PSYCHOLOGICAL DISORDERS

1. PSYCHOLOGICAL DISORDERS Psychological Disorders Psychological Disorders No known society is free of two terrible maladies: Depression Schizophrenia Psychological Disorder – deviant, distressful, and dysfunctional behavior patterns Deviant = different from others • “To study the abnormal is the best way of understanding the normal.” • William James (1842-1910) • World Health Organization (2008) estimates 450 million people worldwide suffer from mental or behavioral disorders

2. PSYCHOLOGICAL DISORDERS Defining Psychological Disorders Defining Psychological Disorders After 1973, the APA no longer viewed homosexuality as an illness However… The stigma and stresses associated with being homosexual increase the risk of mental health problems (Meyer, 2003) • Standards for deviant behavior vary by context and culture • Mass killing of people • Talking with the dead • From 1952 to 1973, homosexuality was classified as an illness by the American Psychiatric Association

3. PSYCHOLOGICAL DISORDERS Defining Psychological Disorders Defining Psychological Disorders To be considered disordered: Deviant behavior usually causes the person distress When behaviors are judged as “harmful dysfunction” Interferes with work or leisure When behaviors become disabling Dysfunction is the key descriptor for a disorder • Attention-deficit hyperactivity disorder (ADHD) – a psychological disorder marked by the appearance by age 7 of one or more of three key symptoms: • Extreme inattention • Hyperactivity • Impulsivity

4. PSYCHOLOGICAL DISORDERS Understanding Psychological Disorders Understanding Psychological Disorders Medical model – the concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and, in most cases, cured, often through treatment in a hospital • Yesterday’s Therapy: • “devil made him do it” • Beatings, burning, castration • Trephination (drilling holes in skull to release evil) • Pulling teeth • Removing lengths of intestines • Etc.

5. PSYCHOLOGICAL DISORDERS Understanding Psychological Disorders Understanding Psychological Disorders Support for medical model: Genetically influenced abnormalities in brain structure and biochemistry contribute to many disorders Eating disorders are primarily phenomena of Western cultures Depression and Schizophrenia occur worldwide • Philippe Pinel (1745-1826) – reformer who insisted that madness is NOT demon possession, but a sickness of the mind caused by severe stresses and inhumane conditions • Supported “moral treatment” such as gentleness, activity, clean air and sunshine, and boosting morale

6. PSYCHOLOGICAL DISORDERS Classifying Psychological Disorders Classifying Psychological Disorders DSM-IV-TR – the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, with an updated “text revision”; a widely used system for classifying psychological disorders • Schizophrenia characteristics • Talks incoherently • Hallucinates or has delusions (bizarre beliefs) • Shows little emotion or inappropriate emotion • Socially withdrawn

7. PSYCHOLOGICAL DISORDERS Classifying Psychological Disorders Labeling Psychological Disorders How are psychological disorders diagnosed? Critics claim that as the number of disorder categories has grown, so too has the number of adults who meet that criteria – more and more disordered people • ICD-10 – International Classification of Diseases • Covers both mental and psychological disorders • Using the DSM-IV-TR • Clinicians answer a series of objective questions about observable behaviors • This process makes diagnosis very reliable and replicable

8. PSYCHOLOGICAL DISORDERS Labeling Psychological Disorders Labeling Psychological Disorders Labels matter When we attach a label to a person, we perceive them as being different Labels such as gifted, hostile, and extraverted encourage us to look for those traits Mental disorders seldom lead to violence Media portrays disorders to the extremes • Critics more fundamental claim is that labels are arbitrary and are value judgments pretending to be science • Rosenhan study (1977) • 8 healthy people intentionally claimed of “hearing voices” • They proceeded to answer all questions truthfully • All 8 normal people were misdiagnosed with disorders

9. PSYCHOLOGICAL DISORDERS Labeling Psychological Disorders Labeling Psychological Disorders When should we – and should we not – hold people accountable for their actions? Insanity Defense in today’s U.S. Court System • Benefits of labels include: • Communication about cases • Comprehension of underlying causes • Discernment of effective treatment • John Hinckley, Jeffrey Dahmer, Kip Kinkel, and Andrea Yates • Each either killed or attempted to kill others, and were imprisoned rather than hospitalized

10. PSYCHOLOGICAL DISORDERS Anxiety Disorders Anxiety Disorders Generalized Anxiety Disorder Panic Disorder Phobias Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder • Anxiety Disorders– psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety

11. PSYCHOLOGICAL DISORDERS Anxiety Disorders Anxiety Disorders Panic Disorder – an anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person terror and accompanying chest pain, choking, or other frightening sensations 1 in 75 with disorder experience panic attacks Smokers have double the risk due to stimulant nicotine • Generalized Anxiety Disorder – an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal • 2/3 of cases are women • Person cannot identify cause • May lead to ulcers and high blood pressure • Rare for those age 50+

12. PSYCHOLOGICAL DISORDERS Anxiety Disorders Anxiety Disorders Social phobia is shyness taken to the extreme Agoraphobia is fear or avoidance of situations in which escape might be difficult or help unavailable when panic strikes Those who experience panic attacks learn to fear “fear itself” • Phobia – an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object or situation • A strong fear becomes a phobia if it provokes a compelling but irrational desire to avoid the dreaded object or situation

13. PSYCHOLOGICAL DISORDERS Anxiety Disorders Anxiety Disorders OCD is more common among teens and young adults Obsessions and compulsions tend to lessen as one gets older • Obsessive-Compulsive Disorder – an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions) • Behaviors cross the line from normal to OCD when they persistently interfere with everyday living and cause the person distress

14. PSYCHOLOGICAL DISORDERS Anxiety Disorders Anxiety Disorders Common Compulsions (repetitive behaviors) Excessive hand washing, bathing, tooth brushing, or grooming Repeating rituals (in/out of a door, up/down from a chair) Checking doors, locks, appliances, car brakes, homework • Common Obsessions (repetitive thoughts) • Concern with dirt, germs, toxins • Something terrible happening (fire, death, illness) • Symmetry, order, or exactness

15. PSYCHOLOGICAL DISORDERS Anxiety Disorders Anxiety Disorders Approximately 19% of Vietnam War veterans experienced PTSD About same % for Iraq War veterans The greater one’s emotional distress during trauma, the higher the risk for PTSD • Post-Traumatic Stress Disorder (PTSD) – an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience • Once called “shell shock” or “battle fatigue”

16. PSYCHOLOGICAL DISORDERS Anxiety Disorders Anxiety Disorders Twice as many women as men develop PTSD Holocaust survivors “What doesn’t kill you may make you stronger.” Altruism born of suffering Greater than usual sensitivity to suffering and empathy for others who suffer, an increased sense of responsibility, and an enlarged capacity for caring • Sensitive limbic system continues to flood body with stress hormones over and over again in PTSD • Symptoms of PTSD may be genetically predisposed • “Debriefing” survivors immediately after a trauma in an attempt to get them to relive it and vent tends to be ineffective and harmful

17. PSYCHOLOGICAL DISORDERS Anxiety Disorders Understanding Anxiety Disorders 2 Perspectives: Learning Perspective Biological Perspective Learning Perspective Link between conditioned fear and general anxiety keeps people hyperattentive to possible threats Generalization – when a person attacked by a dog comes to fear all dogs • Post-Traumatic Growth – positive psychological changes as a result of struggling with extremely challenging circumstances and life crises • Idea that out of our worst experiences some good can come • Cancer patient may develop increased appreciation for life, more meaningful relationships, etc.

18. PSYCHOLOGICAL DISORDERS Understanding Anxiety Disorders Understanding Anxiety Disorders Biological Perspective Natural Selection Biological preparedness to fear threats faced by our ancestors Easy to condition fear, but difficult to extinguish • Learning (cont’d) • Reinforcement – helps maintain our phobias and compulsions after they arise • Observational Learning • We learn some fears by observing others • Parents transmit their fears to their children • Monkeys transmit fear of snakes to other monkeys

19. PSYCHOLOGICAL DISORDERS Understanding Anxiety Disorders Understanding Anxiety Disorders Brain Anterior Cingulate Cortex – brain region that monitors our actions and checks for errors Hyperactive region in someone with OCD Fear circuits within the amygdala may be a result of fear-learning experiences A sharp increase in anxiety levels of both children and college students in last 50 years may be more the result of fraying social support accompanying family break-up • Genes • Identical twins may develop similar phobias even when raised separately • Genes influence disorders by regulating neurotransmitters • Serotonin – influences sleep and mood • Glutamate – too much of this results in brain’s alarm centers to become overactive

20. PSYCHOLOGICAL DISORDERS Somatoform Disorders Somatoform Disorders Hypochondriasis – a somatoform disorder in which a person interprets normal physical sensations as symptoms of a disease A stomach cramp or a headache is interpreted as some dreaded disease People suffering from this tend to move from doctor to doctor as there is nothing serious wrong with them • Somatoform Disorders – psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause • Conversion Disorder – a rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found

21. PSYCHOLOGICAL DISORDERS Dissociative Disorder Dissociative Disorder Dissociation is not so rare; sometimes we may say “I was not myself at the time” Facing trauma, detachment may protect us from overwhelming emotions In D.I.D. the original personality typically denies any awareness of the others • Dissociative Disorders – disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings • Dissociative Identity Disorder – a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Formerly called multiple personality disorder.

22. PSYCHOLOGICAL DISORDERS Understanding Dissociative Identity Disorder Understanding Dissociative Identity Disorder In other cultures D.I.D. is explained as being “possessed” by an alien spirit D.I.D. is rare in Britain, where they call it a “wacky American fad” In India & Japan it is virtually nonexistent • In D.I.D.: • Each person has own voice and mannerisms • Person is usually not violent • Nicholas Spanos questions existence of D.I.D.: • From 1930-1960, # of diagnoses was 2/decade • In 1980s with new DSM classification the # grew to 20,000+

23. PSYCHOLOGICAL DISORDERS Understanding Dissociative Identity Disorder Understanding Dissociative Identity Disorder Two Possibilities: D.I.D. is a result of desperate efforts of the traumatized to detach from a horrific existence D.I.D. is contrived by fantasy-prone, emotionally vulnerable people, and constructed out of therapist-patient interaction • There is evidence that handedness sometimes switches with personality in D.I.D. patient • D.I.D. patients exhibit heightened brain activity in areas associated with control and inhibition of traumatic memories

24. PSYCHOLOGICAL DISORDERS Mood Disorders Mood Disorders Major Depressive Disorder – a mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities • Mood Disorders – psychological disorders characterized by emotional extremes • Major Depressive Disorder • Prolonged hopelessness and lethargy • Bipolar Disorder (formerly manic depressive disorder) • Person alternates between depression and mania

25. PSYCHOLOGICAL DISORDERS Mood Disorders Mood Disorders Prolonged adolescent mood swings produce a bipolar diagnosis Mania may cause the person to take more risks A racing mind arouses an upbeat mood Those who rely on emotional expression and vivid imagery are more prone: composers, artists, poets, novelists, entertainers It afflicts men and women equally • Mania – a mood disorder marked by a hyperactive, wildly optimistic state • Bipolar Disorder (formerly Manic-Depressive Disorder) – a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania

26. PSYCHOLOGICAL DISORDERS Understanding Mood Disorders Understanding Mood Disorders Most major depressive episodes self-terminate Professional help is good, but episodes will end on their own Half of those who recover will suffer another episode within 2 years Stressful events related to work, marriage, and close relationships often precede depression Not usually caused by 1 event • Many behavioral and cognitive changes accompany depression • Inactive; feel unmotivated • More sensitive to negative things, recall negative info, expect negative outcomes • Depression is widespread • Women are twice as likely as men to suffer major depression • Gap begins in adolescence • Men’s disorders are more external; women’s internal • Women get more sad; men get more mad

27. PSYCHOLOGICAL DISORDERS Understanding Mood Disorders Biological Perspective Risk of major depression and bipolar disorder increases if you have a parent or sibling with the disorder One estimate is the heritability of major depression is 35-40% Linkage Analysis – when geneticists examine DNA from affected and unaffected family members, looking for differences Many genes probably work together to cause depression • Depression striking earlier and affecting more people with each new generation • Onset now is early as the late teens • Most parents of don’t recognize depression in their children

28. PSYCHOLOGICAL DISORDERS Depressed Brain Depressed Brain Drugs that relieve depression Increase Norepinephrine or Serotonin by blocking reuptake Slows their chemical breakdown Left Frontal Lobe Active during positive emotions Inactive during depressed states Hippocampus Memory-processing center Vulnerable to stress-related damage • Neurotransmitters influence depressed and manic states • Norepinephrine • Increases arousal & boosts mood • Scarce during depression and abundant during mania • Drugs that alleviate mania reduce norepinephrine • Serotonin • Scarce during depression • Increases with physical exercise • Stimulates hippocampus neuron growth

29. PSYCHOLOGICAL DISORDERS Social-Cognitive Perspective Social-Cognitive Perspective Explanatory Style – who or what a person blames for their failures Internal vs External Depressed people see negative events as: Stable – going to last forever Global – going to affect everything Internal – it’s all my fault Depressed people: Often exhibit a pessimistic thinking style Optimistic people tend to find more social support • Self-defeating beliefs and negative explanatory style feed depression’s vicious cycle • Learned helplessness may be cause of self-defeating beliefs • Comes after experiencing uncontrollable painful events • Women more often than men: • Tend to overthink or ruminate • Tend to feel “frequently overwhelmed by all they do” • Are twice as vulnerable to depression during early teenage years

30. PSYCHOLOGICAL DISORDERS Social-Cognitive Perspective Social-Cognitive Perspective The Depression Cycle 1. negative stressful events interpreted through 2. a ruminating, pessimistic explanatory style create 3. a hopeless, depressed state that 4. hampers the way the person thinks and acts. This in turn, fuels (back to 1.) negative experiences such as rejection • Depression is common: • Among individualist cultures • Less commitment to religion • Less commitment to family • Self-blame over personal failure • Depression is a vicious cycle: • “Depressed persons induced hostility, depression, and anxiety in others, and got rejected.” • High risk for divorce, job loss, and other stressful life events

31. PSYCHOLOGICAL DISORDERS Social-Cognitive Perspective Social-Cognitive Perspective When we feel down, we think negatively and remember bad experiences Mood-congruent memories We can break the cycle by: Moving to a different environment Reversing self-blame Turning attention outward Engaging in more pleasant activities • Depression related to sports: • Many fans see a team’s performance as an extension of themselves • After a loss, fans offer bleaker assessments about their own performance on various tasks

32. PSYCHOLOGICAL DISORDERS Schizophrenia Schizophrenia Schizophrenia is a split from reality Delusions = false beliefs such as “I’m Mary Poppins” Paranoid = prone to delusions of persecution Part of schizophrenia is a breakdown in selective attention There is NO filter – it ALL comes in • Nearly 1 in 100 people will suffer schizophrenia • Schizophrenia – a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions; literally means “split mind”

33. PSYCHOLOGICAL DISORDERS Schizophrenia Schizophrenia Inappropriate Emotions and Actions Laughing during a typically sad moment Flat effect – emotionless state Catatonia – being motionless for sometimes hours followed by agitation Social relations are difficult to maintain • Hallucinations – sensory experiences without sensory stimulation • Seeing, feeling, hearing, tasting, or smelling things • Most common is hearing voices that aren’t there

34. PSYCHOLOGICAL DISORDERS Schizophrenia Schizophrenia Positive Symptoms Presence of inappropriate behaviors Hallucinations, disorganized and delusional talk, inappropriate laughter, tears, or rage Negative Symptoms Absence of appropriate behaviors Toneless voices, expressionless faces, mute or rigid bodies • Disorder typically strikes young people maturing into adulthood • Men are affected earlier, more severely, and more often • Sometimes develops suddenly and appears as a response to stress • Sometimes develops gradually from a long history of social inadequacy

35. PSYCHOLOGICAL DISORDERS Schizophrenia Schizophrenia Catatonic Immobility (or excessive, purposeless movement), extreme negativism, and/or parrotlike repeating of another’s speech or movements Undifferentiated Many and varied symptoms Residual Withdrawal, after hallucinations and delusions have disappeared • Subtypes of Schizophrenia • Paranoid • Preoccupation with delusions or hallucinations, often with themes of persecution or grandiosity • Disorganized • Disorganized speech or behavior, or flat or inappropriate emotion

36. PSYCHOLOGICAL DISORDERS Schizophrenia Understanding Schizophrenia “About 60% of schizophrenia patients smoke, often heavily. Nicotine apparently stimulates certain brain receptors, which helps focus attention.” Javitt & Coyle, 2004 • Chronic/Process Schizophrenia • Slow-developing • Recovery is doubtful • Acute/Reactive Schizophrenia • When a well-adjusted person develops schizophrenia rapidly following stress • Recovery is much more likely

37. PSYCHOLOGICAL DISORDERS Understanding Schizophrenia Understanding Schizophrenia Frontal lobes Critical for reasoning, planning, and problem solving During hallucinations Core regions of brain such as thalamus and amygdala are very active Thalamus – sensory switchboard Amygdala – fear-processing center • “Mad as a hatter” • Gets its meaning from British hat makers whose brains were slowly poisoned as they moistened the brims of mercury-laden felt hats with their lips • Dopamine over activity • May intensify brain signals • Impaired glutamate activity • Leads to schizophrenic symptoms

38. PSYCHOLOGICAL DISORDERS Understanding Schizophrenia Understanding Schizophrenia Identical twins are 5x more likely than fraternal twins to “share” schizophrenia 98% of women who get flu during 2nd trimester do NOT pass on schizophrenia Twins who share a placenta are likely to share the same viruses • Brain abnormalities may be caused by: • Mishap during prenatal development or delivery • Low birth weight • Oxygen deprivation during delivery • Viral infection during mid-pregnancy fetal brain development

39. PSYCHOLOGICAL DISORDERS Understanding Schizophrenia Understanding Schizophrenia There is some tendency to socially withdraw and behave oddly prior to the onset of the disorder • Adopted children have an elevated risk only if a biological parent is diagnosed with Schizophrenia • No environmental causes alone are known to produce schizophrenia in someone who isn’t already related to a person with schizophrenia

40. PSYCHOLOGICAL DISORDERS Understanding Schizophrenia Understanding Schizophrenia Warning signs (cont’d): Disruptive or withdrawn behavior Emotional unpredictability Poor peer relations and solo play • Warnings signs of schizophrenia: • A mother whose schizophrenia was severe and long lasting • Birth complications, often involving oxygen deprivation and low birth weight • Separation from parents • Short attention span and poor muscle coordination

41. PSYCHOLOGICAL DISORDERS Personality Disorders Personality Disorders 2. Schizoid – eccentric behaviors; emotionless disengagement 3. Histrionic – dramatic or impulsive behaviors; attention getting 4. Narcissistic – self-focused and self-inflating • Personality Disorders – psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning • Avoidant – withdrawal; fearful sensitivity to rejection

42. PSYCHOLOGICAL DISORDERS Personality Disorders Personality Disorders Antisocial Personality Disorder Person has been called a sociopath or psychopath Lack of conscience is visible prior to age 15 Express little regret over violating others’ rights Show no concern for family members and friends • Antisocial Personality Disorder – a personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. May be aggressive and ruthless or a clever con artist.

43. PSYCHOLOGICAL DISORDERS Personality Disorders Personality Disorders Early signs include: Impulsivity Uninhibited Unconcerned with social rewards Low in anxiety These signs could lead in a good or bad direction • Antisocial (cont’d) • Those with biological relatives with antisocial and unemotional tendencies are more at risk • Stress hormones such as adrenaline display relatively low arousal • Early signs of disorder appear in children as young as 3-6 years old

44. PSYCHOLOGICAL DISORDERS Personality Disorders Personality Disorders Other evidence indicates childhood maltreatment and a gene that altered neurotransmitter balance predicted antisocial problems • Antisocial murderers have reduced activity in their frontal lobes • 1787 – Britain exiled 160,000 of their criminals to Australia • Their offspring managed to establish an orderly society

45. PSYCHOLOGICAL DISORDERS Rates of Psychological Disorders Rates of Psychological Disorders Symptoms of Disorder (and age of onset): A.P.D. (8-10) Alcohol dependency, OCD, bipolar, schizophrenia (20) Major depression (25) 18 U.S. Presidents have suffered from some sort of psychological disorder • Highest estimates of diagnosable mental disorders lies in the U.S. • At any given time, approximately 26% of us may have a “mental disorder” • Who is most vulnerable? • Those in poverty • Those in early adulthood