Understanding Psychological Disorders and Mental Well-being

1. Myers’ PSYCHOLOGY For AP Unit 12 Psychological Disorders Abnormal Psychology Ms. Vangelista

2. Carol Ryff’s Theory of Mental Well Being • Well-being is a dynamic concept that includes subjective, social, and psychological dimensions as well as, health-related behaviors. • The Ryff Scales of Psychological Well-Being measures multiple facets of one’s well being including: • Autonomy - I have confidence in my opinions, even if they are contrary to the general consensus.Environmental Mastery - In general, I feel I am in charge of the situation in which I live.Personal Growth -I think it is important to have new experiences that challenge how you think about yourself and the world.Positive Relations with Others - people would describe me as a giving person, willing to share my time with others.Purpose in Life - Some people wander aimlessly through life, but I am not one of them.Self-Acceptance - I like most aspects of my personality.

3. Psychological Disorders • Psychological Disorder • a “harmful dysfunction” in which behavior is judged to be: • unjustifiable--sometimes there’s a good reason • maladaptive--harmful • atypical--not enough in itself • disturbing--varies with time and culture • UMAD!

4. Considerations… • Cross cultural differences in normative behavior/social practices… • Japan- hissing is a sign of respecting elders • Among the Karaki of New Guinea – a man is considered abnormal if he has not engaged in homosexual behavior before marriage. • Public displays of affection between men and women in Thailand are unacceptable; men holding hands is considered friendship; the use of straws is vulgar. • Definitions of “disorder” change in time and space (location)!

5. Historical Perspective • Perceived Causes • movements of sun or moon • lunacy--full moon • evil spirits • Ancient Treatments • exorcism, caged like animals, beaten, burned, castrated, mutilated, blood replaced with animal’s blood

6. Psychological Disorders • Medical Model • concept that diseases have physical causes • can be diagnosed, treated, and in most cases, 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

7. Psychological Disorders • Bio-Psycho-Social Perspective • assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders

8. Psychological Disorders

9. Psychological Disorders--Etiology • DSM-IV • American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) • a widely used system for classifying psychological disorders • presently distributed as DSM-IV-TR (text revision)

10. DSM-V To be published during the year 2013. Changes include: • Mental Retardation will now be classified as Intellectual Disability • New disorders will include: • Binge Eating Disorder • Hoarding Disorder • Hypersexual Disorder • Somatoform disorder, hypochondriasis, undifferentiated somatoform disorder and pain disorder combined under Complex Somatic Symptom Disorder (CSSD) • For more info visit www.dsm5.com

11. DSM Continued • You should know the 5 Axis diagnostic criteria used in the DSM (Table 12.2). These help doctors determine not only the type of mental illness a person has, but also some contributing factors that might need to be dealt with in order to get the primary mental illness symptoms under control. • Not only is this important for doctors but also for insurance companies.

12. Labelling….Pros and Cons • “Pros” – provide a starting point for treatment, understanding behavior, simplifies behavior and communication, can convey a large amount of information within the label, standardizes concepts • “Cons” – labelled for life, all or nothing thinking when using the label, stigma/stereotyping, civil violations and lapses in treatment.

13. Psychological Disorders- Etiology • Neurotic Disorder (term seldom used now) • usually distressing but that allows one to think rationally and function socially • Psychotic Disorder • person loses contact with reality • experiences irrational ideas and distorted perceptions

14. Anxiety Disorders • Anxiety Disorders • distressing, persistent anxiety or maladaptive behaviors that reduce anxiety • Generalized Anxiety Disorder • person is tense, apprehensive, and in a state of autonomic nervous system arousal

15. GAD Generalized Anxiety Disorder • Usually if a person is diagnosed with GAD there is also a comorbid disorder. This means they have two disorders operating at the same time. Accompanying GAD is often major depression. • Effective treatment for both is Effexor. • Paxil (same family of drug as Prozac and Zoloft) serotonin reuptake inhibitor is also used to treat GAD, social phobia and panic disorder.

16. Anxiety Disorders • Panic Disorder • marked by a minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensation • Agoraphobia (the fear of being in open spaces or in public) often accompanies Panic Disorder. They begin to fear going out in fear of having a panic attack in public and leaves them suffering in their homes alone.

17. Anxiety Disorders • Phobia • persistent, irrational fear of a specific object or situation • one of the most successfully treated disorders. • Obsessive-Compulsive Disorder • unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

18. Compulsions • Can manifest in different ways: • Hoarders – collect things, have a hard time throwing things away, keep everything for fear of needing it or losing it. • Checkers – recheck actions they have preformed over again. Ie. Turn off oven, climb stairs etc usually # of checks increases with each experience. • Counters – count everything ie. Number of words people say etc. unimportant to the point of stopping their daily progress. • Cleaners – clean excessively, a number of times to relieve anxiety.

19. OCD vs OCDP • OCD Obsessive Compulsive Disorder – is an anxiety disorder characterized by obsessive thoughts with corresponding compulsions. People with OCD likely to lead lives where strict routines become essential, repeating tasks over and over again to find relief from their anxieties. • OCPD Obsessive Compulsive Personality Disorder is characterized by an obsessive need for neatness, order, and symmetry. More likely to be called anal retentive or neat freaks!

20. Frontal Lobes and OCD/OCPD • Frontal Lobes are responsible for judgement and decision making, people with OCD have overactive frontal lobes thus, they are controlled by overzealous decision making. They cannot control what decisions they should be making, or they allow their behavior to be ruled by repetitive and overbearing thoughts.

21. Anxiety Disorders • Common and uncommon fears

22. Anxiety Disorders

23. Anxiety Disorders • PET Scan of brain of person with Obsessive/ Compulsive disorder • High metabolic activity (red) in frontal lobe areas involved with directing attention

24. 1962 Calhoun Rat Study • Demonstrated that a high population density causes abnormal behavior in rat populations. • Rats lived in overcrowded population for 16 months. Findings: • Aggression – increase in fighting among males • Submissiveness – non dominating males became submissive • Sexual deviance – non dominant rats didn’t follow rules for mating. • Nesting abnormalities – females no longer built nests. • High infant mortality

25. Somatoform Disorders • Not as commonly diagnosed as in the past. • These are disorders in which symptoms take a somatic (bodily) form without apparent physical cause. • One contributing factor may be stress. (relate stress related symptoms as you read about somatoform disorders).

26. Somatoform Disorders • Conversion Disorder – a rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found. • Hypochondriasis – a somatoform disorder in which a person interprets normal physical sensations as symptoms of disease.

27. Conversion Disorder • People who suffer from this disorder generally suffer problems with parts of their bodies that directly relate to the stress they are under. • For example, a quarterback may feel numbness in his throwing hand before the Grey Cup but may otherwise say he is not stressed about the big game.

28. Hypochondriacs • Aren’t people who fake sickness to get attention. They truly believe they are sick from illness that doctors haven’t caught yet. • They switch doctors seeking a diagnosis that ill confirm their condition. • People who fake illness are “melingering” – this means they avoid trouble or they seek a gain or gains.

29. Somatoform Disorders Con’t • Body Dysmorphic Disorder – preoccupation with defects in one’s body. Concern about it becomes excessive. • Pain Disorder – complaints of severe pain without any particular physical condition; or malingering. • Somatization Disorder – patients under 30 will exhibit a variety of unexplained physical symptoms.

30. Dissociative Disorders • Disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts and feelings. • Dissociation is not the same as psychosis. • Dissociation involves breaking away from the sense of self, either losing memory and identity or adding personalities. • Psychosis involves a break with reality, believing that are untrue or having hallucinations about things that are not true.

31. DID – Dissociative Identity Disorder • This disorder is characterized by two or more distinct identities and are said to control the person’s behavior. • Formerly called Multiple Personality Disorder. • Controversial because claims of patients are difficult to prove/confirm. Not diagnosed until later in life when alleged perpetrators died or there is a loss of evidence. Often only reported in women.

32. Dissociative Disorders Continued • Dissociative Amnesia – Patients suffer from a complete loss of identity, they forget who they are due to trauma. • Dissociative Fugue – Patients suffer from identity loss as in dissociative amnesia, but these patients also travel away form home, often showing up ass someone else in a community far away.

33. Mood Disorders • Mood Disorders • characterized by emotional extremes • Major Depressive Disorder • a mood disorder in which a person, for no apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities

34. Depression • Depression following a traumatic event (death of a loved one, a major failure, a serious physical injury) is considered normal. • Depression without a known stressor or causal event maybe due to biological or psychological reasons. • Being genetically predisposed to depression does not mean one is guaranteed to get the disease. Mitigating environmental circumstances can help avoid the symptoms of disease.

35. Dysthymic Disorder • A depressive state lasting more than 2 years (in children or adolescents it need only last 1 year). Patients must also present 2 or more of the following symptoms: • Poor appetite or overeating. • Insomnia (not enough sleeping) or hypersomnia (too much sleeping). • Low energy or fatigue. • Low self-esteem. • Feelings of hopelessness. • Poor concentration or difficulty in making decisions.

36. Suicide, Depression and Feelings of Loneliness • Read the Close – Up on page 584. • 5 reasons for loneliness: • Being unattached…no partner, significant other or breaking up. • Alienation…being misunderstood, feeling different, having no friends. • Being alone…coming home to an empty house. • Forced isolation…being hospitalized, homebound having no transportation. • Dislocation…being away from home, new job or school.

37. Coping with Loneliness • Rubenstein and Shaver found 4 major strategies: • Sad passivity-sleeping, drinking, overeating, watching tv. • Social contact-calling a friend or visiting someone. • Active solitude-studying, reading, exercising, going to a movie. • Distractions-spending money, going shopping.

38. Mood Disorders • Manic Episode • a mood disorder marked by a hyperactive, wildly optimistic state • Bipolar Disorder • a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania • formerly called manic-depressive disorder

39. Bipolar Disorder • Bipolar Disorder I – classic diagnosis of disorder – characterized with periods of inflated mood followed by episodes of depressive episodes occurring in cycles. • Bipolar Disorder II – milder form of bipolar disorder in which patients experience at least one episode of hypomania ( a period of elevated mood but without psychosis) and at least one major depressive episode.

40. Mood Disorders-Depression

41. Mood Disorders-Depression • Canadian depression rates

42. Mood Disorders- Suicide

43. Depressed state Manic state Depressed state Mood Disorders-Bipolar • PET scans show that brain energy consumption rises and falls with emotional switches

44. Mood Disorders-Depression • Altering any one component of the chemistry-cognition-mood circuit can alter the others

45. Mood Disorders-Depression • The vicious cycle of depression can be broken at any point

46. Dissociative Disorders • Dissociative Disorders • conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings • Dissociative Identity Disorder • rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities • formerly called multiple personality disorder

47. Schizophrenia • Schizophrenia • literal translation “split mind” • a group of severe disorders characterized by: • disorganized and delusional thinking • disturbed perceptions • inappropriate emotions and actions

48. Schizophrenia • Delusions • false beliefs, often of persecution or grandeur, that may accompany psychotic disorders • These are dysfunctions of our cognitive systems. • Hallucinations • sensory experiences without sensory stimulation • These are dysfunctions of our perceptual systems.

49. Other Striking Symptoms of Schizophrenia • Loose associations occur in patients with disorganized schizophrenia as they link events and memories that don’t seem to fit together logically. • Neologisms are words that patients create, usually as part of the “word salad” symptom. They will make up words that make no logical sense.

50. Schizophrenia