Download Personality Disorder

EXPLORING
PSYCHOLOGY
(7th Edition)
David Myers
PowerPoint Slides
Aneeq Ahmad
Henderson State University
Worth Publishers, © 2008
1
Psychological Disorders
Chapter 13
2
Psychological Disorders
I felt the need to clean my room … would spend four to
five hours at it … At the time I loved doing it. Then I
didn't want to do it any more, but I couldn’t stop … The
clothes hung … two fingers apart …I touched my
bedroom wall before leaving the house … I had
constant anxiety … I thought I might be nuts.
Marc, diagnosed with
obsessive-compulsive disorder
(from Summers, 1996)
3
Psychological Disorders
People are fascinated by the exceptional, the
unusual, and the abnormal. This fascination
may be caused by two reasons:
1.
During various moments we feel, think, and act
like an abnormal individual.
2.
Psychological disorders may bring unexplained
physical symptoms, irrational fears, and suicidal
thoughts.
4
Psychological Disorders
To study the abnormal is the best way of
understanding the normal.
William James (1842-1910)
1.
There are 450 million people suffering from
psychological disorders (WHO, 2004). What is the
implication of this statement?
2.
Depression and schizophrenia exist in all cultures
of the world. What is the implication of this
statement?
5
BEWARE OF
MEDICAL
STUDENT’S
DISEASE!!
6
EXAMPLE
• In a few sentences, describe an example of
behavior you would label as abnormal. Do
not include any names or information that
would identify the people involved.
• Why do you consider the behavior to be
abnormal? List one to three reasons.
7
Normal or Abnormal? Why?
• He suffers from severe fits of depression
periodically. He can be very charming among
people, but he frequently isolates himself from all
human contact. He has had an excessively close
relationship with his mother and then his
stepmother. Although he behaves respectfully
toward his father, he secretly hates him. He is
very, very fond of telling dirty jokes to whomever
will listen.
8
Defining Psychological Disorders
Mental health workers view psychological
disorders as persistently harmful thoughts,
feelings, and actions.
When behavior is atypical, disturbing,
maladaptive and unjustifiable psychiatrists and
psychologists label it as disordered
9
Maladaptive
• An exaggeration of normal, acceptable
behaviors
• Destructive to oneself or others
Unjustifiable
• A behavior which does not have a
rational basis
Disturbing
• A behavior which is troublesome to
other people
Atypical
• A behavior so different from other
people’s behavior that it violates a norm
• Norms vary from culture to culture
MUDA
• A mnemonic device used to remember
the four attributes of a psychological
disorder
– Maladaptive
– Unjustifiable
– Disturbing
– Atypical
ALTERNATIVE
TERMINOLOGY
• Deviant = Atypical
• Dysfunctional = Maladaptive
• Distressful = Disturbing
15
CASE STUDY: JUDY SMITH
• Read the case study of Judy Smith.
• Analyze the case to determine how Judy Smith
suffers from a psychological disorder by
answering the questions on the back of your paper.
• Keep in mind the definitions of
– Atypical (Deviant): behavior differing from the norm
– Disturbing (Distressful): causing misery or suffering to
the person
– Maladaptive (Dysfunctional): impaired or unhealthy
behavior causing an inability to be successful in job,
school, etc.
– Unjustifiable
16
Understanding Psychological
Disorders
Ancient Treatments of psychological disorders
include trephination, exorcism, being caged like
animals, being beaten, burned, castrated,
mutilated, or transfused with animal’s blood.
John W. Verano
Trephination (boring holes in the skull to remove evil forces)
17
The Medical Model
Philippe Pinel (1745-1826) from France, insisted
that madness was not due to demonic possession,
but an ailment of the mind.
George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago
Dance in the madhouse.
18
Medical Model
When physicians discovered that syphilis led to
mental disorders, they started using medical models
to review the physical causes of these disorders.
1.
2.
3.
4.
Etiology: Cause and development of the
disorder.
Diagnosis: Identifying (symptoms) and
distinguishing one disease from another.
Treatment: Treating a disorder in a psychiatric
hospital.
Prognosis: Forecast about the disorder.
19
The Biopsychosocial Approach
Assumes that biological, socio-cultural, and
psychological factors combine and interact to
produce psychological disorders.
20
Classifying Psychological Disorders
The American Psychiatric Association rendered
a Diagnostic and Statistical Manual of Mental
Disorders (DSM) to describe psychological
disorders.
The most recent edition, DSM-IV-TR (Text
Revision, 2000), describes 400 psychological
disorders compared to 60 in the 1950s.
21
Multiaxial Classification
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?
22
Multiaxial Classification
Note 16 syndromes in Axis I
23
Multiaxial Classification
Note Global Assessment for Axis V
24
Goals of DSM
1.
2.
Describe (400) disorders.
Determine how prevalent the
disorder is.
Disorders outlined by DSM-IV are reliable.
Therefore, diagnoses by different professionals
are similar.
Others criticize DSM-IV for “putting any kind
of behavior within the compass of psychiatry.”
25
Labeling Psychological Disorders
1. Critics of the DSM-IV argue that labels may
stigmatize individuals.
Elizabeth Eckert, Middletown, NY. From L. Gamwell and
N. Tomes, Madness in America, 1995. Cornell University Press.
Asylum baseball team (labeling)
26
Labeling Psychological Disorders
2. Labels may be helpful for healthcare
professionals when communicating with
one another and establishing therapy.
27
Labeling Psychological Disorders
3.
Elaine Thompson/ AP Photo
“Insanity” labels raise
moral and ethical
questions about how
society should treat
people who have
disorders and have
committed crimes.
Insanity is a legal not
psychological term.
Theodore Kaczynski
(Unabomber)
28
Anxiety Disorders
Feelings of excessive apprehension and anxiety.
1.
2.
3.
4.
5.
Generalized anxiety disorder
Panic disorder
Phobias
Obsessive-compulsive disorder
Post-traumatic stress disorder
29
Generalized Anxiety Disorder
Symptoms
1. Persistent and uncontrollable tenseness and
apprehension.
2. Autonomic arousal - define.
3. Inability to identify or avoid the cause of
certain feelings.
30
Panic Disorder
Symptoms
Minutes-long episodes of intense dread which
may include feelings of terror, chest pains,
choking, or other frightening sensations.
Anxiety is a component of both disorders. It
occurs more in the panic disorder, making
people avoid situations that cause it.
31
Phobias
Marked by a persistent and irrational fear of an
object or situation that disrupts behavior.
32
Kinds of Phobias
Agoraphobia
Acrophobia
Claustrophobia
Hemophobia
Phobia of open places.
Phobia of heights.
Phobia of closed spaces.
Phobia of blood.
33
Morning Routine
Write a brief description of your morning
routine, listing in order the basic things you
do from the moment you wake until you are
ready to leave the house.
34
Morning Routine
• Is your routine the same every day?
• Would it cause you tension if your routine
was changed?
• Would it cause you tension if someone
intruded on your routine?
35
Morning Routine
This is a characterization of a compulsion,
which is a form of neurosis, but before you
decide that you are neurotic, let me read the
following:
36
OBSESSIVE/COMPULSIVE
She dresses in black from head to toe every
day. On her way to each class, she
invariably takes exactly the same route
every day, changing it for nothing or no
one. Not only does she avoid stepping on
cracks in the floor, but also she walks on the
same floor tiles and she counts every
footfall.
37
OBSESSIVE COMPULSIVE
Once in class, she sits in exactly the same
seat as the day before, and she places her
book bag on the exact spot on the floor.
Whenever the teacher moves to the right
side of the room, the girl makes a mark in
her notebook. Whenever the teacher moves
to the left, the girl nods her head.
38
OBSESSIVE COMPULSIVE
If the teacher is on the left side of the room
when the class is dismissed, the girl is
confident that she has learned well. The girl
has no friends because her behavior is so
bizarre and absorbs too much of her energy
to allow her to be responsive to others.
Also, people are threatening to her, since
they may interfere with the demands of her
self-imposed rituals.
39
OBSESSIVE COMPULSIVE
How does the behavior described differ from your
morning routine?
Have you ever had a song in your head that
wouldn’t go away? How is this like an obsession?
40
Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions)
and urges to engage in senseless rituals
(compulsions) that cause distress.
41
Brain Imaging
A PET scan of the brain
of a person with
Obsessive-Compulsive
Disorder (OCD). High
metabolic activity (red)
in the frontal lobe areas
are involved with
directing attention.
Brain image of an OCD
42
VIDEO CLIP (6 minutes)
United Streaming: Obsessive Compulsive
Behavior
43
Post-Traumatic Stress Disorder
Four or more weeks of the following symptoms
constitute post-traumatic stress disorder
(PTSD):
1. Haunting memories
2. Nightmares
3. Social withdrawal
Bettmann/ Corbis
4. Jumpy anxiety
5. Sleep problems
44
Resilience to PTSD
Only about 10% of women and 20% of men
react to traumatic situations and develop PTSD.
Holocaust survivors show remarkable resilience
against traumatic situations.
All major religions of the world suggest that
surviving a trauma leads to the growth of an
individual.
45
Dissociative Disorders
Conscious awareness becomes separated
(dissociated) from previous memories,
thoughts, and feelings.
Symptoms
1. Having a sense of being unreal.
2. Being separated from the body.
3. Watching yourself as if in a movie.
46
Dissociative Identity Disorder (DID)
A disorder in which a person exhibits two or
more distinct and alternating personalities,
formerly called multiple personality disorder.
Lois Bernstein/ Gamma Liason
Chris Sizemore (DID)
47
DID Critics
Critics argue that the diagnosis of DID
increased in the late 20th century. DID has
not been found in other countries.
Critics’ Arguments
1. Role-playing by people open to a
therapist’s suggestion.
2. Learned response that reinforces
reductions in anxiety.
48
Personality Disorders
Personality disorders
are characterized by
inflexible and
enduring behavior
patterns that impair
social functioning.
They are usually
without anxiety,
depression, or
delusions.
49
Antisocial Personality Disorder
A disorder in which the person (usually men) exhibits a
lack of conscience for wrongdoing, even toward friends
and family members. Formerly, this person was called a
sociopath or psychopath.
Read the case study: Profile of a Sociopath.
Look for examples of the following symptoms:
Conscienceless
Manipulative
Impulsive
Difficult to reform
Superficial emotion
50
Antisocial Personality Disorder
Characteristics
• Give an example from Erica’s profile of
each characteristic:
–
–
–
–
–
Consciencelessness
Manipulative
Impulsive
Difficult to reform
Superficial emotion
51
Understanding Antisocial
Personality Disorder
PET scans of 41 murderers revealed reduced
activity in the frontal lobes. In a follow-up study,
repeat offenders had 11% less frontal lobe activity
(Raine et al., 1999; 2000).
Courtesy of Adrian Raine,
University of Southern California
Normal
Murderer
52
Mood Disorders
Emotional extremes of mood disorders come in
two principal forms.
1. Major depressive disorder
2. Bipolar disorder
53
Major Depressive Disorder
Depression is the “common cold” of
psychological disorders. In a year, 5.8% of men
and 9.5% of women report depression
worldwide (WHO, 2002).
Blue mood
Major Depressive Disorder
Gasping for air after a
hard run
Chronic shortness of
breath
54
Major Depressive Disorder
Major depressive disorder occurs when signs of
depression last two weeks or more and are not
caused by drugs or medical conditions.
1.
2.
3.
4.
Signs include:
Lethargy and fatigue
Feelings of worthlessness
Loss of interest in family & friends
Loss of interest in activities
55
Bipolar Disorder
Formerly called manic-depressive disorder. An
alternation between depression and mania
signals bipolar disorder.
Depressive Symptoms
Manic Symptoms
Gloomy
Elation
Withdrawn
Euphoria
Inability to make decisions
Tired
Slowness of thought
Desire for action
Hyperactive
Multiple ideas
56
Bipolar Disorder
Many great writers, poets, and composers
suffered from bipolar disorder. During their
manic phase creativity surged, but not during
their depressed phase.
Earl Theissen/ Hulton Getty Pictures Library
The Granger Collection
Wolfe
George C. Beresford/ Hulton Getty Pictures Library
Bettmann/ Corbis
Whitman
Clemens
Hemingway
57
CASE STUDY ACTIVITY
• In a small group prepare a case study of a
person suffering from major depressive
disorder and a person suffering from
bipolar disorder.
• The assignment will be handed in.
• Each case study should
– Sound realistic
– Incorporate the major symptoms of the disorder
58
CASE STUDIES
• Listen to your classmates as they read their
case studies.
• Determine the symptoms of the disorder
they have included.
• Are there any other symptoms they should
have included?
59
Schizophrenia
The literal translation is “split mind” which
refers to a split from reality. A group of severe
disorders characterized by the following:
1. Disorganized and delusional
thinking.
2. Disturbed perceptions.
3. Inappropriate emotions and
actions.
