Psychological Disorders

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Psychological Disorders
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What do you think?

• Write a definition for a psychological disorder.
• Do not give examples or define specific
  disorders- what does it mean to have a
  psychological disorder?

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Psychological Disorder

• distressing harmful disruptive
• behavior is uncontrollable
• Unjustified, Irrational

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Psychological Disorders

• Must have personal distress and impaired
  functioning

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Personal Distress

• The behavior/symptoms causes significant personal
  distress to the patient (may not realize)
• Potential harm to self or others

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Impairs Functioning

• Daily life functioning is impaired (one or both)
• Work/School life
• Home life

• Varies throughout time/ culture

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Diagnosis DSM-IV-TR

• Diagnostic and Statistical Manual of Mental
  Disorders

• describes specific symptoms and diagnostic
  guidelines for psychological disorders
• Provides a common language comprehensive
  guidelines to help diagnose

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When diagnosing a client the American
Psychological Association recommends that the
clinician use a multiaxial Assessment System. As
follows

• Axis I Clinical Disorders
• Axis II Personality Disorders and Mental
  Retardation
• Axis III General Medical Condition (major medical
  conditions that may be relevant )
• Axis IV Psychosocial and Environmental Factors
  (psychosocial and environmental factors affecting
  the person)
• Axis V Global Assessment of Functioning (best
  guess of the clients overall level of
  functioning )

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Diagnosis

• Axis I 296.21 Major Depressive Disorder , Single
  Episode
• Axis I 303.90 Alcohol Dependence
• Axis II 301.6 Dependent Personality Disorder
• Axis III None
• Axis IV Recent Divorce, unemployment
• Axis V 58

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Insanity

• legal definition only
• unable to determine between right wrong or
  understand consequences

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Anxiety Disorders

• An unpleasant emotional state characterized by
  general, vague feelings of tension, fear and
  apprehension

Anxiety
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• Anxiety Disorders differ from general feelings of
  anxiety in that

• Distressing, persistent
• And/or
• The behaviors that reduce anxiety

begin to control and dominate life!
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Anxiety Disorders are

• Irrational (exaggerated or non existent threats,
  response is out of proportion)
• Uncontrollable (can not be turned off, even if
  the person wants to)
• Disruptive (interferes with life)

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Types of Anxiety Disorders

• GAD
• Panic
• Agoraphobia
• Phobias
• PTSD
• OCD

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Generalized Anxiety Disorder (GAD)

• Constant worry about many issues w/o cause,
  seriously interferes with functioning
• Physical symptoms
• headaches
• stomach aches
• muscle tension
• irritability

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Panic Disorder

• Panic attackssudden episode of helpless terror
  with high physiological arousal (increased blood
  pressure, heart beat, temp., sweating)

• Very frightening sufferers live in fear of
  having them

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• Agoraphobia often develops
• NOT FEAR OF OUTDOORS

• Fear of being in situations in which escape might
  be difficult, they dont feel safe- public
  places, crowds, wide open spaces
• Mostly confined to homes- they are safe there

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Specific Phobias

• Intense, irrational fears that may focus on .
• Inappropriate response to ..

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Natural environment type

• the fear of heights (acrophobia)
• the fear of lightning and thunderstorms
  (astraphobia).

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Situational type

• the fear of small confined spaces
  (claustrophobia)
• being "afraid of the dark," (nyctophobia).
• Monophobiafear of being alone
• Gephyrophobia - Fear of crossing bridges.
• Ligyrophobia Fear of loud noises.
• Xenophobia Fear of strangers, foreigners, or
  aliens.

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Blood/injection/injury type

• the fear of medical procedures including needles
  and injections (aichmophobia)
• Algobphobiafear of pain
• Pyrophobiafear of fire
• Emetophobia Fear of vomiting.
• Radiophobia Fear of radiation or x-rays
• Hemophopia (Haemophobia) Fear of blood

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Animal type

• the fear of spiders (arachnophobia)
• the fear of snakes (ophidiophobia).
• Ailurophobiafear of cats
• Myrmecophobia Fear of ants.
• Cynophobia Fear of dogs or of rabies.
• Mottephobia Aversion to moths and butterflies.

