Download Dissociative disorders

6th Edition
Psychology
Stephen F. Davis
Morningside College
Joseph J. Palladino
University of Southern Indiana
PowerPoint Presentation by
Fred W. Whitford
Montana State University
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12-1
Chapter 12
6th Edition
Psychological
Disorders
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12-2
Abnormal Behavior
• The most commonly used criteria for
distinguishing between normal and abnormal
behaviors are statistical rarity, interference with
normal functioning, personal distress, and
deviance from social norms.
• By the standard of statistical rarity, behavior is
abnormal when it does not occur very often.
• By itself, statistical rarity is clearly not a
consistently useful indicator of what we should
label abnormal.
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12-3
Abnormal Behavior
• Dysfunctional behavior interferes with a
person’s ability to function in day-to-day life.
• People may be diagnosed as suffering from a
psychological disorder if their behavior is
upsetting, distracting, or confusing to
themselves.
• The distress criterion is useful in cases in which
the psychological disorder is accompanied by
discomfort.
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12-4
Abnormal Behavior
• Departures from social norms are used to define
deviant, and therefore abnormal behaviors;
social norms, however, can change over time
and vary across groups.
• We can define behaviors as abnormal when
they are statistically unusual, are not socially
approved, and cause distress to the person or
interfere with his or her ability to function.
• Because different cultural groups have different
social norms, definitions of abnormality using
this criterion are culturally variable.
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12-5
Abnormal Behavior
• Insanity is a legal ruling that an accused
individual is not responsible for a crime.
• Insanity is defined in most states as the inability
to tell the difference between right and wrong at
the time the crime is committed.
• Contrary to the public’s understanding of the
insanity plea, such pleas are infrequently used
and rarely successful.
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12-6
Abnormal Behavior
• The medical model views abnormal
behaviors as no different from illnesses
and seeks to identify symptoms and
prescribe medical treatments.
• The psychodynamic model views
psychological disorders as resulting from
unconscious conflicts related to sex and
aggression.
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12-7
Abnormal Behavior
• The behavioral model views abnormal
behaviors as learned through classical
conditioning, operant conditioning, and
modeling.
• The cognitive model suggests that our
interpretation of events and our beliefs
influence our behavior.
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12-8
Abnormal Behavior
• The sociocultural model emphasizes the
importance of social and cultural influences on the
frequency, diagnosis, and conception of
psychological disorders.
• There is a growing recognition that many
disorders have multiple causes; thus the
simultaneous use of several models is likely to
advance our understanding.
• This emphasis on multiple causation is evident in
the biopsychosocial model, which incorporates
biological (medical-model) factors along with
psychological and sociocultural (social) factors.
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12-9
Classifying and Counting
Psychological Disorders
• Diagnosis is the process of deciding
whether a person has symptoms that meet
established criteria of an existing
classification system.
• A major purpose of diagnosis is to make
predictions regarding the course of the
disorder, whether it will respond to
treatment, and which treatment is best.
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12-10
Classifying and Counting
Psychological Disorders
• The most frequently used system for
classifying psychological disorders is the
American Psychiatric Association’s
Diagnostic and Statistical Manual of
Mental Disorders, 4th Edition, Text
Revision (DSM-IV-TR).
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12-11
Classifying and Counting
Psychological Disorders
• Rosenhan’s pseudopatient study raises
questions about our ability to distinguish
normal and abnormal behaviors and
shows how labels affect the perception of
behavior.
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12-12
Classifying and Counting
Psychological Disorders
• Epidemiologists study the distribution and
factors associated with accidents, diseases, and
psychological disorders.
• Epidemiologists are interested in the
prevalence of disorders—the percentage of a
population or the number of persons
experiencing a given disorder during some
specified period.
• The incidence of a disorder is the rate (or
number) of new cases reported during a given
period.
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12-13
Classifying and Counting
Psychological Disorders
• One-year
prevalence estimates
for selected
psychological
disorders based on
combined data from
the Epidemiologic
Catchment Area
Study and the
National Comorbidity
Survey.
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12-14
Classifying and Counting
Psychological Disorders
• Phobias, alcohol and drug abuse or
dependence, and major depressive
disorder are among the most common
psychological disorders.
• These and other psychological disorders
are often comorbid, meaning they occur
with other disorders.
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12-15
Classifying and Counting
Psychological Disorders
• The simultaneous occurrence of disorders, or comorbidity,
makes it more difficult to make appropriate diagnoses and
to develop effective treatment plans.
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12-16
Anxiety, Somatoform, and
Dissociative Disorders
• Anxiety is a general feeling of
apprehension characterized by behavioral,
cognitive, or physiological symptoms.
• Phobias are excessive, irrational fears of
activities, objects, or situations.
• Agoraphobia is the most common phobia
treated in mental health clinics.
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12-17
Anxiety, Somatoform, and
Dissociative Disorders
• Agoraphobia is the avoidance of public
places or situations in which escape may
be difficult should the individual develop
incapacitating or embarrassing symptoms
of panic.
• Social phobia refers to a fear related to
being seen or observed by others.
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12-18
Anxiety, Somatoform, and
Dissociative Disorders
• A specific phobia is any phobia other
than agoraphobia or the social phobias,
including the fear of specific animals, of
elements of the natural environment, and
of such things as blood, injections, or
injury.
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12-19
Anxiety, Somatoform, and
Dissociative Disorders
• Specific phobias are not uncommon.
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12-20
Anxiety, Somatoform, and
Dissociative Disorders
• Classical conditioning and modeling (vicarious
conditioning) have been offered as
explanations for the development of phobias.
• Panic disorder is the most severe anxiety
disorder, characterized by intense
physiological arousal not related to a specific
stimulus.
• About 50% of the people who suffer from panic
attacks also experience agoraphobia.
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12-21
Anxiety, Somatoform, and
Dissociative Disorders
• Rapid
increase in
heart rate
during a
panic
attack.
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12-22
Anxiety, Somatoform, and
Dissociative Disorders
• A number of tests called biological
challenges have revealed that certain
biologically related phenomena can bring
on panic attacks.
• According to cognitive psychologists, panic
attacks occur when the bodily sensations of
anxiety are misinterpreted as signs of
impending disaster.
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12-23
Anxiety, Somatoform, and
Dissociative Disorders
• Generalized anxiety disorder (GAD)
involves a chronically high level of anxiety
that is not attached to a specific stimulus
(it is free-floating).
• GAD, along with some other anxiety
disorders, may result from low levels of the
inhibitory neurotransmitter gammaaminobutyric acid (GABA).
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12-24
Anxiety, Somatoform, and
Dissociative Disorders
• Obsessive–compulsive disorder (OCD)
is an anxiety disorder characterized by
repetitive, irrational, intrusive thoughts,
impulses, or images (obsessions) and
irresistible, repetitive acts (compulsions)
such as checking that doors are locked or
washing hands.
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12-25
Anxiety, Somatoform, and
Dissociative Disorders
• Behavioral psychologists view
compulsions as learned habits that reduce
anxiety.
• That is, the compulsive behavior has been
associated with anxiety reduction through
operant conditioning.
• OCD runs in families; identical twins are
more likely than fraternal twins to share
the disorder.
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12-26
Anxiety, Somatoform, and
Dissociative Disorders
• Posttraumatic stress disorder (PTSD) is
a reaction to a traumatic or life-threatening
situation; this is characterized by repeated
reexperiencing of the traumatic event,
avoidance of reminders of the situation,
emotional numbness, and increase
arousal.
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12-27
Anxiety, Somatoform, and
Dissociative Disorders
• Somatoform disorders involve
complaints of bodily symptoms that do not
have a known medical cause; instead
psychological factors are involved.
• Among these disorders are
hypochondriasis, somatization disorder
and conversion disorder.
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12-28
Anxiety, Somatoform, and
Dissociative Disorders
• Hypochondriasis is a somatoform disorder in
which a person believes that he or she has a
serious disease despite repeated medical
findings to the contrary.
• People with somatization disorder present
vague but complicated and dramatic medical
histories.
• In contrast to hypochondriasis, which centers on
some specific disease, somatization disorder
involves a large number of symptoms.
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12-29
Anxiety, Somatoform, and
Dissociative Disorders
• Conversion disorder involves mainly
sensory and motor functions that are
normally under voluntary control.
• Consequently, symptoms can be dramatic
and include apparent blindness, deafness,
paralysis, and seizures.
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12-30
Anxiety, Somatoform, and
Dissociative Disorders
• Dissociative disorders involve disruptions in
a particular function of the mind, such as
memory of events, knowledge of one’s
identity, or consciousness.
• Dissociative amnesia is a dissociative
disorder that involves a sudden inability to
recall important personal information; it often
occurs in response to trauma or extreme
stress.
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12-31
Anxiety, Somatoform, and
Dissociative Disorders
• Dissociative fugue is a dissociative
disorder involving amnesia and flight from
the workplace or home; it may involve
establishing a new identity in a new
location.
• Dissociative identity disorder (multiple
personality) is a dissociative disorder in
which a person has two or more separate
personalities, which usually alternate.
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12-32
Anxiety, Somatoform, and
Dissociative Disorders
• There are usually three or four
personalities or alters (short for alternate
identities), although more than 100 have
been reported in a single individual.
• The alters in dissociative identity disorder
often contrast sharply with one another
and have very different personal histories,
behavior patterns, friends, beliefs, habits,
values, and even voices and facial
expressions.
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12-33
Anxiety, Somatoform, and
Dissociative Disorders
• Depersonalization disorder is a disorder
in which the person has a persistent or
recurring depersonalization episode that
interferes with normal functioning.
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12-34
Mood Disorders
• Mood disorders occur at both ends of a
continuum ranging from severe depression to
excessive euphoria.
• The symptoms of depression fall into four broad
categories: emotional, cognitive, motivational,
and somatic/behavioral.
• The most obvious symptoms of depression are
sadness (dysphoria), lack of interest in
previously pleasurable activities, and reduced
energy.
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12-35
Mood Disorders
• Depressed people often describe themselves in
unflattering terms such as inferior and
unattractive.
• They do not see themselves as capable of
completing intellectually demanding tasks.
• Two forms of insomnia are frequently associated
with depression: difficulty falling asleep (sleeponset insomnia) and awakening early in the
morning with an inability to return to sleep.
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12-36
Mood Disorders
• Major depression is the fourth leading cause of
worldwide disease and is responsible for more
disability than heart disease.
• Major depression is one of the most commonly
identified psychological disorders in the United
States.
• Depression strikes children as well as adults.
• In many cultures, the rate of depression is twice
as high among women as among men.
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12-37
Mood Disorders
• Poverty is a path to depression, and the rate of
poverty is especially high among women and
children.
• The rate of depression has risen dramatically
over the past century.
• Although depression usually diminishes with time
(typically within 6 months), episodes tend to
recur.
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12-38
Mood Disorders
• Suicide, which is often associated with
depression, is one of the leading causes of
death in the United States.
• The risk factors for suicide include being male,
unmarried, and depressed.
• If you suspect that someone you know might
attempt suicide, you should not be afraid to
ask, “Are you thinking about suicide?”
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12-39
Mood Disorders
• People who talk about or attempt suicide
need immediate medical and
psychological help.
• Most suicidal people are ambivalent about
committing suicide; they are experiencing
pain, helplessness, and hopelessness.
• Time is an important ally in the effort to
prevent a suicide because people do not
usually remain seriously suicidal for long.
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12-40
Mood Disorders
• Mania refers to excessive activity,
accelerated speech, poor judgment,
elevated self-esteem, and euphoria that
occur in bipolar disorder.
• Bipolar disorder is a mood disorder in
which a person experiences episodes of
mania and depression, which usually
alternate.
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12-41
Mood Disorders
• Experts believe that biological factors play
a role in the development of mood
disorders.
• The symptoms of depression tend to be
similar across cultures, suggesting a
common underlying biological cause.
• Drugs such as Elavil and Prozac reduce
depression; mania responds to lithium
treatment.
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12-42
Mood Disorders
• Mood
disorders
tend to run in
families,
which
suggests
genetic
transmission.
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12-43
Mood Disorders
• A twin pair is said to be concordant when
both twins have mood disorders.
• The concordance rate is the percentage
of twin pairs in which both twins have the
disorder.
• The concordance rate for mood disorders
among identical twins is approximately
65%; the rate among fraternal twins is
about 14%.
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12-44
Mood Disorders
• Depression may involve low levels of
norepinephrine or serotonin.
• According to the learned helplessness
model, depression can also be brought on
when people believe that they cannot
control outcomes.
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12-45
Mood Disorders
• The psychodynamic model emphasizes
early childhood experiences as the
foundation of adult behavior and emotional
reactions.
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12-46
Mood Disorders
• Learned helplessness occurs when you
believe you have no control over the
reinforcements in your life.
• This model of depression explains the
lethargy and lack of motivation seen in
depressed individuals.
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12-47
Mood Disorders
• A reformulation of the learned helplessness
model, called the hopelessness model,
focuses on people’s beliefs about the
situations in which they find themselves.
• Some people become depressed not
because they lack control over a situation
but because of the way they explain the
situation.
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12-48
Mood Disorders
• The hopelessness model has much in
common with the cognitively oriented
theories of researchers who view
depression as stemming from problems in
the way people think.
• Depressed people may draw arbitrary
inferences, conclusions drawn in the
absence of supporting information.
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12-49
Schizophrenia
• Schizophrenia is a psychotic disorder that
is characterized by positive symptoms
(excesses) or negative symptoms
(deficits).
• Psychosis is a general term for disorders
in which severely disturbed people lose
contact with reality and may require
hospitalization.
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12-50
Schizophrenia
• Schizophrenia is often confused with
dissociative identity disorder.
• The “split” in schizophrenia, however, is
not among different personalities; it is a
split from reality as well as a split between
thoughts and emotions.
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12-51
Schizophrenia
• The positive symptoms of schizophrenia are
distortions or excesses of normal functions, such
as fluent but disorganized speech, delusions,
and hallucinations.
• While listening to the speech of a patient with
schizophrenia, you may struggle to follow his or
her pattern of thought; the disorganized speech
is thought to reflect disturbances in the
underlying thought processes.
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12-52
Schizophrenia
• The ideas expressed by a person with
schizophrenia can be like a train that has
slipped off its track onto another track; this
pattern of speech is called loose
associations.
• Among the most frequently observed
positive symptoms are delusions, or false
beliefs that cannot be corrected despite
strong evidence to the contrary.
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12-53
Schizophrenia
• Hallucinations are perceptions that are
not caused by stimulation of the relevant
sensory receptors.
• They can occur in any of the senses,
although auditory hallucinations are the
most common.
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12-54
Schizophrenia
• Negative symptoms are reductions or
losses of function.
• These behavior deficits or defects include
poverty of speech as well as disturbances
in affect and volition (will).
• These symptoms are associated with
more cognitive impairment and poorer
prognoses than positive symptoms.
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12-55
Schizophrenia
• The speech of people with schizophrenia
may be adequate in amount yet convey
little information: Language that is vague,
too abstract, too concrete, or repetitive is
termed poverty of content.
• A restriction in the amount of spontaneous
speech that is evident in brief and
unelaborated replies to questions is called
poverty of speech.
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12-56
Schizophrenia
• Failure to experience any emotion is called flat
affect; an inability to experience the typical range
of emotions is called blunted affect.
• Avolition (difficulty making decisions) and apathy
are characterized by a lack of energy and drive
such that a person is unable to initiate or persist
in tasks.
• A number of disturbances in motor movements
and a lack of self-care also characterize some
forms of schizophrenia.
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12-57
Schizophrenia
• The DSM-IV lists five subtypes of schizophrenia:
catatonic, disorganized, paranoid, residual, and
undifferentiated.
