Download OL Chapter 12

Psychological Disorders
Chapter 12
Psychological Disorders
What is a Psychological Disorder?
 Defining Psychological Disorders
 Understanding Psychological Disorders
 Classifying Psychological Disorders – and
Labeling People
Psychological Disorders
Anxiety Disorders
 Generalized Anxiety Disorder
 Panic Disorder
 Phobias
 Obsessive-Compulsive Disorder (OCD)
 Post-Traumatic Stress Disorder (PTSD)
 Understanding Anxiety Disorders
Psychological Disorders
Dissociative and Personality
Disorders
 Dissociative Disorders
 Personality Disorders
Substance-Related Disorders
 Tolerance, Addiction, and Dependence
 Types of Psychoactive Drugs
 Understanding Substance Abuse
Psychological Disorders
Mood Disorders
 Major Depressive Disorder
 Bipolar Disorder
 Suicide
 Understanding Mood Disorders
Psychological Disorders
Schizophrenia
 Symptoms of Schizophrenia
 Onset and Development of Schizophrenia
 Understanding Schizophrenia
Psychological Disorders
• Worldwide, 450 million people suffer from
mental or behavioral disorders
• 26% of adult Americans suffer from a
diagnosable mental disorder at some point
during a given year
What Is a Psychological Disorder?
An ongoing pattern of thoughts,
feelings, or actions that are:
• Deviant. Different from most
other people who share one’s
culture.
• Distressful. Causing distress to
the person or to others.
• Dysfunctional. Behaviors
interfere with normal day-to-day
life.
History of Approaches to
Psychological Disorders
• Phillipe Pinel (1745-1826)
– Madness is not a
demon possession, but a
sickness of the mind
• Pinel and others
unchained patients,
talked with them, used
gentleness, gave them
activity and fresh air and
sunshine
The Medical Model
• In the 1800s, it was discovered that
syphillis could invade the brain and distort
the mind.
• Gave rise to the medical model of mental
disorders – diseases (including
psychological disorders) have physical
causes that can be diagnosed, treated,
and often cured
The Biopsychosocial Approach
• Psychological disorders are influenced by the
interaction of our biology, our psychology, and our
socio-cultural environment
• Some disorders are linked with specific cultures
– Anxiety related to a fear of black magic in Latin
America
– Anorexia and bulimia in Western cultures
• Some disorders occur worldwide
– Depression and schizophrenia
Classifying Disorders and
Labeling People
• Diagnostic classification gives us a quick
description of patient’s behavior, predicts future
course, suggests treatment, and prompts
research into causes.
• Guidebook is the American Psychiatric
Association’s Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV-TR)
– Categories and guidelines are fairly reliable, resulting
in the same diagnosis being made by different
clinicians
Diagnosing Psychological
Disorders
Criticisms of Diagnoses
• Casts too wide a net
– 400 disorder categories
• Labels trigger society’s
value judgments
– Can cause us to view a
person differently
• Labels can be selffulfilling
Mental illness is portrayed as dangerous
Overdiagnosis
• Study: David Rosenhan and 7 others went
to a hospital admissions office,
complaining of “hearing voices” (1973)
• Answered all other questions truthfully
• All were misdiagnosed with mental
disorders
• Doctors were able to “discover” the causes
of their disorders
Benefits of Diagnostic Labels
Help mental health professionals
• Communicate about their cases
• Pinpoint underlying causes
• Share information about effective
treatments
Anxiety Disorders
• Psychological disorders
characterized by distressing,
persistent anxiety or
maladaptive behaviors that
reduce anxiety
–
–
–
–
–
Generalized anxiety disorder
Panic disorder
Phobias
Obsessive-compulsive disorder
Post-traumatic stress disorder
Anxiety: Basket Case?
Generalized Anxiety Disorder
• Disorder in which a person is continually tense,
fearful, and in a state of autonomic nervous
system arousal
• Free-floating anxiety – person cannot identify
the cause of the tension
• Often coupled with depression, physical
problems such as high blood pressure
• Gender bias: 2/3 of those with GAD are women
Panic Disorder
• An anxiety disorder marked by unpredictable
minutes-long episodes of intense dread in which
a person experiences terror and chest pain,
choking, or other frightening sensations
• Panic attack symptoms often misread as a heart
attack or similar
• Smokers have at least doubled risk of panic
attack
Phobias
• A phobia is an anxiety disorder marked by a
persistent, irrational fear or avoidance of a
specific object or situation
• Can trigger a panic attack
• Social phobia: fear of being judged by others
• Agoraphobia: fear or avoidance of situations in
which panic may strike, escape may be difficult,
and help unavailable
Most Common Phobias
• A strong fear may become a phobia if it
provokes a compelling but irrational desire to
avoid the dreaded object or situation
Obsessive-Compulsive Disorder
(OCD)
• Characterized by
unwanted repetitive
thoughts (obsessions)
and/or actions
(compulsions)
• Effective functioning may
become impossible
Post-Traumatic Stress Disorder
(PTSD)
• An anxiety disorder characterized by
haunting memories, nightmares, social
withdrawal, jumpy anxiety, and/or
insomnia lingering for four weeks or
more after a traumatic experience
• Odds of getting PTSD after a trauma are
higher for women (10%) than for men
(5%)
• Most people display survivor resilience – the ability to
recover after severe stress
– Some people may have more sensitive emotion-processing
limbic systems than others
Understanding Anxiety Disorders
How do anxious thoughts and feelings
arise?
• The Learning Perspective
– Fear Conditioning
– Observational Learning
• The Biological Perspective
– Genes
– The Brain
– Natural Selection
The Learning Perspective
• Fear Conditioning
– Classical conditioning can produce fear and anxiety
– Stimulus generalization: a person experiences a
fearful event and later fears similar events
– Feeling relief by escaping a feared situation can
reinforce phobic behavior
• Observational Learning
– We may learn fear by observing others’ fears
– Parents may transmit fears to children
The Biological Perspective
• Genes
– Fearfulness runs in families
• The Brain
– Fear-learning experiences cause new brain
pathways  easy inroads for more fearful
experiences
– Brain scans of OCD patients reveal higherthan-normal activity in regions involved in
impulse control and habitual behaviors
The Biological Perspective on
Anxiety/OCD/Phobias
• Natural Selection
– Our ancestors evolved to fear snakes,
confinements, toxins, and heights
– Our phobias focus on dangers our
ancestors face
– Compulsive acts typically exaggerate
behaviors that helped them survive
(grooming, cleaning)
Dissociative Disorders
• Dissociative disorders involve a separation of
conscious awareness from previous memories,
thoughts, and feelings
Dissociative Disorders
• Dissociative identity disorder (DID) is a
rare dissociative disorder in which a
person exhibits two or more alternating
personalities
Skepticism About DID
• A short history
– Between 1930 and 1960, 2 cases per year.
By they 1980s there were 20,000 cases
• Much less common outside North America
– May be a cultural phenomenon
• May be an extension of the way we vary
the “selves” we present
Personality Disorders
• Disorders characterized by inflexible and
enduring behavior patterns that impair
social functioning
Personality Disorders
• Antisocial personality
disorder is a personality
disorder in which the person
exhibits a lack of
conscience for wrong-doing,
even toward friends and
family
– More common in men
– May be aggressive and
ruthless or a clever con artist
Dennis Rader,
the “BTK killer”
Antisocial Personality Disorder
• Lack of conscience manifests before age 15
• Most criminals do not have this disorder
• There is a genetic component – appears as low
arousal
– Lower stress hormones than average as children
– Slower to develop conditioned fears
• Combined with childhood abuse, can wire the
brain for antisocial behavior
Antisocial Personality Disorder
• The frontal lobes help brake impulsive,
aggressive behavior are less active in this
disorder.
Substance-Related Disorders
• Maladaptive patterns of substance use can lead
to significant impairment or distress
• Substances are often psychoactive drugs,
chemical substances that alter perceptions or
moods.
• A drug’s effect depends on the biological effects
and the user’s psychological expectations, which
vary with cultures
Guidelines for Substance Abuse
Tolerance, Addiction, and Dependence
• Tolerance: diminishing effects with regular use,
requiring larger doses to experience effect
• Addiction: compulsive drug craving and use
• Withdrawal: discomfort and distress following
discontinuing drug use
• Physical dependence: A physiological need for
a drug, marked by withdrawal symptoms
• Psychological dependence: a psychological
need for a drug, to relieve negative emotions
Substance Dependence
Types of Psychoactive Drugs
• Depressants
• Stimulants
• Hallucinogens
• Work at the brain’s synapses
• Stimulate, inhibit, or mimic the activity of
neurotransmitters
Depressants
• Calm neural activity and slow body
functions
• Alcohol
• Barbiturates
• Opiates
Alcohol Effects
• Slowed neural processing. Slow
sympathetic nervous system activity.
• Memory disruption. Suppresses REM
sleep, which helps to consolidate
memories
• Effects of expectations. User’s
expectations influence behavior:
– People who think they have been drinking
alcohol are more likely to feel uninhibited and
sexually interested
Alcohol Dependence
• Chronic alcohol abuse shrinks the brain
Alcohol Dependence
Barbiturates
• Barbiturates, or tranquilizers, depress
activity of the central nervous system,
reducing anxiety but impairing memory
and judgment
• Sometimes prescribed to induce sleep or
reduce anxiety
Opiates
• Opium and its derivatives, morphine and
heroin
• Depress neural activity, lessening pain
and anxiety
• Mimic the effects of endorphins, the
body’s natural painkillers
• Highly addictive
Stimulants
• Stimulants excite neural activity and
speed up body functions
– Caffeine
– Nicotine
– Amphetamines
– Cocaine
– Ecstasy
Is smoking really this cool?
Nicotine
The stimulating
and highly
addictive
psychoactive
drug in tobacco
How Cocaine Works
Methamphetamine
• A powerfully addictive drug
• Triggers release of dopamine
– Enhances energy and mood
• Aftereffects include irritability, insomnia, high
blood pressure, seizures, periods of
disorientation, and violent behavior
• Over time, can permanently reduce brain’s
normal dopamine output– leading to craving
more meth
Ecstasy (MDMA)
• MDMA is a synthetic stimulant and mild
hallucinogen
– Produces euphoria and social intimacy
– Short-term health risks
– Long-term harm to serotonin-producing
neurons and to mood and cognition
Hallucinogens
• Psychedelic drugs that distort perceptions and
evoke sensory images without sensory input
• LSD: a powerful hallucinogen
– Interferes with serotonin transmission
• Near-death experience:
altered state of
consciousness reported after
close brush with death, may
be similar to drug-induced
hallucinations
Marijuana/THC
• A difficult drug to classify. Effects include:
– Mild hallucinations, increases sensitivity to
colors, sounds, tastes and smells
– Also relaxes, disinhibits, produces euphoria
– Impairs motor coordination, perceptual skills,
and reaction time
– May help control pain, as well as reduce
ability to sense that hunger is satisfied
• Unlike alcohol, THC lingers for a month or
so, during which it takes smaller amounts
of THC to trigger effects”
Psychoactive Drugs
Rates of Substance Abuse
Understanding Substance Abuse
Biological Influences
• Adopted persons more likely to have alcohol
dependence if a biological parent was alcoholic
• Identical twins have correlated alcohol
dependence
• Boys at age 6 who are excitable and fearless are
more likely as teens to smoke, drink, and abuse
other drugs
• Researchers have bred rats and mice that prefer
alcoholic drinks to water
Understanding Substance Abuse
Psychological and Social-Cultural
Influences
• Substance abusers may
have experienced significant
stress or failure and
depression
• Can have social roots –
contributions from media and
culture
• Location matters – more
opportunities and less
supervision in cities
• Peer pressure
Peer pressure: To use, or not to use
Mood Disorders
Psychological disorders characterized
by a prolonged state of emotional
extremes
– Major depressive disorder
– Mania
– Bipolar disorder
Mood Disorders
• Anxiety is a response to threat of future loss
• Depressed mood is often a response to past and
current loss
• We all feel depressed or anxious sometimes
• Anxiety is a response to threat of future loss;
Depressed mood is often a response to past and
current loss
• We all feel depressed or anxious sometimes, but a
mood disorder:
– lasts longer,
– sticks around even when there is not something to be
depressed about, and
– makes it hard to function
Seasonal Affective Disorder
• Recurring depression during the dark
months of winter
Depression and Evolution
• Biologically, life’s purpose is survival and
reproduction, not happiness
• Depression helps us face and solve
problems
– Protects us from dangerous thoughts and
feelings
– Gives us time to think and consider our
options in the face of trouble
Major Depressive Disorder
• A person with major depressive disorder
experiences two or more weeks of
significantly depressed moods
– Lethargy
– Feeling worthless
– Loss of interest in family, friends, and
activities
• Leading cause of disability worldwide
Bipolar Disorder
• A person with bipolar disorder alternates
between depression and mania
– Much more extreme and problematic than
simple ‘mood swings’
• During mania, people are overtalkative,
overactive, and elated
– Sleep less, sexually uninhibited, easily
irritated
– Extreme optimism and self-esteem
Bipolar Disorder: Mania
• In milder forms, mania’s energy and freeflowing thinking can fuel creative energy
Madonna
Mark Twain
Virginia Woolf
Tim Burton
Suicide
• Nearly 1 million suicides a year worldwide
• Risk is 5x greater for those who have been
depressed
– People may feel most suicidal in the depths of
depression, but lack initiative and energy to
act on it; they may be more at risk of actually
committing suicide when mood and energy
seem to be improving
Anyone who threatens suicide is at least
sending a signal of feeling desperate or
hopeless
Facts about Depression
• Depression leads to negative thoughts and
behaviors, which in turn reinforce depression
• All around the world, Women’s risk of major
depression is nearly twice that of men’s.
More Facts about Depression
• Most major depressive episodes end on
their own, especially one’s first episode.
• Stressful events often precede depression
• Depression is striking earlier in each
generation, and affecting more people
– May reflect cultural differences between
generations
– Today’s youth may be more willing to talk
openly about depression
Mood Disorders:
Biological Influences
Genetics
– Mood disorders run in families
– If one identical twin is diagnosed with major
depression, 50% chance the other one will be
too
– 70% chance for bipolar disorder
Biological Aspects of Depression
• The Depressed Brain
– Brain activity slows during depression,
increases during mania
Biological Aspects of Depression
• The Depressed Brain: Levels of Activity
– Decreased activity in left frontal lobe, which is
active during positive emotions
• The Depressed Brain: Levels of
Neurotransmitters
– Levels of Norepinephrine (which increases
arousal and boosts mood) are lower during
depression, too high during mania
– Serotonin levels are also lower during
depression
Psychological and Social
Influences
• Negative thoughts and negative moods
interact
• Self-defeating thoughts can arise from
learned helplessness
• Women’s increased vulnerability to
depression may be related to tendency to
overthink
• Outlook influences whether an event will
become depressing
Explanatory Style and Depression
A Chicken-and-Egg Problem
• Which comes first: pessimistic explanatory
style, or depressed mood?
• A depressed mood may trigger negative
thoughts.
