Download 2. Anxiety Disorders

Chapter 14
Psychological
Disorders: Part 1
Music: “Rock’n Roll Suicide”
David Bowie
“Mad World”
Adam Lambert
Today’s Agenda
•
1. What is Abnormal?
– Criteria / Classification
•
2. Anxiety Disorders:
– Generalized Anxiety/ Phobias/ Obsessive Compulsive
Disorders
•
3. Somatoform Disorders
– Somatization Disorders/ Hypochondriasis
•
4. Dissociative Disorders
– Multiple Personality Disorder
•
5. Mood Disorders
– Depression/ Bipolar Disorders /Suicide
1. What IS Abnormal??

Criteria:

1) Distress is present:
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
2) Behaviour is maladaptive
•
•

Impaired functioning
Inability to meet responsibilities
3) Socially Deviant


Person is suffering, unhappy, afraid
Behaviour is unusual, “not normal”
Classification


DSM-IV, p. 580
Why Classify?
•
•
•
Simplify and create order
Research
Plan treatment
Criteria for Abnormality
 Fig. 14.2 p. 578
Where is the dividing line between normal
and abnormal behavior?
• Deviation from statistical
average
• Deviation from cultural/societal average
1. Classification (cont’d)
 Older Distinction:
 Neurotic vs. Psychotic
 Neurotic:
 Distressing problem but person is still coherent and can
function socially (once acute phase of disorder is
treated).
 E.g. most disorders discussed today
 Psychotic:
 More bizarre, involving delusions or halucinations.
Individual has impaired thought processes and cannot
function socially. Treatment is long term
 E.g. schizophrenia (next week)
2. Anxiety Disorders
• Anxiety:
– Fear in situations that pose no objective threat
– 3 components:
• A) Cognitive:
– Extreme/chronic worry; fear of harm
• B) Physiological:
– Muscle tension, increased heart rate and blood pressure
• C) Behavioural:
– Shaking, jumpiness, pacing, avoidance
• Generalized Anxiety Disorders (5%)
– Symptoms of anxiety felt continuously for at least 6 months
– Excessive worry, restlessness, sleep disturbance that are difficult
to control
2. Anxiety Disorders
(cont’d)
• Panic Disorders: (2-3%)
– Presence of recurrent, and unexpected panic attacks:
• Intense dread, shortness of breath, chest pain, choking, fear of going crazy or
losing control or dying, shaking, sweating, nausea…
– May lead to Agoraphobia (fear of open spaces)
• Phobic Disorders: (10%)
– Fear of a particular object, animal or context which is irrational
– Is causing distress and impairment in functioning
• Social Phobia: (3-13%)
– Fear of social or performance situations
• Public speaking;
• Eating, drinking, writing in public
2. Anxiety Disorders
(cont’d)
• Obsessive-Compulsive Disorders (2%)
– Obsessions:
• Persistent, uncontrollable thoughts
– Compulsions:
• Rituals, behaviours that reduce anxiety
• Interfere with functioning
– Thoughts and behaviours are not under voluntary
control
– Case example:
• Howie Mandel: Germaphobic & Hypochondriac
3. Somatoform Disorders
– Hypochondriasis:
• 4-9% in medical practice
• Inordinate preoccupation with health and illness
• excessive anxiety about having a disease
– Somatization Disorder:
• (1-2% women)
• History of diverse physical complaints for which
there is NO organic basis
• Long medical history of treatments for minor
physical ailments
4. Dissociative Disorders
• Multiple Personality Disorder (very rare)
– Presence of at least 2 distinct personalities
within the same individual
– Leads to sudden changes in identity and
consciousness
– Each personality has its unique style and may
unaware of the existence of the other
personalities
– Often related to severe abuse in early childhood
5. Mood Disorders
• Depression
– Lifetime prevalence rates
• 20% in women; 10% in men
– Why more common in women?
• Cost of caring
– Greater burden due to nurturing roles
– Also more affected by disruptions in relational ties
• Exposure to higher levels of stress
– Victimization, abuse
• Ruminative cognitive style
– as opposed to distraction or taking action
– Perpetuates negative mood
• More likely to report symptoms
• Seasonal Affective Disorders (SAD)
– Depressive symptoms related to physiological consequences of shorter
winter days
– Treatable with light therapy
5. Theories of Depression
• Biological predisposition
– Concordance rates in twins:
• Identical: 65%
• Fraternal: 15%
– G X E models (interaction of genetic and environmental contributors)
• Cognitive Perspective
– Beck: Negative (dysfunctional) attitudes
– Seligman: Attribution Theory
• How do you explain your circumstances?
– Internal vs external
– Stable vs unstable
– Global vs specific
• Depression: internal, stable, global attributions for negative events
– Diathesis-stress models
• Depression results from an interaction between personality and negative life events
– Dependency and vulnerability to loss
– Self-Criticism/Perfectionism and vulnerability to perceived failure
Cognitive Risk and Depression
• Featured Study p. 596
– Those with dysfunctional attitudes and depressive attributional style were more
likely to become depressed over 2 year period.
5. Mood Disorders
(cont’d)
• Bipolar Disorders:
– Periods of depression alternate with manic episodes
– Mania:
• abnormally elevated mood, inflated self-esteem, pressure of
speech, increased energy, decreased need for sleep, overactivity, lack of inhibition and impaired judgment
– Prevalence rates:
• 1% in men and women
• Strong genetic component
– Understood as a primarily biological disorder
» Unlike unipolar depression which has cognitive,
interpersonal and environmental determinants
– Case Example: Vincent Van Gogh
Comparison of symptoms of
depression and mania (p. 592)
5. Suicide
• University students:
– 40-50% have had suicidal thoughts
– 15% attempt suicide
• 3rd leading cause of death among 15-24 year-olds
• Major Risk Factors:
– Feelings of Isolation
– Having a serious mental or physical illness
• Including mood disorder (42%)/ depression and feelings of hopelessness
– Experiencing a major loss or stressor
• Leading to feelings of shame, humiliation, failure or rejection
• History of child abuse (leading to self-harm in women)
– Abuse of drugs or alcohol/ impulsivity (40%)
– Having a plan
– Risk increases in adolescence and young adulthood
5. Suicide (cont’d)
• How to help:
– 1) Establish communication
• Talk about suicidal wishes
– 2) Identify needs that have been frustrated
• Search for love, recognition, respect?
– 3) Broaden suicidal person’s perspective
• Impermanence of feelings
– This too will pass
– Give yourself the chance to experience a better future
• Provide support for treatment
• Until next week: