Psychological Disorders and Their Treatment

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Chapter 11Psychological Disorders and Their
Treatment
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Prevalence of Psychological Disorders

• In a year in the U.S.
• 20 of persons experience psychological problems
  severe enough to adversely affect their daily
  living.
• 40 of persons experience at least mild mental
  health problems.
• About 2.1 million people are admitted to
  hospitals due to serious psychological problems.
• Worldwide
• About 400 million people are afflicted with
  psychological disorders.

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How Should We Understand Psychological Disorders?

• The medical model proposes that psychological
  disorders have a biological basis and can be
  classified into discrete categories and are
  analogous to physical diseases.

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How Should We Understand Psychological Disorders?

• Although not agreeing that all mental health
  problems have a biological basis, mainstream
  psychology has adopted the medical models
  terminology.
• Symptom a sign of a disorder
• Diagnosis distinguishing one disorder from
  another
• Etiology a disorders apparent causes and
  developmental history
• Prognosis prediction about the likely course of
  a disorder

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Defining Psychological Disorders

• A pattern of atypical behavior
• Results in personal distress or
• Significant impairment in a persons social or
  occupational functioning

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Defining Psychological Disorders

• Major criteria used to differentiate normal from
  disordered behavior
• Atypical
• Significantly above or below the average in its
  frequency of occurrence
• Violates cultural norms
• Maladaptive
• Interferes with ability to perform normal
  activities
• Causes personal distress
• Individuals who report experiencing troubling
  emotions are often considered to have
  psychological problems.

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Numerous Theoretical Explanations

• Five primary perspectives to understand mental
  illness
• Psychodynamic Disordered behavior is controlled
  by unconscious forces shaped by childhood
  experiences.
• Behavioral Disordered behavior is caused by
  identifiable factors in the persons environment
  and results from learning.
• Cognitive ineffective or inaccurate thinking is
  the root cause of mental illness

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Numerous Theoretical Explanations

• Five primary perspectives to understand mental
  illness
• Sociocultural Mental illness is the product of
  broad social and cultural forces .
• Biological Disordered behavior is caused by
  biological conditions, such as genetics, hormone
  levels, or neurotransmitter activity in the
  brain.

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Combined Models

• Diathesis-stress model a predisposition to a
  given disorder (diathesis) that combines with
  environmental stressors to trigger a
  psychological disorder
• Bio-psycho-social model. Takes into account
  predispositions, personal experience, and life
  circumstances.

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The Diathesis-Stress Model
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Psychological Disorders

• Bio-psycho-social Perspective
• assumes that biological, sociocultural, and
  psychological factors combine and interact to
  produce psychological disorders

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Models from Outside Psychology

• Spirit Possession
• Trephining
• Lunacy
• Curses
• Family/generational
• Occult (voodoo, witchcraft)
• Sin
• Guilt
• Unforgiveness, bitterness

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Risks of Using Diagnostic Labels

• David Rosenhan demonstrated diagnostic labels
  biasing effects.
• Misdiagnosis of insanity by hospital personnel
  due to their bias toward calling a healthy person
  sick
• Diagnostic labels can harm patients in several
  ways.
• Label may dehumanize patients by encouraging
  mental health practitioners to treat them as
  labels rather than as unique individuals with
  problems.
• Labeled individuals may experience discrimination
  and may cause people to expect those labeled to
  behave abnormally and thus to misperceive normal
  behavior as disordered.

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Benefits of Using Diagnostic Labels

• Despite ethical concerns, diagnostic labels are
  used because they serve several important
  functions
• Summarize patients symptoms or problems, and
  thus, communicate great deal of information with
  a single word
• Convey information about possible causes of the
  disorder
• Convey information about the patients prognosis

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DSM Classification System

• Diagnostic and Statistical Manual of Mental
  Disorders (DSM) use to diagnose mental disorders
• Published by the American Psychiatric
  Association.
• Since 1980, DSM has been updated several times
  and is now in its fourth edition, text revision,
  or DSM-IV-TR.

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DSM Classification System

• DSM classification system is descriptive rather
  than explanatory, meaning that
• it is not based on a particular theory concerning
  the cause(s) of psychological disorders.
• diagnoses are based mainly on observable
  symptoms.
• DSM provides clearer directions concerning
  number, duration, and severity of symptoms
  necessary to assign a diagnosis.
• By recognizing that two patients with same
  disorder may substantially differ from one
  another, clinicians much more likely to
  acknowledge uniqueness of all patients.

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Anxiety Disorders Distressing, Persistent
Anxiety, Maladaptive Behavior

• Characterized by distressing, persistent anxiety
  or maladaptive behavior
• About 25 percent of the population will
  experience this disorder in our lifetime.
• Anxiety disorders occur across the life span and
  commonly co-occur with many other disorders, such
  as depression and substance abuse.

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Anxiety Disorders Distressing, Persistent
Anxiety, Maladaptive Behavior

• Five major anxiety disorders
• Panic disorder brief episodes of intense anxiety
  with no apparent reason
• Phobic disorder strong irrational fears of
  specific objects or situations, called phobias
• Generalized anxiety disorder (GAD) a constant
  state of moderate anxiety

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Anxiety Disorders Distressing, Persistent
Anxiety, Maladaptive Behavior

• Five major anxiety disorders
• Obsessive-compulsive disorder repetitive,
  unwanted, and distressing actions and/or thoughts
  
• Post-traumatic stress disorder occurs among
  individuals who have experienced or witnessed
  traumatic events
• Later reexperience the event through nightmares,
  flashbacks, and avoid situations or persons that
  trigger flashbacks

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Anxiety Disorders
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Anxiety Disorders

• PET Scan of brain of person with obsessive/
  compulsive disorder
• High metabolic activity (red) in frontal lobe
  areas involved with directing attention

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Etiology of Anxiety Disorders

• Genetic and biological factors
• Genetic heritage may predispose us to more easily
  develop phobic reactions or to respond intensely
  to stressful events.
• Behavioral or conditioning factors
• Classical conditioning may instill conditioned
  emotional responses, and operant conditioning may
  reinforce and maintain the persons avoidance
  responses.
• Cognitive factors
• People suffering from panic disorder closely
  monitor their physiological reactions, and often
  exaggerate the significance of their
  physiological symptoms.

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Mood Disorders Emotional Extremes

• Characterized by emotional extremes that cause
  significant disruption in daily functioning.
• To qualify as a mood disorder, emotional extremes
  must persist for a long time.
• Most common mood disorder is depression
• Characterized by extreme and persistent negative
  moods and the inability to experience pleasure by
  participating in activities one previously
  enjoyed (Kramlinger, 2001)

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Mood Disorders Emotional Extremes

• Depressed individuals
• Often experience physiological problems such as
  lack of appetite, weight loss, fatigue, and sleep
  disorders
• Often experience behavioral symptoms, such as
  slowed thinking and acting, social withdrawal,
  and decreased activity
• Exhibit cognitive symptoms, such as low
  self-esteem, thinking about death and/or suicide,
  and having little hope for the future

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Mood Disorders-Depression

• The vicious cycle of depression can be broken at
  any point

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Mood Disorders-Depression
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Mood Disorders Emotional Extremes

• Bipolar disorder characterized by swings between
  the emotional extremes of mania and depression
• Less common than major depressive disorder,
  occurring in about 1 percent of the population
• Unlike major depression, this disorder occurs
  about equally in men and women and tends to occur
  earlier than major depression

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Mood Disorders Emotional Extremes

• Bipolar disorder
• Bipolar patients depressive episodes differ from
  the depressive episodes in major depression in
  that they tend to be more severe, are accompanied
  by higher suicide risks, and have a distinct
  pattern of brain activity during sleep.

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Mood Disorders-Bipolar

• PET scans show that brain energy consumption
  rises and falls with emotional swings

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Suicide

• A major danger of depression is suicide.
• As many as 30 of people with severe mood
  disorders die from suicide.
• In the U.S. suicide rates are higher among
• Men than women
• Elderly adults than younger adults
• Unemployed ( retired) adults than employed
  persons
• Widowed adults than married adults
• Native European Americans than Asian. Hispanic,
  and African Americans.

