Psychological disorders

Psychological

Disorders

13-2

Defining and Classifying

Historical Explanations of Abnormal Behaviors

• Demonic possession

• Physical diseases

• Products of psychological conflicts

• Learned maladaptive behaviors

• Distorted perceptions of the world

13-3


Vulnerability-Stress Model

• Each of us has vulnerability for

developing a psychological

disorder

• Stress plays a role in

development

13-5


Criteria for “abnormality”

• Distress

• Dysfunction

• Deviance

13-6


Distress

• Judgments of abnormality

most likely when distress is

disproportionately acute or

long-lasting

13-7


Dysfunctionality

• Either for individual or for

society

13-8


Deviance

• From cultural norms

13-9


What is Abnormal Behavior?

• Behavior that is so:

•Personally distressful

•Personally dysfunctional

•Culturally deviant

that others judge it as

inappropriate or maladaptive

13-11


Diagnosing Psychological

Disorders

• Reliability

•Clinicians should show high

levels of agreement in their

diagnostic decisions

13-12


Diagnosing Psychological Disorders

• Validity

•Diagnostic categories should accurately capture essential features of disorders

13-13


DSM-IV

• Diagnostic and Statistical

Manual of Mental Disorders,

Fourth Edition

• Most widely used classification

system in U.S.

13-14


DSM-IV Axes

• Axis I: Primary clinical symptoms

• Axis II: Long-standing personality or developmental disorders

• Axis III: Relevant physical conditions

13-15


DSM-IV Axes cont.

• Axis IV: Intensity of

environmental stressors

• Axis V: Coping resources as

reflected in recent adaptive

functioning

13-16


Consequences of Diagnostic

Labeling

• Social

• Personal

• Legal

13-17


Social Consequences of Diagnostic Labeling

• Becomes too easy to accept label as description of the individual

13-18


Personal Consequences of

Diagnostic Labeling

• May accept the new identity

implied by the label

• May develop the expected role

and outlook

13-19


Legal Consequences of

Diagnostic Labeling

• Involuntary commitment to

mental institutions

• Loss of civil rights

• Indefinite detainment

13-20


Legal Concepts

• Competency

•Defendant’s state of mind at the time of a judicial hearing

• Insanity

•Presumed state of mind of defendant at time crime was committed

13-21

Anxiety Disorders

Definition

• Frequency and intensity of anxiety responses are out of proportion to the situations that trigger them

• Anxiety interferes with daily life

13-22

Anxiety Disorders

Components of Anxiety

Responses

• Subjective-emotional

• Cognitive

• Physiological

• Behavioral

13-24

Anxiety Disorders

Phobias

• Strong and irrational fears

of certain objects or

situations

13-25

Anxiety Disorders

Agoraphobia: Fear of open and public spaces from which escape would be difficult

Social phobias: Fear of situations in which evaluation might occur

13-26

Anxiety Disorders

Specific phobias: Fear of

specific objects such as

animals or situations

13-27

Anxiety Disorders

Generalized Anxiety Disorder

• Chronic state of diffuse, “free-

floating” anxiety

• Anxiety not attached to

specific objects or situations

13-28

Anxiety Disorders

Panic Disorder

• Panic occurs suddenly and

unpredictably

• Much more intense than

typical anxiety

13-32

Anxiety Disorders

Obsessive-Compulsive Disorder

• Obsessions

•Repetitive and unwelcome thoughts, images, or impulses

• Compulsions

•Repetitive behavioral responses

13-33

Anxiety Disorders

Posttraumatic Stress

Disorder

• Severe anxiety disorder

• Can occur in people

exposed to extreme trauma

13-34

Anxiety Disorders

Symptoms of PTSD

• Severe symptoms of anxiety, arousal, and distress

• Reliving of trauma in flashbacks

• Numb to world and avoidance of reminders

• Intense “survivor guilt”

