item.
48
Understanding Anxiety Disorders:
Explanations from Different Perspectives
Psychodynamic/
Freudian:
repressed
impulses
Observational
learning:
worrying like
mom
Classical
conditioning:
overgeneralizing
a conditioned
response
Cognitive
appraisals:
uncertainty is
danger
Operant
conditioning:
rewarding
avoidance
Evolutionary:
surviving by
avoiding danger
Understanding Anxiety Disorders:
Freudian/Psychodynamic
Perspective
 Sigmund Freud felt that
anxiety stems from
repressed childhood
impulses, socially
inappropriate desires, and
emotional conflicts.
 We repress/bury these
issues in the unconscious
mind, but they still come
up, as anxiety.

Classical
Conditioning and
Anxiety
In the experiment
by John B.
Watson and Rosalie Rayner in
1920, Little Albert learned to
feel fear around a rabbit
because he had been
conditioned to associate the
bunny with a loud scary noise.
 Sometimes, such a conditioned
response becomes
overgeneralized. We may begin
to fear all animals, everything
fluffy, and any location where
we had seen those, or even fear
that those items could appear
soon along with the noise.
 The result is a phobia or
generalized anxiety.
Operant Conditioning
and Anxiety
 We may feel anxious in a
situation and make a decision
to leave. This makes us feel
better and our anxious
avoidance was just reinforced.
 If we know we have locked a
door but feel anxious and
compelled to re-check,
rechecking will help us
temporarily feel better.
 The result is an increase in
anxious thoughts and
behaviors.
Observational
Learning and
Anxiety
 Experiments with humans
and monkeys show that
anxiety can be acquired
through observational
learning. If you see
someone else avoiding or
fearing some object or
creature, you might pick
up that fear and adopt it
even after the original
scared person is not
around.
 In this way, fears get
passed down in families.
Cognition and
Anxiety
 Cognition includes worried
thoughts, as well as
interpretations, appraisals,
beliefs, predictions, and
ruminations.
 Cognition includes mental
habits such as
hypervigilance (persistently
watching out for danger).
This accompanies anxiety in
PTSD.
 In anxiety disorders, such
cognitions appear
repeatedly and make
anxiety worse.
Examples of Cognitions that can
Worsen Anxiety:
Cognitive errors, such as believing that we
can predict that bad events will happen
Irrational beliefs, such as “bad things don’t
happen to good people, so if I was hurt, I
must be bad”
Mistaken appraisals, such as seeing aches as
diseases, noises as dangers, and strangers as
threats
Misinterpretations of facial expressions and
actions of others, such as thinking “they’re
talking about me”
Biology and Anxiety:
An Evolutionary Perspective
1. Human phobic objects: 2. Similar but non-phobic
Snakes objects:
Heights Fish
Closed spaces Low places
Darkness Open spaces
light
3. Dangerous yet non-phobicBright
subjects:
We are likely to become cautious about, but not phobic about:
Guns
Electric wiring
McDonalds
 Evolutionary psychologists believe that ancestors
prone to fear the items on list #1 were less likely to
die before reproducing.
 There has not been time for the innate fear of list #3
(the gun list) to spread in the population.
Biology and Anxiety: Genes
 Studies show that
identical twins, even
raised separately,
develop similar
phobias (more similar
than two unrelated
people).
 Some people seem to
have an inborn highstrung temperament,
while others are more
easygoing.
 Temperament may
be encoded in our
genes.
Genes and
Neurotransmitters
17 Genes regulate are
associated with Anxiety
People with anxiety have
problems with a gene associated
with levels of serotonin, a
neurotransmitter involved in
regulating sleep and mood.
People with anxiety also have a
gene that triggers high levels of
glutamate, an excitatory
neurotransmitter involved in the
brain’s alarm centers.
Biology and Anxiety: The Brain
 Traumatic
experiences can burn
fear circuits into the
amygdala; these
circuits are later
triggered and
activated.
 Anxiety disorders
include overarousal
of brain areas
involved in impulse
control and habitual
behaviors.
The OCD brain shows extra
activity in the ACC, which
monitors our actions and checks
for errors.
ACC = anterior cingulate gyrus
Understanding Anxiety Disorders:
Nadine:Explanations from Different Perspectives
Use each of these perspectives to explain why Nadine has been
having problems. Be prepared to share out in class.
Psychodynamic/
Freudian:
repressed
impulses
Observationa
l learning:
worrying like
mom
Classical
conditioning:
overgeneralizing
a conditioned
response
Cognitive
appraisals:
uncertainty is
danger
Operant
conditioning:
rewarding
avoidance
Evolutionary:
surviving by
avoiding
danger
The Biological Perspective
• Natural Selection has led our ancestors to
learn to fear snakes, spiders, and other
animals. Therefore, fear preserves the species.
• Twin studies suggest that our genes may be
partly responsible for developing fears and
anxiety. Twins are more likely to share
phobias.
• 17 genes that appear to be expressed with
anxiety symptoms:
–
–
Serotonin levels – sleep and mood
Glutamate levels - overactivity
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The Biological Perspective
S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action
monitoring in obsessive-compulsive disorder. Psychological Science, 14, 347-353.
Generalized anxiety,
panic attacks, and even
OCD are linked with
brain circuits like the
anterior cingulate cortex.
Linked to amygdala and
processes the salience of
emotions (picks out
things that are important
in the environment).
Anterior Cingulate Cortex
of an OCD patient.
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Auditory and visual stimuli:
sights and sounds are processed first
by the thalamus, which filter the
incoming cues and shunts them
either to the amygdala or the cortex.
Olfactory and tactile stimuli:
smells and touch sensations bypass
the thalamus, taking a shortcut to the
amygdala. Smells, often evoke
stronger memories or feelings than
do sights or sounds.
Amygdala: the emotional core of
the brain, primary roles of triggering
the fear response. Information that
passes through the amygdala is
tagged with emotional significance.
Hippocampus: vital to storing the
raw information coming in from the
senses, along with the emotional
baggage attached to the data during
their trip through the amygdala.
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Obsessive-Compulsive and
Related Disorders
• OCD
• Body Dysmorphic
Disorder
• Hoarding Disorder
• Trichotillomania
(hair pulling)
• Excoriation (skinpicking)
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Diagnostic Criteria - OCD
•
Presence of obsessions, compulsions, or both:
• Obsessions are defined by
– Recurrent and persistent thoughts, urges, or images that are
experienced, at some time during the disturbance, as intrusive and
unwanted, and that in most individuals cause marked anxiety or distress.
– The individual attempts to ignore or suppress such thoughts, urges, or
images, or to neutralize them with some other thought or action (i.e., by
performing a compulsion).
• Compulsions are defined by
– Repetitive behaviors (e.g., hand washing, ordering, checking) or mental
acts (e.g., praying, counting, repeating words silently) that the individual
feels driven to perform in response to an obsession or according to rules
that must be applied rigidly.
– The behaviors or mental acts are aimed at preventing or reducing anxiety
or distress, or preventing some dreaded event or situation; however, these
behaviors or mental acts are not connected in a realistic way with what 63
they are designed to neutralize or prevent, or are clearly excessive.
Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions)
and urges to engage in senseless rituals
(compulsions) that cause distress.
64
Brain Imaging
A PET scan of the brain
of a person with
Obsessive-Compulsive
Disorder (OCD). High
metabolic activity (red)
in the frontal lobe areas
are involved with
directing attention.
Brain image of an OCD
65
66
Depressive Disorders
Emotional extremes of mood disorders come
in two principal forms.
•Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population
age 18 and older in a given year, have a mood disorder.
•The median age of onset for mood disorders is 30 years.
•Depressive disorders often co-occur with anxiety disorders and substance abuse. (NIMH,
2010)
•90,000 college students surveyed – 44% responded that on more than one occasion they
felt “so depressed it was difficult to function”
67
Disruptive Mood Dysregulation
Disorder
•
•
•
•
•
•
•
•
•
Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or
behaviorally (e.g., physical aggression toward people or property) that are grossly out of
proportion in intensity or duration to the situation or provocation.
The temper outbursts are inconsistent with developmental level.
The temper outbursts occur, on average, three or more times per week.
The mood between temper outbursts is persistently irritable or angry most of the day,
nearly every day, and is observable by others (e.g., parents, teachers, peers).
Criteria A–D have been present for 12 or more months. Throughout that time, the
individual has not had a period lasting 3 or more consecutive months without all of the
symptoms in Criteria A–D.
Criteria A and D are present in at least two of three settings (i.e., at home, at school,
with peers) and are severe in at least one of these.
The diagnosis should not be made for the first time before age 6 years or after age 18
years.
By history or observation, the age at onset of Criteria A–E is before 10 years.
There has never been a distinct period lasting more than 1 day during which the full
symptom criteria, except duration, for a manic or hypomanic episode have been met. 68
•
•
•
Premenstrual Dysphoric
Disorder
In the majority of menstrual cycles, at least five symptoms must be present in the final week before the
onset of menses, start to improve within a few days after the onset of menses, and become minimal or
absent in the week postmenses.
One (or more) of the following symptoms must be present:
– Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased
sensitivity to rejection).
– Marked irritability or anger or increased interpersonal conflicts.
– Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
– Marked anxiety, tension, and/or feelings of being keyed up or on edge.
One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms
when combined with symptoms from Criterion B above.
– Decreased interest in usual activities (e.g., work, school, friends, hobbies).
– Subjective difficulty in concentration.
– Lethargy, easy fatigability, or marked lack of energy.
– Marked change in appetite; overeating; or specific food cravings.
– Hypersomnia or insomnia.
– A sense of being overwhelmed or out of control.
– Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of
“bloating,” or weight gain.
69
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
70
Major Depressive Disorder
•
•
•
•
Five (or more) of the following symptoms have been present during the same
2-week period and represent a change from previous functioning; at least one
of the symptoms is either (1) depressed mood or (2) loss of interest or
pleasure.
Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad, empty, hopeless) or observation made by
others (e.g., appears tearful). (Note: In children and adolescents, can be
irritable mood.)
Markedly diminished interest or pleasure in all, or almost all, activities most of
the day, nearly every day (as indicated by either subjective account or
observation).
Significant weight loss when not dieting or weight gain (e.g., a change of more
than 5% of body weight in a month), or decrease or increase in appetite nearly
every day. (Note: In children, consider failure to make expected weight gain.)
71
Major Depressive Disorder
•
•
•
•
•
•
•
•
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day (observable by others, not merely
subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)
nearly every day (not merely self-reproach or guilt about being sick).
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by
subjective account or as observed by others).
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific plan for committing suicide.
The symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
The episode is not attributable to the physiological effects of a substance or to another
medical condition.
72
College & Depression
•
•
•
Aaron Beck, a leading investigator of depression, suggests that college students may
be especially prone to psychological problems because they simultaneously
experience all the transitions that are major stresses in adulthood.
Entering college, they lose family, friends, and familiar surroundings and are provided
no ready made substitutes. Furthermore, while in high school, they were the most able
students; in college they must compare their own abilities with equally able students.
Research indicates that students who exhibit optimism as they enter college
develop more social support and experience a lowered risk of depression.
Moreover, students’ frequent misperception of these stresses may be as important a
cause of depression as the stresses themselves. While they do not hallucinate their
problems of academic or social adjustment, they often inflate the importance of
temporary setbacks and misjudge the severity of rejections. They may
overestimate academic difficulties on the basis of one mediocre grade. They may
grieve over their social isolation, even though they often have at least some caring and
supportive friends. Their pessimism and dissatisfaction may lead to clinical depression
that in turn interferes with actual performance. A vicious cycle is created in which
misperceptions of academic and social difficulties result in still poorer grades and
greater
73
• Studies suggest that perhaps 40 to 50
percent of college students have suicidal
thoughts at one time or another and that as
many as 15 percent may have actually.
• Edwin Schneidman presents the following
in the belief that knowledge of these
characteristics may help the general public
and mental health professionals reduce
suicide rates.
74
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
75
Bipolar I
• The essential feature of a manic episode is
a distinct period during which there is an
abnormally, persistently elevated,
expansive, or irritable mood and
persistently increased activity or energy that
is present for most of the day, nearly every
day, for a period of at least 1 week.
76
Bipolar I -Diagnostic Criteria
•
For a diagnosis of bipolar I disorder, it is necessary to meet the following criteria for a manic episode. The
manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.
Manic Episode
•
•
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and
abnormally and persistently increased goal-directed activity or energy, lasting at least 1
week and present most of the day, nearly every day (or any duration if hospitalization is
necessary).
During the period of mood disturbance and increased energy or activity, three (or more) of the
following symptoms (four if the mood is only irritable) are present to a significant degree and
represent a noticeable change from usual behavior:
– Inflated self-esteem or grandiosity.
– Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
– More talkative than usual or pressure to keep talking.
– Flight of ideas or subjective experience that thoughts are racing.
– Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli),
as reported or observed.
– Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation (i.e., purposeless non-goal-directed activity).
– Excessive involvement in activities that have a high potential for painful consequences (e.g.,
77
engaging in unrestrained buying sprees, sexual indiscretions, or foolish business
investments).
Manic state of a bipolar disorder
•
When I start going into a high, I no longer feel like an ordinary housewife.
Instead, I feel organized and accomplished, and I begin to feel I am my most
creative self. I can write poetry easily. I can compose melodies without effort.
I can paint. My mind feels facile and absorbs everything. I have countless
ideas about improving the conditions of mentally retarded children, how a
hospital for these children should be run, what they should have around them
to keep them happy and calm and unafraid. I see myself as being able to
accomplish a great deal for the good of people. I have countless ideas about
how the environmental problem could inspire a crusade for the health and
betterment of everyone. I feel able to accomplish a great deal for the good of
my family and others. I feel pleasure, a sense of euphoria or elation. I want it
to last forever. I don’t seem to need much sleep. I’ve lost weight and feel
healthy, and I like myself. I’ve just bought six new dresses, in fact, and they
look quite good on me. I feel sexy and men stare at me. Maybe I’ll have an
affair, or perhaps several. I feel capable of speaking and doing good in politics.
I would like to help people with problems similar to mine so they won’t feel
hopeless. (Fieve, 1975, p. 17)
78
Bipolar II
•
Bipolar II disorder is characterized by a clinical course of recurring mood episodes consisting of one or more major
depressive episodes (Criteria A–C under “Major Depressive Episode”) and at least one hypomanic episode (Criteria
A–F under “Hypomanic Episode”).
79
Hypomanic episode
• Not a disorder in itself, but rather is a description of a part
of a type of bipolar II disorder.
• Associated with a change in functioning that is
uncharacteristic of the person.
• Hypomanic episodes have the same symptoms as manic
episodes with two important differences:
– (1) the mood usually isn’t severe enough to cause problems
with the person working or socializing with others (e.g., they
don’t have to take time off work during the episode), or to require
hospitalization; and
– (2) there are never any psychotic features present in a hypomanic
episode.
80
Bipolar Disorder
Many great writers, poets, and composers
suffered from bipolar disorder. During their
manic phase creativity surged, but not during
their depressed phase.
Earl Theissen/ Hulton Getty Pictures Library
The Granger Collection
Wolfe
George C. Beresford/ Hulton Getty Pictures Library
Bettmann/ Corbis
Whitman
Clemens
Hemingway
81
Dysthymic Disorder
Dysthymic disorder lies between a blue mood
and major depressive disorder. It is a disorder
characterized by daily depression lasting two
years or more.
Blue
Mood
Dysthymic
Disorder
Major Depressive
Disorder
82
Bipolar Disorder in Children and
Adolescents
 Does bipolar disorder
show up before
adulthood, and even
before puberty?
 Many young people
have cycles from
depression to
extended rage rather
than mania.
 The DSM-V may
have a new diagnosis
for these kids:
disruptive mood
dysregulation
disorder.
Understanding Mood
Disorders
Why are mood disorders so pervasive,
and more common among the young,
and especially among women?
Why Does Depression Have so
Many Symptoms?

Understanding Mood Disorders
Can
we
explain…
why does depression often
go away on its own?
 the course/development of
reactive depression?
Often, time heals a mood
disorder, especially when
the mood issue is in
reaction to a stressful
event. However, a
significant proportion of
people with major
depressive disorder do not
automatically or easily get
better with time.
Suicide and Self-Injury
 Every year, 1 million people commit suicide, giving
up on the process of trying to cope and improve their
emotional well-being.
 This can happen when people feel frustrated, trapped,
isolated, ineffective, and see no end to these feelings.
 Non-suicidal self-injury has other functions such as
sending a message, or self-punishment.
Understanding Mood Disorders
Biological aspects and
explanations
Social-cognitive aspects
and explanations
Evolutionary
Genetic
Brain /Body
Negative thoughts and
negative mood
Explanatory style
The vicious cycle
An Evolutionary Perspective on the
Biology of Depression
 Depression, in its milder, nondisordered form, may have
had survival value.
 Under stress, depression is
social-emotional hibernation.
It allows humans to:
 conserve energy.
 avoid conflicts and other
risks.
 let go of unattainable goals.
 take time to contemplate.
Biology of Depression: Genetics
Evidence of genetic influence on depression:
1. DNA linkage analysis reveals depressed gene regions
2. twin/adoption heritability studies
Biology of Depression: The Brain
 Brain activity is diminished in depression and increased in
mania.
 Brain structure: smaller frontal lobes in depression and
fewer axons in bipolar disorder
 Brain cell communication (neurotransmitters):
 more norepinephrine (arousing) in mania, less in
depression
 reduced serotonin in depression
Preventing or Reducing Depression:
Using Knowledge of the Biology of Depression
1. Adjust
neurotransmitters
with medication.
2. Increase serotonin
levels with
exercise.
3. Reduce brain
inflammation with
a healthy diet
(especially olive
and fish oils).
4. Prevent excessive
alcohol use .
Understanding Mood Disorders:
The Social-Cognitive Perspective
Low SelfEsteem
Discounting positive
information and assuming the
worst about self, situation,
and the future
Self-defeating
beliefs such as
assuming that
one (self) is
Learned
unable to cope,
Helplessness
improve, achieve,
or be happy
Depression is
associated with:
Depressive
Explanatory
Style
Rumination
Stuck focusing on
what’s bad
Depressive Explanatory Style
How we analyze bad news predicts mood.
Problematic event:
Assumptions about
the problem
The problem is:
The problem is:
The problem is:
Mood/result that
goes along with
these views:
Depression’s Vicious Cycle
A depressed mood may develop when a person with a
negative outlook experiences repeated stress.
The depressed
mood changes a
person’s style of
thinking and
interacting in a
way that makes
stressful
experience
more likely.
Zung Depression Scale
• The authors do not provide specific norms but indicate that
“most respondents score in the lower range.” The specific scale
items introduce four important components of depression:
• Items 2 and 9 reflect the presence of negative affect; items 3
and 6 suggest the absence of positive affect; 7, 8, and 10
indicate interpersonal difficulty; and items 1, 4, and 5 assess
“somatic” difficulties.
• Handout 16–14, the Zung Self-Rating Depression Scale, is one
of the most widely used measures of depression.
• In scoring, students should reverse their responses to items 2, 5,
6, 11, 12, 14, 16, 17, 18, and 20 (that is, 1 = 4, 2 = 3, 3 = 2, 4 =
1). They should then add all the numbers to obtain a total
score, which can range from 20 to 80.
• Scores from 50 to 59 suggest mild to moderate depression, from
60 to 69 indicate moderate to severe depression, and 70 and 96
above indicate severe depression.
1. Unendurable psychological pain. Suicide is not an act of hostility or revenge
but a way of switching off unendurable and inescapable pain. If you reduce
their level of suffering, even just a little, suicidal people will choose to live.
2. Frustrated psychological needs. Needs for security, achievement, trust, and
friendship are among the important ones not being met. Address these
psychological needs and the suicide will not occur. Although there are
pointless deaths, there is never a “needless” suicide.
3. The search for a solution. Suicide is never done without purpose. It is a way
out of a problem or crisis and seems to be the only answer to the question:
“How do I get out of this?”
4. An attempt to end consciousness. Suicide is both a movement away from pain
and a movement to end consciousness. The goal is to stop awareness of a
painful existence.
5. Helplessness and hopelessness. Underneath all the shame, guilt, and loss of
effectiveness is a sense of powerlessness. There is the feeling that no one can
help and nothing can be done except to commit suicide.
97
6.
7.
8.
9.
10.
Constriction of options. Instead of looking for a variety of answers,
suicidal people see only two alternatives: a total solution or a total
cessation. All other options have been driven out by pain. The goal of
the rescuer should be to broaden the suicidal person’s perspective.
Ambivalence. Some ambivalence is normal, but for the suicidal person
ambivalence is only between life and death. In the typical case, a
person cuts his or her own throat and calls for help simultaneously. The
rescuer can use this ambivalence to shift the inner debate to the side of
life.
Communication of intent. About 80 percent of suicidal people give
family and friends clear clues about their intention to kill themselves.
Departure. Quitting a job, running away from home, leaving a spouse
are all departures, but suicide is the ultimate escape. It is a plan for a
radical, permanent change of scene.
Lifelong coping patterns. To spot potential suicides, one must look to
earlier episodes of disturbance, to the person’s style of enduring pain,
and to a general tendency toward “either/or” thinking. Often, there has
been a style of problem solving that might be characterized as “cut and
run.”
98
Women experience depression at roughly
twice the rate as men. What might account for
this large difference?
• Is it possible that women are simply more willing to admit to
being depressed than men are? As a researcher, how could you
assess rates of depression in a way that minimized this potential
reporting problem? To answer this question: a) describe the
method you would choose to collect your data; b) explain why
you chose that method; and c) describe the specific measures
you would take to minimize the anticipated reporting problem.
• What biological factors might account for women's greater
susceptibility to depression?
• What social factors might account for women's greater
susceptibility to depression?
• Young boys and girls have been shown to suffer from
depression equally until they reach adolescence. At that point,
depression becomes much more common in women. What might
99
account for this change?
Dissociative Disorder
Common denominator is the “fragmentation”
of personality – a sense that parts of personality
have detached (dissociated) from others.
Symptoms
1. Having a sense of being unreal.
2. Being separated from the body.
3. Watching yourself as if in a movie.
100
101
Dissociative Disorder
• Non-psychotic Fragmentation of the Personality
(note: all diagnosis is disputed) – essential feature is a disruption in the
usually integrated functions of consciousness, memory identity, or
perception.
– Dissociative amnesia – memory loss due to stress
– Dissociative fugue – loss of identity which leads to
fugue (flight)
– Depersonalization disorder – mind / body are separated.
Dream state / Near death experiences
– Dissociative Identity disorder
102
Dissociative Identity Disorder (DID)
Hershel Walker
Is a disorder in which a person exhibits two or
more distinct and alternating personalities,
formerly called multiple personality disorder.
Lois Bernstein/ Gamma Liason
Chris Sizemore (DID)
103
DID Critics
Critics argue that the diagnosis of DID
increased in the late 20th century. DID has
not been found in other countries.
Critics’ Arguments
1. Role-playing by people open to a
therapist’s suggestion.
2. Learned response that reinforces
reductions in anxiety.
104
Is DID the same as Schizophrenia?
• NO –
– DID is sometimes called a “split personality”
– Schizophrenia’s split is based on reality, not a
fracturing of personalities.
105
106
Schizophrenia
If depression is the common cold of
psychological disorders, schizophrenia is the
cancer.
Nearly 1 in a 100 suffer from schizophrenia, and
throughout the world over 24 million people
suffer from this disease (WHO, 2002).
Schizophrenia strikes young people as they
mature into adults. It affects men and women
equally, but men suffer from it more severely
than women.
107
Andrea Yates
• Case of post-pardon depression with
psychosis.
• Is she mentally ill?
– Prison / Mental Instruction.
108
Symptoms of Schizophrenia
The literal translation is “split mind.” A group
of severe disorders characterized by the
following:
1. Disorganized and delusional
thinking.
2. Disturbed perceptions.
3. Inappropriate emotions and
actions.
109
Yates . . .
• June 2001 – drowned 5 children
• Pleaded not guilty by reason of insanity
• Found guilty (acknowledged mental illness
but she knew right from wrong). . . Sent her
to prison.
• July 26, 2006 in a retrial was found not
guilty by reason of insanity. She now
resides in a low level mental illness
110
hospital.
History of Insanity Defense
• M’Naghten Test (1800s) – experiencing a
mental disorder at the time of a crime does
not by itself mean the person was insane. . .
.has to know right from wrong.
• Irresistible Impulse (1834) – inability to
control one’s actions.
111
History of Insanity Defense
• Durham Test (1954) – replaced previous two.
– People are not criminally responsible if their
“unlawful act was the product of mental disease
or mental defect”
• 1955 American Law Institute combined all three
to determine sanity cases, although some states
have different standards. (guilty but mentally ill,
guilty with diminished capacity)
• 2/3rds who qualify for this standard have a
diagnosis of schizophrenia.
112
Subtypes
(case study of Gerald)
113
Schizophrenia Symptoms
Schizophrenia is a cluster of disorders. These
subtypes share some features, but there are
other symptoms that differentiate these
subtypes.
114
Disorganized & Delusional Thinking
This morning when I was at Hillside [Hospital], I was
making a movie. I was surrounded by movie stars …
I’m Marry Poppins. Is this room painted blue to get me
upset? My grandmother died four weeks after my
eighteenth birthday.”
(Sheehan, 1982)
Other
forms of delusions
delusions
of
This
monologue
illustratesinclude,
fragmented,
bizarre
persecution
is following
me”) or
thinking
with (“someone
distorted beliefs
called delusions
grandeur
(“I am
a king”).
(“I’m Mary
Poppins”).
115
Delusional Disorder
• Erotomanic type: This subtype applies when the central theme of the
delusion is that another person is in love with the individual.
• Grandiose type: This subtype applies when the central theme of the
delusion is the conviction of having some great (but unrecognized)
talent or insight or having made some important discovery.
• Jealous type: This subtype applies when the central theme of the
individual’s delusion is that his or her spouse or lover is unfaithful.
• Persecutory type: This subtype applies when the central theme of the
delusion involves the individual’s belief that he or she is being
conspired against, cheated, spied on, followed, poisoned or drugged,
maliciously maligned, harassed, or obstructed in the pursuit of longterm goals.
• Somatic type: This subtype applies when the central theme of the
116
delusion involves bodily functions or sensations.
Disorganized & Delusional Thinking
Many psychologists believe disorganized
thoughts occur because of selective attention
failure (fragmented and bizarre thoughts).
117
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.
L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg
Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg
118
Inappropriate Emotions & Actions
A schizophrenic person may laugh at the news
of someone dying or show no emotion at all
(apathy).
Patients with schizophrenia
may continually rub an arm,
rock a chair, or remain
motionless for hours
(catatonia).
119
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).
120
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.
121
What Causes schizophrenia?
1.
2.
(etiology)
The Mother - Schizophrenogenic mother
Blame the Synapses

Chlorpromazine blocks dopamine receptors
•
3.
Best antipsychotics block D4 receptor sights for dopamine
Blame the Virus
–
4.
Women in their middle 3 months more likely to have schizophrenic
kids with a certain flu strain –specifically mom’s who got a certain flu
strain in the 23 month of pregnancy.
Blame Development
–
5.
Reelin vital for brain development; shortage can cause faulty synapses
Blame the Diet
–
Brains of schizotypal people need more fatty acids than normal people
122
Understanding Schizophrenia
Schizophrenia is a disease of the brain exhibited
by the symptoms of the mind.
Brain Abnormalities
Dopamine Over activity: Researchers found that
schizophrenic patients express higher levels of
dopamine D4 receptors in the brain.
123
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
124
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
125
Viral Infection
Schizophrenia has also been observed in
individuals who contracted a viral infection
(flu) during the middle of their fetal
development.
126
What Causes schizophrenia?
Blame the Genes - Runs in families
Biological and Environmental Causes:
Relationship
Genetic Relatedness % Risk of Developing
Schizophrenia%
Identical Twin
100
48
Child of two schizophrenic
parents
100
46
Fraternal twin
50
17
Offspring of one schizophrenic
parent
50
17
Sibling
50
9
Nephew or niece
25
4
Spouse
0
2
Unrelated person
0
1
127
Genetic Factors
The following shows the prevalence of
schizophrenia in identical twins as seen in
different countries.
128
Psychological Factors
Psychological and environmental factors can
trigger schizophrenia if the individual is
genetically predisposed (Nicols & Gottesman,
1983).
Courtesy of Genain Family
Genain Sisters
The genetically identical
Genain
sisters suffer from
schizophrenia. Two more than
others, thus there are
contributing environmental
factors.
129
Warning Signs
Early warning signs of schizophrenia include:
1. A mother’s long lasting schizophrenia.
2. Birth complications, oxygen deprivation and
low-birth weight.
3. Short attention span and poor muscle
coordination.
4. Disruptive and withdrawn behavior.
5. Emotional unpredictability.
6. Poor peer relations and solo play.
130
Type this up and hand in before the unit test.
Often misunderstood, schizophrenia in a psychological disorder affecting one percent
of the population. In addition to treating the disorder, psychologists work to identify
its nature and origins.
a. Identify two characteristic symptoms used to diagnose schizophrenia
b. Discuss a research finding that supports a genetic basis for schizophrenia
c. What is the dopamine hypothesis regarding the origins of schizophrenia?
d. Describe how medications used to treat schizophrenia affect the actions of
neurotransmitters at the synapses
e. Identify a risk inherent in using medications in the treatment of schizophrenia
f.
People sometimes confuse schizophrenia with dissociative identify disorder
(DID). Identify two key characteristics that differentiate DID from
schizophrenia
131
Psychological Disorders
•
What CAUSES disorders . . .
Schizophrenia / psychosis?
–
•
•
•
•
•
Important to know how mental disorders arise
& how they can be treated.
Diabetes: Signs and Symptoms
Fatigue
Increase in frequency of urination
Thirst
Appetite
Proximate cause of Diabetes
• Body can’t effectively use insulin produced by the pancreas
–
–
–
–
Treatments:
Controlled diet,
Exercise
Oral or injections of insulin
• BUT WHAT IS THE ULTIMATE CAUSE, WHAT LED TO THE
INEFFEICIENT USE OF INSULIN IN THE FIRST PLACE?
