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1
Psychological Psychological DisordersDisorders
2
Psychological DisordersPsychological Disorders
To study the abnormal is the best way of To study the abnormal is the best way of understanding the normal.understanding the normal.
1.1. There are 450 million people suffering from There are 450 million people suffering from psychological disorders (WHO, 2004).psychological disorders (WHO, 2004).
2.2. Depression and schizophrenia exist in all Depression and schizophrenia exist in all cultures of the world.cultures of the world.
William James (1842-1910)William James (1842-1910)
3
Deviant, Distressful & Deviant, Distressful & DysfunctionalDysfunctional
1.1. DeviantDeviant behavior behavior (going naked) in one (going naked) in one culture may be culture may be considered normal, considered normal, while in others it while in others it may lead to arrest.may lead to arrest.
2.2. DistressDistress must must accompany the accompany the deviant behaviordeviant behavior
3.3. If a behavior is If a behavior is dysfunctionaldysfunctional it is it is clearly a disorder.clearly a disorder.
In the Wodaabe tribe men wear costumes to
attract women. In Western society this would be considered
abnormal.
Carol B
eckwith
4
Defining Psychological Defining Psychological DisordersDisorders
Mental health workers view Mental health workers view psychological disorders as persistently psychological disorders as persistently harmful thoughts, feelings, and actions.harmful thoughts, feelings, and actions.
When behavior is When behavior is deviant, distressing, deviant, distressing, and dysfunctionaland dysfunctional psychiatrists and psychiatrists and psychologists label it as disordered psychologists label it as disordered
(Comer, 2004).(Comer, 2004).
5
Philippe Pinel (1745-1826) from France, insisted Philippe Pinel (1745-1826) from France, insisted that madness was not due to demonic that madness was not due to demonic
possession, but an ailment of the mind.possession, but an ailment of the mind.
Dance in the madhouse.
George W
esley Bellow
s, Dancer in a M
adhouse, 1907. © 1997 T
he Art Institute of C
hicago
6
Medical ModelMedical Model
When physicians discovered that syphilis led to When physicians discovered that syphilis led to mental disorders, they started using mental disorders, they started using medical modelsmedical models
to review the physical causes of these disorders.to review the physical causes of these disorders.
1.1. Etiology: Cause and development of the Etiology: Cause and development of the disorder.disorder.
2.2. Diagnosis: Identifying (symptoms) and Diagnosis: Identifying (symptoms) and distinguishing one disease from another.distinguishing one disease from another.
3.3. Treatment: Treating a disorder in a Treatment: Treating a disorder in a psychiatric hospital.psychiatric hospital.
4.4. Prognosis:Prognosis: Forecast about the disorder.Forecast about the disorder.
7
Biopsychosocial Biopsychosocial PerspectivePerspective
Assumes that biological, socio-cultural, and Assumes that biological, socio-cultural, and psychological factors combine and interact psychological factors combine and interact
to produce psychological disorders.to produce psychological disorders.
Classifying Psychological Classifying Psychological DisordersDisorders
Why do it?Why do it?
plus/minus plus/minus
8
9
Labeling Psychological Labeling Psychological DisordersDisorders
Labels may be helpful for healthcare Labels may be helpful for healthcare professionals and researchers when professionals and researchers when communicating with one another and communicating with one another and establishing therapiesestablishing therapies
10
Labeling Psychological Labeling Psychological DisordersDisorders
Critics of the DSM-IV argue that labels Critics of the DSM-IV argue that labels may stigmatize individuals.may stigmatize individuals.
Asylum baseball team (labeling)
Elizabeth E
ckert, Middletow
n, NY
. From
L. G
amw
ell and N
. Tom
es, Madness in A
merica, 1995. C
ornell University P
ress.
11
Labeling Psychological Labeling Psychological DisordersDisorders
““InsanityInsanity”” labels labels raise moral and raise moral and ethical questions ethical questions about how about how society should society should treat people who treat people who have disorders have disorders and have and have committed committed crimes.crimes.
Theodore Kaczynski(Unabomber)
Elaine T
hompson/ A
P Photo
12
Classifying Psychological Classifying Psychological DisordersDisorders
The American Psychiatric Association The American Psychiatric Association rendered a Diagnostic and Statistical rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to Manual of Mental Disorders (DSM) to
describe psychological disorders.describe psychological disorders.
The most recent edition, DSM-IV-TR The most recent edition, DSM-IV-TR (Text Revision, 2000), describes 400 (Text Revision, 2000), describes 400
psychological disorders compared to 60 psychological disorders compared to 60 in the 1950s.in the 1950s.
13
DSM Multiaxial DSM Multiaxial ClassificationClassification
Are Are PsychosocialPsychosocial or or Environmental Environmental ProblemsProblems (school or housing issues) (school or housing issues) also present?also present?
Axis IVAxis IV
What is the What is the Global AssessmentGlobal Assessment of the of the personperson’’s functioning?s functioning?Axis VAxis V
Is a Is a General Medical ConditionGeneral Medical Condition (diabetes, hypertension or arthritis etc) (diabetes, hypertension or arthritis etc) also present?also present?
Axis IIIAxis III
Is a Is a Personality DisorderPersonality Disorder or or Mental Mental RetardationRetardation present? present?Axis IIAxis II
Is a Is a Clinical SyndromeClinical Syndrome (cognitive, (cognitive, anxiety, mood disorders [16 anxiety, mood disorders [16 syndromes]) present?syndromes]) present?
Axis IAxis I
14
Multiaxial ClassificationMultiaxial Classification
Note 16 syndromes in Axis INote 16 syndromes in Axis I
15
Multiaxial ClassificationMultiaxial ClassificationNote Global Assessment for Axis VNote Global Assessment for Axis V
16
Anxiety DisordersAnxiety Disorders
Feelings of excessive apprehension and anxiety.Feelings of excessive apprehension and anxiety.physiological, cognitive and behavioral symptomsphysiological, cognitive and behavioral symptoms
1.1. Generalized anxiety Generalized anxiety
disordersdisorders
2.2. PhobiasPhobias
3.3. Panic disordersPanic disorders
4.4. Obsessive-compulsive Obsessive-compulsive
disordersdisorders
17
Generalized Anxiety Generalized Anxiety DisorderDisorder
1. Persistent and uncontrollable 1. Persistent and uncontrollable tenseness and apprehension.tenseness and apprehension.
2.2. Autonomic arousal. (e.g., heart Autonomic arousal. (e.g., heart racing, shortness of breath, sweating, racing, shortness of breath, sweating, etc.)etc.)
3.3. Inability to identify or avoid the cause Inability to identify or avoid the cause of certain feelings.of certain feelings.
SymptomsSymptoms
18
Panic DisorderPanic Disorder
Episodes of intense dread which may Episodes of intense dread which may include feelings of terror, chest pains, include feelings of terror, chest pains,
choking, or other frightening sensationschoking, or other frightening sensations..
SymptomSymptomss
19
PhobiaPhobia
Marked by a persistent and Marked by a persistent and irrational fearirrational fear of an of an object or situation accompanied by object or situation accompanied by avoidanceavoidance..
20
Kinds of PhobiasKinds of Phobias
Phobia of blood.Phobia of blood.HemophobiaHemophobia
Phobia of closed Phobia of closed spaces.spaces.
ClaustrophobiClaustrophobiaa
Phobia of heights.Phobia of heights.AcrophobiaAcrophobia
Phobia of open Phobia of open places.places.AgoraphobiaAgoraphobia
21
Post-Traumatic Stress Post-Traumatic Stress DisorderDisorder
Four or more weeks of the following Four or more weeks of the following symptoms constitute post-traumatic symptoms constitute post-traumatic
stress disorder (PTSD):stress disorder (PTSD):
1. Flashbacks1. Flashbacks
2.2. NightmaresNightmares
3.3. Social Social withdrawalwithdrawal4.4. Jumpy Jumpy anxietyanxiety5.5. Sleep problemsSleep problems
Bettm
ann/ Corbis
22
Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder
Persistence of unwanted thoughts (Persistence of unwanted thoughts (obsessionsobsessions) ) and urges to engage in senseless, ritualistic and urges to engage in senseless, ritualistic behavior (behavior (compulsionscompulsions) that cause distress.) that cause distress.
23
Explaining Anxiety Explaining Anxiety DisordersDisorders
Freud suggested that we repress our Freud suggested that we repress our painful and intolerable ideas, feelings, painful and intolerable ideas, feelings,
and thoughts, resulting in anxiety.and thoughts, resulting in anxiety.
24
The Learning PerspectiveThe Learning Perspective
Learning theorists Learning theorists suggest that fear suggest that fear
conditioning leads conditioning leads to anxiety. This to anxiety. This
anxiety then anxiety then becomes associated becomes associated with other objects with other objects or events (stimulus or events (stimulus generalization) and generalization) and
is reinforced.is reinforced.
John Coletti/ Stock, B
oston
25
The Learning PerspectiveThe Learning Perspective
Investigators believe that fear responses Investigators believe that fear responses are inculcated through are inculcated through observational observational
learninglearning. Young monkeys develop fear . Young monkeys develop fear when they watch other monkeys who are when they watch other monkeys who are
afraid of snakes.afraid of snakes.
26
The Biological PerspectiveThe Biological Perspective
Natural Selection has led our ancestors to Natural Selection has led our ancestors to learn to fear snakes, spiders, and other learn to fear snakes, spiders, and other animals. Therefore, fear preserves the animals. Therefore, fear preserves the
species.species.
Twin studies suggest that our Twin studies suggest that our genesgenes may may be partly responsible for developing fears be partly responsible for developing fears
and anxiety. Twins are more likely to and anxiety. Twins are more likely to share phobias.share phobias.
27
The Biological PerspectiveThe Biological Perspective
Generalized anxiety, Generalized anxiety, panic attacks, and panic attacks, and
even OCD are even OCD are linked with linked with brain brain
circuitscircuits..
Anterior Cingulate Cortexof an OCD patient.
S. U
rsu, V.A
. Stenger, M
.K. S
hear, M.R
. Jones, & C
.S. Carter (2003). O
veractive action m
onitoring in obsessive-compulsive disorder. P
sychological Science, 14, 347-353.
28
A PET scan of the A PET scan of the brain of a person with brain of a person with Obsessive-Compulsive Obsessive-Compulsive Disorder (OCD). High Disorder (OCD). High
metabolic activity metabolic activity (red) in the frontal (red) in the frontal
lobe areas are lobe areas are involved with involved with
directing attention.directing attention.
Brain ImagingBrain Imaging
Brain image of an OCD
29
Mood DisordersMood Disorders
Emotional extremes of mood disorders Emotional extremes of mood disorders come in two principal forms.come in two principal forms.
1.1. Major depressive Major depressive
disorderdisorder
2.2. Bipolar disorderBipolar disorder
30
Major Depressive Major Depressive DisorderDisorder
Depression is the Depression is the ““common coldcommon cold”” of of psychological disorders. In a year, 5.8% psychological disorders. In a year, 5.8%
of men and 9.5% of women report of men and 9.5% of women report depression worldwide (WHO, 2002).depression worldwide (WHO, 2002).
31
Major Depressive Major Depressive DisorderDisorder
Major depressive disorder occurs when signs Major depressive disorder occurs when signs of depression last two weeks or more and are of depression last two weeks or more and are
not caused by drugs or medical conditionsnot caused by drugs or medical conditions..
1.1. Lethargy and fatigueLethargy and fatigue
2.2. Feelings of worthlessnessFeelings of worthlessness
3.3. Loss of interest or pleasureLoss of interest or pleasure
4.4. Loss of motivationLoss of motivation
5.5. Sleep or appetite disturbanceSleep or appetite disturbance
Signs include:Signs include:
32
Dysthymic DisorderDysthymic Disorder
Dysthymic disorder lies between a blue Dysthymic disorder lies between a blue mood and major depressive disorder. It is mood and major depressive disorder. It is
a disorder characterized by daily a disorder characterized by daily depression lasting two years or more.depression lasting two years or more.
Major Major DepressiveDepressive
DisorderDisorder
Blue Blue
MoodMoodDysthymicDysthymic
DisorderDisorder
33
Biological PerspectiveBiological Perspective
Genetic Influences: Mood disorders run Genetic Influences: Mood disorders run in families. The rate of depression is in families. The rate of depression is
higher in identical (50%) than fraternal higher in identical (50%) than fraternal twins (20%).twins (20%).
Linkage analysis and Linkage analysis and
association studies link association studies link
possible genes and possible genes and
dispositions for dispositions for
depressiondepression..
Jerry Irwin Photography
34
Neurotransmitters & Neurotransmitters & DepressionDepression
Post-synapticNeuron
Pre-synapticNeuron
Norepinephrine Serotonin
A reduction of A reduction of
norepinephrine norepinephrine
and serotonin has and serotonin has
been found in been found in
depression.depression.
Drugs that Drugs that
alleviate mania alleviate mania
reduce reduce
norepinephrine.norepinephrine.
35
The Depressed BrainThe Depressed Brain
PET scans show that brain energy PET scans show that brain energy consumption rises and falls with manic consumption rises and falls with manic
and depressive episodes.and depressive episodes.
Courtesy of L
ewis B
axter an Michael E
. P
helps, UC
LA
School of M
edicine
36
Social-Cognitive Social-Cognitive PerspectivePerspective
The social-cognitive perspective suggests The social-cognitive perspective suggests that depression arises partly from self-that depression arises partly from self-
defeating beliefs and negative defeating beliefs and negative explanatory styles.explanatory styles.
37
Depression CycleDepression Cycle
1.1. Negative stressful Negative stressful
events.events.
2.2. Pessimistic Pessimistic
explanatory style.explanatory style.
3.3. Hopeless depressed Hopeless depressed
state.state.
4.4. These hamper the way These hamper the way
the individual thinks the individual thinks
and acts, fueling and acts, fueling
personal rejection.personal rejection.
38
Bipolar DisorderBipolar Disorder
Formerly called manic-depressive disorder. Formerly called manic-depressive disorder. An alternation between depression and An alternation between depression and
mania signals bipolar disorder.mania signals bipolar disorder.
Grandiosity/IrritibilityGrandiosity/IrritibilityHyperactive Hyperactive
Pressured speechPressured speech
Flight of ideasFlight of ideas
Elation/EuphoriaElation/Euphoria
Manic SymptomsManic Symptoms
Slowness of thoughtSlowness of thoughtTiredTired
Inability to make Inability to make decisionsdecisions
WithdrawnWithdrawn
GloomyGloomy
Depressive SymptomsDepressive Symptoms
39
Bipolar DisorderBipolar Disorder
Many great writers, poets, and Many great writers, poets, and composers suffered from bipolar disorder. composers suffered from bipolar disorder.
During their manic phase creativity During their manic phase creativity surged, but not during their depressed surged, but not during their depressed
phase.phase.
Whitman Wolfe Clemens Hemingway
Bettm
ann/ Corbis
George C
. Beresford/ H
ulton Getty Pictures L
ibrary
The G
ranger Collection
Earl T
heissen/ Hulton G
etty Pictures L
ibrary
40
SuicideSuicide
Each year some 1 million people commit Each year some 1 million people commit suicide worldwide.suicide worldwide.
1.1. National National
differencesdifferences
2.2. Racial differencesRacial differences
3.3. Gender Gender
differencesdifferences
4.4. Age differencesAge differences
5.5. Other differencesOther differences
Suicide Statistics
41
Risk Factors and SignsRisk Factors and Signs
history of attempts/gestureshistory of attempts/gestures feelings of hopelessnessfeelings of hopelessness preoccupation with suicidepreoccupation with suicide giving away possessions giving away possessions recent lossrecent loss physical problemsphysical problems substance usesubstance use etc.etc.
42
SchizophreniaSchizophrenia
Nearly 1 in a 100 suffer from Nearly 1 in a 100 suffer from schizophrenia, and throughout the world schizophrenia, and throughout the world
over 24 million people suffer from this over 24 million people suffer from this disease (WHO, 2002).disease (WHO, 2002).
Schizophrenia strikes young people as Schizophrenia strikes young people as they mature into adults. It affects men they mature into adults. It affects men
and women equally, but men suffer from and women equally, but men suffer from it more severely than women.it more severely than women.
43
Symptoms of Symptoms of SchizophreniaSchizophrenia
The literal translation is “split mind,” which The literal translation is “split mind,” which is a misnomer. A group of severe disorders is a misnomer. A group of severe disorders
characterized by the following:characterized by the following:
1. Disorganized and delusional thinking.
2. Disturbed perceptions. 3. Inappropriate emotions
and actions.
44
Disordered thinkingDisordered thinking
loose associationsloose associations word saladword salad clang associationsclang associations cognitive flooding/stimulus overloadcognitive flooding/stimulus overload
inability to selectively attendinability to selectively attend
45
Other forms of delusions include, Other forms of delusions include, delusions of persecution (“someone is delusions of persecution (“someone is following me”) or grandeur (“I am a following me”) or grandeur (“I am a
king”).king”).
Disorganized & Delusional Disorganized & Delusional ThinkingThinking
This morning when I was at Hillside [Hospital], I This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie was making a movie. I was surrounded by movie stars … I’m Marry Poppins. Is this room painted stars … I’m Marry Poppins. Is this room painted blue to get me upset? My grandmother died four blue to get me upset? My grandmother died four weeks after my eighteenth birthday.”weeks after my eighteenth birthday.”
(Sheehan, 1982)
This monologue illustrates fragmented, This monologue illustrates fragmented, bizarre thinking and distorted beliefs bizarre thinking and distorted beliefs
called called delusionsdelusions (“I’m Mary Poppins”). (“I’m Mary Poppins”).
DelusionsDelusions
Examples:Examples: Delusions of persecutionDelusions of persecution Delusions of grandeurDelusions of grandeur Delusions of referenceDelusions of reference
46
47
Disturbed PerceptionsDisturbed Perceptions
A schizophrenic person may perceive things A schizophrenic person may perceive things that are not there (that are not there (hallucinationshallucinations). Frequently ). Frequently
such such hallucinationshallucinations are auditory and lesser are auditory and lesser visual, somatosensory, olfactory, or gustatory.visual, somatosensory, olfactory, or gustatory.
L. B
erthold, Untitled. T
he Prinzhorn Collection, U
niversity of Heidelberg
August N
atter, Witches H
ead. The Prinzhorn C
ollection, University of H
eidelberg
Photos of paintings by K
rannert Museum
, University of Illinois at U
rbana-Cham
paign
48
Inappropriate Emotions & Inappropriate Emotions & ActionsActions
A schizophrenic person may laugh at the A schizophrenic person may laugh at the news of someone dying or show no news of someone dying or show no
emotion at all.emotion at all.
Patients with schizophrenia may Patients with schizophrenia may continually rub an arm, rock a chair, or continually rub an arm, rock a chair, or remain motionless for hours (remain motionless for hours (catatoniacatatonia).).
49
Subtypes of SchizophreniaSubtypes of Schizophrenia
Schizophrenia is a cluster of disorders. Schizophrenia is a cluster of disorders. These subtypes share some features, but These subtypes share some features, but
there are other symptoms that there are other symptoms that differentiate these subtypes.differentiate these subtypes.
50
SubtypesSubtypes
51
Positive and Negative Positive and Negative SymptomsSymptoms
Schizophrenics have inappropriate symptoms Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, (hallucinations, disorganized thinking,
deluded ways) that are not present in normal deluded ways) that are not present in normal individuals (individuals (positive symptomspositive symptoms).).
Schizophrenics lack appropriate Schizophrenics lack appropriate behaviors (behaviors (negative symptomsnegative symptoms), such as ), such as apathy, anhedonia, blunted or flat affect apathy, anhedonia, blunted or flat affect
poor social relatedness, etc.poor social relatedness, etc.
