Psychological Disorders

What is normal?

Psychological Disorder (defined)

• To be considered a “disorder”, the behavior must be:– maladaptive (harmful) or disturbing to the

individual– disturbing to others– unusual to the vast majority of people in that

culture– irrational, not make sense to the average person

• What is maladaptive, disturbing, unusual, and irrational depends on– the culture

– time period

– environmental conditions

– individual person

How do we diagnose?

• DSM-IV-TR

School or Perspective Cause of Disorder

Psychoanalytic/Psychodynamic Internal, unconscious conflicts

BehavioralReinforcement history/ the

environment

BiomedicalOrganic problems, biochemical

imbalances, genetic predispositions

CognitiveIrrational, dysfunctional thoughts

or ways of thinking

HumanisticFailure to strive towards one's

potential or being out of touch with one's feelings

Sociocultural Dysfunctional society

It’s a Buffet…

Early Theories

• Evil spirits

• Music or sing to chase spirits away

• Trephining

• Make the body uncomfortable

History of Mental Disorders

• Not madmen, but mentally ill

• Treatment involved placement in hospitals

Early Mental Hospitals

• Barbaric prisons

• Patients chained and locked away

• Some hospitals even charged admission for the public to see the “crazies”, just like a zoo

Philippe Pinel

• French doctor who was the first to take the chains off and declare that these people are sick and “a cure must be found!!!”

Categories of Disorders

• Anxiety Disorders

• Somatoform Disorders

• Dissociative Disorders

• Mood Disorders

• Personality Disorders

• Schizophrenia

• Other Disorders

Anxiety Disorders

Five Anxiety Disorders

• Phobia

• Generalized Anxiety Disorder

• Panic Disorder

• Obsessive-Compulsive Disorder

• Post-traumatic Stress Disorder

Phobia

• An intense, irrational fear of specific objects or things

• There is a phobia for just about anything– www.phobialist.com

Generalized Anxiety Disorder

• Is chronic (at least 6 months), generalized and persistent

• Characterized by a constant, low level of anxiety

Panic Disorder

• Characterized by sudden, acute episodes of intense anxiety without an apparent cause

Obsessive-Compulsive Disorder

• OCD

• Different symptoms– Obsessions: persistent, often unreasonable

thoughts that can’t be dispelled– Compulsion: persistent act which is repeated over

and over

• Obsessions result in the anxiety, anxiety reduced when compulsive behavior performed

Common Examples of OCD

Common Obsessions:Common

Compulsions

Contamination fears of germs, dirt, etc.

Washing

Imagining having harmed self or others

Repeating

Imagining losing control of aggressive urges

Checking

Intrusive sexual thoughts or urges Touching

Excessive religious or moral doubt Counting

Forbidden thoughts Ordering/arranging

A need to have things "just so" Hoarding or saving

A need to tell, ask, confess Praying

Post-traumatic Stress Disorder

• Memories of traumatic event cause intense feelings of anxiety– Can result in persistent nightmares or

flashbacks

Somatoform Disorders

Hypochondriasis

• Complaints of frequent, usually small, physical problems but no evident problems

• Physical symptoms usually have psychological roots

Conversion Disorder

• Certain bodily functions impaired, but no biological cause found– Common symptoms reported:

• Paralysis

• Blindness

• Seizures

• Anesthesia (loss of feeling)

Dissociative Disorders

Psychogenic amnesia

• Can’t remember things & no physiological basis for forgetting– Organic amnesia is different (2 types of

organic): retrograde & anterograde

Fugue

• Not only forget who the are (psychogenic amnesia) but usually find themselves in place with no idea of how they got there

Dissociative Identity Disorder

• Formerly know as Multiple Personality Disorder (MPD)

• Several distinct personalities

• No limit to number, age, gender of personalities

• Theory is the personalities are created to cope with abuse

Mood Disorders

Major Depression

• Symptoms of depression include the following:– depressed mood (such as feelings of sadness or emptiness)

– reduced interest in activities that used to be enjoyed, sleep disturbances (either not being able to sleep well or sleeping to much)

– loss of energy or a significant reduction in energy level

– difficulty concentrating, holding a conversation, paying attention, or making decisions that used to be made fairly easily

– suicidal thoughts or intentions.

Seasonal Affective Disorder

• Severe depression every fall and winter followed by normal or elevated mood in the spring

• Symptoms: intense hunger, weight gain during the winter, sleeping more.

• Treatment: sunlight (“light therapy”)

Dysthymic Disorder

• Occurs when a person suffers from a mild depression for at least two years. – No major depressive bouts occur during this time.

• Treatment– Similar to Major Depression, treatment could include medication

and/or therapy.

Bipolar Disorder

• Also known as manic depression, is characterized by bouts of depression (discussed above) alternating with bouts of mania (an energetic feeling of confidence and power). 

• In many cases, the manic periods are more dangerous than the depressive ones because during mania, the person exhibits extremely risky behavior. 

• Many creative people suffer from bipolar.

• Research shows strong biological component

• Broken down into two types– Bipolar I

– Bipolar II

• Treatment – medication, most common is Lithium– Therapy is beneficial to help patient understand the illness & it’s

consequences

Personality Disorders

Antisocial Personality Disorder

• Characterized by a lack of respect for other’s rights, feelings, and needs, beginning by age 15

• Deceitful, manipulative

• Often lack empathy & remorse

– May be superficially charming

• Behavior often aggressive, impulsive, reckless and irresponsible

• Once referred to as sociopathy or psychopathy

Histrionic Personality Disorder

• Involves attention-seeking behavior and shallow emotions

Narcissistic Personality Disorder

• Characterized by an exaggerated sense of importance, a strong desire to be admired, and a lack of empathy

Dependent Personality Disorder

• Rely too much on the attention and help of others

• Need approval – trouble making decisions by themselves

Paranoid Personality Disorder

• Always feel persecuted

Obsessive-Compulsive Personality Disorder

• Overly concerned with certain thoughts and performing certain behaviors, but will not be debilitated to the same extent that someone with OCD would

Schizophrenia

schizophrenia video

Positive Symptoms

• “adding on”, NOT “good”

• Examples:– Delusions– Hallucinations– Inappropriate effect

Negative Symptoms

• Involves a loss of something a person WITHOUT schizophrenia has

• Examples:– Flat effect– Catatonia

Types of Schizophrenia

• Paranoid schizophrenia

• Disorganized schizophrenia

• Catatonic schizophrenia

• Undifferentiated schizophrenia

Paranoid Schizophrenia

• Characterized by marked delusions or hallucinations & relatively normal cognitive and emotional functioning

• Delusions are usually persecutory, grandiose, or both

• This subtype usually happens later in life than the other subtypes

• Prognosis may also be better for this type of schizophrenia

Disorganized Schizophrenia

• Characterized by disorganized behavior, disorganized speech, and emotional flatness or inappropriateness.

Catatonic Schizophrenia

• Characterized by unnatural movement patterns such as rigid, unmoving posture or continual, purposeless movements, or by unnatural speech patterns such as absence of speech or parroting of other people’s speech.

Undifferentiated Schizophrenia

• Diagnosis given to a patient that does not meet criteria for paranoid, disorganized, or catatonic schizophrenia.

Causes of Schizophrenia

• Research suggests that many things may play a role in the onset of schizophrenia– genes– neurotransmitters– brain abnormalities (structure & injury)

Genetic Predisposition

• Substantial evidence suggests that there is a genetically inherited predisposition to schizophrenia.– there is a concordance rate of about 48 percent for identical

twins

– the concordance rate for fraternal twins is considerably less, about 17 percent.

– Concordance rate refers to the percentage of both people in a pair having a certain trait or disorder.

• A person who has two parents with schizophrenia has about a 46 percent chance of developing schizophrenia.

Neurotransmitters

• Some researchers have proposed that schizophrenia is related to an excess of the dopamine

• Other researchers have suggested that both serotonin and dopamine may be involved

• The neurotransmitter glutamate may also play a role– Underdevelopment of glutamate neurons results in

the overactivity of dopamine neurons

Brain Structure

• Some researchers have suggested that schizophrenia may involve an inability to filter out irrelevant information, which leads to being overwhelmed by stimuli.– researchers have looked for brain abnormalities in

schizophrenia patients.

– The brains of people with schizophrenia do differ structurally from the brains of normal people in several ways.

– They are also more likely to have abnormalities in the thalamus and reduced hippocampus volume.

Brain Injury

• Some research suggests that injuries to the brain during sensitive periods of development can make people susceptible– viral infections or malnutrition during the prenatal period

– complications during the birthing process can increase the later risk of schizophrenia.

• Some researchers have suggested that abnormal brain development during adolescence may also play a role in schizophrenia.

Stress and Schizophrenia

• Stress may play a role in people who are biologically vulnerable to schizophrenia

Summary

What Is a Psychological Disorder?

• Criteria for defining psychological disorders depend on whether cultural norms are violated, whether behavior is maladaptive or harmful, and whether there is distress.

Medical Model

• The medical model describes and explains psychological disorders as if they are diseases.

Vulnerability-stress Model

• The vulnerability-stress model states that disorders are caused by an interaction between biological and environmental factors.

Learning Model

• The learning model theorizes that psychological disorders result from the reinforcement of abnormal behavior.

Psychodynamic Model

• The psychodynamic model states that psychological disorders result from maladaptive defenses against unconscious conflicts.

Assessment

• Psychologists use objective and projective tests to assess psychological disorders.

Classification

• Classification allows psychologists to describe disorders, predict outcomes, consider treatments, and study etiology.

• Insanity is a legal term, not a diagnostic label.

The DSM

• Psychologists and psychiatrists use a reference book called the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose psychological disorders.

• The American Psychiatric Association published the first version of the DSM in 1952. It has been revised several times, and the newest version is commonly referred to as the DSM-IV-TR

DSM

• The DSM-IV uses a multi-axial system of classification, which means that diagnoses are made on several different axes or dimensions.

DSM

• The DSM has five axes:– Axis I records the patient’s primary diagnosis.

– Axis II records long-standing personality problems or mental retardation.

– Axis III records any medical conditions that might affect the patient psychologically.

– Axis IV records any significant psychosocial or environmental problems experienced by the patient.

– Axis V records an assessment of the patient’s level of functioning.

DSM

Criticisms of the DSM

• Although the DSM is used worldwide and considered a very valuable tool for diagnosing psychological disorders, it has been criticized for several reasons:

DSM

• Some critics believe it can lead to normal problems of living being turned into “diseases.” – For example, a child who displays the inattentive

and hyperactive behavior normally seen in young children could be diagnosed with attention-deficit/hyperactivity disorder by an overzealous clinician.

DSM

• Some critics argue that including relatively minor problems such as caffeine-induced sleep disorder in the DSM will cause people to liken these problems to serious disorders such as schizophrenia or bipolar disorder.

DSM

• Other critics argue that giving a person a diagnostic label can be harmful because a label can become a self-fulfilling prophecy.– A child diagnosed with

attention-deficit/hyperactivity disorder may have difficulty overcoming his problems if he or other people accept the diagnosis as the sole aspect of his personality.

DSM

• Some critics point out that the DSM makes the process of diagnosing psychological disorders seem scientific when, in fact, diagnosis is highly subjective.

DSM

• In general, psychologists view the DSM as a valuable tool that, like all tools, has the potential for misuse. The DSM contains many categories of disorders, and the following sections will cover a few of these categories.

DSM

Anxiety Disorders

• A chronic, high level of anxiety may be a sign of an anxiety disorder.

• Generalized anxiety disorder involves persistent and excessive anxiety for at least six months.

