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Psychological Disorders. Definition, diagnosis and treatment. What constitutes a disorder?. Behavior is ___________ Behavior is ___________ Behavior is ___________. Understanding psychological disorders through the ages. Ancient Greece: imbalance of the “four humours”

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Psychological disorders l.jpg

Psychological Disorders

Definition, diagnosis and treatment


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What constitutes a disorder?

  • Behavior is ___________

  • Behavior is ___________

  • Behavior is ___________


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Understanding psychological disorders through the ages

  • Ancient Greece: imbalance of the “four humours”

  • Dark ages-Middle ages: devil or witchcraft

  • 18th century: medical (biological) model of disease

  • 20th century: biopsychosocial model of psychological disorders


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Classification of disorders

  • DSM-IV-TR - diagnostic manuals used by clinicians

    • Symptoms

    • Labels

    • Prognoses

    • Sample cases

    • Statistics


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Anxiety disorders

  • Characterized by feelings of excessive apprehension and anxiety

    • Generalized anxiety disorder

    • Phobic disorders

    • Panic disorder

    • Obsessive-compulsive disorder

    • Post-traumatic stress disorder


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Generalized Anxiety disorder

  • Symptoms

    -

    -

    -

  • Prevalence

  • Treatment


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Phobic disorders

  • Persistent and irrational fears

    • Social phobias

    • Specific phobias

      • Acrophobia, claustrophobia, hemophobia, pyrophobia, triskadekaphobia, ophidiophobia, astraphobia, nyctophobia, aichmophobia, coulrophobia, trichophobia…


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Treatment for phobias

  • Exposure

    • Systematic Desensitization

    • Flooding

    • Imaginal vs. In Vivo

  • Classical Conditioning Rationale

  • Anxiety hierarchy

    • Subjective Units of Distress (SUDS)

  • Response prevention

    • Safety Cues


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Panic disorder

  • Panic attacks

    • Symptoms

    • Not:

    • May result in agoraphobia


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Treatment for Panic Disorder

  • Exposure is still used, but this time the cue for the fear is _________________.

    • Hypervigilance

  • Exposure Techniques:

  • Breathing Retraining and Muscle Relaxation


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Obsessive-Compulsive disorder

  • Persistent obsessions and compulsions

    • Obsession =

    • Compulsion =


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Treating OCD

  • Exposure with Ritual Prevention

    • Operational conditioning of fear through avoidance

    • Self Monitoring

    • Block compulsion responses to anxiety

  • Cognitive Restructuring

    • Catastrophic Thinking

  • Psychopharmacology

    • Clomipramine (anafranil). Fluoxetine (prozac), Fluvoxamine (luvox)


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Post-Traumatic Stress disorder

  • Result of severe trauma and emotional distress.

    • Symptoms

    • Lasting 4+ weeks

  • Relies on (lack of) emotional resilience


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Treating PTSD

  • Prolonged Exposure

    • Expose to memories and cues related to trauma

    • Imaginal: recite memories in first person repeatedly until SUDS go down.

    • In vivo: spend time in similar environments that create anxiety related to the trauma


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Treatment for anxiety disorders

  • Biological

    • Antianxiety drugs

    • Antidepressant drugs

    • D-Cycloserine

  • Cognitive

    • Cognitive-behavior therapy

  • Behavioral

    • Exposure therapy

    • Systematic desensitization


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Mood disorders

  • Disorders characterized by emotional extremes

    • Major depressive disorder

    • Bipolar disorder


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Major Depressive disorder

  • Overwhelming sadness, hopelessness and loss of interest

    • Symptoms

      • Emotional

      • Cognitive

      • Motivational

      • Somatic

    • Symptoms last 2+ weeks

    • Prevalence


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Treating Depression

  • Albert Ellis – Cognitive Therapy

    • Confronting Irrational Thinking

  • Beck – Cognitive Behavioral Therapy

    • Socratic Dialogue

    • Thought Records

      • Event – Feelings – Cognitions – Other interpretations

    • Cognitive Restructuring

    • Collaborative Empiricism

      • Behavioral Homework Assignments

      • Scheduling Activities (Mastery, Pleasure, Tests)

  • Jacobson – Behavioral Activation

    • Increase opportunities for reinforcement


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Bipolar disorder

  • Characterized by wide swings between two emotional extremes

    • Mania

    • Depression

  • Cyclic switching between moods

  • Treatment – Lithium and behavioral therapies


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Treatment for mood disorders

  • Biological

    • Antidepressants (depression)

    • Mood stabilizers (bipolar)

    • Electroconvulsive therapy (depression)

    • Deep-brain stimulation (depression)

    • Transcranial magnetic stimulation (depression)

  • Psychotherapy

    • Cognitive-behavioral therapy

    • Psychodynamic/Interpersonal therapy


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Personality disorders

  • Maladaptive behaviors which impair social functioning

    • Antisocial personality disorder

    • Borderline personality disorder


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Antisocial personality disorder

  • Marked by a lack of conscience and malicious behavior patterns

    • Symptoms

    • Prevalence

      • Low in ______________ population,

        high in _______________ populations


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Antisocial personality disorder

  • Associated with reduced cortical volume and activation of the frontal cortex

  • Also associated with low levels of stress hormones and arousal


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Borderline personality disorder

  • Unstable personality, mood, identity and behavior

    • Symptoms

      • Emotional instability

      • Impulsivity

      • Unstable identity

      • Fear of abandonment

      • Paranoid ideation

    • Prevalence

      • 3:1 Females:Males


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Treating BPD

  • Linehan - Dialectical Behavior Therapy

    • Individual Therapy

      • Acceptance-Change dialectic

    • Group Skills Training

      • Emotion Regulation

      • Distress Tolerance

      • Interpersonal Effectiveness

      • Mindfulness

    • Therapist Consult Team

    • 24 Hour Phone Consultation


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Schizophrenia

  • Split from reality

    • Disorganization of thought, perceptions, emotions and behaviors

    • Prevalence


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Schizophrenia

  • Symptoms

    • Positive

      • Thought disorder

      • Hallucinations

      • Delusions

    • Negative

      • Flat affect

      • Lack of motivation

      • Decline in communication and interaction


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Schizophrenia

  • Dopamine hypothesis - excess of DA causes positive symptoms

  • Prenatal factors

    • Virus

    • Stress

  • Environmental or developmental factor influences onset


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Treatment for Schizophrenia

  • Biological

    • Antipsychotic drugs

      • Reduce dopamine

      • Long-term consequences

  • Behavioral

    • Operant conditioning

      • Token economy


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