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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.