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PSYCHOLOGY: MAKING CONNECTIONS GREGORY J. FEIST ERIKA L. ROSENBERG Copyright 2010 The McGraw-Hill Companies, Inc. Psychological Disorders Chapter Fifteen Copyright 2010 The McGraw-Hill Companies, Inc. Preview Questions How do we know whether or not someone’s behavior is disordered? What causes mental illness? Should I be concerned about my roommate, who is tired all the time and doesn't feel like doing anything? Copyright 2010 The McGraw-Hill Companies, Inc. Preview Questions What is the chance that my friend who has an identical twin sister with bipolar disorder will also develop this disorder? Copyright 2010 The McGraw-Hill Companies, Inc. Chapter Preview Defining Psychological Disorders Anxiety Disorders Mood Disorders Schizophrenia Dissociative Disorders Copyright 2010 The McGraw-Hill Companies, Inc. Chapter Preview Breaking New Ground: Abuse, Disorders, and the Dynamic Brain Personality Disorders Childhood Disorders Making Connections in Psychological Disorders: Creativity and Mental Health Copyright 2010 The McGraw-Hill Companies, Inc. Defining Psychological Disorders Diagnostic and Statistical Manual IV-TR (DSM-IV-TR) – Axis I – – – – Syndromes Comorbidity Axis Axis Axis Axis II III IV V Copyright 2010 The McGraw-Hill Companies, Inc. Anxiety Disorders Copyright 2010 The McGraw-Hill Companies, Inc. Generalized Anxiety Disorder (GAD) Characterized by a pervasive and excessive state of anxiety lasting at least six months – “Worry warts” Copyright 2010 The McGraw-Hill Companies, Inc. Panic Disorder With or Without Agoraphobia Panic disorder – Panic attacks Sudden, short period of extreme anxiety involving physiological and psychological symptoms and intense fear – Agoraphobia Intense fear of being in places from which escape might be difficult or in which help might not be available should a panic attack occur Copyright 2010 The McGraw-Hill Companies, Inc. Post-Traumatic Stress Disorder (PTSD) Triggered by exposure to a catastrophic or horrifying event that poses serous harm or threat – Reexperiencing the trauma – Avoiding thoughts, feelings, and activities associated with the trauma – Increased arousal, irritability, difficulty sleeping, or exaggerated startle response Copyright 2010 The McGraw-Hill Companies, Inc. Social Phobia (Social Anxiety Disorder) Pronounced fear of humiliation in the presence of others Marked by severe self-consciousness about appearance or behavior or both Copyright 2010 The McGraw-Hill Companies, Inc. Specific Phobias Characterized by intense fear of particular objects or situations Marked by an intense and immediate fear, even panic, when confronted with very particular situations or objects Copyright 2010 The McGraw-Hill Companies, Inc. Obsessive-Compulsive Disorder Obsession – Unwanted thought, word, phrase, or image that persistently and repeatedly comes into a person’s mind and causes distress Copyright 2010 The McGraw-Hill Companies, Inc. Obsessive-Compulsive Disorder Compulsion – Repetitive behavior performed in response to uncontrollable urges or according to a ritualistic set of rules Copyright 2010 The McGraw-Hill Companies, Inc. Obsessive-Compulsive Disorder Impulse-control disorder – Related to OCD in which a person feels an intense, repetitive desire to perform certain behaviors Copyright 2010 The McGraw-Hill Companies, Inc. Nature and Nurture Explanations of Anxiety Disorders Diathesis-stress model – Combination of biological predispositions (diathesis) plus stress on an abusive environment Copyright 2010 The McGraw-Hill Companies, Inc. Mood Disorders Copyright 2010 The McGraw-Hill Companies, Inc. Depression and Its Causes Major depressive disorder – Characterized by pervasive low mood, lack of motivation, low energy, and feelings of worthlessness and guilt that last for at least two consecutive weeks – Dysthymia Form of depression that is milder that major depressive disorder Copyright 2010 The McGraw-Hill Companies, Inc. Depression and Its Causes Combination of brain chemistry and life circumstance – Diathesis-stress model Serotonin gene Stressful events Copyright 2010 The McGraw-Hill Companies, Inc. Bipolar Disorder and Its Causes Characterized by substantial mood fluctuations, a cycling between very low and very high moods – Manic episode – Cyclothymia Relatively mild form of bipolar disorder Copyright 2010 The McGraw-Hill Companies, Inc. Bipolar Disorder and Its Causes May be seen in development of fetus in a woman who abused alcohol Genetic component – Neurochemistry of brain Stress and trauma Copyright 2010 The McGraw-Hill Companies, Inc. The Bipolar Brain Copyright 2010 The McGraw-Hill Companies, Inc. Major Symptoms and Behaviors of Mood Disorders Copyright 2010 The McGraw-Hill Companies, Inc. Schizophrenia Copyright 2010 The McGraw-Hill Companies, Inc. Major Symptoms of Schizophrenia Positive – Hallucinations – Delusional thinking – Disorganized thought and speech Copyright 2010 The McGraw-Hill Companies, Inc. Major Symptoms of Schizophrenia Negative – Non-responsiveness – Emotional flatness – Immobility – Catatonia – Problems with speech – Inability to complete tasks Copyright 2010 The McGraw-Hill Companies, Inc. Major Symptoms of Schizophrenia Cognitive – Problems with working memory – Attention – Verbal and visual learning and memory – Reasoning and problem solving – Speed of processing – Disordered speech Word salad Copyright 2010 The McGraw-Hill Companies, Inc. Subtypes of Schizophrenia Paranoid – preoccupation with delusions and auditory hallucinations Catatonic – Two of the following: Extreme immobility or excessive activity, peculiar posturing, mutism, or parroting what other people say Copyright 2010 The McGraw-Hill Companies, Inc. Subtypes of Schizophrenia Disorganized – Exhibits both disorganized speech and behavior and flat or inappropriate affect Undifferentiated – General symptoms of delusions, hallucinations, and disorganized speech Copyright 2010 The McGraw-Hill Companies, Inc. Nature and Nurture Explanations of Schizophrenia Maternal infections and schizophrenia – Influenza – Rubella – Toxoplasmosis – Herpes Copyright 2010 The McGraw-Hill Companies, Inc. Nature and Nurture Explanations of Schizophrenia Schizophrenia and the brain – Abnormal brain development before birth – Dysfunctional prefrontal cortex Copyright 2010 The McGraw-Hill Companies, Inc. Nature and Nurture Explanations of Schizophrenia Neurochemistry of schizophrenia – Dopamine hypothesis Glutamate deficiencies Crucial in – – – – – Learning Memory Neural processing Brain development Amplifies certain neural signals Copyright 2010 The McGraw-Hill Companies, Inc. Dissociative Disorders Copyright 2010 The McGraw-Hill Companies, Inc. Dissociative Identity Disorder (DID) Development of at least two distinct personalities, each with its own memories, thoughts, behaviors, and emotions – “Multiple personality” Copyright 2010 The McGraw-Hill Companies, Inc. Causes of Dissociative Disorders Lived through a highly traumatic experience – Sexual or physical abuse – Survived a terrible accident or natural disaster in which one was killed Copyright 2010 The McGraw-Hill Companies, Inc. Breaking New Ground: Abuse, Disorders, and the Dynamic Brain Copyright 2010 The McGraw-Hill Companies, Inc. Abuse and Neglect Change Brains Adverse Childhood Experiences (ACE) study – Abuse and neglect shape long-term behavior, physical, and psychological health Illness and disease, substance abuse, aggression and violence, and depression and schizophrenia were more likely to occur after being abused Copyright 2010 The McGraw-Hill Companies, Inc. Personality Disorders Copyright 2010 The McGraw-Hill Companies, Inc. Odd-Eccentric Personality Disorders Schizoid personality disorder – Wants a solitary life – Does not want close relationships – Emotionally aloof – Reclusive – Humorless Copyright 2010 The McGraw-Hill Companies, Inc. Odd-Eccentric Personality Disorders Schizotypal personality disorder – Isolated and asocial – Has very odd thoughts and beliefs Might think that stories in the newspaper or on the news are written directly about them Copyright 2010 The McGraw-Hill Companies, Inc. Odd-Eccentric Personality Disorders Paranoid personality disorder – Extremely suspicious and mistrustful of other people in ways that are both unwarranted and not adaptive – Test loyalty of their friends and lovers – Hold grudges for a long time Copyright 2010 The McGraw-Hill Companies, Inc. Dramatic-Emotional Personality Disorders Histrionic personality disorder – Want to be the center of attention – Dramatic, seductive, flamboyant, and exaggerated behavior – Emotional – Intense – Self-centered – Shallow in emotions and relationships Copyright 2010 The McGraw-Hill Companies, Inc. Dramatic-Emotional Personality Disorders Borderline personality disorder – Out-of-control emotions – Afraid of being abandoned by others – Vacillate between idealizing and despising those who are close to them – Likely to hurt themselves or suffer from eating disorders or substance abuse Copyright 2010 The McGraw-Hill Companies, Inc. Dramatic-Emotional Personality Disorders Narcissistic personality disorder – Extremely positive and arrogant selfimage – Attention is self-focused – Exaggerated sense of self-importance – Grandiose Think they are “God’s gift to humanity” Copyright 2010 The McGraw-Hill Companies, Inc. Dramatic-Emotional Personality Disorders Antisocial personality disorder – Impulsive – Deceptive – Violent – Ruthless behavior – Engage in criminal behavior Copyright 2010 The McGraw-Hill Companies, Inc. Anxious-Fearful Personality Disorder Avoidant personality disorder – Afraid of being criticized – Avoid interacting with others – Become socially isolated – Feel inadequate – Have low self-esteem Copyright 2010 The McGraw-Hill Companies, Inc. Anxious-Fearful Personality Disorder Dependent personality disorder – Fear being rejected – Strong need to be cared for Form clingy and dependent relationships with others – Feel safe only in relationships but tend to drive others away, because they are too demanding Copyright 2010 The McGraw-Hill Companies, Inc. Anxious-Fearful Personality Disorder Obsessive-compulsive personality disorder – Very rigid in habits – Extremely perfectionistic – More general than obsessive-compulsive disorder Copyright 2010 The McGraw-Hill Companies, Inc. Nature and Nurture Explanations of Personality Disorders Focus on antisocial personality disorder – Being male – Being from abusive and neglectful households – Having at least one psychological disorder – Head or brain injury Copyright 2010 The McGraw-Hill Companies, Inc. Childhood Disorders Copyright 2010 The McGraw-Hill Companies, Inc. Subtypes of Childhood Disorders Attention deficit hyperactivity disorder (ADHD) – Inability to focus attention for more than a few minutes, to remain still and quiet, to do careful work Copyright 2010 The McGraw-Hill Companies, Inc. Subtypes of Childhood Disorders Autism – Characterized by severe language and social impairment along with repetitive habits and inward focused behaviors – Pica – http://www.autismspeaks.org/whatautism/video-glossary Copyright 2010 The McGraw-Hill Companies, Inc. Subtypes of Childhood Disorders Asperger’s syndrome – Impaired social interest and skills and restricted interests – Not delayed or deficient in language – Have above-average intelligence Copyright 2010 The McGraw-Hill Companies, Inc. Reactive Attachment Disorder http://www.youtube.com/watch?v=ME 2wmFunCjU&feature=related Copyright 2010 The McGraw-Hill Companies, Inc. Mental Retardation “Functional Impairment” in multiple areas Lower IQ – Borderline – Mild – Moderate – Profound Copyright 2010 The McGraw-Hill Companies, Inc. Oppositional Defiant Disorder Frequent temper tantrums Excessive arguing with adults Often questioning rules Active defiance and refusal to comply with adult requests and rules Deliberate attempts to annoy or upset people Blaming others for his or her mistakes or misbehavior Often being touchy or easily annoyed by others Frequent anger and resentment Mean and hateful talking when upset Spiteful attitude and revenge seeking Copyright 2010 The McGraw-Hill Companies, Inc. Treatments for ODD Parent Management Training Programs to help parents and others manage the child’s behavior. Individual Psychotherapy -more effective anger management. Family Psychotherapy -improve communication and mutual understanding. Cognitive Problem-Solving Skills Training and Therapies to assist with problem solving and decrease negativity. Social Skills Training -increase flexibility and improve social skills and frustration tolerance with peers. Medication may be helpful in controlling some of the more distressing symptoms of ODD as well as the symptoms related to coexistent conditions such as ADHD, anxiety and mood disorders Copyright 2010 The McGraw-Hill Companies, Inc. Conduct Disorder Aggression to people and animals – bullies, threatens or intimidates others – often initiates physical fights – has used a weapon that could cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife or gun) – is physically cruel to people or animals – steals from a victim while confronting them (e.g. assault) – forces someone into sexual activity Copyright 2010 The McGraw-Hill Companies, Inc. Conduct Disorder Destruction of Property – deliberately engaged in fire setting with the intention to cause damage – deliberately destroys other's property Deceitfulness, lying, or stealing – has broken into someone else's building, house, or car – lies to obtain goods, or favors or to avoid obligations – steals items without confronting a victim (e.g. shoplifting, but without breaking and entering) Copyright 2010 The McGraw-Hill Companies, Inc. Conduct Disorder Serious violations of rules often stays out at night despite parental objections runs away from home often truant from school Copyright 2010 The McGraw-Hill Companies, Inc. Conduct Disorder They are often viewed by other children, adults and social agencies as "bad" or delinquent, rather than mentally ill. Many factors may contribute to a child developing conduct disorder, including brain damage, child abuse, genetic vulnerability, school failure, and traumatic life experiences. Copyright 2010 The McGraw-Hill Companies, Inc. Conduct Disorder Treatment Can be complex and challenging. Can be provided in a variety of different settings depending on the severity of the behaviors. Adding to the challenge of treatment are the child's uncooperative attitude, fear and distrust of adults. Behavior therapy and psychotherapy are usually necessary to help the child appropriately express and control anger. Special education may be needed for youngsters with learning disabilities. Parents often need expert assistance in devising and carrying out special management and educational programs in the home and at school. Treatment may also include medication in some youngsters, such as those withdifficulty paying attention, impulse problems, or those with depression. Treatment is rarely brief since establishing new attitudes and behavior patterns takes time. However, early treatment offers a child a better chance for considerable improvement and hope for a more successful future. Copyright 2010 The McGraw-Hill Companies, Inc. Causes of Childhood Disorders Stem from genetic factors but often remain latent unless triggered by some environmental condition In ADHD, brain has low levels of activation In autism, brain growth is much faster in the first few years of life Copyright 2010 The McGraw-Hill Companies, Inc. Making Connections in Psychological Disorders: Creativity and Mental Health Copyright 2010 The McGraw-Hill Companies, Inc. Psychotic Symptoms and Creativity Creativity and psychological disorders are related, especially in the arts – Some disorders occur at higher rates in creative artists than in members of other professions and in the general population Copyright 2010 The McGraw-Hill Companies, Inc.