1. Psychological Disorders Chapter 18

2. What are Psychological Disorders? Psychological disorder: Behavior patterns or mental processes that cause serious personal suffering or interfere with a person’s ability to cope with everyday life. Psychological disorder: Behavior patterns or mental processes that cause serious personal suffering or interfere with a person’s ability to cope with everyday life. In 2001, WHO released findings from a survey which estimates that 450 million people world- wide were suffering from a psychological disorder, and that 25% of all people will have a psychological disorder at some point in their lives. In 2001, WHO released findings from a survey which estimates that 450 million people world- wide were suffering from a psychological disorder, and that 25% of all people will have a psychological disorder at some point in their lives.

3. Symptoms Most people with psychological disorders do not differ from “normal” people. Most people with psychological disorders do not differ from “normal” people. Symptoms are usually exaggerations of “normal” behavior or mental patterns. Symptoms are usually exaggerations of “normal” behavior or mental patterns. Behaviors and mental processes that suggest psychological disorders include: Behaviors and mental processes that suggest psychological disorders include: Typicality Typicality Maladaptivity Maladaptivity Emotional Discomfort Emotional Discomfort Socially Unacceptable Behavior Socially Unacceptable Behavior

4. Classifications The Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition (DSM-IV) is the most widely used method of classifying psychological disorders. The Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition (DSM-IV) is the most widely used method of classifying psychological disorders. In earlier versions, causes were primary classification method. Today they are classified by symptoms. In earlier versions, causes were primary classification method. Today they are classified by symptoms. The DSM is in constant revision as research brings new knowledge into the field. The DSM is in constant revision as research brings new knowledge into the field. Examples Examples The DSM-IV classifies 18 categories of psychological disorders. The DSM-IV classifies 18 categories of psychological disorders.

5. Categories Diagnosed in Childhood* Diagnosed in Childhood* Dementia, Delirium Amnesiac, etc.* Dementia, Delirium Amnesiac, etc.* Substance-Abuse* Substance-Abuse* Schizophrenia Schizophrenia Mood Mood Anxiety Anxiety Somatoform Somatoform Dissociative Dissociative Focus of Clinical Attention* Focus of Clinical Attention* Factitious Factitious Sexual and Gender Identity Sexual and Gender Identity Sleep* Sleep* Impulse-Control Impulse-Control Adjustment Adjustment Personality Personality Eating* Eating* General Medical Condition General Medical Condition Other Other

6. Anxiety Disorders Anxiety refers to a general state of dread or unease that occurs in response to a vague or imagined danger. Anxiety refers to a general state of dread or unease that occurs in response to a vague or imagined danger. Nervousness, concern about losing control, inability to relax. Nervousness, concern about losing control, inability to relax. Result of overactivity in the sympathetic branch of the automatic nervous system. Result of overactivity in the sympathetic branch of the automatic nervous system. This is more than simply feeling nervous – anxiety disorders are classified when they interfere with effective living, achievement of goals, life satisfaction or emotional comfort. This is more than simply feeling nervous – anxiety disorders are classified when they interfere with effective living, achievement of goals, life satisfaction or emotional comfort.

7. Anxiety Disorders Phobic Disorders Simple Phobia Simple Phobia Most common anxiety disorder Most common anxiety disorder Persistent or irrational fear or an object or situation. Persistent or irrational fear or an object or situation. Fear must lead to avoidance behavior. Fear must lead to avoidance behavior. Examples Examples Social Phobia Social Phobia

8. Anxiety Disorders Panic Disorders and Agoraphobia Panic Disorder Panic Disorder Characterized by panic attacks, short periods of intense fear or discomfort. Characterized by panic attacks, short periods of intense fear or discomfort. Shortness of breath, dizziness, rapid heartbeat, trembling, shaking, sweating, choking, nausea, etc. Shortness of breath, dizziness, rapid heartbeat, trembling, shaking, sweating, choking, nausea, etc. Patients typically fear future attacks. Patients typically fear future attacks. Agoraphobia Agoraphobia Fear of being in places where escape is difficult or impossible. Fear of being in places where escape is difficult or impossible. Most common phobia among adults. Most common phobia among adults. Many who have panic disorder also have agoraphobia. Many who have panic disorder also have agoraphobia.

9. Anxiety Disorders Generalized Anxiety Disorder According to the DSM-IV, GAD is an excessive or unrealistic worry about life situations that lasts for at least 6 months. According to the DSM-IV, GAD is an excessive or unrealistic worry about life situations that lasts for at least 6 months. Finances, accidents, illness, relationships Finances, accidents, illness, relationships Sense of worry must be present all of the time to warrant a diagnosis of GAD. Sense of worry must be present all of the time to warrant a diagnosis of GAD. Most who have GAD have another anxiety disorder (usually phobic disorders). Most who have GAD have another anxiety disorder (usually phobic disorders). Those who may only have GAD often don’t seek treatment because it is difficult to distinguish from the anxiety or everyday life. Those who may only have GAD often don’t seek treatment because it is difficult to distinguish from the anxiety or everyday life.

10. Anxiety Disorders Obsessive Compulsive Disorder I OCD is one of the most acute of the anxiety disorders. OCD is one of the most acute of the anxiety disorders. Obsessions are unwanted thoughts, ideas or mental images that occur over and over. Most with obsessions try to ignore or suppress them. Obsessions are unwanted thoughts, ideas or mental images that occur over and over. Most with obsessions try to ignore or suppress them. Compulsions are repetitive ritual behaviors, which often involve checking or cleaning. Compulsions are repetitive ritual behaviors, which often involve checking or cleaning. Compulsions frequently develop as ways of dealing with obsessions. Compulsions frequently develop as ways of dealing with obsessions.

11. Anxiety Disorders OCD II People who have OCD are usually aware that their behavior is unjustified. People who have OCD are usually aware that their behavior is unjustified. Compulsions often alleviate the obsessive impulses, however they may interfere with daily life. Compulsions often alleviate the obsessive impulses, however they may interfere with daily life. OCD vs. OCPD OCD vs. OCPD Ego Dystonic vs. Syntonic

12. Anxiety Disorders Stress Disorders Two most common stress disorders are post-traumatic stress disorder and acute stress disorder. Two most common stress disorders are post-traumatic stress disorder and acute stress disorder. PTSD is most common after rape, child abuse, severe accident, plane crashes, natural disasters and war. PTSD is most common after rape, child abuse, severe accident, plane crashes, natural disasters and war. May begin 6 months or more after trauma, and last for years or even decades. May begin 6 months or more after trauma, and last for years or even decades. Over 50% of the victims of Hurricane Katrina suffered from PTSD. Over 50% of the victims of Hurricane Katrina suffered from PTSD. Symptoms: Flashbacks, nightmares, numbness, avoidance, sleeplessness, irritability and poor concentration. Symptoms: Flashbacks, nightmares, numbness, avoidance, sleeplessness, irritability and poor concentration. Acute stress disorder is short-term, with symptoms similar to PTSD. Starts within a month of the trauma and lasts up to a few weeks. Acute stress disorder is short-term, with symptoms similar to PTSD. Starts within a month of the trauma and lasts up to a few weeks.

13. Dissociative Disorders Dissociation: The separation of certain personality components or mental processes from conscious thought. Dissociation: The separation of certain personality components or mental processes from conscious thought. Often a normal process. Often a normal process. It is difficult to determine the prevalence of dissociative disorders because the DSM-IV categorizes them differently. It is difficult to determine the prevalence of dissociative disorders because the DSM-IV categorizes them differently. Four common types: Dissociative Amnesia, Dissociative Fugue, Dissociative Identity Disorder, and Depersonalization Disorder. Four common types: Dissociative Amnesia, Dissociative Fugue, Dissociative Identity Disorder, and Depersonalization Disorder.

14. Dissociative Disorders Dissociative Amnesia Also known as psychogenic amnesia – this is characterized by a sudden loss of memories, typically after a traumatic event, without physical causes. Also known as psychogenic amnesia – this is characterized by a sudden loss of memories, typically after a traumatic event, without physical causes. Less common is the phenomena of losing memories of everything – self, others, etc. Less common is the phenomena of losing memories of everything – self, others, etc. Memory often recurs as suddenly as it disappears, and does not often recur. Memory often recurs as suddenly as it disappears, and does not often recur. The incidence of dissociative amnesia rises sharply during wartime or natural disasters. The incidence of dissociative amnesia rises sharply during wartime or natural disasters.

15. Dissociative Disorders Dissociative Fugue Characterized by forgetting personal information and past events, however subjects also take on a new identity. Characterized by forgetting personal information and past events, however subjects also take on a new identity. Usually follows some kind of traumatic event which is psychologically stressful. Usually follows some kind of traumatic event which is psychologically stressful. When those with dissociative fugue travel to their new home or workplace, they become socially active, and may not seem ill. When those with dissociative fugue travel to their new home or workplace, they become socially active, and may not seem ill. Once the fugue is over, they typically forget what occurred in the fugue state. Once the fugue is over, they typically forget what occurred in the fugue state.

