Chapter 15 Psychological Disorders

1. Chapter 15 Psychological Disorders

2. Abnormal Behavior: Myths & Realities • The medical model and mental illness. • The medical model “proposes that it is useful to think of abnormal behavior as a disease” and has become the main way of thinking about mental illness today. • This view is in stark contrast to how mental illness used to be perceived (see Figure 15.1). • Thus, the medical model has brought much needed improvement in patient care.

3. Abnormal Behavior: Myths & Realities (cont.) • Other key terms. • Diagnosis – “involves distinguishing one illness from another”. • Etiology – “refers to the apparent causation and developmental history of an illness”. • Prognosis – “is a forecast about the probable course of an illness”.

4. Abnormal Behavior: Myths & Realities (cont.) • Criteria for abnormal behavior. • Deviance – the behavior must be significantly different from what society deems acceptable. • Maladaptive behavior – the behavior interferes with the person’s ability to function. • Personal distress – the behavior is troubling to the individual.

5. Abnormal Behavior: Myths & Realities (cont.) • Classification of disorders. • The American Psychological Association (A.P.A.) uses the Diagnostic and Statistical Manual (now in it’s fourth revision and referred to as the DSM IV) to classify disorders. • This provides detailed information about various mental illnesses that allow clinicians to make more consistent diagnoses.

6. Abnormal Behavior: Myths & Realities (cont.) • Classification of disorders. (cont.) • The DSM has five “axes” or components: • Axis I: criteria for diagnosing most disorders are listed here. • Axis II: specific to personality disorders. • Axis III: patient’s general medical condition. • Axis IV: psychosocial and environmental problems. • Axis V: global assessment of functioning.

7. Abnormal Behavior: Myths & Realities (cont.) • Prevalence of psychological disorders. • Epidemiology is “the study of the distribution of mental or physical disorders in a population”. • Prevalence “refers to the percentage of the population that exhibits a disorder during a specified time period”. • Research suggests that there has been a real increase in the prevalence in disorder (see Figure 15.4). • The most common classes are substance use, anxiety and mood disorders.

8. Figure 15.4

9. Anxiety Disorders • Anxiety disorders “are a class of disorders marked by feelings of excessive apprehension and anxiety”. • Generalized anxiety disorder “is marked by a chronic, high level of anxiety that is not tied to any specific threat”. • Phobic disorder “is marked by a persistent and irrational fear of an object of situation that presents no realistic danger”.

10. Anxiety Disorders (cont.) • Panic disorder “is characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly” (see following animation sequence). • Agoraphobia “is a fear of going out to public places”. • Agoraphobia may result from severe panic disorder, in which people “hide” in their homes out of fear of the outside world.

11. Panic Disorder: Symptoms

12. Anxiety Disorders (cont.) • Obsessive Compulsive Disorder(OCD) “is marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions)”. • Common obsessions include fear of contamination, harming others, suicide, or sexual acts. • Compulsions are highly ritualistic acts that temporarily reduce anxiety brought on by obsessions.

13. Anxiety Disorders (cont.) • Obsessive Compulsive Disorder (cont.) • OCD disorders occur in approximately 2.5% of the population. • Most cases of OCD emerge before the age of 35.

14. Anxiety Disorders (cont.) • Etiology of anxiety disorders. • Biological factors. • Inherited temperament may be a risk factor for anxiety disorders. • “Anxiety sensitivity” theory posits that some people are more sensitive to internal physiological symptoms of anxiety and overreact with fear when they occur.

15. Anxiety Disorders (cont.) • Etiology of anxiety disorders. (cont.) • The brain’s neurotransmitters, or “chemicals that carry signals from one neuron to another”, may underlie anxiety. • In particular, drugs that affect the neurotransmitter GABA (e.g., Valium) suggest that these chemical circuits may be involved in anxiety disorders.

16. Anxiety Disorders (cont.) • Etiology of anxiety disorders. (cont.) • Conditioning and learning. • Classical conditioning may cause one to fear a particular object or scenario. • Then, avoiding the fear stimulus is negatively reinforced, through operant conditioning, by making the person feel less anxious. • Seligman (1971) adds we are “biologically prepared” to fear some things more than others, however.

17. Anxiety Disorders (cont.) • Etiology of anxiety disorders. (cont.) • Cognitive factors. • Some people are more likely to experience anxiety disorders because they: • Misinterpret harmless situations as threatening. • Focus excess attention on perceived threats. • Selective recall information that seems threatening.

18. Anxiety Disorders (cont.) • Etiology of anxiety disorders. (cont.) • Finally, anxiety disorders may be linked to excessive stress. • Specifically, research (Brown, 1998) has found that people with anxiety disorders were more likely to have experienced severe stress one month prior to the onset of their disorder. • Thus, stress may precipitate the onset of anxiety disorders.

19. Somatoform Disorders • Somatoform disorders “are physical ailments that cannot be fully explained by organic conditions and are largely due to psychological factors”. • Somatization disorder “is marked by a history of diverse physical complaints that appear to be psychological in origin”. • It occurs mostly in women. • Symptoms seem to be linked to stress.

20. Somatoform Disorders (cont.) • Conversion disorder – “is characterized by a significant loss of physical function with no apparent organic basis, usually in a single organ system”. • Common symptoms include: • Partial or total loss of vision or hearing. • Partial paralysis. • Laryngitis or “mutism” (inability to speak). • Seizures or vomiting. • Loss of function in limbs.

21. Somatoform Disorders (cont.) • Hypochondriasis (or hypochondria) “is characterized by excessive preoccupation with health concerns and incessant worry about developing physical illnesses”. • People with hypochondria are convinced their symptoms are real and often become frustrated with the medical establishment. • Hypochondria often occurs along with anxiety disorders and depression.

22. Somatoform Disorders (cont.) • Etiology of somatoform disorders. • Biological factors. • People with somatoform disorders may have an inherited sensitivity to the autonomic nervous system. • However, there is not much evidence to support a biological basis for this class of disorders.

23. Somatoform Disorders (cont.) • Etiology of somatoform disorders. (cont.) • Personality factors. • Somatoform disorders are more common in people with “histrionic” personalities (those who thrive on the attention that illness brings). • Neuroticism also seems to elevate one’s predisposition to somatoform disorders.

24. Somatoform Disorders (cont.) • Etiology of somatoform disorders. (cont.) • Cognitive factors. • Some people focus excessive attention on bodily sensations and amplify them into perceived symptoms of distress. • They also have unrealistically high standards of “good health”. Thus, any deviation from perfect health is seen as a sign of illness.

25. Somatoform Disorders (cont.) • Etiology of somatoform disorders. (cont.) • The sick role. • Some people learn to “like” being sick because: • It allows one to avoid challenging tasks. • Demands aren’t placed on sick people. • It provides an excuse for failure. • Being sick elicits attention from others.

26. Dissociative Disorders • Dissociative disorders “are a class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity”. • Dissociative amnesia “is a sudden loss of memory for important personal information that is too extensive to be due to normal functioning”. • It often occurs after a single traumatic event or an extended period of severe trauma or stress.

27. Dissociative Disorders (cont.) • Dissociative fugue is a disorder in which “people lose their memory for their sense of personal identity”. • People suffering from this disorder often wander away from home, not know who they are, where they live, or who they know.

28. Dissociative Disorders (cont.) • Dissociative Identity Disorder (DID) “involves the coexistence in one person of two or more largely complete, and usually very different personalities”. • Also known as “multiple personality disorder”, in which each personality has their own name, memories, traits and physical mannerisms. • Transitions between identities can be sudden and the differences between them can be extreme (e.g., different races or genders).

29. Dissociative Disorders (cont.) • Etiology of dissociative disorders. • Psychogenic amnesia and fugue are usually the result of extreme stress. • Dissociative identity disorder is a fascinating, and bizarre disorder and its causes are largely unknown. • However, many clinicians suspect that DID may result from severe emotional trauma that occurs in childhood.

30. Mood Disorders • Mood disorders “are a class of disorders marked by emotional disturbances that may spill over to disrupt physical, perceptual, social and thought processes”. • Major depressive disorder is a disorder in which people “show persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure”. • Onset can occur at any time, but most cases occur before age 40. • The majority of people with depression (75 – 95%) will experience a repeat episode.

31. Mood Disorders (cont.) • Major depressive disorder (cont.) • Depression is one of the most common mental illnesses (the lifetime prevalence is 16.2%). • However, prevalence is tied to gender. Women are twice as likely to be diagnosed with depression. • This does not appear to be tied to biological differences between men and women and could result from greater stress and abuse that women experience.

32. Mood Disorders (cont.) • Bipolar Disorder (once known as manic-depressive disorder) “is marked by the experience of both depressed and manic periods”. • “Manic” periods are characterized by bouts of extreme exuberance and a feeling of invincibility. • However, this state of elation alternates (sometimes suddenly) with periods of depression.

33. Mood Disorders (cont.) • Bipolar disorder is much less common than depression (a “unipolar” disorder), affecting about 1% to 2.5% of the population. • Peak age of vulnerability is between 20 and 29. • See following animation sequence.

34. Bipolar Disorder: Delusional Thinking

35. Bipolar Disorder: Expression of Mood

36. Mood Disorders (cont.) • Etiology of mood disorders. • Genetic vulnerability. • Concordance rates, or “the percentage of twin pairs or other pairs of relatives that exhibit the same disorder”, suggests there is a genetic basis for mood disorders. • Concordance rates for identical twins is 65% to 72%, whereas it is only 14% to 19% for fraternal twins who share fewer genes but the same environment.

37. Mood Disorders (cont.) • Etiology of mood disorders. (cont.) • Neurochemical factors. • Mood disorders are correlated with low levels of two neurotransmitters in the brain: • Norepinephrine. • Seratonin. • However, it is unclear whether changes in these chemicals are the cause, or the result, of the onset of mood disorders.

38. Mood Disorders (cont.) • Etiology of mood disorders. (cont.) • Cognitive factors. • Depression may be linked to negative thinking (see Figure 15.13). • Specifically, Seligman (1974) proposes that depression is caused by “learned helplessness”, in which people become passive and “give up” in times of difficulty. • Learned helplessness is also related to a “pessimistic explanatory style” in which people attribute setbacks to personal flaws.

39. Figure 15.13

40. Mood Disorders (cont.) • Etiology of mood disorders. (cont.) • Hopelessness theory, is another cognitive explanation of mood disorders in which other factors, in addition to a pessimistic explanatory style, push people into depression. • Such factors include high stress and low self-esteem. • Nolen-Hoeksema (1991, 2000) also asserts that those who ruminate about problems put themselves at risk for depression.

41. Mood Disorders (cont.) • Etiology of mood disorders. (cont.) • Interpersonal roots. • Depression has also been correlated with interpersonal factors, such as poor social skills. • However, it is unclear what the direction of cause and effect is, with regard to this correlation. • Precipitating stress. • There is also a link between stress and the onset of mood disorders.

42. Schizophrenic Disorders • “Schizophrenia” literally means “split mind”. • Schizophrenic disorders “are a class of disorders marked by disturbances in thought that spill over to affect perceptual, social and emotional processes”. • Prevalence is quite low, with only about 1% of the population suffering from this class of disorders. • Schizophrenia is a severe disorder that usually has an early onset and a poor prognosis.

43. Schizophrenic Disorders (cont.) • General symptoms of schizophrenia: • Irrational thought. • Delusions “are false beliefs that are maintained even though they clearly are out of touch with reality”. • A common delusion is the belief that one’s mind is being controlled by an external source. • Delusions of grandeur are irrational beliefs that one is “extremely important or famous”.

44. Schizophrenic Disorders (cont.) • General symptoms of schizophrenia: (cont.) • Deterioration of adaptive behavior. • (e.g., inability to function at work or home.) • Distorted perceptions. • Auditory hallucinations – “sensory perceptions that occur in the absence of a real external stimulus or that represent gross distortions of perceptual input” are common symptoms. • Disturbed emotions(either “flat” affect or inappropriate emotions for a situation).

45. Schizophrenic Disorders (cont.) • Subtypes of schizophrenia: • Paranoid type. • Paranoid schizophrenia “is dominated by delusions of persecution along with delusions of grandeur”. • People with this type often believe others are watching and plotting against them. • Catatonic type. • Catatonic schizophrenia “is marked by striking motor disturbances, ranging from muscular rigidity to random motor activity”.

46. Schizophrenic Disorders (cont.) • Subtypes of schizophrenia: (cont.) • Disorganized type. • In disorganized schizophrenia, “a particularly severe deterioration of adaptive behavior is seen”. • Major symptoms include: • Emotional indifference. • Incoherence. • Severe social withdrawal. • Aimless giggling and babbling. • Delusions centered on bodily functions.

47. Schizophrenic Disorders (cont.) • Subtypes of schizophrenia: (cont.) • Undifferentiated type. • Undifferentiated schizophrenia “is marked by idiosyncratic mixtures of schizophrenic symptoms”. • Essentially, symptoms do not fit neatly into one of the subtypes.

48. Schizophrenic Disorders (cont.) • Subtypes of schizophrenia (cont.) • Positive versus Negative Symptoms • An alternative to dividing schizophrenia into four subtypes has been proposed by Andreasen (1990) and others. • There are only two subtypes with this approach: • Schizophrenias with negative symptoms (behavioral deficits, such as flat affect). • Schizophrenias with positive symptoms (hallucinations, delusions & bizarre behavior).

49. Schizophrenia: Common Symptoms

50. Schizophrenic Disorders (cont.) • Course and outcome. • Schizophrenia usually emerges during adolescence or early adulthood. • Its course is variable, with three likely outcomes: • Patients with milder versions who experience a full recovery. • Patients who experience a partial recovery and who are in and out of treatment facilities. • Patients whose symptoms are persistent and severe, and who require permanent hospitalization.