Download Chapter 11 Psychological Disorders and Their Treatment

Chapter 11
Psychological Disorders
and Their Treatment
Prevalence of Psychological Disorders

In a year in the U.S.:




20% of persons experience psychological
problems severe enough to adversely affect their
daily living.
40% of persons experience at least mild mental
health problems.
About 2.1 million people are admitted to
hospitals due to serious psychological problems.
Worldwide:

About 400 million people are afflicted with
psychological disorders.
How Should We Understand Psychological
Disorders?

The medical model proposes that
psychological disorders have a biological basis
and can be classified into discrete categories
and are analogous to physical diseases.
How Should We Understand Psychological
Disorders?

Although not agreeing that all mental health
problems have a biological basis, mainstream
psychology has adopted the medical model’s
terminology.


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Symptom: a sign of a disorder
Diagnosis: distinguishing one disorder from another
Etiology: a disorder’s apparent causes and
developmental history
Prognosis: prediction about the likely course of a
disorder
Defining Psychological Disorders

A pattern of atypical behavior

Results in personal distress or

Significant impairment in a person’s social or
occupational functioning
Defining Psychological Disorders

Major criteria used to differentiate normal from
disordered behavior:



Atypical
 Significantly above or below the average in its
frequency of occurrence
 Violates cultural norms
Maladaptive
 Interferes with ability to perform normal activities
Causes personal distress
 Individuals who report experiencing troubling
emotions are often considered to have psychological
problems.
Numerous Theoretical Explanations

Five primary perspectives to understand mental
illness:

Psychodynamic: Disordered behavior is controlled by
unconscious forces shaped by childhood experiences.

Behavioral: Disordered behavior is caused by identifiable
factors in the person’s environment and results from
learning.

Cognitive: ineffective or inaccurate thinking is the root
cause of mental illness
Numerous Theoretical Explanations

Five primary perspectives to understand mental
illness:

Sociocultural: Mental illness is the product of broad
social and cultural forces .

Biological: Disordered behavior is caused by biological
conditions, such as genetics, hormone levels, or
neurotransmitter activity in the brain.
Combined Models


Diathesis-stress model: a predisposition to
a given disorder (diathesis) that combines
with environmental stressors to trigger a
psychological disorder
Bio-psycho-social model. Takes into
account predispositions, personal
experience, and life circumstances.
The Diathesis-Stress Model
Psychological Disorders
Biological
(Evolution,
individual
genes, brain
structures
and chemistry)
Sociocultural
(Roles, expectations,
definition of normality
and disorder)
Psychological
(Stress, trauma,
learned helplessness,
mood-related perceptions
and memories)

Bio-psycho-social
Perspective

assumes that
biological,
sociocultural, and
psychological
factors combine
and interact to
produce
psychological
disorders
Models from Outside Psychology

Spirit Possession



Curses



Trephining
Lunacy
Family/generational
Occult (voodoo, witchcraft)
Sin


Guilt
Unforgiveness, bitterness
Risks of Using Diagnostic Labels

David Rosenhan demonstrated diagnostic labels’
biasing effects.


Misdiagnosis of insanity by hospital personnel due to their
bias toward calling a healthy person sick
Diagnostic labels can harm patients in several
ways.


Label may “dehumanize” patients by encouraging mental
health practitioners to treat them as labels rather than as
unique individuals with problems.
Labeled individuals may experience discrimination and may
cause people to expect those labeled to behave abnormally
and thus to misperceive normal behavior as disordered.
Benefits of Using Diagnostic Labels

Despite ethical concerns, diagnostic labels are used
because they serve several important functions:

Summarize patient’s symptoms or problems, and thus,
communicate great deal of information with a single word

Convey information about possible causes of the disorder

Convey information about the patient’s prognosis
DSM Classification System



Diagnostic and Statistical Manual of Mental
Disorders (DSM) use to diagnose mental disorders
Published by the American Psychiatric Association.
Since 1980, DSM has been updated several
times and is now in its fourth edition, text
revision, or DSM-IV-TR.
DSM Classification System

DSM classification system is descriptive rather than
explanatory, meaning that:



it is not based on a particular theory concerning the
cause(s) of psychological disorders.
diagnoses are based mainly on observable symptoms.
DSM provides clearer directions concerning
number, duration, and severity of symptoms
necessary to assign a diagnosis.

By recognizing that two patients with same disorder may
substantially differ from one another, clinicians much more
likely to acknowledge uniqueness of all patients.
Anxiety Disorders: Distressing,
Persistent Anxiety, Maladaptive Behavior



Characterized by distressing, persistent anxiety or
maladaptive behavior
About 25 percent of the population will experience
this disorder in our lifetime.
Anxiety disorders occur across the life span and
commonly co-occur with many other disorders,
such as depression and substance abuse.
Anxiety Disorders: Distressing,
Persistent Anxiety, Maladaptive Behavior

Five major anxiety disorders:



Panic disorder: brief episodes of intense anxiety with no
apparent reason
Phobic disorder: strong irrational fears of specific objects
or situations, called phobias
Generalized anxiety disorder (GAD): a constant state of
moderate anxiety
Anxiety Disorders: Distressing,
Persistent Anxiety, Maladaptive Behavior

Five major anxiety disorders:


Obsessive-compulsive disorder: repetitive, unwanted,
and distressing actions and/or thoughts
Post-traumatic stress disorder: occurs among individuals
who have experienced or witnessed traumatic events
 Later reexperience the event through nightmares,
flashbacks, and avoid situations or persons that
trigger flashbacks
Anxiety Disorders
Common Obsessions and Compulsions Among
People With Obsessive-Compulsive Disorder
Thought or Behavior
Percentage*
Reporting Symptom
Obsessions (repetitive thoughts)
Concern with dirt, germs, or toxins
40
Something terrible happening (fire, death, illness)
24
Symmetry order, or exactness
17
Compulsions (repetitive behaviors)
Excessive hand washing, bathing, tooth brushing,
or grooming
85
Repeating rituals (in/out of a door,
up/down from a chair)
Checking doors, locks, appliances,
car brake, homework
51
46
Anxiety Disorders


PET Scan of brain of
person with obsessive/
compulsive disorder
High metabolic activity
(red) in frontal lobe
areas involved with
directing attention
Etiology of Anxiety Disorders

Genetic and biological factors:


Behavioral or conditioning factors:


Genetic heritage may predispose us to more easily develop
phobic reactions or to respond intensely to stressful events.
Classical conditioning may instill conditioned emotional
responses, and operant conditioning may reinforce and
maintain the person’s avoidance responses.
Cognitive factors:

People suffering from panic disorder closely monitor their
physiological reactions, and often exaggerate the significance
of their physiological symptoms.
Mood Disorders: Emotional Extremes

Characterized by emotional extremes that cause
significant disruption in daily functioning.


To qualify as a mood disorder, emotional extremes must
persist for a long time.
Most common mood disorder is depression

Characterized by extreme and persistent negative moods
and the inability to experience pleasure by participating in
activities one previously enjoyed (Kramlinger, 2001)
Mood Disorders: Emotional Extremes

Depressed individuals:



Often experience physiological problems such as
lack of appetite, weight loss, fatigue, and sleep
disorders
Often experience behavioral symptoms, such as
slowed thinking and acting, social withdrawal, and
decreased activity
Exhibit cognitive symptoms, such as low selfesteem, thinking about death and/or suicide, and
having little hope for the future
Mood DisordersDepression

1
Stressful
experiences
4
Cognitive and
2
Negative
behavioral changes
explanatory style
3
Depressed
mood
The vicious
cycle of
depression
can be
broken at
any point
Mood DisordersDepression
25
Percentage
of population
aged 18-84
experiencing
major
depression
at some
point In life
Around the world
women are more
susceptible to
depression
20
20
15
15
10
10
5
5
0
0
USA Edmonton Puerto
Rico
Males
Females
Paris
West
Florence Beirut
Germany
Taiwan
Korea
New
Zealand
Mood Disorders: Emotional Extremes

Bipolar disorder: characterized by swings
between the emotional extremes of mania
and depression


Less common than major depressive disorder,
occurring in about 1 percent of the population
Unlike major depression, this disorder occurs
about equally in men and women and tends to
occur earlier than major depression
Mood Disorders: Emotional Extremes


Bipolar disorder
Bipolar patients’ depressive episodes differ
from the depressive episodes in major
depression in that they tend to be more
severe, are accompanied by higher suicide
risks, and have a distinct pattern of brain
activity during sleep.
Mood Disorders-Bipolar

PET scans show that brain energy consumption
rises and falls with emotional swings
Depressed state
Manic state
Depressed state
Suicide

A major danger of depression is suicide.
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As many as 30% of people with severe mood disorders
die from suicide.
In the U.S. suicide rates are higher among:


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Men than women;
Elderly adults than younger adults;
Unemployed (& retired) adults than employed persons;
Widowed adults than married adults;
Native & European Americans than Asian. Hispanic, and
African Americans.
Etiology of mood disorders

Genetic/ biological influence?


Bipolar patients show imbalances in neural circuits using
serotonin, norepinephrine, etc.? Enlarged amygdala?
Major depressive disorder: Family, twin, and adoption studies
indicate at least a moderate genetic influence on depression.

Cognitive contributions:


Depressed persons have negative views and they
misinterpret daily experiences so that their negative
outlook is supported.
Behavioral psychologists propose that depression
results from low social reinforcement.
Gender & Mood Disorders

Why is depression more common among women?


May due to biological factors.
Sociocultural factors: Women have fewer educational and
occupational opportunities, receive less money for their work, and
experience more violence due to their gender than men.

Difference in diagnosis?


Women may be diagnosed more frequently because they are
more likely to seek help for their problems.
Gender bias among mental health professionals may result in
women and men with identical symptoms being diagnosed
differently, i.e., women labeled as depressed and men diagnosed
with other conditions
Dissociative Disorders: Loss of Contact
with Consciousness or Memory



Characterized by disruptions in consciousness,
memory, sense of identity, or perception
Dissociative amnesia: a sudden loss of memory
of one’s identity and other personal information
Dissociative fugue: a sudden departure from
home or work, combined with loss of memory of
identity and the assumption of a new identity
Dissociative Disorders: Loss of Contact
with Consciousness or Memory

Dissociative identity disorder (DID): characterized
by the presence of two or more distinct identities
or personalities, which take turns controlling the
person’s behavior (also known as multiple
personality disorder)
Etiology of Dissociative Disorders



Psychodynamic theory: results from the
individual’s attempt to repress some troubling
event
Biological explanation: patient may have a
neurological problem that has not yet been
detected
Cognitive perspective: individuals learn to
dissociate as a way to cope with intense distress
Schizophrenia: Disturbances in Almost All
Areas of Psychological Functioning



Characterized by severe impairment in thinking,
including hallucinations, delusions, or loose
associations
Diagnosed when symptoms persist for at least six
months, are not due to some other condition, and
cause significant impairment in daily functioning
Schizophrenics often cannot work, manage a home
or apartment successfully, or care for their basic
needs.
Schizophrenia

Delusions

false beliefs, often of persecution or
grandeur, that may accompany
psychotic disorders
Hallucinations


false sensory experiences such as seeing
something without any external visual
stimulus
Risk of Developing Schizophrenia
Personality Disorders: Inflexible Behavior
Patterns That Impair Social Functioning


Personality disorders: general styles of living that
are ineffective and lead to problems for the person
and for others
Ten personality disorders in the DSM-IV-TR.
Personality Disorders: Inflexible Behavior
Patterns That Impair Social Functioning

Three common personality disorders are:
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Paranoid personalities: habitually distrustful and
suspicious of others’ motives
Histrionic personalities: excessively emotional and
attention seeking, often turning minor incidents into fullblown dramas
Narcissistic personalities: desire constant admiration
from others
Personality Disorders: Inflexible Behavior
Patterns That Impair Social Functioning

The personality disorder that receives the most
attention is the antisocial personality disorder.

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Exhibit a persistent pattern of disregard for and violation of the
rights of others
Repeatedly exhibit antisocial behavior across all realms of life, lying,
cheating, stealing, and manipulating others
When caught, they take no responsibility and feel no remorse.
Personality Disorders
Adrenaline 15
excretion(ng/min)
Those with criminal
convictions have lower
levels of arousal
10
5
0
Nonstressful
situation
Stressful
situation
No criminal conviction
Criminal conviction
Personality Disorders
PET scans illustrate reduced activation in a
murderer’s frontal cortex
Normal
Murderer
Etiology of Personality Disorders



A genetic component: related to abnormal brain
development or chronic underarousal of both the
autonomic and central nervous systems
May be caused by the interaction of both biological and
environmental factors.
Children in chaotic households who have a biological
predisposition for this disorder may not learn to control
their impulses, and so behave in ways to maximize
their benefit even if this means violating social rules.
What Are the Therapies for Psychological
Disorders?

The two broad categories of therapy:


Psychotherapy: psychological methods that include a
personal relationship between a trained therapist and a
client
Biomedical therapies: the treatment of psychological
disorders by altering brain functioning with physical or
chemical interventions
What Are the Therapies for Psychological
Disorders?

The two broad categories of therapy:


Psychotherapy: psychological methods
including a personal relationship between a
trained therapist and a client
Biomedical therapies: altering brain functioning
with physical or chemical interventions
What Are the Therapies for Psychological
Disorders?

Three mental health professions:




Psychiatry
Social work
Psychology
Two specialty areas in psychology:


Clinical psychology
Counseling psychology
Psychodynamic Therapies


A group of psychotherapies based on the work of Sigmund
Freud that say that psychological disorders stem from
unconscious forces
Important psychodynamic terms:



Free association: therapy technique in which clients say
whatever comes to mind
Resistance: anything client does to interfere with free
chain of thought or therapeutic progress
Transference: client transfers feelings for significant
others early in life to therapist (countertransference)
Behavior Therapies



Psychotherapies that apply learning principles to
the elimination of unwanted behaviors.
Counterconditioning is based on classical
conditioning.
Counterconditioning: involves conditioning new
responses to stimuli that trigger unwanted behaviors
Counterconditioning: Three Techniques

Systematic desensitization:


Response prevention:


used to treat phobias in which client is gradually
exposed to feared object, while remaining relaxed
used to treat obsessive-compulsive disorder; client is
exposed to situation that triggers the compulsive
behavior but is not permitted to engage in the ritual
Aversive conditioning:

a classically conditioned aversive response is
conditioned to occur in response to a stimulus that has
previously been associated with an undesired behavior
Aversive Conditioning for Alcoholism
Aversive Conditioning for Alcoholism
Aversive Conditioning for Alcoholism
Humanistic Therapies Focus on Feelings
and Personal Growth

Goal: To help people get in touch with



their feelings,
their “true selves”
their purpose in life
Humanistic Therapies Focus on Feelings
and Personal Growth

Humanistic therapies: help people get in
touch with their feelings, with their “true
selves,” and with their purpose in life

Client-centered therapy: Carl Rogers


Therapists should be facilitators of personal growth
providing supportive environment—clients discover
their “true selves.”
Gestalt therapy: Fritz Perls

Therapists help people become aware of their true
feelings or some other important aspect of the self.
Cognitive Therapies: Focus on Altering
Dysfunctional Thought Patterns


Cognitive therapies seek to identify and then modify faulty cognitive
processes.
Rational-emotive behavior therapy (REBT):
Albert Ellis


Mental distress is caused by the irrational thinking
people have about those events.
Cognitive-behavior therapy (CBT): Aaron Beck

Depressed people have negative views of
themselves, the world, and their future, and they
misinterpret everyday events to support these
negative views.
Cognitive Therapy

Cognitive Therapy
teaches people new, more adaptive
ways of thinking and acting
 based on the assumption that
thoughts intervene between events
and our emotional reactions

Cognitive Therapy

The
Cognitive
Revolution
Cognitive Therapy

Cognitive-Behavior Therapy

a popular integrated therapy that
combines cognitive therapy (changing
self-defeating thinking) with behavior
therapy (changing behavior)
Cognitive Therapy
Lost job

Internal beliefs:
I’m worthless.
It’s hopeless.
Depression
A cognitive
perspective on
psychological
disorders
Lost job
Internal beliefs:
My boss is a jerk.
I deserve something better.
No
depression
Child, Group & Family Therapy

Child therapies
 Common approach used—play therapy
Therapist provides children with toys and drawing
materials
 Assumption is that whatever is troubling them will be
expressed in play

Child, Group & Family Therapy

Group therapies


Simultaneous treatment of several clients under the
guidance of a therapist
Variation of group therapy is the self-help group:

Several people regularly meeting and discussing their problems
with one another without the guidance of a therapist
Child, Group & Family Therapy

Family and couples therapies


Family therapies—designed to constructively modify the
dysfunctional relationships among family members
Couples therapy—designed to help couples improve the
quality of their relationship
Who Does Therapy?

Where do
people turn
for help?
Who Does Therapy?
Therapists and Their Training
Type
Clinical
Clinical or
psychiatric
Social worker
Description
Ph.D. In psy6chology or Psy.D.
A two-year Master of Social Work plus postgraduate supervision
About half have earned the National Association of Social Workers’
designation of clinical social worker.
Counselors
LPC,
Marriage & Family (MFT)
Pastoral
Abuse
Psychiatrist
Physicians (M.D.) who specialize in the treatment of psychological
disorders.
Not all psychiatrists have had extensive training in psychotherapy
Can prescribe medications.
Evaluating Therapy

Client Perceptions





Consumer Reports Study
Clinician’s Perceptions
Outcome Research
Spontaneous Remission
Regression toward the mean
Does Therapy Work?

Meta-analysis

procedure for statistically combining the
results of many different research studies
Number of
persons
Average
untreated
person
Poor outcome
80% of untreated people have poorer
outcomes than average treated person
Average
psychotherapy
client
Good outcome
Alternative Therapies


Disconnect between Research and
Therapy
Alternative Therapies



Therapeutic touch
Eye movement desensitization
Light exposure therapy
Commonalities among Therapies

A new perspective

Trusting, caring relationship

Culture and values (therapist-client match)
Biomedical Therapies

Psychopharmacology


study of the effects of drugs on mind and
behavior
Lithium

chemical that provides an effective drug
therapy for the mood swings of bipolar
(manic-depressive) disorders
Biomedical Therapies

The emptying of U.S. mental hospitals
State and county
mental hospital 700
residents, in 600
thousands
500
Introduction of antipsychotic drugs
Rapid decline
in the mental
hospital
population
400
300
200
100
0
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990
Year
Biomedical Therapies

Today in the United States, less than
one-third the number of people are fulltime residents in psychiatric hospitals.

Reason for this sharp decrease—the
widespread use of drug therapies in
treating psychological disorders

This form of therapy is often less expensive
than psychological therapies.
Use of Drugs in Treating Psychological
Disorders
Biomedical Therapies
Message is sent
across synaptic gap.
Message is received;
excess neurotransmitter
molecules are reabsorbed
by sending neuron.
Sending
neuron
Vesicles
containing
neurotransmitters
Prozac blocks normal
reuptake of the neurotransmitter serotonin;
excess serotonin in
dynapse enhances its
mood-lifting effect.
Action
potential
Synaptic
gap
Neurotransmitter
molecule
Receptors
Receiving
neuron
Reuptake
Serotonin
Prozac
Antipsychotic Drugs Reduce Dopamine Activity

Antipsychotic drugs:


a group of medications that are effective in
treating the delusions, hallucinations, and loose
associations of schizophrenia by blocking
dopamine receptors & thereby reducing
dopamine activity
Do not actually “cure” schizophrenia. They
merely help control its severe symptoms.
Classes of Psychoactive Drugs

Antipsychotics






Thorazine
Clozapine
Olanzapine, etc.
Block dopamine receptor sites
Treat Schizophrenia & other psychoses
May cause sluggishness & muscle tremors
Classes of Psychoactive Drugs

Antianxiety


Valium, Librium, Xanax, etc.
Tend to be addictive
Classes of Psychoactive Drugs

Antidepressants



Increase availability of epinephrine or
serotonin
Prozac, Zoloft, Paxil, etc. world’s most widely
prescribed drugs
Require about a month for full effectiveness
Antidepressant Drugs: Increase Serotonin
and Norepinephrine



MAO inhibitors (MAOI) inhibit the enzyme involved
in breaking down norepinephrine and serotonin are
called the monoamine oxidase inhibitors (MAOI).
Tricyclics are antidepressant drugs that have milder
side effects than MAOI inhibitors
Antidepressants that affect only serotonin are
selective serotonin reuptake inhibitors (SSRIs).
Biomedical Therapies

Electroconvulsive Therapy (ECT)


therapy for severely depressed patients
in which a 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
Electroconvulsive Therapy (ECT)



A physiological treatment for severe depression in
which a brief electric shock is administered to the
brain of an anesthetized patient
Although ECT is effective in treating severe
depression, no one knows for sure why it works.
Several temporary negative side effects, including
confusion, loss of memory, and impaired motor
coordination
Electroconvulsive Therapy
Psychosurgery: Destroys Portions of the
Brain



Most radical & controversial treatment
A seldom-used surgical procedure in which
brain tissue thought to cause the disorder is
destroyed.
Today, MRI-guided precision psychosurgery
is performed only in extreme cases and it
focuses on much smaller brain areas than
those involved in lobotomies.
Lobotomy


now-rare psychosurgical procedure once
used to calm uncontrollably emotional
or violent patients
cut the nerves that connect the frontal
lobes to the emotion-controlling centers
of the brain