• Each subtype of schizophrenia is characterized
by a different set of symptoms, although
distinctions among the types are not always
clear-cut and there is significant overlap in
symptoms.
• Indeed, the undifferentiated subtype is a
category for cases that do not fit into other
subtypes.
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12-58
Schizophrenia
• Schizophrenia
tends to run in
families.
• The risk of
developing the
disorder increases
with the degree of
genetic relatedness
between an
individual and a
family member who
has schizophrenia.
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12-59
Schizophrenia
• Prevalence estimates range from .5% to
1.5%. Onset for men is mid-teens to early
20s and mid-to-late 20s for women.
Prognosis is relatively positive with 30%
eventually able to return to work.
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12-60
Schizophrenia
• Evidence of various brain abnormalities,
including larger ventricles, in people with
schizophrenia suggests a possible
biological cause.
• The neurotransmitter dopamine seems to
be involved in the development of
schizophrenia.
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12-61
Schizophrenia
• Environmental influences on schizophrenia
include stress and hostile family
communication.
• Researchers are beginning to converge on
what they have called a
neurodevelopmental model, which
suggests that schizophrenia results from a
combination of a genetic predisposition
along with other factors.
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12-62
Personality and Sexual Disorders
and Substance Use Disorders
• Personality disorders are long-standing
patterns of maladaptive behavior that are
usually evident during the adolescent
years and are resistant to treatment.
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12-63
Personality and Sexual Disorders
and Substance Use Disorders
• The DSM-IV-TR describes 10 personality
disorders divided into three clusters:
– odd or eccentric behavior; paranoid, schizoid
and schizotypal
– dramatic, emotional, or erratic behavior;
antisocial, borderline, histrionic and
narcissistic
– anxious or fearful behavior; avoidant
dependent and obsessive-compulsive
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12-64
Personality and Sexual Disorders
and Substance Use Disorders
• Antisocial personality disorder is a
personality disorder characterized by
deceitful, impulsive, reckless actions that
violate social norms for which the
individual feels no remorse.
• In the past, the terms psychopath and
sociopath have been used to describe this
behavior pattern.
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12-65
Personality and Sexual Disorders
and Substance Use Disorders
• The signs of disturbance seen in other
disorders—anxiety, depression, delusions,
or hallucinations—are absent in antisocial
personality disorder.
• Individuals with this disorder rarely seek
professional help unless their goal is to
obtain an excuse to be absent from work,
to acquire drugs, or to avoid prison by
submitting to court-ordered treatment.
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12-66
Personality and Sexual Disorders
and Substance Use Disorders
• Because antisocial individuals do not experience
the warning signals of anxiety, they are prone to
act impulsively, without regard for the feelings or
well-being of others.
• They want immediate gratification, fail to develop
emotional attachments, and have no remorse for
their actions.
• Antisocial persons do not develop conditioned
fear responses readily.
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12-67
Personality and Sexual Disorders
and Substance Use Disorders
• The DSM-IV-TR divides sexual disorders
into several categories: gender identity
disorder (transsexualism), the paraphilias,
and sexual dysfunctions.
• Gender identity disorder
(transsexualism) is a sexual disorder in
which a person believes that he or she was
born with the wrong biological sex organs.
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12-68
Personality and Sexual Disorders
and Substance Use Disorders
• Paraphilia refers to sexual arousal by
objects or situations not considered sexual
by most people.
• Fetishism is a paraphilia in which a
person is sexually aroused by unusual
objects or body parts.
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12-69
Personality and Sexual Disorders
and Substance Use Disorders
• Psychodynamic theorists see paraphilias
as associated with early childhood
experiences or, in some cases, as
alternatives that arouse less anxiety than
sexual encounters with adult partners.
• Behavioral psychologists, in contrast,
believe that most fetishes, and probably
many of the paraphilias, develop through
classical conditioning.
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12-70
Personality and Sexual Disorders
and Substance Use Disorders
• “Substance” has eleven separate
categories, with alcohol being the most
widely used.
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12-71