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Geri Lavrov / Photographer's Choice / Getty Images Psychological Disorders What is a psychological disorder? Anxiety disorders, OCD, and PTSD Substance use and addictive disorders Mood disorders Schizophrenia Other disorders What Is a Psychological Disorder? Defining psychological disorders THINKING CRITICALLY ABOUT: ADHD— Normal high energy or disordered behavior? Understanding psychological disorders Classifying disorders—and labeling people CLOSE-UP: Are people with psychological disorders dangerous? What Is a Psychological Disorder? Theorists and clinicians consider many perspectives How should we define psychological disorders? How should we understand disorders? How do underlying biological factors contribute to disorder? How do troubling environments influence our well-being? And how do these effects of nature and nurture interact? How should we classify psychological disorders? How can we use labels to guide treatment without stigmatizing people or excusing their behavior? Defining Psychological Disorders Psychological disorder A syndrome marked by a clinically significant disturbance in a person’s thoughts, feelings, or behaviors Culture and time Diagnosis of specific disorders has varied from culture to culture and over time in the same culture Percentage of Americans Reporting Certain Psychological Disorders in the Past Year The Granger Collection, NYC -- All rights reserved. Understanding Psychological Disorders “MORAL TREATMENT” Under Philippe Pinel’s influence, hospitals sometimes sponsored patient dances, often called “lunatic balls,” depicted in this painting by George Bellows (Dance in a Madhouse). Once upon a time… Middle Ages: Wide variety of therapies (often cruel or barbaric by today’s standards) used to drive out demons or modify madness Pinel: Opposed brutal treatment and proposed moral treatment; viewed madness as a sickness of mind caused by severe stress and inhumane treatment Understanding Psychological Disorders The medical model 1800s: Search for physical causes of mental disorders and for curative treatments Mental illness is diagnosed on the basis of symptoms and cured through therapy, including treatment The biopsychosocial approach General approach positing that biological, psychological, and social-cultural factors, all play a significant role in human functioning in the context of disease or illness ADHD—Normal High Energy or Disordered Behavior? Attention-deficit/hyperactivity disorder (ADHD) 11 percent of American 4- to 17-year-olds receive this diagnosis after displaying its key symptoms (extreme inattention, hyperactivity, and impulsivity); 2.5 percent have ADHD symptoms Symptoms can be treated with medication and other therapies Debate continues over whether normal high energy is too often diagnosed as a psychiatric disorder, and whether there is a cost to the long-term use of stimulant drugs in treating ADHD Are psychological disorders universal, or are they culture-specific? Explain with examples. What is the biopsychosocial perspective, and why is it important in our understanding of psychological disorders? Classifying Disorders—and Labeling People Classification in psychiatry and psychology Provides name and description Attempts to predict the future of a disorder Suggests treatment Classifying Disorders—and Labeling People DSM-5 American Psychiatric Association’s 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Changes Some label changes (e.g., Autism spectrum disorder; intellectual disability) New or altered diagnoses (e.g., disruptive mood dysregulation disorder; prolonged bereavement/depression)—some controversial Classifying Disorders—and Labeling People DSM-5 Criticism Antisocial personality disorder and generalized anxiety disorder did poorly on field trials DSM-5 contributes to pathologizing of everyday life System labels are society’s value judgments Rosenhan (1973) DSM-5 Benefits System helps mental health professionals communicate and is useful in research What is the value, and what are the dangers, of labeling individuals with disorders? Anxiety Disorders, OCD, and PTSD Generalized anxiety disorder Panic disorder Phobias Obsessive-compulsive disorder (OCD) Posttraumatic stress disorder (PTSD) Understanding anxiety disorders, OCD, and PTS Anxiety Disorders, OCD, and PTSD Anxiety disorders are marked by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety Generalized anxiety disorder Person is constantly tense and uneasy for no apparent reason Panic disorder Person experiences sudden episodes of intense dread and often lives in fear of when the next attack might strike Phobias Person feels irrationally and intensely afraid of a specific object or situation Obsessive-compulsive disorder Person is troubled by repetitive thoughts or actions Posttraumatic stress disorder Person has lingering memories, nightmares, and other symptoms for weeks after a severely threatening, uncontrollable event LIVING WITH ANXIETY DISORDER Garrett Ellwood/NBAE/Getty Images NBA basketball player Royce White speaks openly about his generalized associated fear of flying (Wrenn, 2012). Classifying Disorders—and Labeling People General anxiety disorder Symptoms: Continual worrying, often jittery, sleep deprived, concentration difficulties, often experienced with depression Two-thirds are women; decreases with age in many Panic disorder Symptoms: Irregular heartbeat, cheat pains, shortness of breath, choking, dizziness, trembling Smoking increases the risk for attacks SOME COMMON AND UNCOMMON SPECIFIC FEARS Researchers surveyed Dutch people to identify the most common events or objects they feared. A strong fear becomes a phobia if it provokes a compelling but irrational desire to avoid the dreaded object or situation. (From Marja et al., 2008.) Sam Greenwood/Getty Images Classifying Disorders PLAYING THROUGH PANIC Golfer Charlie Beljan suffered panic and a racing pulse during a 2012 PGA golf tournament After finishing, he left and spent the night in a hospital before returning the next day and winning $846,000 Unfocused tension, apprehension, and arousal is called ________ disorder. If a person is focusing anxiety on specific feared objects or situations, that person may have a(n) ________. Those who experience unpredictable periods of frightening physical sensations, may be diagnosed with a(n) ________ disorder. Obsessive-Compulsive Disorder (OCD) Obsessive-compulsive disorder (OCD) A disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions) Occurs when obsessive thoughts and compulsive behaviors interfere with everyday life and cause distress Post traumatic Stress Disorder (PTSD) Post Traumatic stress disorder (PTSD) A disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia lingering for four weeks or more after a traumatic experience Often involves battle-scarred veterans (7.6 percent of combatants; 1.4 of noncombatants) and survivors of accidents, disasters, and violent and sexual assaults (two-thirds of prostitutes) Women are at higher risk Post traumatic Stress Disorder (PTSD) Whitney Shefte/ The Washington Post via Getty Images During his three deployments to Iraq, this Marine Staff Sergeant suffered traumatic brain injury. After his return home, he was diagnosed with posttraumatic stress disorder. He regularly travels two hours each way with his wife to Bethesda Naval Hospital for psychiatric and medical appointments. BRINGING THE WAR HOME PTSD Some believe it’s overdiagnosed because of a broad definition of “trauma” May include “normal” bad memories “Debriefing” may exacerbate the problem; reliving the situation may be traumatic Those who express anxiety through unwanted repetitive thoughts or actions may have a(n) ________ disorder. Those with symptoms of withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia for weeks after a traumatic event may be diagnosed with ________ disorder. Understanding Anxiety Disorders, OCD, and PTSD: How Do Anxious Feelings Arise? Conditioning Classical conditioning research helps explain how panic-prone people associate anxiety with certain cues Stimulus generalization research demonstrates how a fearful event can later become a fear of similar events Reinforcement (operant conditioning) can help maintain a developed and generalized phobia Understanding Anxiety Disorders, OCD, and PTSD: How Do Anxious Feelings Arise? Cognition Observing others can contribute to the development of some fears Olsson and colleagues: Wild monkey research findings Interpretations and expectations shape reactions Hypervigliance Understanding Anxiety Disorders, OCD, and PTSD Biology The brain: Trauma is linked to new fear pathways, hyperactive danger detection, impulse control, and habitual behavior areas of the brain Natural selection: Biological preparedness to fear threats—easily conditioned and difficult to extinguish Tim Boyles/ Getty Images Genes: Genetic predisposition to anxiety, OCD, and PTSD FEARLESS? The biological perspective helps us understand why most of us have more fear of heights than does Nick Wallenda, shown here crossing the Grand Canyon in 2013 without a security harness or safety net. Researchers believe that anxiety disorders, OCD, and PTSD are influenced by conditioning and cognition. What other factors contribute to these disorders? Substance Use and Addictive Disorders Tolerance and addiction Depressants Stimulants Hallucinogens Understanding substance use disorder Substance Use and Addictive Disorders • Substance use disorder • Involves continued substance craving and use despite significant life disruption and/or physical risk • Psychoactive drugs • Include chemicals that change perceptions and mood • Drug effectiveness • Depends on biological effects and the user’s psychological expectations Tolerance and Addiction • Tolerance • With repeated use, the desired effect requires larger doses • Addiction • Compulsive craving of drugs or certain behaviors (such as gambling) despite known harmful consequences • Withdrawal • Discomfort and distress that follow discontinuing an addictive drug or behavior DRUG TOLERANCE When Is Drug Use a Disorder? What is the process that leads to drug tolerance? Substance Use and Addictive Disorders Can you identify the three major categories of psychoactive drugs? Depressants: Alcohol Unleashing urges Helpful and harmful tendencies are increased Destructive behaviors and consequences occur Binge drinking occurs Slowed neural processing Sympathetic nervous system slows Potential sedative effect and lowered inhibitions Moral and physical judgment is impaired Depressants: Alcohol Memory disruption Processing of recent experiences into long-term memory is disrupted (blackouts) Long-term effects on the brain (rat studies) The death of nerve cells and the birth of new cells and impaired growth of synaptic connections is linked to binge drinking Expectations Alcohol users’ expectations influence their behavior Daniel Hommer, NIAAA, NIH, HHS ALCOHOL USE DISORDER SHRINKS THE BRAIN MRI scans show brain shrinkage in women with alcohol use disorder (left) compared with women in a control group (right). Depressants Barbiturates