Download lecture ch 15

Psychological
Disorders Chapter 15
Abnormal Behaviour Example
• Two weeks ago, a man jumped
from a 401 overpass after
throwing his 5 year old daughter
off. He died and she is still in
guarded condition in the
hospital. He left a suicide note
that seemed to indicate that he
wanted to punish his wife.
• What would cause someone to
take such a drastic act?
What Is Abnormal Behaviour?
Abnormal behaviour is characterized as
(a) not typical (genius)
(b) socially unacceptable (naked tantrums)
(c) distressing (to self and others)
(d) maladaptive (causes problems for the
person)
(e) result of disorganized
cognition (thought processes are disturbed)
Perspectives on Abnormality
• Model:
Framework of explanation
• Abnormal psychology:
Use models to explain
maladapative behavior
Models of Abnormal
Behaviour
The Medical-Biological Model
• focuses on the physiological
conditions that initiate and
underlie abnormal behaviour
• Many terms used in abnormal
psychology borrowed from
medical field
• Diagnose, treat, cure with
emphasis on drugs and
hospitalization
The Psychodynamic Model
• rooted in Freud’s theory of
personality
• assumes psychological
disorders result from anxiety
produced by unresolved
conflicts outside a person’s
awareness
The Humanistic Model
• focuses on individual uniqueness
and decision making
• Maladjustment occurs when a
person’s needs are not met
The Behavioural Model
• Abnormal behaviour is
learned through selective
reinforcement and
punishment
The Cognitive Model
• Human beings engage in
both prosocial and
maladjusted behaviours
because of their thoughts
• Change your thoughts;
change your behavior
The Sociocultural Model
• Maladjustment occurs
within and because of a
context – family,
community, culture, etc.
• Frequency and type of
disorders varies across
cultures
The Evolutionary Model
• humans evolved in a
specific environment
• Maladjustments may be
expressions of behaviour that
would once have been
normal in evolutionary history
• (e.g., phobias, aggression)
Which Model Is Best?
• Some psychologists use
only one model to
analyze all behaviour
problems
• Others may take an
eclectic approach
Diagnosis: DSM
Diagnosing Psychopathology:
The DSM
Diagnostic and Statistical Manual
of Mental Disorders (DSM)
A way to try to standardize and
clarify the language used by
practitioners in the diagnosis
and treatment of mental
disorders.
Diagnosing Psychopathology
GOALS of DSM
• To improve the reliability of
diagnoses by categorizing disorders
according to observable
behavior
• To ensure that the diagnoses are
consistent with research evidence
and practical experience
16 major categories & 200 subcategories
Table 15.1 Major Classifications of the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (TR)
Diagnosing Psychopathology
Criticisms:
- Potential biases
- Symptom focus rather
than etiology
- Too complex
- Medical model focus
- Reliability
- Pathologize everyday
behaviour
Anxiety Disorders
Defining Anxiety
• Anxiety :
a generalized feeling of
fear and apprehension
that may be related to a
particular situation or
object often
accompanied by
increased physiological
arousal
Generalized Anxiety Disorder
Diagnostic Criteria:
• Excessive anxiety and worry for at least 6 months
• Difficult to control the worry
• At least three of the following: restlessness, fatigue, difficulty
concentrating, irritability, muscle tension, sleep disturbance
• Focus of anxiety is NOT associated with other anxiety disorders
• Symptoms cause clinically significant distress
• Not due to direct effects of substance abuse or medical
condition
Generalized Anxiety Disorder
• Prevalence
– 3% of the population
• Risk factors
– suicide
• Comorbidity
– Depression
– Substance abuse
Phobic Disorders
• Phobic disorders :
– Irrational fear of an
object or a situation
• Three main Types
– Agoraphobia
– Social phobia
– Specific phobias (table
15.3 pg. 543)
Agoraphobia
• Excessive fear and avoidance
of being alone in a place
from which escape may be
difficult or embarrassing
• Accompanied by panic
attacks
• More common in females
than males (5.8% : 2.8%)
• Often brought on by
interpersonal stress
Social Phobia
• Excessive fear and
avoidance of situations
where one might be
scrutinized by others
• Fear of acting in a way that
may lead to humiliation or
embarrassment
• Affects males and females
equally
• Identified in all cultures
Social Phobia
Specific Phobias
• Irrational and persistent fear
and avoidance of a
particular object or
situation
• 5 – 12% of the population
has one or more specific
phobias
• Categories of specific
phobias: animal, natural
environment, blood-injectioninjury, situational, other
Obsessive-Compulsive Disorder
• Persistent, uncontrollable
thoughts and irrational
beliefs that cause
compulsive rituals that
interfere with daily life
– Obsessions =
thoughts
– Compulsions = behaviors
Obsessive-Compulsive Disorder
• 80% of cases report both
obsessions and compulsions
• Compulsions are used to
combat anxiety associated with
obsessions
(think, do, feel better – for a
while)
• 2% of the population (males =
females)
• Neurological mechanisms
identified (frontal lobe and
amygdala)
Obsessive Compulsive Disorder
Mood Disorders
Depressive Disorders
• Depressive disorders
– General category of mood
disorders in which people
show extreme and
persistent sadness, despair,
and loss of interest in life’s
usual activities
Depression is the “common
cold” of psychological
disorders.
