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Summary: Criteria of Psychological Disorders
1. Occurs in a minority of people.
2. Maladaptive (interferes with normal functioning).
3. Personally distressing (usually)
Diagnosis of psychological disorders
•
Definition of Diagnosis
–
•
“Process of matching a person's symptoms, life history, and
current functions with pre-established categories of disorders.”
Diagnostic Tools
–
Diagnostic and Statistical Manual of Mental Disorders–IV
Consensual definition of mental disorders
•
•
“Each of the mental disorders is conceptualized as:
A clinically significant (=abnormal) behavioural or psychological syndrome or
pattern that
– Occurs in a person and that is associated with present distress (a painful symptom)
– Or disability (impairment in one or more important areas of functioning) or with
significantly increased risk of suffering death, disability, or an important loss of
freedom...
• Not merely an expectable response to a particular event (e.g., death of a loved one)
•
Mental disorders are not defined by…
– deviant behaviour per se
– Nor conflicts that are primarily between the individual and society “
[From DSM]
Major Diagnostic Categories of the DSM-IV
DSM: Five Axes
Psychological Disorders: Medical Model
• Medical Model
• concept that diseases have physical causes
• can be diagnosed, treated, and in most cases, cured
• assumes that these “mental” illnesses can be diagnosed
on the basis of their symptoms and cured through
therapy, which may include treatment in a psychiatric
hospital
Psychological Disorders: Bio-psycho-social Perspective
Biological
(Evolution,
individual
genes, brain
structures
and chemistry)
Bio-psycho-social Perspective
– assumes that biological,
sociocultural, and
psychological factors
combine and interact to
produce psychological
disorders
Psychological
Sociocultural
(Roles, expectations,
definition of normality
and disorder)
(Stress, trauma,
learned helplessness,
mood-related perceptions
and memories)
Psychological Disorders- Etiology
• Neurotic disorder (term seldom used now)
– usually distressing but that allows one to think
rationally and function socially
– Freud saw the neurotic disorders as ways of
dealing with anxiety
• Psychotic disorder
– person loses contact with reality
– experiences irrational ideas and distorted
perceptions
Diagnosis of psychological disorders (cont.)
•
The three most common categories of psychological
disorders are
–
–
–
mood disorders (= affective disorder, especially depression)
anxiety disorders
substance dependence/abuse.
Rate and Gender differences in psychological disorders
Anxiety Disorders
• Anxiety Disorders
– distressing, persistent anxiety or maladaptive behaviors
that reduce anxiety
• Generalized Anxiety Disorder
– client is tense, apprehensive, and in a state of autonomic
nervous system arousal
• Phobia
– persistent, irrational fear of a specific object or situation
Case Vignette 1: Symptoms
Case Vignette 1: Diagnosis
Panic Disorder
•
Brief periods of intense anxiety; feeling out of control;
sudden unpredictable onset
–
–
–
E.g., Lecture Case History I
Panic DO (without agorophobia)
Often misdiagnosed as agoraphobia
Phobic Disorders
•
•
Fear has little or no justification in reality; individual
knows fear is not rational (unlike some delusions) but
still can't control it
Agoraphobia: fear of public places where escape might
be difficult
–
•
•
Individuals often won't leave home
Social phobia: fear of being in groups or interacting
with others, of embarrassing themselves
Simple phobia: other phobias, including fear of
animals, darkness, pain, needles
Anxiety Disorders
• Common and uncommon fears
100
Percentage 90
of people 80
surveyed
70
60
50
40
30
20
10
0
Snakes Being Mice Flying Being Spiders Thunder Being Dogs
in high,
on an closed in, and
and alone
exposed
airplane in a
insects lightning In a
small
house
places
place
at night
Afraid of it
Bothers slightly
Not at all afraid of it
Driving Being Cats
a car
In a
crowd
of people
Little-Known Phobia
Radical Phobia Therapy
Generalized Anxiety Disorder
•
Persistent non-specific anxiety, feels constantly
threatened
Anxiety Disorders
• Obsessive-Compulsive Disorder
– characterized by unwanted repetitive thoughts (obsessions)
and/or actions (compulsions)
Obsessive-Compulsive Disorder
•
Obsessions: persistent, disturbing, non-volitional ideas
or images
–
–
–
–
–
E.g., thinking hands remain dirty despite washing
Disabling fear that loved one has been hurt or killed
Repeatedly thinking left door unlocked
Worrying constantly about leaving toaster on
Repeatedly thinking about a specific sexual act
Obsessive-Compulsive Disorder (cont.)