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Other

• the fear of the number 13 (triskaidekaphobia)
• the fear of clowns (coulrophobia).
• Anthropophobiafear of men
• Ephebiphobia Fear/dislike of teenagers.
• Zapatophobia - Fear of shoes, socks, or sandals.
  

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Common and uncommon fears
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Posttraumatic Stress Disorder (PTSD)

• Follows events that produce intense horror or
  helplessness (traumatic episodes)
• Actual or threatened death and/or injury
• War, Rape, Accidents, Attacks, Abuse, Rescue
  workers
• May be delayed after event- onset with trigger

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• Core symptoms include
• Frequent recollection of traumatic event, often
  intrusive and interfering with normal thoughts

• Avoidance of situations that trigger recall of
  the event
• Increased physical arousal associated with stress

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Obsessive-Compulsive Disorder (OCD)

• Obsessionsirrational, disturbing thoughts that
  intrude into consciousness
• Compulsionsrepetitive actions performed to
  alleviate obsessions

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• The compulsions (actions) help to keep away the
  obsessions (thoughts)
• If the actions are not performedanxiety
• Observable or mental compulsions

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OCD Examples

• Obsessions about getting hurt, hurting someone,
  getting sick, contamination, symmetry
• Compulsions cleaning, checking, hoarding,
  touching, counting, arranging, ordering,
  repeating phrases

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Personality Disorders

• Inflexible, maladaptive pattern of thoughts,
  emotions, behaviors
• stable over time and across situations
• deviate from the expectations of the individuals
  culture
• Antisocial, Borderline, Dependent, Narcissistic

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Antisocial Personality Disorder

• Might start as conduct disorder (children)
• Manipulative, charming, con man
• Cruel, destructive

• Lacking conscience, no guilt, no responsibility

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Borderline Personality Disorder

• Instability of mood, self-image, relationships
• Self-destructive behaviors, impulsive
• Fear of abandonment

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Dependent Personality Disorder

• Unable to make decisions or do things on own

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Narcissistic Personality Disorder

• self importance,
• success fantasies,
• need for attention,
• envy
• arrogance others are inferior

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Dissociative Disorders

• literally a dis-association of memory
• person suddenly becomes unaware of some aspect of
  their identity or history
• unable to recall except under special
  circumstances (e.g., hypnosis)
• dissociative amnesia, dissociative fugue,
  dissociative identity disorder

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Dissociative Amnesia

• Memory loss the only symptom
• Often selective loss surrounding traumatic events
• person still knows identity and most of their past

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Dissociative Amnesia

• Margie and her brother were recently victims of a
  robbery. Margie was not injured, but her brother
  was killed when he resisted the robbers.
• Margie was unable to recall any details from the
  time of the accident until four days later.

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Dissociative Fugue

• Amnesia with a journey involved often with
  identity replacement
• leaves home
• develops a new identity
• apparently no recollection of former life
• If fugue wears off
• old identity recovers
• new identity is totally forgotten

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Dissociative Fugue

• Jay, a high school physics teacher in New York
  City, disappeared three days after his wife
  unexpectedly left him for another man.
• Six months later, he was discovered tending bar
  in Miami Beach. Calling himself Martin, he
  claimed to have no recollection of his past life
  and insisted that he had never been married.

http//www.msnbc.msn.com/id/21134540/vp/153847241
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Dissociative Identity Disorder

• 2 or more distinct personalities manifested by
  the same person at different times, VERY rare and
  controversial disorder

• Most report recall of torture or sexual abuse as
  children and show symptoms of PTSD
• Pattern typically starts prior to age 10
  (childhood)

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Dissociative Identity Disorder (DID)

• Norma has frequent memory gaps and cannot account
  for her whereabouts during certain periods of
  time.
• While being interviewed by a clinical
  psychologist, she began speaking in a childlike
  voice. She claimed that her name was Donna and
  that she was only six years old.
• Moments later, she seemed to revert to her adult
  voice and had no recollection of speaking in a
  childlike voice or claiming that her name was
  Donna.

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Psychotic Disorders

• Psychotic loss of contact w/reality-
  irrational, distorted

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Schizophrenia

• Disordered thoughts/ communications/
• inappropriate emotions, bizarre behavior

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Symptoms of Schizophrenia

• Hallucinations
• Seeing hearing things that are not there
• Command (something/ someone giving orders)

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Symptoms of Schizophrenia

• Delusions
• Persecution (theyre out to get me paranoia)
• Grandeur (God complex, megalomania)
• being controlled (the CIA is controlling my brain
  with a radio signal)

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Symptoms of Schizophrenia

• disorganized speech (e.g., word salad)
• jumping from idea to idea without the benefit of
  logical association
• Paralogicon the surface, seems logical, but
  seriously flawed
• e.g., Jesus was a man with a beard, I am a man
  with a beard, therefore I am Jesus

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Symptoms of Schizophrenia

• Disorganized behavior
• behavior is inappropriate for the situation
• e.g., wearing sweaters and overcoats on hot days
• Emotion is inappropriately expressed
• no emotion at all in face or speech, laughing at
  very serious things, crying at funny things

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Types of Schizophrenia

• Paranoid type

• delusions of persecution, believes others are
  spying and plotting
• delusions of grandeur, believes others are
  jealous, inferior, subservient

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Catatonic type

• unresponsive to surroundings, purposeless
  movement, parrot-like speech
• usually marked by immobility for extended
  periods

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Disorganized type

• disorganized speech and behavior
• Childlike
• Inappropriate emotions
• delusions and hallucinations with little meaning

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• Vulnerability
• Cognitive impairments
• Social Anxiety
• Odd ideas

WHERE DOES IT COME FROM?
PSYCHOSIS!
Reinforcement Social stress Isolation Drug/Alcoho
l abuse
Early Causes Genetic Predisposition Prenatal
Factors
Nature AND Nurture!
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Mood Disorders

• Significant and persistent disruption in mood,
  causing impaired cognitive, behavioral, and
  physical functioning
• Major depression
• Dysthymic disorder
• SAD
• Bipolar disorder

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Major Depression

• extreme and persistent feelings of despondency,
  worthlessness and hopelessness that disturb
  everyday functioning

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Symptoms of Major Depression

• Emotionalsadness, hopelessness, guilt, turning
  away from others
• Behavioraltearfulness, dejected facial
  expression, loss of interest in normal
  activities, slowed movements and gestures,
  withdrawal from social activities

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• Cognitivedifficulty thinking and concentrating,
  global negativity, preoccupation with
  death/suicide
• Physicalappetite and weight changes, excessive
  or diminished sleep, loss of energy, global
  anxiety, restlessness

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treatment
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• Difficult to sleep, to eat, to think, to
  concentrate
• May have suicidal thoughts, may not be able to
  carry out plan

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Dysthymic Disorder

• Chronic, low-grade depressed feelings that are
  not severe enough to be major depression
• May develop in response to trauma, but does not
  decrease with time
• Usually does not severely impair functioning
• Over two years

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Seasonal Affective Disorder

• Episodes of depression occur in fall and winter
  then subside in spring and summer (Seasonal
  regularity)

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Bipolar Disorders

• Mood levels swing from severe depression to
  extreme euphoria (mania), can have normal in
  between
• No regular relationship to time of year (SAD)
• Can vary in length of time for depression and
  mania

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• Must have at least one manic episode
• Supreme self-confidence
• Grandiose ideas and movements, little effort in
  carrying out plans
• Flight of ideas
• Aggressive, hostile, wild, incomprehensible,
  violent

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PET scans show that brain energy consumption
rises and falls with emotional swings
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• There are over 250 identifiable types of
  psychotherapy, though the most influential are
• Psychoanalytical Therapies
• Humanistic Therapies
• Cognitive Therapies
• Behavior Therapies
• Group and Family Therapies
• Psychosurgery
• Psychopharmacology
• Any therapist who uses a combination of therapies
  is said to be using an eclectic approach to
  therapy

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Therapeutic Perspectives

• Psychoanalysis - assumes that many psychological
  problems are fueled by the childhood repression
  of impulses and conflicts
• Humanistic - goal is to boost self-fulfillment by
  helping people grow in self-awareness and
  self-acceptance.

