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Psychological
Disorders
Chapter 16
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Monday, March 26, 2012
Psychological Disorders
Perspectives on
Psychological Disorders
 Defining Psychological Disorders
 Understanding Psychological
Disorders
 Classifying Psychological
Disorders
 Labeling Psychological Disorders
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Psychological Disorders
Anxiety Disorders
 Generalized Anxiety Disorder and
Panic Disorder
 Phobias
 Obsessive-Compulsive Disorders
 Post-Traumatic Stress Disorders
 Anxiety Disorder Explanation
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Psychological Disorders
Mood Disorders
 Major Depressive Disorders
 Bipolar Disorder
 Mood Disorder Explanation
Schizophrenia
 Symptoms of Schizophrenia
 Subtypes of Schizophrenia
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Psychological Disorders
Schizophrenia
 Understanding Schizophrenia
Personality Disorders
Rates of Psychological
Disorders
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Psychological Disorders
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.
Marc, diagnosed with
obsessive-compulsive disorder
(from Summers, 1996)
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Psychological Disorders
People are fascinated by the exceptional,
the unusual, and the abnormal. This
fascination may be caused by two reasons:
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Psychological Disorders
People are fascinated by the exceptional,
the unusual, and the abnormal. This
fascination may be caused by two reasons:
1. During various moments we feel, think,
and act like an abnormal individual.
2.
Psychological disorders may bring
unexplained physical symptoms,
irrational fears, and suicidal thoughts.
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Psychological Disorders
To study the abnormal is the best way of
understanding the normal.
William James (1842-1910)
1. There are 450 million people suffering
from psychological disorders (WHO,
2004).
2. Depression and schizophrenia exist in
all cultures of the world.
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Defining Psychological Disorders
Mental health workers view psychological
disorders as persistently harmful thoughts,
feelings, and actions.
When behavior is deviant, distressful, and
dysfunctional psychiatrists and
psychologists label it as disordered (Comer,
2004).
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Deviant, Distressful &
Dysfunctional
Carol Beckwith
1. Deviant behavior
(going naked) in one
culture may be
considered normal,
while in others it may
lead to arrest.
2. Deviant behavior
must accompany
distress.
3. If a behavior is
dysfunctional it is
clearly a disorder.
In the Wodaabe tribe men
wear costumes to attract
women. In Western
society this would be
considered abnormal.
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Understanding Psychological
Disorders
Ancient Treatments of psychological
disorders include trephination, exorcism,
being caged like animals, being beaten,
burned, castrated, mutilated, or transfused
with animal’s blood.
John W. Verano
Trephination (boring holes in the skull to remove evil forces)11
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Medical Perspective
Philippe Pinel (1745-1826) from France,
insisted that madness was not due to
demonic possession, but an ailment of the
mind.
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George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago
Dance in the madhouse.
12
Medical Model
When physicians discovered that syphilis led to
mental disorders, they started using medical
models to review the physical causes of these
disorders.
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
13
disorder.
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Biopsychosocial Perspective
Assumes that biological, socio-cultural,
and psychological factors combine and
interact to produce psychological
disorders.
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Classifying Psychological
Disorders
The American Psychiatric Association
rendered a Diagnostic and Statistical
Manual of Mental Disorders (DSM) to
describe psychological disorders.
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Classifying Psychological
Disorders
The American Psychiatric Association
rendered a Diagnostic and Statistical
Manual of Mental Disorders (DSM) to
describe psychological disorders.
The most recent edition, DSM-IV-TR (Text
Revision, 2000), describes 400
psychological disorders compared to 60 in
the 1950s.
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Multiaxial Classification
Axis I
Is a Clinical Syndrome (cognitive, anxiety, mood
disorders [16 syndromes]) present?
Axis II
Is a Personality Disorder or Mental
Retardation present?
Axis III
Is a General Medical Condition (diabetes,
hypertension or arthritis etc) also present?
Axis
IV
Axis V
Are Psychosocial or Environmental Problems
(school or housing issues) also present?
What is the Global Assessment of the
person’s functioning?
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Multiaxial Classification
Note 16 syndromes in Axis I
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Multiaxial Classification
Note Global Assessment for Axis V
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Goals of DSM
1.
2.
Describe (400) disorders.
Determine how prevalent the
disorder is.
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Goals of DSM
1.
2.
Describe (400) disorders.
Determine how prevalent the
disorder is.
Disorders outlined by DSM-IV are reliable.
Therefore, diagnoses by different
professionals are similar.
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Goals of DSM
1.
2.
Describe (400) disorders.
Determine how prevalent the
disorder is.
Disorders outlined by DSM-IV are reliable.
Therefore, diagnoses by different
professionals are similar.
Others criticize DSM-IV for “putting any
kind of behavior within the compass of
psychiatry.”
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Labeling Psychological Disorders
1. Critics of the DSM-IV argue that labels
may stigmatize individuals.
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Elizabeth Eckert, Middletown, NY. From L. Gamwell and
N. Tomes, Madness in America, 1995. Cornell University Press.
Asylum baseball team (labeling)
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Labeling Psychological Disorders
2. Labels may be helpful for healthcare
professionals when communicating with
one another and establishing therapy.
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Labeling Psychological Disorders
Theodore Kaczynski
22
(Unabomber)
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Elaine Thompson/ AP Photo
3. “Insanity” labels
raise moral and
ethical questions
about how
society should
treat people who
have disorders
and have
committed
crimes.
Anxiety Disorders
Feelings of excessive apprehension and
anxiety.
1.
2.
3.
4.
Generalized anxiety disorders
Phobias
Panic disorders
Obsessive-compulsive disorders
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Generalized Anxiety Disorder
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Generalized Anxiety Disorder
Symptoms
1. Persistent and uncontrollable tenseness
and apprehension.
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Generalized Anxiety Disorder
Symptoms
1. Persistent and uncontrollable tenseness
and apprehension.
2. Autonomic arousal.
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Generalized Anxiety Disorder
Symptoms
1. Persistent and uncontrollable tenseness
and apprehension.
2. Autonomic arousal.
3. Inability to identify or avoid the cause of
certain feelings.
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Panic Disorder
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Panic Disorder
Symptoms
Minute-long episodes of intense dread
which may include feelings of terror, chest
pains, choking, or other frightening
sensations.
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Panic Disorder
Symptoms
Minute-long episodes of intense dread
which may include feelings of terror, chest
pains, choking, or other frightening
sensations.
Anxiety is a component of both disorders.
It occurs more in the panic disorder,
making people avoid situations that cause
it.
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Phobia
Marked by a persistent and irrational fear of
an object or situation that disrupts behavior.
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Kinds of Phobias
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Kinds of Phobias
Agoraphobia
Phobia of open places.
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Kinds of Phobias
Agoraphobia
Acrophobia
Phobia of open places.
Phobia of heights.
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Kinds of Phobias
Agoraphobia
Acrophobia
Claustrophobia
Phobia of open places.
Phobia of heights.
Phobia of closed
spaces.
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Kinds of Phobias
Agoraphobia
Acrophobia
Phobia of open places.
Phobia of heights.
Claustrophobia
Phobia of closed
spaces.
Hemophobia
Phobia of blood.
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Obsessive-Compulsive Disorder
Persistence of unwanted thoughts
(obsessions) and urges to engage in
senseless rituals (compulsions) that cause
distress.
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Brain Imaging
A PET scan of the brain
of a person with
Obsessive-Compulsive
Disorder (OCD). High
metabolic activity (red)
in the frontal lobe
areas are involved with
directing attention.
Brain image of an OCD
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Post-Traumatic Stress Disorder
Four or more weeks of the following
symptoms constitute post-traumatic stress
disorder (PTSD):
Bettmann/ Corbis
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Post-Traumatic Stress Disorder
Four or more weeks of the following
symptoms constitute post-traumatic stress
disorder (PTSD):
1. Haunting memories
2. Nightmares
3. Social withdrawal
Bettmann/ Corbis
4. Jumpy anxiety
5. Sleep problems
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Resilience to PTSD
Only about 10% of women and 20% of men
react to traumatic situations and develop
PTSD.
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Resilience to PTSD
Only about 10% of women and 20% of men
react to traumatic situations and develop
PTSD.
Holocaust survivors show remarkable
resilience against traumatic situations.
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Resilience to PTSD
Only about 10% of women and 20% of men
react to traumatic situations and develop
PTSD.
Holocaust survivors show remarkable
resilience against traumatic situations.
All major religions of the world suggest
that surviving a trauma leads to the growth
of an individual.
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Explaining Anxiety Disorders
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Explaining Anxiety Disorders
Freud suggested that we repress our
painful and intolerable ideas, feelings, and
thoughts, resulting in anxiety.
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The Learning Perspective
John Coletti/ Stock, Boston
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The Learning Perspective
John Coletti/ Stock, Boston
Learning theorists
suggest that fear
conditioning leads to
anxiety. This anxiety
then becomes
associated with other
objects or events
(stimulus
generalization) and is
reinforced.
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The Learning Perspective
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The Learning Perspective
Investigators believe that fear responses are
inculcated through observational learning.
Young monkeys develop fear when they
watch other monkeys who are afraid of
snakes.
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The Biological Perspective
Natural Selection has led our ancestors to
learn to fear snakes, spiders, and other
animals. Therefore, fear preserves the
species.
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The Biological Perspective
Natural Selection has led our ancestors to
learn to fear snakes, spiders, and other
animals. Therefore, fear preserves the
species.
Twin studies suggest that our genes may be
partly responsible for developing fears and
anxiety. Twins are more likely to share
phobias.
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The Biological Perspective
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S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action
monitoring in obsessive-compulsive disorder. Psychological Science, 14, 347-353.
Anterior Cingulate Cortex
of an OCD patient.
The Biological Perspective
Anterior Cingulate Cortex
of an OCD patient.
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S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action
monitoring in obsessive-compulsive disorder. Psychological Science, 14, 347-353.
Generalized anxiety,
panic attacks, and
even OCD are linked
with brain circuits
like the anterior
cingulate cortex.
Dissociative Disorder
Conscious awareness becomes separated
(dissociated) from previous memories,
thoughts, and feelings.
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Dissociative Disorder
Conscious awareness becomes separated
(dissociated) from previous memories,
thoughts, and feelings.
Symptoms
1. Having a sense of being unreal.
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Dissociative Disorder
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.
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Dissociative Disorder
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.
3. Watching yourself as if in a movie.
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Dissociative Identity Disorder
(DID)
Is a disorder in which a person exhibits two
or more distinct and alternating
personalities, formerly called multiple
personality disorder.
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Lois Bernstein/ Gamma Liason
Chris Sizemore (DID)
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DID Critics
Critics argue that the diagnosis of DID
increased in the late 20th century. DID
has not been found in other
countries.
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DID Critics
Critics argue that the diagnosis of DID
increased in the late 20th century. DID
has not been found in other
countries.
Critics’ Arguments
1.
Role-playing by people open to a
therapist’s suggestion.
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DID Critics
Critics argue that the diagnosis of DID
increased in the late 20th century. DID
has not been found in other
countries.
Critics’ Arguments
1.
Role-playing by people open to a
therapist’s suggestion.
2. Learned response that
reinforces reductions in
anxiety.
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16-2
Mood Disorders
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Mood Disorders
Emotional extremes of mood disorders
come in two principal forms.
1.
2.
Major depressive
disorder
Bipolar disorder
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Major Depressive Disorder
Depression is the “common cold” of
psychological disorders. In a year, 5.8% of
men and 9.5% of women report depression
worldwide (WHO, 2002).
Blue mood
Major Depressive
Disorder
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Major Depressive Disorder
Depression is the “common cold” of
psychological disorders. In a year, 5.8% of
men and 9.5% of women report depression
worldwide (WHO, 2002).
Blue mood
Gasping for air after
a hard run
Major Depressive
Disorder
Chronic shortness of
breath
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Major Depressive Disorder
Major depressive disorder occurs when
signs of depression last two weeks or more
and are not caused by drugs or medical
conditions.
1.
2.
3.
4.
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Signs include:
Lethargy and fatigue
Feelings of worthlessness
Loss of interest in family &
friends
Loss of interest in activities
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Dysthymic Disorder
Dysthymic disorder lies between a blue
mood and major depressive disorder. It is a
disorder characterized by daily depression
lasting two years or more.
Blue
Mood
Dysthymic
Disorder
Major Depressive
Disorder
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Dysthymic Disorder
Dysthymic disorder lies between a blue
mood and major depressive disorder. It is a
disorder characterized by daily depression
lasting two years or more.
Blue
Mood
Dysthymic
Disorder
Major Depressive
Disorder
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Bipolar Disorder
Formerly called manic-depressive disorder.
An alternation between depression and
mania signals bipolar disorder.
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Bipolar Disorder
Formerly called manic-depressive disorder.
An alternation between depression and
mania signals bipolar disorder.
Depressive
Symptoms
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Bipolar Disorder
Formerly called manic-depressive disorder.
An alternation between depression and
mania signals bipolar disorder.
Depressive
Symptoms
Gloomy
Withdrawn
Inability to make decisions
Tired
Slowness of thought
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44
Bipolar Disorder
Formerly called manic-depressive disorder.
An alternation between depression and
mania signals bipolar disorder.
Depressive
Manic
Symptoms
Symptoms
Gloomy
Withdrawn
Inability to make decisions
Tired
Slowness of thought
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44
Bipolar Disorder
Formerly called manic-depressive disorder.
An alternation between depression and
mania signals bipolar disorder.
Depressive
Manic
Symptoms
Symptoms
Gloomy
Withdrawn
Inability to make decisions
Tired
Slowness of thought
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Elation
Euphoria
Desire for action
Hyperactive
Multiple ideas
44
Bipolar Disorder
Many great writers, poets, and composers
suffered from bipolar disorder. During their
manic phase creativity surged, but not
during their depressed phase.
Hemingway
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Earl Theissen/ Hulton Getty Pictures Library
Clemens
The Granger Collection
Wolfe
George C. Beresford/ Hulton Getty Pictures Library
Bettmann/ Corbis
Whitman
Explaining Mood Disorders
1.
2.
Behavioral and cognitive changes
Common causes of depression
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Explaining Mood Disorders
Since depression is so prevalent worldwide,
investigators want to develop a theory of
depression that will suggest ways to treat it.
1.
2.
Behavioral and cognitive changes
Common causes of depression
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Explaining Mood Disorders
Since depression is so prevalent worldwide,
investigators want to develop a theory of
depression that will suggest ways to treat it.
Lewinsohn et al., (1985, 1995) note that a
theory of depression should explain the
following:
1.
2.
Behavioral and cognitive changes
Common causes of depression
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Theory of Depression
3.
Gender differences
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Theory of Depression
4.
5.
Depressive episodes self-terminate.
Depression is increasing, especially in the
teens.
Desiree Navarro/ Getty Images
Post-partum depression
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Suicide
The most severe form of behavioral
response to depression is suicide. Each
year some 1 million people commit suicide
worldwide.
Suicide Statistics
1. National differences
2. Racial differences
3. Gender differences
4.
Age differences
5. Other differences
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Biological Perspective
Genetic Influences: Mood disorders run in
families. The rate of depression is higher in
identical (50%) than fraternal twins (20%).
Jerry Irwin Photography
Linkage analysis and
association studies
link possible genes
and dispositions for
depression.
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Neurotransmitters &
Depression
A reduction of
norepinephrine and
serotonin has been
found in
depression.
Drugs that alleviate
mania reduce
norepinephrine.
Pre-synaptic
Neuron
Norepinephrine
Serotonin
Post-synaptic
Neuron
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The Depressed Brain
PET scans show that brain energy
consumption rises and falls with manic and
depressive episodes.
Courtesy of Lewis Baxter an Michael E.
Phelps, UCLA School of Medicine
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Social-Cognitive Perspective
The social-cognitive perspective suggests
that depression arises partly from selfdefeating beliefs and negative explanatory
styles.
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Depression Cycle
1. Negative stressful events.
2. Pessimistic explanatory style.
3. Hopeless depressed state.
4. These hamper the way the
individual thinks and acts,
fueling personal rejection.
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Example
Explanatory style plays a major role in
becoming depressed.
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16-3
Schizophrenia,
Somatoform
Disorders
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Schizophrenia
If depression is the common cold of
psychological disorders, schizophrenia is
the cancer.
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Schizophrenia
If depression is the common cold of
psychological disorders, schizophrenia is
the cancer.
