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To study the abnormal is the best way of
understanding the normal.
William James (1842-1910)
Psychological Disorders
and Therapies
Chapter 15 and 16
1
Rates of Psychological Disorders
1.
2.
3.
http://www.learner.org/resources/se
ries60.html?pop=yes&pid=780
There are 450 million
people suffering from
psychological disorders
(WHO, 2004).
Depression and
schizophrenia exist in all
cultures of the world.
Two Major Classifications
Neurotic: Distressing
but one can still
function in society and
act rationally
Psychotic: Person
loses contact with
reality, experiences
2
distorted perceptions
Common Culture Bound Syndromes
Syndrome
Region/Pop
Affected
Description
Koro
Southeast
Asia and
Africa
Episode of sudden and intense anxiety that the penis (or in women, the
vulva and nipples) will recede into the body and possibly cause death.
Amok
Malaysia
Dissociative episode characterized by a period of withdrawal and
brooding followed by an outburst of violent, aggressive or homicidal
behavior; often a response to a perceived slight
2-D Love
Japan
Men develop what appear to be amorous relationships with animated
female characters; they may carry around pillows or other tangible
reminders of these characters wherever they go
Windigo
Native
Americans
Morbid state of anxiety with fears of becoming a cannibal
Susto
Mexico,
Central
America, and
South
America
Illness attributed to a frightening event that causes the soul to leave the
body and results in unhappiness and sickness. Ritual healings are
focused on calling the soul back to the body and cleansing the person to
restore bodily and spiritual balance
Taijin
Kyofu Sho
Japan
Intense fear that one’s body, its parts or its functions, displease,
embarrass, or are offensive to other people in appearance, odor, facial
3
expressions, or movements
Defining Psychological Disorders
Mental health workers view psychological disorders as
persistently harmful thoughts, feelings, and actions. Behavior
is judged to be:
1. Atypical – statistically infrequent; uncommon
2. Disturbing – socially disagreeable behaviors (varies with
time and culture)
3. Maladaptive – cause social or physical harm
a. To self - Inability to reach goals, to adapt to the
demands of life
b. To society – interferes, disrupts social group functioning
4. Personal Distress – behavior causes a person discomfort,
anxiety, depression.
5. Unjustifiable – no good reason for behavior
4
DSM IV: Multiaxial Classification
(pg. 623-626 in CP )
Axis I
Axis II
Is a Clinical Syndrome (cognitive, anxiety,
mood disorders [16 syndromes]) present?
Is a Personality Disorder or Mental Retardation
present?
Is a General Medical Condition (diabetes,
Axis III
hypertension or arthritis etc) also present?
Are Psychosocial or Environmental Problems
Axis IV
(school or housing issues) also present?
What is the Global Assessment of the person’s
Axis V functioning?
The most recent edition, DSM-IV-TR (Text Revision, 2000),
describes 400 psychological disorders compared to 60 in the
1950s. DSM-V is supposed to come out in May 2013
Strengths/Weaknesses of DSM
Strengths
Weaknesses
1. Describe (400) disorders
2. Disorders outlined by DSM-IV
are reliable. Therefore,
diagnoses by different
professionals are similar.
3. Determines how prevalent the
disorder is
4. Labels may be helpful for
healthcare professionals when
communicating with one
another and establishing
therapy. Correct labeling of a
disorder may help people
identify the source of their
unhappiness and lead to a
proper treatment
1.
Does not explain CAUSES – just
describes disorder and lists prevalence
2.
Labels may stigmatize individuals and
increase the risk of creating
self-fulfilling prophecies.
*Rosenhan Study – normal people
misdiagnosed in mental hospital
(http://www.psychblog.co.uk/video-beingsane-in-insane-places-163.html)
1.
May foster over-diagnosis and confuse
serious mental disorders with normal
problems in living
2.
Diagnoses can be misused for social and
political purposes
3.
“Insanity” (legal status indicating that a
person cannot be held responsible for
his or her actions because of mental
illness; unable to distinguish right from
wrong) labels raise moral and ethical
6
questions about how society should
treat people who have disorders and
History of Mental Disorders: Early Theories
• Afflicted people were
possessed by evil spirits.
– Music or singing was often
used to chase away spirits.
– In some cases trephening
was used: cutting a hole in
the head of the afflicted to
let out the evil spirit.
– Another theory was to
make the body extremely
uncomfortable.
Trephening
History of Mental Disorders: Hospitalization
• In the 1800’s, disturbed people
were no longer thought of as
madmen, but as mentally ill.
– They were first put in hospitals;
however, they were nothing
more than barbaric prisons.
– The patients were chained and
locked away and some
hospitals even charged
admission for the public to see
the “crazies”, just like a zoo.
• Philippe Panel - French doctor
who was the first to take the chains
off and declare that these people are
sick and “a cure must be found!!!”
Insisted that madness was not
due to demonic possession, but
an ailment of the mind
Current Perspectives: Medical Model
When physicians discovered that syphilis led to
mental disorders, they started using medical models
to review the physical causes of these disorders.
Psychological disorders are sicknesses and can be
diagnosed, treated and cured.
1. Etiology: Cause and development of the
disorder.
2. Diagnosis: Identifying (symptoms) and
distinguishing one disease from another.
3. Treatment: Treating a disorder in a psychiatric
hospital.
4. Prognosis: Forecast about the disorder.
10
Current Perspectives: Biopsychosocial
Perspective
Assumes that biological, socio-cultural, and psychological factors combine
and interact to produce psychological disorders
(Mental illnesses are socially defined - major disorders, like depression and
schizophrenia appear to be universal, however; other disorders appear to be tied to
specific cultures)
Used to be
called
DiathesisStress Model:
diathesis
meaning
predisposition
and stress
meaning
environment.
Models of Abnormality and Therapy:
Biological Perspective
Physiological factors (brain activity, genes, hormones, NTs,
nervous) determine behavior and mental processes
Causes of Mental Disorders
 Physical diseases that can be
treated medically
 Brain abnormalities
 Chemical imbalances
 Birth difficulties
 Heritability
Treatment of Mental Disorders
 Drug Therapy
 Electroconvulsive Therapy
(ECT) – effective for certain
kinds of severe, otherwiseuntreatable depression.
 Psychosurgery/neurosurgery –
surgery to destroy selected
areas of the brain thought to be
responsible for emotional
disorders. Prefrontal lobotomy.
Brain Abnormalities
A PET scan of the brain of a person with ObsessiveCompulsive Disorder (OCD). High metabolic activity
(red) in the frontal lobe areas are involved with
directing attention.
Generalized anxiety, panic
attacks, and even OCD are
linked with brain circuits like
the anterior cingulate cortex.
PET scans of 41 murderers revealed
reduced activity in the frontal lobes. In a
follow-up study repeat offenders had 11%
less frontal lobe activity compared to
individuals without antisocial personality
disorder
Brain Abnormalities
Schizophrenia patients may
exhibit morphological changes
in the brain like enlargement
of fluid-filled ventricles.
Dopamine
Overactivity:
Researchers found
that schizophrenic
patients express
higher levels of
dopamine D4
receptors in the
brain (neurons using
dopamine fire too
often).
Drug Therapy
Anti-anxiety drugs: Xanax , Valium,
Klonopin, Ativan depress the central nervous
system and reduce anxiety and tension by
elevating the levels of the (GABA)
neurotransmitter.
Atypical antipsychotic drugs: Clozapine (Clozaril)
blocks receptors for dopamine and serotonin to
remove the negative symptoms (apathy, jumbled
thoughts, concentration difficulties, and difficulties
in interacting with others) of schizophrenia but does
not restore normal thought patterns.
Classical antipsychotics: Chlorpromazine
(Thorazine) removes a number of positive
symptoms associated with schizophrenia such as
agitation, delusions, and hallucinations.
Drug Therapy
Anti-depressants: Monoamine
Oxidase (MAO) inhibitors elevate
levels of norepinephrine and
serotonin by blocking or inhibiting
the enzyme that deactivates these
Norepinephrine
NT. Serotonin-norepinephrine
inhibitors (SNRIs) also elevate levels
of norepinephrine and serotonin by
blocking the reuptake of these NT.
Pre-synaptic
Neuron
Serotonin
Post-synaptic
Neuron
Anti-depressants: Selective serotonin
reuptake inhibitors (SSRIs) – (Prozac,
Zoloft, and Paxil) elevate levels of
serotonin by preventing its reuptake
Lithium Carbonate, a common
salt, has been used to stabilize
manic episodes in bipolar disorders
reducing levels of norepinephrine
and glutuamate
Brain Stimulation
Electroconvulsive Therapy (ECT)
ECT is used for severely depressed
patients who do not respond to
drugs. The patient is anesthetized
and given a muscle relaxant. Patients
usually get a 100 volt shock that
relieves them of depression.
Transcranial Magnetic Stimulation (TMS)
In TMS, a pulsating magnetic coil is
placed over prefrontal regions of the
brain to treat depression with minimal
side effects.
Models of Abnormality and Therapy:
Psychodynamic Perspective
Unconscious desires, needs, memories, and conflicts determine
behavior and mental processes. Struggle to fulfill instinctive
desires and wishes despite society’s rules
Causes of Mental Disorders
Treatment for Mental Disorders
 Repressed unconscious
conflicts and drives
 Early childhood trauma
 Free association – patient reports all
feelings, thoughts, memories, and
images that come to mind in order to
bring repressed feelings into
conscious awareness where the
patient can deal with them
 Dream analysis
 When energy devoted to id-egosuperego conflicts is released, the
patient’s anxiety lessens.
Psychoanalysis
Dissatisfied with hypnosis, Freud developed the method of free
association to unravel the unconscious mind and its conflicts.
During free association, the patient
lies on a couch and speaks about
whatever comes to his or her mind.
Often, the patient will edit his
thoughts, resisting his or her feelings
to express emotions. Such resistance
becomes important in the analysis of
conflict-driven anxiety.
Eventually the patient opens
up and reveals his or her
innermost private thoughts,
developing positive or
negative feelings
(transference) towards the
therapist.
Interpersonal psychotherapy, a
variation of psychodynamic
therapy, is effective in treating
depression. It focuses on symptom
relief here and now, not an overall
personality change. 19
Models of Abnormality and Therapy:
Cognitive Perspective
The way we process, interpret, and store information determines behavior
and mental processes. Emphasize cognitions (mental processes such as
learning, memory, perception, thinking, and decision making)
Causes of Mental Disorders Treatment for Mental Disorders
 Rational Emotive Behavior Therapy (Albert
 Mental disorders are a
Ellis) – therapist challenges illogical beliefs
result of learned
directly with rational arguments; aim is to
maladaptive thought
identify self-defeating thought patterns and
replace them with more constructive thoughts
patterns or irrational
 Cognitive Therapy (Aaron Beck) – cognitive
thoughts (a
restructuring in which a client sees that his/her
misinterpretation of what
depression is due in part to erroneous and
illogical thought patterns. Therapist helps
is happening and is not
point out those thoughts that precede anxiety
supported by the available
and depression and then works with the client
evidence)
to test the logic of these thoughts.
Models of Abnormality and Therapy:
Humanistic Perspective
One’s inborn tendency to grow toward his/her unique potential
determines behavior and mental processes. Emphasize free will,
self-concept, and self-actualization
Causes of Mental Disorders
Treatment
 Distorted sense of self
 Growth-thwarting
environment (real and
ideal self are
incongruent; did not
receive unconditional
positive regard or
empathy)
 Do not delve into the past; help people to feel
better about themselves here and now; boost
self-fulfillment by helping people grow in
self-awareness and self-acceptance.
 Client-centered therapy (Carl Rogers) therapist offers unconditional positive regard
(non-judgemental) to build self-esteem;
therapist must be warm, genuine, and empathic
so client can adopt these views and become
self-accepting
 Active listening - echoes, restates, and
clarifies the patient’s thinking,
acknowledging expressed feelings
Models of Abnormality and Therapy:
Behaviorist Perspective
Learning through rewards and punishments in our external
environment (classical conditioning, operant conditioning,
observational learning) determines behavior and mental processes.
Causes of Mental Treatment
 Counterconditioning
Disorders
 Flooding or exposure treatments – therapist
 Learned
accompanies client into the feared situation
 Systematic desensitization – a step by step process
maladaptive
of desensitizing a client to a feared object or
patterns of
experience; based on counterconditioning
behavior cause
 Aversive conditioning – substitutes punishment for
the reinforcement that has perpetuated a bad habit
mental disorders
 Behavior Modification
 Skills training – practice in specific acts needed to
achieve goals
 Token economy - in institutional settings therapists
may create a token economy in which patients
exchange a token of some sort, earned for exhibiting
the desired behavior, for various privileges or treats
Anxiety Disorders
Anxiety (a sense of apprehension that shares many of the same
symptoms as fear but builds more slowly and lingers longer)
that persists to the point that it interferes with one’s life.
The CNS’s physiological and emotional response to a vague
sense of threat or danger.
http://www.youtube.com/watch?v=_Cr7IomSy8s
1. Generalized anxiety disorders
2. Phobias
• Copycat Agoraphobia
http://www.youtube.com/watch?v=u0dpgmwETcg&playnext=1&list=PLD14A589E28BB
9502
3.
Obsessive-compulsive disorders
•
•
•
•
•
4.
5.
As Good as it Gets http://www.youtube.com/watch?v=44DCWslbsNM
Aviator http://www.youtube.com/watch?v=7FapiKgs4y8&feature=related
Grey’s Anatomy http://www.youtube.com/watch?v=ETFQ9fyRP0s&feature=related
Exposure Therapy Aims to Curb OCD http://www.youtube.com/watch?v=B-qtnCiX5b4
Deep Brain Stimulation for OCD http://abcnews.go.com/video/playerIndex?id=3379057
Panic disorders
Posttraumatic Stress Disorder
Generalized Anxiety Disorder
Symptoms
1. Feeling unexplainably tense
and uneasy
2. Anxiety and worry are
associated with at least 3 of
these symptoms: restlessness,
easily fatigued, difficulty
concentrating, irritability,
muscle tension, sleep
problems
3. Difficulty controlling the
worry, which may develop
into “panic attacks”
4. Inability to identify or avoid
the cause of certain feelings.
5. Occurs more days than not for
six months
I wish I could tell you what’s the matter.
Sometimes I feel like something terrible has
just happened when actually nothing has
happened at all. Other times, I’m expecting
the sky to fall down any minute. Most of the
time I can’t point my finger at something
specific. The fact is that I am tense and
jumpy almost all the time. Sometimes my
heart beats so fast, I’m sure it’s a heart
attack. Little things can set it off. The other
day I thought a supermarket clerk had
overcharged me a few cents on an item. She
showed me that I was wrong, but that didn’t
end it. I worried the rest of the day . I kept
going over the incident in my mind, feeling
terribly embarrassed at having raised the
possibility that the clerk had committed an
error. The tension was so great, I wasn’t
sure I’d be able to go to work in the
afternoon.
Panic Disorder
Symptoms:
1. Recurrent, unexpected
attacks of acute anxiety ,
peaking within 10 minutes.
2. Such panic may occur in a
familiar situation, such as a
crowded elevator.
3. May include feelings of
terror, chest pains, nausea,
choking, or other frightening
sensations.
4. Can cause secondary
disorders, such as
agoraphobia (phobia of open
places)
It happened without any
warning, a sudden wave
of terror. My heart was
pounding like mad, I
couldn’t catch my breath,
and the ground underfoot
seemed unstable. I was
sure it was a heart attack.
It was the worst
experience of my life.
Phobia Disorder
Symptoms:
1. Marked by a persistent
and irrational fear of an
object or situation that
disrupts behavior and is
often accompanied by
extreme anxiety
symptoms
2. Participate in elaborate
ways to avoid the object
or situation; just thinking
about the thing you fear
causes anxiety
I can’t tell you why I’m
afraid of rats. They fill
me with terror. Even if
I just see the word
“rat” my heart starts
pounding. I worry
about rats in
restaurants I go to, in
my kitchen cupboard,
and anywhere I hear
noise that sounds like a
small animal
scratching or running.
Types of Phobic Disorder
•
•
•
Specific Phobia
– Most common phobias: specific animals or insects, heights, enclosed spaces,
thunderstorms, and blood
Social Phobia
– Severe, persistent and unreasonable fears of social or performance situations in
which embarrassment may occur
Agoraphobia
– Intense fear of being alone in public places from which escape would be difficult
or help is not readily available
27
Obsessive-Compulsive Disorder
Persistence of unwanted thoughts, wishes, images,
ideas, doubts (obsessions) and urges to engage in
senseless rituals (compulsions) that cause distress.
28
Obsessive-Compulsive Disorder
• 20% of those with OCD have only
obsessions or only compulsions; all others
experiences both
• Obsession: A young woman is continuously
terrified by the thought that cars might careen
onto the sidewalk and run over her.
Compulsion: She always walks as far from
the street pavement as possible and wars red
clothes so that she will be immediately
visible to an out-of-control car
• Obsession: A college student has the urge to
shout obscenities while sitting through
lectures in classes. Compulsion: Carefully
monitoring his watch, he bites his tongue
every sixty seconds in order to ward off the
inclination to shout
• Obsession: A young boy worries incessantly
that something terrible might happen to his
mother while sleeping at night. Compulsion:
ON his way up to bed each night, he climbs
the stairs according to a fixed sequence of
three steps up, followed by two steps down in
order to ward off danger.
I felt the need to clean
my room … spent four
to five hour at it … At
the time I loved it but
then didn't want to do
it any more, but could
not stop … The clothes
hung … two fingers
apart …I touched my
bedroom wall before
leaving the house … I
had constant anxiety
… I thought I might be
nuts.
Common Examples of OCD
Common Obsessions:
Contamination fears of germs, dirt,
etc.
Common Compulsions:
Washing
Imagining having harmed self or
others
Repeating
Imagining losing control of aggressive
urges
Checking
Intrusive sexual thoughts or urges
Touching
Excessive religious or moral doubt
Counting
Forbidden thoughts
Ordering/arranging
A need to have things "just so"
Hoarding or saving
Acute Stress Disorder
• Characteristics of traumatic event:
– Threatened death or serious injury
– Person’s response involved intense fear, helplessness, or
horror
• During/after event person has 3 or more dissociative symptoms:
– Feel numb, detached, or lack of emotional responsiveness
– Less aware of surroundings
– Derealization - an alteration in the perception or experience of
the external world so that it seems strange or unreal
– Depersonalization - subjective experience of unreality in one's
sense of self
– Dissociative amnesia
• Traumatic event is persistently re-experienced
• Avoidance of stimuli that reminds one of the traumatic event
• Disturbance lasts for a minimum of 2 days and a maximum of 4
weeks of the traumatic event
Post-Traumatic Stress Disorder
Repeated, anxious reliving of a horrifying event
over an extended period of time.
1. Haunting memories
2. Nightmares
3. Social withdrawal
4. Jumpy anxiety
http://www.mtv.com/videos/true-life-i-have-post-traumaticstress-disorder/1601333/playlist.jhtml
Bettmann/ Corbis
5. Sleep problems
32
Etiology of Anxiety Disorders
Biological:
• Genetic; runs in families
• Inherit overly responsive autonomic
nervous system
• Overactivity of norepinephrine,
(noradrenaline), specifically connected to
the onset of panic attacks
• Lack of serotonin function, especially in
OCD and social phobias.
• Deficiency in GABA
• Too much glutamate in OCD patients,
which causes the alarm center in the brain
to keep going off
• Overactive amygdala or an underactive
prefrontal cortex, which creates an
inability to turn off the initial stress
response by the amygdala
Evolutionary:
• Biological preparedness to acquire some
fears much more easily than others
Behavioral:
• Through observational learning,
children adopt behaviors of anxiety
disorders displayed by their parents.
• As demonstrated in the Little Albert
experiment, fear can be classically
conditioned and then maintained
through operant conditioning
Cognitive:
• A lack of perceived control (socialcognitive)
• Inaccurate or irrational interpretation of
an event/stimulus.
Psychodynamic:
• Ego defense mechanisms are
inadequate.
Sociocultural Perspective
• Pressures, such as poverty or race, that
cause anxiety.
Treatment of Anxiety Disorders
Behavioral:
• Counterconditioning
– Exposure Therapy
• Systematic desensitization
(Video 13)
• Flooding
• Aversion conditioning
Biological:
• Antianxiety drugs (Valium,
Xanax) – reduce the symptoms of
anxiety, nervousness, and
sleeping problems by increasing
the level of GABA, which
inhibits nerve impulses in the
brain.
Generalized Anxiety Disorder results from…
• Psychodynamic Perspective
– Ego defense mechanisms are inadequate
• Severe punishment for expressing id impulses, which causes high
levels of anxiety
• Cognitive Perspective
– Unrealistic goals or unreasonable beliefs about the world and ourselves that
foster worry and fears.
– Inaccurate or irrational interpretation of an event/stimulus Tendency to
overgeneralize and magnify the significance of an event.
– Lack of perceived control.
• Sociocultural Perspective
– Pressures, such as poverty or race, that cause anxiety.
• Behavioral Perspective
– Observational learning – parents model the characteristics of anxiety
disorders for their children; trouble leaving the house or being overly
concerned about certain events.
• Humanistic Perspective
– People not looking at themselves honestly and acceptingly
35
Generalized Anxiety Disorder results from…
• Biological Perspective
– Certain people inherit autonomic nervous system traits that make them
vulnerable or predisposed to anxiety (such as, overly responsive or
reactive, strong alarm tendencies,). Minor events trigger anxiety.
• Heritability of anxiety is 30 to 40%
• Anxiety disorders run in families
– Breakdown in the neural circuitry that signals the brain to stop responding.
May be a result of an overactive amygdala or an underactive prefrontal
cortex, which creates an inability to turn off the initial stress response by
the amygdala
– Anti-anxiety drugs: Xanax , Valium, Klonopin, Ativan depress the central
nervous system and reduce anxiety and tension by elevating the levels of
the neurotransmitter GABA. Deficiency in GABA, inhibitory disorder,
which could account for racing thoughts.
Panic Disorder results from…
• Biological Perspective
– Heightened startle response –
hypersensitivity to neurochemicals
that alert sympathetic nervous
system.
– Overactive norepinephrine (NT
linked with arousal)
• Cognitive Perspective
– Full panic reactions are experienced
only be people who misinterpret
bodily events
Phobia Disorder results from…
• Behavioral Perspective
– Learning theorists suggest that fear conditioning leads to anxiety.
This anxiety then becomes associated with other objects or events
(stimulus generalization) and is reinforced.
– Fear is initially learned through classical conditioning
• Claustrophobia
• NS (closet)  no response
• UCS (lack of oxygen)  UCR (gasping for air)
• UCS (lack of oxygen) + NS (closet)  UCR (gasping for air)
• CS (closet)  CR (gasping for air)
• Generalization: closet to enclosed spaces
– Fear is then maintained through avoidance (operant conditioning)
because the individual avoids the thing he/she is afraid of, there are
no opportunities for “reality testing” and new learning.
– Investigators believe that fear responses are inculcated through
observational learning. Young monkeys develop fear when they
watch other monkeys who are afraid of snakes.
Phobia Disorder results from…
• Since phobias most likely develop as a result
of fear conditioning, therapists use learning
principles to eliminate unwanted behaviors.
• Counterconditioning is a classical
conditioning procedure that conditions new
responses to stimuli that trigger unwanted
behaviors.
– Exposure Therapy - expose (in real or
virtual environments) patients to things
they fear and avoid. Through repeated
exposures, anxiety lessens because the
brain habituates to the fear.
• Systematic Desensitization - A type
of exposure therapy that associates a
pleasant, relaxed state with gradually
increasing anxiety-triggering stimuli
• Flooding – immediate, direct and
constant exposure to feared object, no
chance of escape
– Aversive Conditioning - associates an
unpleasant state with an unwanted
behavior.
40
Phobia Disorder results from…
• Operant conditioning procedures enable therapists to
use behavior modification, in which desired behaviors
are rewarded and undesired behaviors are either
unrewarded or punished.
– Token Economy - In institutional settings therapists
may create a token economy in which patients
exchange a token of some sort, earned for exhibiting
the desired behavior, for various privileges or treats.
I
Phobia Disorder results from…
• Biological Perspective
– Natural Selection has led our ancestors to
learn to fear snakes, spiders, and other
animals. Therefore, fear preserves the
species. Role of biological preparedness –
people are biologically prepared by their
evolutionary history to acquire some fears
much more easily than others
– Twin studies suggest that our genes may
be partly responsible for developing fears
and anxiety. Twins are more likely to share
phobias
– Giving anti-depressants, such as SSRIs
Obsessive Compulsive Disorder results from…
•
•
•
•
Psychodynamic Perspective
– Id battles with ego on conscious level
• Id impulses = obsessive thoughts
• Ego defenses = counter-thoughts or compulsive actions
Behavioral Perspective
– Compulsions are learned by chance
– Exposure and response prevention (ERP), in which OCD sufferers don’t
try to avoid their particular source of anxiety but actually seek it out.
Eventually, emotional nerve endings grow desensitized to the stimulus.
Cognitive Perspective
– Overreact to unwanted thoughts
– Try to neutralize these thoughts with actions
– If neutralizing activity reduces anxiety, it becomes reinforced
Biological Perspective
– Twin studies – genetic component
High metabolic
• 53% in identical twins
activity (red) in
• 23% in fraternal twins
frontal lobes
- Brain abnormalities
- Too much glutamate, which causes the alarm centers in the brain to
keep going off
- Lack of serotonin functioning (NT involved with regulation of
sleep and mood
- High level of activity in frontal lobes, associated with attention
- In the future, OCD patients may receive deep brain stimulation.
Causes of Stress Disorders
•
•
•
•
Combat
• Psychological Debriefing
Disasters
– Normalize responses to
Abuse and victimization
the disaster
Why doesn’t everyone develop
– Encourage expressions of
psychological stress disorders?
anxiety, anger, and
– Biological and genetic factors
frustration
• Physical changes in body
– Teach self-help skills
• Abnormal NT and hormonal
– Provide referrals
activity
– Personality factors
• Preexisting high anxiety
• History of psychological
problems
• Negative worldview
– Negative childhood experiences
– Weak social support
44
– Severity of the trauma
Additional Anxiety Disorder Videos
• OCD Videos
– http://www.metacafe.com/watch/84755/true_life_living
_with_ocd/
– http://www.metacafe.com/watch/ytSH0r44qn6pI/my_life_with_ocd_laurens_story_part_i_
dramatic_health/
– http://www.metacafe.com/watch/ytT0FMXyp6ZEs/my_life_with_ocd_laurens_story_part_
ii_dramatic_health/
• PTSD Videos
– http://www.mtv.com/videos/true-life-i-have-posttraumatic-stress-disorder/1601333/playlist.jhtml
45
Mood Disorders
Emotional extremes, which come in two principal forms.
1.
2.
Unipolar disorders – experience emotional extremes at
just one end of the mood continuum
 Major depressive disorder
 Dysthymic disorder
 Seasonal Affective disorder
Bipolar disorders – experience emotional extremes at
both ends of the mood continuum – depression and
mania
Major Depressive Disorder
Symptoms
1.
Signs of depression last two weeks or
more and are not caused by drugs or
medical conditions
2.
Signs include: Lethargy and fatigue
(takes tremendous effort to get up and
get dressed); feelings of worthlessness
(tearfulness and weeping; exaggerate
minor failings, discount positive
events, interpret things that go wrong
as evidence that nothing will ever go
right); loss of interest in family &
friends; recurrent thoughts of
death/suicide; loss of interest in
activities; depressed most of the day;
significant weight gain/loss;
insomnia; psychomotor
agitation/retardation; concentration
difficulties or indecisiveness
I was seized with an unspeakable
physical weariness. There was a
tired feeling in the muscles unlike
anything I had ever experienced…
my nights were sleepless. I lay
with dry, staring eyes gazing into
space. The most trivial duty
became a formidable task. Finally
mental and physical exercises were
impossible; the tired muscles
refused to respond, my “thinking
apparatus” refused to work,
ambition was gone. My general
feeling might be summed up in the
familiar saying “What’s the use.”
Dysthymic Disorder
Symptoms
1. Mild but chronic; lies between a blue mood and major
depressive disorder
2. Characterized by daily depression lasting two years or
more; longer lasting but less disabling
3. When dysthymic disorder leads to major depressive
disorder, the sequence is called “double depression”
Blue
Mood
Dysthymic
Disorder
Major Depressive
Disorder
Seasonal Affective Disorder
Symptoms
1. Depression on a recurring basis in one season of the year
when it gets dark early and light late in the day
Treatment
 Light Therapy – exposure to bright light for a specific length
of time
 The level of light produced must match that of visible light
outdoors shortly after sunrise or before sunset
49
Etiology of Mood Disorders
Biological:
• Genetic; runs in families
• Low serotonin may “open the door” to a
mood disorder and permit norepinephrine
activity to define the particular form the
disorder will take:
– Low serotonin + Low
norepinephrine = Depression
– Low serotonin + High
norepinephrine = Mania.
• An excessive release of the stress hormone
cortisol, which could be connected to
impaired functioning of the hypothalamus
and pituitary gland of the endocrine system
• Malfunctions in the body’s circadian
clock, specifically for SAD.
Socio-cultural:
• Dysfunctional family systems, poverty,
high-crime neighborhoods, domestic
violence, and other stressful situations
• Women have a higher chance than men of
developing a mood disorder
Psychodynamic:
• Link between depression and grief:
when a loved one dies, the mourner
regresses to the oral stage:
Cognitive:
• Ruminating response style, selfdefeating thoughts, external locus of
control, learned helplessness, and
pessimistic views of: themselves, the
world, the future.
Treatment of Mood Disorders
Cognitive:
• Aaron Beck’s Cognitive Therapy – depression is caused
by errors in thinking - illogical thinking about themselves,
the world they live in, and the future. In therapy, clients
are taught not only to identify negative, distorted thoughts
but also to actually go out and test those negative beliefs.
EX: a client who believes that nobody likes him will be
instructed to engage in conversations with other people
and report back with all of his experiences, which the
therapist will try to build on successes and explore
reasons for lack of success.
• Albert Ellis’ Rational Emotive Behavior Therapy
(RET) –Emotional disorders are caused by irrational
beliefs - absolute, unrealistic views of the world and
perfectionistic - that cause us to expect too much of
ourselves and lead us to feel unnecessarily that we are
worthless failures. Therapists identify client’s irrational
beliefs and directly challenge or confront the patient and
persuade them to adopt more realistic beliefs.
• Stress Inoculation Training - A type of self-instructional
training focused on altering self-statements an individual
routinely makes in stress producing situations. EX:
“Relax, the exam may be hard, but it will be hard for
everyone else too. I studied harder than most people.
Besides, I don’t need a perfect score to get a good grade.”
Cognitive-Behavioral Therapy
• Combine the reversal of self-defeated
thinking with efforts to modify behavior.
Aims to alter the way people act
(behavior therapy) and alter the way they
think (cognitive therapy).
• Lewinsohn’s Behavioral Treatment
– reintroduce clients to pleasurable
activities and events
– appropriately reinforce their
depressive and nondepressive
behaviors
– help them improve their social skills
Treatment of Mood Disorders
Biological:
Monoamine Oxidase (MAO) inhibitors
elevate levels of norepinephrine and
serotonin by blocking or inhibiting the
enzyme that deactivates these NT. Norepinephrine
Serotonin-norepinephrine inhibitors
(SNRIs) also elevate levels of
norepinephrine and serotonin by
blocking the reuptake of these NT.
Pre-synaptic
Neuron
Serotonin
Post-synaptic
Neuron
Selective serotonin reuptake inhibitors
(SSRIs) (Prozac, Zoloft, and Paxil)
elevate levels of serotonin by preventing
its reuptake
Treatment of Mood Disorders
Electroconvulsive Therapy (ECT)
ECT is used for severely depressed
patients who do not respond to
drugs. The patient is anesthetized
and given a muscle relaxant. Patients
usually get a 100 volt shock that
relieves them of depression.
Transcranial Magnetic Stimulation (TMS)
In TMS, a pulsating magnetic coil is
placed over prefrontal regions of the
brain to treat depression with minimal
side effects.
Treatment of Mood Disorders
Psychosurgery was popular even in Neolithic times.
Although used sparingly today, about
200 such operations do take place in the US alone.
Psychosurgery is used as a last resort in
alleviating psychological disturbances.
Psychosurgery is irreversible. Removal of brain
tissue changes the mind. Modern methods use
stereotactic neurosurgery and radiosurgery that
refine older methods of psychosurgery.
Unipolar Disorders results from…
• Biological Perspective
- Low norepinephrine (a stress hormone which
affects parts of the brain where attention and
responding actions are controlled. Underlies
fight or flight response) and/or low serotonin
levels
- Brain scans show reduced frontal lobe activity
- Mood disorders run in families. The rate of
depression is higher in identical (50%) than
fraternal twins (20%).
- Linkage analysis and association studies link
possible genes and dispositions for
depression.
Unipolar Disorders results from…
• Psychodynamic Perspective
– Link between depression and grief: when a loved one dies, the
mourner regresses to the oral stage
• For most people, grief is temporary
• If grief is severe and long-lasting, depression results
• Those with oral stage issues (unmet or excessively met needs)
are at greater risk for developing depression
• Behavioral Perspective
– Depression results from changes in rewards and punishments
people receive in their lives; social rewards are especially important
• Sociocultural Perspective
– Focus on conditions of people’s lives; may explain gender
differences in depression rates. Also found links between
depression and culture, race, and social support
– Marriage and employment associated with lower rates of
depression
– People with depression experience a greater number of stressful life
events during the month just prior to the onset of their symptoms
56
Unipolar Disorders results from…
• Cognitive Perspective
– Conscious thoughts = how a person attends to, interprets, and uses
information
– Learned maladaptive thought patterns cause mental disorder (maladaptive
thinking  maladaptive behavior)
– Ruminating response style - depressed people hold pessimistic views of:
themselves, the world, the future and distort their experiences in negative
ways: exaggerate bad experiences, minimize good experiences.
– Learned helplessness - people become depressed when their efforts to
avoid pain or control the environment fail; however, not all depressed
people have actually experienced failure (social-cognitive)
Explanatory Style and Depression Cycle
1.
2.
3.
4.
Negative stressful events.
Pessimistic explanatory style.
Learned helplessness/Hopeless
depressed state.
These hamper the way the
individual thinks and acts,
fueling personal rejection.
Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
59
•
•
•
Rational Emotive Therapy (RET)
Albert Ellis
Emotional disorders are caused by irrational beliefs - absolute, unrealistic views of the world and
perfectionistic values (i.e. “Everyone must love me all of the time.” or “I should be thoroughly
adequate and competent in everything.”) – that cause us to expect too much of ourselves and lead us to
feel unnecessarily that we are worthless failures
Clients are taught that it is not the external events, but the interpretation of such events that leads to
feeling of despair. 1) Therapists search for a client’s irrational beliefs, especially with respect to the
irrational “shoulds,” “oughts,” and “musts” that are preventing a more positive sense of self worth and
a fulfilling life, 2) points out the impossibility of fulfilling them, and 3) uses any and every technique
to persuade the client to adopt more realistic beliefs, such as directly challenging/confronting the
client’s beliefs during therapy
ABC Model:
A = Activating Event (the individual cannot
find a date for the prom)
B = Belief, irrational (I guess nobody likes
me enough to go with me to the prom)
C = Consequences (Feelings of depression).
Ellis would challenge irrational beliefs with
rational arguments and provide other
reasons why he or she doesn’t have a date
for the prom, because the thought is causing
the depression not the event.
Rational Emotive Therapy (RET)
•
•
•
Cognitive Therapy
Aaron Beck
Depression is caused by errors in thinking - illogical thinking about themselves, the world they live in,
and the future – which lead them to:
– 1) selectively perceive the world as harmful while ignoring evidence to the contrary
– 2) overgeneralize on the basis of limited examples – for example, seeing themselves as totally
worthless because they were laid off at work,
– 3) magnify the significance of undesirable events – for example, seeing the job loss as the end of the
world for them,
– 4) engage in absolutistic thinking – for example, exaggerating the importance of someone’s mildly
critical comment and perceiving it as proof of their instant descent from goodness to worthlessness
Clients are taught not only to identify negative, distorted thoughts but also to actually go out and test
those negative beliefs.
– First taught to simply identify their own automatic thoughts (e.g. “This event is a total disaster.”)
and to keep records of their thought content and their emotional reactions.
– With the therapist’s help, they then learn about the logical errors in their thinking, and to challenge
the validity of these automatic thoughts by designing ways in which the client can check out these
thoughts in the real world. These disconfirmation experiments are planned to give the individual
successful experiences, thus interrupting the destructive thought sequence. .
– EX: a client who believes that nobody likes him will be instructed to engage in conversations with
other people and report back with all of his experiences, which the therapist will try to build on
successes and explore reasons for lack of success.
Cognitive Therapy
Bipolar Disorder
(formerly called manic-depressive disorder)
An alternation between depression and mania signals bipolar disorder.
Depressive Symptoms
Manic Symptoms
Gloomy
Elation
Withdrawn
Euphoria
Inability to make decisions
Tired
Slowness of thought
Desire for action
Hyperactive
Multiple ideas
64
Types of Bipolar Disorder
• Manic Episode
– Three or more symptoms of mania lasting
one week or more
• Hypomanic Episode
– a less severe version of a manic episode
that does not cause marked impairment in
social or occupational functioning
• Bipolar I Disorder
– Full manic and major depressive episodes
– Most sufferers experience an alternation of
episodes
– Some experience mixed episodes
• Bipolar II Disorder
– Hypomanic episodes and major
depressive episodes
• Cyclothymic Disorder
– a chronic pattern of less-severe mood
swings
• hypomania
• mild depression
• may blossom into bipolar I or II
disorder
When experiencing manic
symptoms, a 38 year old woman,
periodically hospitalized because of
her extreme moods, would become
“overactive and exuberant in spirits
and visited her friends, to whom she
outlined her plans for reestablishing
different forms of lucrative business.
She purchased many clothes, bought
furniture, pawned rings, and wrote
checks without funds. She played
her radio until late in the night,
smoked excessively, took out
insurance on a car that she had not
yet bought. Contrary to her usual
habits, she swore frequently and
loudly and created a disturbance in
a club to which she did not belong.
On the day prior to her second
admission to the hospital, she
purchased 57 hats.
Bipolar Disorder
Many great writers, poets, and composers
suffered from bipolar disorder. During their
manic phase creativity surged, but not during
their depressed phase.
Earl Theissen/ Hulton Getty Pictures Library
The Granger Collection
Wolfe
George C. Beresford/ Hulton Getty Pictures Library
Bettmann/ Corbis
Whitman
Clemens
Hemingway
Bipolar Disorder results from…
• Biological Perspective
- Low serotonin may “open the door” to a mood disorder and permit
norepinephrine activity to define the particular form the disorder will
take:
- Low serotonin + Low norepinephrine = Depression
- Low serotonin + High norepinephrine = Mania. Excessive
production of norepinephrine.
- Ions, which are needed to send incoming messages to nerve endings,
may be improperly transported through the cells of individuals with
bipolar disorder this improper transport may cause neurons to fire
too easily (mania) or to resist firing (depression)
- PET scans show that brain energy consumption rises and falls with
manic and depressive episodes.
Lithium Carbonate, a common salt, has
been used to stabilize manic episodes in
bipolar disorders. It moderates the levels of
norepinephrine and glutamate
neurotransmitters.
Schizophrenia
Symptoms: The literal translation is
“split mind.” A group of severe
disorders characterized by the
following:
1. Disorganized thinking
(neologisms, clang/loose
associations, word salad)
2. Delusions and hallucinations.
3. Inappropriate emotions and
actions.
http://www.youtube.com/watch?v=t
vkj1qlQ9vM&feature=related
This morning when I was at
Hillside [Hospital], I was
making a movie. I was
surrounded by movie stars
… I’m Marry Poppins. Is
this room painted blue to get
me upset? My grandmother
died four weeks after my
eighteenth birthday.”
This monologue illustrates
fragmented, bizarre thinking with
distorted beliefs called delusions
(“I’m Mary Poppins”).
Subtypes of Schizophrenia
Schizophrenia is a cluster of disorders. These
subtypes share some features, but there are
other symptoms that differentiate these
subtypes.
69
Schizophrenia Symptoms
Inappropriate symptoms
Appropriate symptoms absent
present (positive symptoms –
(negative symptoms –
behavioral excesses)
behavioral deficitis)
Hallucinations, disorganized
Apathy, (avolition – no
thinking, deluded ways.
emotion), expressionless faces,
rigid bodies blunted or flat
affect, social withdrawal,
poverty of speech (alogia) .
When schizophrenia rapidly develops (acute/reactive)
recovery is better. Such schizophrenics usually show
positive symptoms.
When schizophrenia is slow to develop (chronic/process)
recovery is doubtful. Such schizophrenics usually display
negative symptoms.
Positive Symptoms (Behavioral Excesses)
Schizophrenics have inappropriate symptoms (hallucinations, disorganized
thinking, deluded ways) that are not present in normal individuals
 Delusions: false beliefs about reality
a. delusions of grandeur – GOD complex/meglomania – people maintain
that they are famous or important
b. delusions of persecution – they’re out to get me/ paranoia
c. delusions of being controlled – the CIA is controlling my brain with a
radio signal
 Disordered thought & speech - Many psychologists believe disorganized
thoughts occur because of selective attention failure (fragmented and
bizarre thoughts).
a. loose associations/derailment – people shift topics in disjointed ways.
b. neologisms – meaningless, made up words
c. Perseveration – repetition of speech
d. thought insertion
e. thought broadcasting
 Heightened perception
 Hallucinations - A schizophrenic person may perceive things that are not
there. Frequently such hallucinations are auditory and lesser visual,
somatosensory, olfactory, or gustatory. Sensory perceptions that occur in
the absence of sensory stimulus
 Inappropriate affect - A schizophrenic person may laugh at the news of
71
someone dying
Psychomotor Symptoms
1. Awkward movements, repeated
grimaces, odd gestures
2. Movements seem to have a magical
quality
3. Catatonia: extreme form
 includes stupor, rigidity, posturing, and
excitement - patients with schizophrenia
may continually rub an arm, rock a chair,
or remain motionless for hours
72
Schizophrenia
Nearly 1 in a 100 suffer from schizophrenia, and
throughout the world over 24 million people
suffer from this disease (WHO, 2002).
Schizophrenia strikes young people as they
mature into adults. It affects men and women
equally, but men suffer from it more severely
and it appears earlier than women.
More common among the poor. Stress of
poverty might cause the disorder or
schizophrenia causes victims from higher social
levels to fall to lower social levels (downward
73
drift theory)
Etiology of Schizophrenia
Biological:
• Genetic; runs in families.
• Increased size in the ventricles (negative
symptoms)
• Dopamine Hypothesis: Excessive dopamine or
excessive receptor sites for dopamine is
connected to the positive symptoms..
• Prenatal viruses, such as influenza, or physical
trauma during fetal development.
Socio-cultural:
• Dysfunctional family systems: display conflict,
verbal exchanges are often confused, vague or
incomplete, critical and overly involved parents
• Substance abusers are more likely to develop
disorder, such as cocaine users.
• Disadvantaged communities report more
incidences of disorder than better-off areas..
• Vulnerability theory of schizophrenia
(diathesis-stress model): schizophrenia is the
result of a biological predisposition and the
amount of stress one encounters.
