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The Nature and Causes of Mental Disorders Classification and Diagnosis • What is abnormal? • Departure from the norm • Causes stress, discomfort, and interferes in lives Perspectives on the Causes • Psychodynamic Perspective • Originate from intra-psychic conflict • Produced by Id, Ego, and Superego • Therapists make clients more aware of conflict • Medical Perspective • Originate from abnormalities in the brain and nervous system • Treated with drugs • Cognitive-Behavioral Perspective • Learned maladaptive behavior patterns • Focus on environmental factors, and person perception of these patterns • Therapists want client to replace with more adaptive behaviors • Humanistic Perspective • Originates from thinking one must earn positive regard from others • Therapists urge to achieve own potential, no matter what • Sociocultural Perspective • Cultures play a role • Perceive actions as abnormal, or normal • Culture-Bound Syndromes • Mental disorders only seen in certain cultures – Southeast Asians and Koro • Treated using folklore • Diathesis-Stress Model • Previous perspectives combined into one • Genetics and early experience yields predispositions • Only develop if person has stressor that they can’t cope with. DSM-IV Classification • Diagnostic and Statistical Manual IV • Reliable and universal set of categories to describe a patients psychological condition. • Assessed on four Axes • • • • • Axis I – Major disorders requiring clinical attention Axis II – Personality disorders Axis III – Physical disorders Axis IV – Severity of stress encountered Axis V – Persons overall level of functioning – Ratings on 100 pt. Global Assessment of Functioning (GAF) scale Problems With Classification • Looks more from the medical perspective • Questionable reliability • Langer & Abelson's study • Patients or job applicant • Assessed patient as worse off Need For Classification • Thomas Szasz – no need for classification • Benefits to patient • Recognition precedes development of treatment • Different disorders respond to different treatment • Good prognosis, bad prognosis Clinical Method vs. Actuarial Method • Judgments based on an experts experiences • Knowledge of previous symptoms, and applies to present symptoms • Applying empirically derived rules • Relate particular outcomes with particular indications Which Method (Actuarial or Clinical) is More ACCURATE? Actuarial Method • Reliability is Higher • Decision is based on a precise formula • Goldberg (1970) • Studied patients released from mental institutions • Found that actuarial method was more accurate 60% – 70% of the time Anxiety, Somatoform, and Dissociative Mental Disorders • Neuroses – anxious, fearful, depressed, and generally unhappy • Almost all realize that they have a problem Anxiety Disorders • Panic Disorders (description) • Episodic attacks of acute anxiety • Physical symptoms • Anticipatory anxiety – fear of more panic attacks • Panic Disorders (Causes) • Genetic – appears to be hereditary • Cognitive - sensitive to risk or danger in environment Anxiety Disorders • Phobic Disorders (description) • • • • Irrational fears of specific objects and situations Fear makes life difficult Agoraphobia – fear of open spaces Social Phobia – fear of possible scrutiny or embarrassment • Specific Phobia – all other phobias • Early onset more likely to leave Phobic Disorders (Causes) • Psychoanalytic theory – stress caused by intolerable unconscious impulses • Classical Conditioning • Direct – when they are present in an unpleasant situation • Vicarious – observing another show fear to an object or animal. • Some objects more likely to be feared Phobic Disorder (causes) cont. • Genetic Causes • Reflective of our evolution • Chimpanzees are afraid of snakes even though they had never seen them before • Simple and social families do not run in families • Stable families with overprotective mothers Obsessive-Compulsive Disorder (description) Obsessions • Thoughts that won’t leave • Two principle types • Doubt or Uncertainty • Fear of doing something prohibited Compulsions • Behaviors can’t keep from doing • Four Categories • • • • Counting Checking Cleaning Avoidance Obsessive-Compulsive Disorder (Causes) Cognitive Causes • Reduce anxiety caused by fear of being perceived as incompetent • Behaviors replace fear or anxiety, thus more fear, more behavior Genetic Causes • Associated with Tourette’s Syndrome • Produced by same gene as previous • Sometimes occurs after brain damage Somatoform Disorders • Somatization disorder (description) • Complaints of physical problems that have no biological basis • It is often chronic lasts for decades • DSM-IV requires a history of complaints • Hypochondriasis – fear of having major illness Somatization Disorder (causes) • Common in poorly educated women in low economic status • Runs in families • Closely associated with Antisocial personality disorder Conversion Disorder (description) • Physical complaints of neurological problems that have no real basis • DSM - IV • Must be response to stimulus, avoid activity, or get sympathy • Not Faking Illnesses (malingering) • Enjoy talking about illness • Change with time, and knowledge Conversion Disorder (causes) • Psychoanalytic – unresolved conflicts displaced into physical symptoms • Learned – most have already suffered from the disease they are then complaining about Dissociative Disorders Disruptions in Consciousness • Freud and massive repression • Psychogenic Amnesia • Forgets all of past, and starts new one • Psychogenic Fugue • Leaves home and starts a new life somewhere • Multiple Personality Disorder • Two or more separate people within one person • Form of self-hypnosis Dissociative Disorders Causes • Responses to severe conflicts or guilt • Usually advantageous to person Personality Disorders Abnormalities that impair social functioning • Antisocial Personality Disorder (psychopaths or sociopath) • Failure to conform to social norms: lying, stealing, failure at relationships, lack of guilt • DSM-IV - evidence of three types of Antisocial behavior before fifteen • Pattern of antisocial behavior where another person was violated Antisocial Personality Causes • Physiological causes and learning • Lower signs of fear, unresponsive autonomic nervous system • Do not learn to avoid an aversive stimuli, but do learn to avoid a loss of appetitive stimulus • Genetic – somewhat hereditable Antisocial Personality Causes • Environmental • Parenting – ignoring or leaving children unsupervised develop delinquency • Cognitive • View world different than well behaved kids • See others as being hostile • May be biologically predisposed Psychoactive Substance Use Disorders • Psychoactive Substance Dependence and Abuse • Drug addiction a serious problem • Alcohol – car accidents, fetal alcohol syndrome, cirrhosis of the liver, increased heart rate of cerebral hemorrhage • Cocaine – causes psychosis, brain damage, and death Substance Use Causes • Genetic and Physiological causes • Susceptibility comes from inability to metabolize alcohol, or difference in brain • Brain of steady drinker has under sensitive punishment mechanism • Binge drinkers have an oversensitive punishment mechanism • Cognitive Causes • Develop heavy drug use, by what they believe about the benefit of the drug • Use is negatively reinforced by the escape it gives to people Schizophrenic Disorders • Most common psychosis • Distortions of thought, perception, and emotion; bizarre behavior, and social withdrawal • Two categories of symptoms • Positive – make known by presence (thought disorders, hallucinations, and delusions) • Delusions of Persecution, Grandeur, and Control • Negative – absence of normal behaviors (flattened emotional response, no speech, no pleasure, withdrawal Types of Schizophrenia • Undifferentiated • Have delusions, hallucinations, and disorganized behavior, but are not he other types of schizophrenia • Catatonic • Motor disturbances (catatonic postures, and waxy flexibility); are aware of what is going on • Paranoid • Delusions of persecutions, grandeur and control • Disorganized • Disturbances of thought, word salad (a jumble of words) Early signs of Schizophrenia • Bleuler (1950) divided disorder • Reactive – those with a good history of mental health. Reaction to stressor. Recover. • Process – those diagnosed as having a mental illness early in life. • Predictors – being “different” than everyone else. Possible Causes • Genetic Causes • Heritability is firmly established. Have tendency towards illness • Predisposition towards having schizophrenia • Physiological Causes (Dopamine Hypothesis) • Over-activity of dopamine synapses using dopamine as transmitter substance • Cocaine users Possible Causes (cont.) • Physiological causes (neurological disorders) • Drugs alleviate positive symptoms, and not negative • Weinberger and Wyatt (1982) ventricles in brains, • • • • twice as large Pfefferbaum (1988) sulci were wider Positive symptoms – dopamine: negative – loss of brain tissue Damage may be viral (multiple sclerosis) Births during winter months; trauma Possible Causes (cont) • Cognitive and Environmental Causes • Being raised by a mentally healthy family may protect against onset • Raised by dominating, overprotective, rigid, and insensitive to the needs of others type of household. • Double-blind parent – verbally accepting, rejecting • Rate of recovery affected by how family deals Mood Disorders • Disorders of emotion; affect normal perceptions, thoughts and behaviors • Bipolar Disorder • Alternating periods of mania (wild excitement) and depression • Major Depression • Persistent feelings of sadness, worthlessness, and changes in behavior, appetite, and sleeping • Mania • Wild, exuberant, unrealistic activity • Have delusions and hallucinations • Person with mania always has bi-polar • Depression • Sad, and filled with self-directed guilt, can’t always say why they are depressed • Five symptoms • • • • • A sad apathetic mood Feelings of worthlessness and hopelessness A desire to withdraw from other people Sleeplessness and a loss of appetite and sexual desire Change in activity level to laziness, or agitation Possible Causes • Cognitive • Caught in a vicious cycle • Distortion in perception of reality • Beck’s Cognitive Triad • Negative thoughts about self, present, and future • Attributional style • Negative to self, positive to others Possible Causes (cont) • Genetic • First degree relatives ten times more likely to get a mood disorder • Physiological (Biochemical Factors) • Electro-convulsive therapy, antidepressant drugs • Biochemical abnormalities in brain – less activity of serotonin-secreting neurons • Decrease in activity of 5-HT and NE related to depression, antidepressants increase activity Possible Causes (cont) • Physiological (Sleep Cycle) • Enter REM sleep sooner and spend more time in it during last part of sleep • Depression triggered environmentally through zeitgeber • A stimulus synchronizing biological rhythms • Seasonal Affective Disorder • Depressed in winter seasons • Sleep depravation helps