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Chapter 11 Psychological Disorders and Their Treatment
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  1. Chapter 11Psychological Disorders and Their Treatment

  2. Prevalence of Psychological Disorders • In a year in the U.S.: • 20% of persons experience psychological problems severe enough to adversely affect their daily living. • 40% of persons experience at least mild mental health problems. • About 2.1 million people are admitted to hospitals due to serious psychological problems. • Worldwide: • About 400 million people are afflicted with psychological disorders.

  3. How Should We Understand Psychological Disorders? • The medical model proposes that psychological disorders have a biological basis and can be classified into discrete categories and are analogous to physical diseases.

  4. How Should We Understand Psychological Disorders? • Although not agreeing that all mental health problems have a biological basis, mainstream psychology has adopted the medical model’s terminology. • Symptom: a sign of a disorder • Diagnosis: distinguishing one disorder from another • Etiology:a disorder’s apparent causes and developmental history • Prognosis:prediction about the likely course of a disorder

  5. DefiningPsychological Disorders • A pattern of atypical behavior • Results in personal distress or • Significant impairment in a person’s social or occupational functioning

  6. DefiningPsychological Disorders • Major criteria used to differentiate normal from disordered behavior: • Atypical • Significantly above or below the average in its frequency of occurrence • Violates cultural norms • Maladaptive • Interferes with ability to perform normal activities • Causes personal distress • Individuals who report experiencing troubling emotions are often considered to have psychological problems.

  7. Numerous Theoretical Explanations • Five primary perspectives to understand mental illness: • Psychodynamic: Disordered behavior is controlled by unconscious forces shaped by childhood experiences. • Behavioral: Disordered behavior is caused by identifiable factors in the person’s environment and results from learning. • Cognitive: ineffective or inaccurate thinking is the root cause of mental illness

  8. Numerous Theoretical Explanations • Five primary perspectives to understand mental illness: • Sociocultural: Mental illness is the product of broad social and cultural forces . • Biological: Disordered behavior is caused by biological conditions, such as genetics, hormone levels, orneurotransmitter activity in the brain.

  9. Combined Models • Diathesis-stress model: a predisposition to a given disorder (diathesis) that combines with environmental stressors to trigger a psychological disorder • Bio-psycho-social model. Takes into account predispositions, personal experience, and life circumstances.

  10. The Diathesis-Stress Model

  11. 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

  12. Models from Outside Psychology • Spirit Possession • Trephining • Lunacy • Curses • Family/generational • Occult (voodoo, witchcraft) • Sin • Guilt • Unforgiveness, bitterness

  13. Risks of Using Diagnostic Labels • David Rosenhan demonstrated diagnostic labels’ biasing effects. • Misdiagnosis of insanity by hospital personnel due to their bias toward calling a healthy person sick • Diagnostic labels can harm patients in several ways. • Label may “dehumanize” patients by encouraging mental health practitioners to treat them as labels rather than as unique individuals with problems. • Labeled individuals may experience discrimination and may cause people to expect those labeled to behave abnormally and thus to misperceive normal behavior as disordered.

  14. Benefits of Using Diagnostic Labels • Despite ethical concerns, diagnostic labels are used because they serve several important functions: • Summarize patient’s symptoms or problems, and thus, communicate great deal of information with a single word • Convey information about possible causes of the disorder • Convey information about the patient’s prognosis

  15. DSM Classification System • Diagnostic and Statistical Manual of Mental Disorders (DSM) use to diagnose mental disorders • Published by the American Psychiatric Association. • Since 1980, DSM has been updated several times and is now in its fourth edition, text revision, or DSM-IV-TR.

  16. DSM Classification System • DSM classification system is descriptive rather than explanatory, meaning that: • it is not based on a particular theory concerning the cause(s) of psychological disorders. • diagnoses are based mainly on observable symptoms. • DSM provides clearer directions concerning number, duration, and severity of symptoms necessary to assign a diagnosis. • By recognizing that two patients with same disorder may substantially differ from one another, clinicians much more likely to acknowledge uniqueness of all patients.

  17. Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior • Characterized by distressing, persistent anxiety or maladaptive behavior • About 25 percent of the population will experience this disorder in our lifetime. • Anxiety disorders occur across the life span and commonly co-occur with many other disorders, such as depression and substance abuse.

  18. Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior • Five major anxiety disorders: • Panic disorder: brief episodes of intense anxiety with no apparent reason • Phobic disorder: strong irrational fears of specific objects or situations, called phobias • Generalized anxiety disorder (GAD): a constant state of moderate anxiety

  19. Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior • Five major anxiety disorders: • Obsessive-compulsive disorder: repetitive, unwanted, and distressing actions and/or thoughts • Post-traumatic stress disorder: occurs among individuals who have experienced or witnessed traumatic events • Later reexperience the event through nightmares, flashbacks, and avoid situations or persons that trigger flashbacks

  20. 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) 24 Symmetry order, or exactness 17 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

  21. Anxiety Disorders • PET Scan of brain of person with obsessive/ compulsive disorder • High metabolic activity (red) in frontal lobe areas involved with directing attention

  22. Etiology of Anxiety Disorders • Genetic and biological factors: • Genetic heritage may predispose us to more easily develop phobic reactions or to respond intensely to stressful events. • Behavioral or conditioning factors: • Classical conditioning may instill conditioned emotional responses, and operant conditioning may reinforce and maintain the person’s avoidance responses. • Cognitive factors: • People suffering from panic disorder closely monitor their physiological reactions, and often exaggerate the significance of their physiological symptoms.

  23. Mood Disorders: Emotional Extremes • Characterized by emotional extremes that cause significant disruption in daily functioning. • To qualify as a mood disorder, emotional extremes must persist for a long time. • Most common mood disorder is depression • Characterized by extreme and persistent negative moods and the inability to experience pleasure by participating in activities one previously enjoyed (Kramlinger, 2001)

  24. Mood Disorders: Emotional Extremes • Depressed individuals: • Often experience physiological problems such as lack of appetite, weight loss, fatigue, and sleep disorders • Often experience behavioral symptoms, such as slowed thinking and acting, social withdrawal, and decreased activity • Exhibit cognitive symptoms, such as low self-esteem, thinking about death and/or suicide, and having little hope for the future

  25. 1 Stressful experiences 4 Cognitive and behavioral changes 2 Negative explanatory style 3 Depressed mood Mood Disorders-Depression • The vicious cycle of depression can be broken at any point

  26. Around the world women are more susceptible to depression 20 15 10 5 0 Percentage of population aged 18-84 experiencing major depression at some point In life USA Edmonton Puerto Paris West Florence Beirut Taiwan Korea New Rico Germany Zealand Mood Disorders-Depression

  27. Mood Disorders: Emotional Extremes • Bipolar disorder: characterized by swings between the emotional extremes of mania and depression • Less common than major depressive disorder, occurring in about 1 percent of the population • Unlike major depression, this disorder occurs about equally in men and women and tends to occur earlier than major depression

  28. Mood Disorders: Emotional Extremes • Bipolar disorder • Bipolar patients’ depressive episodes differ from the depressive episodes in major depression in that they tend to be more severe, are accompanied by higher suicide risks, and have a distinct pattern of brain activity during sleep.

  29. Depressed state Manic state Depressed state Mood Disorders-Bipolar • PET scans show that brain energy consumption rises and falls with emotional swings

  30. Suicide • A major danger of depression is suicide. • As many as 30% of people with severe mood disorders die from suicide. • In the U.S. suicide rates are higher among: • Men than women; • Elderly adults than younger adults; • Unemployed (& retired) adults than employed persons; • Widowed adults than married adults; • Native & European Americans than Asian. Hispanic, and African Americans.

  31. Etiology of mood disorders • Genetic/ biological influence? • Bipolar patients show imbalances in neural circuits using serotonin, norepinephrine, etc.? Enlarged amygdala? • Major depressive disorder: Family, twin, and adoption studies indicate at least a moderate genetic influence on depression. • Cognitive contributions: • Depressed persons have negative views and they misinterpret daily experiences so that their negative outlook is supported. • Behavioral psychologists propose that depression results from low social reinforcement.

  32. Gender & Mood Disorders • Why is depression more common among women? • May due to biological factors. • Sociocultural factors: Women have fewer educational and occupational opportunities, receive less money for their work, and experience more violence due to their gender than men. • Difference in diagnosis? • Women may be diagnosed more frequently because they are more likely to seek help for their problems. • Gender bias among mental health professionals may result in women and men with identical symptoms being diagnosed differently, i.e., women labeled as depressed and men diagnosed with other conditions

  33. Dissociative Disorders: Loss of Contact with Consciousness or Memory • Characterized by disruptions in consciousness, memory, sense of identity, or perception • Dissociative amnesia: a sudden loss of memory of one’s identity and other personal information • Dissociative fugue: a sudden departure from home or work, combined with loss of memory of identity and the assumption of a new identity

