Psychological Disorders

1. Psychological Disorders Chapter 12

2. Psychopathology • What was formerly known as mental illness or mental disorder is now often referred to as psychopathology. • Some feel “mental illness” puts the basis for the illness on biology, even though psychologists have shown that environment is often the cause of the disorder. • Psychopathology is any pattern of emotions, behavior, or thoughts inappropriate to the situation and leading to personal distress or the inability to achieve important goals.

3. Prevalence of Psychopathology In America, mental illness is far more common than most people realize. Another study found that during any given year, the behaviors of over 56 million Americans meet the criteria for a diagnosable psychological disorder (Carson et al. 1996). Over the lifespan, as many as 32% of Americans suffer from some psychological disorder (Regier et al., 1988).

4. What is Psychological Disorder? How do we discern what is normal and abnormal? Consider eccentric personalities: What about a soldier who risks his life in war? A grief stricken mother who cannot return to her normal routines three months after losing her son?

5. 3 Classical Symptoms of Severe Mental Illness • The more extreme a disorder is, the more easily it is detected. When trying to diagnose a patient, doctors look for three classic symptoms of sever psychopathology: • Hallucinations-false sensory experiences. • Delusions-extreme disorders that involve persistent false beliefs. • Affect (emotion)-characteristically depressed, anxious, manic, or no emotional response.

6. Psychological Disorders as a Continuum Disorders are exaggerations of normal behavior and responses.

7. Two Contrasting Views As with most topics in psychology, there are multiple perspectives on psychological disorders. The medical model takes a “disease” view. Psychology, on the other hand, sees psychological disorders as an interaction of biological, mental, social and behavioral factors.

8. Historical Roots In the ancient world, psychopathology was thought to be caused by demons and spirits that had taken possession of the person’s mind and body. Part of daily life in ancient worlds was spent doing rituals aimed at outwitting or placating these supernatural beings.

9. Hippocrates • In 400 B.C. the Greek physician Hippocrates took the first step toward a scientific view of mental illness when he said that abnormal behavior had physical causes. • He taught his disciples to interpret the symptoms of psychopathology as an imbalance among our body fluids called “humors.”

10. Regression in Thought Then in the Middle Ages, superstition eclipsed the Hippocratic model. Under the influence of the medieval Church, physicians and clergy reverted to the old ways of explaining abnormal behavior. Hippocrates

11. Salem Witch Trials As a result of erroneous thinking, thousands of mentally disturbed people were executed. In Salem Massachusetts, was one example of the problems with this type of thinking. A modern analysis of the Salem witch trials has concluded that the girls were probably suffering from poisoning by a fungus growing on rye grain-the same fungus that produces the hallucinogenic drug LSD.

12. The Medical Model In the late 18th century, the “disease view” reemerged. The result was the medical model, a view that mental disorders are diseases of the mind that, like ordinary physical diseases, have objective causes and require specific treatment.

13. Medical Model in Practice The medical model led to mental hospitals or “asylums.” In this supportive atmosphere, many patients actually improved, even thrived, on rest, contemplation and simple but useful work.

14. Problems with the Medical Model Despite its success, modern psychologists find fault with relying solely on the medical model. They suggest that treating the disorder as a “disease” leads to a doctor-knows-best approach in which the therapist takes all the responsibility for diagnosing and correcting the problem. In this model, the patient becomes a passive recipient of medication and advice.

15. Psychologists vs. Psychiatrists The other problem psychologists have with the medical model (doctor-knows-best), is that it takes responsibility away from psychologists and gives it to psychiatrists. According to our authors, it assigns psychologists to second-class professional status.

16. Social-Cognitive-Behavioral Approach As psychology has evolved, theories which were originally at odds, have now been combined to offer more thorough explanations, for example, cognitive psychology and behaviorism. Cognitive psychology looks inward, emphasizing mental processes. Behaviorism looks outward and emphasizes the influences of the environment. Psychologists from these perspectives see these two as complementary, and add that cognitions and behavior usually happen in social context, requiring social perspective.

17. Combining Perspectives The behavioral perspective tells us that abnormal behaviors can be acquired in the same fashion as healthy behaviors-- through behavioral learning. The cognitive perspective suggests that we must consider how people think about themselves and their relations with other people. Social-cognitive-behavioral approach, then, is an alternative to the medical model combining all three of psychology’s major perspectives.

18. The Biopsychology of Mental Disorder Modern biopsychology assumes that some mental disturbances involve the brain or nervous system in some way. Subtle changes in the brain’s tissue or its chemical messengers- the neurotransmitters- can profoundly alter thoughts and behaviors. Genetic factors, brain injury, infection, and learning are some of the factors that can tip the balance towards psychopathology.

