Psychological Disorders & Treatment

1. Psychological Disorders & Treatment Chapters 15 & 16

2. Psychological Disorders • In the past, people went to extremes (harsh and ineffective) to cure psychological disorders/demon posessions: • Beaten • Burned • Castrated • Removal of teeth, intestines, or • Blood transfusions with animal blood • Psychological disorder: (as defined by mental health workers) A “harmful dysfunction” in which behavior is judged to be atypical, disturbing, maladaptive, and unjustifiable

3. Mental Health Perspective • Psychological disorder: • Being different “atypical” or deviant from most other people in one’s culture is part of the classification process….however, DISTURBING to others must also be a part of this • Standards of acceptability vary across time, culture…so what is the key?... • Maladaptive- so distressing or disabling that it puts one at risk of suffering or death • Unjustifiable- not rationally justified/supported • Personally Distressing- reported by self or others

4. The Medical Model Perspective • According to the medical model: • Psychological disorders are sicknesses that need to be diagnosed and cured • Determined once they discovered that syphilis infects the brain and distorts the mind • Diagnosis- distinguishing one illness from another • Etiology- refers to the apparent causation & developmental history of the illness • Prognosis- forecast about the probable course of an illness

5. The Bio-Psycho-Social Perspective • Bio-psycho-social perspective • Contemporary perspective which assumes that biological (nature),psychological, and socio-cultural (nurture) factors combine and interact to produce psychological disorders • Basically the mind and body are inseparable • Environmental impact evidence: some disorders are across cultures (depression & schizophrenia) and some are culture bound (eating disorders are mostly western cultural based)

6. Classification- The DSM-5 • In order to create order we classify • The classification scheme for psychological disorders is the DSM-5 Diagnostic and Statistical Manual of Mental Disorders (5th Edition) as of 2013 - a widely used system for classifying psychological disorders - no longer a multi-axial system (AXIS I, II, & III have been combined: mental, personality, intellectual disability, & medical diagnoses all combined) - Now uses classifications along with Level 1 (patient-rated measure assessing different health domains) & Level 2 (in-depth clinical look at domain threshold scores) Assessment Measures

7. The DSM-5 • DSM-5 • It is a reliable system and this can consistently be used to diagnose a disorder clinician to clinician based upon observable behavior • Systematic in its process • It includes a very broad range of psychological disorders and some differences are controversial, such as Asperger’s and Autism being merged into Autism Spectrum Disorder

8. The DSM-5 • Criticized for: • Classifying an excessively broad range of human behaviors as psychologically disordered (ex. Social phobia & Disruptive mood dysregulation disorder) • Comorbidity- coexistence of two or more disorders • One of the main disagreements with LABELING in general is that is colors our perceptions or biases our opinions of people • Can also lead to stereotypes • Why people have begun to talk about individuals with disabilities by placing the classification AFTER the person

9. The DSM-5 • Labels can also alter reality • Self-fulfilling prophecy: people behavior that is expected of them or that they expect of themselves • But Diagnostic Labels are good for: 1. Communication btwn professionals about specific concerns 2. Comprehending the pathological processes involved in psychiatric illnesses 3. Controlling psychiatric outcomes

10. Prevalence of Disorders • epidemiology- the study of the distribution of mental or physiological disorders in a population • prevalence- refers to the percentage of a population that exhibit a disorder during a specified time period • concordance rate- indicates the percentage of twin pairs or other pairs of relatives who exhibit the same disorder

11. Anxiety Disorders • Anxiety disorders: psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety • These are the most common mental disorders 4 examples of anxiety disorders • Generalized Anxiety Disorder • Panic Disorder • Phobias/Phobic Disorder • Obsessive-compulsive disorder

12. Anxiety Disorders • Generalized Anxiety Disorder: an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal • The symptoms are common but the intensity is not • 2/3 women • Jittery & agitation • Sleeplessness • Sweating • Eye-twitching • BUT NO IDENTIFIABLE CAUSE (Freud calls it Free Floating)

13. Anxiety Disorders • Panic Disorder: • Anxiety disorder marked by minute-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations (panic attack=specifier) • To develop a panic disorder you would have multiple attacks over time and begin to fear the fear or the places where the attacks have occurred • 1 in 75 people

14. Anxiety Disorders • Phobias/Phobic Disorder an anxiety disorder marked by persistent, irrational fear and avoidance of a specific object, activity, or situation • Common and many people suffer from this • Examples: animals, insects, heights, blood, or tunnels • Social anxiety phobia: intensely fears of being scrutinized by others and avoids potentially embarrassing social situations (sweat, tremble, or diarrhea) (DSM-IV= social phobia) • Shyness taken to an extreme

15. Anxiety Disorders • Agoraphobia: Fear or avoidance of situations in which escape might be difficult or help unavailable when panic strikes - may avoid being outside the home, in a crowd, on a bus, or even on an elevator

16. Why Anxiety? • Learning Perspective: • General Anxiety has been linked to a classical conditioning of fear via the environment where the unpredictable and uncontrollable aversive or anxiety-ridden event occurred • Classical & Operant Conditioning-natural fears can become very intense due to conditioning • Stimulus generalization: condition fears overflow to similar situations creating new fears • Reinforcement: by avoiding or escaping the situations, reduces anxiety and then reinforces the phobic behavior 2. Observational learning: observing others’ fears 3. Cognition: interpretations & irrational beliefs

17. Why Anxiety? • The Biological Perspective: • Natural selection • Genes • Physiology

18. Trauma & Stress Related DisordersAnxiety Related Disorders • Post-Traumatic Stress Disorder haunting memories and nightmares, a numbed social withdrawal, jumpy anxiety, and insomnia - basic trust erodes - fearful wariness - troubled sleep - nightmares - sense of hopelessness about their future

19. Obsessive-Compulsive & Related DisordersAnxiety Related Disorders • Obsessive-Compulsive Disorder An anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions) • Ex. Obsession: thinking about catching a disease • Ex. Compulsion: continually washing hands • 2 to 3% of teens & young adults cross the line of worry into OCD

20. Mood Disorders- DSM-IV classified into 2 categories • Mood disorders psychological disorders characterized by emotional extremes. • 2 main presentations • Major depressive disorder • Bipolar disorder (formerly manic-depressive disorder) • Now each of these have become Classifications of their own

21. Depressive Disorders • Major Depressive Disorder Includes lethargy, feeling of personal worthlessness, or loss of interest in family, friends, & activites • Symptoms experience for 2 or more weeks with no identifiable cause • “Common cold” of psychological disorders • DSM-5 no longer excludes bereavement if grief lasts longer than 2 wks • Whereas anxiety is a response to future loss, depression is the response to past and current loss • Anhedonia- a diminished ability to experience pleasure • Usually accompanied anxiety, drug, alcohol abuse • With or without therapy, episodes of major depression usually end

22. Depressive Disorders • Persistent Depressive Disorder (old DSM-IV…Dysthymic disorder): a down-in-the-dumps mood that fills most of the day, nearly everyday for two years or more • Less disabling than major depressive disorder • Experience chronic low energy and low self-esteem • Difficulty concentrating or making decisions • Sleep and eat too much or too little

23. Bipolar & Related Disorders • Bipolar I Disorder: • Alteration between depression and mania • Manic episode: a abnormally & persistently expansive, elevated, or irritable mood and increased goal-directed activity or energy, lasting at least 1 week • Typically over-talkative, overactive, elated (though easily irritated), little need for sleep, shows fewer sexual inhibitions • Speech is loud, flighty, and hard to interrupt • Grandiose optimism and high self-esteem • High levels = reckless behavior • Lower levels = creativity (Walt Whitman, Virginia Woolf, Edgar Allen Poe, Mark Twain, Ernest Hemingway, Margot Kidder)

24. Bipolar & Related Disorders • Bipolar II Disorder: • Alteration between depression and mania • Key Difference is hypomanic episode: period of at least 4 consecutive days marked by a abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy

25. Research about Mood Disorders • Women are twice as likely to experience depression • Stressful events related to work, marriage, and close relationships often preceded depression • As with anxiety, the rate of depression is increasing with each generation; adolescents are 3x more likely to suffer than grandparents

26. Why Mood Disorders? • Psychodynamic Perspective: depression happens when significant losses evoke losses experienced in childhood or current unresolved anger towards parents gets turned inward • Biological Perspective: • More prominent in families and twins (depression & bipolar) • Looking for a gene connection through linkage analysis • In depression: reduced levels of serotonin and norepinephrine (increases arousal and boosts mood) • In bipolar manic state: increased norepinephrine • Small frontal lobes (7% decrease)

27. Why Mood Disorders? • Social-Cognitive Perspective: • Learned helplessness can lead to self-defeating beliefs • 35% women & 16% men going into colleges feel overwhelmed by all they have to do • Negative thoughts feed negative moods….attributional styles • Rumination: staying focused on a problem • Explanations of individuals who are depressed state things as stable, global, and internal • Seligman states that depression in young westerners stems from the rise of individualism and the decline of commitment to religion and family

