1. Abnormal Psychology Psychological Disorders Chapter 14 1

2. 2 Defining Psychological Disorders Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions. When behavior is deviant, distressful, and dysfunctional psychiatrists and psychologists label it as disordered (Comer, 2004). Intern’s Syndrome - diagnose yourself or those around you while studying a particular disorder

3. 3 Deviant, Distressful & Dysfunctional 1.Deviant behavior (going naked) in one culture may be considered normal, while in others it may lead to arrest. 2.Deviant behavior must accompany distress. 3. If a behavior is dysfunctional it is clearly a disorder.  Maladaptive In the Wodaabe tribe men wear costumes to attract women. In Western society this would be considered abnormal. Carol Beckwith

4. Abnormality  Statistically rare  Deviant from social norms  Situational context - the social or environmental setting of a person’s behavior.  Subjective discomfort - emotional distress or emotional pain.  Maladaptive - anything that does not allow a person to function within or adapt to the stresses and everyday demands of life.

5. Abnormality vs. Insanity  Insanity is a legal term  The insanity defense is used to argue that a mentally ill person should not be held responsible for his or her actions.  Not everyone diagnosed with a mental disorder would be able to claim insanity – that designation is determined by judges and juries.

6. 6 Understanding Psychological Disorders Ancient Treatments of psychological disorders include trephination, exorcism, being caged like animals, being beaten, burned, castrated, mutilated, or transfused with animal’s blood. Trephination (boring holes in the skull to remove evil forces) John W. Verano

7. Perspectives and Disorders Psychological School/Perspective Cause of the Disorder Psychoanalytic/Psychodynamic Internal, unconscious drives Humanistic Failure to strive to one’s potential or being out of touch with one’s feelings. Behavioral Reinforcement history, the environment. Cognitive Irrational, dysfunctional thoughts or ways of thinking. Sociocultural Dysfunctional Society Biomedical/Neuroscience Organic problems, biochemical imbalances, genetic predispositions. 7

8. 8 Medical Perspective Philippe Pinel (1745-1826) from France, insisted that madness was not due to demonic possession, but an ailment of the mind. Dance in the madhouse. George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago

9. 9 Medical Model When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders. 1.Etiology: Cause and development of the disorder. 2.Diagnosis: Identifying (symptoms) and distinguishing one disease from another. 3.Treatment: Treating a disorder in a psychiatric hospital. 4.Prognosis: Forecast about the disorder.

10. 10 Biopsychosocial Perspective

11. DSM IV  Diagnostic Statistical Manual of Mental Disorders: the big book of disorders.  Operational definitions of each disorder  DSM will classify disorders and describe the symptoms.  DSM will NOT explain the causes or possible cures.  400 psychological disorders compared to 60 in 1950’s 11

12. Two Major Classifications in the DSM Neurotic Disorders  Distressing but one can still function in society and act rationally. Psychotic Disorders  Person loses contact with reality, experiences distorted perceptions. John Wayne Gacy 12

13. 13 Multiaxial Classification Are Psychosocial or Environmental Problems (school or housing issues) also present? Axis IV What is the Global Assessment of the person’s functioning? Axis V Is a General Medical Condition (diabetes, hypertension or arthritis etc) also present? Axis III Is a Personality Disorder or Mental Retardation present? Axis II Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? Axis I

14. 14 Goals of DSM 1.Describe (400) disorders. 2.Determine how prevalent the disorder is. Disorders outlined by DSM-IV are reliable. Therefore, diagnoses by different professionals are similar. Others criticize DSM-IV for “putting any kind of behavior within the compass of psychiatry.”

15. 15 Labeling Psychological Disorders 1.Critics of the DSM-IV argue that labels may stigmatize individuals. 2.David Rosenhan “pseudopatient” study 1970 Asylum baseball team (labeling) Elizabeth Eckert, Middletown, NY. From L. Gamwell and N. Tomes, Madness in America, 1995. Cornell University Press.

16. 16 Labeling Psychological Disorders 3. Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy. 4. “Insanity” labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes. Theodore Kaczynski (Unabomber) Elaine Thompson/ AP Photo

17. Anxiety Disorders  A group of conditions where the primary symptoms are anxiety or defenses against anxiety.  the patient fears something awful will happen to them.  They are in a state of intense apprehension, uneasiness, uncertainty, or fear.  Important that their behavior is maladaptive 17

18. Phobias  A person experiences sudden episodes of intense dread.  Must be a deep seated, irrational fear.  3 Basic Categories  Specific  Social  Agoraphobia  Phobia List Phobia List Phobia List 18

19. Generalized Anxiety Disorder GAD  An anxiety disorder in which a person is continuously tense, apprehensive and in a state of autonomic nervous system arousal.  The patient is constantly tense and worried, feels inadequate, is oversensitive, can’t concentrate and suffers from insomnia.  No specific stimulus  Free Floating 19

20. Panic Disorder  An anxiety disorder marked by a minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking and other frightening sensations.  Can be recurrent; unexpected  Symptoms: chest pain, muscle tightness, numbness and dizziness 20

21. Obsessive-compulsive disorder  Persistent unwanted thoughts (obsessions) cause someone to feel the need (compulsion) to engage in a particular action.  Interfere with everyday living and cause the person distress  Example: Obsession about dirt and germs may lead to compulsive hand washing. 21

22. 22 Obsessive-Compulsive Disorder

23. 23 A PET scan of the brain of a person with Obsessive-Compulsive Disorder (OCD). High metabolic activity (red) in the frontal lobe areas are involved with directing attention. Brain Imaging Brain image of an OCD

24. 24 Post-Traumatic Stress Disorder Four or more weeks of the following symptoms constitute post-traumatic stress disorder (PTSD) after a deeply troubling event: 1.Haunting memories 2.Nightmares 3.Social withdrawal 4.Jumpy anxiety 5.Sleep problems Bettmann/ Corbis

25. 25 Resilience to PTSD Only about 10% of women and 20% of men react to traumatic situations and develop PTSD. Survivor Resilience- Holocaust survivors show remarkable resilience against traumatic situations. Post-traumatic Growth- All major religions of the world suggest that surviving a trauma leads to the growth of an individual and a new positive view on life.

26. Causes of Anxiety Disorders  Psychoanalytic explanations point to repressed urges and desires that are trying to come into conscious, creating anxiety that is controlled by the abnormal behavior.  Behaviorists state that disordered behavior is learned through both positive and negative reinforcement; conditioning; observation  Cognitive psychologists believe that excessive anxiety comes from illogical, irrational thought processes.  Biological explanations of anxiety disorders include chemical imbalances in the nervous system, in particular serotonin and GABA systems; biologically prepared

27. Somatoform Disorders  Occur when a person manifests a psychological problem through a physiological symptom without a physiological cause  Three types…… 27

28. Hypochondriasis  Has frequent physical complaints for which medical doctors are unable to locate the cause.  They usually believe that the minor issues (headache, upset stomach) are indicative are more severe illnesses. 28

29. Conversion Disorder  Report the existence of severe physical problems with no biological reason; tied with psychological stress  Like blindness, paralysis, pain, or the inability to swallow. 29

30. Body Dysmorphic Disorder  Intense anxiety about perceived physical deformity or defect  Flaw is usually minor or imagined  Western Civilization and its effect…

31. Dissociative Disorders  These disorders involve a disruption in the conscious process.  Separated from previous memories, thoughts, and feelings in response to a stressful situation  Three types…. 31

32. Dissociative Amnesia  A large scale loss of memory for events or one’s own identity  Injury or highly traumatic event  Retrograde Amnesia 32

33. Dissociative Fugue  People with psychogenic amnesia that find themselves in an unfamiliar environment.  People travel miles from home unaware of how they got there  “Traveling Amnesia” 33

34. Dissociative Identity Disorder  Used to be known as Multiple Personality Disorder.  A person exhibits two or more distinct and alternating personalities  May not know about one another  People with DID commonly have a history of childhood abuse or trauma. 34

35. 35 DID Critics Critics argue that the diagnosis of DID increased in the late 20 th century. DID has not been found in other countries. Critics’ Arguments 1.Role-playing by people open to a therapist’s suggestion. 2.Learned response that reinforces reductions in anxiety. Psychoanalytic Viewpoint – protect us against a painful memory

36. Mood Disorders  Experience extreme or inappropriate emotion.  Also known as Affective Disorders 36

37. Major Depression  A.K.A. unipolar depression  Unhappy for at least two weeks with no apparent cause.  Sadness, hopelessness and worthlessness, loss of energy, changes in appetite and sleep  Depression is the common cold of psychological disorders.  5.8% Men vs. 9.5% Women 37

38. 38 Theory of Depression Gender differences Women get sadder, men get madder.

39. 39 Neurotransmitters & Depression Post-synaptic Neuron Pre-synaptic Neuron Norepinephrine Serotonin A reduction of norepinephrine and serotonin has been found in depression. Drugs that alleviate mania reduce norepinephrine.

40. 40 The Depressed Brain & Genetic Influences PET scans show that brain energy consumption rises and falls with manic and depressive episodes. (Left Frontal Lobe) Identical Twins- 1 in 2 will have depressive disorder; 7 in 10 will have bipolar disorder

41. Seasonal Affective Disorder  Experience depression during the winter months.  Based not on temperature, but on amount of sunlight.  Treated with light therapy.  Vitamin D 41

42. Seasonal Affective Disorder

43. Bipolar Disorder  Formally manic depression.  Involves periods of depression and manic episodes.  Manic episodes involve feelings of high energy, euphoria, inflated self esteem  but they tend to differ a lot…some get confident and some get irritable  Engage in risky behavior during the manic episode. 43

44. 44 Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase. Whitman WolfeClemensHemingway Bettmann/ Corbis George C. Beresford/ Hulton Getty Pictures Library The Granger Collection Earl Theissen/ Hulton Getty Pictures Library

45. Your turn… Explain mood disorders from the following perspectives:  Behavioral  Psychodynamic  Humanistic  Cognitive  Socio-cultural  Biological

46. Causes of Mood Disorders  Psychoanalytic theories see depression as anger at authority figures from childhood turned inward on the self.  Learning theories link depression to learned helplessness; can be reinforced  Cognitive theories see depression as the result of distorted, illogical thinking.  Internal, Stable, Logical  Biological explanations of mood disorders look at the function of serotonin, norepinephrine, and dopamine systems in the brain.

47. Personality Disorders  Well-established, maladaptive ways of behaving that negatively affect people’s ability to function.  Dominates their personality.  Hard to tell apart and treat 47

48. Antisocial Personality Disorder  Lack of empathy.  Little regard for other’s feelings.  View the world as hostile and look out for themselves.  Manipulative, rebellious, hurtful  Sociopath or psychopath  Conduct Disorder 48

49. 49 Understanding Antisocial Personality Disorder PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study repeat offenders had 11% less frontal lobe activity compared to normals (Raine et al., 1999; 2000). Normal Murderer Courtesy of Adrian Raine, University of Southern California

50. Histrionic Personality Disorder  Needs to be the center of attention and a tendency toward highly emotional behavior.  Whether acting silly or dressing provocatively. 50

51. Narcissistic Personality Disorder  Having an unwarranted sense of self- importance and an extreme preoccupation with themselves.  Thinking that you are the center of the universe. 51

52. Paranoid Personality Disorder  Persistent suspicion marked by the chronic sense of being observed and persecuted  Highly suspicious of others

53. Borderline Personality Disorder  Sudden and intense rages, deep insecurity and fear of abandonment, and general instability in relationships  Impulsive  High suicide risk group 53

54. Dependent Personality Disorder  Extreme dependence on others, submissive and clingy behavior, difficulty making decisions, and helplessness

55. Causes of Personality Disorders  Psychoanalysts blame an inadequate resolution to the Oedipal complex for personality disorders, stating that this results in a poorly developed superego.  Cognitive-learning theorists see personality disorders as a set of learned behavior that has become maladaptive— bad habits learned early on in life.  Biological explanations look at the lower than normal stress hormones in antisocial personality disordered persons as responsible for their low responsiveness to threatening stimuli.  Other possible causes of personality disorders may include disturbances in family communications and relationships, childhood abuse, neglect, overly strict parenting, overprotective parenting, and parental rejection.

56. Schizophrenic Disorders  If depression is the common cold of psychological disorders, schizophrenia is the cancer.  About 1 in every 100 people are diagnosed with schizophrenia.  Schizophrenia strikes young people as they mature into adults.  It affects men and women equally, but men suffer from it more severely than women.  Symptoms of Schizophrenia 1.Disorganized thinking. 2.Disturbed Perceptions 3.Inappropriate Emotions and Actions 56

57. Disorganized Thinking  The thinking of a person with Schizophrenia is fragmented and bizarre and distorted with false beliefs.  Word Salad  Disorganized thinking comes from a breakdown in selective attention.- they cannot filter out information. 57

58. Disturbed Perceptions  hallucinations- sensory experiences without sensory stimulation.  Usually auditory  The do not exist! 58

59. Disturbed Perceptions  Delusions- false beliefs  Delusions of Persecution or Paranoia  Delusions of Grandeur  Delusions of Reference  Beautiful Mind 59

60. Inappropriate Emotions and Actions  Apathy  Laugh at inappropriate times.  may laugh at the news of someone dying or  Flat Effect- show no emotion at all  Catatonia  motionless Waxy Flexibility  senseless, compulsive acts.  may continually rub an arm, rock a chair, or remain motionless for hours 60

61. Types of Schizophrenia 61

62. 62 Positive and Negative Symptoms Positive Symptoms Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, deluded ways) that are not present in normal individuals. (presence) Negative Symptoms Schizophrenics also have an absence of appropriate symptoms (apathy, expressionless faces, rigid bodies) that are present in normal individuals. (absence)

63. 63 Subtypes

64. 64 Understanding Schizophrenia: Biological Model Schizophrenia is a disease of the brain exhibited by the symptoms of the mind. Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain. Brain Abnormalities

65. 65 Abnormal Brain Activity Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients. Adolescent schizophrenic patients also have brain lesions. Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health

66. 66 Abnormal Brain Morphology Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles.  Effects frontal lobes and temporal lobes Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC

67. 67 Viral Infection Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development. Low birth weight and lack of oxygen may also contribute to higher risk of Schizophrenia. Disruptions of the normal maturation process of the brain

68. 68 Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 1991). 0 10 20 30 40 50 Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated 6x 46x

69. 69 Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries. Averages out to about 1 in 2

70. 70 Diathesis-Stress Model Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicols & Gottesman, 1983). Socio-cultural Perspective Income levels and home environments can play a role Low socioeconomic correlation

71. 71 Warning Signs Early warning signs of schizophrenia include: Birth complications, oxygen deprivation and low-birth weight. 2. Short attention span and poor muscle coordination.3. Poor peer relations and solo play.6. Emotional unpredictability.5. Disruptive and withdrawn behavior.4. A mother’s long lasting schizophrenia.1.