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Psychological Disorders An Introduction Psychological Disorder • A “harmful dysfunction” in which behavior is judged to be atypical, disturbing, maladaptive and unjustifiable. What is abnormal, disturbing maladaptive and unjustifiable depends on: •Culture •Time Period •Environmental Conditions •Individual Person Early Theories • Afflicted people were possessed by evil spirits. Early Theories • Music or singing was often used to chase away spirits. •In some cases trephening was used: Cutting a hole in the head of the afflicted to let out the evil spirit. Trephening Early Theories • Another theory was to make the body extremely uncomfortable. History of Mental Disorders • In the 1800’s, disturbed people were no longer thought of as madmen, but as mentally ill. They were first put in hospitals. Did this mean better treatment? Early Mental Hospitals • They were nothing more than barbaric prisons. •The patients were chained and locked away. •Some hospitals even charged admission for the public to see the “crazies”, just like a zoo. Philippe Pinel • French doctor who was the first to take the chains off and declare that these people are sick and “a cure must be found!!!” Somatogenic • At this time- it was believed that mental illness had a bodily cause- Somatogenic. General Paresis and Syphilis Example. But Somatogenic could not explain disorders such as hysteria (now called conversion disorder). Many disorders are psychogenic: the origin is psychological, not physical. Assessment Prompt #1 1. The purpose of trephening was to a. Perform brain surgery b. Give a haircut c. Ensure sterilization d. Let out the evil spirits e. Find the part of the brain where the problem resided. 2. In the late 1800’s, it was believed that mental illness was __________, physical in nature,but some mental illness is __________, psychological in nature. a. Psychogenic; somatogenic b. Psychotic; somatogenic c. Somatogenic; psychotic d. Somatogenic; psychogenic e. Psychogenic; psychotic Current Perspectives • Medical Perspective: psychological disorders are sicknesses and can be diagnosed, treated and cured. Current Perspectives • Bio-Psycho-Social Perspective: assumes biological, psychological and sociocultural factors combine to interact causing psychological disorders. Used to be called Diathesis-Stress Model: diathesis meaning predisposition and stress meaning environment. Classifying Psychological Disorders • DSM-IV: Diagnostic Statistical Manual of Mental Disorders: the big book of disorders. • Axis I-IV Two Major Classifications: Neurotic Disorders • Distressing but one can still function in society and act rationally Psychotic Disorders • Person loses contact with reality, experiences distorted perceptions Assessment Prompt #2 1. A serious criticism of the medical model is the theory that disorders are a. Learned b. Genetic c. A disease d. A hormonal imbalance e. The fault of those experiencing the illness 2. The DSM-IV is organized by a. Treatments b. Causes c. Situations d. Symptoms e. Cultural indicators Mood Disorders Mood Disorders • Psychological Disorders characterized by emotional extremes. • Dysthymic Disorder • Major Depressive Disorder •Seasonal Affective Disorder •Bipolar Disorder Depression • The common cold of psychological disorders. It is like a warning that something is wrong. Depression Depression Major Depressive Disorder • A person, for no apparent reason, experiences two or more weeks of depressive moods. Includes feelings of worthlessness and diminished interest or pleasure in most activities. Dysthymic Disorder • Suffering from mild depression every day for at least two years. Seasonal Affective Disorder -Related to Melatonin levels Bipolar Disorder • Person alternates between the hopelessness and lethargy of depression and the overexcited state of mania. Famous People with Bipolar Norepinephrine Increases arousal and boosts moods. Assessment Prompt #3 1. ______ is the most common of all major mental disorders a. Mania b. Schizophrenia c. Depression d. Seasonal affective disorder e. Anorexia nervosa 2. Bipolar disorder was once known as a. Manic-depressive disorder b. ADHD c. Clinical depression d. Disasociative disorder e. schizophrenia Anxiety Disorders a group of conditions where the primary symptoms are anxiety or defenses against anxiety. the patient fears something awful will happen to them. Are anxiety disorders a neurosis or psychosis.? What is anxiety? • is a state of intense apprehension, uneasiness, uncertainty, or fear. Generalized Anxiety Disorder • An anxiety disorder in which a person is continuously tense, apprehensive and in a state of autonomic nervous system arousal. The patient is constantly tense and worried, feels inadequate, is oversensitive, can’t concentrate and suffers from insomnia. Panic Disorder • An anxiety disorder marked by a minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking and other frightening sensations. Can cause secondary disorders, such as agoraphobia. Phobias • A person experiences sudden episodes of intense dread. Obsessive Compulsive Disorder • An anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions). Common Examples of OCD Common Obsessions: Common Compulsions: Contamination fears of germs, dirt, Washing etc. Imagining having harmed self or others Repeating Imagining losing control of aggressive urges Checking Intrusive sexual thoughts or urges Touching Excessive religious or moral doubt Counting Forbidden thoughts Ordering/arranging A need to have things "just so" Hoarding or saving A need to tell, ask, confess Praying Explanations for Anxiety Disorders • You Learn them through conditioning. •Evolution •Genes •Physiology (the brain) Assessment Prompt #4 1. The DSM-IV considers ____ an anxiety disorder a. Schizophrenia b. Bipolar disorder c. OCD d. Amnesia e. Multiple personality disorder 2. Jenny feels anxious all the time, but is not afraid of anything in particular. She is likely suffering from a. Panic attacks b. OCD c. Agoraphobia d. Generalized anxiety disorder e. Anticipatory anxiety Somatoform Disorders • Somatoform disorders – Psychological problems appearing in the form of bodily symptoms or physical complaints • Conversion disorder – Somatoform disorder marked by paralysis, weakness, or loss of sensation, but with no discernable physical cause Copyright © Allyn & Bacon 2007 Somatoform Disorders • Glove Anesthesia Copyright © Allyn & Bacon 2007 Somatoform Disorders Hypochondriasis – Somatoform disorder involving excessive concern about health and disease Copyright © Allyn & Bacon 2007 Dissociative Disorders Dissociative Disorders • Disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts and feelings. Dissociative Amnesia • This disorder is characterized by a blocking out of critical personal information, usually of a traumatic or stressful nature. Dissociative Amnesia • Dissociative amnesia, unlike other types of amnesia, does NOT result from other medical trauma (e.g. a blow to the head). Dissociative Fugue • An individual with dissociative fugue suddenly and unexpectedly takes physical leave of his or her surroundings and sets off on a journey of some kind. •These journeys can last hours, or even several days or months. Dissociative Fugue • Individuals experiencing a dissociative fugue have traveled over thousands of miles. An individual in a fugue state is unaware of or confused about his identity, and in some cases will assume a new identity (although this is the exception). Depersonalization Disorder • is marked by a feeling of detachment or distance from one's own experience, body, or self. One can easily relate to feeling as they are in a dream, or being "spaced out." A person's experience with depersonalization can be so severe that he or she believes the external world is unreal or distorted. Dissociative Identity Disorder • A rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. •Also known as multiple personality disorder. Assessment Prompt #5 1. A key feature of _____ disorders is the presence of physical symptoms without an apparent physical cause a. affective b. Dissociative c. Somatoform d. Organic e. Hallucinatory 2. _____ involves persistent loss of memory, as well as fleeing from one’s home, family and job a. Conversion disorder b. Dissociative fugue c. Identity disorders d. Somatoform disorder e. Anxiety disorder Schizophrenia How Prevalent? • About 1 in every 100 people are diagnosed with schizophrenia. Symptoms of Schizophrenia • Disorganized thinking. •Disturbed Perceptions •Inappropriate Emotions and Actions Disorganized Thinking • The thinking of a person with Schizophrenia is fragmented and bizarre and distorted with false beliefs. •Disorganized thinking comes from a breakdown in selective attention.they cannot filter out information. Often causes……… Delusions (false beliefs) • Delusions of Persecution • Delusions of Grandeur Disturbed Perceptions • hallucinations- sensory experiences without sensory stimulation. Inappropriate Emotions and Actions • Laugh at inappropriate times. • Flat Effect • Senseless, compulsive acts. • Catatoniamotionless Waxy Flexibility Positive v. Negative Symptoms Positive Symptoms • Presence of inappropriate symptoms Negative Symptoms • Absence of appropriate ones. Types of Schizophrenia Paranoid Schizophrenia • preoccupation with delusions or hallucinations. • Somebody is out to get me!!!! Disorganized Schizophrenia • disorganized speech or behavior, or flat or inappropriate emotion. Catatonic Schizophrenia • parrot like repeating of another’s speech and movements Undifferentiated Schizophrenia • Many and varied Symptoms. Possible Causes of Schizophrenia Evidence for the causes of schizophrenia has been found in a variety of factors including genetics, abnormal brain structure, and biochemistry Diathesis-stress hypothesis – Genetic factors place the individual at risk, but environmental stress factors transform this potential into an actual schizophrenic disorder Copyright © Allyn & Bacon 2007 Personality Disorders Psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning. Antisocial Personality Disorder • antisocial personality disorder is characterized by a lack of conscience •People with this disorder are prone to criminal behavior, believing that their victims are weak and deserving of being taken advantage of. They tend to lie and steal Antisocial Personality Disorder • they are careless with money and take action without thinking about consequences They are often aggressive and are much more concerned with their own needs than the needs of others. Borderline Personality Disorder • characterized by mood instability and poor self-image People with this disorder are prone to constant mood swings and bouts of anger. Borderline Personality Disorder • they will take their anger out on themselves, causing themselves injury Suicidal threats and actions are not uncommon They are quick to anger when their expectations are not met. Narcissistic Personality Disorder • characterized by selfcenteredness They exaggerate their achievements, expecting others to recognize them as being superior Narcissistic Personality Disorder They tend to be choosy about picking friends, since they believe that not just anyone is worthy of being their friend. They are generally uninterested in the feelings of others and may take advantage of them. Developmental Disorders Autism – A developmental disorder marked by disabilities in language, social interaction, and the ability to understand another person’s state of mind Dyslexia – A reading disability, thought by some experts to involve a brain disorder Copyright © Allyn & Bacon 2007 Developmental Disorders Attention-deficit hyperactivity disorder – A developmental disability involving short attention span, distractibility, and extreme difficulty in remaining inactive for any period Copyright © Allyn & Bacon 2007 What is Therapy? Therapy for psychological disorders takes a variety of forms, but all involve some relationship focused on improving a person’s mental, behavioral, or social functioning Copyright © Allyn & Bacon 2007 Contemporary Approaches to Therapy Psychological therapies – Based on psychological principles (rather than biomedical approach) The psychological therapies are often collectively called psychotherapy Copyright © Allyn & Bacon 2007 Contemporary Approaches to Therapy Biomedical therapies – Treatments that focus on altering the brain, especially with drugs, psychosurgery, or electroconvulsive therapy Copyright © Allyn & Bacon 2007 Types of Mental Health Care Professionals Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Copyright © Allyn & Bacon 2007 Professional Title Counseling psychologist Specialty: Clinical psychologist Problems of normal living Psychiatrist Work setting: Psychoanalyst Schools, clinics, other institutions Psychiatric nurse practitioner Credentials: Clinical social worker Master’s in counseling, PhD, EdD, or PsyD Pastoral counselor Copyright © Allyn & Bacon 2007 Professional Title Counseling psychologist Specialty: Clinical psychologist Those with severe disorders Psychiatrist Work setting: Psychoanalyst Private practice, mental health agencies, hospitals Psychiatric nurse practitioner Clinical social worker Pastoral counselor Credentials: PhD or PsyD Copyright © Allyn & Bacon 2007 Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Specialty: Severe mental disorders (often by means of drug therapies) Work setting: Private practice, clinics, hospitals Credentials: MD Copyright © Allyn & Bacon 2007 Professional Title Counseling psychologist Clinical psychologist Specialty: Psychiatrist Psychoanalyst Freudian therapy Work setting: Psychiatric nurse practitioner Private practice Clinical social worker Credentials: Pastoral counselor MD Copyright © Allyn & Bacon 2007 Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Specialty: Nursing specialty; licensed to prescribe drugs Work setting: Private practice, clinics, hospitals Credentials: RN – plus special training in treating mental disorders and prescribing drugs Copyright © Allyn & Bacon 2007 Professional Title Counseling psychologist Clinical psychologist Psychiatrist Specialty: Social worker with specialty in dealing with mental disorders Psychoanalyst Work setting: Psychiatric nurse practitioner Often employed by government Clinical social worker Pastoral counselor Credentials: MSW Copyright © Allyn & Bacon 2007 Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Specialty: Combines spiritual guidance with practical counseling Work setting: Religious order or ministry Credentials: Varies Copyright © Allyn & Bacon 2007 Psychological Therapies Psychotherapy • An interaction between a trained therapist and someone suffering from psychological difficulties. Eclectic Approach • The most popular form of therapyit is basically a smorgasbord where the therapist combines techniques from different schools of psychology. Psychoanalysis • Freud's therapy. •Freud used free association, hypnosis and dream interpretation to gain insight into the client’s unconscious. Psychoanalytic Methods • Psychotherapists use their techniques to overcome resistance by the client. •The psychoanalyst wants you to become aware of the resistance and together interpret (ex. Latent content) it’s underlying meaning. Transference • In psychoanalysis, the patient’s transfer to the analyst of emotions linked with other relationships. Humanistic Therapy • Focuses of people’s potential for selffulfillment (self-actualization). •Focus on the present and future (not the past). •Focus on conscious thoughts (not unconscious ones). •Take responsibility for you actionsinstead of blaming childhood anxieties. Most widely used Humanistic technique is: Client (Person) Centered Therapy • Developed by Carl Rogers •Therapist should use genuineness, acceptance and empathy to show unconditional positive regard towards their clients. Active Listening • Central to Roger’s client-centered therapy •Empathetic listening where the listener echoes, restates and clarifies. Behavior Therapies • Therapy that applies learning principles to the elimination of unwanted behaviors. •The behaviors are the problems- so we must change the behaviors. Classical Conditioning Techniques Counterconditioning: • A behavioral therapy that conditions new responses to stimuli that trigger unwanted behaviors. Two Types: Systematic Desensitization • A type of counterconditioning that associates a pleasant relaxed state with gradually increasing anxietytriggering stimuli. How would I use systematic desensitization to reduce my fear of old women? Systematic Desensitization Progressive Relaxation Exposure Therapy Flooding Aversive Conditioning • A type of counterconditioning that associates an unpleasant state with an unwanted behavior. How would putting poop on the fingernails of a nail biter effect their behavior? Aversive Conditioning Aversive Conditioning What are some ways you can change the behaviors of your friends with aversive conditioning? Operant Conditioning Token Economy: an operant conditioning procedure that rewards a desired behavior. A patient exchanges a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats. Cognitive Therapies • A therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumptions that thoughts intervene between events and our emotional reactions. Cognitive Therapy • Cognitive Therapists try to teach people new, more constructive ways of thinking. Is .300 a good or bad batting average? Aaron Beck and his view of Depression • Noticed that depressed people were similar in the way they viewed the world. • Used cognitive therapy get people to take off the “dark sunglasses” in which they view their surroundings Evaluating the Psychological Therapies Eysenck proposed that people with nonpsychotic problems recover just as well with or without therapy Reviews of evidence have shown: That therapy is better than no therapy It appears advantageous to match specific therapies with specific conditions Copyright © Allyn & Bacon 2007 The Biomedical Therapies Therapies aimed at the altering the body chemistry. Psychopharmacology • The study of the effects of drugs on mind and behavior. Drugs and Hospitalization Emptying of Mental Hospitals Testing New Drugs • When a new drug is released there is always too much enthusiasm. •Must use a double-blind procedure to combat placebo and experimental effects. These experiments better able use to classify different types of drugs: Antipsychotic Drugs • Antipsychotic drugs are a class of medicines used to treat psychosis and other mental and emotional conditions. These drugs are beginning to help schizophrenics with both positive and negative symptoms. These drugs (Thorazine) often have powerful side effects Antianxiety Drugs • Includes drugs like Valium and Librium. •Like alcohol, they depress nervous system activity. •Most widely abused drugs. Do they really solve the problem? Antidepressant Drugs • Lift you up out of depression. Most increase the neurotransmitter Norepinephrine. Prozac, Paxil Zoloft • Work by blocking serotonin reuptake. Electroconvulsive Therapy • Biomedical therapy for severely depressed patients in which brief electric current is sent through the brain of an anesthetized patient. Psychosurgery • Surgery that removes or destroys brain tissue in an effort to change behavior. Egas Moniz developed the lobotomy in the 1930s. Ice pick like instrument through the eye sockets cutting the links between the frontal lobes and the emotional control centers. Lobotomy