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Chapter 12 Psychological Disorders This multimedia product and its contents are protected under copyright law. The following are prohibited by law: •Any public performance or display, including transmission of any image over a network; •Preparation of any derivative work, including the extraction, in whole or in part, of any images •Any rental, lease or lending of the program. • ISBN: 0-131-73180-7 Copyright © Allyn & Bacon 2007 What is Psychological Disorder? The medical model takes a “disease” view, while psychology sees psychological disorder as an interaction of biological, cognitive, social, and behavioral factors Copyright © Allyn & Bacon 2007 What is Psychological Disorder? Psychopathology – Any pattern of emotions, behaviors, or thoughts inappropriate to the situation and leading to personal distress or the inability to achieve important goals Synonymous terms include: Mental illness Mental disorder Psychological disorder Copyright © Allyn & Bacon 2007 What is Psychological Disorder? Three classic signs suggest severe psychological disorder • Hallucinations • Delusions • Severe affective disturbances Copyright © Allyn & Bacon 2007 Indicators of Abnormality Other signs of a disorder are more subtle, and a diagnosis depends heavily on clinical judgment Distress Maladaptiveness Irrationality Unpredictability Unconventionality and undesirable behavior Copyright © Allyn & Bacon 2007 Deviant: being different from most other people in one’s culture; may vary by context (example – wartime) and time (example - homosexuality was classified as an illness from 1952 to 1973) Men of the West Africa Wodaabe tribe put on elaborate makeup and costumes to attract women. In Western society, the same behavior would break behavioral norms and might be judged Distressful: causes the individual stress (pain, anxiety, sorrow, etc.) Dysfunction: considered to be disorderly if it impairs your everyday life Early Theories Abnormal behavior was evil spirits trying to get out, godlike powers, movement of stars Treatments: institutionalized, castration, drilling holes in skull, removing intestines, transfusion of animal blood, and more Medical Model By the 1800s, we started reforming the way we looked at mental illness and developed the medical model Mental illness needs to be diagnosed on basis of symptoms and cured through therapy and treatment Biopsychosocial Approach considers combination of biological, psychological, and social factors as contributing to development of disorders DSM IV American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders; a widely used system for classifying psychological disorders Lists symptoms, examples, etc. Helps psychologists diagnose disorders Used by insurance companies People First Language seeing individuals as people first and not defined by their disorder Ex: “a person with schizophrenia,” not “a schizophrenic” Labels can negatively affect the way we perceive people Example: What emotions come to you when you hear the words “cancer patient?” Labels can result in self-fulfilling prophecies Criticisms Are people with disorders truly mentally ill or are they just deviating from social norms? Rosenhan Study: associates were malingering symptoms of hearing voices. They were ALL admitted for schizophrenia. None were exposed as imposters. They all left diagnosed with schizophrenia in remission. What are some of the questions raised by this study? Changing Concepts of Psychological Disorder: The Cognitive-Behavioral Approach Behavioral perspective – Abnormal behaviors can be acquired through behavioral learning – operant and classical conditioning Cognitive perspective – Abnormal behaviors are influenced by mental processes – how people perceive themselves and their relations with others Copyright © Allyn & Bacon 2007 The Biopsychology of Mental Disorder Although most psychologists have reservations about the medical model, they do not deny the influence of biology on thought and behavior Copyright © Allyn & Bacon 2007 How are Psychological Disorders Classified? The most widely used system, found in the DSMIV, classifies disorders by their mental and behavioral symptoms Copyright © Allyn & Bacon 2007 Overview of DSM-IV Classification System DSM-IV – Fourth edition of the Diagnostic and Statistical Manual of Mental Disorders; the most widely accepted classification system in the United States Neurotic disorder or neurosis Psychotic disorder or psychosis In multiaxial diagnosis, professionals look at the entire person, not just their “abnormal” behavior Copyright © Allyn & Bacon 2007 Mood Disorders Major depression – Form of depression that does not alternate with mania Seasonal affective disorder (SAD) – Believed to be caused by deprivation of sunlight Copyright © Allyn & Bacon 2007 Mood Disorders Experience extreme or inappropriate emotion. Females are twice as likely as men to suffer from these – why do you think this is? Major Depressive Disorder Unhappy for at least two weeks with no apparent cause. A.K.A. unipolar depression Depression is the common cold of psychological disorders. – what does this mean? Why does it happen? Slows us down, diffuses aggression, restrains risk-taking, etc. Major Depression Symptoms of major depression: Lethargy Feelings of worthlessness Loss of interest in friends/family/activities Problems eating or sleeping Thoughts of suicide Depression is the #1 reason people seek mental health services Depression Example Norman, a Canadian college professor, recalling his depression: “I despaired of ever being human again. I honestly felt subhuman, lower than the lowest vermin. Furthermore, I was self-deprecatory and could not understand why anyone would want to associate with me, let alone love me… I was positive that I was a fraud and a phony and that I didn’t deserve my Ph.D. I didn’t deserve to have tenure; I didn’t deserve to be a Full Professor… I didn’t deserve the research grants I had been awarded; I couldn’t understand how I had written books and journal articles… I must have conned a lot of people.” Explanations for Depression Alcohol abuse increases risk Genetic influence • If identical twin has Major Depression, you are 50% likely to have it (compared to 20% if you have a fraternal twin) • Low amount of neurotransmitters • Serotonin and Norepinephrine Mood/arousal boosters Social/Cognitive differences • People with depression tend to blame themselves and have a negative explanatory style Mood DisordersDepression Mood DisordersDepression Canadian depression rates Methods of coping with Depression Mood Disorders- Suicide Seasonal Affective Disorder (SAD) Experience depression during the winter months. Based not on temperature, but on amount of sunlight. Treated with light therapy. Bipolar Disorder Bipolar disorder – Mental abnormality involving swings of mood from mania to depression Copyright © Allyn & Bacon 2007 Bipolar Disorder Formally manic depression. Involves alternating periods of depression and mania. Manic episodes involve feelings of high energy (but they tend to differ a lot…some get confident and some get irritable). Mark Twain Ernest Engage in risky behavior during the manic episode. Charlie Sheen? Mood Disorders-Bipolar PET scans show that brain energy consumption rises and falls with emotional switches Depressed state Manic state Depressed state Bipolar I and Bipolar II Two Main Distinctions Bipolar I Disorder: Technically, this should mean Mania/Mixed + Depression Actually, this means Mania/Mixed ± Depression Bipolar II Disorder: Hypomania + Depression (No mania ever) It is distinguished from Major Depressive Disorder by the lifetime history of at last one Manic or Mixed Episode Copyright © Allyn & Bacon 2007 Bipolar I Disorder One or more manic episode Manic or Mixed Episode OR OR Depressed and manic episodes Major Manic Depressiveor Mixed Episode Episode Bipolar Disorder Depressive Symptoms Manic Symptoms Gloomy Elation Withdrawn Euphoria Inability to make decisions Desire for Action Tired Hyperactive Slowness of thought (lethargic thinking) Multiple Ideas Copyright © Allyn & Bacon 2007 Bipolar II Disorder One or more OR hypomanic episode Hypomanic Episode OR Depressed and hypomanic episodes Major Hypomanic Depressive Episode Episode Bi-Polar I and Bi-Polar II Hypomania: At first when I'm high, it's tremendous ... ideas are fast ... like shooting stars you follow until brighter ones appear... All shyness disappears, the right words and gestures are suddenly there ... uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria ... you can do anything ... but somewhere this changes. Mania: The fast ideas start coming too fast and there are far too many ... overwhelming confusion replaces clarity ... you stop keeping up with it … memory goes. Infectious humor ceases to amuse. Your friends become frightened ... everything is now against the grain ... you are irritable, angry, frightened, uncontrollable, and trapped. (information from webmd.com) Copyright © Allyn & Bacon 2007 Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase. Whitman Wolfe Clemens Hemingway Copyright © Allyn & Bacon 2007 Mood Disorders The Etiology of Depression Depression often triggered by stress However, unlikely that stress alone causes depression Some people are more vulnerable to depression – biological vulnerability; developmental vulnerability Biological Perspective Genetic Influences: Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%). Jerry Irwin Photography Linkage analysis and association studies link possible genes and dispositions for depression. Neurotransmitters & Depression A reduction of norepinephrine and serotonin has been found in depression. Drugs that alleviate mania reduce norepinephrine. Pre-synaptic Neuron Serotonin Norepinephrine Post-synaptic Neuron The Depressed Brain PET scans show that brain energy consumption rises and falls with manic and depressive episodes. Courtesy of Lewis Baxter an Michael E. Phelps, UCLA School of Medicine Systems Approach Anxiety Disorders Generalized anxiety disorder – Characterized by persistent and pervasive feelings of anxiety, without any external cause Panic disorder – Marked by panic attacks that have no connection to events in a person’s present experience Agoraphobia – Fear of public places/open spaces Copyright © Allyn & Bacon 2007 Anxiety Disorders Phobias– A group of anxiety disorders involving a pathological fear of a specific object or situation Preparedness hypothesis – Notion that we have an innate tendency, acquired through natural selection, to respond quickly and automatically to stimuli that posed a survival threat to our ancestors Copyright © Allyn & Bacon 2007 Anxiety Disorders Obsessive-compulsive disorder – Condition characterized by patterns of persistent, unwanted thoughts and behaviors Copyright © Allyn & Bacon 2007 Somatoform Disorders Somatoform disorders – Psychological problems appearing in the form of bodily symptoms or physical complaints Conversion disorder – Somatoform disorder marked by paralysis, weakness, or loss of sensation, but with no discernable physical cause Copyright © Allyn & Bacon 2007 Somatoform Disorders Glove Anesthesia Copyright © Allyn & Bacon 2007 Somatoform Disorders Hypochondriasis – Somatoform disorder involving excessive concern about health and disease Copyright © Allyn & Bacon 2007 Dissociative Disorders Dissociative disorders – Group of pathologies involving “fragmentation” of the personality Dissociative amnesia Dissociative fugue Depersonalization disorder Dissociative identity disorder Copyright © Allyn & Bacon 2007 Dissociative Disorders Dissociative amnesia Dissociative fugue Depersonalization disorder A psychologically induced loss of memory for personal information Dissociative identity disorder Copyright © Allyn & Bacon 2007 Dissociative Disorders Dissociative amnesia Dissociative fugue Depersonalization disorder Dissociative amnesia with the addition of “flight” from one’s home, family, and job Dissociative identity disorder Copyright © Allyn & Bacon 2007 Dissociative Disorders Dissociative amnesia Dissociative Fugue Depersonalization disorder Dissociative identity disorder Abnormality involving the sensation of mind and body having separated Copyright © Allyn & Bacon 2007 Dissociative Disorders Dissociative amnesia Dissociative Fugue Depersonalization disorder Dissociative identity disorder Condition in which the individual displays multiple identities Copyright © Allyn & Bacon 2007 Eating Disorders Anorexia nervosa – Eating disorder involving persistent loss of appetite that endangers an individual’s health – stemming from psychological reasons rather than organic causes Bulimia – Eating disorder characterized be eating binges followed by “purges,” induced by vomiting or laxatives; typical initiated as a weight-control measure Copyright © Allyn & Bacon 2007 Schizophrenic Disorders Schizophrenia – Psychotic disorder involving distortions in thoughts, perceptions, and/or emotions Copyright © Allyn & Bacon 2007 Major Types of Schizophrenia Disorganized Catatonic Paranoid Undifferentiated Residual Positive Negative Copyright © Allyn & Bacon 2007 Major Types of Schizophrenia Disorganized Catatonic Paranoid Features incoherent speech, hallucinations, delusions, and bizarre behavior Undifferentiated Residual Type Copyright © Allyn & Bacon 2007 Major Types of Schizophrenia Disorganized Catatonic Involves stupor or extreme excitement Paranoid Undifferentiated Residual Type Copyright © Allyn & Bacon 2007 Major Types of Schizophrenia Disorganized Catatonic Paranoid Undifferentiated Residual Type Prominent feature: combination of delusions and hallucinations Copyright © Allyn & Bacon 2007 Major Types of Schizophrenia Disorganized Catatonic Paranoid Undifferentiated Residual Type Persons displaying a combination of symptoms that do not clearly fit in one of the other categories Copyright © Allyn & Bacon 2007 Major Types of Schizophrenia Disorganized Catatonic Paranoid Undifferentiated Residual Type Individuals who have had a past episode of schizophrenia but are free of symptoms Copyright © Allyn & Bacon 2007 Major Types of Schizophrenia Positive Schizophrenia Negative Schizophrenia Any form in which the person displays active symptoms (e.g. delusions, hallucinations) Copyright © Allyn & Bacon 2007 Major Types of Schizophrenia Positive Schizophrenia Negative Schizophrenia Any form distinguished by deficits, such as withdrawal and poverty of thought processes Copyright © Allyn & Bacon 2007 Possible Causes of Schizophrenia Evidence for the causes of schizophrenia has been found in a variety of factors including genetics, abnormal brain structure, and biochemistry Diathesis-stress hypothesis – Genetic factors place the individual at risk, but environmental stress factors transform this potential into an actual schizophrenic disorder Copyright © Allyn & Bacon 2007 Personality Disorders Personality disorders – Conditions involving a chronic, pervasive, inflexible, and maladaptive pattern of thinking, emotion, social relationships, or impulse control Copyright © Allyn & Bacon 2007 Personality Disorders Narcissistic personality disorder – Characterized by a grandiose sense of self-importance, a preoccupation with fantasies of success and power, and a need for constant attention Copyright © Allyn & Bacon 2007 Personality Disorders Antisocial personality disorder – Characterized by a long-standing pattern of irresponsible behavior indicating a lack of conscience and a diminished sense of responsibility to others Copyright © Allyn & Bacon 2007 Personality Disorders Borderline personality disorder – An unstable personality given to impulsive behavior Copyright © Allyn & Bacon 2007 Adjustment Disorders and Other Conditions That May Be a Focus of Clinical Attention Mild depression Physical complaints Parent-child problems Bereavement Marital problems Academic problems Job problems Malingering Copyright © Allyn & Bacon 2007 Developmental Disorders Autism – A developmental disorder marked by disabilities in language, social interaction, and the ability to understand another person’s state of mind Dyslexia – A reading disability, thought by some experts to involve a brain disorder Copyright © Allyn & Bacon 2007 Developmental Disorders Attention-deficit hyperactivity disorder – A developmental disability involving short attention span, distractibility, and extreme difficulty in remaining inactive for any period Copyright © Allyn & Bacon 2007 Shyness Shyness, a distressing pattern of avoiding or withdrawing from social contact is treatable, but it is not a DSM-IV disorder Copyright © Allyn & Bacon 2007 What are the Consequences of Labeling People? Ideally, accurate diagnoses lead to proper treatments, but diagnoses may also become labels that depersonalize individuals and ignore the social and cultural contexts in which their problems arise Copyright © Allyn & Bacon 2007 The Plea of Insanity Insanity – A legal term, not a psychological or psychiatric one, referring to a person who is unable, because of a mental disorder or defect, to confirm his or her behavior to the law Copyright © Allyn & Bacon 2007 End of Chapter 12 Copyright © Allyn & Bacon 2007