Psychological Disorders

1. Psychological Disorders Chapter 13

2. What is Abnormal? • Abnormal - literally meanss “away from the normal” so Einstein was “abnormal.” • Society: Abnormal behavior must be defined within the context of the society. • A practial definition: Behavior is abnormal when it causes the individual or those around him discomfort, distress, or danger.

3. A Brief History • Primitive peoples - saw aabnormal behavior as a sign that the person was possessed by demons or spirits • Golden age of Greece - Hippocrates and others viewed mental illness as a “natural” phenomenon like other illness • Middle ages - a return to belief in possession and demonology. Knowledge was kept alive in the Islamic countries.

4. Phillipe Pinel - In 1793 was made head of La Bicetre hospital in Paris and began a trend toward humane treatment • Dorothea Dix - In the U. S. during the 1800s fought for the rights of the mentally ill • A medical discovery - by 1900 it was discovered that “general paresis” (which included severe mental deterioration) was caused by syphilis (a physical disease). This gave rise to the “biological model” of mental illness

5. Approaches to Psychological Disorders • biological model: Disorders have a biochemical or physiological basis. • psychoanalytic model: Disorders result from unconscious internal conflicts. • cognitive-behavioral model: Disorders result from learning maladaptive ways of thinking and behaving.

6. Approaches to Psychological Disorders • diathesis-stress model: A “diathesis” is a genetic or other biological predisposition or vulnerability. Under stress, a person may develop a disorder to which he/she is predisposed. • systems approach: Biological, psychological, and social risk factors combine to produce disorders. Also known as the “Biopsychosocial” model

7. Classifying Psychological Disorders • Diagnostic & Statistic Manual of Mental Disorders (4th edition) “DSM IV” Published by the AmericanPsychiatricAssociation • It is the most widely used classification system of psychological disorders. • It is a listing of disorders, their symptoms, and statistical data (e.g., gender, age, differences) • It does NOT specify treatments and does NOT list causes of disorders

8. Prevalence and Incidence • Prevalence - refers to how common a disorder is. For example, schizophrenia is rare (1% of the population) while depression is more common at about 3-4% • Incidence - refers to the rate at which new cases occur. If the yearly incidence rate for depression is 1%, then there would be one new case for every hundred people in the population this year.

9. Basic Diagnostic Categories of DSM-IV

10. Basic Diagnostic Categories of DSM-IV

11. Mood Disorders (affective disorders) • Disorders in which one’s range of affect (mood) is restricted (as in depression) or expanded (as in bipolar disorder). • Major Depression • Dysthymia • Bipolar Disorder (formerly manic depression) • Cyclothymia

12. Depression • more than just a case of “the blues” • overwhelming feelings of sadness • lack of interest in activities and inability to experience pleasure • excessive guilt or feelings of worthlessness • changes in sleep, appetite, ability to concentrate • possible suicidal thoughts or actions

13. Major Depression • very severe • symptoms must be present for two weeks • person may be unable to function normally and may need hospitalization Dysthymia • less severe but “chronic”or long lasting • symptoms must be present for two years • person can usually function but leads a very unhappy, painful, unfulfilling existence

14. Bipolar Disorder • Person experiences alternating episodes of depression and mania “mood swings” • a manic state involves excess energy, racing thoughts, pressured speech, grandiosity, impulsive behavior, poor judgement Cyclothymia • a less severe form of bipolar disorder

15. Causes of Mood Disorders • biological factors • genetics - mood disorders are more common in close relatives, esp. bipolar disorder • brain chemistry changes as a result of experience (e.g., stress or illness) • psychological (cognitive) factors • cognitive distortions such as (1) all or none thinking (2) inaccurate maladaptive beliefs • social factors/stressors • real or perceived loss or stress in various areas

16. Suicide • myth - people who talk about it never do it • fact - most people will give clues about their plans • fact - more women attempt but more men complete, men use more lethal methods • fact - people thinking of suicide will often give away possessions and “put their affairs in order” • fact - suicide is becoming more common among teens and children

17. Gender, Race, & Suicide

18. Anxiety Disorders Disorders in which anxiety is a characteristic feature OR the avoidance of anxiety seems to motivate abnormal behavior. • phobias • panic disorder • generalized anxiety disorder • obsessive-compulsive disorder

19. Phobic Disorders • phobia: (from the Greek “phobos”) which means fear • The person feels intense fear when confronted with the phobic object or situation. This may lead to a “panic attack.” • The phobic person avoids the phobic object or situation. Some may endure it but with great anxiety and discomfort.

20. Types of Phobias • specific phobia: fear of a particular object or situation, common examples • insects, animals, blood/injury, heights, enclosed spaces, thunder, water, germs • social phobia: excessive, inappropriate fears connected with social situations or performances in front of other people • agoraphobia: fear of multiple situations, is almost always a consequence of “panic disorder”

21. Panic Disorder • panic attack: is a sudden, unpredictable, and overwhelming experience of intense fear or terror without reasonable cause. • Hallmark symptoms: fear of dying, losing control, or going crazy, depersonalization, and derealization (things seeming weird) • other symptoms: chest pain, increased heartbeat, dizziness, choking sensations, intense headache, tingling in arms or legs, terror of being left alone

22. agoraphobia: fear and avoidance of places (1) in which help would not be available if needed and (2) from which escape would be difficult or embarassing • typical situations: public transportation, large stores/malls, interstates, bridges, elevators, wilderness, theatres, sports arenas, concerts, • panic disorder with agoraphobia: often, especially in women, panic attacks lead to fear and avoidance of places/situations in which panic attacks occurred

23. Generalized Anxiety Disorder • anxiety disorder characterized by prolonged vague fears that are not attached to any particular object or circumstance • “chronic”: long term, almost a part of the person’s personality • symptoms: sleep problems, muscle aches, digestive problems, headaches, inability to relax, constant worry, difficulty in concentration, headaches, etc.

24. Obsessive-Compulsive Disorder (OCD) • The person is plagued by “obsessions” and/or “compulsions” • obsessions: unwanted intrusive thoughts, obsessions often involve fear of making mistakes which might cause harm. Contamination and guilt are also common themes • compulsions: behaviors/rituals that reduce anxiety caused by obsessions, classic compulsions are checking, and washing

25. Posttraumatic Stress Disorder (PTSD) • Results from a “traumatic” event that is “outside the normal range of human experience” • Typical experiences are military combat, police action, natural disaster, accidents, and being a crime victim.

26. Symptoms of PTSD • re-experiencing of the trauma through • intrusive thoughts, dreams, and “flashbacks” • avoidance of “trauma-related” stimuli • the person is made anxious by, and avoids, reminders of the trauma • exaggerated startle and hypervigilence • other symptoms and associated problems: • tension, sleep problems, depression, social withdrawal, explosiveness, suspiciousness of others, substance abuse

27. Causes of Anxiety Disorders • heredity: anxiety disorders do tend to run in families (esp. OCD) • stress: triggers anxiety in predisposed people, the primary cause of PTSD • learning: fears can be acquired via classical/operant conditioning or modeling • “biological preparedness hypothesis” (Martin Seligman) We are prepared to become phobic of certain things as a result of our evolutionary history

28. Psychosomatic Disorder(Psychophysiological Disorder) • Disorders in which there is REAL physical illness that is largely caused by psychological factors such as stress and anxiety. • Examples are hypertension, headaches, bruxism (teeth grinding), insomnia, ulcers, digestive problems, etc.

29. Somatoform Disorders There is an APPARENT physical illness for which no organic (physical) basis can be found • somatization disorder • conversion disorder • hypochondriasis • body dysmorphic disorder

30. Somatization Disorder • A somatoform disorder characterized by recurrent vague physical complaints with no apparent physical cause • Typical are bachaches, headaches, dizziness, stomach pains, chest pains • It is important to distinguish this from “malingering” or faking in which the person is “acting” sick to gain something

31. Conversion Disorder • complaints of a dramatic specific disability with no apparent physical cause (e.g., paralysis, blindness, deafness) Classic Conversion Phenomena • glove anasthesia: paralysis or numbness of the hand that does not conform to anatomy • la belle indifference: “beautiful indifference” the person’s level of concern not consistent with the severity of the ailment

32. Hypochondriasis • The person interprets insignificant symptoms as signs of serious illness • A series of headaches might convince the person he/she has a brain tumor • Again, there is no organic evidence of such illness. • Patients may “doctor shop” searching for one who will confirm their suspicions

33. Body Dysmorphic Disorder • a recent phenomenon found in developed western cultures • the person becomes preoccupied with his or her imagined ugliness, usually of a particular body part • plastic surgery is often sought • probably has a lot to do with society’s obsession with beauty and appearance

34. Causes of Somatoform Disorders • Causes are less well understood than for depression or anxiety • Often “secondary gain” is a major cause • By being sick, the person may unconsciously avoid work, child care, or other responsibilities

35. Dissociative Disorders Disorders in which some part of the personality seems separated from the rest. These are relatively rare. • dissociative amnesia • dissociative fugue • dissociative identity disorder • depersonalization disorder

36. Dissociative Amnesia • There is a loss of memory for past events (days, weeks, or years) without organic cause. • Dissociative amnesia may result from an intolerable or painful experience such as physical or sexual abuse.

37. Dissociative Fugue • “fugue”: literally means to take flight • a person suddenly leaves home and assumes a new identity, with amnesia for past identity and events. • The person may emerge from the fugue weeks or months later in a strange city not knowing how he/she got there

38. Dissociative Identity Disorder • formerly called “multiple personality disorder” (MPD) or “split personality” • a person has several distinct personalities that emerge at different times. • a history of physical or sexual abuse in childhood is common • borderline personality and eating disorders often co-occur • this isNOT the same as schizophrenia

39. Depersonalization Disorder • A dissociative disorder whose main feature is that the person suddenly feels strange or different. • Some describe it as an “out of body” experience. • Because depersonalization is also a symptom of panic disorder (which is much more common), that disorder should be ruled out before making this diagnosis.

40. Causes of Dissociative Disorders • The most widely accepted cause is that the person has experiences one or more traumatic experiences that they cannot bear to think about. • By separating the personality into “parts,” the traumatic memories can be avoided. • General psychological instability may also be a factor

41. Sexual Disorders DSM-IV classifies sexual disorders under two major divisions: • sexual dysfunctions: loss or impairment in some aspect of the normal human sexual response • paraphilias: Sexual disorders in which unconventional objects or situations become the focus of sexual interest

42. Sexual Dysfunctions Some sexual dysfunctions are physical but most have a psychological basis • erectile disorder: The inability of a man to achieve or maintain an erection. • female sexual arousal disorder: The inability of a woman to become sexually aroused.

43. Sexual Dysfunctions • sexual desire disorders: Disorders in which the person lacks sexual interest or has an active distaste for sex. • sexual arousal disorder: Inability to achieve or sustain arousal until the end of intercourse in a person who is capable of experiencing sexual desire.

44. Sexual Dysfunctions • orgasmic disorders: Inability to reach orgasm in a person able to experience sexual desire and maintain arousal. • premature ejaculation: In ability of a man to inhibit orgasm as long as desired. • vaginismus: Involuntary muscle spasms in the outer part of the vagina that make intercourse impossible.

45. Paraphilias Paraphillias are primarily a “male” phenomenon. Classical and operant “conditioning” likely play a role. • fetishism: A paraphilia in which a nonhuman object is the preferred or exclusive method of achieving sexual excitement.

46. voyeurism: Desire to watch others having sexual relations or to spy on nude people. • exhibitionism: Compulsion to expose one’s genitals in public to achieve sexual arousal. • frotteurism: Compulsion to achieve sexual arousal by touching or rubbing against a non-consenting person in public situations.

47. transvestic fetishism: Wearing the clothes of the opposite sex to achieve sexual gratification. (don’t confuse with trans-sexualism) • sexual sadism: Obtaining sexual gratification from humiliating or inflicting physical pain on a sex partner. • sexual masochism: Obtaining sexual gratification from being humiliated or receiveing physical pain from a sex partner.

48. pedophilia: “pre-pubescent” children are the focus of sexual fantasy or actual sexual activity • While this remains a “fantasy” it is a psychological disorder. When the person acts on the desire, it also becomes a criminal activity. • most pedophiles have great difficulty fighting their desires

49. Gender-Identity Disorder • a strong belief that one is really a member of the opposite biological sex (i.e., a woman trapped in a man’s body). • many seek an operation to change their gender which is granted only after extensive counseling therapy (most are happy with the change) • These individuals are NOT transvestites nor are they homosexuals

50. Personality Disorders • Disorders in which inflexible and maladaptive ways of thinking and behaving learned early in life cause distress to the person and/or conflicts with others. • As you might expect a person’s basic way of relating to the world is very difficult to modify