Psychological Disorders

1
Psychological Disorders
2
Understanding Abnormal Behavior

• Medical Model
• Useful to think about abnormal behavior as a
  disease
• Prior to medical model in 18th century
• Abnormal behavior was based on superstition
• possessed by demons, witches, victims of Gods
  punishment
• Medical model resulted in more sympathy and
  better treatment
• Criticism of Szasz - abnormal behaviors are
  problems of living not disease processes

3
Medical Model Today

• Medical concepts have remained prominent
• Diagnosis
• distinguishing one illness from another
• Etiology
• refers to the apparent causation and
  developmental history of an illness
• Prognosis
• a forecast about the probable course of an illness

4
What is Abnormal Behavior

• General criteria for abnormal behavior
• Deviance
• the behavior is different from societal norms of
  what is acceptable and normal
• Maladaptive Behavior
• when the behavior interferes with ones social or
  occupational functioning
• Personal Distress
• many may not exhibit deviant or maladaptive
  behavior, but experience personal discomfort
  associated with symptoms

5
Psychodiagnosis The Classification of Disorders

• Diagnostic and Statistical Manual of Mental
  Disorders (DSM)
• Classification system published by the American
  Psychiatric Association
• First published in 1952
• Currently in 4th edition
• DSM-IV-TR (Text Revision)
• Criteria and research has improved with each
  edition

6
Multiaxial System of Classification

• Axis I
• Clinical syndromes, psychological disorders
• Axis II
• Personality disorders, mental retardation
• Axis III
• General medical disorders/conditions
• Axis IV
• Psychosocial/Environmental Stressors
• Axis V
• Global Assessment of Functioning (1-100 rating)

7
Anxiety Disorders

• Generalized Anxiety Disorder
• marked by a chronic, high level of anxiety that
  is not tied to any specific event
• free-floating anxiety
• ruminative over decisions and minor matters
• Phobic Disorder
• marked by persistent and irrational fear of an
  object or situation that presents no realistic
  danger
• most recognize their own phobias are irrational

8
Anxiety Disorders

• Panic Disorder
• characterized by recurrent panic attacks
• panic attack
• rush of overwhelming anxiety, thoughts that one
  is dying/going crazy, increased heart rate,
  numbing in hands
• typically occurs suddenly and unexpectedly
• after experiencing multiple panic attacks,
  patient may worry about where they will be when
  next one hits
• agoraphobia - fear of going into public places

9
Anxiety Disorders

• Obsessive-Compulsive Disorder (OCD)
• obsessions
• thoughts that repeatedly intrude ones
  consciousness in a distressing way
• compulsions
• actions that one feels forced to carry out
  typically to reduce anxiety brought on by
  obsessions
• OCD is marked by persistent, uncontrollable
  intrusions of unwanted thoughts and urges to
  engage in senseless rituals

10
Anxiety Disorders

• Posttraumatic Stress Disorder
• person experienced, witnessed, or was confronted
  with an event that involved actual or threatened
  death/injury, or threat to physical integrity of
  self/others
• response marked by intense fear, helplessness
• Symptoms
• reexperiencing the event
• persistent avoidance/numbing
• hyperarousal

11
Anxiety Disorders Etiology

• Biological Factors
• Rates are highest among identical twins
• Anxiety sensitivity - some are tuned to respond
  to lower levels of physical anxiety
• Conditioning and Learning
• a stimulus may be paired with a frightening event
  resulting in an learned anxiety response
• Cognitive Factors
• people misinterpret threat (internal or
  external), focus excessive attention on threat,
  and tend to recall information that seems
  threatening

12
Anxiety Disorders Etiology

• Personality
• Certain personality traits are positively
  correlated with anxiety disorders
• Neuroticism
• self-conscious, nervous, jittery, insecure,
  guilt-prone
• This finding may be related to third variable
• genetic predisposition
• Stress
• Those with anxiety disorder tend to experience
  more stressors in prior month

13
Somatoform Disorders

• Somatoform vs. Psychosomatic
• Somatoform Disorders
• physical ailments that cannot be fully explained
  by organic conditions and are largely due to
  psychological factors
• THIS IS NOT DELIBERATE FAKING
• Psychosomatic Diseases
• genuine physical ailments caused in part by
  psychological factors, especially emotional
  distress
• ulcers, asthma, high blood pressure