19. Indicators of Abnormality • While psychologists look for the three classical symptoms, not all disorders have such sever symptoms. A few others are: • Distress:Does the individual show unusual or prolonged levels of anxiety? • Maladaptiveness:Does the person act in ways that make others fearful? • Irrationality:Does the person act or talk in ways that are irrational or incomprehensible to others? • Unpredictability:Does the individual behave erratically and inconsistently at different times? • Unconventional/undesirable behavior:Does the person act in ways that are statistically rare and violate social norms?

20. The More the Better • Clinicians are more confident in labeling behavior as “abnormal” when two or more of the indicators are present. • Extremes and prevalence = greater confidence in diagnosis

21. DSM-IV-TR The American Psychological Association developed the most widely used classification system for psychological disorders. The book is called the Diagnostic and Statistical Manuel of Mental Disorders. *IV=4th edition **TR=Text revised

22. DSM-IV-TR The DSM-IV-TR offers practitioners a common and concise language for the description of psychopathology. The DSM also contains language for diagnosing each of the disorders.

23. Experiment in a Mental Hospital A young psychologist, David Rosenhan, set up an experiment to see if mental hospitals could really detect someone with mental illness. He felt that terms like “sanity,” “insanity,” “schizophrenia,” “mental illness” and “abnormal” might have fuzzier boundaries and more fluid definitions than those in the medical world were giving them credit for.

24. Rosenhan Experiment Rosenhan also suspected that some strange behaviors seen in mental patients might originate in the abnormal atmosphere mental hospitals, rather than in the patients themselves. To test these theories, Rosenhan and seven collogues conducted the Rosenhan Experiment in the early 1970s. David Rosenhan

25. Explaining Rosenhan • Rosenhan said that the mistaken diagnosis were most likely a result of the lack of time the doctors spent with the patients. • Surprisingly, the other hospital patients readily detected the experiment. The pseudo-patients reported that the other patients regularly voiced their suspicions.

26. After the Experiment All of the people who served in the original study were eventually discharged from the hospital with the label of "schizophrenic in remission." To put it another way, they were still considered schizophrenic, but they were temporarily free of symptoms.

27. Mood Disorders Mood disorders are abnormal disturbances in emotion or mood. They are also referred to as affective disorders. The two most common are major depressionand bipolar disorder.

28. Major Depression Major depression is a form of depression that does not alternate with mania (happiness). It is normal to become depressed after a sad or unfortunate even but if a person remains depressed weeks or months after that event, it may be classified as major depression. Major depression does not give way to manic episodes.

29. Major Depression Lifetime Risk of a Depressive Episode lasting a Year or More • By many accounts, depression is under diagnosed and under treated. • Globally speaking, studies indicate that depression is the single most prevalent disability. • While some differences may be a result of reporting, other factors seem to be at work too: • Taiwan/Korea = low divorce rate • Lebanon = war in Middle East

30. Causes of Depression • Some causes of major depression involve genetic predisposition. Severe bouts of depression often run in families. • Further indication of a biological basis for depression are that drugs that affect the brains levels of certain neurotransmitters are very effective. • However, biology alone cannot account for everything.

31. Cognitive Explanations Probably because of low self-esteem, depression-prone people are more likely to perpetuate the depression cycle by attributing negative events to their own personal flaws or external conditions they feel helpless to change. Martin Seligman calls this learned helplessness.

32. Low self-esteem and negative interpretations Negative events Depression Social rejection and loneliness Negative behaviors Cognitive-Behavioral Cycle of Depression Fred decides to be more sociable, but when he asks Teresa for a date she already has plans. Fred concludes that he is not very interesting or attractive and that people don’t like him. Because of Fred’s negative behaviors, people avoid him-reinforcing his symptoms. Fred feels completely alone and unhappy Fred avoids people, skips school and neglects personal hygiene

33. The Cognitive Approach • The cognitive approach to depression points out that negative thinking styles are learned and modifiable. *Think classical and operant conditioning.

34. Beck’s Basics • Aaron Beck suggests that depression is a result of negative thinking which he called ‘cognitive errors’ (errors in logic) • Beck identified three negative thoughts that seemed to be really automatic and occurred without delay in depressed patients. The “Cognitive Triad:” • Self • External World • Future • Beck believes that faulty thinking leads to depression. The question remains though, which came first, the depression or the faulty thoughts.

35. WHO BECOMES DEPRESSED? • Studies show that depression rates are higher in women. The difference may be in the way men and women handle emotional situations. • Women tend to be introspective: • Think about their feelings and what may be causing them. • Men, on the other hand, try to distract themselves from the depressed feelings. • This suggests the more ruminative response of women increases their vulnerability to depression. • Depression breeds depression

36. Increasing Rates of Depression • Rates of depression have increased 10-20 times what they were 50 years ago. • The average age of people experiencing depression has gone down. • Seligman identifies three causes for this trend: • Out-of-control individualism/self-centeredness-focuses on individual successes and failures rather than group accomplishments.

37. Increasing Rates of Depression The self-esteem movement- teaching a generation of children they should feel good about themselves, irrespective of their efforts and achievements. A culture of victimology- reflexively pointing the finger of blame at someone or something else.

38. Bipolar Disorder • Formerly known as manic-depressive disorder, bipolar disorder is a mental abnormality involving swings of mood from mania to depression. • A strong genetic component is well established, although the exact genes involved are not known. • 1% of the population has bipolar attacks, having an identical twin with the problem inflates a person’s chances to about 70%

39. Anxiety Disorders Everyone has experienced some level of anxiety in their life. For some people, a spider, or a tall ladder are enough to send chills down the spine. Psychopathology anxiety is far more sever than the anxiety associated with normal life challenges.

40. Prevalence of Mental Disorders =Anxiety Disorder

41. Generalized Anxiety Disorder • Generalized anxiety disorder is a psychological problem characterized by persistent and pervasive feelings of anxiety, without any external cause. • May experience times when your worries don't completely consume you, but you still feel rather anxious • May feel on edge about many or all aspects of your life • May have a general sense that something bad is about to happen, even when there's no apparent danger. • May not remember when you last felt relaxed or at ease. • GAD often begins at an early age, and the signs and symptoms may develop slowly.

42. Panic Disorder • Panic disorder is a disturbance marked by sudden and severe anxiety attacks that have no obvious connections with events in the person’s life. • Usually free of anxiety between panic attacks Panic attack symptoms: * Rapid heart rate * Sweating * Trembling * Shortness of breath * Hyperventilation * Chills * Hot flashes * Nausea * Abdominal cramping * Chest pain * Headache * Dizziness * Faintness * Trouble swallowing * A sense of impending death

43. Panic Disorder • Many people who suffer from panic disorder also have agoraphobia. A condition which involves panic that develops when people find themselves in situations from which they cannot easily escape: crowed places, open spaces, etc. • Occurs in about 2% of Americans and affect women more than men.

44. Phobic Disorders In contrast to panic disorder, phobias involve persistent and irrational fear associated with a specific object, activity or situation. While many of us have fears, or dislikes of specific objects or situations, these only become psychopathology when they have a cause substantial disruptions in our lives.

45. Preparedness Hypothesis • This theory suggests that we carry an innate biological tendency, acquired through natural selection, to respond quickly and automatically to stimuli that posed a survival threat to our ancestors. • May explain why we develop phobias for snakes and lightening much more easily than automobiles and electrical outlets

46. Obsessive-Compulsive Disorder OCD is a condition characterized by patterns of persistent, unwanted thoughts and behaviors. The obsessive component consists of thoughts, images or impulses that recur or persist despite a person’s efforts to suppress them.

47. Obsessive-Compulsive Disorder • The compulsive component are repetitive, purposeful acts performed according to certain private “rules,” in response to an obsession. • Many characters on TV and in movies have OCD: Jack Nicolson in As Good As It Gets; Monica on Friends; Monk • Others?

48. Obsessive-Compulsive Disorder • When they are calm, people with obsessive-compulsive disorder view their compulsions as senseless. However, when anxiety arises, they cannot resist performing the compulsive behavior rituals to relieve tension. • OCD has a tendency to run in families • A clear genetic connection • Environment seems to play a factor • Behavioral therapy helps many OCD sufferers

49. Somatoform Disorders • Somatoform disorders are psychological problems appearing in the form of bodily symptoms or physical complaints such as weakness or excessive worry about disease. • Conversion Disorder: A disorder marked by paralysis, weakness or loss of sensation but with no discernable physical cause. • Hypochondriasis: A disorder involving excessive worry about health and disease. How a hypochondriac might see himself

50. Dissociative Disorders • Dissociative disorders are a group of pathologies involving the “fragmentation” of the personality, in which some parts of the personality have become detached from other parts. • Dissociative Amnesia: A psychologically induced loss of memory for personal information, like one’s identity. • Usually the result of a stressful situation, it is often associated with Post Traumatic Stress Disorder (PTSD).