PsychopathologyPsychopathology

Chapter 12Chapter 12

This multimedia product and its contents are protected under copyright law.  The following are prohibited by law: any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. ISBN: 0-205-37181-7

Evolving Concepts of Mental Disorder

• How do we define “abnormality”?• Medical model

“disease” view, biological causes• Psychological models

Psychogenic – Caused by psychological factors

(thoughts, beliefs, childhood, experiences)

Indicators of Abnormality

DistressDistress MaladaptivenessMaladaptiveness

IrrationalityIrrationality UnpredictabilityUnpredictability

Observer Observer discomfortdiscomfort

Unconventional Unconventional and undesirable and undesirable

behaviorbehavior

Classifying System

DSM-IV – (1994)Fourth edition of the Diagnostic and Statistical

Manual of Mental Disorders• the most widely accepted classification

system in the United States• Common terminology across disciplines• Etiology –

The causes of, or factors related to, the development of a disorder

Explosion of Mental Disorders

• Supporters of new categories answer that is important to distinguish disorders precisely.

• Critics point to an economic reason: diagnoses are needed for insurance reasons so therapists will be compensated.

Problems with DSM-IV

• Danger of overdiagnosis

• Power of labels (self-fulfilling prophecy)

• Confusion of serious disorders with normal problems

• Illusion of objectivity and universality

• Diagnostic labels can compound the problem (Rosenhan Study**)

What are the ConsequencesWhat are the Consequencesof Labeling People?of Labeling People?

• The cultural context of mental disorder

:general state of apprehension or psychological tension

Generalized Anxiety disorder (GAD)Post-traumatic Stress disorder (PTSD)Panic disorder –

Marked by panic attacks that have no connection to events in a person’s present experience

PhobiasAgoraphobia- Fear of public places/open spaces

Social Phobia- fear of being observed by others

I. Anxiety Disorders

Obsessive-compulsive disorder – Condition characterized by patterns of persistent, unwanted thoughts and behaviors

Anxiety Disorders

A loss of memory for personal information

AmnesiaAmnesia

Dissociative fugue

Dissociative identity disorder

II. Dissociative Disorders

Amnesia with the addition of “flight” from one’s home, family, and job

Amnesia

Dissociative fugueDissociative fugue

Dissociative identity disorder

Dissociative Disorders

Condition in which individual displays multiple identities

Amnesia

Dissociative Fugue

Dissociative Dissociative identity disorderidentity disorder

Dissociative Disorders

The D.I.D./M.P.D. Controversy

• First view– MPD is common but often unrecognized or

misdiagnosed.– The disorder starts in childhood as means of coping.

– Trauma produced a mental splitting.

• 2nd view– Created through pressure and suggestions by

clinicians.

– Range: Only Handfuls of people to 10000 since 1980.

III. Mood Disorders

Bipolar disorder – Mental abnormality involving swings of mood from mania to depression

Mania – Pathologically excessive elation or manic excitement

Depression – Pathological sadness or despair

Unipolar depression

• Incidence

• Causes of depression

• Seasonal affective disorder (SAD) – Believed to be caused by deprivation of sunlight

Mood Disorders

Symptoms of Depression

• Depressed mood. • Reduced interest in almost all activities.• Significant weight gain or loss, without dieting. • Sleep disturbance • Change in motor activity • Fatigue or loss of energy.• Feelings of worthlessness or guilt.• Reduced ability to think or concentrate. • Recurrent thoughts of death.

DSM IV Requires 5 of these within the past 2 weeks

Vulnerability-Stress Model

IV. Schizophrenic Disorders

Schizophrenia –

Psychotic disorder involving distortions in thoughts, perceptions, and/or emotions(most likely to hospitalized)

Features incoherent speech, hallucinations, delusions, and bizarre behavior

DisorganizedDisorganized

Catatonic

Paranoid

Undifferentiated

Major Types of Schizophrenia

Involves stupor or extreme excitement

Disorganized

CatatonicCatatonic

Paranoid

Undifferentiated

Major Types of Schizophrenia

Prominent feature: combination of delusions and hallucinations

Disorganized

Catatonic

ParanoidParanoid

Undifferentiated

Major Types of Schizophrenia

Persons displaying a combination of symptoms that do not clearly fit in one of the other categories

Disorganized

Catatonic

Paranoid

UndifferentiatedUndifferentiated

Major Types of Schizophrenia

Theories of Schizophrenia

• Genetic predispositions

• Structural brain abnormalities

• Neurotransmitter abnormalities

• Prenatal abnormalities

V. Problem Personalities

• Personality Disorder– Rigid, maladaptive patterns that cause personal

distress or an inability to get along with others.

• Narcissistic Personality Disorder– exaggerated sense of self-importance and self-

absorption.– preoccupation with fantasies of success and

power, and a need for constant attention

• Paranoid Personality Disorder– habitually unreasonable and excessive

suspiciousness and jealousy.

Personality Disorders cont’d

Antisocial personality disorder – Characterized by aggressiveness, lack of guilt, and exploitation of others

• Must have 3 of these criteria and a history of behaviors– Repeatedly break the law.

– They are deceitful, using aliases and lies to con others.

– They are impulsive and unable to plan ahead.

– They repeatedly get into physical fights or assaults.

– They show reckless disregard for own safety or that of others.

– They are irresponsible, failing to meet obligations to others.

– They lack remorse for actions that harm others

VI. Somatoform Disorders

Somatoform disorders – Psychological problems appearing in the form of bodily symptoms or physical complaints

Conversion disorder – marked by paralysis, weakness, or loss of sensation, but with no discernable physical cause

Glove Anesthesia

Somatoform Disorders

Hypochondriasis – Somatoform disorder involving excessive concern about health and disease

Somatoform Disorders

VII. Drug Abuse and Addiction

• Biology and addiction.– a person’s biochemistry, – metabolism, and – genetic predisposition

Learning, Culture, and Addiction

• Addiction patterns vary according to cultural practices and the social environment.

• Policies of total abstinence tend to increase addiction rates rather than reduce them.

• Not all addicts have withdrawal symptoms when they stop taking a drug.

• Addiction does not depend on the properties of the drug alone, but also on the reason for taking it.

Failure of the Addiction Prediction• 75% of US Soldiers who

tested “drug positive” in reported being addicted during their tour.

• Fewer reported post-Vietnam drug use (blue bar).

• Even fewer still showed dependency(green bar).

• This contradicts what the biomedical model of addiction would predict.**

Debating the Causes of Addiction

• Problems with drugs are more likely when:– A person has a physiological vulnerability to a drug.– A person believes she or he has no control over the

drug.– Laws or customs encourage people to take the drug in

binges, and moderate use is neither tolerated nor taught.

– A person comes to rely on a drug as a method of coping with problems, suppressing anger or fear, or relieving pain.

– Peer group uses drugs or drinks heavily, forcing the person to choose between using drugs or losing friends.