  34. Dissociative Disorders: Loss of Contact with Consciousness or Memory • Dissociative identity disorder (DID): characterized by the presence of two or more distinct identities or personalities, which take turns controlling the person’s behavior (also known as multiple personality disorder)

  35. Etiology of Dissociative Disorders • Psychodynamic theory: results from the individual’s attempt to repress some troubling event • Biological explanation: patient may have a neurological problem that has not yet been detected • Cognitive perspective: individuals learn to dissociate as a way to cope with intense distress

  36. Schizophrenia: Disturbances in Almost All Areas of Psychological Functioning • Characterized by severe impairment in thinking, including hallucinations, delusions, or loose associations • Diagnosed when symptoms persist for at least six months, are not due to some other condition, and cause significant impairment in daily functioning • Schizophrenics often cannot work, manage a home or apartment successfully, or care for their basic needs.

  37. Schizophrenia • Delusions • false beliefs, often of persecution or grandeur, that may accompany psychotic disorders • Hallucinations • false sensory experiences such as seeing something without any external visual stimulus

  38. Risk of Developing Schizophrenia

  39. Personality Disorders: Inflexible Behavior Patterns That Impair Social Functioning • Personality disorders: general styles of living that are ineffective and lead to problems for the person and for others • Ten personality disorders in the DSM-IV-TR.

  40. Personality Disorders: Inflexible Behavior Patterns That Impair Social Functioning • Three common personality disorders are: • Paranoid personalities: habitually distrustful and suspicious of others’ motives • Histrionic personalities: excessively emotional and attention seeking, often turning minor incidents into full-blown dramas • Narcissistic personalities: desire constant admiration from others  

  41. Personality Disorders: Inflexible Behavior Patterns That Impair Social Functioning • The personality disorder that receives the most attention is the antisocial personality disorder. • Exhibit a persistent pattern of disregard for and violation of the rights of others • Repeatedly exhibit antisocial behavior across all realms of life, lying, cheating, stealing, and manipulating others • When caught, they take no responsibility and feel no remorse.

  42. Personality Disorders Those with criminal convictions have lower levels of arousal 15 10 5 0 Adrenaline excretion(ng/min) Nonstressful situation Stressful situation No criminal conviction Criminal conviction

  43. Murderer Normal Personality Disorders PET scans illustrate reduced activation in a murderer’s frontal cortex

  44. Etiology of Personality Disorders • A genetic component: related to abnormal brain development or chronic underarousal of both the autonomic and central nervous systems • May be caused by the interaction of both biological and environmental factors. • Children in chaotic households who have a biological predisposition for this disorder may not learn to control their impulses, and so behave in ways to maximize their benefit even if this means violating social rules.

  45. What Are the Therapies for Psychological Disorders? • The two broad categories of therapy: • Psychotherapy: psychological methods that include a personal relationship between a trained therapist and a client • Biomedical therapies:the treatment of psychological disorders by altering brain functioning with physical or chemical interventions

  46. What Are the Therapies for Psychological Disorders? • The two broad categories of therapy: • Psychotherapy: psychological methods including a personal relationship between a trained therapist and a client • Biomedical therapies:altering brain functioning with physical or chemical interventions

  47. What Are the Therapies for Psychological Disorders? • Three mental health professions: • Psychiatry • Social work • Psychology • Two specialty areas in psychology: • Clinical psychology • Counseling psychology

  48. Psychodynamic Therapies • A group of psychotherapies based on the work of Sigmund Freud that say that psychological disorders stem from unconscious forces • Important psychodynamic terms: • Free association: therapy technique in which clients say whatever comes to mind • Resistance: anything client does to interfere with free chain of thought or therapeutic progress • Transference: client transfers feelings for significant others early in life to therapist (countertransference)

  49. Behavior Therapies • Psychotherapies that apply learning principles to the elimination of unwanted behaviors. • Counterconditioning is based on classical conditioning. • Counterconditioning: involves conditioning new responses to stimuli that trigger unwanted behaviors

  50. Counterconditioning: Three Techniques • Systematic desensitization: • used to treat phobias in which client is gradually exposed to feared object, while remaining relaxed • Response prevention: • used to treat obsessive-compulsive disorder; client is exposed to situation that triggers the compulsive behavior but is not permitted to engage in the ritual • Aversive conditioning: • a classically conditioned aversive response is conditioned to occur in response to a stimulus that has previously been associated with an undesired behavior