Download Psychological Disorders

Psychological
Disorders
Chapter 14
Identifying Psychological Disorders:
What Is Abnormal?
• Medical model: the conceptualization of
psychological disorders as diseases that, like physical
diseases, have biological causes, defined symptoms,
and possible cures
– Diagnosis of symptoms underlying a syndrome
• DSM provides a reliable way of classifying
(operationalizing) mental disorders: psychiatrists and
psychologists all want to able to arrive at the same
diagnosis. (Its validity is another issue).
Problems with DSM
• Strong medical orientation; only half of 290+
diagnoses have a concrete medical component.
– Can be misleading: causing overprescription of
drugs and “victimization” of “I have depression.”
• Reification & naming something is not the same as
explaining it.
• Labeling can be damaging: stigmatization, Rosenhan
study: “On Being Sane in Insane Places.”
Physiognomy and Phrenology
Classification of Disorders
• Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV-TR; 4th ed., text revision): a classification
system that describes the features used to diagnose
each recognized mental disorder and indicates how the
disorder can be distinguished from other similar
problems
– Involves disturbances in behavior, thoughts, or emotions
– Causes significant distress or impairment.
– Stem from internal dysfunction (biological and/or
psychological).
– Global Assessment of Functioning (GAF score)
– Comorbidity: the co-occurrence of two or more disorders
in a single individual
Table 14.1
Main
DSM-IV-TR
Categories of
Mental
Disorders
Table 14.2
Global
Assessment
of
Functioning
(GAF) Scale
Figure 14.1
Comorbidity of Depression and Anxiety
Disorders
Causation of Disorders and the
Dangers of Labeling
• An integrated perspective incorporates biological,
psychological, and environmental factors.
• Different individuals may experience a similar psychological
disorder for different reasons.
• Diathesis-stress model: suggests that a person may be
predisposed for a mental disorder that remains unexpressed
until triggered by stress
• The intervention-causation fallacy assumes treatment
addresses the cause of the disorder.
– The brain is likely not the only cause.
• Stigmas are likely attached to labeling people with
psychological disorders.
–
–
–
–
Roughly 70% of sufferers do not seek treatment.
Education does not dispel the stigma.
May result in unnecessary incarceration
May lead to low self-esteem
The Diathesis Stress Model
Culture and Community
• Can people in different parts of the world
have different mental disorders?
• The DSM-IV-TR includes a description of
culture-bound syndromes that appear only in
some cultures.
– Ataque de nervios, ghost sickness, koro, mal de
ojo
Anxiety Disorders
Fears &
Phobias
Panic
Disorder
Generalized
Anxiety
Disorder
Obsessive
Compulsive
Disorder
Anxiety Disorders and GAD
• Anxiety disorder: the class of mental disorder in which
anxiety is the predominant feature
– Anxiety can be adaptive or maladaptive, when it is
disproportionate to real threats and challenges.
• Generalized anxiety disorder (GAD): a disorder
characterized by chronic excessive worry accompanied
by three or more of the following symptoms:
restlessness, fatigue, concentration problems,
irritability, muscle tension, and sleep disturbance
– Roughly 5% of North Americans suffer
– Occurs more in lower SES groups
Phobic Disorders
• Phobic disorders: disorders characterized by marked,
persistent, and excessive fear and avoidance of specific
objects, activities, or situations
– Specific phobia: a disorder that involves an irrational fear of a
particular object or situation that markedly interferes with an
individual’s ability to function
– Social phobia: a disorder that involves an irrational fear of being
publicly humiliated or embarrassed
• Preparedness theory: the idea that people are instinctively
predisposed toward certain fears; proposed by Martin
Seligman (1942- )
– Evolution, heritability, and temperament argue for biological
predispositions.
• Phobias can also be classically conditioned.
Phobias: Lifetime Prevalence
No Acrophobia Here
Panic Disorder
• Panic disorder: a disorder
characterized by the sudden
occurrence of multiple psychological
and physiological symptoms that
contribute to a feeling of stark terror;
panic attacks
– Approximately 22% of the U.S. population
reports having at least one panic attack.
