Psychological Disorders

1. Psychological Disorders Chapter 14

2. Atypical (Deviation from Average): Behavior is statistically rare Problem is that not all rare behaviors (e.g. genius) are abnormal Socially unacceptable (Deviation from Ideal): Behavior violates social norms Problem is that norms change over time and people do not agree on “ideal behavior” Distressing (Subjective Discomfort): causes distress or anxiety in that individual Problem is that people may not be feeling stress about their bizarre behaviors Dysfunction Inability to function effectively and adapt to the demands of society Problem is that this definition does not consider personal choice Characteristics of Abnormality

3. Mental Illness and the Law • Insanity • Legal term for mentally disturbed people who are not considered responsible for their criminal actions • Competency • Is the individual fit to stand trial? • Those found insane often spend more time in mental institutions than they would have in prison

4. Historical Views of Psychological Disorders • Supernatural view, where mysterious behavior was attributed to supernatural powers, likely dominated early societies • Naturalistic View, where abnormality is attributed to medical problems. • Mental hospitals and asylums were used more like prisons to keep the afflicted away from society • Church dominance over culture in Middle Ages and lack of scientific knowledge caused the supernatural view to dominate through the 17th century.

5. Historical Views of Psychological Disorders • Enlightenment and the Triumph of Human Rights: ALL PEOPLE HAVE RIGHTS! • Philippe Pinel: Used more humane approaches to treating patients in France. • Dorothea Dix: Brought these humane ideas about mental healthcare to the U.S. • Deinstitutionalization of the mid-20th century: • Advent of Drug Therapies allowed people to be more functional in the real world. • Rosenhan Study (1973): institutionalization not necessarily effective! • Brief Film Clip tracing the history of understanding mental illness

6. Biological model (Medical) Underlying cause (etiology) of mental disorders is biological Medication or medical therapies are used as treatments Learning model Abnormal behaviors are learned the same way as normal ones, through conditioning, reinforcements, imitation, etc. and are not considered symptoms of some underlying disease – the behaviors themselves are the problem. Treatments consist of retraining and reconditioning Psychodynamic Model Abnormal behaviors represent unconscious motives and conflicts Psychoanalysis is used as treatment Humanistic-Existential Model Abnormal behaviors result from failure to fulfill one’s self-potential; and faulty self-image Client-centered and Gestalt therapies are used to increase self acceptance. Cognitive Model Faulty or negative thinking can cause depression or anxiety. Focus of treatment is on changing faulty/irrational thinking Diathesis-Stress model Biological predisposition to disorder which is triggered by stress Systems theory (biopsychosocial model) Model in which biological, psychological, and social risk factors combine to produce psychological disorders Models of the Causes of Psychological Disorders

7. Classifying Psychological Disorders • Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association • Describes more than 300 specific mental disorders and is used by most professionals • DSM: First edition published in 1952 • DSM-II: Revised in 1968 to reflect changing culture • DSM-III: Revised in 1977 to describe mental disorders in greater detail • DSM-III-R: clarified and updated DSM-III • DSM-IV: Published in 1994 with revisions • DSM-IV-TR: Released in 2000, text revision • DSM 5- Release date May 2013 • Criticisms • Disorders classified as diseases • Many of the symptoms have nothing to do with mental illness • Stereotypes and expectations based on labels can be damaging

8. The Prevalence of Psychological Disorders • One in four adults−approximately 61.5million Americans−experiences mental illness in a given year. One in 17−about 13.6 million−live with a serious mental illness such as schizophrenia, major depression or bipolar disorder.1 • Approximately 20 percent of youth ages 13 to 18 experience severe mental disorders in a given year. For ages 8 to 15, the estimate is 13 percent.2 • Approximately 1.1 percent of American • In 2005, 26.2 % of the U.S. population 18 and over had experienced a mental disorder in the last year • 6% suffered “serious” mental disorder • According to 2004 census, that is over 50 million people • Most common disorders were anxiety, phobias, and mood disorders

9. Anxiety Disorders

10. Anxiety Disorders Defining Anxiety: Anxiety is a general feeling of fear and apprehension that may be related to an object or event and is often accompanied by increased physiological arousal.

11. Causes of Anxiety Disorders • Conditioning • For example, phobias can be learned through classical conditioning • Feelings of not being in control can lead to anxiety • Predisposition to anxiety disorders may be inherited (genetic) • Displacement or repression of unacceptable thoughts or impulses can lead to anxiety

12. Types of Anxiety Disorders:1. Generalized Anxiety Disorder • Prolonged vague but intense fears not attached to any particular object or circumstance • Often results from Free-Floating Anxiety – anxiety not attached to any particular event or object • Difficult to treat

13. Types of Anxiety Disorders: 2. Panic Disorder • Recurrent panic attacks in which the person experiences intense terror without cause • Person is often left with fear of having another panic attack • Can lead to agoraphobia

14. Types of Anxiety Disorders: 3. Phobic Disorders • Intense fear of specific situations or objects • Agoraphobia • Intense fear of crowds and public places or other situations that require separation from source of security, such as the home • Social Anxiety Disorder • Excessive fear of social situations • Fear of scrutiny of others • Specific Phobia • Common phobias include animals, heights, closed places, needles

15. Obsessive Compulsive Disorder • Driven to disturbing thoughts (obsessions) and/or performing senseless rituals (compulsions) • Individual recognizes behavior is excessive but cannot stop without experiencing anxiety. • “Washers” and “Checkers” • Touching Hoarding is now a separate diagnosis

16. Post-Traumatic Stress Disorder • Psychologically distressing experience (direct, witnessed, indirect) continues to plague individual after the fact and causes anxiety. • Could result from either personally experiencing or witnessing a life-threatening situation • Often linked with combat or rape

17. Psychosomatic and Somatoform Disorders

18. Somatoform Disorders • Somatoform Disorders • Physical symptoms without any physical cause • Person experiences symptoms as real • Contrast with Psychosomatic Disorders… • Real physical illness with psychological causes such as stress or anxiety • Tension headaches, for example • Research indicates that most, if not all, illnesses may have a psychosomatic component

19. Causes of Somatoform Disorders • Freud • Symptoms related to traumatic experience in the past • Cognitive-behavioral • Examines ways in which the behavior is being rewarded, either tangibly or mentally • Biological perspective • May be real physical illnesses that are misdiagnosed or overlooked

20. Types of Somatoform Disorders • Somatization Disorder– vague, recurrent physical symptoms; plentiful and unrelated and unresponsive to medical treatment (back pain, dizziness, stomach pains, etc.) • Conversion Disorder – sudden but temporary loss of physical functions triggered by psychological factors. • La belle indifference – apathy over loss of functioning. • Glove anesthesia – lack of feeling in hand only – neurologically impossible. • Hysterical blindness • Hypochondriasis – without physical evidence, individual believes they have a serious illness • Body Dysmorphic Disorder – preoccupation with a minor physical anomaly to the point of dysfunction.

21. Dissociative Disorders

22. Dissociative Disorders • Disorders in which conscious awareness becomes separated from previous memories, thoughts and feelings. • Dissociative disorders are characterized by a sudden but temporary alteration in consciousness, identity, sensory/motor behavior, or memory. • These disorders are relatively rare, but quite noticeable.

23. Causes of Dissociative Disorders • Seems to involve unconscious processes • Memory impairments may also include biological factors such as normal aging and Alzheimer’s disease • Dissociation is common with use of some drugs such as LSD • Trauma is often involved

24. Dissociative Disorders • Dissociative amnesia • Loss of memory without a physical cause (Freudian Rep?) • Dissociative fugue • Flight from home and adoption of a new identity and amnesia for past events (Asnel Bourne) • Depersonalization disorder • Person suddenly feels strangely changed or different; “outside self” • Dissociative identity disorder • Person has several distinct personalities that emerge at different times • Previously called multiple personality disorder

25. Sexual Disorders

26. Sexual Disorders • Include a range of sexual problems typically divided into two categories • sexual dysfunctions • sexual desiredisorders, known as paraphilias. • Difficult to diagnose! • Sexuality is a private thing • Difficult to label acts as “abnormal” or “normal” • Kinsey’s research? • Additionally, must people be diagnosed for desire or for acts or both? (Cannibal Case- Ex-NY Cop) • Key factor in definition of sexual disorders: it causes the individual stress and anxiety. This is a sign that something is wrong, no matter how acceptable or unacceptable the desire or behavior may be to the rest of society.

27. Sexual Dysfunction • Sexual dysfunctions involve an impairment of “normal” sexual functioning. • This can refer to an inability to perform or reach an orgasm, painful sexual intercourse, a strong repulsion of sexual activity, or an exaggerated sexual response cycle or sexual interest.  • A medical cause must be ruled out prior to making any sexual dysfunction diagnosis and the symptoms must be hindering the person's everyday functioning.

28. Sexual Dysfunction • Erectile disorder • Inability of a man to achieve or maintain an erection • Female sexual interest/arousal disorder • Inability of a woman to become sexually aroused or reach orgasm • Sexual aversion disorders • Lack of sexual interest or active distaste for sex • Orgasmic disorders • Inability to reach orgasm in a person who has sexual desire and can maintain arousal • Premature ejaculation • Male’s inability to inhibit orgasm as long as desired • Vaginismus • Involuntary muscle spasms in the outer part of the vagina making intercourse impossible

29. Sexual Dysfunction

30. Paraphilias • Paraphilias all have in common distressing and repetitive sexual fantasies, urges, or behaviors.  • Must occur for a significant period of time • Must interfere with either satisfactory sexual relations or everyday functioning if the diagnosis of Paraphilic Disorder to be made. • There is also a sense of distress within these individuals • Typically recognize the symptoms as negatively impacting their life • Feel as if they are unable to control the symptoms

31. Paraphilias • Fetishism • Non-human object is preferred method of sexual excitement • Voyeurism • Desire to watch others having sex or undressing • Exhibitionism • Compulsion to expose one’s genitals to achieve sexual arousal • Frotteurism • Touching or rubbing against a non-consenting person in public • Transvestic fetishism • Wearing clothing of the opposite sex to achieve sexual arousal • Sexual sadism • Obtain sexual gratification by humiliating or physically harming a sex partner • Sexual masochism • Inability to enjoy sex without physical or emotional pain • Pedophilic Disorder • Preferred desire to have sex with children

32. Gender Dysphoria • Involves a desire to become, or insistence that one really is, a member of the other sex • Usually begins in childhood • Most develop normal gender identity in adulthood • Gender correction surgery is an option for adults who have this disorder • Causes are not known

33. Mood Disorders

34. Mood disorders are characterized by ongoing, dysfunctional emotional patterns Mood disorders are also referred to as affective disorders An affect is another word for an emotion Mood disorders come in two general categories, depressive disorders and bipolar disorders Mood Disorders

35. Causes of Mood Disorders • Biological factors • Twin studies suggest genetic factors play a role • Mood disorders may be linked to chemical imbalances in the brain • Psychological factors • Cognitive distortions: Maladaptive response to early negative life events that leads to feelings of incompetence and unworthiness • These responses are reactivated whenever a new situation arises that resembles the original events • Social factors • Depression is linked to troubled close relationships • May explain greater incidence of depression in women, who tend to be more relationship-oriented • Depressed people can evoke anxiety and hostility in others, who then withdraw, which in turn can intensify feelings of depression

36. Treatment of Mood Disorders • In most cases, mood disorders are treated with a combination of drug therapy and talk therapy. • In some extreme cases when these methods do not work, ECT has been effective. • used rarely – if all other treatments fail • Use if person is a serious harm to themselves or others • Not as heinous as depicted in films • Many more women are diagnosed with mood disorders than men- Why? • Psychologists have been researching both biological and cultural causes for this.

37. Depression • General Symptoms: • Overwhelming feelings of sadness • Lack of interest in activities • Excessive guilt or feelings of worthlessness • Types: • Major depressive disorder • Intense symptoms that may last for several months • Dysthymic Disorder • Less intense, but may last for periods of two years or more • Seasonal Affective Disorder (SAD) • symptoms of depression triggered by weather patterns (melatonin hypersensitivity) • PPD (Postpartum depression) • Depression with onset within 4 weeks of childbirth