60
SCHIZOPHRENIA EXAMPLE
• Describe Concetta’s life before the onset of the
disorder
• When did Concetta first develop the disorder?
• What were the factors that were stressful in
Concetta’s life?
• What were Concetta’s symptoms?
• What was the long term prognosis for Concetta?
• Star Wars Case Study
61
VIDEO OF SCHIZOPHRENIA
• As you view the clips determine what
symptoms of schizophrenia the patients are
exhibiting
• Do you notice differences in the severity of
the symptoms between patients?
62
Symptoms of Schizophrenia
Positive symptoms: the presence of inappropriate
behaviors (hallucinations, disorganized or
delusional talking)
Negative symptoms: the absence of appropriate
behaviors (expressionless faces, rigid bodies)
63
Disorganized & Delusional Thinking
This morning when I was at Hillside [Hospital], I was
making a movie. I was surrounded by movie stars …
I’m Mary Poppins. Is this room painted blue to get me
upset? My grandmother died four weeks after my
eighteenth birthday.”
(Sheehan, 1982)
Other
forms of delusions
delusions
of
This
monologue
illustratesinclude,
fragmented,
bizarre
persecution
is following
me”) or
thinking
with (“someone
distorted beliefs
called delusions
grandeur
(“I am
a king”).
(“I’m Mary
Poppins”).
64
Disorganized & Delusional Thinking
Many psychologists believe disorganized
thoughts occur because of selective attention
failure (fragmented and bizarre thoughts).
65
Disturbed Perceptions
A schizophrenic person may perceive things
that are not there (hallucinations). Frequently
such hallucinations are auditory and lesser
visual, somatosensory, olfactory, or gustatory.
L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg
Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg
66
Inappropriate Emotions & Actions
A schizophrenic person may laugh at the news
of someone dying or show no emotion at all
(flat affect).
Patients with schizophrenia may continually
rub an arm, rock a chair, or remain motionless
for hours (catatonia).
67
Onset and Development of
Schizophrenia
Nearly 1 in a 100 suffer from schizophrenia, and
throughout the world over 24 million people
suffer from this disease (WHO, 2002).
Schizophrenia strikes young people as they
mature into adults. It affects men and women
equally, but men suffer from it more severely
than women.
68
Chronic and Acute Schizophrenia
When schizophrenia is slow to develop
(chronic/process) recovery is doubtful. Such
schizophrenics usually display negative
symptoms.
When schizophrenia rapidly develops
(acute/reactive) recovery is better. Such
schizophrenics usually show positive
symptoms.
69
A BEAUTIFUL MIND
• Read “Mind Over Matter”
• Complete “A Beautiful Mind” Viewing
Guide
70
REVIEW ACTIVITY
• Complete the following in your Study
Guide:
Pages 379 - 381: Progress Test 1
Questions: omit #’s 9, 14, 15, 19
• If you score a B or above: Go on to
Thinking Critically About Ch 13 (omit #’s
4,5, 15-20)
• If you score below a B, complete the
Matching Items on page 381 and 383.
71
Understanding Schizophrenia
Schizophrenia is a disease of the brain exhibited
by the symptoms of the mind.
Brain Abnormalities
Dopamine Overactivity: Researchers found that
schizophrenic patients express higher levels of
dopamine D4 receptors in the brain.
72
Abnormal Brain Activity
Brain scans show abnormal activity in the
frontal cortex, thalamus, and amygdala of
schizophrenic patients.
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Health
73
Abnormal Brain Morphology
Schizophrenia patients may exhibit
morphological changes in the brain like
enlargement of fluid-filled ventricles.
Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC
74
Viral Infection
Schizophrenia has also been observed in
individuals who contracted a viral infection
(flu) during the middle of their fetal
development.
75
Genetic Factors
The likelihood of an individual suffering from
schizophrenia is 50% if their identical twin has
the disease (Gottesman, 2001).
0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
76
Genetic Factors
The following shows the prevalence of
schizophrenia in identical twins as seen in
different countries.
77
Psychological Factors
Psychological and environmental factors can
trigger schizophrenia if the individual is
genetically predisposed (Nicol & Gottesman,
1983).
Courtesy of Genain Family
Genain Sisters
The genetically identical
Genain
sisters suffer from
schizophrenia. Two more than
others, thus there are
contributing environmental
factors.
78
Rates of Psychological Disorders
79
Rates of Psychological Disorders
The prevalence of psychological disorders during
the previous year is shown below (WHO, 2004).
80