Nearly 1 in a 100 suffer from
schizophrenia, and throughout the world
over 24 million people suffer from this
disease (WHO, 2002).
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Schizophrenia
If depression is the common cold of
psychological disorders, schizophrenia is
the cancer.
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 than women.
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Symptoms of Schizophrenia
The literal translation is “split mind.” A
group of severe disorders characterized by
the following:
1.
2.
3.
Disorganized and
delusional thinking.
Disturbed perceptions.
Inappropriate emotions
and actions.
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Disorganized & Delusional
Thinking
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”).
Other forms of delusions include, delusions of
persecution (“someone is following me”) or
grandeur (“I am a king”).
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Disorganized & Delusional
Thinking
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.”
Other forms of delusions include, delusions of
persecution (“someone is following me”) or
grandeur (“I am a king”).
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Disorganized & Delusional
Thinking
Many psychologists believe disorganized
thoughts occur because of selective
attention failure (fragmented and bizarre
thoughts).
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Disturbed Perceptions
August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg
Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
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L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg
A schizophrenic person may perceive
things that are not there (hallucinations).
Frequently such hallucinations are auditory
and lesser visual, somatosensory, olfactory,
or gustatory.
Inappropriate Emotions & Actions
A schizophrenic person may laugh at the
news of someone dying or show no
emotion at all (apathy).
Patients with schizophrenia may continually
rub an arm, rock a chair, or remain
motionless for hours (catatonia).
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Subtypes of Schizophrenia
Schizophrenia is a cluster of disorders.
These subtypes share some features, but
there are other symptoms that differentiate
these subtypes.
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Positive and Negative Symptoms
Schizophrenics have inappropriate
symptoms (hallucinations, disorganized
thinking, deluded ways) that are not
present in normal individuals (positive
symptoms).
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Positive and Negative Symptoms
Schizophrenics have inappropriate
symptoms (hallucinations, disorganized
thinking, deluded ways) that are not
present in normal individuals (positive
symptoms).
Schizophrenics also have an absence of
appropriate symptoms (apathy,
expressionless faces, rigid bodies) that are
present in normal individuals (negative
symptoms).
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Chronic and Acute Schizophrenia
When schizophrenia is slow to develop
(chronic/process) recovery is doubtful.
Such schizophrenics usually display
negative symptoms.
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Chronic and Acute Schizophrenia
When schizophrenia is slow to develop
(chronic/process) recovery is doubtful.
Such schizophrenics usually display
negative symptoms.
When schizophrenia rapidly develops
(acute/reactive) recovery is better. Such
schizophrenics usually show positive
symptoms.
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Subtypes
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Understanding Schizophrenia
Schizophrenia is a disease of the brain
exhibited by the symptoms of the mind.
Brain Abnormalities
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Understanding Schizophrenia
Schizophrenia is a disease of the brain
exhibited by the symptoms of the mind.
Brain Abnormalities
Dopamine Overactivity: Researchers found
that schizophrenic patients express higher
levels of dopamine D4 receptors in the
brain.
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Abnormal Brain Activity
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Health
Brain scans show abnormal activity in the
frontal cortex, thalamus, and amygdala of
schizophrenic patients. Adolescent
schizophrenic patients also have brain
lesions.
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Abnormal Brain Morphology
Schizophrenia patients may exhibit
morphological changes in the brain like
enlargement of fluid-filled ventricles.
Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC
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Viral Infection
Schizophrenia has also been observed in
individuals who contracted a viral infection
(flu) during the middle of their fetal
development.
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Genetic Factors
The likelihood of an individual suffering
from schizophrenia is 50% if their identical
twin has the disease (Gottesman, 1991).
0
Identical
10
20
30
40
50
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
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Genetic Factors
The following shows the prevalence of
schizophrenia in identical twins as seen in
different countries.
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Psychological Factors
Psychological and environmental factors
can trigger schizophrenia if the individual
is genetically predisposed (Nicols &
Gottesman, 1983).
Courtesy of Genain Family
Genain Sisters
Monday, March 26, 2012
The genetically identical
Genain
sisters suffer from
schizophrenia. Two
more than others, thus
there are contributing
environmental factors.
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Warning Signs
Early warning signs of schizophrenia
include:
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Warning Signs
Early warning signs of schizophrenia
include:
1.
A mother’s long lasting schizophrenia.
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Warning Signs
Early warning signs of schizophrenia
include:
1.
A mother’s long lasting schizophrenia.
2.
Birth complications, oxygen deprivation
and low-birth weight.
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Warning Signs
Early warning signs of schizophrenia
include:
1.
A mother’s long lasting schizophrenia.
2.
Birth complications, oxygen deprivation
and low-birth weight.
3.
Short attention span and poor muscle
coordination.
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Warning Signs
Early warning signs of schizophrenia
include:
1.
A mother’s long lasting schizophrenia.
2.
Birth complications, oxygen deprivation
and low-birth weight.
3.
Short attention span and poor muscle
coordination.
4. Disruptive and withdrawn behavior.
73
Monday, March 26, 2012
Warning Signs
Early warning signs of schizophrenia
include:
1.
A mother’s long lasting schizophrenia.
2.
Birth complications, oxygen deprivation
and low-birth weight.
3.
Short attention span and poor muscle
coordination.
4. Disruptive and withdrawn behavior.
5.
Emotional unpredictability.
73
Monday, March 26, 2012
Warning Signs
Early warning signs of schizophrenia
include:
1.
A mother’s long lasting schizophrenia.
2.
Birth complications, oxygen deprivation
and low-birth weight.
3.
Short attention span and poor muscle
coordination.
4. Disruptive and withdrawn behavior.
5.
6.
Monday, March 26, 2012
Emotional unpredictability.
Poor peer relations and solo play.
73
16-4
Personality
Disorders
77
Monday, March 26, 2012
Personality Disorders
Personality disorders
are characterized by
inflexible and
enduring behavior
patterns that impair
social functioning.
They are usually
without anxiety,
depression, or
delusions.
74
Monday, March 26, 2012
Cluster A
(odd or eccentric disorders)
• Paranoid personality disorder:
characterized by irrational suspicions and
mistrust of others.
• Schizoid personality disorder: lack of
interest in social relationships, seeing no
point in sharing time with others.
• Schizotypal personality disorder:
characterized by odd behavior or thinking.
79
Monday, March 26, 2012
Cluster B
(dramatic, emotional or erratic disorders)
• Antisocial personality disorder: a pervasive disregard
for the law and the rights of others.
• Borderline personality disorder: extreme "black and
white" thinking, instability in relationships, self-image,
identity and behavior often leading to self-harm and
impulsivity. Borderline personality disorder occurs in 3
times as many females as males.
• Histrionic personality disorder: pervasive attentionseeking behavior including inappropriate sexual
seductiveness and shallow or exaggerated emotions.
• Narcissistic personality disorder: a pervasive pattern of
grandiosity, need for admiration, and a lack of empathy.
80
Monday, March 26, 2012
Cluster C
(anxious or fearful disorders)
• Avoidant personality disorder: social
inhibition, feelings of inadequacy, extreme
sensitivity to negative evaluation and
avoidance of social interaction.
• Dependent personality disorder: pervasive
psychological dependence on other people.
• Obsessive-compulsive personality disorder
(not the same as obsessive-compulsive
disorder): characterized by rigid conformity to
81
rules, moral codes and excessive orderliness.
Monday, March 26, 2012
Antisocial Personality Disorder
A disorder in which the person (usually men)
exhibits a lack of conscience for wrongdoing,
even toward friends and family members.
Formerly, this person was called a sociopath
or psychopath.
75
Monday, March 26, 2012
Sociopath vs. Psychopath
• Sociopath- Erratic, tend to leave several
clues and evidence. Unable to maintain
normal relationships
– Jeffrey Dahmer, Ted Kaczynski, Klebold/Harris, Timothy
McVeigh
• Psychopath- Controlled, tend to have well
planned crimes, try not to leave any clues
behind. Appear normal in their social
relationships
– Ted Bundy, Charles Manson, Richard Ramirez, David
Berkowitz, BTK
83
Monday, March 26, 2012
Understanding Antisocial
Personality Disorder
Like mood disorders
and schizophrenia,
antisocial personality
disorder has
biological and
psychological reasons.
Youngsters, before
committing a crime,
respond with lower
levels of stress
hormones than others
do at their age.
76
Monday, March 26, 2012
Understanding Antisocial
Personality Disorder
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 normals (Raine et
al., 1999; 2000).
Monday, March 26, 2012
Murderer
Courtesy of Adrian Raine,
University of Southern California
Normal
77
Understanding Antisocial
Personality Disorder
The likelihood that one will commit a crime
doubles when childhood poverty is
compounded with obstetrical complications
(Raine et al., 1999; 2000).
78
Monday, March 26, 2012
Rates of Psychological Disorders
79
Monday, March 26, 2012
Rates of Psychological Disorders
The prevalence of psychological disorders
during the previous year is shown below
(WHO, 2004).
80
Monday, March 26, 2012
Risk and Protective Factors
Risk and protective factors for mental
disorders (WHO, 2004).
81
Monday, March 26, 2012
Risk and Protective Factors
82
Monday, March 26, 2012
Low Socioeconomic Class
•Why?
91
Monday, March 26, 2012
Therapy
Chapter 17-1
83
Monday, March 26, 2012
Therapy
The Psychological Therapies
 Psychoanalysis
 Humanistic Therapies
 Behavior Therapies
 Cognitive Therapies
 Group and Family Therapies
84
Monday, March 26, 2012
Therapy
Evaluating Psychotherapies
 The Effectiveness of
Psychotherapy
 The Relative Effectiveness of
Different Therapies
 Alternative Therapies Evaluated
 Commonalities Among
Psychotherapies
 Culture and Values in
Psychotherapies
Monday, March 26, 2012
85
Therapy
The Biomedical Therapies
 Drug Therapies
 Brain Stimulation
Psychosurgery
Preventing Psychological
Disorders
86
Monday, March 26, 2012
History of Insane Treatment
Maltreatment of the insane throughout the
ages was the result of irrational views.
Many patients were subjected to strange,
debilitating, and downright dangerous
treatments.
The Granger Collection
The Granger Collection
Monday, March 26, 2012
87
History of Insane Treatment
Philippe Pinel in France, Dorthea Dix and
Nellie Bly in America founded humane
movements to care for the mentally sick.
Culver Pictures
http://wwwihm.nlm.nih.gov
Philippe Pinel
(1745-1826)
Dorthea Dix
(1745-1826)
Nellie Bly
88
Monday, March 26, 2012
Therapies
Psychotherapy involves an emotionally
charged, confiding interaction between a
trained therapist and a mental patient.
89
Monday, March 26, 2012
Therapies
Psychotherapy involves an emotionally
charged, confiding interaction between a
trained therapist and a mental patient.
Biomedical therapy uses drugs or other
procedures that act on the patient’s
nervous system, curing him or her of
psychological disorders.
89
Monday, March 26, 2012
Therapies
Psychotherapy involves an emotionally
charged, confiding interaction between a
trained therapist and a mental patient.
Biomedical therapy uses drugs or other
procedures that act on the patient’s
nervous system, curing him or her of
psychological disorders.
An eclectic approach uses various forms of
healing techniques depending upon the
client’s unique problems.
89
Monday, March 26, 2012
Psychological Therapies
We will look at four major forms of
psychotherapies based on different
theories of human nature:
1.
2.
3.
4.
Psychoanalytical theory
Humanistic theory
Behavioral theory
Cognitive theory
90
Monday, March 26, 2012
Psychoanalysis
The first formal psychotherapy to emerge
was psychoanalysis, developed by Sigmund
Freud.
Edmund Engleman
Sigmund Freud's famous couch
91
Monday, March 26, 2012
Psychoanalysis: Aims
Since psychological problems originate
from childhood repressed impulses and
conflicts, the aim of psychoanalysis is to
bring repressed feelings into conscious
awareness where the patient can deal with
them.
When energy devoted to id-ego-superego
conflicts is released, the patient’s anxiety
lessens.
92
Monday, March 26, 2012
Psychoanalysis: Methods
Dissatisfied with hypnosis, Freud developed
the method of free association to unravel
the unconscious mind and its conflicts.
93
Monday, March 26, 2012
Psychoanalysis: Methods
Dissatisfied with hypnosis, Freud developed
the method of free association to unravel
the unconscious mind and its conflicts.
The patient lies on a couch and speaks
about whatever comes to his or her mind.
http://www.english.upenn.edu
Monday, March 26, 2012
93
Psychoanalysis: Methods
During free association, the patient edits
his thoughts, resisting his or her feelings to
express emotions. Such resistance
becomes important in the analysis of
conflict-driven anxiety.
94
Monday, March 26, 2012
Psychoanalysis: Methods
During free association, the patient edits
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.
94
Monday, March 26, 2012
Psychoanalysis: Criticisms
1. Psychoanalysis is hard to refute because
it cannot be proven or disproven.
2. Psychoanalysis takes a long time and is
very expensive.
95
Monday, March 26, 2012
Psychodynamic Therapies
Influenced by Freud, in a face-to-face
setting, psychodynamic therapists
understand symptoms and themes across
important relationships in a patient’s life.
96
Monday, March 26, 2012
Psychodynamic Therapies
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.
97
Monday, March 26, 2012
Humanistic Therapies
Humanistic therapists aim to boost selffulfillment by helping people grow in selfawareness and self-acceptance.
98
Monday, March 26, 2012
Person-Centered Therapy
Developed by Carl Rogers, person-centered
therapy is a form of humanistic therapy.
99
Monday, March 26, 2012
Person-Centered Therapy
Developed by Carl Rogers, person-centered
therapy is a form of humanistic therapy.
The therapist listens to the needs of the
patient in an accepting and nonjudgmental way, addressing problems in a
productive way and building his or her selfesteem.
99
Monday, March 26, 2012
Humanistic Therapy
The therapist engages in active listening
and echoes, restates, and clarifies the
patient’s thinking, acknowledging
expressed feelings.
Michael Rougier/ Life Magazine © Time Warner, Inc.
Monday, March 26, 2012
100
Behavior Therapy
Therapy that applies learning principles to
the elimination of unwanted behaviors.
101
Monday, March 26, 2012
Behavior Therapy
Therapy that applies learning principles to
the elimination of unwanted behaviors.
To treat phobias or sexual disorders,
behavior therapists do not delve deeply
below the surface looking for inner causes.
101
Monday, March 26, 2012
Classical Conditioning
Techniques
Counterconditioning is a procedure that
conditions new responses to stimuli that
trigger unwanted behaviors.
It is based on classical conditioning and
includes exposure therapy and aversive
conditioning.
102
Monday, March 26, 2012
Exposure Therapy
The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved.
Expose patients to
things they fear and
avoid. Through
repeated exposures,
anxiety lessens because
they habituate to the
things feared.
103
Monday, March 26, 2012
Exposure Therapy
Exposure therapy involves exposing people
to fear-driving objects in real or virtual
environments.
Both Photos: Bob Mahoney/ The Image Works
N. Rown/ The Image Works
104
Monday, March 26, 2012
Systematic Desensitization
A type of exposure therapy that associates
a pleasant, relaxed state with gradually
increasing anxiety-triggering stimuli
commonly used to treat phobias.
105
Monday, March 26, 2012
Aversive Conditioning
A type of
counterconditioning that
associates an unpleasant
state with an unwanted
behavior. With this
technique, temporary
conditioned aversion to
alcohol has been
reported.
106
Monday, March 26, 2012
Operant Conditioning
Operant conditioning procedures enable
therapists to use behavior modification, in
which desired behaviors are rewarded and
undesired behaviors are either unrewarded
or punished.
107
Monday, March 26, 2012
Operant Conditioning
Operant conditioning procedures enable
therapists to use behavior modification, in
which desired behaviors are rewarded and
undesired behaviors are either unrewarded
or punished.
A number of withdrawn, uncommunicative
3-year-old autistic children have been
successfully trained by giving and
withdrawing reinforcements for desired and
undesired behaviors.
107
Monday, March 26, 2012
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.
108
Monday, March 26, 2012
Cognitive Therapy
Teaches people adaptive ways of thinking
and acting based on the assumption that
thoughts intervene between events and our
emotional reactions.
109
Monday, March 26, 2012
Cognitive Therapy for Depression
Aaron Beck (1979) suggests that depressed
patients believe that they can never be
happy (thinking) and thus associate minor
failings (e.g. failing a test [event]) in life as
major causes for their depression.
110
Monday, March 26, 2012
Cognitive Therapy for Depression
Aaron Beck (1979) suggests that depressed
patients believe that they can never be
happy (thinking) and thus associate minor
failings (e.g. failing a test [event]) in life as
major causes for their depression.
Beck believes that cognitions such as “I can
never be happy” need to change in order for
depressed patients to recover. This change
is brought about by gently questioning
patients.
110
Monday, March 26, 2012
Cognitive Therapy for Depression
Rabin et al., (1986)
trained depressed
patients to record
positive events each
day, and relate how
they contributed to
these events.
Compared to other
depressed patients,
trained patients
showed lower
depression scores.
Monday, March 26, 2012
111
Stress Inoculation Training
Meichenbaum (1977, 1985) trained people
to restructure their thinking in stressful
situations.
112
Monday, March 26, 2012
Stress Inoculation Training
Meichenbaum (1977, 1985) trained people
to restructure their thinking in stressful
situations.
“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.”
112
Monday, March 26, 2012
Cognitive-Behavior Therapy
Cognitive therapists often combine the
reversal of self-defeated thinking with
efforts to modify behavior.
113
Monday, March 26, 2012
Cognitive-Behavior Therapy
Cognitive therapists often combine the
reversal of self-defeated thinking with
efforts to modify behavior.
Cognitive-behavior therapy aims to alter
the way people act (behavior therapy) and
alter the way they think (cognitive therapy).
113
Monday, March 26, 2012
Group Therapy
Group therapy normally consists of 6-9
people attending a 90-minute session that
can help more people and costs less.
Clients benefit from knowing others have
similar problems.
© Mary Kate Denny/ PhotoEdit, Inc.
Monday, March 26, 2012
114
Family Therapy
Family therapy treats the family as a
system. Therapy guides family members
toward positive relationships and improved
communication.
115
Monday, March 26, 2012
Monday, March 26, 2012
Would you believe me if I said seeing you
laugh and smile makes me happier than I’ve
ever been before?
Monday, March 26, 2012
Would you believe me if I said seeing you
laugh and smile makes me happier than I’ve
ever been before?
Or if anytime I’m not with you I miss you?
Monday, March 26, 2012
Would you believe me if I said seeing you
laugh and smile makes me happier than I’ve
ever been before?
Or if anytime I’m not with you I miss you?
While reading this you might already know this is
from ‘you know who.’
Monday, March 26, 2012
Would you believe me if I said seeing you
laugh and smile makes me happier than I’ve
ever been before?
Or if anytime I’m not with you I miss you?
While reading this you might already know this is
from ‘you know who.’
Kathryn will you go to prom with me?
-Love, Drew
Monday, March 26, 2012
17-2
Evaluating Therapy
126
Monday, March 26, 2012
Evaluating Therapies
Who do people turn to for help with
psychological difficulties?
116
Monday, March 26, 2012
Evaluating Psychotherapies
Within psychotherapies cognitive therapies
are most widely used, followed by
psychoanalytic and family/group
therapies.
117
Monday, March 26, 2012
Is Psychotherapy Effective?
It is difficult to gauge the effectiveness of
psychotherapy because there are different
levels upon which its effectiveness can be
measured.
118
Monday, March 26, 2012
Is Psychotherapy Effective?
It is difficult to gauge the effectiveness of
psychotherapy because there are different
levels upon which its effectiveness can be
measured.
1.
2.
3.
Does the patient sense improvement?
Does the therapist feel the patient has
improved?
How do friends and family feel about the
patient’s improvement?
118
Monday, March 26, 2012
Client’s Perceptions
If you ask clients about their experiences of
getting into therapy, they often
overestimate its effectiveness. Critics
however remain skeptical.
119
Monday, March 26, 2012
Client’s Perceptions
If you ask clients about their experiences of
getting into therapy, they often
overestimate its effectiveness. Critics
however remain skeptical.
1.
2.
3.
Clients enter therapy in crisis, but crisis may
subside over the natural course of time
(regression to normalcy).
Clients may need to believe the therapy was
worth the effort.
Clients generally speak kindly of their
therapists.
119
Monday, March 26, 2012
Clinician’s Perceptions
Like clients, clinicians believe in therapy’s
success. They believe the client is better off
after therapy than if the client had not
taken part in therapy.
120
Monday, March 26, 2012
Clinician’s Perceptions
Like clients, clinicians believe in therapy’s
success. They believe the client is better off
after therapy than if the client had not
taken part in therapy.
1.
2.
3.
Clinicians are aware of failures, but they
believe failures are the problem of other
therapists.
If a client seeks another clinician, the former
therapist is more likely to argue that the
client has developed another psychological
problem.
Clinicians are likely to testify to the efficacy
of their therapy regardless of the outcome of
treatment.
120
Monday, March 26, 2012
Outcome Research
How can we objectively measure the
effectiveness of psychotherapy?
Meta-analysis of a number of studies
suggests that thousands of patients benefit
more from therapy than those who did not
go to therapy.
121
Monday, March 26, 2012
Outcome Research
Research shows that treated patients were
80% better than untreated ones.
122
Monday, March 26, 2012
The Relative Effectiveness of
Different Therapies
Which psychotherapy would be most
effective for treating a particular problem?
Disorder
Therapy
Depression
Behavior, Cognition, Interpersonal
Anxiety
Cognition, Exposure, Stress Inoculation
Bulimia
Cognitive-behavior
Phobia
Behavior
Bed Wetting
Behavior Modification
123
Monday, March 26, 2012
Evaluating Alternative
Therapies
Lilienfeld (1998) suggests comparing
scientific therapies against popular
therapies through electronic means. The
results of such a search are below:
124
Monday, March 26, 2012
Eye Movement Desensitization
and Reprocessing (EMDR)
In 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.
EMDR has not held up under scientific
testing.
125
Monday, March 26, 2012
Light Exposure Therapy
Courtesy of Christine Brune
Seasonal Affective
Disorder (SAD), a
form of depression,
has been effectively
treated by light
exposure therapy.
This form of therapy
has been
scientifically
validated.
126
Monday, March 26, 2012
Commonalities Among
Psychotherapies
Three commonalities shared by all forms of
psychotherapies are the following:
© Mary Kate Denny/ PhotoEdit, Inc.
1. A hope for
demoralized people.
2. A new perspective.
3. An empathic,
trusting and caring
relationship.
127
Monday, March 26, 2012
Culture and Values in
Psychotherapy
Psychotherapists may differ from each
other and from clients in their personal
beliefs, values, and cultural backgrounds.
128
Monday, March 26, 2012
Culture and Values in
Psychotherapy
Psychotherapists may differ from each
other and from clients in their personal
beliefs, values, and cultural backgrounds.
A therapist search should include visiting
two or more therapists to judge which one
makes the client feel more comfortable.
128
Monday, March 26, 2012
Therapists & Their Training
Clinical psychologists: They have PhDs
mostly. They are experts in research,
assessment, and therapy, all of which is
verified through a supervised internship.
Clinical or Psychiatric Social Worker: They
have a Masters of Social Work.
Postgraduate supervision prepares some
social workers to offer psychotherapy,
mostly to people with everyday personal
and family problems.
129
Monday, March 26, 2012
Therapists & Their Training
Counselors: Pastoral counselors or abuse
counselors work with problems arising
from family relations, spouse and child
abusers and their victims, and substance
abusers.
Psychiatrists: They are physicians who
specialize in the treatment of psychological
disorders. Not all psychiatrists have
extensive training in psychotherapy, but as
MDs they can prescribe medications.
130
Monday, March 26, 2012
The Biomedical Therapies
These include physical, medicinal, and
other forms of biological therapies.
1. Drug Treatments
2. Surgery
3. Electric-shock
therapy
131
Monday, March 26, 2012
Drug Therapies
Psychopharmacology is the study of drug
effects on mind and behavior.
With the advent of drugs, hospitalization in mental
132
institutions has rapidly declined.
Monday, March 26, 2012
Drug Therapies
However, many patients are left homeless
on the streets due to their ill-preparedness
to cope independently outside in society.
Les Snider/ The Image Works
133
Monday, March 26, 2012
Double-Blind Procedures
To test the effectiveness of a drug, patients
are tested with the drug and a placebo. Two
groups of patients and medical health
professionals are unaware of who is taking
the drug and who is taking the placebo.
134
Monday, March 26, 2012
Schizophrenia Symptoms
Inappropriate symptoms
present (positive symptoms)
Appropriate symptoms absent
(negative symptoms)
Hallucinations, disorganized
thinking, deluded ways.
Apathy, expressionless faces,
rigid bodies.
135
Monday, March 26, 2012
Antipsychotic Drugs
Classical antipsychotics [Chlorpromazine
(Thorazine)]: Remove a number of
positive symptoms associated with
schizophrenia such as agitation,
delusions, and hallucinations.
Atypical antipsychotics [Clozapine
(Clozaril)]: Remove negative symptoms
associated with schizophrenia such as
apathy, jumbled thoughts, concentration
difficulties, and difficulties in interacting
with others.
136
Monday, March 26, 2012
Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors for
dopamine and serotonin to remove the
negative symptoms of schizophrenia.
137
Monday, March 26, 2012
Antianxiety Drugs
Antianxiety drugs (Xanax and Ativan) depress the
central nervous system and reduce anxiety and
tension by elevating the levels of the Gammaaminobutyric acid (GABA) neurotransmitter.
138
Monday, March 26, 2012
Antidepressant Drugs
Antidepressant drugs like Prozac, Zoloft, and Paxil
are Selective Serotonin Reuptake Inhibitors (SSRIs)
that improve the mood by elevating levels of
serotonin by inhibiting reuptake.
139
Monday, March 26, 2012
Mood-Stabilizing Medications
Lithium Carbonate, a common salt, has been
used to stabilize manic episodes in bipolar
disorders. It moderates the levels of
norepinephrine and glutamate
neurotransmitters.
140
Monday, March 26, 2012
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.
Monday, March 26, 2012
141
Alternatives to ECT
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.
142
Monday, March 26, 2012
Psychosurgery
http://www.epub.org.br
Psychosurgery was
popular even in
Neolithic times.
Although used
sparingly today, about
200 such operations
do take place in the US
alone.
143
Monday, March 26, 2012
Psychosurgery
Psychosurgery is used as a last resort in
alleviating psychological disturbances.
Psychosurgery is irreversible. Removal of
brain tissue changes the mind.
144
Monday, March 26, 2012
Psychosurgery
http://www.epub.org.br
Modern methods use
stereotactic
neurosurgery and
radiosurgery (Laksell,
1951) that refine
older methods of
psychosurgery.
http://www.epub.org.br
145
Monday, March 26, 2012
Preventing Psychological
Disorders
“It is better to prevent than cure.”
Peruvian Folk Wisdom
Preventing psychological disorders means
removing the factors that affect society.
Those factors may be poverty, meaningless
work, constant criticism, unemployment,
racism, and sexism.
146
Monday, March 26, 2012
Psychological Disorders are
Biopsychosocial in Nature
147
Monday, March 26, 2012