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Psychological Disorders. Psychopathology. The study of ‘abnormal’ behavior. But how do we define ‘abnormal’? Try to…. Video Clips. Watch the following clips and add to your definition. Where should we draw the line between normal and abnormal?

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Psychopathology
Psychopathology

  • The study of ‘abnormal’ behavior.

  • But how do we define ‘abnormal’?

  • Try to…..


Video clips
Video Clips

  • Watch the following clips and add to your definition.

    • Where should we draw the line between normal and abnormal?

    • How should we define psychological disorders?

    • How should we understand disorders…as sicknesses or as natural responses to the environment.


The history
The HISTORY

  • From as early as

    3000 B.C.E. skulls have

    been found w/ evidence

    of an ancient surgical

    technique. (Trepanning)

    Mainly done to release the

    DEMONS and EVIL SPIRITS


The history1
The History

  • In the 1800’s, disturbed people were no longer thought of as madmen, but as mentally ill.

  • Locked/chained away in ‘mental hospitals’

  • Some hospitals even charged

    admission for the public to

    see the “crazies”, just like a zoo.


Currently abnormality
CURRENTLY - ABNORMALITY

  • Statistical Definition

    • Frequently occurring behavior = normal

    • Infrequent behavior = abnormal

  • Social Norm Deviance

    • Going against normal behavior (refusing to wear clothing)

  • Subjective Discomfort

    • When the person experiences discomfort while engaging in a behavior

  • Inability to Function Normally

    • Maladaptive behavior – can’t ‘do’ daily living


Definition
Definition -

  • Psychological Disorder – a ‘harmful dysfunction’ in which behavior is judged to be atypical, disturbing, maladaptive and unjustifiable.


Abnormality across cultures
Abnormality across cultures

  • Read the ‘Current Issues in Psychology’ to see how abnormality differs in various cultures.

  • Answer the two discussion questions


What causes
What causes?

  • Biological Model

  • Medical Perspective: psychological disorders are sicknesses and can be diagnosed, treated and cured.

    • assumes that these “mental” illnesses can be diagnosed on the basis of their symptoms and cured through therapy, which may include treatment in a psychiatric hospital


What causes1
What causes?

  • Psychodynamic View –

    Hiding Problems

  • Behaviorism –

    Learning Problems

  • Cognitive Perspective –

    Thinking Problems

  • Biopsychosocial Perspective

    All of the above



Classifying psychological disorders
Classifying Psychological Disorders

  • DSM-IV: Diagnostic Statistical Manual of Mental Disorders: the big book of disorders.

  • Describes 250 disorders on 5 Axes


Dsm iv tr
DSM – IV - TR

Official categorization of psych disorders in U.S.

  • 5-Axis model adopted in 1980

    • Axis 1

      • Clinical disorders (e.g., mood & anxiety disorders)

    • Axis 2

      • Personality disorders (e.g., narcissism, antisocial) & mental retardation

    • Axis 3

      • Medical (physical) conditions influencing Axis 1 & 2 disorders

    • Axis 4

      • Psychosocial & environmental stress influencing Axis 1 & 2 disorders

    • Axis 5

      • Global Assessment of Functioning score: highest level of functioning patient has achieved in work, relationships, and activities


Dsm iv tr1
DSM – IV - TR

  • Look at ‘your’ page.

  • How is each disorder described?


Anxiety disorders
Anxiety Disorders

  • All disorders where the most dominant symptom is EXCESSIVE or UNREALISTIC anxiety

  • Free-floating anxiety – anxiety that seems to be unrelated to any realistic or known factor.


Anxiety phobic disorders
(Anxiety)Phobic Disorders

  • Phobia – an irrational, persistent fear of something

    Social Phobias (social anxiety disorder)

    fear of interacting with others or

    being in social situations.

    Specific Phobias- fear of some

    object or specific situation

    Agoraphobia – the fear of being somewhere where you can’t escape if something should go wrong.


Name the phobia
Name the phobia

  • Washing and bathing

  • Spiders

  • Lightning

  • Dirt, germs

  • Darkness

  • Fire

  • Foreigners, strangers

  • animals

  • Ablutophobia

  • Arachnophobia

  • Ceraunophobia

  • Mysophobia

  • Nyctophobia

  • Pyrophobia

  • Xenophobia

  • Zoophobia

FEAR OF

SCIENTIFIC NAME


Anxiety panic disorder
(Anxiety)Panic Disorder

  • Anna is sitting in science class when she starts feeling strange. Her vision is blurry, ears feel stuffed with cotton. She was cold, breaking into a sweat – extremely afraid for no reason. When she stands up to go to the teacher everything immediately turns to normal.

  • What was going on with Anna?

    Panic Attack – a sudden onset of extreme panic with various physical symptoms


Anxiety panic disorder1
(Anxiety)Panic Disorder

  • Becomes a disorder when it affects the person’s ability to function daily.

    Q. What would you call it if a person has a fear of panic attacks in a public place that prevents the person from going out into unfamiliar or exposed places?

