PSYCHOLOGICAL DISORDERS

1
PSYCHOLOGICAL DISORDERS
2
Common Psychological Disorders

• Anxiety disorders
• Mood disorders
• Schizophrenia
• Personality disorders
• Eating disorders
• Disorders of childhood and adolescence

3
Anxiety Disorders

• Specific phobias
• Panic disorder
• Generalised anxiety disorder (GAD)
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)

4
The Experience of Anxiety

• Feeling of apprehension
• Resulting from anticipation of threat
• Physiological symptoms
• Muscle tension
• Dry mouth
• Perspiring trembling
• Dizziness fatigue
• Sleeping difficulties nightmares

5
Common Specific Phobias

• Animal phobias
• Social phobia
• Dental phobia
• Water phobia
• Height phobia
• Claustrophobia
• Blood-injury-inoculation fears (BII)

6
Common Atypical Phobias
7
Theories of Phobias

• Classical conditioning
• Evolutionary accounts
• Multiple pathways

8
The Little Albert Study
Conditioning a loud noise to a rat.
9
Panic Disorder

• Symptoms of panic disorder
• Heart palpitations
• Perspiring
• Dizziness
• Hyperventilation
• Nausea
• Trembling
• Feelings of apprehension and depersonalisation

10
Theories of Panic Disorder

• Biological theories
• Hyperventilation (Ley, 1987)
• Psychological theories
• Catastrophic misinterpretation of bodily
  sensations (Clark, 1986)

11
Catastrophic Misinterpretation of Bodily
Sensations
12
Generalised Anxiety Disorder

• GAD
• Chronic uncontrollable worry
• Fatigue
• Trembling
• Muscle tension
• Headache
• Nausea

13
The Nature of Worry in GAD

• Associated with anxiety and depression
• Perceived as uncontrollable
• Takes the form of catastrophising

14
Catastrophic Worrying
Table 33.1 Chronic worrier and non-worrier
topics Chronic worrier topic getting good
grades in school Discomfort Likelihood
Catastrophising step I wont live up to my
expectations. 50 30 Id be disappointed in
myself. 60 100 Id lose
my self-confidence
70 50 My loss of self-confidence would spread to
other areas of my life.
70 50 I wouldnt have as much
control as Id like. 75 80 Id be afraid of
facing the unknown. 75 100 Id become very
anxious. 75 100 Anxiety
would lead to further loss of self-confidence.

75 80 I wouldnt get my confidence
back. 75 50 Id feel like 1 wouldnt have any
control over my life.
75 80 Id be susceptible
to things that normally wouldnt bother me.
75 80 Id become more and
more anxious. 80 80 Id have no control at all
and Id become mentally ill.
85 30 Id become dependent on drugs and
therapy. 50 30 Id always remain dependent on
drugs. 85 50 Theyd deteriorate my body.
85 100 Id be in pain.

85 100 Id die.
90 80 Id end up in hell.
95 80
Non-worrier topic getting good grades in
school
Discomfort Likelihood
Catastrophising step I might do poorly on a
test. 3 20 Id get a bad grade in the
class. 3 100 That would lower my
grade-point average.
2 100 Id have less of a chance of
getting a good job. 2 60 Id end up
in a bad job. 2 80 Id get a low
salary. 2 100 Id have less money to
spend on what I want.
2 100 Id be unhappy.
2 35 It would be a strain
on me. 2 10 Id worry more.
2 5 Source after Vasey and Borkovec, 1992
15
Theories of GAD

• GAD as an inherited characteristic
• GAD and information processing biases
• GAD and beliefs about worrying
• Dispositional characteristics of worriers

16
Obsessive-Compulsive Disorder

• OCD
• Repeated, unwanted thoughts, images or
  compulsions
• Compulsive washing and fears of contamination
• Compulsive checking

17
The Experience of Howard Hughes

• It would appear that during his declining years
  Howard Hughes suffered from a severe obsessional
  disorder, among many other problems. Although the
  information is scanty and of unknown reliability,
  it seems extremely probable that he had a strong
  obsessional fear of contamination. In order to
  avoid infection, he constructed for himself a
  sterile, isolated environment in which his
  contact with potentially contaminated people was
  kept to a minimum. For the most part he
  successfully avoided touching any person or
  object directly instead, he covered himself
  with paper tissues and other protective
  materials. His barber was required to repeatedly
  sterilise all of his instruments by immersing
  them in alcohol. There was a complicated ritual
  for handling objects. Before handing Hughes a
  spoon, his attendants had to wrap the handle in
  tissue paper and seal it with cellophane tape. A
  second piece of tissue was wrapped around the
  first protective wrapping to ensure that it would
  be protected from contamination. On receiving the
  protected spoon. Hughes would use it only with
  the handle covered. When he finished with it, the
  tissue was discarded into a specially provided
  receptacle. The spoon itself had to be carefully
  cleaned.
• On one occasion he observed that a bottle had
  been broken on the steps of his range. He wrote
  out a series of instructions that involved
  marking out a grid of one-inch squares on each
  step and then meticulously cleaning one square at
  a time to ensure that every splinter of glass had
  been removed. 

18
Theories of OCD

• Biological factors
• Psychological factors
• Memory deficits
• Inflated responsibility

19
Post-Traumatic Stress Disorder

• PTSD symptoms include
• Increased arousal, hypervigilance and sleeping
  difficulties
• Numbing of emotions
• Re-experiencing (vivid flashbacks, recurrent
  nightmares)

20
Predictors of PTSD

• Vulnerability Factors
• Feeling responsibility for the traumatic event
• Developmental factors (e.g. early separation)
• Family history of PTSD
• Existing high levels of anxiety or
  pre-disposition to psychological disorders

21
Theories of PTSD

• Theory of shattered assumptions (Bolton Hill,
  1996)
• Emotional processing theory (Foa et al., 1989)
• Mental defeat (Ehlers Clark, 2000)

22
Mood Disorders

• Bipolar disorder
• Major depression (unipolar)

23
The Characteristics of Depression

• Sadness
• Lethargy
• Low self-esteem
• Lack of initiative
• Loss of appetite, sleep and sexual desire
• Associated with loss or perceived failure

24
Bipolar Disorder

• Depression I doubt completely my ability to do
  anything well. It seems as though my mind has
  slowed down and burned out to the point of being
  virtually useless I am haunted with the
  total, the desperate hopelessness of it all.
  Others say, Its only temporary, it will pass,
  you can get over it, but of course they havent
  any idea of how I feel, although they are certain
  they do. If I cant feel, move, think or care,
  then what on earth is the point?
•  
• Hypomania At first when Im high, its
  tremendous ideas are fast like shooting stars
  you follow until brighter ones appear. All
  shyness disappears, the right words and gestures
  are suddenly there uninteresting people, things
  become intensely interesting. Sensuality is
  pervasive, the desire to seduce and be seduced is
  irresistible. Your marrow is infused with
  unbelievable feelings of ease, power, well-being,
  omnipotence, euphoria you can do anything
  but, somewhere this changes.
•  
• Mania The fast ideas become too fast and there
  are far too many overwhelming confusion
  replaces clarity you stop keeping up with it --
  memory goes. Infectious humour ceases to amuse.
  Your friends become frightened everything is
  now against the grain you are irritable, angry,
  frightened, uncontrollable, and trapped.

25
Causes of Bipolar Disorder

• Inherited predisposition
• The role of brain neurotransmitters

26
Major Depression (Unipolar)

• Biological causes
• Psychological and cognitive factors
• Becks cognitive theory
• Learned helplessness theory
• Attributional theories

27
Becks Negative Schema
28
Schizophrenia

• The experience of schizophrenia
• Delusions
• Hallucinations
• Disordered thinking
• Inappropriate moods and behaviours
• Lack of insight into the actions of others
• Flat affect
• Problems in concentrating and planning
• Negative mood

29
Diagnosing Schizophrenia

• Disorganised schizophrenia disorganised speech,
  flat affect and shifts of emotion behaviour is
  generally disorganised, neglects appearance and
  may be incontinent
• Catatonic schizophrenia alternate between
  catatonic immobility and excitement may echo
  back the speech of others, states of stupor
• Paranoid schizophrenia
• Grandiose delusions exaggerated sense of own
  importance, power, knowledge
• Delusional jealousy delusions of being
  persecuted or being spied on belief that partner
  is being unfaithful
• Paranoia delusions of persecution generally
• Supplemental types
• Undifferentiated schizophrenia category reserved
  for those who meet the criteria for
  schizophrenia, but not for any of the above three
  categories
• Residual schizophrenia individual shows some
  signs of the disorder, but no longer meets the
  full criteria for schizophrenia

30
The Causes of Schizophrenia

• Genetic factors
• Biochemical factors
• Neo-analytic perspectives
• Expressed emotion (EE)

31
Genetic Factors

• Family inheritance
• Concordance studies
• Twin studies
• Relation to proband with schizophrenia
• Spouse 1.00
• Grandchildren 2.84
• Nieces/nephews 2.65
• Children 9.35
• Siblings 7.30
• Dizygotic (fraternal) twins 12.08
• Monozygotic (identical) twins 44.30

32
Biochemical Factors

• Amphetamine psychosis
• Dopamine hypothesis
• The effect of antipsychotic drugs

33
Neo-Analytic Perspectives

• Schizophrenogenic mother (Fromm-Reichman, 1948)
• Double-bind hypothesis (Bateson et al., 1956)

34
The Role of Expressed Emotion

• Relapse is a function of
• Number of critical remarks made by family members
• Number of expressions of hostility towards the
  individual
• Number of comments indicating emotional
  over-involvement with the individual

35
Personality Disorders
A. An enduring pattern of inner experience and
behaviour that deviates markedly from the
expectations of the individuals culture. This
pattern is manifested in two (or more) of the
following areas cognition, affectivity,
interpersonal functioning, impulse control B.
The enduring pattern is inflexible and pervasive
across a broad range of personal and social
situations. C. The enduring pattern leads to
clinically significant distress or impairment in
social, occupational or other important areas of
functioning. D. The pattern is stable and of
long duration and its onset can be traced back to
adolescence or early adulthood. E. The enduring
pattern is not better accounted for as a
manifestation or consequence of another mental
disorder. F. The enduring pattern is not due to
the direct physiological effects of a substance
(e.g. a drug of abuse, a medication) or a general
medical condition (e.g. head trauma).
36
Antisocial Personality Disorder (ASPD)

• Failure to conform to social and legal norms
• Deceitfulness and impulsivity
• Irritability and aggressiveness
• Consistent irresponsibility
• Lack of remorse

37
Eating Disorders

• Anorexia nervosa (AN)
• Bulimia nervosa (BN)

38
Diagnosing Anorexia Nervosa

• Refusal to maintain body weight above 85 of norm
• Intense fear of gaining weight or becoming fat
• Disturbance in normal perception of body shape
• The absence of at least three consecutive
  menstrual cycles (in post-menarcheal females)

39
Theories of Anorexia Nervosa

• Biological models
• Inherited factors
• Neuroendocrine dysfunction
• Biopsychosocial models
• Media and peer pressure
• Familial influences
• Life experience factors
• Psychological factors

40
Disorders of Childhood Adolescence

• Externalising disorders
• Attention deficit hyperactivity disorder (ADHD)
• Conduct disorders
• Internalising disorders
• Childhood anxiety and depression

41
Attention Deficit Disorder (ADD)

• Mark, age 14, has more energy than most boys his
  age. But then, hes always been overly active.
  Starting at age 3, he was a human tornado,
  dashing around and disrupting everything in his
  path. At home, he darted from one activity to the
  next, leaving a trail of toys behind him. At
  meals, he upset dishes and chattered nonstop. He
  was reckless and impulsive, running into the
  street with oncoming cars, no matter how many
  times his mother explained the danger or scolded
  him. In the playground, he seemed no wilder than
  the other kids. But his tendency to overreact
  like hitting playmates simply for bumping in to
  him had already gotten him into trouble several
  times. His parents didnt know what to do. Marks
  doting grandparents reassured them, Boys will be
  boys. Dont worry, hell grow out of it. But he
  didnt.

42
Theories of ADD

• Biological theories
• Inherited factors
• Brain dysfunction
• Biochemical theories
• Psychological theories
• Delay of gratification
• Sensation-seeking behaviour
• Vicious cycles between child and parent

43
Childhood Anxiety

• Categories of childhood anxiety
• Separation anxiety disorder (SAD)
• Specific phobias
• Generalised anxiety disorder (GAD)
• Panic disorder

44
Differentiating Childhood Anxiety
Externalising Disorders

• Children with externalising disorders are more
  likely to be boys
• Anxious children are more likely to have anxious
  parents
• Anxious children are more likely to show avoidant
  behaviours