Behavioral:
• Some people are not reinforced for their
attention to social cues and, as a result, they
stop attending to those cues and focus instead
on irrelevant cues (e.g., room lighting) and
their responses become increasingly bizarre
Cognitive:
• Faulty interpretation and a misunderstanding
of biological events (EX: a man experiences
auditory hallucinations and approaches his
friends for help; they deny the reality of his
sensations; he concludes that they are trying
to hide the truth from him; he begins to reject
all feedback and starts feeling persecuted)
Treatment of Schizophrenia
Biological:
Classical antipsychotics: Chlorpromazine (Thorazine) blocks all
receptor sites for dopamine; thereby lessening the effects of dopamine
and removing a number of positive symptoms associated with
schizophrenia such as agitation, delusions, and hallucinations. Also
known as neuroleptic drugs because they often produce undesired movement
effects similar to symptoms of neurological diseases, such Tardive Dyskinesia
(involuntary movements, usually of the mouth, lips, tongue, legs, or body)
Atypical antipsychotic drugs: Clozapine
(Clozaril) also blocks receptors for
dopamine, but selectively blocks some of
them and not all of them; thereby,
eliminating some of the negative side
effects of classic antipsychotics (i.e. has less
of an effect on the D-2 receptors which control
body movements, so it does not cause
symptoms like Parkinson's disease). Also
blocks serotonin receptors
Treatment of Schizophrenia
• Socio-Cultural Perspective
– Family Therapy attempts to address the issues of living with a
schizophrenic, creating more realistic expectations, and providing
psychoeducation about the disorder
– Social Therapy focuses on techniques that address social and
personal difficulties in the clients’ lives (e.g., practical advice,
problem solving, decision making, social skills training,
medication management, employment counseling, financial
assistance, and housing
Schizophrenia results from…
• Psychodynamic Perspective
– Freud believed that schizophrenia developed from two processes:
1. regression to a pre-ego stage
2. efforts to re-establish ego control
• Behavioral Perspective
– Cites principles of reinforcement as the cause; some people are
not reinforced for their attention to social cues and, as a result,
they stop attending to those cues and focus instead on irrelevant
cues (e.g., room lighting) and their responses become increasingly
bizarre
• Cognitive Perspective
– Schizophrenic symptoms develop because of faulty interpretation
and a misunderstanding of biological events (EX: a man
experiences auditory hallucinations and approaches his friends
for help; they deny the reality of his sensations; he concludes that
they are trying to hide the truth from him; he begins to reject all
feedback and starts feeling persecuted)
Schizophrenia results from…
• Biological Perspective
– Twin studies – genetic component
• Risk of schiz for general population is 1-2 percent
• The likelihood of an individual suffering from
schizophrenia is 50% if their identical twin has the
disease
• No specific genes for schiz have been identified
0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
Schizophrenia results from…
•
Biological Perspective
– Schizophrenia may develop through 2 kinds of biological abnormalities:
– Dopamine Overactivity Hypothesis
• neurons using dopamine fire too often, producing symptoms of schizophrenia
• there are an unusually large number of dopamine receptors in people with
schizophrenia
• take antipsychotic meds, which block dopamine and help with positive
symptoms
• may have low levels of serotonin, which may lead to high levels of dopamine
activity.
– Brain abnormalities
• decreased brain weight
• reduced volume in specific brain areas, or reduced number of neurons in
certain brain areas
• enlarged ventricles
• Abnormal activity in frontal lobe, thalamus, and amygdala. Adolescent
schizophrenic patients also have brain lesions.
Schizophrenia results from…
• Biological Perspective
– Schizophrenia has also been observed in individuals who
contracted a viral infection (flu) during the middle of their fetal
development.
• large # of people with schizophrenia born in winter months
• women with schizophrenic children were more often
exposed to the influenza virus during pregnancy
• link between schizophrenia and a particular group of
viruses found in animals
Diathesis-Stress Model: People with a biological predisposition
will develop schizophrenia only if certain kinds of stressors or
events are also present. Psychological and environmental
factors can trigger schizophrenia if the individual is genetically
predisposed
Schizophrenia results from…
• Socio-Cultural Perspective
– Family dysfunction: parents of people with schizophrenia often:
– display more conflict – negative emotional climate
– have greater difficulty communicating; erbal exchanges are often
confused, vague, or incomplete.
– are more critical of and overinvolved with their children
– “expressed emotion:” family members frequently express criticism
and hostility and intrude on each other’s privacy
– Family Therapy attempts to address the issues of living with a
schizophrenic, creating more realistic expectations, and providing
psychoeducation about the disorder
– Social Therapy focuses on techniques that address social and
personal difficulties in the clients’ lives (e.g., practical advice,
problem solving, decision making, social skills training,
medication management, employment counseling, financial
assistance, and housing
Dr. Phil Schizophrenia
http://www.youtube.com/watch?v=uJOT45wXErk&
feature=related
http://www.youtube.com/watch?v=CoaZgvXQjik
20/20 Schizophrenia: Part 1
http://www.youtube.com/watch?v=moP_e-gx5hk
83
20/20 Schizophrenia: Part 2
84
http://www.youtube.com/watch?v=QPXkwYM9G-s&feature=related
Childhood Schizophrenia
http://www.hulu.com/watch/134660/abc-2020-fri-mar-12-201085
Young Schizophrenic at Her Mind's Mercy
http://www.youtube.com/watch?v=UTUMt05_nCI&feature=fvwrel
86
Dissociative Disorders
Conscious awareness becomes separated (dissociated)
from previous memories, thoughts, and feelings.
1. Dissociative Identity Disorder
(Multiple Personality Disorder)
2. Dissociative Amnesia
3. Dissociative Fugue
Dissociative Disorders
Conscious awareness becomes separated (dissociated)
from previous memories, thoughts, and feelings.
Symptoms:
1. Having a sense of being
unreal.
2. Being separated from the
body - depersonalization.
Watching yourself as in a
movie
3. Feature major losses or
changes in memory,
consciousness, and
identity, but do not have
physical causes.
Common Dissociative Experiences
in Everyday Life
• Daydreaming
• Missing parts of conversations
• Forgetting part of drive home
• Reading an entire page and not
knowing what you read
• Not sure whether you’ve done
something or only thought
about doing it
• Seeing oneself as if looking at
another person
• Not sure if an event happened
or was just a dream
Dissociative Identity Disorder (DID)
(formally called Multiple Personality Disorder)
Symptoms:
1. Person exhibits two or more distinct and
alternating personalities,
2. Each personality has his or her own
name, memories, traits and physical
mannerisms. The original personality
often is unaware of the alternate
personalities. The alternate personalities
usually are aware of the original one and
have varying amounts of awareness of
each other. Alternate personalities
display traits that are quite foreign to the
original’s personality
Norma has frequent 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.
Criticisms:
• The diagnosis of DID increased in the late 20th century.
DID has not been found in other countries.
• Role-playing by people open to a therapist’s
suggestion.
• Learned response that reinforces reductions in anxiety.
Dissociative Fugue
Jay, a high school physics
Symptoms:
teacher in NY City,
1. Forget their personal identities of
disappeared three days
their past (name, family, where
after his wife unexpectedly
they live, and where they work)
left him for another man.
and also flee to an entirely different Six months later, he was
location
discovered tending bar in
Miami Beach. Calling
2. For some, the fugue is brief: they
himself Marin, he claimed
may travel a short distance but do
to have no recollection of
not take on a new identity
his past life and insisted
3. For others, the fugue is more
severe: they may travel thousands that he had never been
married.
of miles, take on a new identity,
build new relationships, and
display new personality
characteristics
90
Dissociative Amnesia
Unable to recall important information, usually of
an upsetting nature, about their lives. Memory loss
is the only symptom and does NOT result from
other medical trauma, such as blow to the head
Marian and her brother were recently victims of
robbery. Marian was not injured, but her brother
was killed when he resisted. Marian is unable to
recall any details from the time of the accident until
four days later.
Sybil – Part 1
http://www.youtube.com/watch?v=m1_Z6-v4uT0&feature=related92
Sybil – Part 2
93
http://www.youtube.com/watch?v=1vANyDFgjZU&NR=1
60 Minutes: A Fractured Mind
Robert Oxnam discovered he had multiple personality disorder in
1990. Oxnam, or in this case his personality 'Bobby,' performing a
balancing act with bottles in New York's Central Park.
http://www.cbsnews.com/video/watch/?id=890396n&tag=related;photovideo
http://www.cbsnews.com/stories/2005/09/30/60minutes/main892181.shtml
94
Etiology & Treatment of Dissociative Disorders
• Psychodynamic Perspective
– Dissociative disorders are caused by repression, the most basic ego
defense mechanism
– People fight off anxiety by unconsciously preventing painful
memories, thoughts, or impulses from reaching awareness
– Repeated, severe sexual or physical abuse with biological
predisposition toward dissociation, such as fantasy prone
personality.
• Behavioral Perspective
– Dissociation grows from normal memory processes and is a
response learned through operant conditioning
– Momentary forgetting of trauma decreases anxiety, which increases
the likelihood of future forgetting
In Eye Movement Desensitization and Reprocessing (EMDR) therapy, the
therapist attempts to unlock and reprocess previous frozen traumatic memories by
waving a finger in front of the eyes of the client.
In order to treat DID, the therapist has to help recover memories (often
through hypnosis); merge the subpersonalities into one; further therapy
is needed to maintain fusion
Somatoform Disorders
Involve physical symptoms that have no organic (biological)
cause (ulcers, asthma, high blood pressure).
1. Conversion Disorder
–
Band of Brothers http://www.youtube.com/watch?v=_2NbEV8cFzs
2. Somatization Disorder (Briquet’s syndrome)
3. Pain Disorder Associated w/ Psychological
Factors
4. Hypochondriasis
5. Body Dysmorphic Disorder
–
–
–
Too Ugly for Love http://www.youtube.com/watch?v=MUKlLpMg-eM&feature=related
Mirror Mirror http://www.youtube.com/watch?v=iAuc2xAM7-8&feature=related
Dr. Phil http://www.youtube.com/watch?v=QMxL1uv9Vh0&feature=related;
http://www.youtube.com/watch?v=hYJRlPk0ShI&feature=related;
http://www.youtube.com/watch?v=NvAPYutZUUU&feature=related;
Somatoform Disorders
Involve physical symptoms that have no organic (biological)
cause (ulcers, asthma, high blood pressure).
Hysterical Somatoform Disorders: suffer actual changes in their physical functioning.
Hard to distinguish from genuine medical problems.
1. Conversion Disorder
– A psychological conflict or need is converted into dramatic physical symptoms that
affect voluntary or sensory functioning. Person temporarily loses some bodily
function. No physical damage to cause problems
– Symptoms often seem neurological, such as paralysis, blindness, or loss of feeling
– Most conversion disorders begin between late childhood and young adulthood
– They usually appear suddenly and are thought to be rare
2. Somatization Disorder (Briquet’s syndrome)
– Have numerous long-lasting physical ailments that have little or no organic basis.
Complaints usually vague, undifferentiated (heart palpitations, dizziness, nausea)
– To receive a diagnosis, a patient must have multiple ailments that include several
pain symptoms, gastrointestinal symptoms, a sexual symptom, and a neurological
symptom
– Patients usually go from doctor to doctor seeking relief.
3. Pain Disorder Associated w/ Psychological Factors
– Diagnosed when psychosocial factors play a central role in the onset, severity, or
continuation of pain
– The disorder often develops after an accident or illness that has caused genuine
pain. The disorder may begin at any age, and more women than men seem to
experience it
Somatoform Disorders
Faking Medical Disorders
1. Malingering
– Intentionally faking illness to achieve external gain (e.g., financial
compensation, military deferment)
2. Factitious disorders
– Intentionally producing or feigning symptoms simply from a wish to be a
patient
– Factitious Disorder is Common Among:
• received extensive medical treatment for a true physical disorder as a
child
• family problems or physical/emotional abuse in childhood
• grudge against medical profession
• worked in medical field
• have an underlying personality problem
- Most Common Factitious Disorders
• Münchausen syndrome - fake being ill or make oneself ill
• Münchausen syndrome by proxy – parents make up or produce physical
illnesses in their children
Somatoform Disorders
Preoccupation Somatoform Disorders
1. Hypochondriasis
– Unrealistically interpret bodily symptoms as signs of serious
illness. Excessive preoccupation with health concerns.
Assume physician must be incompetent
– Often their symptoms are merely normal bodily changes, such
as occasional coughing, sores, or sweating
– Although some patients recognize that their concerns are
excessive, many do not
2. Body Dysmorphic Disorder
– Preoccupation with an imagined or exaggerated defect in one’s
appearance
Etiology of Somatoform Disorders
• Psychodynamic Perspective
– two mechanisms are at work in the hysterical disorders:
• Primary gain: hysterical symptoms keep internal conflicts out of
conscious awareness
• Secondary gain: hysterical symptoms further enable people to avoid
unpleasant activities or to receive kindness or sympathy from others
• Behavioral Perspective: classical conditioning or modeling
– physical symptoms of hysterical disorders bring rewards to sufferers
• may remove individual from an unpleasant situation
• may bring attention to the individual – sick role
• Cognitive Perspective: oversensitivity to bodily cues
– Hysterical disorders are a form of communication, providing a means for
people to express difficult emotions
– Some people focus excessive attention on their internal physiological
processes and amplify normal bodily sensations into symptoms of distress,
which lead them to pursue medical treatment. Tend to have a faulty
standard of good health, equating health with a complete absence of
symptoms.
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Personality Disorders
Enduring or continuous inflexible patterns of thinking, feeling, and
acting. Start in childhood and continue through adolescence and
adulthood. Personality disorders tend to be lifelong, pervasive, and
inflexible (which makes them different from clinical disorders in
Axis I). Tend to be more resistant to treatment than those with
clinical disorders.
3 Clusters of Personality Disorders
A. eccentric/odd behavior
B. dramatic/erratic behavior
C. anxious/fearful behavior
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Cluster A Personality Disorders
Type
Characteristics
Paranoid
Distrust of others, believe people
out to harm them; could react with
violence to defend themselves
Schizoid
No social relationships; the
“hermit”
Problems with either starting or
maintaining relationships; odd
perceptions, emotions, thoughts,
and behavior
Schizotypal
Cluster B Personality Disorders
Type
Characteristics
Histrionic
Obsessed with being center of attention; very
dramatic; emotionally shallow person
Exaggerated belief that he or she is very
important and has achieved much success;
arrogant
Instability of emotions, impulse control,
obsessive fear of being alone, difficulty
maintaining relationships and routines
No feelings of regard for others or their welfare;
lack of conscience or remorse; most heavily
studied personality disorder; sociopath and
psychopath have been used to describe this
disorder.
Narcissistic
Borderline
Antisocial
Cluster B Personality Disorders
Psychopathy vs. ASPD
• Psychopathy - focuses primarily on underlying
personality traits (e.g., being self-centered or
manipulative)
• ASPD - focuses primarily on observable
behavior (e.g., impulsivity, repeatedly changes
jobs)
ASPD vs. Criminality
• “criminal” is a legal term denoting conviction
for breaking a law:
– not all people with ASPD are criminals (or
in jails)
– not all people in jail or considered criminal
have ASPD
– not all people with ASPD are psychopaths
ASPD Influences & Treatment
• deficient emotional arousal and conditioning is
associated with a lack of empathy, thrill-seeking
• punishment of offenders not likely to be very
effective for rehabilitation
• programs like “Scared Straight” and boot camps
make kids with ASPD potential worse rather
than better
• “getting tough” with this population not likely
to work
“Social predators who
charm, manipulate, and
ruthlessly plow their way
through life, leaving a
broad trail of broken
hearts, shattered
expectations, and empty
wallets. Completely
lacking in conscience and
empathy, they selfishly
take what they want and
do as they please,
violating social norms and
expectations without the
slightest sense of guilt or
regret.”
Robert Hare (1993)
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Etiology of Antisocial PD
Biological::
• Reduced activity in the frontal lobe,
which is responsible for planning and
organization.
Socio-cultural:
• Dysfunctional family, lack of positive
parenting, attachment problems that
appeared in early childhood, and
childhood trauma.
• Living in a high crime neighborhood
Cluster C Personality Disorders
Type
Characteristics
Dependent
An enormous need to be taken
care of; cannot make
decisions; very needy
Obsession with order and
control; perfectionist
Oversensitive to criticism;
does not partake in social
situations.
Obsessive
Compulsive
Avoidant
What about Bob? Dependent Personality Disorder
http://www.youtube.com/watch?v=GCfq7yistd4
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