Psychological Disorders and Therapy

1. Psychological Disorders and Therapy Ella Sternisha Kaley Slagle Jenna Ramsey Rachel Simon Kaitlyn Hocutt

2. Abnormal Behavior • behavior that is deviant,maladaptive, or personally distressful over a relatively long period of time • Deviant- both atypical and abnormal behavior. Ex: a person who flosses her teeth every 15 minutes • Maladaptive- behavior that interferes with a person’s ability to function effectively or behavior that presents a danger to the person or those around him/her. Ex: a person who is afraid to leave their house • Personal distress- the person engaging in the behavior finds it troubling. Ex: a man who often skips meals to lose weight

3. Abnormal Behavior • Only needs one of these things to be considered abnormal • depends on the setting

4. Approaches • Biological • Focuses on the brain, genetic factors, and neurotransmitter • medical model- the view that psychological disorders are medical diseases with a biological origin (Patient Mental illness Doctor) • Psychological • emphasizes the mixture of thoughts, experiences, emotions and personality characteristics. Focus on the rewards and punishers in ones environment that determine ab. behavior

5. Approaches • Sociocultural • emphasizes social context in which a person lives, one’s gender, ethnicity, socioeconomic status , family relationships, and culture. • Socioeconomic status plays a bigger role than ethnicity • cultures influences our understanding and treatment of psychological disorders • Biopsychosocial • must take into account a variety of interacting factors • biological, psychological, and social factors are all important and they work together to produce normal & abnormal behavior

6. Classifying Abnormal Behavior • classifying helps not only patients but also psychologists • could create stigma • DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) list of 374 diagnosable disorders. • Classifies on the basis of five axes that take into account one’s history and highest level of functioning within the previous year

7. DSM-IV • The five axes are • 1- all diagnostic categories except personality disorders and mental retardation, • 2- Personality disorders, • concerned with the classification, • 3-general medical conditions, • 4-Psychosocial and environmental problems, • 5- current level of functioning • not needed to diagnose a person, but included to get an overview of a persons life

10. Critiques of DSM-IV • focuses strictly on pathology and problems • identifying a person strengths may help them in realizing their ability to contribute to society • uses medical terminology, in traditional mind set that mental disorders are diseases • on reflects the medical model, does not consider other factors that could lead to a disorder

11. Dissociative Disorders Dissociative disorders are conditions that involve disruptions or breakdowns of memory, awareness, identity or perception. Dissociation, a defense mechanism, is used pathologically and involuntarily to cope with trauma or other anxiety disorders.

12. Dissociative Identity Disorder • Most subjects suffered severe abuse during childhood • Physical, sexual, and/or psychological • May feel other people talking inside your head • Commonly paired with dissociative amnesia

13. Dissociative Identity Disorder • Two or more personalities within an individual • At least two of the personalities take turns controlling the individual's behavior • Can't recall important personal information that is too extensive to be explained by ordinary forgetfulness

14. Dissociative Identity Disorder - Case Study In a case of dissociative identity disorder, a woman who had been physically and sexually abused by her father throughout her childhood and adolescence exhibited at least 4 personalities as an adult. Each personality was of a different age, representing the phases of the woman's experience – a fearful child, a rebellious teenager, a protective adult, and the woman's primary personality. Only one of the personalities, the protective adult, was consciously aware of the others, and during therapy sessions was realized to have been developed to protect the woman during the abusive experiences. When one of the secondary personalities took over, it often led to dissociative amnesia, during which the woman acted out. During intensive therapy sessions, each personality was called upon as necessary to facilitate their integration.

15. Dissociative Fugue • Creating physical distance from reality • Short duration • Starts and ends abruptly • No recollection of what happened during episode

16. Dissociative Fugue - Symptoms • Sudden unplanned travel • Inability to recall past events or important information • Confusion or memory loss about identity • Extreme distress interferes with daily functioning

17. Dissociative Fugue - Case Study • Post-traumatic stress induced amnesia • 35-year-old businessman who disappeared more than 2 years after narrowly escaping from the World Trade Center terrorist attack on September 11, 2001 • Leaving behind his wife and children • The man was missing for more than 6 months when an anonymous tip helped police in Virginia identify him

18. Dissociative Fugue - Treatment • Often recover spontaneously • Psychotherapy • Hypnosis • Psychopharmacology

19. Dissociative Amnesia • Inability to recall important personal information • More extensive than can be explained by normal forgetfulness • Remembering is usually traumatic or produces stress

20. Dissociative Amnesia - Symptoms • Sudden inability to remember past experiences or personal information • Confusion • Depression • Anxiety

21. Dissociative Amnesia - Case Study • A 29-year-old female on an academic trip to China. • Found in a hotel bathroom unconscious, with no signs of structural or neurologic abnormalities • Could not remember her any facts about her life • Amnesia persisted for 10 months, until the feeling of blood on the woman's fingers triggered the recollection of events from the night of onset of dissociative amnesia • The woman finally remembered having witnessed a murder that night • She came to remember other aspects of her life; however, some memories remain unretrievable.

22. Dissociative Amnesia - Treatment • Psychotherapy • Cognitive therapy • Antidepressant or anti-anxiety medicine • Creative therapies • Clinical hypnosis http://education-portal.com/academy/lesson/dissociative-disorders.html

23. Mood Disorders A psychological disorder in which there is a primary disturbance of mood: prolonged emotion that colors the individual’s entire emotional state.

24. Depression-What is it? • Most common of all psychological disorders • Affects more than 100 million people worldwide • 8% of the population will experience depression at some point in their life

25. Depression • Most common of all psychological disorders • Major Depressive Disorder Must experience 5 of 9 listed symptoms to be diagnosed, one of which must be one of the first 2 listed • Persistent depressed mood for most of the day • Loss of interest, pleasure in all/almost all activities • Significant weight loss/gain due to changes in appetite • Sleeping more or less than usual • Speeding up/slowing down of physical/emotional reactions • Fatigue, loss of energy • Reduced ability to concentrate, make meaningful decisions • Recurrent thoughts of death or suicide • No history of manic episodes

26. Treatment • Antidepressant medication-effective • Psychotherapy or Cognitive Behavioral Therapy focused on negative thinking • Electroconvulsive Therapy: last resort

27. Dysthymic Disorder-What is it? • Most commonly known as dysthymia • Characterized as an overwhelming state of depression • People are depressed for not only days and months, but often years

28. Dysthymia Individual must have two or more of the following symptoms: • Poor appetite or overeating • sleep problems • low energy or fatigue • low self esteem • poor concentration • feelings of hopelessness

29. Treatment • Little research is shown on how to treat Dysthymic Disorder • Patients respond to very few antidepressants •Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants • Supportive psychotherapy and psychoeducation significantly improve the patient compliance and family cooperation

30. Case Study Rahim, Public Sector Lawyer Rahim has been a moderately successful public sector lawyer for the last 20 years. In that time (in fact, ever since he was a young child) Rahim does not remember a period where he has been truly happy—he has always felt a sense of sadness about himself even though he has a loving family. Although intelligent, he suffers from low self-esteem and has always been plagued by poor sleep and low levels of energy. Rahim is functional at work, however, he definitely feels that he has not excelled in his career the way he could have, which he attributes largely to a crippling talent for procrastination about making important decisions, as well as his difficulty concentrating. Although Rahim feels that he certainly isn’t a miserable as he could be, he feels burdened by a nagging sense of hopeless about his situation and worries that he might get even worse one day.

31. Biological Factors • genetic influences • brain structures and neurotransmitters • problem in regulation

32. Psychological Factors • based on behavioral & cognitive theories • Behavioral: learned helplessness ( individuals can’t control stress) • Cognitive: thoughts & and beliefs that lead to this. • what and how people think • how individuals deeply reflect on certain negative events & feelings • Pessimistic attributional style “It’s my fault…”

33. Sociocultural Factors • Areas with poverty, learned helplessness, & alcoholism • Found in Native American groups • Lower SES more likely to develop depression

34. Men & Women across cultures • Women 2X more likely to get depression • single & head of the household • working in unsatisfying jobs • difference occurs in many countries • minority women more likely

35. Depressed Children • 1.5-2.5% of children depressed • 15-20% of adolescents • interference with development • higher risk of variety of problems (substance abuse & academic issues) • Developmental Psychopathology: used to treat & prevent disorders in children

