Psychological Disorders

1. Psychological Disorders

2. Psychopathology • The study of ‘abnormal’ behavior. • But how do we define ‘abnormal’? • Try to…..

3. Video Clips • Watch the following clips and add to your definition. • Where should we draw the line between normal and abnormal? • How should we define psychological disorders? • How should we understand disorders…as sicknesses or as natural responses to the environment.

4. The HISTORY • From as early as 3000 B.C.E. skulls have been found w/ evidence of an ancient surgical technique. (Trepanning) Mainly done to release the DEMONS and EVIL SPIRITS

5. The History • In the 1800’s, disturbed people were no longer thought of as madmen, but as mentally ill. • Locked/chained away in ‘mental hospitals’ • Some hospitals even charged admission for the public to see the “crazies”, just like a zoo.

6. CURRENTLY - ABNORMALITY • Statistical Definition • Frequently occurring behavior = normal • Infrequent behavior = abnormal • Social Norm Deviance • Going against normal behavior (refusing to wear clothing) • Subjective Discomfort • When the person experiences discomfort while engaging in a behavior • Inability to Function Normally • Maladaptive behavior – can’t ‘do’ daily living

7. Definition - • Psychological Disorder – a ‘harmful dysfunction’ in which behavior is judged to be atypical, disturbing, maladaptive and unjustifiable.

8. Abnormality across cultures • Read the ‘Current Issues in Psychology’ to see how abnormality differs in various cultures. • Answer the two discussion questions

9. What causes? • Biological Model • Medical Perspective: psychological disorders are sicknesses and can be diagnosed, treated and cured. • assumes that these “mental” illnesses can be diagnosed on the basis of their symptoms and cured through therapy, which may include treatment in a psychiatric hospital

10. What causes? • Psychodynamic View – Hiding Problems • Behaviorism – Learning Problems • Cognitive Perspective – Thinking Problems • Biopsychosocial Perspective All of the above

11. PRACTICE MCQ 1-5

12. Classifying Psychological Disorders • DSM-IV: Diagnostic Statistical Manual of Mental Disorders: the big book of disorders. • Describes 250 disorders on 5 Axes

13. DSM – IV - TR Official categorization of psych disorders in U.S. • 5-Axis model adopted in 1980 • Axis 1 • Clinical disorders (e.g., mood & anxiety disorders) • Axis 2 • Personality disorders (e.g., narcissism, antisocial) & mental retardation • Axis 3 • Medical (physical) conditions influencing Axis 1 & 2 disorders • Axis 4 • Psychosocial & environmental stress influencing Axis 1 & 2 disorders • Axis 5 • Global Assessment of Functioning score: highest level of functioning patient has achieved in work, relationships, and activities

14. DSM – IV - TR • Look at ‘your’ page. • How is each disorder described?

15. Anxiety Disorders • All disorders where the most dominant symptom is EXCESSIVE or UNREALISTIC anxiety • Free-floating anxiety – anxiety that seems to be unrelated to any realistic or known factor.

16. (Anxiety)Phobic Disorders • Phobia – an irrational, persistent fear of something Social Phobias (social anxiety disorder) fear of interacting with others or being in social situations. Specific Phobias- fear of some object or specific situation Agoraphobia – the fear of being somewhere where you can’t escape if something should go wrong.

17. Name the phobia • Washing and bathing • Spiders • Lightning • Dirt, germs • Darkness • Fire • Foreigners, strangers • animals • Ablutophobia • Arachnophobia • Ceraunophobia • Mysophobia • Nyctophobia • Pyrophobia • Xenophobia • Zoophobia FEAR OF SCIENTIFIC NAME

18. (Anxiety)Panic Disorder • Anna is sitting in science class when she starts feeling strange. Her vision is blurry, ears feel stuffed with cotton. She was cold, breaking into a sweat – extremely afraid for no reason. When she stands up to go to the teacher everything immediately turns to normal. • What was going on with Anna? Panic Attack – a sudden onset of extreme panic with various physical symptoms

19. (Anxiety)Panic Disorder • Becomes a disorder when it affects the person’s ability to function daily. Q. What would you call it if a person has a fear of panic attacks in a public place that prevents the person from going out into unfamiliar or exposed places? A. Panic disorder with agoraphobia

20. (ANXIety)Obsessive-compulsive disorder • When intruding thoughts (that occur repeatedly) are followed by some compulsion, a repetitive ritualistic behavior. The compulsions are meant to lower the anxiety caused by the thought.

21. (ANXIETY)Generalized anxiety disorder • The kind of anxiety that has no real source and lasts for more days than not for a period of at least 6 months.

22. Causes? • Psychodynamic? • Behaviorists? • Cognitive? – • magnification (mountains out of molehills) • All-or-nothing thinking • Overgeneralization • Minimization • Biological? • Imbalance of neurotransmitters including low levels of serotonin and GABA.

23. PRACtice MCQ

24. Somatoform disorders • Disorders in which people think they are sick…but are not, its ‘all in one’s head’ • Differs from psychosomatic disorders (psychophysiologic) because physical ailments are not real with somatoform

25. (SOMATOFORM)hypochodriasis • when a person worries excessively and almost constantly about getting ill. • Differs from anxiety disorder because the worry is about ‘illness’

26. (SOMATOFORM) Somatization disorder • Person feels vague, recurring physical symptoms for which medical attention has been sought repeatedly but no organic cause found. Less worry…more drama • Symptoms described as ‘unbearable’ or ‘beyond description’ • Example: backpain, dizziness, partial paralysis, abdominal pains, sometimes anxiety and depression

27. (SOMATOFORM) Conversion disorder • A dramatic specific disability has no physical cause but instead seems related to psychological problems (psychological problems are “converted” into a physical illness.) • Examples: paralysis, blindness, deafness, seizures, loss of feeling ….. Serious physical impairments • Symptoms leave when hypnotized, under anesthesia or unconscious

28. SOMATOFORM (MUNCHAUSEN) Munchausen syndrome Patient is usually admitted to a hospital presenting some acute illness that has a dramatic but plausible origin. History is riddled with falsehoods, and that the patient has similarly deceived the staff of several other hospitals.

29. SOMATOFORM (MUNCHAUSEN) Munchausen syndrome by proxy Involves a caregiver’s persistent fabrication of medical symptoms and signs in the person cared for (typically a mother/child relationship) leading to illness, endangerment, and unnecessary invasive or hazardous treatments.

30. MUNCHAUSEN Key elements: presence of physical symptoms that are self-induced (or other-induced, mother/child proxy), pathological lying Baron Munchausen was a teller of tall tales ILLUSTRATIVE CASES (FOLLOWING SLIDES):

31. MUNCHAUSEN • ACUTE ABDOMINAL DISTURBANCES • SWALLOW OBJECTS, SAFETY PINS, NEEDLES • INGEST POISONOUS SUBSTANCES • HEMORRAGHIC DISTURBANCES • CREATE WOUNDS • CONTAMINATE/IRRITATE/INFECT WOUNDS • RESPIRATORY DISTURBANCES • INSSERT NEEDLES INTO CHEST; • BREATHE TOXIC CHEMICALS

32. Causes? • Psychodynamic? • Behaviorists? – positive/neg reinforcement • Cognitive? magnification

33. Dissociative DIsorders • What is dissociation? • literally a dis-association of memory (a split) • person suddenly becomes unaware of some aspect of their identity or history • unable to recall except under special circumstances (e.g., hypnosis) • Three types are recognized • dissociative amnesia • dissociative fugue • dissociative identity disorder

34. Dissociative amnesia • Marian and her brother were recently victims of a robbery. Marian was not injured, but her brother was killed when he resisted the robbers. Marian is unable to recall any details from the time of the accident until four days later. • Memory loss the only symptom • Often selective loss surrounding traumatic events • person still knows identity and most of their past

35. Dissociative fugue • Jay, a high school physics teacher in New York City, disappeared three days after his wife unexpectedly left him for another man. Six months later, he was discovered tending bar in Miami Beach. Calling himself Martin, he claimed to have no recollection of his past life and insisted that he had never been married.

36. Dissociative Fugue (flight) • Complete amnesia • leaves home • develops a new identity • apparently no recollection time in fugue state • If fugue wears off • old identity recovers • new identity is totally forgotten

37. Dissociative identity disorder (DID) • Norma has frequent memory gaps and cannot account for her whereabouts during certain periods of time. While being interviewed by a clinical psychologist, she began speaking in a childlike voice. She claimed that her name was Donna and that she was only six years old. Moments later, she seemed to revert to her adult voice and had no recollection of speaking in a childlike voice or claiming that her name was Donna.

38. DID • Originally known as “multiple personality disorder” • Two or more distinct personalities manifested by the same person at different times • VERY RARE and controversial disorder • Examples include Sybil, Trudy Chase, Chris Sizemore (“Eve”) • Has been tried as a criminal defense • Hillside strangler • He was (both) convicted

39. CAUSES? • Psychodynamic? • Cognitive/Behavioral? • Biological? • Those with DID show significant differences in PET scan activity taken when different ‘personalities’ are present • Maybe due to childhood abuse??

40. Practice MCQ

41. Dissociation and multiple personalities • 644-645 • Read about Sybil • What are the arguments for and against DID as an actual disorder? What do you think?

42. Three faces of eve

43. Sybil? • Was she a true DID case?

44. Mood disorders • Disorders that are a disturbance in emotion. • They are also referred to as ‘Affective (emotion/mood) Disorders’ (mild mood disorders) • Dysthymia – mild depression (2 yrs or more) • Cyclothymia – sad, happy, sad, happy (2 yrs) Extreme Sadness Mild Sadness Normal Emotion Extreme elation Mild Elation

45. Major depression • A deeply depressed mood that comes on fairly suddenly and seems too severe for the circumstances or exists without any external cause • Most common of the diagnosed mood disorders • More common in women…that’s changing. • (Unipolar disorder)

46. Bipolar disorder • Severe mood swings that go from severe depression (extreme sadness) to manic episodes (extreme elation). • No external cause for either mood • Manic episodes can last from a few weeks to a few months • Extreme happiness • Restless, irritable • May become aggressive when not allowed to carry out their ‘grand’ plans • Rapid speech

47. Causes? • Biological – • serotonin, norepinephrine and dopamine. • Appear in genetically related individuals at a higher rate • Specific genes

48. Practice MCQ

49. schizophrenia • A long lasting psychotic disorder, involving a severe break with reality, in which there is an inability to distinguish what is real from fantasy as well as disturbances in thinking, emotions, behavior and perception

50. symptoms • Delusions • Delusions of persecution (Dr. Nash- A Beautiful Mind) • Delusions of grandeur • Delusions of reference • Delusions on influence IF ONLY DELUSIONS THEN NOT SCHIZOPHRENIA, INSTEAD A DELUSIONAL DISORDER