Download Psychological Disorders

Psychological Disorders
I. General Overview
II. Specific Disorders
©2001 Prentice Hall
Defining Abnormal
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What it is …
 Low statistical frequency
 Social deviation
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Maladaptive behavior
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Disrupted functioning at home, work, and in
social life
Personal distress
 Source of the problem lies within the person
What it’s not …
 A response to specific life events
 A deliberate reaction to a societal condition
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40 years ago, if men wore earrings . . .
Culture and Psychopathology
 Psychological
disorders are
somewhat culturally relative
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In Roman Catholic rural Ireland,
schizophrenics have more bizarre
religious beliefs
Alaskan Eskimos define someone as
“crazy” when they drink urine or kill
dogs
Anorexia and bulimia nervosa
DSM-IV
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DSM-IV: Diagnostic and Statistical Manual of
Mental Disorders, 4th edition
Multiaxial (multidimensional) system of
diagnosis
• Axis I - the clinical syndrome for which a
patient seeks treatment
• Axis II - an enduring personality disorder that
may contribute to axis I
• Axis III – medical condition
• Axis IV – stressors
• Axis V – global assessment of functioning
Traditional classification scheme
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Neuroses
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Personality disorders
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Has conflicts in relationships, competitiveness
Rigid, defensive, under-confident at work
Reality is slightly distorted
Begins and ends relationships too quickly
Underemployed, drifting from job to job
Misinterprets interpersonal events
Psychoses: biological etiology
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Cannot maintain relationships; socially peculiar
Chronically unemployed
Has delusions, hallucinations, etc.
Assessment for
Psychological Disorders
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Assessment
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Examining a person’s mental, emotional, and
behavioral functions
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The goal is to make a diagnosis and, from there,
form a prognosis
Mental Status Exam
Clinical Interview
• Unstructured vs. structured (e.g., SCID)
Neuropsychological testing
• Is there some specific brain insult involved?
Psychological testing (see next slide)
Psychological Testing

Minnesota Multiphasic Personality Inventory –
2 (MMPI –2)
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Most widely used personality/psychological
disorders instrument
Measures aspects of personality that, if extreme,
suggest a psychological problem
Long test - 567 questions
Has ten different diagnostic scales (“multiphasic”;
see next slide)
Scale scores indicate how you compare with
others
Yields a personality profile (see next slide)
MMPI Score Profile
(across the 10 diagnostic scales)
MMPI Validity Scales
Four additional scales are designed to
determine whether respondent is
presenting self accurately.
 Example: L scale (‘Fake Good’) - Trying
too hard to present self in a positive
light.
• “I smile at everyone I meet” (T)
• “I read every editorial every day” (T)
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Pros and cons of diagnosis
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Pros
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Diagnosis is the first step towards
treatment and research
Cons (“labeling”)
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Can be used to mark an individual that
society considers deviant
Stigmatization
Stereotyping
Discrimination
Rosenhan (1973)
Models of Abnormality
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Psychological Model: Mental disorders
are caused and maintained by life experience.
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Psychodynamic
Cognitive and/or behavioral
Family systems (see notes page)
Biological (Medical) Model: Mental
disorders are caused by biological conditions
and can be treated through medical
intervention.
 Diathesis-Stress Model: Mental disorders
occur when people with an underlying
vulnerability (genetically or environmentally
caused) are under a great deal of stress.
The case of Charlie
 24-year old business student with an
intense fear of being in groups (anxiety
disorder: social phobia)
 He is most anxious when talking about
business
 This disorder is disruptive of work and
social life and is a cause of personal
distress
 Problem has intensified since his father,
who did not go to college, ridiculed him for
going to business school
Charlie viewed by different
psychological models
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Psychodynamic: conflict
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Behavioral: learning
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Consciously, Charlie wants to succeed but
unconsciously this evokes father’s ridicule
and guilt feelings about outdoing his father
Phobia is a conditioned emotional response;
anxiety -> social incompetence -> avoidance ->
negative reinforcement of avoidance -> further
erosion of social skills
Cognitive: dysfunctional cognitions
•
Low self-efficacy expectancies, learned
helplessness, negative cognitions regarding
self
Psychological disorders
 Anxiety
disorders
 Mood disorders
 Schizophrenic disorders
 Personality disorders
 Childhood disorders
 Some others
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Substance abuse
Somatoform disorders
Dissociative disorders
Sexual and gender-identity disorders
Eating disorders
Understanding psychological disorders
Prevalence rates
 Types: Major types and subtypes
 Anxiety disorders is one example of a
major type of disorder
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Anxiety disorder subtypes
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Phobic
Generalized
Panic
Obsessive-compulsive
Post-traumatic stress
Symptoms
 Theories/Causes
 Nature vs. Nurture
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Comorbidity of Disorders

Many people who have psychological
disorders experience more than one
diagnosable disorder at the same time.
Substance abuse: Alcoholism
 3rd largest health problem, following heart
disease and cancer
• Prevalence rate ~ 5%
 Children of alcoholics are 4x as likely to
develop alcoholism as children of
nonalcoholics
 Environmental causes
• Parents model alcoholic behavior
• Parenting style leads to low self-esteem in
children, who then self-medicate
Alcoholism and heredity
 Genetic predispositions may cause
 Liking the taste of alcohol or finding
the effects of alcohol soothing
 Depression or anxiety, which then
leads to self-medication
 Antisocial or delinquent personality
and behaviors, which in turn may
include alcohol abuse given the
appropriate social environment
Anxiety Disorders
Phobic Disorder
Generalized Anxiety Disorder
Panic Disorder
Obsessive-Compulsive Disorder
©2001 Prentice Hall
Phobic Disorder
A phobia is an irrational fear of an object
or situation.
 Most common subtype of anxiety
disorder
 This anxiety disorder subtype itself
includes three subtypes
• Simple (specific) phobia (10%)
• Social phobia (5%)
• Agoraphobia (1-2%)
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Panic Attack
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Panic: Sudden and
intense
physiological
reactions that occur
in the absence of an
emergency
Frequent attacks
diagnosed as panic
disorder
In many cases, the
first attack comes
soon after illness,
miscarriage, or other
traumatic event.
Obsessive-Compulsive Disorder
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Obsessions
• Persistent thoughts that cannot be controlled
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Compulsions
• Intentional behaviors or mental acts (that often
become ritualistic) that are performed in the
hope of warding off the obsession
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Terrible accident involving a loved one is about to
occur
Underwear is filled with germs
Washing one’s underwear 22 times
If the compulsion is prevented, anxiety occurs.
Two-thirds of Obsessive-Compulsive patients
improved after 10 years (w/o treatment), but very
few were symptom-free
Causes of anxiety disorders I
Cognitive
• Anxious individuals perceive
ambiguous stimuli as threatening
 Biological
• Children with inhibited temperaments
are more likely to have anxiety
disorders as adults
• OCD has been linked to an underactive caudate nucleus and an
overactive prefrontal cortex
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Causes of anxiety disorders II
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Situational (Learning)
• In phobias, associations may be learned between
previously neutral objects and a traumatic event
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In OCD, relief is associated with performing an
action to escape an aversive stimulus
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And then generalized to other previously neutral objects
This can be rewarding and can cause that behavior to be
performed with increasing frequency
In agoraphobia, embarrassing panic attacks in
public are avoided by staying at home
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Again, the relief from anxiety is rewarding and causes the
person to stay home with increasing frequency
Mood Disorders
Major Depression
Dysthymia
Bipolar Disorder
©2001 Prentice Hall
Mood disorders:
Major depression
 Symptoms include
 Depressed mood and loss of interest in
pleasurable activities
 Disturbances in appetite, sleep, energy
level, and concentration
 Feelings of guilt and worthlessness
 Thoughts of suicide
 15% of depressed people go on to commit
suicide
 30,000 people per year in the USA
 Depression is a progressive disorder
 Lifetime prevalence rate ~ 20%
 5% in a given year
Major Depression:
Theories/Causes
 Genetics
 Fraternal twins: 20%; Identical twins: 50%
 Heritability is .3 to .5
 Family history doubles/triples chances
 Biology
 Low levels of two neurotransmitters
(serotonin and norepinephrine) that are
involved in arousal and control of sleep
cycles
 Antidepressants (Prozac) increase the level
of these neurotransmitters in the brain by
blocking reuptake at synapses
Major Depression:
Environmental factors
 Childhood: Depressed adults are more likely to
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have grown up in disruptive, hostile, and
negative home environments
Adulthood: Severe stressors (e.g.,
interpersonal loss), high levels of criticism, and
lack of intimate relationships
Depressed people themselves
 Their social behavior leads to social
rejection which, in turn, worsens depression
 They tend to seek out others that have
negative views of themselves
Major Depression:
Behavioral/Cognitive Theories
 Beck’s theory of depression
 Interpret events unfavorably
 Do not like themselves
 Regard the future pessimistically
 These lead to cognitive distortions
 Learned helplessness
 Pessimistic (depressive or negative)
explanatory style
 Explain failures with internal (personal), stable,
and global attributions
Explanatory Style and
Depression
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Measured
explanatory styles
among first-year
college students
Two years later,
those with negative
style were more
likely to experience
a major or minor
depressive disorder
Helping a suicidal friend
 Recognizing the signs
 Talking about suicide
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 Preoccupation with death
 Putting things in order; “saying goodbye”
Changes in behavior
 Outgoing person becomes withdrawn
 Loss of interest in school and usual activities
 Problems with sleeping, eating, personal hygiene
 Taking action
 Talk to your friend; ask about suicidal
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thoughts and plans
Stay with your friend; help them help
themselves and/or tell others in a position to
help
Schizophrenic Disorders
The Symptoms of Schizophrenia
Types of Schizophrenia
Theories of Schizophrenia
©2001 Prentice Hall
Schizophrenia
 Umbrella term for a number of different
disorders marked by gross cognitive,
perceptual, emotional, and behavioral
disturbance
 Lifetime prevalence rate < 1%
 Negative symptoms
 Flat affect
 Slowed movement or speech
 Social withdrawal
 Impoverished thought
Positive symptoms of
schizophrenia
 Delusions: firmly held false beliefs
 Influence: thoughts are read or manipulated
 Grandeur: famous or capable of powerful acts
 Persecution: target of secret plots
 Hallucinations: sensory experiences w/o external
stimulation; auditory hallucinations are the most common
 Incoherent thinking
 Loosening of associations
 Displayed in speech whose direction flows in a freely
associative manner
 Inability to focus on one thing and filter out distractions
 Bizarre behavior
Types of Schizophrenia
 Paranoid: Delusions (especially persecution)
and hallucinations
 Disorganized: Illogical thought, incoherent
speech, and inappropriate affect
 Catatonic: Motor immobility, rigid posture or
excessive motor activity, including parrot-like
repetition
 Undifferentiated: Mixture of the above
 Residual: Partial remission after an acute
episode, marked by negative symptoms
Schizophrenia:
Theories/Causes
 Genetics
 Fraternal twins: 17%; Identical twins: 48%
 Heritability is .5 to .9
 Biology
 High levels of dopamine
 Antipsychotic medications decrease influence of
dopamine by blocking receptor sites at the synapse
 Brain atrophy (neuronal loss) reflected in
enlarged ventricles in schizophrenics
 Even though schizophrenia typically emerges in
early 20’s, unusual social, emotional, and motor
behaviors are evident during childhood
Schizophrenia:
Environmental Factors
 Psychological
 Patterns of communication within families
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 Confusing communication that involves mixed messages
Expressed emotion in families
 Criticism, hostile interchanges, and emotional intrusiveness
 Biological
 Schizovirus?
 Antibodies found in blood of schizophrenics, but not others
 Schizophrenics more likely to have been born in spring, meaning that
they were in their 2nd trimester during flu season
 In late-splitting identical twins that shared the same plancenta, the
concordance rate is 60%
 20% in early splitting identical twins
Personality Disorders
The Borderline Personality
The Antisocial Personality
©2001 Prentice Hall
Personality Disorders
 Marked by persistent (since adolescence),
extremely maladaptive behavior
 Usually lasts throughout the life span
Seldom seek treatment
Improvement is uncommon
 Lifetime prevalence rate ~ 5-10%
 Two subtypes of interest
Borderline Personality Disorder
Antisocial Personality Disorder
Borderline Personality Disorder:
Symptoms
 Unstable personal relationships
 Lack of a clear identity leads them to . . .
 Seek out dependent relationships
 Fear abandonment
 Extremely sensitive to rejection
 Be very manipulative about controlling any relationship
 Intense, unstable moods
 Chronic anger
 Impulsive behavior
 Drug and alcohol abuse
 Sexual promiscuity
 Self-mutilation
Borderline Personality Disorder:
Causes
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Biological
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Evidence for heritability
Low serotonin levels
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Linked to depression
Situational
• History of trauma or abuse
• Hypercritical caregivers
• Caregivers that encourage dependence
Antisocial Personality Disorder:
Symptoms
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Known pejoratively as “psychopath” or “sociopath”
Lack of remorse; lack of empathy
Seeks immediate gratification without any thought of
others
Impulsive; sensation-seeking
Many are very intelligent and highly verbal
Punishment has little effect on them
Different “subtypes”
• White collar criminal
• Con man
• Habitually violent offender
• Psychopath (e.g., Hannibal Lecter)
Antisocial Personality Disorder:
Causes
Feel little fear or anxiety
 Lower overall level of arousal
• Therefore they are sensation-seekers
• Therefore they do not find punishment
aversive
 Evidence for heritability
• Adopted male children have a higher
rate of crime if their biological fathers
had criminal records
 Low SES, poor nutrition as a child
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Somatoform Disorders
Hypochondriasis
Conversion Disorder
©2001 Prentice Hall
Somatoform Disorders
Hypochondriasis: A disorder
characterized by an unwarranted
preoccupation with one’s physical health.
 Conversion Disorder: A disorder in
which a person temporarily loses a bodily
function in the absence of a physical
cause.
 Lifetime prevalence rate of .3%
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Sensitivity in Hypochondriasis
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Foot put into tub of ice water
• 15 hypochondriac women
• 15 control women
Heart rate and hand
temperature were recorded
Hypochondriacs
• removed their foot sooner
• rated cold as more
unpleasant
Physiological signs of stress
were higher in
hypochondriacs
Conversion Disorders
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In “Glove Anesthesia”
(shown), the hand may
be numb, although four
different nerve tracts
provide sensation to
the hand and lower arm
• The physical
symptoms don’t
match what is
known about
physiology
Symptoms
Neural Wiring
Dissociative Disorders
Amnesia and Fugue States
Dissociative Identity Disorder
©2001 Prentice Hall
Dissociative Disorders
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Amnesia: A dissociative disorder involving a
partial or complete loss of memory.
Fugue State: A form of amnesia in which a
person “forgets” his or her identity, wanders
from home, and starts a new life.
Dissociative Identity Disorder (DID): A
condition in which an individual develops two
or more distinct identities.
• Formerly known as “Multiple Personality
Disorder.”
Lifetime prevalence rate is “very rare”
Childhood Disorders
Autism
Attention-Deficit/Hyperactivity
©2001 Prentice Hall
Autism
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Extreme lack of awareness of others
Deficits in social interaction, impaired
communication, and restricted interests
characterize autism
3-6 of 1000 children show signs of autism, with
males outnumbering females 3:1
Asperger’s syndrome is high-functioning autism
Autism is a biological disorder
• Some evidence for heritability
• Prenatal or neonatal events
• Some neurochemistry abnormalities
Attention-Deficit/Hyperactive Disorder
Restlessness, inattentiveness, and
impulsivity characterize ADHD
• Need to have directions repeated
• Friendly, but not many friends because
they miss social cues
 50% of mothers of 4-year-old boys believe
their sons are hyperactive, but actual
diagnostic estimates are 3-5%
 Symptoms often persist into adulthood
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ADHD Causes
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Causes are unknown but probably
heterogeneous
• Situational
Poor parenting
– Dysfunctional family
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Chicken and egg problem
Biological
Some evidence for heritability
– Frontal lobe dysfunction
– Basal ganglia dysfunction
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