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Etiology of mood disorders

• Genetic/ biological influence?
• Bipolar patients show imbalances in neural
  circuits using serotonin, norepinephrine, etc.?
  Enlarged amygdala?
• Major depressive disorder Family, twin, and
  adoption studies indicate at least a moderate
  genetic influence on depression.
• Cognitive contributions
• Depressed persons have negative views and they
  misinterpret daily experiences so that their
  negative outlook is supported.
• Behavioral psychologists propose that depression
  results from low social reinforcement.

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Gender Mood Disorders

• Why is depression more common among women?
• May due to biological factors.
• Sociocultural factors Women have fewer
  educational and occupational opportunities,
  receive less money for their work, and experience
  more violence due to their gender than men.
• Difference in diagnosis?
• Women may be diagnosed more frequently because
  they are more likely to seek help for their
  problems.
• Gender bias among mental health professionals may
  result in women and men with identical symptoms
  being diagnosed differently, i.e., women labeled
  as depressed and men diagnosed with other
  conditions

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Dissociative Disorders Loss of Contact with
Consciousness or Memory

• Characterized by disruptions in consciousness,
  memory, sense of identity, or perception
• Dissociative amnesia a sudden loss of memory of
  ones identity and other personal information
• Dissociative fugue a sudden departure from home
  or work, combined with loss of memory of identity
  and the assumption of a new identity

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Dissociative Disorders Loss of Contact with
Consciousness or Memory

• Dissociative identity disorder (DID)
  characterized by the presence of two or more
  distinct identities or personalities, which take
  turns controlling the persons behavior (also
  known as multiple personality disorder)

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Etiology of Dissociative Disorders

• Psychodynamic theory results from the
  individuals attempt to repress some troubling
  event
• Biological explanation patient may have a
  neurological problem that has not yet been
  detected
• Cognitive perspective individuals learn to
  dissociate as a way to cope with intense distress

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Schizophrenia Disturbances in Almost All Areas
of Psychological Functioning

• Characterized by severe impairment in thinking,
  including hallucinations, delusions, or loose
  associations
• Diagnosed when symptoms persist for at least six
  months, are not due to some other condition, and
  cause significant impairment in daily functioning
  
• Schizophrenics often cannot work, manage a home
  or apartment successfully, or care for their
  basic needs.

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Schizophrenia

• Delusions
• false beliefs, often of persecution or grandeur,
  that may accompany psychotic disorders
• Hallucinations
• false sensory experiences such as seeing
  something without any external visual stimulus

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Risk of Developing Schizophrenia
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Personality Disorders Inflexible Behavior
Patterns That Impair Social Functioning

• Personality disorders general styles of living
  that are ineffective and lead to problems for the
  person and for others
• Ten personality disorders in the DSM-IV-TR.

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Personality Disorders Inflexible Behavior
Patterns That Impair Social Functioning

• Three common personality disorders are
• Paranoid personalities habitually distrustful
  and suspicious of others motives
• Histrionic personalities excessively emotional
  and attention seeking, often turning minor
  incidents into full-blown dramas
• Narcissistic personalities desire constant
  admiration from others  

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Personality Disorders Inflexible Behavior
Patterns That Impair Social Functioning

• The personality disorder that receives the most
  attention is the antisocial personality disorder.
• Exhibit a persistent pattern of disregard for and
  violation of the rights of others
• Repeatedly exhibit antisocial behavior across all
  realms of life, lying, cheating, stealing, and
  manipulating others
• When caught, they take no responsibility and feel
  no remorse.

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Personality Disorders
Those with criminal convictions have lower levels
of arousal
15 10 5 0
Adrenaline excretion(ng/min)
Nonstressful situation
Stressful situation
No criminal conviction
Criminal conviction
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Personality Disorders
PET scans illustrate reduced activation in a
murderers frontal cortex
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Etiology of Personality Disorders

• A genetic component related to abnormal brain
  development or chronic underarousal of both the
  autonomic and central nervous systems
• May be caused by the interaction of both
  biological and environmental factors.
• Children in chaotic households who have a
  biological predisposition for this disorder may
  not learn to control their impulses, and so
  behave in ways to maximize their benefit even if
  this means violating social rules.

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What Are the Therapies for Psychological
Disorders?

• The two broad categories of therapy
• Psychotherapy psychological methods that include
  a personal relationship between a trained
  therapist and a client
• Biomedical therapies the treatment of
  psychological disorders by altering brain
  functioning with physical or chemical
  interventions

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What Are the Therapies for Psychological
Disorders?

• The two broad categories of therapy
• Psychotherapy psychological methods including a
  personal relationship between a trained therapist
  and a client
• Biomedical therapies altering brain functioning
  with physical or chemical interventions

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What Are the Therapies for Psychological
Disorders?

• Three mental health professions
• Psychiatry
• Social work
• Psychology
• Two specialty areas in psychology
• Clinical psychology
• Counseling psychology

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Psychodynamic Therapies

• A group of psychotherapies based on the work of
  Sigmund Freud that say that psychological
  disorders stem from unconscious forces
• Important psychodynamic terms
• Free association therapy technique in which
  clients say whatever comes to mind
• Resistance anything client does to interfere
  with free chain of thought or therapeutic
  progress
• Transference client transfers feelings for
  significant others early in life to therapist
  (countertransference)

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Behavior Therapies

• Psychotherapies that apply learning principles to
  the elimination of unwanted behaviors.
• Counterconditioning is based on classical
  conditioning.
• Counterconditioning involves conditioning new
  responses to stimuli that trigger unwanted
  behaviors

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Counterconditioning Three Techniques

• Systematic desensitization
• used to treat phobias in which client is
  gradually exposed to feared object, while
  remaining relaxed
• Response prevention
• used to treat obsessive-compulsive disorder
  client is exposed to situation that triggers the
  compulsive behavior but is not permitted to
  engage in the ritual
• Aversive conditioning
• a classically conditioned aversive response is
  conditioned to occur in response to a stimulus
  that has previously been associated with an
  undesired behavior

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Aversive Conditioning for Alcoholism
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Aversive Conditioning for Alcoholism
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Aversive Conditioning for Alcoholism
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Humanistic Therapies Focus on Feelings and
Personal Growth

• Goal To help people get in touch with
• their feelings,
• their true selves
• their purpose in life

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Humanistic Therapies Focus on Feelings and
Personal Growth

• Humanistic therapies help people get in touch
  with their feelings, with their true selves,
  and with their purpose in life
• Client-centered therapy Carl Rogers
• Therapists should be facilitators of personal
  growth providing supportive environmentclients
  discover their true selves.
• Gestalt therapy Fritz Perls
• Therapists help people become aware of their true
  feelings or some other important aspect of the
  self.

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Cognitive Therapies Focus on Altering
Dysfunctional Thought Patterns

• Cognitive therapies seek to identify and then
  modify faulty cognitive processes.
• Rational-emotive behavior therapy (REBT) Albert
  Ellis
• Mental distress is caused by the irrational
  thinking people have about those events.
• Cognitive-behavior therapy (CBT) Aaron Beck
• Depressed people have negative views of
  themselves, the world, and their future, and they
  misinterpret everyday events to support these
  negative views.

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Cognitive Therapy

• Cognitive Therapy
• teaches people new, more adaptive ways of
  thinking and acting
• based on the assumption that thoughts intervene
  between events and our emotional reactions

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Cognitive Therapy

• The Cognitive Revolution

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Cognitive Therapy

• Cognitive-Behavior Therapy
• a popular integrated therapy that combines
  cognitive therapy (changing self-defeating
  thinking) with behavior therapy (changing
  behavior)

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Cognitive Therapy

• A cognitive perspective on psychological disorders

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Child, Group Family Therapy

• Child therapies
• Common approach usedplay therapy
• Therapist provides children with toys and drawing
  materials
• Assumption is that whatever is troubling them
  will be expressed in play

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Child, Group Family Therapy

• Group therapies
• Simultaneous treatment of several clients under
  the guidance of a therapist
• Variation of group therapy is the self-help
  group
• Several people regularly meeting and discussing
  their problems with one another without the
  guidance of a therapist

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Child, Group Family Therapy

• Family and couples therapies
• Family therapiesdesigned to constructively
  modify the dysfunctional relationships among
  family members
• Couples therapydesigned to help couples improve
  the quality of their relationship

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Who Does Therapy?

