Download Psychological Disorders

Psychological Disorders
Chapter 16
©2002 Prentice Hall
Psychological Disorders







Defining and diagnosing disorder.
Anxiety disorders.
Mood disorders.
Personality disorders.
Drug abuse and addiction.
Dissociative identity disorder.
Schizophrenia.
©2002 Prentice Hall
Defining and Diagnosing Disorder



Dilemmas of definition.
Dilemmas of diagnosis.
Dilemmas of measurement.
©2002 Prentice Hall
Dilemmas of Definition

Possible Models for Defining Disorders:




Mental disorder as a violation of cultural standards.
Mental disorder as maladaptive or harmful behavior.
Mental disorder as emotional distress.
Mental Disorder

Any behavior or emotional state that causes an
individual great suffering or worry, is self-defeating
or self-destructive, or is maladaptive and disrupts the
person’s relationships or the larger community.
©2002 Prentice Hall
Diagnostic and Statistical Manual





Axis I: Primary clinical problem
Axis II: Personality disorders
Axis III: General medical conditions
Axis IV: Social and environmental stressors
Axis V: Global assessment of overall
functioning
©2002 Prentice Hall
Explosion of Mental Disorders


Supporters of new
categories answer that
is important to
distinguish disorders
precisely.
Critics point to an
economic reason:
diagnoses are needed
for insurance reasons
so therapists will be
compensated.
©2002 Prentice Hall
Concerns About Diagnostic System




The danger of overdiagnosis.
The power of diagnostic labels.
Confusion of serious mental disorders with
normal problems.
The illusion of objectivity and universality.
©2002 Prentice Hall
Advantages of the DSM


When the manual is used correctly and
diagnoses are made with valid objective
tests, the DSM improves the reliability of
and agreement among clinicians.
The DSM-IV included for the first time a
list of culture-bound syndromes, disorders
specific to a particular culture.
©2002 Prentice Hall
Projective Tests

Projective Tests


Psychological tests used to
infer a person’s motives,
conflicts, and unconscious
dynamics on the basis of
the person’s interpretations
of ambiguous stimuli.
Rorschach Inkblot Test

A projective personality
test that asks respondents
to interpret abstract,
symmetrical inkblots.
©2002 Prentice Hall
A sample inkblot
Objective Tests

Inventories


Standardized objective questionnaires
requiring written responses; they typically
include scales on which people are asked to
rate themselves.
Minnesota Multiphasic Personality
Inventory (MMPI)

A widely used objective personality test.
©2002 Prentice Hall
Anxiety Disorders



Anxiety and panic.
Fears and phobias.
Obsessions and compulsions.
©2002 Prentice Hall
Anxiety and Panic

Generalized Anxiety Disorder


A continuous state of anxiety marked by feelings of
worry and dread, apprehension, difficulties in
concentration, and signs of motor tension.
Panic Disorder

An anxiety disorder in which a person experiences
recurring panic attacks, feelings of impending doom
or death, accompanied by physiological symptoms
such as rapid breathing and dizziness.
©2002 Prentice Hall
Posttraumatic Stress Disorder
(PTSD)



An anxiety disorder in which a person who
has experienced a traumatic or lifethreatening event has symptoms such as
psychic numbing, reliving the the trauma,
and increased physiological arousal.
Diagnosed only if symptoms persist for 6
months or longer.
May immediately follow event or occur later.
©2002 Prentice Hall
Panic Disorder

An anxiety disorder in
which a person
experiences:




recurring panic attacks,
periods of intense fear,
and
feelings of impending
doom or death,
accompanied by
physiological symptoms
such as rapid heart rate
and dizziness.
©2002 Prentice Hall
Fears and Phobias

Phobia

An exaggerated, unrealistic fear of a specific
situation, activity, or object.
©2002 Prentice Hall
Agorophobia

A set of phobias, often set off by a panic
attack, involving the basic fear of being
away from a safe place or person.
©2002 Prentice Hall
Obsessions and Compulsions

Obsessive-Compulsive Disorder (OCD)


An anxiety disorder in which a person feels
trapped in repetitive, persistent thoughts
(obsessions) and repetitive, ritualized
behaviors (compulsions) designed to reduce
anxiety.
Person understands that the ritual behavior is
senseless but guilt mounts if not performed.
©2002 Prentice Hall
Mood Disorders


Depression and Bipolar Disorder.
Theories of Depression.
©2002 Prentice Hall
Depression

Major Depression

A mood disorder involving disturbances in
emotion (excessive sadness), behavior (loss
of interest in one’s usual activities), cognition
(thoughts of hopelessness), and body function
(fatigue and loss of appetite).
©2002 Prentice Hall
Symptoms of Depression









DSM IV Requires 5 of these
within the past 2 weeks
Depressed mood.
Reduced interest in almost all activities.
Significant weight gain or loss, without dieting.
Sleep disturbance (insomnia or too much sleep).
Change in motor activity (too much or too little) .
Fatigue or loss of energy.
Feelings of worthlessness or guilt.
Reduced ability to think or concentrate.
Recurrent thoughts of death.
©2002 Prentice Hall
Gender, Age, & Depression

Women are about
twice as likely as men
to be diagnosed with
depression.


True around the
world
After age 65, rates of
depression drop
sharply in both sexes.
©2002 Prentice Hall
Bipolar Disorder

Bipolar Disorder: A
mood disorder in
which episodes of
depression and mania
(excessive euphoria)
occur.
Mood
©2002 Prentice Hall
The Bipolar Brain


Bipolar disorder can
have rapid mood
swings
These wild changes
are shown in brain
activity (right)
©2002 Prentice Hall
Theories of Depression





Biological explanations emphasize genetics and brain
chemistry.
Social explanations emphasize the stressful
circumstances of people’s lives.
Attachment explanations emphasize problems with
close relationships.
Cognitive explanations emphasize particular habits of
thinking and ways of interpreting events.
“Vulnerability-Stress” explanations draw on all four
explanations described above.
©2002 Prentice Hall
Vulnerability-Stress
Model
©2002 Prentice Hall
Personality Disorders


Problem Personalities.
Antisocial Personality Disorder.
©2002 Prentice Hall
Problem Personalities

Personality Disorder


Narcissistic Personality Disorder


Rigid, maladaptive patterns that cause personal
distress or an inability to get along with others.
A disorder characterized by an exaggerated sense of
self-importance and self-absorption.
Paranoid Personality Disorder

A disorder characterized by habitually unreasonable
and excessive suspiciousness and jealousy.
©2002 Prentice Hall
Antisocial Personality Disorder (APD)

A disorder characterized by antisocial
behavior such as lying, stealing,
manipulating others, and sometimes
violence; and a lack of guilt, shame and
empathy.


Sometimes called psychopathy or sociopathy
Occurs in 3% of all males and 1% of all
females.
©2002 Prentice Hall
Emotions and
Antisocial Personality Disorder


People with APD were
slow to develop
classically conditioned
responses to anger, pain,
or shock.
Such responses indicate
normal anxiety.
©2002 Prentice Hall
DSM Criteria for APD

Must have 3 of these criteria and a history of
behaviors







Repeatedly break the law.
They are deceitful, using aliases and lies to con others.
They are impulsive and unable to plan ahead.
They repeatedly get into physical fights or assaults.
They show reckless disregard for own safety or that of
others.
They are irresponsible, failing to meet obligations to
others.
They lack remorse for actions that harm others.
©2002 Prentice Hall
Causes of APD



Abnormalities in central nervous system.
Genetically influenced problems with impulse
control.
Brain damage.
©2002 Prentice Hall
Drug Abuse and Addiction



Biology and addiction.
Learning, culture, and addiction.
Debating the causes of addiction.
©2002 Prentice Hall
Biology and Addiction

The biological model holds that addiction,
whether to alcohol or other drugs is due
primarily to:




a person’s biochemistry,
metabolism, and
genetic predisposition,
Most evidence comes from twin studies.
©2002 Prentice Hall
Learning, Culture, and Addiction




Addiction patterns vary according to cultural
practices and the social environment.
Policies of total abstinence tend to increase
addiction rates rather than reduce them.
Not all addicts have withdrawal symptoms when
they stop taking a drug.
Addiction does not depend on the properties of
the drug alone, but also on the reason for taking
it.
©2002 Prentice Hall
Failure of the Addiction Prediction




75% of US Soldiers who
tested “drug positive” in
reported being addicted
during their tour.
Fewer reported postVietnam drug use (blue bar).
Even fewer still showed
dependency(green bar).
This contradicts what the
biomedical model of
addiction would predict.
©2002 Prentice Hall
Debating the Causes of Addiction

Problems with drugs are more likely when:





A person has a physiological vulnerability to a drug.
A person believes she or he has no control over the
drug.
Laws or customs encourage people to take the drug
in binges, and moderate use is neither tolerated nor
taught.
A person comes to rely on a drug as a method of
coping with problems, suppressing anger or fear, or
relieving pain.
Members of a person’s peer group use drugs or drink
heavily, forcing the person to choose between using
drugs or losing friends.
©2002 Prentice Hall
Dissociative Identity Disorder



Defining identity disorders.
The MPD controversy.
The sociocognitive explanation.
©2002 Prentice Hall
Dissociative Identity Disorders

A controversial disorder marked by the
appearance within one person of two or
more distinct personalities, each with its
own name and traits; commonly known as
“Multiple Personality Disorder (MPD).”
©2002 Prentice Hall
The MPD Controversy

First view




MPD is common but often unrecognized or
misdiagnosed.
The disorder starts in childhood as means of
coping.
Trauma produced a mental splitting.
2nd view


Created through pressure and suggestions by
clinicians.
Handfuls to 10000 since 1980.
©2002 Prentice Hall
Sociocognitive Explanation



MPD is an extreme form of our ability to
present many aspects of our personalities to
others.
MPD is a socially acceptable way for some
troubled people to make sense of their
problems.
Therapists looking for MPD may reward
patients with attention and praise for
revealing more and more personalities.
©2002 Prentice Hall
Schizophrenia



Defining schizophrenia and psychosis.
Symptoms of schizophrenia.
Theories of schizophrenia.
©2002 Prentice Hall
Symptoms of Schizophrenia




Bizarre delusions.
Hallucinations and heightened sensory
awareness.
Disorganized, incoherent speech.
Grossly disorganized and inappropriate
behavior.
©2002 Prentice Hall
Delusions and Hallucinations

Delusions


False beliefs that often accompany
schizophrenia and other psychotic disorders.
Hallucinations

Sensory experiences that occur in the absence
of actual stimulation.
©2002 Prentice Hall
Positive Symptoms

Cognitive, emotional, and behavioral
excesses

Examples of Positive Symptoms
Hallucinations.
 Bizarre delusions.
 Incoherent speech.
 Inappropriate/Disorganized behaviors.

©2002 Prentice Hall
Negative Symptoms


Cognitive, emotional, and behavioral
deficits.
Examples of Negative Symptoms




Loss of motivation.
Emotional flatness.
Social withdrawal.
Slowed speech or no speech.
©2002 Prentice Hall
Theories of Schizophrenia




Genetic predispositions
Structural brain abnormalities
Neurotransmitter abnormalities
Prenatal abnormalities
©2002 Prentice Hall
Genetic Vulnerability to
Schizophrenia

The risk of developing
schizophrenia (i.e.,
prevalence) in one’s
lifetime increases as the
genetic relatedness with
a diagnosed
schizophrenic increases.
©2002 Prentice Hall
Structural Brain Abnormalities

Several abnormalities exist, especially when
schizophrenia is characterized by primarily
negative symptoms:




Decreased brain weight.
Decreased volume in temporal lobe or
hippocampus.
Enlargement of vetricles.
About 25% do not have these observable
brain deficiencies
©2002 Prentice Hall
Neurotransmitter Abnormalities



Include serotonin, glutamate, and
dopamine.
Many schizophrenics have high levels of
brain activity in brain areas served by
dopamine as well as greater numbers of
particular dopamine receptors.
Similar neurotransmitter abnormalities are
also found in depression and alcoholism.
©2002 Prentice Hall
Prenatal Problems or Birth
Complications

Damage to the fetal brain increases chances
of schizophrenia and other mental
disorders.


May occur as a function of maternal
malnutrition, maternal illness.
May also occur if brain injury or oxygen
deprivation occurs at birth.
©2002 Prentice Hall
Adolescent Abnormalities in Brain
Development


Normal pruning of excessive synapses in
the brain occurs during adolescence.
In schizophrenics, a greater number of
synapses are pruned away.

Many explain why first episode occurs in
adolescence or early adulthood.
©2002 Prentice Hall