Psychological Disorders WHEN ADAPTATION BREAKS DOWN

1. 15 Psychological Disorders WHEN ADAPTATION BREAKS DOWN Slides prepared by Matthew Isaak

2. What is Mental Illness?LO 15.1 Identify criteria for defining mental disorders. • Psychopathology (mental illness) is often seen as a failure of adaptation to the environment. • Failure analysis approach tries to understand mental illness by examining breakdowns in functioning • Mental disorder does not have a clear cut definition.

3. What is Mental Illness?LO 15.1 Identify criteria for defining mental disorders. • Many different conceptions of mental illness, each with pros and cons: • Statistical rarity • Subjective distress • Impairment • Societal disapproval • Biological dysfunction

4. Historical Views of Mental IllnessLO 15.2 Describe conceptions of diagnoses across history and cultures. • During Middle Ages, mental illnesses were often viewed through a demonic model. • Odd behaviors were the result of evil spirits inhabiting the body. • Exorcisms and witch hunts were common during this time.

5. Historical Views of Mental IllnessLO 15.2 Describe conceptions of diagnoses across history and cultures. • During the Renaissance, the medical model saw mental illness as a physical disorder needing treatment. • Began housing people in asylums – but they were often overcrowded and understaffed • Treatments were no better than before (bloodletting and snake pits).

6. Historical Views of Mental IllnessLO 15.2 Describe conceptions of diagnoses across history and cultures. • Reformers like Phillippe Pinel and Dorothea Dix pushed for moral treatment. • Treated patients with dignity, respect, and kindness • Still no effective treatments, though, so many continued to suffer with no relief

7. Modern EraLO 15.2 Describe conceptions of diagnoses across history and cultures. • In early 1950s, a drug was developed called chlorpromazine (Thorazine). • Moderately decreased symptoms of schizophrenia and similar problems • With advent of other medications, policy of deinstitutionalization was enacted

8. Modern EraLO 15.2 Describe conceptions of diagnoses across history and cultures. • Deinstitutionalization had mixed results. • Some patients returned to almost normal lives but tens of thousands had no follow-up care and went off medications. • Community mental health centers and halfway houses attempt to help this problem.

9. Psychiatric Diagnosis TodayLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Diagnostic and Statistical Manual of Mental Disorders (DSM) is a system that contains the criteria for mental disorders. • Currently on fifth edition (DSM-5) • Has 18 different classes of disorders

10. The DSM-5LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Provides list of diagnostic criteria and a set of decision rules for each condition • Warns to "think organic" (rule out physical causes of symptoms first) • Contains information on prevalence and adopts a biopsychosocial approach

11. DSM CriticismsLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Some diagnoses may be invalid • High level of comorbidity-about 50% of people who meet the criteria for one disorder also meet the criteria for a second disorder. This suggests there may be a simpler underlying structure to psychopathology than the one implied by the current classification system. • Medicalizes normality • Reliance on categorical model of psychopathology • Vulnerable to political and social influences

12. Mental Illness and the LawLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Insanity defense requires people to either: • Not know what they were doing at time of crime, or • Not know what they were doing was wrong. • Less than 1% of criminal cases use the defense successfully.

13. Mental Illness and the LawLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Overwhelming majority of people with schizophrenia are not aggressive or violent

14. Mental Illness and the LawLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Involuntary commitment is a procedure for protecting us from certain people with mental disorders and protecting them from themselves.

15. Mental Illness and the LawLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Can only be committed against their will if they: • Pose a clear and present threat to themselves or others. • Are so impaired they can't care for themselves.

16. Anxiety DisordersLO 15.4 Describe the many ways people experience anxiety. • Most anxieties are transient and can be adaptive. • They can, though, spin out of control and become excessive and inappropriate. • One of the most prevalent and earliest-onset of all classes of disorders.

17. Anxiety DisordersLO 15.4 Describe the many ways people experience anxiety. • Can also see inappropriate anxiety in other disorders and problems • Somatic symptom disorder entails anxieties about physical symptoms that interfere with daily living. • Illness anxiety disorder is the preoccupation that one has a serious undiagnosed disease.

18. Generalized Anxiety DisorderLO 15.4 Describe the many ways people experience anxiety. • Continual feelings of worry, anxiety, physical tension, and irritability about many areas • About 3% of the population; 1/3 develop it after major stressor or life change • More prevalent in females and Caucasians

19. Panic DisorderLO 15.4 Describe the many ways people experience anxiety. • Repeated, unexpected panic attacks, along with either: • Persistent concerns about future attacks, or • A change in personal behavior in an attempt to avoid them. • Can be associated with specific situation or come "out of the blue"

20. PhobiasLO 15.4 Describe the many ways people experience anxiety. • Intense fear of an object or situation that's greatly out of proportion to its actual threat • Most common anxiety disorder (11%) • Comes in different forms, such as: • Agoraphobia • Specific or social phobia

21. Posttraumatic Stress DisorderLO 15.4 Describe the many ways people experience anxiety. • Marked emotional disturbance after you experience or witness a severely stressful event • Symptoms include: • Flashbacks and recurrent dreams • Avoiding reminders of the trauma • Increased physiological arousal

22. Obsessive-Compulsive DisorderLO 15.4 Describe the many ways people experience anxiety. • Marked by obsessions - persistent ideas, thoughts, or impulses that are unwanted and inappropriate and cause marked distress

23. Obsessive-Compulsive DisorderLO 15.4 Describe the many ways people experience anxiety. • This distress is relieved by compulsions – repetitive behaviors or mental acts. • Related disorders include body dysmorphic disorder and Tourette's syndrome

24. Explanations for Anxiety DisordersLO 15.4 Describe the many ways people experience anxiety. • Learning models focus on acquiring fears via classical conditioning, then maintaining them through operant conditioning. • Can also learn fears by observing others or by hearing misinformation from others.

25. Explanations for Anxiety DisordersLO 15.4 Describe the many ways people experience anxiety. • Anxious people tend to think about the world in different ways from non-anxious people. • Catastrophic thinking - predicting terrible events despite low probability • Anxiety sensitivity – a fear of anxiety-related symptoms • Many anxiety disorders are genetically influenced through level of neuroticism.

26. Mood DisordersLO 15.5 Identify the characteristics of different mood disorders. • Over 20% of Americans will experience a mood disorder. • Major Depressive Disorder (MDD) is the most common, at 16%. • More prevalent in females, most likely to develop in 30s

27. Mood DisordersLO 15.5 Identify the characteristics of different mood disorders. • Depression symptoms can develop gradually or suddenly, but are often recurrent. • Average episode lasts 6 months to 1 year; most people experience 5-6 episodes • Can cause extreme functional impairment across all areas

28. Sample MDD SymptomsLO 15.5 Identify the characteristics of different mood disorders. • Feeling blue or irritable • Sleep difficulties • Fatigue and loss of energy • Weight changes • Thoughts of death or suicide

29. Explanations for MDDLO 15.6 Describe major explanations for depression and how life events can interact with characteristics of the individual to produce depression symptoms. • Complex interplay of biological, psychological, and social influences • Life events such as loss of something that is dearly valued can set stage for depression. • Depression can create interpersonal problems, which cause lack of social support.

30. Explanations for MDDLO 15.6 Describe major explanations for depression and how life events can interact with characteristics of the individual to produce depression symptoms. • Behavioral model sees depression resulting from a low rate of positive reinforcement in the environment. • Beck's cognitive model holds that depression is caused by negative beliefs and expectations. • Cognitive triad, negative schemas, cognitive distortions

31. Explanations for MDDLO 15.6 Describe major explanations for depression and how life events can interact with characteristics of the individual to produce depression symptoms. • Learned helplessness - tendency to feel helpless in the face of events we can't control • People with depression attribute failure internally and have global, stable attributions. • Genes exert a moderate influence on MDD; role of serotonin, norepinephrine, and dopamine

32. Bipolar DisorderLO 15.5 Identify the characteristics of different mood disorders. • Both depressive and manic episodes • Elevated mood, lowered need for sleep, high energy, talkativeness, inflated self-esteem • Also show highly irresponsible behavior • Equally common in men and women

33. Bipolar DisorderLO 15.5 Identify the characteristics of different mood disorders. • Produces serious problems in social and occupational realms • Very heavily genetically influenced, but stressful life events can cause episode onset • These can be negative or positive events

34. SuicideLO 15.7 Identify common myths and misconceptions about suicide. • Major depression and bipolar disorder – higher risk for suicide than most disorders • More than 30,000 people commit suicide in US each year (11th leading cause of death). • Risk factors include previous suicide attempts and feelings of hopelessness

35. Table 15.5 Common Myths and Misconceptions About Suicide.

36. Personality DisordersLO 15.8 Identify the characteristics of borderline and psychopathic personality disorders. • Should only be diagnosed when: • Personality traits first appear by adolescence • Traits are inflexible, stable, and expressed in a wide variety of situations • Traits lead to distress or impairment • Show substantial comorbidity with other psychological disorders, like mood and anxiety disorders

37. Personality DisordersLO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. • Examples include Borderline, Antisocial/Psychopathic, Narcissistic, Histrionic, Schizoid, Paranoid, Dependent, Avoidant, Obsessive-Compulsive

38. Borderline Personality DisorderLO 15.8 Identify the characteristics of borderline and psychopathic personality disorders. • Mainly women; about 2% of population • Marked by instability in mood, identity, and impulse control; self-destructive tendencies • In sociobiological model, individuals with BPD overreact to stress and experience lifelong difficulties with regulating their emotions.

39. Psychopathic PersonalityLO 15.8 Identify the characteristics of borderline and psychopathic personality disorders. • Condition marked by superficial charm, dishonesty, manipulativeness, self-centeredness, and risk taking • Overlaps with antisocial personality disorder • Primarily males; about 25% of the prison population qualifies

40. Psychopathic PersonalityLO 15.8 Identify the characteristics of borderline and psychopathic personality disorders. • Causes are largely unknown, but may stem in part from a deficit in fear • Alternatively, they may be perpetually underaroused and experiencing stimulus hunger.

41. Dissociative DisordersLO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. • Involve disruptions in consciousness, memory, identity, or perception • Examples include depersonalization disorder, derealization disorder, dissociative amnesia, and dissociative fugue.

42. Dissociative Identity DisorderLO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. • Characterized by presence of two or more distinct identities (alters) • Intriguing differences between alters shown, but could be easily explained in other ways • Primary controversy surrounds issue of posttraumatic vs sociocognitive models

43. Dissociative Identity DisorderLO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. • Little evidence to support the posttraumatic model • Support for sociocognitive model includes: • Most DID patients don't show alters prior to therapy

44. Dissociative Identity DisorderLO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. • Support for sociocognitive model includes: • Treatment reinforces idea person has alters • Treatment tends to increase number of alters seen

45. SchizophreniaLO 15.10 Recognize the characteristic symptoms of schizophrenia. • Severe disorder of thought and emotion associated with a loss of contact with reality • Symptoms include disturbances in attention, thinking, language, emotion, and relationships. • Less than 1% of population, but over half of people in mental institutions

46. SchizophreniaLO 15.10 Recognize the characteristic symptoms of schizophrenia. • Symptoms include: • Delusions – strongly held, fixed beliefs with no basis in reality (a psychotic symptom) • Hallucinations – sensory perceptions in the absence of external stimuli • Disorganized speech (word salad) and behavior (echolalia, catatonia)

47. Schizophrenia LO 15.11 Explain how psychosocial, neural, biochemical, and genetic influences create the vulnerability to schizophrenia. • Psychosocial factors play a role in schizophrenia, but only trigger it in persons with genetic vulnerabilities. • Family members can influence whether patients relapse (expressed emotion).

48. SchizophreniaLO 15.11 Explain how psychosocial, neural, biochemical, and genetic influences create the vulnerability to schizophrenia. • Brain abnormalities: • Enlarged ventricles • Increased sulci size • Hypofrontality • Neurotransmitter differences in dopamine, norepinephrine, glutamate, and serotonin • Significant genetic element

49. Figure 15.5 Schizophrenia Risk and the Family. The lifetime risk of developing schizophrenia is largely a function of how closely an individual is genetically related to a person with schizophrenia. (Source: Feldman, 1991)

50. Vulnerability to SchizophreniaLO 15.11 Explain how psychosocial, neural, biochemical, and genetic influences create the vulnerability to schizophrenia. • Diathesis-stress models propose that disorder is a joint product of a genetic vulnerability (diathesis) and stressors that trigger it • Early warning signs of schizophrenia vulnerability: • Social withdrawal • Thought and movement problems • Lack of emotions, decreased eye contact