Psychological Disorders Chapter

Psychological DisordersAn Introduction

Psychological Disorder• Patterns of thought, feelings or behaviors

which are deviant, distressful, and dysfunctional

• Deviant – Devoid of normal, acceptable behavior

• Distressful – causes feelings of anxiety and distress

• Dysfunctional – a behavior so different that it interferes with family and/or life.

Early Theories

• Afflicted people were possessed by evil spirits or sinners.

During the Middle Ages treatment methods were inhumane and cruel

• Music or singing was often used to chase away spirits.• In some cases trephening was used:

Cutting a hole in the head of the afflicted to let out the evil spirit.

Trephening

Early Theories• Another theory was to make the body

extremely uncomfortable.

History of Mental Disorders

• In the 1800’s, disturbed people were no longer thought of as madmen, but as mentally ill.

Did this mean better treatment?

They were first put in hospitals.

Early Mental Hospitals• They were nothing more than barbaric

prisons.

• The patients were chained and locked away.

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

Philippe Pinel (1745-1826)

• French physician who worked to reform the treatment of people with mental disorders

• Encouraged more humane treatment

Philippe Pinel

• Pinel said “take the chains off and declare that these people are sick” “a cure must be found!!!”

Somatogenic

• At this time- it was believed that mental illness had a bodily cause- Somatogenic.

General Paresis and Syphilis Example.

But Somatogenic could not explain disorders such as hysteria (now called conversion disorder).

Many disorders are psychogenic: the origin is psychological, not physical.

The Medical Model

• Concept that mental illnesses have physical causes that can be diagnosed, treated, and in most cases, cured.

• Psychological disorders can be diagnosed based on their symptoms and treated or cured through therapy.

• Psychological disorders are similar to a physical illness.

Current Perspectives

• Bio-Psycho-Social Perspective: assumes biological, psychological and sociocultural factors combine to interact causing psychological disorders.

Used to be called Diathesis-Stress Model: diathesis meaning predisposition and stress meaning environment.

Bio-Psycho-Social Perspective

DSM-IV-TR

• Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition

• The text of the DSM-IV was recently revised, hence “TR” at the end

DSM-IV-TR

• Divides mental disorders into 17 major categories

• Includes the symptoms but not the causes of each disease

• Has changed significantly since the first edition

DSM-IV-TR Axis

DSM-IV-TR Axis

DSM-IV-TR Axis

DSM-IV-TR Axis

Labeling Stigmas

• Studies show a clear bias against people diagnosed with mental disorders.

Thomas Eagleton and George McGovern 1972

Anxiety Disordersa group of conditions where the

primary symptoms are anxiety or defenses against anxiety.the patient fears something awful will happen to them.

Anxiety and Anxiety Disorders

• Anxiety: Vague feeling of apprehension or nervousness

• Anxiety disorder: where anxiety begins to take control and dominate a person’s life

What is anxiety?• is a state of

intense apprehension, uneasiness, uncertainty, or fear.

Types of Anxiety Disorders

• Anxiety disorders are divided into:–Generalized Anxiety Disorder–Panic Disorder–Phobia–Obsessive-Compulsive Disorder–Posttraumatic Stress Disorder

Anxiety Disorders

Generalized Anxiety Disorder• An anxiety disorder in which a

person is continuously tense, apprehensive and in a state of autonomic nervous system arousal.

The patient is constantly tense and worried, feels inadequate, is oversensitive, can’t concentrate and suffers from insomnia.

Symptoms of Generalized Anxiety• Must have at least three of the following:

–Restlessness–Feeling on edge–Difficulty concentrating/mind going

blank–Irritability–Muscle Tension–Sleep Disturbance

Panic Disorder• An anxiety disorder marked by a

minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking and other frightening sensations.

Can cause secondary disorders, such as agoraphobia.

Panic Disorder

• An anxiety disorder characterized by sudden bouts of intense, unexplained anxiety

• Often associated with physical symptoms like choking sensations or shortness of breath

• Panic attacks may happen several times a day

Phobias• A person experiences sudden episodes of intense dread.

Phobia

• An anxiety disorder characterized by disruptive, irrational fears of specific objects or situations

• The fear must be both irrational and disruptive.

Social Phobia

• Phobias which produce fear in social situations

• Fear of speaking in public

Agoraphobia

• Fear of situations the person views as difficult to escape from

• Fear of leaving one’s home or room in the house

The Phobia List Link

Obsessive-Compulsive Disorder

• An anxiety disorder characterized by unwanted, repetitive thoughts and actions

• Obsessions – repetitive thoughts• Compulsions – repetitive actions• The obsessions/compulsions begin to

take control of the person’s life.

Common Examples of OCDCommon Obsessions: Common

Compulsions:Contamination fears of germs,

dirt, etc. WashingImagining having harmed self or

others RepeatingImagining losing control of

aggressive urges CheckingIntrusive sexual thoughts or

urges TouchingExcessive religious or moral

doubt Counting

Forbidden thoughts Ordering/arrangingA need to have things "just so" Hoarding or savingA need to tell, ask, confess Praying

Posttraumatic Stress Disorder

• An anxiety disorder characterized by reliving a severely upsetting event in unwanted recurring memories (flashbacks) and dreams

Explanations for Anxiety Disorders

• You Learn them through conditioning.

•Evolution

•Genes•Physiology (the brain)

Biological Factors

• Hereditary factors may result in a predisposition for developing anxiety disorders

• Brain functions appear to be different in an anxiety disorder patient

• Evolutionary factors may lead to anxiety disorders.

Learning Factors

• Through classical conditioning people may associate fear with an object.

• Observational learning--watching another experiencing fearfulness--may result in developing fear.

• Fear of an object may be reinforced when by avoiding the feared objects.

Mood Disorders

Mood Disorders

• Classification of disorders where there is a disturbance in the person’s emotions

• Major types of mood disorders include:–Major Depressive Disorder–Bipolar Disorder–Dysthymic Disorder

Mania

• Period of abnormally high emotion and activity

Depression

• Extended period of feeling sad, listless, and drained of energy

Major Depressive Disorder

• A mood disorder in which a person, for no apparent reason, experiences at least two weeks of –depressed moods, –diminished interest in activities, and –other symptoms, such as feelings of

worthlessness

Bipolar Disorder

• A mood disorder in which the person alternates between the hopelessness of depression and the overexcited and unreasonably optimistic state of mania

• Formerly called manic-depressive disorder

• Many times will follow a cyclical pattern

Biological Factors

• Mood disorders have a hereditary nature to them.

• Depressed individuals tend to have depressed brains.–PET scans indicate less activity during

periods of depression.

Social-Cognitive Factors

• Depression may be a variation of learned helplessness.

• Depressed individuals attribute events using the following characteristics:–Stable: the bad situation will last for a

long time–Internal: they are at fault–Global: all of life is bad

Attribution and Depression

Determination of Mood

Personality Disorders

Psychological disorders characterized by inflexible and enduring behavior

patterns that impair social functioning.

Personality Disorders

• Psychological disorders characterized by rigid and lasting behavior patterns that disrupt social functioning

• Divided into three clusters:–Related to anxiety–With odd and eccentric behaviors–With dramatic or impulsive behaviors

Personality Disorders

Avoidant Personality Disorder

• So sensitive about being rejected that personal relationships become difficult

Avoidant personality disorder

• characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and extreme sensitivity to negative evaluation.

• consider themselves to be socially inept or personally unappealing, and avoid social interaction for fear of being ridiculed or humiliated.

Dependent Personality Disorder

• Behave in clingy, submissive ways and displays a strong need to have others take care of them

Dependent personality disorder

• characterized by a pervasive psychological dependence on other people.

• has difficulty making everyday decisions without an excessive amount of advice and reassurance from others

Paranoid Personality Disorder

• Paranoid personality disorder is characterized by a distrust of others and a constant suspicion that people around you have sinister motives.

Paranoid Personality Disorder

• They search for hidden meanings in everything and read hostile intentions into the actions of others.

• They are quick to challenge the loyalties of friends and loved ones and often appear cold and distant to others. They usually shift blame to others and tend to carry long grudges.

Schizoid Personality Disorder

• Is detached from social relationships• Are true hermits, preferring life alone

and avoiding intimate interactions at all costs

Schizoid Personality Disorder• People with

schizoid personality disorder avoid relationships and do not show much emotion

They genuinely prefer to be alone and do not secretly wish for popularity.

Schizoid Personality Disorder• They tend to seek jobs that require

little social contact

Their social skills are often weak and they do not show a need for attention or acceptance

They are perceived as humorless and distant and often are termed "loners."

Borderline Personality Disorder• characterized by mood instability

and poor self-image

People with this disorder are prone to constant mood swings and bouts of anger.

Borderline Personality Disorder

• they will take their anger out on themselves, causing themselves injury

Suicidal threats and actions are not uncommon They are quick to anger when their expectations are not met.

Antisocial Personality Disorder

• Personality disorder in which the person shows a lack of conscience for wrongdoing

• Shows no respects for the rights others• Usually male• Also known as psychopathic or

sociopathic personality disorder

Antisocial Personality Disorder

• antisocial personality disorder is characterized by a lack of conscience

• People with this disorder are prone to criminal behavior, believing that their victims are weak and deserving of being taken advantage of. They tend to lie and steal

Antisocial Personality Disorder

• they are careless with money and take action without thinking about consequences

They are often aggressive and are much more concerned with their own needs than the needs of others.

Histrionic Personality Disorder

• constant attention seekers

They need to be the center of attention all the time, often interrupting others in order to dominate the conversation.

Histrionic Personality Disorder

• They may dress provocatively or exaggerate illnesses in order to gain attention.

They also tend to exaggerate friendships and relationships, believing that everyone loves them

Narcissistic Personality Disorder

• characterized by self-centeredness

They exaggerate their achievements, expecting others to recognize them as being superior

Narcissistic Personality Disorder

They tend to be choosy about picking friends, since they believe that not just anyone is worthy of being their friend.

They are generally uninterested in the feelings of others and may take advantage of them.

Schizotypal Personality Disorder

• characterized by a need for social isolation, odd behavior and thinking, and often unconventional beliefs such as being convinced of having extra sensory abilities.

• Some people believe that schizotypal personality disorder is a mild form of schizophrenia.

Obsessive Compulsive Personality Disorder

• characterized by a general psychological inflexibility, rigid conformity to rules and procedures, perfectionism, and excessive orderliness.

• people with OCPD tend to stress perfectionism above all else, and feel anxious when they perceive that things aren't "right".

Dissociative Disorders

Dissociative Disorders

• Disorders in which the sense of self has become separated (dissociated) from previous memories, thoughts, or feelings

Types of Dissociative Disorders

• Three main types:–Dissociative Amnesia–Dissociative Fugue–Dissociative Identity Disorder

Dissociative Disorders

Dissociative Disorders• Disorders in which

conscious awareness becomes separated (dissociated) from previous memories, thoughts and feelings.

Dissociative Amnesia• This disorder is

characterized by a blocking out of critical personal information, usually of a traumatic or stressful nature.

Dissociative Amnesia

• A dissociative disorder characterized by loss of memory in reaction to a traumatic event

• Example: soldiers in combat

Dissociative Amnesia• Dissociative amnesia, unlike other

types of amnesia, does NOT result from other medical trauma (e.g. a blow to the head).

Dissociative Amnesia• Localized amnesia is present in an individual who has no

memory of specific events that took place, usually traumatic. The loss of memory is localized with a specific window of time. For example, a survivor of a car wreck who has no memory of the experience until two days later is experiencing localized amnesia.

• Selective amnesia happens when a person can recall only small parts of events that took place in a defined period of time. For example, an abuse victim may recall only some parts of the series of events around the abuse.

• Generalized amnesia is diagnosed when a person's amnesia encompasses his or her entire life.

• Systematized amnesia is characterized by a loss of memory for a specific category of information. A person with this disorder might, for example, be missing all memories about one specific family member.

Dissociative Fugue

• A dissociative disorder characterized by loss of identity and travel to a new location

• The person may develop a new identity and begin a new life.

Dissociative Fugue• An individual with dissociative fugue

suddenly and unexpectedly takes physical leave of his or her surroundings and sets off on a journey of some kind.

• These journeys can last hours, or even several days or months.

Dissociative Fugue• Individuals experiencing a dissociative

fugue have traveled over thousands of miles.

An individual in a fugue state is unaware of or confused about his identity, and in some cases will assume a new identity (although this is the exception).

Depersonalization Disorder

• is marked by a feeling of detachment or distance from one's own experience, body, or self. One can easily relate to feeling as they in a dream, or being "spaced out."

A person's experience with depersonalization can be so severe that he or she believes the external world is unreal or distorted.

Dissociative Identity Disorder• A rare dissociative disorder in

which a person exhibits two or more distinct and alternating personalities.

•Also known as multiple personality disorder.

Dissociative Identity Disorder

• Rare and controversial dissociative disorder in which an individual experiences two or more distinct and alternating personalities

• Formerly called multiple personalities

Dissociative Identity Disorder• Personalities can be different ages, sex,

and self perception of characteristics• Three Faces of Eve• Sybil

Schizophrenia

Schizophrenia

• Group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions

• Is not one disorder but a family of disorders• Is not “split personality”• Occurs in about 1% of the population

Symptoms of Schizophrenia

• Symptoms of schizophrenia include:–Delusions (false beliefs)–Hallucinations (false perceptions)–Inappropriate emotions or behaviors

Symptoms of Schizophrenia

How Prevalent?• About 1 in every 100 people are

diagnosed with schizophrenia.

Symptoms of Schizophrenia

• Disorganized thinking.

•Disturbed Perceptions•Inappropriate Emotions and Actions

Disorganized Thinking• The thinking of a person with

Schizophrenia is fragmented and bizarre and distorted with false beliefs.

• Disorganized thinking comes from a breakdown in selective attention.- they cannot filter out information. Often causes………

Delusions (false beliefs)

• Delusions of Persecution

• Delusions of Grandeur

Delusions

• False beliefs that are symptoms of schizophrenia and other serious psychological disorders

• Four major types of delusions:–Grandeur–Persecution–Sin or guilt– Influence

Delusions of Grandeur

• False beliefs that a person is more important than they really are

• Patients may believe they are a famous person (e.g. Napoleon)

Delusions of Persecution

• False beliefs that people are out to get the person

• Believe they are being followed, the phone is wiretapped, etc.

Delusions of Sin or Guilt

• False beliefs that the person is responsible for some misfortune

Delusions of Influence

• False beliefs of being controlled by outside forces

Hallucinations

• False perceptions that are symptoms of schizophrenia or other serious psychological disorders

• Types of hallucinations:–Auditory (hearing voices)–Visual (seeing things)–Tactile (feeling skin sensations)

• Can also have distorted smell and taste

Disturbed Perceptions• hallucinations- sensory

experiences without sensory stimulation.

Inappropriate Emotions/Behaviors

• Flat affect – showing little or no emotional response

• Word salad – nonsense talk• Waxy flexibility – the person’s arms and

legs will remain in place after being moved there

Inappropriate Emotions and Actions

• Laugh at inappropriate times.

• Flat Effect • Senseless,

compulsive acts.• Catatonia-

motionless Waxy Flexibility

Positive v. Negative Symptoms

Positive Symptoms

• Presence of inappropriate symptoms

Negative Symptoms

• Absence of appropriate ones.

Types of Schizophrenia

Paranoid Schizophrenia

• preoccupation with delusions or hallucinations.

• Somebody is out to get me!!!!

Paranoid Schizophrenia

• Characterized by delusions, especially grandeur and persecution. Auditory and other hallucinations support the delusions.

A Beautiful Mind

Disorganized Schizophrenia

• disorganized speech or behavior, or flat or inappropriate emotion.

Disorganized Schizophrenia

• Characterized by bizarre behavior, delusions, and hallucinations.

• Very disturbed thought and language (word salad)

Catatonic Schizophrenia

• parrot like repeating of another’s speech and movements

Catatonic Schizophrenia

• Characterized by variations in voluntary movement

• Catatonic excitement – rapid movements with delusions and hallucinations

• Catatonic stupor – little or no activity, movement, or speech (waxy flexibility)

Undifferentiated Schizophrenia

• Many and varied Symptoms.

Undifferentiated Schizophrenia

• Symptoms that don’t clearly fit into one of the other types of schizophrenia but still show clear symptoms of schizophrenia

Biological Factors - Genetics

• Schizophrenia tends to run in families.• Genetics appears to produce a

predisposition (increased likelihood) to develop schizophrenia.

Genain Quadruplets

Genetics and Schizophrenia

Biological Factors – Brain Structure

• Brain structure of those with schizophrenia is different than the normal brain

• Those with schizophrenia have smaller amounts of brain tissue and larger fluid filled spaces.

• The thalamus is smaller in those with schizophrenia.

Biological Factors – Brain Function

• The brain of those with schizophrenia operates differently than the normal brain.

• The frontal lobes show less activity.• Those with schizophrenia have a larger

number of receptor sites for the neurotransmitter dopamine.

Biological Factors – Brain Function

Biological Factors – Prenatal Viruses

• A viral infection during the middle of pregnancy may increase schizophrenia risk.

Psychological Factors

• Two main areas:–Stress–Disturbed family

–It’s unclear whether these are causes or consequences of schizophrenia.