36. Bipolar Disorder-What is it? Bipolar Disorder is a mood disorder characterized by extreme mood swings that include one or more episodes of mania. Mania: person feels euphoric and on top of the world Two Types: Bipolar I and Bipolar II Disorders • Genetic influences play more of a role • Disorder associated with brain activity

37. Case Study A 29-year old married, mother of a young child age 2, presented with a history of recurrent and disabling depression and headaches. Several weeks prior to presentation, she became severely depressed and had difficulty moving, had diminished appetite, had crying spells much of the day and felt suicidal. At the time she presented, she was on Prozac 20 mg a day, and described herself as getting “manicky” on the Prozac. By this, she meant that she was “rushing around, laughing a lot and having more anxiety.” A past trial with Wellbutrin was poorly tolerated because of sweating episodes, insomnia and agitation. Her depression was worsening despite the Prozac treatment. There was a past history of concussion at age 18, when she suffered loss of consciousness. She also described a history of mood swings for many years. There was also a history of alcohol abuse when she was a teenager. The diagnosis of major depressive disorder was suspect, given the poor response to both antidepressants. Prozac was discontinued because it appeared to be worsening the underlying mood swings. Family history revealed severe mood swings in both her father and paternal grandmother. Grandmother at times would take to bed for long spells, and she had been hospitalized for “unknown reasons” that the family refused to talk about, and the client recalled that the secrecy was because of something “shameful” about her grandmother’s condition and behavior. Because of the suggestion of Manic Depressive Disorder by personal and family history, she was placed on Seroquel 100 mg at bedtime. Within one week’s time, she began to improve markedly, including clearer thinking, more productive work being done, less depression and more energy. Within five weeks after the institution of Seroquel, the client was feeling “terrific.” She was seen in supportive psychotherapy and provided advice on parenting her two year old daughter, which helped to settle down the child’s behavior and gave the client more confidence and a feeling of control over her life.

38. Treatments Aimed at managing symptoms and preventing episodes •Combination of medication and psychotherapy •Medications include: –Mood stabilizers –Antidepressants –Antipsychotics •Cognitive Behavioral Therapy (CBT)

39. Suicide • Result of psychological disorder • thinking about suicide is normal, acting on it is abnormal • 3rd leading cause for death in U.S

40. Biological Factors • genetic factors important • suicide runs in family linked with low levels of of serotonin • poor health is a risk factor

41. Psychological Factors • mental disorders and traumas • 90% of individuals who commit suicide have a psychological disorder • immediate & highly stressful circumstance can lead to suicide

42. Sociocultural Factors • chronic economic hardship • attempts vary across ethnic groups • major risk factor is alcohol abuse (esp. in adolescents) • women 3X more likely • women more likely to be diagnosed and men more likely to commit

43. Anxiety Disorders

44. Definition Psychological Disorders involving fears that are uncontrollable, disproportionate, to the actual danger the person might be in, and disruptive of ordinary life.

45. 5 types of Anxiety Disorder • Generalized Anxiety Disorder • Panic Disorder • Phobic Disorder • Obsessive-Compulsive Disorder • Post-Traumatic Stress Disorder

46. Generalized Anxiety Disorder • Anxiety lasting for more than 6 months. • A person cannot find a reason behind their persistent anxiety. • Symptoms include fatigue, muscle tension, stomach problems, and difficulty sleeping.

47. Psychological and Sociocultural Factors • Having harsh self standards • Dealing with overly strict and critical parents (authoritarian) • Automatic negative thoughts when feeling stressed • A history of uncontrollable traumas or stressors (abusive memories)

48. Biological Factors • Genetic predisposition • Deficiency in the neurotransmitter GABA • Overactive sympathetic nervous system • Respiratory system abnormalities

49. Panic Disorder • Recurrent, sudden onsets of intense fear and terror • Often occur without warning and no specific cause • Symptoms include severe palpitations, extreme shortness of breath, chest pains, trembling, sweating, dizziness, and a feeling of helplessness • Can lead to agoraphobia

50. Biological Factors • Genetic predisposition • Overactive sympathetic nervous system • Low on neurotransmitter GABA and norepinephrine