Psychological Disorders Chapter 15

1. Psychological DisordersChapter 15 AP Psychology Alice F. Short Hilliard Davidson High School

2. Chapter Preview • Defining/Explaining Abnormal Behavior • Anxiety Disorders • Mood Disorders • Dissociative Disorders • Schizophrenia • Personality Disorders • Psychological Disorders and Health and Wellness

3. Abnormal Behavior • abnormal behavior - behavior that is… • deviant (atypical) • example: washing hands 4x an hour • maladaptive (dysfunctional) • example: believing that you can hurt people by breathing and hiding away and avoiding people • personally distressing (despair) • example: feeling extreme shame or guilt … over a relatively long period of time NOTE: context matters!

4. Theoretical Approaches • Biological Approach: Medical Model • disorders with biological origins • Psychological Approach • experiences, thoughts, emotions, personality • Sociocultural Approach • social context • Biopsychosocial Model • interaction of biological, psychological and sociocultural factors

5. Theoretical ApproachesBiological Approach: Medical Model • medical model – the view that psychological disorers are medical diseases with biological origin • disorders with biological origins • abnormalities = mental illnesses • patients = afflicted individuals • doctors = people who treat the patients

6. Theoretical Approaches:Psychological Approach • psychological approach – focuses on experiences, thoughts, emotions, personality • in the development and course of psychological disorders

7. Theoretical Approaches:Sociocultural Approach • Sociocultural Approach • social context • includes: gender, ethnicity, socioeconomic status, family relationships, culture, technological aspects of culture, religious aspects of culture • socioeconomic status = greater impact than ethnicity • living conditions of poverty = stressful

8. Theoretical Approaches:Biopsychosocial Model • Biopsychosocial Model • interaction of biological, psychological and sociocultural factors • biological factors (such as genes) • psychological factors (such as childhood experiences) • sociocultural factors (such as gender)

9. DSM-V Classification System • Advantages • provides a common basis for communication • helps clinicians make predictions • naming the disorder can provide comfort • Disadvantages • stigma (shame, negative reputation) • medical terminology implies internal cause • focus on weaknesses ignores strength • DISUCSSION: Which do you think is more significant—the advantages or disadvantages?

10. Critical Controversy: Psychological Disorders – Real or Myth? • Szasz & Cruise • phrase “mental illness” is presumptuous • medication of mental illnesses is presumptuous • Response of Medical Professionals • mental illnesses are real medical conditions • drugs effectively alleviate symptoms • ADHD: over-diagnosed or non-medical? • should prescription drugs be used to treat ADHD?

11. Critical Controversy:A SHORT Time to Ponder • When do you think it is appropriate to label someone as having a psychological disorder? • When do you think medical treatments for psychological disorders are appropriate? • If a teacher suggested that your child be tested for ADHD, what do you think you would do? Why?

12. DSM-V-TR Axes • Multiaxial System • Axis I and II: Psychological Disorders • Axis III: Another Medical Conditions • Axis IV: Psychosocial/Environmental Problems • Axis V: Current Level of Functioning

13. Axis I Disorders • Major Categories: • disorders usually first diagnosed in infancy, childhood, or adolescence and communication disorders • anxiety disorders • somatoform disorders • factitious disorders • dissociative disorders • delirium, dementia, amnesia, and other cognitive disorders • mood disorders • schizophrenia and other psychotic disorders • substance-related disorders • sexual and gender identity disorders • eating disorders • sleep disorders • impulse control disorders not elsewhere classified • adjustment disorders

14. Axis II Disorders • Major Categories: • intellectual disability • personality disorders • other conditions that may be a focus of clinical attention

15. Anxiety Disorders • anxiety disorders - uncontrollable fears that are disproportionate to the actual danger and disruptive to ordinary life (Axis I) • generalized anxiety disorder • panic disorder • phobic disorder • separation anxiety disorder • selective mutism • obsessive-compulsive disorder • now in the obsessive-compulsive and related disorders • post-traumatic stress disorder • now in the trauma- and stressor-related disorders • sequential order of chapter reflects close relationship

16. Generalized Anxiety Disorder • Diagnosis and Symptoms • persistent anxiety for at least 6 months • inability to specify reasons for the anxiety • Etiology – the causes or significant preceding conditions • biological factors • genetic predisposition, GABA deficiency, sympathetic nervous system activity, respiration • psychological and sociocultural factors • harsh self-standards, critical parents, automatic negative thoughts, history of uncontrollable trauma (like an abusive parent)

17. Panic Disorder • Diagnosis and Symptoms • recurrent, sudden onsets of intense terror that often occur without warning • panic attacks: can produce sever palpitations, extreme shortness of breath, chest pains, trembling, sweating, dizziness and a feeling of helplessness • types changed to unexpected panic attack and expected panic attack • panic disorder and agoraphobia are unlinked • Etiology • biological factors: genetic predisposition • psychological factors: misinterpret arousal • sociocultural factors: gender differences • American women = 2x as likely to suffer from a panic disorder • FUN FACT: Charles Darwin had a panic disorder

18. Phobic Disorder • Diagnosis and Symptoms • an irrational, overwhelming, persistent fear of a particular object or situation • social anxiety disorder social phobia – an intense fear of being humiliated or embarrassed in social situations • deletion of requirement that individuals over age 18 years recognize that their anxiety is excessive or unreasonable • 6-month duration expanded to include all ages • panic disorder and agoraphobia are unlinked • “generalized” specifier has been deleted and replaced with a “performance only” specifier (fear of speaking/performing in front of an audience) • Etiology • biological factors: genetic disposition • neural circuit: thalamus, amygdala and cerebral cortex • psychological factors: learned • classical conditioning / learned associations

19. Examples of Phobic Disorders • phobic disorders – it is no longer a requirement that individuals over age 18 years must recognize that their fear and anxiety are excessive or unreasonable

20. Social Anxiety Disorders in the US • social anxiety disorder (formerly called social phobias)

21. Obsessive Compulsive and Related Disorders • Diagnosis and Symptoms • persistent anxiety-provoking thoughts and/or urges to perform repetitive, ritualistic behaviors to prevent or produce a situation • cognitive perspective: inability to turn off negative, intrusive thoughts by ignoring or effectively dismissing them • obsession – recurrent thoughts • compulsions – recurrent behaviors • most common: excessive checking, cleansing, counting • Etiology • biological factors: genetic predisposition • more activity in frontal cortex, basal ganglia, thalamus • smaller amygdala (counter-intuitive) • lower levels of serotonin and dopamine • psychological factors: life stress

22. Obsessive-Compulsive and Related Disorders • new disorders: • hoarding disorder • excoriation (skin-picking) disorder • substance-/medication induced obsessive-compulsive and related disorder • obsessive-compulsive related disorder due to another medical condition • from impulse-control disorders • trichotillomania (hair-pulling) disorder • new specifiers • “with poor insight”… “fair”… “good”… “absent insight/delusional”

23. Post-Traumatic Stress Disorder (PTSD) • Diagnosis and Symptoms • Symptoms develop as a result of exposure to a traumatic event--oppressive situation, natural or unnatural disasters—that have overwhelmed the person’s abilities to cope • flashbacks  reliving event • avoidance of emotional experiences/talking with others • constricted ability to feel emotions • excessive arousal  inability to sleep, exaggerated startle response • difficulties with memory and concentration • feelings of apprehension • impulsive outbursts • 4 major symptom clusters: reexperiencing, avoidance, persistent negative alteration in cognitions and mood, arousal

24. Post-Traumatic Stress Disorder • Etiology • stressor criterion: requires being explicit to whether qualifying traumatic events were experienced directly, witnessed, or experienced indirectly • subjective reaction (removed) • trauma • combat and war-related • sexual abuse and assault • natural and unnatural disasters (plane crashes, terrorists attacks) • vulnerability • previous history of trauma • conditions: abuse, psychological disorders • genetic predispositions

25. Mood Disorders • mood disorder - disturbance of mood that affects entire emotional state (Axis I Disorder) • depressive disorders • major depressive disorder • dysthymic disorder • bipolar disorders • correlate: suicide • Symptoms may include • cognitive, behavioral, or physical symptoms • interpersonal difficulties

26. Major Depressive Disorder (MDD) • Diagnosis and Symptoms • significant depressive episode that lasts for at least two weeks • defined by presence of at least 5 out of 9 symptoms • depressed mood most of the day • reduced interest or pleasure in all or most activities • significant weight loss or gain or significant decrease or increase in appetite • trouble sleeping or sleeping too much • psychological and physical agitation, or, in contrast, lethargy • fatigue or loss of energy • feeling worthless or guilty in an excessive or inappropriate manner • problems thinking, concentrating, or making decisions • recurrent thoughts of death and suicide • no history of manic episodes (periods of euphoric moods) • daily functioning is impaired • the coexistence of within a major depressive episode of at least three manic symptoms (insufficient to satisfy criteria for a manic episode) is now acknowledged by the specifier “with mixed feature”  increases likelihood illness exists in bipolar spectrum • bereavement exclusion removed - was an exclusion applied to depressive symptoms lasting less than 2 months following the death of a loved one

