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PSYCHOLOGICAL DISORDERS Psychopathology • Psychopathology refers to problematic patterns of thought, feeling or behavior that disrupt an individual’s sense of well-being or social/occupational functioning • Psycho – Involves the brain and personality • Pathology – Disorder or illness Cultural Influence • Culture influences the concept of pathological behavior – What is acceptable in one culture is considered abnormal in others • Culture influences the manifestations of disturbed behavior – In Catholic cultures visions often involve the Virgin Mary • Prevalence rates for a given disorder – Vary by culture Labeling Theory • Suggests that diagnosing individuals as deviant serves the goal of stigmatizing them • Tends to become a self-fulfilling prophecy – Those labeled as crazy take on the role of a crazy person Psychodynamic Perspective • Neuroses – Temporary problems we encounter during our lives – We can still function in society – Emotional illness that we all experience at some point • Personality Disorders – Enduring maladaptive patterns of thought, feeling and behavior that lead to chronic disturbances in our functioning • Psychoses – Gross disturbances involving a loss of touch with reality – Mental illness – Ongoing nature of illnesses Etiology • Etiology – Psychoses • Often biological based problems in the structure of the brain (nature) – Neuroses and personality disorders • Environmental influences (nurture) Psychodynamic Formulation • Clinician determines: – Patient’s current level of functioning – Origin and course of symptoms – Salient events in the person’s developmental history Psychodynamic Formulation • Clinician attempts to answer three questions – What does the patient wish for and fear? • Motives and conflicts – What psychological resources dos the patient have available? • Ego functioning (one’s ability to function in society) – How does the patient experience himself and others? • Object relations (Patient’s interactions with others) Cognitive-Behavioral Perspective • Combine classical and operant conditioning with a cognitive-social perspective • Conditioned emotional responses – Post 9/11 fear of airplanes – Such fears generate avoidance • Avoid flights to visit friends and relatives • Dysfunctional cognitive attitudes and beliefs – Propensity to interpret events in a negative manner • Stereotyping Biological Perspective • Explores roots of mental disorders in the brain’s neural circuitry • Genetic sources of mental illness Diathesis-Stress Model • Integrates nature and nurture perspectives on psychological disorders • Model suggests that people have an underlying vulnerability (diathesis) that may be activated by stressful circumstances Systems Approach • Approaches problems with individual behavior within the context of a social group – Couple, family, work team • Individuals are parts of systems (groups) and the dysfunction may be within the system Family Systems • Family system model – Symptom bearer- Person identified as needing help • Family homeostatic mechanisms – Efforts by family to maintain the status quo • Family roles – Roles one assumes in an ongoing family drama • Mediator Family Systems • Family boundaries – Enmeshed • members too involved with each other’s business – Disengaged • Minimal contact between family members – Family Alliances • Members take sides Evolutionary Perspective • Random Variation – Maladaption of a small percent of population – Likely to be weeded out via natural selection • Selected gene pools – Will interact with other adaptive or maladaptive genes to determine behavior • Maladaptive environmental tuning of psychological mechanisms that are normally adaptive DSM-IV • Descriptive Diagnosis – Disorders are classified in terms of clinical syndromes & multiple syndromes • Diagnostic and Statistical Manual of Mental Disorders (DSM) 4th edition so DSM-IV – Listing of clinical syndromes used for diagnosis Multiaxial System of DSM-IV • Axis I – Symptoms that cause distress or impairment • Axis II – Personality disorders (enduring problems) • Axis III – Medical conditions (relevant to diagnosis) • Axis IV – Psychosocial and environmental problems • Parents divorce • Axis V – Global assessment of function (patient’s overall level of functioning) Sample Disorders Sample Disorders (continued) ADHD • Attention-deficit hyperactivity disorder • Inattention, impulsiveness, hyperactivity • More prevalent in boys • Tends to run in families – Genetic & environmental contributions Conduct Disorder • Physical aggression towards humans and animals – Chronic fighting • Vandalism • Persistent lying • Stealing • Genetic and environmental links Substance-Related Disorders • Alcoholism – Genetic link to alcoholism – Environmental pressures to consume alcohol – Negative impact on social functioning • Substance Use and Abuse – Use - Occasional use and able to ignore – Abuse - Regular use and dependence Schizophrenia • Umbrella term for a numerous psychotic disorders • Involve disturbances of thought, perception, behavior, language, communications, and emotion Symptoms of Schizophrenia • Delusions – Disturbance of thought, perception