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2 factors of sandwich making: Time and Ingredients 2 factors of mental disorder: Environment and Genetics The Diathesis-Stress Model is a broadly applicable framework for understanding human behavior. It is based upon the premise that a dynamic interaction exists between a diathesis and life stressors. By examining the effects of this interaction, we can better understand a person's behavior, coping strategies, and decision making. A diathesis is defined as a person's predisposition towards a problem or disorder. This can be inherited (genetic factors), acquired (biological, physiological, psychosocial, sociocultural factors), or a combination of both. How are mental disorders viewed by mental health professionals in this clip? Write one piece of evidence to support your opinion. How did the schizophrenic patients view their own disorders in this clip? Why? What do you think qualifies a cognitive or behavioral pattern as “a mental disorder”? Think of schizophrenia as an example. The medical model --proposes that it is useful to think of abnormal behavior as a disease, like the flu or cancer. --Philippe Pinel (18th century) of France was the first to propose that madness is a sickness of the mind. --The illness that caused the turning point: syphilis. A disease with BOTH mental and physical repercussions. Parts of the Medical Model --diagnosis: distinguishing one illness from another --etiology: causes and history of an illness --prognosis: a forecast about the probable course of an illness Another important term ---diathesis: vulnerability toward a disorder that results from a combination of stress and genetic vulnerability Q: What are some of the advantages of considering mental disorders “illnesses.” Disadvantages? What is abnormal behavior? Here are some accepted criteria that answer this question: › Deviant: deviates from what society deems “acceptable.” EX. Cross dressing is a “disorder.” › Maladaptive: everyday adaptive behavior is impaired or counterproductive. EX. Alcohol use is maladaptive in some circumstance and isn’t in others. › Personal distress: individual’s report of personal distress. EX. Depression and anxiety disorders Mental illness (psychopathology) arises from the interaction of nature and nurture. Broken Bone Finding out Scheduling an appointment Doctor’s questions Doctor’s actions Diagnosis Doc’s prediction Treatment Reevaluation Free-floating Anxiety Finding out Scheduling an appointment Therapist’s questions Therapist’s actions Diagnosis Therapist’s prediction Treatment Reevaluation American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - IV) DSM-V will be released in May 2013! Figure 14.5 Lifetime prevalence of psychological disorders 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 DSM-V revisions: http://www.dsm5.org/Documents/1203%20Autism%20Spectrum%20Disorders% 20-%20DSM5.pdf You will have to read, think, infer, and reference Myers Module 48 to complete this activity. Google “Psych Central.” Click on the diseases along the left side. Click on 3 disorders and for each (1) write the name, (2) axis (I, II, III, IV), (3) criteria that the disease matches (deviant, maladaptive, personal distress), (4) an explanation of why the disease matches the criteria (5) Use the Internet to research treatments and write a five-point summary of treatment for each of the three disorders you chose. Please include insight/talk treatments, behavioral treatments, and biomedical treatments if possible. Anxiety Disorders Somatoform Disorders Dissociative Disorders Mood Disorders Schizophrenic Disorders Read aloud with a group of 2-3 Module 50 (pgs. 618-623) on dissociative, personality, and somatoform disorders. Then write three paragraph-long stories characterizing fictional people who could serve as “the poster child” for each of the three categories of disorder and their subtypes. You may think of the stories together, but each group member must serve as scribe in his/her own spiral for at least one story. Objective: Now let’s get specific. Learn the following (1) disorders by name, (2) their symptoms, and (3) their etiologies (causes of disease). Copy these down leaving a few spaces between each. 1. 2. 3. 1. 2. 1. 2. 