Chapter 16 Specific Disorders and Treatments

1. Chapter 16Specific Disorders and Treatments

2. Progress in Abnormal Psychology • The growth of understanding of mental disorders and their treatment has paralleled the progress of medical science. • Although we have much yet to learn, we now can make accurate distinctions between a wide range of disorders and we can tailor treatments to meet the needs of those suffering from specific disorders.

3. Psychological Disorders Psychopathology—scientific study of the origins, symptoms, and development of psychological disorders What is a psychological disorder? What are common characteristics of people with mental disorders? How do we as a culture view mental illness?

4. Stigmas and Misconceptions • Most people have some experience with mental illness • through personal experience or • through illness of someone they are close to • However there is still a stigma associated with mental illness in the U.S. (e.g., people are more likely to talk openly about other forms of disease) • Media--People with mental disorders are the most stigmatized group on television • Portrayed as helpless victims or evil villains who are unpredictable, dangerous, and violent. • One study found 70% of characters labeled as mentally ill on TV were violent. In the real world this is not the case-- • Steadman et. al. (1998) -- overall, former mental patients did not have a higher rate of violence than a matched comparison group. • People with severe mental disorders who are experiencing bizarre delusional ideas and hallucinated voices do have a slightly higher level of violent and illegal behavior than do “normal” people.

5. Psychological Disorder • A pattern of behavioral and psychological symptoms that causes significant personal distress, impairs the ability to function in one or more important areas of daily life, or both. • Patterns of behaviors or psychological symptoms must represent a serious departure from the norm.

6. 4 common DSM categories • Anxiety and Avoidance Disorders • Substance-Related Disorders • Mood Disorders • Schizophrenia

7. Anxiety and Avoidance Disorders Anxiety refers to a certain amount of fear and caution in the face of potential hazards. • Normal Anxiety -- A certain amount of anxiety is normal. • puts us on physical alert, preparing us to defensively “fight” or “flee” potential dangers, and on mental alert, making us focus our attention squarely on the threatening situation. • Anxiety disorders -- considered pathological when it interferes with daily functioning. • maladaptive, disrupting everyday activities, moods, and thought processes or maladaptive behaviors that reduce anxiety

8. Overview of Anxiety Disorders

9. Disorders Characterized by Excessive Anxiety • Generalized anxiety disorder (GAD) is the experience of almost constant and exaggerated worry. • No basis for worries but the person is tense, irritable and tired. • Free-floating anxiety--when one source of worry is removed another quickly takes its place • Physical symptoms: headaches, stomach aches, muscle tension, irritability • About 5% of the general population will experience GAD. • Often it is co-diagnosed with other mood disorders such as depression.

10. Disorders Characterized by Excessive Anxiety • Panic disorder • Panic disorder (PD) is characterized by frequent periods of anxiety and occasional attacks of panic. • Panic attacks involve rapid breathing, increased heart rate, chest pains, sweating, trembling and faintness. • Panic attacks usually last just a few minutes, but can be much longer.

11. Panic Attacks My heart was pounding. It was intense. It felt like I was having a heart attack, like a mad man was on a rampage through my body. Thoughts were racing through my mind -- spinning, confusion, jumping. It was almost as if lightning bolts were catapulting my thoughts, twisting them without focus. In less than a minute, I went from a peaceful, restful state into an attack. Imaginary hands were choking my throat. Cutting off air. Smothering me. I thought I was dying.

12. Disorders Characterized by Excessive Anxiety • Panic disorder • 1-3% of adults • in many cultures. • More women than men • Hyperventilation, or rapid deep breathing, is a key symptom.

13. Disorders Characterized by Excessive Anxiety • Panic disorder • Hyperventilation causes the body to react as if suffocation were occurring. • The person’s subjective interpretation of the symptoms of hyperventilation can cause an increase in panic or a calming down. • People with panic disorder tend to interpret these episodes as uncontrollable and life threatening. • The constant anxiety they experience increases the likelihood of further panic attacks. (cycle of panic)

14. Causes of Panic Disorder • Biological -- genetics--tends to run in families • Psychological -- people with panic disorder seem to be unusually sensitive to signs of physical arousal • Cognitive-behavioral Theory of Panic Disorder • Sufferers tend to misinterpret the physical signs of arousal as catastrophic and dangerous • This interpretation leads to further physical arousal, tending toward a vicious cycle • After the attack the person becomes very apprehensive of another attack, more aware of the signals, and more likely to have another attack as a result • Person become behaviorally conditioned • physical symptoms of arousal -> fear

15. Disorders Characterized by Excessive Anxiety • Panic disorder • Treatments for panic disorder include: • Psychotherapy • Anti-depressant drugs • Advice: “Don’t worry about panic attacks; they won’t kill you.”

16. Disorders Characterized by Excessive Anxiety • Panic disorder • Common co-existing disorders include: • Social phobia – severe avoidance of other people and fear of doing anything in public. • Agoraphobia – an intense fear of open or public places.

17. Disorders Characterized by Excessive Anxiety • Phobias • Avoidance behaviors are highly resistant to extinction. • Phobia is the most common type disorder involving avoidance behaviors. • A phobia is strong and persistent fear of a specific object or situation – so strong it interferes with daily living. • May focus on • Natural environment—heights, water, lightening • Situation—flying, tunnels, crowds, social gathering • Injury—needles, blood, dentist, doctor • Animals or insects—insects, snakes, bats, dogs

18. Study of normal anxieties 100 90 80 70 60 50 40 30 20 10 0 Percentage of people surveyed Snakes Mice Being closed in, in a small place Thunder and lightning Dogs Being in a crowd of people Being in high, exposed places Flying on an airplane Spiders and insects Being alone in a house at night Driving a car Cats Afraid of it Bothers slightly Not at all afraid of it It is not phobic to simply be anxious about something

19. Disorders Characterized by Excessive Anxiety • Phobias • The Prevalence of Phobias • Not all extreme fears qualify as phobias. • About 11% of U.S. adults suffer from a phobia at some point in their lives. • About 5-6% are experiencing a phobia at any given time. • Phobia usually does not persist across the lifetime – many young adults lose them by middle age.

20. Figure 16.2 Most phobias do not last a lifetime. Young people with phobias often lose them by middle age.

21. Some Unusual Phobias Ailurophobia —fear of cats Algobphobia —fear of pain Anthropophobia —fear of men Monophobia —fear of being alone Pyrophobia —fear of fire Scolionophobia -- Fear of school. Testophobia —fear of taking tests

22. Disorders Characterized by Excessive Avoidance • Phobias • Acquiring a phobia: • Some fears are innate but many are learned. • Some phobias can be traced to a specific event. • The early behaviorists were the first to demonstrate how fears might be learned. • This does not account for the fact that: • some phobias are much more common and easily acquired than others. • Some phobias are towards objects that have never injured

23. Disorders Characterized by Excessive Avoidance • Phobias • The most common phobias include: • Open spaces • Closed spaces • Heights • Lightening and thunder • Certain animals – (snakes, spiders, dogs) • Illnesses/germs

24. Can phobias be socially learned? Figure 16.4 A lab-reared monkey learns to fear snakes from the reactions of a wild-reared monkey. But if the snake is not visible, the lab-reared monkey fails to learn any fear.

25. Figure 16.4 A lab-reared monkey learns to fear snakes from the reactions of a wild-reared monkey. But if the snake is not visible, the lab-reared monkey fails to learn any fear.

26. Figure 16.4 Interpretation -- to develop fear of snakes lab-reared monkey needs to see that the other monkey was afraid and what caused the fear

27. Disorders Characterized by Excessive Avoidance • Phobias • Behavior therapy for phobias • Systematic desensitization – reduces fear by gradually exposing people to the object under controlled conditions. Virtual reality is now being employed for this kind of therapy. • Flooding or implosion – a sudden and large-scale exposure to the object under controlled conditions.

28. Disorders Characterized by Excessive Avoidance • Phobias • Drug therapies for phobias and anxieties • Benzodiazepines, a common type of tranquilizer, are often prescribed for anxiety disorders. • They suppress symptoms only temporarily and can be addictive. • Anti-depressants, which are not likely to be taken habitually, are used more effectively.

29. Disorders Characterized by Excessive Avoidance • Obsessions—irrational, disturbing thoughts that intrude into consciousness • Compulsions—repetitive actions performed to alleviate obsessions • Checking and cleaning most common compulsions • Not done out of joy of being clean but to relieve extreme anxiety if not done • Magical thinking -- e.g., “If I don’t get dressed according to a strict pattern my husband will die”

31. Disorders Characterized by Excessive Avoidance • Obsessive-compulsive disorder • Therapies for obsessive-compulsive disorder: • Exposure therapy is very similar to systematic desensitization. • The patient is exposed to the situation that brings on the compulsive behavior, but is prevented from engaging in it. • The most common drug treatments for this disorder utilize clomipramine and other serotonin reuptake inhibiters.

32. Anxieties and Avoidance • Phobias and anxiety disorders involve the interaction and influence of cognition and emotion upon each other. • People who suffer from these conditions are aware that their reactions are exaggerated, but this awareness doesn’t cure the problem. • These disorders are challenging but psychologists continue to improve the efficacy of available treatments.

33. Module 16.3 • Mood Disorders A category of mental disorders in which significant and chronic disruption in mood is the predominant symptom, causing impaired cognitive, behavioral, and physical functioning • Two common mood Disorders • Major depression • Bipolar disorder

34. Mood Disorders • Depression • Major depression--A mood disorder characterized by extreme and persistent feelings of despondency, worthlessness and hopelessness • Major depression is an extremeprolonged condition. • Severe symptoms for at least 2 weeks (usually persists for months). • The person experiences little interest in anything, little pleasure, and little motivation to be productive. • Global negativity and pessimism • Very low self-esteem

35. Mood Disorders • Depression • Major depression • Loss of interest in food and sex are common. • The person has feelings of worthlessness, guilt and powerlessness over their lives. • Sleep abnormalities are associated with depression (there is a characteristic rapid onset of REM sleep). • The person may attempt suicide.

36. Symptoms of Depression

37. Figure 16.9 When most people go to sleep at their usual time, they progress slowly to stage 4 and then back through stages 3 and 2, reaching REM sleep toward the end of their first 90-minute cycle. Depressed people, however, reach REM more rapidly, generally in less than 45 minutes. They also tend to awaken frequently during the night.

38. Mood Disorders • Depression • Seasonal affective disorder (SAD) • Cyclic severe depression and elevated mood • Seasonal regularity -- onset with changing seasons • most common in areas that have little sunlight in winter • Unique cluster of symptoms • intense hunger • gain weight in winter • sleep more than usual • depressed more in evening than morning • It can be relieved by light therapy, which requires the depressed person to sit in front of a bright light for a few hours each day.

39. Mood Disorders • Depression • Genetic predisposition to depression • Having close biological relatives who were diagnosed with depression increases one’s probability of becoming depressed. • Having adoptive relatives who were depressed also increases that probability, but not as much.

40. Mood Disorders • Depression • Sex differences in depression • Before adolescence, depression is about equally common in boys and girls. • From adolescence onward, women are about twice as likely to experience depression as men. • Why? • estrogen cycle has been linked to mood changes • puberty brings on low self-esteem related to body image -- may lead to prolonged feelings of dissatisfaction resulting in depression • explanatory style -- girls tend to look within to explain failures and problems • micro-aggressions from society that convey girls as less important and competent may lead to feelings of worthlessness

41. Mood Disorders • Depression • Events that precipitate depression • Exposure to recent stressful events is one of the best predictors of major depression • spouse or companion • long-term job • health • income • There is little relationship between the scale of the event and the intensity and duration of the subsequent depression. • Severe losses early in life may make people more vulnerable to depression later on in life.

42. Mood Disorders • Depression • Events that precipitate depression • Lack of social support also increases vulnerability to depression. • Person’s interpretation of the event’s significance influences degree of depression. • The way people think about their lives, as well as the course of the events, is a factor to consider.

43. Mood Disorders • Depression • Cognitive aspects of depression • Every person has an explanatory style in accounting for successes and failures. • Internal attributions cite causes within the person. • External attributions identify causes outside the person.

44. Mood Disorders • Depression • Cognitive aspects of depression • more consistent in attributions for their failures. • pessimistic explanatory style--blame themselves for all failures, regardless of the circumstances, • negative experiences are due to stable, global reasons • e.g., “I didn’t get the job because I’m stupid and inept” vs. “I didn’t get the job because the interview didn’t go well” “Depressed people believe that every silver lining has a cloud.” -- Kalat

45. Mood Disorders • Depression • Treatments for depression • Cognitive therapy helps the individual develop more positive beliefs. • Drug therapies use anti-depressant medications including the tricyclics, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and atypical antidepressants. • St. John’s Wort is a naturally occurring herb that has antidepressant effects. It should not be used with other medications.

46. Figure 16.13 Antidepressant drugs prolong the activity of the neurotransmitters dopamine, norepinephrine, and serotonin. (a) Ordinarily, after the release of one of the neurotransmitters, some of the molecules are reabsorbed by the terminal button, and other molecules are broken down by the enzyme monoamine oxidase (MAO). (b) Selective serotonin reuptake inhibitors (SSRIs) prevent reabsorption of serotonin. Tricyclic drugs prevent reabsorption of dopamine, norepinephrine, and serotonin. (c) MAO inhibitors (MAOIs) block the enzyme monoamine oxidase and thereby prolong the effects of the neurotransmitters.

47. Mood Disorders • Depression • Treatments for depression • Electroconvulsive shock therapy (ECT) is a well-known but controversial treatment. • A brief electrical shock is administered to the patient’s head. • It induces a convulsion similar to an epileptic seizure. • How it works is not fully understood.

48. Mood Disorders • Depression • Treatments for depression • It is an effective treatment, although the benefits are temporary. Other treatments must be offered also. • ECT fell out of favor because it was widely abused (administered without patient consent, given too often, used as a threat). • It is now used only for patients who have treatment-resistant depressions or who are strongly suicidal.

49. Mood Disorders • Bipolar disorder • Cyclic disorder (manic-depressive disorder) • Mood levels swing from severe depression to extreme euphoria (mania) • Must have at least one manic episode • extreme euphoria, excitement, • physical energy, • Supreme self-confidence • Grandiose ideas and movements • Flight of ideas(rapid thoughts and speech)

50. Mood Disorders • Bipolar Disorder • Bipolar Disorder: types • Psychologists diagnose two types of bipolar disorder. • Bipolar I disorder involves the experience of at least one episode of mania. • Bipolar II disorder involves alternation between major depression and hypomania, which is a milder form of mania.