Chapter 14

1. Chapter 14 Psychological Disorders – 8th Edition

2. Abnormal Behavior • Historical aspects of mental disorders – F 14.1 • The medical model • What is abnormal behavior? • 3 criteria – F 14.2 • Deviant • Maladaptive • Causing personal distress • A continuum of normal/abnormal

4. Prevalence, Causes, and Course • Epidemiology • Prevalence - % of population that displays the disorder during a specific period • Lifetime prevalence – F 14.5 • Diagnosis • Etiology – causes • Prognosis

6. Psychodiagnosis: The Classification of Disorders • American Psychiatric Association – published first taxonomy in 1952 • Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - IV) • Multiaxial system • 5 axes or dimensions – F 14.3 • Axis I – Clinical Syndromes • Axis II – Personality Disorders or Mental Retardation • Axis III – General Medical Conditions • Axis IV – Psychosocial and Environmental Problems • Axis V – Global Assessment of Functioning • Example Figure 14.4 • DSM V – to be published in 2011-12

7. Figure 14.3 – DSM-IV overview Fig. 14-3, p. 555

8. The DSM multiaxial system Figure 14.4 – Example multiaxial evaluation

9. Axis I Clinical Syndromes and Axis II Personality Disorders • Anxiety Disorders – p. 583 • Somatoform Disorders – p. 586 • Dissociative Disorders – p. 589 • Mood Disorders – p. 590 • Schizophrenic Disorders – p. 598 • Eating Disorders – p. 613 • Axis II – Personality Disorders – p. 604

10. Clinical Syndromes: Anxiety Disorders • Generalized anxiety disorder • “free-floating anxiety” • Phobic disorder • Specific focus of fear • Panic disorder and agoraphobia (definition issue – p. 582) • Physical symptoms of anxiety/leading to agoraphobia • Obsessive compulsive disorder • Obsessions • Compulsions

11. Etiology of Anxiety Disorders • Biological factors – F 14.6 • Genetic predisposition, anxiety sensitivity • GABA circuits in the brain • Conditioning and learning • Acquired through classical conditioning or observational learning – F 14.7 • Maintained through operant conditioning • Cognitive factors • Judgments of perceived threat – F 14.8 • Personality • Neuroticism • Stress – F 14.9 • A precipitator

15. Clinical Syndromes: Somatoform Disorders • Somatization Disorder • Conversion Disorder – Figure 14.10 • Hypochondriasis • Etiology • Reactive autonomic nervous system • Personality factors • Cognitive factors • The sick role

17. Clinical Syndromes: Dissociative Disorders • Dissociative amnesia • Dissociative fugue • Dissociative identity disorder • Etiology • severe emotional trauma during childhood • Controversy • Media creation? • Sybil • Repressed memories

19. Clinical Syndromes: Mood Disorders • Figure 14.11 and Table 14.1 • Major depressive disorder • Dysthymic disorder • Bipolar disorder (manic-depressive disorder) • Cyclothymic disorder • Etiology • Age of onset – F 14.12 • Genetic vulnerability – F 14.14 • Neurochemical factors • Cognitive factors – negative thinking – F 14.15, F 14.16 • Interpersonal roots • Precipitating stress

23. XX 14.14

24. XX 14.16

25. XX 14.17

26. Clinical Syndromes: Schizophrenia • General symptoms • Delusions and irrational thought • Deterioration of adaptive behavior - avolition • Hallucinations – any modality but usually auditory • Disturbed emotions – 66% • Prognostic factor • Gradual onset • Sudden onset

27. Subtyping of Schizophrenia • 4 subtypes • Paranoid type – most common subtype - John Nash • Catatonic type • Disorganized type • Undifferentiated type • New model for classification • Positive vs. negative symptoms

28. Etiology of Schizophrenia • Genetic vulnerability – F 14.18 • Neurochemical factors – Dopamine hypothesis – F 14.19 • Structural abnormalities of the brain – prefrontal lobe and ventricles – F 14.20 • The neurodevelopmental hypothesis – F 14.21 • Expressed emotion – F 14.22 • Precipitating stress – stress-vulnerability model – Slide 33

29. Figure 14.18 – Genetic vulnerability - schizophrenia

30. Figure 14.19 The dopamine hypothesis as an explanation for schizophrenia

31. Neurological Changes in Schizophrenia Figure 14.20 XXXX

32. Figure 14.21 – Neurodevelopment hypothesis of schizophrenia Figure 14.22 – Expressed emotion and relapse rates in schizophrenia

33. Slide 33 – The stress-vulnerability model of schizophrenia

34. Personality Disorders • Table 14.2 – description and male/female percents • Anxious-fearful cluster • Avoidant, dependent, obsessive-compulsive • Dramatic-impulsive cluster • Histrionic, narcissistic, borderline, antisocial • Odd-eccentric cluster • Schizoid, schizotypal, paranoid • Etiology • Genetic predispositions, inadequate socialization in dysfunctional families • Prognosis

36. Psychological Disorders and the Law • Insanity • M’naghten rule • The insanity defense – Figure 14.23 – perception versus actual cases • Involuntary commitment – varies by states • danger to self • danger to others • in need of treatment • Culture and pathology – p. 610 - 611

37. XXX 14.23

38. John Hinkley, Jr. – assassination attempt of President Reagan in 1981

39. Eating Disorders – p. 613-615 • Issues of weight – slide 41 • Anorexia nervosa • Criteria and subtypes: restrictive and binge/purge • Bulimia nervosa • Binge eating • History and prevalence • Age onset – Figure 14.25 • Etiology • Genetics • Personality – perfectionism • Cultural issues - “perfect” body type and digital photograph • Family role • Cognitive factors

40. Figure 14.25 - Age of anorexia nervous in the United States – Lucas et al. (1991)

41. XXXXX Slide 41