1. PSYCHOLOGICAL DISORDERS AP Psychology Myers, Ch. 16 With your neighbors… define “psychological disorder.” - What are the key elements?

2. Defining Psychological Disorders ■Psychological disorder – a psychological condition characterized by patterns of behaviors and/or thinking patterns that are UMAD Unusual, not shared by many others Makes oneself and/or others uncomfortable Harmful to oneself and/or others Irrational, does not make sense to most people UnjustifiableMaladaptive AtypicalDisturbing *** CHANGE FROM TEXTBOOK***

3. Understanding Psychological Disorders ■Until the late 1800s, psychological disorders were attributed to evil spirits, demonic possessions, or star movements. ■With greater scientific knowledge came a shift to viewing psychological disorders using the medical model –the concept that psychological disorders are sicknesses/diseases that have physical causes, thus can be diagnosed and hopefully cured

4. Understanding Psychological Disorders ■Psychopathology – the study of mental illnesses ■Biospychosocial approach –Bio: evolution, individual genes, brain structure/chemistry –Psycho: stress, trauma, mood-related perceptions and memories –Social: societal norms, influence of expectations and roles ■“Insane” = LEGAL term, not clinical –Often we say “insane” or “crazy” when we are confused or uncomfortable.

5. Classifying and Diagnosing Psychological Disorders ■DSM 5 (May 2013) –Diagnostic and Statistical Manual of Mental Disorders –Published by the American Psychiatric Association (applicable to the US) –A widely used system for classifying psychological disorders. –DSM-5 changesDSM-5 changes ■Side note… are there 2 APA’s? –“the bigger APA” - American PSYCHOLOGICAL Association –“the little APA” – American PSYCHIATRIC Association *** CHANGE FROM TEXTBOOK***

6. Classifying and Diagnosing Psychological Disorders ■Disorders are diagnosed using the DSM based on standardized assessments, interviews, and observations. ■Previous versions of the DSM used 5 axes, used to code different kinds of disorders and illnesses - NOT used in the DSM-5! AxisCategory Axis IClinical psychological syndromes (mood, anxiety, dissociative, sleep, sexual, substance-related, schizophrenia, eating, etc) Axis IIPersonality disorders Mental retardation Axis IIIGeneral medical conditions (diabetes, hypertension, arthritis) Axis IVPsychosocial or Environmental problems (social/environmental stressors Axis VGlobal Assessment of Functioning

7. Classifying and Diagnosing Psychological Disorders ■Neurodevelopmental Disorders ■Schizophrenia Spectrum and Other Psychotic Disorders ■Bipolar and Related Disorders ■Depressive Disorders ■Anxiety Disorders ■Obsessive-Compulsive and Related Disorders ■Trauma- and Stressor-Related Disorders ■Dissociative Disorders ■Somatic Symptom and Related Disorders ■Feeding and Eating Disorders ■Elimination Disorders ■Sleep-Wake Disorders ■Sexual Dysfunctions ■Gender Dysphoria ■Disruptive, Impulse-Control, and Conduct Disorders ■Substance-Related and Addictive Disorders ■Neurocognitive Disorders ■Personality Disorders ■Paraphilic Disorders ■Other Disorders ■Medication-Induced Movement Disorders and Other Adverse Effects of Medication ■Other Conditions That May Be a Focus of Clinical Attention

8. Labeling Psychological Disorders PRO ■Communication between health professionals about care and therapy. ■Common vocabulary for research and treatment. ANTI ■Labels can stigmatize people. ■Labels can distort a person’s perception of themselves (affecting their well-being) and others’ perceptions of them (affecting treatment). David Rosenhan (1973David Rosenhan (1973) – found that the label of a psychological disorder caused others to think of the disorder as the central personality trait  “stickiness of the diagnostic label” Labeling symptoms as disorders and labeling people as having disorders have real consequences.

9. ADHD Attention-Deficit Hyperactivity Disorder

10. ■Category – Neurodevelopmental Disorders ■a psychological disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity (pg. 31) ■Must display 5+ (adults) or 6+ (children) symptoms in either/both inattention and hyperactivity/ impulsivity categories for at least 6 months *** CHANGE FROM TEXTBOOK***

11. ADHD Debate Genuine Disorder ■ADHD is a real neurological disorder that is inheritable ■can be studied using brain imaging techniques ■not caused by too much sugar or boring classes ■treatable with medications (such as Ritalin or Adderall) and behavioral therapies (help modify behaviors in the classroom and at home) Over-Diagnosed ■ADHD diagnoses have been on the rise for 2 decades ■more children are unnecessarily on medication ■ADHD rates differ in different counties and states ■adults also accept the diagnosis and use it to account for life failings Bottom line – ADHD symptoms are disruptive and can be treated with medication and therapy.

12. Famous ADHD Sufferers ■Walt Disney ■Whoopi Goldberg ■Justin Timberlake ■Will Smith ■Michael Phelps ■Jim Carrey ■Suzanne Somers ■Cher

13. ANXIETY DISORDERS Psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.

14. In your packet… ■Take the first test labeled “Taylor Manifest Anxiety Scale.” (Handout 16-7) ■Answer True or False as it concerns you. ■I will read a list of “true” responses – if your response is also “true” – circle the number. ■Add all matched “true” responses. ■Average college student – 14/15

15. DisorderCharacteristics Generalized Anxiety Disorder Continually tense and apprehensive for 6+ months Cannot identify, avoid, or cope with anxiety source Panic Disorder Unpredictable minutes long panic attacks Attacks – several minutes, resembles heart attack Often accompanies other anxiety disorders PhobiasPersistent, irrational fear and avoidance of a specific object or situation that disrupts normal life 1. Agorophobia (fear of inability to escape situation) 2. Social phobia 3. Object phobias

16. In your packet… ■Take the test labeled “Handout 16-10.” ■Follow the instructions and calculate your score. ■Social phobia – 52.4 ■Anxiety – 28.0 ■No diagnosis – 22.3

17. Common/Interesting Phobias AcrophobiaHeightsAquaphobiaWater GephyrophobiaBridgesOphidiophobiaSnakes AerophobiaFlyingAstraphobiaLightning HerpetophobiaReptilesPhonophobiaSpeaking loudly MikrophobiaGermsBrontophobiaThunder AilurophobiaCatsPyrophobiaFire MurophobiaMiceClaustrophobiaClosed spaces AmaxophobiaVehicles, drivingThanatophobiaDeath NumerophobiaNumbersCynophobiaDogs AnthophobiaFlowersTrichphobiaHair NyctophobiaDarknessDementophobiaInsanity AnthrophobiaPeopleXenophobiaStrangers OchlophobiaCrowdsOrnithiophobiabirds

18. PTSD Posttraumatic Stress Disorder

19. ■Category – Trauma- and Stressor-Related Disorders ■A psychological disorder characterized by haunting memories, nightmares, social withdrawal, anxiety, and/or insomnia that lingers for at least 4 weeks after a traumatic experience ■Traumatic experience – exposure to actual or threatened death, serious injury, or sexual violence –directly experiences the traumatic event; –witnesses the traumatic event in person; –learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or –experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related). *** CHANGE FROM TEXTBOOK***

20. OCD Obsessive-Compulsive Disorders

21. In your packet… ■Take the test labeled “Handout 16-11.” ■Follow the instructions and calculate your score. ■OCD diagnosis: 28+

22. Obsessive-Compulsive Disorder ■Psychological disorders characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions). ■Must disrupt everyday life ■Trichotillomania - hair-pulling ■Excoriation - skin-picking ■Hoarding disorder – difficulty discarding or parting with possessions, regardless of actual value *** CHANGE FROM TEXTBOOK***

23. Obsession vs. Compulsion OBSESSION (Thought)COMPULSION (Ritual) A young woman is continuously scared that a car will hit her when she walks on the sidewalk. She always walks as far from the street pavement as possible and wears red clothes so that she will be immediately visible to cars. A mother is tormented by the concern that she will contaminate her family’s food while cooking. Everyday she sterilizes all cooking utensils in boiling water, scours every pot and pan before placing food in it, and wears rubber gloves while handling food. A college student has the urge to yell obscenities while sitting through lectures in class. Carefully monitoring his watch, he bites his tongue every 60 seconds to ward off the inclination to shout. A young boy worries incessantly that something terrible might happen to his mother while sleeping at night. On his way to bed each night, he climbs the stairs in the same sequence of three steps up, followed by two steps down in order to ward off the danger.

24. OCD Common thought/behavior % Reporting Symptom OBESSIONS (thoughts) Concern with dirt, germs, toxins40 Something terrible happening24 Symmetry, order, exactness17 COMPULSIONS (rituals, behaviors) Excessive hand-washing, bathing, or grooming 85 Repeating rituals (in/out of a door, up/down in a chair) 51 Checking doors, locks, appliances, car brakes, homework 46

25. Famous OCD Sufferers ■Charles Darwin ■Howard Hughes ■Marc Summers ■Howie MandelHowie Mandel ■Megan Fox ■Crash Course Anxiety/OCDCrash Course Anxiety/OCD

26. Explaining Anxiety Disorders, PTSD, and OCD Nature ■Biological to fear certain things: snakes, spiders, closed spaces, darkness, heights  natural selection ■Twins show similar anxiety levels ■Brain activity –Amygdala – fear –OCD and overactive anterior cingulate cortex – monitors behaviors and checks for errors Nurture ■General anxiety and fear with classical conditioning –Ex: :Little Albert ■Observational learning –Learning fears through observing others

27. MDD Major Depressive Disorder

28. In your packet… ■Take the test on the first page labeled “Handout 16-14.” ■Read and follow the instructions. ■Carefully calculate your score. ■50-59 = mild depression ■60-69 = moderate depression ■70-79 = severe depression

29. Major Depressive Disorder ■Category – Depressive Disorders ■A psychological disorder characterized by depressed mood and/or loss of interest/pleasure and 4+ other identifying symptoms for 2+ weeks –Significant weight loss/gain –Daily insomnia or hypersomnia –Psychomotor agitation or retardation –Daily Fatigue or loss of energy –Inability to concentrate –Indecisiveness –Recurrent thoughts of death, suicide, or suicide attempt ■Subcodes for severity and presentation with other disorders ■If persistent for 2+ years  Persistent Depressive Disorder (Dysthymia) ■Depression is the top reason people seek mental health help. *** CHANGE FROM TEXTBOOK***

30. BIPOLAR DISORDER

31. Bipolar Disorder ■Category – Bipolar and Related Disorders –Formerly called “manic-depression’ ■A psychological disorder characterized by fluctuating manic and depressive episodes –Mania – period of abnormally elevated mood, hyperactivity, increased energy, and inflated self-esteem ■Bipolar I is more severe than Bipolar II *** CHANGE FROM TEXTBOOK***

32. Suicide – 1 million/year worldwide Racial Differences White Americans are nearly twice as likely as black Americans to kill themselves Gender Differences Women are much more likely than men to attempt suicide, but men are 2-4 times more likely to succeed. Men use more brutal methods such as a bullet in the head (6 of 10 US suicides). Age Differences Suicide rate surges among older men, also common among teenage-young adult males Other Differences Suicide rates are higher among the rich, the nonreligious, and those who are single, divorced, or widowed. Gay and lesbian youth are more likely to attempt suicide than their heterosexual counterparts.

33. Suicide ■Depression makes a person 5 times more likely to attempt suicide, however while in a depressed state, people seldom commit suicide (less energy, motivation). ■Teenage suicides often follow a traumatic event, such as a break-up or bad social experience; and are also linked with drug and alcohol abuse. ■Those addicted to alcohol are 100 times more likely to commit suicide. ■Following highly publicized suicides or TV programs featuring suicide, suicidal acts are likely to follow.

34. Suicide ■1/3 of people who commit suicide have tried before. ■Few who talk of suicide or think suicidal thoughts actually attempt suicide, and few of those are successful. However, if a friend or family member speaks of suicide, it is important to listen and direct them to professional help.

35. Explaining MDD and Bipolar Disorder Nature ■Mood related disorders are heritable ■Scarcity of norepinephrine and serotonin ■Left-frontal lobe inactivity ■7% smaller frontal lobe Nurture ■Negative appraisal of events ■Learned helplessness ■Pessimism ■Rise of individualism and decline of family/religion? ■Chicken-or-the-egg: depressive state and negative emotions/beliefs  BREAK the cycle!

36. Famous MDD and Bipolar Disorder Sufferers Major Depressive Disorder ■Abraham Lincoln ■Woody Allen ■Bob Dylan ■Winston Churchill ■Audrey Hepburn ■Marilyn Monroe Bipolar Disorder ■Kurt Cobain ■Robin Williams ■Russell Brand ■Carrie Fischer ■Ernest Hemingway ■Amy Winehouse Crash Course – Depression/Bipolar

37. DISSOCIATIVE DISORDERS Psychological disorders in which conscious awareness becomes separated (disassociated) from previous memories, thoughts, and feelings

38. DisorderCharacteristics Dissociative Identity Disorder (DID) AKA multiple personalities Two or more distinct and alternating personalities marked by discontinuity in sense of self, mood, memory, cognition, and perception. Rare and contested Possibly a coping mechanism for anxiety or PTSD Dissociative Fugue Sudden and unexpected travel away from home/work/life with an inability to recall autobiographical information Dissociative amnesia – loss of personal identity, but no travel

39. DID Debate Supporters ■Different brain and body states with different personalities ■Handedness can also change with personalities Skeptics ■Why so prevalent in the late 20 th century? ■Jump from 3 to 12 personalities? ■Why not prevalent outside of North America ■Disorder created by therapists and clients in a certain social context.

40. SOMATOFORM DISORDERS Psychological disorders characterized by symptoms that suggest physical illness or injury but cannot be explained fully by a medical condition, a drug substance, or another mental disorder

41. DisorderCharacteristics Hypocondriasis Excessive preoccupancy or worry about having a serious illness Often accompanied by other disorders, mainly anxiety disorders and OCD Conversion Disorder Blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation, likely the physical manifestation of psychological anxiety Mind-over-matter

42. SCHIZOPHRENIA

43. Schizophrenia ■A group of severe disorders characterized by disorganized thinking, disturbed perception, and inappropriate emotions and actions. –Literally means “split mind” – mind is splitting from reality –1 /100 people (1/10 if familial history) –24 million worldwide –Typically strikes during young adulthood –Men are afflicted more often, earlier in life, and more severely

44. Schizophrenia’s Characteristics Disorganized thinking Delusions – false BELIEFS (usually about persecution or grandeur) I AM Santa Claus. I KNOW the FBI is following me. Can result in paranoia and withdrawal from social activities Possibly results from a breakdown of selective attention Disturbed perceptions Hallucinations – false PERCEPTIONS (usually auditory voices) I FEEL bugs crawling under my skin. I HEAR voices telling me the FBI is following me. Voices can speak in sentences or just words; mostly negative.

45. Inappropriate emotions and actions Inappropriate emotions laughing at a family member’s death becoming angry for no reason crying for no reason Flat effect – an apathetic, zombielike state Compulsive acts Rubbing an arm Continuous rocking Catatonia – remaining motionless for extended periods of time Schizophrenia’s Characteristics Symptoms must impair social and occupational activities AND be present for 6+ months, with 1 month active symptoms.

46. Schizophrenia Subtypes (no longer used in DSM 5) TypeCharacteristics ParanoidMost common Auditory hallucinations Delusions about persecution or conspiracy DisorganizedLess hallucinations/delusions Disorganized speech or behavior (word salad) Difficulty performing basic tasks Inappropriate emotions CatatonicDisturbances in movement Catatonic state – withdrawal and immobility Parrotlike repeating of another’s speech or movements UndifferentiatedMany and varied symptoms that cannot be categorized into a particular subtype ResidualAfter hallucinations, delusions, and other symptoms have mostly disappeared Managed but may need support There is not “a typical case” of schizophrenia, therefore the subtypes are too rigid. *** CHANGE FROM TEXTBOOK***

47. Schizophrenia Symptoms Positive Symptoms Presence of inappropriate behaviors Hallucinations, delusions, disorganized speech, inappropriate actions Negative Symptoms Absence of appropriate behaviors Toneless voice, catatonia, flat effect Baseline for typical behaviors

48. Schizophrenia Onset Slow developing Recovery is doubtful Chronic or Process Schizophrenia Quickly developed, possibly due to stress or traumatic event Recovery is hopeful Acute or Reactive Schizophrenia

49. Understanding Schizophrenia Biological Roots ■Dopamine hypothesis - schizophrenia is related to over- activity of dopamine in the brain. –medication (antipsychotics) can lessen dopamine activity –amphetamines (like stimulant drugs) can worsen symptoms ■Paranoid – more activity in amygdala ■Shrinkage of tissue and enlargement of fluid-filled areas ■Appears to be heritable – 1 in 10 with a parent/sibling will develop schizophrenia

50. Understanding Schizophrenia Fetal Development and Genes ■Mid-pregnancy during flu season ■Low birth weight ■Oxygen deprivation ■Appears to be heritable – 1 in 10 with a parent/sibling will develop schizophrenia Early Warning Predictors ■Family history ■Oxygen deprivation and low birth weight. ■Short attention span and poor muscle coordination ■Disruptive or withdrawn behavior ■Emotional unpredictability

51. Schizophrenia – Nature and Nurture ■Diathesis-stress model –Behaviors are a result of both biological (nature) factors and life experiences (nurture). ■Schizophrenia –Nature – family studies show that schizophrenia is in part heritable (family studies, 1/10 if parent has disease; 1/100 if not) –Nurture – stressful or traumatic events can trigger the onset of schizophrenia

52. Famous Schizophrenics ■There are few famous schizophrenics due to its early-life development and impairment ■Mary-Todd Lincoln (possibly bipolar) ■Jack Kerouac ■Eduard Einstein (son of Albert) ■Syd Barrett ■Crash Course Schizophrenia/DissociativeCrash Course Schizophrenia/Dissociative

53. PERSONALITY DISORDERS Psychological disorders characterized by inflexible and enduring behavior and cognitive patterns that impair social functioning and appear in early adulthood

54. Personality Disorders ■PDs can appear similar to psychological disorders, however personality disorders are enduring and inflexible, therefore difficult to treat or cure with medication or psychotherapy. ■10 distinct types: –paranoid personality disorder, –schizoid personality disorder –schizotypal personality disorder –antisocial personality disorder –borderline personality disorder –histrionic personality –narcissistic personality disorder –avoidant personality disorder –dependent personality disorder –obsessive-compulsive personality disorder

55. Cluster A: “ODD” PDCharacteristics ParanoidDistrust and suspiciousness of others Occurs outside of the course of schizophrenia, bipolar disorder, or other disorders with psychotic features SchizoidDetachment from social relationships and little/no emotional expression Lack of relationships due to indifference/apathy Occurs outside of the course of schizophrenia, bipolar disorder, or other disorders with psychotic features, or autism spectrum disorder SchizotypalDiscomfort in social settings with cognitive and perceptual distortions and eccentricities of behavior (ex: magical thinking, superstitious beliefs) Lack of relationships due to discomfort with others Occurs outside of the course of schizophrenia, bipolar disorder, or other disorders with psychotic features, or autism spectrum disorder

56. Cluster B: “DRAMATIC” PDCharacteristics AntisocialDisregard for and violation of the rights of others, impulsivity, lack of remorse, aggressiveness Onset before age 15 Occurs outside of the course of schizophrenia or bipolar disorder BorderlineInstability of interpersonal relationships, self-image, and moods Suicidal threats/attempts and self-mutilation are common HistrionicExcessive emotionality and attention seeking Easily suggestible, displays inappropriate sexual activity NarcissisticGrandiose sense of self-importance, need for admiration, lack of empathy, manipulative/exploitative, arrogant

57. Cluster C: “ANXIOUS” PDCharacteristics AvoidantSocial inhibition, feelings of inadequacy, hypersensitivity to negative evaluation Hesitant to establish relationships DependentExcessive need to be taken care of that leads to submissive and clinging behavior and fears of separation Indecisiveness and difficulty initiating tasks Obsessive- Compulsive Preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency Crash Course – Personality Disorders

58. In your packet… ■Take the test labeled “Handout 16-20.” ■Reply True or False. ■Mark each “True” response that matches the responses I call out. Then total your responses. ■1500 college students –Males – 8.56 –Females – 9.69

59. In your packet… ■Take the test titled “Handout 16-22” – Personality Inventory. ■Circle true or false for each statement as it relates to you. ■Add number of “true” responses. ■Male mean – 6.5 ■No female data

60. Rate of Psychological Disorders % of Americans who have experienced selected psychological disorders in the prior year (2002) Alcohol abuse5.2 % Generalized anxiety4.0 Phobias7.8 OCD2.1 Mood disorder5.1 Antisocial personality1.5 Any mental disorder14.9