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Psychological Disorders I. General Overview II. Specific Disorders ©2001 Prentice Hall Defining Abnormal What it is … Low statistical frequency Social deviation Maladaptive behavior 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 40 years ago, if men wore earrings . . . Culture and Psychopathology Psychological disorders are somewhat culturally relative 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 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 Neuroses • • • Personality disorders • • • 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 • • • Cannot maintain relationships; socially peculiar Chronically unemployed Has delusions, hallucinations, etc. Assessment for Psychological Disorders Assessment • Examining a person’s mental, emotional, and behavioral functions – 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) • • • • • • 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) Pros and cons of diagnosis Pros Diagnosis is the first step towards treatment and research Cons (“labeling”) Can be used to mark an individual that society considers deviant Stigmatization Stereotyping Discrimination Rosenhan (1973) Models of Abnormality Psychological Model: Mental disorders are caused and maintained by life experience. 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 Psychodynamic: conflict • Behavioral: learning • 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 ⁉ ⁉ ⁉ ⁉ ⁉ 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 Anxiety disorder subtypes Phobic Generalized Panic Obsessive-compulsive Post-traumatic stress Symptoms Theories/Causes Nature vs. Nurture 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%) Panic Attack 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 Obsessions • Persistent thoughts that cannot be controlled – – Compulsions • Intentional behaviors or mental acts (that often become ritualistic) that are performed in the hope of warding off the obsession – 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 Causes of anxiety disorders II Situational (Learning) • In phobias, associations may be learned between previously neutral objects and a traumatic event – • In OCD, relief is associated with performing an action to escape an aversive stimulus – • 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 – 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 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 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 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 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 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 Biological • • Evidence for heritability Low serotonin levels – Linked to depression Situational • History of trauma or abuse • Hypercritical caregivers • Caregivers that encourage dependence Antisocial Personality Disorder: Symptoms 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 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% Sensitivity in Hypochondriasis 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 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 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 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 ADHD Causes Causes are unknown but probably heterogeneous • Situational Poor parenting – Dysfunctional family – • • Chicken and egg problem Biological Some evidence for heritability – Frontal lobe dysfunction – Basal ganglia dysfunction –