• Having a specific phobia means becoming anxious when exposed to a specific circumstance.

• Social phobia is characterized by anxiety in social or performance situations.

• A person with panic disorder experiences recurrent, unexpected panic attacks.

• Agoraphobia involves anxiety about having panic attacks in difficult or embarrassing situations.

• Obsessive-compulsive disorder entails obsessions, compulsions, or both.

• Post–traumatic stress disorder is a set of psychological and physiological responses to a highly traumatic event.

• Biological factors implicated in the onset of anxiety disorders include genes, different sensitivity to anxiety, the neurotransmitters GABA and serotonin, and brain damage.

• Conditioning and learning may contribute to the development of phobias.

• Neuroticism is associated with anxiety disorders.

Mood Disorders

• Mood disorders are characterized by marked disturbances in emotional state, which cause physical symptoms and affect thinking, social relationships, and behavior.

• Mood disorders may be unipolar or bipolar.

• People with dysthymic disorder have depressed mood for at least two years.

• Major depressive disorder involves at least one period with significant depressive symptoms.

• Bipolar disorders involve at least one period with manic symptoms and usually depressive periods as well.

• Biological influences on mood disorders include genes, the neurotransmitters norepinephrine and serotonin, and brain abnormalities.

• Cognitive characteristics of depressed people include learned helplessness; a pessimistic worldview; hopelessness; a tendency to make internal, stable, global attributions; and a tendency to ruminate.

• Depression may be related to experiences of loss.

• The onset and course of mood disorders may be influenced by stress.

Somatoform Disorders

• Somatoform disorders are characterized by real physical symptoms that cannot be fully explained by a medical condition, the effects of a drug, or another mental disorder.

• A person with somatoform disorder has many different, recurrent physical symptoms.

• Conversion disorder involves symptoms that affect voluntary motor functioning or sensory functioning.

• People with hypochondriasis constantly fear that they may have a serious disease.

• People with histrionic personality traits may be more likely to develop somatoform disorders.

• Several cognitive factors may contribute to somatoform disorders.

Dissociative Disorders

• Dissociative disorders are characterized by disturbances in consciousness, memory, identity, and perception.

• Dissociative fugue involves sudden and unexpected travel away from home, failure to remember the past, and confusion about identity.

• People with dissociative identity disorder fail to remember important personal information and have two or more identities or personality states that control behavior.

• Dissociative identity disorder is a controversial diagnosis. Psychologists disagree about why its prevalence has risen since the 1980s.

• Severe stress may play a role in the onset of dissociative disorders.

Personality Disorders

• Personality disorders are stable patterns of experience and behavior that differ noticeably from patterns that are considered normal by a person’s culture.

• Histrionic personality disorder is characterized by attention-seeking behavior and shallow emotions.

• People with narcissistic personality disorder have an exaggerated sense of importance, a strong desire to be admired, and a lack of empathy.

• Antisocial personality disorder begins at age fifteen and includes a lack of respect for other people’s rights, feelings, and needs.

• Abnormalities in physiological arousal, a genetically inherited inability to control impulses, and brain damage may be involved in the development of antisocial personality disorder.

• Environmental influences are also likely to influence the development of antisocial personality disorder.

Schizophrenia

• Schizophrenia is a psychotic disorder that includes positive and negative symptoms.

• There are several subtypes of schizophrenia.• The paranoid type is characterized by marked

delusions or hallucinations and relatively normal cognitive and emotional functioning.

• The disorganized type involves disorganized behavior, disorganized speech, and emotional flatness or inappropriateness.

• The catatonic type is characterized by unnatural movement or speech patterns.

• A diagnosis of undifferentiated type applies if diagnostic criteria are not met for any of the above three subtypes.

• Research suggests that genes, neurotransmitters, and brain abnormalities are involved in the onset of schizophrenia.

• Stress may help to induce schizophrenia in people who are already biologically vulnerable to the disorder.