3. • Dissociative amnesia Dissociative fugue Dissociative identity disorder Antisocial Personality Disorder Borderline Personality Disorder Somatization disorder Hypochondriasis Conversion Disorder You will create a group of 3 and choose one of the above categories to study. Find and write down the 3 key parts of the objective for each disease in your category. You may use other text books and the Internet in addition to Myers. Dissociative amnesia: sudden loss of personal memory “involv[ing] a specific event or series of events—usually a threatening experience in childhood” [Zimbardo, 503) Dissociative fugue: people lose memory of entire lives and personal identity Dissociative identity disorder: coexistence in one person of two or more largely complete, and usually very different, personalities. › Etiology severe emotional trauma during childhood › Controversy Media creation? Since the advent of books like Sybil (1973), the average number of personalities has climbed from 2-3 to 15. Key Word: Inflexible Fonagy, etc. (1996): People with personality disorders seem to lack a highly necessary skill called "mentalization." Mentalization refers to the ability to reflect upon the behaviors, internal states, and motivations of both ourselves and other people. Clarkin (2006) “Personality disorders are long-standing ways of behaving that are not so much severe mental disorders as dysfunctional styles of living” (Bernstein 628) Anxious-fearful cluster › Avoidant, dependent, obsessive-compulsive › Anxious-fearful cluster: › Avoidant – excessively sensitive to potential rejection, humiliation or shame, avoids forming social relationships › Dependent – excessively lacking in self-reliance and self-esteem, › Obsessive-compulsive – preoccupied with organization, rules, schedules, lists, and trivial details. Dramatic-impulsive cluster › Histrionic, narcissistic, borderline, antisocial › Histrionic – overly dramatic, tending to exaggerate expressions of emotion, › Narcissistic – grandiosely self-important, lacking interpersonal empathy, › Borderline – unstable in self-image, mood, and interpersonal relationships, angry outbursts, impulsivity › Antisocial – chronically violating the rights of others, non-accepting of social norms, inability to form attachments. vs. Odd-eccentric cluster › Schizoid, schizotypal, paranoid › Schizoid – defective in capacity for forming social relationships, › Schizotypal – social deficits and oddities in thinking, perception, and communication, “illusions” of sights and sounds, “magical thinking,” strange superstitions (Bernstein 628) › Paranoid – pervasive and unwarranted suspiciousness and mistrust. Etiology › Genetic predispositions, inadequate socialization in dysfunctional families Diagnostic Problem: There is a large overlap between personality disorders with each other and with Axis I disorders. Are they even real? Somatization Disorder Conversion Disorder Hypochondriasis › Etiology Reactive autonomic nervous system Personality factors Cognitive factors The sick role Smeagol often argues with his other personality, Gollum, about his future plans. Many times, however, these two personalities are out-of-touch with each other. He alternates between possessing a benign, pitiable outlook on his past/ future and an alternate murderous perspective regarding his possession of the Ring of Power. 1. Diagnose his disorder and explain its etiology. 2. Interpret Smeagol’s disordered behavior and/or its origin using the following psychological perspectives. 1. humanistic, 2. behavioral 3. psychoanalytic 4. cognitive, 5. biological, 6. sociocultural Terms or THEIR ROOTS EXAMPLES of Explanations Diagnosis Dissociative identity disorder Development of two or more personalities that are largely unaware of each other Humanistic 2 of the following: free will, potential; growth; unique; self Gollum feels he cannot reach his potential/growth, etc. with one personality alone. He can no longer progress as “Smeagol” after being evicted from his society. So, he develops “Gollum” to progress in his current circumstances. When he meets Frodo, he exercises his free will to renew his potential to progress beyond the dismal character, Gollum, in an environment of acceptance and loyalty, so “Smeagol” remerges. Behavioral Environment, condition Gollum has been conditioned through his punitive environment to have two personalities. His society punishes “Smeagol,” so he develops “Gollum,” a resilient and antisocial being who is reinforced by the Ring of Power with a sense of importance. A lot of conditioning examples possible. Pick one. Psychoana ytic unconscious The identity and childhood being, Smeagol, is repressed in Gollum’s unconscious until he meets Frodo. At this point, Smeagol is reborn into consciousness and challenges Gollum’s control over Smeagol’s behaviors. Repressing Gollum’s identity ultimately fails as traumatic events continue to befall Smeagol. Cognitive You must refer to thought processes in some way! Here are some options: catastrophic view, unrealistic view, cognitive restructuring Gollum interprets his not having the Ring as catastrophic. He begins to restructure his thought processes when Frodo offers him companionship and meaning in life. Perhaps, he thinks, the Ring is not so important after all. He temporarily abandons his quest for the Ring and perceives friendship with Frodo as more important. Biological Brain OR genetics/DNA Gollum was predisposed because of his genetics to dissociate under very traumatic and stressful circumstances (i.e. exile, meeting Frodo, trauma with Boromir). Sociocultur al Culture OR society OR Ingroup/Outgroup Gollum belonged to a simple, idealistic culture, so when he committed the hideous crime of murder, he was cast out of his society. No longer being a part of the ingroup caused him stress, so he developed an alternate persona Read Modules 49 (pg. 610) and 51 (pg. 625) in Myers. With a partner, write a quiz with 10 questions on anxiety disorders and 10 questions on mood disorders. The questions should focus on identifying specific kinds of these disorders within these categories, their symptoms, and etiologies. You will have 1 hour to read through the material and write the quiz! *No true/false or yes/no questions! 1. 2. 3. 4. 5. Generalized anxiety disorder 1. “free-floating anxiety” 2. Continually tense, apprehensive, and experiencing constant autonomic arousal Panic disorder 1. Sometimes unpredictable episodes of dread and terror accompanied by physical anxiety symptoms (chest pains, vomiting, increased pulse) Phobic disorder 1. Specific, usually irrational fear and avoidance of an object or situation Obsessive compulsive disorder 1. Obsessions: unwanted repetitive thoughts 2. Compulsions: actions to assuage the repetitive thoughts Posttraumatic Stress Disorder 1. Haunting memories, nightmares, social withdrawal, jumpy anxiety, and or insomnia that lingers four weeks or more • • • • • Conditioning and learning – Fear conditioning: – CC establishes conditioning and OC maintains it – stimulus generalization and reinforcement – Observational learning: Mineka (1985) demonstrated that wild monkeys transmit fear of snakes to watchful offspring Biological factors – Natural selection: fear has kept us alive as a species; it is easy to condition and difficult to extinguish – Genetic predisposition, anxiety sensitivity runs in families and correlates to personality – EX. Twins have high correlation to anxiety disorder – “Anxiety gene” impacts brain level of serotonin (Canli, 2008) which regulates sleep and mood. – Glutamate (Lafleur et al., 2006) which causes the brain’s alarm centers to become overactive. GABA counterbalances glutamate, and anxiety patients have GABA irregularities – Brain circuitry irregularities in PTSD and OCD patients Cognitive factors – Judgments of perceived threat Personality – Neuroticism Stress—a precipitator Figure 14.7 Conditioning as an explanation for phobias Anxious and non-anxious subjects are asked to interpret a benign statement made by the experiment such as (to a child), “You need to cut it out and start behaving.” Subjects are then asked to interpret the statements on a scale of threatening to nonthreatening. Anxious subjects much more likely to find the statement threatening. -Eyesenck, 1991 Figure 14.8 Cognitive factors in anxiety disorders 1. Major depressive disorder: a person experiences two or more weeks of persistent feelings of sadness, worthlessness, and/or despair and a loss of interest in previous sources of pleasure 1. Dysthymic disorder: chronic depression that isn’t severe enough to be diagnosed as a depressive episode 2. Bipolar disorder: the experience of one or more manic episodes as well as periods of depression. 1. Bipolar 1: at least one full-blown manic episode lasting at least one week or any duration if hospitalization is required. Symptoms: inflated self-esteem or grandiosity, decreased need for sleep, being more talkative than usual, flight of ideas, distractibility, increase in goaloriented activity and excessive involvement in risky activities. 2. Bipolar II: at least one major depressive episode, plus at least one hypomanic episode over at least four days. The same characteristics as mania are evident, with the disturbance of mood observable by others; but, the episode is not enough to disrupt normal functioning or necessitate hospitalization and there are no psychotic features. 3. Cyclothymic disorder: people exhibit mild symptoms of bipolar • Etiology – Behavioral Origins: – People react to their environment, and when their environment changes, their mood stabilizes. – Precipitating stress: Moderate link between stress and the onset of mood disorders – Interpersonal roots: People with inadequate social skills are often depressed – Genetic vulnerability – Monozygotic Twin Studies: depression (4 in 10) (Kendler, 2006), bipolar (7 in 10) (Tsuang & Faraone, 1990) – Linkage analysis: look at family which has many depressed members, find non-depressed members in that family, and analyze genes. Conclusion is that depression is polygenic (Hu and McMahon and Paddock et al., 2007) – Genetic predisposition for neurochemical abnormalities in the brain – Less brain activity during depressive episodes and more brain activity during manic episodes – Left frontal lobe interprets positive emotions and is 7% smaller in depressed patients (Cofey et al., 1993). – Emotional information coming from the primitive brain is not interpreted in the cerebra cortex (the thinking part of the brain) due to the cortex's inactivity during depression (Discovery Ed) – Hippocampus, which processes memories and is linked with emotion, is vulnerable to stress-related damage. – Norepinephrine, which increases arousal and boosts mood, is scarce during depression and abundant during mania (HMHL, 2002). – Serotonin, which soothes, is scarce during depression due to genes for a protein that controls serotonin activity (combined with stress) (Plomin & McGuffin, 2003) – Cognitive factors: – How do people explain setbacks and other negative events? Pessimistic people likely to be depressed because negative thoughts and negative moods interact #27 Who’s Crazy Here, Anyway? › Experimenter › Hypothesis › Experimental Design: variables, groups, set-up › Results #28 You’re Getting Defensive Again › Scientist › Hypothesis › Results and Discussion › Implications #29 Learning to Be Depressed › Experimenter › Hypothesis › Experimental Design: variables, groups, set-up › Results What was surprising about Rosenhan’s study on mental hospitals? Who in the hospital could tell the difference between real and psuedo patients? How does this study point out the difficulty of psychological diagnosis? What is confirmation bais? How did the homophobic subjects in Anna Freud’s study calm their anxiety? (what are the mechanisms they used?) Were the homophobic or non-homophobic subjects in Freud’s study more reactive to the images on the screen? Which mechanism were homophobics using to cope with their feelings, thus openly fearing homosexuals? Describe the two different experimental environments Seligman used for his dogs. Why wouldn’t the “no-escape” dogs fail to escape in the second environment even when they were not restrained? What is learned helplessness? Based on Seligman’s experiment, how do you think depressed patients can do so as not to fall prey to “learned helplessness?’ Real Patients Pseudo Patients Confirmation Bias: accept evidence that says you’re right. Ignore evidence that says you’re wrong Escape group No Escape group Learned Helplessness Key Points General Symptoms Paranoid Catatonic Disorganized Positive symptoms Negative symptoms Etiology Summary: Notes Definition and General symptoms › Delusions and irrational thought › Deterioration of adaptive behavior › Hallucinations › Disorganized speech › Disturbed thoughts How is schizophrenia different from a mood disorder (like bipolar)? Key question: Disturbed thoughts and emotions, or just disturbed emotions? Prognostic factors: early onset and requires lengthy hospital care. 4 subtypes › Paranoid type: delusions of persecution, argumentativeness, along with delusions of grandeur, auditory hallucinations More easily hidden than other types 40% of schizophrenics, onset after age 25 and sudden Patients more functional than other schizophrenics. › Catatonic type: lack of motivation, motor disturbances ranging from muscular rigidity to waxy flexibility to random motor activity. Sometimes unable to move at all, sometimes hyperactive. Often “pose” in any position. Symptoms negative. 8% of schizophrenics Uncommon. Disorganized type: deterioration of adaptive behavior including emotional indifference or inappropriateness, complete social withdrawal, frequent incoherence, aimless babbling, giggling delusions, hallucinations. Neglect hygiene and manifests bladder/bowel control problems Both positive (babbling, etc.) and negative (emotionlessness, etc.) symptoms 5 %. Often found in homeless population Severe. › Undifferentiated type: the person’s emotional, behavioral, and thought patterns are schizophrenic but don’t conform to any of the other three categories because their symptoms are mixed. 40%. New model for classification › Positive vs. negative symptoms: behavioral excesses vs behavioral deficiencies. **Genetic vulnerability: 48% for identical twin (Weiten). 16% of children with schizophrenic mothers developed the disorder while only 2% of children with non-schizophrenic mothers developed the disorder (Bernstein) Genes: 5-HT-sub (5A) receptor gene, for example, and about 3 more (Bernstein) **Neurochemical factors: Excess dopamine? Abnormalities **Structural abnormalities of the brain: enlarged ventricles The neurodevelopmental hypothesis: brain Expressed emotion: Do family members of the patient baby Precipitating stress: High stress on people who are predisposed in neural circuits using glutamate? lead to less brain tissue in thalamic, prefrontal, and subcortical areas. maldevelopement before birth, abnormal metabolic activity in the temporal and frontal lobes him/her? If yes, the patients symptoms persist. to suffer from schizophrenia causes its onset. Write your summary and cite evidence! Write a 1-paragraph-per-topic connection between what we’ve learned in our Abnormal Behavior Unit and the story of Nathaniel Ayers as portrayed in The Soloist: Onset of schizotypal behavior Treatment Social Support The homeless problem and mental illness Deinstitutionalization Read the article, “Catching Autism Earlier” from the Oct. 2009 Monitor on Psychology. Pay attention not only to the breakthroughs in treating autism, but to the changes in (1) the number of recent diagnosis and (2) proposed reasons for those numbers. 1. 2. 3. -Write your thoughts regarding the increased number of recent autism diagnoses and reasons for them (either from the text or from deductive reasoning) which make the most sense to you. Cite evidence and explain. -Review the successful treatments of this disorder. What do the successful treatments indicate about the etiology of this disease? Cite evidence and explain. -Find one other credible source online regarding recent breakthroughs in explaining and treating autism. Summarize it in a paragraph. Insanity (criminal) › A legal status indicating that a person cannot be held responsible for his/her actions because of mental illness. › M’naghten rule: insanity exists when a mental disorder makes a person unable to distinguish right from wrong. Involuntary commitment (civil) › danger to self or others › in need of treatment New Mexico is one of a few states whose laws make it difficult to commit someone involuntarily. There is no involuntary commitment law in NM. Group Question Minute: Should insanity be a factor in deciding criminals’ fates? Why and why not? Group Question Minute: Should civil courts take into account mental disorder when deciding issues like custody of children? Why or why not? "Andrea Yates admitted to drowning her five children in the bathtub of her Houston, Texas home in 2001. She had twice tried to kill herself in previous years , and she was reportedly depressed at the time of the murders. Accordingly, she pleaded not guilty by reason of insanity. The court's first step in deciding her fate was to confine her in a mental institution for assessment of her mental competency to stand trial. Following testimony of psychologists who examined her, she was found competent, tried, and sentenced to life in prison. Her conviction was overturned on appeal, though, and at a second trial in 2006, she was found not guilty by reason of insanity and committed to a mental hospital” (Bernstein, 639). Figure 14.22 The insanity defense: public perceptions and actual realities Relativistic view vs universalistic view Cultural variations (1) Are the psychological disorders seen in Western societies found throughout the world? (2) Are the symptom patters of mental disorders invariant across cultures? Culture bound disorders › Koro- Present in Chinese males. Fear that a very manly part of anatomy will disappear into the abdomen › Windigo- an intense craving for human flesh and the perpetual fear that one will become a cannibal. Only happens Algonquin Indian cultures. › Anorexia nervosa- fear of being fat and abstinence from food. Only in affluent Western cultures.