1. Chapter 11 Psychological Disorders and Their Treatment

2. Prevalence of Psychological Disorders
In a year in the U.S.:
20% of persons experience psychological problems severe enough to adversely affect their daily living.
40% of persons experience at least mild mental health problems.
About 2.1 million people are admitted to hospitals due to serious psychological problems.
Worldwide:
About 400 million people are afflicted with psychological disorders.

3. How Should We Understand Psychological Disorders?
The medical model proposes that psychological disorders have a biological basis and can be classified into discrete categories and are analogous to physical diseases.

4. How Should We Understand Psychological Disorders?
Although not agreeing that all mental health problems have a biological basis, mainstream psychology has adopted the medical model’s terminology.
Symptom: a sign of a disorder
Diagnosis: distinguishing one disorder from another
Etiology: a disorder’s apparent causes and developmental history
Prognosis: prediction about the likely course of a disorder

5. Defining Psychological Disorders
A pattern of atypical behavior
Results in personal distress or
Significant impairment in a person’s social or occupational functioning

6. Defining Psychological Disorders
Major criteria used to differentiate normal from disordered behavior:
Atypical
Significantly above or below the average in its frequency of occurrence
Violates cultural norms
Maladaptive
Interferes with ability to perform normal activities
Causes personal distress
Individuals who report experiencing troubling emotions are often considered to have psychological problems.

7. Numerous Theoretical Explanations
Five primary perspectives to understand mental illness:
Psychodynamic: Disordered behavior is controlled by unconscious forces shaped by childhood experiences.
Behavioral: Disordered behavior is caused by identifiable factors in the person’s environment and results from learning.
Cognitive: ineffective or inaccurate thinking is the root cause of mental illness

8. Numerous Theoretical Explanations
Five primary perspectives to understand mental illness:
Sociocultural: Mental illness is the product of broad social and cultural forces .
Biological: Disordered behavior is caused by biological conditions, such as genetics, hormone levels, or neurotransmitter activity in the brain.

9. Combined Models
Diathesis-stress model: a predisposition to a given disorder (diathesis) that combines with environmental stressors to trigger a psychological disorder
Bio-psycho-social model. Takes into account predispositions, personal experience, and life circumstances.

10. The Diathesis-Stress Model

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

12. Models from Outside Psychology
Spirit Possession
Trephining
Lunacy
Curses
Family/generational
Occult (voodoo, witchcraft)
Sin
Guilt
Unforgiveness, bitterness

13. Risks of Using Diagnostic Labels
David Rosenhan demonstrated diagnostic labels’ biasing effects.
Misdiagnosis of insanity by hospital personnel due to their bias toward calling a healthy person sick
Diagnostic labels can harm patients in several ways.
Label may “dehumanize” patients by encouraging mental health practitioners to treat them as labels rather than as unique individuals with problems.
Labeled individuals may experience discrimination and may cause people to expect those labeled to behave abnormally and thus to misperceive normal behavior as disordered.

14. Benefits of Using Diagnostic Labels
Despite ethical concerns, diagnostic labels are used because they serve several important functions:
Summarize patient’s symptoms or problems, and thus, communicate great deal of information with a single word
Convey information about possible causes of the disorder
Convey information about the patient’s prognosis

15. DSM Classification System
Diagnostic and Statistical Manual of Mental Disorders (DSM) use to diagnose mental disorders
Published by the American Psychiatric Association.
Since 1980, DSM has been updated several times and is now in its fourth edition, text revision, or DSM-IV-TR.

16. DSM Classification System
DSM classification system is descriptive rather than explanatory, meaning that:
it is not based on a particular theory concerning the cause(s) of psychological disorders.
diagnoses are based mainly on observable symptoms.
DSM provides clearer directions concerning number, duration, and severity of symptoms necessary to assign a diagnosis.
By recognizing that two patients with same disorder may substantially differ from one another, clinicians much more likely to acknowledge uniqueness of all patients.

17. Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior
Characterized by distressing, persistent anxiety or maladaptive behavior
About 25 percent of the population will experience this disorder in our lifetime.
Anxiety disorders occur across the life span and commonly co-occur with many other disorders, such as depression and substance abuse.

18. Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior
Five major anxiety disorders:
Panic disorder: brief episodes of intense anxiety with no apparent reason
Phobic disorder: strong irrational fears of specific objects or situations, called phobias
Generalized anxiety disorder (GAD): a constant state of moderate anxiety

19. Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior
Five major anxiety disorders:
Obsessive-compulsive disorder: repetitive, unwanted, and distressing actions and/or thoughts
Post-traumatic stress disorder: occurs among individuals who have experienced or witnessed traumatic events
Later reexperience the event through nightmares, flashbacks, and avoid situations or persons that trigger flashbacks

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

21. Anxiety Disorders
PET Scan of brain of person with obsessive/ compulsive disorder
High metabolic activity (red) in frontal lobe areas involved with directing attention

22. Etiology of Anxiety Disorders
Genetic and biological factors:
Genetic heritage may predispose us to more easily develop phobic reactions or to respond intensely to stressful events.
Behavioral or conditioning factors:
Classical conditioning may instill conditioned emotional responses, and operant conditioning may reinforce and maintain the person’s avoidance responses.
Cognitive factors:
People suffering from panic disorder closely monitor their physiological reactions, and often exaggerate the significance of their physiological symptoms.

23. Mood Disorders: Emotional Extremes
Characterized by emotional extremes that cause significant disruption in daily functioning.
To qualify as a mood disorder, emotional extremes must persist for a long time.
Most common mood disorder is depression
Characterized by extreme and persistent negative moods and the inability to experience pleasure by participating in activities one previously enjoyed (Kramlinger, 2001)

24. Mood Disorders: Emotional Extremes
Depressed individuals:
Often experience physiological problems such as lack of appetite, weight loss, fatigue, and sleep disorders
Often experience behavioral symptoms, such as slowed thinking and acting, social withdrawal, and decreased activity
Exhibit cognitive symptoms, such as low self-esteem, thinking about death and/or suicide, and having little hope for the future

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

26. Mood Disorders-Depression
Percentage
of population
aged 18-84
experiencing
major
depression
at some
point In life 20 15 10 5
USA Edmonton Puerto Paris West Florence Beirut Taiwan Korea New
Rico Germany Zealand
Around the world
women are more
susceptible to

27. Mood Disorders: Emotional Extremes
Bipolar disorder: characterized by swings between the emotional extremes of mania and depression
Less common than major depressive disorder, occurring in about 1 percent of the population
Unlike major depression, this disorder occurs about equally in men and women and tends to occur earlier than major depression

28. Mood Disorders: Emotional Extremes
Bipolar disorder
Bipolar patients’ depressive episodes differ from the depressive episodes in major depression in that they tend to be more severe, are accompanied by higher suicide risks, and have a distinct pattern of brain activity during sleep.

29. Mood Disorders-Bipolar
PET scans show that brain energy consumption rises and falls with emotional swings
Depressed state
Manic state

30. Suicide A major danger of depression is suicide.
As many as 30% of people with severe mood disorders die from suicide.
In the U.S. suicide rates are higher among:
Men than women;
Elderly adults than younger adults;
Unemployed (& retired) adults than employed persons;
Widowed adults than married adults;
Native & European Americans than Asian. Hispanic, and African Americans.

31. Etiology of mood disorders
Genetic/ biological influence?
Bipolar patients show imbalances in neural circuits using serotonin, norepinephrine, etc.? Enlarged amygdala?
Major depressive disorder: Family, twin, and adoption studies indicate at least a moderate genetic influence on depression.
Cognitive contributions:
Depressed persons have negative views and they misinterpret daily experiences so that their negative outlook is supported.
Behavioral psychologists propose that depression results from low social reinforcement.

32. Gender & Mood Disorders
Why is depression more common among women?
May due to biological factors.
Sociocultural factors: Women have fewer educational and occupational opportunities, receive less money for their work, and experience more violence due to their gender than men.
Difference in diagnosis?
Women may be diagnosed more frequently because they are more likely to seek help for their problems.
Gender bias among mental health professionals may result in women and men with identical symptoms being diagnosed differently, i.e., women labeled as depressed and men diagnosed with other conditions

33. Dissociative Disorders: Loss of Contact with Consciousness or Memory
Characterized by disruptions in consciousness, memory, sense of identity, or perception
Dissociative amnesia: a sudden loss of memory of one’s identity and other personal information
Dissociative fugue: a sudden departure from home or work, combined with loss of memory of identity and the assumption of a new identity

34. Dissociative Disorders: Loss of Contact with Consciousness or Memory
Dissociative identity disorder (DID): characterized by the presence of two or more distinct identities or personalities, which take turns controlling the person’s behavior (also known as multiple personality disorder)

35. Etiology of Dissociative Disorders
Psychodynamic theory: results from the individual’s attempt to repress some troubling event
Biological explanation: patient may have a neurological problem that has not yet been detected
Cognitive perspective: individuals learn to dissociate as a way to cope with intense distress

36. Schizophrenia: Disturbances in Almost All Areas of Psychological Functioning
Characterized by severe impairment in thinking, including hallucinations, delusions, or loose associations
Diagnosed when symptoms persist for at least six months, are not due to some other condition, and cause significant impairment in daily functioning
Schizophrenics often cannot work, manage a home or apartment successfully, or care for their basic needs.

37. Schizophrenia Delusions
false beliefs, often of persecution or grandeur, that may accompany psychotic disorders
Hallucinations
false sensory experiences such as seeing something without any external visual stimulus

38. Risk of Developing Schizophrenia

39. Personality Disorders: Inflexible Behavior Patterns That Impair Social Functioning
Personality disorders: general styles of living that are ineffective and lead to problems for the person and for others
Ten personality disorders in the DSM-IV-TR.

40. Personality Disorders: Inflexible Behavior Patterns That Impair Social Functioning
Three common personality disorders are:
Paranoid personalities: habitually distrustful and suspicious of others’ motives
Histrionic personalities: excessively emotional and attention seeking, often turning minor incidents into full-blown dramas
Narcissistic personalities: desire constant admiration from others  

41. Personality Disorders: Inflexible Behavior Patterns That Impair Social Functioning
The personality disorder that receives the most attention is the antisocial personality disorder.
Exhibit a persistent pattern of disregard for and violation of the rights of others
Repeatedly exhibit antisocial behavior across all realms of life, lying, cheating, stealing, and manipulating others
When caught, they take no responsibility and feel no remorse.

42. Personality Disorders
Those with criminal
convictions have lower
levels of arousal 15 10 5
Adrenaline
excretion(ng/min)
Nonstressful
situation
Stressful
situation
No criminal conviction
Criminal conviction

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

44. Etiology of Personality Disorders
A genetic component: related to abnormal brain development or chronic underarousal of both the autonomic and central nervous systems
May be caused by the interaction of both biological and environmental factors.
Children in chaotic households who have a biological predisposition for this disorder may not learn to control their impulses, and so behave in ways to maximize their benefit even if this means violating social rules.

45. What Are the Therapies for Psychological Disorders?
The two broad categories of therapy:
Psychotherapy: psychological methods that include a personal relationship between a trained therapist and a client
Biomedical therapies: the treatment of psychological disorders by altering brain functioning with physical or chemical interventions

46. What Are the Therapies for Psychological Disorders?
The two broad categories of therapy:
Psychotherapy: psychological methods including a personal relationship between a trained therapist and a client
Biomedical therapies: altering brain functioning with physical or chemical interventions

47. What Are the Therapies for Psychological Disorders?
Three mental health professions:
Psychiatry
Social work
Psychology
Two specialty areas in psychology:
Clinical psychology
Counseling psychology

48. Psychodynamic Therapies
A group of psychotherapies based on the work of Sigmund Freud that say that psychological disorders stem from unconscious forces
Important psychodynamic terms:
Free association: therapy technique in which clients say whatever comes to mind
Resistance: anything client does to interfere with free chain of thought or therapeutic progress
Transference: client transfers feelings for significant others early in life to therapist (countertransference)

49. Behavior Therapies
Psychotherapies that apply learning principles to the elimination of unwanted behaviors.
Counterconditioning is based on classical conditioning.
Counterconditioning: involves conditioning new responses to stimuli that trigger unwanted behaviors

50. Counterconditioning: Three Techniques
Systematic desensitization:
used to treat phobias in which client is gradually exposed to feared object, while remaining relaxed
Response prevention:
used to treat obsessive-compulsive disorder; client is exposed to situation that triggers the compulsive behavior but is not permitted to engage in the ritual
Aversive conditioning:
a classically conditioned aversive response is conditioned to occur in response to a stimulus that has previously been associated with an undesired behavior

51. Aversive Conditioning for Alcoholism

52. Aversive Conditioning for Alcoholism

53. Aversive Conditioning for Alcoholism

54. Humanistic Therapies Focus on Feelings and Personal Growth
Goal: To help people get in touch with
their feelings,
their “true selves”
their purpose in life

55. Humanistic Therapies Focus on Feelings and Personal Growth
Humanistic therapies: help people get in touch with their feelings, with their “true selves,” and with their purpose in life
Client-centered therapy: Carl Rogers
Therapists should be facilitators of personal growth providing supportive environment—clients discover their “true selves.”
Gestalt therapy: Fritz Perls
Therapists help people become aware of their true feelings or some other important aspect of the self.

56. Cognitive Therapies: Focus on Altering Dysfunctional Thought Patterns
Cognitive therapies seek to identify and then modify faulty cognitive processes.
Rational-emotive behavior therapy (REBT): Albert Ellis
Mental distress is caused by the irrational thinking people have about those events.
Cognitive-behavior therapy (CBT): Aaron Beck
Depressed people have negative views of themselves, the world, and their future, and they misinterpret everyday events to support these negative views.

57. Cognitive Therapy Cognitive Therapy
teaches people new, more adaptive ways of thinking and acting
based on the assumption that thoughts intervene between events and our emotional reactions

58. Cognitive Therapy
The Cognitive Revolution

59. Cognitive Therapy Cognitive-Behavior Therapy
a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

60. Cognitive Therapy A cognitive perspective on psychological disorders
Lost job
Depression
Internal beliefs:
I’m worthless.
It’s hopeless.
My boss is a jerk.
I deserve something better. No
depression
A cognitive perspective on psychological disorders

61. Child, Group & Family Therapy
Child therapies
Common approach used—play therapy
Therapist provides children with toys and drawing materials
Assumption is that whatever is troubling them will be expressed in play

62. Child, Group & Family Therapy
Group therapies
Simultaneous treatment of several clients under the guidance of a therapist
Variation of group therapy is the self-help group:
Several people regularly meeting and discussing their problems with one another without the guidance of a therapist

63. Child, Group & Family Therapy
Family and couples therapies
Family therapies—designed to constructively modify the dysfunctional relationships among family members
Couples therapy—designed to help couples improve the quality of their relationship

64. Who Does Therapy?
Where do people turn for help?

65. Who Does Therapy? Therapists and Their Training Type Description
Psychiatrist Physicians (M.D.) who specialize in the treatment of psychological
disorders.
Not all psychiatrists have had extensive training in psychotherapy Can prescribe medications.
Clinical Ph.D. In psy6chology or Psy.D.
Clinical or A two-year Master of Social Work plus postgraduate supervision
psychiatric About half have earned the National Association of Social Workers’
Social worker designation of clinical social worker.
Counselors LPC,
Marriage & Family (MFT)
Pastoral
Abuse

66. Evaluating Therapy Client Perceptions Clinician’s Perceptions
Consumer Reports Study
Clinician’s Perceptions
Outcome Research
Spontaneous Remission
Regression toward the mean

67. Does Therapy Work? Meta-analysis
procedure for statistically combining the results of many different research studies
Poor outcome
Good outcome
Average
untreated
person
psychotherapy
client
Number of
persons
80% of untreated people have poorer
outcomes than average treated person

68. Alternative Therapies
Disconnect between Research and Therapy
Alternative Therapies
Therapeutic touch
Eye movement desensitization
Light exposure therapy

69. Commonalities among Therapies
A new perspective
Trusting, caring relationship
Culture and values (therapist-client match)

70. Biomedical Therapies Psychopharmacology Lithium
study of the effects of drugs on mind and behavior
Lithium
chemical that provides an effective drug therapy for the mood swings of bipolar (manic-depressive) disorders

71. Biomedical Therapies The emptying of U.S. mental hospitals Year
Introduction of antipsychotic drugs
Rapid decline
in the mental
hospital
population
Year
700
600
500
400
300
200
100
State and county
mental hospital
residents, in
thousands

72. Biomedical Therapies
Today in the United States, less than one-third the number of people are full-time residents in psychiatric hospitals.
Reason for this sharp decrease—the widespread use of drug therapies in treating psychological disorders
This form of therapy is often less expensive than psychological therapies.

73. Use of Drugs in Treating Psychological Disorders

74. Biomedical Therapies Prozac blocks normal reuptake of the neuro-
transmitter serotonin;
excess serotonin in
dynapse enhances its
mood-lifting effect.
Vesicles
containing
neurotrans-
mitters
Sending
neuron
Action
potential
Neurotransmitter
molecule
Synaptic
gap
Receptors
Receiving
Reuptake
Prozac
Message is sent
across synaptic gap.
Message is received;
excess neurotransmitter
molecules are reabsorbed
by sending neuron.
Serotonin

75. Antipsychotic Drugs Reduce Dopamine Activity
a group of medications that are effective in treating the delusions, hallucinations, and loose associations of schizophrenia by blocking dopamine receptors & thereby reducing dopamine activity
Do not actually “cure” schizophrenia. They merely help control its severe symptoms.

76. Classes of Psychoactive Drugs
Antipsychotics
Thorazine
Clozapine
Olanzapine, etc.
Block dopamine receptor sites
Treat Schizophrenia & other psychoses
May cause sluggishness & muscle tremors

77. Classes of Psychoactive Drugs
Antianxiety
Valium, Librium, Xanax, etc.
Tend to be addictive

78. Classes of Psychoactive Drugs
Antidepressants
Increase availability of epinephrine or serotonin
Prozac, Zoloft, Paxil, etc. world’s most widely prescribed drugs
Require about a month for full effectiveness

79. Antidepressant Drugs: Increase Serotonin and Norepinephrine
MAO inhibitors (MAOI) inhibit the enzyme involved in breaking down norepinephrine and serotonin are called the monoamine oxidase inhibitors (MAOI).
Tricyclics are antidepressant drugs that have milder side effects than MAOI inhibitors
Antidepressants that affect only serotonin are selective serotonin reuptake inhibitors (SSRIs).

80. Biomedical Therapies Electroconvulsive Therapy (ECT) Psychosurgery
therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient
Psychosurgery
surgery that removes or destroys brain tissue in an effort to change behavior

81. Electroconvulsive Therapy (ECT)
A physiological treatment for severe depression in which a brief electric shock is administered to the brain of an anesthetized patient
Although ECT is effective in treating severe depression, no one knows for sure why it works.
Several temporary negative side effects, including confusion, loss of memory, and impaired motor coordination

82. Electroconvulsive Therapy

83. Psychosurgery: Destroys Portions of the Brain
Most radical & controversial treatment
A seldom-used surgical procedure in which brain tissue thought to cause the disorder is destroyed.
Today, MRI-guided precision psychosurgery is performed only in extreme cases and it focuses on much smaller brain areas than those involved in lobotomies.

84. Lobotomy
now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients
cut the nerves that connect the frontal lobes to the emotion-controlling centers of the brain