Psychological Disorders: Anxiety, Phobias, and OCD

1. The Psychological Disorders • What is abnormal • Refers to maladaptive cognitions, affects, and or behaviors that are at odds with social expectations and result in distress or discomfort • Abnormal means not of the norm or not average • Michael Jordan • Einstein

2. Abnormal • The reactions of people with psychological disorders are maladaptive • They must be impaired somehow • Not just strange • May present itself in various ways • Affect • Behavior • Cognition • Social factors are also important • Behavior at a party vs. school • Distressing • Psychological disorders are uncomfortable for those that have one as well as those around them

3. Diagnostic Statistical Manual of Mental Disorders (DSM) • A way to classify and diagnose mental disorders. • Lists 297 different diagnostic categories • Does not attempt to address the causes of mental disorders • It is an attempt to be as objective as possible in describing the symptoms of mental disorders

4. Anxiety Disorders, Somatoform Disorders, and Dissociative Disorders

5. Anxiety Disorders • Definition of anxiety • A feeling of general apprehension or dread accompanied by predictable physiological changes • Two levels • Subjective feelings • Dread • Fear • Physiological responses • Increased muscle tension • Shallow rapid breathing • Cessation of digestion • Increased perspiration • Drying of the mouth

6. Anxiety Disorders • Major symptom of anxiety • Feeling of anxiety coupled with avoidance behavior • Attempt to avoid situations that seems to produce anxiety • Most common of all the psychological disorders • Perhaps as many as 25% of people will experience an anxiety disorder at some time in their lives. • Two to three times more common in women

7. Five anxiety disorders • 1) Generalized anxiety disorder (GAD) • Distressing felt anxiety • Unrealistic, excessive, persistent worry • Chronic • An intense anxiety that is diffuse • Not brought on by anything specific • No clear insight to what is causing the anxiety

8. 2) Panic Disorder • 1.5-3.5% of the population • More acute than GAD • Recurrent, unpredictable, unprovoked onset of sudden, intense anxiety. • Can last from seconds to hours • No particular stimulus to bring it on • Age of onset is adolescence to mid twenties • Initial attacks are often associated with stress • Loss of an important relationship • Often accompanied with depression • High rate of suicide attempts – 20 %

9. 3) Phobic Disorders • A persistent and excessive fear of some object, activity, or situation that consistently leads a person to avoid it. • No real or significant threat involved • The fear is unreasonable • Two main categories of phobic disorders • Specific Phobias • Animals • Physical environment – storms, heights • Blood, injection, or injury • Specific situations – tunnels, airplanes • Social phobias • Persistent fears of social or performance situations in which embarrassment could occur • Public speaking

10. 4) Obsessive-Compulsive Disorder (OCD) • A pattern of recurrent obsessions and compulsions • Obsessions • Ideas or thoughts that involuntarily and constantly intrude into awareness • Cleanliness, violence, disease, danger, doubt • Did I turn off the stove? • Compulsions • Constantly intruding, repetitive behaviors • Handwashing, grooming, counting, and checking • Checking your alarm repeatedly to make sure it is set

11. 5) Posttraumatic Stress Disorder (PTSD) • Distressing symptoms that arise some time after the experience of a highly traumatic event • Trauma as defined by the DSM-IV • The person has experienced, witnessed, or been confronted with an event that involves actual or threatened death or serious injury • The person’s response involves intense fear, helplessness, or horror.

12. Symptoms of PTSD • Re-experiencing the traumatic event • Flashbacks • Nightmares • Avoidance of any possible reminders of the event • People who were there • Increased arousal or alertness • Irritability • Insomnia • Difficulty concentrating

13. Somatoform Disorders • Disorders that involve some physical, bodily complaint • Psychological disorders • No known medical or biological cause for the symptoms. • Three types • Hypochondriasis • Somatization disorder • Conversion disorder

14. Hypochondriasis and Somatization Disorders • A person diagnosed with hypochondriasis is preoccupied with the fear of a serious disease • Fear of a nonexistent disease • A person with somatization disorder is preoccupied with nonexistent symptoms • Really the two disorders are quite similar

15. Conversion Disorder • Loss or altering of physical function that suggests that there is some physical problem • Paralysis – often times of just the hand • Glove anesthesia • Blindness • Deafness • This was Freud’s Hysteria • Diagnosed much more often in Freud’s time • Why?

16. Dissociative Disorders • To dissociate means to become separate or escape • Dissociative amnesia • Inability to recall important personal information • Beyond simple forgetfulness • Often times it involves forgetting some traumatic event • Somewhat controversial disorder • Like repressed memories

17. Dissociative Identity Disorder • Multiple personality disorder • Not schizophrenia – which we will talk about later • The existence within the same person of two or more distinct personalities. • Very rare • Most recorded cases are restricted to North America • Usually this disorder occurs in patients working closely with a therapist

18. Personality Disorders

19. Personality Disorders • These disorders represent stable abnormal personality characteristics that people are born with and are difficult to treat.

20. What is a Personality Disorder? • Personality disorder- an enduring pattern of inner experience and behavior that: • deviates markedly from the expectation of the individual’s culture • Is pervasive and inflexible • Has an onset in adolescence or early adulthood • Is stable over time • Leads to distress or impairment

21. What is Impaired? • To be diagnosed with a personality disorder, one must exhibit behavior that is abnormal with respect to any two of the following: • Thinking • Mood • Personal relations • The control of impulses

22. The DSM’s 3 Clusters of Personality Disorders • Cluster A - Odd or Eccentric • (paranoid, schizoid, schizotypal) • Cluster B- Dramatic, Emotional, or Erratic • (antisocial, borderline, histrionic, narcissistic) • Cluster C- Anxious or Fearful • (avoidant, dependent, obsessive-compulsive)

23. Cluster A Paranoid Schizoid Schizotypal

24. Paranoid • Distrust of others, including the belief, without reason, that others are exploiting, harming, or trying to deceive them • Belief in hidden meanings • Unforgiving and grudge holding

25. Schizoid • Very limited range of emotion, both in expression of and experiencing • Indifferent to social relationships • Prefer solitary interests

26. Schizotypal • Peculiarities of thinking • Odd beliefs (e.g.- belief that they have telepathic or magical powers) • Eccentricities of appearance, behavior, interpersonal style, and thought (e.g.- “I am not a very talkable person”) • Recurrent illusions

27. Cluster B Antisocial Borderline Histrionic Narcissistic

28. Antisocial • Lack of regard for the moral or legal standards in the local culture • Inability to get along with others or abide by societal rules • Sometimes called “psychopaths” or “sociopaths”

29. Borderline • Problems with self-identity • Rapid changes in mood • Intense unstable relationships • Impulsivity • Instability in affect and self-image

30. Histrionic • Overly dramatic and attention seeking • Exaggerated or inappropriate displays of emotional reactions, often to the point of being theatrical, in everyday behavior • Unusual clothing, hairstyle, or makeup used to draw attention to themselves • Overly concerned with their physical attractiveness and are uncomfortable when they are not the center of attention

31. Narcissistic • Behavior or a fantasy of grandiosity • Relationships are disturbed because of their lack of empathy and feelings of envy, arrogance, and taking advantage of others • A need to be admired by others • Inability to see the viewpoints of others • Hypersensitive to the opinions of others

32. Cluster C Avoidant Dependent Obsessive-Compulsive

33. Avoidant • Social inhibition • Feelings of inadequacy • Extremely sensitive to criticism

34. Dependent • Extreme need of other people, to a point where the person is unable to make any decisions or take an independent stand on their own • Fear of separation and submissive behavior • Lack self-confidence

35. Obsessive-Compulsive • Perfectionism • Inflexibility • Preoccupation with uncontrollable patterns of thought and action • Obsessive-compulsive personality disorder is NOT the same as obsessive-compulsive disorder • No actual obsessions or compulsions

36. Alzheimer’s Dementia, Mood Disorders, and Schizophrenia

37. Alzheimer's Disease • How many get it? • 15% of people over 65 • 35% over 85 • First signs? • Decline in cognitive ability • forgetfulness • Emotional instability • depression

38. Alzheimer’s • Eventually • Total dementia • Inability to perform even the most simple responses • swallowing • Terminal • Definitively diagnosed by autopsy • Amyloid plaques • clumps of degenerating neurons • an abnormal protein called amyloid • Neurofibrillary tangles • tangles of neurofibrils within neurons

40. Alzheimer's Disease • Loss of neurons is common • Plaques, tangles and neuron loss are often most common in areas involved in memory such as • Hippocampus • Amygdala • entorhinal cortex

42. Alzheimer’s Disease • Appears to be a clear genetic component • If immediate family member has Alzheimer’s • 50% chance if live into 80’s • Cholinergic neurons often die early in the course of Alzheimer’s disease • Cholinergic agonists are effective at reducing symptoms early in the disease

43. Mood Disorders • Used to be called affective disorders • Any disorder where a disturbance of the mood is the defining symptom • Symptoms and Etiology • All of us have experienced depression • people in whom depression is so severe and so frequent, often without obvious cause, are said to be suffering from the psychiatric disorder of depression

44. Depression is characterized by • Despair • Hypoactivity • sleep problems • Withdrawal • lack of appetite • an inability to care for oneself

45. Mania • The other type of affective disorder • in many respects it is the opposite of depression • patients with mania are overconfident, impulsive, distractible and highly energetic • Many people who suffer from depression also suffer from mania • bipolar disorder (1% of people) • unipolar disorder (6% of people) • depression only • About 10% of people suffering from a mood disorder will commit suicide

46. Concordance rate for bipolar disorder • identical twins about 60% • fraternal twins about 15% • thus, there is a strong genetic component • Stress can play a major role in the etiology of mood disorders • Stress can trigger attacks of depression • 84% of a large sample of patients seeking treatment for depression had experienced a severe stress in the preceding year

47. Antidepressant Drugs • monoamine oxidase (MAO) inhibitors • Tricyclic Antidepressants • block the reuptakeserotonin and norepinephrine as well as other monoamines • safer than MAO inhibitors • Selective serotonin reuptake inhibitors (SSRIs) • Prozac • a variation of tricyclic antidepressants • selectively block serotonin uptake. • have fewer side effects • effective against many types of psychological disorders • Recently, serotonin -norepinephrine reuptake inhibitors (SNRIs) have proven equally effective in the treatment of depression

48. Monoamine Theory of Depression • Most widely accepted theory of depression • All the drugs are serotonin and/or norepinephrine agonists • Increase the effectiveness of serotonin and norepinephrin • Depression due to underactivity at serotonin and norepinephrine synapses?

49. Diathesis-Stress Theory of Depression • Based on the idea that some people inherit a diathesis (genetic predisposition) for depression • if the individual is stressed early in life their systems become altered so that they are hypersensitive to stress for the rest of their lives. • This leads to the development of depression.

50. Schizophrenia • Symptoms and Etiology • schizophrenia literally means a splitting of psychic function (“the shattered mind”) • characterized by a complex and diverse set of symptoms