13-35

Anxiety Disorders

Biological Factors in Anxiety

• Overreactive autonomic nervous system

• Overreactive neurotransmitter systems involved in emotional responses

• Overreactive right hemisphere sites involved in emotions

13-36

Anxiety Disorders

Evolutionary Explanations

• Biological preparedness

•Makes it easier for us to learn

to fear certain stimuli

13-37

Anxiety Disorders

Psychodynamic Theory

• Neurotic anxiety

•Occurs when unacceptable impulses threaten to overwhelm the ego’s defenses

13-38

Anxiety Disorders

Cognitive Factors

• Maladaptive thought

patterns and beliefs

• Exaggerated

misinterpretations of stimuli

13-39

Anxiety Disorders

Learned Responses

• Result of “emotional

conditioning” (Öhman, 2000;

Rachman, 1998)

• Classically conditioned fear

• Observational learning

13-40

Anxiety Disorders

Culture-Bound Disorders

•Occur only in certain

locales

•e.g., Anorexia Nervosa,

Taijin Kyofushu

13-41

Somatoform Disorders

Involve physical complaints

that suggest a medical

problem

But no biological cause

13-42


Hypochondriasis

• Great alarm about physical

symptoms

• Convinced of serious

illness

13-43


Pain Disorder

• Experience of intense pain out

of proportion to medical

conditions

• No physical basis for

13-44


Conversion Disorder

• Serious neurological

disorders suddenly occur

• e.g., paralysis, loss of

sensation, blindness

13-45

Glove Actual nerveanethesia innervation

13-46


Predispositions

• May involve combinations of biological and psychological vulnerabilities

• Genetics, environmental learning, and social reinforcement for bodily symptoms (Trimble, 2003)

13-47


Incidence (Tanaka-Matsumi & Draguns, 1997)

• Higher in cultures that:

•Discourage open discussion of emotions

•Stigmatize psychological disorders

13-48

Dissociative Disorders

Breakdown of normal personality

integration

• Results in alterations to

memory or identity

13-49


Psychogenic Amnesia

• Response to stressful event

with extensive but selective

memory loss

13-50


Psychogenic Fugue

• Loss of all sense of

personal identity

• Establishment of new

identity in a new location

13-51


Dissociative Identity Disorder (DID)

• Formerly called multiple personality disorder

• Two or more separate personalities coexist in the same person

13-52


Causes of DID

• Trauma-Dissociation Theory

•Development of personalities

is a response to severe

stress

13-53


Criticisms of DID

• Large increase in cases in recent years

• Are personalities unintentionally implanted by overzealous therapists?

13-54

Mood (Affective) Disorders

Involve depression and mania

Most frequently experienced (with anxiety disorders) psychological disorders

13-55


Major Depression

• Intense depressed state

• Leaves people unable to

function effectively in their

lives

13-56


Dysthymia

• Intense form of depression

• Less dramatic effects on personal and occupational functioning

• More chronic than major depression

13-57


Symptoms of Depression

• Negative mood

• Cognitive symptoms

• Motivational symptoms

• Somatic (physical) symptoms

13-60


Negative Mood in Depression

• Sadness, misery, loneliness

• Loss of capacity for psychological, biological pleasures

13-61


Cognitive Symptoms of Depression

• Difficulty concentrating and making decisions

• Low self-esteem

• Feelings of inferiority

• Blame selves for failures

• Pessimism and hopelessness

13-62


Motivational Symptoms of

Depression

• Inability to get started on task

• Inability to perform behaviors

leading to pleasure or

accomplishment

13-63


Somatic (Bodily) Symptoms of

Depression

• Loss of appetite and weight

loss in moderate and severe

depression

• Weight gain in mild depression

13-64


Bipolar Disorder

• Depression alternates with

periods of mania

• Mania = Highly excited

mood and behavior

13-65


Prevalence of Mood Disorders

• 1 in 20 Americans is severely depressed (Narrow et al., 2002)

• 1 in 5 Americans will have a depressive episode of clinical proportions during lifetime (Hamilton, 1989)

13-66


Gender Differences

• Women about twice as

likely to suffer from

unipolar depression

13-67


Biological Explanations for

Gender Differences in

Depression

• Genetic factors

• Biochemical differences

• Premenstrual depression

13-68


Environmental Explanations for

Gender Differences in Depression

(Nolen-Hoeksma, 1990)

• Female passivity and

dependency

• Distraction by physical activity

and drinking in males

13-69


Patterns After Depressive

Episodes

• No recurrence of clinical

depression

• Recovery with recurrence

• No recovery

13-70


Genetic Factors

• 67% concordance rate for identical twins; only 15% for fraternal twins (Gershon et al., 1989)

• Genetic predisposition to mood disorder

13-72


Brain Chemistry Factors

• Underactivity of norepinephrine, dopamine, and serotonin in depression (Davidson, 1998)

• Overactivity of neurotransmitters in mania?

