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Psychological Disorders Psychological behaviors run a continuum from very mild to extreme. Everyone has these behaviors to one degree or another. It is not until a behavior or feeling interferes with your quality of life that they become a disorder. Psychological Order 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 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. Defining Disorders 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 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 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 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: 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 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 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 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 College students with dysthymic or moderate depression responded far better to aerobics than other treatments. Depression Facts 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 Bipolar Disorder (formerly manic-depression): Bipolar Disorder alternates between hopelessness and lethargy of depression and over-excited manic state. Bipolar Disorder (manicdepression): Some Symptoms… 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 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… 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: 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: 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 No definitive causes for most of the somatoform disorders have been established. 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: 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 Psychology: triggering experiences, genes predisposed but some react to traumatic triggers (stressors) by developing schizophrenia. They vary. Biochemical: 6 times the normal amount of Dopamine receptors that increase brain activity to manic levels. Thus dopamine blockers reduce symptoms. Causes of Schizophrenia 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 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. 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 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 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. Dissociative Amnesia 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 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: 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 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: 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