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Psychological Disorders AP Psychology Mr. Boyd Abnormal Behavior The medical model What is abnormal behavior? Deviant Maladaptive Causing personal distress A continuum of normal/abnormal We can not draw a “line”. Figure 14.2 Normality and abnormality as a continuum Prevalence, Causes, and Course Epidemiology-study of the distribution of illness Prevalence-% of population has illness over time Lifetime prevalence Diagnosis-distinguishing one from another Etiology-apparent cause/development Prognosis-forecast of the probable course Figure 14.5 Lifetime prevalence of psychological disorders Psychodiagnosis: The Classification of Disorders American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM-4, DSM-IV) Five Axes Axis I – Clinical Syndromes Axis II – Personality Disorders or Mental Retardation Axis III – General Medical Conditions Axis IV – Psychosocial and Environmental Problems Axis V – Global Assessment of Functioning Axis I Clinical Syndromes Anxiety Disorders-excessive apprehension Somatoform Disorders-physical / psychological Dissociative Disorders-multiple personalities Mood Disorders-emotional disturbances Schizophrenic Disorders-delusions, disorganized speech, hallucinations Clinical Syndromes: Anxiety Disorders Generalized anxiety disorder Phobic disorder “free-floating anxiety” Specific focus of persistent, irrational fear Panic disorder and agoraphobia Obsessive compulsive disorder Obsessions Compulsions Posttraumatic Stress Disorder attributed to experience of a major traumatic event Etiology of Anxiety Disorders Biological factors Conditioning and learning Judgments of perceived threat Over interpreting harmless situations Personality Acquired through classical conditioning or observational learning Maintained through operant conditioning Cognitive factors Genetic predisposition GABA synapse Serotonin synapses implicated in panic/OCD Neuroticism trait linked Stress—a precipitator Clinical Syndromes: Somatoform Disorders Somatization Disorder- Are physical ailments that cannot be explained by organic conditions. They are not psychosomatic diseases, which are real physical ailments caused in part by psychological factors. They occur mostly in women and often coexist with depression and anxiety disorders. Conversion Disorder- is characterized by a significant loss of physical function (with no apparent organic basis), usually in a single organ system(vision) Hypochondriasis- excessive preoccupation with health concerns Etiology Reactive autonomic nervous system Personality factors Cognitive factors The sick role Figure 14.10 Glove anesthesia Inconsistent with the known facts of physiology Clinical Syndromes: Dissociative Disorders Dissociative amnesia-people lose contact with portions of their Dissociative fugue-loss of memory, entire lives, sense of personal consciousness or memory, resulting in disruptions in their sense of identity. A sudden loss of memory for important personal information that is too extensive to be due to normal forgetting. Memory loss may be for a single traumatic event or for an extended time period around the event. identity Dissociative identity disorder-multiple personality disorder Etiology severe emotional trauma during childhood Controversy 25% of American psychiatrists accept scientific validity Media creation? Clinical Syndromes: Mood Disorders Major depressive disorder-marked by profound sadness, Etiology slowed thought processes, low self-esteem, and loss of interest in previous sources of pleasure. Unipolar. Dysthymic disorder- chronic depression that is insufficient in severity to justify diagnosis of major depression Bipolar disorder- characterized by the experience of one or more manic episodes usually accompanied by periods of depression. Cyclothymic disorder-chronic but relatively mild symptoms of bipolar disturbance Genetic vulnerability- predispositions Neurochemical factors- norepinephrine and serotonin synapses Cognitive factors- negative thinking, learned helplessness Interpersonal roots- poor social skills, frequent rejection Precipitating stress Clinical Syndromes: Schizophrenia General symptoms Delusions and irrational thought Deterioration of adaptive behavior Hallucinations Disturbed emotions Prognostic factors A more favorable prognosis exists when the onset of the disorder is sudden and at a later age, the individual’s social and work adjustment was good prior to onset, the proportion of negative symptoms is low, and the patient has a good social support system. Subtyping of Schizophrenia 4 subtypes Paranoid type- delusions of persecution, grandeur Catatonic type- striking motor disturbances, muscular rigidity to random motor activity. Disorganized type- severe deterioration of adaptive behavior, incoherence, complete social withdrawal, delusions centering on bodily functions. Undifferentiated type- cannot be placed in any of the above subtypes Critics want new model for classification Positive symptoms: behavioral excesses or peculiarities such as hallucinations, and delusions Negative symptoms: behavioral deficits, such as flattened emotions, social withdrawal and apathy Etiology of Schizophrenia Genetic vulnerability Neurochemical factors Structural abnormalities of the brain The neurodevelopmental hypothesis Expressed emotion Precipitating stress Figure 14.18 The dopamine hypothesis as an explanation for schizophrenia Figure 14.20 The neurodevelopmental hypothesis of schizophrenia Personality Disorders Anxious-fearful cluster Dramatic-impulsive cluster Histrionic, narcissistic, borderline, antisocial Odd-eccentric cluster Avoidant, dependent, obsessive-compulsive Schizoid, schizotypal, paranoid Etiology Genetic predispositions, inadequate socialization in dysfunctional families Table 14.2 Personality Disorders Psychological Disorders and the Law Insanity- Insanity is not a diagnosis, it is a legal concept. Insanity is a legal status indicating that a person cannot be held responsible for his or her actions because of mental illness. M’naghten rule- holds that insanity exists when a mental disorder makes a person unable to distinguish right from wrong. Involuntary commitment danger to self danger to others in need of treatment Figure 14.22 The insanity defense: public perceptions and actual realities