Chapter 14: What Are Psychological Disorders and How Can We Understand Them?

1. Chapter 14:What Are Psychological Disorders and How Can We Understand Them?

2. What Is Abnormal Behavior? • Four criteria help distinguish normal from abnormal behavior: • Statistical infrequency • Violation of social norms • Problematic criterion on its own • Personal distress • Level of impairment • Interferes with ability to function

3. Prevalence of Abnormal Behaviors • 26% of Americans over 18 have diagnosable psychological disorders within a given year; 46% lifetime prevalence • Psychological disorders are leading cause of disability in U.S. and Canada for individuals between 15 and 44

6. Explaining Psychological Disorders: Perspectives Revisited • Western cultures explain abnormal behavior through three perspectives: • Biological theories • Psychological theories • Social or cultural theories

7. Biological Theories: The Medical Model • Abnormal behavior attributable to physical processes: • Genetics, hormone/neurotransmitter imbalance, brain/bodily dysfunction • Also called the medical model • Emphasizes diagnosis, treatment, and cure, in similar manner to physical illnesses

8. Psychological Theories: Humane Treatment and Psychological Processes • Internal & external stressors result in abnormal behavior • Four predominant perspectives • Psychoanalytic: unconscious conflicts • Social-learning: past learning and modeling • Cognitive: ineffective mental processes • Humanistic: distorted perception of self and reality

9. Sociocultural Theories: • Internal biological and psychological processes can only be understood in context of social factors • Culture, age, race, sex, gender-identity, sexual orientation, religion/spirituality, socioeconomic status, and social conditions must be taken into consideration in evaluating abnormal behavior

10. A Biopsychosocial Model: Integrating Perspectives • No one perspective is “correct” • Most disorders are a result of biological psychological, & social factors • No one single “cause”

11. The DSM Model for Classifying Abnormal Behavior • Ability to describe behavior is more advanced than understanding of causes • Diagnostic and Statistical Manual of Mental Disorders, now in fourth revision (DSM-IV-TR) • Lists specific, concrete criteria for diagnosis • Atheoretical: does not address causes of mental illness

12. A Multidimensional Evaluation • Five dimensions for evaluation, known as axes • Axis I: clinical disorders • 15 major categories • Axis II: personality disorders; mental retardation • Axis III: general medical conditions • Axis IV: psychosocial and environmental problems • Axis V: global assessment of functioning

13. Anxiety Disorders: Not Just “Nerves” Four components: • Physical: activation of sympathetic nervous system and hormonal system (fight-or-flight) • Cognitive: unrealistic thoughts (exaggerated danger, fear losing control, paranoia) • Emotional: terror, panic, irritability • Behavioral: coping (freezing, aggression)

14. Panic Attack • Discrete period of intense fear or discomfort, which usually peaks within 10 minutes. • And… 4 of the following: • Racing Heart Sweating • Trembling Shortness of breath • Choking Chest discomfort • Nausea Dizziness/lightheadedness

15. Panic Attack • Discrete period of intense fear or discomfort, which usually peaks within 10 minutes. • And… 4 of the following: • Derealization Depersonalization (detached from self) • Fear of dying Fear of losing control/going crazy • Numbness Chills or hot flashes

16. Panic Disorder W/O Agoraphobia • Recurrent Panic attacks, followed by one or more (for at least 1 month): • Persistent concern about future attacks • Worry About implications of attack (heart attack; “crazy”) • Significant change in behavior *30 - 40% of young Americans report occasional attacks

17. Panic Disorder with Agoraphobia • Panic Disorder AND… • Agoraphobia: “fear of the marketplace” • Anxiety & avoidance of places/situations where help may not be available if panic occurs.

18. GAd • Excessive worry, most days, at least 6 months • Difficulty controlling the worry • 3 or more of 6 symptoms, most days: • Restless/”on edge” Easily fatigued • Difficulty concentrating Irritability • Muscle tension Sleep disturbance • “clinically significant distress” or impaired functioning

19. OCD • A. Obsessions Or compulsions that cause marked distress or impairment in functioning. • Obsessions: persistent, intrusive thoughts, images and impulses. • Product of own mind (e.g., not hallucinations) • Difficulty ignoring or suppressing obsessions • Compulsions: Repetitive behaviors or mental acts (to reduce distress and anxiety…attempt to prevent fear from occurring in an unrealistic way).

