Chapter 14 Psychological

Disorders: Part 1Music

“I’ll Go Crazy if I Don’t Go Crazy”

U2

“Mad World” Adam Lambert

Today’s Agenda

1. What is Abnormal?1. What is Abnormal? Criteria / Classification

2. Anxiety Disorders: Generalized Anxiety/ PTSD/ Obsessive Compulsive

Disorders 3. Somatoform Disorders

Somatization Disorders/ Hypochondriasis 4. Dissociative Disorders

Multiple Personality Disorder 5. Mood Disorders

Depression/ Bipolar Disorders /Suicide

1. What IS Abnormal?? Criteria:

1) Distress is present: Person is suffering, unhappy, afraid

2) Behaviour is maladaptive Impaired functioning Inability to meet responsibilities

3) Socially Deviant Behaviour is unusual, “not normal”

Classification DSM-IV, p. 580 text Why Classify?

Simplify and create order Research Plan treatment

Criteria for Abnormality Fig. 14.2 p. 608

Where is the dividing line between normal and abnormal behavior?

Deviation from statistical average

Deviation from cultural/societal average

1. Classification (cont’d)

Older Distinction: Neurotic vs. Psychotic

Neurotic: Distressing problem but person is still coherent and can

function socially (once acute phase of disorder is treated). E.g. most disorders discussed today

Psychotic: More bizarre, involving delusions or hallucinations.

Individual has impaired thought processes and cannot function socially. Treatment is long term

E.g. schizophrenia (next week)

2. Anxiety Disorders

Anxiety: Fear in situations that pose no objective threat 3 components:

A) Cognitive: Extreme/chronic worry; fear of harm

B) Physiological: Muscle tension, increased heart rate and blood pressure

C) Behavioural: Shaking, jumpiness, pacing, avoidance

Generalized Anxiety Disorders (5%) Symptoms of anxiety felt continuously for at least 6 months Excessive worry, restlessness, sleep disturbance that are

difficult to control http://www.youtube.com/watch?v=dRmBJhtys9g 

2. Anxiety Disorders (cont’d)

Panic Disorders: (2-3%) Presence of recurrent, and unexpected panic attacks:

Intense dread, shortness of breath, chest pain, choking, fear of going crazy or losing control or dying, shaking, sweating, nausea…

May lead to Agoraphobia (fear of open spaces) Post-Traumatic Stress Disorder

Re-experiencing traumatic event (e.g. dreams, flashbacks, reliving the experience) Avoidance of stimuli associated with the trauma (thoughts, feelings, people, places) Difficulties with sleep, concentration, irritability Is causing distress and impairment in functioning http://movieclips.com/e7Xc-born-on-the-fourth-of-july-movie-the-homecoming-speech/

Social Phobia: (3-13%) Fear of social or performance situations

Public speaking; Eating, drinking, writing in public

2. Anxiety Disorders (cont’d)

Obsessive-Compulsive Disorders (2%) Obsessions:

Persistent, uncontrollable thoughts Compulsions:

Rituals, behaviours that reduce anxiety Interfere with functioning

Four different themes: Obsessions and checking Symmetry and order Cleanliness and washing Hoarding

Case examples: Illustration from movie “As Good as it Gets”

http://www.youtube.com/watch?v=48jD-ZEuB0I  Howie Mandel: Germaphobic & Hypochondriac

3. Somatoform Disorders Hypochondriasis:

4-9% in medical practice Inordinate preoccupation with health and illness excessive anxiety about having a disease http://www.youtube.com/watch?v=lkIQ39538Ig&feature=related http://www.youtube.com/watch?v=tV_ORdpOK3g

Somatization Disorder: (1-2% women) History of diverse physical complaints for which there is NO

organic basis Long medical history of treatments for minor physical

ailments

4. Dissociative Disorders Multiple Personality Disorder (very rare)

Presence of at least 2 distinct personalities within the same individual

Leads to sudden changes in identity and consciousness

Each personality has its unique style and may unaware of the existence of the other personalities

Often related to severe abuse in early childhood

5. Mood Disorders

Depression Lifetime prevalence rates

20% in women; 10% in men Why more common in women?

Cost of caring Greater burden due to nurturing roles Also more affected by disruptions in relational ties

Exposure to higher levels of stress Victimization, abuse

Ruminative cognitive style as opposed to distraction or taking action Perpetuates negative mood

More likely to report symptoms

Seasonal Affective Disorders (SAD) Depressive symptoms related to physiological consequences of shorter winter

days Treatable with light therapy

5. Theories of Depression Biological predisposition

Concordance rates in twins: Identical: 65% Fraternal: 15%

G X E models (interaction of genetic and environmental contributors) Cognitive perspective

Beck: Negative (dysfunctional) attitudes Seligman: Attribution Theory

How do you explain your circumstances? Internal vs external Stable vs unstable Global vs specific

Depression: internal, stable, global attributions for negative events Diathesis-stress models

Depression results from an interaction between personality and negative life events

Dependency and vulnerability to loss Self-Criticism/Perfectionism and vulnerability to perceived failure

Cognitive Risk and Depression Featured Study p. 629

Students with dysfunctional attitudes and depressive attributional style were more likely to become depressed over 2 year period.

5. Mood Disorders (cont’d)

Bipolar Disorders: Periods of depression alternate with manic episodes Mania:

abnormally elevated mood, inflated self-esteem, pressure of speech, increased energy, decreased need for sleep, over-activity, lack of inhibition and impaired judgment

http://www.youtube.com/watch?v=3mJoHqmtFcQ

Prevalence rates: 1% in men and women Strong genetic component

Understood as a primarily biological disorder Unlike unipolar depression which has cognitive, interpersonal and

environmental determinants

Case Example: Vincent Van Gogh

5. Suicide University students:

40-50% have had suicidal thoughts 15% attempt suicide

3rd leading cause of death among 15-24 year-olds Major Risk Factors:

Feelings of isolation; withdrawal from friends and family Having a serious mental or physical illness

Including depression and feelings of hopelessness Experiencing a major loss or stressor

Leading aggression or feelings of shame, humiliation, failure, rejection History of child abuse (leading to self-harm in women)

Abuse of drugs or alcohol/ impulsivity Talking about wanting to hurt oneself/ Having a plan Feeling trapped, like there is no way out

5. Suicide (cont’d)

How to help: 1) Establish communication

Talk about suicidal wishes 2) Identify needs that have been frustrated

Search for love, recognition, respect? 3) Broaden suicidal person’s perspective

Impermanence of feelings This too will pass Give yourself the chance to experience a better

future Provide support for treatment

Resources Mental Health Service Information Ontario

1-866-531-2600 http://www.mhsio.on.ca Mood Disorders Association of Ontario

416-486-8049 http://www.mooddisorders.on.ca

Until next week: