1. P S Y C H O L O G Y T h i r d E d i t i o n by Drew Westen PowerPoint  Presentation C h a p t e r 15 P S Y C H O L O G I C A L D I S O R D E R S John Wiley & Sons, Inc.

2. Lecture Outline n Definitions of Psychopathology n Perspectives on Psychopathology n Diagnostic Systems © 2002 John Wiley & Sons, Inc.

3. Psychopathology n Psychopathology refers to problematic patterns of thought, feeling, and behavior  Disrupted functioning at home, work, and in the person’s social life  Patterns that cause distress in the person or in others  Psychopathology literally means sickness of the mind n Psychopathology varies between and within cultures © 2002 John Wiley & Sons, Inc.

4. Labeling of Mental Illness n The notion of abnormality carries with it the presumption that we can define what is and in not abnormal  Labeling theory argues that diagnoses of abnormality are but labels we use for people who we consider deviant  Rosenhan study: “Pseudo”-patients claimed to hear voices and were admitted to various psychiatric hospitals. Rosenhan noted that no hospital detected them as fakes. The study suggests support for labeling theory. © 2002 John Wiley & Sons, Inc.

5. Psychodynamic Perspective n The psychodynamic perspective recognizes three classes of pathology:  Neuroses refer to issues in living that involve anxiety (phobias) or interpersonal conflict  Personality disorders are chronic and severe disturbances that alter the capacity to work and to love  Psychoses refer to marked disturbances of contact with reality  These classes form a continuum of functioning from minimal to serious disturbance © 2002 John Wiley & Sons, Inc.

6. Psychodynamic View of Psychopathology © 2002 John Wiley & Sons, Inc.

7. Biological Perspective on Psychopathology n The biological perspective seeks the roots of abnormal behavior within the brain n The biological view holds that brain disturbance results in mental changes  Gross pathology of the brain: damage to the frontal lobes associated with syphilis  Disturbance of neurotransmitter function Schizophrenia as too much dopamine Depression as too little serotonin © 2002 John Wiley & Sons, Inc.

8. Systems Perspective n The systems perspective seeks the roots of abnormality in the broad social context  Each person is a member of a social group  The group functions as a system and the system parts are interdependent A change in one member may influence other members A father may show evidence of anxiety that is traced to his children: Father is the symptom bearer –Son arrested for driving while intoxicated –Daughter runs away from home © 2002 John Wiley & Sons, Inc.

9. Descriptive Diagnosis n The current diagnostic system assumes that we can distinguish normal from abnormal  Abnormality is reflected in discrete symptoms  As in physical illness, symptoms fall into discrete clusters called syndromes  Syndromes are assumed to have discrete causes and are to be treated using different therapies  This system is based on the medical model © 2002 John Wiley & Sons, Inc.

10. DSM-IV n The American Psychiatric Association published a diagnostic manual that attempts to classify signs and symptoms into syndromes  Signs are observable phenomena (temperature)  Symptoms are reports from patients (headache) n The current edition is termed the DSM-IV  The DSM-IV uses a multi-axial system of diagnosis The axes cover symptoms as well as medical conditions, stress, and current level of function © 2002 John Wiley & Sons, Inc.

11. The Axes of DSM-IV © 2002 John Wiley & Sons, Inc. AxisDescription ISymptoms that cause distress IIPersonality disorders and mental retardation IIIMedical conditions that may be relevant to understanding or treating a psychological disorder IVPsychosocial and environmental problems VGlobal assessment of functioning (Source: DSM-IV, American Psychiatric Association, 1994)

12. Childhood Disorders n Attention-Deficit Hyperactivity Disorder is characterized by inattention, impulsiveness, and hyperactivity  Prevalence of ADHD is likely 3-5% of school- aged children, more common in boys  ADHD is often treated with Ritalin n Conduct Disorder refers to the child who persistently violates rules and norms  Prevalence is larger in boys than girls  Conduct disorder may reflect a problem in conditioning © 2002 John Wiley & Sons, Inc.

13. Substance-Related Disorders n Substance-Related Disorders refer to continued use of a substance (alcohol) that impairs social and physical functioning n Alcoholism is a common substance-related disorder  Some 13 million in the USA are alcoholic  Alcoholism is the 3rd largest cause of death  Heredity plays a large role in alcoholism Children of alcoholics are prone to developing alcoholism Male children are more likely than female children to develop alcoholism © 2002 John Wiley & Sons, Inc.

14. Nature Versus Nurture in Substance Abuse (Figure adapted from Kendler et al., 2000) © 2002 John Wiley & Sons, Inc.

15. Schizophrenia n Schizophrenia refers to a profound disturbance in human function including:  Thought: Illogical thought systems (delusions) and loosening of associations  Perception: Presence of hallucinations  Language: Word salad, disconnected ideas  Affect: Emotion (often flat or absent) n Symptoms can be viewed as:  Positive: Delusions are an added function  Negative: Signal the absence of a function (flat affect) © 2002 John Wiley & Sons, Inc.

16. Major Types of Schizophrenia © 2002 John Wiley & Sons, Inc. n Paranoid n Catatonic n Disorganized n Undifferentiated n Residual

17. Biological Basis of Schizophrenia n Diathesis-stress model proposes that some persons develop schizophrenia because of a underlying biological vulnerability(diathesis) that is compounded by stress n The heritability of schizophrenia is 50-83%  Risk of schizophrenia is 48% in monozygotic, 17% in dizygotic twins, and 9% in siblings n Dopamine hypothesis: schizophrenia reflects elevated levels of dopamine in brain  Paranoid schizophrenia is induced by chronic treatment with amphetamine, a drug that releases dopamine © 2002 John Wiley & Sons, Inc.

18. Diathesis-Stress Models of Schizophrenia © 2002 John Wiley & Sons, Inc.

19. Neural Atrophy in Schizophrenia n Neuron loss in brain results in a diminished volume of brain tissue  The fluid-filled ventricles enlarge to take up the volume n Enlarged ventricles are a common finding in schizophrenia  Atrophy of the frontal, temporal, and prefrontal cortex has been noted in schizophrenic patients: reflects brain damage  Note that negative symptoms induced by brain cell loss may not respond to drug treatment © 2002 John Wiley & Sons, Inc.

20. Mood Disorders n Mood disorders are characterized by disturbance of emotion and mood state  Mania refers to an excessive degree of happiness, and a belief the person can do anything  Major Depressive Disorder refers to a long-term episode of intense sadness, loss of appetite, and difficulty in sleeping Duration may be 5 months or more Women are twice as likely to have major depression (incidence is 2-3% for men and 5-9% for women) © 2002 John Wiley & Sons, Inc.

21. Mood Disorders, Continued n Dysthymia is a less severe type of depression  Symptoms of dysthymia are evident over longer time periods (two years) but are not as debilitating as those of major depression n Bipolar disorder involved alternating episodes of mania and depression  Lifetime risk is low (0.5-1.6%)  Appears more often in upper classes  Bipolar patients achieve high levels of education © 2002 John Wiley & Sons, Inc.

22. Theories of Depression n Depression may reflect a biological vulnerability and an environmental basis n The heritability of depression is about 30%  Twin studies show a clear role of genetics in depression n Effective antidepressant drugs alter serotonin activity (Prozac blocks the reuptake of serotonin) n Cognitive theories of depression note that depresses people have negative cognitive schemas about themselves © 2002 John Wiley & Sons, Inc.

23. Beck’s Negative Triad © 2002 John Wiley & Sons, Inc. (Figure adapted from Beck, 1976, p 256)

24. Anxiety Disorders n Anxiety disorders refer to feelings of distress, uneasiness, or apprehension n Types of anxiety disorders:  Phobias refer to an irrational fear of an object or situation Social phobia: a fear of being in a public situation  Panic Disorders are intense attacks of anxiety that are justified by the situation  Agoraphobia refers to anxiety associated with being in places or situations from which it might be difficult to escape (e.g. an elevator) © 2002 John Wiley & Sons, Inc.

25. Obsessive-Compulsive Disorder n An obsession is a persistent thought that cannot be controlled  “Did I lock the door?” n A compulsion is an intentional behavior (ritual) that occurs in response to a thought  Check the door (22 times) n Key aspect is that OC persons experience anxiety if they are unable to complete their ritual © 2002 John Wiley & Sons, Inc.

26. Copyright Copyright 2002 by John Wiley & Sons, Inc., New York, NY. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the copyright owner. © 2002 John Wiley & Sons, Inc.