52
Chronic and Acute Chronic and Acute SchizophreniaSchizophrenia
When schizophrenia is slow to develop When schizophrenia is slow to develop (chronic/process) recovery is doubtful. (chronic/process) recovery is doubtful.
Such schizophrenics usually display Such schizophrenics usually display negative symptoms.negative symptoms.
When schizophrenia rapidly develops When schizophrenia rapidly develops (acute/reactive) recovery is better. Such (acute/reactive) recovery is better. Such
schizophrenics usually show positive schizophrenics usually show positive symptoms.symptoms.
53
Understanding Understanding SchizophreniaSchizophrenia
Schizophrenia is a disease of the brain Schizophrenia is a disease of the brain exhibited by the symptoms of the mind.exhibited by the symptoms of the mind.
Dopamine Overactivity: Researchers Dopamine Overactivity: Researchers found that schizophrenic patients express found that schizophrenic patients express higher levels of dopamine D4 receptors in higher levels of dopamine D4 receptors in
the brain.the brain.
Brain Abnormalities
54
Abnormal Brain ActivityAbnormal Brain Activity
Brain scans show abnormal activity in the Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdalafrontal cortex, thalamus, and amygdala of of
schizophrenic patients. Adolescent schizophrenic patients. Adolescent schizophrenic patients also have brain lesions.schizophrenic patients also have brain lesions.
Paul T
hompson and A
rthur W. T
oga, UC
LA
Laboratory of N
euro Im
aging and Judith L. R
apport, National Institute of M
ental Health
55
Abnormal Brain Abnormal Brain MorphologyMorphology
Schizophrenia patients may exhibit Schizophrenia patients may exhibit morphological changes in the brain like morphological changes in the brain like
enlargement of fluid-filled ventricles.enlargement of fluid-filled ventricles.
Both Photos: C
ourtesy of Daniel R
. Weinberger, M
.D., N
IH-N
IMH
/ NSC
56
Genetic FactorsGenetic Factors
The likelihood of an individual suffering The likelihood of an individual suffering from schizophrenia is 50% if their identical from schizophrenia is 50% if their identical
twin has the disease (Gottesman, 1991).twin has the disease (Gottesman, 1991).
0 10 20 30 40 50Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
57
Genetic FactorsGenetic Factors
The following shows the prevalence of The following shows the prevalence of schizophrenia in identical twins as seen schizophrenia in identical twins as seen
in different countries.in different countries.
58
Psychological FactorsPsychological Factors
Psychological and environmental factors Psychological and environmental factors can trigger schizophrenia if the individual can trigger schizophrenia if the individual
is genetically predisposed (Nicols & is genetically predisposed (Nicols & Gottesman, 1983).Gottesman, 1983).
Genain Sisters
The genetically identical Genain
sisters suffer from schizophrenia. Two more
than others, thus there are contributing environmental
factors.
Courtesy of G
enain Fam
ily
59
Personality DisordersPersonality Disorders
Personality Personality disorders are disorders are
characterized by characterized by inflexible and inflexible and
enduring behavior enduring behavior patterns that patterns that
impair social and impair social and occupational occupational functioning. functioning.
60
Antisocial Personality Antisocial Personality DisorderDisorder
A disorder in which the person (usually men) A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, exhibits a lack of conscience for wrongdoing,
even toward friends and family members. even toward friends and family members. Formerly, this person was called a Formerly, this person was called a sociopathsociopath
or or psychopath.psychopath.
61
Understanding Antisocial Understanding Antisocial Personality DisorderPersonality Disorder
PET scans of 41 murderers revealed reduced PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up activity in the frontal lobes. In a follow-up
study repeat offenders had 11% less frontal study repeat offenders had 11% less frontal lobe activity compared to normals (Raine et lobe activity compared to normals (Raine et
al., 1999; 2000).al., 1999; 2000).
Normal Murderer
Courtesy of A
drian Raine,
University of Southern C
alifornia
62
Risk and Protective Risk and Protective FactorsFactors
Risk and protective factors for mental Risk and protective factors for mental disorders (WHO, 2004).disorders (WHO, 2004).
63
Risk and Protective Risk and Protective FactorsFactors