• People put in bad or sad moods tend to
become more pessimistic
• These negative thoughts also worsen
depression, thus completing a cycle
Depression’s Vicious Cycle
• Rejection and
depression feed
each other
• Recognizing the
cycle, we can break
it
– Each of the 4 points
offers an exit
Schizophrenia
• A group of severe disorders characterized
by
– Disorganized and delusional thinking
– Disturbed perceptions
– Inappropriate emotions and actions
• Disrupts social relationships, holding a job
is difficult
Symptoms of Schizophrenia
• Positive symptoms
– Inappropriate behaviors that are present
– Hallucinations, talking in disorganized or
deluded ways, laugh or rage at inappropriate
times
• Negative symptoms
– Feels or actions that one expects to be
present are absent
– Toneless voices, expressionless faces, mute
and rigid bodies
Disorganized Thinking
• May appear as word salad – jumbled
ideas that make no sense
– “A little more allegro in the treatment”
– “Liberationary movement with a view to the
widening of the horizon will ergo extort some
wit in lectures.”
• Often distorted by delusions (false
beliefs, often of persecution or grandeur)
Disturbed Perceptions
• Hallucinations – people with
schizophrenia may hear, see, feel, taste,
or smell things that are not there
– Most often take the form of sounds, usually
voices giving insults or instructions
Inappropriate Emotions and Actions
• Emotions are often split off from reality
– Laughing at grandmother’s death
– Crying when others laugh
– Becoming angry for no reason
• Others may exhibit flat affect
• Inappropriate motor behaviors may take many
forms
– Senseless, compulsive acts
– Remaining motionless for hours (catatonia)
Onset and Development of
Schizophrenia
• Nearly 1 in 100 people develop
schizophrenia
• 24 million sufferers worldwide
• Men struck earlier, more severely, and
slightly more often
• May appear suddenly, or develop
gradually
Onset and Development of
Schizophrenia
• When a slow-developing process (chronic, or
process schizophrenia), recovery is doubtful
– Often characterized by more negative symptoms
– More common in men
• Recovery is more likely when a well-adjusted
person develops it rapidly (acute, or reactive
schizophrenia)
– Follows stress
– Often characterized by more positive symptoms that
respond to drug therapy
Understanding Schizophrenia
Brain Abnormalities
• By studying the brains
of schizophrenic
patients, we can gain
insight into the causes
of this disorder, as
well as possible
treatments
E. Fuller Torrey
Understanding Schizophrenia
Brain Abnormalities
• Dopamine overactivity
– Schizophrenic patients’ brains have excess
number of dopamine receptors
– Drugs that block dopamine receptors often
lessen positive symptoms
– Drugs that increase dopamine (e.g.,
amphetamines, cocaine) sometimes intensify
them
Understanding Schizophrenia
Brain Abnormalities
• Abnormal brain activity and anatomy
– Low activity in frontal lobes
– PET study during hallucinations – activation in
the thalamus and amygdala
– Areas of the brain fill with fluid, and cerebral
tissue shrinks
Schizophrenia involves problems with several
brain regions and their interconnections
Understanding Schizophrenia
Prenatal Environment and Risk
• Prenatal viral infections can contribute to
the development of schizophrenia
– Increased risk if fetus develops during flu
epidemic
– Increased risk if born right after flu season
– Mothers who report being sick with flu during
pregnancy more likely to have schizophrenic
children
Understanding Schizophrenia
Genetics and Risk
• Predisposition to the disorder may be inherited
– Odds of being diagnosed: 1 in 100
– Odds if sibling or parent has schizophrenia: 1 in 10
Schizophrenia in Identical Twins
• Identical twins also share prenatal environment
– Shared germs PLUS shared genes produce identical
twin similarities
– Chances of sharing a diagnosis 6 in 10 if shared
placenta, 1 in 10 if separate
• Adoption studies confirm genetic link is real
Only afflicted twin has enlarged cavities. Implies a nongenetic factor.
On to the next topic…
These mental health disorders and others,
from Panic Disorder to Schizophrenia, are
the subject of:
• much suffering,
• much research, and
• much effort in the form of mental health
treatment, which is also known as:
Therapy.