– Two factors:
– Factors that stress the body and cause the insulin to malfunction
• Obesity
• Old age
– Only if the individual has a predisposition (diathesis) toward the illness
• Genetic Factors create a susceptibility to the disease
Psychological Disorders
• NEITHER THE DIATHESIS
(predisposition) NOR THE STRESS BY
ITSELF CAUSES THE DISEASE. IT’S
THE COMIBINATION OF THE
PREDISPOSITION PLUS THE
PRECIPITATING FACTORS THAT
TRIGGER IT.
Personality Disorders
Personality disorders
are characterized by
inflexible and
enduring behavior
patterns that impair
social functioning.
They are usually
without anxiety,
depression, or
delusions.
135
Dramatic Cluster
• Borderline PD: difficulty developing a secure
sense of who they are. Tend to rely on
relationships with others to define their identity.
• Rejections are devastating.
• Very distrustful of others; difficulty controlling anger;
impulsive and self destructive behavior.
• Narcissistic Personality Disorder – exaggerated
sense of self-importance.
– Expect special treatment form others; disregard
others’ feelings
– Inability to experience empathy for other people. 136
Dramatic Cluster
• Histrionic PD - long-standing pattern of
attention seeking behavior and extreme
emotionality. Wants to be the center of
attention in any group of people
– Have difficulty when people aren’t focused
exclusively on them.
– May be perceived as being shallow, and may
engage in sexually seductive or provocating
behavior to draw attention to themselves.
137
Personality Disorders
• Histrionic personality disorder - person acts very emotional and
dramatic in order to get attention.
–
–
–
–
–
–
–
–
–
–
–
Acting or looking overly seductive
Being easily influenced by other people
Being overly concerned with their looks
Being overly dramatic and emotional
Being overly sensitive to criticism or disapproval
Believing that relationships are more intimate than they actually are
Blaming failure or disappointment on others
Constantly seeking reassurance or approval
Having a low tolerance for frustration or delayed gratification
Needing to be the center of attention
Quickly changing emotions, which may seem shallow to others
138
Dramatic Cluster
• Antisocial Personality Disorder
• Axis II personality disorder characterized by "...a
pervasive pattern of disregard for, and violation of,
the rights of others that begins in childhood or early
adolescence and continues into adulthood.“
• Formerly, this person was called a sociopath or
psychopath.
1.
2.
3.
4.
Etiology of Disorder:
Biology (frontal lobe / amygdala)
Morality – shift in what is expected
Impulsiveness
Childhood
139
• Anxious Cluster
– Dependent – Clinginess, submissiveness
– Avoidant: Sense of inadequacy, inhibition.
– Obsessive-Compulsive: Rigidity, ruleboundedness, perfectionism.
• Odd Cluster:
– Paranoid – Extreme distrust, suspicion
– Schizoid – Social detachment, limited range of
emotional expressions.
– Schizotypal- social deficits, delusions.
140
Hare PCL-R Checklist
Researchers and clinicians define individuals as psychopathic if they fall at the upper end of the
dimension; that is, they have the majority the defining features in an extreme form over much of the
lifespan. Only about one percent of the general population meets these conditions.
1.
2.
3.
Glibness/superficial charm
Grandiose sense of self-worth
Need for stimulation / proneness
to boredom
4. Pathological lying
5. Conning/manipulative
6. Lack of remorse or guilt
7. Shallow affect
8. Callous/lack of empathy
9. Parasitic lifestyle
10. Poor behavioral controls
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Promiscuous sexual behavior
Early behavior problems
Lack of realistic long-0term goals
Impulsivity
Irresponsibility
Failure to accept responsibility for
one’s actions
Many short-term marital
relationships
Juvenile delinquency
Revocation of conditional release
Criminal versatility
141
Personality Disorders
• Borderline personality disorder –
difficulty developing a secure sense of who
they are. Tend to rely on relationships with
others to define their identity.
– Rejections are devastating.
– Very distrustful of others; difficulty controlling
anger; impulsive and self destructive behavior.
142
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.
143
Understanding Antisocial
Personality Disorder
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
compared to normals (Raine et al., 1999; 2000).
Courtesy of Adrian Raine,
University of Southern California
Normal
Murderer
144
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).
145
Rates of Psychological Disorders
146
Rates of Psychological Disorders
The prevalence of psychological disorders during
the previous year is shown below (WHO, 2004).
147
Risk and Protective Factors
Risk and protective factors for mental disorders
(WHO, 2004).
148
Risk and Protective Factors
149