Transcript Dissociative disorders

Psychology:
From Inquiry to Understanding 1/e
Scott O. Lilienfeld
Steven Jay Lynn
Laura Namy
Nancy J. Woolf
Prepared by Jennifer Sage
This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display,
including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or part, of any images; any
rental, lease, or lending of the program.
Chapter 15:
Psychological Disorders
When Adaptation Breaks Down
Copyright © Allyn & Bacon 2009
Lecture Preview





Discuss conceptions of mental illness and
identify criteria for defining mental disorders
Describe and explain how people experience
anxiety
Identify the characteristics of different mood
disorders
Explore dissociative disorders and
schizophrenia
Examine the link between personality disorders
and substance abuse
Copyright © Allyn & Bacon 2009
What Defines a Mental Disorder?






Statistical rarity
Subjective distress
Impairment
Societal disapproval
Biological dysfunction
Family resemblance view – mental disorders
don’t all have one thing in common, rather they
share a loose set of features
Copyright © Allyn & Bacon 2009
Historical Conceptions
of Mental Illness

Demonic model – view of mental illness in
which odd behavior, hearing voices, or talking
to oneself was attributed to evil spirits infesting
the body

Medical model – perception that mental illness
was due to a physical disorder requiring
medical treatment


Governments began to house troubled individuals in
asylums
Bloodletting and snake pits were often used as
treatments
Copyright © Allyn & Bacon 2009
More Modern Approaches

Moral treatment –
approach to mental illness
calling for dignity,
kindness, and respect for
the mentally ill

Deinstitutionalization –
1960s-70s government
policy that focused on
releasing hospitalized
psychiatric patients into
the community and closing
mental hospitals
Copyright © Allyn & Bacon 2009
Apply Your Thinking

What are some of the benefits and costs
of the governmental policy of
deinstitutionalization?

Benefits: Some patients returned to normal lives and
continued outpatient programs. It has saved the
government a large amount of money.

Costs: Many patients ended up homeless. This can still
be seen today as a recent study indicated that 15% of
all patients treated for mental disorders are homeless.
Copyright © Allyn & Bacon 2009
Psychiatric Diagnoses Over
Time

Diagnostic labels devoid of scientific
support:
Codependency
 Sexual addiction
 Road rage disorder
 Compulsive shopping disorder

Copyright © Allyn & Bacon 2009
Psychiatric Diagnosis Across
Cultures

Many mental illnesses are specific to certain
cultures (culture-bound)


Koro – in a number of Asian countries, men with this
condition falsely believe their penis and testicles are
disappearing and receding into their abdomen
Bulimia nervosa - unique to Western cultures
• Likely genetic, but triggered by sociocultural expectations


Anorexia nervosa - more culturally universal
Many mental disorders are culturally universal
(schizophrenia, alcoholism, psychopathic
personality)
Copyright © Allyn & Bacon 2009
The Media and Unrealistic Ideals:
Weights of Playboy Centerfolds
Over Time
Copyright © Allyn & Bacon 2009
Popular Misconceptions about
Psychiatric Diagnosis

Psychiatric diagnosis is nothing more than
pigeonholing, like sorting people into different “boxes”


Psychiatric diagnoses are unreliable


For major mental disorders, interrater reliability is high
Psychiatric diagnoses are invalid


Psychiatrists actually realize that people differ
Diagnoses do tell us something new about the person
Psychiatric diagnoses stigmatize people

Contrary to labeling theorists’ claims, diagnoses may improve
others’ perceptions of the mentally ill
Copyright © Allyn & Bacon 2009
Psychiatric Diagnosis Today:
The DSM-IV

Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV) - diagnostic system containing
the American Psychiatric Association (APA) criteria for
mental disorders
 Provides a list of symptoms and a decision rule on
how many of these symptoms must be present for a
diagnosis
 Biopsychosocial approach – acknowledges the
interplay between biological, psychological, and social
influences
 Utilizes prevalence of mental disorders and assesses
patients along multiple axes (dimensions of
functioning)
Copyright © Allyn & Bacon 2009
Criticisms of the DSM-IV

“Mathematics Disorder”


Not everything is based on scientific data



Tells us little beyond difficulties learning math
Some disorders are based on subjective committee
decisions
High level of comorbidity among diagnoses
Exclusive reliance on a categorical model

Some mental disorders may better fit a dimensional
model, where disorders differ from normal
functioning by degree rather than kind (e.g.,
depression, anxiety)
Copyright © Allyn & Bacon 2009
Mental Illness and
the Law


Most mentally ill individuals are not physically
aggressive toward others
Insanity defense – legal defense proposing that
people should not be held responsible for their action
if they weren’t of “sound mind” when committing them

Incompetence to stand trial – assessment of a
defendant’s mental capacity to stand trial in a court of
law

Do defendants understand the charges against
them?

Can defendants assist in their defense?
Copyright © Allyn & Bacon 2009
True or False?
In most states, a judge must approve
involuntary commitment of mentally ill
individuals.
TRUE. Individuals must pose a clear and
present threat to themselves or others, or
be so impaired that they are unable to care
for themselves. Two M.D.s may authorize
an emergency three-day hold, but only
pending a judicial hearing.
Copyright © Allyn & Bacon 2009
Anxiety Disorders

The most prevalent of all psychiatric disorders

Somatoform disorders – class of conditions
marked by physical symptoms that suggest an
underlying medical illness, but that are actually
psychological in origin
 Conversion disorder
 Hypochondriasis – an individual’s continual
preoccupation with the notion that he is
suffering from a serious physical disease
Copyright © Allyn & Bacon 2009
Anxiety Disorders

Panic disorder – repeated and unexpected panic
attacks, along with a change in behavior to avoid panic
attacks
 Nervous feelings escalate to fear/terror
 About 20-25 percent of college students report at
least one panic attack within a year
 Generalized anxiety disorder – continual feelings
of worry, anxiety, physical tension, and irritability
 Spend on average 60% of each day worrying,
compared with 18% of the general population
 Often experience other anxiety disorders such as
panic disorder or phobias
Copyright © Allyn & Bacon 2009
Anxiety Disorders

Phobia – intense fear of an object or situation
that’s greatly out of proportion to its actual
threat



Agoraphobia – fear of being in a place or situation
from which escape is difficult or embarrassing
Specific phobia – intense fear of objects, places, or
situations
Social phobia – marked fear of public appearances
in which embarrassment or humiliation is possible,
such as public speaking, eating, or performing
Copyright © Allyn & Bacon 2009
Anxiety Disorders

Posttraumatic stress disorder (PTSD) – marked
emotional disturbance after experiencing or witnessing a
severely stressful event


Includes sleep loss, anxiety, increased sensitivity to stimuli,
nightmares, and flashbacks
Obsessive-compulsive disorder (OCD) – marked by
repeated and lengthy (>1 hour/day) immersion in
obsessions, compulsions, or both


Obsessions – persistent ideas, thoughts, or impulses that are
unwanted and inappropriate, cause marked distress (e.g.,
contamination, aggression)
Compulsions – repetitive behaviors or mental acts preformed
to reduce or prevent stress (e.g., repeated checking)
Copyright © Allyn & Bacon 2009
Explanations for Anxiety Disorders



Learning models – fears arise from learned
associations
 Through classical conditioning (Little Albert),
operant conditioning (reinforcement/punishment),
observing others, or being given information from
others
Catastrophizing and anxiety sensitivity – the negative
misinterpretation of minor physical symptoms
Genetic and biological influences – twin studies show
that many anxiety disorders are genetically influenced
Copyright © Allyn & Bacon 2009
Mood Disorders

Major depressive episode – state in which a
person experiences a lingering depressed
mood or diminished interest in pleasurable
activities


Symptoms include weight loss, sleep difficulties,
fatigue, lack of concentration, and feelings of
worthlessness
DSM-IV mood disorders:

Manic episode, bipolar disorder, dysthymic disorder,
hypomanic episode, cyclothymia, postpartum
depression, seasonal affective disorder
Copyright © Allyn & Bacon 2009
Explanations for Major Depressive
Disorder



Life events – stressful events that represent
loss are closely tied to depression
Interpersonal model – depressed people
seek excessive reassurance which leads
them to being disliked and rejected
Behavioral model – depressed people have
a lack of positive reinforcement and this
leads them to stop engaging in enjoyable
behavior
Copyright © Allyn & Bacon 2009
Explanations for Major Depressive
Disorder

Learned helplessness – tendency to feel
helpless in the face of events we can’t control


Depressed individuals attribute negative outcomes to
internal factors (i.e., ‘I failed because I am stupid’)
Attribute positive outcomes to external factors (i.e., ‘I
did well because the test was easy’)
Copyright © Allyn & Bacon 2009
Apply Your Thinking

It’s unlikely that most non-human animals, even
intelligent ones, can engage in complex
attributions about themselves and the world.
What does this imply about the relevance of the
animal model of learned helplessness?

It implies that while these complex attributions may
play a role in depression, there is likely a much
simpler mechanism that is also working to control
behavior.
Copyright © Allyn & Bacon 2009
Explanations for Major Depressive
Disorder

Cognitive model – depression is caused by
negative views of self, the future, and the
world


Includes cognitive distortions such as
overgeneralization or selective abstraction
The role of biology – genes exert a moderate
influence on the risk of developing major
depression

May be due to low levels of serotonin,
norepinephrine, and/or dopamine
Copyright © Allyn & Bacon 2009
Bipolar Disorder


Manic episode – experience marked by dramatically
elevated mood, decreased need for sleep, increased
energy, inflated self-esteem, increased talkativeness,
and irresponsible behavior
Bipolar disorder – condition marked by a history of at
least one manic episode




More than half the time a major depressive episode precedes
or follows a manic episode
Very heritable (perhaps around 85%)
Increased activity in amygdala (associated with emotions),
decreased activity in prefrontal cortex (associated with
planning)
Increased risk of suicide (as with major depression)
Copyright © Allyn & Bacon 2009
Major Suicide Risk Factors













Depression
Hopelessness
Substance abuse
Schizophrenia
Homosexuality
Unemployment
Chronic, painful, or disfiguring physical illness
Recent loss of a loved one; being divorced, separated or widowed
Family history of suicide
Personality disorder
Anxiety disorders (panic, social phobia)
Old age (especially men)
Recent discharge from a hospital
Copyright © Allyn & Bacon 2009
Dissociative Disorders:
The Divided Self

Dissociative disorders – conditions involving
disruptions in consciousness, memory, identity, or
perception
 Depersonalization disorder – frequent episodes
of observing your body from the perspective of an
outsider, the external world seems unreal
 Dissociative amnesia – inability to recall important
personal information
• Most often related to a stressful experience
 Dissociative fugue – sudden, unexpected travel
away from home or the workplace, accompanied by
amnesia for significant life events
Copyright © Allyn & Bacon 2009
Dissociative Disorders:
The Divided Self

Dissociative identity disorder (DID) – the
presence of two or more distinct identities (called
alters) that recurrently take control of the person’s
behavior
 Up to 4,500 identities have been found in one
person
 Can have differences in brain waves, eyeglass
prescriptions, handedness, voice patterns,
handwriting
 However, information presented to one alter is
generally available to the others
Copyright © Allyn & Bacon 2009
Explanations for DID

Posttraumatic model – DID arises from a history of
severe abuse during childhood
 Up to 90% of patients with DID were abused as a
child
 However, childhood abuse is not unique to DID

Sociocognitive model – expectancies and beliefs
from psychotherapy and cultural influences shape and
maintain the disorder
 Most DID patients show no signs of the disorder
before psychotherapy
 Dramatic increase in DID after the release of the
best-selling book Sybil, which showcased a woman
with 16 personalities
Copyright © Allyn & Bacon 2009
Schizophrenia

Disturbances in thinking, language, emotion, and
relationships, often confused with DID



Psychotic symptoms – serious distortions of reality
Delusions – strongly held, fixed beliefs that have no
basis in reality
Hallucinations – sensory perceptions that occur in the
absence of an external stimulus
• Mostly auditory, but can also be gustatory, tactile, or visual


Disorganized speech – language jumps from topic to
topic
Catatonia – motor problems
• Resistance to comply with simple suggestions, holding the
body in rigid postures, curling up in the fetal position
Copyright © Allyn & Bacon 2009
Explanations for Schizophrenia

Family interactions play a role, but are not a cause of
schizophrenia


Brain abnormalities




Criticism, hostility, and overinvolvement (high expressed
emotion) can induce relapse (varies across ethnic groups)
Increased size of ventricles and sulci in the brain
Decreased hemispherical symmetry
Decreased activation of the amygdala, hippocampus, and frontal
lobe
Neurotransmitter differences

Dopamine hypothesis – excess dopamine signaling, likely
through dopamine receptors
Copyright © Allyn & Bacon 2009
Explanations for Schizophrenia

Genetic findings



Highly genetic
As genetic similarity
increases, so does the risk
of getting schizophrenia
Diathesis-stress
models

Mental disorders are a
joint product of a genetic
vulnerability (diathesis),
and stressors that trigger
this vulnerability
Copyright © Allyn & Bacon 2009
Apply Your Thinking
 What
other disorders could the
diathesis-stress model account for?

The diathesis-stress model could account for numerous
mental disorders that contain a heritable component,
but which are not 100% heritable. Major depression
and anxiety disorders are examples.
Copyright © Allyn & Bacon 2009
Personality Disorders

Personality disorder – condition in which personality
traits, appearing first in adolescence, are inflexible,
stable, expressed in a wide variety of situations, and
lead to distress or impairment

Borderline personality disorder – extreme instability in
mood, identity, and impulse control
 Increased impulsivity and rapidly fluctuating emotions
 Many engage in drug abuse, sexual promiscuity,
overeating, and self-mutilation
 Sociobiological model – individuals inherit tendency
to overreact to stress and cannot properly control
their emotions
Copyright © Allyn & Bacon 2009
Personality Disorders

Psychopathic personality – condition marked by a
distinctive set of personality traits, including superficial
charm, dishonesty, manipulativeness, self-centeredness,
and risk-taking
 Possible deficit in fear: reduced classical conditioning
 Possible deficit in arousal

Antisocial personality disorder – condition marked by
a lengthy history of irresponsible and/or illegal actions
 Often overlaps with psychopathic personality
Copyright © Allyn & Bacon 2009
Substance Abuse and
Dependence

Substance abuse – recurrent problems associated with a drug
 Problems often surface in the family, with friends, on the
job, or with the law

Substance dependence – pattern of substance use associated
with tolerance and withdrawal
 Addictive personality? Tied to impulsivity, sociability, and
negative disposition (but correlation or causation?)
 Tension reduction hypothesis – people take drugs to relieve
anxiety, “self-medication”
 Genetic predisposition for alcoholism
Copyright © Allyn & Bacon 2009