Introduction to Psychology

1
PSYCHOLOGICAL DISORDERS
2
Rate this person using the following scale1
Basically OK Psychotherapy is not
necessary2Mild Disturbance. Psychotherapy
should be considered3 Significant disturbance.
Psychotherapy is definitely required4 Severe
disturbance. Hospitalize!

• Jim was vice president of the freshman class at a
  local college and played on the schools football
  team. Later that year he dropped out of these
  activities and gradually became more and more
  withdrawn from friends and family. Neglecting to
  shave and shower, he began to look dirty and
  unhealthy. He spent most of his time alone in his
  room and sometimes complained to his parents that
  he heard voices in the curtains and in the
  closet. In his sophomore year he dropped out of
  school entirely. With increasing anxiety and
  agitation, he began to worry that the Nazis
  were plotting to kill his family and kidnap him.

3
Rate this person using the following scale1
Basically OK Psychotherapy is not
necessary2Mild Disturbance. Psychotherapy
should be considered3 Significant disturbance.
Psychotherapy is definitely required4 Severe
disturbance. Hospitalize!

• Mary is a 30 year old musician who is very
  dedicated and successful in her work as a teacher
  in a local high school and as a part time member
  of local musical groups. Since her marriage five
  years ago, which ended in divorce after six
  months, she has dated very few men. She often
  worries that her time is running out for
  establishing a good relationship with a man,
  getting married, and raising a family. Her
  friends tell her that she gets way too anxious
  around men, and that she needs to relax a little
  in general.

4
Its All a Matter of Degree
5
Historical Perspective

• Perceived Causes
• movements of sun or moon
• lunacy--full moon
• evil spirits
• Ancient Treatments
• exorcism, caged like animals, beaten, burned,
  castrated, mutilated, blood replaced with
  animals blood

6
Trephination-holes drilled into skulls ostensibly
to let evil spirits to escape (found in
prehistoric human remains during the Neolithic
times)
Procedure had survived and continued through the
Middle Ages and Renaissance.
7
Psychological Disorders

• Philippe Pinel (1745-1846)
• French reformer insisted that madness was not
  demon possession, but a sickness in response to
  severe stresses and inhumane conditions.
• Proposed moral treatment whereby doctors
  would unchain the patients and talk to them.

8
(No Transcript)
9
Psychological Disorders

• Medical Model
• concept that diseases have physical causes
• can be diagnosed, treated, and in most cases,
  cured
• assumes that these mental illnesses can be
  diagnosed on the basis of their symptoms and
  cured through therapy, which may include
  treatment in a psychiatric hospital

10
Psychological Disorders

• Thomas Szasz
• believes that mental illnesses are socially, not
  medically, defined.

11
Psychological Disorders

• Psychological Disorder
• a harmful dysfunction in which behavior is
  judged to be
• atypical--not enough in itself
• disturbing--varies with time and culture
• maladaptive--harmful
• unjustifiable--sometimes theres a good reason
• Three Ds dysfunction, deviance,
• distressful

12
(No Transcript)
13
Psychological Disorders--Etiology

• DSM-IV
• American Psychiatric Associations Diagnostic and
  Statistical Manual of Mental Disorders (Fourth
  Edition)
• a widely used system for classifying
  psychological disorders
• presently distributed as DSM-IV-TR (text revision)

14
Labeling Psychological Disorders

• Once we label a person, we view that person
  differently.
• Labels create preconceptions that guide our
  perceptions and our interpretations.

15
Labeling Psychological Disorders (David Rosenhan)

• David Rosenhan and seven others went to mental
  hospital admissions offices, complaining of
  hearing voices that were saying empty,
  hollow, and thud. Apart from this complaint
  and giving false names and occupations, they
  answered all the questions truthfully. All eight
  were diagnosed as mentally ill.

16
Psychological Disorders

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

17
Psychological Disorders
18
Prevalence

• Approximately 48 of adults experienced symptoms
  at least once in their lives
• Approximately 80 who experienced symptoms in the
  last year did NOT seek treatment
• Most people seem to deal with symptoms without
  complete debilitation
• Women have higher prevalence of depression and
  anxiety
• Men have higher prevalence of substance abuse and
  antisocial personality disorder

19
(No Transcript)
20
Psychological Disorders- Etiology

• Neurotic Disorder (term seldom used now)
• usually distressing but that allows one to think
  rationally and function socially
• Psychotic Disorder
• person loses contact with reality
• experiences irrational ideas and distorted
  perceptions

21
(No Transcript)
22
Anxiety Disorders

• Anxiety Disorders
• distressing, persistent anxiety or maladaptive
  behaviors that reduce anxiety
• Generalized Anxiety Disorder
• person is tense, apprehensive, and in a state of
  autonomic nervous system arousal

23
Model of Development of GAD

• GAD has some genetic component
• Related genetically to major depression
• Childhood trauma also related to GAD

24
Generalized Anxiety Disorder (GAD)

• More or less constant worry about many issues
• The worry seriously interferes with functioning
• Physical symptoms
• headaches
• stomach aches
• muscle tension
• irritability

25
Anxiety Disorders

• Panic Disorder
• marked by a minutes-long episode of intense dread
  in which a person experiences terror and
  accompanying chest pain, choking, or other
  frightening sensation

26
Anxiety Disorders

• Phobia
• persistent, irrational fear of a specific object
  or situation
• Obsessive-Compulsive Disorder
• unwanted repetitive thoughts (obsessions) and/or
  actions (compulsions)

27
Phobias

• Intense, irrational fears that may focus on
• Natural environmentheights, water, lightening
• Situationflying, tunnels, crowds, social
  gathering
• Injuryneedles, blood, dentist, doctor
• Animals or insectsinsects, snakes, bats, dogs

28
(No Transcript)
29
(No Transcript)
30
Anxiety Disorders

• Common and uncommon fears

31
Anxiety Disorders
32
Anxiety Disorders

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

33
The Learning Perspective

• The Learning Perspective
• sees anxiety disorders as a product of learned
  helplessness or fear conditioning
• Fear Conditioning
• Researchers have linked general anxiety with
  classical conditioning of fear.

34
The Learning Perspective

• Stimulus Generalization
• Conditioned fears may remain long after we
  have forgotten the experiences that produced
  them.
• Stimulus generalization may occur when a
  person who fears heights after a fall may be
  afraid of airplanes without ever having flown.

35
The Learning Perspective

• Reinforcement
• Once phobias and compulsions arise,
  reinforcement helps maintain them. Avoiding or
  escaping the feared situation reduces anxiety,
  thus reinforcing the phobic behavior.

36
The Learning Perspective

• Observational Learning
• We learn fear through observing others.
  Parents transmit their fears to their children.

37
The Biological Perspective

• The Biological Perspective
• Considers possible evolutionary, genetic, and
  physiological influences.
• Natural Selection
• Phobias focus on dangers faced by our
  ancestors. Compulsive acts typically exaggerate
  behaviors that contributed to our species
  survival.

38
The Biological Perspective

• Genes
• Some people seem genetically predisposed to
  particular fears and high anxiety. Identical
  twins often develop similar phobias, even when
  raised separately.

39
The Biological Perspective

• Physiology
• General anxiety, panic attacks, and even
  obsessions and compulsions are biologically
  measurable as an overarousal of brain areas
  involved in impulse control and habitual
  behaviors. (PET scans)

40
Post-Traumatic Stress Disorder

• Post-Traumatic Stress Disorder Traumatic stress
  (experiencing or witnessing severely threatening,
  uncontrollable events with a sense of fear,
  helplessness, or horror) can produce PTSD,
  symptoms of which include haunting memories and
  nightmares, numbed social withdrawal, jumpy
  anxiety, and insomnia.

41
POST-TRAUMATIC STRESS DISORDER

• Some experts estimate that as many as 200,000
  World War II veterans continue to suffer from
  PTSD.
• Currently, about 19 of Iraqi veterans and 11 of
  Afghanistan veterans return home with mental
  health problems.
• Children can also suffer from PTSD

42
Somatoform Disorders

• Psychological disorders in which the symptoms
  take a somatic (bodily) form without apparent
  physical cause.
• In Freuds day, called hysteria. In 1970s,
• hysteria as an independent diagnostic entity
• was deleted from the official manuals of
• medical diagnosis.

43
Somatoform Disorders

• Conversion Disorders
• a rare somatoform disorder in which a person
  experiences very specific genuine physical
  symptoms for which no physiological basis can be
  found.

44
Somatoform Disorders

• Hypochondriasis
• a somatoform disorder in which a person
  misinterprets normal physical sensations as
  symptoms of a disease.

