7 Psychological Disorders I felt the need to clean my room … spent four to five hour at it … At the time I loved it but then didn't want to do it any more, but could not stop … The clothes hung … two fingers apart …I touched my bedroom wall before leaving the house … I had constant anxiety … I thought I might be nuts. Marc, diagnosed with obsessive-compulsive disorder (from Summers, 1996)
8 Psychological Disorders People are fascinated by the exceptional, the unusual, and the abnormal. This fascination may be caused by two reasons: 1.During various moments we feel, think, and act like an abnormal individual. 2.Psychological disorders may bring unexplained physical symptoms, irrational fears, and suicidal thoughts.
9 What behaviors do we consider to be abnormal? Evaluate examples. What basis did you use to determine if the behavior was abnormal? Anne Case Study: - What is abnormal? - Why is each abnormal?
10 Psychological Disorders To study the abnormal is the best way of understanding the normal. There are 450 million people suffering from psychological disorders (WHO, 2004). Depression and schizophrenia exist in all cultures of the world. Significance? William James ( )
11 Defining Psychological Disorders Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions (dysfunctional) that are disturbing and interfere with normal day-to – day life (maladaptive) A syndrome that is marked by a clinically significant disturbance in an individual’s cognition, emotional regulation or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning is considered a mental disorder (APA, 2013).
ALTERNATIVE TERMINOLOGY Deviant = Atypical different from other people’s behavior that it violates a norm Distressful = Disturbing A behavior which is troublesome to other people or to person *Dysfunctional = Maladaptive Destructive to oneself or others; can’t live a normal life (loss of house, job, family) 12
13 DEFINING PSYCHOLOGICAL DISORDERS Standards for deviant behavior vary by culture and context. Examples? Standards for deviant behavior also vary with time. Examples? Deviance alone is not enough to label behavior as abnormal. Why?
14 DEFINING ABNORMAL BEHAVIOR Deviant and Distressful behavior must generally also be judged Dysfunctional to be considered abnormal. Use of term psychopathology Judy Smith Case Study
15 Understanding Psychological Disorders Ancient Treatments of psychological disorders include trephination, exorcism, being caged like animals, being beaten, burned, castrated, mutilated, or transfused with animal’s blood. See transparency for other treatments. Trephination (boring holes in the skull to remove evil forces) John W. Verano
17 Medical Model When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders. Implies behavior is an illness. 1.Etiology: Cause and development of the disorder. 2.Diagnosis: Identifying (symptoms) and distinguishing one disease from another. 3.Treatment: Treating a disorder in a psychiatric hospital. 4.Prognosis: Forecast about the disorder.
18 Biopsychosocial Perspective Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders.
19 BIOPSYCHOSOCIAL MODEL OF PSYCHOPATHOLOGIES Assumptions that disorders are influenced by: –Genetic predispositions –Physiological states –Inner psychological dynamics –Social and cultural circumstances.
20 Classifying Psychological Disorders The American Psychiatric Association rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe psychological disorders. The most recent edition, DSM 5 (2013) Following slides credited to Jeff Nevid Professor of Psychology and Director of Clinical Psychology St. John’s University
A Short History of the DSM (J.N.) The DSM-1 (1952), 106 disorders across several major categories, reflecting a psychodynamic perspective on etiology DSM II (1968), 182 disorders, similar framework as DSM-1; like DSM-1, it lacked specification of specific symptoms of many disorders; distinguished among disorders at broader levels of neurosis, psychosis, and personality disturbance DSM-III (1980) and DSM-III-R (1987), which focused on standardization of diagnostic categories by linking them to specific criteria or symptom clusters, expressed in colloquial language; included 265 diagnoses in DSM- III and 292 in DSM-III-R, which changed some of the diagnostic criteria DSM-IV (1994) and DSM-IV-TR (2000), 297 disorders, relatively minor changes DSM- 5 (2013) 20 categories- 250 disorders, major changes
22 Goals of DSM 1.Describe / Classify disorders. 2.Determine how prevalent the disorder is. Disorders outlined by DSM are reliable. Therefore, diagnoses by different professionals are similar. Others criticize DSM for “putting any kind of behavior within the compass of psychiatry.”
DSM-5 In a given year, about 26.2 percent of American adults over age 18 suffer from a mental disorder –only about 5.8 percent suffer from a severe mental disorder –common to suffer from more than one disorder at a time 23
Major Changes (J. Nevid) ChangeComment Elimination of multiaxial system and GAF (Global Assessment Functioning) Clinicians wanted simplified, diagnosis- based system; distinctions between Axis I and Axis II disorders were never clearly justified; clinicians can still specify external stressors; new assessment measures will be introduced Establishes 20 diagnostic classes or categories of mental disorders Categories based on groupings of disorders sharing similar characteristics; some categories represent spectrums of related disorders Roman numerals dropped: DSM-5, not DSM-V Allows for easier nomenclature for midcourse revisions, 5.1, 5.2, etc.
DSM-5 Controversies (J.Nevid) Point of ControversyConcerns Expansion of diagnosable disorders Net result of diagnostic inflation may be to greatly expand the numbers of people labeled as suffering from a mental disorder or mental illness; e.g., Mild Neurocognitive Disorder may pathologize mild cognitive changes or everyday forgetting in older adults; e.g., Disruptive Mood Dysregulation Disorder may pathologize repeated temper tantrums in children Changes in classification of mental disorders Critics question whether changes in classification are justified and might lead to greater diagnostic confusion; parents of Asperger’s children are concerned their children may not qualify for the new ASD diagnosis and associated treatment benefits
DSM-5 Controversies (J.Nevid) Point of ControversyConcerns Changes in diagnostic criteria for particular disorders Critics contend that many of the changes in the diagnostic criteria have not been sufficiently validated. Particular concerns are raised about the substantial changes made in the set of symptoms used to diagnose Autism Spectrum Disorders, which may have profound effects on the numbers of children identified as suffering from these disorders Process of developmentCritics claim development of the DSM-5 was shrouded in secrecy, that it failed to incorporate input from many leading researchers and scholars in the field, and that changes to the diagnostic manual were not clearly documented based on an adequate body of empirical research
27 Labeling Psychological Disorders 1.Critics of the DSM argue that labels may stigmatize individuals. Describe the Rosenhan study. Asylum baseball team (labeling) Elizabeth Eckert, Middletown, NY. From L. Gamwell and N. Tomes, Madness in America, Cornell University Press.
28 Labeling Psychological Disorders 2.Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy. 3.What stereotypes are caused or supported by the media? 4.Labels can be self-fulfilling prophesies. Explain.
29 Labeling Psychological Disorders 3.“Insanity” labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes. (We will cover when we do antisocial personality disorder.) Theodore Kaczynski (Unabomber) Elaine Thompson/ AP Photo
Rates of Psychological Disorders
Labeling Stigmas Studies show a clear bias against people diagnosed with mental disorders. Say DSM contributes to that. _aizzykhttp://www.youtube.com/watch?v=LTIZ _aizzyk
33 Anxiety Disorders Characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.. 1.Generalized anxiety disorders 2.Phobias 3.Panic disorders 4.Obsessive-compulsive disorders 5.Post traumatic stress disorder
34 Generalized Anxiety Disorder (free floating anxiety) 1.Persistent and uncontrollable tenseness and apprehension. 2.Autonomic arousal. 3.Inability to identify or avoid the cause of certain feelings. 4.Often accompanied by depression Symptoms
35 Panic Disorder Minutes-long episodes of intense dread which may include feelings of terror, chest pains, choking, or other frightening sensations. Anxiety is a component of both disorders. It occurs more in the panic disorder, making people avoid situations that cause it. Symptoms
36 Phobia Marked by a persistent and irrational fear of an object or situation that disrupts behavior.
37 Kinds of Phobias Phobia of blood.Hemophobia Phobia of closed spaces.Claustrophobia Phobia of heights.Acrophobia Phobia of open places.Agoraphobia
38 SOCIAL PHOBIA Intense fear of being scrutinized by others. Severe shyness.
39 Your morning routine: Describe your typical morning routine from the time you get up in the morning until you leave for school. Raise your hand if: your routine the same every day it would cause you tension if someone changed or intruded on it
Routine, superstition, or OCD? You make the call (Wade Boggs) 2pm - chicken dinner 3pm - leaves apartment 3:30 - dresses at locker 4pm - sits in dugout 4:10 - warms-up arm 4: ground balls Steps on 3rd-2nd-1st- baseline-2 steps through coaches box-4 steps to dugout Drink, then jogs to centerfield to meditate Batting practice 7:17 wind sprints Applies pine tar, doughnut, resin to bat Draws a Chai in the dirt
When does a routine become obsessive-compulsive? 41
42 OBSESSIVE-COMPULSIVE DISORDER Listen to the description of one compulsive person. Decide what the difference is between her behavior and your morning routine:
43 OBSESSIVE/COMPULSIVE She dresses in black from head to toe every day. On her way to each class, she invariably takes exactly the same route every day, changing it for nothing or no one. Not only does she avoid stepping on cracks in the floor, but also she walks on the same floor tiles and she counts every footfall.
44 OBSESSIVE COMPULSIVE Once in class, she sits in exactly the same seat as the day before, and she places her book bag on the exact spot on the floor. Whenever the teacher moves to the right side of the room, the girl makes a mark in her notebook. Whenever the teacher moves to the left, the girl nods her head.
45 OBSESSIVE COMPULSIVE If the teacher is on the left side of the room when the class is dismissed, the girl is confident that she has learned well. The girl has no friends because her behavior is so bizarre and absorbs too much of her energy to allow her to be responsive to others. Also, people are threatening to her, since they may interfere with the demands of her self-imposed rituals.
46 Obsessive-Compulsive Disorder Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress.
47 OBSESSIVE-COMPULSIVE DISORDER How do obsessions and compulsions become linked? –The compulsions originate to reduce the anxiety brought on by the obsession. –Ritualized behavior carries out the compulsion –The person then becomes anxious about the ritual. Example: video clip on flashdrive
48 EXAMPLES Obsession: A young woman is continuously terrified by the thought that cars might careen onto the sidewalk and run over her. Compulsion: She always walks as far from the street pavement as possible and wears red clothes so that she will be immediately visible to an out-of-control car.
49 EXAMPLES Obsession: A college student has the urge to shout obscenities while sitting through lectures in classes. Compulsion: Carefully monitoring his watch, he bites his tongue every sixty seconds in order to ward off the inclination to shout.
50 EXAMPLES Obsession: A young boy worries incessantly that something terrible might happen to his mother while sleeping at night. Compulsion: On his way up to bed each night, he climbs the stairs according to a fixed sequence of three steps up, followed by two steps down in order to ward off danger.
51 EXAMPLES Obsession: A mother is tormented by the concern that she might inadvertently contaminate food as she cooks dinner for her family. Compulsion: Every day she sterilizes all cooking utensils in boiling water, scours every pot and pan before placing food in it, and wears rubber gloves while handling food.
53 A PET scan of the brain of a person with Obsessive-Compulsive Disorder (OCD). High metabolic activity (red) in the frontal lobe areas are involved with directing attention. Brain Imaging Brain image of an OCD
54 Post-Traumatic Stress Disorder Four or more weeks of the following symptoms constitute post-traumatic stress disorder (PTSD): 1.Haunting memories 2.Nightmares 3.Social withdrawal 4.Jumpy anxiety 5.Sleep problems 6.Dose response relationship Bettmann/ Corbis
55 Resilience to PTSD Only about 10% of women and 20% of men react to traumatic situations and develop PTSD. Holocaust survivors show remarkable resilience against traumatic situations. All major religions of the world suggest that surviving a trauma leads to the growth of an individual. (“Post-Traumatic Growth”)
56 Explaining Anxiety Disorders Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety. PSYCHODYNAMIC
57 The Learning Perspective - BEHAVIORAL Learning theorists suggest that fear conditioning leads to anxiety. This anxiety then becomes associated with other objects or events (stimulus generalization) and is reinforced. Review behavioral studies, esp neg reinforcement. John Coletti/ Stock, Boston
58 The Learning Perspective - BEHAVIORAL Investigators believe that fear responses are inculcated (taught to you) through observational learning. Young monkeys develop fear when they watch other monkeys who are afraid of snakes.
59 The Biological Perspective Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. Predisposition (vulnerability, diasthesis) Grooming, territorialism, washing up lead to ? Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias.
60 The Biological Perspective Generalized anxiety, panic attacks, and even OCD are linked with brain circuits like the anterior cingulate cortex (esp for OCD). Fear circuits also in amygdala. Antidepressants can help. Anterior Cingulate Cortex of an OCD patient. S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action monitoring in obsessive-compulsive disorder. Psychological Science, 14,
Give out Causes Chart Fill out first row for Anxiety Disorders using the persectives 61
62 Dissociative Disorder Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. Symptoms 1.Having a sense of being unreal. 2.Being separated from the body. 3.Watching yourself as if in a movie. 4.Fugue: amnesia with flight (wander off)
63 DISSOCIATIVE IDENTITY DISORDER CAUSES Abuse, often sexual Dissociation or separation from trauma: conscious awareness become separated from painful memories, thoughts, and feelings Presumes existence of repressed memories (controversial) Psychoanalytic and learning theory: a way of dealing with extreme anxiety A cultural phenomenon – a disorder created by therapists in a particular social context?
64 Dissociative Identity Disorder (DID) Is a disorder in which a person exhibits two or more distinct and alternating personalities, formerly called multiple personality disorder. This is NOT schizophrenia. Chris Sizemore (DID) Lois Bernstein/ Gamma Liason
Dissociative Identity Disorder Used to be called “Multiple Personality Disorder” Very rare 65
DID Video clip (VHS) 66
67 DID Critics Critics argue that the diagnosis of DID increased in the late 20 th century. DID has not been found in other countries. Critics’ Arguments 1.Role-playing by people open to a therapist’s suggestion. 2.Learned response that reinforces reductions in anxiety.
Causes Chart Fill in 2 nd Row -- DID 68
69 Mood Disorders (Affective Disorders) Emotional extremes of mood disorders come in two principle forms. 1.Major depressive disorder – prolonged lethargy and hopelessness 2.Bipolar disorder – alternate between depression and mania formerly called manic depressive disorder.
70 Major Depressive Disorder Depression is the “common cold” of psychological disorders. In a year, 5.8% of men and 9.5% of women report depression worldwide (WHO, 2002). Chronic shortness of breath Gasping for air after a hard run Major Depressive DisorderBlue mood
71 Major Depressive Disorder Depression is often a response to past and current loss. It is a type of psychic hibernation: slows us down, defuses aggression, and restrains risk taking. Rumination (define) can be adaptive: reassess, redirect energy
73 Dysthymic Disorder Dysthymic disorder lies between a blue mood and major depressive disorder. It is a disorder characterized by daily depression lasting two years or more. Major Depressive Disorder Blue Mood Dysthymic Disorder
75 Bipolar Disorder Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder. Multiple ideas Hyperactive Desire for action Euphoria Elation Manic Symptoms Slowness of thought Tired Inability to make decisions Withdrawn Gloomy Depressive Symptoms
Disruptive mood dysregulation disorder Note: The DSM 5 will likely reduce the number of child & adolescent bipolar diagnoses, by classifying as D.M.D.D. 76
77 Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase. Whitman WolfeClemensHemingway Bettmann/ Corbis George C. Beresford/ Hulton Getty Pictures Library The Granger Collection Earl Theissen/ Hulton Getty Pictures Library
78 BIPOLAR DISORDER Mild form of bipolar disorder: cyclothymia Maladaptive symptoms of manic phase –Grandiose optimism and self-esteem –Reckless behavior –Loud, flighty, hard to interrupt speech
79 Subsets of Bipolar Disorder Bipolar I: manic episodes may alternate with periods of deep depression or sometimes periods of relatively normal mood separate these extremes (also called manic depression). –Tends to be very rare Bipolar II: major depressive episodes alternate with episodes known as hypomania, which are less severe than the manic phases seen in bipolar I disorder. Cyclothymic Disorder: the bipolar equivalent of dysthymia; it involves episodes of depression and mania, but the intensity of both moods is less severe than in cases of bipolar I disorder.
82 Explaining Mood Disorders Since depression is so prevalent worldwide, investigators want to develop a theory of depression that will suggest ways to treat it. Lewinsohn et al., (1985, 1995) note that a theory of depression should explain the following: 1.Behavioral and cognitive changes, including symptoms of other disorders such as delusions 2.Common causes of depression
83 Theory of Depression 3.Gender differences
84 Theory of Depression 4.Depressive episodes usually self- terminate. 5.Stressful events often precede depression. 6.Depression is increasing, especially in the teens. Gene penetrance (define) or comfort level with reporting? Desiree Navarro/ Getty Images
85 Suicide The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide. 1.National differences 2.Racial differences 3.Gender differences 4.Age differences 5.Other differences Suicide Statistics
86 Biological Perspective Genetic Influences: Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%). Linkage analysis and association studies link possible genes and dispositions for depression. Jerry Irwin Photography
87 Neurotransmitters & Depression Post-synaptic Neuron Pre-synaptic Neuron Norepinephrine Serotonin A reduction of norepinephrine and serotonin has been found in depression. Drugs that alleviate mania reduce norepinephrine.
88 Biology and Depression Depressed people have lower levels in their diet and blood of a “good” fat: omega-3 fatty acid that enhances brain function
89 The Depressed Brain PET scans show that brain energy consumption rises and falls with manic and depressive episodes. Courtesy of Lewis Baxter an Michael E. Phelps, UCLA School of Medicine
90 Social-Cognitive Perspective/SELIGMAN The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles.
91 Depression Cycle 1.Negative stressful events. 2.Pessimistic explanatory style. May arise from learned helplessness. 3.Hopeless depressed state. 4.These hamper the way the individual thinks and acts, fueling personal rejection.
92 Example Explanatory style plays a major role in becoming depressed.
93 RISE OF DEPRESSION EXPLAINED BY SELIGMAN Due to epidemic hopelessness (preexisting pessimism encountering failure). Hopelessness due to: rise of individualism decline of commitment to religion and family resulting self-blame with nothing to fall back on
94 Women and Depression Women are more likely to suffer from depression Women tend to think, often overthink (ruminate) when trouble arises Differences in emotional memory (more vivid recall of bad experiences)
95 Schizophrenia If depression is the common cold of psychological disorders, schizophrenia is the cancer. Nearly 1 in a 100 suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease (1%)(WHO, 2002). Schizophrenia strikes young people as they mature into adults. It affects men and women equally, but men suffer from it more severely than women. * Is not Dissociative Identity Disorder
Symptoms of Schizophrenia –Excesses of, or additions to, normal behavior Delusions: Unshakeable, false beliefs –Delusions of persecution –Delusions of reference –Delusions of influence –Delusions of grandeur Hallucinations: Seeing or hearing things that don’t exist –Less than, or an absence of, normal behavior Poor attention Flat affect: A lack of emotional responsiveness Poor speech production POSITIVE- not present in normal people - ACTIVE NEGATIVE - PASSIVE AP: Diagnostic Categories and Their Symptoms
97 Symptoms of Schizophrenia The literal translation is “split mind.” A group of severe disorders characterized by the following: 1.Disorganized and delusional thinking. 2.Disturbed perceptions (hallucinations). 3.Inappropriate emotions (flat affect) and actions. Psychotic: the break away from an ability to perceive what is real and what is fantasy (psychosis)
98 Other forms of delusions include, delusions of persecution (“someone is following me”) or grandeur (“I am a king”). Disorganized & Delusional Thinking This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Marry Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.” (Sheehan, 1982) This monologue illustrates fragmented, bizarre thinking with distorted beliefs called delusions (“I’m Mary Poppins”).
99 DELUSIONS Delusions are NOT hallucinations! Types: –Delusions of grandeur –Delusions of persecution –Delusions of reference –Delusions of influence
100 Disorganized & Delusional Thinking Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and bizarre thoughts).
101 Disturbed Perceptions A schizophrenic person may perceive things that are not there (hallucinations). Frequently such hallucinations are auditory and lesser visual, somatosensory, olfactory, or gustatory. L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
102 Inappropriate Emotions & Actions A schizophrenic person may laugh at the news of someone dying or show no emotion at all (apathy or “flat affect”). Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia).
103 Additional Symptoms of Schizophrenia 1)Disruptions of language: a)word salads, b)neologisms (invent new words), c)clang associations (rhyming rather than meaning for word choice) 2) Disruptions of thinking: a) thought blocking b) thought insertion 3) Personal hygiene often suffers.
104 Types - Chronic and Acute Schizophrenia When schizophrenia is slow to develop (chronic/process) recovery is doubtful. Such schizophrenics usually display negative symptoms. When schizophrenia rapidly develops (acute/reactive) recovery is better. Such schizophrenics usually show positive symptoms. Respond better to meds.
105 Understanding Schizophrenia Schizophrenia is a disease of the brain exhibited by the symptoms of the mind. Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors (6x) in the brain. Brain Abnormalities
106 Abnormal Brain Activity Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients. Adolescent schizophrenic patients also have brain lesions. Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health
107 Abnormal Brain Morphology Schizophrenia patients may exhibit morphological changes in the brain, like enlargement of fluid-filled ventricles. Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC
Other risk factors Low birth weight Maternal diabetes Older paternal age Oxygen deprivation during delivery Famine exposure 108
109 Viral Infection Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development. Occurs in 2% of pregancies where mother had the flu virus
Figure 13.2 Genetics and Schizophrenia This chart shows a definite pattern: The greater the degree of genetic relatedness, the higher the risk of schizophrenia in individuals related to each other. The only individual to carry a risk even close to that of identical twins (who share 100 percent of their genes) is a person who is the child of two parents with schizophrenia. Based on Gottesman (1991).
111 Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries.
112 Psychological Factors 1)Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicols & Gottesman, 1983). 2) Stress-vulnerability model: assumes a biological sensitivity, or vulnerability, to a certain disorder that will develop under the right conditions of environmental or emotional stress Genain Sisters The genetically identical Genain sisters suffer from schizophrenia. Two suffer more than the others, thus there are contributing environmental factors. Courtesy of Genain Family
113 Warning Signs Early warning signs of schizophrenia include: Birth complications, oxygen deprivation and low-birth weight. 2. Short attention span and poor muscle coordination. 3. Poor peer relations and solo play.6. Emotional unpredictability.5. Disruptive and withdrawn behavior.4. A mother’s long lasting schizophrenia.1.
115 SOMATOFORM DISORDERS (not in textbook) Somatoform disorder: psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause Two types of somatoform disorder –Conversion disorder –Illness Anxiety Disorder
116 SOMATOFORM DISORDER Conversion Disorder: a rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found. Illness Anxiety Disorder (formally called Hypochondriasis): a somatoform disorder in which a person interprets normal physical sensations as symptoms of a disease
117 Somatoform Disorders Conversion Disorders differ from true physical disorders in 3 ways: 1. usually appear under severe stress, 2. allow person to reduce stress by avoiding unpleasant or threatening situations, and 3. the person may show little concern about what apparently should be a serious problem. Tend to be very rare
118 Dissociative Disorder Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. Symptoms 1.Having a sense of being unreal. 2.Being separated from the body. 3.Watching yourself as if in a movie. 4.Fugue: amnesia with flight
119 Dissociative Identity Disorder (DID) Is a disorder in which a person exhibits two or more distinct and alternating personalities, formerly called multiple personality disorder. This is NOT schizophrenia. Chris Sizemore (DID) Lois Bernstein/ Gamma Liason
120 DISSOCIATIVE IDENTITY DISORDER CAUSES Abuse, often sexual Dissociation or separation from trauma: conscious awareness become separated from painful memories, thoughts, and feelings Presumes existence of repressed memories (controversial) Psychoanalytic and learning theory: a way of dealing with extreme anxiety A cultural phenomenon – a disorder created by therapists in a particular social context?
Dissociative Amnesia (Dissociative Fugue now a characteristic of) Characterized by loss of identity and travel to a new location Time- hours, days, weeks, months, years Caused by extreme stress
122 DID Critics Critics argue that the diagnosis of DID increased in the late 20 th century. DID has not been found in other countries. videovideo Critics’ Arguments 1.Role-playing by people open to a therapist’s suggestion. 2.Learned response that reinforces reductions in anxiety.
Eating Disorders Eating disorders –covered in Ch 12 – Anorexia nervosa an eating disorder in which a person (usually an adolescent female) maintains a starvation diet despite being significantly (15 percent or more) underweight. – Bulimia nervosa an eating disorder in which a person alternates binge eating (usually of high- calorie foods) with purging (by vomiting or laxative use), excessive exercise, or fasting. – Binge -eating disorder - significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise that marks bulimia 123
124 Personality Disorders (AXIS II) Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions.
Personality disorders –Cluster A Schizoid personality disorder – eccentric or odd behaviors –Cluster B Histrionic personality disorder – attention getting behaviors Narcissistic personality disorder – self focused and self- inflating Antisocial personality disorder –Cluster C Avoidant personality disorder-fearful sensitivity to rejection 125
126 Antisocial Personality Disorder A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, even toward friends and family members. Formerly, this person was called a sociopath or psychopath.
127 Understanding Antisocial Personality Disorder Like mood disorders and schizophrenia, antisocial personality disorder has biological and psychological reasons. Youngsters, before committing a crime, respond with lower levels of stress hormones than others do at their age.
128 Understanding Antisocial Personality Disorder PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study repeat offenders had 11% less frontal lobe activity compared to normals (Raine et al., 1999; 2000). Normal Murderer Courtesy of Adrian Raine, University of Southern California
129 Understanding Antisocial Personality Disorder The likelihood that one will commit a crime doubles when childhood poverty is compounded with obstetrical complications (Raine et al., 1999; 2000).
131 Rates of Psychological Disorders The prevalence of psychological disorders during the previous year is shown below (WHO, 2004).
132 INSANITY DEFENSE Read: “The Insanity Defense: A Closer Look” Skim over the John Hinckley packet. Determine why John Hinckley received the sentence of not guilty by reason of insanity. Summarize this view; include in your answer your understanding of paranoid schizophrenia. Do you agree with the sentence? Why or why not? Video clip:
133 Risk and Protective Factors Risk and protective factors for mental disorders (WHO, 2004).