• Where do people turn for help?

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Who Does Therapy?
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Evaluating Therapy

• Client Perceptions
• Consumer Reports Study
• Clinicians Perceptions
• Outcome Research
• Spontaneous Remission
• Regression toward the mean

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Does Therapy Work?

• Meta-analysis
• procedure for statistically combining the results
  of many different research studies

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Alternative Therapies

• Disconnect between Research and Therapy
• Alternative Therapies
• Therapeutic touch
• Eye movement desensitization
• Light exposure therapy

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Commonalities among Therapies

• A new perspective
• Trusting, caring relationship
• Culture and values (therapist-client match)

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Biomedical Therapies

• Psychopharmacology
• study of the effects of drugs on mind and
  behavior
• Lithium
• chemical that provides an effective drug therapy
  for the mood swings of bipolar (manic-depressive)
  disorders

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Biomedical Therapies

• The emptying of U.S. mental hospitals

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Biomedical Therapies

• Today in the United States, less than one-third
  the number of people are full-time residents in
  psychiatric hospitals.
• Reason for this sharp decreasethe widespread use
  of drug therapies in treating psychological
  disorders
• This form of therapy is often less expensive than
  psychological therapies.

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Use of Drugs in Treating Psychological Disorders
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Biomedical Therapies
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Antipsychotic Drugs Reduce Dopamine Activity

• Antipsychotic drugs
• a group of medications that are effective in
  treating the delusions, hallucinations, and loose
  associations of schizophrenia by blocking
  dopamine receptors thereby reducing dopamine
  activity
• Do not actually cure schizophrenia. They
  merely help control its severe symptoms.

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Classes of Psychoactive Drugs

• Antipsychotics
• Thorazine
• Clozapine
• Olanzapine, etc.
• Block dopamine receptor sites
• Treat Schizophrenia other psychoses
• May cause sluggishness muscle tremors

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Classes of Psychoactive Drugs

• Antianxiety
• Valium, Librium, Xanax, etc.
• Tend to be addictive

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Classes of Psychoactive Drugs

• Antidepressants
• Increase availability of epinephrine or serotonin
• Prozac, Zoloft, Paxil, etc. worlds most widely
  prescribed drugs
• Require about a month for full effectiveness

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Antidepressant Drugs Increase Serotonin and
Norepinephrine

• MAO inhibitors (MAOI) inhibit the enzyme involved
  in breaking down norepinephrine and serotonin are
  called the monoamine oxidase inhibitors (MAOI).
• Tricyclics are antidepressant drugs that have
  milder side effects than MAOI inhibitors
• Antidepressants that affect only serotonin are
  selective serotonin reuptake inhibitors (SSRIs).

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Biomedical Therapies

• Electroconvulsive Therapy (ECT)
• therapy for severely depressed patients in which
  a brief electric current is sent through the
  brain of an anesthetized patient
• Psychosurgery
• surgery that removes or destroys brain tissue in
  an effort to change behavior

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Electroconvulsive Therapy (ECT)

• A physiological treatment for severe depression
  in which a brief electric shock is administered
  to the brain of an anesthetized patient
• Although ECT is effective in treating severe
  depression, no one knows for sure why it works.
• Several temporary negative side effects,
  including confusion, loss of memory, and impaired
  motor coordination

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Electroconvulsive Therapy
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Psychosurgery Destroys Portions of the
Brain

• Most radical controversial treatment
• A seldom-used surgical procedure in which brain
  tissue thought to cause the disorder is
  destroyed.
• Today, MRI-guided precision psychosurgery is
  performed only in extreme cases and it focuses on
  much smaller brain areas than those involved in
  lobotomies.

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Lobotomy

• now-rare psychosurgical procedure once used to
  calm uncontrollably emotional or violent patients
  
• cut the nerves that connect the frontal lobes to
  the emotion-controlling centers of the brain