1. PowerPoint® Presentation by Jim Foley Psychological Disorders © 2013 Worth Publishers

2. Module 39: Basic Concepts of Psychological Disorders, and Mood Disorders

3. Topics deserving our understanding and contemplation  Defining Psychological Disorders  Case study: ADHD  Biopsychosocial and Medical models  Classifying Disorders  The effects of labeling  Responsibility for one’s actions  Rates of various Disorders  Major Depressive Disorder  Bipolar Disorder  Prevalence and Course of mood disorders  Biological Influences on Depression  Suicide and Self-Injury  Social- Cognitive Factors: Explanatory style  Depression’s vicious self- reinforcing cycle

4. Why Learn about Psychological Disorders? Reasons for curiosity:  personal familiarity with psychological symptoms  knowing someone else with the disorder  hearing about how prevalent and socially devastating some disorders have become in society  wanting to learn more about mental health and human nature

5. Questions to Keep in Mind Perspectives on Psychological Disorders  Defining psychological disorders  Thinking critically about ADHD  Understanding psychological disorders  Classifying psychological disorders  Labeling psychological disorders  Insanity and responsibility How do we decide when a set of symptoms are severe enough to be called a disorder that needs treatment? Can we define specific disorders clearly enough so that we can know that we’re all referring to the same behavior/mental state? Can we use our diagnostic labels to guide treatment rather than to stigmatize people?

6. A Psychological disorder is: A significant dysfunction in an individual’s cognitions, emotions, or behaviors.  Disorders are diagnosed when there is dysfunction, behaviors which are considered maladaptive because they interfere with one’s daily life  Disorders are diagnosed when the symptoms and behaviors are accompanied by Distress, suffering.  New definition (DSM 5): “a disturbance in the psychological, biological, or developmental processes underlying mental functioning.” More Understandings about disorders:

7. Is Attention-Deficit/Hyperactivity Disorder (ADHD) a real disorder? ADHD: Impulsivity mixed with Inattention and/or hyperactivity. Can include distractibility, disorganization, fidgeting, difficulty suppressing impulses, and impaired working memory. Is this a disorder?  Is it deviant? Do some people have a level of inattentiveness, impulsiveness, or restlessness that goes beyond laziness or immaturity?  Is it distressful? Is the person enjoying being energetic, or are they frustrated that they can’t sustain focus?  Is there dysfunction? Are the symptoms harmless fun, or do they negatively impact work and relationships?

8. Understanding the Nature of Psychological Disorders  One reason to diagnose a disorder is to make decisions about treating the problem.  Based on older understanding of psychological disorders, treatments have included: exorcising evil spirits, beatings, caging/restraint, and Pinel’s New Approach  Philippe Pinel (1745-1826) proposed that mental disorders were not caused by demonic possession, but by stress and inhumane conditions.  Pinel’s “moral treatment” involved gentleness, nature, and social interaction. Pinel’s interventions improved lives but often did not effectively treat mental illness. But then…

9. The Medical Model  Psychological disorders can be seen as psychopathology, an illness of the mind.  Disorders can be diagnosed, labeled as a collection of symptoms that tend to go together.  People with disorders can be treated, attended to, given therapy, all with a goal of restoring mental health. The discovery that the disease of syphilis causes mental symptoms (by infecting the brain) suggested a medical model for mental illness.

10. The Biopsychosocial Approach

11. Cultural Influences on Disorders Examples: Bulimia Nervosa: binging/purging, in the United States Running amok: violent outbursts, in Malaysia Hikikomori: social withdrawal, in Japan Culture-bound syndromes are disorders which only seem to exist within certain cultures; they demonstrate how culture can play a role in both causing and defining a disorder.

12. Classifying Psychological Disorders Why create classifications of mental illness? What is the value of talking about diagnoses instead of just talking about individuals? 1.Diagnoses create a verbal shorthand for referring to a list of associated symptoms. 2.Diagnoses allow us to statistically study many similar cases, learning to predict outcomes. 3.Diagnoses can guide treatment choices. The Diagnostic and Statistical Manual  It’s easier to count cases of autism if we have a clear definition.  Versions: DSM-IV-TR, DSM-V (May 2013)  The DSM is used to justify payment for treatment.  It’s consistent with diagnoses used by medical doctors worldwide.

13. The DSM suggests describing someone not just with a label but with a five-part picture. Axis I: Is a clinical syndrome present? Using specifically defined criteria, clinicians may select none, one, or more syndromes. Axis II: Is a personality disorder or mental retardation (intellectual developmental disorder) present? Clinicians may or may not also select one of these two conditions. Axis III: Is a general medical condition, such as diabetes, arthritis, or hypertension also present? Axis IV: Are psychosocial or environmental problems, such as school or housing issues, also present? Axis V: What is the global assessment of this person’s functioning? Clinicians assign a code from 0-100. The Five “Axes” of Diagnosis

14. Categories of Diagnoses

15. Categories of Diagnoses: The 5 Axes

16. Critiques of Diagnosing with the DSM 1. The DSM calls too many people “disordered.” 2.The border between diagnoses, or between disorder and normal, seems arbitrary. 3.Decisions about what is a disorder seem to include value judgments; is depression necessarily deviant? 4.Diagnostic labels direct how we view and interpret the world, telling us which behavior and mental states to see as disordered.

17. Stigma and Stereotypes Many people think a diagnostic label means being seen as tainted, weak, and weird. However:  these negative views/stigma come from popular cultural views of mental illness, and not from the DSM.  the DSM may contain the information to correct inaccurate perceptions of mental illness.

18. Insanity and Responsibility  Jared Loughner shot many people, including a U.S. Representative, in 2011.  Loughner had schizophrenia and substance abuse problems, a combination associated with increased violence. What is the appropriate consequence? To what degree, if any, should he be held responsible for his actions?

19. How common are psychological disorders? Countries vary greatly in the percentage of people reporting mental health issues in the past year.

20. Vulnerable factors and ages for developing Mental Disorders  Poverty increases the risk of many mental disorders including aggression and anxiety. Disorders decrease when poverty is lifted.  “Immigrant paradox”: Despite the stress of immigrating, those who immigrate to the U.S.A. have a lower risk of disorders than their children born in the U.S.A.  Many disorders begin to show symptoms by early adulthood.  Developing on average around age 20: OCD, Schizophrenia, Bipolar, Alcohol Dependence.  Showing some signs earlier: Phobias (median age 10) and antisocial personality disorder (some symptoms by age 8)  Developing later than 20: Major Depressive Disorder. Who is vulnerable to mental disorders? Age of vulnerability:

21. Rates of Psychological Disorders This list takes a closer look at the past-year prevalence of various mental health diagnoses in the United States.

22. Mood Disorders: Not just feeling “down;” not just sad about something  Major Depressive Disorder: Stuck in dark withdrawal  Bipolar Disorder: sometimes fleeing depression into mania  Prevalence and Course of depression: Common, but for many it goes away  Genetic Influences on Depression  Suicide and Self-Injury  Negative Moods and Negative thoughts: Explanatory style  The vicious cycle: Interaction of bad experiences  depressive thoughts  mood changes  behavior changes  more sad days

23. Mood Disorders Major depressive disorder [MDD] is:  more than just feeling “down.”  more than just feeling sad about something. Bipolar disorder is:  more than “mood swings.”  depression plus the problematic overly “up” mood called “mania.”

24. Criteria of Major Depressive Disorders  Depressed mood most of the day, and/or  Markedly diminished interest or pleasure in activities  Significant increase or decrease in appetite or weight  Insomnia, sleeping too much, or disrupted sleep  Lethargy, or physical agitation  Fatigue or loss of energy nearly every day  Worthlessness, or excessive/inappropriate guilt  Daily problems in thinking, concentrating, and/or making decisions  Recurring thoughts of death and suicide Major depressive disorder is not just one of these symptoms. It is one or both of the first two, PLUS three or more of the rest.

25. Depression is Everywhere Depression shows up in people seeking treatment:  Phobias are the most common (frequently experienced) disorder, but depression is the #1 reason people seek mental health services. Depression appears worldwide:  Per year, depressive episodes happen to about 6 percent of men and about 9 percent of women.  Over the course of a lifetime, 12 percent of Canadians and 17 percent of USA residents experience depression. Depression: The “Common Cold” of Disorders? Although both are “common” (occurring frequently and pervasively), comparing depression to a cold doesn’t work. Depression:  is more dangerous because of suicide risk.  has fewer observable symptoms.  is more lasting than a cold, and is less likely to go away just with time.  is much less contagious. And…depressive pain is beyond sniffles.

