2 OBJECTIVES: The student will know and understand the Psychological Disorders investigates patterns of behavior that are considered deviant or distressful in our culture and includes how psychologists diagnose these patterns. After completing their study of this chapter, students should be able to:identify the criteria for judging whether behavior is psychologically disordered.2) Describe the medical model of psychological disorders, and discuss the bio-psycho-social perspective offered by critics of this model3) Describe the aims of DSM-IV, and discuss the potential dangers associated with the use of diagnostic labels.
3 4) Describe the symptoms of generalized anxiety disorder, phobias, and obsessive-compulsive disorder.5) Explain the development of anxiety disorders from both a learning and a biological perspective.6) Describe major depressive disorder and bipolar disorder.7) Explain the development of mood disorders, paying special attention to the biological and social-cognitive perspectives.8)Describe the characteristics and possible cause of dissociative identity disorder.
4 9) Describe the various symptoms and types of schizophrenia, and discuss research on its causes. 10) Describe the nature of personality disorders, focusing on the characteristics of the antisocial personality disorder.11) Describe the prevalence of various disorders and the timing of their onset.
6 Unit Overview Perspectives on Psychological Disorders Anxiety DisordersSomatoform DisordersDissociative DisordersMood DisordersSchizophreniaPersonality DisordersRates of Disorder
7 Introduction How should we define psychological disorders? How should we understand disorders?How should we classify psychological disorders?
8 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?
9 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” viewPsychology model: interaction of biological, mental, social, and behavioral factors
10 According to a study conducted by the National Institute of mental health: *15.4% of the population suffers from diagnosable mental health problems*56 million Americans meet the criteria for a diagnosable psychological disorder (Carson, 1996, Regier 1993).*Over the lifespan, +/- 32% of Americans will suffer from some psychological disorder (Regier, 1988).1 in 5 in the U. S. in a given year (Allaboutdepression.com,1993).1 in 4 n the world- 450 million people (WHO.int.com, 2001).
11 Psych in Film, Ver.2, #33, Patch Adams SHOW:Psych in Film, Ver.2, #33, Patch Adams
14 Understanding Psychological Disorders The Medical Model Philippe Pinel-French physician who was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy.He also made notable contributions to the classification of mental disorders and has been described by some as "the father of modern psychiatry".An 1809 description of a case that Pinel recorded in the second edition of a textbook on insanity is regarded as the earliest evidence for the existence of the form of mental disorder known as dementia praecox or schizophrenia in the 20th century.
15 Historical Perspective Perceived Causes*movements of sun or moon*lunacy- full moon*demons & evil spiritsAncient Treatments*exorcism, caged like animals, beaten, burned, castrated, mutilated, blood replaced with animal’s blood
16 Historical Perspective Hippocrates (400 bc)*first step in scientific view of mental disturbance.*imbalance (excess) among four body fluids called “humors”Humors Origin TemperamentBlood heart sanguine (cheerful)Choler (yellow bile) liver choleric (angry)Melancholer spleen melancholy (depressed) (black bile)Phlegm brain phlegmatic (sluggish)
17 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
18 Understanding Psychological Disorders The Biopsychosocial Approach Interaction of nature and nurtureInfluence of culture on disorders
19 The Biopsychosocial Approach to Psychological Disorders
20 Psychological Disorders Biological(Evolution,individualgenes, brainstructuresand chemistry)Psychological(Stress, trauma,learned helplessness,mood-related perceptionsand memories)Sociocultural(Roles, expectations,definition of normalityand disorder)Bio-psycho-social Perspective*assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders
21 Origins of the Diagnostic and Statistical Manual: Mental Disorders United States was the recording of the frequency of "idiocy/insanity" in the 1840 census. By the 1880 census, seven categories of mental health were distinguished: mania, melancholia, monomania, paresis, dementia, dipsomania, and epilepsy.The American Psychiatric Association Committee on Nomenclature and Statistics developed a variant of the ICD-6 that was published in 1952 as the first edition of Diagnostic and Statistical Manual: Mental Disorders (DSM-I).
22 Classifying Psychological Disorders Diagnostic and Statistical Manual of Mental Disorders (DSM)DSM-IV-TRDSM-5International Classification of Diseases (ICD-10)
30 Psychological Disorders- Etiology DSM-V*American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition)*a widely used system for classifying psychological disorders*Prior to last May we used the DSM-IV-TR (text revision. Now we use the DSM V*today used as “convenient shorthand” to avoid labeling.
31 DSM-IV-TR organizes each psychiatric diagnosis into five levels (axes) relating to different aspects of the disorder or disability: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.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.
32 DSM-IV-TR continued:3) Axis 3 -- Acute medical conditions and physical disorders. Common disorders in this category include brain trauma, brain injury, brain disease..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 -- Global Assessment of Functioning or Children’s Global Assessment Scale (under 18)
34 David Rosenhan suspected that terms such as sanity, insanity, schizophrenia, mental illness, and abnormal might have fuzzier boundaries that 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, 1958Professor, Stanford University
35 David Rosenhan Being Sane in Insane Places Dangers of LabelingDavid Rosenhan Being Sane in Insane PlacesIn 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 sanityWhen 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.
36 Failure to detect sanity during the course of hospitalization may be due to the fact that physicians operate with a strong bias toward what statisticians call the Type 2 error .This is to say that physicians are more inclined to call a healthy person sick (a false positive, Type 2) than a sick person healthy (a false negative, Type 1). The reasons for this are not hard to find: it is clearly more dangerous to misdiagnose illness than health. Better to err on the side of caution, to suspect illness even among the healthy.Power of labelsPreconception can stigmatizeInsanity label-mental illness of such a severe nature that a person cannot distinguish fantasy from reality, cannot conduct her/his affairs due to psychosis, or is subject to uncontrollable impulsive behavior.Insanity is a concept discussed in court to help distinguish guilt from innocenceStereotypes of the mentally illSelf-fulfilling prophecy
37 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)
38 THE WORLD OF AbNORMAL BEHAVIOR: #1 Looking at Abnormal Behavior ShowTHE WORLD OF AbNORMAL BEHAVIOR:#1 Looking at Abnormal Behavior#2 The Nature of Stress
39 Carol D. Ryff argues that we must define mental illness in terms of the positive. She names 6 core dimensions:Self-acceptance:positive attitude towards selfmultiple aspects of selfpositive about past life2) Positive self relations with other people:warm, trusting, satisfying interpersonal relationshipscapable of empathy, affection, intimacy3) Autonomyindependent, self-determinedable to resist social pressures
40 4) Environmental mastery: sense of mastery and competencemakes good use of opportunitiescreates contexts that support their personal needs5) Purpose of Life:has goals and directednessfeels there is meaning to past and present life6) Personal Growth:see oneself as growing and expandingopen to new experienceschange in ways that reflect self-knowledge and effectiveness
41 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 anxietyPsychotic disorder*person loses contact with reality*experiences irrational ideas and distorted perceptions
42 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.
47 Anxiety DisordersAnxiety Disorders*distressing, persistent anxiety or maladaptive behaviors that reduce anxiety
48 Panic DisorderPanic disorder = an anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations.Panic attacks
49 Anxiety Disorders 1) Panic Disorder 1a) Panic Disorder w/Agoraphobia *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
50 Generalized Anxiety Disorder Generalized anxiety disorder = an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.*2/3 women*Free floating anxiety = a generalized, persistent, pervasive fear that is not attributable to any specific object, event, or source.
51 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.
52 Psych in Film, Ver 2, #24, Apollo 13 SHOW:Psych in Film, Ver 2, #24, Apollo 13
53 PhobiasPhobias = an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity, or situation.Specific phobiaSocial phobiaAgoraphobia
54 Excessive, irrational fear of objects or situations 3) Phobiasa) SimpleExcessive, irrational fear of objects or situationsb) SocialPersistent fear of scrutiny by others doing something humiliating (stage fright or speech phobia)c) AgoraphobiaFear of being in a place or situation with no escape. (childhood environments in which one did not feel safe)
55 persistent, irrational fear of a specific object or situation Anxiety DisordersPhobiaspersistent, irrational fear of a specific object or situationGenophobia: sexGynephobia: womenIchthyophobia: fishLutraphobia: ottersMacrophobia: long waitsMedorthophobia: erect penisParthenophobia: virginsPophyrophobia: color purpleSomniphobia: sleepTestophobia: taking a testAblutophobia: washing, bathingAcrophobia: heightsAlgophobia: painArachibutyrophobia: peanut butter sticking to roof of mouthCaligynephobia: beautiful womenCleptophobia: stealingDemophobia: crowdsEcclesiophobia: churchErgophobia: work
56 Common and uncommon fears Anxiety DisordersCommon and uncommon fearsAfraid of itBothers slightlyNot at all afraid of itBeingclosed in,in asmallplacealoneIn a houseat nightPercentageof peoplesurveyed100908070605040302010Snakesin high,exposedplacesMiceFlyingon anairplaneSpidersandinsectsThunderlightningDogsDrivinga carIn acrowdCats
59 Obsessive-Compulsive Disorder Obsessive-compulsive disorder = an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions).An obsession versus a compulsionCheckersHand washers
60 Obsessive Compulsive Spectrum Disorders 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.New DSM V DisordersHoarding Disorder, Excoriation (skin-picking) Disorder, Substance or Medication Induced OCD, and OCD due to another medical condition
61 Obsessive Compulsive Disorders *1 in 50 adults has OCD*Exact pathophysiologic process that underlies OCD has not been established.*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.
62 OCD Common Obsessions and Compulsions Among People With Obsessive-Compulsive DisorderThought or BehaviorPercentage*Reporting SymptomObsessions (repetitive thoughts)Concern with dirt, germs, or toxinsSomething terrible happening (fire, death, illness)Symmetry order, or exactnessExcessive hand washing, bathing, tooth brushing,or groomingCompulsions (repetitive behaviors)Repeating rituals (in/out of a door,up/down from a chair)Checking doors, locks, appliances,car brake, homework
64 OCD PET Scan of brain of person with Obsessive/ Compulsive disorder High metabolic activity (red) in frontal lobe areas involved with directing attention
65 Good examples of obsessions and their closely related compulsions: 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 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 foodObsession: A woman cannot rid herself of the thought that she might accidentally leave her gas stove turned on, causing her house to explodeCompulsion: Every day she feels the irresistible urge to check the stove exactly 10 times before leaving for work.
66 Post-Traumatic Stress Disorder Post-traumatic stress disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience.PTSD“shellshock” or “battle fatigue”Not just due to a war situationPost-traumatic growth = positive psychological changes as a result of struggling with extremely challenging circumstances and life crises.
67 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 responsivenessPerpetration-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, fearp341 Zim
68 Psych in Film, Ver 2, #23, Deer Hunter SHOW:Psych in Film, Ver 2, #23, Deer Hunter
69 6) Stockholm Syndrome*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 lifeExample 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.
71 Somatoform disordersMental illnesses that cause bodily symptoms, including pain. The symptoms can't be traced back to any physical cause. And they are not the result of substance abuse or another mental illness.People with somatoform disorders are not faking their symptoms. The pain and other problems they experience are real.
72 Somotoform Disorders Disorders, involving physical complaints for which no organic basis can be found.1. HypochondriaFear of having serious disease where no evidence of illness can be found.2. Conversion disorder. This condition strikes when people have neurological symptoms that can't be traced back to a medical cause. For example, patients may have symptoms such as:paralysisblindnesshearing lossloss of sensation or numbness
73 Psych in Film, ver 2, #29, Freud (therapy) SHOW:Psych in Film, ver 2, #29, Freud (therapy)
74 Somatoform Disorders3. Somatization disorder. This is also known as Briquet's syndrome. Patients with this type have a long history of medical problems that starts before the age of 30.The symptoms involve several different organs and body systems. The patient may report a combination of:painneurologic problemsgastrointestinal complaintssexual symptoms
75 4. Body Dysmorphic Disorder. People with this disorder are obsessed with -- or may exaggerate -- a physical flaw. Patients may also imagine a flaw they don't have.The worry over this trait or flaw is typically constant. It may involve any part of the body. Patients can be obsessed with things such as wrinkles, hair, or the size or shape of the eyes, nose, or breasts.
76 5. Pain DisorderPeople who have pain disorder typically experience pain that started with a psychological stress or trauma.Continue reading below...For example, they develop an unexplained, chronic headache after a stressful life event.
77 Understanding Anxiety Disorders The Learning Perspective Fear conditioningStimulus generalizationReinforcementObservational learning
78 Understanding Anxiety Disorders The Biological Perspective Natural selectionGenesAnxiety geneGlutamateThe BrainAnterior cingulate cortex- resembles a "collar" surrounding the frontal part of the corpus callosum. It is also involved in rational cognitive functions, such as reward anticipation, decision-making, empathy, impulse control, and emotion.
