1. Psychological disorders
Abnormal vs. normal
The 4 D’s
The 3 C’s plus norms, zeitgeist
Explanations
various psychological and personality theories
Classifying psychological disorders
History
Diagnostic and statistical Manual
Major psychological disorders
Anxiety
Somatoform & dissociative
Mood
Psychotic
Personality disorders

2. Abnormal vs. normal Dialectic thinking The 4 D’s
Opposite concepts define each other (thesis – antithesis)
The 4 D’s
Deviance (statistical, not judgmental)
Distress
Danger
Dysfunction

3. Abnormal vs. normal The 3 C’s
Contents (what a person does, maladaptive, irrational, unpredictable)
Context (When and where a BX occurs )
Consequences (Distress or suffering)
Norms (Age gender culture historical period)

4. Theoretical explanations for psychological disorders
Biological
Psychodynamic
Behavioral
Cognitive
Humanistic – existential
Social cultural
Bio-psycho-social

5. Theories, continued Diathesis- stress model
Also known as the vulnerability – stress model
Assumes a predisposition that will only present with sufficient and disorder specific stress
Classic example in biology is heart disease
Psychology examples include cognitive models of depression
For example relationship oriented vs. achievement oriented

6. Cultural issues Constructivist vs Objectivist definitions
Definitions of normality to a large degree are based on cultural traditions.

7. Epidemiology Study of prevalence and cause of disease
Etiology : study of cause
Prevalence
Point
Lifetime
Point
Lifetime
Source
Schizophrenia
0.3–0.7%
Wikipedia 2012
Bipolar
1.0%
Depression
3-6% ♂
8-10% ♀
17%

8. DSM History
DSM stands for The Diagnostic & Statistical Manual of mental disorders
DSM I 1952
DSM II
Homosexuality removed as a disorder, 1973
DSM III 1980
Descriptive vs theoretical (atheoretical)
DSM III-R 1989
DSM-IV 1994
DSM- V 2013
Major overhaul

9. Classification DSM IV 5 Axes Axis I Major Mental disorders
Axis II notes personality disorders and mental retardation
Axis III reflect any relevant physical conditions
Axis IV records any psychosocial or environmental problems
Axis V has a rating of one's current level of psychological social functioning

10. DSM Benefits Criticisms Increased interrelater reliability
Reliability improved for some, not all
Validity improved for some, not many
Qualitative differences between health/non-health
Discrete categories
vs dimension (or 3rd variable, eg, “negative emotionality”)
Same sx in different categories
Subjectivity inherent

11. DSM-V are they more like theoretical constructs or more like diseases;
how to reach an agreed definition;
whether the DSM-V should take a cautious/conservative approach;
the role of practical rather than scientific considerations;
the issue of use by clinicians or researchers;
and whether an entirely different diagnostic system is required

12. Anxiety Disorders Biological factors Psychological factors
Some people appear to have inherited predispositions
norepinephrine, serotonin may be factors
Psychological factors
People with anxiety disorders may exaggerate dangers of some stimuli while underestimating their own ability to deal with them

13. Anxiety Disorders
Key commonality is physiological: heart rate, breathing, sweating, dry mouth, sense of dread
Fear/anxiety
phobia
generalized anxiety disorder
Panic disorder
obsessive compulsive disorder
PTSD

14. Phobia Often phobias are experienced as irrational Simple or specific
Classic, typically afraid of a specific object or situation:
Spiders, Heights, Etc.
Social
Major fear his of humiliation and/embarrassment
Avoids opportunities that could put them into a position of ridicule:
Eating in public, public restrooms, public speaking
Agora
Fear of being separated from a safe place or person

15. Generalized Anxiety Disorder
A nonspecific experience of anxiety, worry
This excessive worry often interferes with daily functioning, as individuals suffering GAD typically anticipate disaster, and are overly concerned about everyday matters such as health issues, money, death, family problems, friend problems, relationship problems or work difficulties.
Often comorbid with dysthymia

16. Panic Disorder Attack vs Disorder
Terror and fear of death, going crazy
Often experienced as coming from out of the blue
Hyper sensitivity to physiological changes
Cognitive tendency to catastrophize those changes

17. OCD
Obsessive compulsive disorder is characterized by obsessions and compulsions
Obsessions are thoughts the create anxiety
The thoughts made be about germs dirt or graphically violent thoughts
Compulsions temporarily reduce that anxiety

18. PTSD Trauma defined Acute vs. post
Acute occurs within 30 days of trauma, post occurs after
Symptoms include avoidance of anything that could remind a person of trauma
Flashbacks and nightmares

19. Somatoform Disorders Physical ailments without physical cause
Earliest forms were targeted by Freud
(Anna O)
Conversion
Hypochondriasis
Somatization (Briquettes)
Pain Disorder

20. Somatoform
Over the course of the 20th century numerous studies convinced medical and clinical researchers that psychological factors, such as stress, worry, and perhaps even unconscious needs, can contribute to bodily illness

21. Somatoform
Sometimes when physicians cannot find a medical cause for a patient’s symptoms, he or she may suspect other factors are involved.
Patients may malinger, intentionally fake illness to achieve external gain (e.g., financial compensation, military deferment)
Patients may be manifesting a factitious disorder - intentionally producing or faking symptoms simply out of a wish to be a patient

22. Somatoform
Known popularly as Munchausen syndrome, people with a factitious disorder often go to extremes to create the appearance of illness
Many secretly give themselves medications to produce symptoms
Patients often research their supposed ailments and are impressively knowledgeable about medicine

23. Somatoform
Conversion disorder often is hard to distinguish from genuine medical problems
It is always possible that a diagnosis of conversion disorder is a mistake and the patient’s problem has an undetected medical cause
Physicians sometimes rely on oddities in the patient’s medical picture to help distinguish the two
For example, conversion symptoms may be at odds with the known functioning of the nervous system, as in cases of glove anesthesia

24. Somatoform
People with a somatization pattern experience many long-lasting physical ailments that have little or no organic basis
Also known as Briquet’s syndrome
A sufferer’s ailments often include pain symptoms, gastrointestinal symptoms, sexual symptoms, and neurological symptoms
Patients usually go from doctor to doctor in search of relief

25. Somatoform Predominant pain pattern
If the primary feature of somatic symptom disorder is pain, the individual is said to have a predominant pain pattern
Although the precise prevalence has not been determined, this pattern appears to be fairly common
The pattern often develops after an accident or illness that has caused genuine pain
The pattern may begin at any age, and more women than men seem to experience it

26. Somatoform Tx Difficult to treat
Controversial: maybe not psychological but we don’t have the tech to dx
Hypochondriasis tx includes recommendation to Doctors to being open and setting the stage for the next doctor to do the same. Be honest, sincere, and supportive, but don’t feed the client’s anxieties or demands.

27. Dissociative Based on the Defense Mechanism Amnesia (not biological)
Think of your safe place rather than be present
Similar to hypnosis
Common in childhood (make believe friend)
Amnesia (not biological)
Fugue
Dissociative Identity Disorder
(DID, FKA Multiple Personality Disorder)

28. Dissociative
The key to our identity – the sense of who we are and where we fit in our environment – is memory
In dissociative disorders, one part of the person’s memory typically seems to be dissociated, or separated, from the rest

29. Dissociative
There are several kinds of dissociative disorders, including:
Dissociative amnesia
Dissociative identity disorder (multiple personality disorder)
Depersonalization-derealization disorder
These disorders are often memorably portrayed in books, movies, and television programs

30. Dissociative
People with dissociative amnesia are unable to recall important information, usually of a stressful nature, about their lives
The loss of memory is much more extensive than normal forgetting and is not caused by physical factors
Often an episode of amnesia is directly triggered by a specific upsetting event

31. Dissociative Dissociative amnesia may be:
Localized – most common type; loss of all memory of events occurring within a limited period
Selective – loss of memory for some, but not all, events occurring within a period
Generalized – loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends
Continuous – forgetting continues into the future; quite rare in cases of dissociative amnesia

32. Dissociative
All forms of the disorder are similar in that the amnesia interferes mostly with a person’s memory for personal material
Memory for abstract or encyclopedic information – usually remains intact
Clinicians do not known how common dissociative amnesia is, but many cases seem to begin serious threats to health and safety

33. Dissociative
An extreme version of dissociative amnesia is called dissociative fugue
Here persons not only forget their personal identities and details of their past, but also flee to an entirely different location
For some, the fugue is brief – a matter of hours or days – and ends suddenly
For others, the fugue is more severe: people may travel far from home, take a new name and establish new relationships, and even a new line of work; some display new personality characteristics

34. DISSOCIATIVE IDENTITY DISORDER
A person with dissociative identity disorder (DID, or multiple personality disorder) develops two or more distinct personalities, called “subpersonalities”, each with a unique set of memories, behaviors, thoughts, and emotions

35. DISSOCIATIVE IDENTITY DISORDER
At any given time, one of the subpersonalities dominates the person’s functioning
Usually one of these subpersonalities – called the primary, or host, personality – appears more often than the others
The transition from one subpersonality to the next (“switching”) is usually sudden and may be dramatic

36. DISSOCIATIVE IDENTITY DISORDER
Most cases are first diagnosed in late adolescence or early adulthood
Symptoms generally begin in childhood after episodes of abuse
Women receive the diagnosis three times as often as men

37. DISSOCIATIVE IDENTITY DISORDER
How do subpersonalities interact?
The relationship between or among subpersonalities varies from case to case
Generally there are three kinds of relationships:
Mutually amnesic relationships – subpersonalities have no awareness of one another
Mutually cognizant patterns – each subpersonality is well aware of the rest
One-way amnesic relationships – most common pattern; some personalities are aware of others, but the awareness is not mutual
Those who are aware (“co-conscious subpersonalities”) are “quiet observers”

38. DISSOCIATIVE IDENTITY DISORDER
How do subpersonalities interact?
Investigators used to believe that most cases of the disorder involved two or three subpersonalities
Studies now suggest that the average number is much higher – 15 for women, 8 for men
There have been cases of more than 100!

39. DISSOCIATIVE IDENTITY DISORDER
How do subpersonalities differ?
Subpersonalities often display dramatically different characteristics, including:
Identifying features
Subpersonalities may differ in features as basic as age, sex, race, and family history
Abilities and preferences
Although encyclopedic information is not usually affected by dissociative amnesia, in DID it is often disturbed
It is not uncommon for different subpersonalities to have different abilities, including being able to drive, speak a foreign language, or play an instrument

40. DISSOCIATIVE IDENTITY DISORDER
How do subpersonalities differ?
Subpersonalities often display dramatically different characteristics, including:
Physiological responses
Researchers have discovered that subpersonalities may have physiological differences, such as differences in autonomic nervous system activity, blood pressure levels, and allergies

41. DISSOCIATIVE IDENTITY DISORDER
How common is DID?
Traditionally, DID was believed to be rare
Some researchers even argue that many or all cases are iatrogenic; that is, unintentionally produced by practitioners
These arguments are supported by the fact that many cases of DID first come to attention only after a person is already in treatment
Not true of all cases

42. DISSOCIATIVE IDENTITY DISORDER
The psychodynamic view
Psychodynamic theorists believe that dissociative disorders are caused by repression, the most basic ego defense mechanism
People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness

43. DISSOCIATIVE IDENTITY DISORDER
The psychodynamic view
In this view, dissociative amnesia is a single episode of massive repression
DID is thought to result from a lifetime of excessive repression, motivated by very traumatic childhood events

44. DISSOCIATIVE IDENTITY DISORDER
The behavioral view
Behaviorists believe that dissociation grows from normal memory processes and is a response learned through operant conditioning:
Momentary forgetting of trauma leads to a drop in anxiety, which increases the likelihood of future forgetting
Like psychodynamic theorists, behaviorists see dissociation as escape behavior
Also like psychodynamic theorists, behaviorists rely largely on case histories to support their view of dissociative disorders
Moreover, these explanations fail to explain all aspects of these disorders

45. DISSOCIATIVE IDENTITY DISORDER
State-dependent learning
If people learn something when they are in a particular state of mind, they are likely to remember it best when they are in the same condition
This link between state and recall is called state-dependent learning
This model has been demonstrated with substances and mood and may be linked to arousal levels

46. DISSOCIATIVE IDENTITY DISORDER
Self-hypnosis
Although hypnosis can help people remember events that occurred and were forgotten years ago, it can also help people forget facts, events, and their personal identity
Called “hypnotic amnesia,” this phenomenon has been demonstrated in research studies with word lists
The parallels between hypnotic amnesia and dissociative disorders are striking and have led researchers to conclude that dissociative disorders may be a form of self-hypnosis

47. DISSOCIATIVE IDENTITY DISORDER
People with dissociative amnesia often recover on their own
Only sometimes do their memory problems linger and require treatment
In contrast, people with DID usually require treatment to regain their lost memories and develop an integrated personality
Treatment for dissociative amnesia tends to be more successful than treatment for DID

48. DISSOCIATIVE IDENTITY DISORDER
How do therapists help people with dissociative amnesia?
The leading treatments for these disorders are psychodynamic therapy, hypnotic therapy, and drug therapy
Psychodynamic therapists guide patients to search their unconscious and bring forgotten experiences into consciousness
In hypnotic therapy, patients are hypnotized and guided to recall forgotten events
Sometimes intravenous injections of barbiturates are used to help patients regain lost memories
Often called “truth serums,” the key to the drugs’ success is their ability to calm people and free their inhibitions

49. DISSOCIATIVE IDENTITY DISORDER
How do therapists help individuals with DID?
Therapists usually try to help the client by:
Recognizing the disorder
Once a diagnosis of DID has been made, therapists try to bond with the primary personality and with each of the subpersonalities
As bonds are forged, therapists try to educate the patients and help them recognize the nature of the disorder
Some use hypnosis or video as a means of presenting other subpersonalities
Many therapists recommend group or family therapy

50. DISSOCIATIVE IDENTITY DISORDER
How do therapists help individuals with DID?
Therapists usually try to help the client by:
Recovering memories
To help patients recover missing memories, therapists use many of the approaches applied in other dissociative disorders, including psychodynamic therapy, hypnotherapy, and drug treatment
These techniques tend to work slowly in cases of DID