13-73


Psychological Factors

• Early traumatic losses or

rejections create vulnerability

(e.g. Abraham, 1911; Freud,

1917, Brown and Harris, 1978)

13-74


Humanistic Factors

• Definition of self-worth in terms of individual attainment

• React more strongly to failures; view failures as due to inadequacies

• Experience of meaninglessness

13-75


Depressive Cognitive Triad

(Wenzlaff et al., 1988)

• Negative thoughts concerning:

•The world

•Oneself

•The future

13-76


Depressive Attributional Pattern

• Attributing success to factors

outside self

• Attributing negative outcomes

to personal factors

13-78


Learned Helplessness Theory (Abramson et al., 1978; Seligman & Isaacowitz, 2000)

• Depression occurs when people expect that bad events will occur and they think that they can’t cope with them

13-79


Environmental Factors (Hammen, 1991)

• Poor parenting

• Many stressful experiences

• Failure to develop good coping skills

• Failure to develop positive self-concept

13-80


Sociocultural Factors

• Prevalence of depressive disorders less in Hong Kong and Taiwan than in the West

• Feelings of guilt and inadequacy are highest in North America and Western Europe

13-81


Sociocultural Factors cont.

• Gender difference not found

in developing countries

13-82

Suicide

Willful taking of one’s life

Second most frequent cause of death among high school and college students

Women attempt more suicides; men are more likely to kill selves

13-84

Suicide

Motives for Suicide (Beck et al.,

1979)

• Desire to end one’s life

• Manipulation of others

13-85

Suicide

Warning Signs of Suicide

• Verbal or behavioral threat to kill self

• History of previous attempts

• Detailed plan that involves a lethal method

13-86

Suicide

Suicide Prevention

• Talk about it with the person

• Provide social support and empathy

13-87

Suicide

Suicide Prevention cont.

• Help the person to consider positive future possibilities

• Stay with the person and help him or her to seek professional assistance

13-88

Schizophrenia

Severe disturbances in (Herz & Marder, 2002):

• Thinking

• Speech

• Perception

• Emotion

• Behavior

13-89

Schizophrenia

Diagnosis of Schizophrenia (American Psychiatric Association, 1994, 2000)

• Misinterpretation of reality

• Disordered attention, thought, perception

• Withdrawal from social activities

13-90

Schizophrenia

Diagnosis of Schizophrenia cont.

• Strange or inappropriate

communication

• Neglect of personal grooming

• Disorganized behavior

13-91

Schizophrenia

Delusions

• False beliefs that are sustained

in the face of contrary

evidence normally sufficient to

destroy them

13-92

Schizophrenia

Hallucinations

• False perceptions that have a

compelling sense of reality

• Can be auditory or visual

13-93

Schizophrenia

Types of Affect

• Flat: No emotions at all

• Inappropriate

13-94

Schizophrenia

Subtypes of Schizophrenia

• Paranoid

•Delusions of persecution

and grandeur

13-95

Schizophrenia


• Disorganized

•Confusion and incoherence

•Severe deterioration of adaptive behavior

13-96

Schizophrenia


• Catatonic

•Motor disturbances from muscular rigidity to random or repetitive movements

13-97

Schizophrenia


• Undifferentiated

•Do not show enough specific criteria to be classified as paranoid, disorganized, or catatonic

13-98

Schizophrenia

Positive Symptoms

• Bizarre behaviors such as delusions, hallucinations, and disordered speech, thinking

Negative Symptoms

• Absence of normal reactions

• e.g., emotional expression, motivation, normal speech

13-99

Schizophrenia

Positive Symptoms

• Better prognosis for later

recovery

13-100

Schizophrenia

Biological Causes

• Genetic predisposition

• Destruction of neural tissue (neurodegenerative hypothesis)

•Atrophy in brain regions that influence cognitions, emotions

13-101

Schizophrenia

Dopamine hypothesis

•Overactivity of the dopamine

system in brain areas

regulating emotions,

motivations, and cognitions

13-102

Schizophrenia

Psychological Factors

• Freud: extreme example of regression

• Retreat from painful intrapersonal world

• Chaotic sensory input

• Deficits in frontal lobe executive functions

13-103

Schizophrenia

Environmental Factors

• Stressful life events

• Family dynamics

• Home environments high in

expressed emotion (Vaughn &

Leff, 1976)

13-104

Schizophrenia

Expressed Emotion

• High levels of criticism

• High levels of hostility

• Overinvolvement in person’s

life

13-105

Schizophrenia

Sociocultural Factors

• Highest in lower

socioeconomic populations

• Causal or correlational?

13-106

Schizophrenia

Social Causation Hypothesis

• Higher prevalence of schizophrenia due to higher levels of stress

Social Drift Hypothesis

• Deterioration of social and personal functioning causes drift into poverty

13-107

Personality Disorders

Stable, ingrained, inflexible, and maladaptive ways of thinking, feeling, and behaving

Increase likelihood of acquiring, maintaining several Axis I disorders

13-108


Three Clusters:

• Dramatic and impulsive behaviors

• Anxiety and fearfulness

• Odd and eccentric behaviors

13-109


Antisocial Personality Disorder

• Psychopaths or sociopaths

• 3:1 male-female ratio

• Lack a conscience

• Fail to respond to punishment

13-110


Biological Causes of Antisocial

Personality Disorder

• Genetic predisposition

• Dysfunction in brain structures

that govern self-control and

emotional arousal?

13-111


Psychological Causes of Antisocial Personality Disorder

• Psychodynamic view: lack of a superego

• Inability to develop conditioned fear responses when punished leads to poor impulse control

13-112


Psychological Causes of Antisocial Personality Disorder cont.

• Modeling of aggression

• Parental inattention to children’s needs (Rutter, 1997)

13-113


Psychological Causes of Antisocial Personality Disorder cont.

• Exposure to deviant peers

• Consistent failure to think about or anticipate long-term negative consequences of acts

13-114

Childhood Disorders

Over 20% of children aged 2-5 diagnosed with DSM-IV disorder (Lavigne et al., 1996)

Only about 40% of children with behavior disorders receive professional attention (Satcher, 1999)

13-115

Childhood Disorders

Externalizing Disorders

• Disruptive and aggressive

behaviors

• e.g., ADHD

13-116

Childhood Disorders

ADHD (Attention Deficit/Hyperactivity Disorder)

• Attentional difficulties

• Hyperactivity-impulsivity

• Most common childhood disorder (7-10% of U.S. children)

13-117

Childhood Disorders

Causes of ADHD

• Genetic predispositions

• Brain scans show no

differences with “normals”

• Environmental factors

13-118

Childhood Disorders

Other Externalizing Disorders

• Oppositional Defiant Disorder (ODD)

•Disobedient, defiant, hostile

• Conduct Disorder

•Violate social norms and show disregard for others’rights

13-119

Childhood Disorders

Internalizing Disorders

• Involve maladaptive thoughts

and emotions

• Include anxiety and mood

disorders

13-120

Dementia in Old Age

Gradual loss of cognitive abilities

Accompanies brain deterioration

e.g., Alzheimer’s, Parkinson’s, Huntington’s, Creutzfeldt-Jakob Diseases

13-121

Dementia in Old Age

Senile Dementia

• Dementia that begins after age 65

• 2:1 female-male ratio

• Onset is typically gradual

• Over 1/2 cases resemble schizophrenia

13-122

Dementia in Old Age

Alzheimer’s Disease

• 60% of senile dementias

• Caused by deterioration in frontal and temporal lobes of brain

• Plaques in brain

• Destruction of cells that produce acetylcholine

Psychological disorders

Documents

Transcript of Psychological disorders