Psychological Disorders

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Psychological Disorders
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What is Abnormal Behavior?

• Unusualness
• Social Deviance
• Emotional Distress
• Maladaptive Behavior
• Dangerousness
• Faulty Perception of Reality
• Hallucinations
• Delusions

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Mental or Psychological Disorder

• Any behavior or emotional state that
• causes a person to suffer, is self-destructive
  seriously impairs the persons ability to work or
  get along with others or endangers others or the
  community.

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Insanity

• Legal term that depends on whether the person is
  aware of the consequences of behavior and is able
  to control it.

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Culture-Bound Syndrome

• Psychological disorders found only among specific
  cultural groups.

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Culture-Bound Syndrome

• Dhat Syndrome
• Intense fear of losing semen (India).
• Ataque de Nervios
• Uncontrollable shouting, crying, trembling, and
  verbal or physical aggression. Prevalent among
  women (Latin America).
• Brain Fag
• Difficulties in concentration, memory thinking
  among HS college students in responses to the
  challenges of schooling ( West Africa).
• Koro
• Intense anxiety that the sexual organs will
  recede into the body and possibly cause death
  (Malaysia).
• Amok
• Brooding followed by violent outburst often
  precipitated by an insult seems to be prevalent
  only among men (Malaysia).

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Culture-Bound Syndrome

• Ghost Sickness
• Preoccupation with death and the dead, with bad
  dreams, fainting, appetite loss, fear,
  hallucinations (Native Americans).
• Pibloktoq
• Episodes of extreme excitement of up to 30
  minutes, during which the individual behaves
  irrationally or violently (Artic Inuit
  Communities).
• Qi-gong psychotic reaction
• Short episode of mental symptoms after engaging
  in the Chinese folk practice of qi-gong, or
  exercise of vital energy (China).
• Tajin kyofusho
• Intense fear that the body, its parts, or its
  functions displease, embarrass, or are offensive
  to others (Japan).
• Zar
• Belief in possession by a spirit, causing
  shouting, laughing, head banging, weeping
  withdrawal (North Africa Middle East).

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Models of Abnormal Behavior

• Early Beliefs
• Medical Model
• Psychological Models
• Sociocultural Model
• Biopsychosocial Model

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Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR)

• The bible of psychological and psychiatric
  diagnosis.
• Primary aim of the DSM is descriptive
• provide clear criteria for diagnostic categories.

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Advantages of the DSM

• When used correctly it improves the reliability
  of the diagnosis making it more accurate.
• Creates uniformity among clinicians
• Correct labeling of the disorder may help people
  identify the source of their condition that may
  lead to proper treatment.

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Limitations of the DSM

• May foster over diagnosis.
• May increase risk of creating self-fulfilling
  prophecies.
• Label will follow the individual.
• May confuse serious mental disorders with normal
  problems.
• Diagnoses reflect prevailing attitudes and
  prejudice.
• Create illusion of universality.

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Multiaxial Assessment

• Axis I Clinical Disorders
• Other conditions that may be a focus of
  clinical attention
• Axis II Personality Disorders
• Mental Retardation
• Axis III General medical conditions
• Axis IV Social and environmental stressors
• Axis V Global assessment of overall
  functioning

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DSM-IV TR (Axis I)

• Disorders first diagnosed in Infancy, childhood,
  or adolescence
• Delirium, dementia, and amnesic and other
  cognitive disorders
• Substance related disorders
• Schizophrenia and other psychotic disorders
• Anxiety disorders
• Somatoform disorders
• Fastidious disorders
• Dissociative disorders
• Sexual and gender identity disorders
• Eating disorders
• Sleep disorders
• Impulse control disorders
• Adjustment disorders
• Other conditions that may be a focus of clinical
  attention

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DSM-IV TR (Axis II)

• Mental Retardation
• Personality Disorders

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Disorders First Diagnosed in Infancy, Childhood,
or Adolescence

• Learning disorders (Learning disabilities)
• Pervasive developmental disorders
• Autism, Asperger's Disorders, etc.
• Attention-deficit and disruptive disorders
• ADHD, Conduct Disorder, Oppositional Defiant
  Disorder, Disruptive Behavior Disorder, etc.
• Feeding eating disorders of infancy or early
  childhood
• Pica, Rumination Disorders, etc.
• Tic disorders
• Tourettes Disorder, Chronic Motor or Vocal Tic
  Disorder, etc.
• Elimination disorders
• Encopresis, Enuresis, etc.
• Other disorders of infancy, childhood or
  adolescence

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Delirium, Dementia, Amnestic and other Cognitive
Disorders

• Delirium
• Acute and relatively sudden decline in
  attention-focus, perception, and cognition.
  Delirium is not the same as dementia, though it
  commonly occurs in demented patients.
• Dementia
• Progressive decline in cognitive function due to
  damage or disease in the body beyond what might
  be expected from normal aging. Although dementia
  is far more common in the geriatric population,
  it may occur in any stage of adulthood.
• Amnestic Disorders

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Schizophrenia

• A psychosis or mental condition involving
  distorted perceptions of reality and an inability
  to function in most aspects of life.
• Severity and duration of symptoms vary.
• Onset can be abrupt or gradual.
• Prognosis is unpredictable when onset is gradual.

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Schizophrenia and other Psychotic Disorders

• Schizophrenia
• Paranoid Type
• Disorganized Type
• Catatonic Type
• Undifferentiated Type
• Residual Type
• Schizophrenic Disorder
• Schizoaffective Disorder
• Delusional Disorders
• Erotomanic Type
• Grandiose Type
• Jealous Type
• Persecutory Type
• Somatic Type
• Mixed Type
• Shared psychotic disorders (Folie a Deux)
• Other

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Symptoms of Schizophrenia

• Active or positive symptoms
• Delusions--false beliefs about reality
• Hallucinations and heightened sensory awareness
• visual, auditory, olfactory, gustatory, tactile,
  etc.
• Disorganized, incoherent speech--illogical jumble
  of ideas
• Grossly disorganized and inappropriate behavior
  ranging from childlike silliness to violent
  agitation
• Negative symptoms
• Loss of motivation
• Poverty of speech--brief, empty replies
  reflecting diminished though
• Emotional flatness--unresponsive facial
  expressions, poor eye contact, diminished
  emotionality
• Tend to occur before and last after positive
  symptoms

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Origins of Schizophrenia Biological factors

• Genetic predispositions
• Risk of schizophrenia for general population is
  1-2
• Risk is about 50 if identical twin has
  schizophrenia
• Risk is 12 for people with one schizophrenic
  parent
• Risk is 35-46 for people with two schizophrenic
  parents
• No specific genes for schizophrenia have been
  identified
• Structural brain abnormalities
• May have decreased brain weight, reduced volume
  in specific brain areas, or reduced number of
  neurons in certain brain areas
• May have enlarged ventricles
• More likely to have abnormalities in the thalamus
• Antipsychotic medications might affect the brain
• Neurotransmitter abnormalities
• Schizophrenics may have low levels of serotonin
  and high levels of dopamine activity
• Prenatal abnormalities
• Damage to fetal brain may increase likelihood of
  schizophrenia
• Severe malnutrition during pregnancy
• Infectious viruses, such as influenza, especially
  during second trimester of gestation

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Anxiety Disorder

• Panic Disorder
• Phobic Disorders
• Obsessive-Compulsive Disorder (OCD)
• Post-traumatic stress Disorders (PTSD)
• Acute Stress Disorder
• Generalized Anxiety Disorder
• Substance Induced Anxiety Disorder
• Others

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Panic Disorder

• Characterized by sudden attacks of intense fear,
  with feelings of impending doom.
• Symptoms
• Heart palpitations, dizziness, and faintness.
• Often related to stress, prolonged emotion, or
  traumatic experiences.
• Are not uncommon whether it develops into a
  disorder depends on how the bodily reactions are
  interpreted.
• Culture influences the particular symptoms.

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Phobias

• Unrealistic fear of a specific situation,
  activity, or object.
• Social phobia
• Persistent, irrational fear of situations in
  which one will be observed by others.
• Agoraphobia
• Fear of being alone in a public place from which
  escape might be difficult or help unavailable.
• The most disabling phobia--most common phobia for
  which people seek treatment.
• May begin with panic attacks--sudden onset of
  intense fear, then avoiding situations that might
  provoke another attack.

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Obsessive Compulsive Disorders

• Obsessions
• Recurrent, persistent, unwished-for thoughts.
• May be frightening or repugnant.
• Compulsions
• Repetitive, ritualized behaviors that the person
  feels must be carried out to avoid disaster.
• People feel a lack of control over the
  compulsion.
• Common compulsions include repeated hand washing,
  counting, touching, and checking things.
• Most OCD sufferers do not enjoy the rituals and
  realize the behavior is senseless, but if they
  try to break off the ritual, they feel mounting
  anxiety.
• Several parts of the brain are overactive in OCD
  sufferers, resulting in the person experiencing a
  constant state of danger.

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Posttraumatic Stress Disorder (PTSD)

• Can occur as a result of uncontrollable and
  unpredictable danger such as rape, war, or
  natural disasters.
• Symptoms
• Reliving the trauma in thoughts or dreams
• Psychic numbing
• Increased physiological arousal
• Reaction may be immediate or delayed with PTSD
• Symptoms of PTSD may recur for 10 years or more

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Generalized Anxiety Disorder

• Symptoms
• Continuous, uncontrollable anxiety or worry
• Feelings of foreboding and dread
• Restlessness, difficulty concentrating,
  irritability, and jitteriness
• Duration of at least 6 months
• Predisposing factors
• Physiological tendency
• Unpredictable environment in childhood

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MOOD DISORDERS

• Depressive Disorders
• Major Depressive Disorders
• Dysthymic Disorders
• Bipolar Disorders
• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder
• Substance Induced Mood Disorder
• Postpartum Onset

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Major Depressive Disorder

• Disrupts ordinary functioning for at least six
  months.
• Symptoms emotional, cognitive behavioral
  changes.
• Emotional
• Feelings of despair and hopelessness.
• Loss of pleasure in usual activities.
• Thoughts of death or suicide.
• Cognitive
• Exaggerate minor failings, discount positive
  events, interpret things that go wrong as
  evidence that nothing will ever go right.
• Low self-esteem, losses interpreted as sign of
  personal failure.
• Memory and concentration difficulties.
• Behavioral
• Unable to do everyday activities (e.g., takes
  tremendous effort to get up and get dressed).
• May stop eating or overeat, have difficulty
  falling asleep or staying asleep, feel tired all
  the time.

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Bipolar Disorder

• Depression alternates with mania
• Bipolar I
• One or more manic episodes.
• Bipolar II
• One or more depressive episodes with at least one
  hypomanic episode

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Manic Episode

• A distinct period of abnormally and persistently
  elevated , expansive or irritable mood lasting at
  least 1 week.
• Inflated self esteem or grandiosity
• Decrease need for sleep
• More talkative
• Distractibility
• Excessive involvement in pleasurable activities

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Origins of Mood Disorders Biological Explanations

• Focus on genetics and brain chemistry
• Low norepinephrine and/or serotonin levels
  implicated in depression
• Mania may be caused by excessive production of
  norepinephrine
• Drugs help to bring the levels of
  neurotransmitter into balance
• Brain scans show reduced frontal lobe activity in
  depressed people

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Other Explanations for Depression

• Social explanations--focus on stressful
  conditions of peoples lives
• Marriage and employment associated with lower
  rates of depression.
• In women, having more children is associated with
  higher rates of depression
• A history of exposure to violence is related to
  depression
• Attachment explanations--focus on disturbed
  relationships and separations and a history of
  insecure attachments
• Disruption of a primary relationship most often
  sets off a depressive episode
• Cognitive explanations--propose that depression
  results from particular habits of thinking and
  interpreting events
• Learned helplessness theory held that people
  become depressed when their efforts to avoid pain
  or control the environment fail--however, not all
  depressed people have actually experienced
  failure
• Ruminating response style may also lead to
  longer, more intense periods of depression
• Women more likely to adopt this style than men

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Somatoform Disorders

• Somatization Disorder
• Conversion Disorder
• Pain Disorder
• Hypochondriasis
• Body Dysmorphic Disorder
• Others

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Dissociative Disorders

• Dissociative Amnesia
• Dissociative Fugue
• Dissociative Identity Disorder
• Others

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Sexual Disorder

• Sexual Dysfunctions
• Male erectile disorder
• Premature ejaculation
• Female orgasmic disorder
• Hypoactive sexual desire
• others
• Paraphilias
• Exhibitionism
• Fetishism
• Frotteurism
• Pedophilia
• Voyeurism
• Sexual masochism
• Sexual sadism
• others
• I

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Eating Disorders

• Anorexia Nervosa
• Bulimia Nervosa

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Sleep Disorders

• Dyssomnia
• Insomnia
• Hypersomnia
• Narcolepsy
• other
• Parasomnia
• Nightmare disorders
• Sleep terror disorder
• Sleepwalking disorder
• other

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Impulse Control Disorders

• Intermittent Explosive Disorders
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Other

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Axis IIPersonality Disorder

• Paranoid Personality Disorder
• Antisocial Personality Disorder
• Borderline Personality Disorder
• Histrionic Personality Disorder
• Narcissistic Personality Disorder
• Avoidant Personality Disorder
• Dependent Personality Disorder
• Other

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Axis IVPsychosocial Environmental Problems

• Problems with primary support group
• Problems related to social environment
• Educational problems
• Occupational problems
• Housing problems
• Economic problems
• Problems with accese to heath care
• Legal problems
• Other psychosocial problems

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Axis VGlobal Assessment of Functioning Scale
(GAF)

• 100 Superior functioning
• 90 Minimal symptoms
• 80 Transient symptoms
• 70 Mild symptoms
• 60 Moderate symptoms
• 50 Serious symptoms
• 40 Some impairment of reality
• 30 Serious impairment
• 20 Dangerous symptoms
• 10 Extremely severe dangerous symptoms