Chapter 16

1. Chapter 16 Psychological Disorders

2. A. What is Normal? • Symptoms of Psychological Disorders • Deviation from a norm • Maladaptive • Emotional Discomfort

3. Why do you think the U.S. has such a high prevalence of mental disorders?

4. A. What is Normal? • Deviation from a statistically calculated norm: If a person behaves in a way that a majority of people do (approximately 68%) then the behavior is normal. If not, the behavior is abnormal abnormal abnormal normal

5. A. What is Normal? • Shortcomings of this definition • It doesn’t discriminate between desirable and undesirable abnormality • Just because a statistical majority of people engage in a particular behavior does not mean that society would like to encourage it as being normal

6. A. What is Normal? • Emotional Discomfort If a person’s behavior causes him/her distress than the behavior is considered to be abnormal

7. A. What is Normal? • Shortcomings of this definition • Some behavior are so abhorrent that despite someone’s comfort level if it is not normal behavior

8. A. What is Normal? • Deviation from a social/cultural norm • A cultural norm is what society deems as being acceptable. There are norms that cover all types of behaviors. • When do we notice norms?

9. A. What is Normal? • Shortcomings of this definition • There are different norms for different cultures, and different age groups. Additionally, norms change over time.

10. A. What is Normal? • Maladaptivity If a behavior interferes with a person’s ability to function it is considered to be abnormal. If a person is still able to function adequately in everyday life, than it is not abnormal.

11. Explaining Psychological Disorders • Biological Factors: • The earliest supporter of this view was Hippocrates. He saw mental disorders as being some kind of physical illness. He believed that disorders were caused by imbalances of the four humors (bodily fluids) which are blood, black bile, phlegm, and yellow bile. • Hippocrates believed that depression resulted from an excess of black bile (melancholia)

12. Explaining Psychological Disorders • Neurobiological model: • This model looks at problems in anatomy and physiology of the brain and other areas. • This model dominates modern research on the causes—and treatments—of psychological disorders. People who adhere to this model see mental disorders as being caused by a physical illness, and believed it can be diagnosed, treated and cured.

13. Explaining Psychological Disorders • Psychological Processes: • In this view, mental disorders are seen as being caused by inner turmoil or other psychological events. • Psychological models: Include the psychodynamic, cognitive-behavioral, and phenomenological (humanistic) approaches

14. Explaining Psychological Disorders • Sociocultural Context: • Sociocultural explanations rely on factors such as gender and age, physical and social situations, cultural values and expectations, and historical eras. Culture-general disorders appear in most societies while culture-specific forms appear only in certain ones.

15. Explaining Psychological Disorders • Diathesis-Stress as an Integrative Approach • Diathesis-stress model: This model views genetics, early learning, and biological processes as contributing factors to psychological disorders. • In other words, a person’s inherited characteristics, biological processes, and early learning experiences may create a predisposition (or diathesis) for a psychological disorder, but whether or not the disorder appears depends on the stressors the person encounters

16. Classifying Psychological Disorders • A Classification System: DSM-IV-TR This is the most comprehensive and authoritative set of guidelines available for diagnosing psychological disorders. It includes the symptoms, the exact criteria that must be met to make a diagnosis, and the typical course for each mental disorder.

17. Classifying Psychological Disorders • Axis I: Clinical Syndromes: comprises descriptive criteria of 16 major mental disorders) • Diagnosis of disorders are made on Axes I and II • It is on this axis that clinician record any major disorders that are apparent.

18. Classifying Psychological Disorders • Axis II: Personality disorders: these disorders are patterns of personality traits that are longstanding, maladaptive, and inflexible and involve impaired functioning or subjective distress. Examples include borderline, schizoid, and antisocial personality disorders) and mental retardation

19. Classifying Psychological Disorders • Axis III: General Medical ConditionsPhysical disorders of conditions are recorded on this axis. Examples include diabetes, arthritis, and hemophilia)

20. Classifying Psychological Disorders • Axis IV: Psychosocial and Environmental Problems: Types and levels of stress, it may be a negative life event, an environmental difficulty or deficiency, a familial or other interpersonal stress, an inadequacy of social support or personal resources, or another problem that describes the context in which a person’s difficulties have developed

21. Classifying Psychological Disorders • Axis V: Global Assessment of Function (GAF) Scale: Has a rating of that ranges from 100 (Superior functioning in a wide range of activities) to 1 (Persistent danger of severely hurting self or others). Estimate are made of the individual’s current level of adaptive functioning as a whole and of the individual’s highest level of functioning in the past year

22. Classifying Psychological Disorders • Diagnosis of disorders are made on Axes I and II • Axes III, IV, and V are used to record supplemental information about the patient

23. Classifying Psychological Disorders • Purposes and Problems of Diagnosis • Goals: Help identify appropriate treatment for clients and to accurately and consistently group patients with similar disorders so that research efforts can more easily identify underlying causes of mental illness • Limitations • Validity: Some argue that attempts on improving the consistency of the diagnosis has taken away from the validity of the diagnosis

24. Classifying Psychological Disorders • Purposes and Problems of Diagnosis • Limitations • Interrater Reliability:Studies have shown that 80% of the time there is agreement between independent raters

25. Neurosis • Mild personality disorder, usually does not impair one’s ability to function in society. • Symptoms: • Depression • Anxiety • Self-defeating patterns of behavior

26. Psychosis • Serious personality disorder, usually incapacitating preventing one from functioning in society. • Symptoms • Loss of contact with reality • Hallucinations: inappropriate feelings that come to us from one of our senses • Delusions: false but persistent beliefs despite evidence to the contrary

28. Psychosis • Types of Hallucinations: • Auditory Hallucinations: hearing things that are not there • Visual Hallucinations: seeing things that aren’t there

29. Psychosis • Types of Hallucinations: • Tactile Hallucinations: feeling things that aren’t there • Olfactory Hallucinations: smelling things that aren’t there • Gustatory Hallucinations: tasting things that aren’t there

30. Psychosis • Symptoms of Psychosis • Delusions: false but persistent beliefs despite evidence to the contrary

31. Psychosis • Types of Delusions: • Delusions of Grandeur: thinking you are someone of great importance

32. Psychosis • Types of Delusions: • Delusions of Reference: thinking that you are the center of attention, that people are looking at, or talking about you • Delusions of Depersonalization: thinking you are turning into an inanimate or vegetative object

33. Psychosis • Types of Delusions: • Delusions of Persecution: thinking that people are out to get you or harm you • Delusions of Guilt: thinking that you have just committed a terrible wrong

34. Anxiety Disorders • Anxiety: Freud called anxiety a “free floating fear” meaning that it is not attached to any particular object or event. Anxiety is a general feeling of doom and dread. Anxiety disorders are marked by feelings of excessive apprehension

35. Anxiety Disorders • Generalized Anxiety Disorder: A person with General Anxiety Disorder (GAD) is continually tense, apprehensive, and in a state of autonomic nervous system (ANS) arousal. This anxiety is persistent and many escalate into a panic attack

36. Anxiety Disorders • Generalized Anxiety Disorder: • People with this disorder worry constantly about yesterday’s mistakes and tomorrow’s problems. In particular, they worry about minor matters related to family finances, work and personal illness. They often dread decisions and brood over them endlessly. Their anxiety is commonly accompanied by physical symptoms

37. I wish I could tell you exactly what’s the matter. Sometimes I feel like something terrible has just happened when actually nothing has happened. Other times, I’m expecting the sky to fall down any minute. Most of the time I can’t point my finger at something specific. Still, I feel tense and jumpy. The fact is that I am tense and jumpy almost all the time. Sometimes my heart beats so fast, I’m sure it’s a heart attack. Little things can set it off. The other day I thought a Supermarket clerk had overcharged me a few cents on an item. She showed me that I was wrong, but that didn’t end it. I worried the rest of the day. I kept going over the incident in my mind, feeling terribly embarrassed at having raised the possibility that the clerk had committed an error. The tension was so great, I wasn’t sure I’d be able to go to work in the afternoon. That sort of thing is painful to live with.

38. Taylor Manifest Anxiety Scale

39. Anxiety Disorders • Phobic Disorder:Phobic disorders are marked by a persistent, irrational fear of a specific object or situation. • What’s the difference between a phobia and a fear? Phobia is the Greek word for morbid fear after the lesser Greek god, Phobos

40. Anxiety Disorders • Specific Phobias: involve fear and avoidance of a specific stimuli or situation. • About 10% of the general population will experience a specific phobia at some point in their lives. • More than twice as many women as men suffer from specific phobia.

41. Anxiety Disorders • Specific phobia tend to fall into four categories 1. Fear of particular situations: such as flying driving, tunnels, bridges, elevators, crowds, or enclosed placed 2. Fear of features of the natural environment: such as heights, water, thunderstorms, or lightning 3. Fear of injury or blood: including the fear of injections, needles, and medical or dental procedures 4. Fear of animals and insects: such as snakes, spiders, dogs, cats, slugs, or bats

42. Hilda is 32 years of age and is terrified of snow. She cannotgo outside in the snow. She cannot even stand to see snow or hear about it on the weather report. Her phobia severelyconstricts her day-to- day behavior. Probing in therapy revealed that her phobia was caused by a traumatic experience at age 11. Playing at a ski lodge, she was buried briefly by a smallavalanche of snow. She had no recollection of this experience until it was recovered in therapy.

43. Anxiety Disorders • Social Phobias: a fear of being negatively evaluated by others or publicly embarrassed by doing something impulsive, outrageous, or humiliating. • Social phobia goes well beyond the shyness that everyone sometimes feels at social gatherings. Rather, the person with social phobia is paralyzed by fear of social situations, especially if the social situation involves performing even routine behaviors in front of others.

44. Anxiety Disorders • Agoraphobia: a fear of situations the person views as difficult to escape from if panic begins to build. Many people with this disorder become trapped in their own homes or in similar safe zones.

45. Anxiety Disorders • Phobias are considered anxiety disorders because they focus general feelings of anxiety onto a feared object or situation • General Facts about phobias • Phobias are twice as high for females than males • Phobias are more prevalent in blacks than in whites or Hispanics • Phobias tend to be chronic (lasts between 24-31 years) • Typical onset is childhood or young adulthood

46. Anxiety Disorders Common Phobias and the Feared ObjectsAcrophobia: High Places Agoraphobia: Open Places Astraphobia: Thunderstorms Claustrophobia: Enclosed Places

47. Anxiety Disorders Common Phobias and the Feared Objects Hematophobia: Blood Mysophobia: Contamination Pyrophobia: Fire Xenophobia: Foreigners/Strangers Hippophobia: Horses

48. Anxiety Disorders • Panic Disorder:Periodic episodes of extreme terror (panic attacks) without warning or obvious cause are characteristic of people with panic disorder.

49. Anxiety Disorders • Obsessive-Compulsive Disorder (OCD) • Obsessions: are unwanted thoughts, ideas or mental images that occur over and over again • Compulsions: are repetitive, ritual behaviors, often involving cleaning or checking.

50. Anxiety Disorders • Obsession-Compulsive Disorder marked by persistent uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) • Rate: 3% of the general population • Onset: for males 6-15; for females 20-29 • Demographics: for commonly found among upper income, highly intelligent groups, males and females are equally likely to suffer from this disorder