Psychological Disorders and

TherapyElla Sternisha Kaley Slagle Jenna Ramsey Rachel Simon Kaitlyn Hocutt

• behavior that is deviant,maladaptive, or personally distressful over a relatively long period of timeo Deviant- both atypical and abnormal behavior. Ex: a person

who flosses her teeth every 15 minutes o Maladaptive- behavior that interferes with a person’s ability to

function effectively or behavior that presents a danger to the person or those around him/her. Ex: a person who is afraid to leave their house

o Personal distress- the person engaging in the behavior finds it troubling. Ex: a man who often skips meals to lose weight

Abnormal Behavior

Abnormal Behavior• Only needs one of these things to be considered

abnormal

• depends on the setting

Approaches• Biological

o Focuses on the brain, genetic factors, and neurotransmitter medical model- the view that psychological disorders are

medical diseases with a biological origin (Patient Mental illness Doctor)

• Psychologicalo emphasizes the mixture of thoughts, experiences, emotions

and personality characteristics. Focus on the rewards and punishers in ones environment that determine ab. behavior

Approaches • Sociocultural

o emphasizes social context in which a person lives, one’s gender, ethnicity, socioeconomic status , family relationships, and culture.

o Socioeconomic status plays a bigger role than ethnicity o cultures influences our understanding and treatment of

psychological disorders

• Biopsychosocialo must take into account a variety of interacting factorso biological, psychological, and social factors are all important and

they work together to produce normal & abnormal behavior

Classifying Abnormal Behavior

• classifying helps not only patients but also psychologists o could create stigma

• DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) list of 374 diagnosable disorders. o Classifies on the basis of five axes that take into account one’s

history and highest level of functioning within the previous year

DSM-IV• The five axes are

o 1- all diagnostic categories except personality disorders and mental retardation,

o 2- Personality disorders, concerned with the classification,

o 3-general medical conditions, o 4-Psychosocial and environmental problems, o 5- current level of functioning

not needed to diagnose a person, but included to get an overview of a persons life

Critiques of DSM-IV• focuses strictly on pathology and problems

o identifying a person strengths may help them in realizing their ability to contribute to society

• uses medical terminology, in traditional mind set that mental disorders are diseases o on reflects the medical model, does not consider other factors

that could lead to a disorder

Dissociative DisordersDissociative disorders are conditions that

involve disruptions or breakdowns of memory, awareness, identity or perception.

Dissociation, a defense mechanism, is used pathologically and involuntarily to cope with trauma or other anxiety disorders.

Dissociative Identity Disorder• Most subjects suffered severe abuse

during childhood o Physical, sexual, and/or psychological

• May feel other people talking inside your head

• Commonly paired with dissociative amnesia

Dissociative Identity Disorder• Two or more personalities within an

individual• At least two of the personalities take turns

controlling the individual's behavior• Can't recall important personal

information that is too extensive to be explained

by ordinary forgetfulness

Dissociative Identity Disorder - Case Study

In a case of dissociative identity disorder, a woman who had been physically and sexually abused by her father throughout her childhood and adolescence exhibited at least 4 personalities as an adult. Each personality was of a different age, representing the phases of the woman's experience – a fearful child, a rebellious teenager, a protective adult, and the woman's primary personality. Only one of the personalities, the protective adult, was consciously aware of the others, and during therapy sessions was realized to have been developed to protect the woman during the abusive experiences. When one of the secondary personalities took over, it often led to dissociative amnesia, during which the woman acted out. During intensive therapy sessions, each personality was called upon as necessary to facilitate their integration.

Dissociative Fugue • Creating physical distance from reality• Short duration• Starts and ends abruptly • No recollection of what happened

during episode

Dissociative Fugue - Symptoms • Sudden unplanned travel • Inability to recall past events or important

information• Confusion or memory loss about identity• Extreme distress interferes with daily functioning

Dissociative Fugue - Case Study • Post-traumatic stress induced amnesia• 35-year-old businessman who

disappeared more than 2 years after narrowly escaping from the World Trade Center terrorist attack on September 11, 2001o Leaving behind his wife and children o The man was missing for more than 6 months

when an anonymous tip helped police in Virginia identify him

Dissociative Fugue - Treatment• Often recover spontaneously• Psychotherapy• Hypnosis • Psychopharmacology

Dissociative Amnesia• Inability to recall important personal

information o More extensive than can be explained by

normal forgetfulness• Remembering is usually traumatic or

produces stress

Dissociative Amnesia - Symptoms• Sudden inability to remember past

experiences or personal information • Confusion• Depression• Anxiety

Dissociative Amnesia - Case Study• A 29-year-old female on an academic trip to China.• Found in a hotel bathroom unconscious, with no signs of

structural or neurologic abnormalities • Could not remember her any facts about her life • Amnesia persisted for 10 months, until the feeling of blood on the

woman's fingers triggered the recollection of events from the night of onset of dissociative amnesiao The woman finally remembered having witnessed a murder

that night o She came to remember other aspects of her life; however,

some memories remain unretrievable.

Dissociative Amnesia - Treatment

• Psychotherapy• Cognitive therapy• Antidepressant or anti-anxiety

medicine• Creative therapies• Clinical hypnosis

http://education-portal.com/academy/lesson/dissociative-disorders.html

Mood Disorders

A psychological disorder in which there is a primary disturbance of mood: prolonged emotion that colors the individual’s entire emotional state.

Depression-What is it?

• Most common of all psychological disorders• Affects more than 100 million people

worldwide • 8% of the population will experience

depression at some point in their life

Depression• Most common of all psychological disorders

• Major Depressive Disorder Must experience 5 of 9 listed symptoms to be diagnosed, one of which must be one of the first 2 listedo Persistent depressed mood for most of the dayo Loss of interest, pleasure in all/almost all activitieso Significant weight loss/gain due to changes in appetiteo Sleeping more or less than usualo Speeding up/slowing down of physical/emotional reactionso Fatigue, loss of energyo Reduced ability to concentrate, make meaningful decisionso Recurrent thoughts of death or suicideo No history of manic episodes

Treatment

• Antidepressant medication-effective• Psychotherapy or Cognitive Behavioral Therapy focused on

negative thinking• Electroconvulsive Therapy: last resort

Dysthymic Disorder-What is it?

• Most commonly known as dysthymia• Characterized as an overwhelming state of depression• People are depressed for not only days and months, but often years

DysthymiaIndividual must have two or more of the following symptoms:

• Poor appetite or overeating

• sleep problems

• low energy or fatigue

• low self esteem

• poor concentration

• feelings of hopelessness

Treatment

• Little research is shown on how to treat Dysthymic Disorder• Patients respond to very few antidepressants•Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants • Supportive psychotherapy and psychoeducation significantly

improve the patient compliance and family cooperation

Case StudyRahim, Public Sector Lawyer Rahim has been a moderately successful public sector lawyer for the last 20 years. In that time

(in fact, ever since he was a young child) Rahim does not remember a period where he has been truly happy—he has always felt a sense of sadness about himself even though he has a loving family.

Although intelligent, he suffers from low self-esteem and has always been plagued by poor sleep and low levels of energy. Rahim is functional at work, however, he definitely feels that he has not excelled in his career the way he could have, which he attributes largely to a crippling talent for procrastination about making important decisions, as well as his difficulty concentrating.

Although Rahim feels that he certainly isn’t a miserable as he could be, he feels burdened by a nagging sense of hopeless about his situation and worries that he might get even worse one day.

Biological Factors

• genetic influences• brain structures and neurotransmitters

o problem in regulation

Psychological Factors• based on behavioral & cognitive theories

• Behavioral: learned helplessness ( individuals can’t control stress)

• Cognitive: thoughts & and beliefs that lead to this.o what and how people thinko how individuals deeply reflect on certain negative events &

feelingso Pessimistic attributional style “It’s my fault…”

Sociocultural Factors

• Areas with poverty, learned helplessness, & alcoholism

• Found in Native American groups

• Lower SES more likely to develop depression

Men & Women across cultures• Women 2X more likely to get depression

o single & head of the householdo working in unsatisfying jobs

• difference occurs in many countrieso minority women more likely

Depressed Children• 1.5-2.5% of children depressed

• 15-20% of adolescents

• interference with development

• higher risk of variety of problems (substance abuse & academic issues)

• Developmental Psychopathology: used to treat & prevent disorders in children

Bipolar Disorder-What is it?Bipolar Disorder is a mood disorder characterized by extreme mood

swings that include one or more episodes of mania. Mania: person feels euphoric and on top of the worldTwo Types: Bipolar I and Bipolar II Disorders• Genetic influences play more of a role

• Disorder associated with brain activity

Case StudyA 29-year old married, mother of a young child age 2, presented with a history of recurrent and disabling depression and

headaches. Several weeks prior to presentation, she became severely depressed and had difficulty moving, had diminished appetite, had crying spells much of the day and felt suicidal. At the time she presented, she was on Prozac 20 mg a day, and described herself as getting “manicky” on the Prozac. By this, she meant that she was “rushing around, laughing a lot and having more anxiety.” A past trial with Wellbutrin was poorly tolerated because of sweating episodes, insomnia and agitation. Her depression was worsening despite the Prozac treatment.

There was a past history of concussion at age 18, when she suffered loss of consciousness. She also described a history of mood swings for many years. There was also a history of alcohol abuse when she was a teenager. The diagnosis of major depressive disorder was suspect, given the poor response to both antidepressants. Prozac was discontinued because it appeared to be worsening the underlying mood swings.

Family history revealed severe mood swings in both her father and paternal grandmother. Grandmother at times would take to bed for long spells, and she had been hospitalized for “unknown reasons” that the family refused to talk about, and the client recalled that the secrecy was because of something “shameful” about her grandmother’s condition and behavior.

Because of the suggestion of Manic Depressive Disorder by personal and family history, she was placed on Seroquel 100 mg at bedtime. Within one week’s time, she began to improve markedly, including clearer thinking, more productive work being done, less depression and more energy. Within five weeks after the institution of Seroquel, the client was feeling “terrific.”

She was seen in supportive psychotherapy and provided advice on parenting her two year old daughter, which helped to settle down the child’s behavior and gave the client more confidence and a feeling of control over her life.

Treatments

Aimed at managing symptoms and preventing episodes•Combination of medication and psychotherapy•Medications include:–Mood stabilizers–Antidepressants–Antipsychotics•Cognitive Behavioral Therapy (CBT)

Suicide

• Result of psychological disorder• thinking about suicide is normal, acting on it

is abnormal• 3rd leading cause for death in U.S

Biological Factors• genetic factors important

• suicide runs in family linked with low levels of of serotonin

• poor health is a risk factor

Psychological Factors• mental disorders and traumas

• 90% of individuals who commit suicide have a psychological disorder

• immediate & highly stressful circumstance can lead to suicide

Sociocultural Factors• chronic economic hardship

• attempts vary across ethnic groups

• major risk factor is alcohol abuse (esp. in adolescents)

• women 3X more likely

• women more likely to be diagnosed and men more likely to commit

Anxiety Disorders

DefinitionPsychological Disorders involving fears that are uncontrollable, disproportionate, to the actual danger the person might be in, and disruptive of ordinary life.

5 types of Anxiety Disorder

• Generalized Anxiety Disorder• Panic Disorder• Phobic Disorder• Obsessive-Compulsive Disorder• Post-Traumatic Stress Disorder

Generalized Anxiety Disorder

• Anxiety lasting for more than 6 months.• A person cannot find a reason behind their

persistent anxiety.• Symptoms include fatigue, muscle tension,

stomach problems, and difficulty sleeping.

Psychological and Sociocultural Factors

• Having harsh self standards• Dealing with overly strict and critical parents

(authoritarian)• Automatic negative thoughts when feeling

stressed• A history of uncontrollable traumas or

stressors (abusive memories)

Biological Factors

• Genetic predisposition• Deficiency in the neurotransmitter GABA• Overactive sympathetic nervous system• Respiratory system abnormalities

Panic Disorder

• Recurrent, sudden onsets of intense fear and terror

• Often occur without warning and no specific cause

• Symptoms include severe palpitations, extreme shortness of breath, chest pains, trembling, sweating, dizziness, and a feeling of helplessness

• Can lead to agoraphobia

Biological Factors

• Genetic predisposition• Overactive sympathetic nervous system• Low on neurotransmitter GABA and

norepinephrine

Psychological and Sociocultural Factors

• Individuals misinterpret harmless indicators of physiological arousal as an emergency.

• American women are twice as likely to have panic attacks over American men.

• Possibly due to hormones.• Women deal with situations differently than

men.

Phobic Disorder

• Disorder characterized by an irrational, overwhelming, persistent fear of a particular object or situation.

• A fear becomes a phobia when a situation is so dreaded that an individual goes to any length to avoid it.

Biological Factors

• Researchers have found that genes play a role in phobias. There is a proposed neural circuit that includes the thalamus, amygdala, and cerebral cortex.

• Levels of serotonin can affect phobias.

Psychological and Sociocultural Factors

• Phobias can be considered learned fears.• Example- a fear of falling off a building can

come from a fall earlier in life.

Obsessive Compulsive Disorder

• An individual has anxiety provoking thoughts that will not go away and/or urges to perform repetitive, ritualistic behaviors to prevent or produce some future situation.

• People dwell on normal doubts and repeat their routines sometimes hundreds of times a day.

Biological Factors

• The frontal cortex and basal ganglia are so active in OCD that numerous impulses reach the thalamus, generating obsessive thoughts.

• After treatment of OCD, the frontal cortex shows much less activity.

• Low levels of serotonin and dopamine.

Psychological and Sociocultural Factors

• OCD can occur during stressful times in life like a change in marital status or the birth of a child.

• The inability to turn off obsessive thoughts or dismiss them.

Post-Traumatic Stress Disorder• Develops through exposure to a traumatic event that

has overwhelmed the person’s abilities to cope.

• Includes flashbacks and avoidance of emotional experiences.

• Sudden outbursts of irrational behavior.

• Stress can begin immediately or months after event

Biological Factors

• The only biological factor is how your brain naturally responds to stress, since this disorder is caused by a specific event.

Psychological and Sociocultural Factors

• Depends mainly on a traumatic event • Could become worse if person was sexually

or physically abused earlier in life.

Case StudyI remember my first panic attack like it was yesterday. I guess I’d always been an anxious type, but this was like nothing I’d ever experienced. I was at a football game about

six years ago, big crowd, St Kilda getting hammered by the Pies. I think I was a bit edgy – I’ve never liked being hemmed in, stuck somewhere I couldn’t get out of easily.

Then suddenly this thing just took me over. I got these pains in my chest and I couldn’t breathe. I was sure I was having a heart attack and was going to die. I was thinking

about my daughter – she was two at the time – and thinking it can’t end like this, I’ve got to see her again. I was sweating, heart racing, trembling….I had to get out of

there. I managed to push my way through the crowd and I saw a St John’s ambo. What a relief. He helped me to the ambulance and they took me straight to hospital,

wired me up to all sorts of machines and then…..they told me there was nothing wrong, that it was all in my head. All in my head? Those pains were real, I can tell you. All

they said was that I’d had a panic attack, and I was so happy to be alive, I didn’t ask them more about it. I just wanted to get home. But since then, my life has changed. I

only went back to sea once (my skills are needed more on shore than at sea, thank God) but that was terrifying. I spent the whole time worrying about whether I’d have an

attack while we were far from land and I avoided being below decks whenever I could. Since the first time, I’ve had about a dozen attacks and each one was terrifying. I’ve

stopped going anywhere that I can’t get out of easily in case I have another one. No shopping centres. No cinemas. No football games. No public transport. No crowded

places. I left the navy because I couldn’t face going to sea again.A month ago it came to a head, my daughter’s 8 th birthday. She wanted me to take her and a couple of

friends into the city on the train to see a movie. I told her I couldn’t and got angry with her – poor kid. Then I had a big fight with my husband. After we’d all had a bit of a

cry I decided I had to do something about it. I went along to see our GP – he told me I had panic disorder (which I guess I already knew) and something called

agoraphobia. That’s the part where I won’t go anywhere in case I have an attack. He gave me a script for some tablets and a referral to see a psychologist. I managed to

get in to see her and the first thing she told me was to only take the tablets when I absolutely had to. That annoyed me – one doctor tells you one thing, another tells you

something else. But the more she explained what was happening, the more it made sense. The tablets help to stop the attacks when they’re happening, but they don’t do

anything to prevent another one. She says I can only learn how to control them if I let myself risk having one.

Case Study ContinuedI think we’re on the right track. We’ve spent a lot of time talking about my breathing. She says I’m “hyperventilating”, that my body is getting ready for fight or flight when

there’s no danger there. I’ve been practicing the exercises she gave me and I really do feel more in control. The next step is to start getting back to do the things I’ve been

avoiding. That’s very scary, but she says I can do it in small steps. And she’s started to talk about how my thoughts play a part.

I’m a long way from being cured, but I feel much more confident now. My husband says I’m much better. And I’m going to take my daughter to the city on her 9 th birthday for

sure.

Treatment of Anxiety Disorders

• Cognitive Behavioral Therapyo Helps change the way you think and deal with anxiety.

• Medicationo Prozac, Xanax, Valium, Paxil, Zoloft, SSRI’s.

• Facing what scares you and coming to terms with it

Biological Therapies

● Biological therapies (Biomedical therapies)- reduce symptoms of

psychological disorders by altering body functioning.

○ Ex. Drug therapy is most common

● Only psychiatrists can prescribe drugs as part of therapy.

● Covers three diagnostic categories: anxiety disorders, mood disorders,

and schizophrenia.

Antianxiety Drugs • AKA tranquilizers

• Reduces anxiety and make the individual calm.

• Benzodiazepines greatest relief for anxiety symptoms in a matter of hours but

addictive. Side Effects include drowsiness, loss of coordination, fatigue, and mental

slowing.

• Nonbenzodiazepines- takes 2-3 weeks before feeling benefits; not as many side

effects.

Antidepressant Drugs • Help alleviate depressed mood

• Effect norepinephrine and serotonin in braino Tricyclics- 3 ring structure, works in 60-70% of cases, takes 2-4 weeks,

some side effects are memory difficulties and faintness.o Tetracyclic- 4 ring structure; Remeron was most effective in reducing

depression. o MAO Inhibitors- Blocks the enzyme monoamine oxidase. This enzyme

breaks down neurotransmitters in the brain. Blocking this enzyme will allow neurotransmitters in the brain's synapses. More harmful to body.

o Selective Serotonin reuptake inhibitors- Interferes with the reabsorption of serotonin in the brain and leaves excess in the synaptic gap. Drug with the least amount of side effects.

Antipsychotic Drugs• Diminish agitated behavior, reduce tension, decrease hallucinations, improve social

behavior, and better sleep patterns in people who have a psychological disorder.

• Neuroleptics are the most commonly used; they block dopamine’s action in the brain; they don’t cure its causes, only treats its symptoms. Can have severe side effects like lack of pleasure and tardive dyskinesia- a neurological disorder characterized by involuntary random movements. Up to 20% develop this disorder.

• Atypical antipsychotic medications have a lower risk of side effects.o The way these drugs work is unknown, but appears to influence dopamine and

serotonino Reduces schizophrenia's symptoms without the side effects of neuroleptics

Increase suicide risk in childrenCould drugs being prescribed to children to get rid of depression increase their

suicidal thoughts? 4% of the antidepressant pill group, double of the placebo group percentage, had random thoughts of suicide. This caused the FDA to

make sure all antidepressant drugs had the “black box” warning on them. This warning said children could have increase thoughts of suicide. The black box caused prescriptions to decrease dramatically. There are so many different

variables to teens suicidal thoughts like 17% think those thoughts in a year even while not on antidepressant drugs. After the black box warning, a number of

case studies haven’t been able to link antidepressants and suicide.There have been strategies to increase the effectiveness of these antidepressant drugs by

prescribing in smaller doses than normal and combining drug therapy with psychotherapy.

Drug Chart

Electroconvulsive Therapy • AKA shock therapy

• Mainly used to treat severe depression

• Involves passing a small electrical current of less than a second through two electrodes placed on the individual's head. The current stimulates a seizure that lasts for about a minute.

• Used when drug therapy and psychotherapy doesn't work

• Medication lets patients sleep through the procedure and awaken with no memory of treatment.

• Most rapid relief to a patient’s mood

• Side effects include memory loss and other cognitive impairments

• In deep brain stimulation doctors implant electrodes in brain that

give off signals to alter the brain’s electrical circuitry.

Psychosurgery • Used as a last resort

• The removal or destruction of brain issue to improve the individual's symptoms.

• Cannot be reversed.

• Moniz first developed an operation that breaks the fibers connecting the frontal lobe (thought process) to the thalamus (emotions).

• Freeman developed a similar procedure that took only a couple minutes and worked on thousands of people called lobotomies

• These procedures cause major brain damage and were required in order to leave a mental hospital

• Lobotomies are no longer performed because of ethical concern

• Nowadays psychosurgery is making a small cut in the amygdala or other part of limbic system and used for OCD, depression, or bipolar disorders

Reference SlideTextbook: The Science of Psychology: An Appreciative View by Laura A. King