Chapter 14 Psychological Disorders: Part 1 Music: Rockn Roll Suicide David Bowie Mad World Adam Lambert Todays Agenda 1. What is Abnormal? Criteria / Classification 2. Anxiety Disorders: Generalized Anxiety/ Phobias/ 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 Why Classify? Simplify and create order Research Plan treatment Criteria for Abnormality Fig p. 578 Where is the dividing line between normal and abnormal behavior? Deviation from statistical average Deviation from cultural/societal average 1. Classification (contd) 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 halucinations. 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 2. Anxiety Disorders (contd) 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) Phobic Disorders: (10%) Fear of a particular object, animal or context which is irrational Is causing distress and impairment in functioning Social Phobia: (3-13%) Fear of social or performance situations Public speaking; Eating, drinking, writing in public 2. Anxiety Disorders (contd) Obsessive-Compulsive Disorders (2%) Obsessions: Persistent, uncontrollable thoughts Compulsions: Rituals, behaviours that reduce anxiety Interfere with functioning Thoughts and behaviours are not under voluntary control Case example: 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 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. 596 Those with dysfunctional attitudes and depressive attributional style were more likely to become depressed over 2 year period. 5. Mood Disorders (contd) 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 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 Comparison of symptoms of depression and mania (p. 592) 5. Suicide University students: 40-50% have had suicidal thoughts 15% attempt suicide 3 rd leading cause of death among year-olds Major Risk Factors: Feelings of Isolation Having a serious mental or physical illness Including mood disorder (42%)/ depression and feelings of hopelessness Experiencing a major loss or stressor Leading to feelings of shame, humiliation, failure or rejection History of child abuse (leading to self-harm in women) Abuse of drugs or alcohol/ impulsivity (40%) Having a plan Risk increases in adolescence and young adulthood 5. Suicide (contd) 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 persons perspective Impermanence of feelings This too will pass Give yourself the chance to experience a better future Provide support for treatment Until next week: