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Psychological Disorders Chapter 16 Copyright © 2007 Pearson Education Canada 1 Chapter Outline • • • • • • • Defining and diagnosing disorder Anxiety disorders Mood disorders Personality disorders Drug abuse and addiction Dissociative identity disorder Schizophrenia Copyright © 2007 Pearson Education Canada 2 Defining and Diagnosing Disorder • Dilemmas of definition • Dilemmas of diagnosis • Dilemmas of measurement Copyright © 2007 Pearson Education Canada 3 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 Copyright © 2007 Pearson Education Canada 4 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 Copyright © 2007 Pearson Education Canada 5 Diagnostic and Statistical Manual • • • • 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 Copyright © 2007 Pearson Education Canada 6 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 Copyright © 2007 Pearson Education Canada 7 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 Copyright © 2007 Pearson Education Canada 8 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 Copyright © 2007 Pearson Education Canada 9 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 Copyright © 2007 Pearson Education Canada 10 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 Copyright © 2007 Pearson Education Canada 11 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 Copyright © 2007 Pearson Education Canada 12 Fears and Phobias • Phobia – An exaggerated, unrealistic fear of a specific situation, activity, or object Copyright © 2007 Pearson Education Canada 13 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 Copyright © 2007 Pearson Education Canada 14 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 Copyright © 2007 Pearson Education Canada 15 Mood Disorders • Depression • Bipolar Disorder • Theories of Depression Copyright © 2007 Pearson Education Canada 16 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) Copyright © 2007 Pearson Education Canada 17 Symptoms of Depression • • • • • • • • • 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 Copyright © 2007 Pearson Education Canada 18 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 Copyright © 2007 Pearson Education Canada 19 Bipolar Disorder • A mood disorder in which episodes of depression and mania (excessive euphoria) occur Copyright © 2007 Pearson Education Canada 20 The Bipolar Brain • Bipolar disorder can have rapid mood swings • These wild changes are shown in brain activity (right) Copyright © 2007 Pearson Education Canada 21 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 Copyright © 2007 Pearson Education Canada 22 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 Copyright © 2007 Pearson Education Canada 23 Cognitive Habits • • • 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 Copyright © 2007 Pearson Education Canada 24 Vulnerability-Stress Model • “Vulnerability-Stress” explanations draw on all four explanations described above Copyright © 2007 Pearson Education Canada 25 Personality Disorders • Problem Personalities • Antisocial Personality Disorder Copyright © 2007 Pearson Education Canada 26 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 Copyright © 2007 Pearson Education Canada 27 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 Copyright © 2007 Pearson Education Canada 28 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 Copyright © 2007 Pearson Education Canada 29 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 Copyright © 2007 Pearson Education Canada 30 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 Copyright © 2007 Pearson Education Canada 31 Causes of APD • Abnormalities in central nervous system • Genetically influenced problems with impulse control • Brain damage Copyright © 2007 Pearson Education Canada 32 Drug Abuse and Addiction • Biology and addiction • Learning, culture, and addiction • Debating the causes of addiction Copyright © 2007 Pearson Education Canada 33 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 Copyright © 2007 Pearson Education Canada 34 The Addicted Brain Copyright © 2007 Pearson Education Canada 35 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 Copyright © 2007 Pearson Education Canada 36 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 Copyright © 2007 Pearson Education Canada 37 Dissociative Identity Disorder • Defining identity disorders • The MPD controversy • The sociocognitive explanation Copyright © 2007 Pearson Education Canada 38 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)” Copyright © 2007 Pearson Education Canada 39 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 Copyright © 2007 Pearson Education Canada 40 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 Copyright © 2007 Pearson Education Canada 41 Schizophrenia • Symptoms of schizophrenia • Theories of schizophrenia Copyright © 2007 Pearson Education Canada 42 Symptoms of Schizophrenia • Bizarre delusions • Hallucinations and heightened sensory awareness • Disorganized, incoherent speech • Grossly disorganized and inappropriate behaviour Copyright © 2007 Pearson Education Canada 43 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 Copyright © 2007 Pearson Education Canada 44 Positive Symptoms • Cognitive, emotional, and behavioural excesses – Examples of Positive Symptoms • • • • Hallucinations Bizarre delusions Incoherent speech Inappropriate/Disorganized behaviours Copyright © 2007 Pearson Education Canada 45 Negative Symptoms • Cognitive, emotional, and behavioural deficits • Examples of Negative Symptoms – Loss of motivation – Emotional flatness – Social withdrawal – Slowed speech or no speech Copyright © 2007 Pearson Education Canada 46 Theories of Schizophrenia • • • • • Genetic predispositions Structural brain abnormalities Neurotransmitter abnormalities Prenatal abnormalities Adolescent abnormalities in brain development Copyright © 2007 Pearson Education Canada 47 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 Copyright © 2007 Pearson Education Canada 48 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 Copyright © 2007 Pearson Education Canada 49 Schizophrenia and the Brain Copyright © 2007 Pearson Education Canada 50 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 Copyright © 2007 Pearson Education Canada 51 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 Copyright © 2007 Pearson Education Canada 52 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 Copyright © 2007 Pearson Education Canada 53