Psychological disorder

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Psychological disorder

• What is abnormal behavior? What is
• meant by a psychological disorder?
• A harmful dysfunction judged to be
• Atypical outside of norms (deviance model)
• Disturbing - varies with time and culture
• Maladaptive
• Harmful
• Unjustifiable
• Resource Discovering Psychology Updated Edition

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Historical Perspective

• Demonological view
• Possession by evil spirits.
• Movement of moon (lunacy)
• Treatments
• Exorcism, beaten, trephined, castrated,
  mutilated, and killed
• Later mental asylums were used like prisons to
  keep the afflicted away from society (bethlehem
  bedlam)

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Psychological Disorders

• Formerly two major divisions
• 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

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Psychological Models

• Medical/Biological model
• Physiological or biochemical basis
• Concept that diseases have physical cause
• Psychoanalytic model
• Disorders are the result of unconscious conflicts
• Cognitive-Behavioral model
• Disorders are the result of learning maladaptive
  ways of behaving and thinking
• Diathesis-Stress model
• Biological predisposition to disorder which is
  triggered by stress
• Systems theory (BioPsychoSocial model)
• Biological, psychological, and socio-cultural
  risk factors combine to produce psychological
  disorders

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Prevalence of Disorders Some Stats

• Harvard Medical School estimates 46 of Americans
  will experience a psychological disorder in their
  lifetime (appx 150 million Americans), Kessler
  and Wang, 2008

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Psychological Disorders--Etiology

• DSM-V
• American Psychiatric Associations Diagnostic and
  Statistical Manual of Mental Disorders-5 recently
  replaced the DSM-IV-TR
• Widely used system for classifying psychological
  disorders into major categories Clinical guide
• Major Criticisms?
• Diagnostic labeling (Rosenhan Study)
• Pathologizing normal behaviors (thresholds for
  diagnosis)?
• Overdiagnosis

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DSM-5

• The DSM-5 replaced the Multi-Axial System and now
  has 3 sections
• Section 1 Introduction and instructions on how to
  use the new version
• Section 2 Diagnostic categories
• Section 3 Conditions that need additional
  research, a glossary of terms, and other
  important information
• The DSM 5

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Some Disorder Categories in DSM-5

• Anxiety Disorders
• Obsessive-Compulsive and Related Disorders
• Trauma and Stressor-Related Disorders
• Depressive Disorders
• Bipolar and Related Disorders
• Neurodevelopmental Disorders- Intellectual
  disability categories (eliminates use of mental
  retardation)
• Schizophrenic Spectrum and other Psychotic
  Disorders
• Disassociative Disorders
• Somatic Symptom Disorder
• Personality Disorders

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Anxiety Disorders

• Anxiety Disorders Any disorder in which anxiety
  or avoidance of anxiety motivates abnormal
  behavior
• Generalized Anxiety Disorder Tension,
  apprehension, and state of autonomic arousal
• Panic Disorder Acute episodes of intense dread.
  Terror, accompanying chest pain, choking, or
  other frightening sensations
• Phobia Persistent, irrational fear of a specific
  object or situation. Common phobias?
• Agoraphobia
• Social Anxiety
• Separation Anxiety
• Selective Mutism

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Anxiety Disorders

• Common and uncommon fears

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Explaining Anxiety Disorders

• Freudian view (Psychodynamic) Repression of
  painful and intolerable ideas, feelings, and
  thoughts, results in anxiety
• Learning perspective Conditioning causes anxiety.
  Anxiety becomes associated with other objects or
  events through observation (and generalization)
  and is reinforced.
• Cognitive perspective Misinterpretation and
  errors in cognition
• Biological perspective
• Genes may be partly responsible for developing
  fears and anxiety. (Twin studies and temperament)
• Evoutionary/Natural Selection has led our
  ancestors to learn to fear snakes, spiders, and
  other animals. Fear preserves the species
• Neuroscientific explanations. Brain regions and
  chemistry

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Obsessive Compulsive Disorder

• Obsessive-Compulsive and Related Disorders (New
  Chapter/Category in DSM-5)
• Characterized by obsessions (repetitive thoughts)
  and/or compulsions (repetitive behaviors)
• Four new OC disorders were added to DSM-5
  including Hoarding and Excoriation Disorder
• Body Dysmorphic Disorder and Trichotillomania
  now fall under OCDRD
• Trauma and Stressor Related Disorders (New
  Chapter)
• Post Traumatic Stress Disorder - Recurring
  episodes of anxiety following a stress event
  symptoms include haunting memories, withdrawal,
  anxiety, and depression
• Reactive Attachment, Acute Stress, and Adjustment
  D/Os

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Depressive Disorders (formerly under Mood
Disorders)

• Major Depressive Disorder A person experiences
  two or more weeks of depressed moods, feelings of
  worthlessness, and diminished interest or
  pleasure in most activities
• Depression is the common cold of psychological
  disorders - 5.8 of men and 9.5 of women report
  depression worldwide a year (WHO, 2002)
• Usually goes away in time (even without
  treatment, although treatment can speed up
  recovery)
• Persistent Depressive Disorder (formerly
  Dysthymic Disorder)

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Persistent Depressive Disorder (formerly
Dysthymic Disorder)

• A long-term, low-level depression while not
  debilitating, it is characterized by low
  self-esteem and a persistent sense of
  hopelessness for a period of two years. People
  with PDD may also experience low energy,
  indecisiveness, insomnia or excessive sleeping,
  and a change in appetite.

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Perspectives on Depression

• Genetic Influences Depressive disorders run in
  families. Rates of depression are much higher in
  identical (50) than fraternal twins (20)
• Biological perspective Brain and
  neurotransmitters the role of serotonin,
  dopamine and epinephrine
• Social-Cognitive Depression causes negative
  thinking AND negative thinking causes depression

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Neurotransmitters Depression
A deficit of serotonin, (norepinephrine and
dopamine) has been found in depression
Pre-synaptic Neuron
Serotonin
Norepinephrine
Post-synaptic Neuron
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Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles
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Bipolar Disorder and Related Disorders (New
Chapter-formerly a Mood DO)

• Bipolar Disorder (Condition in which a person
  alternates between the hopelessness and lethargy
  of depression and the overexcited state of mania
  (once aka manic-depressive disorder). See
  handout
• Manic Episode A disorder marked by a hyperactive,
  wildly optimistic state
• New diagnosis Disruptive Mood Disregulation
  Disorder for children up to 18

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Neurodevelopmental Disorders

• Various categories marked by neurological and
  developmental issues (new and revised conditions)
• Intellectual Disability (no longer mental
  retardation)
• Communication Disorders
• Autism Spectrum Disorders
• Global Developmental Disorder
• Tic Disorders (Tourettes, e.g.)
• Attention Deficit Hyperactivity Disorder
• Disruptive, Impulse Control and Conduct Disorders
  (new category) characterized by problems in
  emotional and behavioral self-control

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Dissociative Disorders

• Dissociative Disorders Conscious awareness
  becomes separated (dissociated) from previous
  memories, thoughts, and feelings (See handout)
• Dissociative amnesia
• Dissociative fugue
• Depersonalization disorder
• Dissociative Identity Disorder Rare disorder in
  which a person exhibits two or more distinct and
  alternating personalities (once multiple
  personality disorder)

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Somatic Symptom and Related Disorders (formerly
Somatoform)

• Physical symptoms without any physical cause.
  Person experiences symptoms as real (Pain
  disorder)
• Conversion disorder (hysteria)
• La belle indifference
• Freud/Psychodynamic - Symptoms related to
  traumatic experience in the past
• Cognitive-Social - Ways in which the behavior is
  being rewarded
• Biological perspective - Real physical illnesses
  that are misdiagnosed or overlooked. Many
  disorders eliminated from DSM 5 to avoid overlap
  with medical conditions

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Schizophrenic Spectrum and Other Psychotic
Disorders

• Schizophrenia literal translation split mind,
  therefore often it is often confused with DID
  (formerly MPD). Severe disorders characterized by
• Disorganized and delusional thinking and
  hallucinations
• Disturbed perceptions
• Inappropriate emotions and actions
• The Brain

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Schizophrenic Spectrum and Other Psychotic
Disorders

• DSM-5 Revisions
• Subtypes under DSM-IVTR are eliminated
• Symptoms required for diagnosis have been changed

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Schizophrenia Interesting facts
Nearly 1 in a 100 suffer from schizophrenia.
Worldwide over 24 million people suffer from this
disease (WHO, 2002)
Schizophrenia strikes young people as they mature
into adults (adult onset). It affects men and
women equally, but men suffer from it more
severely than women

• When schizophrenia is slow to develop
  (chronic/process) recovery is doubtful. Such
  schizophrenics usually display negative symptoms

When schizophrenia rapidly develops
(acute/reactive) recovery is better. Such
schizophrenics usually show positive symptoms
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Symptoms of Schizophrenia

• Schizophrenics have inappropriate symptoms
  (hallucinations, disorganized thinking,
  delusional thinking) that are not present in
  normal individuals. These are called positive
  symptoms

Schizophrenics also have an absence of
appropriate symptoms or behaviors (apathy,
expressionless faces flat affect, rigid bodies)
that are present in normal individuals. These
are called negative symptoms worse prognosis,
less responsive to drugs
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Schizophrenia
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Understanding Schizophrenia

• Schizophrenia is a disease of the brain exhibited
  by the symptoms of the mind

Dopamine Overactivity Researchers have found that
schizophrenic patients express higher levels of
dopamine D4 receptors in their brains
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AP Essay 2007

• Often misunderstood, schizophrenia is a
  psychological disorder affecting one percent of
  the population. In addition to treating the
  disorder psychologists work to identify its
  nature and origins.
• Identify two characteristic symptoms used to
  diagnose schizophrenia.
• Discuss a research finding that supports a
  genetic basis for schizophrenia.
• What is the dopamine hypothesis regarding the
  origins of schizophrenia?
• Describe how medications used to treat
  schizophrenia affect the actions of
  neurotransmitters at the synapses.
• Identify a risk inherent in using medications
  in the treatment of schizophrenia
• People sometimes confuse schizophrenia with
  disassociative identity disorder (DID). Identify
  two key characteristics that differentiate DID
  from schizophrenia.

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Personality Disorders

• All PDs are characterized by inflexible and
  enduring behavior patterns that impair social
  functioning
• The DSM-5 retained a hybrid methodology
  emphasizing six personality disorder types
• Borderline Personality Disorder
• Obsessive-Compulsive Personality Disorder
• Avoidant Personality Disorder
• Schizotypal Personality Disorder
• Antisocial Personality Disorder
• Narcissistic Personality Disorder
• Personality Disorders Fact Sheet (DSM5)

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Personality Disorders

• Antisocial Personality Disorder
• Disorder in which the person exhibits a lack of
  conscience for wrongdoing, even toward friends
  and family members
• May be aggressive and ruthless or a clever con
  artist.
• Patients formerly referred to as psychopaths or
  sociopaths

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Personality Disorders

• Cluster A (odd or eccentric disorders)
• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder
• Cluster B (dramatic, emotional, or erratic
  disorders)
• Antisocial personality disorder
• Borderline personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder