Psychological Disorders and Treatment

1. Psychological Disorders andTreatment Presented by Kathleen McCarney, Tsering Choeden, and Andrea Galicia

2. Defining Abnormality …as a deviation from the ideal …as a deviation from the average Abnormality …as an inability to function effectively …as a sense of personal discomfort …as a legal concept

3. Abnormal behavior is… • Behavior that causes people to experience distress and prevents them from functioning in their daily lives. • Because of the multiple definitions of “abnormal”, it is best to look at the behavior on a spectrum, rather than as absolute states. Abnormal Normal

4. What are the major perspectives on psychological disorders used by mental health professionals? • Medical • Psychoanalytical • Behavioral • Cognitive • Humanistic • Sociocultural

5. Medical Perspective …suggests that when an individual displays symptoms of abnormal behavior, the root cause will be found in a physical examination of the of the individual, which may reveal a hormonal imbalance, a chemical deficiency, or a brain injury. Pros Many abnormal behaviors have biological causes and can be treated with medicine. Cons Many abnormal behaviors have no apparent biological cause. Suggests that people are not accountable for, or have no control over their behavior.

6. Psychoanalytical Perspective …suggests abnormal behavior stems from childhood conflicts over opposing wishes regarding sex and aggression. Freud asserted that children go through stages where sexual and aggressive impulses take different forms and cause conflicts. When left unresolved, these issues can bring about abnormal behavior in adulthood. Pros Highlights that people can have rich involved inner life and that prior experiences can have profound affects on current psychological functioning. Cons No conclusive way to link childhood experiences with abnormal behaviors displayed as adults Suggests people have little control over their behavior, since it is guided by unconscious impulses.

7. Behavioral Perspective …looks at the behavior itself as the problem. • All behaviors are responses to various stimuli • These responses are learned through past experiences and guided in the present by the stimuli in the environment. To figure out why the behavior occurs… • Analyze how the individual learned the behavior and when it is displayed. Pros Provides the most precise and objective approach for examining behavioral symptoms of specific disorders. Cons Ignores the rich inner world of thoughts, attitudes and emotions that contribute to abnormal behavior.

8. Cognitive Perspective …suggests peoples thoughts and emotions are central components of their abnormal behavior. • Primary goal in treatment is to explicitly teach new, more adaptive ways of thinking. Pros Patients can free themselves from maladaptive thoughts and beliefsand thus, the abnormal behavior they cause. Cons Maladaptive cognitions could be symptoms, or results of a disorder, rather than the cause. Negative beliefs may accurately reflect the sometimes unpleasant circumstances of life. Cognitive Behavioral Therapy

9. Humanistic Perspective …emphasizes responsibility people have for their own behavior, even when it’s abnormal. • Views people as: • basically rational • oriented towards the social world • motivated to seek self-actualization. • Rather than looking for a cure, people should set their own limits and choose what behaviors to engage in. Pros Stresses the unique aspect of being human. Cons Very vague and philosophical, without any scientific or verifiable proof.

10. Sociocultural Perspective …suggests that people’s behaviors, both normal and abnormal, are shaped by the society and culture in which they live. • Based on the concept that societal and cultural factors are at the root of abnormal behaviors. • Certain kinds of stressors and conflicts in everyday life can promote and maintain abnormal behaviors. Pros Based on research showing certain abnormal behaviors are more prevalent in poor than affluent. Poor economic times are linked with general decline in mental health and increase in social problems. • Cons • Poor are less likely to seek treatment, resulting in more severe symptoms and serious diagnosis. • Sociocultural explanations provide little specific guidance for treatment, focusing on broader societal factors.

11. DSM: Diagnostic and Statistical Manual of Mental Disorders • System devised by APA to diagnose and classify abnormal behaviors. • Behavior needs to be classified in order to diagnose and treat it. • Comprehensive and precise definitions for over 200 disorders with over 17 categories. • There are 5 types of information (axes) to be considered when diagnosing a patient.

12. DSM: The Five Axes Axis I: Clinical Disorders – Disorders that produce stress and impair functioning. Axis II: Personality Disorders and Mental Retardation – Enduring, rigid behavior patterns. Axis III: General Medical Conditions – Physical Disorders that may be related to psychological disorders. Axis IV: Psychosocial and Environmental Problems – Problems in like that may affect the diagnosis, treatment, and outcome of psychological forces. Axis V: Global Assessment Functioning – Overall level of mental, social, occupational, and leisure functioning.

13. DSM: Pros and Cons • Pros • Offers logical way to organize examination of mental disturbances. • Descriptive and clinical, allowing communication between practitioners of diverse backgrounds and theoretical approaches. • Provides conceptual shorthand for professionals to describe behaviors that tend to occur together. “…behaviors that are stimulated by the environment are commonly misattributed to the patient's  disorder. For example, one  kindly nurse found a pseudopatient pacing the long hospital corridors.  ‘Nervous, Mr. X?’ she asked. ‘No, bored,’ he  said.” • Cons • Diagnosing influences perception and interpretation of patients behaviors. • Criteria is sometimes too rigid, too inflexible. • Relies too much on medical perspective. • Lifelong dehumanizing stigma associated with mental health problems. • Initial diagnoses are not usually taken back or reevaluated. • Rosenhan’s Experiment, 1973.

14. Major Psychological Disorders Anxiety Disorders Somatoform Disorders Dissociative Disorders Mood Disorders Schizophrenia Personality Disorders Childhood Disorders Other Disorders

15. Anxiety Disorders Anxiety is a normal reaction resulting in feelings of apprehension or tension, in response to stressful situations. Anxiety disorders occur when anxiety arises without an obvious external cause and affects daily functioning. • There are four major types of anxiety disorders. • Phobic Disorder • Panic Disorder • Generalized Anxiety Disorder • Obsessive-Compulsive Disorder

16. Phobic Disorder • This disorder is based on a phobia, an intense, irrational fear of a specific object or situation. • Danger of the anxiety-producing stimulus is typically small or nonexistent, but seems greater to the person suffering from the phobia. • Many phobias might not affect everyday life, but some can cause serious problems. • Social Phobia – fear of strangers, being judged by others • Agoraphobia – fear of large or crowded spaces

17. Panic Disorder A disorder that takes the form of panic attacks lasting a few seconds to several hours. Panic attacks do not have any identifiable stimuli. Anxiety suddenly rises to a peak, and there is a sense of unavoidable doom. Because of this, some people with panic disorder also develop agoraphobia and do not want to leave their home. Research suggests that recurring high levels of emotional arousal desensitize the brain to emotional stimuli. Physical Symptoms can include: Heart palpitations Shortness of breath Sweating Dizziness Sense of impending death

18. Generalized Anxiety Disorder The experience of long-term, persistent anxiety and uncontrollable worry. Concerns are sometimes about specific issues, like money, family, work, etc. People sometimes experience free-floating anxiety, in which they feel that something dreadful will happen but they don’t know what. Those with GAD are unable to concentrate, or set their worries aside. Anxiety is often accompanied by physical symptoms. Muscle tension Headaches Dizziness Heart palpitations Insomnia

19. Obsessive Compulsive Disorder • A disorder characterized by obsessions and/or compulsions. • Obsession – A persistent unwanted thought or idea that recurs. • Many people suffer from mild obsessions that last for a short time, but for those with OCD, the obsessions persist for days or months and may consist of bizarre, troubling images. • Compulsion – An irresistible urge to repeatedly carry out an act that seems strange and unreasonable. • People with OCD experience extreme anxiety if they are unable to carry out their compulsions, even if they want to stop. • Although carrying out the compulsion may result in immediate reduction of anxiety, the anxiety always returns and can worsen.

20. Somatoform Disorders • Psychological difficulties that take on a physical(somatic) form, for which there is no medical cause. • Hypochondriasis – constant fear of illness and a preoccupation with their health. Symptoms are not faked, but are exaggerated or misinterpreted. • Conversion Disorder – a major disorder that involves an actual physical disturbance, such as the inability to use a sensory organ or the compete or partial inability to move an arm or leg. • The cause is purely psychological. • Often appear and disappear suddenly. • Those experiencing the symptoms often react in a bland, matter-of-fact way, whereas most people would experience anxiety.

21. Dissociative Disorders Psychological dysfunctions characterized by the separation (dissociation) of different facets of personality that are usually integrated. By dissociating key parts of who they are, people are able to keep disturbing memories or perceptions from reaching their conscious awareness, which reduces their anxiety. Allow people to escape from anxiety-producing situations, by producing a new personality to deal with stress, or completely leaving the stressful situation behind. • Dissociative Identity Disorder – Also known as Multiple Personality Disorder, person displays characteristics of two or more distinct personalities. • Dissociative Amnesia – Significant, selective memory loss occurs. • Repression – memories still exist, but cannot be recalled. • Dissociative Fugue – A form of amnesia in which the individual leaves home and sometimes assumes a new identity.

22. Mood Disorders A disturbance in emotional experience, either depression or euphoria, that is strong enough to intrude on everyday living. Major Types of Mood Disorders Major Depression Mania/Bipolar Disorder Cause of Mood Disorders Many studies have been done on depression but there is no definitive cause. Speculations include genetic and biochemical causes, while some believe that experiencing loss and feelings of hopelessness lead to depression. Learned Helplessness – a learned attitude that events are uncontrollable and there is no escape. Women are twice as likely to experience depression as men. Why? Different coping mechanisms Different levels of different hormones Different stressors in life

23. Major Depression • A severe form of depression that interferes with concentration, decision-making, and sociability. • While everyone experiences sadness at times, depression is marked by severe sadness that lasts months, or years. • Sad Facts • At any given time, 6-10% of the US population is clinically depressed. • 1 in 5 Americans will suffer major depression at some point in life. • The cost of depression is over $80 billion a year in lost productivity.

24. Mania and Bipolar Disorder Bipolar Disorder – Disorder where a person alternates between periods of euphoric feelings of mania and periods of severe depression. (Previously known as manic-depressive disorder). Mania – An extended state of intense, wild elation. • Those with bipolar usually experience depression and mania sequentially. • The swings between highs and lows could happen every few days or over a period of years. • Periods of mania often result in high levels of imagination, drive, creativity, and energy. • Those with bipolar often show a recklessness that can result in emotional and physical injury. • May alienate others with talkativeness, inflated self-esteem and indifference to needs of others.

25. Schizophrenia A class of disorders in which severe distortion of reality occurs. • Symptoms(positive/negative) • Decline from previous level of functioning. • Disturbances of thought and speech. Speech can be illogical, garbled and lacking in meaningful content. • Delusions – firmly held unshakable beliefs with no basis in reality. • Hallucinations and Perceptual Disorders – perceiving things that do not exist (visual, auditory, etc.) • Emotional Disturbances – inappropriate, or lack of emotion. • Withdrawal – little interest in others, or the world around them.

26. Schizophrenia: Types and Causes Types of Schizophrenia Disorganized (hebephrenic) – giggling, infantile behavior, strange behavior. Paranoid – delusions of persecution or greatness, erratic behavior, hallucinations. Catatonic – disturbances in movement; loss of all motion for hours or days, hyperactive, wild and violent movement. Undifferentiated – cannot be classified as any other type. Residual – minor signs after a more serious episode. • Causes of Schizophrenia • Genetic factors • Biochemical factors • Environmental factors • Expressed emotion – interaction style in families with schizophrenia, high levels of criticism, hostility, and intrusiveness. • Overattention to stimuli • Underattention to stimuli • Predisposition Model – Interaction among various factors produces the condition in those with a genetic sensitivity to it. • Extremely vulnerable to stressful situations, like social rejection.

27. Personality Disorders A disorder characterized by a set of inflexible, maladaptive, behavior patterns that keep a person from functioning appropriately in society. People with personality disorders do not feel personal distress associated with their psychological maladjustments. • Antisocial Personality Disorder – individuals show no regard for the moral and ethical rules of society or the rights of others. • Manipulative, impulsive, cannot stand frustration, can be charming and engaging. Possibly due to lack of affection in childhood. • Borderline Personality Disorder – individuals have difficulty developing a secure sense of who they are. • Reliance on relationships, devastated by rejection, sense of distrust, impulsive, self-destructive behavior. Possibly due to others discounting or criticizing their emotional reactions, cannot regulate emotions. • Narcissistic Personality Disorder – individuals have an exaggerated sense of self-importance. • Expect special treatment, disregard others feelings, no empathy. Behaviors range from mild and frustrating to criminal and dangerous.

28. Childhood Disorders 20% of children and 40 % of adolescents experience significant emotional or behavioral disorders. • Autism - severe developmental disability that impairs children’s ability to communicate and relate to others. • Usually appears in first 3 years of life • Difficulties in verbal and nonverbal communication • May avoid social contact • About 1 in 110 children are thought to have autism. • Attention-Deficit Hyperactivity Disorder (ADHD) – disorder marked by: • Inattention • Impulsiveness • Low tolerance for frustration • Inappropriate activity • Difficult to deal with at times • These symptoms are severe enough to interfere with everyday functioning. • About 3-5% of school-age children are thought to have ADHD.

29. Psychological Disorders in Perspective

30. About 50% ofthe people in the US are likely to experience a psychological disorder at some point in their lives. 30% experience a disorder in any given year. Comorbidity: simultaneous multiple disorders The most common disorder is reported in the study was depression. The next most common disorder was alcohol dependence, which occurred at a lifetime incidence rate of 14%.Additionally, 7% suffered from drug dependence, involving panic and posttraumatic stress disorder. Psychological disorders make up 14% of global illness, and 90% of people in developing countries receive no care at all for their disorders. Cross-cultural surveys show that the incidence of major depression varies significantly from one culture to another. • 1.5% Taiwan • 2.9% Korea • 11.6% New Zealand • 16.4% France

31. What indicators signal a need for the help of a mental health practitioner? • long-term feelings of psychological distress • feelings of inability to cope with stress • withdrawal from other people • thought of inflicting harm on oneself or suicide • prolonged feelings of hopelessness • chronic physical problems with no apparent causes • phobias and compulsions • paranoia • an inability to interact with others.

32. The Social and Cultural Context of Psychological Disorders Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States Self-defeating Personality Disorder- people who were treated unpleasantly or demeaning in relationships neither left nor took other action. (described as people who stay in abusive relationships) Premenstrual Dysphoric Disorder- severe, incapacitating mood changes or depression related to a woman’s menstrual cycle, in other words premenstrual syndrome (PMS). In men its called healthy aggression and initiative.

33. Southeast Asia and West Africa In Malaysia a behavior called Amok is characterized by a wild outburst in which usually a quiet and withdrawn person kills or severely injures another Koro- a condition which Southeast Asia males develop and intense panic that the penis is about to withdraw into the abdomen. “Brain fag”- a disorder that West African men develop when they first attend college, this disorder includes trembling, crying, uncontrollable screams, and incidents of verbal or physical aggression. Exploring Diversity North America and Europe Anorexia nervosa- disorder in which people become obsessed with their weight and sometimes stop eating, ultimately starving to death in the process Dissociative Identity- makes sense as a problem only in societies in which a sense of self is fairly concrete (Indians assume that the person is possessed by demons or by gods) Disorders like catatonic schizophrenia which unmoving patients appear to be frozen in the same position are rare in North America and Europe but in India 80% of the Schizophrenia are catatonic

34. Deciding When You Need Help If you are feeling: • Long-term feelings of distress that interfere with your sense of well-being, competence, and ability to function effectively in daily activities • Occasions in which you experience overwhelming high stress accompanied by feelings of inability to cope with the situation • Prolonged depression or feelings of hopelessness, especially when they do not have any clear cause • Withdrawal from other people • Thoughts of inflicting harm on oneself or suicide • A chronic physical problem which no physical cause can be determined • A fear or phobia that prevents you from engaging your every day activities • Feeling that other people are out to get you or are talking about you and plotting against you • Inability to interact effectively with others, preventing the development of friendships and loving relationships

35. Psychodynamic Approaches to Therapy • Psychodynamic therapy- seeks to bring unresolved past conflicts and unacceptable impulses from the unconscious into the conscious, where the patients may deal with the problems more effectively. • Defense mechanisms- psychological strategies to protect themselves from unacceptable unconscious impulses. • The most common defense mechanism is repression- pushes threatening and unpleasant thoughts and impulses back into the unconscious How do we rid ourselves of the anxiety produced by unconscious, unwanted impulses and drives? • Freud’s answer was to confront the conflicts and impulses by bringing them out of the unconscious part of the mind and into the conscious part. • Contemporary Psychodynamic Approaches- focuses on unconscious processes as they are manifested in a person’s present behavior

36. Psychoanalysis: Freud’s Therapy • Psychoanalysis- the kind of psychotherapy developed by Freud in which the goal is to release hidden unconscious thoughts and feelings in order to reduce their power in controlling behavior. • Free association- psychoanalysts using this technique tell patients to say aloud whatever comes to mind, regardless of its apparent irrelevance or senselessness, and the analysts attempt to recognize and label the connections between what a patient says and the patient’s unconscious. • Therapists also use dream interpretation- examining dreams to find clues to unconscious conflicts and problems • Resistance- an inability or willingness to discuss or reveal particular memories, thoughts, or motivations • Transference- the transfer of feelings to a psychoanalyst of love or anger that had been originally directed to a patient’s parents or other authority figures.

37. Behavioral Approaches to Therapy • Behavioral treatment approaches come to the assumption: both abnormal and normal behaviors are learned • Aversive Conditioning- a from of therapy that reduces the frequency of undesired behavior by pairing an aversive, unpleasant stimulus with undesired behavior. • Systematic desensitization- gradual exposure to an anxiety-producing stimulus is paired with relaxation to extinguish the response of anxiety • Exposure treatments- a behavioral treatment for anxiety in which people are confronted either suddenly or gradually with a stimulus that they fear. • Token system- rewards a person for desire behavior with a token such as a poker chip or some kind of play money • Contingency contracting- the therapist and the patient draw up a written agreement, the contract states a series of behavioral goals the client hopes to achieve • Observational learning- the focus is on getting people to change their behavior and view of themselves by accepting who they are regardless of whatever it matches their ideal

38. Cognitive Behavioral Therapy • CBT centers around the fact that how you think influences how you feel, which then influences your behavior. • When people are taught how to deconstruct their feelings, they can learn a more adaptive positive way of thinking, they will feel differently and then behave differently. Thought Record

40. Interpersonal Therapy • Short term therapy that focuses on the context of current social relationships. • Focuses on interpersonal issues such as conflicts with others, social skill issues, role transitions, or grief. • Effective in dealing with depression, anxiety, addictions and eating disorders.

41. PSYCHOTHERAPY • Group Therapy • Interpersonal Therapy • Humanistic Therapy • Person Centered Therapy • Self-Help Therapy • Family • Therapy

42. Humanistic Therapy Focuses on self-responsibility in developing treatment techniques • Person Centered Therapy: • Enable people to reach their potential for self actualization by providing a warm and accepting environment.

43. Is Therapy Effective? Several comprehensive reviews indicate that therapy brings greater improvement than no treatment at all, with the rate of spontaneous remission being fairly low.

44. BIOMEDICAL THERAPY • Psycho Surgery • Electroconvulsive Therapy • Drug Therapy • Antianxiety • Drugs • Antipsychotic Drugs • Antidepressant • Drugs • Mood Stabilizers

45. Group Therapy Therapy in which people meet in a group with a therapist to discuss some aspect of their psychological problems. • Family therapy: It involves two or more family members, one of whose problems led to treatment. Family therapists view the family as a system and assume that individuals in the family cannot improve without understanding the conflicts found in interactions among family members. • Self-Help Therapy: People with similar problems get together to discuss their shared feelings and experiences.

46. Biomedical Therapy This approach suggests that rather than focusing on a patient’s psychological conflicts, past traumas, or environmental factors that may produce abnormal behavior, focusing treatment directly on brain chemistry and other neurological factors may be more appropriate.

47. Drug Therapy The control of psychological disorders through drugs-works by altering the operation of neurotransmitters and neurons in the brain.

48. Types of Drugs • Antipsychotic Drugs: Drugs that temporarily reduce psychotic symptoms such as agitation, hallucinations, and delusions. • Antidepressant Drugs:A class of medications used in cases of severe depression to improve a patient’s mood and feeling of well-being. • Mood Stabilizers: Drugs used to treat mood disorders that prevent manic episodes of bipolar disorder. • Antianxiety Drugs: Drugs used to reduce the level of anxiety a person experience and increase feelings of well-being.

49. Electroconvulsive Therapy A procedure used in the treatment of severe depression in which an electric current of 70-150 volts are briefly administered to a patient’s head.

50. Psycho Surgery Brain surgery once used to reduce the system of mental disorder but is rarely used today. Psychosurgery did improve a patient’s behavior, but not without drastic side effects. Along with the remission of the symptoms of the mental disorders, patients sometimes experienced personality changes and became bland, colorless, and unemotional.