Psychological Disorders

Psychological Disorders K. T. Hinkle Chapter 15

Diagnostic and Statistical Manual • Axis I: Primary clinical problem • Axis II: Personality disorders • Axis III: General medical conditions • Axis IV: Social and environmental stressors • Axis V: Global assessment of overall functioning

DSM-IV Example Diagnosis • Axis I 296.23 Major Depression Disorder, Single Episode, Severe Without Psychotic Features 305 Alcohol Abuse • Axis II 301.6 Dependent Personality Disorder • Axis III none • Axis IV Threat of job loss • Axis V GAF=35 (current)

DSM-IV Example Diagnosis • Axis I 312.82 Conduct Disorder, Adolescent-Onset Type 305.20 Cannabis Abused V62.3 Academic Problem • Axis II 317 Mild Mental Retardation • Axis III 345.00 Epilepsy, petit mal • Axis IV Problems related to interaction with the legal system • Axis V GAF=55 (on admission) GAF=65 (at discharge)

Explosion of Mental Disorders • Supporters of new categories answer that is important to distinguish disorders precisely. • Critics point to an economic reason: diagnoses are needed for insurance reasons so therapists will be compensated.

What Is Abnormal? • Defining mental disorders • Several questions can help determine what behavior is abnormal: • Is the behavior considered strange within the person’s own culture? • Does the behavior cause personal distress? • Is the behavior maladaptive? • Is the person a danger to self of others? • Is the person legally responsible for his or her acts?

What Is Abnormal? • Prevalence of psychological disorders • Mental disorders have a lifetime prevalence rate of nearly 50% • Mental disorders represent a significant source of personal misery for individuals and lost productivity for society • Explaining psychological disorders • Biological perspective • Views abnormal behavior as arising from a physical cause, such as genetic inheritance, biochemical abnormalities or imbalances, structural abnormalities within the brain, and/or infections

What Is Abnormal? • Explaining psychological disorders (continued) • Biopsychosocial perspective • Agrees that physical causes are of central importance but also recognizes the influence of biological, psychological, and social factors in the study, identification, and treatment of psychological disorders • Psychodynamic perspective • Originally proposed by Freud • Maintains that psychological disorders stem from early childhood experiences and unresolved, unconscious conflicts, usually of a sexual or aggressive nature

What Is Abnormal? • Explaining psychological disorders (continued) • Learning perspective • Psychological disorders are thought to be learned and sustained in the same way as any other behavior • Cognitive perspective • Suggests that faulty thinking or distorted perceptions can contribute to some types of psychological disorders

Anxiety Disorders • Generalized anxiety disorder • An anxiety disorder in which people experience excessive anxiety or worry that they find difficult to control • This disorder affects twice as many women as men and leads to considerable distress and impairment • Panic disorder • An anxiety disorder in which a person experiences recurrent unpredictable attacks of overwhelming anxiety, fear, or terror • Panic attacks • An attack of overwhelming anxiety, fear, or terror

Anxiety Disorders • Phobias • An intense fear of being in a situation from which immediate escape is not possible or in which help is not immediately available in case of incapacitating anxiety • Agoraphobia • An agoraphobic often will not leave home unless accompanied by a friend or family member and, in severe cases, not even then • Women are four times more likely than men to be diagnosed with agoraphobia

Anxiety Disorders • Phobias (continued) • Social phobia • An irrational fear and avoidance of social situations in which one might embarrass or humiliate oneself by appearing clumsy, foolish, or incompetent • Specific phobia • A marked fear of a specific object or situation • A person has three times the risk of developing a phobia if a close relative suffers from one

Anxiety Disorders • Obsessive compulsive disorder (OCD) • An anxiety disorder in which a person suffers from obsessions and/or compulsions • Obsessions • A persistent, recurring, involuntary thought, image, or impulse that invades consciousness and causes great distress • Compulsion • A persistent, irresistible, irrational urge to perform an act or ritual repeatedly

Mood Disorders • Disorders characterized by extreme and unwarranted disturbances in feeling or mood • Depressive disorders • Major depressive disorder • A mood disorder marked by feelings of great sadness, despair, guilt, worthlessness, and hopelessness

Mood Disorders • Bipolar disorder • A mood disorder in which manic episodes alternate with periods of depression, usually with relatively normal periods in between • Manic episode • A period of extreme elation, euphoria, and hyperactivity, often accompanied by delusions of grandeur and by hostility if activity is blocked • Bipolar disorder is much less common than major depressive disorder

Mood Disorders • Causes of mood disorders • Biological factors such as genetic inheritance and abnormal brain chemistry play a major role in bipolar disorder and major depressive disorder • In one twin study, researchers found that 50% of the identical twins of bipolar sufferers had also been diagnosed with a mood disorder, compared to only 7% of fraternal twins

Mood Disorders • Suicide and race, gender, and age • Whites are more likely to commit suicide than African Americans • Native American suicide rates are similar to those of whites; rates for Hispanic Americans are similar to those of African Americans • Suicide rates are far lower for both white and African American women than for men • Older Americans are at far greater risk for suicide than younger people

Schizophrenia • A severe psychological disorder characterized by loss of contact with reality, hallucinations, delusions, inappropriate or flat affect, some disturbance in thinking, social withdrawal, and/or other bizarre behavior • Positive symptoms of schizophrenia • Positive symptoms are the abnormal behaviors that are present in people with schizophrenia • Hallucinations • A sensory perception in the absence of any external sensory stimulus; an imaginary sensation

Schizophrenia • Delusions • A false belief, not generally shared by others in the culture, that cannot be changed despite strong evidence to the contrary • Delusions of grandeur • A false belief that one is a famous person or a person who has some great knowledge, ability, or authority • Delusions of persecution • A false belief that a person or group is trying in some way to harm one

Schizophrenia • Types of schizophrenia • Paranoid schizophrenia • A type of schizophrenia characterized by delusions of grandeur or persecution • Paranoid schizophrenics often show exaggerated anger and suspiciousness • Disorganized schizophrenia • The most serious type of schizophrenia, marked by inappropriate affect, silliness, laughter, grotesque mannerisms, and bizarre behavior • Tends to occur at an earlier age than the other types

Schizophrenia • Types of schizophrenia (continued) • Catatonic schizophrenia • A type of schizophrenia characterized by complete stillness or stupor and/or periods of great agitation and excitement; patients may assume an unusual posture and remain in it for long periods • Undifferentiated Schizophrenia • A term for people who display symptoms of schizophrenia but who do not fit into other categories

Schizophrenia • Risk factors in schizophrenia • Schizophrenia develops when there is both a genetic predisposition toward the disorder and more stress than a person can handle • Schizophrenia is more likely to strike men than women • The earlier age of onset of the disorder among males appears to be independent of culture and socioeconomic variables

Somatoform and Dissociative Disorders • Somatoform disorders • Disorders in which physical symptoms are present that are due to psychological rather than physical causes • Hypochondriasis • A somatoform disorder in which persons are preoccupied with their health and convinced they have some serious disorder despite reassurance from doctors to the contrary • Conversion disorder • A somatoform disorder in which a person suffers a loss of motor or sensory functioning in some part of the body (blind, deaf, or unable to speak)

Somatoform and Dissociative Disorders • Dissociative disorders • A disorder in which, under stress, one loses the integration of consciousness, identity, and memories of important personal events • Dissociative amnesia • A dissociative disorder in which there is a loss of memory of limited periods in one’s life or of one’s entire identity

Somatoform and Dissociative Disorders • Dissociative disorders (continued) • Dissociative fugue • A dissociative disorder in which one has a complete loss of memory of one’s entire identity, travels away from home, and may assume a new identity • Dissociative identity disorder (DID) • A dissociative disorder in which two or more distinct personalities occur in the same person, each taking over at different times; also called multiple personality

Somatoform and Dissociative Disorders • Dissociative disorders (continued) • Dissociative identity disorder (continued) • The alternate personalities may differ radically in intelligence, speech, accent, vocabulary, posture, body language, hairstyle, taste in clothes, manners, and even handwriting and sexual orientation • There is the common complaint of “lost time”—periods for which a given personality has no memory because he or she was not in control of the body

Other Psychological Disorders • Sexual disorders • Disorders that are destructive, guilt- or anxiety-producing, compulsive, or that cause discomfort or harm to one or both parties involved • Perhaps the most common of all of the sexual disorders are the sexual dysfunctions • Drug treatment for sexual dysfunctions in both men and women have proven successful

Other Psychological Disorders • Sexual disorders (continued) • Paraphilias • Disorders in which recurrent sexual urges, fantasies, and behaviors involve nonhuman objects, children, other nonconsenting persons, or the suffering or humiliation of the individual or his/her partner • Gender Identity Disorders • Disorders characterized by a problem accepting one’s identity as male or female • An individual may feel so strongly that she or he is psychologically of the other gender that sex-reassignment surgery is sought

Other Psychological Disorders • Personality disorders • A continuing, inflexible, maladaptive pattern of inner experience and behavior that causes great distress or impaired functioning and differs significantly from the patterns expected in the person’s culture • Characteristics of personality disorders • People who suffer from other disorders, especially the mood disorders, are often diagnosed with personality disorders as well • People with personality disorders are extremely difficult to get along with

Psychological Disorders