82 Mood DisordersMood disorders = psychological disorders characterized by emotional extremes.Major depressive disorderPersistent Depressive Disorder-chronic major depressive disorder and the previous dysthymic disorder.Premenstrual Dysphoric DisorderSEASONAL AFFECTIVE DISORDER (SAD)Bipolar disorderDisruptive Mood Dysregulation Disorder-childhood BipolarCyclothmia
83 a) Major Depressive Disorder Mood DisordersMood Disorderscharacterized by emotional extremes1) 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 activitiesa) Major Depressive DisorderUnhappy for 2 weeks without reason, appetite changes, insomnia, inability to concentrate, worthlessness, hallucinationsb) Persistent Depressive Disorder-Unhappy for over 2 years
84 Major Depressive Disorder LethargyFeelings of worthlessnessLoss of interest in family and friendsLoss of interest in activities
86 Persistent Depressive Disorder Formerly known as Dysthymic Disorder (also known as dysthymia)The essential feature of persistent depressive disorder (dysthymia) is a depressed mood that occurs for most of the day, for more days than not, for at least 2 years (at least 1 year for children and adolescents).Individuals with persistent depressive disorder describe their mood as sad or “down in the dumps.” During periods of depressed mood, at least two of the following six symptoms from are present.Poor appetite or overeatingInsomnia or hypersomniaLow energy or fatigueLow self-esteemPoor concentration or difficulty making decisionsFeelings of hopelessness
87 Seasonal Affective disorder (SAD) A type of depression that's related to changes in seasons — SAD begins and ends at about the same times every year. If you're like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody.Treatment for SAD may include light therapy (phototherapy), psychotherapy and medications.
88 Symptoms of major depression may be part of SAD, such as: Feeling depressed most of the day, nearly every dayFeeling hopeless or worthlessHaving low energyLosing interest in activities you once enjoyedHaving problems with sleepingExperiencing changes in your appetite or weightFeeling sluggish or agitatedHaving difficulty concentratingHaving frequent thoughts of death or suicideFall and winter SADSymptoms specific to winter-onset SAD, sometimes called winter depression, may include:IrritabilityTiredness or low energyProblems getting along with other peopleHypersensitivity to rejectionHeavy, "leaden" feeling in the arms or legsOversleepingAppetite changes, especially a craving for foods high in carbohydratesWeight gain
89 Premenstrual Dysphoric D/O (PMDD) In most menstrual cycles during the past year, five (or more) of the following symptoms occurred during the final week before the onset of menses, started to improve within a few days after the onset of menses, and were minimal or absent in the week postmenses, with at least one of the symptoms being either (1), (2), (3), or (4):(1) marked affective liability (e.g., mood swings; feeling suddenly sad or teaful or increased sensitivity to rejection)(2) marked irritability or anger or increased interpersonal conflicts(3) markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts(4) marked anxiety, tension, feelings of being “keyed up” or “on edge”(5) decreased interest in usual activities (e.g., work, school, friends, hobbies)(6) subjective sense of difficulty in concentration(7) lethargy, easy fatigability, or marked lack of energy(8) marked change in appetite, overeating, or specific food cravings(9) hypersomnia or insomnia(10) a subjective sense of being overwhelmed or out of control(11) other physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” weight gain
90 Mood Disorders 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 disordera) Manic Episodea mood disorder marked by a hyperactive, wildly optimistic state, excessive excitement, silliness, poor judgment, abrasive, rapid flight of ideasb) Major depressionLethargic, sleepy, social withdrawal, irritability
91 It affects both sexes equally. Symptoms of ManiaMood 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.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.Motivational symptoms: hyperactivity has intrusive, dominating, domineering quality. Some engage in compulsive gambling, reckless driving, promiscuity, or poor financial investment.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.
92 Manic EpisodeA period of at least one week during which the person is in an abnormally and persistently elevated or irritable mood. The person may instead be predominately irritable. This period of mania must be marked by three of the following symptoms to a significant degree. If the person is only irritable, they must experience four of the following symptoms.Inflated self-esteem or grandiosity (ranges from uncritical self-confidence to a delusional sense of expertise).Decreased need for sleep.Intensified speech (possible characteristics: loud, rapid and difficult to interrupt, a focus on sounds, theatrics and self-amusement, non-stop talking regardless of other person’s participation/interest, angry tirades).Rapid jumping around of ideas or feels like thoughts are racing.Distractibility (attention easily pulled away by irrelevant/unimportant things).Increase in goal-directed activity (i.e. excessively plans and/or pursues a goal; either social, work/school or sexual) or psychomotor agitation (such as pacing, inability to sit still, pulling on skin or clothing).Excessive involvement in pleasurable activities that have a high risk consequence.
93 Hypomanic EpisodeA is very similar to a manic one, but less intense. It is only required to persist for 4 days and it should be observable by others that the person is noticeably different from his or her regular, non-depressed mood and that the change has an impact on his or her functioning.
94 Disruptive Mood Dysregulation Disorder (DMDD) The defining characteristic in children is a chronic, severe and persistent irritability. This irritability is often displayed by the child as a temper tantrum, or temper outburst, that occur frequently (3 or more times per week).When the child isn’t having a temper outburst, they appear to be in a persistently irritable or angry mood, present most of the day, nearly every day.“Far beyond temper tantrums, DMDD is characterized by severe and recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation.”
95 Understanding Mood Disorders Many behavioral and cognitive changes accompany depressionDepression is widespreadCompared with men, women are nearly twice as vulnerable to major depressionMost major depressive episodes self-terminateStressful events related to work, marriage and close relationships often precede depressionWith each new generation, depression is striking earlier and affecting more people
96 Understanding Mood Disorders The Biological Perspective Genetic InfluencesMood disorders run in familiesHeritabilityLinkage analysisThe depressed brainBiochemical influencesNorepinephrine and serotonin
97 Understanding Mood Disorders The Biological Perspective PET scans show that brain energy consumption rises and falls with emotional swings
104 Aaron Beck is called the FATHER OF COGNITIVE THERAPYHe believed that:depressed people draw illogical conclusions about themselves.Created the BECK SCALES for labeling clinical depression.Aaron Temkin Beck (1921-?)Professor, Univ PennsylvaniaPhD: Brown, YaleBeck believed that depressed people blame themselves for normal problems and consider every minor failure a catastrophe. Depressive Triad- negative thoughts about themselves, the world and their future.
105 Cognitive errors included the following: 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:overgeneralizing: drawing global conclusions about worth, ability, or performance on basis of single factSelective abstraction: focusing on one insignificant detail and ignoring othersPersonalization: incorrectly taking responsibility for events in the worldMagnification & minimization: bad events magnified and good events minimized.Arbitrary inference: drawing conclusions without sufficient evidenceDichotomous thinking: seeing everything in one extreme or its opposite.
106 Mood Disorders-Depression Altering any one component of the chemistry-cognition-mood circuit can alter the othersBrainchemistryCognitionMoodGenerally speaking, a deficit of serotonin is associated with depression.
107 Mood Disorders-Depression A happy or depressed mood strongly influences people’s ratings of their own behaviorNegative Positivebehaviors behaviorsSelf-ratings35%30252015Percentage ofobservations
108 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.Richard Dreyfuss: bipolar disorderBrittany Spears: post-partum depression and bipolar disorderAbraham Lincoln: depression (melancholia)Drew Carey: suicidal (twice)Harrison Ford: depressionJim Carrey: depression
109 Mood Disorders-Suicide Increasing rates of teen suicideYear12%108642Suicide rate,ages 15 to 19(per 100,000)
110 REASONS for suicide:Unendurable psychological pain: if you reduce the pain just a little, most suicidal people will choose to live.Frustrated psychological needs: (security, achievement, trust, friendship)Search for a solution: Suicide is never done without purpose --“How do I get out of this?”Attempt to end consciousness: goal is to stop awareness of painful existence.Helplessness & hopelessness: loss of powerConstriction of options: Not seeing the broad picture; limited options.Ambivalence: Some is normal--In typical case, victim cuts throat and calls for help.Communication of intent: 80 percent gives clear clues to family & friendsDeparture: quitting job, running away from home, leaving spouse are all departures but suicide is the ultimate departure.Lifelong coping patterns: look for earlier episodes--often a style of problem solving that is characterized as “cut and run.”
111 LONELINESSSharon Brehm reports that gender interacts with marital status in the following ways:Married females report greater loneliness than do married malesAmong those never married, males report more loneliness than do femalesAmong the separated and divorced, males report greater loneliness than do femalesAmong those whose spouse has died, males report greater loneliness than do females.
112 REASONS for Loneliness Being unattachedAlienation: being misunderstood & feeling differentBeing alone: coming home to empty houseForced isolation: hospitalized or houseboundDislocation: starting new job or schoolFour major strategies in coping with Loneliness:Sad passivity: sleeping, drinking, overeating, watching TVSocial contact: calling friendActive solitude: studying, reading, exercising, going to movieDistractions: spending money, going shopping
113 DRUG TREATMENTS for Depression: Monoamine oxidase inhibitors (MAOIs)- first type of antidepressant developed. brain.MAOIs prevent the removal of removing the neurotransmitters norepinephrine, serotonin and dopamine from the brain., which makes more of these brain chemicals availableDiet restrictions because they can cause dangerously high blood pressure*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.For extreme Depression-Electroconvulsive therapy (ECT) uses small amounts of electricity applied to the scalp to affect neurotransmitters in the brain.
114 TREATMENTS:*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).*Psychoanalysis :unconscious conflicts, intrapscyhic structures*Learning Theories: Observational learning and socaiil roles*Behaviorists: Counterconditoning*Cognitive Therapies: interpersonal therapy (Beck Scales)*Humanistic: client-centered therapies, responsibility, active-listening, emotional support and assistance in recognizing signs of relapse to avert a full-blown episode
122 Dissociative Disorders 1) Psychogenic AmnesiaSudden inability to recall important information--NOT as a result of physical “blow” or drug-related.DUE TO EXTREMESTRESS!!2) Psychogenic FugueLoss of memory--flees to a new location and establishes new lifestyleAfter recovery, events during fugue are not remembered
123 Dissociative Disorders 3) Dissociative Identity Disorderrare dissociative disorder in which a person exhibits two or more distinct and alternating personalitiesformerly called multiple personality disorder*often history of child or sex abuseIn 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.
126 Understanding Dissociative Identity Disorder Genuine disorder or not?DID ratesTherapist’s creationDifferences are too greatDID and other disorders
127 4) Depersonalization Disorder Persistent, recurring feelings that one is not real or is detached from one’s own experience or body.Symptoms:*distorted perception of the body*might feel like he or she is a robot or in a dream*some might fear they are going crazy and might become depressed, anxious, or panicky.For some people, the symptoms are mild and last for just a short time. For others, symptoms can be chronic (ongoing) and last or recur for many years, leading to problems with daily functioning or even to disability.
128 People with Dissociative Disorders may experience any of the following: 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 disordersheadaches,amnesias,time loss,trances, and "out of body experiences."self-persecution,self-sabotageviolence (both self-inflicted and outwardly directed).
129 Recent research suggests the risk of suicide attempts among people with trauma disorders may be even higher than among people who have major depression.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, % of people diagnosed with a Dissociative Disorder also have a secondary diagnosis of PTSDThere is evidence that people with trauma disorders have higher rates of alcoholism, chronic medical illnesses, and abusiveness in succeeding generations.
130 EXAMPLES of Dissociative Disorders: Herschel Walker: DID(Univ. Georgia, Heisman Trophy, Dallas Cowboys)
131 TREATMENTS:*Medical model: therapy to recall the memories, hypnosis or a medication called Pentothal (thiopental) can sometimes help to restore the memories*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: irrational interpretations (Depersonalization Dis)*Humanistic: client-centered therapies, responsibility, active-listening.
132 Psych in Film, Ver 2, #27, Bourne Identity and #30, Raising Cain SHOW:Psych in Film, Ver 2, #27, Bourne Identity and #30, Raising CainOprah “Dissociative Disorders”
133 SCHIZOPHRENIC DISORDERS (also called Psychotic Disorders)
135 Symptoms of Schizophrenia Schizophrenia (split mind) = a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions.Not multiple personalities
136 PSYCHOTIC: split from reality Schizophrenia literally means “split mind,” meaning a split from reality that shows itself in disorganized thinking, disturbed perceptions and inappropriate emotions and actions.The term coined by Emil Kraepelin, who established the diagnostic category “dementia praecox” and Eugen Bleuler, who introduced the term “schizophrenia.”( ) Medicene, University of Bern1874, Medicene, Leipzig & Wurtzburg, GermanyPSYCHOTIC: split from reality
137 SchizophreniaIt is a chronic, severe, and disabling brain disorder that has affected people throughout history. About 1 percent of Americans have this illness.The symptoms of schizophrenia fall into three broad categories:Positive symptoms (psychotic behaviors, thoughts and movements).Negative symptoms (disruptions to normal emotions and behaviors).Cognitive symptoms (poor decision making and concentration, problems with working memory).
138 Symptoms of Schizophrenia Disorganized Thinking Delusions = false beliefs, often of persecution or grandeur, that may accompany psychotic disorders.Delusions of Persecution (paranoid)Delusions of GrandeurDelusions of ControlDelusions of Reference – A neutral environmental event is believed to have a special and personal meaning.
139 Disorganized Thinking and Speech *Word Salad- random words and phrases*Neologisms- a newly coined word/expression*Echolalia (also known as echologia or echophrasia) is the automatic repetition of vocalizations made by another personBreakdown in selective attention
140 Symptoms of Schizophrenia Disturbed Perceptions Hallucinations6 typesAuditory, Visual,Tactile, Olfactory,Gustatory andProprioceptive-This was covered under the category of sleep paralysis. These sensations of floating, flying, out-of-body experiences and other dissociative movement events are most likely when in bed before and after sleeping.
141 Symptoms of Schizophrenia Inappropriate Emotions and Actions Flat affectInappropriate ActionsCatatoniaDisruptive social behavior
142 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
143 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 lobesresearch shows (during hallucinations) increased activity in thalamus, amygdala, and cortexgreater than normal cerebral cortex tissue loss between ages 13 and 18.genetics: enlarged, fluid-filled cranial cavities
144 A common finding in the brains of people with schizophrenia is larger than normal lateral ventricles.
145 DIANTHESIS-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.
146 Types of Schizophrenia These classicifcations are not in DSM V.
147 DISORGANIZED SCHIZOPHRENIC confused and incoherent,jumbled speechemotionless 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
148 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…….
149 2) CATATONIC SCHIZOPHRENIC Physical symptomsimmobile and unresponsive to the world around themvery rigid and stiff, unwilling to movewaxy flexibilityoccasional 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.
150 3) PARANOID SCHIZOPHRENIC preoccupied with false beliefs (delusions) about being persecuted or being punished by someonethinking, 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
151 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 delusionsmildly disturbed thinkingemotionally impoverished
152 **6) PARANOID DELUSIONAL DISORDER characterized by non-bizarre delusions in the absence of other mood or psychotic symptomsdelusions involving real-life situations that could be true, such as being followed, being conspired against or having a diseasedelusions 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 spouseneeds to be evaluated with respect to religious and cultural differences.
153 Onset and Development Statistics on schizophrenia Onset of the disease Positive versus negative symptomsChronic (process) schizophreniaAcute (reactive) schizophrenia
155 Understanding Schizophrenia Brain Abnormalities Abnormal Brain Activity and AnatomyFrontal lobe and core brain activityFluid filled areas of the brain
156 Understanding Schizophrenia Brain Abnormalities Maternal Virus During PregnancyStudies on maternal activity and schizophreniaInfluence of the flu during pregnancy
157 Understanding Schizophrenia Genetic Factors Genetic predispositionTwin studiesGenetics and environmental influencesThe 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.
158 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
159 Understanding Schizophrenia Psychological Factors Possible warning signsMother severely schizophrenicBirth complications (low weight/oxygen deprivation)Separation from parentsShort attention spanPoor muscle coordinationDisruptive or withdrawn behaviorEmotional unpredictabilityPoor peer relations and solo play
160 *Humanistic: medication, psychological counseling and social support. TREATMENTS:*Medical model: Start: olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), or aripiprazole (Abilify)….Then: chlorpromazine, fluphenazine, and haloperidol (Haldol)…. Last resort: Clozapine (Clozaril) (has side effects)*Psychoanalysis: medication, psychological counseling and social support.*Learning Theories:*Behaviorists: medication, psychological counseling and social support.*Cognitive Therapies:*Humanistic: medication, psychological counseling and social support.
161 Tardive dyskinesia is a difficult-to-treat form of dyskinesia, a disorder resulting in involuntary, repetitive body movements.In this form of dyskinesia, the involuntary movements are tardive, meaning they have a slow or belated onset.This neurological disorder frequently appears after long-term or high-dose use of antipsychotic drugs, or in children and infants as a side effect from usage of drugs for gastrointestinal disorders
162 EXAMPLES of Schizophrenia : John Nash:Nobel Prize Winning MathematicianMary Todd Lincoln:former First Lady of U. S.Alan Alda’s mother:Actor
168 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
169 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 %Antisocial PD 3.6%Schizoid PD %Schizotypal PD 3%Avoidant PD %Borderline PD 2%Histrionic personality disorder 1.8%Narcissistic PD >1%Dependent PD >1%
170 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 othersCAUSES:*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.
171 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* Discomfort with emotions and aspects of personal relationships that you can't control ***interferes with daily lifeExample: Howard HughesTreatment: 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.
173 Personality Disorder Types 3) Antisocial Personality DisorderChronic irresponsibility and unreliabilityLack of regard for the law and for others' rightPersistent lying and stealingAggressive, often violent behaviorLack of remorse for hurting othersLack of concern for the safety of yourself and othersIntelligent, charmingsocial skills75% menPotentially dangerousTreatment--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).Example: Hannibal Lecter in Silence of the Lambs
174 Antisocial Personality Disorder Antisocial personality disorder = a personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. May be aggressive and ruthless or a clever con artist.Sociopath or psychopathUnderstanding antisocial personality disorder
175 **Chronic lying, stealing, and fighting are common signs. **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.
177 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% femaleTreatment: 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.
180 5) Schizoid Personality Disorder *Lack of interest in social relations*Inability to express feelingsLack of regard for others' opinionsExtreme introversionEmotional distance, even from family membersFixation on your own thoughts and feelings
181 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
182 Personality Disorder Types 7) Narcissistic Personality Disorder*Preoccupied with receiving attention & nurturance*Exaggerated sense of self-importanceTreatment: 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.Charlie Manson is the most famous NPD. In 1968, he was found guilty of being responsible for the famous Tate-LaBianca murders which he had concocted to start a black-white race war in the U.S. He persuaded his “followers” to brutally kill actress Sharon Tate who was 8 months pregnant with child. Three days later his followers killed Mr. & Mrs. LaBianca in a similar fashion. (see video following)
184 Another famous NPD is Diane Downs who was convicted of attempting to kill her 3 children so she could continue her affair with a man who didn’t want children. She claimed she stopped her car for a man in distress and he came up to the vehicle and shot her children. One daughter died, her son was paralyzed from the waist down, and the third daughter (8 at the time) was in such shock that she refused to speak. Eventually, the third daughter testified against her mother and was adopted by the district attorney who prosecuted the case. (see video following)MOVIE: Small Sacrifices (1989)
188 EXAMPLES of Personality Disorders : There is some speculation that Diana, Princess of Wales and Marilyn Monroe both suffered from Borderline PD.Adolph Hitler:Anti-Social PD & Narcissistic PD
189 TREATMENTS:*Medical model:*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: 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: 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.
190 #35 The Mind of The Psychopath and THE WORLD OF AbNORMAL PSYCHOLOGY: ShowTHE MIND#35 The Mind of The PsychopathandTHE WORLD OF AbNORMAL PSYCHOLOGY:#5 Personality DisordersGacy or Bundy
193 Biopsychosocial Disorders 1) Coronary Heart Disease (Ch 14, p )*Lethal blockage of arteries that supply blood to heart muscle*Causes: age, gender, family history, blood pressure, chloresterol, weight, lifestyle, psychological state (type A personality)
194 Biopsychosocial Disorders 2) Migraine Headaches (not in book)*Intensely painful, recurring headache--reduced flow of bloodto certain parts of brain--overarousal of sympathetic nervous system*Causes: stress, change in weather, hormonal changes, neurotransmitter: glutimate*Family history***Seeing zigzag lines or flashing lights, tingling, numbness in arms & legs.
195 Biopsychosocial Disorders 3) Breast Cancer (Ch 14, p )*Over 50, no children, family history*Stressful life leads to higher level of the diseaseSwedish researchers say that being under stress may double a woman's risk of developing breast cancer.They based their findings on surveys of more than 1,400 Swedish women in the late 1960s who were part of a long-term health-care study. They found that women who reported being under stress had twice the risk of developing breast cancer as women who managed to stay cool, calm, and collected.
196 Biopsychosocial Disorders 4) Anorexia Nervosa (Ch 12, p )*Eating disorder, intense abhorrence of obesity, insistance that one is fat*Loss of 25%+ original body fat*Refusal to maintain normal weight5) Bulimia Nervosa (Ch 12, p )*Unable to stop eating voluntarily*Preoccupation with weight gain*Attempt to lose weight thru binge eating, self-induced vomiting & overuse of laxatives and diuretics
202 Neurophysical Disorders 1) Injury (not in book)*Brain trauma2) Alzheimers (Ch 4, p )**trouble remembering recent events, activities, or the names of familiar people or things**Age (number of people w/disease doubles every 5 years past age 65 )**family history (usually occurs between age if it’s genetic) One risk factor for this type of AD is a protein called apolipoprotein E (apoE).**Deficiency of acetylcholine
203 Neurophysical Disorders 3) Wernicke’s-Korsakoff’s Syndrome (not in book)*memory disorder caused by a lack of vitamin B1 (thiamine).*affects short-term memory.*Most common cause: alcoholism*A related disorder, Wernicke's syndrome, often occurs before Korsakoff's syndrome. Because they often occur together, the range of symptoms caused by the two diseases is often called Wernicke's-Korsakoff syndrome. The main symptoms of Wernicke's syndrome occur acutely. They include:Difficulty with walking and balanceConfusionDrowsinessParalysis of some eye muscles
204 Neurophysical Disorders 3) Korsakoff’s Syndrome*Thiamine is necessary for memory and other brain functions. People who drink a lot of alcohol often replace food with alcohol. As a result, they take in fewer vitamins, leading to vitamin deficiencies. In addition, alcohol increases the body's need for B vitamins while interfering with its ability to absorb, store, and use thiamine.*A genetic abnormality may make some people more susceptible to Korsakoff's syndrome when they drink large amounts of alcohol and consume diets low in vitamins.
205 Neurophysical Disorders 4) Parkinson’s Syndrome (not in book)*tremor in hand, foot, mouth, or chin*stiffness or rigidity of the limbs and trunk*bradykinesia (slowness of movement)*postural instability, or impaired balance and coordination*Occurs in about 1% of people over 65, 15% in ages 74-85, and over 50% of people over 85
206 Neurophysical Disorders Parkinson’s Disease (not in book)caused by the progressive impairment or deterioration of neurons (nerve cells) in an area of the brain known as the substantia nigra. When functioning normally, these neurons produce a vital brain chemical known as dopamine. Dopamine serves as a chemical messenger allowing communication between the substantia nigra and another area of the brain called the corpus striatum. This communication coordinates smooth and balanced muscle movement. A lack of dopamine results in abnormal nerve functioning, causing a loss in the ability to control body movements.
207 Neurophysical Disorders Parkinson’s DiseaseWhy Parkinson’s occurs and how the neurons become impaired is not known. However, increasing evidence suggests that it may be inherited.
209 Cholinesterase inhibitors (Aricept, Exelon) L-dopa (OTC)**naturally-occurring dietary supplement and psychoactive drug commonly found in some foods and herbs.**precursor to the neurotransmitter dopamine, norepinephrine (noradrenaline), and epinephrine (adrenaline).**crosses the blood-brain barrier whereas dopamine cannot. Once into the CNS, it is converted into dopamine.Cholinesterase inhibitors (Aricept, Exelon)**Alzheimer’s causes brain cells die and connections among cells are lost, causing cognitive symptoms to worsen.**cannot stop the damage, however, they may help lessen or stabilize symptoms**prevents the breakdown of acetylcholine
210 EXAMPLES of Biopsychsocial Disorders : Mao Zedong:Chinese leaderMohammed Ali:Prize Fighter/boxerJanet Reno:former U.S. Attorney GeneeralMichael J. Fox:Actor
211 THE WORLD OF AbNORMAL PSYCHOLOGY #10 Organic Brain Disorders ShowTHE WORLD OF AbNORMAL PSYCHOLOGY#10 Organic Brain Disorders
214 Substance Abuse Disorders 1) Alcohol (Ch 7, p )*Drinking impairs life adjustments*Health, personal relationships, occupational functioning*Strong relationship between alcohol & violence.Am I drinking too much?YES, if you are:･A woman who has more than seven drinks* per week or more than three drinks per occasion･A man who has more than 14 drinks* per week or more than four drinks per occasion･Older than 65 years and having more than seven drinks* per week or more than three drinks per occasion*--One drink = one 12-oz bottle of beer (4.5 percent alcohol) or one 5-oz glass of wine (12.9 percent alcohol) or 1.5 oz of 80-proof distilled spirits.
215 Substance Abuse Disorders 2) Cocaine (Ch 7, p )*Chronic abuse can promote acute psychotic symptoms & hallucinations*Activates the part of the brain as areas of pleasure & rewards (food, sex, water)*Long term effects include:AddictionIrritability and mood disturbancesRestlessnessParanoiaAuditory hallucinations
216 Substance Abuse Disorders 3) Methamphetamines*synthetic amphetamines or stimulants that are produced and sold illegally in pill form, capsules, powder and chunks.*has a structure similar to dopamine (the brain's pleasure transmitter) and causes neurons to release large amounts of dopamine to produce a high. ……… leads to permanent brain damage as natural dopamine production sites are destroyed - forcing the user to become even more reliant on meth for pleasure.*known as meth, crank, glass, speed, crystal, ice, batu, chalk, shabu, or zip
218 Substance Abuse Disorders 4) Nicotine (Ch 7, p )*Poisonous substance in cigarettes*450,000 related deaths per year.**Used as a coping device*About 80 percent of nicotine is broken down to cotinine by enzymes in your liver.*Nicotine is also metabolized in your lungs to cotinine and nicotine oxide.*Cotinine and other metabolites are excreted in your urine. Cotinine has a 24-hour half-life, so you can test whether or not someone has been smoking in the past day or two by screening his or her urine for cotinine.
219 Substance Abuse Disorders 4) Nicotine (Ch 7, p )A synapse is the site where two neurons come into contact. The presynaptic neuron releases a neurotransmitter, which binds to receptors on the postsynaptic cell. This allows signals to be transmitted from neuron to neuron in the brain.
220 Substance Abuse Disorders 4) Nicotine (Ch 7, p )Nicotine works by docking to a subset of receptors that bind the neurotransmitter acetylcholine. Acetylcholine is the neurotransmitter that (depending on what region of the brain a neuron is in):* Delivers signals from your brain to your muscles* Controls basic functions like your energy level, the beating of your heart and how you breathe* Acts as a "traffic cop" overseeing the flow of information in your brain* Plays a role in learning and memory
221 Substance Abuse Disorders 5) MDMA (ECSTACY)*methylenedioxymethamphetamine*amphetamine family of compounds with stimulant and psychodelic properties.*Short-term effects include feelings of mental stimulation, emotional warmth, enhanced sensory perception, and increased physical energy.*Adverse health effects can include nausea, chills, sweating, teeth clenching, muscle cramping, and blurred vision.
222 Substance Abuse Disorders 5) MDMA (ECSTACY) (cont)*ecstasy contains a number of other drugs, including methamphetamine, caffeine, dextromethorphan, ephedrine, and cocaine.*has potent effects on the cardiovascular system and on the body's ability to regulate its internal temperature……increases the risk of heart damage**increases the activity levels of at least three neurotransmitters: serotonin, dopamine, and norepinepherine.
223 Substance Abuse Disorders 5) MDMA (ECSTACY) (cont)**Compared to methamphetamine, MDMA triggers a larger increase in serotonin and a smaller increase in dopamine.Serotonin is a major neurotransmitter involved in regulating mood, sleep, pain, emotion, and appetite, as well as other behaviors. By releasing large amounts of serotonin, and also interfering with its synthesis, MDMA leads to a significant depletion of this important neurotransmitter. As a result, it takes the human brain a significant amount of time to rebuild the store of serotonin needed to perform important physiological and psychological functions.
226 THE WORLD OF AbNORMAL PSYCHOLOGY: #6 Substance Abuse Disorders ShowTHE WORLD OF AbNORMAL PSYCHOLOGY:#6 Substance Abuse DisordersThe Meth EpidemicPsych in Film, Ver 2, #25, Lost Weekend (alcoholism)
228 1) GENDER IDENTITY DISORDER (TRANSSEXUALISM) 2) SEXUAL DISFUNCTION3) PARAPHILIAS
229 Sexual Disorders (Ch 12, p.467-482) 1) Gender Identity Disorder (Transsexualism)*Confusion or uncertainty between biological sex and gender identity.2) Sexual Disfunction*Inhibitions in sexual response
230 Sexual Disorders 3) Paraphilias Fetishism, zoophilia, pedophila, exhibitionism, voyeurism, masochism, sadism et. al.Sexual response to unusual objects or situations
235 *drug treatment includes stimulants 1) Attention Deficit Hyperactivity Disorder (ADHD) (not in book)*Maladaptive behavior that interferes with effective task-oriented behavior*Impulsive, excessive motor activity, exaggerated muscular activity, difficulty maintaining attention*controversial diagnosis*Critics claim ADHD is overdiagnosed (i.e.)blame children for unskilled parents or teachers.*drug treatment includes stimulants*stimulant drug therapy combined with behavioral therapy can improve attention and diminished hyperactivity in 70% of ADHD children.*Strattera -- a drug used for ADHD is a norepinephrine reuptake inhibitor
236 One of the theories as to why Ritalin (stimulants) helps people with ADHD is that they may have more dopamine transporters than others. The excess of transporters removes dopamine from the synapse before it can reach a dopamine reward receptor in the receiving neuron, so the attention circuitry in the ADHD brain is under stimulated.By blocking transporters, Ritalin allows more dopamine to reach receptors, thus increasing attention signaling, which helps people with ADHD to focus. Ritalin, when taken orally, slowly raises dopamine levels over the course of an hour or so.
237 2) Conduct Disorders (not in book) *Persistant, repetitive violation of rules and disregard for rights of others*Fighting, defiance, disobedience, destruction of property, attention seeking, inattentiveness, over-aggressive behavior, bullying, physical aggression, cruel behavior toward people and pets, destructive behavior, lying, truancy, vandalism, and stealing.*ODD--Oppositional Defiant Disorder: disobedient, hostile behavior towards authority figures*clinically significant impairment in social, academic, or occupational functioning.
238 3) Separation Anxiety Disorder (not in book) *Excessive anxiety about separation from people to whom the child is attached*Unrealistic fears, oversensitivity, self-consciousness, nightmares, chronic anxiety
239 4) Autism (p , 424, 668)*Pervasive developmental disorder occurring in infancy or childhood—1 in 88 children (as of 2008*Qualitative impairment in reciprocal social interaction & communication--restricted repertoire of activities & interestsExample: Sally and Ann are playing together, when Sally puts a piece of candy in a box and leaves the room. While Sally is gone, Anne opens the box, removes the candy and stashes it in her purse. When Sally comes back, where will she look for the candy?Normal children will say that Sally will look in the box. Autistic children are most likely to say (if they communicate at all) that Sally will look in the purse. The autistic child lacks “theory of mind”. Severely autistic children cannot imagine themselves in Sally’s place.
240 *reading difficulties *affects 1 of 5 children 5) Dyslexia*reading difficulties*affects 1 of 5 children*involves the abnormalities in the brain’s language-processing circuits.Another cause may be language itself:*English: bizarre spelling menagerie, containing 1120 ways to spell only 40 different sounds, are more likely to be dyslexic than*Italian: 33 combinations of letters for 25 sounds.
242 THE WORLD OF AbNORMAL PSYCHOLOGY: #11 Behavior Disorders of Childhood ShowTHE WORLD OF AbNORMAL PSYCHOLOGY:#11 Behavior Disorders of ChildhoodPsych in Film, Ver 2, #26, Mercury Rising (autism), #15, Parenthood (special needs child)
244 ADJUSTMENT DISORDERS: Other conditions that may be a focus of clinical attention.*mild depression*physical complaints*marital problems*academic problems*job problems*parent-child problems*bereavement*malingering (faking an illness)
248 Rates of Disorder Mental health statistics Influence of poverty Other factors(2008 data, NIMH)
249 Rates of Psychological Disorders Percentage of Americans Who Have Ever Experienced Psychological DisordersDisorder White Black Hispanic Men Women TotalsEthnicity GenderAlcohol abuseor dependence % % % % % %Generalized anxietyPhobiaObsessive-compulsivedisorderMood disorderSchizophrenicdisorderAntisocial personalitydisorder
251 1) RECALLIn Rosenhan’s study, who discovered that the “pseudopatients” were feigning mental illness?psychiatristspsychologistsNurses and aides working on the wardd) Other patientse) Other physicians
252 2) APPLICATIONWhich of the following symptoms most clearly suggests the presence of abnormality?hallucinationsworriesUnusual behaviord) creativitye) distraction
253 3) RECALL Hippocrates proposed that mental disorder was caused by Possession by demonsAn imbalance in four bodily fluidsA fungus growing on rye graind) Traumatic memories in the unconsciouse) The taking of potions.
254 4) RECALLThe behavioral perspective emphasizes the influence of __, while the cognitive perspective emphasizes __.Genetics / conscious processesConscious processes / unconscious processesHeredity / environmentd) Medical factors / psychological factorse) The environment / mental process
255 5) UNDERSTANDING THE CORE CONCEPT Which of the following would be least likely to be noticed by a clinician using strictly the medical model of mental disorder?delusionsSevere disturbances in affectAn unhealthy family environmentd) A degenerative brain diseasee) hallucinations
256 6) RECALL The DSM IV is based on the Cognitive perspective Behavioral perspectiveEclectic viewd) Psychoanalytic viewe) medical model
257 7) RECALLWhich disorder involves extreme swings of mood from elation to depression?Panic disorderBipolar disorderschizophreniad) Unipolar depressione) PTSD
258 8) APPLICATIONAccording to the preparedness hypothesis, which one of the following phobias would you expect to be most common?Fear of snakes (ophidiophobia)Fear of books (bibliophobia)Fear of horses (equinophobia)d) Fear of the number 13 (triskaidekaphobia)e) Fear of water (aquaphobia)
259 9) RECALLWhich of the following disorders involves a deficiency in memory?phobiaAntisocial personalityDissociative fugued) obsessive-compulsive diordere) schizophrenia
260 10) RECALLWhich of the following is a disorder in which the individual displays more than one distinct personality?schizophreniaDepersonalization disorderBipolar disorderd) phobiae) Dissociative identity disorder
261 11) RECALLWhich of the following is primarily a disorder of young American women?Bipolar disorderschizophreniaAnorexia nervosad) Antisocial personality disordere) Dissociative identity disorder
262 12) RECALL Hallucinations and delusions are symptoms of schizophrenia Somatoform disordersAnxiety disordersd) Depersonalization disorderse) Panic disorders
263 13) RECALL Which category of disorder is most common? schizophrenia Dissociative disorderEating disordersd) The adjustment disorders and “other conditions that may be a focus of clinical attention”e) Mood disorders
264 14) UNDERSTANDING THE CORE CONCEPT The DSM-IV groups most mental disorders by theirtreatmentscausessymptomsd) theoretical basise) cures
265 15) UNDERSTANDING THE CORE CONCEPT Which unfortunate consequence of diagnosing mental disorders is emphasized chapter?The inaccuracy of diagnosisStigmatizing those with mental disordersAdding to the already overcrowded conditions in mental hospitalsd) That some cultures do not recognize mental disorderse) The importance of the insanity defense.
266 16) RECALL Which one of the following statements is true? Mental disorders have a similar prevalence in all culturesIn general, biology creates mental disorder, while culture merely shapes the way a person experiences it.Culture-specific stressors occur primarily in developing countriesd) Cultures around the world seem to distinguish between people with mental disorders and people who are visionaries or prophets.e) Mental disorders are more prevalent in Eastern culture.
267 17) RECALL Insanity is Psychological term Psychiatric term, found in DSM-IV under “psychotic disorders.”Legal termd) Term that refers either to “neurotic” or “psychotic” symptomse) A classification for those seeking treatment.
268 18) RECALLA long-standing pattern of irresponsible behavior that hurts others without causing feelings of guilt or remorse is typical ofAn obsessive-compulsive disorderAn antisocial personality disorderA narcissistic personality disorderd) Paranoid schizophreniae) Dissociative fugue.
269 19) APPLICATIONA young woman wanders into a hospital, claiming not to know who she is, where she is from, or how she got there. Her symptoms indicate that she might be suffering from a(n) ____ disorderanxietyaffectivepersonalityd) dissociativee) mood
270 20) RECALL____ has been called the “common cold of psychopathology” because it occurs so frequently and because almost everyone has experienced it, at least briefly, at some time.Obsessive-compulsive disorderBipolar disorderDepressiond) Paranoid schizophreniae) Autism
271 21) RECALLA person who suffers from ____ cannot eat normally but engages in a ritual of “binging”--periodic binges of overeating--followed by “purging” with induced vomiting or use of laxitives.Anorexia nervosaBulimia nervosaInhibitiond) Maniae) Depression
272 22) RECALLThe ____ type of schizophrenia is characterized by delusions.residualcatatonicparanoidd) undifferentiatede) disorganized
273 23) RECALLRosenhan believes that his “pseudopatients” were not recognized as normal becauseThe staff members in the mental hospital were incompetentThe staff members in the mental hospitals were just as disturbed as the patientsMental illness is a mythd) Staff members did not expect patients to be normale) He denied the existance of psychological disorders
275 J 25) MATCHING Hallucinations f) Somatoform disorders Delusions g) Dissociative disordersMedical model h) Diathesis-stress hypothesisMood disorders i) Borderline personality disorderAnxiety disorders j) Autism_____A developmental disorder marked by disabilities in language and social interaction.J
276 D 26) MATCHING Hallucinations f) Somatoform disorders Delusions g) Dissociative disordersMedical model h) Diathesis-stress hypothesisMood disorders i) Borderline personality disorderAnxiety disorders j) Autism_____ A class of disorders including bipolar disorder.D
277 E 28) MATCHING Hallucinations f) Somatoform disorders Delusions g) Dissociative disordersMedical model h) Diathesis-stress hypothesisMood disorders i) Borderline personality disorderAnxiety disorders j) Autism_____ A class of disorders including panic disorder.E
278 I 29) MATCHING Hallucinations f) Somatoform disorders Delusions g) Dissociative disordersMedical model h) Diathesis-stress hypothesisMood disorders i) Borderline personality disorderAnxiety disorders j) Autism_____ A disorder characterized by an unstable personality given to impulsive behavior for which includes remorse after the fact.I
279 G 30) MATCHING Hallucinations f) Somatoform disorders Delusions g) Dissociative disordersMedical model h) Diathesis-stress hypothesisMood disorders i) Borderline personality disorderAnxiety disorders j) Autism_____ A class of disorders including depersonalization disorder.G
280 F 31) MATCHING Hallucinations f) Somatoform disorders Delusions g) Dissociative disordersMedical model h) Diathesis-stress hypothesisMood disorders i) Borderline personality disorderAnxiety disorders j) Autism_____ A class of disorders including conversion disorder.F
281 A 32) MATCHING Hallucinations f) Somatoform disorders Delusions g) Dissociative disordersMedical model h) Diathesis-stress hypothesisMood disorders i) Borderline personality disorderAnxiety disorders j) Autism_____ False sensory experiences that may suggest a mental disorder.A
282 C 33) MATCHING Hallucinations f) Somatoform disorders Delusions g) Dissociative disordersMedical model h) Diathesis-stress hypothesisMood disorders i) Borderline personality disorderAnxiety disorders j) Autism_____ The view that mental disorders are diseases that have objective physical causes and require specific treatments.C
283 H 34) MATCHING Hallucinations f) Somatoform disorders Delusions g) Dissociative disordersMedical model h) Diathesis-stress hypothesisMood disorders i) Borderline personality disorderAnxiety disorders j) Autism_____ The proposal that genetic factors place the individual at risk while environmental stress factors transform this potential into schizophrenic disorder.H