27. Persistent Depressive Disorder:Dysthymic Disorder (DD) • Diagnosis and Symptoms • chronic depression • unbroken depressed mood lasting at least two years (adult) or one year (child) • adult: less than two months regular mood still = diagnosis • fewer symptoms than MDD • defined by presence of 2 out of 6 symptoms • poor appetite or overeating • sleep problems • low energy or fatigue • low self-esteem • poor concentration or difficulty making decisions • feelings of hopelessness • dysthymic disorder now falls in category of persistent depressive disorder (along with chronic major depressive disorder)

28. Major Depressive Disorder (MDD) • Etiology • biological factors: genetic disposition • underactive prefrontal cortex • regulation of neurotransmitters • serotonin • norepinephrine • psychological factors: • learned helplessness • ruminating on negative, self-defeating thoughts • pessimistic attribution • sociocultural factors • poverty • women head of households • minorities • gender differences (women = 2x likely)

29. Childhood Depression • Developmental Psychopathology • risk factors for depression • parental psychopathology • genetics • protective factors • supportive adult role model, or strong extended family • genetics

30. Mood Disorder: Bipolar Disorder • Characterized by extreme mood swings • Bipolar I (more severe) • hallucinations – seeing or hearing things that are not there • mania – an overexcited, unrealistically optimistic state • new specifier of “with mixed features” (meeting full criteria for both has been removed) • Bipolar II • less extreme level of euphoria • manic and hypomanic episodes now include an emphasis on changes in activity and energy as well as mood • Frequency and separation of episodes • usually separated by 6 months to a year • Etiology • strong genetic component • swings in metabolic activity in cerebral cortex • levels of neurotransmitters • high levels of norepinephrine, glutamate • low levels of serotonin

31. Suicide • Prevalence • over 32,000 in year 2004 • one completion for every 8 to 25 attempts • 3rd leading cause of death in early adolescence • 10-14 • 13-19

32. Suicide • Biological factors • low levels of serotonin • 10x likely to try again • poor health • Psychological Factors • mental disorders • 90 percent • trauma (recent/immediate and highly stressful) • sexual abuse • loss of a job/flunking out of school/unwanted pregnancy • substance abuse • Sociocultural Factors • chronic economic hardship • cultural and religious norms • norms against suicide = lower rates • eastern Europe, Japan, South Korea • gender differences

33. When Someone is Threatening Suicide • attempters: connection to others • women 3x morel likely to attempt • completers: disconnected / burden on others • men 4x more likely to complete suicide; more likely to use a firearm • highest suicide rate is among non-Latino men aged 85+

34. Dissociative Disorder • dissociative disorder - sudden loss of memory or change in identity due to the dissociation (separation) of the individual’s conscious awareness from previous memories and thoughts • Dissociation • protection from extreme stress or shock • problems integrating emotional memories • Types • dissociative amnesia • dissociative fugue * is now a specifier of dissociative amnesia rather than a separate diagnosis • dissociative identity disorder (DID)

35. Dissociative Disorders • Dissociative Amnesia • individuals experience extreme memory loss caused by extensive psychological stress • only aspects of their own identity and autobiographical experiences are forgotten • Example: sodium pentathol “truth serum”  stress • Dissociative Fugue • dissociative fugue * is now a specifier of dissociative amnesia rather than a separate diagnosis • individuals experience amnesia, unexpectedly travel away, and sometimes assume a new identity • tendency to run away*

36. Dissociative Identity Disorder (DID) • formerly known as multiple personality disorder • most dramatic, least common, most controversial dissociative disorder • Diagnosis and Symptoms • the same individual possesses two or more distinct personalities • symptoms of disruption may be reported as well as observed • each personality has unique memories, behaviors, and relationships • only one personality is dominant at a time • personality shifts (and gaps in recall) occur under distress and everyday (not just traumatic events) • * “experiences of pathological possession in some cultures are included in the description of identity disruption” • Etiology • extraordinarily severe abuse in early childhood (70%) • social contagion • mostly women • runs in families • individual compartmentalizes different aspects of the self into independent identities

37. Schizophrenia • highly disordered thought • thought disorder – refers to the unusual, sometimes bizarre thought processes that are characteristic positive symptoms of schizophrenia • split from reality (psychotic) • typically diagnosed in early adulthood • high suicide risk (8x general population) • categories of symptoms: • positive symptoms • hallucinations • delusions • thought disorders • disorders of movement • negative symptoms

38. Symptoms of Schizophrenia • Positive Symptoms • hallucinations – sensory experiences in the absence of real stimuli • auditory and visual = more common • smells or tastes = less common • delusions – false, unusual, and sometimes magical beliefs that are not part of an individual’s culture • believing you’re Jesus Christ, Muhammad, etc. • that your thoughts are being broadcast over the radio, etc. • disorganized speech * in DSM-V must have one of these core positive symptoms • thought disorder • “word salad”; neologisms – making up new words • referential thinking – ascribing personal meaning to completely random events – traffic light turned red because YOU’RE in a hurry • disorders of movement – unusual mannerisms, body movements, facial expressions, may repeat certain motions over and over • catatonia – state of immobility and unresponsiveness lasting for long periods of time (all contexts require 3 catatonic symptoms (of 12); may be diagnosed as specifier for depressive, bipolar, psychotic disorders) • Negative Symptoms • flat affect – the display of little or no emotion (common) • Cognitive Symptoms • attention difficulties and memory problems • impaired ability to interpret information and make decisions • subtypes of schizophrenia are removed in DSM-V (paranoid, disorganized, catatonic, undifferentiated, residual, etc.)

39. Etiology of Schizophrenia • Biological Factors • genetic predisposition • structural brain abnormalities (no glial cells  prenatal) • enlarged ventricles (fluid-filled spaces) in brain  indicates deterioration in other brain tissue • smaller and less active prefrontal cortex • regulation of neurotransmitters • excess dopamine production (or overactivation of pathways) • bizarre beliefs continue after dopamine regulation  may disappear only after experience demonstrates that such schemas no longer carry their explanatory power • Psychological Factors • diathesis-stress model – view of schizophrenia emphasizing that a combination of biogenetic disposition and stress causes the disorder • diathesis – physical vulnerability or predisposition to a particular disorder • Sociocultural Factors • influence how disorder progresses (course) • developing, non-industrialized countries have better results

40. Personality Disorders • personality disorder - chronic maladaptive cognitive-behavioral patterns • antisocial personality disorder • borderline personality disorder • Antisocial Personality Disorder • Diagnosis and Symptoms • guiltless lawbreaking, violence, deceit • impulsive, irritable, reckless, irresponsible • exploitative, lacks empathy • psychopaths – remorseless predators who engage in violence to get what they want (examples: John Wayne Gacy, Ted Bundy) • “successful psychopaths” and “unsuccessful psychopaths” • Etiology • biological factors • genetic heritable • brain: less prefrontal activation, structural abnormalities in amygdala and hippocampus • underaroused ANS (autonomic nervous system) differences • testosterone – hormone most associated with aggressive behavior • more common in men

41. Personality Disorders • Borderline Personality Disorder • Diagnosis and Symptoms • instability in interpersonal relationships & self-image • impulsive, insecure, unstable & extreme emotions • very sensitive to treatment of others • paranoia – a pattern of disturbed thought featuring delusion of grandeur or persecution • dissociative symptoms • recurrent suicidal behavior, gestures, or threats or self-mutilating behaviors • cutting – insuring oneself with a sharp object but without suicidal attempt • splitting – thinking style of seeing things in black or white • Etiology • genetic (40% heritability) • childhood abuse, neglect – suggests diathesis-stress explanation • irrational belief one is powerless, unacceptable, and that others are hostile • hypervigilance – the tendency to be constantly on the alert, looking for threatening information in the environment • 75% women

42. Psychological Disorders and Health and Wellness • Stereotypes and Stigma • Rosenhan’s study - fake psychiatric patients • 3-52 days hospitalization for (FAKE) schizophrenia • negative attitudes toward mentally ill • physical health risk • successfully functioning individuals with mental illness reluctant to “come out”

43. Chapter Summary • Discuss the characteristics, explanations, and classifications of abnormal behavior. • Distinguish among the various anxiety disorders. • Compare the mood disorders and specify risk factors for depression and suicide. • Describe the dissociative disorders. • Characterize schizophrenia. • Identify behavior patterns typical of personality disorders. • Explain the impact of the stigma associated with mental illness.

44. Chapter Summary • Abnormal Behavior • deviant, maladaptive, or personally distressing • Theoretical Approaches • biological, psychological, and sociocultural • biopsychosocial • Classifying Abnormal Behavior • DSM-IV-TR Axes • advantages and disadvantages

45. Chapter Summary • Anxiety Disorders • generalized anxiety disorder • panic disorder • phobic disorder • obsessive-compulsive disorder • post-traumatic stress disorder

46. Chapter Summary • Mood Disorders • major depressive disorder • dysthymic disorder • bipolar disorder • suicide • Dissociative Disorders • dissociative amnesia • dissociative fugue • dissociative identity disorder

47. Chapter Summary • Schizophrenia • positive, negative and cognitive symptoms • etiology (biological, psychological, sociocultural) • Personality Disorders • antisocial personality disorder • borderline personality disorder • Psychological Disorders and Health & Wellness • stigmas and stereotypes