1. Psychological Disorders
PSYCHOLOGY
Mr. Noble
A special thanks to my former student teacher--Ms. Sharon Mohr--for her diligent research, insightful professional expertise, and valuable thoughtful effort in compiling much of the information included in this overview of Psychological Disorders.

2. Defining Abnormality Difficult to define… 3 Criteria…
Deviance
Distress
Disability/Maladaptive Behavior
Symptom/Behavior Continuum:
_----_________________ normal range__ __________________+++
Abnormal Abnormal

3. Ancient Perspective Perceived Causes Ancient Treatments
movements of sun or moon
lunacy- full moon
evil spirits
Ancient Treatments
exorcism, caged like animals, beaten, burned, mutilated, blood replaced with animal’s blood

4. Bio-psycho-social Model
assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders
Biological
(chemistry, brain)
Psychological
( learned helplessness,
negative perceptions
and memories)
Sociocultural
(Societal expectations,
definition of normality
and disorder)

5. Medical Model Diagnosis Prognosis Etiology Label for a set of symptoms
Prediction or forecast for the course of a D/O
Etiology
Suspected cause of a disorder

6. Classifying Disorders
DSM-IV-TR
Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision
Published by the American Psychiatric Association
2000…(most recent update 2004)
Next major revision (DSM-V) anticipated for 2011.
Provides for reliable classification and description of all mental illnesses
Allows for better communication

7. DSM’s Multi-axial Diagnosis
Axis I Major Clinical Disorders
Axis II Mental Retardation & Personality Disorders
Axis III General Medical Conditions
Axis IV Psychosocial/Environmental Stressors
Axis V Global Assessment of Functioning
# between 1 and 100
Current and Highest in past year

8. Labeling Issues Reasons to Label/Diagnose: Arguments against Labeling:
Needed for communication
Guide treatment
Insurance reimbursement
Arguments against Labeling:
Creates a stigma
Creates a self-fulfilling prophecy
Fail to see the person behind the disorder

9. Major Classes of Disorders
Anxiety Disorders
Mood Disorders
Somatoform Disorders
Dissociative Disorders
Schizophrenia
Substance Use Disorders
Other Axis I Disorders
Personality Disorders (Axis II)

10. I. Anxiety Disorders
Characterized by generalized apprehension, worry, and a variety of physical symptoms
Generalized Anxiety Disorder
Phobias
Panic Disorder
Obsessive-Compulsive Disorder
Post-traumatic Stress Disorder

11. Generalized Anxiety Disorder
Experiencing a continuous, generalized feeling of anxiety (reaction to vague or imagined dangers) – 6 months or more
Anxiety in many different areas of life
Accompanied by physical symptoms…
muscle tension, trouble sleeping, irritability, lack of concentration, headaches, fatigue, inability to relax, twitching/trembling, etc.

12. Phobias Specific Phobia Social Phobia Agoraphobia
Severe anxiety is focused on a specific object or situation
Examples:
Enclosed spaces
Snakes
Spiders
Heights
Flying
Social Phobia
Fear of embarrassing oneself in a social situation
Speaking, eating, using bathroom in public
Agoraphobia
“fear of the marketplace”
Associated with panic disorder

13. PHOBIAS http://www.phobialist.com/reverse.html
Common and uncommon phobias
Afraid of it
Bothers slightly
Not at all afraid of it
Being
closed in,
in a
small
place
alone
In a house
at night
Percentage
of people
surveyed
100 90 80 70 60 50 40 30 20 10
Snakes
in high,
exposed
places
Mice
Flying
on an
airplane
Spiders
and
insects
Thunder
lightning
Dogs
Driving
a car
In a
crowd
Cats

14. PHOBIAS Treatment Exposure Treatment Flooding Counter-Conditioning
Systematic Desensitization (1) training the patient to physically relax (2) establishing an anxiety hierarchy of the stimuli (3) counter-conditioning relaxation responding to ea. feared stimulus
Biofeedback
Modeling

15. Panic Disorder Frequent Panic Attacks or fear of them:
“Nothing is so much to be feared as Fear”
---Henry David Thoreau
Panic Disorder
Frequent Panic Attacks or fear of them:
Sudden and unexplainable attacks of
intense fear
Come on without warning
Not associated with a stimulus
Individual fears that he/she is about to die
Physical symptoms…choking, tightness in chest, difficulty breathing, nausea, dizziness
Commonly occurs with Agoraphobia

16. Obsessive-Compulsive Disorder
OBSESSIONS
Intrusive and uncontrollable thoughts
Contamination, safety, etc.
COMPULSIONS
Ritualistic and purposeless actions
Cleaning, washing, checking, etc.
O and C are usually related… compulsions help to decrease the anxiety caused by the obsession
This pattern begins to interfere with functioning

17. OCD 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

18. Post-traumatic Stress Disorder
Common among veterans of combat, survivors of accidents and disasters, victims of crimes, etc.
Feel long-lasting after-effects of trauma
Flashbacks, nightmares, insomnia, mood symptoms, stimulus generalization
Symptoms last more than 1 month… up to years later

19. II. Mood Disorders
Mental disorders characterized by disturbances of mood that are intense and persistent enough to be maladaptive
Normal range of mood…
Major Depressive Disorder
Bipolar Disorder

20. Major Depressive Disorder
Clinical depression/Major Depression
Unipolar depression
Single-episode or recurrent episodes
Symptoms must occur for at least 2 weeks
Subtypes:
Post-partum onset
S.A.D.
Secondary symptoms…

21. Depression…symptoms Guilt/worthlessness Energy  = fatigue
Sleep disturbance
Interest 
Guilt/worthlessness
Energy  = fatigue
Concentration 
Appetite disturbance/weight gain/loss
Psychomotor agitation/retardation
Suicidal/thoughts of death

22. Causes of Depression Genetic Predisposition Neurotransmitters
+ stressful life events
Neurotransmitters
Serotonin
Norepinephrine
Cognitive Theories
Beck & Seligman
Behavioral Theories

24. Bipolar Disorder Previously known as Manic-Depression
Experience both manic and depressive episodes
Mania = emotional state characterized by intense and unrealistic feelings of excitement and euphoria, along with impulsivity
Cycles…not mood swings
High rate of suicide

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

26. Mood Disorders & Suicide
Not all people who commit suicide are depressed; Not all depressed people commit suicide
Associated with mood disorders, especially bipolar disorder (also schizophrenia)
Warning Signs…
Risk factors…
Prevention…

27. SUICIDE: Male v. Female Males Females
Suicide is the eighth leading cause of death for all U.S. men.
Males are four times more likely to die from suicide than females.
Suicide rates are highest among Whites and second highest among American Indian and Native Alaskan men.
Of the 24,672 suicide deaths reported among men in 2001, 60% involved the use of a firearm.
Females
Women report attempting suicide during their lifetime about three times as often as men.

28. SUICIDE: Youth
Overall rate of suicide among youth has declined slowly since ‘92.
However, rates remain unacceptably high.
Adolescents and young adults often experience stress, confusion, and depression from situations occurring in their families, schools, and communities.
Such feelings can overwhelm young people and lead them to consider suicide as a “solution.”
Few schools and communities have suicide prevention plans that include screening, referral & crisis intervention programs for youth.

29. SUICIDE: Youth
Suicide is the third leading cause of death among young people ages 15 to 24.
Of the total number of suicides among ages 15 to 24 in 2001, 86% were male and 14% were female.
American Indian and Alaskan Natives have the highest rate of suicide in the 15 to 24 age group.
In 2001, firearms were used in 54% of youth suicides.

31. Previous suicide attempt(s)
SUICIDE: Risk Factors
The first step in preventing suicide is to identify and understand the risk factors.
Previous suicide attempt(s)
History of mental disorders, particularly depression
History of alcohol and substance abuse
Family history of suicide
Family history of child maltreatment
Feelings of hopelessness
Impulsive or aggressive tendencies
Barriers to accessing mental health treatment

32. Loss (relational, social, work or financial) Physical illness
SUICIDE: Risk Factors
The first step in preventing suicide is to identify and understand the risk factors.
Loss (relational, social, work or financial)
Physical illness
Easy access to lethal methods
Unwillingness to seek help due to stigma
Local epidemics of suicide
Isolation - feeling cut off from other people

33. Effective clinical care
SUICIDE: Protective Factors
Protective factors buffer people from the risks associated with suicide. A number of protective factors have been identified:
Effective clinical care
Easy access to clinical interventions & support
Family and community support
Medical & mental health care relationships
Problem solving, conflict resolution skills
Cultural & religious beliefs/support

34. III. Somatoform Disorders
Also know as Hysteria (Freud)
Conditions involving physical complaints or disabilities that occur without physical pathology
NOT psychosomatic disorders…
Conversion Disorder
Hypochondriasis

35. Conversion Disorder
Conversion of emotional difficulties into the persistent loss of a physiological function
Paralysis, loss of feeling, exceptional sensitivity, mutism, blindness, deafness
Not faking a physical problem
Cannot be explained physically

36. Hypochondriasis & Somatization Disorders
History of diverse physical complaints of all varieties (all body systems)
Focus on numerous symptoms
Many trips to doctor, many medications, no root cause found
Hypochondriasis
Preoccupation with fear that he/she has a serious disease
Based on the misinterpretation of bodily symptoms
Mountain out of a molehill
No evidence of illness

37. IV. Dissociative Disorders
Dissociation…the human mind’s capacity to mediate complex mental activity in channels split off from or independent of conscious awareness
A way of managing anxiety and stress…
Psychogenic/Dissociative Amnesia & Fugue
Dissociative Identity Disorder

38. Amnesia & Fugue PSYCHOGENIC AMNESIA PSYCHOGENIC FUGUE
Inability to recall certain personal information, which is still know at the unconscious level
Loss in episodic memory, not procedural or semantic
PSYCHOGENIC FUGUE
Loss of memory accompanied by an actual flight from one’s present life situation to a new environment
May take on a new identity

39. Dissociative Identity Disorder
Previously known as Multiple Personality Disorder
Individual manifests at least two or more distinct systems of identity
Host personality + Alter identities (15)
Associated with childhood abuse
Rare disorder; Popular in media
Can be faked or influenced by therapist

40. V. Schizophrenia
Characterized by confused and disordered thoughts and perceptions
Most debilitating of the mental disorders; Deterioration of adaptive behavior
Subtypes:
Paranoid
Disorganized
Catatonic
Undifferentiated

41. Schizophrenia…symptoms
Bizarre behaviors (catatonia, others)
Affect (inappropriate, flat)
Delusions
Speech (disorganized, incoherent)
Hallucinations
Inability to care for self or function
Negative symptoms

42. Positive vs. Negative Sx
POSITIVE SYMPTOMS
Presence of something abnormal
Examples:
NEGATIVE SYMPTOMS
Absence of something normal

43. Schizophrenia… DELUSIONS HALLUCINATIONS
False beliefs maintained in the face of contrary evidence
Types: Grandeur Identity
Persecution Reference
HALLUCINATIONS
Sensations in the absence of external stimuli
Types: visual, auditory, tactile, olfactory, gustatory

44. Causes of Schizophrenia
Genetic Predisposition
Twin study evidence
Neurotransmitters
Dopamine hypothesis
Brain Structure & Function
Family & Interactions
Double-bind theory
Schizophrenogenic mother

45. VI. Substance Use Disorders
Substance Abuse
Substance Dependence
Psychological dependence + Addiction
Alcoholism = Alcohol Dependence
Important terms…
Tolerance
Withdrawal

46. VII. Other Axis I Disorders
Eating Disorders
Sleep Disorders
Disorders of childhood and adolescence
Autism, ADHD, Tourette’s, Conduct Disorder
Sexual and Gender Identity Disorders
Cognitive Disorders
Impulse Control Disorders
Adjustment Disorders

47. VIII. Personality Disorders
Diagnosed on Axis II
Stem from the gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of relating to the world
Ego-syntonic…not a problem for the person
A problem for others
Resistant to treatment (only behavioral)
FOCUS Antisocial, Narcissistic, OCPD

48. Symptoms of Obsessive Compulsive Personality Disorder
OCPD symptoms tend to appear early in adulthood and are defined by inflexibility, close adherence to rules, anxiety when rules are transgressed, and unrealistic perfectionism. A person with obsessive compulsive personality disorder exhibits several of the following symptoms:
abnormal preoccupation with lists, rules, and minor details
excessive devotion to work, to the detriment of social and family activities
miserliness or a lack of generosity
perfectionism that interferes with task completion, as performance is never good enough
refusal to throw anything away (pack-rat mentality)
rigid and inflexible attitude towards morals or ethical code
unwilling to let others perform tasks, fearing the loss of responsibility
upset and off-balance when rules or routines disrupted.

49. Psychopathology & The Law
Competence to Stand Trial
Can individual participate in own defense at time of trial?
Involuntary Civil Commitment
Should individual be hospitalized against their will due to imminent danger?
Suicidal or homicidal
Decided by doctor, then court; need evidence

50. More Legal Issues…State-level
Insanity Plea
Should individual not be held accountable due to their mental state at the time of the crime?
Could not determine right from wrong
Determined by judge before actual trial
Difficult to prove, but prevalent in media
Sent for treatment, then released
*Insanity is a LEGAL term…!

51. More Legal Issues…State-level
Guilty but Mentally Ill
Alternative to insanity plea in some states
Adopted by Pennsylvania…
1st trial determines guilt or innocence
2nd trial determines sanity or insanity
Sent for treatment, then to prison to complete sentence…get treatment as well as punishment

52. TYPES OF PSYCHOTHERAPY — A number of types of psychotherapy are used to treat psychological disorders:
Cognitive therapy identifies habitual ways in which patients distort information (e.g. automatic thoughts) and teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs, using a variety of techniques to change thinking, mood, and behavior. Cognitive therapy is a structured, goal oriented, problem focused, and time limited intervention.

53. TYPES OF PSYCHOTHERAPY
Behavioral therapy attempts to alter behavior by systematically changing the environment that produces the behavior. Behavioral changes are believed to lead to changes in thoughts and emotions.
Exposure-based behavioral treatments utilize gradual, systematic, repeated exposure to the feared object or situation to allow patients with anxiety disorders to become desensitized to the feared stimulus.

54. TYPES OF PSYCHOTHERAPY
Cognitive Behavioral therapy (CBT) combines principles of both behavioral and cognitive therapy, focusing simultaneously on the environment, behavior, and cognition. Cognitive behavioral therapy is also structured, goal directed, problem focused. Patients learn how their thoughts contribute to symptoms of their disorder and how to change these thoughts. Increased cognitive awareness is combined with specific behavioral techniques.

55. TYPES OF PSYCHOTHERAPY
Problem Solving therapy, a short-term, cognitive behavioral intervention, teaches a systematic method for solving current and future problems. Patients acquire new skills for successfully resolving interpersonal difficulties. These skills include the following sequential steps: 1) Problem definition; 2) Goal setting; 3) Generating, choosing, and implementing solutions; and 4) Evaluating outcomes.

56. TYPES OF PSYCHOTHERAPY
Interpersonal therapy addresses issues such as grief, role transitions, interpersonal role disputes, and interpersonal deficits as they relate to the patient's current symptoms.
Family therapy attempts to correct distorted communications and relationships as a means of helping the entire family, including the identified patient. In patients with serious mental illness, such as schizophrenia, family therapy helps family members learn about the disorder, solve problems, and cope more constructively with the patient's illness.

57. TYPES OF PSYCHOTHERAPY
Psychoeducation provides patients with information about their diagnosis, its treatment, how to recognize signs of relapse, relapse prevention, and strategies to cope with the reality of prolonged emotional or behavioral difficulties.
The goal of psychoeducation is to reduce distress, confusion, and anxiety within the patient and/or the patient's family to facilitate treatment compliance and reduce the risk of relapse.
Psychoeducation is often particularly helpful for patients and the families of patients with chronic, severe psychiatric disorders such as schizophrenia and bipolar disorder.