and language – Person truly believes his or her thoughts are being monitored by the CIA – Clear break from reality • Hallucinations – Perception of something not there • Hearing voices Symptoms of Schizophrenia • Loosing of Associations – Metaphorical language – Associative thinking and rational thought intermix and patient has no control • Positive Symptoms – Delusions, hallucinations and loose associations – Most apparent in acute phases of the disease – Often treatable with antipsychotic medications Symptoms of Schizophrenia • Negative Symptoms – Negative in that something is missing – Flat affect – Lack of motivation – Peculiar & withdrawn interpersonal behavior – Intellectual impairments Theories of Schizophrenia • Diathesis-stress model – Genetic and environmental contributors • Dopamine Hypothesis – Suggests symptoms reflect too much dopamine in the bloodstream • Expressed Emotion – Environmental factors, especially hostile feelings from family members, contribute to the disease Mood Disorders • Disturbances of emotion and mood • Normally disorders involve a negative impact • Women more prone to mood disorders than men Manic Disorder • Dangerously out of control state of euphoria • Very high energy level – Unable to go to sleep – Multitask in an irrational, ineffective, manner • Sustained state of hyperactivity Major Depressive Disorder • Depressed mood and loss of interest in pleasurable activities • Disturbances in: – – – – Appetite Sleep Energy level Concentration Dysthymic Disorder • Chronic low level depression that lasts over 2 years • Intervals of normal behavior that lasts from several weeks to several months • Manic episodes • May experience intense depression Theories of Depression • Genetics – Estimates range from 30-40% of patients have family history of depression • Neural Transmission – Low levels of serotonin and norepinephrine – Replacement treatments elevate moods • Environmental Factors – Negative household – Death, divorce and other key life events can trigger depression Theories of Depression • Cognitive distortions – Transforming of positive information into depressive cognitions • Cognitive theories – Learned helplessness • Perceived inability to make things better • I can’t make it better – Hopelessness • Perception that situation will never improve • Loss of hope • Nothing will ever make it better Eating Disorders • Anorexia Nervosa – Weight drops below 85% of ideal body weight – Refusal to eat – Distorted perceptions of one’s actual weight • Bulimia Nervosa – Binge eating & purging body of food Dissociative Disorders • Dissociation – Involves disruptions in consciousness, memory, sense of identity, or perception • Periods of amnesia • Perceive mind and body as two separate entities • Dissociative identity disorder – Also known as multiple personality disorder – Two or more separate personalities within the same person Personality Disorders • Chronic and severe disturbances that substantially inhibit the capacity to love and to work • Narcissistic Personality Disorder – – – – – Perceive the world revolving around themselves Use people for personal ends Feeling of entitlement Hypersensitive to criticism May go into rage when others don’t respond as expected Personality Disorders Borderline Personality Disorder • Symptoms include: – Extremely unstable interpersonal relationships – Dramatic mood swings – Unstable sense of identity – Intense fears of separation and abandonment – Manipulativeness – Impulsive behavior Antisocial Personality Disorder • Irresponsible and socially disruptive behavior across a variety of situations • Absence of a sense of conscious – Complete lack of empathy • Can be extremely charming individuals but in reality are accomplished “con artists:” Theories of Depression • Psychodynamic theories – Focus on motivation – Depression is integrated into the personality structure of an individual – Depression is a manifestation of other issues Anxiety Disorders • Anxiety state that are intense, frequent and even continuous • Generalized anxiety disorder – Persistent anxiety at a moderate but disturbing level – Excessive and unrealistic worry about life circumstances Types of Anxiety Disorders • Phobias – Excessive fear about a specific object or activity • Snakes • Flying – Social phobia • Intense anxiety about public speaking Types of Anxiety Disorders • Panic Disorder – Attacks of intense fear and feeling of doom or terror not justified by the situation – Sudden onset • Agoraphobia – Fear of being in places or situations from which escape might be difficult Types of Anxiety Disorders • Obsessive-compulsive disorder – Obsessions • Excessive and recurring thoughts about something • Thinking about one event, person, thing all the time – Compulsions • Excessive behaviors • Constantly washing your hands • One can have an obsession or a compulsion or both symptoms Types of Anxiety Disorders • Post-traumatic stress disorder (PTSD) – Flashbacks and recurrent thoughts of a psychologically distressing event outside normal human experience • War • Fatal car accident – Symptoms include • • • • • Nightmares Flashbacks Psychological numbness Hypervigilance Exaggerated startle response