Download Mental disorder

Psychology:
From Inquiry to Understanding 2/e
Scott O. Lilienfeld
Steven Jay Lynn
Laura Namy
Nancy J. Woolf
Prepared by Caleb W. Lack
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Chapter Fifteen
Psychological Disorders:
When Adaptation Breaks Down
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Lecture Preview
• Conceptions of mental illness
• Anxiety disorders
• Mood disorders and suicide
• Personality and dissociative disorders
• Enigma of schizophrenia
• Childhood disorders
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What is Mental Illness?
• Psychopathology (mental illness) is often seen
as a failure of adaptation to the environment
• Failure analysis approach tries to understand
MI by examining breakdowns in functioning
• Mental disorder does not have a clear cut
definition
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What is Mental Illness?
• Many different conceptions of MI, each with
pros and cons
– Statistical rarity
– Subjective distress
– Impairment
– Societal disapproval
– Biological dysfunction
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Historical Conceptions of MI
• During Middle Ages, mental illnesses were
often viewed through a demonic model
• Odd behaviors were the result of evil spirits
inhabiting the body
• Exorcisms and witch hunts were common
during this time
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Historical Conceptions of MI
• During Renaissance, the medical model saw
MI as a physical disorder needing treatment
• Began housing people in asylums – but they
were often overcrowded and understaffed
• Treatments were no better than before
(bloodletting and snake pits)
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Historical Conceptions of MI
• Reformers like Phillippe Pinel and Dorothea
Dix pushed for moral treatment
• Treated patients with dignity, respect, and
kindness
• Still no effective treatments, though, so many
continued to suffer with no relief
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Modern Era
• In early 1950s, a drug was developed called
chlorpromazine (Thorazine)
• Moderately decreased symptoms of
schizophrenia and similar problems
• With advent of other medications, policy of
deinstitutionalization was enacted
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Modern Era
• Deinstitutionalization had mixed results
• Some patients returned to almost normal lives
but tens of thousands had no follow-up care
and went off medications
• Community mental health centers and halfway
houses attempt to help this problem
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Diagnosis across Cultures
• Certain conditions are culture-bound
• Koro involves believing your genitals are
shrinking and receding into your abdomen
• Amok is marked by episodes of intense
sadness and brooding followed by
uncontrolled behavior and violence
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Diagnosis across Cultures
• Taijin kyofushu is a fear of offending others by
saying something offensive or body odor
• Many severe mental disorders (schizophrenia,
alcoholism, psychopathy) appear to be
universal across cultures
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Misconceptions
• Psychiatric diagnosis is nothing more than
pigeonholing
• Psychiatric diagnoses are unreliable
• Psychiatric diagnoses are invalid
• Psychiatric diagnoses stigmatize people
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The DSM-IV
• Diagnostic and Statistical Manual of Mental
Disorders (DSM) is a system that contains the
criteria for mental disorders
• Currently on fourth edition, fifth expected in
2013
• Has 17 different classes of disorders
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The DSM-IV
• Provides list of diagnostic criteria and a set of
decision rules for each condition
• Warns to “think organic” (rule out physical
causes of symptoms first)
• Contains information on prevalence and
assess patients along five axes
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DSM-IV Axes
• Axis I – Major mental disorders
• Axis II – Personality disorders and mental
retardation
• Axis III – Associated medical conditions
• Axis IV – Life stressors
• Axis V – Overall level of daily functioning
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DSM Criticisms
• Not all diagnoses meet Robins and Guze
criteria for validity (Mathematics Disorder)
• Not all criteria and decisions rules are based
on scientific data
• High level of comorbidity
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DSM Criticisms
• Reliance on categorical rather than
dimensional model of psychopathology
• Reluctance on many to change (cognitive
misers)
• Vulnerable to political and social influences
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Mental Illness and the Law
• Overwhelming majority of people with
schizophrenia are not aggressive or violent
• Insanity defense requires people to
– Not know what they were doing at time of crime
– Not know what they were doing was wrong
• Less than 1% of criminal cases use this
successfully
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Mental Illness and the Law
• Involuntary commitment is a procedure for
protecting us from certain people with mental
disorders and protecting them from themselves
• Can only be committed against their will if
– Pose a clear and present threat to themselves or
others
– Are so impaired they can’t care for themselves
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Anxiety Disorders
• Most anxieties are transient and can be
adaptive
• They can, though, spin out of control and
become excessive and inappropriate
• One of the most prevalent and earliest onset
of all classes of disorders
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Anxiety Disorders
• Can also see inappropriate anxiety in other
disorders and problems
• Somatoform disorders are physical symptoms
with psychological origins
• Hypochondriasis is a preoccupation that you
have a serious disease despite no evidence
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Generalized Anxiety Disorder
• Continual feelings of worry, anxiety, physical
tension, and irritability about many areas
• About 3% of the population; 1/3 develop it
after major stressor or life change
• More prevalent in females and Caucasians
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Panic Disorder
• Repeated, unexpected panic attacks, along
with either
– Persistent concerns about future attacks
– A change in personal behavior in an attempt to
avoid them
• Can be associated with specific situation or
come “out of the blue”
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Phobias
• Intense fear of an object or situation that’s
greatly out of proportion to its actual threat
• Most common anxiety disorder (11%)
• Comes in different forms
– Agoraphobia
– Specific or social phobia
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Posttraumatic Stress Disorder
• Marked emotional disturbance after you
experience or witness a severely stressful event
• Symptoms include
– Flashbacks and recurrent dreams
– Avoiding reminders of the trauma
– Increased physiological arousal
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Obsessive-Compulsive Disorder
• Marked by obsessions - persistent ideas,
thoughts, or impulses that are unwanted and
inappropriate and cause marked distress
• This distress is relieved by compulsions –
repetitive behaviors or mental acts
• Must spend at least 1 hour per day engaging
in obsessions, compulsions, or both
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Explanations for Anxiety Disorders
• Learning models focus on acquiring fears via
classical conditioning, then maintaining them
through operant conditioning
• Can also learn fears by observing others or by
hearing misinformation from others
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Explanations for Anxiety Disorders
• Anxious people tend to think about the world
in different ways from non-anxious people
• Catastrophic thinking - predicting terrible
events despite low probability
• Anxiety sensitivity – a fear of anxiety-related
symptoms
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Explanations for Anxiety Disorders
• Many are genetically influenced through level
of neuroticism
• A malfunction of the caudate nucleus in
people with OCD
• Genetic relationship between OCD and
Tourette’s Disorder
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Mood Disorders
• Over 20% of Americans will experience a
mood disorder
• Major Depressive Disorder (MDD) is the most
common, at 16%
• More prevalent in females, most likely to
develop in 30s
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Mood Disorders
• Depression symptoms can develop gradually
or suddenly, but are often recurrent
• Average episode lasts 6 months to 1 year,
most people experience 5-6 episodes
• Can cause extreme functional impairment
across all areas
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Sample MDD Symptoms
• Feeling blue or irritable
• Sleep difficulties
• Fatigue and loss of energy
• Weight changes
• Thoughts of death or suicide
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Explanations for MDD
• Complex interplay of biological, psychological,
and social influences
• Life events such as loss of something that is
dearly valued can set stage for depression
• Depression can create interpersonal problems,
which cause lack of social support
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Explanations for MDD
• Behavioral model sees depression resulting from
a low rate of positive reinforcement in the
environment
• Beck’s cognitive model holds that depression is
caused by negative beliefs and expectations
– Cognitive triad, negative schemas, cognitive distortions
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Explanations for MDD
• Learned helplessness - tendency to feel
helpless in the face of events we can’t control
• People with depression attribute failure
internally and have global, stable attributions
• Genes exert a moderate influence on MDD; role
of serotonin, norepinephrine, and dopamine
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Bipolar Disorder
• Have both depressive and manic episodes
• Elevated mood, lowered need for sleep, high
energy, talkativeness, inflated self-esteem
– Also show highly irresponsible behavior
• Equally common in men and women
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Bipolar Disorder
• Produces serious problems in social and
occupational realms
• Very heavily genetically influenced, but
stressful life events can cause episode onset
– These can be negative or positive events
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Suicide
• MDD and bipolar disorder are at higher risk
for suicide than most disorders
• More than 30,000 people commit suicide in
US each year (11th leading cause of death)
• Prediction is difficult due to lack of research
and low base rates
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SUICIDE MYTH
REALITY
Talking to persons with depression about
suicide makes them more likely to commit
the act.
Talking to persons with depression about
suicide makes them more likely to obtain
help.
Suicide is almost always completed with
no warning.
Many or most people who commit suicide
tell others.
As a severe depression lifts, people’s
suicide risk decreases.
The risk actually increases, in part because
individuals have more energy to attempt
the act.
Most people who threaten suicide are
seeking attention.
Most stem from severe depression and
helplessness.
People who talk a lot about suicide almost Talking about suicide is associated with a
never commit it.
greater risk.
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Personality Disorders
• Should only be diagnosed when
– Personality traits first appear by adolescence
– Traits are inflexible, stable, and expressed in a
wide variety of situations
– Traits lead to distress or impairment
• Show substantial comorbidity with Axis I
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Borderline Personality Disorder
• Mainly women, about 2% of population
• Marked by instability in mood, identity, and
impulse control, often highly self-destructive
• In sociobiological model, individuals with BPD
overreact to stress and experience lifelong
difficulties with regulating their emotions
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Psychopathic Personality
• Condition marked by superficial charm,
dishonesty, manipulativeness, selfcenteredness, and risk taking
• Overlaps with antisocial personality disorder
• Primarily males, about 25% of the prison
population qualifies
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Psychopathic Personality
• Causes are largely unknown, but may stem in
part from a deficit in fear
• Alternatively, they may be perpetually
underaroused and experiencing stimulus
hunger
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Dissociative Disorders
• Involve disruptions in consciousness, memory,
identity, or perception
• Depersonalization disorder and frequently
feeling detached from yourself
• Controversy around dissociative amnesia and
dissociative fugue
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Dissociative Identity Disorder
• Characterized by presence of two or more
distinct identities (alters)
• Intriguing differences between alters shown,
but could be easily explained in other ways
• Primary controversy surrounds issue of
posttraumatic vs sociocognitive models
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Dissociative Identity Disorder
• Little evidence to support the posttraumatic
model
• Support for sociocognitive model includes
– Most DID patients don’t show alters prior to therapy
– Treatment reinforces idea person has alters
– Treatment tends to increase number of alters seen
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Schizophrenia
• Severe disorder of thought and emotion
associated with a loss of contact with reality
• Symptoms include disturbances in attention,
thinking, language, emotion, and relationships
• Less than 1% of population, but over half of
people in mental institutions
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Schizophrenia
• A hallmark symptom are delusions – strongly
held, fixed beliefs with no basis in reality
• This and other psychotic symptoms reflect
serious distortions in reality
• Hallucinations are sensory perceptions that
occur in the absence of external stimuli
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Schizophrenia
• Disorganized speech (word salad) and behavior
(echolalia, catatonia) are also common
symptoms
• Psychosocial factors play a role in schizophrenia,
but only trigger it in persons with genetic
vulnerabilities
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Schizophrenia
• Family members can influence whether
patients relapse (expressed emotion)
• Number of brain abnormalities seen
– Enlarged ventricles
– Increased sulci size
– Hypofrontalitiy
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Schizophrenia
• Neurotransmitter differences also found, such
as abnormalities in dopamine receptors
• Dopamine, norepinephrine, glutamate, and
serotonin are all disturbed
• Highly genetically influenced disorder as well
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Vulnerability to Schizophrenia
• Diathesis-stress models propose that MI is a
joint product of a genetic vulnerability (diathesis)
and stressors that trigger it
• Early warning signs of schizophrenia vulnerability
– Social withdrawal
– Thought and movement problems
– Lack of emotions, decreased eye contact
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Autistic Disorder
• Marked by severe deficits in language, social
bonding, and imagination
– Often accompanied by mental retardation
• Dramatic increase in autism diagnoses from
early 1990s to today, but why?
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Autistic Disorder
• Many have blamed MMR vaccines, starting
with a 1998 UK study
• Study was later retracted by the journal that
published it as flawed in several ways
• Subsequent research showed no link between
vaccines and autism
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Autistic Disorder
• Parents fell prey to an illusory correlation
– They noticed symptoms after administering
vaccines, so the vaccines must have caused the
symptoms!
• Increase is most likely due to changes in
diagnostic practices and ADA and IDEA laws
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Attention-Deficit/Hyperactivity Disorder
• Primary problems include inattentive,
impulsive, and hyperactivity symptoms
• Diagnosable in 3-7% of school children, more
males than females (3:1)
• Related to numerous functional problems in
both children and adults
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Attention-Deficit/Hyperactivity Disorder
• Highly genetically influenced, can be
successfully treated with stimulant meds
• Rates of “early-onset bipolar disorder” have
skyrocketed over last 20 years
– 0.42% to 6.67% from 1990 to 2003
• Likely that most diagnosed actually have severe
ADHD symptoms and not bipolar disorder
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