28. Why Mood Disorders? • Social-Cognitive Perspective: • Negative moods feed negative thoughts…being in a temporarily good or bad mood colors memories, judgments, and expectations • Cycle is often perpetuated by social rejection 1 Stressful Experiences 4 Cognitive & Behavioral Changes 2 Negative Explanatory style 3 Depressed Mood

29. Why Mood Disorders? • Social-Cognitive Perspective: • Loneliness: painful awareness that social relationships are deficient • 4 Types: • Excluded • Unloved • Constricted • Alienated Like people suffering with depression, people with loneliness tend to blame themselves and own inadequacies for their social deficiencies

30. Suicide • National Differences • U.S. • Racial Differences • Whites/Blacks • Gender Differences • Men/Women • Age/Trend • Additional Differences • Alcoholism

31. Schizophrenia Spectrum & Other Psychotic Disorders • Delusions- fixed beliefs that don’t change with contradictory evidence (ex. Persecution, grandiosity, referential, etc.) • Hallucinations- sensory experience without external stimuli • Disorganized Thinking (Speech)- switching from topic to topic, unrelated answers to questions, incoherent word salads • Grossly Disorganized or Abnormal Motor Behavior (including Catatonia)- too little or too much movement, no speech • Negative Symptoms- diminished emotional expression, avolition (lacking self-motivation), reduced speech, experience of pleasure, and social interaction

32. Schizophrenia Spectrum & Other Psychotic Disorders • Schizophrenia a group of severe PSYCHOTIC disorders characterized by 2 or more of the previously listed symptoms for the majority of 1 month (disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions) & leads to impairment in major life areas with some disturbances for at least 6 months • Delusions: false beliefs, often of persecution or grandeur, that may accompany psychotic disorders • “I am Mary Poppins” • Delusions of persecution = paranoid • Word Salads- jumping from one idea or even within sentences • This breakdown in selective attention

33. Schizophrenia • Disturbed Perceptions Perceiving things that are not there, most frequently auditory hallucinations- sensory experiences without external sensory stimulation….also see, feel, taste, and smell things that are not there Ex. Hear voices of insulting statements, tell them to burn themselves • “Split mind” experienced by nearly 1 in 100 people…over 20 million across the globe

34. Schizophrenia • Inappropriate Emotions & Actions - laughing at death - angry or crying at wrong times - Flat Affect- a zombielike state of apparent apathy, an expressionless face - awkward or inappropriate motor behaviors- continually rocking or remaining motionless for hours followed by agitation

35. Schizophrenia • Positive symptoms- behavioral excesses or peculiarities, such as hallucinations, delusions, bizarre behavior, and wild flights of ideas • Negative symptoms- behavioral deficits, such as flattened emotions, social withdrawal, apathy, impaired attention, and poverty of speech

36. Schizophrenia • Subtypes of Schizophrenia • Paranoid: Preoccupation with delusions or hallucination, often with themes of persecution or grandiosity • Disorganized: disorganized speech or behavior, or flat or inappropriate emotion • Catatonic: Immobility (or excessive, purposeless movement), extreme negativism, and/or parrot-like repeating of another’s speech or movements • Undifferentiated: Many and varied symptoms • Residual: withdrawal, after hallucinations and delusions have disappeared No longer divided into these subcategories…old DSM-IV method of classification, which were present at time of diagnosis

37. Why Schizophrenia? • Brain Abnormalities • Dopamine overactivity- excess of receptors & is related to impaired attention • Neurodevelopmental hypothesis • Brain anatomy • Fluid-filled areas are abnormally large & thalamus is abnormally small • Maternal virus (flu)during mid-pregnancy • Low birth weight and lack of oxygen during labor • Genetic Factors • Diathesis-stress model: people are predisposed to schizophrenia are more vulnerable to stress than others • Psychological Factors • Expressed emotion: the degree to which a relative of a patient displays highly critical or emotionally over-involved attitudes toward the patient

38. Somatic Symptom & Related Disorders • All disorders in this classification are associated with significant distress and impairment…seen more with medical disorders than with psychological disorders • Somatic Symptom Disorder…a psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause. • Vomitting, dizziness, blurred vision, difficulty swallowing, or severed & prolonged pain

39. Somatic Symptom & Related Disorders • Illness Anxiety Disorder- (DSM-IV: hypochondriasis) • Conversion Disorder- anxiety turns into a physical symptom; unexplained paralysis, blindness, or inability to swallow • Factitious Disorder- falsification of physical or psychological signs or symptoms or induction of injury or disease, associated with identified deception (can be for self or imposed on another…called by Proxy)

40. Dissociative Disorders • Dissociative Disorders:disorders in which conscious awareness becomes separated (dissociated ) from previous memories, thoughts, and feelings; the experience of a sudden loss of memory or a change in identity Dissociation: sense of being separated from your body as if watching yourself; a sense of detachment • Dissociative Amnesia & Dissociative Fugue • Dissociative Identity Disorder: two or more distinct personalities that alternate to control one’s behavior • Handedness may switch • Sometimes memories transfer • Biological visual changes may occur

41. Personality Disorders • Personality Disorders: psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning p. 633 Chart • Avoidant personality disorder: fearful sensitivity to rejection and thus withdrawn • Schizoid personality disorder: cluster of eccentric behaviors such as social disengagement • Histrionic personality disorder: dramatic or impulsive behaviors such as shallow, attention-getting emotions and goes to great lengths to earn praise and approval • Narcissitic personality disorder: exaggeration of own importance and fantasies success stories; often react to criticism with rage or shame • Borderline personality disorder: unstable identity, relationships, and emotions; overall unstable sense of self

42. Personality Disorders • Antisocial personality disorder: a personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. • Formerly sociopath or psychopath • May be aggressive and ruthless or a clever con artist • Typically male • May show signs by 3 to 6…impulsive, unconcerned with social rewards, and low anxiety levels • Lack of consciousness by 15- lie, steal, fight , unrestrained sexual behavior • As adults, cant keep job, poor spouse or parent, and assaultive

43. Neurodevelopmental Disorders • Attention-Deficit Hyperactivity Disorder (ADHD) • inattention: six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level - hyperactivity-impulsivity: six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level

44. Neurodevelopmental Disorders • Autism Spectrum Disorder A. Persistent deficits in social communication & social interaction 1. deficits in social-emotional reciprocity 2. deficits in nonverbal communication 3. deficits in developing, maintaining, and understanding relationships • Restricted, repetitive patterns of behavior, interests, or activities, as manifested by a least 2 of the following, currently or historically 1. stereotyped or repetitive motor movements, use of objects, or speech 2. insistence on sameness and routines 3. highly restricted or fixated interests 4. hyper or hypo-sensitivity to sensory input

45. Feeding & Eating Disorders • Anorexia nervosa- usually adolescents; 9 out of 10 are females. Drop far below normal weight but still feel fat, fear being fat, and remain obsessed with losing weight • Bulimia nervosa-mostly late teens or early twenties; cycle of overeating and then compensatory vomiting, laxative use, fasting, or excessive exercise (binging & purging); marked weight fluctuations within normal weight range; so its easy to hide • Binge-eating disorder-new DSM-5 category that involves significant binge with remorse but not expulsion or excessive exercise

46. Guess Who? 1. I felt the need to clean my room at home in Indianapolis every Sunday and would spend four to five hours at it. I would take every books out of the bookcase, dust and put it back. At the time I loved doing it. Then I didn’t want to do it anymore, but I couldn’t stop. The clothes in my closet hung exactly two fingers apart…I made a ritual of touching the wall in my bedroom before I went outside because something bad was going to happen if I didn’t do it the right way. I had a constant anxiety about it as a kid, and it made me think for the first time that I might be nuts.

47. Guess Who? 2.Whenever I get depressed it’s because I’ve lost a sense of self. I can’t find reasons to like myself. I think I am ugly. I think non one likes me…I become grumpy and short-tempered. Nobody wants to be around ,e. I’m left alone. Being alone confirms I am ugly and not worth being with. I think I am responsible for everything that goes wrong. 3.Once I’ve done a crime, I just forget it. I think of killing like smoking a cigarette, like another habit.

48. Guess Who? 4.Voices, like the roar of a crowd came. I felt like Jesus; I was being crucified. It was dark. I just continued to huddle under the blanket, feeling weak, laid bare and defenseless in a cruel world I could no longer understand. 5.Tom, a 27-year-old electrician, complains of dizziness, sweating palms, heart palpitations, and ringing in his ears. He feels edgy and sometimes finds himself shaking. With reasonable success he hides his symptoms from his family and co-workers. Nevertheless, he has had few social contacts since the symptoms began two years ago. He occasionally had to leave work. His family doctor and a neurologist can find no physical problem.

49. Psychological Disorders & the Law • Insanity- a legal status indicating that a person cannot be held responsible for his or her actions because of mental illness • Involuntary commitment- people are hospitalized in psychiatric facilities against their will

50. Psychological Disorders & Culture • Culture-bound disorders- abnormal syndromes found only in a few cultural groups