20. PTSD • Exposure to traumatic event • “actual or threatened death, serious injury, or physical integrity” • Response involved intense fear, helplessness • Reexperience event: images, dreams, reliving, or intense distress from triggers of event • Persistent avoidance of stimuli associated with trauma • Avoid: thoughts, feelings, activities, loss of recall, detachment form others, restricted affect, etc

21. PTSD • Duration is more than 1 month • Less than 1 month= acute distress disorder • Acute or chronic • Duration of symptoms less than 3 months, or longer

23. Phobic Disorders • Intense fears vs. normal fears • intense fears causing anxiety, possibly panic attacks, that interfere with functioning • Specific phobias: persistent fear and avoidance of object or situation • Most common, 8% lifetime • Usually begin in childhood • Social phobias • Irrational fear of being negatively evaluated by others in social situations

24. Explaining Anxiety Disorders: Psychological Factors • Social learning • Phobias develop through • classical conditioning • observational learning • behaviors reinforced by avoidance of fears (operant conditioning) • Reinforcement in compulsions • Cognitive • Misinterpretation of bodily sensations in panic • Negative and catastrophic thinking heighten anxiety

25. Anxiety Disorders • Common Disorders: Panic Disorder, Specific Phobia, Social Phobia, GAD, PTSD, OCD • Panic Disorder: 20% have attempted suicide • Similar suicide rates as depression • Suicide risk highest when comorbid with depression • ~50% with an anxiety disorder have another disorder

26. Suicide: Rates & Facts • 32,000 Americans complete suicide a year (12 people per 100,000; 85 per day). • A person is more likely to die by suicide than to be murdered in the U.S. • Suicide is the 11th leading cause of death overall in the U.S., yet 2nd for college students. • Guns are used in more than half of completed suicides. • Females 3x attempts; Males 4x completions Source: (Granello & Granello, 2007)

27. Suicide: IncreasedRisk • Abuse and Assault (Granello & Granello, 2007). • Women with a history of sexual assault during childhood or adulthood have a higher risk for suicide attempts (Ullman & Brucklin, 2002). • The more types of abuse, the higher the risk (Ullman & Brucklin, 2002). • Family History of Suicide • 11 times the risk (AAS, 2009). • Eating Disorders • Over 20x Suicide Mortality (Death) rate (AAS, 2009; Harris & Barraclough,1997) • HIghest Mortality rate for Anorexia Nervosa (AAS, 2009).

29. Explaining Mood Disorders: Biological Factors • Genetics • Family, twin and adoption studies show genetic transmission (clearer for bipolar than major depression) • Neurotransmitters • Serotonin and norepinephrine abnormalities • Hormones • Repeated activation of hormonal stress system may lay ground for depression

30. Explaining Mood Disorders: Psychological Factors • Psychoanalytic: unresolved childhood issues, symbolic expression of anger • Attachment: insecure attachments, separations, losses increase vulnerability • Behavioral/learning: reduction in positive reinforcers from others • Learned helplessness • Ruminative coping style • Cognitive research: cognitive distortions and attributions of events

31. Explaining Mood Disorders: Sociocultural Factors • Depression more likely among people of lower social status • Cross-culturally, more women than men • Biological: hormonal imbalance • Psychological: ruminative coping, relational style • Social: less power, more victimized, gender-role socialization

33. Unipolar Depressive Disorders • Depression is leading cause of disability in U.S. and worldwide • 17% acute episode in lifetime; 6% chronic • Average age of onset is 32 • 15 to 24 years at highest risk for major depressive episode • Women more likely to experience than men • European American have highest risk, but African and Hispanic American more severe

34. Bipolar Depressive Disorders: The Presence of Mania • 2.6% lifetime, late adolescence, early adulthood • Bipolar disorder • Shift in mood between two states (poles) • Depression to mania characterized by high energy, impulsiveness, euphoria • Cyclothymic disorder • Less severe, but more chronic, form of bipolar • Alternates between milder periods of mania and moderate depression

35. Mood Disorders: Beyond the Blues • Significant change in one’s emotional state • 9.5% per year • Although most experience some depression, clinical depression is related to length of time symptoms exist and interference with functioning • Symptoms exist even in absence of triggering events

36. Unipolar Depressive Disorders: A Change to Sadness • Major depression • Extreme sadness (dysphoria) or extreme apathy (loss of interest in activities) plus four other symptoms for at least two weeks • May be single or repeated episodes • Dysthymic disorder • Less severe, more chronic form of depression • Depressed mood plus two other symptoms lasting at least two years

37. Depressive Disorder NOS • NOS means “Not Otherwise Specified” • This is a “catch all” category for those who do not fit neatly into the other categories

38. Mood Disorders & Suicide • Double Depression: MDD & Dysthymic Disorder • “Dual Diagnosis”: Mental Disorder and Substance Abuse or Dependence Disorder

39. Mania • A distinct period of abnormally elevated, expansive, or irritable mood, lasting at least 1 week (or hospitalization required) • 3 criteria must be met • 4 if mood is irritable instead of elevated

40. Mania • Criteria 3 must be met “to a significant degree” • Inflated self-esteem or grandiosity • Decreased need for sleep (rested after 3 hours a night) • More talkative/ “Pressured speech” • Racing Thoughts for “Flight of ideas” • Distractibility • Increased goal-directed activity or psychomotor agitation • Excessive involvement in pleasurable activities with high chance of painful consequences

41. Hypomanic Episode • A distinct period of abnormally elevated, expansive, or irritable mood, lasting at least 4 days • 3 criteria must be met • 4 if mood is irritable instead of elevated • Not severe enough to hospitalize; no psychotic features

42. Hypomania • Criteria 3 must be met “to a significant degree” • Inflated self-esteem or grandiosity • Decreased need for sleep (rested after 3 hours a night) • More talkative/ “Pressured speech” • Racing Thoughts for “Flight of ideas” • Distractibility • Increased goal-directed activity or psychomotor agitation • Excessive involvement in pleasurable activities with high chance of painful consequences

43. Bipolar I Disorder • Presence of a Manic Episode • Bipolar II: One or more depressive episodes with at least one Hypomanic Episode (No full manic episode)

44. Schizophrenia • From Greek…“split mind” is a misnomer • Affects approximately 1-2% of population in lifetime • Strong biological component • Identical (monozygotic) twin ~ 50% • Schizophrenia or Mood disorder with psychotic features?.. often difficult to determine • Many call this disorder “the schizophrenias”

45. Schizophrenia A. 2 or more of these criteria: • Delusions • Hallucinations • Disorganized speech • Grossly disorganized, or catatonic behavior • Negative symptoms (affective flattening, alogia, or avolition) • Only 1 criteria needed if: bizaare delusions, voice keeping commentary of person’s behaviors and thoughts, two or more voices conversing together.

46. Types of Schizophrenia: Positive and Negative Symptoms • Positive and negative symptoms exist in schizophrenia • Positive: increase in behaviors (i.e.unusual perceptions, thoughts, behaviors) • Negative: loss of behaviors (i.e. motor movements, social withdrawal, etc.) • Some show both positive and negative • Better outcome for treatment in cases where predominantly positive symptoms

47. Schizophrenia: 2 types of symptoms • Between 50-70% experience positive symptoms Positive Symptoms: • Hallucinations (auditory most common) • Delusions Delusion of grandeur: “I can save the world by sacrificing myself” Delusion of persecution: “The FBI and CIA are out ot get me and have bugged all of my electronic devices”

48. Schizophrenia: 2 types of symptoms • Negative: • Avolition: inability to persist in daily activities (unable to groom, shower, etc). • Alogia: Relative absence of speech (brief replies, with little content; for example, one word answers). • Anhedonia: Loss of pleasure / interest • Affective flattening: show almost no emotion, even when you’d expect strong emotional display. • Disorganized: • Disorganized speech, thought process • Tangential thought process

50. Symptoms of Schizophrenia • Disordered thoughts • Thought disorder: lack of association between ideas and events • Loose associations, poverty of content, word salad • Delusions: thoughts and beliefs the person believes to be true, while having no basis in reality • Persecutory, grandiose, delusions of reference, delusions of thought control