Download Psychological Disorders

Psychological Disorders
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Psychological behaviors run a continuum
from very mild to extreme. Everyone has
these behaviors to one degree or another.
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It is not until a behavior or feeling
interferes with your quality of life that they
become a disorder.
Psychological Order
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Self-acceptance: understanding yourself
and accepting the good and bad parts of
yourself.
Positive relationships with others:
ability to form good trusting interpersonal
relationships.
Autonomy: self-controlled and able to
resist peer pressure.
Psychological Order
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Environmental masters: internal locus of
control; master of your domain.
Purpose in life: goals and sense of
direction; not diffused.
Personal Growth: see yourself growing
and expanding; self knowledge; self
actualization.
Psychological Disorders are:
 Atypical,
disturbing,
maladaptive, and unjustifiable
behavior.
Psychological Disorders: Causes
Are not usually caused by a single
factor. The medical model is probably
not correct where you can take a pill
to rid yourself of a disorder.
 The bio-psycho-social school: most
disorders are caused by a biological
predisposition, physiological state,
psychological dynamics, and social
circumstances.
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Defining Disorders
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DSM IV-Diagnostic and Statistical Manual
vol. 4.: attempts to describe psychological
disorders, without explaining the causes,
predicts the future course, and suggests
treatments.
Categorizes 230 disorders, in 17
categories.
Dangers of Labeling
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Labeling someone with a disorder can
create self-fulfilling prophesies, where
the label creates the behavior.
Also, if a professional hears a person
“has” a disorder, they may look back at
that person’s history and see things that
“caused” those behaviors, which might not
be accurate.
Anxiety Disorders
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Generalized Anxiety Disorder (GAD):
Persistent symptoms of an excited
sympathetic, nervous system: sweating,
heart racing, dizziness, shakiness,
accompanied by persistent negative
feelings and fear…not triggered by
specific events.
Anxiety Disorders
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Panic Disorder: unpredictable, minutes
long intense anxiety attack, as if you're
going to be killed any second, but no
specific, real threat is apparent.
Phobias: persistent, irrational fear of a
specific object of situation. Very common.
Spiders, snakes, heights, water, enclosed
spaces are all very common phobias.
Anxiety Disorders
Obsessive-Compulsive disorder (OCD):
 Obsessions: intrusive thoughts or fears.
 Compulsions: repetitive behaviors that
soothe the fears
Anxiety Disorders—Different
perspectives would ascribe different
causes:
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Psychoanalytic: repressed feelings during
childhood symbolized by trigger.
Behavioral: learned fear, which has been
reinforced, or social learning, imitating others
who have fear, like parents. May be generalized
from other learned experiences: one dog to all
dogs.
Biological: predisposed genetically to be afraid
of things that can cause death: snakes, spiders,
height, enclosed places, disease.
Post Traumatic Stress Disorder
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PTSD--Caused by prolonged or intensely
stressful situations, like war or rape.
Symptoms: difficulty sleeping, nightmares;
anxiety attacks or GAD; intrusive memories;
Guilt associated with event…
Some psychologists dismiss this disorder
pointing to those who do not get it after
experiencing similar trauma
That probably has more to do with biological
predisposition than to lack of evidence that
PTSD exists
Multiaxial Classification in DSM-IV
Axis I
Axis II
Is a Clinical Syndrome (cognitive, anxiety,
mood disorders [16 syndromes]) present?
Is a Personality Disorder or Mental Retardation
present?
Is a General Medical Condition (diabetes,
Axis III
hypertension or arthritis etc) also present?
Are Psychosocial or Environmental Problems
Axis IV
(school or housing issues) also present?
What is the Global Assessment of the person’s
Axis V functioning?
Mood Disorders
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Some types: Major, Clinical Depression;
Dysthymic Depression; Bipolar disorder
Mood disorders are the most common
psychological disorders: called the
“common cold” of disorders
Depression among the young is on the
rise: more diagnosis or more cases?
Major Depressive Disorder
Major Depressive Disorder:
 2 or more weeks of depressed mood, intense
feelings of worthlessness and hopelessness;
and diminished interest in things that were once
considered pleasurable.
 People feel like they are in a deep black hole
with no way to get out. The hopeless feeling
often prevents them from seeing any reason to
try to get out. Very dangerous illness.
Symptoms for Major
Depressive Disorder
Symptoms include:
 discouraging feelings about the future
 life dissatisfaction
 isolation from others
 difficulty sleeping OR sleeping a lot
 inability to concentrate
 lethargy; feelings of worthlessness
 loss of interest in friends or family activities
Dysthymic Depression
Symptoms
Dysthymic Depression:
 Down-in-the-dumps mood that lasts from
months to years; the feelings aren't as
intense, but they last longer
 Difficult to detect because of the lack of
intensity but takes a large toll on body and
psychology systems
Treatments for Depression
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Cognitive Therapy is effective, coupled with
antidepressants: trying to change internal
sentences. Because depressed people see the
world through dark glasses, their thoughts
intensify the feelings leading to a downward
spiral.
Medical: now treated with classes of Selective
Serotonin Reuptake Inhibitors. SSRIs. They
keep serotonin in the synapse longer, elevating
mood. (some well-known brands--Prozac, Zoloft,
Paxil, Lexapro…)
Treatment for Dysthymic
Depression
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College students with dysthymic or
moderate depression responded far
better to aerobics than other
treatments.
Depression Facts
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Facts: Major Depression usually lasts less than
three months; may or may not return; often
triggered by stressful events, although not
necessarily caused by it (biological
predisposition)
Dysthymic depression lasts two years or longer.
Women are twice as likely to have it as men;
Depression is a whole body disorder with
biochemical and psychological roots, therefore
generally requires both therapy and
antidepressant treatment.
Depression facts:
Those who are depressed often become
socially isolated as they withdraw from
friends and friends withdraw from them as
their “old self” changes.
 The depressed person is likely to blame
themselves with negative “self speak”
which exacerbates the depression
Reciprocal Determinism
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Bipolar Disorder (formerly
manic-depression):
Bipolar Disorder
 alternates between hopelessness
and lethargy of depression and
over-excited manic state.
Bipolar Disorder (manicdepression): Some Symptoms…
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Manic state: typically over-talkative;
overactive; little or no sleep; highly
impulsive, loud, flighty, hard to interrupt,
sexually less inhibited. Grandiose
optimism and self-esteem. May be very
irritable.
People then fall back to either a normal
state, or into a major depressed state
Treatment for Bipolar Disorder
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Treatment—In depressed state: high
levels of neurotransmitter Norepinephrine.
Treatment: usually with Lithium—mood
stabilizer--for the manic state and
antidepressants for the depression.
Treatment is very effective if patients
continue using medication.
Somatoform Disorders
Characterized by physical symptoms—pain,
paralysis, blindness, or deafness W/OUT
any demonstrated physical cause…
Differs from psychosomatic (tension
headaches, ulcers, heart problems
brought on by stress…)
as no physical damage is done
Somatoform Disorders—
5 types
1.)Somatization disorder: characterized by
many somatic symptoms that cannot be
explained adequately based on physical
and laboratory examinations. Specific
characteristics include the following:
 Onset of unexplained medical
symptoms in persons younger than 30
years
 Multiple and chronic complaints of
unexplained physical symptoms
Somatoform Disorders:
Somatization Symptoms contd…
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Multiple pain symptoms involving multiple
sites, such as the head, neck, back, stomach,
and limbs
At least 2 or more unexplained
gastrointestinal symptoms, such as nausea
and indigestion
At least 1 sexual complaint and/or menstrual
complaint
At least 1 pseudoneurological symptom, such
as blindness or inability to walk, speak, or
move
2 more Somatoform Disorders:
2.) Conversion Disorder—used to be known as
hysteria—loss of function (becoming blind, deaf,
or paralyzed) w/out physical damage to the
affected organs nor their neural connections
3.) Hypochondriasis—person unrealistically
interprets physical signs—pains, lumps, or
irritations—as evidence of serious disease
Somatoform Disorders
4. Pain disorder: somatoform disorder
characterized by a focused pain complaint that
cannot be entirely attributed to a specific
medical disorder. Specific symptoms of pain
disorder include the following:
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Pain in 1 or more anatomical sites producing a
predominant clinical focus
Psychological factors (felt to play an important role in
the onset, severity, or course of pain)
Pain symptom that is not feigned or intentionally
produced
Somatoform Disorders
5.) Body Dysmorphic Disorder: somatoform
disorder characterized by a focus on a physical
defect that is not evident to others. Specific
characteristics of body dysmorphic disorder
include the following:
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Preoccupation with an imagined defect in appearance
May be associated with multiple, frantic, and
unsuccessful attempts to correct imagined defect by
cosmetic surgery
Somatoform Disorders--Causes
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No definitive causes for most of the somatoform
disorders have been established.
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Genetic and environmental influences appear to
contribute to somatization.
Children raised in homes with a high degree of
parental somatization may model somatization.
Sexual abuse may be associated with an increased
risk of somatization later in life.
Poor ability to express emotions (alexithymia) may
result in somatization.
Somatoform Disorders--Treatment
for specific somatoform disorders
Somatization disorder: Patients may resist
suggestions for individual or group
psychotherapy because they view their illness
as a medical problem.
 Patients who accept psychotherapy may be
able to reduce health care utilization.
 Psychosocial interventions that focus on
maintaining social and occupational function
despite chronic medical symptoms may be
helpful.
Somatoform Disorders--Treatment
Conversion disorder: Limited studies about
specific psychotherapy exist for conversion
disorder.
 Behavior therapy or hypnosis may be
effective. Symptoms often resolve
spontaneously.
Somatoform Disorders—
Treatment contd…
Hypochondriasis: Physicians should attempt to
answer questions and reduce the patient's fear of a
specific illness.
 Group psychotherapy may provide social support and
reduce anxiety.
 Cognitive therapy strategies may help by focusing on
distorted disease-related cognitions.
 Individual insight-oriented psychotherapy has not
been proven effective.
Somatoform Disorders—
Treatment contd…
Pain disorder: Behavior therapy, including
biofeedback, can be helpful.
 Hypnosis also may be considered for chronic
pain syndromes.
 Some outcome data supports the
effectiveness of individual psychotherapy.
 Exploration of interpersonal effects of chronic
pain may reduce social complications of pain.
Schizophrenia and Symptoms
A group of severe psychotic disorders
characterized by disorganized thought and
delusional thinking disturbed perceptions
and inappropriate emotions and actions.
Onset often occurs in late adolescence.
 Delusion-irrational, unjustifiable,
grandiose, usually paranoid, belief of
persecution by an unseen entity.
 Hallucinations: the perception of nonexistent, external stimuli, usually auditory.
4 Types of Schizophrenia:
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Paranoid: preoccupations with delusions and
hallucinations=positive symptoms
Catatonic: immobility or excessive purposeless
movements.---negative symptoms= flat affect
Disorganized: disorganized speech or
behavior, inappropriate emotions. Word Salads:
scrambled or nonsensical speech.
Undifferentiated; symptoms, but doesn't fit
above models.
2 Levels of Schizophrenia
1.) Chronic: slowly develops over time,
prognosis=bad.
2.) Acute: reaction to life stresses, quick
onset, good prognosis.
 Schizophrenic thinking may be seen as an
uncontrolled rapid change of selective
attention, where the mind rapidly shifts
from one thought to another.
Causes
of Schizophrenia
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Psychology: triggering experiences,
genes predisposed but some react to
traumatic triggers (stressors) by
developing schizophrenia. They vary.
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Biochemical: 6 times the normal amount
of Dopamine receptors that increase
brain activity to manic levels. Thus
dopamine blockers reduce symptoms.
Causes of Schizophrenia
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It is also thought to perhaps be triggered
or caused by the introduction of a prenatal
virus that affects brain development,
possibly in the thalamus.
People conceived in Winter months are
more apt to develop schizophrenia in
Northern hemisphere, while the reverse is
true in the Southern.
Rule of Thirds
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About 1/3 of people who develop
schizophrenia only have one episode, 1/3
have reoccurring episodes, and 1/3 are
chronic with unremitting symptoms.
Causes of Schizophrenia contd.
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Amphetamines and cocaine sometimes intensify
symptoms.
Dopamine is also associated with physical
movement, disruption of is associated with
schizophrenia—(excess dopamine receptors)
Brain anatomy: they have abnormal brain tissue,
low frontal lobe activity.
Thalamus—structure is smaller than normal and
is reactive--that may cause brain over stimulation.
People exposed to certain flu viruses during
prenatal development have higher incidences.
Genetic factors of
Schizophrenia
 Definite
genetic link: the closer
you are genetically to someone
with Schizophrenia, the more
likely you are to get it.
 1 in 100 people get it.
 1 in 10 of siblings
 1 in 2 identical twins, even if
raised apart
Treatment for Schizophrenia
Psychopharmaceuticals:
Antipsychotic Medication OR Neuroleptics—
Haldol, Clozaril, Thorazine—decreases
hallucinations, lessen agitated behavior
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Negative side effects because the drugs are
Dopamine blockers:
Tardive Dyskinesia—problems walking, drooling,
involuntary muscle movements
Dissociative Disorders
 Dissociation
is the feeling that you
are outside of yourself, looking at
yourself. That your mind is
separate from body.
 Person has separated parts of
their personality or memory for
consciousness.
Dissociative Identity Disorder:
Multiple Personality Disorder
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This is a disorder in which your mind partitions
itself into two or more distinct personalities that
may or may not know about each other. One
“personality” emerges to handle stressful
situations that the whole psyche or other parts
cannot handle.
Caused by traumatic event or events where the
mind represses parts of itself that can’t handle
the pain. Repressed from a psychoanalytical
point of view.
Dissociative Identity Disorder
Skeptics believe that people are
either lying, are fantasy-prone, or
have had this disorder suggested to
them by therapists.
 It only seems to occur in places, like
here, where people know about it
through books like the Sybil and the
Three Faces of Eve.
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Dissociative Amnesia
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Selective memory loss of a specific
traumatic event. The amnesia
vanishes as abruptly as it begins and
rarely reoccurs.
Dissociative Fugue
 In
this type of dissociation, the
person just leaves their home and
starts on new life, with no
memory of their past life. The
memory may reoccur and the
person may return home, only to
leave again.
Personality Disorders
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Personality consists of enduring traits or
characteristics…so personality
disorders=persistent traits or
characteristics that are atypical, disturbing,
maladaptive and unjustified.
Prognosis for treatment (intensive
psychotherapy) for many is not very good.
Personality Disorders-6 Types
1.) Antisocial: most common, person has no
conscience. Lacks a sense of wrongdoing, even
toward friends or family members.
 Usually a man thing.
 Usually emerges before 15
 Person may be aggressive and/or ruthless.
Deceiving or conning others or be aggressive
sexually—any & all with no remorse.
Psychopaths, serial killers, sociopaths.
Personality Disorders
2.) Histrionic: displays shallow, attentiongetting behaviors, feeling uncomfortable
when not the center of attention.
 Acting in an aggressive, sexual way that
makes others uncomfortable.
 Rapid shifting of emotions. Dressing
provocatively to gain attention, speaks in
dramatic tones.
Personality Disorders
3.) Narcissistic: Preoccupied with
themselves and an exaggerated
sense of their own importance.
Personality Disorders
4.) Schizoid:
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either desires nor enjoys close relationships, including
being part of a family
Almost always chooses solitary activities
Has little, if any, interest in having sexual experiences
with another person
Takes pleasure in few, if any, activities
Lacks close friends or confidants other than first-degree
relatives
Appears indifferent to the praise or criticism of others
Shows emotional coldness, detachment, or flattened
affectivity
(Source: MayoClinic.com)
Personality Disorders contd.
5.) Avoidant
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Avoids occupational activities that involve significant
interpersonal contact, b/c of fears of criticism or
rejection.
Is unwilling to get involved w/people unless certain of
being liked.
Shows restraint w/in intimate relationships b/c of the fear
of being shamed or ridiculed.
Is preoccupied with being criticized or rejected in social
situations.
Is inhibited in new interpersonal situations because of
feelings of inadequacy.
Views self as socially inept, personally unappealing, or
inferior to others.
Is unusually reluctant to take personal risks or to engage
in any new activities because they may prove
embarrassing. (DSM-IV)
Personality Disorders
6.) Borderline:
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unstable sense of self
rapidly changing affect; will be clingy one minute
and then hostile the next;
try to pull people close and then do things to
drive them away
very manipulative to gain attention; unstable
relationships
Very poor prognosis for recovery, so some
therapists won’t treat them