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Therapeutic Perspectives

• Cognitive - attempt to teach people new, more
  adaptive ways of thinking and acting
• Behaviorists - believe that problem behaviors are
  the problem, and the goal is to simply eliminate
  or unlearn the problem behavior

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Types of Behavior Therapies

• Systematic Desensitization attempt to gradually
  substitute a positive response for a negative
  response to a harmless stimulus.
• Implosive Therapy floods patients with their
  worst fears first, in hopes that by confronting
  them, theyll overcome them.
• Aversive conditioning replace a positive response
  to a harmful stimulus with a negative response.

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Therapeutic Perspectives

• Group therapy is generally for people
  experiencing family conflicts or those whose
  behavior is distressing to others.

• Benefits
• others have same disorder
• share therapy ideas
• receive feedback
• you are not alone

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Therapeutic Perspectives

• Methods
• Usually groups of six to ten individuals
• Averaging up to 90 minutes per week

• Family Therapy promotes the idea that families
  are a unit that depends on each member to be
  positive and to communicate

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Therapeutic Perspectives

• Psychosurgery
• Surgery that removes or destroys brain tissue in
  an effort to change behavior.
• Once popular, but no more, a lobotomy cuts the
  nerves that connect the frontal lobe to the
  emotion-controlling centers in the inner-brain.

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Therapeutic Perspectives

• Psychopharmacology
• The study of the effects of drugs on the mind and
  behavior
• Introduced in the 1950s
• Greatly reduced those confined to a hospital
• currently applied to just about anything

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Types of Drugs

• Antianxiety Drugs
• Are used for the purpose of alleviating the
  symptoms stemming from frightening situations and
  fear-inducing stimuli
• IE. Xanax, Valium

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Types of Drugs

• Antipsychotic Drugs
• Drugs used for the purpose of calming psychotic
  patients those patients with fundamental mental
  derangement (such as schizophrenia)
• IE. Thorazine, Clozaril, Haldol

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Types of Drugs

• Antidepressant Drugs
• The purpose is to lift people up from a state of
  depression
• IE. Prozac, Paxil, Zoloft
• Lithium is an anti-depressant used mainly for
  manic-depressives (bipolar)

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Some Criticisms of Drug Therapy

• Doesnt address the root causes of behavior
  disorders
• May cause addiction
• Increased risks for suicide with some drugs?
• May cause other symptoms, disorders or diseases

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• Alternative Therapies

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Therapeutic Touch

• A practitioner moves their hands a few inches
  from a patients body, purportedly pushing
  energy fields into balance

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Eye Movement Desensitization Reprocessing (EMDR)

• Usually for disorders associated with trauma and
  anxiety.
• A patient is asked to close their eyes and to
  think about a traumatic scene from their life.
• A therapist waves their hand in front of their
  eyes as they are thinking, causing rapid eye
  movement

Does this resemble the stress-less REM of sleep?

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Light Exposure Therapy

• Especially for seasonal affective disorder, or
  depression brought on seasonal changes from
  summer to winter (less light). The therapy
  includes timed doses of intense light in light
  boxes.

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Electroconvulsive Therapy

• Patients brains are given momentary shock
  treatments, generally for about 30 seconds.

• Patients are given an anesthetic so that they are
  not conscious, and a muscle relaxant to prevent
  any injuries that may occur from convulsions.

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• Electroconvulsive Therapy
• Used in cases of deep depression, but
  historically used for almost anything determined
  to be abnormal behavior.