DSM IV – definition, assessment, diagnosis, norms Therapies Causes Anxiety Disorders

1. DSM IV – definition, assessment, diagnosis, norms Therapies Causes Anxiety Disorders Panic Disorder Generalized Anxiety Disorder Phobic Disorder Obsessive Compulsive Disorder Personality Disorders Anti-Social Disorder (Sociopath/Psychopath) Conduct Disorder Review all notes and wksts! Borderline Disorder Misc. Munchausen by Proxy Tourette Syndrome Body Dysmorphia Trichotilomania Schizophrenia Multiple Personality Depression Uni-polar Bi-polar (manic) Dysthymic Eating disorders, suicide, body mutilation Abnormal Psych Test Review

2. What is “abnormal”? • Explanations for mental disorders always come out of the social and intellectual atmosphere of the time

3. The Not-so-gentle Art of Trephining

4. wkst • 1800’s Boston – Dorothea Dix – reform and moral treatments in the asylums • The wretched conditions and inhumane treatments continued until the 1950’s (women often victims as a result of sexism “husband knows best”) • Anti-psychotic drugs discovered • DEINSTITUTIONALIZATION • Outpatient • Half-way houses

5. Figure 1.3: Rates of Various Mental Disorders

6. Cost and Burden to Society • At least 30% of adult Americans and 20% of American children suffer from mental illness. • Inadequate knowledge about causes, treatment, and prevention • Major obstacle to progress is “stigma” • Mental disorders account for less than 15% of the overall burden of disease from all causes. • Mental illness/health must become part of public policy.

7. Figure 1.4: Rates of Psychiatric Disorders in Particular Groups

8. Defining Abnormal…. Rate each case history on a scale from 1–10 (1=perfectly sane; 10=completely insane) • John collects stamps. This is his main interest in life. He works at it all day long, talks about it all day long, even dreams about it. He is not married and has no other hobbies. • Joe has problems with impulse control. If he sees a ring in a jewelry store, he may simply grab it and walk away. He feels little or no guilt when he is caught after such crimes. On the surface he appears very nice, but deep down he is completely out for himself and possesses little or no conscience.

9. One day Mary left college and took up residence in a jungle. She stopped speaking English, built a hut, lived in it and ate berries, and ate berries, bugs etc. – just like the natives. • Sam refuses to write because he believes writing is bad. He is a homosexual and believes that “gods” control people. He doesn’t have a regular job but spends his day simply asking questions that many people think are “crazy.”

10. Now what do you think….? Slight variations change the norm. • John toilet paper tubes. This is his main interest in life. He works at it all day long, talks about it all day long, even dreams about it. He is not married and has no other hobbies. • Joe has problems with impulse control. If he sees a ring in a jewelry store, he may simply grab it and walk away. He feels little or no guilt when he is caught after such crimes. On the surface he appears very nice, but deep down he is completely out for himself and possesses little or no conscience. Joe is 2 years old.

11. One day Mary left college and took up residence in a jungle. She stopped speaking English, built a hut, lived in it and ate berries, and ate berries, bugs etc. – just like the natives. Mary is an anthropologist. • Socrates, the famous Greek philosopher, refused to write because he believed writing was bad. He was a homosexual and believed that “gods” control people. He didn’t have a regular job but spent his day simply asking questions that many people thought were “crazy.”

12. The Healthy adult MALE – pick 5 characteristics that our society would agree with. • Ambitious • Tactful • Adventurous • Aware of others’ feelings • Need for security • Self-Confident • Logical • Gentle • Independent • Expresses tender feelings

13. The Healthy adult FEMALE – pick 5 characteristics that our society would agree with. • Ambitious • Tactful • Adventurous • Aware of others’ feelings • Need for security • Self-Confident • Logical • Gentle • Independent • Expresses tender feelings

14. The Healthy adult PERSON – pick 5 characteristics that our society would agree with. • Ambitious • Tactful • Adventurous • Aware of others’ feelings • Need for security • Self-Confident • Logical • Gentle • Independent • Expresses tender feelings

15. Place each of the behaviors below into one of the categories below (one number per box): 1. Hallucinates and believes herself to be the virgin Mary. 2. Feels anxious much of the time. 3. Commits murder w/o feeling guilt. 4. Is attracted exclusively to the members of the same sex. • Is dissatisfied with his/her life. • Has a phobia of snakes. • Cleans the house twice a day. • Drinks 5 cups of coffee a day. • Has sexually abused a child of 6 years old.

16. Anxiety Disorders wkst Biological and Psychological Roots. There’s a strong genetic connection. Feelings of frequent and prolonged anxiety that are out of proportion to the situation at hand. Interferes with daily living. They know it’s not rational but they can’t control it. 2/3 women yet…. Onset: early teens Nervous, tense, always feeling something bad about to happen, constant state of fear and dread.

17. wkst • Worrying helps client AVOID the situation. • By worrying they gain a false sense of CONTROL (they believe worrying will stop something bad from happening). • GAD – Generalized Anxiety Disorder • Panic Disorder • Phobic Disorder • OCD – Obsessive Compulsive Disorder Many times they’re related!

18. GAD – Generalized Anxiety Disorder wkst • Chronic, persistent anxiety – unrealistic and excessive. • Can’t focus on tasks at hand • Tense, nervous • “on-edge” • Racing heart, sinking stomach “If I worry about it, it won’t happen so I’ll worry about everything to cover my bases.”

19. Panic Disorder wkst • SEVERE attacks of terror and impending doom • Lasts few minutes to several hours • Sweating, choking, heart palpatations, pass-out/black out often report that they feel like they’re “going to die.” • Isolated “attack” vs. disorder Phobic Disorder • (Operant and Classical Conditioning) • Persistent, irrational fear and anxiety in presence of phobic stimulus with compelling desire to AVOID the situation. • Phobic anxiety focuses on some specific object, activity or situation ex. • Can be incapacitating

20. Simple Phobias Type of Phobia: % Reporting: *Bugs, mice, snakes, bats 25% *Heights 18% Water 12% Storms 10% Closed Places 8% Animals 4%

21. Social Phobias Type of Phobia % reporting *Speaking in public 8% Speaking to new acquaintances 5% Eating in public 4%

22. *Agoraphobia* Type of Phobia % reporting Public transportation 12% Tunnels or bridges 8% Crowds 8% Being alone 4% Going out by oneself 4%

23. OCD – Obsessive Compulsive Disorder wkst • Persistent and unwanted images not intentionally produced – person does something to try to get rid of them. • 1-2% of the population • Control/Superstition • Belief that the ritual stops something bad from happening • COMPULSION is the action you do to get rid of the OBSESSIVE thought • Can be all consuming • Ex. washers, counters, cleaners, checkers, hoarders, repeaters, etc….

24. Body Dysmorphia

27. Personality Disorder: Anti-Social Personality a.k.a. PSYCHOPATH or SOCIOPATH • NO REASONS • No remorse, lack of guilt – therapy and rehabilitation doesn’t work – failure to learn from experience • No morals, no feelings, mistrusting of others • Unabashed liars • Superego never developed? • Impulsive, thrill seekers • High need for thrill tend to go in one direction or the other: positive upbringing = T-type – thrill seekers – need the adrenaline rush • Reckless behavior • Always had troubled childhoods • White, male, intelligent, smooth talkers, charming, “boy next door” • narcissistic • Abusive to animals as children

28. The face of a psychopath or “the boy next door”?

29. Craigslist killer – Harvard grad!

30. Ted Bundy • "...a sadistic sociopath who took pleasure from another human's pain and the control he had over his victims, to the point of death, and even after." He once called himself "...the most cold-hearted son of a bitch you'll ever meet.” His attorney wrote: "Ted was the very definition of heartless evil."

31. Schizophrenia – “cancer of mental illness” wkst • Loss of contact with reality • 1% of population (30% of patients in mental hospitals) • 10% violent (90% not violent!) • 50/50 nature/nurture • No cure – thorazine • Increased risk for suicide • Speak and write irrationally – WORD SALAD

32. wkst • Hallucinations – faulty, sense like perceptions for which there is no outside stimuli. Auditory hallucinations – hearing voices even though no real voices are present. Visual hallucinations - visions of people who are dead. • Delusions – false beliefs that the person strongly defends, despite evidence that these beliefs cannot be true. Grandiose delusions – ex. “Queen of England”

34. Magical Thinking – the kind of thinking schizophrenics have…..

35. Some people can make me aware of them just by thinking about me. • I think I could learn to read others’ minds if I wanted to. • Things sometimes seem to be in different places when I get home, even though no one has been there. • I have occasionally had the silly feeling that a TV or radio broadcaster knew I was listening to him. • I have worried that people on other planets may be influencing what happens on earth, • I have felt that there were messages for me in the way things were arranged, like in a store window. • I have noticed sounds on my records that are not there at other times. Continued….

36. The hand motions that strangers make seem to influence me at times. • I have had the momentary feeling that someone’s place has been taken by a look-alike. • I have sometimes sensed an evil presence around me, although I could not see it. • Sometimes I have a feeling of gaining or losing energy when certain people look at me or touch me. • I have sometimes had the passing thought that strangers are in love with me. • People are so strange sometimes that they’re probably part of an experiment. • I have felt that I might cause something to happen just by thinking about it too much. • At times I’ve felt a teacher’s lecture was meant especially for me. • I have sometimes felt that strangers were reading my mind.

37. Schizophrenia wkst • Acute • Chronic • Catatonic • Paranoid • Disorganized

38. Disorganized schizophrenic

40. Depression • Uni-Polar/Major Depression • Bi-Polar/Manic Depression • Dysthymic

41. Depression – Warning Signs • General loss of interest/ “flat” • Withdrawal • Chronic fatigue and lack of energy • Neglect • Sleeping too much or Insomnia • Poor memory • Irritability • Anxiety • Suicidal thoughts • Indecision • Hopeless • Appetite/Digestive problems • Loss of Sexual Desire • Guilt

42. SAWS SAWS Diagnosis – Sex, Appetite, Weight, Sleep A person who shows marked decreases or disturbances in these four areas may be suffering from acute depression.