S UMMER AT THE A CADEMY Introduction to Psychology Days 11 & 12: Psychological Disorders Ms. Mary-Liz Fuhrman

TOPICS Perspectives Anxiety Disorders Mood Disorders Schizophrenia Personality Disorders Rates of Psych. Disorders

W HAT DO YOU KNOW ? What Psychological disorders do you know? Why do you think it is important to study and understand these disorders? Why do we tend to be fascinated by psychological disorders?

“T O STUDY THE ABNORMAL IS THE BEST WAY OF UNDERSTANDING THE NORMAL ”- W ILLIAM J AMES Common Disorders: Depression Obsessive-Compulsive Disorder Schizophrenia ADD/ADHD Our curiosity: We exhibit some of characteristics at different points– we relate to some of these disorders 450 million people suffer from psychological disorders

P ERSPECTIVES ON P SYCHOLOGICAL D ISORDERS Questions To Be Considered… How should we define psychological disorders? How should we understand disorders? Sicknesses to be cured or reactions to environment? How should we classify disorders? How do we help people without adding labels?

P ERSPECTIVES ON P SYCHOLOGICAL D ISORDERS D EFINING P SYCHOLOGICAL D ISORDERS Psychological Disorder: deviant, distressful, and dysfunctional behavior patterns Persistently harmful thoughts, feelings, and actions Q: What is deviant behavior? Standards for deviance vary by culture and context What are our standards for behavior in the US? How might these be different in other countries? Vary over time Homosexuality What are some common diagnoses today that may be controversial?

P ERSPECTIVES ON P SYCHOLOGICAL D ISORDERS D EFINING P SYCHOLOGICAL D ISORDERS C ONT ’ D Distress Problematic, stressful, worrisome Dysfunctional When thoughts and behaviors interfere in daily activities KEY in defining disorders

P ERSPECTIVES ON P SYCHOLOGICAL D ISORDERS U NDERSTANDING P SYCHOLOGICAL D ISORDERS Medical Model 1800’s Diseases have physical causes that can be diagnosed, treated and cured. Diagnosed based on symptoms and treated with therapy Hospitalization Depression & Schizophrenia Biopsychosocial Approach Nature and nurture Cultural Influences Depression and Schizophrenia are found worldwide Anorexia Nervosa is western Different causes of anxiety in different cultures Takes into account Biological: genetics, evolution Psychological: stress, mood Social-Cultural: roles, expectations

P ERSPECTIVES ON P SYCHOLOGICAL D ISORDERS C LASSIFYING P SYCHOLOGICAL D ISORDERS Classification based on symptoms Diagnostic classification describes and predicts DSM-IV: the APA Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) Pros and Cons of Diagnosing -Pro: $$ insurance -Con: illness = stigma Describes various disorders and prevalence Offers standards, consistency, and organization for subjective symptoms

P ERSPECTIVES ON P SYCHOLOGICAL D ISORDERS L ABELING P SYCHOLOGICAL D ISORDERS Labels affect how we perceive people Normal v. Different Movies/Media Accurate: A Beautiful Mind “Freaks”- Silence of the Lambs Changes “reality” Students are “slow” Someone is “hostile”

ANXIETY DISORDERS What are some anxiety provoking situations? What is anxiety? A feeling of apprehension, often characterized by feelings of stress. (WebMD) Anxiety Disorder: psychological disorder characterized by distressing, persistent, anxiety or maladaptive behaviors that reduce anxiety

ANXIETY DISORDERS G ENERALIZED A NXIETY D ISORDER Person is continually tense, apprehensive, and in a state of autonomic nervous system arousal Symptoms are common; persistence is key in diagnosing Symptoms: dizziness, heart palpitations, sweating, edgy, shaky 2/3 women Tense, jittery, worried, sleepless Twitching, sweating, trembling, fidgeting Concentration is difficult Hard to find one cause Often linked with depression

ANXIETY DISORDERS P ANIC D ISORDER Disorder marked by unpredictable minutes-long episodes (attacks) of intense dread n which a person experiences terror and accompanying chest pain, choking, or other frightening sensations 1 in 75 people Panic Attacks affect social interactions and daily life Withdrawal and avoidance of social situations/ interactions that cause attacks

ANXIETY DISORDERS P HOBIAS Persistent, irrational fear and avoidance of a specific object, activity, or situation Disrupts behavior and daily life Social Phobia Common Phobias: Being alone -storms-water -height close spaces-flying-blood -animals

ANXIETY DISORDERS O BSESSIVE -C OMPULSIVE D ISORDER Unwanted repetitive thoughts (obsessions) and/or actions (compulsions) Interfere with everyday life and cause distress Check to see if the door is closed- normal Checking the door 10 times everyday- abnormal Late teens, early twenties

ANXIETY DISORDERS O BSESSIVE -C OMPULSIVE D ISORDER : C OMMON O BSESSIONS AND C OMPULSIONS Obsessions Dirt, germs, toxins Fire, death, illness Symmetry, order, or exactness Compulsions Excessive hand- washing, bathing, tooth-brushing, or grooming Repeating rituals Checking doors, locks, appliances, homework

ANXIETY DISORDERS P OST - T RAUMATIC S TRESS D ISORDER Haunting memories, nightmares, social withdrawal, anxiety, and/or insomnia that lingers for 4 weeks+ after a traumatic experience Veterans Accident and Disaster Survivors Sexual Assault Victims Trauma: direct exposure to serious threats Controversial

ANXIETY DISORDERS E XPLAINING A NXIETY D ISORDERS Anxiety includes feelings and thoughts Freud said we repress these feelings from childhood Two contemporary Perspectives Learning Perspective Biological Perspective

ANXIETY DISORDERS E XPLAINING A NXIETY D ISORDERS : L EARNING P ERSPECTIVE Fear Conditioning Classical conditioning—associate anxiety with certain cues People, places, environments Stimulus Generalization Fear heights—begin to fear flying Reinforcement maintains Observational Learning Observing others’ fears If your mom is afraid of heights, you may also develop that fear

ANXIETY DISORDERS E XPLAINING A NXIETY D ISORDERS : B IOLOGICAL P ERSPECTIVE Natural Selection Fears faced by our ancestors—way to protect ourselves What do we learn NOT to fear? Genes Temperament: sensitive, high strung Family esp. twins Brain Over arousal of brain areas for impulse control Fear-learning experiences can traumatize the brain

D ISSOCIATION AND M ULTIPLE P ERSONALITIES Dissociative Disorders: conscious awareness becomes seperated from previous memories, thoughts, and feelings Stressful situations—dissociate self from them Dissociative Identity Disorder: person exhibits 2 or more distinct and alternating personalities A.k.a. multiple personality disorder Is this a more exaggerated version of our ability to vary ourselves? Are we playing roles? Support: Brain and body states; memories fail to transfer Skeptics: only few cases reported before 1960 when it was first noted in the DSM; less in North America—cultural phenomenon Seen as a way to cope w/ anxiety and protect selves WHAT DO YOU THINK?

TREATMENT OPTIONS (ADAA) Behavior Therapy The goal of Behavior Therapy is to modify and gain control over unwanted behavior. The individual learns to cope with difficult situations, often through controlled exposure to them. This kind of therapy gives the individual a sense of having control over their life. Cognitive Therapy The goal of Cognitive Therapy is to change unproductive or harmful thought patterns. The individual examines his feelings and learns to separate realistic from unrealistic thoughts. As with Behavior Therapy, the individual is actively involved in his own recovery and has a sense of control. Cognitive-Behavior Therapy (CBT) Many therapists use a combination of Cognitive and Behavior Therapies, this is often referred to as CBT. One of the benefits of these types therapies is that the patient learns recovery skills that are useful for a lifetime. Relaxation Techniques Relaxation Techniques help individuals develop the ability to more effectively cope with the stresses that contribute to anxiety, as well as with some of the physical symptoms of anxiety. The techniques taught include breathing re-training and exercise. Medication Medication Medication can be very useful in the treatment of anxiety disorders, and it is often used in conjunction with one or more of the therapies mentioned above. Sometimes anti-depressants or anxiolytics (anti-anxiety medications) are used to alleviate severe symptoms so that other forms of therapy can go forward. Medication is effective for many people and can be either a short-term or long-term treatment option, depending on the individual.

T AKING S IDES : I SSUE 11: D OES ADHD E XIST ? What is ADHD? Why is it so controversial? Class Survey: Does ADHD Exist? Questions 3) Medication v. Other treatments? 4) Side effects for medications; pros & cons

YES Scientists and scholars agree that it exists Neuro-imaging studies show brain irregularities Meets scientific criteria for valid psychological disorder Twin studies—heritable NO No stable definition Neuro-imaging studies do not adequately show that it is a biochemical disorder Prevalence is due to unrealistic cultural expectations Heritability is debatable

W HAT DO THESE FAMOUS NAMES HAVE IN COMMON ? Walt Whitman Ernest Hemingway Ludwig von Beethoven Kurt Cobain Isaac Newton Edgar Allen Poe Vincent Van Gough Kurt Vonnegut Billy Joel Brooke Shields Jim Carrey Abraham Lincoln Rodney Dangerfield Tim Burton All suffered from Mood Disorders

MOOD DISORDERS What is mood? relatively lasting emotional or affective state What are mood disorders? Mood Disorders: psychological disorders characterized by emotional extremes 2 Principal forms: 1) Major Depressive Disorder 2) Bipolar Disorder

MOOD DISORDERS M AJOR D EPRESSIVE D ISORDER What are some common symptoms of depression? Discouraged, dissatisfied, isolated, lethargic, changes in sleeping and eating patterns, suicidal thoughts What are some common causes of depression? Academic successes/failures, social stresses, relationships, family stressors Depression is the “common cold” of psychological disorders #1 reason people seek psychological help

MOOD DISORDERS M AJOR D EPRESSIVE D ISORDER ( CONT ’ D ) Anxiety is a response to the threat of the future loss; Depression is a response to the past and current loss. Q: When do these responses become maladaptive? Major Depressive Disorder: a mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities. Grasping for breath for a few minutes after a run v. chronic short breath Almost 2x more common in females than males

MOOD DISORDERS B IPOLAR D ISORDER Major depression usually ends and people often return back to previous state…sometimes, they rebound with the opposite emotional extreme Mania: mood disorder marked by a hyperactive, wildly optimistic state Alternating between mania and depression signals Bipolar disorder Formerly known as Manic-Depressive Disorder Manic Phase: talkative, overactive, elated, little sleep Maladaptive Symptoms: grandiose optimism and self- esteem Less common than Major Depression Affects men and women equally Mild forms of bipolar may fuel creativity

MOOD DISORDERS B IPOLAR D ISORDER ( CONT ’ D ) Mild forms of bipolar may fuel creativity Walt Whitman Ernest Hemingway Ludwig von Beethoven Kurt Cobain Isaac Newton Edgar Allen Poe Vincent Van Gough Kurt Vonnegut

MOOD DISORDERS E XPLAINING M OOD D ISORDERS Theories of depression must explain: Behavioral and cognitive changes accompany depression Depression is widespread Women are nearly twice as vulnerable to major depression Most major depressive episodes self-terminate Stressful events related to work, marriage, and close relationships often precede depression The rate of depression is increasing and striking earlier with each generation

G ENDER AND D EPRESSION : W ORLDWIDE Why are females consistently more depressed?

MOOD DISORDERS T HE B IOLOGICAL P ERSPECTIVE Genetic predispositions, biochemical imbalances, negative thoughts, and melancholy mood GENETIC INFLUENCES Increase in vulnerability if parent/sibling is diagnosed Adopted children with mood disorders have biological links Genes alone have small effects– when they combine with other genes and nongenetic factors risk rises DEPRESSED BRAIN Norepinephrine and Serotonin- scarce in depression Omega-3 fatty acids low- support brain and mental health

MOOD DISORDERS T HE S OCIAL -C OGNITIVE P ERSPECTIVE Self-defeating beliefs and negative explanatory style feed cycle of depression Negative Thoughts and Negative Moods Interact Self-defeating beliefs – learned helplessness “I’ll never be able to do this” Who do we blame? Blame self: depressed Blame others: anger

MOOD DISORDERS T HE S OCIAL -C OGNITIVE P ERSPECTIVE E XPLANATORY STYLE AND DEPRESSION : R OMANTIC B REAK -U P Stable “I’ll never get over this” Global “Without him, I can’t do anything” Internal “It’s all my fault” RESULT: Depression Temporary “This is tough but I’ll get through this” Specific “I miss him but I still have my friends and family” External “Yes I made mistakes, but so did he and it was not working” RESULT: Successful Coping

MOOD DISORDERS T HE S OCIAL -C OGNITIVE P ERSPECTIVE E XPLANATORY STYLE AND DEPRESSION : _____________ Stable Global Internal RESULT: Depression Temporary Specific External RESULT: Successful Coping

Negative Explanatory Style Depressed Mood Cognitive and Behavioral Changes Stressful Events

S CHIZOPHRENIA 1 in 100 people suffer from Schizophrenia Who is likely to develop it? Adolescents into young adulthood No cultural influences Equal for males and females Men develop earlier, more severely, more often Schizophrenia: group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate actions and emotions. “Split Mind”—Split from reality

S CHIZOPHRENIA S YMPTOMS OF S CHIZOPHRENIA Disorganized Thinking Delusions: false beliefs that may accompany psychotic disorders Often of grandeur or persecution * Paranoid tendencies are more prone Possibly due to a breakdown in selective attention/sensory processing Disturbed Perceptions hallucinations Inappropriate Emotions and Actions Angry for no reason; laughing at sad events Flat affect: “zombie” Behaviors: senseless and compulsive Catatonia: motionless for hours

S CHIZOPHRENIA S UBTYPES OF S CHIZOPHRENIA Cluster of disorders that share common features but distinguishing symptoms: Positive Symptoms: hallucinations, talk is disorganized and deluded, inappropriate laughter, tears, or rage Negative Symptoms: toneless voices, expressionless faces, mute or rigid bodies Positive symptoms = inappropriate behaviors Negative Symptoms = absence of behaviors

S CHIZOPHRENIA T YPES OF S CHIZOPHRENIA Chronic or Process Schizophrenia Develops slowly, gradually, from a long history of social inadequacy Exhibit negative symptom of withdrawal Recovery is unlikely Acute or Reactive Schizophrenia Develops quickly, as a reaction to stress Recovery is likely -Men more often exhibit negative symptoms and chronic schizophrenia -Outlook is better for those with positive symptoms— reactive condition responds to drug therapy

S CHIZOPHRENIA 5 S UBTYPES OF S CHIZOPHRENIA Paranoid  Preoccupation with delusions or hallucinations, often with themes of persecution or grandiosity Disorganized  Disorganized speech or behavior or flat or inappropriate emotion Catatonic  Immobility, extreme negativism, and/or parrot-like repetition of another’s speech or movements Undifferentiated many and varied symptoms Residual withdrawal, after hallucinations and delusions have disappeared

S CHIZOPHRENIA U NDERSTANDING S CHIZOPHRENIA Brain Abnormalities Dopamine overactivity– high levels may increase positive symptoms Drugs to decrease dopamine Little effect on negative symptoms Abnormal Brain Activity and Anatomy Frontal lobes (reasoning and problem solving) Decline in brain waves Fluid-filled areas and shrinking cerebral tissue Possibly due to problems in prenatal development and/or delivery

S CHIZOPHRENIA U NDERSTANDING S CHIZOPHRENIA Psychological Factors Environmental causes Warning Signs Mother with severe and long-lasting schizophrenia Birth complications Separation from parents Short attention span and poor muscle coordination Disruptive/withdrawn behavior Emotional unpredictability Poor peer relations and solo play We have difficulty relating to schizophrenia

PERSONALITY DISORDERS Some maladaptive behavior patterns impair people’s social functioning without anxiety, depression, or delusions REMEMBER… (Personality: Enduring pattern of thinking, feeling and acting) Personality Disorders: characterized by inflexible and enduring behavior patterns that impair social functioning Grouped into 3 Clusters in the DSM-IV

PERSONALITY DISORDERS: C LUSTERS Cluster A- Odd/Eccentric Cluster Paranoid Suspicious of others, secretive, looking for signs of trickery and abuse Schizoid Eccentric behaviors, emotionless disengagement-no desire for social relationships Schizotypal Interpersonal difficulties of the schizoid and excessive social anxiety; some symptoms of residual phase of schizophrenia

PERSONALITY DISORDERS: C LUSTERS Cluster B- Dramatic/Erratic Cluster Antisocial Borderline Personality Disorder Unstable identity, unstable relationships, unstable or impulsive emotions; unstable sense of self Histrionic Dramatic or impulsive behaviors; use features of physical appearance to draw attention to selves (clothes, makeup, hair color) Narcissistic Personality Disorder Self-focused, exaggerating own importance and success; require constant attention and excessive admiration

PERSONALITY DISORDERS: C LUSTERS Cluster C- Anxious/Fearful Cluster Avoidant Anxiety, fearful sensitivity to rejection and criticism causing withdrawal Dependent Lacking self-confidence and sense of autonomy; view selves as weak; passive and agreeable Obsessive-Compulsive Perfectionist, preoccupied with details, rules, schedules, etc.; pay attention to details so much that they may never finish a project

PERSONALITY DISORDERS A NTISOCIAL P ERSONALITY D ISORDER Antisocial Personality Disorder: person exhibits a lack of conscience for wrong doing, even toward friends and family. May be aggressive and ruthless or a clever con artist Formerly called sociopath or psychopath Usually males Often begins before age 15 Stealing, fighting, displays unrestrained sexual behaviors How does this affect adult life? Jobs, relationships (spouse and parent), assaultive or otherwise criminal

PERSONALITY DISORDERS A NTISOCIAL P ERSONALITY D ISORDER Antisocial Personality Disorder and Criminals Most criminals do not fit the description Many show responsibility and remorse for their actions (concern for family and friends) Antisocial Personalities feel and fear little, express little regret over violating others’ rights

PERSONALITY DISORDERS U NDERSTANDING A NTISOCIAL P ERSONALITY D ISORDER Biological and psychological Relatives of those w/ antisocial tendencies are at an increased risk for antisocial behavior Reduced activity in the Frontal Lobes Antisocial behavior has been detected as early as ages 3-6 Boys who become aggressive or antisocial adolescents may have been impulsive, uninhibited, low in anxiety as young children Environment/Society 1960s to 1990s

R ATES OF P SYCHOLOGICAL D ISORDERS How prevalent are the various disorders? Who is most vulnerable to them? At what times of life? 1 in 7 Americans Britain: 1 in 6 Australia: 1 in 6 to 1 in 7 World Health Organization study in 2004 Lowest Rate: Shanghai Highest Rate: United States When people immigrate to the US their mental health declines over time

P ERCENTAGE OF A MERICANS WHO HAVE EXPERIENCED SELECTED PSYCHOLOGICAL DISORDERS IN THE PRIOR YEAR (U.S. N ATIONAL I NSTITUTE OF M ENTAL H EALTH IN 2002) DisorderPercentage Alcohol Abuse5.2 Generalized Anxiety4.0 Phobias7.8 OCD2.1 Mood Disorder5.1 Schizophrenia1.0 Antisocial Personality1.5

Predictor: Poverty Does poverty cause disorders or do disorders cause poverty? Varies with disorder Schizophrenia leads to poverty Stress and demoralization of poverty can cause depression and substance abuse Risk Factors and Protective Factors Usually experience by early adulthood (by age 24) Antisocial personality (age 8) and phobias (age 10) are among the earliest to appear Alcohol Abuse, OCD, Bipolar, and Schizophrenia by age 20 R ATES OF P SYCHOLOGICAL D ISORDERS

RISK AND PROTECTIVE FACTORS FOR MENTAL DISORDERS Academic Failure Birth Complications Caring for chronically ill patients Child abuse/neglect Chronic insomnia Chronic pain Family disorganization/conflict Low Birth Weight Low Socioeconomic Status Medical Illness Neurochemical Imbalance Parental Mental Illness Parental Substance abuse Personal loss/bereavement Poor work skills and habits Reading disabilities Sensory Disabilities Social incompetence Stressful life events Substance Abuse Trauma experiences Aerobic Exercise Community offering empowerment, opportunity, and security Economic independence Feelings of security Feelings of master and control Good parenting Literacy Positive attachment and early bonding Problem-solving skills Resilient coping with stress and adversity Self-esteem Social and work skills Social support from family and friends