Symptoms of Major Depressive
Disorder
• Poor appetite
• Insomnia
• Weight loss
• Loss of energy
• Feelings of
worthlessness and
guilt
• Inability to
concentrate
• Suicidality
Major Depressive Disorder:
Onset and Duration
• Onset
– usually prior to age 40
• Duration
– days, weeks, or months
– Single episode or
recurring episodes
Major Depressive Disorder:
Prevalence
• Major depressive disorder
affects about 1.3 million
Canadians each year
• Women are twice as likely as
men to be diagnosed
– Increased negative
experiences
– Lower feelings of mastery
– rumination
• May include delusions
– Major depression with
psychotic features
Major Depressive Disorder: Clinical
Evaluation
• Diagnosis of depression (or any
other mental disorder) should
involve a complete clinical
evaluation:
• A physical examination
• Thyroid, virus, anemia?
• Brain disorders
• A psychiatric history
• Course, genetics, history
• A mental status examination
• Evaluate the current
status/severity
• Rule out dysthymia
SAD: Seasonal Affective Disorder
Causes of Major Depressive
Disorder (many & varied)
Biological Theories:
genetics
children of depressed
parents
twin studies
neurotransmitters
e.g. Monoamine theory
dopamine,
norepinephrine, epinephrine,
serotonin
Learning and Cognitive
Theories
• Learning and thoughts underlie
depression
• Lewinsohn:
– The vicious cycle of lack of reinforcement leading
to lack of reinforcement
– Poor social skills?
• Beck:
– Negative views of self, environment, future
– Poor self-concept and negative expectations
– Negative interpretation of self and the world in
general
Figure 15.2 Lewinsohn’s View of Depression
Learned Helplessness
• The behaviour of giving up or not
responding exhibited by people and
animals exposed to negative
consequences over which the feel they
have no control
– Why try? I can’t change anything.
• Seligman suggests that people’s beliefs
about the causes of failure determines
whether they will become depressed
– I failed because I am weak, stupid, etc.
– Environment is the key!
The Biopsychosocial Model
Diathesis-stress model
• Combination of factors lead to
vulnerability (BIO / PSYCHO / SOCIAL)
• Vulnerability: person’s
diminished ability to deal with
life events
• Increased vulnerability means
less stress is needed to initiate
depression
Bipolar Disorder
• originally known as manicdepressive disorder
• People with the disorder
experience behaviour varying
between two extremes
– The key is the extreme swing in mood
– Mania and depression
Bipolar Disorder
• Manic Phase:
rapid speech, inflated self-esteem,
impulsiveness, euphoria, decreased need for
sleep, promiscuity, grandiose ideas, extreme
spending, quick anger responses
• Depressed Phase:
symptoms of depression
Prevalence: 1% of the population = 200,000 Canadians;
Affects men and women equally
Treatment: Tricky because moods are too stable
Comorbidity: OCD, dependence, narcissism
Bipolar Disorder
Dissociative Disorders
Dissociative Disorders
• Dissociative disorders are
characterized by a sudden,
temporary, alteration in
consciousness, identity,
behaviour, and/or memory
Dissociative Disorders
Dissociative Disorders include:
• Dissociative amnesia –
– Sudden & extensive memory loss
(personal/traumatic)
• Dissociative identity disorder
– The existence within an individual of
two or more distinct personalities
– Different memories, habits, abilties,
genders, ages,etc.
Three Faces of Eve
MEDIA DEPICTION OF DID
Schizophrenia
Schizophrenia: Split Mind
• Schizophrenic disorders –
a group of disorders characterized by a
lack of reality testing & by deterioration of
social & intellectual functioning &
personality
• Psychosis – break with reality that impairs
daily functioning
Essential Characteristics of
Schizophrenic Disorders
• People who suffer from schizophrenia can have
significantly different symptoms, yet still be given the same
label
• Schizophrenia is a group or class of disorders and each
case is identified according to some kind of basic
disturbance in one of the following areas: language,
thought, perception, affect (emotions), and behaviour
• 1:100 Canadians (220,000 per year)
• Men and women affected equally
• Hospitalization is common treatment
• Socioeconomic bias
Essential Characteristics of
Schizophrenic Disorders
• Positive symptoms –
– Things that shouldn’t be there
– Delusions (false beliefs) &
hallucinations
(sensory experience when there is
no sensory stimuli)
• Negative symptoms –
– Lack of things that are there in
normal people
– Can’t experience pleasure
– Lack of appropriate emotional
response
Schizophrenia: Language and
Thought Disturbances
• Difficulty maintaining logical thought and coherent
conversation
• Word Salad – “I am of pepper and music that makes the news.”
• Neologism – making up words
Delusions - mistaken beliefs maintained in spite of strong
evidence to the contrary. Three common delusions include:
 Thought broadcasting
 Thought insertion
 Thought withdrawal
 Capgras Syndrome (body double)
 Cotard’s Syndrome (body part – brain – has changed)
Schizophrenia: Perceptual
Disturbances
• The senses of people with
schizophrenia may either be
enhanced or blunted
• Sensory stimulation is jumbled and
distorted
• Hallucinations –
visual, tactile, olfactory, auditory
• Auditory hallucinations are most
common
Schizophrenia: Emotional
Disturbances
• inappropriate affect –
– Laughing or crying at
inappropriate times
– Inappropriate sexuality, anger,
etc.
• ambivalent affect –
– Emotional range is marked and
dramatic
• flat affect –
– No emotional response
Schizophrenia: Behavioural
Disturbances
• Disturbances in behaviour
may take the form of
unusual actions that have
special meaning
• The abnormal behaviours
of individuals with
schizophrenia are often
related to disturbances in
their perceptions,
thoughts and feelings
Etta – video clip
Five Types of Schizophrenia
Table 15.5
• Paranoid hallucinations and delusions of persecution or
grandeur (or both); may have irrational jealousy
• Catatonic - two subtypes:
• Excited type – agitated motor activity
• Withdrawn type – stupor; waxy flexibility
• Disorganized - characterized by severely disturbed
thought processes, incoherence, disorganized
behaviour, and inappropriate affect, bizarre
emotions, loss of reality, poor hygiene
Five Types of Schizophrenia
(cont’d)
• Residual at least one previous episode with
psychotic symptoms, continuing
evidence of the illness (less severe
because still have some grasp of reality)
• Undifferentiated –
– Delusions, hallucinations,
incoherence, grossly disorganized
behavior, but doesn’t meet criteria of
other subtypes
Causes of Schizophrenia
• Diathesis-stress model of
schizophrenia –
– Biology
• Twin studies (identical = 48% concordance
/ fraternal = 17%)
• Parent-child (1 = 3 to 14% / 2 = 35%)
• Brain structures – enlarged ventricles
– Environment
• Emotionally fragmented
– Alcoholism, abuse, communication patterns
Causes of Schizophrenia
Biological Factors:
• Genetics
• Neurotransmitters (dopamine – too much);
glutamate; GABA
• Brain Function
Psychosocial (Environmental) Factors:
a “trigger” of some sort
Nature and Nurture
• The development of
schizophrenia does not
occur through a simple
mechanism
• Both biology and
environment are involved
• Vulnerability is a
diminished ability to deal
with demanding life
events
MEDIA DEPICTION OF
SCHIZOPHRENIA
Personality Disorders
Personality Disorders
• Axis II of the DSM
classification system
• Personality disorders –
psychological disorders
characterized by
inflexible and longstanding maladaptive
behaviours that typically
cause stress and/or
social or occupational
problems
Personality Disorders: Clusters
• Three broad classes or clusters:
A) odd or eccentric –
Paranoid PDO
B) dramatic, emotional, or erratic –
Borderline PDO
Histrionic PDO
Narcissistic PDO
Anti-social PDO
C) anxious or fearful –
Dependent PDO