38. Bipolar Disorder • Characterized by alternating between depression and mania • Manic-Depressive Disorder (Kelsey and Chase) • Periods of normal mood may come between bouts of depression and mania • Symptoms of Mania include • Feelings of euphoria • Extreme physical activity • Excessive talkativeness • Grandiosity • Mania rarely occurs alone – it is typically part of manic-depressive disorder • Much less common than depression • Stronger biological component than depression • Cyclothemia – less intense mood swings

39. Personality Disorders

40. Personality Disorders • Disorders in which maladaptive ways of thinking and behaving learned early in life cause distress in the person and/or conflicts with others • Axis II in DSM • Rate among prisoners is close to 50% • They are often easy to identify in others, but difficult to treat • Personality disorders are grouped by the DSM into three groups or clusters

41. Types of Personality Disorders: TheThree Clusters • Cluster A: Odd or Eccentric Behavior • Paranoid • Very suspicious of others • Schizoid • Withdrawn and lacks feelings for others • Do not want or seek social relationships

42. Types of Personality Disorders: TheThree Clusters • Cluster B: Dramatic or Erratic Behavior • Histrionic(Hysterical) • Attention-hungry • “drama-queen” • Narcissistic • exaggerated sense of self-importance • Antisocial - Ted Bundy • Violates social norms • Enjoys harming others • Conduct Disorder • Borderline • Unpredictable, impulsive and sometimes destructive behavior • Chaotic relationships

43. Types of Personality Disorders: TheThree Clusters • Cluster C: Anxious or Inhibited Behavior • Avoidant • Fearful of social interactions • Wants relationships, but feels inferior  • Dependent • Uncomfortable being alone • Uncomfortable making decisions   • Obsessive-Compulsive • Obsessed with order, lists, organizing • Need for control over all aspects of life 

44. Spotlight: Causes of Antisocial Personality Disorder • Combination of biological predisposition, adverse psychological experiences, and an unhealthy social environment • Also possible link to damaged frontal lobe during infancy • Emotional deprivation during childhood may lead to antisocial tendencies I enjoy long walks on the beach, soft music, oh, and killing people.

45. Schizophrenia

46. Schizophrenic Disorders • Schizophrenia is the most debilitating and complex of all the psychological disorders. • Diverse symptoms; one common denominator: psychoticism • Being psychotic means that the individual is suffering from a break with reality that inhibits their ability to function. • Additionally, there is ongoing evidence of deteriorating social and intellectual functioning. • The diagnosis must be made before age 45 and symptoms must persist for at least 6 months. • One of: hallucination, delusion, disorganized speech for classification • The Schizophrenic Experience

47. Schizophrenic Disorders • Most cases of schizophrenia are treated with antipsychotic medication (dopamine ant.) • Neuroleptics, Antipsychotics • When these medications first were introduced, they only treated some of the symptoms of the disorder • Tardive dyskinesia in long-term patients • Medications used now better treat both the positive and negative symptoms of the disease. • Positive symptoms are symptoms people with schizophrenia experience, but normal people do not • Hallucinations, delusions, disorganized thought, movements • Negative symptoms are behaviors that occur normally, but do not in schizophrenics • Flat affect, minimal speech

48. Schizophrenic Disorders: Symptoms • Symptoms have further been categorized by the effect they have on functioning: disturbances of thought, perception, and emotions • Thought Disturbances • Delusions - False beliefs about reality • Language Disturbances (Word Salad- Unintelligible speech or language) • Clang – rhyming speech pattern (The run sun done the gun; don't drink drown down, brown gown." ) • Neologism – making up new words (Watch out for the flagoports) • Loose Association – words don’t hold together; language does not make sense ("I need to go to the store to buy some band-aids. I read an article about how expensive AIDS drugs are. People take too many street drugs. The streets should be clean from the rain today, etc" ) • Echolalia – repeating words over and over (also seen in autism) • Perceptual Disturbances  • Hallucinations - Sensory experiences without external stimulation • Emotional Disturbances • Flat Affect – having no emotion • Ambivalent Affect – having erratic emotional responses

49. Causes of Schizophrenia • Biological predisposition to schizophrenia may be inherited • Twin studies show genetic link • Excessive levels of dopamine lead to psychotic symptoms (hence, dopamine antagonists) • Abnormalities of brain structures (enlarged, fluid-filled ventricles) • Abnormal patterns of connections between brain cells • May involve family relationships and social class

50. Childhood Disorders