14
Somatoform Disorders

• Somatization Disorder
• marked by a history of diverse physical
  complaints that appear to be psychological in
  origin
• unlikely combination of symptoms
  (gastrointestinal, pulmonary, neurological)
• Conversion Disorder
• significant loss of physical function (with no
  apparent organic basis)
• loss of sight/hearing, mutism, paralysis

15
Somatoform Disorders

• Hypochondriasis
• characterized by excessive preoccupation with
  ones health and worry about developing physical
  illness
• tend to doctor shop and think professionals are
  incompetent
• over-interpret ANY sign of illness

16
Somatoform Disorders Etiology

• Personality
• Histrionic - self-centered, suggestible, overly
  dramatic, highly emotional, thrive on attention
• Cognitive Factors
• amplify normal bodily sensations and draw
  catastrophic conclusions
• Sick Role
• some grow fond of perks of being sick (avoid
  responsibility, attention from others)

17
Dissociative Disorders

• Loss of contact with portions of memory or
  consciousness resulting in disruption of ones
  sense of identity
• Dissociative Amnesia
• sudden loss of memory for important personal
  information
• common after disasters, accidents, combat stress,
  physical abuse, rape, witnessing a violent death
• Dissociative Fugue
• People lose their memory for their entire lives
  along with their sense of personal identity

18
Dissociative Disorders

• Dissociative Identity Disorder (DID)
• multiple personality disorder
• NOT schizophrenia
• coexistence in one person of two or more largely
  complete, and usually very different,
  personalities
• experiences of one personality are typically
  not known by others

19
Dissociative Disorders Etiology

• Psychogenic amnesia and fugue
• excessive stress
• DID
• SEVERE emotional trauma during childhood
• Criticisms
• intentional role playing
• therapist subtly create DID in patients through
  suggestion

20
Mood Disorders

• Major Depressive Disorder
• persistent feelings of sadness/despair and a loss
  of interest in previous sources of pleasure, lack
  of energy, hopelessness, suicidal ideation
• in adolescents, may manifest as agitation
• average duration 5 months
• 75-95 who suffer one episode of depression will
  suffer another
• affects 7 of population at some point

21
Mood Disorders

• Bipolar Disorder
• manic-depressive disorder
• marked by experience of both depressed and manic
  periods
• mania
• marked by euphoria, hyperactivity, impaired
  judgement, extravagance, impulsivity, insomnia
• may have uneasiness, irritability that may be
  disturbing
• affects about 1 of the population

22
Mood Disorders Etiology

• Genetic Vulnerability
• heredity may create a predisposition to mood
  disorders
• Neurochemical Factors
• Norepinephrine and serotonin appear important in
  development of depression
• Cognitive Factors
• Learned helplessness Martin Seligman
• passive giving up response to uncontrollable
  situations

23
Mood Disorders Etiology

• Cognitive Factors
• Pessimistic explanatory style
• attribute setbacks to personal flaws instead of
  situational factors
• draw global generalizations about their
  inadequacies
• Rumination
• those who continue to worry about their
  depression tend to remain depressed longer than
  those who distract themselves
• Interpersonal Roots
• lack social finesse, tend to be depressing

24
Mood Disorders Etiology

• Stress-vulnerability models
• vulnerability to a disorder is influenced by
  heredity
• stress from ones environment results in
  potential manifestation of vulnerability
• If a person has a genetic predisposition to
  develop a disorder, stress from the environment
  may increase the likelihood that the disorder
  will appear

25
Schizophrenic Disorders

• Term meaning split mind was coined by Eugen
  Bleuler in 1911
• refers to fragmentation of thought processes
• not split personality associated with MPD
• Class of disorders marked by delusions,
  hallucinations, disorganized speech, and
  deterioration of adaptive behavior
• 1 - 1.5 of population
• 3-4 million people in U.S.

26
Schizophrenic Disorders

• General Symptoms
• Irrational Thought
• Delusions - false beliefs that are maintained
  even though they clearly are out of touch with
  reality
• thought broadcasting
• ideas being injected into ones mind against
  ones will
• delusions of grandeur
• Train of thought deteriorates
• becomes less logical and linear and more chaotic
• loosening of associations

27
Schizophrenic Disorders

• General Symptoms
• Deterioration of adaptive behavior
• impairment of work, social relations, personal
  care
• Distorted perception
• Hallucinations - sensory perceptions that occur
  in the absence of a real, external stimulus or
  gross distortions of perceptual input
• visual or auditory (auditory more common)
• Disturbed emotion
• Flattening of emotions (little emotional
  response)
• Emotionally volatile and inapproapriate

28
Schizophrenic Disorders

• Subtypes
• Paranoid
• dominated by delusions of persecution and
  delusions of grandeur
• Catatonic
• marked by striking motor disturbances, ranging
  from muscular rigidity to random motor activity
• Disorganized
• severe deterioration of adaptive behavior
• Undifferentiated
• marked by a mix of symptoms

29
Schizophrenic Disorders

• Positive Versus Negative Symptoms
• with criticism of subtype classification, this
  scheme was devised
• Negative Symptoms
• behavioral deficits, such as flattened emotions,
  social withdrawal, apathy, impaired attention,
  poverty of speech
• Positive Symptoms
• behavioral excesses or peculiarities, such as
  hallucinations, delusions, bizarre behavior, and
  wild flights of ideas

30
Schizophrenic Disorders Etiology

• Genetic vulnerability
• concordance rate for identical twins is 48
• Neurochemical factors
• Excess dopamine
• Structural abnormalities in the brain
• chronic schizophrenic disturbance is associated
  with enlarged brain ventricles
• Expressed emotion
• degree to which family displays highly critical
  or emotionally overinvolved attitudes (critical
  comments, resentment, overprotective)

31
Schizophrenic Disorders Etiology

• Neurodevelopmental Hypothesis
• disruptions in normal maturation processes of
  brain before or at birth
• viral infections during prenatal development
• study of 1957 flu epidemic in Finland
  Schizophrenia rates elevated among individuals
  who were in their second trimester of prenatal
  development during epidemic
• malnutrition during prenatal development
• obstetrical complications during birth process
• Precipitating Stress
• stress can trigger onset or relapses

32
Eating Disorders

• Severe disturbances in eating behavior
  characterized by preoccupation with weight
  concerns and unhealthy efforts to control it
• Anorexia nervosa
• intense fear of gaining weight, disturbed body
  image, refusal to maintain normal weight, and
  dangerous measures to lose weight
• Bulimia nervosa
• habitually engaging in out-of-control overeating
  followed by unhealthy compensatory efforts, such
  as self-induced vomiting, fasting, laxatives

33
Eating Disorders Etiology

• Genetic Vulnerability
• Personality Factors
• anorexia
• obsessive, rigid, neurotic, emotionally
  restrained
• bulemia
• impulsive, overly sensitive, low self-esteem
• Cultural Values
• Western societys emphasis on attractive

34
Eating Disorders Etiology

• The Role of the Family
• Overly involved parents turn normal adolescent
  drive for independence into unhealthy struggle
• in response, child may seek extreme control over
  body and eating behavior
• Parents may endorse societys messages about body
  image
• Cognitive Factors
• rigid, all-or-none thinking, maladaptive beliefs,
  obsessive, ruminative

35
Psychology and the Law

• Insanity
• NOT a diagnosis
• a legal concept indicating that a person cannot
  be held responsible for his/her actions because
  of mental illness
• used with people that admit they committed the
  crime but claim that they lacked intent
• Involuntary commitment
• people are hospitalized in psychiatric facilities
  against their will

36
Culture and Psychopathology

• Relativistic View
• criteria for mental disorders vary across
  cultures
• no universal standards of normal or abnormal
• Pancultural view
• basic standards of normality are universal
• most serious psychological disorders
  (schizophrenia, depression, bipolar disorder) are
  found in all cultures
• Culture-bound disorders
• abnormal syndromes found only in a few cultural
  groups
• koro - obsesive fear that penis will retract into
  abdomen (Southern Asia)