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Psychological Disorders • • • • • U – njustifiable M – aladaptive A – typical D – istorted thinking, D-isturbed •Qualitatively •Quantitatively Etiology • • • • • • Psychoanalytic theory Humanistic theory Behavioral theory Cognitive theory Psychophysiological Cultural Classifying Psychological Disorders • DSM V – Classification orders and describes symptoms – Predicts its future course – Treatment – Stimulate research • “Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth. • “And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.” • NY Times Revising Book on Disorders of the Mind • Benedict Carey Feb 10, 2010 Anxiety Disorders - Most common disorder after substance abuse What differentiates phobias and normal fear? - Intensity - Length of anxiety - Able to adequately respond Anxiety Disorders • Generalized anxiety disorder – continuously tense • Phobic disorder – irrational and intense fear of object • Obsessive compulsive disorder – repetitive thoughts or actions • Panic disorder – anxiety tornado – “fear of fear”, sudden episodes • Post traumatic stress disorder – after trauma • Panic Disorder: • Minute-long episodes of intense dread which may include feelings of terror, chest pains, choking, or other frightening sensations. • Anxiety is a component of both disorders (generalized anxiety disorder and panic disorder). It occurs more in the panic disorder, making people avoid situations that cause it. • Post-traumatic stress disorder (PTSD) – Affects soldiers from Vietnam, Operation Desert Storm, and Iraqi wars; also Nazi death camp and prison camp survivors) – Suffering severe reactions years after traumatic event (some recover, some get worse over time) – Experiences include: • Dreams with horror • Intense emotional bodily reactions • Difficulty concentrating or sleeping Stressors Causing PTSD • Combat-related events • Sudden death of loved one • Involved in or witnessing accidents • Physical assault, rape, sexual molestation experienced by women • Terrorism experiences Who Develops PTSD • Four factors involved • – Severity of stress • Risk increased when physical injury occurs – Person’s characteristics before event • Affects those with higher anxiety levels, lower intelligence, previous mental health problems – Social support • More support lessens risk – Sex of the victim • Women more at risk Etiology of Anxiety Disorders • Psychoanalytic – – GAD – id overcomes ego => anxiety – Phobias – Little Hans – OCD – fixated an anal stage • Behavioral – classical conditioning, modeling, reinforcement – Little Albert • Humanistic – gap between one’s real self and ideal self • Cognitive – misinterpret bodily sensations, lack ability to cope with stress • Biomedical – genetic predisposition, - Lower levels of GABA neurotransmitter – inhibitory “brakes of a car” - Malfunctions in amygdala – part of brain that deals with agression and fear Kinds of Phobias - Intense, unrealistic or irrational fear Agoraphobia Acrophobia Claustrophobia Hemophobia Phobia of open places. Phobia of heights. Phobia of closed spaces. Phobia of blood. Phobias • Agoraphobia – fear of panic attacks in public places • Social phobias – social anxiety disorders – More women than men – Irrational fear of being embarrassed, judged or critically evaluated by others – Realize that their fear is excessive but they still approach social situations with tremendous anxiety Phobias • More unusual phobias: – – – – – – – – – – – – Amathophobia- fear of dust Amenophobia – fear of wind Aphephobia – fear of being touched by another person Bibliophobia- fear of books Catotrophobia – fear of breaking a mirror Ergophobia – fear of work or responsibility Gamophobia – fear of marriage Hypertrichophobia – fear of growing excessive amounts of body hair Levophobia – fear of things being on the left side of your body Phobophobia – fear of acquiring a phobia Phonophobia – fear of sound of your own fource Triskaidekaphobia – fear of the number 13 Phobias – Humans are predisposed – biologically prepared to acquire certain fears • Fear of particular situations – flying, driving, tunnels, bridges, elevators, crowds, enclosed places • Fear of features of the natural environment – thunder, heights, water • Fear of injury or blood – injections, needles, medical or dental procedures • Fear of animals and insects – snakes, spiders, dogs, slugs, bats • Agoraphobia – fear of panic attacks in public places • Social phobias – social anxiety disorders – More women than men – Irrational fear of being embarrassed, judged or critically evaluated by others – Realize that their fear is excessive but they still approach social situations with tremendous anxiety Somatoform Disorders – Experiencing symptoms of physical health problems with psychological causes, Symptoms take a somatic (bodily) form without apparent physical cause • Four types – Hypochondriasis – preoccupation with health – Conversion disorders – symptoms not medically possible • person experiences very specific genuine physical symptoms for which no physiological basis can be found – Somatoform pain disorders – primary symptom is pain with no physical cause – Body dysmorphic disorder - exaggerated concern and preoccupation about minor or imagined defects in appearance Somatoform Disorders – Symptoms take a somatic (bodily) form without apparent physical cause Conversion disorder: person experiences very specific genuine physical symptoms for which no physiological basis can be found Hypocondriasis: person interprets normal physical sensations as symptoms of a disease Body dysmorphic disorder: exaggerated concern and preoccupation about minor or imagined defects in appearance Disassociative Disorders • Broad category of loosely related conditions – Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. People lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity – Dissociative amnesia – psychological cause – Dissociative fugue – complete loss of memory – Dissociative identity disorder – once known as multiple personality disorder; very controversial issue Criticism of DID • Critics argue that the diagnosis of DID increased in the late 20th century. DID has not been found in other countries. – Role-playing by people open to a therapist’s suggestion. – Learned response that reinforces reductions in anxiety Mood Disorders • Extreme and persistent feelings of despondency, worthlessness and hopelessness, causing… impaired emotional, cognitive, behavioral and physical functioning Blue mood Major Depressive Disorder Gasping for air after a hard run Chronic shortness of breath Mood Disorders • Extreme and persistent feelings of despondency, worthlessness and hopelessness, causing… impaired emotional, cognitive, behavioral and physical functioning Types of mood disorders • Major depression – “common cold” of psychological disorders • Dysthymic disorder • Seasonal affect disorder – depression associated with seasons • Bipolar – emotional roller coaster • Cyclothymic Disorder - moderate mood swings Etiology of Mood Disorders • Genetic predisposition • Disruptions in brain chemistry – Antidepressants – increase 2 neurotransmitters • Norepinephrine • Seratonin – Lithium – regulates avaliability of NT called glutamate • Stress Bipolar disorder • Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder. Gloomy Elation Withdrawn Euphoria Inability to make decisions Desire for action Tired Hyperactive Slowness of thought Multiple ideas Explaining Depression… Cognitive Beck Attributions Internal personal factors/external situational factors Stable or unstable over time Global /specific implications People who make global, stable, internal personal attribution => more prone to depression Seligman: learned helplessness Depression is caused by person learning that his effort does not pay off “giving up behavior” Originally conditioning => more cognitive slant Etiology of Depression (con’t) • Cognitive – Beck – Attributions • Internal personal factors/external situational factors • Stable or unstable over time • Global /specific implications People who make global, stable, internal personal attribution => more prone to depression – Seligman: learned helplessness • Depression is caused by person learning that his effort does not pay off “giving up behavior” – Originally conditioning => more cognitive slant Etiology of Depression (con’t) • Behavioral: – Inadequate social skills – Not enough reinforcement of social relationships – Depressed people can be depressing to be around Social-Cognitive Perspective • The social-cognitive perspective suggests that depression arises partly from selfdefeating beliefs and negative explanatory styles. Disassociative Disorders • People lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity – Disassociatve amnesia – Disassociative fugue – Disassociatve Identity Disorder or Multiple personality disorder Schizophrenia • “split mind” – split from reality – Disorganized thinking • Delusions -false beliefs, grandeur – Disorganized perceptions • Hallucinations – sensory experiences without sensory stimulation – Inappropriate emotions or action • Laughing when inappropriate/flat affect Subtypes of schizophrenia • • • • Paranoid Disorganized Catatonic Undifferentiated Schizophrenia • “split mind” – split from reality – Disorganized thinking • Delusions -false beliefs, grandeur – Disorganized perceptions • Hallucinations – sensory experiences without sensory stimulation – Inappropriate emotions or action • Laughing when inappropriate/flat affect Schizophrenia • Subtypes – Paranoid schizophrenia • False beliefs, delusions (grandeur, paranoia, persecution), hallucinations – Disorganized schizophrenia • Delusions, hallucinations, cognitive processes highly disorganized or fragmented • Extreme social withdrawal – Catatonic schizophrenia • May have delusions and hallucinations; most abnormalities in social interaction, body posture and movement (waxy flexibility in stupors) Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, deluded ways) that are not present in normal individuals (positive symptoms). Schizophrenics also have an absence of appropriate symptoms (apathy, expressionless faces, rigid bodies) that are present in normal individuals (negative symptoms). Understanding Schizophrenia Schizophrenia is a disease of the brain exhibited by the symptoms of the mind. Brain Abnormalities Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain. 40 Abnormal Brain Activity Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients. Adolescent schizophrenic patients also have brain lesions. Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health 41 Abnormal Brain Morphology Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles. Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC 42 Viral Infection Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development. 43 Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 1991). 0 10 20 30 40 50 Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated 44 Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries. 45 Psychological Factors Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicols & Gottesman, 1983). The genetically identical Genain sisters suffer from schizophrenia. Two more than others, thus there are contributing environmental factors. Courtesy of Genain Family Genain Sisters 46 Personality Disorders Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions. • Schizoid personality disorder – Blunted emotions, social withdrawal, but no serious cognitive disturbances • Antisocial personality disorder – Feel little guilt, exploit others, frequent violation of social rules and laws – Difficulty with personal relationships – Low tolerance for frustration, lie easily/skillfully 47 Personality Disorders • Inflexible, maladaptive patterns of thoughts, emotions, behavior and interpersonal functioning that are stable over time and across situations, and deviate from the expectations of the individual’s culture • Person doesn’t consider his personality characteristics as problematic => don’ Types of Personality Disorders Odd, eccentric • Paranoid Personality Disorder • Schizoid Personality Disorder • Schizotypal Personality Disorder Dramatic, emotional, erratic • Antisocial Personality Disorder • Borderline Personality Disorder • Histrionic Personality Disorder • Narcissistic Personality Disorder Anxious, fearful • Avoidant Personality Disorder • Dependent Personality Disorder • Obsessive-Compulsive Personality Disorder Antisocial Personality Disorder A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, even toward friends and family members. Formerly, this person was called a sociopath or psychopath. 50 Understanding Antisocial Personality Disorder Like mood disorders and schizophrenia, antisocial personality disorder has biological and psychological reasons. Youngsters, before committing a crime, respond with lower levels of stress hormones than others do at their age. 51 Understanding Antisocial Personality Disorder PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study repeat offenders had 11% less frontal lobe activity compared to normals (Raine et al., 1999; 2000). Courtesy of Adrian Raine, University of Southern California Normal 52 Murderer Understanding Antisocial Personality Disorder The likelihood that one will commit a crime doubles when childhood poverty is compounded with obstetrical complications (Raine et al., 1999; 2000). 53 Risk and Protective Factors Risk and protective factors for mental disorders (WHO, 2004). 54 Risk and Protective Factors 55