26. Seasonal Affective Disorder [SAD]  Seasonal affective disorder is more than simply disliking winter.  Seasonal affective disorder involves a recurring seasonal pattern of depression, usually during winter’s short, dark, cold days.  Survey: “Have you cried today”? Result: More people answer “yes” in winter. Percentage who cried MenWomen August47 December821

27. Bipolar Disorder  Bipolar disorder was once called “manic-depressive disorder.”  Bipolar disorder’s two polar opposite moods are depression and mania. Mania refers to a period of hyper-elevated mood that is euphoric, giddy, easily irritated, hyperactive, impulsive, overly optimistic, and even grandiose. Contrasting Symptoms Depressed mood: stuck feeling “down,” with: Mania: euphoric, giddy, easily irritated, with:  exaggerated pessimism  social withdrawal  lack of felt pleasure  inactivity and no initiative  difficulty focusing  fatigue and excessive desire to sleep  exaggerated optimism  hypersociality and sexuality  delight in everything  impulsivity and overactivity  racing thoughts; the mind won’t settle down  little desire for sleep

28. Many famous and successful people have lived with the ups and downs of bipolar disorder. Some speculate that the depressive periods gave them ideas, and the manic episodes gave them creative energy. Any evidence of mood swings here? Bipolar Disorder and Creative Success

29. Bipolar Disorder in Children and Adolescents  Does bipolar disorder show up before adulthood, and even before puberty?  Many young people have cycles from depression to extended rage rather than mania.  The DSM-V may have a new diagnosis for some of these kids: disruptive mood dysregulation disorder.

30. Understanding Mood Disorders Why are mood disorders so pervasive, especially among women? Women, starting in adolescence, appear to ruminate more, have deeper sadness then men, encounter more stressors, and report their depression more readily.

31. Understanding Mood Disorders Can we explain…  Why does depression often go away on its own?  the course/development of reactive depression? Often, time heals a mood disorder, especially when the mood issue is in reaction to a stressful event. However, a significant proportion of people with major depressive disorder do not automatically or easily get better with time.

32. Understanding Mood Disorders Biological aspects and explanations Social-cognitive aspects and explanations Evolutionary Genetic Brain /Body Negative thoughts and negative mood Explanatory style The vicious cycle

33. An Evolutionary Perspective on the Biology of Depression  Depression, in its milder, non- disordered form, may have had survival value.  Under stress, depression is social-emotional hibernation. It allows humans to:  conserve energy.  avoid conflicts and other risks.  let go of unattainable goals.  take time to contemplate.

34. Biology of Depression: Genetics Evidence of genetic influence on depression: 1.DNA linkage analysis reveals depressed gene regions 2.twin/adoption heritability studies

35. Biology of Depression: The Brain  Brain activity is diminished in depression and increased in mania.  Brain structure: smaller frontal lobes in depression and fewer axons in bipolar disorder  Brain cell communication (neurotransmitters):  more norepinephrine (arousing) in mania, less in depression  reduced serotonin in depression

36. Suicide and Self-Injury  Every year, 1 million people commit suicide, giving up on the process of trying to cope and improve their emotional well-being.  This can happen when people feel frustrated, trapped, isolated, ineffective, and see no end to these feelings.  Non-suicidal self-injury has other functions such as sending a message, distracting from emotional pain, giving oneself permission to feel, or self-punishment.

37. Depressive Explanatory Style Low Self- Esteem Learned Helplessness Rumination Discounting positive information and assuming the worst about self, situation, and the future Self-defeating beliefs such as assuming that one (self) is unable to cope, improve, achieve, or be happy Depression is associated with: Stuck focusing on what’s bad Understanding Mood Disorders: The Social-Cognitive Perspective

38. Depressive Explanatory Style Mood/result that goes along with these views: How we analyze bad news predicts mood. Assumptions about the problem The problem is: Problematic event:

39. Depression’s Vicious Cycle A depressed mood may develop when a person with a negative outlook experiences repeated stress. The depressed mood changes a person’s style of thinking and interacting in a way that makes stressful experience more likely.