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To study the abnormal is the best way of understanding the normal. William James (1842-1910) Psychological Disorders and Therapies Chapter 15 and 16 1 Rates of Psychological Disorders 1. 2. 3. http://www.learner.org/resources/se ries60.html?pop=yes&pid=780 There are 450 million people suffering from psychological disorders (WHO, 2004). Depression and schizophrenia exist in all cultures of the world. Two Major Classifications Neurotic: Distressing but one can still function in society and act rationally Psychotic: Person loses contact with reality, experiences 2 distorted perceptions Common Culture Bound Syndromes Syndrome Region/Pop Affected Description Koro Southeast Asia and Africa Episode of sudden and intense anxiety that the penis (or in women, the vulva and nipples) will recede into the body and possibly cause death. Amok Malaysia Dissociative episode characterized by a period of withdrawal and brooding followed by an outburst of violent, aggressive or homicidal behavior; often a response to a perceived slight 2-D Love Japan Men develop what appear to be amorous relationships with animated female characters; they may carry around pillows or other tangible reminders of these characters wherever they go Windigo Native Americans Morbid state of anxiety with fears of becoming a cannibal Susto Mexico, Central America, and South America Illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness. Ritual healings are focused on calling the soul back to the body and cleansing the person to restore bodily and spiritual balance Taijin Kyofu Sho Japan Intense fear that one’s body, its parts or its functions, displease, embarrass, or are offensive to other people in appearance, odor, facial 3 expressions, or movements Defining Psychological Disorders Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions. Behavior is judged to be: 1. Atypical – statistically infrequent; uncommon 2. Disturbing – socially disagreeable behaviors (varies with time and culture) 3. Maladaptive – cause social or physical harm a. To self - Inability to reach goals, to adapt to the demands of life b. To society – interferes, disrupts social group functioning 4. Personal Distress – behavior causes a person discomfort, anxiety, depression. 5. Unjustifiable – no good reason for behavior 4 DSM IV: Multiaxial Classification (pg. 623-626 in CP ) Axis I Axis II Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? Is a Personality Disorder or Mental Retardation present? Is a General Medical Condition (diabetes, Axis III hypertension or arthritis etc) also present? Are Psychosocial or Environmental Problems Axis IV (school or housing issues) also present? What is the Global Assessment of the person’s Axis V functioning? The most recent edition, DSM-IV-TR (Text Revision, 2000), describes 400 psychological disorders compared to 60 in the 1950s. DSM-V is supposed to come out in May 2013 Strengths/Weaknesses of DSM Strengths Weaknesses 1. Describe (400) disorders 2. Disorders outlined by DSM-IV are reliable. Therefore, diagnoses by different professionals are similar. 3. Determines how prevalent the disorder is 4. Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy. Correct labeling of a disorder may help people identify the source of their unhappiness and lead to a proper treatment 1. Does not explain CAUSES – just describes disorder and lists prevalence 2. Labels may stigmatize individuals and increase the risk of creating self-fulfilling prophecies. *Rosenhan Study – normal people misdiagnosed in mental hospital (http://www.psychblog.co.uk/video-beingsane-in-insane-places-163.html) 1. May foster over-diagnosis and confuse serious mental disorders with normal problems in living 2. Diagnoses can be misused for social and political purposes 3. “Insanity” (legal status indicating that a person cannot be held responsible for his or her actions because of mental illness; unable to distinguish right from wrong) labels raise moral and ethical 6 questions about how society should treat people who have disorders and History of Mental Disorders: Early Theories • Afflicted people were possessed by evil spirits. – Music or singing was often used to chase away spirits. – In some cases trephening was used: cutting a hole in the head of the afflicted to let out the evil spirit. – Another theory was to make the body extremely uncomfortable. Trephening History of Mental Disorders: Hospitalization • In the 1800’s, disturbed people were no longer thought of as madmen, but as mentally ill. – They were first put in hospitals; however, they were nothing more than barbaric prisons. – The patients were chained and locked away and some hospitals even charged admission for the public to see the “crazies”, just like a zoo. • Philippe Panel - French doctor who was the first to take the chains off and declare that these people are sick and “a cure must be found!!!” Insisted that madness was not due to demonic possession, but an ailment of the mind Current Perspectives: Medical Model When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders. Psychological disorders are sicknesses and can be diagnosed, treated and cured. 1. Etiology: Cause and development of the disorder. 2. Diagnosis: Identifying (symptoms) and distinguishing one disease from another. 3. Treatment: Treating a disorder in a psychiatric hospital. 4. Prognosis: Forecast about the disorder. 10 Current Perspectives: Biopsychosocial Perspective Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders (Mental illnesses are socially defined - major disorders, like depression and schizophrenia appear to be universal, however; other disorders appear to be tied to specific cultures) Used to be called DiathesisStress Model: diathesis meaning predisposition and stress meaning environment. Models of Abnormality and Therapy: Biological Perspective Physiological factors (brain activity, genes, hormones, NTs, nervous) determine behavior and mental processes Causes of Mental Disorders Physical diseases that can be treated medically Brain abnormalities Chemical imbalances Birth difficulties Heritability Treatment of Mental Disorders Drug Therapy Electroconvulsive Therapy (ECT) – effective for certain kinds of severe, otherwiseuntreatable depression. Psychosurgery/neurosurgery – surgery to destroy selected areas of the brain thought to be responsible for emotional disorders. Prefrontal lobotomy. Brain Abnormalities A PET scan of the brain of a person with ObsessiveCompulsive Disorder (OCD). High metabolic activity (red) in the frontal lobe areas are involved with directing attention. Generalized anxiety, panic attacks, and even OCD are linked with brain circuits like the anterior cingulate cortex. PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study repeat offenders had 11% less frontal lobe activity compared to individuals without antisocial personality disorder Brain Abnormalities Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles. Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain (neurons using dopamine fire too often). Drug Therapy Anti-anxiety drugs: Xanax , Valium, Klonopin, Ativan depress the central nervous system and reduce anxiety and tension by elevating the levels of the (GABA) neurotransmitter. Atypical antipsychotic drugs: Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms (apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others) of schizophrenia but does not restore normal thought patterns. Classical antipsychotics: Chlorpromazine (Thorazine) removes a number of positive symptoms associated with schizophrenia such as agitation, delusions, and hallucinations. Drug Therapy Anti-depressants: Monoamine Oxidase (MAO) inhibitors elevate levels of norepinephrine and serotonin by blocking or inhibiting the enzyme that deactivates these Norepinephrine NT. Serotonin-norepinephrine inhibitors (SNRIs) also elevate levels of norepinephrine and serotonin by blocking the reuptake of these NT. Pre-synaptic Neuron Serotonin Post-synaptic Neuron Anti-depressants: Selective serotonin reuptake inhibitors (SSRIs) – (Prozac, Zoloft, and Paxil) elevate levels of serotonin by preventing its reuptake Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders reducing levels of norepinephrine and glutuamate Brain Stimulation Electroconvulsive Therapy (ECT) ECT is used for severely depressed patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression. Transcranial Magnetic Stimulation (TMS) In TMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects. Models of Abnormality and Therapy: Psychodynamic Perspective Unconscious desires, needs, memories, and conflicts determine behavior and mental processes. Struggle to fulfill instinctive desires and wishes despite society’s rules Causes of Mental Disorders Treatment for Mental Disorders Repressed unconscious conflicts and drives Early childhood trauma Free association – patient reports all feelings, thoughts, memories, and images that come to mind in order to bring repressed feelings into conscious awareness where the patient can deal with them Dream analysis When energy devoted to id-egosuperego conflicts is released, the patient’s anxiety lessens. Psychoanalysis Dissatisfied with hypnosis, Freud developed the method of free association to unravel the unconscious mind and its conflicts. During free association, the patient lies on a couch and speaks about whatever comes to his or her mind. Often, the patient will edit his thoughts, resisting his or her feelings to express emotions. Such resistance becomes important in the analysis of conflict-driven anxiety. Eventually the patient opens up and reveals his or her innermost private thoughts, developing positive or negative feelings (transference) towards the therapist. Interpersonal psychotherapy, a variation of psychodynamic therapy, is effective in treating depression. It focuses on symptom relief here and now, not an overall personality change. 19 Models of Abnormality and Therapy: Cognitive Perspective The way we process, interpret, and store information determines behavior and mental processes. Emphasize cognitions (mental processes such as learning, memory, perception, thinking, and decision making) Causes of Mental Disorders Treatment for Mental Disorders Rational Emotive Behavior Therapy (Albert Mental disorders are a Ellis) – therapist challenges illogical beliefs result of learned directly with rational arguments; aim is to maladaptive thought identify self-defeating thought patterns and replace them with more constructive thoughts patterns or irrational Cognitive Therapy (Aaron Beck) – cognitive thoughts (a restructuring in which a client sees that his/her misinterpretation of what depression is due in part to erroneous and illogical thought patterns. Therapist helps is happening and is not point out those thoughts that precede anxiety supported by the available and depression and then works with the client evidence) to test the logic of these thoughts. Models of Abnormality and Therapy: Humanistic Perspective One’s inborn tendency to grow toward his/her unique potential determines behavior and mental processes. Emphasize free will, self-concept, and self-actualization Causes of Mental Disorders Treatment Distorted sense of self Growth-thwarting environment (real and ideal self are incongruent; did not receive unconditional positive regard or empathy) Do not delve into the past; help people to feel better about themselves here and now; boost self-fulfillment by helping people grow in self-awareness and self-acceptance. Client-centered therapy (Carl Rogers) therapist offers unconditional positive regard (non-judgemental) to build self-esteem; therapist must be warm, genuine, and empathic so client can adopt these views and become self-accepting Active listening - echoes, restates, and clarifies the patient’s thinking, acknowledging expressed feelings Models of Abnormality and Therapy: Behaviorist Perspective Learning through rewards and punishments in our external environment (classical conditioning, operant conditioning, observational learning) determines behavior and mental processes. Causes of Mental Treatment Counterconditioning Disorders Flooding or exposure treatments – therapist Learned accompanies client into the feared situation Systematic desensitization – a step by step process maladaptive of desensitizing a client to a feared object or patterns of experience; based on counterconditioning behavior cause Aversive conditioning – substitutes punishment for the reinforcement that has perpetuated a bad habit mental disorders Behavior Modification Skills training – practice in specific acts needed to achieve goals Token economy - in institutional settings therapists may create a token economy in which patients exchange a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats Anxiety Disorders Anxiety (a sense of apprehension that shares many of the same symptoms as fear but builds more slowly and lingers longer) that persists to the point that it interferes with one’s life. The CNS’s physiological and emotional response to a vague sense of threat or danger. http://www.youtube.com/watch?v=_Cr7IomSy8s 1. Generalized anxiety disorders 2. Phobias • Copycat Agoraphobia http://www.youtube.com/watch?v=u0dpgmwETcg&playnext=1&list=PLD14A589E28BB 9502 3. Obsessive-compulsive disorders • • • • • 4. 5. As Good as it Gets http://www.youtube.com/watch?v=44DCWslbsNM Aviator http://www.youtube.com/watch?v=7FapiKgs4y8&feature=related Grey’s Anatomy http://www.youtube.com/watch?v=ETFQ9fyRP0s&feature=related Exposure Therapy Aims to Curb OCD http://www.youtube.com/watch?v=B-qtnCiX5b4 Deep Brain Stimulation for OCD http://abcnews.go.com/video/playerIndex?id=3379057 Panic disorders Posttraumatic Stress Disorder Generalized Anxiety Disorder Symptoms 1. Feeling unexplainably tense and uneasy 2. Anxiety and worry are associated with at least 3 of these symptoms: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep problems 3. Difficulty controlling the worry, which may develop into “panic attacks” 4. Inability to identify or avoid the cause of certain feelings. 5. Occurs more days than not for six months I wish I could tell you what’s the matter. Sometimes I feel like something terrible has just happened when actually nothing has happened at all. Other times, I’m expecting the sky to fall down any minute. Most of the time I can’t point my finger at something specific. The fact is that I am tense and jumpy almost all the time. Sometimes my heart beats so fast, I’m sure it’s a heart attack. Little things can set it off. The other day I thought a supermarket clerk had overcharged me a few cents on an item. She showed me that I was wrong, but that didn’t end it. I worried the rest of the day . I kept going over the incident in my mind, feeling terribly embarrassed at having raised the possibility that the clerk had committed an error. The tension was so great, I wasn’t sure I’d be able to go to work in the afternoon. Panic Disorder Symptoms: 1. Recurrent, unexpected attacks of acute anxiety , peaking within 10 minutes. 2. Such panic may occur in a familiar situation, such as a crowded elevator. 3. May include feelings of terror, chest pains, nausea, choking, or other frightening sensations. 4. Can cause secondary disorders, such as agoraphobia (phobia of open places) It happened without any warning, a sudden wave of terror. My heart was pounding like mad, I couldn’t catch my breath, and the ground underfoot seemed unstable. I was sure it was a heart attack. It was the worst experience of my life. Phobia Disorder Symptoms: 1. Marked by a persistent and irrational fear of an object or situation that disrupts behavior and is often accompanied by extreme anxiety symptoms 2. Participate in elaborate ways to avoid the object or situation; just thinking about the thing you fear causes anxiety I can’t tell you why I’m afraid of rats. They fill me with terror. Even if I just see the word “rat” my heart starts pounding. I worry about rats in restaurants I go to, in my kitchen cupboard, and anywhere I hear noise that sounds like a small animal scratching or running. Types of Phobic Disorder • • • Specific Phobia – Most common phobias: specific animals or insects, heights, enclosed spaces, thunderstorms, and blood Social Phobia – Severe, persistent and unreasonable fears of social or performance situations in which embarrassment may occur Agoraphobia – Intense fear of being alone in public places from which escape would be difficult or help is not readily available 27 Obsessive-Compulsive Disorder Persistence of unwanted thoughts, wishes, images, ideas, doubts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress. 28 Obsessive-Compulsive Disorder • 20% of those with OCD have only obsessions or only compulsions; all others experiences both • Obsession: A young woman is continuously terrified by the thought that cars might careen onto the sidewalk and run over her. Compulsion: She always walks as far from the street pavement as possible and wars red clothes so that she will be immediately visible to an out-of-control car • Obsession: A college student has the urge to shout obscenities while sitting through lectures in classes. Compulsion: Carefully monitoring his watch, he bites his tongue every sixty seconds in order to ward off the inclination to shout • Obsession: A young boy worries incessantly that something terrible might happen to his mother while sleeping at night. Compulsion: ON his way up to bed each night, he climbs the stairs according to a fixed sequence of three steps up, followed by two steps down in order to ward off danger. I felt the need to clean my room … spent four to five hour at it … At the time I loved it but then didn't want to do it any more, but could not stop … The clothes hung … two fingers apart …I touched my bedroom wall before leaving the house … I had constant anxiety … I thought I might be nuts. Common Examples of OCD Common Obsessions: Contamination fears of germs, dirt, etc. Common Compulsions: Washing Imagining having harmed self or others Repeating Imagining losing control of aggressive urges Checking Intrusive sexual thoughts or urges Touching Excessive religious or moral doubt Counting Forbidden thoughts Ordering/arranging A need to have things "just so" Hoarding or saving Acute Stress Disorder • Characteristics of traumatic event: – Threatened death or serious injury – Person’s response involved intense fear, helplessness, or horror • During/after event person has 3 or more dissociative symptoms: – Feel numb, detached, or lack of emotional responsiveness – Less aware of surroundings – Derealization - an alteration in the perception or experience of the external world so that it seems strange or unreal – Depersonalization - subjective experience of unreality in one's sense of self – Dissociative amnesia • Traumatic event is persistently re-experienced • Avoidance of stimuli that reminds one of the traumatic event • Disturbance lasts for a minimum of 2 days and a maximum of 4 weeks of the traumatic event Post-Traumatic Stress Disorder Repeated, anxious reliving of a horrifying event over an extended period of time. 1. Haunting memories 2. Nightmares 3. Social withdrawal 4. Jumpy anxiety http://www.mtv.com/videos/true-life-i-have-post-traumaticstress-disorder/1601333/playlist.jhtml Bettmann/ Corbis 5. Sleep problems 32 Etiology of Anxiety Disorders Biological: • Genetic; runs in families • Inherit overly responsive autonomic nervous system • Overactivity of norepinephrine, (noradrenaline), specifically connected to the onset of panic attacks • Lack of serotonin function, especially in OCD and social phobias. • Deficiency in GABA • Too much glutamate in OCD patients, which causes the alarm center in the brain to keep going off • Overactive amygdala or an underactive prefrontal cortex, which creates an inability to turn off the initial stress response by the amygdala Evolutionary: • Biological preparedness to acquire some fears much more easily than others Behavioral: • Through observational learning, children adopt behaviors of anxiety disorders displayed by their parents. • As demonstrated in the Little Albert experiment, fear can be classically conditioned and then maintained through operant conditioning Cognitive: • A lack of perceived control (socialcognitive) • Inaccurate or irrational interpretation of an event/stimulus. Psychodynamic: • Ego defense mechanisms are inadequate. Sociocultural Perspective • Pressures, such as poverty or race, that cause anxiety. Treatment of Anxiety Disorders Behavioral: • Counterconditioning – Exposure Therapy • Systematic desensitization (Video 13) • Flooding • Aversion conditioning Biological: • Antianxiety drugs (Valium, Xanax) – reduce the symptoms of anxiety, nervousness, and sleeping problems by increasing the level of GABA, which inhibits nerve impulses in the brain. Generalized Anxiety Disorder results from… • Psychodynamic Perspective – Ego defense mechanisms are inadequate • Severe punishment for expressing id impulses, which causes high levels of anxiety • Cognitive Perspective – Unrealistic goals or unreasonable beliefs about the world and ourselves that foster worry and fears. – Inaccurate or irrational interpretation of an event/stimulus Tendency to overgeneralize and magnify the significance of an event. – Lack of perceived control. • Sociocultural Perspective – Pressures, such as poverty or race, that cause anxiety. • Behavioral Perspective – Observational learning – parents model the characteristics of anxiety disorders for their children; trouble leaving the house or being overly concerned about certain events. • Humanistic Perspective – People not looking at themselves honestly and acceptingly 35 Generalized Anxiety Disorder results from… • Biological Perspective – Certain people inherit autonomic nervous system traits that make them vulnerable or predisposed to anxiety (such as, overly responsive or reactive, strong alarm tendencies,). Minor events trigger anxiety. • Heritability of anxiety is 30 to 40% • Anxiety disorders run in families – Breakdown in the neural circuitry that signals the brain to stop responding. May be a result of an overactive amygdala or an underactive prefrontal cortex, which creates an inability to turn off the initial stress response by the amygdala – Anti-anxiety drugs: Xanax , Valium, Klonopin, Ativan depress the central nervous system and reduce anxiety and tension by elevating the levels of the neurotransmitter GABA. Deficiency in GABA, inhibitory disorder, which could account for racing thoughts. Panic Disorder results from… • Biological Perspective – Heightened startle response – hypersensitivity to neurochemicals that alert sympathetic nervous system. – Overactive norepinephrine (NT linked with arousal) • Cognitive Perspective – Full panic reactions are experienced only be people who misinterpret bodily events Phobia Disorder results from… • Behavioral Perspective – Learning theorists suggest that fear conditioning leads to anxiety. This anxiety then becomes associated with other objects or events (stimulus generalization) and is reinforced. – Fear is initially learned through classical conditioning • Claustrophobia • NS (closet) no response • UCS (lack of oxygen) UCR (gasping for air) • UCS (lack of oxygen) + NS (closet) UCR (gasping for air) • CS (closet) CR (gasping for air) • Generalization: closet to enclosed spaces – Fear is then maintained through avoidance (operant conditioning) because the individual avoids the thing he/she is afraid of, there are no opportunities for “reality testing” and new learning. – Investigators believe that fear responses are inculcated through observational learning. Young monkeys develop fear when they watch other monkeys who are afraid of snakes. Phobia Disorder results from… • Since phobias most likely develop as a result of fear conditioning, therapists use learning principles to eliminate unwanted behaviors. • Counterconditioning is a classical conditioning procedure that conditions new responses to stimuli that trigger unwanted behaviors. – Exposure Therapy - expose (in real or virtual environments) patients to things they fear and avoid. Through repeated exposures, anxiety lessens because the brain habituates to the fear. • Systematic Desensitization - A type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli • Flooding – immediate, direct and constant exposure to feared object, no chance of escape – Aversive Conditioning - associates an unpleasant state with an unwanted behavior. 40 Phobia Disorder results from… • Operant conditioning procedures enable therapists to use behavior modification, in which desired behaviors are rewarded and undesired behaviors are either unrewarded or punished. – Token Economy - In institutional settings therapists may create a token economy in which patients exchange a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats. I Phobia Disorder results from… • Biological Perspective – Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. Role of biological preparedness – people are biologically prepared by their evolutionary history to acquire some fears much more easily than others – Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias – Giving anti-depressants, such as SSRIs Obsessive Compulsive Disorder results from… • • • • Psychodynamic Perspective – Id battles with ego on conscious level • Id impulses = obsessive thoughts • Ego defenses = counter-thoughts or compulsive actions Behavioral Perspective – Compulsions are learned by chance – Exposure and response prevention (ERP), in which OCD sufferers don’t try to avoid their particular source of anxiety but actually seek it out. Eventually, emotional nerve endings grow desensitized to the stimulus. Cognitive Perspective – Overreact to unwanted thoughts – Try to neutralize these thoughts with actions – If neutralizing activity reduces anxiety, it becomes reinforced Biological Perspective – Twin studies – genetic component High metabolic • 53% in identical twins activity (red) in • 23% in fraternal twins frontal lobes - Brain abnormalities - Too much glutamate, which causes the alarm centers in the brain to keep going off - Lack of serotonin functioning (NT involved with regulation of sleep and mood - High level of activity in frontal lobes, associated with attention - In the future, OCD patients may receive deep brain stimulation. Causes of Stress Disorders • • • • Combat • Psychological Debriefing Disasters – Normalize responses to Abuse and victimization the disaster Why doesn’t everyone develop – Encourage expressions of psychological stress disorders? anxiety, anger, and – Biological and genetic factors frustration • Physical changes in body – Teach self-help skills • Abnormal NT and hormonal – Provide referrals activity – Personality factors • Preexisting high anxiety • History of psychological problems • Negative worldview – Negative childhood experiences – Weak social support 44 – Severity of the trauma Additional Anxiety Disorder Videos • OCD Videos – http://www.metacafe.com/watch/84755/true_life_living _with_ocd/ – http://www.metacafe.com/watch/ytSH0r44qn6pI/my_life_with_ocd_laurens_story_part_i_ dramatic_health/ – http://www.metacafe.com/watch/ytT0FMXyp6ZEs/my_life_with_ocd_laurens_story_part_ ii_dramatic_health/ • PTSD Videos – http://www.mtv.com/videos/true-life-i-have-posttraumatic-stress-disorder/1601333/playlist.jhtml 45 Mood Disorders Emotional extremes, which come in two principal forms. 1. 2. Unipolar disorders – experience emotional extremes at just one end of the mood continuum Major depressive disorder Dysthymic disorder Seasonal Affective disorder Bipolar disorders – experience emotional extremes at both ends of the mood continuum – depression and mania Major Depressive Disorder Symptoms 1. Signs of depression last two weeks or more and are not caused by drugs or medical conditions 2. Signs include: Lethargy and fatigue (takes tremendous effort to get up and get dressed); feelings of worthlessness (tearfulness and weeping; exaggerate minor failings, discount positive events, interpret things that go wrong as evidence that nothing will ever go right); loss of interest in family & friends; recurrent thoughts of death/suicide; loss of interest in activities; depressed most of the day; significant weight gain/loss; insomnia; psychomotor agitation/retardation; concentration difficulties or indecisiveness I was seized with an unspeakable physical weariness. There was a tired feeling in the muscles unlike anything I had ever experienced… my nights were sleepless. I lay with dry, staring eyes gazing into space. The most trivial duty became a formidable task. Finally mental and physical exercises were impossible; the tired muscles refused to respond, my “thinking apparatus” refused to work, ambition was gone. My general feeling might be summed up in the familiar saying “What’s the use.” Dysthymic Disorder Symptoms 1. Mild but chronic; lies between a blue mood and major depressive disorder 2. Characterized by daily depression lasting two years or more; longer lasting but less disabling 3. When dysthymic disorder leads to major depressive disorder, the sequence is called “double depression” Blue Mood Dysthymic Disorder Major Depressive Disorder Seasonal Affective Disorder Symptoms 1. Depression on a recurring basis in one season of the year when it gets dark early and light late in the day Treatment Light Therapy – exposure to bright light for a specific length of time The level of light produced must match that of visible light outdoors shortly after sunrise or before sunset 49 Etiology of Mood Disorders Biological: • Genetic; runs in families • Low serotonin may “open the door” to a mood disorder and permit norepinephrine activity to define the particular form the disorder will take: – Low serotonin + Low norepinephrine = Depression – Low serotonin + High norepinephrine = Mania. • An excessive release of the stress hormone cortisol, which could be connected to impaired functioning of the hypothalamus and pituitary gland of the endocrine system • Malfunctions in the body’s circadian clock, specifically for SAD. Socio-cultural: • Dysfunctional family systems, poverty, high-crime neighborhoods, domestic violence, and other stressful situations • Women have a higher chance than men of developing a mood disorder Psychodynamic: • Link between depression and grief: when a loved one dies, the mourner regresses to the oral stage: Cognitive: • Ruminating response style, selfdefeating thoughts, external locus of control, learned helplessness, and pessimistic views of: themselves, the world, the future. Treatment of Mood Disorders Cognitive: • Aaron Beck’s Cognitive Therapy – depression is caused by errors in thinking - illogical thinking about themselves, the world they live in, and the future. In therapy, clients are taught not only to identify negative, distorted thoughts but also to actually go out and test those negative beliefs. EX: a client who believes that nobody likes him will be instructed to engage in conversations with other people and report back with all of his experiences, which the therapist will try to build on successes and explore reasons for lack of success. • Albert Ellis’ Rational Emotive Behavior Therapy (RET) –Emotional disorders are caused by irrational beliefs - absolute, unrealistic views of the world and perfectionistic - that cause us to expect too much of ourselves and lead us to feel unnecessarily that we are worthless failures. Therapists identify client’s irrational beliefs and directly challenge or confront the patient and persuade them to adopt more realistic beliefs. • Stress Inoculation Training - A type of self-instructional training focused on altering self-statements an individual routinely makes in stress producing situations. EX: “Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.” Cognitive-Behavioral Therapy • Combine the reversal of self-defeated thinking with efforts to modify behavior. Aims to alter the way people act (behavior therapy) and alter the way they think (cognitive therapy). • Lewinsohn’s Behavioral Treatment – reintroduce clients to pleasurable activities and events – appropriately reinforce their depressive and nondepressive behaviors – help them improve their social skills Treatment of Mood Disorders Biological: Monoamine Oxidase (MAO) inhibitors elevate levels of norepinephrine and serotonin by blocking or inhibiting the enzyme that deactivates these NT. Norepinephrine Serotonin-norepinephrine inhibitors (SNRIs) also elevate levels of norepinephrine and serotonin by blocking the reuptake of these NT. Pre-synaptic Neuron Serotonin Post-synaptic Neuron Selective serotonin reuptake inhibitors (SSRIs) (Prozac, Zoloft, and Paxil) elevate levels of serotonin by preventing its reuptake Treatment of Mood Disorders Electroconvulsive Therapy (ECT) ECT is used for severely depressed patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression. Transcranial Magnetic Stimulation (TMS) In TMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects. Treatment of Mood Disorders Psychosurgery was popular even in Neolithic times. Although used sparingly today, about 200 such operations do take place in the US alone. Psychosurgery is used as a last resort in alleviating psychological disturbances. Psychosurgery is irreversible. Removal of brain tissue changes the mind. Modern methods use stereotactic neurosurgery and radiosurgery that refine older methods of psychosurgery. Unipolar Disorders results from… • Biological Perspective - Low norepinephrine (a stress hormone which affects parts of the brain where attention and responding actions are controlled. Underlies fight or flight response) and/or low serotonin levels - Brain scans show reduced frontal lobe activity - Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%). - Linkage analysis and association studies link possible genes and dispositions for depression. Unipolar Disorders results from… • Psychodynamic Perspective – Link between depression and grief: when a loved one dies, the mourner regresses to the oral stage • For most people, grief is temporary • If grief is severe and long-lasting, depression results • Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depression • Behavioral Perspective – Depression results from changes in rewards and punishments people receive in their lives; social rewards are especially important • Sociocultural Perspective – Focus on conditions of people’s lives; may explain gender differences in depression rates. Also found links between depression and culture, race, and social support – Marriage and employment associated with lower rates of depression – People with depression experience a greater number of stressful life events during the month just prior to the onset of their symptoms 56 Unipolar Disorders results from… • Cognitive Perspective – Conscious thoughts = how a person attends to, interprets, and uses information – Learned maladaptive thought patterns cause mental disorder (maladaptive thinking maladaptive behavior) – Ruminating response style - depressed people hold pessimistic views of: themselves, the world, the future and distort their experiences in negative ways: exaggerate bad experiences, minimize good experiences. – Learned helplessness - people become depressed when their efforts to avoid pain or control the environment fail; however, not all depressed people have actually experienced failure (social-cognitive) Explanatory Style and Depression Cycle 1. 2. 3. 4. Negative stressful events. Pessimistic explanatory style. Learned helplessness/Hopeless depressed state. These hamper the way the individual thinks and acts, fueling personal rejection. Social-Cognitive Perspective The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles. 59 • • • Rational Emotive Therapy (RET) Albert Ellis Emotional disorders are caused by irrational beliefs - absolute, unrealistic views of the world and perfectionistic values (i.e. “Everyone must love me all of the time.” or “I should be thoroughly adequate and competent in everything.”) – that cause us to expect too much of ourselves and lead us to feel unnecessarily that we are worthless failures Clients are taught that it is not the external events, but the interpretation of such events that leads to feeling of despair. 1) Therapists search for a client’s irrational beliefs, especially with respect to the irrational “shoulds,” “oughts,” and “musts” that are preventing a more positive sense of self worth and a fulfilling life, 2) points out the impossibility of fulfilling them, and 3) uses any and every technique to persuade the client to adopt more realistic beliefs, such as directly challenging/confronting the client’s beliefs during therapy ABC Model: A = Activating Event (the individual cannot find a date for the prom) B = Belief, irrational (I guess nobody likes me enough to go with me to the prom) C = Consequences (Feelings of depression). Ellis would challenge irrational beliefs with rational arguments and provide other reasons why he or she doesn’t have a date for the prom, because the thought is causing the depression not the event. Rational Emotive Therapy (RET) • • • Cognitive Therapy Aaron Beck Depression is caused by errors in thinking - illogical thinking about themselves, the world they live in, and the future – which lead them to: – 1) selectively perceive the world as harmful while ignoring evidence to the contrary – 2) overgeneralize on the basis of limited examples – for example, seeing themselves as totally worthless because they were laid off at work, – 3) magnify the significance of undesirable events – for example, seeing the job loss as the end of the world for them, – 4) engage in absolutistic thinking – for example, exaggerating the importance of someone’s mildly critical comment and perceiving it as proof of their instant descent from goodness to worthlessness Clients are taught not only to identify negative, distorted thoughts but also to actually go out and test those negative beliefs. – First taught to simply identify their own automatic thoughts (e.g. “This event is a total disaster.”) and to keep records of their thought content and their emotional reactions. – With the therapist’s help, they then learn about the logical errors in their thinking, and to challenge the validity of these automatic thoughts by designing ways in which the client can check out these thoughts in the real world. These disconfirmation experiments are planned to give the individual successful experiences, thus interrupting the destructive thought sequence. . – EX: a client who believes that nobody likes him will be instructed to engage in conversations with other people and report back with all of his experiences, which the therapist will try to build on successes and explore reasons for lack of success. Cognitive Therapy Bipolar Disorder (formerly called manic-depressive disorder) An alternation between depression and mania signals bipolar disorder. Depressive Symptoms Manic Symptoms Gloomy Elation Withdrawn Euphoria Inability to make decisions Tired Slowness of thought Desire for action Hyperactive Multiple ideas 64 Types of Bipolar Disorder • Manic Episode – Three or more symptoms of mania lasting one week or more • Hypomanic Episode – a less severe version of a manic episode that does not cause marked impairment in social or occupational functioning • Bipolar I Disorder – Full manic and major depressive episodes – Most sufferers experience an alternation of episodes – Some experience mixed episodes • Bipolar II Disorder – Hypomanic episodes and major depressive episodes • Cyclothymic Disorder – a chronic pattern of less-severe mood swings • hypomania • mild depression • may blossom into bipolar I or II disorder When experiencing manic symptoms, a 38 year old woman, periodically hospitalized because of her extreme moods, would become “overactive and exuberant in spirits and visited her friends, to whom she outlined her plans for reestablishing different forms of lucrative business. She purchased many clothes, bought furniture, pawned rings, and wrote checks without funds. She played her radio until late in the night, smoked excessively, took out insurance on a car that she had not yet bought. Contrary to her usual habits, she swore frequently and loudly and created a disturbance in a club to which she did not belong. On the day prior to her second admission to the hospital, she purchased 57 hats. Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase. Earl Theissen/ Hulton Getty Pictures Library The Granger Collection Wolfe George C. Beresford/ Hulton Getty Pictures Library Bettmann/ Corbis Whitman Clemens Hemingway Bipolar Disorder results from… • Biological Perspective - Low serotonin may “open the door” to a mood disorder and permit norepinephrine activity to define the particular form the disorder will take: - Low serotonin + Low norepinephrine = Depression - Low serotonin + High norepinephrine = Mania. Excessive production of norepinephrine. - Ions, which are needed to send incoming messages to nerve endings, may be improperly transported through the cells of individuals with bipolar disorder this improper transport may cause neurons to fire too easily (mania) or to resist firing (depression) - PET scans show that brain energy consumption rises and falls with manic and depressive episodes. Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders. It moderates the levels of norepinephrine and glutamate neurotransmitters. Schizophrenia Symptoms: The literal translation is “split mind.” A group of severe disorders characterized by the following: 1. Disorganized thinking (neologisms, clang/loose associations, word salad) 2. Delusions and hallucinations. 3. Inappropriate emotions and actions. http://www.youtube.com/watch?v=t vkj1qlQ9vM&feature=related This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Marry Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.” This monologue illustrates fragmented, bizarre thinking with distorted beliefs called delusions (“I’m Mary Poppins”). Subtypes of Schizophrenia Schizophrenia is a cluster of disorders. These subtypes share some features, but there are other symptoms that differentiate these subtypes. 69 Schizophrenia Symptoms Inappropriate symptoms Appropriate symptoms absent present (positive symptoms – (negative symptoms – behavioral excesses) behavioral deficitis) Hallucinations, disorganized Apathy, (avolition – no thinking, deluded ways. emotion), expressionless faces, rigid bodies blunted or flat affect, social withdrawal, poverty of speech (alogia) . When schizophrenia rapidly develops (acute/reactive) recovery is better. Such schizophrenics usually show positive symptoms. When schizophrenia is slow to develop (chronic/process) recovery is doubtful. Such schizophrenics usually display negative symptoms. Positive Symptoms (Behavioral Excesses) Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, deluded ways) that are not present in normal individuals Delusions: false beliefs about reality a. delusions of grandeur – GOD complex/meglomania – people maintain that they are famous or important b. delusions of persecution – they’re out to get me/ paranoia c. delusions of being controlled – the CIA is controlling my brain with a radio signal Disordered thought & speech - Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and bizarre thoughts). a. loose associations/derailment – people shift topics in disjointed ways. b. neologisms – meaningless, made up words c. Perseveration – repetition of speech d. thought insertion e. thought broadcasting Heightened perception Hallucinations - A schizophrenic person may perceive things that are not there. Frequently such hallucinations are auditory and lesser visual, somatosensory, olfactory, or gustatory. Sensory perceptions that occur in the absence of sensory stimulus Inappropriate affect - A schizophrenic person may laugh at the news of 71 someone dying Psychomotor Symptoms 1. Awkward movements, repeated grimaces, odd gestures 2. Movements seem to have a magical quality 3. Catatonia: extreme form includes stupor, rigidity, posturing, and excitement - patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours 72 Schizophrenia Nearly 1 in a 100 suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease (WHO, 2002). Schizophrenia strikes young people as they mature into adults. It affects men and women equally, but men suffer from it more severely and it appears earlier than women. More common among the poor. Stress of poverty might cause the disorder or schizophrenia causes victims from higher social levels to fall to lower social levels (downward 73 drift theory) Etiology of Schizophrenia Biological: • Genetic; runs in families. • Increased size in the ventricles (negative symptoms) • Dopamine Hypothesis: Excessive dopamine or excessive receptor sites for dopamine is connected to the positive symptoms.. • Prenatal viruses, such as influenza, or physical trauma during fetal development. Socio-cultural: • Dysfunctional family systems: display conflict, verbal exchanges are often confused, vague or incomplete, critical and overly involved parents • Substance abusers are more likely to develop disorder, such as cocaine users. • Disadvantaged communities report more incidences of disorder than better-off areas.. • Vulnerability theory of schizophrenia (diathesis-stress model): schizophrenia is the result of a biological predisposition and the amount of stress one encounters. Behavioral: • Some people are not reinforced for their attention to social cues and, as a result, they stop attending to those cues and focus instead on irrelevant cues (e.g., room lighting) and their responses become increasingly bizarre Cognitive: • Faulty interpretation and a misunderstanding of biological events (EX: a man experiences auditory hallucinations and approaches his friends for help; they deny the reality of his sensations; he concludes that they are trying to hide the truth from him; he begins to reject all feedback and starts feeling persecuted) Treatment of Schizophrenia Biological: Classical antipsychotics: Chlorpromazine (Thorazine) blocks all receptor sites for dopamine; thereby lessening the effects of dopamine and removing a number of positive symptoms associated with schizophrenia such as agitation, delusions, and hallucinations. Also known as neuroleptic drugs because they often produce undesired movement effects similar to symptoms of neurological diseases, such Tardive Dyskinesia (involuntary movements, usually of the mouth, lips, tongue, legs, or body) Atypical antipsychotic drugs: Clozapine (Clozaril) also blocks receptors for dopamine, but selectively blocks some of them and not all of them; thereby, eliminating some of the negative side effects of classic antipsychotics (i.e. has less of an effect on the D-2 receptors which control body movements, so it does not cause symptoms like Parkinson's disease). Also blocks serotonin receptors Treatment of Schizophrenia • Socio-Cultural Perspective – Family Therapy attempts to address the issues of living with a schizophrenic, creating more realistic expectations, and providing psychoeducation about the disorder – Social Therapy focuses on techniques that address social and personal difficulties in the clients’ lives (e.g., practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing Schizophrenia results from… • Psychodynamic Perspective – Freud believed that schizophrenia developed from two processes: 1. regression to a pre-ego stage 2. efforts to re-establish ego control • Behavioral Perspective – Cites principles of reinforcement as the cause; some people are not reinforced for their attention to social cues and, as a result, they stop attending to those cues and focus instead on irrelevant cues (e.g., room lighting) and their responses become increasingly bizarre • Cognitive Perspective – Schizophrenic symptoms develop because of faulty interpretation and a misunderstanding of biological events (EX: a man experiences auditory hallucinations and approaches his friends for help; they deny the reality of his sensations; he concludes that they are trying to hide the truth from him; he begins to reject all feedback and starts feeling persecuted) Schizophrenia results from… • Biological Perspective – Twin studies – genetic component • Risk of schiz for general population is 1-2 percent • The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease • No specific genes for schiz have been identified 0 10 20 30 40 50 Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated Schizophrenia results from… • Biological Perspective – Schizophrenia may develop through 2 kinds of biological abnormalities: – Dopamine Overactivity Hypothesis • neurons using dopamine fire too often, producing symptoms of schizophrenia • there are an unusually large number of dopamine receptors in people with schizophrenia • take antipsychotic meds, which block dopamine and help with positive symptoms • may have low levels of serotonin, which may lead to high levels of dopamine activity. – Brain abnormalities • decreased brain weight • reduced volume in specific brain areas, or reduced number of neurons in certain brain areas • enlarged ventricles • Abnormal activity in frontal lobe, thalamus, and amygdala. Adolescent schizophrenic patients also have brain lesions. Schizophrenia results from… • Biological Perspective – Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development. • large # of people with schizophrenia born in winter months • women with schizophrenic children were more often exposed to the influenza virus during pregnancy • link between schizophrenia and a particular group of viruses found in animals Diathesis-Stress Model: People with a biological predisposition will develop schizophrenia only if certain kinds of stressors or events are also present. Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed Schizophrenia results from… • Socio-Cultural Perspective – Family dysfunction: parents of people with schizophrenia often: – display more conflict – negative emotional climate – have greater difficulty communicating; erbal exchanges are often confused, vague, or incomplete. – are more critical of and overinvolved with their children – “expressed emotion:” family members frequently express criticism and hostility and intrude on each other’s privacy – Family Therapy attempts to address the issues of living with a schizophrenic, creating more realistic expectations, and providing psychoeducation about the disorder – Social Therapy focuses on techniques that address social and personal difficulties in the clients’ lives (e.g., practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing Dr. Phil Schizophrenia http://www.youtube.com/watch?v=uJOT45wXErk& feature=related http://www.youtube.com/watch?v=CoaZgvXQjik 20/20 Schizophrenia: Part 1 http://www.youtube.com/watch?v=moP_e-gx5hk 83 20/20 Schizophrenia: Part 2 84 http://www.youtube.com/watch?v=QPXkwYM9G-s&feature=related Childhood Schizophrenia http://www.hulu.com/watch/134660/abc-2020-fri-mar-12-201085 Young Schizophrenic at Her Mind's Mercy http://www.youtube.com/watch?v=UTUMt05_nCI&feature=fvwrel 86 Dissociative Disorders Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. 1. Dissociative Identity Disorder (Multiple Personality Disorder) 2. Dissociative Amnesia 3. Dissociative Fugue Dissociative Disorders Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. Symptoms: 1. Having a sense of being unreal. 2. Being separated from the body - depersonalization. Watching yourself as in a movie 3. Feature major losses or changes in memory, consciousness, and identity, but do not have physical causes. Common Dissociative Experiences in Everyday Life • Daydreaming • Missing parts of conversations • Forgetting part of drive home • Reading an entire page and not knowing what you read • Not sure whether you’ve done something or only thought about doing it • Seeing oneself as if looking at another person • Not sure if an event happened or was just a dream Dissociative Identity Disorder (DID) (formally called Multiple Personality Disorder) Symptoms: 1. Person exhibits two or more distinct and alternating personalities, 2. Each personality has his or her own name, memories, traits and physical mannerisms. The original personality often is unaware of the alternate personalities. The alternate personalities usually are aware of the original one and have varying amounts of awareness of each other. Alternate personalities display traits that are quite foreign to the original’s personality Norma has frequent gaps and cannot account for her whereabouts during certain periods of time. While being interviewed by a clinical psychologist, she began speaking in a childlike voice. She claimed that her name was Donna and that she was only six years old. Moments later, she seemed to revert to her adult voice and had no recollection of speaking in a childlike voice or claiming that her name was Donna. Criticisms: • The diagnosis of DID increased in the late 20th century. DID has not been found in other countries. • Role-playing by people open to a therapist’s suggestion. • Learned response that reinforces reductions in anxiety. Dissociative Fugue Jay, a high school physics Symptoms: teacher in NY City, 1. Forget their personal identities of disappeared three days their past (name, family, where after his wife unexpectedly they live, and where they work) left him for another man. and also flee to an entirely different Six months later, he was location discovered tending bar in Miami Beach. Calling 2. For some, the fugue is brief: they himself Marin, he claimed may travel a short distance but do to have no recollection of not take on a new identity his past life and insisted 3. For others, the fugue is more severe: they may travel thousands that he had never been married. of miles, take on a new identity, build new relationships, and display new personality characteristics 90 Dissociative Amnesia Unable to recall important information, usually of an upsetting nature, about their lives. Memory loss is the only symptom and does NOT result from other medical trauma, such as blow to the head Marian and her brother were recently victims of robbery. Marian was not injured, but her brother was killed when he resisted. Marian is unable to recall any details from the time of the accident until four days later. Sybil – Part 1 http://www.youtube.com/watch?v=m1_Z6-v4uT0&feature=related92 Sybil – Part 2 93 http://www.youtube.com/watch?v=1vANyDFgjZU&NR=1 60 Minutes: A Fractured Mind Robert Oxnam discovered he had multiple personality disorder in 1990. Oxnam, or in this case his personality 'Bobby,' performing a balancing act with bottles in New York's Central Park. http://www.cbsnews.com/video/watch/?id=890396n&tag=related;photovideo http://www.cbsnews.com/stories/2005/09/30/60minutes/main892181.shtml 94 Etiology & Treatment of Dissociative Disorders • Psychodynamic Perspective – Dissociative disorders are caused by repression, the most basic ego defense mechanism – People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness – Repeated, severe sexual or physical abuse with biological predisposition toward dissociation, such as fantasy prone personality. • Behavioral Perspective – Dissociation grows from normal memory processes and is a response learned through operant conditioning – Momentary forgetting of trauma decreases anxiety, which increases the likelihood of future forgetting In Eye Movement Desensitization and Reprocessing (EMDR) therapy, the therapist attempts to unlock and reprocess previous frozen traumatic memories by waving a finger in front of the eyes of the client. In order to treat DID, the therapist has to help recover memories (often through hypnosis); merge the subpersonalities into one; further therapy is needed to maintain fusion Somatoform Disorders Involve physical symptoms that have no organic (biological) cause (ulcers, asthma, high blood pressure). 1. Conversion Disorder – Band of Brothers http://www.youtube.com/watch?v=_2NbEV8cFzs 2. Somatization Disorder (Briquet’s syndrome) 3. Pain Disorder Associated w/ Psychological Factors 4. Hypochondriasis 5. Body Dysmorphic Disorder – – – Too Ugly for Love http://www.youtube.com/watch?v=MUKlLpMg-eM&feature=related Mirror Mirror http://www.youtube.com/watch?v=iAuc2xAM7-8&feature=related Dr. Phil http://www.youtube.com/watch?v=QMxL1uv9Vh0&feature=related; http://www.youtube.com/watch?v=hYJRlPk0ShI&feature=related; http://www.youtube.com/watch?v=NvAPYutZUUU&feature=related; Somatoform Disorders Involve physical symptoms that have no organic (biological) cause (ulcers, asthma, high blood pressure). Hysterical Somatoform Disorders: suffer actual changes in their physical functioning. Hard to distinguish from genuine medical problems. 1. Conversion Disorder – A psychological conflict or need is converted into dramatic physical symptoms that affect voluntary or sensory functioning. Person temporarily loses some bodily function. No physical damage to cause problems – Symptoms often seem neurological, such as paralysis, blindness, or loss of feeling – Most conversion disorders begin between late childhood and young adulthood – They usually appear suddenly and are thought to be rare 2. Somatization Disorder (Briquet’s syndrome) – Have numerous long-lasting physical ailments that have little or no organic basis. Complaints usually vague, undifferentiated (heart palpitations, dizziness, nausea) – To receive a diagnosis, a patient must have multiple ailments that include several pain symptoms, gastrointestinal symptoms, a sexual symptom, and a neurological symptom – Patients usually go from doctor to doctor seeking relief. 3. Pain Disorder Associated w/ Psychological Factors – Diagnosed when psychosocial factors play a central role in the onset, severity, or continuation of pain – The disorder often develops after an accident or illness that has caused genuine pain. The disorder may begin at any age, and more women than men seem to experience it Somatoform Disorders Faking Medical Disorders 1. Malingering – Intentionally faking illness to achieve external gain (e.g., financial compensation, military deferment) 2. Factitious disorders – Intentionally producing or feigning symptoms simply from a wish to be a patient – Factitious Disorder is Common Among: • received extensive medical treatment for a true physical disorder as a child • family problems or physical/emotional abuse in childhood • grudge against medical profession • worked in medical field • have an underlying personality problem - Most Common Factitious Disorders • Münchausen syndrome - fake being ill or make oneself ill • Münchausen syndrome by proxy – parents make up or produce physical illnesses in their children Somatoform Disorders Preoccupation Somatoform Disorders 1. Hypochondriasis – Unrealistically interpret bodily symptoms as signs of serious illness. Excessive preoccupation with health concerns. Assume physician must be incompetent – Often their symptoms are merely normal bodily changes, such as occasional coughing, sores, or sweating – Although some patients recognize that their concerns are excessive, many do not 2. Body Dysmorphic Disorder – Preoccupation with an imagined or exaggerated defect in one’s appearance Etiology of Somatoform Disorders • Psychodynamic Perspective – two mechanisms are at work in the hysterical disorders: • Primary gain: hysterical symptoms keep internal conflicts out of conscious awareness • Secondary gain: hysterical symptoms further enable people to avoid unpleasant activities or to receive kindness or sympathy from others • Behavioral Perspective: classical conditioning or modeling – physical symptoms of hysterical disorders bring rewards to sufferers • may remove individual from an unpleasant situation • may bring attention to the individual – sick role • Cognitive Perspective: oversensitivity to bodily cues – Hysterical disorders are a form of communication, providing a means for people to express difficult emotions – Some people focus excessive attention on their internal physiological processes and amplify normal bodily sensations into symptoms of distress, which lead them to pursue medical treatment. Tend to have a faulty standard of good health, equating health with a complete absence of symptoms. 100 Personality Disorders Enduring or continuous inflexible patterns of thinking, feeling, and acting. Start in childhood and continue through adolescence and adulthood. Personality disorders tend to be lifelong, pervasive, and inflexible (which makes them different from clinical disorders in Axis I). Tend to be more resistant to treatment than those with clinical disorders. 3 Clusters of Personality Disorders A. eccentric/odd behavior B. dramatic/erratic behavior C. anxious/fearful behavior 101 Cluster A Personality Disorders Type Characteristics Paranoid Distrust of others, believe people out to harm them; could react with violence to defend themselves Schizoid No social relationships; the “hermit” Problems with either starting or maintaining relationships; odd perceptions, emotions, thoughts, and behavior Schizotypal Cluster B Personality Disorders Type Characteristics Histrionic Obsessed with being center of attention; very dramatic; emotionally shallow person Exaggerated belief that he or she is very important and has achieved much success; arrogant Instability of emotions, impulse control, obsessive fear of being alone, difficulty maintaining relationships and routines No feelings of regard for others or their welfare; lack of conscience or remorse; most heavily studied personality disorder; sociopath and psychopath have been used to describe this disorder. Narcissistic Borderline Antisocial Cluster B Personality Disorders Psychopathy vs. ASPD • Psychopathy - focuses primarily on underlying personality traits (e.g., being self-centered or manipulative) • ASPD - focuses primarily on observable behavior (e.g., impulsivity, repeatedly changes jobs) ASPD vs. Criminality • “criminal” is a legal term denoting conviction for breaking a law: – not all people with ASPD are criminals (or in jails) – not all people in jail or considered criminal have ASPD – not all people with ASPD are psychopaths ASPD Influences & Treatment • deficient emotional arousal and conditioning is associated with a lack of empathy, thrill-seeking • punishment of offenders not likely to be very effective for rehabilitation • programs like “Scared Straight” and boot camps make kids with ASPD potential worse rather than better • “getting tough” with this population not likely to work “Social predators who charm, manipulate, and ruthlessly plow their way through life, leaving a broad trail of broken hearts, shattered expectations, and empty wallets. Completely lacking in conscience and empathy, they selfishly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret.” Robert Hare (1993) 104 Etiology of Antisocial PD Biological:: • Reduced activity in the frontal lobe, which is responsible for planning and organization. Socio-cultural: • Dysfunctional family, lack of positive parenting, attachment problems that appeared in early childhood, and childhood trauma. • Living in a high crime neighborhood Cluster C Personality Disorders Type Characteristics Dependent An enormous need to be taken care of; cannot make decisions; very needy Obsession with order and control; perfectionist Oversensitive to criticism; does not partake in social situations. Obsessive Compulsive Avoidant What about Bob? Dependent Personality Disorder http://www.youtube.com/watch?v=GCfq7yistd4 107