Psychological Disorders

Psychological Disorders Chapter 16

Psychological Disorders • Defining and diagnosing disorder • Anxiety disorders • Mood disorders • Personality disorders • Drug abuse and addiction • Dissociative identity disorder • Schizophrenia

Defining and Diagnosing Disorder • Dilemmas of definition • Dilemmas of diagnosis • Dilemmas of measurement

Dilemmas of Definition • Possible Models for Defining Disorders: • Mental disorder as a violation of cultural standards. • Mental disorder as maladaptive or harmful behaviour. • Mental disorder as emotional distress. • Mental Disorder • Any behaviour or emotional state that causes an individual great suffering or worry, is self-defeating or self-destructive, or is maladaptive and disrupts the person’s relationships or the larger community.

Diagnostic and Statistical Manual • Axis I: Primary clinical problem • Axis II: Personality disorders • Axis III: General medical conditions • Axis IV: Social and environmental stressors • Axis V: Global assessment of overall functioning

Explosion of Mental Disorders • Supporters of new categories answer that is important to distinguish disorders precisely. • Critics point to an economic reason: diagnoses are needed for insurance reasons so therapists will be compensated.

Concerns About Diagnostic System • The danger of over-diagnosis • The power of diagnostic labels • Confusion of serious mental disorders with normal problems • The illusion of objectivity and universality

Advantages of the DSM • When the manual is used correctly and diagnoses are made with valid objective tests, the DSM improves the reliability of and agreement among clinicians. • The DSM-IV included for the first time a list of culture-bound syndromes, disorders specific to a particular culture.

Projective Tests • Projective Tests • Psychological tests used to infer a person’s motives, conflicts, and unconscious dynamics on the basis of the person’s interpretations of ambiguous stimuli. • Rorschach Inkblot Test • A projective personality test that asks respondents to interpret abstract, symmetrical inkblots. A sample inkblot

Objective Tests • Inventories • Standardized objective questionnaires requiring written responses; they typically include scales on which people are asked to rate themselves. • Minnesota Multiphasic Personality Inventory (MMPI) • A widely used objective personality test.

Anxiety Disorders • Anxiety and panic • Fears and phobias • Obsessions and compulsions

Anxiety and Panic • Generalized Anxiety Disorder • A continuous state of anxiety marked by feelings of worry and dread, apprehension, difficulties in concentration, and signs of motor tension. • Some people suffer from generalized anxiety disorder without having lived through any specific anxiety-producing event. • Other chronically anxious people may have a history, starting in childhood, of being unable to control or predict their environments.

Posttraumatic Stress Disorder (PTSD) • An anxiety disorder in which a person who has experienced a traumatic or life-threatening event has symptoms such as psychic numbing, reliving the the trauma, and increased physiological arousal. • Diagnosed only if symptoms persist for 6 months or longer. • May immediately follow event or occur later.

Panic Disorder • An anxiety disorder in which a person experiences: • recurring panic attacks, • periods of intense fear, and • feelings of impending doom or death, • accompanied by physiological symptoms such as rapid heart rate and dizziness.

Fears and Phobias • Phobia • An exaggerated, unrealistic fear of a specific situation, activity, or object.

Agorophobia • A set of phobias, often set off by a panic attack, involving the basic fear of being away from a safe place or person.

Obsessions and Compulsions • Obsessive-Compulsive Disorder (OCD) • An anxiety disorder in which a person feels trapped in repetitive, persistent thoughts (obsessions) and repetitive, ritualized behaviours (compulsions) designed to reduce anxiety. • Person understands that the ritual behaviour is senseless but guilt mounts if not performed.

Mood Disorders • Depression and Bipolar Disorder • Theories of Depression

Depression • Major Depression • A mood disorder involving disturbances in emotion (excessive sadness), behaviour (loss of interest in one’s usual activities), cognition (thoughts of hopelessness), and body function (fatigue and loss of appetite).

Symptoms of Depression DSM IV Requires 5 of these within the past 2 weeks • Depressed mood • Reduced interest in almost all activities • Significant weight gain or loss, without dieting • Sleep disturbance (insomnia or too much sleep) • Change in motor activity (too much or too little) • Fatigue or loss of energy • Feelings of worthlessness or guilt • Reduced ability to think or concentrate • Recurrent thoughts of death

Gender, Age, & Depression • Women are about twice as likely as men to be diagnosed with depression. • True around the world • After age 65, rates of depression drop sharply in both sexes.

Bipolar Disorder • Bipolar Disorder: A mood disorder in which episodes of depression and mania (excessive euphoria) occur.

The Bipolar Brain • Bipolar disorder can have rapid mood swings • These wild changes are shown in brain activity (right)

Theories of Depression • Biological explanations emphasize genetics and brain chemistry. • Social explanations emphasize the stressful circumstances of people’s lives. • Attachment explanations emphasize problems with close relationships. • Cognitive explanations emphasize particular habits of thinking and ways of interpreting events. • “Vulnerability-Stress” explanations draw on all four explanations described above.

Vulnerability-Stress Model

Personality Disorders • Problem Personalities • Antisocial Personality Disorder

Problem Personalities • Personality Disorder • Rigid, maladaptive patterns that cause personal distress or an inability to get along with others. • Narcissistic Personality Disorder • A disorder characterized by an exaggerated sense of self-importance and self-absorption. • Borderline Personality Disorder • A disorder characterized by intense but unstable relationships, a fear of abandonment by others, an unrealistic self-image, and emotional volatility.

Antisocial Personality Disorder (APD) • A disorder characterized by antisocial behaviour such as lying, stealing, manipulating others, and sometimes violence; and a lack of guilt, shame and empathy. • Sometimes called psychopathy or sociopathy • Occurs in 3% of all males and less than 1% of all females.

DSM Criteria for APD • Must have 3 of these criteria and a history of behaviours • Repeatedly break the law. • They are deceitful, using aliases and lies to con others. • They are impulsive and unable to plan ahead. • They repeatedly get into physical fights or assaults. • They show reckless disregard for own safety or that of others. • They are irresponsible, failing to meet obligations to others. • They lack remorse for actions that harm others.

Causes of APD • Abnormalities in central nervous system. • Genetically influenced problems with impulse control. • Brain damage.

Emotions and Antisocial Personality Disorder • People with APD were slow to develop classically conditioned responses to anger, pain, or shock. • Such responses indicate normal anxiety.

Drug Abuse and Addiction • Biology and addiction • Learning, culture, and addiction • Debating the causes of addiction

Biology and Addiction • The biological model holds that addiction, whether to alcohol or other drugs is due primarily to: • a person’s biochemistry, • metabolism, and • genetic predisposition. • Most evidence comes from twin and family studies of alcoholism.

Learning, Culture, and Addiction • Addiction patterns vary according to cultural practices and the social environment. • Policies of total abstinence tend to increase addiction rates rather than reduce them. • Not all addicts have withdrawal symptoms when they stop taking a drug. • Addiction does not depend on the properties of the drug alone, but also on the reason for taking it.

Failure of the Addiction Prediction • 75% of US Soldiers who tested “drug positive” reported being addicted during their tour. • Fewer reported post-Vietnam drug use (blue bar). • Even fewer still showed dependency(green bar). • This contradicts what the biomedical model of addiction would predict.

Debating the Causes of Addiction • Problems with drugs are more likely when: • A person has a physiological vulnerability to a drug. • A person believes she or he has no control over the drug. • Laws or customs encourage people to take the drug in binges, and moderate use is neither tolerated nor taught. • A person comes to rely on a drug as a method of coping with problems, suppressing anger or fear, or relieving pain. • Members of a person’s peer group use drugs or drink heavily, forcing the person to choose between using drugs or losing friends.

Dissociative Identity Disorder • Defining identity disorders • The MPD controversy • The sociocognitive explanation

Dissociative Identity Disorders • A controversial disorder marked by the appearance within one person of two or more distinct personalities, each with its own name and traits; commonly known as “Multiple Personality Disorder (MPD).”

The MPD Controversy • First view • MPD is common but often unrecognized or misdiagnosed. • The disorder starts in childhood as means of coping. • Trauma produced a mental splitting. • 2nd view • Created through pressure and suggestions by clinicians. • Handful of cases to tens of thousands since 1980.

Sociocognitive Explanation • MPD is an extreme form of our ability to present many aspects of our personalities to others. • MPD is a culturally acceptable way for some troubled people to make sense of their problems. • Therapists looking for MPD may reward patients with attention and praise for revealing more and more personalities.

Schizophrenia • Symptoms of schizophrenia • Theories of schizophrenia

Symptoms of Schizophrenia • Bizarre delusions • Hallucinations and heightened sensory awareness • Disorganized, incoherent speech • Grossly disorganized and inappropriate behaviour

Delusions and Hallucinations • Delusions • False beliefs that often accompany schizophrenia and other psychotic disorders. • Hallucinations • Sensory experiences that occur in the absence of actual stimulation.

Positive Symptoms • Cognitive, emotional, and behavioural excesses • Examples of Positive Symptoms • Hallucinations • Bizarre delusions • Incoherent speech • Inappropriate/Disorganized behaviours

Negative Symptoms • Cognitive, emotional, and behavioural deficits • Examples of Negative Symptoms • Loss of motivation • Emotional flatness • Social withdrawal • Slowed speech or no speech

Theories of Schizophrenia • Genetic predispositions • Structural brain abnormalities • Neurotransmitter abnormalities • Prenatal abnormalities • Adolescent abnormalities in brain development

Genetic Vulnerability to Schizophrenia • The risk of developing schizophrenia (i.e., prevalence) in one’s lifetime increases as the genetic relatedness with a diagnosed schizophrenic increases.

Structural Brain Abnormalities • Several abnormalities exist, especially when schizophrenia is characterized by primarily negative symptoms: • Decreased brain weight. • Decreased volume in temporal lobe or hippocampus. • Enlargement of ventricles. • About 25% do not have these observable brain deficiencies

Neurotransmitter Abnormalities • Include serotonin, glutamate, and dopamine. • Many schizophrenics have high levels of brain activity in brain areas served by dopamine as well as greater numbers of particular dopamine receptors. • Similar neurotransmitter abnormalities are also found in depression and alcoholism.

Prenatal Problems or Birth Complications • Damage to the fetal brain increases chances of schizophrenia and other mental disorders. • May occur as a function of maternal malnutrition, maternal illness. • May also occur if brain injury or oxygen deprivation occurs at birth.

Psychological Disorders