•
Compulsions: repetitive behaviors performed to ward off
anxiety, not for pleasure
–
–
–
–
E.g., checking work again and again
Checking toaster again and again before leaving home
Performing same behavior again and again in exactly same way
Repeated hand washing
Anxiety Disorders: ObsessiveCompulsive Disorder: Types
Common Obsessions and Compulsions Among
People With Obsessive-Compulsive Disorder
Thought or Behavior
Percentage*
Reporting Symptom
Obsessions (repetitive thoughts)
Concern with dirt, germs, or toxins
40
Something terrible happening (fire, death, illness)
40
Symmetry order, or exactness
24
Compulsions (repetitive behaviors)
Excessive hand washing, bathing, tooth brushing,
or grooming
85
Repeating rituals (in/out of a door,
up/down from a chair)
Checking doors, locks, appliances,
car brake, homework
51
46
The Obsessive-Compulsive Personality Style Test
Mark each statement as it applies to you:
1 - none or little of the time
2 - some of the time
3- a good part of the time
4- most or all of the time
1. I prefer things to be done my way.
2. I am critical of people who do not live up to my
standards or expectations.
3. I stick to my principles, no matter what.
4. I am upset by changes in the environment or in the
behaviour of people.
5. I am meticulous and fussy about my possessions.
6. I get upset if I don’t finish a task.
7. I insist on full value for everything I purchase.
The Obsessive-Compulsive Personality Style Test (cont)
Mark each statement as it applies to you:
1 - none or little of the time
2 - some of the time
3 - a good part of the time
4 - most or all of the time
8. I like everything I do to be perfect.
9. I follow an exact routine for everyday tasks.
10. I do things precisely to the last detail.
11. I get tense when my days schedule is upset.
12. I plan my time so I won’t be late.
13. It bothers me when my surroundings are not neat and
tidy.
14. I make lists for my activities.
15. I think that I worry about minor aches and pains.
The Obsessive-Compulsive Personality Style Test (cont)
Mark each statement as it applies to you:
1 - none or little of the time
2 - some of the time
3 - a good part of the time
4 - most or all of the time
16. I like to be prepared for any emergency.
17. I am strict about fulfilling every one of my
obligations.
18. I think that I expect high moral standards in others.
19. I am badly shaken when someone takes advantage of
me.
20. I get upset when people do not replace things exactly
as I left them.
21. I keep used or old things because they might be
useful.
The Obsessive-Compulsive Personality Style Test (cont)
Mark each statement as it applies to you:
1 - none or little of the time
2 - some of the time
3 - a good part of the time
4 - most or all of the time
22. I think that I am sexually inhibited.
23. I find myself working rather than relaxing.
24. I prefer being a private person.
25. I budget carefully and do not buy things on credit.
Scoring the Obsessive-Compulsive Personality Style Test
• 25-45 You are not obsessive-compulsive
• 46-55 You are mildly obsessive-compulsive. Your
compulsiveness is adaptive, generally having a beneficial
effect.
• 56-70 Moderately obsessive-compulsive. You are
adaptive but “uptightness” has crept into your
functioning and you experience days of high tension.
• 71-100 Severely obsessive-compulsive. You are adaptive
but quite “uptight”, hard-driving and stressed. You have
many days of nervous tension that should be eased off. If
close to 100, depression could be a problem.
Somatoform disorders
•
•
Somatoform disorders are characterized by the
expression of psychological conflicts via
physical/bodily symptoms.
All involve physical complaints but no apparent
physical damage, and no apparent physical cause for
condition.
Somatoform disorders (cont.)
•
Different from psychosomatic DOs (e.g., ulcer induced
by stress)
–
In that case, cause of condition isn't "physical' (e.g., virus,
wound, dysfunction of metabolism like cancer), but there is
real and discernible physical damage (e.g., bleeding in
stomach wall)
Case History 2: Symptoms
Case History 2: Symptoms
Case History: Bear
•
1.
2.
3.
4.
Has symptoms of Conversion Disorder
Loss of physical functioning (he is paralyzed)
Physical damage cannot explain loss of functioning
Surprising indifference/lack of concern about problem
Good evidence for psychological causation:
–
–
–
Friend with paralysis partly caused by him
Bear's paralysis began at same site
Bear did not easily remember friend's paralysis, nor relate it to
own
Conversion Disorder
•
•
•
One or more major physical symptoms that greatly
impair functioning
Used to be known as “hysterical paralysis” or just
“hysteria”
Sometime particular professions or situations develop
“appropriate” physical disabilities, e.g.:
–
–
•
Machinist develops paralysis in hand
A student in one of my classes became blind before each exam
Often (although not always) accompanied by apparent
lack of concern about symptom—'la belle indifference'
Conversion Disorder (cont.)
•
•
Freud did a great deal of work with this condition; he
attributed it to repressed sexual feelings (surprise!).
However, he is credited in being one of the first
researchers to point out that conversion disorder (then
called hysteria) occurs in men as well as women.
General Comments: Somatoform Disorders
• Are they faking it?
– No, not in somatoform conditions; the pain is real, even if it
does not have physical causes or involve tissue damage
• In two other conditions, pain is not 'real'; symptoms are
faked:
• Malingering: faking condition for personal benefit
– E.g., faking a whiplash injury to collect insurance
• Factitious Disorder: faking a condition to get attention,
usually medical
General Comments: Somatoform Disorders (cont.)
• Subtype: Factitious disorder by proxy
– (also called Munchausen syndrome by proxy)
• Relatively rare, but every hospital emergency room
probably sees some cases
• Parents (almost always mothers) who create illnesses in
their children in order take them to hospital and be seen as
caring parent; emotionally rewarding
• Mothers may rub child skin to produce rash; give child
drugs to induce vomiting; or more severe injuries
• Mothers were themselves often abused as children; had
problems with their mother
• Will usually deny condition
General Comments: Somatoform Disorders (cont.)
• Implication: in cases of young children (under 3 years)
children who are repeatedly treated for puzzling physical
symptoms, the possibility that the symptoms have been
induced by a parent should be considered (could also be
simple case of child abuse).
• Simple child abuse differs from Factitious disorder by
proxy because in child abuse parents not abusing in
order to be seen as caring; differing motivations.
Case History: Timmy
Dissociative Disorders:
Dissociative Fugue
•
•
•
•
Timmy’s disorder is called Dissociative Fugue
Person suddenly travels to new place, assumes a new
identity, and forgets about his/her old one
Can be quite short-term, but generally lasts for months
Different from Dissociative Amnesia (another dissociative
disorder), because in Dissociative Fugue
1. The person is unaware that they have forgotten their old
identity.
2. The loss of the old identity is usually accompanied by a move
to new locale.
3. There is often the assumption of a new identity.
Dissociative disorders
• Dissociative disorders are characterized by a disturbance
or alteration in the integrative functions of identity,
memory or consciousness
• In these disorders, person is not aware of or loses contact
with some aspect of their personality
• Relatively rare, but often used in plots of novels, movies,
soap operas
Dissociative Disorders:
Dissociative Amnesia
• Sudden loss of important memories, often after stressful
event
• Can occur after traumatic event, such as in wartime
• Not just usual forgetting, or loss of memories due to
alcohol, drugs, Alzheimers, etc.
Dissociative Disorders:
Dissociative Identity Disorder
Formerly called Multiple Personality Disorder
• Person appears to have two or more different
personalities, one of which is dominant at a given time
• Often, one or more personalities are unaware of others
• Often, conflict between personalities
Dissociative Disorders:
Dissociative Identity Disorder (cont.)
• Some psychologists doubt whether such syndromes
actually exist (or whether many of the reported cases may
be misdiagnoses).
• Many of the cases may be better explained as excuses for
wrongdoing, attention-seeking, and responding to implicit
suggestions by interviewing psychologists
Other Disorders: Video Vignettes
•
Gary: Schizoid Personality Disorder
–
•
Pervasive pattern of detachment from social relationships and
restricted range of emotion.
Rita: Delusional Disorder (Erotomanic subtype):
–
–
Delusional disorder Involves fixed, pervasive and false belief
system
Erotomanic subtype involves the false belief that you are
involved in an intimate or romantic relationship with someone
Personality Disorders
•Jeffrey
Dahmer :
•Ted Bundy
–antisocial
personality
disorder/
–serial murderer
–antisocial
personality
disorder/
–serial murderer
–Murdered several
male youths in the
U.S.
–Murdered over 100
women in the U.S.
•Paul Bernardo:
•Clifford Olson
–antisocial
personality
disorder/
–serial murderer
–antisocial
personality
disorder/
–serial murderer
– Murdered several
women in Ontario
–Murdered 13 children in
BC
Personality Disorders (cont)
• Karla Homolka:
– antisocial personality
disorder/serial murderer
– Assisted in killing several
women in Ontario
•Aileen Wourmos
–antisocial personality
disorder/serial murderer
–killed seven men in Florida
Personality Disorders
• Extreme and inflexible personality traits that are
distressing to the persons who have them or cause such
individuals to have problems in school, work or
interpersonal relations
• usually without anxiety, depression, or delusions
Personality Disorders (cont.)
•
Three distinct clusters:
1. Odd and eccentric
2. Dramatic, emotional and erratic
3. Anxious and fearful
•
Antisocial personality disorder is classified in the
dramatic, emotional and erratic category
Personality Disorders: DSM-IV Clusters
Personality Disorders: DSM-IV Clusters
Personality Disorders: DSM-IVClusters
Antisocial Personality Disorder
•
•
The serial murderers displayed earlier would be
diagnosed as having a psychological disorder called (in
DSM IV) Antisocial Personality Disorder
But an earlier term for the disorder is Psychopathy
(people with it called psychopaths)
Antisocial Personality Disorder (cont.)
•
•
Will use term psychopath in lecture, following one of
the world's experts on psychopathy, Robert Hare of
UBC Psychology Department
Hare has researched psychopaths for many years
–
–
Largely in the BC prison system
See Hare's book, Without Conscience: The Disturbing World
of the Psychopaths Among Us)
Antisocial Personality Disorder (cont.)
•
Do you think all psychopaths are murderers or criminals?
–
–
•
No
Hare says most are not (but the criminal psychopaths get most
attention because of the horrific nature of their crimes)
So what essentially differentiates psychopaths from the
rest of us?
Psychopath exercise
•
•
•
•
Consider someone you know (or think of a fictional
character) who you think might be a psychopath.
Score them 'yes' or 'no' according to the following twelve
characteristics
Score 'yes' if the characteristic consistently or often is in
evidence.
Score 'no' if the characteristic rarely or never is in
evidence.
Psychopath exercise (cont.)
