* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Psychological Disorders
Obsessive–compulsive disorder wikipedia , lookup
Reactive attachment disorder wikipedia , lookup
Postpartum depression wikipedia , lookup
Obsessive–compulsive personality disorder wikipedia , lookup
Schizophrenia wikipedia , lookup
Sluggish schizophrenia wikipedia , lookup
Rumination syndrome wikipedia , lookup
Schizoid personality disorder wikipedia , lookup
Factitious disorder imposed on another wikipedia , lookup
Autism spectrum wikipedia , lookup
Emergency psychiatry wikipedia , lookup
Anxiety disorder wikipedia , lookup
Excoriation disorder wikipedia , lookup
Personality disorder wikipedia , lookup
Bipolar II disorder wikipedia , lookup
Major depressive disorder wikipedia , lookup
Bipolar disorder wikipedia , lookup
Mental status examination wikipedia , lookup
Panic disorder wikipedia , lookup
Glossary of psychiatry wikipedia , lookup
Depersonalization disorder wikipedia , lookup
Controversy surrounding psychiatry wikipedia , lookup
Pyotr Gannushkin wikipedia , lookup
Separation anxiety disorder wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Asperger syndrome wikipedia , lookup
Conversion disorder wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Conduct disorder wikipedia , lookup
Mental disorder wikipedia , lookup
Spectrum disorder wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Child psychopathology wikipedia , lookup
History of psychiatry wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Depression in childhood and adolescence wikipedia , lookup
Classification of mental disorders wikipedia , lookup
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