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Chapter 14 Psychological Disorders. Topics to Explore. Defining & Classifying Disorders Three Categories of Disorders Treatment of Mental Disorders. Part 1 Defining & Classifying Mental Disorders. What is Abnormal Psychology?.
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Topics to Explore • Defining & Classifying Disorders • Three Categories of Disorders • Treatment of Mental Disorders
What is Abnormal Psychology? Abnormal Psychology: the scientific study of mental disorders and their treatment
Ways of Defining “Abnormal” Subjective Discomfort: Feelings of anxiety, depression, or emotional distress. But people we would consider definitely abnormal may not feel subjective discomfort. Social Nonconformity: Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior. But it doesn’t always. Is being a nonconformist always a disorder? 1984! Statistical Abnormality: Having extreme scores on some dimension, such as intelligence, anxiety, or depression. But having a numerically rare characteristic isn’t always a disorder (e.g., having an IQ of 180)
Two Considerations Situational Context: Social situation, behavioral setting, or general circumstances in which an action takes place Is it normal to walk around strangers naked? If you are in a locker room and in the shower area, yes! Cultural Relativity: Judgments are made relative to the values of one’s culture
Three Criteria for Abnormality Maladaptive Behavior: Behavior that makes it difficult to function, to adapt to the environment, and to meet everyday demands Significant impairment in psychological functioning: Those with mental illness lose the ability to control thoughts, behaviors, or feelings adequately Atypical behavior: behavior that is not typical of the majority of the population
DSM-IV DSM-IV: Diagnostic and Statistical Manual of Mental Disorders. Published by the American Psychiatric Association. Provides a classification system of mental disorders.
Mood Disorders Anxiety Disorders Somatoform Disorders Factitious Disorders Dissociative Disorders Sexual & Gender Identity Disorders Eating Disorders Sleep Disorders Adjustment Disorders Personality Disorders Disorders First Diagnosed in Childhood Organic Mental Disorders Substance Related Disorders Schizoprenia Disorders Paranoid Disorders Impulse Control Disorders Some DSM-IV Categories
General Risk Factors for Mental Illness Social Conditions: Poverty, homelessness, overcrowding, stressful living conditions Family Factors: Parents who are immature, mentally ill, abusive, or criminal; poor child discipline; severe marital or relationship problems Psychological Factors: Low intelligence, stress, learning disorders Biological Factors: Genetic defects or inherited vulnerabilities; poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disability
Clarifying Some Terms • Insanity: A legal term; refers to an inability to manage one’s affairs or to be aware of the consequences of one’s actions • Those judged insane (by a court of law) are not held legally accountable for their actions • Can be involuntarily committed to a psychiatric hospital • Some movements today are trying to abolish the insanity plea and defense; desire to make everyone accountable for their actions • Neurosis: Archaic; once used to refer to excessive anxiety, somatoform, dissociative disorders, and some kinds of depression
Anxiety Disorders Anxiety: Feelings of apprehension, dread, or uneasiness Anxiety Disorder: a disorder in which excessive anxiety leads to personal distress and atypical, maladaptive, and irrational behavior
Specific Phobias Specific Phobias: Irrational, persistent fears, anxiety, and avoidance that focus on specific objects, activities, or situations People with phobias realize that their fears are unreasonable and excessive, but they cannot control them
Some Phobias See in class!
Social Phobia Social Phobia: Intense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e.g., shyness, eating, or speaking in public) Those with social phobia avoid social situations, such as eating, writing, or speaking in public. Social phobias impair functioning at work, at school, and in personal relationships. Estimate that 13% of all adults affected by social phobias at some time. Examples: Barbra Streisand, Woody Allen perhaps?
Agoraphobia • Agoraphobia: Intense, irrational fear that a panic attack will occur in a public place or in an unfamiliar situation • Intense fear of leaving the house or entering unfamiliar situations • Can be very crippling • Literally means fear of open places or market (agora) • Can occur with or without accompany panic disorder.
Panic Disorder Panic Disorder: A chronic state of anxiety with brief moments of sudden, intense, unexpected panic (panic attack) Panic Attack: Feels like one is having a heart attack, going to die, or is going insane. Symptoms include vertigo, chest pain, choking, fear of losing control
Generalized Anxiety Disorder Generalized Anxiety Disorder (GAD): Duration of at least six months of chronic, unrealistic, or excessive anxiety Symptoms: sweating, racing heart, clammy hands, dizziness, upset stomach, rapid breathing, irritability, poor concentration. More common in women than in men.
Obsessive-Compulsive Disorder • Obsessive-Compulsive Disorder (OCD): Extreme preoccupation with certain thoughts and compulsive performance of certain behaviors • Obsession: Recurring images or thoughts that a person cannot prevent. • Cause anxiety and extreme discomfort • Enter into consciousness against the person’s will • Most common: Being dirty, wondering if you performed an action (turned off the stove), or worrying about violence (being hit by a car) • Compulsion: Irrational acts that person feels compelled to repeat against his/her will • Help to control anxiety created by obsessions • Most compulsions involve either checking or cleaning something.
Mood Disorders Mood Disorders: Major disturbances in emotion, such as depression or mania Depressive Disorders: Sadness or despondency that are prolonged, exaggerated, or unreasonable Bipolar Disorders: Involve both depression and mania or hypomania
Childbirth-related Mood Disorders • Maternity Blues: Mild depression that lasts for one to two days after childbirth • Marked by crying, fitful sleep, tension, anger, and irritability • Brief and not too severe • Postpartum Depression: Moderately severe depression that begins within three months following childbirth • Marked by mood swings, despondency, feelings of inadequacy, and an inability to cope with the new baby • May last from two months to one year • Part of the problem may be hormonal
Psychotic Disorders • Psychosis: Loss of contact with shared views of reality • Delusions: False beliefs that psychotic individuals insist are true, regardless of overwhelming evidence against them • Hallucinations: Imaginary sensations, such as seeing, hearing, or smelling things that do not exist in the real world • Most common psychotic hallucination is hearing voices • Note that olfactory hallucinations sometimes occur with seizure disorder (epilepsy)
Other Psychotic Symptoms Flat Affect: Lack of emotional responsiveness; face is frozen in blank expression Disturbed Verbal Communication: Garbled and chaotic speech; word salad Personality Disintegration: Uncoordinated thoughts, actions, and emotions
In Lewis Carroll’s time, hatmakers were heavily exposed to mercury used in making felt. Many suffered brain damage and became psychotic; thus, the Mad Hatter. The Mad Hatter
Schizophrenia: The Most Severe Disorder Schizophrenia: Psychotic disorder characterized by hallucinations, delusions, apathy, thinking abnormalities, and “split” between thoughts and emotions Does NOTrefer to having split or multiple personalities
Four Types of Schizophrenia Disorganized Type: Incoherence, grossly disorganized behavior, bizarre thinking, and flat or inappropriate emotions Catatonic Type: Marked by stupor, unresponsiveness, posturing, and mutism Paranoid Type: Preoccupation with delusions; also involves hallucinations that are related to a single theme, especially grandeur or persecution Undifferentiated Type: Any type of schizophrenia that does not have paranoid, catatonic, or disorganized features or symptoms
Causes of Schizophrenia Psychological Trauma: Psychological injury or shock, often caused by violence, abuse, or neglect Disturbed Family Environment: Stressful or unhealthy family relationships, communication patterns, and emotional atmosphere Deviant Communication Patterns: Cause guilt, anxiety, anger, confusion, and turmoil Stress-Vulnerability Hypothesis: Combination of environmental stress and inherited susceptibility cause schizophrenic disorders
Biochemical Causes Biochemical Abnormality: Disturbance in brain’s chemical systems or in the brain’s neurotransmitters Dopamine: Neurotransmitter involved with emotions and muscle movement. Works in limbic system Dopamine overactivity in brain may be related to schizophrenia
Types of Therapists • Clinical psychologist: has doctoral degree in clinical psychology; provides therapy for people with mental disorders • Counseling psychologist: has doctoral degree in psychological or educational counseling; counsels people with milder problems • Psychiatrist: has medical degree with residency in mental health, provides therapy for people with mental disorders and is only type of therapist who can prescribe drugs or other biomedical treatment • Psychoanalyst: Any of the above types of credential, but with training in psychoanalysis from a psychoanalytic institute • Clinical social worker: has master’s or doctoral degree in social work with specialized training in counseling; provides help with social problems, such as family problems.
Biomedical Therapies Biomedical therapies: medical treatment for mental disorders; includes drug therapy and medical procedures treating the brain
Pharmacotherapy Pharmacotherapy: Use of drugs to alleviate emotional disturbance; three classes: Antianxiety (Minor Tranquilizers): Produce relaxation or reduce anxiety (Valium, Lithium, Zanax) Antidepressants: Elevate mood and combat depression (Elavil, Paxil, Prozac, Zoloft) Antipsychotics (Major Tranquilizers): Tranquilize and also reduce hallucinations and delusions in larger dosages (Thorazine, Clozaril)
Problems with Drug Therapy • There can be serious side-effects (tranquilizers can cause neurological disorders; Clozaril associated with a fatal blood disorder) • Drugs do not cure the disorder; they only ameliorate the symptoms. • Reliance on drugs increase belief in the “quick fix”; belief that any disorder can be cured with a pill. • Generally, psychotherapy is needed in addition to medication.
Shock Therapy • Electroconvulsive Therapy (ECT): Electric shock is passed through the brain inducing a convulsion. • Based on belief that seizure alleviates depression by altering brain chemistry • Used in treatment of depression • Produces only temporary improvement • Causes permanent memory loss in many patients • Should only be used as a last resort
Psychosurgery • Psychosurgery: Any surgical alteration of the brain • Prefrontal Lobotomy: Frontal lobes in brain are surgically cut from other brain areas • Supposed to calm people who did not respond to other forms of treatment • Was not very successful • Deep Lesioning: Small target areas in the brain are destroyed by using an electrode
What is Psychotherapy? Psychotherapy: Any psychological technique used to facilitate positive changes in personality, behavior, or adjustment; Some types of psychotherapy: Psychoanalysis: therapy based on Freud’s theory Client-centered therapy: based on Humanism Behavioral and Cognitive therapies
Psychoanalytic Techniques • Main Goal of Psychoanalysis: To resolve internal conflicts that lead to emotional suffering • Free Association: Saying whatever comes to mind, regardless of how embarrassing it is. By doing so without censorship and censure, unconscious material can emerge • Dream Analysis: Dreams express forbidden desires and unconscious feelings • Latent Content: Hidden, symbolic meaning of dreams • Manifest Content: Obvious, visible meaning of dreams • Dream Symbols: Images in dreams that have personal or emotional meanings
Psychoanalytic Techniques, continued Analysis of Resistance: analysis of blockage in flow of ideas; topics the client resists thinking about or discussing. Resistances reveal particularly important unconscious conflicts Analysis of Transference: analysis of tendency to transfer feelings to a therapist that match those the patient has for important people in his or her past. The patient might act like the therapist is a rejecting father, loving mother, etc.
Client-Centered (Humanistic) Therapies • Client-Centered Therapy (Rogers): Nondirective and based on insights from conscious thoughts and feelings • Effective therapist must have four basic conditions • Unconditional Positive Regard: Unshakable acceptance of another person, regardless of what they tell the therapist or how they feel • Empathy: Ability to feel what another person is feeling; capacity to take another person’s point of view • Authenticity: Ability of a therapist to be genuine and honest about his or her feelings • Reflection: Rephrasing or repeating thoughts and feelings of the clients; helps clients become aware of what they are saying
Humanistic Therapies Existential Therapy: An insight therapy that focuses on problems of existence, such as meaning, choice, and responsibility; emphasizes making difficult choices in life Therapy focuses on death, freedom, isolation, and meaninglessness Free Will: Human ability to make choices. You can choose to be the person you want to be Confrontation: Clients are challenged to examine their values and choices
Behavioral Therapies • Behavior Therapy: Use of learning principles to make constructive changes in behavior • Behavior Modification: Using any classical or operant conditioning principles to directly change human behavior • Deep insight is often not necessary • Focus on the present; cannot change the past, and no reason to alter that which has yet to occur • Can also use classical conditioning techniques
Behavioral Therapies Aversion Therapy: Associate a strong aversion to an undesirable habit like smoking, overeating, drinking alcohol, or gambling Flooding: client is exposed to feared object or situation.
Behavioral Therapies • Systematic Desensitization: Guided reduction in fear, anxiety, or aversion; attained by approaching a feared stimulus gradually while maintaining relaxation • Best used to treat phobias: intense, unrealistic fears • Hierarchy: Rank-ordered series of steps, amounts, or degrees • Reciprocal Inhibition: One emotional state is used to block another (e.g., impossible to be anxious and relaxed at the same time)