16. Dissociative Disorders Dissociative Identity Disorder Formerly called multiple personality disorder, this involves the existence of two or more personalities in one individual. Formerly called multiple personality disorder, this involves the existence of two or more personalities in one individual. The personalities may or may not know of one another’s existence. The personalities may or may not know of one another’s existence. Often voice, “age”, handedness, facial expressions and gender are different. Often voice, “age”, handedness, facial expressions and gender are different. DID frequently stems from severe childhood abuse. DID frequently stems from severe childhood abuse. Frequently treatment involves trying to fuse the separate personalities into a single individual. Frequently treatment involves trying to fuse the separate personalities into a single individual. DID / MPD Documentary DID / MPD Documentary DID / MPD Documentary DID / MPD Documentary

17. Dissociative Disorders Depersonalization Disorder Depersonalization refers to feelings of detachment from one’s mental process or body. Depersonalization refers to feelings of detachment from one’s mental process or body. Subjects typically describe being “outside” of themselves. May also feel a lack of control. Depersonalization is a syndrome itself as well as a symptom of other psychological problems – depression and anxiety. Depersonalization is a syndrome itself as well as a symptom of other psychological problems – depression and anxiety.

18. Somatoform Disorders Somatization: Expressing psychological distress through physical symptoms. Somatization: Expressing psychological distress through physical symptoms. Different from faking an illness – somatimatics are not intentionally faking their illness. Different from faking an illness – somatimatics are not intentionally faking their illness. Statistics on prevalence are difficult to determine. Statistics on prevalence are difficult to determine. Many cases are either misdiagnosed or undiagnosed. Many cases are either misdiagnosed or undiagnosed. Two most common types are conversion disorder and hypochondriasis. Two most common types are conversion disorder and hypochondriasis.

19. Somatoform Disorders Conversion Disorder Conversion disorder is characterized by the sudden change in or loss of functioning in a major part of the body. Conversion disorder is characterized by the sudden change in or loss of functioning in a major part of the body. No medical explanation No medical explanation Examples: Eyesight, movement of legs Examples: Eyesight, movement of legs Often characterized by a lack of concern on the part of the patient. Often characterized by a lack of concern on the part of the patient. Most researchers believe conversion disorder is a response to a traumatic or stressful event. Most researchers believe conversion disorder is a response to a traumatic or stressful event.

20. Somatoform Disorders Hypochondriasis Defined as a person’s unrealistic preoccupation with the fear that he or she has a serious disease. Defined as a person’s unrealistic preoccupation with the fear that he or she has a serious disease. Often, minor symptoms are blown out of proportion. Often, minor symptoms are blown out of proportion. Coughs Coughs Coughs Treatment involves therapy and anxiolytic medications. Treatment involves therapy and anxiolytic medications.

21. Mood Disorders Moods are constantly shifting, reflecting the ups and downs of everyday life. Moods are constantly shifting, reflecting the ups and downs of everyday life. When mood changes are inappropriate or inconsistent with the situation, a mood disorder may be the cause. When mood changes are inappropriate or inconsistent with the situation, a mood disorder may be the cause. Most mood disorders fall into two categories: Most mood disorders fall into two categories: Depression Depression Bipolar Disorder Bipolar Disorder

22. Mood Disorders Major Depression Depression is the most common of all the psychological disorders Depression is the most common of all the psychological disorders Between 13-18 million Americans are affected by depression each year – around 9.5% of the population. Between 13-18 million Americans are affected by depression each year – around 9.5% of the population. A 2004 report found that 4% of preschoolers were clinically depressed. A 2004 report found that 4% of preschoolers were clinically depressed. A 2003 report found that 80% of depressed individuals do not seek treatment. A 2003 report found that 80% of depressed individuals do not seek treatment.

23. Mood Disorders Diagnosis At least five of the following: At least five of the following: Persistent depressed mood for most of the day.* Persistent depressed mood for most of the day.* Loss of interest or pleasure in activities.* Loss of interest or pleasure in activities.* Significant weight loss or gain. Significant weight loss or gain. Sleeping more or less than usual. Sleeping more or less than usual. Speeding up or slowing down of reactions. Speeding up or slowing down of reactions. Fatigue or loss of energy. Feelings of worthlessness or guilt. Reduced concentration or decision-making skills. Recurrent thoughts of death or suicide. Must be present for 2 weeks and occur nearly every day. Must be present for 2 weeks and occur nearly every day. At least 15% of depressed individuals commit suicide. At least 15% of depressed individuals commit suicide.

24. Mood Disorders Bipolar Disorder Formerly called Manic Depressive Disorder. Characterized by ups and downs in mood (manic and depressive phases). Formerly called Manic Depressive Disorder. Characterized by ups and downs in mood (manic and depressive phases). Manic phase is abnormally elevated: inflated self-esteem, irritability, restlessness, racing thoughts, difficulty concentrating. Manic phase is abnormally elevated: inflated self-esteem, irritability, restlessness, racing thoughts, difficulty concentrating. Can also involve delusions, hallucinations, or impulsivity – it can be very disruptive. Can also involve delusions, hallucinations, or impulsivity – it can be very disruptive. Depressive phase has the same symptoms as depression. Depressive phase has the same symptoms as depression.

25. Schizophrenia Schizophrenia Schizophrenia is usually considered one of the most serious of the psychological disorders. Schizophrenia is usually considered one of the most serious of the psychological disorders. It is characterized by a loss of contact with reality. It is characterized by a loss of contact with reality. Hallucinations - both visual and auditory. Hallucinations - both visual and auditory. Delusions - over-confidence, paranoia, existence. Delusions - over-confidence, paranoia, existence. Mental processes – illogical thought patterns, repetition, disorganized speech. Mental processes – illogical thought patterns, repetition, disorganized speech. Social withdrawal - loss of social skills, loss of emotion. Social withdrawal - loss of social skills, loss of emotion. Catatonic stupor – immobile, coma-like state. Catatonic stupor – immobile, coma-like state. http://www.youtube.com/watch?v=UTUMt05_nCI&feature=related http://www.youtube.com/watch?v=UTUMt05_nCI&feature=related http://www.youtube.com/watch?v=UTUMt05_nCI&feature=related

26. Schizophrenia Types of Schizophrenia - I DSM-IV categorizes schizophrenia as lasting at least 6 months, along with a combination of the previously listed symptoms. DSM-IV categorizes schizophrenia as lasting at least 6 months, along with a combination of the previously listed symptoms. Three types of schizophrenia are paranoid, disorganized, and catatonic. Three types of schizophrenia are paranoid, disorganized, and catatonic.

27. Schizophrenia Types of Schizophrenia - II Paranoid schizophrenia: Characterized by delusions or frequent auditory hallucinations, relating to a single theme. Paranoid schizophrenia: Characterized by delusions or frequent auditory hallucinations, relating to a single theme. May be delusions of grandeur, persecution or jealousy. May be delusions of grandeur, persecution or jealousy. May be caused by problems in early brain development. May be caused by problems in early brain development. Too many or too few connections in pathways of emotional development. Too many or too few connections in pathways of emotional development. May also be caused by adolescent brain growth in the prefrontal cortex. May also be caused by adolescent brain growth in the prefrontal cortex.

28. Schizophrenia Types of Schizophrenia - III Disorganized schizophrenia is characterized by incoherent thought and speech and disorganized behavior. Disorganized schizophrenia is characterized by incoherent thought and speech and disorganized behavior. Also may have hallucinations or delusions, but these are fragmented and unconnected. Also may have hallucinations or delusions, but these are fragmented and unconnected. Exhibit extremes of emotion. Exhibit extremes of emotion. Neglecting of appearance and hygiene. Neglecting of appearance and hygiene.

29. Schizophrenia Types of Schizophrenia - IV Catatonic schizophrenia is characterized by a disturbance of movement or mobility. Catatonic schizophrenia is characterized by a disturbance of movement or mobility. Activity may slow down or turn quickly to agitation. Activity may slow down or turn quickly to agitation. Patients may hold unusual or uncomfortable body positions of long periods of time, to the point that limbs may swell and stiffen. Patients may hold unusual or uncomfortable body positions of long periods of time, to the point that limbs may swell and stiffen. May also echo what others are saying (echolalia) or mimic the movements of others (echopraxia). May also echo what others are saying (echolalia) or mimic the movements of others (echopraxia).

30. Personality Disorders Personality disorders are patterns of inflexible traits which disrupt social or work life and/or distress the individual. Personality disorders are patterns of inflexible traits which disrupt social or work life and/or distress the individual. Usually show up in late adolescence and may affect all aspects of personality. Usually show up in late adolescence and may affect all aspects of personality. Personality disorders must be differentiated from other disorders. Personality disorders must be differentiated from other disorders. Schizophrenia, phobias and OCD are all episodes of an illness. Schizophrenia, phobias and OCD are all episodes of an illness. Personality disorders represent enduring traits that are major components of personality. Personality disorders represent enduring traits that are major components of personality.

31. Personality Disorders Types of Personality Disorder Paranoid: Suspicious and distrustful Paranoid: Suspicious and distrustful Schizoid: Detachment from social relationships. Schizoid: Detachment from social relationships. Schizotypal: Eccentricities and social discomfort. Schizotypal: Eccentricities and social discomfort. Antisocial: Disregard of the rights of others. Antisocial: Disregard of the rights of others. Borderline: Instability in relationships or self- concept. Borderline: Instability in relationships or self- concept. Histrionic: Excessive emotionality or need for attention. Histrionic: Excessive emotionality or need for attention. Narcissistic: Need for admiration, lack of empathy. Narcissistic: Need for admiration, lack of empathy. Avoidant: Social inhibition and inadequacy. Avoidant: Social inhibition and inadequacy. Dependent: Over-dependent on others or clinging. Dependent: Over-dependent on others or clinging. Obsessive-Compulsive: Obsession with perfection, neatness or control Obsessive-Compulsive: Obsession with perfection, neatness or control