Chapter 14: Psychological Disorders

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Chapter 14 Psychological Disorders
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Abnormal Behavior

• The medical model a disease or a problem
  living?
• What is abnormal behavior?
• Deviant (violate social norms)
• Maladaptive (disturbs daily behavior)
• Causing personal distress
• A continuum of normal/abnormal hard to gauge
  normal versus abnormal behavior!

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Figure 14.2 Normality and abnormality as a
continuum
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Prevalence, Causes, and Course

• Epidemiology distribution of mental or physical
  disorders in a population
• Prevalence the of the population that
  exhibits a disorder
• Lifetime prevalence -- of people diagnosed with
  a certain disorder in their lifetime about 44
  of the adult population will have some type of
  psychological disorder in their lifetime!!!
• Diagnosis distinguishes one illness from
  another
• Etiology apparent cause and development of
  illness
• Prognosis forecast of the course of the illness

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Figure 14.5 Lifetime prevalence of psychological
disorders
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PsychodiagnosisThe Classification of Disorders

• American Psychiatric Association
• Diagnostic and Statistical Manual of Mental
  Disorders 4th ed. (DSM - 4)

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Five Axes

• Axis I Clinical Syndromes
• Axis II Personality Disorders or Mental
  Retardation
• Axis III General Medical Conditions
• Axis IV Psychosocial and Environmental Problems
• Axis V Global Assessment of Functioning

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Axis I Clinical Syndromes

• Anxiety Disorders
• Somatoform Disorders
• Dissociative Disorders
• Mood Disorders
• Schizophrenic Disorders

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Clinical Syndromes Anxiety Disorders

• Excessive apprehension and anxiety
• Generalized anxiety disorder
• free-floating anxiety not tied to any one
  threat
• Phobic disorder
• Specific focus of fear
• Panic disorder and agoraphobia (patients become
  worried about having a panic attack in public, so
  develop agoraphobia, a fear of leaving the house)
• Obsessive compulsive disorder
• Obsessions (unwanted thoughts)
• Compulsions (irrational behaviors, washing and
  rewashing etc.)
• Posttraumatic Stress Disorder (re-experiencing
  the traumatic event in nightmares, flashbacks,
  emotional numbing, alienation, problems socially,
  anxiety and guilt)

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Etiology of Anxiety Disorders

• Biological factors
• Genetic predisposition, anxiety sensitivity
• GABA circuits in the brain
• Conditioning and learning
• Acquired through classical conditioning or
  observational learning
• Maintained through operant conditioning
• Cognitive factors
• Judgments of perceived threat
• Personality
• Neuroticism
• Stressa precipitator

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Figure 14.6 Twin studies of anxiety disorders
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Figure 14.7 Conditioning as an explanation for
phobias
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Figure 14.8 Cognitive factors in anxiety
disorders
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Clinical Syndromes Somatoform Disorders

• Somatization Disorder physical ailments that
  seem to have psychological origins
• Conversion Disorder loss of of physical
  function with no organic reason, usually in only
  one organ blindness, paralysis mutism etc.
• Hypochondriasis excessive preoccupation with
  health concerns and potential illness
• Etiology
• Reactive autonomic nervous system
• Personality factors
• Cognitive factors
• The sick role, reinforced by attention and
  sympathy

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Figure 14.10 Glove anesthesia
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Clinical Syndromes Dissociative Disorders

• People lose contact with portions of their
  consciousness or memory, resulting in disruptions
  in their sense of identity.
• Dissociative amnesia certain loss of memory for
  important personal information. Not just normal
  forgetting.
• Dissociative fugue loss of memory and personal
  identity for entire life. Cannot remember own
  name, but can still do math!
• Dissociative identity disorder formerly
  multiple personality disorder
• Etiology
• severe emotional trauma during childhood
• Controversy
• Media creation? Only ¼ of psychiatrists polled
  felt there was scientific evidence to prove DID.

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Clinical Syndromes Mood Disorders

• Major depressive disorder marked by profound
  sadness, loss of interest in previous sources of
  pleasure. 2x as prevalent in women than men.
• Dysthymic disorder less severe
• Bipolar disorder episodes of mania followed by
  episodes of depression
• Cyclothymic disorder chronic but minor symptoms
  of bipolar disorder.
• Etiology
• Genetic vulnerability
• Neurochemical factors disturbances in serotonin
  and norepinephrine.
• Cognitive factors negative thinking contributes
  to depression, hopelessness theory and learned
  helplessness.
• Interpersonal roots high stress, low
  self-esteem, ruminating over problems etc.
• Precipitating stress

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Figure 14.11 Episodic patterns in mood disorders
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Figure 14.13 Twin studies of mood disorders
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Figure 14.15 Negative thinking and prediction of
depression
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Figure 14.16 Interpersonal factors in depression
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Clinical Syndromes Schizophrenia

• General symptoms
• Delusions and irrational thought, disorganized
  speech and behavior
• 1 of population (several million in US!)
• Deterioration of adaptive behavior cannot
  function in day-to-day life
• Hallucinations often hearing voices
• Disturbed emotions
• Prognostic factors usually better prognosis
  when onset is later in life.

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Subtyping of Schizophrenia

• 4 subtypes
• Paranoid type delusions of persecution and
  delusions of grandeur
• Catatonic type motor disturbance rigid or
  random
• Disorganized type incoherence, social
  withdrawal, delusions concerning own body
• Undifferentiated type a catch-all category
• New model for classification
• Positive vs. negative symptoms?
• People disagree with the subcategories.

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Etiology of Schizophrenia

• Genetic vulnerability
• Neurochemical factors dopamine and serotonin
• Structural abnormalities of the brain enlarged
  ventricles a cause or effect of schizophrenia?
• The neurodevelopmental hypothesis prenatal
  viral infections or malnutrition
• Expressed emotion reaction of relatives can
  affect the course of the illness.
• Precipitating stress unhealthy family dynamics

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Figure 14.18 The dopamine hypothesis as an
explanation for schizophrenia
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Figure 14.20 The neurodevelopmental hypothesis
of schizophrenia
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Personality Disorders

• Anxious-fearful cluster
• Avoidant (worried about rejection, humiliation
  and shame), dependent (lack self-reliance),
  obsessive-compulsive (preoccupied with rules,
  lists, schedules etc.)
• Dramatic-impulsive cluster
• Histrionic (overly emotional), narcissistic
  (self-important, lacking in empathy for others),
  borderline (unstable self-image, mood and
  interpersonal relationships), antisocial (no
  respect for others, ignoring social norms, unable
  to form attachments)
• Odd-eccentric cluster
• Schizoid (unable to form social relationships),
  schizotypal (social deficits in thinking,
  perception and communication), paranoid
  (suspicious and mistrustful)
• Etiology
• Genetic predispositions, inadequate socialization
  in dysfunctional families and observational
  learning.

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Table 14.2 Personality Disorders
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Psychological Disorders and the Law

• Insanity
• Mnaghten rule unable to distinguish between
  right and wrong
• Involuntary commitment
• danger to self
• danger to others
• in need of treatment can be involuntarily
  committed for 24-72 hrs before going through the
  courts.

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Figure 14.22 The insanity defense public
perceptions and actual realities
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Culture and Pathology

• Cultural variations
• Culture bound disorders
• Koro obsessive fear that ones penis will
  withdraw into ones abdomen, seen only in regions
  of southern Asia!
• Windigo fear of turning into a cannibal! Seen
  in Algonquin Native American cultures.
• Anorexia nervosa eating disorder only prevalent
  in affluent Western cultures.