Myers’ PSYCHOLOGY (6th Ed--redone 7th). Chapter 16 Psychological Disorders James A. McCubbin, PhD Clemson University Worth Publishers.
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Myers’ PSYCHOLOGY (6th Ed--redone 7th) Chapter 16 Psychological Disorders James A. McCubbin, PhD Clemson University Worth Publishers
David Rosenhan suspected that terms such as sanity, insanity, schizophrenia, mental illness, and abnormal might have fuzzier boundaries than the psychiatric community thought. He also suspected that some strange behaviors seen in mental patients might originate in the abnormal atmosphere of the mental hospital, rather than the patients themselves. Education ･AB, Yeshiva College, 1951 ･MA, Columbia University, 1953 ･PhD (psychology), Columbia University, 1958 Professor, Stanford University
Dangers of Labeling David RosenhanBeing Sane in Insane Places In 1973 sociologist David Rosenhan designed a clever study to examine the difficulty that people have shedding the "mentally ill" label. He was particularly interested in how staffs in mental institutions process information about patients. • Rosenhan & seven associates had themselves committed to different mental hospitals complaining of hearing voices. All but one were diagnosed as schizophrenic. • Once admitted, they acted totally normal. • Remained hospitalized for average 19 days (9 to 52) • Only the patients detected their sanity • When discharged their chart read, “schizophrenia in remission” No professional staff member at any of the hospitals ever realized that any of Rosenhan’s pseudopatients was a fraud.
According to a study conducted by the National Institute of mental health: *15.4% of the population suffers from diagnosible mental health problems *56 million Americans meet the criteria for a diagnosible psychological disorder (Carson 1996, Regier 1993) *Over the lifespan, +/- 32% of Americans will suffer from some psychological disorder. (Regier1988)
Normal or Abnormal? Not easy task: *Is Robin Williams normal? Anna Nicole Smith? Marilyn Manson? Karl Rove? *Is a soldier who risks his life or her life in combat normal? *Is a grief-stricken woman unable to return to her routine three months after her husband died normal? Is a man who climbs mountains as a hobby normal?
Some abnormalities are easy: Hallucinations (false sensory experiences) Delusions (extreme disorders of thinking) Affective problems (emotion: depressed, anxious, or lack of emotion) CORE CONCEPT: Medical model: takes a “disease” view Psychology model: interaction of biological, mental, social, and behavioral factors
SHOW: Psych in Film, Ver.2, #33, Patch Adams
Psychological Disorder • a “harmful dysfunction” in which behavior is judged to be: • atypical- (not enough in itself) • disturbing- (varies with time & culture) • maladaptive- (harmful) • unjustifiable- (sometimes there’s a good reason)
Show THE WORLD OF AbNORMAL BEHAVIOR: #1 Looking at Abnormal Behavior #2 The Nature of Stress
Carol D. Ryff argues that we must define mental illness in terms of the positive. She names 6 core dimensions: Self-acceptance: positive attitude towards self multiple aspects of self positive about past life 2)Positive self relations with other people: warm, trusting, satisfying interpersonal relationships capable of empathy, affection, intimacy 3) Autonomy independent, self-determined able to resist social pressures
4) Environmental mastery: sense of mastery and competence makes good use of opportunities creates contexts that support their personal needs 5) Purpose of Life: has goals and directedness feels there is meaning to past and present life 6) Personal Growth: see oneself as growing and expanding open to new experiences change in ways that reflect self-knowledge and effectiveness
Historical Perspective Perceived Causes *movements of sun or moon *lunacy- full moon *demons & evil spirits Ancient Treatments *exorcism, caged like animals, beaten, burned, castrated, mutilated, blood replaced with animal’s blood
Historical Perspective Hippocrates (400 bc) *first step in scientific view of mental disturbance. *imbalance (excess) among four body fluids called “humors” • Humors Origin Temperament • Blood heart sanguine (cheerful) • Choler (yellow bile) liver choleric (angry) • Melancholer spleen melancholy(depressed)(black bile) • Phlegm brain phlegmatic (sluggish)
Psychological Disorders Medical Model *concept that diseases have physical causes *can be diagnosed, treated, and in most cases, 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
Biological (Evolution, individual genes, brain structures and chemistry) Psychological (Stress, trauma, learned helplessness, mood-related perceptions and memories) Sociocultural (Roles, expectations, definition of normality and disorder) Psychological Disorders Bio-psycho-social Perspective *assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders
Psychological Disorders- Etiology DSM-IV-TR *American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) *a widely used system for classifying psychological disorders *presently distributed as DSM-IV-TR (text revision) *today used as “convenient shorthand” to avoid labeling.
DSM-IV-TRorganizes each psychiatric diagnosis into five levels (axes) relating to different aspects of the disorder or disability: Axis 1 -- Clinical disorders including major mental disorders, as well as developmental or learning problems. Common disorders in this category include depression, bipolar, anxiety, ADHD, and schizophrenia. Axis 2 -- Pervasive or personality disorders, including mental retardation. Common disorders in this category include borderline PD, schizotypal PD, narcissistic PD, antisocial PD, paranoid PD.
DSM-IV-TRcontinued: 3) Axis 3 -- Acute medical conditions and physical disorders. Common disorders in this category include brain trauma, brain injury, brain disease.. 4) Axis 4 -- Psychosocial and environmental factors contributing to the disorder. Common factors in this category include a man suffering from depression after losing his job, or his wife dying, et. al. 5) Axis 5-- Global Assessment of Functioning or Children’s Global Assessment Scale (under 18)
Psychological Disorders- Etiology Neurotic disorder (term seldom used now) *usually distressing but that allows one to think rationally and function socially *Freud saw the neurotic disorders as ways of dealing with anxiety Psychotic disorder *person loses contact with reality *experiences irrational ideas and distorted perceptions
PREPAREDNESS HYPOTHESIS: Suggests that we have an innate biological tendency, acquired through natural selection, to respond quickly and automatically to stimulti that posed a survival threat to our ancestors. (Ohman & Mineka, 2001) This explains why we develop phobias for snakes and lightening more easily than others.
ANXIETY DISORDERS • MOOD DISORDERS • DISSOCIATIVE DISORDERS • SCHIZOPHRENIA • PERSONALITY DISORDERS • BIOPSYCHOSOCIAL DISORDERS • SUBSTANCE ABUSE DISORDERS • SEXUAL DISORDERS • DEVELOPMENTAL (CHILDHOOD) DISORDERS
PANIC DISORDER w/AGORAPHOBIA GENERALIZED ANXIETY DISORDER PHOBIAS a) simple b) social c) agoraphobia 4) OBSESSIVE-COMPULSIVE DISORDER (OCD) 5) POST TRAUMATIC STRESS DISORDER (PTSD) 6) SOMATOFORM a) hypochondria b) conversion (hysteria)
Anxiety Disorders Anxiety Disorders *distressing, persistent anxiety or maladaptive behaviors that reduce anxiety
Anxiety Disorders 1) Panic Disorder *marked by a minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking, racing heart, sweating, muscle-spasms, or other frightening sensations *common thinking patterns include: "I’m losing control.....” "I feel like I’m going crazy.....” "I must be having a heart attack.....” "I’m smothering and I can’t breathe.....” 1a) Panic Disorder w/Agoraphobia *fear of leaving home for fear of having a panic attack
2) Generalized Anxiety Disorder person is tense, apprehensive, and in a state of autonomic nervous system arousal *Chronic (6 months) unrealistic or excessive worry about 2 or more elements in one’s life.
SHOW: Psych in Film, Ver 2, #24, Apollo 13
3) Phobias a) Simple Excessive, irrational fear of objects or situations b) Social Persistent fear of scrutiny by others doing something humiliating (stage fright or speech phobia) c) Agoraphobia Fear of being in a place or situation with no escape. (childhood environments in which one did not feel safe)
Anxiety Disorders Phobias persistent, irrational fear of a specific object or situation Genophobia: sex Gynephobia: women Ichthyophobia: fish Lutraphobia: otters Macrophobia: long waits Medorthophobia: erect penis Parthenophobia: virgins Pophyrophobia: color purple Somniphobia: sleep Testophobia: taking a test Ablutophobia: washing, bathing Acrophobia: heights Algophobia: pain Arachibutyrophobia: peanut butter sticking to roof of mouth Caligynephobia: beautiful women Cleptophobia: stealing Demophobia: crowds Ecclesiophobia: church Ergophobia: work
100 90 80 70 60 50 40 30 20 10 0 Percentage of people surveyed Snakes Being in high, exposed places Mice Flying on an airplane Being closed in, in a small place Spiders and insects Thunder and lightning Being alone In a house at night Dogs Driving a car Being In a crowd of people Cats Afraid of it Bothers slightly Not at all afraid of it Anxiety Disorders Common and uncommon fears
Anxiety Disorders 4) Obsessive-Compulsive Disorder *unwanted repetitive thoughts (obsessions) and/or actions (compulsions) *feel obsessed w/something they do not want to think about and/or compelled to carry out some action, often pointlessly ritualistic. *1 in 50 adults has OCD *Exact pathophysiologic process that underlies OCD has not been established. *Research suggests that abnormalities in serotonin (5-HT) transmission in the central nervous system are central to this disorder. *Supported by the efficacy of specific serotonin reuptake inhibitors (SSRIs) in the treatment of OCD.
Common Obsessions and Compulsions Among People With Obsessive-Compulsive Disorder Thought or Behavior Percentage* Reporting Symptom Obsessions (repetitive thoughts) Concern with dirt, germs, or toxins 40 Something terrible happening (fire, death, illness) 40 Symmetry order, or exactness 24 Compulsions (repetitive behaviors) Excessive hand washing, bathing, tooth brushing, 85 or grooming Repeating rituals (in/out of a door, 51 up/down from a chair) Checking doors, locks, appliances, 46 car brake, homework Anxiety Disorders
Anxiety Disorders • PET Scan of brain of person with Obsessive/ Compulsive disorder • High metabolic activity (red) in frontal lobe areas involved with directing attention
Good examples of obsessions and their closely related compulsions: Obsession: A young woman is continuously terrified by the thought that cars might careen onto the sidewalk and run over her. Compulsion: She always walks as far from the street pavements as possible and wears red clothes so that she will be immediately visible to an out-of-control car. Obsession: A mother tormented by concern that she might inadvertently contaminate food as she cooks dinner. Compulsion: Every day she sterilizes all cooking utensils in boiling water and wears rubber gloves when handling food Obsession: A woman cannot rid herself of the thought that she might accidentally leave her gas stove turned on, causing her house to explode Compulsion: Every day she feels the irresistible urge to check the stove exactly 10 times before leaving for work.
5) Post Traumatic Stress Disorder (PTSD) Follows a psychologically distressing event that is outside the normal experience (rape, war, murder, beatings, torture, natural disasters) *1 in 12 adults in the U.S. suffer from PTSD *incessant reliving of event, recurring dreams, intrusive memories, flashbacks, intensive fears, sleep problems. *lasting biological effects: causes the brain’s hormone-regulating system to develop hair-trigger responsiveness Perpetration-induced traumatic stress (PITS) *soldiers who had killed in combat were found to suffer higher rates of PTSD than other troops *other studies include grief, survivor’s guilt, fear p341 Zim
6) Stockholm Syndrome Follows a psychologically distressing event that is outside the normal experience (rape, war, murder, beatings, torture, natural disasters) *captor threatens to kill and is able to do so *victim cannot escape or life depends on the captor *victim is isolated from outsiders *captor is perceived as showing some degree of kindness *victim denies anger at abuser & focuses on good qualities *”fight or flight” reactions are inhibited *victim fears interference by authorities--fears the captor will return from jail *victim is grateful to abuser for sparing her life Example of this disorder would be Francine Hughes (The Burning Bed) Francine set fire to her husband while he was asleep after years of repeated physical and mental abuse.
7) Somatoform Disorders Disorders, involving physical complaints for which no organic basis can be found. a) Hypochondria Fear of having serious disease where no evidence of illness can be found. b) Conversion (hysteria) Physical malfunction or loss of bodily control w/no underlying pathology but apparently related to psychological conflict.
TREATMENTS: *Medical model: antianxiety drugs (valium, librium, xanax) *Psychoanalysis: observational learning, childhood (mom/dad), free association, resistance (transference) *Learning Theories: classical conditioning, counterconditioning, systematic desensitization *Behaviorists: principles of learning, aversive conditioning, operant conditioning (token economy) *Cognitive Therapies: irrational interpretations *Humanistic: client-centered therapies, responsibility, active-listening.
MOOD DISORDERS (Affective Disorders)
DEPRESSIVE DISORDERS a) major depression b) dysthymia 2) BIPOLAR DISORDER a) mania b) major depression 3) SEASONAL AFFECTIVE DISORDER (SAD)
Mood Disorders Mood Disorders characterized by emotional extremes 1) Depressive Disorders *most common disorders” a mood disorder in which a person, for no apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities • a) Major Depressive Disorder • Unhappy for 2 weeks without reason, appetite changes, insomnia, inability to concentrate, worthlessness, hallucinations • b) Dysthymia • Unhappy for over 2 years
Aaron Beck is called the FATHER OF COGNITIVE THERAPY • He believed that: • depressed people draw illogical conclusions about themselves. • Created the BECK SCALES for labeling clinical depression. Aaron Temkin Beck (1921-?) Professor, Univ Pennsylvania PhD: Brown, Yale Beck believed that depressed people blame themselves for normal problems and consider every minor failure a catastrophe.
DRUG TREATMENTS for depression: *tricyclic antidepressants: *first to be used--not used as much today. *affect 2 neurotransmitters: norepinephrine & serotonin *side affects: drowsiness & weight gain, increased heart rate, decrease in blood pressure, blurred vision, dry mouth, confusion *SSRI (Selective Serotonin Reuptake Inhibitor) *side effects: nausea, diarrhea, tremors, weight loss, headache *less likely to affect the heart *some people feel more agitated and anxious on SSRIs, and can become increasingly suicidal if not detected and treated.
Mood Disorders 2) Bipolar Disorder *a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania *formerly called manic-depressive disorder a) Manic Episode a mood disorder marked by a hyperactive, wildly optimistic state, excessive excitement, silliness, poor judgment, abrasive, rapid flight of ideas b) Major depression Lethargic, sleepy, social withdrawal, irritability
Symptoms of Mania Mood or emotional symptoms: euphoric, expansive, and elevated. In some cases, dominant mood is irritability. Even when euphoric, manic people are close to tears and if frustrated, will burst out crying. Grandiose cognition: manics believe no limits to their abilities and do not recognize the painful consequences of trying to carry out their plans. May be delusional about themselves. Motivational symptoms: hyperactivity has intrusive, dominating, domineering quality. Some engage in compulsive gambling, reckless driving, or poor financial investment. Physical symptoms: lessened need for sleep. After a few days, exhaustion settles in. • Between .6 and 1.1 percent of U.S. population will have bipolar disorder in their lifetime. • It affects both sexes equally. • Onset is sudden. • First episode occurs between ages 20 and 30.
Depressed state Manic state Depressed state Mood Disorders-Bipolar PET scans show that brain energy consumption rises and falls with emotional swings
10% 8 6 4 2 0 Percentage depressed Females Males 12-17 18-24 25-34 35-44 45-54 55-64 65-74 75+ Age in Years Mood Disorders-Depression • Canadian depression rates
3) Seasonal Affective Disorder (SAD) Experience depression during certain times of the year *usually winter (less sunlight) *treated w/light therapy *Alaska (dark for months)
Aaron Beck’s work with depressed patients convinced him that depression is primarily a disorder of thinking rather than of mood. He argued that depression can best be described as a cognitive triad or negative thoughts about oneself, the situation or the future. Cognitive errors included the following: overgeneralizing: drawing global conclusions about worth, ability, or performance on basis of single fact Selective abstraction: focusing on one insignificant detail and ignoring others Personalization: incorrectly taking responsibility for events in the world Magnification & minimization: bad events magnified and good events minimized. Arbitrary inference: drawing conclusions without sufficient evidence Dichotomous thinking: seeing everything in one extreme or its opposite.