Abnormal Psychology & Therapy Chapters 16 & 17

1. Abnormal Psychology & TherapyChapters 16 & 17

2. Part I: Psychological Disorders

3. Defining Psychological Disorders Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions. When behavior is unjustifiable (not rational), maladaptive, atypical (violates the norm), and disturbing psychiatrists and psychologists label it as disordered. Remember: U-MAD

4. Medical Perspective Philippe Pinel (1745-1826) from France, insisted that madness was not due to demonic possession, but an ailment of the mind. He suggested humane treatment. “Lunatic Ball”

5. Biopsychosocial Perspective Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders.

6. Classifying Psychological Disorders The American Psychiatric Association rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe psychological disorders. The most recent edition, DSM-IV-TR (Text Revision, 2000), describes 400 psychological disorders compared to the 60 identified in the 1950s. http://dsm.psychiatryonline.org/book.aspx?bookid=22

7. Goals of DSM • Describe (400) disorders. • Determine how prevalent the disorder is. Disorders outlined by DSM-IV are reliable. Therefore, diagnoses by different professionals are similar. Also, insurance companies usually require a firm diagnosis to cover health care costs. Others criticize DSM-IV for classifying almost anything as a disorder/syndrome.

8. Anxiety Disorders Feelings of excessive apprehension and anxiety that cause distress or cause maladaptive behaviors to reduce the levels of stress. • Generalized anxiety disorders (GAD) • Phobias • Panic disorders • Obsessive-compulsive disorders (OCD) • Post-Traumatic Stress Disorder (PTSD)

9. Generalized Anxiety Disorder (G.A.D) • Disorder characterized by persistent and uncontrollable tenseness and apprehension (worrying). 2. Autonomic arousal. • Inability to identify or avoid the • cause of certain feelings. • Must have at least three of the following: • - Restlessness • - Feeling on edge • - Difficulty concentrating/mind going blank • - Irritability • - Muscle Tension • - Sleep Disturbance

10. Panic Attack Disorder Minute-long episodes of intense dread which may include feelings of terror, chest pains, choking, or other frightening sensations. Anxiety is a major component of panic attack disorder, making people avoid situations that cause it. Panic Attack disorder and agoraphobia (fear of open/public places) usually go together.

11. Phobias Phobias are marked by a persistent and irrational fearof an object or situation that disrupts behavior. Agoraphobia – fear of open places (only phobia listed in the DSM) http://psychology.about.com/od/phobias/a/phobialist.htm

12. Obsessive-Compulsive Disorder(O.C. D.) Persistence of unwanted thoughts (obsessions) and urges/behaviors (compulsions) to engage in senseless rituals that cause distress.

13. Post-Traumatic Stress Disorder (P.T.S. D.) Often caused by severely threatening uncontrollable events. Four or more weeks of the following symptoms constitute Post-Traumatic Stress Disorder: • Haunting memories (flashbacks) 2. Nightmares 3. Social withdrawal (uncommon anger or substance abuse) 4. Jumpy anxiety 5. Sleep problems (insomnia)

15. Explaining Anxiety Disorders Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety.

16. The Learning Perspective Learning theorists suggest that (classical) conditioningleads to anxiety. This anxiety then becomes associated with other objects or events (stimulus generalization) and is reinforced (operant). Investigators believe that fear responses can be passed along to others through observational learning (modeling).

17. The Biological Perspective Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. Perhaps it’s part of Jung’s collective unconscious? Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias.

18. The Biological Perspective A PET scan of the brain of a person with Obsessive-Compulsive Disorder (OCD). High metabolic activity (red) in the frontal lobe areas are involved with directing attention. Too little of the neurotransmitter Serotonin can also contribute to anxiety disorders

19. Dissociative Disorders Usually nurture-based where conscious awarenessbecomes separated (dissociated) from previous memories, thoughts, and feelings.. Depersonalization Disorder • Having a sense of being unreal. 2. Being separated from the body. 3. Watching yourself as if in a movie.

20. Other Dissociative Disorders • Dissociative Amnesia – amnesia caused by some kind of trauma (not by injury). For example, soldiers in combat. • Dissociative Fugue (flight) – Person totally forgets who they areand may develop a completely new identity, personality, etc. in a new place. Like “witness protection” from yourself!

21. Dissociative Identity Disorder(D.I.D.) Formerly called Multiple Personality Disorder (MPD), it is a disorder in which a person exhibitstwo or more distinct and alternating personalities (each with its own name, voice, mannerisms, occupations, etc). http://www.cbsnews.com/video/watch/?id=4852295n&tag=mncol;lst;2 Chris Sizemore, the basis for the movie The Three Faces of Eve

22. Mood Disorders Emotional extremes of mood disorders come in two principal forms. • Major depressive disorder • Bipolar disorders

23. Major Depressive Disorder Major depressive disorder occurs when signs of depression last two weeks or more and are not caused by drugs or medical conditions. • 5 of the following: • (at least one of which has to be depressed mood or loss of interest/pleasure) • depressed mood • loss of interest/pleasure • weight loss • insomnia/hypersomnia • psychomotor agitation/retardation • loss of energy/fatigue • feelings of worthlessness/guilt • decreased concentration • suicidal ideation/thoughts of death.

24. Blue Mood Dysthymic Disorder Major Depressive Disorder Dysthymic Disorder Dysthymic disorder lies between a blue mood and major depressive disorder. It is a disorder characterized by milddaily depression lasting two years or more with two or more of the following symptoms: • poor appetite/overeating • insomnia/hypersomnia • fatigue/low energy • low self-esteem • decreased concentration • hopelessness

25. Bipolar Disorder Formerly called Manic-Depressive Disorder, it is an alternation between depression and mania (highs & lows). Depressive Symptoms Manic Symptoms Gloomy Elation Withdrawn Euphoria Inability to make decisions Desire for action Tired Hyperactive Slowness of thought Multiple ideas

26. Whitman Wolfe Clemens Hemingway Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase.

27. Explaining Mood Disorders Since depression is so prevalent worldwide, investigators want to develop a theory of depression that will suggest ways to treat it. Lewinsohn notes that a theory of depression should explain the following: • Behavioral and cognitive changes • Common causes of depression • Gender differences • Depressive episodes usually self-terminate. • Depression is increasing, especially in the teens

28. Suicide The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide.

30. Biological Perspective Genetic Influences:Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%). Linkage analysis and association studies link possible genes and dispositions for depression.

31. Biological Perspective Neurotransmitters: A reduction of norepinephrine and serotonin has been found in depression. Drugs that alleviate mania reduce norepinephrine. Pre-synaptic Neuron Serotonin Norepinephrine Post-synaptic Neuron

32. Biological Perspective PET scans show that brain energy consumption rises and falls with manic and depressive episodes.

33. Social-Cognitive Perspective The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles.

34. Depression Cycle • Negative stressful events. • Pessimistic explanatory style. • Hopeless depressed state. • These hamper the way the individual thinks and acts, fueling personal rejection.

35. Explanatory style plays a major role in becoming depressed.

36. Psychotic Disorders Schizophrenia Nearly 1 in a 100 suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease. Schizophrenia strikes young people as they mature into adults. It affects men and women equally, but men suffer from it more severely than women.

37. Symptoms of Schizophrenia The literal translation is “split mind” but is not the same as DID. Schizophrenia is a group of severe disorders characterized by the following: Disorganized (word salad) & delusional thinking. Disturbed perceptions (hallucinations). Inappropriate emotions & actions. John Nash

38. Disorganized & Delusional Thinking This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Marry Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.” This monologue illustrates fragmented, bizarre thinking with distorted beliefs (usually of grandeur or persecution) called delusions (“I’m Mary Poppins”). It also demonstrates a principle called “word salad” (jumbling up ideas in sentences). Other forms of delusions include, delusions of persecution (“someone is following me”) or grandeur (“I am a king”).

39. Disturbed Perceptions A schizophrenic person may perceive things that are not there (hallucinations). Frequently such hallucinations are auditory and lesser visual or tactile.

40. Inappropriate Emotions & Actions A schizophrenic person may laugh at the news of someone dying or show no emotion at all (apathy/flat affect). Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia).

41. Subtypes of Schizophrenia Schizophrenia is a cluster of disorders. These subtypes share some features, but there are other symptoms that differentiate these subtypes.

42. Positive and Negative Symptoms Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, deluded ways) that are not present in normal individuals (positive symptoms - inward). Schizophrenics also have an absence of appropriate symptoms (apathy, expressionless faces, rigid bodies) that are present in normal individuals (negative symptoms - outward).

43. Chronic and Acute Schizophrenia When schizophrenia is slow to develop (chronic/process) recovery is doubtful. Such schizophrenics usually display negative (outward) symptoms. When schizophrenia rapidly develops (acute/reactive) recovery is better. Such schizophrenics usually show positive (inward) symptoms .

45. Understanding Schizophrenia Schizophrenia is a disease of the brain exhibited by the symptoms of the mind. Brain Abnormalities Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain.

46. Abnormal Brain Activity, Etc. Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients. Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles.

47. Pre-natal/Neo-natal development Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development. There is also evidence of people who suffered from oxygen deprivation at birth and/or poor fetal nutrition may also have higher rates of schizophrenia. Malnutrition, methamphetamine and cocaine abuse, and social conditions (urban life, racial discrimination, adversity and family dysfunction) have also been contributed to the development of the disorder.

48. 0 10 20 30 40 50 Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease.

49. Warning Signs Early warning signs of schizophrenia include: 1. A mother’s long lasting schizophrenia. 2. Birth complications, oxygen deprivation and low-birth weight. 3. Short attention span and poor muscle coordination. 4. Disruptive and withdrawn behavior. 5. Emotional unpredictability. 6. Poor peer relations and solo play.

50. Personality Disorders Personality disorders are characterized by inflexible and enduringbehavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions.