Download Psychological Disorders

Psychological Disorders
Chapter 16
Copyright © 2007 Pearson Education
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Chapter Outline
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Defining and diagnosing disorder
Anxiety disorders
Mood disorders
Personality disorders
Drug abuse and addiction
Dissociative identity disorder
Schizophrenia
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Defining and Diagnosing
Disorder
• Dilemmas of definition
• Dilemmas of diagnosis
• Dilemmas of measurement
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Dilemmas of Definition
• Possible Models for Defining Disorders:
– Mental disorder as a violation of cultural
standards
– Mental disorder as maladaptive or harmful
behaviour
– Mental disorder as emotional distress
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Mental Disorder
• Any behaviour or emotional state that causes
an individual great suffering or worry, is selfdefeating or self-destructive, or is
maladaptive and disrupts the person’s
relationships or the larger community
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Diagnostic and Statistical Manual
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Axis I: Primary clinical problem
Axis II: Personality disorders
Axis III: General medical conditions
Axis IV: Social and environmental
stressors
• Axis V: Global assessment of overall
functioning
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Explosion of Mental Disorders
• Supporters of new
categories answer that
is important to
distinguish disorders
precisely
• Critics point to an
economic reason:
diagnoses are needed
for insurance reasons
so therapists will be
compensated
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Problems with DSM
• The danger of overdiagnosis
• The power of diagnostic labels
• Confusion of serious mental disorders
with normal problems
• The illusion of objectivity and
universality
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Advantages of the DSM
• When the manual is used correctly and
diagnoses are made with valid objective
tests, the DSM improves the reliability of
and agreement among clinicians
• The DSM-IV included for the first time a
list of culture-bound syndromes,
disorders specific to a particular culture
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Anxiety Disorders
• Generalized Anxiety Disorder
– A continuous state of anxiety marked by feelings
of worry and dread, apprehension, difficulties in
concentration, and signs of motor tension
• Panic Disorder
– An anxiety disorder in which a person experiences
recurring panic attacks, feelings of impending
doom or death, accompanied by physiological
symptoms such as rapid breathing and dizziness
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Posttraumatic Stress Disorder (PTSD)
• An anxiety disorder in which a person who has
experienced a traumatic or life-threatening
event has symptoms such as psychic numbing,
reliving the trauma, and increased physiological
arousal
• Diagnosed only if symptoms persist for 6
months or longer
• May immediately follow event or occur later
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Panic Disorder
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An anxiety disorder in
which a person
experiences recurring
panic attacks, feelings
of impending doom or
death, accompanied
by physiological
symptoms such as
rapid breathing and
dizziness
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Fears and Phobias
• Phobia
– An exaggerated, unrealistic fear of a
specific situation, activity, or object
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Agoraphobia
• A set of phobias, often set off by a panic
attack, involving the basic fear of being
away from a safe place or person
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Obsessive-Compulsive Disorder (OCD)
• An anxiety disorder in which a person
feels trapped in repetitive, persistent
thoughts (obsessions) and repetitive,
ritualized behaviours (compulsions)
designed to reduce anxiety
• Person understands that the ritual
behaviour is senseless but guilt mounts
if not performed
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Mood Disorders
• Depression
• Bipolar Disorder
• Theories of Depression
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Depression
• Major Depression
– A mood disorder involving disturbances in
emotion (excessive sadness), behaviour
(loss of interest in one’s usual activities),
cognition (thoughts of hopelessness), and
body function (fatigue and loss of appetite)
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Symptoms of Depression
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Depressed mood
Reduced interest in almost all activities
Significant weight gain or loss, without dieting
Sleep disturbance (insomnia or too much sleep)
Change in motor activity (too much or too little)
Fatigue or loss of energy
Feelings of worthlessness or guilt
Reduced ability to think or concentrate
Recurrent thoughts of death
DSM IV Requires 5 of these
within the past 2 weeks
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Gender, Age, & Depression
• Women are about twice
as likely as men to be
diagnosed with
depression
– True around the world
• After age 65, rates of
depression drops
sharply in both sexes
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Bipolar Disorder
• A mood disorder in which episodes of
depression and mania (excessive euphoria)
occur
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The Bipolar Brain
• Bipolar disorder can
have rapid mood
swings
• These wild changes
are shown in brain
activity (right)
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Biological Theories of Depression
• Studies of adopted children support genetic
explanations of depression
• 5-HTT is a gene that is present in either a long or
short form
– 17% of individuals with the long form become severely
depressed
– 43% of Individuals with 2 copies of the short form
become depressed
• Genetics may also influence levels of serotonin
and other neurotransmitters
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Life Experiences and Circumstances
• Social explanations emphasize the
stressful circumstances of people’s
lives. Examples include:
– Loss of or problems with important
relationships throughout life
– Psychologists investigating sex
differences for depression have ruled out
hormones and genetics and are now
investigating life circumstances
• Women are less satisfied with work and
family and more likely to live in poverty
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Cognitive Habits
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Cognitive explanations
emphasize particular
habits of thinking and
ways of interpreting
events
Depressed people believe
their situation is
permanent and
uncontrollable
Rumination involves
brooding about negative
aspects of one’s life
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Vulnerability-Stress
Model
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“Vulnerability-Stress”
explanations draw on
all four explanations
described above
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Personality Disorders
• Problem Personalities
• Antisocial Personality Disorder
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Problem Personalities
• Personality Disorder
– Rigid, maladaptive patterns that cause personal
distress or an inability to get along with others
• Narcissistic Personality Disorder
– A disorder characterized by an exaggerated sense
of self-importance and self-absorption
• Paranoid Personality Disorder
– A disorder characterized by habitually
unreasonable and excessive suspiciousness and
jealousy
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Problem Personalities
• Borderline Personality Disorder
– A disorder characterized by intense but
unstable relationships, a fear of
abandonment by others, an unrealistic selfimage, and emotional volatility
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Antisocial Personality Disorder (APD)
• A disorder characterized by antisocial
behaviour such as lying, stealing,
manipulating others, and sometimes
violence; and a lack of guilt, shame and
empathy
– Sometimes called psychopathy or
sociopathy
• Occurs in 3% of all males and 1% of all
females
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Emotions and
Antisocial Personality Disorder
• People with APD were
slow to develop
classically conditioned
responses to anger,
pain, or shock
• Such responses
indicate normal
anxiety
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DSM Criteria for APD
• Must have 3 of these criteria and a history of
behaviours
– Repeatedly break the law
– They are deceitful, using aliases and lies to con
others
– They are impulsive and unable to plan ahead
– They repeatedly get into physical fights or assaults
– They show reckless disregard for own safety or that
of others
– They are irresponsible, failing to meet obligations to
others
– They lack remorse for actions that harm others
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Causes of APD
• Abnormalities in central nervous system
• Genetically influenced problems with impulse
control
• Brain damage
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Drug Abuse and Addiction
• Biology and addiction
• Learning, culture, and addiction
• Debating the causes of addiction
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Biology and Addiction
• The biological model holds that
addiction, whether to alcohol or other
drugs is due primarily to:
– a person’s biochemistry,
– metabolism, and
– genetic predisposition.
• Most evidence comes from twin studies
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The Addicted Brain
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Learning, Culture, and Addiction
• Addiction patterns vary according to cultural
practices and the social environment
• Policies of total abstinence tend to increase
addiction rates rather than reduce them
• Not all addicts have withdrawal symptoms
when they stop taking a drug
• Addiction does not depend on the properties
of the drug alone, but also on the reason for
taking it
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Debating the Causes of Addiction
• Has a physiological vulnerability to a drug
• Believes she or he has no control over the
drug
• Is encouraged to take the drug in binges, and
moderate use is neither tolerated nor taught
• Comes to rely on the drug as a method of
coping with problems, suppressing anger or
fear, or relieving pain
• Has a peer group using drugs or drinking
heavily
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Dissociative Identity Disorder
• Defining identity disorders
• The MPD controversy
• The sociocognitive explanation
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Dissociative Identity Disorders
• A controversial disorder marked by the
appearance within one person of two or
more distinct personalities, each with its
own name and traits; commonly known
as “Multiple Personality Disorder
(MPD)”
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The MPD Controversy
• First view
– MPD is common but often unrecognized or
misdiagnosed
– The disorder starts in childhood as means of
coping
– Trauma produced a mental splitting
• Second view
– Created through pressure and suggestions by
clinicians
– Since 1980, diagnoses increased from a handful
to tens of thousands
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Sociocognitive Explanation
• MPD is an extreme form of our ability to
present many aspects of our personalities to
others
• MPD is a socially acceptable way for some
troubled people to make sense of their
problems
• Therapists looking for MPD may reward
patients with attention and praise for
revealing more and more personalities
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Schizophrenia
• Symptoms of schizophrenia
• Theories of schizophrenia
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Symptoms of Schizophrenia
• Bizarre delusions
• Hallucinations and heightened sensory
awareness
• Disorganized, incoherent speech
• Grossly disorganized and inappropriate
behaviour
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Delusions and Hallucinations
• Delusions
– False beliefs that often accompany
schizophrenia and other psychotic
disorders
• Hallucinations
– Sensory experiences that occur in the
absence of actual stimulation
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Positive Symptoms
• Cognitive, emotional, and behavioural
excesses
– Examples of Positive Symptoms
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Hallucinations
Bizarre delusions
Incoherent speech
Inappropriate/Disorganized behaviours
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Negative Symptoms
• Cognitive, emotional, and behavioural
deficits
• Examples of Negative Symptoms
– Loss of motivation
– Emotional flatness
– Social withdrawal
– Slowed speech or no speech
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Theories of Schizophrenia
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Genetic predispositions
Structural brain abnormalities
Neurotransmitter abnormalities
Prenatal abnormalities
Adolescent abnormalities in brain
development
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Genetic Vulnerability to Schizophrenia
• The risk of developing
schizophrenia (i.e.,
prevalence) in one’s
lifetime increases as
the genetic relatedness
with a diagnosed
schizophrenic
increases
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Structural Brain Abnormalities
• Several abnormalities exist, especially when
schizophrenia is characterized by primarily
negative symptoms:
– Decreased brain weight
– Decreased volume in temporal lobe or
hippocampus
– Enlargement of ventricles
• About 25% do not have these observable
brain deficiencies
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Schizophrenia and the Brain
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Neurotransmitter Abnormalities
• Include serotonin, glutamate, and dopamine
• Many schizophrenics have high levels of
brain activity in brain areas served by
dopamine as well as greater numbers of
particular dopamine receptors
• Similar neurotransmitter abnormalities are
also found in depression and alcoholism
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Prenatal or Birth Complications
• Damage to the fetal brain increases
chances of schizophrenia and other
mental disorders
– May occur as a function of maternal
malnutrition, maternal illness
– May also occur if brain injury or oxygen
deprivation occurs at birth
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Adolescent Abnormalities in Brain
Development
• Normal pruning of excessive synapses
in the brain occurs during adolescence
• In schizophrenics, a greater number of
synapses are pruned away
– Many explain why first episode occurs in
adolescence or early adulthood
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