    A. Panic disorder with agoraphobia


Anxiety obsessive compulsive disorder
(ANXIety)Obsessive-compulsive disorder

  • When intruding thoughts (that occur repeatedly) are followed by some compulsion, a repetitive ritualistic behavior. The compulsions are meant to lower the anxiety caused by the thought.


Anxiety generalized anxiety disorder
(ANXIETY)Generalized anxiety disorder

  • The kind of anxiety that has no real source and lasts for more days than not for a period of at least 6 months.


Causes
Causes?

  • Psychodynamic?

  • Behaviorists?

  • Cognitive? –

    • magnification (mountains out of molehills)

    • All-or-nothing thinking

    • Overgeneralization

    • Minimization

  • Biological?

    • Imbalance of neurotransmitters including low levels of serotonin and GABA.



Somatoform disorders
Somatoform disorders

  • Disorders in which people think they are sick…but are not, its ‘all in one’s head’

  • Differs from psychosomatic disorders (psychophysiologic) because physical ailments are not real with somatoform


Somatoform hypochodriasis
(SOMATOFORM)hypochodriasis

  • when a person worries excessively and almost constantly about getting ill.

  • Differs from anxiety disorder because the worry is about ‘illness’


Somatoform somatization disorder
(SOMATOFORM) Somatization disorder

  • Person feels vague, recurring physical symptoms for which medical attention has been sought repeatedly but no organic cause found. Less worry…more drama

  • Symptoms described as ‘unbearable’ or ‘beyond description’

  • Example: backpain, dizziness, partial paralysis, abdominal pains, sometimes anxiety and depression


Somatoform conversion disorder
(SOMATOFORM) Conversion disorder

  • A dramatic specific disability has no physical cause but instead seems related to psychological problems (psychological problems are “converted” into a physical illness.)

  • Examples: paralysis, blindness, deafness, seizures, loss of feeling ….. Serious physical impairments

  • Symptoms leave when hypnotized, under anesthesia or unconscious


Somatoform munchausen
SOMATOFORM (MUNCHAUSEN)

Munchausen syndrome

Patient is usually admitted to a hospital presenting some acute illness that has a dramatic but plausible origin.

History is riddled with falsehoods, and that the patient has similarly deceived the staff of several other hospitals.


Somatoform munchausen1
SOMATOFORM (MUNCHAUSEN)

Munchausen syndrome by proxy

Involves a caregiver’s persistent fabrication of medical symptoms and signs in the person cared for (typically a mother/child relationship) leading to illness, endangerment, and unnecessary invasive or hazardous treatments.


Munchausen
MUNCHAUSEN

Key elements: presence of physical symptoms that are self-induced (or other-induced, mother/child proxy), pathological lying

Baron Munchausen was a teller of tall tales

ILLUSTRATIVE CASES (FOLLOWING SLIDES):


Munchausen1
MUNCHAUSEN

  • ACUTE ABDOMINAL DISTURBANCES

    • SWALLOW OBJECTS, SAFETY PINS, NEEDLES

    • INGEST POISONOUS SUBSTANCES

  • HEMORRAGHIC DISTURBANCES

    • CREATE WOUNDS

    • CONTAMINATE/IRRITATE/INFECT WOUNDS

  • RESPIRATORY DISTURBANCES

    • INSSERT NEEDLES INTO CHEST;

    • BREATHE TOXIC CHEMICALS


  • Causes1
    Causes?

    • Psychodynamic?

    • Behaviorists? – positive/neg reinforcement

    • Cognitive? magnification


    Dissociative disorders
    Dissociative DIsorders

    • What is dissociation?

      • literally a dis-association of memory (a split)

      • person suddenly becomes unaware of some aspect of their identity or history

      • unable to recall except under special circumstances (e.g., hypnosis)

    • Three types are recognized

      • dissociative amnesia

      • dissociative fugue

      • dissociative identity disorder


    Dissociative amnesia
    Dissociative amnesia

    • Marian and her brother were recently victims of a robbery. Marian was not injured, but her brother was killed when he resisted the robbers. Marian is unable to recall any details from the time of the accident until four days later.

    • Memory loss the only symptom

    • Often selective loss surrounding traumatic events

      • person still knows identity and most of their past


    Dissociative fugue
    Dissociative fugue

    • Jay, a high school physics teacher in New York City, disappeared three days after his wife unexpectedly left him for another man. Six months later, he was discovered tending bar in Miami Beach. Calling himself Martin, he claimed to have no recollection of his past life and insisted that he had never been married.


    Dissociative fugue flight
    Dissociative Fugue (flight)

    • Complete amnesia

      • leaves home

      • develops a new identity

      • apparently no recollection time in fugue state

    • If fugue wears off

      • old identity recovers

      • new identity is totally forgotten


    Dissociative identity disorder did
    Dissociative identity disorder (DID)

    • Norma has frequent memory gaps and cannot account for her whereabouts during certain periods of time. While being interviewed by a clinical psychologist, she began speaking in a childlike voice. She claimed that her name was Donna and that she was only six years old. Moments later, she seemed to revert to her adult voice and had no recollection of speaking in a childlike voice or claiming that her name was Donna.


    DID

    • Originally known as “multiple personality disorder”

    • Two or more distinct personalities manifested by the same person at different times

    • VERY RARE and controversial disorder

    • Examples include Sybil, Trudy Chase, Chris Sizemore (“Eve”)

    • Has been tried as a criminal defense

      • Hillside strangler

      • He was (both) convicted


    Causes2
    CAUSES?

    • Psychodynamic?

    • Cognitive/Behavioral?

    • Biological?

      • Those with DID show significant differences in PET scan activity taken when different ‘personalities’ are present

      • Maybe due to childhood abuse??



    Dissociation and multiple personalities
    Dissociation and multiple personalities

    • 644-645

    • Read about Sybil

    • What are the arguments for and against DID as an actual disorder? What do you think?



    Sybil
    Sybil?

    • Was she a true DID case?


    Mood disorders
    Mood disorders

    • Disorders that are a disturbance in emotion.

    • They are also referred to as ‘Affective (emotion/mood) Disorders’

      (mild mood disorders)

    • Dysthymia – mild depression (2 yrs or more)

    • Cyclothymia – sad, happy, sad, happy (2 yrs)

    Extreme Sadness

    Mild Sadness

    Normal Emotion

    Extreme elation

    Mild Elation


    Major depression
    Major depression

    • A deeply depressed mood that comes on fairly suddenly and seems too severe for the circumstances or exists without any external cause

    • Most common of the diagnosed mood disorders

    • More common in women…that’s changing.

    • (Unipolar disorder)


    Bipolar disorder
    Bipolar disorder

    • Severe mood swings that go from severe depression (extreme sadness) to manic episodes (extreme elation).

    • No external cause for either mood

    • Manic episodes can last from a few weeks to a few months

      • Extreme happiness

      • Restless, irritable

      • May become aggressive when not allowed to carry out their ‘grand’ plans

      • Rapid speech


    Causes3
    Causes?

    • Biological –

      • serotonin, norepinephrine and dopamine.

      • Appear in genetically related individuals at a higher rate

      • Specific genes



    Schizophrenia
    schizophrenia

    • A long lasting psychotic disorder, involving a severe break with reality, in which there is an inability to distinguish what is real from fantasy as well as disturbances in thinking, emotions, behavior and perception


    Symptoms
    symptoms

    • Delusions

      • Delusions of persecution (Dr. Nash- A Beautiful Mind)

      • Delusions of grandeur

      • Delusions of reference

      • Delusions on influence

        IF ONLY DELUSIONS THEN NOT SCHIZOPHRENIA, INSTEAD A DELUSIONAL DISORDER


    Symptoms1
    symptoms

    • Speech disturbances

      • Make up words

      • Repeat words or phrases persistently

      • Sting words together on the basis of sound

    • Thought disturbances

      • Hard time linking thoughts in a logical fashion

    • Emotional Disturbances

      • Flat affect – when a person shows little to no emotion

      • Excessive or inappropriate


    Symptoms2
    symptoms

    • Hallucinations

      • Hearing voices or seeing things or people not really there

    • Behavior

      • Disorganized and cold


    Types
    types

    • Disorganized

      • Vivid and frequent hallucinations

      • flat affect

      • Socially impaired

      • Giggling, silliness, nonsensical speech and neglect of cleanliness


    Types1
    Types

    • Catatonic

      • Disturbed motor behavior

      • Doesn’t respond to outside world and doesn't move or maintains odd-looking posture for hours on end or moves about wildly in great agitation

      • Totally off or totally on


    Types2
    types

    • Paranoid

      • Hallucinations (often auditory)

      • Delusions


    Cures
    Cures?

    • Positive symptoms

      • Excess or distortion of normal functions (delusions, hallucinations)

        • Overactivity in the dopamine area (prescribed dopamine reducing drugs)

        • Recovery outlook - good

    • Negative symptoms

      • Decrease of normal functions (poor attention or lack of affect)

        • Lower than normal activity in dopamine system and frontal lobe functioning

        • Recovery outlook – not so good



    Case studies
    Case Studies

    • Read 1case study

      Be able to

    • Summarize each case (highlights)

    • List the symptoms

    • Diagnosis – Why

    • Treatment and outcome


    Personality disorders
    Personality disorders

    • A person has an excessively rigid, maladaptive pattern of behavior and ways of relating to others

    • 10 recognized types of personality disorders

      • See list

      • Video – Personality Disorders and Narcissistic


    Antisocial personality disorder
    Antisocial personality disorder

    • Against society

      • Habitually breaks the law

      • Disobeys rules

      • Tells lies

      • Uses others without worrying about their rights or feelings

      • No remorse

    • Sociopath

    • 3 - 6x’s as many men as women


    Borderline personality disorder
    Borderline personality disorder

    • Moody, Unstable, Manipulative, Mistrusting

    • Periods of depression

    • Excessive spending, drug abuse, suicidal behavior

    • More common in women than men

    • Treatment (video)


    Causes4
    Causes?

    • Psychoanalysis – Superego underdeveloped, unresolved issues, fixation on anal stage for narcissism and borderline disorders

    • Cognitive-Behavioral

    • Some biological evidence



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