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The Psychological Disorders. What is abnormal Refers to maladaptive cognitions, affects, and or behaviors that are at odds with social expectations and result in distress or discomfort Abnormal means not of the norm or not average Michael Jordan Einstein. Abnormal.
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The Psychological Disorders • What is abnormal • Refers to maladaptive cognitions, affects, and or behaviors that are at odds with social expectations and result in distress or discomfort • Abnormal means not of the norm or not average • Michael Jordan • Einstein
Abnormal • The reactions of people with psychological disorders are maladaptive • They must be impaired somehow • Not just strange • May present itself in various ways • Affect • Behavior • Cognition • Social factors are also important • Behavior at a party vs. school • Distressing • Psychological disorders are uncomfortable for those that have one as well as those around them
Diagnostic Statistical Manual of Mental Disorders (DSM) • A way to classify and diagnose mental disorders. • Lists 297 different diagnostic categories • Does not attempt to address the causes of mental disorders • It is an attempt to be as objective as possible in describing the symptoms of mental disorders
Anxiety Disorders, Somatoform Disorders, and Dissociative Disorders
Anxiety Disorders • Definition of anxiety • A feeling of general apprehension or dread accompanied by predictable physiological changes • Two levels • Subjective feelings • Dread • Fear • Physiological responses • Increased muscle tension • Shallow rapid breathing • Cessation of digestion • Increased perspiration • Drying of the mouth
Anxiety Disorders • Major symptom of anxiety • Feeling of anxiety coupled with avoidance behavior • Attempt to avoid situations that seems to produce anxiety • Most common of all the psychological disorders • Perhaps as many as 25% of people will experience an anxiety disorder at some time in their lives. • Two to three times more common in women
Five anxiety disorders • 1) Generalized anxiety disorder (GAD) • Distressing felt anxiety • Unrealistic, excessive, persistent worry • Chronic • An intense anxiety that is diffuse • Not brought on by anything specific • No clear insight to what is causing the anxiety
2) Panic Disorder • 1.5-3.5% of the population • More acute than GAD • Recurrent, unpredictable, unprovoked onset of sudden, intense anxiety. • Can last from seconds to hours • No particular stimulus to bring it on • Age of onset is adolescence to mid twenties • Initial attacks are often associated with stress • Loss of an important relationship • Often accompanied with depression • High rate of suicide attempts – 20 %
3) Phobic Disorders • A persistent and excessive fear of some object, activity, or situation that consistently leads a person to avoid it. • No real or significant threat involved • The fear is unreasonable • Two main categories of phobic disorders • Specific Phobias • Animals • Physical environment – storms, heights • Blood, injection, or injury • Specific situations – tunnels, airplanes • Social phobias • Persistent fears of social or performance situations in which embarrassment could occur • Public speaking
4) Obsessive-Compulsive Disorder (OCD) • A pattern of recurrent obsessions and compulsions • Obsessions • Ideas or thoughts that involuntarily and constantly intrude into awareness • Cleanliness, violence, disease, danger, doubt • Did I turn off the stove? • Compulsions • Constantly intruding, repetitive behaviors • Handwashing, grooming, counting, and checking • Checking your alarm repeatedly to make sure it is set
5) Posttraumatic Stress Disorder (PTSD) • Distressing symptoms that arise some time after the experience of a highly traumatic event • Trauma as defined by the DSM-IV • The person has experienced, witnessed, or been confronted with an event that involves actual or threatened death or serious injury • The person’s response involves intense fear, helplessness, or horror.
Symptoms of PTSD • Re-experiencing the traumatic event • Flashbacks • Nightmares • Avoidance of any possible reminders of the event • People who were there • Increased arousal or alertness • Irritability • Insomnia • Difficulty concentrating
Somatoform Disorders • Disorders that involve some physical, bodily complaint • Psychological disorders • No known medical or biological cause for the symptoms. • Three types • Hypochondriasis • Somatization disorder • Conversion disorder
Hypochondriasis and Somatization Disorders • A person diagnosed with hypochondriasis is preoccupied with the fear of a serious disease • Fear of a nonexistent disease • A person with somatization disorder is preoccupied with nonexistent symptoms • Really the two disorders are quite similar
Conversion Disorder • Loss or altering of physical function that suggests that there is some physical problem • Paralysis – often times of just the hand • Glove anesthesia • Blindness • Deafness • This was Freud’s Hysteria • Diagnosed much more often in Freud’s time • Why?
Dissociative Disorders • To dissociate means to become separate or escape • Dissociative amnesia • Inability to recall important personal information • Beyond simple forgetfulness • Often times it involves forgetting some traumatic event • Somewhat controversial disorder • Like repressed memories
Dissociative Identity Disorder • Multiple personality disorder • Not schizophrenia – which we will talk about later • The existence within the same person of two or more distinct personalities. • Very rare • Most recorded cases are restricted to North America • Usually this disorder occurs in patients working closely with a therapist
Personality Disorders • These disorders represent stable abnormal personality characteristics that people are born with and are difficult to treat.
What is a Personality Disorder? • Personality disorder- an enduring pattern of inner experience and behavior that: • deviates markedly from the expectation of the individual’s culture • Is pervasive and inflexible • Has an onset in adolescence or early adulthood • Is stable over time • Leads to distress or impairment
What is Impaired? • To be diagnosed with a personality disorder, one must exhibit behavior that is abnormal with respect to any two of the following: • Thinking • Mood • Personal relations • The control of impulses
The DSM’s 3 Clusters of Personality Disorders • Cluster A - Odd or Eccentric • (paranoid, schizoid, schizotypal) • Cluster B- Dramatic, Emotional, or Erratic • (antisocial, borderline, histrionic, narcissistic) • Cluster C- Anxious or Fearful • (avoidant, dependent, obsessive-compulsive)
Cluster A Paranoid Schizoid Schizotypal
Paranoid • Distrust of others, including the belief, without reason, that others are exploiting, harming, or trying to deceive them • Belief in hidden meanings • Unforgiving and grudge holding
Schizoid • Very limited range of emotion, both in expression of and experiencing • Indifferent to social relationships • Prefer solitary interests
Schizotypal • Peculiarities of thinking • Odd beliefs (e.g.- belief that they have telepathic or magical powers) • Eccentricities of appearance, behavior, interpersonal style, and thought (e.g.- “I am not a very talkable person”) • Recurrent illusions
Cluster B Antisocial Borderline Histrionic Narcissistic
Antisocial • Lack of regard for the moral or legal standards in the local culture • Inability to get along with others or abide by societal rules • Sometimes called “psychopaths” or “sociopaths”
Borderline • Problems with self-identity • Rapid changes in mood • Intense unstable relationships • Impulsivity • Instability in affect and self-image
Histrionic • Overly dramatic and attention seeking • Exaggerated or inappropriate displays of emotional reactions, often to the point of being theatrical, in everyday behavior • Unusual clothing, hairstyle, or makeup used to draw attention to themselves • Overly concerned with their physical attractiveness and are uncomfortable when they are not the center of attention
Narcissistic • Behavior or a fantasy of grandiosity • Relationships are disturbed because of their lack of empathy and feelings of envy, arrogance, and taking advantage of others • A need to be admired by others • Inability to see the viewpoints of others • Hypersensitive to the opinions of others
Cluster C Avoidant Dependent Obsessive-Compulsive
Avoidant • Social inhibition • Feelings of inadequacy • Extremely sensitive to criticism
Dependent • Extreme need of other people, to a point where the person is unable to make any decisions or take an independent stand on their own • Fear of separation and submissive behavior • Lack self-confidence
Obsessive-Compulsive • Perfectionism • Inflexibility • Preoccupation with uncontrollable patterns of thought and action • Obsessive-compulsive personality disorder is NOT the same as obsessive-compulsive disorder • No actual obsessions or compulsions
Alzheimer's Disease • How many get it? • 15% of people over 65 • 35% over 85 • First signs? • Decline in cognitive ability • forgetfulness • Emotional instability • depression
Alzheimer’s • Eventually • Total dementia • Inability to perform even the most simple responses • swallowing • Terminal • Definitively diagnosed by autopsy • Amyloid plaques • clumps of degenerating neurons • an abnormal protein called amyloid • Neurofibrillary tangles • tangles of neurofibrils within neurons
Alzheimer's Disease • Loss of neurons is common • Plaques, tangles and neuron loss are often most common in areas involved in memory such as • Hippocampus • Amygdala • entorhinal cortex
Alzheimer’s Disease • Appears to be a clear genetic component • If immediate family member has Alzheimer’s • 50% chance if live into 80’s • Cholinergic neurons often die early in the course of Alzheimer’s disease • Cholinergic agonists are effective at reducing symptoms early in the disease
Mood Disorders • Used to be called affective disorders • Any disorder where a disturbance of the mood is the defining symptom • Symptoms and Etiology • All of us have experienced depression • people in whom depression is so severe and so frequent, often without obvious cause, are said to be suffering from the psychiatric disorder of depression
Depression is characterized by • Despair • Hypoactivity • sleep problems • Withdrawal • lack of appetite • an inability to care for oneself
Mania • The other type of affective disorder • in many respects it is the opposite of depression • patients with mania are overconfident, impulsive, distractible and highly energetic • Many people who suffer from depression also suffer from mania • bipolar disorder (1% of people) • unipolar disorder (6% of people) • depression only • About 10% of people suffering from a mood disorder will commit suicide
Concordance rate for bipolar disorder • identical twins about 60% • fraternal twins about 15% • thus, there is a strong genetic component • Stress can play a major role in the etiology of mood disorders • Stress can trigger attacks of depression • 84% of a large sample of patients seeking treatment for depression had experienced a severe stress in the preceding year
Antidepressant Drugs • monoamine oxidase (MAO) inhibitors • Tricyclic Antidepressants • block the reuptakeserotonin and norepinephrine as well as other monoamines • safer than MAO inhibitors • Selective serotonin reuptake inhibitors (SSRIs) • Prozac • a variation of tricyclic antidepressants • selectively block serotonin uptake. • have fewer side effects • effective against many types of psychological disorders • Recently, serotonin -norepinephrine reuptake inhibitors (SNRIs) have proven equally effective in the treatment of depression
Monoamine Theory of Depression • Most widely accepted theory of depression • All the drugs are serotonin and/or norepinephrine agonists • Increase the effectiveness of serotonin and norepinephrin • Depression due to underactivity at serotonin and norepinephrine synapses?
Diathesis-Stress Theory of Depression • Based on the idea that some people inherit a diathesis (genetic predisposition) for depression • if the individual is stressed early in life their systems become altered so that they are hypersensitive to stress for the rest of their lives. • This leads to the development of depression.
Schizophrenia • Symptoms and Etiology • schizophrenia literally means a splitting of psychic function (“the shattered mind”) • characterized by a complex and diverse set of symptoms