• Agoraphobia: an extreme fear of
venturing into public places; correlates
with panic disorder
Obsessive Compulsives
Obsessions
Reduce
Compulsions
Anxiety
Obsessive-Compulsive Disorder
• Obsessive-compulsive disorder (OCD): a
disorder in which repetitive, intrusive,
thoughts (obsessions) and ritualistic behaviors
(compulsions) designed to fend off those
thoughts interfere significantly with an
individual’s functioning
– Roughly 1.3% of the population suffers
– Moderate heritability
Mood Disorders and Depressive
Disorders
• Mood disorders: mental disorders that have mood disturbances
as their predominant feature
• Major depressive disorder: a disorder characterized by a
severely depressed mood that lasts 2 wks. or more and is
accompanied by feelings of worthlessness and lack of pleasure,
lethargy, and sleep and appetite disturbances
• Dysthymia: a disorder that involves the same symptoms as in
depression only less severe, but the symptoms last longer,
persisting for at least 2 yrs
• Double depression: a moderately depressed mood that persists
for at least 2 yrs. and is punctuated by periods of major
depression
• Seasonal affective disorder: depression that involves recurrent
depressive episodes in a seasonal pattern
• Women experience depression at twice the rate of men, as in
postpartum depression
Gender & Depression
(Data from Kessler, et al., 1994)
Prognosis (1 year)
(APA Data, 1994)
Questions
• What is the difference between depression
and sadness?
• Why do more women than men experience
depression?
Biological and Psychological Factors
• Heritability estimates for major depression range from
33% to 45%.
• Depression may involve norepinephrine and serotonin,
and/or diminished activity in the left prefrontal cortex
and increased activity in the right prefrontal cortex.
• Aaron Beck (1921- ) noted dysfunctional attitudes and
negative mood states in depressed individuals.
– Helplessness theory: the idea that individuals who are
prone to depression automatically attribute negative
experiences to causes that are internal, stable, and global
– Depressed individuals tend to have depressive biases in
thinking and memory.
Figure 14.2
Brain and Depression
Seasonal Affective Disorder
(After Wurtman & Wurtman,1989)
The Real World: Suicide Risk and
Prevention
• Suicide is the 11th leading cause of death in the U.S. (and third
among high school and college students).
– 50% of those who commit suicide do so during a depressive episode.
• There exist a variety of motives for suicide.
– May be biological and/or “contagious” (the Werther effect)
• Prediction and prevention is difficult, however warning signs are
abundant.
Suicide Attempts
Suicide Deaths
Suicide Methods
Suicide Methods
Bipolar Disorder
• Bipolar disorder: an unstable emotional
condition characterized by cycles of abnormal,
persistent high mood (mania) and low mood
(depression)
– Approximately 1.3% of people suffer
– Rapid cycling bipolar disorder
• Bipolar disorder has the highest heritability
(polygenic) among the psychological disorders.
• Biological causes (specific neurotransmitters) are
difficult to substantiate.
• Stressful life experiences often precede episodes.
Dissociative Disorders: Going to
Pieces
• Dissociative disorder: a condition in which normal cognitive
processes are severely disjointed and fragmented, creating
significant disruptions in memory, awareness, or personality
that can vary in length from a matter of minutes to many years
• Dissociative identity disorder (DID): the presence within an
individual of two or more distinct identities that at different
times take control of the individual’s behavior
– .5% - 1% of the population suffers; female to male prevalence 9:1
• Dissociative amnesia: the sudden loss of memory for
significant personal information
• Dissociative fugue: the sudden loss of memory for one’s
personal history, accompanied by an abrupt departure from
home and the assumption of a new identity
– Dissociative amnesia and fugue usually occur later in life and
memory loss may be temporary.
Schizophrenia: Losing the Grasp on
Reality
• Schizophrenia: a disorder characterized by the profound disruption of
basic psychological processes, a distorted perception of reality, altered or
blunted emotion, and disturbances in though, motivation, and behavior
– Occurs in about 1% of the population
– Delusion: a patently false belief system, often bizarre and grandiose, that is
maintained in spite of its irrationality.
– Hallucination: a false perceptual experience that has a compelling sense of
being real despite the absence of external stimulation
– Disorganized speech: a severe disruption of verbal communication in which
ideas shift rapidly and incoherently from one to another unrelated topic
– Grossly disorganized behavior: behavior that is inappropriate for the situation
or ineffective in attaining goals, often with specific motor disturbances
• Catatonic behavior: a marked decrease in all movement or an increase in muscular
rigidity and overactivity
– Negative symptoms: emotional and social withdrawal, apathy, poverty of
speech, and other indications of the absence or insufficiency of normal
behavior, motivation, and emotion
• Subtypes include: paranoid, catatonic, disorganized, undifferentiated, and
residual
Catatonic Schizophrenia
Table 14.3
Types of
Schizophrenia
Onset Timing
10
20
30
AGE
40
Period of greatest susceptibility
50
Biological and Psychological Factors
• Concordance rates increase greatly with biological
relatedness.
• Prenatal and perinatal environments may also have
effects.
• Dopamine hypothesis: the idea that schizophrenia
involves an excess of dopamine activity
– Effects and treatments related to neurotransmitters have
yet to be completely determined.
• Neuroimaging has revealed enlarged ventricles and
progressive tissue loss in many cases of schizophrenia.
• Disturbed family environment may affect development
and recovery of schizophrenia.
Incidence
Schizophrenic (1%)
Strikes 1/100
Figure 14.3
Average Risk of Developing Schizophrenia
Figure 14.4
Enlarged Ventricles in Schizophrenia
Hot Science: Autism and Childhood
Disorders
• Early onset disorders are recognized in the DSM, and
some resolve into adulthood while others do not.
• Autistic disorder involves abnormal or impaired
development of communication and social interaction,
and a markedly restricted repertoire of
activities/interest.
– Recent increased prevalence
• Variations of the disorder lie along a spectrum,
including Asperger’s syndrome.
• Individuals with the disorder may display unique, gifted
talents.
– Temple Grandin as an example
Personality Disorders: Going to
Extremes
• Personality disorder: disorder characterized by deeply
ingrained, inflexible patterns of thinking, feeling, or
relating to others or controlling impulses that cause
distress or impaired functioning
– Organized into three clusters: odd/eccentric,
dramatic/erratic, and anxious/inhibited
– 14.8% of the population has a personality disorder.
– Common feature is failure to take others’ perspectives
• Diagnosis is controversial and complicated.
• Peer nomination measures may be more valid
assessments.
Table 14.4
Clusters of
Personality
Disorders
Antisocial Personality Disorder
• Antisocial personality disorder(APD): a pervasive
pattern of disregard for and violation of the rights of
others that begins in childhood or early adolescence
and continues into adulthood
– 3.6% of the population suffers; males outnumber females
3:1
– Individuals typically have a history of conduct disorder and
many commit crimes.
• Sociopathology and psychopathology describe people
with APD.
• Newer theories suggest internal (biological) causes.
– Less sensitive to fear in the brain.
Antisocial Personality
Disorder
Marked by a lack of empathy, chronic
underarousal, willingness to lie, cheat, steal, and
break the law
Where Do You Stand: Genetic Tests
for Risk of Psychological Disorders
• In the future, diagnosis of potential
psychological disorders may be as simple as
providing a saliva sample.
• A genetic diagnosis may provide a nice
explanation for a yet unlabelled problem.
• Would you want to know about a
predisposition even if it never manifests? This
could present added stress or a self-fulfilling
prophecy.
Thomas Szasz:
The Myth of Mental Illness
• The concept of "mental illness" is a
myth; i.e., these do not exist in
reality, but only as a type of
explanation for abnormal behavior
• ."Abnormal" behavior is a
normative judgment: the only
consistent definition of
abnormality is one that refers to
the average members of a
community as a frame of
reference.
The Myth of Mental Illness
• People behave abnormally because either they CANNOT abide
by cultural norms, or they CHOOSE not to abide by these
norms.
• .The concept of mental illness is incorrect for two reasons:
• ."problems in living" do not have a medical cause, hence are
not illnesses, even though such problems may result in
physiological changes (eg., stress).
• .reification of mind; mind/body dualism is a false dichotomy: a
disease of the brain may have psychological effects, but that
does not mean the mind is some separate thing that has
diseases.
The Myth of Mental Illness
• Szasz also asks "Whose agent is the psychiatrist?"--on whose behalf is the therapist acting? The
client/patient, the community, the medical
profession, the government?
• .Szasz argues that psychiatry and psychology should
be concerned with problems in living NOT ‘illness’ per
se.
• .The concept of mental illness is harmful and
unethical, in so far as it is used as a rationale for
medical treatments and institutionalization