45
Dissociative Disorders

• conscious awareness becomes separated
  (dissociated) from previous memories, thoughts,
  and feelings
• Dissociative Identity Disorder
• rare dissociative disorder in which a person
  exhibits two or more distinct and alternating
  personalities
• formerly called multiple personality disorder

46
Dissociative Disorders
Amnesia
Fugue
Memories related to a trauma disappear and the
person starts life all over.
Memories related to a trauma disappear.
Identity Disorder
A person will have several personalities that
are unique.
47
(No Transcript)
48
Dissociative Amnesia

• Also known as psychogenic amnesia
• Memory loss the only symptom
• Often selective loss surrounding traumatic events
• person still knows identity and most of their
  past
• Can also be global
• loss of identity without replacement with a new
  one

49
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.

50
Dissociative Fugue

• Also known as psychogenic fugue
• Global amnesia with identity replacement
• leaves home
• develops a new identity
• apparently no recollection of former life
• called a fugue state
• If fugue wears off
• old identity recovers
• new identity is totally forgotten

51
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.

52
Dissociative Identity Disorder
(DID)

• Originally known as multiple personality
  disorder
• 2 or more distinct personalities manifested by
  the same person at different times
• VERY rare and controversial disorder
• Examples include Sybil, Trudy Chase, Chris
  Sizemore (Eve)
• Has been tried as a criminal defense

53
Dissociative Identity Disorder

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

54
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.

55
Causes of Dissociative Disorders?

• Repeated, severe sexual or physical abuse
• However, many abused people do not develop DID
• Combine abuse with biological predisposition
  toward dissociation?
• people with DID are easier to hypnotize than
  others
• may begin as series of hypnotic trances to cope
  with abusive situations

56
The DID Controversy

• Some curious statistics
• 193060 2 cases per decade in USA
• 1980s 20,000 cases reported
• many more cases in US than elsewhere
• varies by therapistsome see none, others see a
  lot
• Is DID the result of suggestion by therapist and
  acting by patient?

57
Moderate depression that will go away without
therapy
Restlessness, inability to concentrate, and
rapid speech
Dysthymic Disorder
Mania
Mood Disorders
Major Depression
Bipolar
Lasting from a couple of weeks to months
Swings of mania and depression
58
(No Transcript)
59
Major Depression

• A mood disorder characterized by extreme and
  persistent feelings of despondency, worthlessness
  and hopelessness

• Prolonged, very severe symptoms
• Passes without remission for at least 2 weeks
• Global negativity and pessimism
• Very low self-esteem

60
Symptoms of Major Depression

• Emotional sadness, hopelessness, guilt, turning
  away from others
• Behavioral tearfulness, dejected facial
  expression, loss of interest in normal
  activities, slowed movements and gestures,
  withdrawal from social activities
• Cognitive difficulty thinking and concentrating,
  global negativity, preoccupation with
  death/suicide
• Physical appetite and weight changes, excess or
  diminished sleep, loss of energy, global anxiety,
  restlessness

61
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
• Can have co-existing major depression

62
Seasonal Affective Disorder
(SAD)

• Cyclic severe depression and elevated mood
• Seasonal regularity
• Unique cluster of symptoms
• intense hunger
• gain weight in winter
• sleep more than usual
• depressed more in evening than morning

63
Prevalence and Course

• Most common of psychological disorders
• Women are twice as likely as men to be diagnosed
  with major depression
• Untreated episodes can become recurring and more
  serious
• Seasonal affective disorder (SAD)onset with
  changing seasons

64
Mood Disorders

• Bipolar Disorder (Manic depression)
• a mood disorder in which the person alternates
  between the hopelessness and lethargy of
  depression and the overexcited state of mania
• formerly called manic-depressive disorder
• Manic Episode
• a mood disorder marked by a hyperactive, wildly
  optimistic state

65
Prevalence and Course

• Bipolar Disorder
• Onset usually in young adulthood
• (early twenties)
• Mood changes more abrupt than in major
  depression
• No sex differences in rate of bipolar disorder
• Commonly recurs every few years
• Can often be controlled by medication (lithium)

66
(No Transcript)
67

• Canadian depression rates

68
(No Transcript)
69
Suicide

• National differences
• England, Italy, Spain little more than half
  rate of Canada, U.S. Australia while Austria and
  Finland higher
• Racial differences-
• white Americans about twice as likely as black
  Americans
• Gender differences-
• More women attempt suicide while men are four
  times more likely to succeed

70

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

71

• Altering any one component of the
  chemistry-cognition-mood circuit can alter the
  others

72

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

73
Explaining Mood Disorders

• Neurotransmitter theories (Biology)
• dopamine
• norepinephrine
• serotonin
• Genetic component
• more closely related people show similar
  histories of mood disorders

74
Causes

• Use linkage analysis- look for genes that may put
  people at risk for depression and points to
  chromosome neighborhoods
• Association studies- look for correlations among
  these genes and a larger population trait.
• Norepinephrine and serotonin are both scarce in
  depression and in excess in mania
• Lower levels of omega-3 fatty acid
• Left frontal lobe less active during depressed
  states

75
Situational Bases for Depression

• Positive correlation between stressful life
  events and onset of depression
• Does life stress cause depression?
• Most depressogenic life events are losses
• spouse or companion
• long-term job
• health
• income

76
Cognitive Bases for Depression

• A.T. Beck depressed people hold pessimistic
  views of
• themselves
• the world
• the future
• Depressed people distort their experiences in
  negative ways
• exaggerate bad experiences
• minimize good experiences

77
Cognitive Bases for Depression

• Hopelessness theory
• depression results from a pattern of thinking
• person loses hope that life will get better
• negative experiences are due to stable, global
  reasons
• e.g., I didnt get the job because Im stupid
  and inept vs. I didnt get the job because the
  interview didnt go well

78
MOOD DISORDERS

• MANIA Symptoms
• Elation, euphoria, desire for action
• Impatience, distractibility
• Inflated self-esteem
• Grandiosity
• Impulsiveness
• Hyperactivity
• Decreased need for sleep
• Sexual indiscretion
• Increased appetite

79
Flight of ideas
-a nearly continuous flow of rapid speech that
jumps from topic to topic. Most commonly seen
in manic episodes.
80
Schizophrenia

• Schizophrenia
• literal translation split mind
• a group of severe disorders characterized by
• disorganized and delusional thinking
• disturbed perceptions
• inappropriate emotions and actions

81
What is Schizophrenia?

• Comes from Greek meaning split and mind
• split refers to loss of touch with reality
• not dissociative state
• not split personality
• Equally split between genders, males have
  earlier onset
• 18 to 25 for men
• 26 to 45 for women

82
IF YOU TALK TO GOD, YOURE PRAYING IF
GOD TALKS TO YOU, YOU HAVE
SCHIZOPHRENIA Thomas Szasz
83
Schizophrenic Disorders
Symptoms
Disorganized Thoughts Hallucinations Delusions Gar
bled Speech Word Salad Clanging
84
Symptoms of Schizophrenia

• Positive symptoms
• hallucinations
• delusions
• Negative symptoms
• absence of normal cognition or affect (e.g., flat
  affect, poverty of speech)
• Disorganized symptoms
• disorganized speech (e.g., word salad)
• disorganized behaviors

85
Frequency of positive and negative symptoms in
individuals at the time they were hospitalized
for schizophrenia. Source Based on data
reported in Andreasen Flaum, 1991.
86
Symptoms of Schizophrenia

• Chronic or process
• schizophrenia is a slow-developing process
  recovery is doubtful.
• Acute or reactive
• schizophrenia develops rapidly recovery is
  much more likely.

87
Schizophrenia

• Delusions
• false beliefs, often of persecution or grandeur,
  that may accompany psychotic disorders
• In a psychiatrist's waiting room two patients are
  having a conversation. One says to the other,
  "Why are you here?"The second answers, "I'm
  Napoleon, so the doctor told me to come
  here."The first is curious and asks, "How do you
  know that you're Napoleon?"The second responds,
  "God told me I was."At this point, a patient on
  the other side of the room shouts, "NO I DIDN'T!"

88
Symptoms of Schizophrenia

• Delusions of persecution
• theyre out to get me
• paranoia
• Delusions of grandeur
• God complex
• megalomania
• Delusions of being controlled
• the CIA is controlling my brain with a radio
  signal

89
Symptoms of Schizophrenia

• Hallucinations
• hearing or seeing things that arent there
• contributes to delusions
• command hallucinations voices giving orders
• Disorganized speech
• Over-inclusionjumping 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

90
(No Transcript)
91
Disorganized Thinking

• Word Salad
• jumping from one idea to another even within
  sentences.
• Clang Associations
• rhyming the last word of a sentence.

92
Disorganized Thinking
93
Symptoms of Schizophrenia

• Disorganized behavior and affect
• behavior is inappropriate for the situation
• e.g., wearing sweaters and overcoats on hot days
• affect is inappropriately expressed
• flat affectno emotion at all in face or speech
• inappropriate affectlaughing at very serious
  things, crying at funny things
• catatonic behavior
• unresponsiveness to environment, usually marked
  by immobility for extended periods

94
Schizophrenia
95
(No Transcript)
96
Schizophrenia
97
Chemical Factors in Schizophrenia
1. Dopamine is a neurotransmitter found in the
brain.
2. Schizophrenics have very high levels of
dopamine.
3. They report that they feel agitated, talk
rapidly, and their thoughts are racing.
4. Some schizophrenics report that lower levels
of dopamine make them feel better.
98
The Dopamine Theory

• Drugs that reduce dopamine reduce symptoms
• Drugs that increase dopamine produce symptoms
  even in people without the disorder
• Theory Schizophrenia is caused by excess
  dopamine
• Dopamine theory not enough other
  neurotransmitters involved as well

99
Genetic Factors

• 1 in 100 odds of any person being diagnosed with
  schizophrenia.
• 1 in 10 chance among those who have an
  afflicted sibling or parent.
• 1 in 2 chance among those who have an
  afflicted identical twin.

100
(No Transcript)
101
Schizophrenia
102
Biological Bases of Schizophrenia

• Other congenital influences
• difficult birth (e.g., oxygen deprivation)
• prenatal viral infection
• Brain chemistry
• neurotransmitter excesses or deficits
• dopamine theory

103
Other Biological Factors

• Brain structure and function
• enlarged cerebral ventricles and reduced neural
  tissue around the ventricles
• PET scans show reduced frontal lobe activity
• Early warning signs
• nothing very reliable has been found yet
• certain attention deficits can be found in
  children who are at risk for the disorder
• Fathers ageolder men are at higher risk for
  fathering a child with schizophrenia

104
(No Transcript)
105
Family Influences on Schizophrenia

• Family variables
• parental communication that is disorganized,
  hard-to-follow, or highly emotional
• expressed emotion
• highly critical, over-enmeshed families

106
(No Transcript)
107
Cultural Differences in Schizophrenia

• Prevalence of symptoms is similar no matter what
  the culture
• Less industrialized countries have better rates
  of recovery than industrialized countries
• families tend to be less critical of the patients
• less use of antipsychotic medications, which may
  impair full recovery
• think of it as transient, rather than chronic and
  lasting disorder

108
Summary of Schizophrenia

• Many biological factors seem involved
• heredity
• neurotransmitters
• brain structure abnormalities
• Family and cultural factors also important
• Combined model of schizophrenia
• biological predisposition combined with
  psychosocial stressors leads to disorder
• Is schizophrenia the maladaptive coping behavior
  of a biologically vulnerable person?

109
Personality Disorders

• Personality Disorders
• disorders characterized by inflexible and
  enduring behavior patterns that impair social
  functioning
• usually without anxiety, depression, or delusions

110
Personality Disorders
Borderline Personality Disorder
These people have unstable and intense
relationships with others. They are dependent on
others and yet, sabotage those relationships.
They have problems controlling their impulses
their perceptions and thoughts are distorted.
111
Borderline Personality Disorder

• Chronic instability of emotions, self-image,
  relationships
• Self-destructive behaviors
• Intense fear of abandonment and emptiness
• Possible history of childhood physical,
  emotional, or sexual abuse
• 75 of diagnosed cases are women

112
Paranoid Personality Disorder

• Pervasive mistrust and suspiciousness of others
  are the main characteristic
• Distrustful even of close family and friends
• Reluctant to form close relationships
• Tend to blame others for their own shortcomings

113
Histrionic Personality Disorder

• displays a shallow, attention-getting
  emotionality.
• Histrionic individuals go to great length to
  gain others praise and reassurance.

114
Narcissistic Personality Disorder

• exaggerate their own importance, aided by success
  fantasies.
• They find criticism hard to accept, often
  reacting with rage or shame.

115

• Antisocial Personality Disorder
• disorder in which the person (usually man)
  exhibits a lack of conscience for wrongdoing,
  even toward friends and family members
• may be aggressive and ruthless or a clever con
  artist
• These people consistently come into conflict with
  the law and show little or no concern, guilt, or
  anxiety.

116
Personality Disorders

• PET scans illustrate reduced activation in a
  murderers frontal cortex

117
Personality Disorders
118
Rates of Psychological Disorders
119
(No Transcript)