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Chapter 14: Psychological Disorders

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Title: Chapter 14: Psychological Disorders


1
Chapter 14 Psychological Disorders
2
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!

3
Figure 14.2 Normality and abnormality as a
continuum
4
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

5
Figure 14.5 Lifetime prevalence of psychological
disorders
6
PsychodiagnosisThe Classification of Disorders
  • American Psychiatric Association
  • Diagnostic and Statistical Manual of Mental
    Disorders 4th ed. (DSM - 4)

7
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

8
Axis I Clinical Syndromes
  • Anxiety Disorders
  • Somatoform Disorders
  • Dissociative Disorders
  • Mood Disorders
  • Schizophrenic Disorders

9
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)

10
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

11
Figure 14.6 Twin studies of anxiety disorders
12
Figure 14.7 Conditioning as an explanation for
phobias
13
Figure 14.8 Cognitive factors in anxiety
disorders
14
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

15
Figure 14.10 Glove anesthesia
16
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.

17
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

18
Figure 14.11 Episodic patterns in mood disorders
19
Figure 14.13 Twin studies of mood disorders
20
Figure 14.15 Negative thinking and prediction of
depression
21
Figure 14.16 Interpersonal factors in depression
22
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.

23
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.

24
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

25
Figure 14.18 The dopamine hypothesis as an
explanation for schizophrenia
26
Figure 14.20 The neurodevelopmental hypothesis
of schizophrenia
27
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.

28
Table 14.2 Personality Disorders
29
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.

30
Figure 14.22 The insanity defense public
perceptions and actual realities
31
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.
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