Psychological Disorders

U – njustifiable M – aladaptive A – typical D – istorted thinking, D-isturbed

Qualitatively Quantitatively

Etiology Psychoanalytic theory Humanistic theory Behavioral theory Cognitive theory Psychophysiological Cultural

Classifying Psychological Disorders DSM IV TR Classification orders and describes symptoms Predicts its future course Treatment Stimulate research

Five Levels of Diagnosis Axis I: Is a clinical syndrome present? Axis II: Is a personality disorder or mental retardation present? Axis III: General medical condition present? Axis IV: Are psychosocial or environmental problems present? Axis V: What is the global assessment? 1-100

Anxiety Disorders Most common disorder after substance abuse What differentiates phobias and normal fear? Intensity Length of anxiety Able to adequately respond

Anxiety Disorders Generalized anxiety disorder – continuously tense Phobic disorder – irrational and intense fear of object Obsessive compulsive disorder – repetitive thoughts or actions Panic disorder – anxiety tornado “fear of fear”, sudden episodes Post traumatic stress disorder – after trauma

Panic Disorder: Minute-long episodes of intense dread which may include feelings of terror, chest pains, choking, or other frightening sensations. Anxiety is a component of both disorders (generalized anxiety disorder and panic disorder). It occurs more in the panic disorder, making people avoid situations that cause it.

Post-traumatic stress disorder (PTSD) Affects soldiers from Vietnam, Operation Desert Storm, and Iraqi wars; also Nazi death camp and prison camp survivors) Suffering severe reactions years after traumatic event (some recover, some get worse over time) Experiences include: Dreams with horror Intense emotional bodily reactions Difficulty concentrating or sleeping

Stressors Causing PTSD Combat-related events Sudden death of loved one Involved in or witnessing accidents Physical assault, rape, sexual molestation experienced by women Terrorism experiences

Who Develops PTSD Four factors involved Severity of stress Risk increased when physical injury occurs Person’s characteristics before event Affects those with higher anxiety levels, lower intelligence, previous mental health problems Social support More support lessens risk Sex of the victim Women more at risk

Etiology of Anxiety Disorders Psychoanalytic – GAD – id overcomes ego => anxiety Phobias – Little Hans OCD – fixated an anal stage Behavioral – classical conditioning, modeling, reinforcement Little Albert Humanistic – gap between one’s real self and ideal self Cognitive – misinterpret bodily sensations, lack ability to cope with stress Biomedical – genetic predisposition, Lower levels of GABA neurotransmitter – inhibitory “brakes of a car” Malfunctions in amygdala – part of brain that deals with agression and fear

Kinds of Phobias - Intense, unrealistic or irrational fear Agoraphobia Phobia of open places. Acrophobia Phobia of heights. Claustrophobia Phobia of closed spaces. Hemophobia Phobia of blood.

Phobias Agoraphobia – fear of panic attacks in public places Social phobias – social anxiety disorders More women than men Irrational fear of being embarrassed, judged or critically evaluated by others Realize that their fear is excessive but they still approach social situations with tremendous anxiety

Phobias More unusual phobias: Amathophobia- fear of dust Amenophobia – fear of wind Aphephobia – fear of being touched by another person Bibliophobia- fear of books Catotrophobia – fear of breaking a mirror Ergophobia – fear of work or responsibility Gamophobia – fear of marriage Hypertrichophobia – fear of growing excessive amounts of body hair Levophobia – fear of things being on the left side of your body Phobophobia – fear of acquiring a phobia Phonophobia – fear of sound of your own fource Triskaidekaphobia – fear of the number 13

Phobias Humans are predisposed – biologically prepared to acquire certain fears Fear of particular situations – flying, driving, tunnels, bridges, elevators, crowds, enclosed places Fear of features of the natural environment – thunder, heights, water Fear of injury or blood – injections, needles, medical or dental procedures Fear of animals and insects – snakes, spiders, dogs, slugs, bats

Agoraphobia – fear of panic attacks in public places Social phobias – social anxiety disorders More women than men Irrational fear of being embarrassed, judged or critically evaluated by others Realize that their fear is excessive but they still approach social situations with tremendous anxiety

Somatoform Disorders Four types Experiencing symptoms of physical health problems with psychological causes, Symptoms take a somatic (bodily) form without apparent physical cause Four types Hypochondriasis – preoccupation with health Conversion disorders – symptoms not medically possible person experiences very specific genuine physical symptoms for which no physiological basis can be found Somatoform pain disorders – primary symptom is pain with no physical cause Body dysmorphic disorder - exaggerated concern and preoccupation about minor or imagined defects in appearance

Somatoform Disorders Symptoms take a somatic (bodily) form without apparent physical cause Conversion disorder: person experiences very specific genuine physical symptoms for which no physiological basis can be found Hypocondriasis: person interprets normal physical sensations as symptoms of a disease Body dysmorphic disorder: exaggerated concern and preoccupation about minor or imagined defects in appearance

Disassociative Disorders Broad category of loosely related conditions Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. People lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity Dissociative amnesia – psychological cause Dissociative fugue – complete loss of memory Dissociative identity disorder – once known as multiple personality disorder; very controversial issue

Criticism of DID Critics argue that the diagnosis of DID increased in the late 20th century. DID has not been found in other countries. Role-playing by people open to a therapist’s suggestion. Learned response that reinforces reductions in anxiety

Mood Disorders Extreme and persistent feelings of despondency, worthlessness and hopelessness, causing… impaired emotional, cognitive, behavioral and physical functioning Blue mood Major Depressive Disorder Gasping for air after a hard run Chronic shortness of breath

impaired emotional, cognitive, behavioral and physical functioning Mood Disorders Extreme and persistent feelings of despondency, worthlessness and hopelessness, causing… impaired emotional, cognitive, behavioral and physical functioning

Types of mood disorders Major depression – “common cold” of psychological disorders Dysthymic disorder Seasonal affect disorder – depression associated with seasons Bipolar – emotional roller coaster Cyclothymic Disorder - moderate mood swings

Etiology of Mood Disorders Genetic predisposition Disruptions in brain chemistry Antidepressants – increase 2 neurotransmitters Norepinephrine Seratonin Lithium – regulates avaliability of NT called glutamate Stress

Inability to make decisions Bipolar disorder Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder. Gloomy Elation Withdrawn Euphoria Inability to make decisions Desire for action Tired Hyperactive Slowness of thought Multiple ideas

Explaining Depression… Cognitive Beck Attributions Internal personal factors/external situational factors Stable or unstable over time Global /specific implications People who make global, stable, internal personal attribution => more prone to depression Seligman: learned helplessness Depression is caused by person learning that his effort does not pay off “giving up behavior” Originally conditioning => more cognitive slant

Etiology of Depression (con’t) Cognitive Beck Attributions Internal personal factors/external situational factors Stable or unstable over time Global /specific implications People who make global, stable, internal personal attribution => more prone to depression Seligman: learned helplessness Depression is caused by person learning that his effort does not pay off “giving up behavior” Originally conditioning => more cognitive slant

Etiology of Depression (con’t) Behavioral: Inadequate social skills Not enough reinforcement of social relationships Depressed people can be depressing to be around

Social-Cognitive Perspective The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles.

Disassociative Disorders People lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity Disassociatve amnesia Disassociative fugue Disassociatve Identity Disorder or Multiple personality disorder

Schizophrenia “split mind” – split from reality Disorganized thinking Delusions -false beliefs, grandeur Disorganized perceptions Hallucinations – sensory experiences without sensory stimulation Inappropriate emotions or action Laughing when inappropriate/flat affect

Subtypes of schizophrenia Paranoid Disorganized Catatonic Undifferentiated

Schizophrenia “split mind” – split from reality Disorganized thinking Delusions -false beliefs, grandeur Disorganized perceptions Hallucinations – sensory experiences without sensory stimulation Inappropriate emotions or action Laughing when inappropriate/flat affect

Schizophrenia Subtypes Paranoid schizophrenia False beliefs, delusions (grandeur, paranoia, persecution), hallucinations Disorganized schizophrenia Delusions, hallucinations, cognitive processes highly disorganized or fragmented Extreme social withdrawal Catatonic schizophrenia May have delusions and hallucinations; most abnormalities in social interaction, body posture and movement (waxy flexibility in stupors)

Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, deluded ways) that are not present in normal individuals (positive symptoms). Schizophrenics also have an absence of appropriate symptoms (apathy, expressionless faces, rigid bodies) that are present in normal individuals (negative symptoms).

Understanding Schizophrenia Schizophrenia is a disease of the brain exhibited by the symptoms of the mind. Brain Abnormalities Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain. OBJECTIVE 18| Outline some abnormal brain functions and structures associated with schizophrenia, and discuss the possible link between prenatal viral infections and schizophrenia.

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

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

Viral Infection Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development.

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 OBJECTIVE 19| Discuss the evidence for a genetic contribution to the development of schizophrenia.

Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries.

Psychological Factors Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicols & Gottesman, 1983). The genetically identical Genain sisters suffer from schizophrenia. Two more than others, thus there are contributing environmental factors. OBJECTIVE 20| Describe some psychological factors that may be early signs of schizophrenia in children. Courtesy of Genain Family Genain Sisters

Personality Disorders Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions. Schizoid personality disorder Blunted emotions, social withdrawal, but no serious cognitive disturbances Antisocial personality disorder Feel little guilt, exploit others, frequent violation of social rules and laws Difficulty with personal relationships Low tolerance for frustration, lie easily/skillfully OBJECTIVE 21| Contrast the three clusters of personality disorders, and describe the behaviors and brain activity associated with antisocial personality disorders.

Personality Disorders Inflexible, maladaptive patterns of thoughts, emotions, behavior and interpersonal functioning that are stable over time and across situations, and deviate from the expectations of the individual’s culture Person doesn’t consider his personality characteristics as problematic => don’

Types of Personality Disorders Odd, eccentric Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Dramatic, emotional, erratic Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder Anxious, fearful Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder

Antisocial Personality Disorder A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, even toward friends and family members. Formerly, this person was called a sociopath or psychopath.

Understanding Antisocial Personality Disorder Like mood disorders and schizophrenia, antisocial personality disorder has biological and psychological reasons. Youngsters, before committing a crime, respond with lower levels of stress hormones than others do at their age.

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). Courtesy of Adrian Raine, University of Southern California Normal Murderer

Understanding Antisocial Personality Disorder The likelihood that one will commit a crime doubles when childhood poverty is compounded with obstetrical complications (Raine et al., 1999; 2000).

Risk and Protective Factors Risk and protective factors for mental disorders (WHO, 2004).

Risk and Protective Factors