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Myers’ PSYCHOLOGY (6th Ed--redone 7th) Chapter 16 Psychological Disorders James A. McCubbin, PhD Clemson University Worth Publishers.

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1 Myers’ PSYCHOLOGY (6th Ed--redone 7th) Chapter 16 Psychological Disorders James A. McCubbin, PhD Clemson University Worth Publishers

2 David Rosenhan suspected that terms such as sanity, insanity, schizophrenia, mental illness, and abnormal might have fuzzier boundaries than the psychiatric community thought. He also suspected that some strange behaviors seen in mental patients might originate in the abnormal atmosphere of the mental hospital, rather than the patients themselves. Education ・ AB, Yeshiva College, 1951 ・ MA, Columbia University, 1953 ・ PhD (psychology), Columbia University, 1958 Professor, Stanford University

3 Dangers of Labeling David Rosenhan Being Sane in Insane Places In 1973 sociologist David Rosenhan designed a clever study to examine the difficulty that people have shedding the "mentally ill" label. He was particularly interested in how staffs in mental institutions process information about patients. Rosenhan & seven associates had themselves committed to different mental hospitals complaining of hearing voices. All but one were diagnosed as schizophrenic. Once admitted, they acted totally normal. Remained hospitalized for average 19 days (9 to 52) Only the patients detected their sanity When discharged their chart read, “schizophrenia in remission” No professional staff member at any of the hospitals ever realized that any of Rosenhan’s pseudopatients was a fraud.

4 According to a study conducted by the National Institute of mental health: *15.4% of the population suffers from diagnosible mental health problems *56 million Americans meet the criteria for a diagnosible psychological disorder (Carson 1996, Regier 1993) *Over the lifespan, +/- 32% of Americans will suffer from some psychological disorder. (Regier1988)

5 Normal or Abnormal? Not easy task: *Is Robin Williams normal? Anna Nicole Smith? Marilyn Manson? Karl Rove? *Is a soldier who risks his life or her life in combat normal? *Is a grief-stricken woman unable to return to her routine three months after her husband died normal? Is a man who climbs mountains as a hobby normal?

6 Some abnormalities are easy: Hallucinations (false sensory experiences) Delusions (extreme disorders of thinking) Affective problems (emotion: depressed, anxious, or lack of emotion) CORE CONCEPT: Medical model: takes a “disease” view Psychology model: interaction of biological, mental, social, and behavioral factors

7 SHOW: Psych in Film, Ver.2, #33, Patch Adams

8 Psychological Disorder –a “harmful dysfunction” in which behavior is judged to be: atypical- (not enough in itself) disturbing- (varies with time & culture) maladaptive- (harmful) unjustifiable- (sometimes there’s a good reason)

9 Show THE WORLD OF AbNORMAL BEHAVIOR: #1 Looking at Abnormal Behavior #2 The Nature of Stress

10 Carol D. Ryff argues that we must define mental illness in terms of the positive. She names 6 core dimensions: 1)Self-acceptance 1)Self-acceptance: positive attitude towards self multiple aspects of self positive about past life 2)Positive self relations with other people 2) Positive self relations with other people: warm, trusting, satisfying interpersonal relationships capable of empathy, affection, intimacy 3) Autonomy independent, self-determined able to resist social pressures

11 4) Environmental mastery 4) Environmental mastery: sense of mastery and competence makes good use of opportunities creates contexts that support their personal needs 5) Purpose of Life 5) Purpose of Life: has goals and directedness feels there is meaning to past and present life 6) Personal Growth 6) Personal Growth: see oneself as growing and expanding open to new experiences change in ways that reflect self-knowledge and effectiveness

12 Historical Perspective Perceived Causes *movements of sun or moon *lunacy- full moon *demons & evil spirits Ancient Treatments *exorcism, caged like animals, beaten, burned, castrated, mutilated, blood replaced with animal’s blood

13 Historical Perspective Hippocrates (400 bc) *first step in scientific view of mental disturbance. *imbalance (excess) among four body fluids called “humors” HumorsOriginTemperament Bloodheartsanguine (cheerful) Choler (yellow bile) livercholeric (angry) Melancholerspleen melancholy(depressed) (black bile) Phlegmbrainphlegmatic (sluggish)

14 Psychological Disorders Medical Model *concept that diseases have physical causes *can be diagnosed, treated, and in most cases, cured *assumes that these “mental” illnesses can be diagnosed on the basis of their symptoms and cured through therapy, which may include treatment in a psychiatric hospital

15 Psychological Disorders Bio-psycho-social Perspective *assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders Biological (Evolution, individual genes, brain structures and chemistry) Psychological (Stress, trauma, learned helplessness, mood-related perceptions and memories) Sociocultural (Roles, expectations, definition of normality and disorder)

16 Psychological Disorders- Etiology DSM-IV-TR *American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) *a widely used system for classifying psychological disorders *presently distributed as DSM-IV-TR (text revision) “convenient shorthand” *today used as “convenient shorthand” to avoid labeling.

17 DSM-IV-TR organizes each psychiatric diagnosis into five levels (axes) relating to different aspects of the disorder or disability: 1)Axis 1 1)Axis 1 -- Clinical disorders including major mental disorders, as well as developmental or learning problems. Common disorders in this category include depression, bipolar, anxiety, ADHD, and schizophrenia. 2)Axis 2 2)Axis 2 -- Pervasive or personality disorders, including mental retardation. Common disorders in this category include borderline PD, schizotypal PD, narcissistic PD, antisocial PD, paranoid PD.

18 DSM-IV-TR continued: 3) Axis 3 3) Axis 3 -- Acute medical conditions and physical disorders. Common disorders in this category include brain trauma, brain injury, brain disease.. 4) Axis 4 4) Axis 4 -- Psychosocial and environmental factors contributing to the disorder. Common factors in this category include a man suffering from depression after losing his job, or his wife dying, et. al. 5) Axis 5 5) Axis 5 -- Global Assessment of Functioning or Children’s Global Assessment Scale (under 18)

19 Psychological Disorders- Etiology Neurotic disorder (term seldom used now) *usually distressing but that allows one to think rationally and function socially *Freud saw the neurotic disorders as ways of dealing with anxiety Psychotic disorder *person loses contact with reality *experiences irrational ideas and distorted perceptions

20 PREPAREDNESS HYPOTHESIS: Suggests that we have an innate biological tendency, acquired through natural selection, to respond quickly and automatically to stimulti that posed a survival threat to our ancestors. (Ohman & Mineka, 2001) This explains why we develop phobias for snakes and lightening more easily than others.




24 Anxiety Disorders *distressing, persistent anxiety or maladaptive behaviors that reduce anxiety

25 Anxiety Disorders 1) Panic Disorder *marked by a minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking, racing heart, sweating, muscle- spasms, or other frightening sensations *common thinking patterns include: "I’m losing control.....” "I feel like I’m going crazy.....” "I must be having a heart attack.....” "I’m smothering and I can’t breathe.....” 1a) Panic Disorder w/Agoraphobia *fear of leaving home for fear of having a panic attack

26 2) Generalized Anxiety Disorder person is tense, apprehensive, and in a state of autonomic nervous system arousal *Chronic (6 months) unrealistic or excessive worry about 2 or more elements in one’s life.

27 SHOW: Psych in Film, Ver 2, #24, Apollo 13

28 3) Phobias a) Simple Excessive, irrational fear of objects or situations b) Social Persistent fear of scrutiny by others doing something humiliating (stage fright or speech phobia) c) Agoraphobia Fear of being in a place or situation with no escape. (childhood environments in which one did not feel safe)

29 Anxiety Disorders Phobias persistent, irrational fear of a specific object or situation Ablutophobia: washing, bathing Acrophobia: heights Algophobia: pain Arachibutyrophobia: peanut butter sticking to roof of mouth Caligynephobia: beautiful women Cleptophobia: stealing Demophobia: crowds Ecclesiophobia: church Ergophobia: work Genophobia: sex Gynephobia: women Ichthyophobia: fish Lutraphobia: otters Macrophobia: long waits Medorthophobia: erect penis Parthenophobia: virgins Pophyrophobia: color purple Somniphobia: sleep Testophobia: taking a test

30 Anxiety Disorders Common and uncommon fears Afraid of itBothers slightlyNot at all afraid of it Being closed in, in a small place Being alone In a house at night Percentage of people surveyed 100 90 80 70 60 50 40 30 20 10 0 SnakesBeing in high, exposed places MiceFlying on an airplane Spiders and insects Thunder and lightning DogsDriving a car Being In a crowd of people Cats

31 Anxiety Disorders 4) Obsessive-Compulsive Disorder *unwanted repetitive thoughts (obsessions) and/or actions (compulsions) *feel obsessed w/something they do not want to think about and/or compelled to carry out some action, often pointlessly ritualistic. *1 in 50 adults has OCD *Exact pathophysiologic process that underlies OCD has not been established. abnormalities in serotonin *Research suggests that abnormalities in serotonin (5-HT) transmission in the central nervous system are central to this disorder. *Supported by the efficacy of specific serotonin reuptake inhibitors (SSRIs) in the treatment of OCD.

32 Anxiety Disorders Common Obsessions and Compulsions Among People With Obsessive-Compulsive Disorder Thought or BehaviorPercentage* Reporting Symptom Obsessions (repetitive thoughts) Concern with dirt, germs, or toxins 40 Something terrible happening (fire, death, illness) 40 Symmetry order, or exactness 24 Excessive hand washing, bathing, tooth brushing, 85 or grooming Compulsions (repetitive behaviors) Repeating rituals (in/out of a door, 51 up/down from a chair) Checking doors, locks, appliances, 46 car brake, homework

33 Anxiety Disorders PET Scan of brain of person with Obsessive/ Compulsive disorder High metabolic activity (red) in frontal lobe areas involved with directing attention

34 Good examples of obsessions and their closely related compulsions Good examples of obsessions and their closely related compulsions: Obsession: A mother tormented by concern that she might inadvertently contaminate food as she cooks dinner. Compulsion: Every day she sterilizes all cooking utensils in boiling water and wears rubber gloves when handling food 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 pavements as possible and wears red clothes so that she will be immediately visible to an out-of-control car. Obsession: A woman cannot rid herself of the thought that she might accidentally leave her gas stove turned on, causing her house to explode Compulsion: Every day she feels the irresistible urge to check the stove exactly 10 times before leaving for work.

35 5) Post Traumatic Stress Disorder (PTSD) Follows a psychologically distressing event that is outside the normal experience (rape, war, murder, beatings, torture, natural disasters) *1 in 12 adults in the U.S. suffer from PTSD *incessant reliving of event, recurring dreams, intrusive memories, flashbacks, intensive fears, sleep problems. *lasting biological effects: causes the brain’s hormone- regulating system to develop hair-trigger responsiveness Perpetration-induced traumatic stress (PITS) *soldiers who had killed in combat were found to suffer higher rates of PTSD than other troops *other studies include grief, survivor’s guilt, fear p341 Zim

36 6) Stockholm Syndrome Follows a psychologically distressing event that is outside the normal experience (rape, war, murder, beatings, torture, natural disasters) *captor threatens to kill and is able to do so *victim cannot escape or life depends on the captor *victim is isolated from outsiders *captor is perceived as showing some degree of kindness *victim denies anger at abuser & focuses on good qualities *”fight or flight” reactions are inhibited *victim fears interference by authorities--fears the captor will return from jail *victim is grateful to abuser for sparing her life Example of this disorder would be Francine Hughes (The Burning Bed) Francine set fire to her husband while he was asleep after years of repeated physical and mental abuse.

37 a) Hypochondria Fear of having serious disease where no evidence of illness can be found. b) Conversion (hysteria) Physical malfunction or loss of bodily control w/no underlying pathology but apparently related to psychological conflict. 7) Somatoform Disorders Disorders, involving physical complaints for which no organic basis can be found.

38 TREATMENTS: *Medical model: *Medical model: antianxiety drugs (valium, librium, xanax) *Psychoanalysis: *Psychoanalysis: observational learning, childhood (mom/dad), free association, resistance (transference) *Learning Theories: *Learning Theories: classical conditioning, counterconditioning, systematic desensitization *Behaviorists: *Behaviorists: principles of learning, aversive conditioning, operant conditioning (token economy) *Cognitive Therapies: *Cognitive Therapies: irrational interpretations *Humanistic: *Humanistic: client-centered therapies, responsibility, active-listening.

39 MOOD DISORDERS (Affective Disorders)

40 1)DEPRESSIVE DISORDERS a) major depression b) dysthymia 2) BIPOLAR DISORDER a) mania b) major depression 3) SEASONAL AFFECTIVE DISORDER (SAD)

41 Mood Disorders 1) Depressive Disorders *most common disorders” a mood disorder in which a person, for no apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities Mood Disorders characterized by emotional extremes a) Major Depressive Disorder Unhappy for 2 weeks without reason, appetite changes, insomnia, inability to concentrate, worthlessness, hallucinations b) Dysthymia Unhappy for over 2 years

42 He believed that: depressed people draw illogical conclusions about themselves. Created the BECK SCALES for labeling clinical depression. Aaron Beck is called the FATHER OF COGNITIVE THERAPY Aaron Temkin Beck (1921-?) Professor, Univ Pennsylvania PhD: Brown, Yale Beck believed that depressed people blame themselves for normal problems and consider every minor failure a catastrophe.

43 DRUG TREATMENTS for depression: *tricyclic antidepressants: *first to be used--not used as much today. *affect 2 neurotransmitters: norepinephrine & serotonin *side affects: drowsiness & weight gain, increased heart rate, decrease in blood pressure, blurred vision, dry mouth, confusion *SSRI (Selective Serotonin Reuptake Inhibitor) *side effects: nausea, diarrhea, tremors, weight loss, headache *less likely to affect the heart *some people feel more agitated and anxious on SSRIs, and can become increasingly suicidal if not detected and treated.

44 Mood Disorders 2) Bipolar Disorder *a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania *formerly called manic-depressive disorder a) Manic Episode a mood disorder marked by a hyperactive, wildly optimistic state, excessive excitement, silliness, poor judgment, abrasive, rapid flight of ideas b) Major depression Lethargic, sleepy, social withdrawal, irritability

45 Symptoms of Mania 1)Mood or emotional symptoms 1)Mood or emotional symptoms: euphoric, expansive, and elevated. In some cases, dominant mood is irritability. Even when euphoric, manic people are close to tears and if frustrated, will burst out crying. 2)Grandiose cognition 2)Grandiose cognition: manics believe no limits to their abilities and do not recognize the painful consequences of trying to carry out their plans. May be delusional about themselves. 3)Motivational symptoms 3)Motivational symptoms: hyperactivity has intrusive, dominating, domineering quality. Some engage in compulsive gambling, reckless driving, or poor financial investment. 4)Physical symptoms 4)Physical symptoms: lessened need for sleep. After a few days, exhaustion settles in. Between.6 and 1.1 percent of U.S. population will have bipolar disorder in their lifetime. It affects both sexes equally. Onset is sudden. First episode occurs between ages 20 and 30.

46 Mood Disorders-Bipolar PET scans show that brain energy consumption rises and falls with emotional swings Depressed stateManic stateDepressed state

47 Mood Disorders-Depression

48 12-17 18-24 25-34 35-44 45-54 55-64 65-74 75+ Age in Years 10% 8 6 4 2 0 Percentage depressed Females Males  Canadian depression rates

49 3) Seasonal Affective Disorder (SAD) Experience depression during certain times of the year *usually winter (less sunlight) *treated w/light therapy *Alaska (dark for months)

50 cognitive triad Aaron Beck’s work with depressed patients convinced him that depression is primarily a disorder of thinking rather than of mood. He argued that depression can best be described as a cognitive triad or negative thoughts about oneself, the situation or the future. Cognitive errors included the following: 1)overgeneralizing: drawing global conclusions about worth, ability, or performance on basis of single fact 2)Selective abstraction: focusing on one insignificant detail and ignoring others 3)Personalization: incorrectly taking responsibility for events in the world 4)Magnification & minimization: bad events magnified and good events minimized. 5)Arbitrary inference: drawing conclusions without sufficient evidence 6)Dichotomous thinking: seeing everything in one extreme or its opposite.

51 Mood Disorders-Depression Altering any one component of the chemistry- cognition-mood circuit can alter the others Brain chemistry Cognition Mood deficit of serotonin Generally speaking, a deficit of serotonin is associated with depression.

52 Mood Disorders-Depression A happy or depressed mood strongly influences people’s ratings of their own behavior Negative Positive behaviors Self-ratings 35% 30 25 20 15 Percentage of observations

53 Mood Disorders-Depression The vicious cycle of depression can be broken at any point 1 Stressful experiences 4 Cognitive and behavioral changes 2 Negative explanatory style 3 Depressed mood

54 Mood Disorders-Depression  Boys who were later convicted of a crime showed relatively low arousal

55 EXAMPLES of Mood Disorders: Andrea Yates: postpartum depression and the insanity plea. It has been suggested that at the far end of the postpartum psychological spectrum lie postpartum psychosis. In Andrea’s case, it represented a state of mind in which killing one’s children seemed the best way to protect them.

56 Mood Disorders- Suicide

57 Increasing rates of teen suicide 1960 1970 1980 1990 2000 Year 12% 10 8 6 4 2 0 Suicide rate, ages 15 to 19 (per 100,000)

58 TREATMENTS: *Medical model: *Medical model: For bipolar-- lithium carbonate, carbamazepine, and valproate. For depression-- tricyclics; the newer selective serotonin re-uptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAO inhibitors). Electroconvulsive therapy (ECT) uses small amounts of electricity applied to the scalp to affect neurotransmitters in the brain.*Psychoanalysis: *Learning Theories: *Behaviorists: *Cognitive Therapies: *Cognitive Therapies: interpersonal therapy *Humanistic: *Humanistic: client-centered therapies, responsibility, active-listening, emotional support and assistance in recognizing signs of relapse to avert a full-blown episode


60 Dissociative Disorders –conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings

61 Dissociative Disorders 1) Psychogenic Amnesia –Sudden inability to recall important information--NOT as a result of physical “blow” or drug-related. 2) Psychogenic Fugue –Loss of memory--flees to a new location and establishes new lifestyle –After recovery, events during fugue are not remembered DUE TO EXTREME STRESS!!

62 Dissociative Disorders 3) Dissociative Identity Disorder –rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities –formerly called multiple personality disorder *often history of child or sex abuse In 2008, Herschal Walker, the 1982 Heisman Trophy winner from the University of Georgia, released his book “Breaking Free” which related his experiences with DID. He reported not being able to remember winning the Heisman in 1982 or darker events, such as threatening his then-wife.

63 4) Depersonalization Disorder –Persistent, recurring feelings that one is not real or is detached from one’s own experience or body.

64 depression, mood swings, suicidal tendencies, sleep disorders (insomnia, night terrors, and sleep walking), panic attacks and phobias (flashbacks, reactions to stimuli or "triggers"), alcohol and drug abuse, compulsions and rituals, psychotic-like symptoms (including auditory and visual hallucinations), eating disorders headaches, amnesias, time loss, trances, and "out of body experiences." self-persecution, self-sabotage violence (both self-inflicted and outwardly directed). People with Dissociative Disorders may experience any of the following:

65 severe trauma in early childhood Dissociative Disorders are now understood to be fairly common effects of severe trauma in early childhood, most typically extreme, repeated physical, sexual, and/or emotional abuse. Posttraumatic Stress Disorder (PTSD), widely accepted as a major mental illness affecting 8% of the general population in the United States, is closely related to Dissociative Disorders. In fact, 80-100% of people diagnosed with a Dissociative Disorder also have a secondary diagnosis of PTSD Recent research suggests the risk of suicide attempts among people with trauma disorders may be even higher than among people who have major depression. There is evidence that people with trauma disorders have higher rates of alcoholism, chronic medical illnesses, and abusiveness in succeeding generations.

66 TREATMENTS: *Medical model: *Medical model: therapy to recall the memories, hypnosis or a medication called Pentothal (thiopental) can sometimes help to restore the memories *Psychoanalysis: *Psychoanalysis: help an individual deal with the trauma associated with the recalled memories. Fugue--Hypnosis. Dissociative identity disorder-- long-term psychotherapy that helps the person merge his/her multiple personalities into one. *Learning Theories: *Behaviorists: *Cognitive Therapies: *Cognitive Therapies: irrational interpretations *Humanistic: *Humanistic: client-centered therapies, responsibility, active-listening.

67 SCHIZOPHRENIC DISORDERS (also called Psychotic Disorders)

68 Schizophrenia literally means “split mind,” meaning a split from reality that shows itself in disorganized thinking, disturbed perceptions and inappropriate emotions and actions. PSYCHOTIC: split from reality Emil Kraepelin Eugen Bleuler The term coined by Emil Kraepelin, who established the diagnostic category “dementia praecox” and Eugen Bleuler, who introduced the term “schizophrenia.” 1874, Medicene, Leipzig & Wurtzburg, Germany (1857-1939) Medicene, University of Bern

69 Possible symptoms of psychotic illnesses include: *Disorganized or incoherent speech *Confused thinking *Strange, possibly dangerous behavior *Slowed or unusual movements *Loss of interest in personal hygiene *Loss of interest in activities *Problems at school or work and with relationships *Cold, detached manner with the inability to express emotion *Mood swings or other mood symptoms, such as depression or mania

70 CAUSES: chemical imbalances (“mad as a hatter”) excess D4 dopamine receptors (in autopsies) (drugs that block dopamine receptors lessen the symptoms) now researching neurotransmitter glutamate (direct neurons to pass along an impulse) abnormal brain activity: low in frontal lobes research shows (during hallucinations) increased activity in thalamus, amygdala, and cortex greater than normal cerebral cortex tissue loss between ages 13 and 18. genetics: enlarged, fluid-filled cranial cavities

71 Identical Twin studies show: *48% probability of having schizophrenia if your twin does. *single placenta: 6 in 10 chance *separate placentas: 1 in 10 chance *one study showed the older the father, the greater risk of schizophrenia in offspring The GENAIN QUADRUPLETS (b.1930) were monozygous woman all suffered from schizophrenia, demonstrating a large genetic component to the disease. The girls (Nora, Iris, Myra, Hester) were fictitiously named for NIMH (National Institute of Mental Health). Both parents had mental disorders during their lifetime.

72 A common finding in the brains of people with schizophrenia is larger than normal lateral ventricles.

73 DIATHESIS-STRESS HYPOTHESIS: The idea that biological factors may place the individual at risk for schizophrenia (or others), but environmental stressors transform this potential into an actual disorder.


75 1)DISORGANIZED SCHIZOPHRENIC confused and incoherent, jumbled speech emotionless or flat or inappropriate, even silly or childlike. (flat affect or lack of affect) disorganized behavior that may disrupt their ability to perform normal daily activities (showering or preparing meals) hallucinations and delusions

76 Disorganized speech is of two types: NEOLOGISMS: “new words” WORD SALAD: “disorganization” “I had belly bad luck and brutal and outrageous.” (I have stomach problems and don’t feel good) “I gave all the work money. (I paid tokens for my meal) I was raised in packs (with other people) and since I was in littlehood (little girl) she blamed a few people with minor words (she scolded people). The lion will have to change from dogs into cats until I can meet my father and mother and we depart some rats. I live on the front part of Whitton’s head. You have to work hard if you don’t get into bed. She did. She said, “Hallelujah, happy landings.” It’s all over for a squab true tray and there ain’t not squabs, there ain’t no men, there ain’t no music, there ain’t no nothing besides my mother and my father who stand alone upon the Island of Capri where there is no ice, there ain’t no nothing but changers, changers, changers…….

77 2) CATATONIC SCHIZOPHRENIC Physical symptoms immobile and unresponsive to the world around them very rigid and stiff, unwilling to move waxy flexibility occasional grimacing or bizarre postures. might repeat a word or phrase just spoken by another person. increased risk of malnutrition, exhaustion, or self-inflicted injury. Catatonic excitement: patients become agitated and hyperactive.

78 3) PARANOID SCHIZOPHRENIC preoccupied with false beliefs (delusions) about being persecuted or being punished by someone thinking, speech and emotions, however, remain fairly normal. the paranoid delusions of persecution or grandiosity (highly-exaggerated self-importance) are less well organized--more illogical--than those of the patient with purely delusional disorder. delusions are usually auditory

79 4) UNDIFFERENTIATED SCHIZOPHRENIC * diagnosed when the person's symptoms do not clearly represent one of the other three subtypes. 5) RESIDUAL SCHIZOPHRENIC * suffered from schizophrenia in the past but no hallucinations or delusions mildly disturbed thinking emotionally impoverished

80 **6) PARANOID DELUSIONAL DISORDER characterized by non-bizarre delusions in the absence of other mood or psychotic symptoms delusions involving real-life situations that could be true, such as being followed, being conspired against or having a disease delusions persist for at least one month. non-bizarre refers to situations such as: being followed, being loved, having an infection, or being deceived by one’s spouse needs to be evaluated with respect to religious and cultural differences.

81 TREATMENTS: *Medical model: *Medical model: Start: olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), or aripiprazole (Abilify)….Then: chlorpromazine, fluphenazine, and haloperidol…. Last resort: Clozapine (Clozaril) (has side effects) *Psychoanalysis : *Psychoanalysis : medication, psychological counseling and social support. *Learning Theories: *Behaviorists: *Behaviorists: medication, psychological counseling and social support. *Cognitive Therapies: *Humanistic: *Humanistic: medication, psychological counseling and social support.


83 1) Paranoid Personality Disorder (PPD) 2) Obsessive-Compulsive Personality Disorder(OCPD) 3) Antisocial Personality Disorder 4) Borderline Personality Disorder 5) Schizoid Personality Disorder 6) Schizotypal Personality Disorder 7) Narcissistic Personality Disorder

84 Personality Disorders *disorders characterized by inflexible and enduring behavior patterns that impair social functioning *usually without anxiety, depression, or delusions **In contrast to other psychological problems, PDs do NOT want to change. They believe the problem lies with the “other” person. 15% of the American population are affected with personality disorders ( Mayo Clinic )….46.5 million people

85 About one in seven U.S. adults has at least one personality disorder, and many have more than one. Obsessive-compulsive PD 8% Paranoid PD 4.4% Antisocial PD3.6% Schizoid PD3.1% Schizotypal PD3% Avoidant PD2.4% Borderline PD2% Histrionic personality disorder1.8% Narcissistic PD >1% Dependent PD >1%

86 Personality Disorder Types 1) Paranoid Personality Disorder * Belief that others are lying, cheating, exploiting or trying to harm you * Perception of hidden, malicious meaning in benign comments * Inability to work collaboratively with others * Emotional detachment * Hostility toward others CAUSES: *Might be learned…. might be traced back to childhood experiences. *Studies of identical and fraternal twins suggest that genetic factors may also play an important role in causing the disorder. Twin studies indicate that genes contribute to the development of childhood personality disorders.

87 Personality Disorder Types 2) Obsessive-Compulsive Personality Disorder * Excessive concern with order, rules, schedules and lists * Perfectionism, often so pronounced that you can't complete tasks because your standards are impossible to meet * Inability to throw out even broken, worthless objects * Inability to share responsibility with others * Inflexibility about the "right" ethics, ideas and methods * Compulsive devotion to work at the expense of recreation and relationships * Financial stinginess ***interferes with daily life * Discomfort with emotions and aspects of personal relationships that you can't control ***interferes with daily life Treatment: A physician in this instance is best sticking with the facts of the presenting problem and underlying disorder rather than offering vague impressions of their opinion. Since the individual with this disorder tends to be meticulous and concerned with details, the treatment regimen -- once accepted -- will likely be adhered to rigorously, without incident. Example: Howard Hughes

88 Personality Disorder Types 3) Antisocial Personality Disorder Chronic irresponsibility and unreliability Lack of regard for the law and for others' right Persistent lying and stealing Aggressive, often violent behavior Lack of remorse for hurting others Lack of concern for the safety of yourself and others Intelligent, charming social skills 75% men Potentially dangerousPotentially dangerous Example: Hannibal Lecter in Silence of the Lambs Treatment--Because many people who suffer from this disorder will be mandated to therapy in a forensic or jail setting, motivation on the patient's part may be difficult to find. Therapy should focus on alternative life issues, such as goals for when they are released from custody, improvement in social or family relationships, learning new coping skills, etc. ….. part of the therapy should be devoted to discussing the antisocial behavior and feelings (or lack thereof).

89 **Although carriers of this personality disorder are frequently found among street criminals and con artists, they are also well represented among successful politicians and business people who put career, money, and power above everything and everyone. **Two to three percent of the population in the U.S. may have antisocial personality disorder. **Chronic lying, stealing, and fighting are common signs. **Violations of social norms begin early in life-- disrupting class, getting into fights, and running away from home.

90 Personality Disorder Types 4) Borderline Personality Disorder * Difficulty controlling emotions or impulses * Frequent, dramatic changes in mood, opinions and plans * Stormy relationships involving frequent, intense anger and possibly physical fights * Fear of being alone despite a tendency to push people away * Feeling of emptiness inside *75% female Treatment: Dialectical Behavior Therapy: teaches the client how to learn to better take control of their lives, their emotions, and themselves through self- knowledge, emotion regulation, and cognitive restructuring.

91 5) Schizoid Personality Disorder *Lack of interest in social relations *Inability to express feelings Lack of regard for others' opinions Extreme introversion Emotional distance, even from family members Fixation on your own thoughts and feeling s

92 6) Schizotypal Personality Disorder *Egocentricity, avoidance of others, eccentricity of thought *Oversensitive & frequently see chance events as related to themselves. * Individuals with this disorder usually distort reality more so than someone with Schizoid Personality Disorder. *Indifference to and withdrawal from others * "Magical thinking" — the idea that you can influence people and events with your thoughts * Odd, elaborate style of dressing, speaking and interacting with others * Talking to yourself * Belief that messages are hidden for you in public speeches and displays * Suspicious or paranoid ideas

93 Personality Disorder Types 7) Narcissistic Personality Disorder *Preoccupied with receiving attention & nurturance *Exaggerated sense of self-importance Treatment: Hospitalization of patients with severe Narcissistic Personality occurs frequently, such as those who are quite impulsive or self-destructive, or who have poor reality-testing.

94 Personality Disorders PET scans illustrate reduced activation in a murderer’s frontal cortex Normal Murderer

95 Personality Disorders Percentage of criminal offenders 35 30 25 20 15 10 5 0 Total crimeThieveryViolence Childhood poverty Obstetrical complications Both poverty and obstetrical complications

96 TREATMENTS: *Medical model: *Psychoanalysis: *Psychoanalysis: SchizoidPD--individual therapy (brief), SchizotypalPD- - the clinician must exercise care to not directly challenge delusional or inappropriate thoughts…warm, supportive, and client-centered environment should be established with initial rapport. *Learning Theories: *Behaviorists: *Cognitive Therapies: *Cognitive Therapies: BorderlinePD-- Dialectical Behavior Therapy: teaches the client how to learn to better take control of their lives, their emotions, and themselves through self-knowledge, emotion regulation, and cognitive restructuring. *Humanistic: *Humanistic: Group setting (BPD), client-centered therapies (OCPD), responsibility, active-listening, NarcissisticPD-- Small staff-patient groups-- feelings are shared and patients' comments taken seriously by staff, constructive work assignments, recreational activities, and opportunities to sublimate painfully conflictual impulses. There's no cure for these conditions, but therapy and medication can help. The symptoms of some personality disorders also may improve with age.

97 Biopsychosocial Disorders 4) Anorexia Nervosa (Ch 12, p.454-467) *Eating disorder, intense abhorrence of obesity, insistance that one is fat *Loss of 25%+ original body fat *Refusal to maintain normal weight 5) Bulimia Nervosa (Ch 12, p. 464-467) *Unable to stop eating voluntarily *Preoccupation with weight gain *Attempt to lose weight thru binge eating, self- induced vomiting & overuse of laxatives and diuretics


99 surplus of serotonin A surplus of serotonin is associated with anorexia

100 TREATMENTS: *Medical model: *Medical model: viagra*Psychoanalysis: *Learning Theories: *Learning Theories: classical conditioning.*Behaviorists: *Cognitive Therapies: *Cognitive Therapies: irrational interpretations *Humanistic: *Humanistic: client-centered therapies, responsibility, active-listening.

101 Rates of Psychological Disorders Percentage of Americans Who Have Ever Experienced Psychological Disorders Disorder White Black Hispanic Men Women Totals Ethnicity Gender Alcohol abuse or dependence 13.6% 13.8% 16.7% 23.8% 4.6% 13.8% Generalized anxiety 3.4 6.1 3.7 2.4 5.0 3.8 Phobia 9.7 23.4 12.2 10.4 17.7 14.3 Obsessive-compulsive disorder 2.6 2.3 1.8 2.0 3.0 2.6 Mood disorder 8.0 6.3 7.8 5.2 10.2 7.8 Schizophrenic disorder 1.4 2.1 0.8 1.2 1.7 1.5 Antisocial personality disorder 2.6 2.3 3.4 4.5 0.8 2.6

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