Download Chapter 16: Psychological Disorders

Psychological Disorders
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What Is Abnormal Behavior?
A Definition
– Not typical
– Socially unacceptable
– Distressing to the person or others
– Maladaptive
– Result of distorted cognitions
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What Is Abnormal Behavior?
Perspectives on Abnormality
Types of Models
a. The Medical–Biological Model
b. The Psychodynamic Model
c. The Humanistic Model
d. The Behavioral Model
e. The Cognitive Model
f. The Sociocultural Model
g. The Evolutionary Model
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Perspectives on Abnormality
Which Model is Best?
– Some psychologists adhere to one model
– Many use different models
• Eclectic approach
– Different models for different disorders
• Biopsychosocial approach
– Acknowledges biological, psychological,
and social factors
– Combines models
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Perspectives on Abnormality
Thinking Critically about Mental Illness
– More people recover from mental illness than
don’t recover
– Few people with mental illness are violent
– Most people with mental illness suffer quietly
and privately
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What Is Abnormal Behavior?
Diagnosing Psychopathology: The DSM
The Diagnostic and Statistical Manual of Mental
Disorders
• Current version: DSM-IV-TR
• Designed to diagnose disorders
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The DSM-IV-TR
• Controversies and Criticisms
– disorders based on symptoms, not causes
• No theoretical basis
– Too complex
– Not enough reliability
– Politically, not scientifically, based
– Biased by gender and culture
– Perpetuates a medical model
– Pathologizes everyday behaviors
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What Are Anxiety Disorders?
Defining Anxiety
– Generalized feeling of fear and
apprehension
– May be associated with a specific object or
situation
– Often accompanied by physiological arousal
– Horney: Anxiety underlies most abnormal
behavior
– Freud: Anxiety from intrapsychic conflict
• Neurosis
• Free-floating anxiety
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What Are Anxiety Disorders?
Types of Anxiety Disorders
Generalized Anxiety Disorder (GAD)
• Persistent anxiety on more days than not
for at least 6 months
• Anxiety is difficult to control
• No specific trigger
• Muscle tension and inability to relax
• Vigilance symptoms
• Fatigue and sleep problems
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Types of Anxiety Disorders
Panic Disorder
– Characterized by panic attacks
– No identifiable trigger for the panic attacks
Phobic Disorders
– Excessive, irrational fear and avoidance of a
specific object or situation
– May be maintained by the relief of escaping
the feared situation
– Agoraphobia
– Social phobia
– Specific phobia
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Types of Anxiety Disorders
Obsessive–Compulsive Disorder (OCD)
– Persistent and uncontrollable thoughts and
irrational beliefs (obsessions)
– Rituals that interfere with daily life
(compulsions)
• Compulsions reduce anxiety from the
obsessions
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Obsessive–Compulsive Disorder (OCD)
• Explanations for OCD
– Psychodynamic theories
– Learning theories
– Biological theories – growing evidence
• Treatments for OCD
– Drugs affecting the neurotransmitter
serotonin
– Relaxation and cognitive behavior therapy
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What Are Mood Disorders?
Depressive Disorders
Description
• Extreme and persistent sadness, despair,
loss of interest in activities
• Major Depressive Disorder (called the
“common cold of mental disorders”)
• Dysthymic Disorder
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Description
Symptoms
– Poor appetite and weight loss
– Sleep disturbance
– Loss of energy and interest
– Difficulty concentrating/ Anxiety
– Feelings of worthlessness, guilt
– Thoughts of suicide
– Inability to experience pleasure
– Feelings of helplessness
– Feelings of hopelessness
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Description
Onset and Duration
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First episode usually occurs by age 40
Symptoms may last days, weeks, or months
May be one or repeated episodes
Stress sometimes brings on an episode
Children and adolescents can be depressed
• May also experience anxiety and
loneliness
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Description
Prevalence
– Higher in industrialized than developing
countries
• May be due to higher rates of diagnosis
– Twice as likely for women than men
• May be due to differences in coping style
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Feelings of Stress and Strain
“I have too much work.”
“My roommate is acting like a jerk.”
Efforts to Cope
Lack of power and low feelings of
mastery (more common in women)
Rumination
“I just can’t manage these courses.”
“I shouldn’t have to put up with my
roommate’s messiness.”
Negative feelings are magnified.
Depression
Power and high feelings of
mastery (more common in men)
Activity
Studying.
Going to a movie.
Negative feelings are decreased.
No depression
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Depressive Disorders
Causes of Major Depressive Disorder
a. Biological Theories
• Genetic factors
• Neurotransmitters
b. Cognitive Theories
• Aaron Beck’s approach
• Negative views of self, environment and
the future
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Cognitive Theories
• Seligman’s learned helplessness
– Repeated failures lead one to stop even
trying
“I’m lonely.”
“Why even bother trying
to make friends?”
“No matter what I try, I
never meet new people.”
Anxiety, depression
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Causes of Major Depressive
Disorder
The Biopsychosocial Model
– Genetics, brain chemistry and cognitions
make some more vulnerable to depression
than others
• Diathesis–stress model
– Both a predisposition and a precipitating
event needed for the disorder to develop
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Depressive Disorders
Bipolar Disorder
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Previously called manic–depressive disorder
Alternating depression and mania
Much less common than major depression
No gender differences in prevalence
Usually appears in late adolescence / early
adulthood
– Substantial genetic component
– Often treated successfully with drugs
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What Are Dissociative
Disorders?
•
Sudden but temporary alteration in
consciousness, identity, or memory
•
Relatively rare, but very dramatic
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What Are Dissociative
Disorders?
Dissociative Amnesia
– Sudden and extensive inability to recall
important personal information
• Not ordinary forgetfulness
– Not caused by head injury
– Affects only certain types of memory
– Often associated with a traumatic event
– Memory may reappear suddenly
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What Are Dissociative
Disorders?
Dissociative Identity Disorder
– Multiple personality disorder
– The existence of two or more distinct
personalities within one individual
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What Is Schizophrenia?
• NOT multiple personalities
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Lack of reality testing
Deterioration of social and intellectual functioning
Symptoms must begin before age 45
Must be present for at least 6 months
– 1 month more or less continuously
• Psychosis (out of touch with reality)
• About 1% of the population
– No gender differences
– Higher rates among lower SES
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What Is Schizophrenia?
Essential Characteristics
1. Types of Symptoms
a. Positive symptoms
– E.g., delusions and hallucinations
• Negative symptoms
– E.g., inability to read others’ emotions
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Essential Characteristics
Thought Distortions
– Disordered thinking and delusions
– Impaired language use
• Word salad
– Memory deficits
• Especially working and long-term memory
• Also problems with attention
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Essential Characteristics
Perceptual Distortions and Cognitive Distortions
– Hallucinations (perceptual distortion)
– Auditory hallucinations (e.g., hearing voices)
most common
» Voices are perceived as coming from
outside the person
» Voices comment on or direct behavior
-- Delusions
Misinterpretations of reality
(cognitive distortion)
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Essential Characteristics
Distortions in Emotional Reactions
– Inappropriate affect
• Flat affect
• Ambivalent affect
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What Is Schizophrenia?
C. Causes of Schizophrenia
1. Biological Factors
• Concordance rates
• Neurotransmitters
– Dopamine theory of schizophrenia
2. Environmental Factors
• Factors before / during birth
• Factors in infancy / childhood
• Family factors
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Environmental Factors
• Environmental and biological factors interact
• Among those with a biological predisposition
– Positive family relationships decrease risk
– Negative family relationships increase risk
• Neurodevelopmental view
– Biological predisposition (genetics and
prenatal events) + stressful life events during
adolescence  schizophrenia
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What Are Personality
Disorders?
Basic Characteristics
– Inflexible and long-standing maladaptive
behaviors that cause distress and social /
occupational impairment
– Stable over time
– Controversial
• Can be difficult to diagnose
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What Are Personality
Disorders?
Three broad classes
1. Odd or eccentric behavior
• Paranoid personality disorder
2. Dramatic, emotional, or impulsive behavior
• Borderline personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder
• Antisocial personality disorder
– Brain characteristics
– History of abuse common
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B. Three Broad Classes of
Personality Disorders
3. Fearful or anxious behavior
– Dependent personality disorder
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How Are Violence and Mental
Disorders Related?
Diagnoses Associated with Violence
– More serious disorders
– Delusions
– Manic phase of bipolar disorder
– Paranoid schizophrenia
• Those with substance problems alone
more violent than those with
schizophrenia alone
– Antisocial personality disorder
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Diagnoses Associated with
Violence
•
Legal Insanity
– Condition that excuses people from legal
responsibility for their behavior
– Must be unable to distinguish right from wrong
at the time the crime was committed
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Diagnoses Associated with
Violence
• Suicide is more likely than violence against
others
– Suicide attempters are unsuccessful
• More likely to be young, female, and make
less lethal attempts
– Suicide completers are successful
• More likely to be White, male, older, and
use more lethal means
– Substance abuse increases risk
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Diagnoses Associated with
Violence
• 60–70% of people with major depression think
about suicide
• Those with antisocial personality disorder or
bipolar disorder also at higher risk
• White men over age 75 at highest risk
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How Are Violence and Mental
Disorders Related?
Violence as a Risk for Developing Mental Disorders
– Child abuse increases risk of a range of
mental disorders
– Also increases risk of becoming an abuser
– Most abusers do not have a mental disorder
• Poor parenting and environmental stress
interact to create abusive parents
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Violence as a Risk for Developing
Mental Disorders
• Intimate partner violence
– Common throughout the world
– Married and unmarried partners
– Victims are at increased risk for PTSD, eating
disorders, and depression
– May explain higher rates of these disorders
among women
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Violence as a Risk for Developing
Mental Disorders
• Women also more likely to be raped
– Date or acquaintance rape more common than
stranger rape
– Experiences of male and female victims is
similar
• Increased risk for PTSD, anxiety disorders,
depression, suicide, substance abuse
– Rapists unlikely to have a mental illness
• Mental disorders less predictive of rape
than social factors and attitudes
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