Some Mental Disorders
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Transcript of Some Mental Disorders
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Some Mental Disorders
Shulin Chen, MD & PhD
Zhejiang UniversityHangzhou Mental Health Center
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Outline • Stress
• Anxiety and OCD
• Somatoform and Dissociative disorders
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Stress-Related Disorders
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Categories of Stressors• Frustrations• Conflicts
– Approach-avoidance– Double approach– Double avoidance
• Pressures– internal and
external
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Factors Predisposing a Person to Stress - Stressor
characteristics• Duration (acute versus chronic)• Number of stressors• Severity (“size” of the stressor)
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Psychological Moderators of Stress
• Self-efficacy• Psychological hardiness
– commitment; high in challenge• Sense of humor• Predictability and controllability• Social support• Task oriented versus defense oriented
coping
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Effects of Stress• Physical effects• Physiological effects
– General Adaptation Syndrome• Alarm stage• Resistance stage• Exhaustion state
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Stress-Related Disorders:Adjustment Disorders
• Adjustment Disorders– Mild– A maladaptive reaction to an identifiable
psychosocial stressor– Typical sources of stress:
• unemployment• relocation
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Disaster Syndrome• Characterizes the initial reactions of
many victims to catastrophes• Stages:
– Shock– Suggestible– Recovery
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Acute Stress Disorder and Post
Traumatic Stress Disorder• Similar symptoms, but “time-frame”
of symptoms differ.• Both occur in reaction to traumatic
events (e.g., natural disasters, rape, assault, war, etc).
• Acute stress disorder, if it lasts past one month, will turn into a diagnosis of PTSD.
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PTSD:General Categories of
Symptoms• Reexperiencing of the traumatic
event• Avoidance of stimuli associated with
the event.• Numbing of general responsiveness• Increased arousal
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PTSD:Vulnerability Factors
• Premorbid personality– pre-existing psychological problems, low self-
esteem, social skill deficits, external locus of control.
• Severity of trauma• Conditioned fear• Childhood factors
– Poverty, early divorce or separation, family history of mental disorders, history of sexual/physical abuse
• Social support
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PTSD- Types of Trauma• Rape
– Anticipatory phase, impact phase, posttraumatic recoil phase, and reconstitution phase
• Military combat
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Treatment• Immediate treatment (if possible)• Stress innoculation training
– provide information about the stressful situation
– rehearse adaptive self-statements– practice self-statements while expose to
various stressors• Exposure
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Anxiety Disorders and OCD
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Who is afraid of ?• small insect
• animal, reptile
• speaking to a large audience
• speaking in front of a small group of familiar people
• meeting new people
• attending social gatherings
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Anxiety as a Normal and an Abnormal Response
• Some amount of anxiety is “normal” and is associated with optimal levels of functioning.
• Only when anxiety begins to interfere with social or occupational functioning is it considered “abnormal.”
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Bell Curve
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The Fear and Anxiety Response Patterns
• Fear• Panic• Anxiety• Anxiety Disorder
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Phobia Disorders
• Phobias– Specific phobias– Social phobia– Agoraphobia
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Specific Phobias
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Specific Phobias
• Psychosocial causal factors• Genetic and temperamental
causal factors• Preparedness and the nonrandom
distribution of fears and phobias• Treating specific phobias
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Social Phobia• General characteristics Fear of being in social situations
in which one will be embarrassed or humiliated
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Social Phobia
• Interaction of psychosocial and biological causal factors– Social phobias as learned behavior– Social fears and phobias in an
evolutionary context– Preparedness and social phobia
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Social Phobia
• Interaction of psychosocial and biological causal factors– Genetic and temperamental factors– Perceptions of uncontrollability– Cognitive variables
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Panic Disorder With and Without Agoraphobia
• Panic disorder• Panic versus anxiety• Agoraphobia• Agoraphobia without panic
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Panic Disorder• Prevalence and age of onset• Comorbidity with other disorders• Biological causal factors• The role of Norepinephrine and
Serotonin
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Panic and the Brain
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Panic Disorder• Genetic factors• Cognitive and behavioral causal factors• Interoceptive fears
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Panic Disorder: The Cognitive Theory of Panic
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Panic Disorder: The Cognitive Theory of Panic
• Perceived control and safety• Anxiety sensitivity as a
vulnerability factor for panic• Safety behaviors and the
persistence of panic• Cognitive biases and the
maintenance of panic
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Treating Panic Disorder and Agoraphobia
• Medications• Behavioral and
cognitive-behavioral treatments
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Generalized Anxiety Disorder
• General characteristics• Prevalence and age of onset• Comorbidity with other disorders
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Generalized Anxiety Disorder:
Psychosocial Causal Factors• The psychoanalytic viewpoint• Classical conditioning to many stimuli• The role of unpredictable and
uncontrollable events• A sense of mastery: immunizing
against anxiety
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Generalized Anxiety Disorder:
Biological Causal Factors• Genetic factors• A functional deficiency of GABA• Neurobiological differences
between anxiety and panic
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Obsessive-Compulsive Disorder
• Obsessions- repetitive unwanted ideas that the person recognizes are irrational
• Compulsions- repetitive, often ritualized behavior whose behavior serves to diminish anxiety caused by obsessions
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Obsessive-Compulsive Disorder
• Prevalence and age of onset
• Characteristics of OCD• Types of compulsions• Comorbidity with other
disorders
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Obsessive-Compulsive Disorder:
Psychosocial Causal Factors• Psychoanalytic viewpoint• Behavioral viewpoint• The role of memory• Attempting to suppress obsessive
thoughts
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Obsessive-Compulsive Disorder:
Biological Causal Factors• Genetic
influences• Abnormalities in
brain function• The role of
serotonin
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Somatoform and Dissociative Disorders
I. Somatoform Disorders
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A. Sick Role• Have you ever “played sick” in
order to get out of something? How did that work out (did you get what you wanted)?
• Sick attention (friends, family, medical) = secondary gains
• Likely link between secondary gains and somatoform disorders
• Some medical condition may actually exist
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B. Somatization Disorder1. Historical perspective
• In the medical/clinical nomenclature since the mid-1600’s
• Known as “Hysteria,” “hypochondriasis,” and “melancholia” until 1800’s when mental disorders were differentiated
• Briquet’s syndrome, named for the French physician who initially defined it in 1859
• Term “somatization disorder” was first used in DSM-III (1980)
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B. Somatization (cont.)2. DSM-IV criteria (p. 174)
A. History of many physical complaints beginning before age 30 occurring over several years resulting in treatment being sought or significant impairment in functioning
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2. DSM-IV criteria (cont.)B. Each of the following met at some point during disorder:
1) 4 pain symptoms2) 2 gastrointestinal symptoms3) 1 sexual symptom4) 1 pseudoneurological
symptom
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2. DSM-IV criteria (cont.)C. Either:1) symptoms in Criterion B cannot be fully explained by a known GMC
or 2) when a GMC does exist, the symptoms in Criterion B are in excess of what would be expected based on medical factsD. Symptoms not intentionally feigned or produced
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B. Somatization (cont.)3. Additional descriptive information
• Report of symptoms usually colorful or exaggerated; factual info usually lacking
• Lab findings do not support somatic complaints
• Treatment sought from several doctors at once hazardous mix of treatments
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3. Additional info (cont.)• Primary relationships are with doctors;
personal relationships usually have problems
• Often seem indifferent about what symptoms represent– Concerned with individual symptoms, not what
symptoms might indicate in terms of a disease• Physical symptoms become part of their
identity (ego syntonic)
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B. Somatization (cont.)4. Statistics and course
– Lifetime prevalence:• 0.2 – 2% in women• less than 0.2% in men• Rates affected by rater, method of
assessment, and demographic variables:– Non-physicians diagnose it less frequently– In primary medical care settings, rate is 4.4 –
20%– Typical demographic is lower SES unmarried
woman
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4. Statistics and course (cont.)
• Onset is usually before 25 (must have symptoms before 30)
• Course is chronic and rarely remits completely
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B. Somatization (cont.)5. Causes
a) familial/genetic• Clear link between somatization and antisocial
personality disorder• Genetic influence (30-50%) on somatization
symptomsb) Social learning
• Parents may reinforce somatic complaints in children gain attention (sick role)
• Research shows somatization features and help seeking for illness in parents of somatizing children
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5. Causes (cont.)c) Cultural– Cultural differences in type of symptoms– Different rates across cultures– Possible differences in the use of somatic
references in communication (not a disorder, just differences in communication?)
d) Societal– More acceptance of medical vs.
psychological problems
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B. Somatization (cont.)6. Treatment
– No treatment shown to be effective– Behavioral approach limit doctor
visits• Use a gatekeeper physician
– Train patient to relate to others without using physical complaints
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Somatoform and Dissociative Disorders
II. Dissociative Disorders
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Overview• Disorders are marked by disruption in
the usually integrated functions of consciousness, memory, identity, or perception of the environment
• What are some “normal” dissociative experiences that people have sometimes?
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A. Common Features of Dissociative Disorders
1. Depersonalization = distortion in perception such that a sense of reality is lost
2. Derealization = losing a sense of the external world
• e.g., things change size or shape
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B. Dissociative Identity Disorder (DID)
• Formerly known as multiple personality disorder
1. DSM-IV criteria (p.192)A. presence of 2 or more distinct identities or personality statesB. At least 2 identities/personalities recurrently take control of the person’s behavior
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1. DSM-IV criteria (cont.)C. Inability to recall important personal information (goes beyond ordinary forgetfulness)D. Not due to effects of a substance or GMC; in children, symptoms not attributable to imaginary playmates or fantasy play
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Additional descriptive info• Alter = identity or personality in DID
– Many have at least 1 impulsive alter– Alters of the opposite gender are
common• Host = identity that seeks treatment
and tries to keep other identities integrated
• Switch = transition to another identity
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B. DID (cont.)2. Course and statistics
- 3-9 times more common among women- ratio may be more even in children- number of identities varies:- women average about 15- men average about 8- course is chronic; dissociation can be spurred by stress
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B. DID (cont.)3. Causes
- almost every DID case has history of severe sexual or physical abuse dissociation seems to be a defense
- may be extreme form of PTSD- biological influences not clear
- very few twin studies suggest environment is more influential than genes
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3. Causes (cont.)• Most are highly suggestible; easily
hypnotized
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B. DID (cont.)4. Treatment
- similar to treatment of PTSD- exposure to traumatic
memories; goal is desensitization and prevention of response (dissociation)
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Summary• Somatoform disorders involve a
focus on physical symptoms that are either not real or are exaggerated
• Dissociative disorders involve a disturbance in normally integrated functions (memory, identity, etc.)
• Course is usually chronic• Causes for most are unknown
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Thanks and
Question Welcome