Download document

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