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Psychological Disorders

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Title: Psychological Disorders


1
Psychological Disorders
Chapter 14
2
Characteristics of Abnormality
  • Distressing (Subjective Discomfort)
  • causes distress or anxiety in that individual
  • Problem is that people may not be feeling stress
    about their bizarre behaviors
  • Dysfunction
  • Inability to function effectively and adapt to
    the demands of society
  • Problem is that this definition does not consider
    personal choice
  • Atypical (Deviation from Average)
  • Behavior is statistically rare
  • Problem is that not all rare behaviors (e.g.
    genius) are abnormal
  • Socially unacceptable (Deviation from Ideal)
  • Behavior violates social norms
  • Problem is that norms change over time and people
    do not agree on ideal behavior

3
Mental Illness and the Law
  • Insanity
  • Legal term for mentally disturbed people who are
    not considered responsible for their criminal
    actions
  • Competency
  • Is the individual fit to stand trial?
  • Those found insane often spend more time in
    mental institutions than they would have in prison

4
Historical Views of Psychological Disorders
  • Supernatural view, where mysterious behavior was
    attributed to supernatural powers, likely
    dominated early societies
  • Naturalistic View, where abnormality is
    attributed to medical problems.
  • Mental hospitals and asylums were used more like
    prisons to keep the afflicted away from society
  • Church dominance over culture in Middle Ages and
    lack of scientific knowledge caused the
    supernatural view to dominate through the 17th
    century.

5
Historical Views of Psychological Disorders
  • Enlightenment and the Triumph of Human Rights
    ALL PEOPLE HAVE RIGHTS!
  • Philippe Pinel Used more humane approaches to
    treating patients in France.
  • Dorothea Dix Brought these humane ideas about
    mental healthcare to the U.S.
  • Deinstitutionalization of the mid-20th century
  • Advent of Drug Therapies allowed people to be
    more functional in the real world.
  • Rosenhan Study (1973) institutionalization not
    necessarily effective!
  • Brief Film Clip tracing the history of
    understanding mental illness

6
Models of the Causes of Psychological Disorders
  • Humanistic-Existential Model
  • Abnormal behaviors result from failure to fulfill
    ones self-potential and faulty self-image
  • Client-centered and Gestalt therapies are used to
    increase self acceptance.
  • Cognitive Model
  • Faulty or negative thinking can cause depression
    or anxiety.
  • Focus of treatment is on changing
    faulty/irrational thinking
  • Diathesis-Stress model
  • Biological predisposition to disorder which is
    triggered by stress
  • Systems theory (biopsychosocial model)
  • Model in which biological, psychological, and
    social risk factors combine to produce
    psychological disorders
  • Biological model (Medical)
  • Underlying cause (etiology) of mental disorders
    is biological
  • Medication or medical therapies are used as
    treatments
  • Learning model
  • Abnormal behaviors are learned the same way as
    normal ones, through conditioning,
    reinforcements, imitation, etc. and are not
    considered symptoms of some underlying disease
    the behaviors themselves are the problem.
  • Treatments consist of retraining and
    reconditioning
  • Psychodynamic Model
  • Abnormal behaviors represent unconscious motives
    and conflicts
  • Psychoanalysis is used as treatment

7
Classifying Psychological Disorders
  • Diagnostic and Statistical Manual of Mental
    Disorders published by the American Psychiatric
    Association
  • Describes more than 300 specific mental disorders
    and is used by most professionals
  • DSM First edition published in 1952
  • DSM-II Revised in 1968 to reflect changing
    culture
  • DSM-III Revised in 1977 to describe mental
    disorders in greater detail
  • DSM-III-R clarified and updated DSM-III
  • DSM-IV Published in 1994 with revisions
  • DSM-IV-TR Released in 2000, text revision
  • Criticisms
  • Disorders classified as diseases
  • Many of the symptoms have nothing to do with
    mental illness
  • Stereotypes and expectations based on labels can
    be damaging

8
Classifying Psychological Disorders
  • DSM-IV evaluates individuals according to five
    dimensions or axes, thus rendering it a
    multiaxial system of classification.
  • Axis I Mental disorder or learned disorder that
    might be present (Anxiety Disorders)
  • Axis II Personality disorder or mental
    retardation that might be present
  • Axis III Physical or medical disorders that
    might be present, such as diabetes, hypertension,
    or arthritis
  • Axis IV Rates the severity of psychosocial
    stressors such as school or housing issues in the
    individuals life during the past year
  • Axis V Assess the level of adaptive functioning
    currently and during the past year on Global
    Assessment of Functioning Scale (GAF) 0-100.

9
The Prevalence of Psychological Disorders
  • In a 2001 survey, 14.9 of respondents reported
    experiencing some type of clinically significant
    mental disorder
  • Six percent were suffering from substance abuse
  • Most common disorders were anxiety, phobias, and
    mood disorders

10
Anxiety Disorders
11
Anxiety Disorders
Defining Anxiety Anxiety is a general feeling of
fear and apprehension that may be related to an
object or event and is often accompanied by
increased physiological arousal.
12
Causes of Anxiety Disorders
  • Conditioning
  • For example, phobias can be learned through
    classical conditioning
  • Feelings of not being in control can lead to
    anxiety
  • Predisposition to anxiety disorders may be
    inherited (genetic)
  • Displacement or repression of unacceptable
    thoughts or impulses can lead to anxiety

13
Types of Anxiety Disorders Generalized Anxiety
Disorder
  • Prolonged vague but intense fears not attached to
    any particular object or circumstance
  • Often results from Free-Floating Anxiety
    anxiety not attached to any particular event or
    object
  • Difficult to treat

14
Types of Anxiety Disorders Panic Disorder
  • Recurrent panic attacks in which the person
    experiences intense terror without cause
  • Person is often left with fear of having another
    panic attack
  • Can lead to agoraphobia

15
Types of Anxiety Disorders Phobic Disorders
  • Intense fear of specific situations or objects
  • Agoraphobia
  • Intense fear of crowds and public places or other
    situations that require separation from source of
    security, such as the home
  • Social phobia
  • Excessive fear of social situations
  • Fear of scrutiny of others
  • Specific Phobia
  • Common phobias include animals, heights, closed
    places, needles

16
Types of Anxiety Disorders Obsessive Compulsive
Disorder
  • Driven to disturbing thoughts (obsessions) and/or
    performing senseless rituals (compulsions)
  • Individual recognizes behavior is excessive but
    cannot stop without experiencing anxiety.
  • Washers and Checkers
  • Hoarding Touching

17
Types of Anxiety Disorders Post-Traumatic Stress
Disorder
  • Psychologically distressing experience continues
    to plague individual after the fact and causes
    anxiety.
  • Could result from either personally experiencing
    or witnessing a life-threatening situation
  • Often linked with combat or rape

18
Psychosomatic and Somatoform Disorders
19
Somatoform Disorders
  • Somatoform Disorders
  • Physical symptoms without any physical cause
  • Person experiences symptoms as real
  • Contrast with Psychosomatic Disorders
  • Real physical illness with psychological causes
    such as stress or anxiety
  • Tension headaches, for example
  • Research indicates that most, if not all,
    illnesses may have a psychosomatic component

20
Causes of Somatoform Disorders
  • Freud
  • Symptoms related to traumatic experience in the
    past
  • Cognitive-behavioral
  • Examines ways in which the behavior is being
    rewarded, either tangibly or mentally
  • Biological perspective
  • May be real physical illnesses that are
    misdiagnosed or overlooked

21
Types of Somatoform Disorders
  • Somatization Disorder vague, recurrent physical
    symptoms plentiful and unrelated and
    unresponsive to medical treatment (back pain,
    dizziness, stomach pains, etc.)
  • Conversion Disorder sudden but temporary loss
    of physical functions triggered by psychological
    factors.
  • La belle indifference apathy over loss of
    functioning.
  • Glove anesthesia lack of feeling in hand only
    neurologically impossible.
  • Hypochondriasis without physical evidence,
    individual believes they have a serious illness
  • Body Dysmorphic Disorder preoccupation with a
    minor physical anomaly to the point of
    dysfunction.

22
Somatoform
  • Somatization disorder- Vague, recurring physical
    symptoms with no cause (back pain, dizziness,
    stomach pains, etc.)
  • Conversion Disorder -Conversion of emotional
    difficulties into the loss of a specific
    physiological function
  • If stuck with a pin, a limb will have no feeling
  • glove anesthesia- lack of feeling from the hand
    down
  • Hypocondriasis - A person who is in good health
    becomes preoccupied with imaginary ailments (a
    cough becomes a serious disease
  • BDD- Body Dysmorphic Disorder- imagined ugliness

23
Dissociative Disorders
24
Dissociative Disorders
  • Disorders in which conscious awareness becomes
    separated from previous memories, thoughts and
    feelings.
  • Dissociative disorders are characterized by a
    sudden but temporary alteration in consciousness,
    identity, sensory/motor behavior, or memory.
  • These disorders are relatively rare, but quite
    noticeable.

25
Causes of Dissociative Disorders
  • Seems to involve unconscious processes
  • Memory impairments may also include biological
    factors such as normal aging and Alzheimers
    disease
  • Dissociation is common with use of some drugs
    such as LSD
  • Trauma is often involved

26
Dissociative Disorders
  • Dissociative amnesia
  • Loss of memory without a physical cause
  • Dissociative fugue
  • Involves flight from home and adoption of a new
    identity and amnesia for past events
  • Depersonalization disorder
  • Person suddenly feels strangely changed or
    different outside self
  • Dissociative identity disorder
  • Person has several distinct personalities that
    emerge at different times
  • Previously called multiple personality disorder

27
Sexual Disorders
28
Sexual Disorders
  • Include a range of sexual problems typically
    divided into two categories
  • sexual dysfunctions
  • sexual desire disorders, known as paraphilias.
  • Difficult to diagnose!
  • Sexuality is a private thing
  • Difficult to label acts as abnormal or normal
  • Kinseys research?
  • Additionally, must people be diagnosed for desire
    or for acts or both?
  • Key factor in definition of sexual disorders it
    causes the individual stress and anxiety. This
    is a sign that something is wrong, no matter how
    acceptable or unacceptable the desire or behavior
    may be to the rest of society.

29
Sexual Dysfunction
  • Sexual dysfunctions involve an impairment of
    normal sexual functioning.
  • This can refer to an inability to perform or
    reach an orgasm, painful sexual intercourse, a
    strong repulsion of sexual activity, or an
    exaggerated sexual response cycle or sexual
    interest. 
  • A medical cause must be ruled out prior to making
    any sexual dysfunction diagnosis and the symptoms
    must be hindering the person's everyday
    functioning.

30
Sexual Dysfunction
  • Erectile disorder
  • Inability of a man to achieve or maintain an
    erection
  • Female sexual arousal disorder
  • Inability of a woman to become sexually aroused
    or reach orgasm
  • Sexual aversion disorders
  • Lack of sexual interest or active distaste for sex
  • Orgasmic disorders
  • Inability to reach orgasm in a person who has
    sexual desire and can maintain arousal
  • Premature ejaculation
  • Males inability to inhibit orgasm as long as
    desired
  • Vaginismus
  • Involuntary muscle spasms in the outer part of
    the vagina making intercourse impossible

31
Sexual Dysfunction
32
Paraphilias
  • Paraphilias all have in common distressing and
    repetitive sexual fantasies, urges, or
    behaviors. 
  • Must occur for a significant period of time
  • Must interfere with either satisfactory sexual
    relations or everyday functioning if the
    diagnosis is to be made. 
  • There is also a sense of distress within these
    individuals
  • Typically recognize the symptoms as negatively
    impacting their life
  • Feel as if they are unable to control the symptoms

33
Paraphilias
  • Transvestic fetishism
  • Wearing clothing of the opposite sex to achieve
    sexual arousal
  • Sexual sadism
  • Obtain sexual gratification by humiliating or
    physically harming a sex partner
  • Sexual masochism
  • Inability to enjoy sex without physical or
    emotional pain
  • Pedophilia
  • Preferred desire to have sex with children
  • Fetishism
  • Non-human object is preferred method of sexual
    excitement
  • Voyeurism
  • Desire to watch others having sex or undressing
  • Exhibitionism
  • Compulsion to expose ones genitals to achieve
    sexual arousal
  • Frotteurism
  • Touching or rubbing against a non-consenting
    person in public

34
Gender-Identity Disorders
  • Involves a desire to become, or insistence that
    one really is, a member of the other sex
  • Usually begins in childhood
  • Most develop normal gender identity in adulthood
  • Sex reassignment surgery is an option for adults
    who have this disorder
  • Causes are not known

35
Mood Disorders
Woh woh.
36
Mood Disorders
  • Mood disorders are characterized by ongoing,
    dysfunctional emotional patterns
  • Mood disorders are also referred to as affective
    disorders
  • An affect is another word for an emotion
  • Mood disorders come in two general categories,
    depressive disorders and bipolar disorders

37
Causes of Mood Disorders
  • Biological factors
  • Twin studies suggest genetic factors play a role
  • Mood disorders may be linked to chemical
    imbalances in the brain
  • Psychological factors
  • Cognitive distortions Maladaptive response to
    early negative life events that leads to feelings
    of incompetence and unworthiness
  • These responses are reactivated whenever a new
    situation arises that resembles the original
    events
  • Social factors
  • Depression is linked to troubled close
    relationships
  • May explain greater incidence of depression in
    women, who tend to be more relationship-oriented
  • Depressed people can evoke anxiety and hostility
    in others, who then withdraw, which in turn can
    intensify feelings of depression

38
Treatment of Mood Disorders
  • In most cases, mood disorders are treated with a
    combination of drug therapy and talk therapy.
  • In some extreme cases when these methods do not
    work, ECT has been effective.
  • used rarely if all other treatments fail
  • Used if suicide is a threat
  • Not as heinous as depicted in films
  • Many more women are diagnosed with mood disorders
    than men.
  • Psychologists have been researching both
    biological and cultural causes for this.

39
Suicide
  • 19,000 people commit suicide in the U.S. every
    year, the 11th leading cause of death
  • More women than men attempt suicide, but more men
    succeed

40
Depression
  • General Symptoms
  • Overwhelming feelings of sadness
  • Lack of interest in activities
  • Excessive guilt or feelings of worthlessness
  • Types
  • Major depressive disorder
  • Intense symptoms that may last for several months
  • Dysthymic Disorder
  • Less intense, but may last for periods of two
    years or more
  • Seasonal Affective Disorder (SAD)
  • symptoms of depression triggered by weather
    patterns (melatonin hypersensitivity)

41
Bipolar Disorder
  • Characterized by alternating between depression
    and mania
  • Manic-Depressive Disorder (Kelsey and Chase)
  • Periods of normal mood may come between bouts of
    depression and mania
  • Symptoms of Mania include
  • Feelings of euphoria
  • Extreme physical activity
  • Excessive talkativeness
  • Grandiosity
  • Mania rarely occurs alone it is typically part
    of manic-depressive disorder
  • Much less common than depression
  • Stronger biological component than depression
  • Cyclothemia less intense mood swings

42
Personality Disorders
43
Personality Disorders
  • Disorders in which maladaptive ways of thinking
    and behaving learned early in life cause distress
    in the person and/or conflicts with others
  • Axis II in DSM
  • Rate among prisoners is close to 50
  • They are often easy to identify in others, but
    difficult to treat
  • Personality disorders are grouped by the DSM into
    three groups or clusters

44
Types of Personality Disorders The Three
Clusters
  • Cluster A Odd or Eccentric Behavior
  • Paranoid
  • Very suspicious of others
  • Schizoid
  • Withdrawn and lacks feelings for others

45
Types of Personality Disorders The Three
Clusters
  • Cluster B Dramatic or Erratic Behavior
  • Histrionic (Hysterical)
  •  Attention-hungry
  • drama-queen
  • Narcissistic
  • exaggerated sense of self-importance
  • Antisocial - Ted Bundy
  • Violates social norms
  • Enjoys harming others
  • Conduct Disorder
  • Borderline
  • Unpredictable, impulsive and sometimes
    destructive behavior
  • Chaotic relationships

46
Types of Personality Disorders The Three
Clusters
  • Cluster C Anxious or Inhibited Behavior
  • Avoidant
  • Fearful of social interactions
  • Feels inferior 
  • Dependent
  • Uncomfortable being alone
  • Uncomfortable making decisions  
  • Obsessive-Compulsive
  • Obsessed with order, lists, organizing
  • Need for control over all aspects of life 

47
Spotlight Causes of Antisocial Personality
Disorder
  • Combination of biological predisposition, adverse
    psychological experiences, and an unhealthy
    social environment
  • Also possible link to damaged frontal lobe during
    infancy
  • Emotional deprivation during childhood may lead
    to antisocial tendencies

I enjoy long walks on the beach, soft music, oh,
and killing people.
48
Schizophrenia
49
Schizophrenic Disorders
  • Schizophrenia is the most debilitating and
    complex of all the psychological disorders.
  • Diverse symptoms one common denominator
    psychoticism
  • Being psychotic means that the individual is
    suffering from a break with reality that inhibits
    their ability to function.
  • Additionally, there is ongoing evidence of
    deteriorating social and intellectual
    functioning.
  • The diagnosis must be made before age 45 and
    symptoms must persist for at least 6 months.
  • The Schizophrenic Experience

50
Schizophrenic Disorders
  • Most cases of schizophrenia are treated with
    antipsychotic medication.
  • When these medications first were introduced,
    they only treated some of the symptoms of the
    disorder
  • Tardive dyskinesia in long-term patients
  • Medications used now better treat both the
    positive and negative symptoms of the disease.
  • Positive symptoms are symptoms people with
    schizophrenia experience, but normal people do
    not
  • Hallucinations, delusions, disorganized thought,
    movements
  • Negative symptoms are behaviors that occur
    normally, but do not in schizophrenics
  • Flat affect, minimal speech

51
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52
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53
Schizophrenic Disorders Symptoms
  • Symptoms have further been categorized by the
    effect they have on functioning disturbances of
    thought, perception, and emotions
  • Thought Disturbances
  • Delusions - False beliefs about reality
  • Language Disturbances
  • Clang rhyming speech pattern (The run sun done
    the gun don't drink drown down, brown gown." )
  • Neologism making up new words
  • Loose Association words dont hold together
    language does not make sense ("I need to go to
    the store to buy some band-aids. I read an
    article about how expensive AIDS drugs are.
    People take too many street drugs. The streets
    should be clean from the rain today, etc" )
  • Echolalia repeating words over and over
  • Perceptual Disturbances 
  • Hallucinations - Sensory experiences without
    external stimulation
  • Emotional Disturbances
  • Flat Affect having no emotion
  • Ambivalent Affect having erratic emotional
    responses

54
Causes of Schizophrenia
  • Biological predisposition to schizophrenia may be
    inherited
  • Twin studies show genetic link
  • Excessive levels of dopamine lead to psychotic
    symptoms
  • Abnormalities of brain structures
  • Abnormal patterns of connections between brain
    cells
  • May involve family relationships and social class

55
Types of Schizophrenic Disorders
  • Disorganized schizophrenia
  • Bizarre and childlike behavior
  • May engage in incoherent conversations
  • Catatonic schizophrenia
  • Can alternate between a catatonic state (mute and
    immobile) and an overly active state (overly
    excited and shouting)
  • Paranoid schizophrenia
  • Marked by extreme suspiciousness and complex
    delusions
  • Undifferentiated schizophrenia
  • Clear symptoms of schizophrenia that do not meet
    criteria for other subtypes
  • Cases
  • Gerald 1
  • Gerald 2
  • Heather

56
Childhood Disorders
57
Defining Childhood Disorders
  • Disorders Usually First Diagnosed in Infancy,
    Childhood, or Adolescence
  • Example Categories
  • Mental Retardation
  • Pervasive Developmental Disorder (Autism,
    Aspergers)
  • Disruptive Behavior Disorders (AD/HD, Conduct
    Disorder, ODD)
  • Tic Disorders (Tourettes)
  • Feeding Disorders (Pica, Rumination Disorder)

58
Childhood Disorders Developmental Disorders
  • Autistic Disorder
  • Qualitative impairment in social interaction
  • Qualitative impairments in communication
  • Restricted repetitive and stereotyped patterns of
    behavior, interests, and activities 
  • Aspergers Disorder
  • Qualitative impairment in social interaction
  • Restricted repetitive and stereotyped patterns of
    behavior, interests, and activities
  • No language or cognitive limitations limitation
    is mostly social

59
Childhood Disorders Disruptive Behavior
Disorders
  • AD/HD (Attention Deficit/Hyperactivity Disorder)
  • 6 month history of behaviors involving multiple
    symptoms of inattention, impulsivity and
    hyperactivity that disrupt normative development
  • Use of psychostimulants for treatment (Ritalin,
    Adderall)
  • ODD (Oppositional Defiant Disorder)
  • A pattern of negativistic, hostile, and defiant
    behavior lasting at least 6 months
  • Impairs social, academic, or occupational
    functioning
  • Conduct Disorder
  • A repetitive and persistent pattern of behavior
    in which the basic rights of others or major
    age-appropriate societal norms or rules are
    violated
  • Aggression to people and animals
  • Destruction of property
  • Deceitfulness or theft
  • Serious violations of rules
  • Antisocial disorder?

60
Childhood Disorders Tic Disorder Feeding
Disorders
  • Tic Disorders
  • A tic is a sudden, rapid, recurrent, nonrhythmic,
    stereotyped motor movement or vocalization
  • The tics occur many times a day (usually in
    bouts) nearly every day or intermittently
    throughout a period of more than 1 year
  • Example Tourettes Disorder (includes motor and
    vocal tics)
  • Feeding Disorders
  • Pica
  • Persistent eating of nonnutritive substances for
    a period of at least 1 month. 
  • The eating of nonnutritive substances is
    inappropriate to the developmental level (older
    than 18-24 mos)
  • clay, dirt, sand, stones, pebbles, hair, feces,
    lead, laundry starch, vinyl gloves, plastic,
    pencil erasers, ice, fingernails, paper, paint
    chips, coal, chalk, wood, plaster, light bulbs,
    needles, string, cigarette butts, wire, and burnt
    matches.
  • Rumination Disorder
  • Repeated regurgitation and rechewing of food for
    a period of at least 1 month following a period
    of normal functioning. 
  • The behavior is not due to an associated
    gastrointestinal or other general medical
    condition (e.g., esophageal reflux). 

61
Trends in Psychological Disorders
62
Gender Differences
  • More women are in treatment for psychological
    disorders
  • Men who are divorced or separated, or who never
    married, have a higher rate of mental disorders
  • Married women have higher rates than married men
  • Women have higher rates of anxiety disorders and
    depression

63
Cultural Differences
  • Many disorders occur only in particular cultural
    groups
  • Prevalence of some disorders among
    males/females/children differs markedly by culture

64
Prevalence of Mental Disorders
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