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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: 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: