Download Chapter 16: Psychological disorders PowerPoint

Chapter 16:
Psychological
disorders
Slides prepared by
Randall E. Osborne, Texas State University-San Marcos,
adapted by Dr Mark Forshaw, Staffordshire University, UK
1
Identifying
Psychological
Disorders: What Is
Abnormal?
2
Identifying Psychological Disorders
• ‘Psychological Disorder’ is a relatively new
invention
– possessed by demons
– God’s punishment
– criminal
• Medical model
• DSM-5
3
Defining the Boundaries of
Normality
• Deviation from average?
• DSM-5 — three key elements for symptoms to
qualify as a potential mental disorder
– manifested in symptoms that involve disturbances in
behaviour, thoughts, or emotions
– symptoms associated with personal distress or
impairment
– symptoms stem from an internal dysfunction
biological, psychological, or both
4
Defining the Boundaries of
Normality
• Determining the degree to which a person
has a mental disorder is difficult
• Global assessment of functioning
• European System
– ICD-10, published by World Health
Organization
– Differs from DSM-5 on criteria
– Only transient tic disorder is identical in both
systems!
5
Classification
• North American and European clinicians
used to divide disorders into just two
categories:
– psychosis
– neurosis
• 1952 — Diagnostic Manual of Mental
Disorders (DSM) published
– recognized need to have a consensual
diagnostic system
6
Classification
• DSM-5
- Neurosis — now anxiety disorders
- each of the anxiety disorders, then, is defined by
observable features such as excessive anxiety in
general, in a particular setting, etc.
- Comorbidity — diagnosis is also difficult
because some people suffer from more than one
disorder
7
Classification & Causation
• The medical model suggests that a
diagnosis is useful, because any given
category of illness is likely to have a
distinctive cause
• Aetiology of mental disorders
• Common prognosis
• In reality, it is too simplistic to think that
there is a single cause, internal to the
person that has a single cure
8
Classification & Causation
• Integrated perspective
– biological factors
– psychological factors
– environmental factors
• Diathesis-stress model — predisposed
with a trigger
– a diathesis can be inherited (heritability)
– stressful conditions, though, needed to trigger
9
Consequences of Labelling
• Stigma may explain why 70% of people
with diagnosable mental disorders do not
seek treatment
• Erroneous beliefs
– mental disorder is a sign of personal
weakness
– psychiatric patients are dangerous
– education about mental disorders dispels the
stigma
10
Anxiety Disorders:
When Fears Take
Over
11
Generalized Anxiety Disorder
• Anxiety disorder
• Generalized anxiety disorder
– Focused on everything and nothing in
particular
– 1 in 50 people at some point in life
– benzodiazepines (valium, librium) stimulate
GABA
12
Phobic Disorders
• Specific phobia
• Social phobia
• Preparedness theory
• Temperament
• Abnormalities in neurotransmitters
serotonin and dopamine common
13
Panic Disorder
• Panic disorder — recurring panic attacks
• Agoraphobia
• 8-12% have an occasional panic attack
– Usually during intense stress
• Modest heritability component
• Those with panic disorder acutely
sensitive to sodium lactate (reinforces
biological view)
14
Obsessive-Compulsive Disorder
• Anxiety plays a role
• Primary symptom is unwanted, recurrent
thoughts (obsession) and actions
(compulsion)
• Numbers often take on exaggerated
meaning
• 2.5% prevalence rate
• e.g. David Beckham’s soft drink cans
15
Obsessive-Compulsive Disorder
• Most common obsessions involve contamination,
aggression, death, sex, disease, orderliness, and
disfigurement
• Most common compulsions involve cleaning,
checking, repeating, ordering/arranging, and counting
• Obsessions typically derive from concerns that
could pose a real threat (e.g., contamination,
disease) — preparedness theory
– but perceived threat is extreme and becomes
maladaptive
16
Dissociative Disorders:
Going to Pieces
17
Dissociative Disorders
• Dissociative disorder
• Dissociative identity disorder
• 0.5 to 1% prevalence
• Female-to-male ratio = 9 to 1
• Most report history of severe childhood
abuse and trauma
18
Dissociative Disorders
• Cannot result from normal forgetting or brain
injury, drugs, or another mental disorder
• Dissociative amnesia
– loss is usually for a traumatic specific event or
period of time
• Dissociative fugue
– loss of former identity and assumption of a new
identity
19
Mood Disorders: At the
Mercy of Emotions
20
Mood Disorders
• Depressive disorders
• Much more than sadness
– dysfunctional
– chronic
– outside socially or culturally accepted norms
• Not the same as sorrow and grief
– normal, possibly adaptive, response to a
tragic situation
21
Depressive Disorders
• Major depressive disorder
– twice as common in women as men
hormones, postnatal depression
response style
• Dysthymia
– same symptoms, less severe
• Recurrent depressive disorder = major
depressive disorder + dysthymia
• Seasonal affective disorder (SAD)
22
Depressive Disorders — Biological
Factors
• Heritability estimates range from 33-45%
• Drugs that affect noradrenaline and
serotonin could reduce depression
• Diminished activity in left prefrontal cortex
and increased activity in right
– areas associated with the processing of
emotions
23
Depressive Disorders —
Psychological Factors
• Negative cognitive style
• Helplessness theory
– Some people construct social worlds in ways that
contribute to and confirm their negative beliefs
• Depressed low self-esteem individuals seek confirming
negative feedback
• Depressive realism hypothesis
– Non-depressed people are actually less realistic than
depressed people
24
Bipolar Disorder
• Bipolar disorder
– Higher and lower moods, both phases can be
disabling
• Lifetime risk of 1.3% for both genders
– 10% have rapid-cycling bipolar disorder
– 4 or more mood episodes per year
• Persistent illness
– 24% relapsed within 6 months
– 77% have at least one new episode within 4
years
25
Bipolar Disorder
• Biological factors
– high rate of heritability (80% for identical
twins)
– close relatives also at heightened risk for
unipolar depression
– bipolar disorder may be polygenic
• Psychological factors
– stressful life experiences
– stress + personality
26
Schizophrenia: Losing
the Grasp on Reality
27
Schizophrenia
• Schizophrenia
– profound disruption of psychological processes,
distorted perceptions, altered emotions
• Symptoms
–
–
–
–
–
delusion
hallucination
disorganised speech
grossly disorganised or catatonic behaviour
negative symptoms (e.g., blunted affect)
28
Schizophrenia - Subtypes
• ICD-10 gives subtypes
– Paranoid
– Catatonic
– Hebephrenic
– Undifferentiated
– Residual
– Simple
29
Schizophrenia
• Biological factors
– symptoms are so severe it suggests “organic”
origins
– strong heritability
– prenatal exposure to toxins
• Dopamine hypothesis
• Neuroanatomy
– enlarged ventricles
– tissue loss in parietal lobe progressing to
much of brain
30
Schizophrenia
• Psychological factors
• Family environment
– extreme conflict
– lack of communication
– chaotic relationships
• Expressed emotion
– intrusiveness
– excessive criticism
31
Personality Disorders:
Going to Extremes
32
Personality Disorders
• Personality disorders
– Deeply ingrained, inflexible patterns of thinking,
feeling or relating to others, difficulty controlling
impulses
• DSM-5 PDs fall into three clusters:
– odd/eccentric
– dramatic/erratic
– anxious/inhibited
33
Personality Disorders
• Antisocial personality disorder
– history of conduct disorder
– sociopath and psychopath
– one study of 22,790 prisoners — 47% of men
and 21% of women were diagnosed with APD
– less activity in amygdala and hippocampus to
words that elicit fear in non-APD
34