World Health Organization

1. World Health Organization • Mental health: a state of well-being in which every individual • realizes his or her own potential, • can cope with the normal stresses of life, • can work productively & fruitfully, • and is able to make a contribution to her or his community. • Positive spectrum: "Health is a state of complete physical, mental & social well-being, and not merely the absence of disease or infirmity.”

2. ADD/ADHD Paranoid Childhood Disorders Schizophrenic Disorders Autism Mental Disorders Catatonic Aspergers Disorganized Sensory Disintegration Un- differentiated Anxiety Disorders Personality Disorders Affective Disorders Somatoform Disorders Dissociative Disorders Odd/Eccentric GAD Anxious Unipolar (dysthymic) Phobic agoraphobic Factitious Amnesia Dramatic Major Depression OCD Conversion Fugue Mania Panic Body Dysmorphic DID Bipolar (cyclothymic) PTSD Hypochondriac

3. Consider the situational context: • Social situation • Behavioral setting • General circumstances • Cultural Relativity • Values of one’s culture

4. Behavior Criteria: Suggestive of a Psych Disorder • Social Non-conformity (DEVIANT / BIZARRE): • Unhealthy unjustifiable, nonconformity(disobeying societal standards) • Unusual; creative & unique lifestyle… atypical, disturbing • Destructive, self-defeating boundaries around self, dangerous • Inflexible, can’t go with the flow, fixed set of responses • Subjective personal discomfort(DISTRESS): • faulty perception or interpretation of reality • See danger, rejection, failure everywhere, worst is always seen or expected. (ideas of persecution, hallucinations) • DYSFUNCTION:maladaptive, inefficient, impairs life

5. Defining Abnormal Behavior • Medical approach: physical cause of mental disorder (disease) • Classification Model (Descriptive Psychopathology): DSM • Legal Approach: aware of actions, responsible? Is person a danger to self or others? • Statistical Deviation: Bell Curve: If normal is what most people do…abnormal behavior deviates from the norm. (extreme scores) • Violation of Cultural Standards: Any action that against standards of the group. • Threshold: determining point matter of degree/context. • Adjustment: functioning, socially inept? Maladaptive behavior: Interrupts everyday life significantly.

6. Biopsychsocial: • nature (genetic & physiological factors) • ~disease of the brain…not failures of character. • nurture (past & present experiences) • Difficulty in person’s environment (STRESS)in person’s current interpretation of events • Person’s bad habits & poor social skills

7. Psychological influence: STRESS… • Eustress vs Distress • Physical Responses • General Adaptation Syndromes • Individual factors • Locus of Control • Explanatory styles • Type A vs. Type B • Coping • Regressive coping…negative option • Transformational coping…positive option

8. Personality • Psychoanalytic: *Freud • NeoFreudians • *Jung • *Horney • *Adler • *Erikson • Humanistic *Rogers *Maslow • Social Cognitive: *Bandura • Trait theorist *McCrea & Costa OCEAN Learning: Operant conditioning = rewards & punishments Classical conditioning = associations

9. Rosenhan study

10. Mental Disorders… Insanity…legal term, not psychological or medical diagnosis

11. Court Cases • Kenneth Bianci…guilty of a series of LA rapes / murders • Dan White…dismissed from job of being city supervisor, killed mayor of San Francisco & another supervisor…innocent… diminished capacity • John Hinkley…assassination attempt of president Reagan to gain attention of an actress… NOT GUILTY…insanity • Jeffrey Dahmer…Milwaukee killed mutilated, consumed his young victims…GUILTY…sane • Theodore Kaczynski…unabomber… refused to allow attorneys to present an insanity defense...

12. History of insanity plea • Mc’Naghten (1843) - party accused laboring under such a defect of reason, from disease of the mind, • not to know the nature & quality of the act he was doing; • did not know he was doing what was wrong • Not guilty by reason of insanity • irresistible impulse…not held responsible • Durham Rule (1954) broadened insanity defense • guilty but mentally ill • not criminally responsible if act was product of mental illness, impairing judgment or behavior…therapy • Insanity Defense Reform Act (1984) • shifts more responsibility to defense from prosecution • as a result of mental illness, the defendant lacks the capacity to appreciate the nature & quality or wrongfulness of the act

13. Legal Fiction… • Doesn’t this excuse people and tell them that they don’t have to be responsible for their behaviors? • What do you think is the success rate of criminals claiming mental illness as their defense?

14. Shouldn't psychiatrists be the ones to determine whether someone with a mental illness is really responsible for his or her actions? After all, they're the experts. • No, experts at diagnosing & treating mental illnesses. • they are trained in medicine, not the law. • offer testimony on the probable nature & severity of the defendant's illness at the time of the crime • offer medical & psychological explanations for behavior • judge or jury, as society's representative, are to determine criminal responsibility.

15. Psychological Disorders

16. Classification • Diagnostic and Statistical Manual (DSM) • Current Edition: DSM-IVR of the American Psychiatric Association • Multidimensional system of assessment • Groups disorders on the basis of observable features or symptoms • Provides a broad base of information on an individuals functioning—not just a diagnosis • 5 Axis—5 different dimensions used to define mental disorders

17. THE UN-DSM Companion catalog of Human Strengths… Thinking, Feeling, Action tendencies that contribute to the good life, for self & others Psychological science seeks to understand & help alleviate human ills and evils, but also to understand & promote human strengths & virtues. • Wisdom & Knowledge • Courage (overcoming opposition) • Humanity • Justice • Temperance • Transcendence

18. Problems with Diagnosis • Inconsistent • Overlapping • Self-Fulfilling prophecy • Stereotyping/Labeling

19. Types of Disorders • Anxiety Disorders • Somatoform Disorders • Dissociative Disorders • Mood Disorders • Schizophrenia • Personality Disorders • Eating Disorders

20. DSM IV

21. Fear…reaction to a real stress • External, directly perceived • Anxiety…feel like fear, but w/out specific cause. • Perceived threats, before the fact, in anticipation of events/situations…that might happen… • and if/when they do will most likely be unpleasant • Diffused feeling of dread, fear, apprehension, impending catastrophe. • Internal not wholly recognized • Stress…response to a situation or event that did happen

22. Anxiety Disorders • Most Common • Anxiety—a generalized feeling of apprehension and pending disaster • Includes both physical and subjective • Physical alert & response: (fight or flight)—sympathetic arousal, trembling, sweating, faintness, erratic breathing • Mental alert: subjective—fear the worst, fear loss of control, nervousness, inability to relax, focus solely on threat, etc. • Can be normal—i.e. response to a threat

23. pathological anxiety (worry/apprehension) • Irrational- perceived threats…exaggerated or nonexistent (out of proportion of actual importance) • Uncontrollable- unrealistic, can’t be shut off • Disruptive- interferes w/job, relationships

24. Development of avoidance, ritual acts, or repetitive thoughts • Meant to protect the individual from experiencing the anxiety. • Alienation • Perception of immediate threat or danger…from possible…to probable

25. Anxiety Disorders • Those who have them…. • may have a few attacks a day • are restless in between attacks • sleep poorly • don’t eat well • are not capable of calming down • They include: • GAD • OCD • PTSD • Panic Disorder • Phobic Disorders

26. http://www.aetv.com/obsessed/?HPF_rid=1310296&HPF_mid=2367_T1_Url10http://www.aetv.com/obsessed/?HPF_rid=1310296&HPF_mid=2367_T1_Url10 • Documentary series Anxiety Disorders • MTV: True Life

27. Persistent anxiety Chronic Excessive (6 months) Global (free floating) Not attributed to a specific object or event Symptoms: inability to relax, shakiness, sweating, dry mouth, racing heart, light-headed, feelings of dread, insomnia, irritability abrupt attack of acute anxiety that is not associated with an object/event Symptoms: strong physical effects, choking, pounding heart, nausea, numbness, tingling, chills Course Vary in length—1-2 min up to an hour May begin due to a chemical or physical disorder Tend to repeat when one is under stress Sensitive to the signs of physical arousal Insecure/helplessness GAD (free floating) Panic Disorder

28. Phobic Disorder • A person becomes disabled and overwhelmed by fear in the presence of certain objects or events • 3 Main Types: • Simple/Specific—objects or particular situations • Natural environment, injury or blood, animals & insects • Social—scrutiny by others or fear of doing something embarrassing (stage fright, speech anxiety) • Agoraphobia—most common—open spaces—most people are homebound –boundaries vary (fear of panic attack & unable to get help)

29. FEAR Survey • Highest intensity rating • 4 suffocating • 5 failing a test • 6 looking foolish • 17 making mistakes • 28 illness or injury to loved one • 29 being self-conscious • 37 Not being a success • 39 Snakes • 41 Speaking before a group • 43 Death of a loved one • 49 Untimely or early death • Average • Men 75 • Range 58-93 • Women 100 • Range 82-118

30. Intense & persistent feelings of anxiety & helplessness caused by a physical or psychological traumatic event Ex.: war, destruction of one’s community, witnessing a death, rape, physical threat or assault to one’s self or community 3 core symptoms 1) Intrusive 2) avoidance 3) increased arousal… Course can occur 6 or more months after the event tends to persist Symptoms: intense fear avoidance of stimuli associated with the event Flashbacks reliving event intrusive memories nightmares sleep problems irritable outbursts difficulty concentrating intensified startle response PTSD

31. Post Traumatic GROWTH~ Benefit finding Increased appreciation for life More meaningful relationships Increased personal strengths Changed priorities Richer spiritual life

32. OCD- 3.3 million adults • Obsessions: Persistent, unwelcome thoughts or images • Create anxiety • Compulsions: urgent need to engage in certain rituals • Faulty attempt to resolve guilt, anxiety, insecurity • Behavior becomes self rewarding • Good workers, like to do perfect job, like routine, planners • 25-45 not OCD • 46-55 mildly OCD, compulsiveness is adaptive, has a beneficial effect. • 56-70 moderately OCD, you are adaptive, uptightness starting to interfere at times, you experience days of high tension • 71-100 severely OCD, possibly insecure, constant high tension

33. Types of OCD • Checkers ~ doors/locks, stoves/ovens, irons, for security issues • Rampant Hoarders ~ Keep EVERYTHING! • Ordering ~ Endlessly rearrange objects in an effort to keep them in precise alignment with each other. • Cleaners ~ wash hands until raw & must clean microscopic dust particles • Counters ~ Count everything ranging from dots to people • Repeaters ~ words or behaviors for a certain number of times • Risk Takers ~ Will stay committed for “their sport” until it kills • Injury doesn’t hold them back • athletics, gambling, drinking, overeating, dangerous sex

34. Identify the type… “I used to enjoy smoking, but I can’t help thinking that the matches I throw out will start a fire and hurt someone. Or when I’m in a car and I hit a bump, I sometimes worry that I’ve hit someone.” ~harming “I do it mainly when I’m bored: I count ceiling times, floor tiles, letters on billboards and street signs. Sometimes I’ll even divide the letters into groups of three or four. I try to stop, but I can’t help myself.” “When I walk through a doorway, I need to make sure that there are six inches between each shoulder and the door jamb. If I walk through and I don’t think I’ve accomplished this, I’ll walk out and try again.”

36. “My hands are a little raw, but I can’t help feeling that they could be a little cleaner, that I might have missed spot where bacteria can grow.”“Did I lock the door? I know I checked, but I better check one more time. OK, it’s locked. I’m satisfied. But maybe I better open the door and start over. Lock it again.”“I don’t need the things that I save, I know that. But what if I throw something away that I’ll later? Of course there are some things I know I won’t need. For instance, I’ve been giving myself haircuts lately so that I can save the hair.”

37. Possible Causes • Psychodynamic • Phobias—conflicts of childhood origin • OCD—leakage of unconscious impulses and acts that allow these impulses to remain repressed • GAD—persistent difficulty in maintaining repression • Personality Traits—neuroticism • Stress connection • can precipitate the development of an anxiety disorder • Behavioral • Phobias—conditioned fears…avoidance is reinforced by reduction in anxiety

38. Possible Causes • Cognitive • Phobias—observational learning can produce fear which results in anxiety • ex. parent fears dogs; child learns to fear • OCD—Divert attention away from more major issues • Panic—Misinterpret bodily cues as threats • In General—Styles of thinking (pessimistic) & control (external) • Biology • Fears represent age-old threats that contribute to our survival—evolutionary perspective • Genetic Predisposition—inhibited temperament is a risk factor • Neurotransmitters-GABA & serotonin deficiency

39. Treatment Options • Behavioral Therapies • systematic desensitization, token economies, aversive conditioning, implosive/exposure therapy, etc. • Cognitive Therapies • REBT or CBT • Medication • Anti-anxiety medications

41. Somatoform Disorders • “soma” = body • Characterized by complaints of physical symptoms that have no organic/physiological cause—they are psychologically based! • caused by great distress!! • Symptoms are NOT voluntary or under conscious control • ex. paralysis, pain, persistent belief of serious disease, etc.

42. Conversion Disorder • Psychological issue manifesting as physical complaint • Characterized by specific physical complaint • paralysis of the legs, blindness. • Patients strongly believe there is impairment, but may show less stress than w/a real loss • Patient converts a source of stress into a physical difficulty • Pilots—WW2 and night blindness

43. Body Dysmorphic • excessive worry about some aspect of physical appearance that is defective • excessive facial hair • wrinkles • spots • swelling face • too big or small…nose, jaw, eyebrow, feet, hands • bad odors & breath • excessive sweat

44. Complex Somatic Symptom Disorder (CSSD) Pain disorder Somatization disorder Under 30 yrs of age 4 different pain symptoms 2 gastrointestinal symptoms 1 sexual symptom 1pseudoneurological symptom. • Complaints of severe pain • No particular physical condition Hypochondriasis Undifferentiated somatoform disorder • persistent preoccupation health & physical condition • Physical symptoms are sign of major illness • Darwin, Tennyson • LittleT and One track Mike Deadman song • Physical complaints • No medical symptoms

45. Hypochondriasis • persistent preoccupation w/one’s health and physical condition despite the fact that genuine symptoms of the disorder are lacking! • see disastrous illness in minor physical complaint! • Famous Hypochondriacs: • Darwin, Tennyson • LittleT and One track Mike Deadman song

46. Explaining Somatoform Disorders • Psychodynamic—protects the individual from shame or guilt (defense mechanism) • Behavioral—used to avoid stressful situations • anxiety is reduced • interpersonal gains—sympathy/support • the above are reinforced • Social Learning—may model parent and learn to use illness as a strategy to deal with tough parts of life

47. Treatment • Cognitive-Behavioral Therapy • Tricyclic Anti-Depressants—possibly • Hypnosis • Psychotherapy

48. Dissociative Disorders

49. Dissociative Disorders • Characterized by disturbances or changes in memory, consciousness, or identity due to psychological factors. • Impacts thoughts, emotions, memories, consciousness • Types: • dissociative amnesia • dissociative fugue • dissociative identity disorder DID/MPD • depersonalization disorder

50. Amnesia • Partial or total loss of important personal info that occurs • psychogenic cause: after a stressful or psychologically traumatic event— • organic cause…high fever/ blow to the head • Can last hrs or yrs—termination is generally sudden