•
Glib and superficial
–
–
•
entertaining conversationalists
tell unlikely but often convincing stories
Egocentric and grandiose
–
–
•
see themselves as superior, entitled to live by own rules
love power and control
Lack of remorse or guilt
–
–
•
no genuine guilt or shame, no matter what they do (although they may try to fake
it)
explain away or minimize problems; shrug off responsibility
Lack of empathy
–
e.g., one example more concerned about car being towed than about daughter being
apprehended by social services
Psychopath exercise (cont.)
•
Deceitful and manipulative
–
–
•
lying and manipulation is very natural and expert
don't really care if they get caught lying
Shallow emotions
–
–
•
don't experience real grief, fear, pride, joy, despair or love (but may fake them)
equate sexual arousal with love
Impulsive
–
•
often quit jobs, break relationships, hurt people; seldom complete extensive
educational or training courses
Poor behaviour controls
–
–
short-tempered
may respond to criticism or frustration with sudden verbal abuse, threats or
violence (but minutes later act like nothing has happened)
Psychopath exercise (cont.)
•
Need for excitement
–
–
•
easily bored, thrill-seeking (gambling, stimulant drugs/alcohol, sexual
promiscuity)
don't like routine or dull jobs
Irresponsible
–
•
skip work, break dates, meetings, leave children with unreliable child care
Early behaviour problems
–
•
as children often torture animals, lie, cheat, steal, set fires, bully, run away
Adult anti-social behaviour
–
engage in dishonest business practices, spouse or child abuse, victimize
acquaintances and strangers
Psychopath exercise (cont.)
•
•
10 -12 yeses: probably psychopathic
6-10 yeses: may be some psychopathic tendencies
Psychopaths among us
•
Hare suggests a number of occupations and categories that may include a
significant proportion of psychopaths:
–
–
–
–
–
–
–
–
–
–
–
–
–
Stock promoters, unscrupulous charity fund organizers
Spousal abusers
Players (as in “guys who sleep around”)
Corporate climbers
Repeat dangerous driving offender
Cult leaders
Disbarred professionals
Child abusers
Political leaders
Serial killers
Gang members
Repeat or serial rapists
Pimps, terrorists, mercenaries
Antisocial Personality Disorder (cont.)
•
•
Hare has developed a psychological scale that helps us
determine if a person is a psychopath: the Psychopathy
Checklist-Revised (PCL-R)
The PCL-R is a 20 item scale that another person (not
the individual being assessed) checks off, based on a
semi-structured interview and access to files detailing
the individual's past history
Antisocial Personality Disorder (cont.)
• PCL-R suggests two basic factors to psychopathy:
1. Interpersonal and emotional characteristics:
egocentricity, lack of remorse, callousness, etc.
2. Lifestyle characteristics: impulsive, antisocial, unstable
What Psychological Disorder do/did these people show symptoms of?
•Bill Gates
•Albert Einstein
•Glenn Gould
•Isaac
Newton
Asperger’s Syndrome
•Bill Gates
Asperger’s
syndrome?
•Albert Einstein
Asperger’s
syndrome?
•Glenn Gould
•Isaac
Newton
Asperger’s
syndrome?
Asperger’s
syndrome?
Pervasive Developmental Disorder
A category of developmental disability that includes some or
all of the following characteristics:
•
•
•
•
•
•
•
•
Ritualistic behaviors
Repetitive behaviors
Short attention Span
Impaired communication/ verbal expression
Limited social interaction
Over or under responsive to sensory stimulation
Over or under physical activity
Apparently baseless tantrums
Pervasive Developmental Disorder
• Affects approximately 1 in 500 children
• Statistics show this rate may be rising to as high as 1 in 200
children
• Boys are approximately 4 times more susceptible that girls
• PDDs cross racial, ethnic and lifestyle
• Children of lower socio-economic status may be more
susceptible to PDD
• PDD symptoms are usually apparent by age 2 or 3
• PDDs are frequently associated with mild to severe mental
retardation
• Subclasses of PDD include autism and Asperger’ syndrome
Autism
Characteristics apparent by age 6
Impaired social interaction
Including non-verbal behaviors, lack of eye gaze, body posture and gestures to
discourage social interaction
Lack of social or emotional reciprocity
Lack of spontaneous enjoyment or interest
No or few friends
Impaired communication
Delay or total lack of spoken language
For those with speech, they do not initiate conversation
Stereotyped or repetitive use of language (maybe echolalia)
Lack of imaginative play
Restrictive or Repetitive Behaviors
Preoccupation with one or more patterns of intense interest
Inflexibility to change in routine
Repetitive motor mannerisms
Asperger’s Syndrome
Impaired social interaction (apparent before age 2)
Including non-verbal behaviors, lack of eye gaze, body posture and gestures to
discourage social interaction
Lack of social or emotional reciprocity
Lack of spontaneous enjoyment or interest
No or few friends
Restrictive or Repetitive Behaviors
Preoccupation with one or more patterns of intense interest
Inflexibility to change in routine
Repetitive motor mannerisms
No Significant delay in language
No Significant delay in cognitive development (self-help skills, curiosity, and
adaptive behaviors)
Mood Disorders
• Mood Disorders
– characterized by emotional extremes
• Major Depressive Disorder
– a mood disorder in which a person, for no
apparent reason, experiences two or more weeks
of depressed moods, feelings of worthlessness,
and diminished interest or pleasure in most
activities
Mood Disorders
• Mania
– a mood disorder marked by a hyperactive, wildly optimistic
state
• Bipolar Disorder
– a mood disorder in which the person alternates between the
hopelessness and lethargy of depression and the overexcited
state of mania
– formerly called manic-depressive disorder
Mood Disorders- Suicide
Suicides per 70
100,000 people 60
50
The higher suicide rate
among men greatly
increases in late
adulthood
40
30
20
10
0
15-24 25-34 35-44 45-44 55-64 65-74 75-84 85+
Males
Females
Mood Disorders-Suicide
Suicide rate
per 100,000
people
In recent decades teen
suicides have soared
12
8
4
0
1960
Ages 15-19
1993
All Ages
Mood Disorders-Depression
Around the world
women are more
susceptible to
depression
Percentage 20
of population
aged 18-84
experiencing 15
major
depression
at some
point In life 10
5
0
USA Edmonton Puerto
Rico
Males
Females
Paris
West
Florence Beirut
Germany
Taiwan
Korea
New
Zealand
Mood Disorders-Bipolar
• PET scans show that brain energy consumption rises and falls
with emotional swings
Depressed state
Manic state
Depressed state
Mood Disorders-Depression
Brain
chemistry
Cognition
Mood
• Altering any one
component of the
chemistry-cognitionmood circuit can
alter the others
Mood Disorders-Depression
1
Stressful
experiences
4
Cognitive and
behavioral changes
2
Negative
explanatory style
3
Depressed
mood
• The vicious cycle of
depression can be
broken at any point
Schizophrenia
• Schizophrenia
– literal translation “split mind”
– a group of severe psychotic disorders
characterized by:
• disorganized and delusional thinking
• disturbed perceptions
• inappropriate emotions and actions
Schizophrenia
• Delusions
– false beliefs, often of persecution or grandeur, that
may accompany psychotic disorders
• Hallucinations
– false sensory experiences such as seeing
something without any external visual stimulus
Schizophrenia
Subtypes of Schizophrenia
Paranoid:
Preoccupation with delusions or hallucinations
Disorganized:
Disorganized speech or behavior, or flat or inappropriate
emotion
Catatonic:
Immobility (or excessive, purposeless movement),
extreme negativism, and/or parrotlike repeating of
another’s speech or movements
Undifferentiated
or residual:
Schizophrenia symptoms without fitting one of the
above types
Schizophrenia
Lifetime risk 40
of developing
schizophrenia
30
for relatives of
a schizophrenic
20
10
0
General
population
Siblings
Children
Identical
Fraternal Children
twin
twin
of two
schizophrenia
victims