Depress the activity of the central nervous system, reducing anxiety but impairing memory and judgment Can impair memory and judgment; potentially lethal when combined with alcohol Nembutal, Seconal, and Amytal Opiates Include opium and its derivatives, such as codeine, morphine and heroin; addictive Constrict pupils, slows breathing, causes lethargy Depress neural activity, temporarily lessening pain and anxiety Cause withdrawal when ingestion is stopped Alcohol, barbiturates, and opiates are all in a class of drugs called ________. Stimulants Stimulant drugs Include caffeine, nicotine, and the more powerful amphetamines (cocaine, Ecstasy, and methamphetamine) that excite neural activity and speed up body functions Involve dilation of pupils, increase in heart and breathing rates, rise in blood sugar, and drop in appetite Often involve increase in energy and self-confidence Nicotine The stimulating and highly addictive psychoactive drug in tobacco Signals the central nervous system to release a flood of neurotransmitters Diminishes appetite, boosts alertness and mental efficiency, calms anxiety, and reduces sensitivity to pain Involves challenging acute craving and withdrawal symptoms which contribute to relapse Where there’s smoke . . . The physiological effects of nicotine • Nicotine reaches the brain within 7 seconds, twice as fast as intravenous heroin. • Within minutes, the amount in the blood soars. Why do tobacco companies try so hard to get customers hooked as teens? Stimulants Cocaine Produces a quick rush of euphoria Involves a crash of agitated depression within 15 to 30 minutes after neurotransmitters drop Produces psychological effects depending on dosage and form consumed and user’s expectations and personality Cocaine Euphoria and Crash Stimulants Cocaine Methamphetamine Ecstasy (MDMA) • Produces quick rush of euphoria • Involves crash of agitated depression within 15 to 30 minutes after neurotransmitters drop • Produces psychological effects depending on dosage and form consumed and user’s expectations and personality • Is powerfully addictive • A synthetic stimulant and mild hallucinogen • Produces euphoria, but with short-term health risks and longer term harm to mood and cognition Hallucinogens Hallucinogens Distort perceptions and call up sensory images without any input from the senses Marijuana Has leaves containing THC (delta-9tetrahydrocannabinol) which are smoked or eaten to produce increased sensitivity to colors, sounds, tastes, and smells; lingers in body longer Can also relax, disinhibit, and impair motor and perceptual skills and reaction time From Hallucinations by Ronald K. Siegel, Scientific American 237, 132 - 139 (1977) HALLUCINATION OR NEAR DEATH VISION? People under the influence of hallucinogenic drugs often see “a bright light in the center of the field of vision…” Hallucinogens LSD Powerful hallucinogenic drug; also known as acid (lysergic acid diethylamide) Interferes with serotonin neurotransmitter system A Guide to Selected Psychoactive Drugs “How strange would appear to be this thing that men call pleasure! And how curiously it is related to what is thought to be its opposite, pain! . . . Wherever the one is found, the other follows up behind.”-- Plato, Phaedo, fourth century B.C.E. How does this pleasure-pain description apply to the repeated use of psychoactive drugs? Understanding Substance Use Disorder Evidence of biological vulnerability to particular drugs Twin studies (Kendler et al., 2002) Genetically influenced traits in boys (Masse & Tremblay, 1997) Genes that produce deficiencies in the dopamine reward system Evidence of psychological and social-cultural influences Links between heavy drug use, significant stress or failure, sexual abuse, eating disorders, and depression Exposure to media models Ethnic difference in rates of smoking, drinking, and cocaine use Location and peer influence create additional risk Studies have found that people who begin drinking in the early teens are much more likely to develop an alcohol use disorder than are those who begin at age 21 or after. What possible explanations might there be for this correlation? Mood Disorders Major depressive disorder Bipolar disorder Suicide and self-injury Understanding mood disorders Mood Disorders Major depressive disorders appear in two principal forms Major depressive disorder A persistent state of hopeless depression Occurs when signs of depression last two or more weeks and are not caused by drugs or a medical condition Bipolar disorder An alternation between depression and overexcited hyperactivity; less common May include seasonal patterns; involves a surge in diagnosis GENDER AND MAJOR DEPRESSION Interviews with 89,037 adults in 18 countries (10 of which are shown here) confirm what many smaller studies have found. Women’s risk of major depression is nearly double that of men’s (Bromet et al., 2011). Diagnosing Major Depressive Disorder Suicide and Self-Injury Suicide 1 million people worldwide; higher risk with diagnosis of depression but may occur with rebound Is more likely to occur when people feel disconnected from or a burden to others Nonsuicidal self-injury (NSS) Includes cutting, burning, and hitting oneself, pulling out hair, inserting objects under the nails or skin, and self-administered tattooing Why? People engage in NSSI to Gain relief from intense negative thoughts through the distraction of pain Ask for help and gain attention Relieve guilt by self-punishment Get others to change their negative behavior (bullying, criticism) Fit in with a peer group Understanding Mood Disorders Findings that any theory of depression must explain Behaviors and thoughts change with depression Depression is widespread Women’s risk of major depression is nearly double men’s Most major depressive episodes end on their own With each new generation, depression is striking earlier in life and affecting more people Risk increases if a family member has the disorder Twin studies data estimate heritability of major depression at 37 percent Linkage analysis points to “chromosome neighborhood” Many genes work together and produce interacting small effects that increase the risk for depression The Heritability of Various Psychological Disorders Understanding Mood Disorders The depressed brain Brain activity slows during depression Left frontal lobe is less active Scarcity of norepinephrine and serotonin Courtesy of Drs. Lewis Baxter and Michael E. Phelps, UCLA School of Medicine THE UPS AND DOWNS OF BIPOLAR DISORDER PET scans show that brain energy consumption rises and falls with the patient’s emotional switches. Red areas are where the brain is using energy most rapidly. During depression Brain activity slows Left frontal lobe is less active Scarcity of norepinephrine and serotonin Understanding Mood Disorders THE VICIOUS CYCLE OF DEPRESSED THINKING Understanding Mood Disorders Psychological and social influences: Socialcognitive perspective Depressed people view the self and the world negatively Learned helplessness may exist with self-defeating beliefs, self-focused rumination, and a self-blaming and pessimistic explanatory style What does it mean to say that “depression is a whole-body disorder”? Schizophrenia Symptoms of schizophrenia Onset and development of schizophrenia Understanding schizophrenia Schizophrenia Definition Psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression Symptoms Disorganized speech Disturbed perceptions Diminished and inappropriate emotions and actions Schizophrenia Onset and development Sudden appearance for some; slow-developing for others Recovery is more difficult for slow-developing onset Men are struck earlier, more severely, and slightly more often Understanding Schizophrenia Brain abnormalities Brain chemistry Excess number of dopamine receptors Abnormal brain activity and anatomy Problems with several brain regions and their interconnections Low activity in frontal lobes More rapid brain tissue loss Understanding Schizophrenia Prenatal environment and risk Low birth weight Lack of oxygen during delivery Maternal prenatal nutrition Midpregnancy viral infection (e.g., flu, dense population, season of birth) RISK OF DEVELOPING SCHIZOPHRENIA The lifetime risk of developing schizophrenia varies for family members of a person with this disorder. Understanding Schizophrenia Genetics and risk The odds of being diagnosed with schizophrenia are nearly 1 in 100; 1 in 10 for those with diagnosed family member Adopted children’s risk is related to the biological parents Schizophrenia is influenced by many genes Epigenetic factors influence gene expression A person with schizophrenia who has ________ (positive/negative) symptoms may have an expressionless face and toneless voice. What factors contribute to the onset and development of schizophrenia? Other Disorders Eating disorders Dissociative disorders Personality disorders Other Disorders Eating disorders Anorexia nervosa Person (usually an adolescent female) maintains a starvation diet despite being significantly underweight Bulimia nervosa Person alternates binge eating (usually of high-calorie foods) with purging (by vomiting or laxative use), fasting, or excessive exercise Binge-eating disorder Significant binge eating, followed by distress, disgust, or guilt, but without the purging, fasting, or excessive exercise that marks bulimia nervosa People with ________ (anorexia nervosa/bulimia nervosa) continue to want to lose weight even when they are underweight. Those with ________ (anorexia nervosa/bulimia nervosa) tend to have weight that fluctuates within or above normal ranges. Other Disorders Dissociative disorder Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings Dissociative identity disorder (DID) Rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities— formerly called multiple personality disorder Dissociative Disorders: The Arguments Critics question Short history of DID Lower incidence outside North America Suggest it could be self-perception instead of a disorder Others support Different areas of the brain and body states associated with differing personalities What do you think? The psychodynamic and learning perspectives agree that dissociative identity disorder symptoms are ways of dealing with anxiety. How do their explanations differ? Personality Disorders Personality disorder Inflexible and enduring behavior pattern that impairs social functioning; may include withdrawal or avoidance of social contact, insecurity, instability, or manipulative behaviors Antisocial personality disorder Lack of conscience for wrongdoing, even toward friends and family members; impulsive, fearless, irresponsible; some genetic tendencies, including low arousal Typically male; emerges before age 15; influenced by nature and nurture Are people with psychological disorders dangerous? The majority of violent crimes are committed by those with no diagnosed disorders There is little risk of violence or harm to a stranger from casual contact with an individual who has a mental disorder Alcohol or drugs, previous violence, and gun availability are better predictors of violence