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Features of Mental Disorders
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Behavior is judged abnormal by others
Behavior generates distress in those
afflicted
Behavior is maladaptive—interferes with
ability to function normally
DSM-IV (Diagnostic &
Statistical Manual of Mental
Disorders)
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Axis I: includes mental disorders
Axis II: personality disorders & mental
retardation—stable and incurable
Axis III: general medical conditions related to
disorder
Axis IV: psychosocial and environmental factors
Axis V: global assessment of current functioning
Symptoms of Depression
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Feeling profoundly sad most of the time for
the last 2 weeks
No interest in eating, sex, family, friends,
hobbies
Dramatic weight loss or gain
Sleep too much or too little
Must have at least 5 of these symptoms
during 2-week period to be diagnosed
Statistics about Depression
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Very common disorder, but almost twice
as common in women than men (21.3% of
women; 12.7% of men)
People with depression suffer 5-6 episodes
in their lives
There is a genetic component to
depression; it runs in families
Treatment of Depression
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Treatment usually takes 6 months to 1 year
Antidepressants are the first choice
(MAOIs, tricyclics, SSRIs, SSNRIs)
Therapy, especially cognitive-behavioral
therapy, is effective
Best approach is to combine medications
with therapy
Bipolar Disorder (manic
depression)
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Wide mood swings over periods of time, going
from deep depression to wild mania
Mania: extreme excitement, elation, energy,
decreased need for sleep, going from one idea to
another, engaging in silly or destructive behaviors
Varying degrees of bipolar disorder, from mild to
severe; some forms may mimic attention-deficitdisorder (ADD/ADHD), depression, or anxiety
Treated with lithium or Depakote, along with
therapy
Living with Bipolar Disorder
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http://www.youtube.com/watch?v=sl95tsiL
vyM&feature=related
Causes of mood disorders
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Appears to be interaction between genetic
and environmental factors
Both occur more in females; bipolar
disorder tends to skip a generation
Abnormalities in brain chemistry
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Serotonin and norepinepherine deficiencies;
drugs target these neurotransmitters
More causes of mood disorders
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Learned helplessness (thinking you have no
control over anything); therapy is
particularly effective here
Negative self-schemas (thinking of
yourself in the harshest ways; start to feel
worthless); therapy also very effective
Anxiety Disorders
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Phobias
Panic disorder with and without
agoraphobia
Generalized anxiety disorder
Obsessive-compulsive disorder
Phobias
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Specific, intense, and irrational fears of objects or
events; interferes with daily life
Most common phobia is social phobia—afflicts
13% of Americans (fear of situations in which
you might be evaluated or embarrassed; e.g.,
public speaking)
Root of most phobias is classical conditioning
Systematic desensitization is the treatment (recall
from Learning section)
Panic disorder
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Periodic unexpected attacks of intense, terrifying
anxiety
People with panic attacks often end up in the ER,
thinking they’re having a heart attack.
Symptoms include racing heart, sweating,
dizziness, nausea, trembling, palpitations, fear of
losing control, fear of dying, chills, tingling,
numbness
Agoraphobia
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Intense fear of specific situations in which
the person suspects help will not be
available in case of a panic attack
Basically, it’s the fear of being afraid (i.e.,
having a panic attack) in public.
Causes people to not want to leave their
homes.
Causes of panic disorder
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Genetic component; over 50% of those who have
it have relatives who have it
PET scans show enlarged locus coreuleus (LC) in
the brain stem of those with panic disorder, which
acts as a primitive “alarm system” alerting people
to danger
Learning also plays a part. People learn to fear
having another panic attack, leading to more
anxiety and agoraphobia.
Treatment of panic disorders
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Benzodiazepines (Xanax, Klonopin,
Ativan)—anti-anxiety drugs that are highly
effective but extremely addictive
SSRIs are also used to treat anxiety;
becoming the treatment of choice because
of addiction potential of benzodiazepines
Generalized anxiety disorder
(GAD)
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Generalized fear and heightened anxiety
about everything in general
Can’t pinpoint anxiety to any one particular
stimulus; everything produces nervousness
Usually no outright panic attacks, but often
feel sick at stomach, nauseated, headaches,
trouble sleeping. Heart may race, palms
sweat for no good reason.
Treatment of GAD
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Therapy is considered more effective than
drugs, but SSRIs are used extensively for
treatment.
Drug called BuSpar also helps many
people with GAD,without the side effects
or addiction potential of other drugs.
Obsessive-compulsive disorder
(OCD)
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Recurrent disturbing thoughts (obsessions) that a
person can’t stop unless they perform specific
behaviors (compulsions)
Common obsessions: fear of dirt or germs,
touching infected people, disgust with bodily
wastes, irrational concern about not having done
a job well, fear of having antireligious or sexual
thoughts, or fear of death or loved one dying
Common compulsions: repetitive hand washing,
checking things, counting, hoarding things,
More about OCD
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People with OCD develop severe anxiety over
their obsessions/compulsions and feel powerless
to stop them. Complex rituals take over their day.
Compulsions relieve anxiety when performed, so
the person learns through conditioning to
continue doing them.
Males and females are equally afflicted with
OCD, but females are more likely to be
compulsive hand washers.
OCD: Ritual Handwashing Video
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http://www.youtube.com/watch?v=tPFQM
Rx2l3Y
Somatoform Disorders
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When the symptoms of physical health
have psychological causes
Somatization disorder
Hypochondriasis
Somatoform pain disorder
Conversion disorder
All seem to have roots in anxiety.
Somatization disorder
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Intensely and chronically uncomfortable
psychological conditions that involve numerous
symptoms of bodily illness without physical
causes
Much more common in women
Involve frequent, dramatic complaints of things
like memory problems, blackouts, numbness,
problems walking, nausea, menstrual problems,
lack of enjoyment of sex
Can lead to addictions to alcohol/drugs and
unnecessary surgeries
Hypochondriasis
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A milder form of somatization disorder
Person has excessive concern over health, but not
as pervasive or intense as in somatization disorder
Hypochondriacs don’t experience side effects,
such as depression, drug addiction, or
unnecessary surgeries that people with
somatization disorder do.
Lives are dominated by excessive concern over
health, attempt to avoid germs, or avoiding
cancer-causing agents
Conversion disorder
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Most dramatic somatoform disorder
Freud coined the term—anxiety has been
“converted” into physical symptoms
Dramatic symptoms experienced—sudden
blindness, paralysis, deafness, muteness, seizures,
etc.
Person acts as if h/she doesn’t care about being
afflicted with this; called the beautiful
indifference; gets them out of responsibilities and
allows dependence on others
Somatoform pain disorder
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Similar to conversion disorders, but the primary
symptom is pain with no physical cause
Difficult to diagnose; must rule out true physical
pain that has biological cause
Somatoform pain usually occurs at times of high
stress; generally beneficial in some way
(disability payments, getting out of school/work)
Dissociative disorders
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Involve disruptions in person’s memory,
consciousness, or identity; often
experienced on a temporary basis
Depersonalization disorder
Dissociative fugue
Dissociative identity disorder
Depersonalization Disorder
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Feeling of detachment from oneself
Experienced by 70% of “normal” people but on a
very fleeting basis; true depersonalization
disorder is longer-lasting
More common in females
Cause is unknown
Sometimes linked to drug use—marijuana,
Ecstasy, acid
Associated with high IQ, analytical thought about
oneself
Dissociative fugue
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A person suddenly leaves his home and
travels somewhere else where he has no
memory of previous life
Like amnesia but with no medical basis
Person often simply makes a new life for
himself and never recovers old identity or
memory
Dissociative Identity Disorder
(DID)
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Formerly known as multiple personality disorder
Fragmenting of the personality into 2 or more
separate but coexisting personalities
One personality is the “host” and the others are
“alters.” Host may not know about the alters, but
the alters usually know about the host and at least
some of the other alters.
Person “switches” between personalities; occurs
in response to anxiety brought on by memories of
past traumatic experiences
More about DID
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Develops early in childhood and is associated
with extreme childhood abuse
Before 1950s and publication of The Three Faces
of Eve, diagnosis was extremely rare, but then it
exploded.
Now it’s considered extremely controversial.
Some experts don’t believe it exists; others
believe it exists but is extremely rare. It’s almost
certain that it’s overdiagnosed now.
A man with DID
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http://www.youtube.com/watch?v=7iHJfIH
20TY
Schizophrenia: Definition
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Complex disorder characterized by
hallucinations, delusions, speech disturbances,
and other symptoms
Schizophrenics are “out of touch with reality” and
often can’t function in society
NOT the same thing as “split personality”
Basic psychological functions (attention,
perception, thoughts, emotions, behavior are
fragmented; person misperceives things around
him
Heather: A Schizophrenic Patient
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http://www.youtube.com/watch?v=kvdw4b
7tC-8
Two types: Type I and Type II
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Type I: involves mostly “positive” symptoms
(symptoms are added that aren’t usually
present)—hallucinations, delusions, bizarre
behaviors
Hallucinations—hearing voices or seeing things;
present in 70% of schizophrenics
Delusions—firmly held beliefs that have no basis
in reality
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Delusion of persecution (someone’s after me)
Delusion of grandeur (someone famous)
Delusion of control (someone’s controlling thoughts)
Type II schizophrenia
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Involves negative symptoms, or an asence
of normal behavior
Zombie-like
Flat affect—total lack of emotion; glazed
look
Avolition—showing no motivation or will
Alogia—lack of speech
Causes of schizophrenia
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No evidence that a single gene is involved, but it
does run in families
Probably a combination of many genetic and
environmental factors
Brain differences between schizophrenics and
non-schizophrenics: ventricles are larger in
schizophrenics, which may produce abnormalities
in cerebral cortex. Also excessive amounts of
dopamine in schizophrenia.
Psychological factors—harsh, critical families
more relapses
Treatment
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No cure; goal is to control symptoms as much as
possible
Antipsychotic meds—Thorazine, clozapine,
haloperidol, Novartis, Zeneca
Tardive dyskinesia—bad side effect of
antipsychotics; loss of motor control, especially
in the face. Doesn’t show up until you’ve taken
drug for several years. Then it’s irreveresible.
More about treatment
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Drugs are better at controlling Type I symptoms;
not good with negative symptoms, so patient
remains somewhat flat
New drugs are being tested that target negative
symptoms and don’t have tardive dyskinesia side
effects
Psychotherapy is sometimes used to help person
function better.
Personality disorders
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An Axis II diagnosis
Considered incurable because they’re a
basic part of personality; present from early
childhood
Involve extreme and inflexible personality
traits that may be distressing to people who
have them or cause problems at
work/home;relationships
Borderline personality disorder
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More common in females
Characterized by extremely unstable
relationships, self-image, or mood swings
Associated with self-mutilation (cutting or
burning self, pulling hair out, etc.)
Physical pain of mutilation reduces
psychological pain
Becky: Borderline Personality
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http://www.youtube.com/watch?v=eOphgC
JX1FY
Antisocial personality disorder
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Also known as “sociopath” or “psychopath”
People are extremely manipulative and callous;
seem to have no morals
Ignore social rules/laws, behave impulsively,
don’t seem to learn from punishment, show no
remorse. Seemingly have no conscience.
May become criminals, politicians, or con artists.