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Psychological Disorders
General Psychology47.101
Psychopathology Conceptions of psychopathology
What is Abnormal?
Diagnostic system: DSM IV
Causes
Types of Disorders Dissociative
Anxiety
Schizophrenia
Mood
Personality
Body Ritual of the Naricema
What is Abnormal?
How can abnormal be differentiated from
normal?
How is abnormal diagnosed?
What is Abnormality? Criteria
Infrequent in the population
Socially deviant
Maladaptive
Personal distress
Psychologically disorganized
No sharp boundaries Continuum is more reasonable
Abnormal behaviors often = normal behaviortaken to the extreme
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Diagnosing Disorders Use diagnostic interview
Performance on Psychological Tests
e.g., MMPI, Projective tests
Interviews with Family & Friends
Compare patient information to pre-establishedpsychological disorders
Diagnostic and Statistical Manual of MentalDisorders (DSM-IV)
DSM IV: Agreed-upon criteria for diagnosingpsychological disorders
DSM IV Axes
Axis I: Primary Diagnosis
Axis II: Developmental & Personality Disorders
Axis III: Physical disorders
Axis IV: Stressors in last year, situational
contributors
Axis V: How well the person has coped with
stress in the past
Axes refer to different major diagnostic categories
of psychological disorders
Classification Systems & Labeling:Advantages
Advantages:
grouping of similar symptoms may help
to identify underlying causes
facilitates communication
May seem dehumanizing for patients
Better to apply diagnostic labels to the disorder
and NOT to the people themselves
May lead clinicians to overlook unique
aspects of each case
Label becomes a lens through which we see
and evaluate a persons behavior
Classification Systems & Labeling:Disadvantages
Disadvantages:
Labeling
How important is it really?
Demo
On being sane in insane placesInvestigation by Rosenhan, Seligman, et al.
Discovering Psychology#21: Psychopathology
6:49 9:55
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Causation1. Predisposition
In place before onset of disorder
genetic characteristics, learned beliefs, sociocultural factors2. Precipitating causes
Immediate events that bring on the disorder
Stress, Negative or positive life changes
Diathesis-stress model
People may have predisposition for disorder
that is only brought out under stress
Low HighPredisposition
Low
High
Stress
manifested
Not manifested
Causation1. Predisposition
In place before onset of disorder
genetic characteristics, learned beliefs, sociocultural factors
2. Precipitating causes
Immediate events that bring on the disorder
Stress, Negative or positive life changes
3. Maintaining causes
Effects of disorder that serve to perpetuate it
depressed person may withdraw from social interactions
Schizophrenics are reacted to strangely or violently, enhancingtheir stress, which enhances the disorder
Major Classes of Disorders
Anxiety disorders Generalized anxiety disorder (GAD)
Panic disorder
Phobias
Obsessive compulsive disorder (OCD)
Post- traumatic stress disorder (PTSD)
Dissociative Disorders Dissociative Identity Disorder
Dissociative Amnesia
Dissociative Fugue
Mood Disorders Depression
Bipolar
Dysthymia
Psychotic disorders Schizophrenia Schizoaffective disorder
Somatoform Disorders Hypochondriasis
Body Dysmorphia
Conversion Disorder
Eating Disorders Anorexia
Bulimia
Substance Disorders Substance abuse
Substance dependence
Personality Disorders Antisocial personality disorder
Borderline personality disorder
Narcissistic personality disorder
Major Classes of Disorders
Anxiety disorders Generalized anxiety disorder (GAD)
Panic disorder
Phobias
Obsessive compulsive disorder (OCD)
Post- traumatic stress disorder (PTSD)
Dissociative Disorders Dissociative Identity Disorder
Dissociative Amnesia
Dissociative Fugue
Mood Disorders Depression
Bipolar
Dysthymia
Psychotic disorders Schizophrenia
Schizoaffective disorder
Somatoform Disorders Hypochondriasis
Body Dysmorphia
Conversion Disorder
Eating Disorders Anorexia
Bulimia
Substance Disorders Substance abuse
Substance dependence
Personality Disorders Antisocial personality disorder
Borderline personality disorder
Narcissistic personality disorder
Prevalence of mental disorders
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Before we start
A word of caution: Do not develop
medical student syndrome
But, if some of the things that we discussring true
If ~ 10-15min left jump to #32
Dissociative Disorders
Ever forget the passage of time?
Driving a car, spacing out (certainly not in this class!)
Dissociation: out of body experience,disconnect form self
Dissociation is part of other disorders as well Ex: BPD
But in dissociative disorders it is the primarysymptom
Dissociative Identity Disorder (DID)
Previously known as Multiple personalitydisorder (MPD)
Characterized by multiple identities
Causes
Often severe trauma in childhood
Means of escape
Controversial
DID
Anxiety Disorders
What does anxiety feel like???
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Anxiety Feeling of dread, apprehension or fear
Accompanied by physiological arousal
Can make it hard to think clearly
Anxiety Disorders Generalized anxiety disorder
Panic attacks
Phobias Obsessive-compulsive disorder
PTSD
As a category, easiest to treat and best long-termprognosis
GAD
Tom, a 37 year old electrician, complains ofdizziness, sweating palms, heart palpitations
and ringing in the ears. He feels edgy andsometimes finds himself shaking. Withreasonable success he hides his symptomsfrom his family and co-workers. Never theless, he has few social contacts since thesymptoms began two years ago. Heoccasionally has to leave work. His family
doctor and a neurologist can find no physicalproblem.
Generalized Anxiety Disorder (GAD)
Symptoms are commonit is there persistencethat is uncommon
Unfocused anxiety
feels vaguely uneasy
overreacts to mild stressors
inability to relax, disturbed sleep
rapid heart rate,
fatigue, headaches, dizziness
Hard to treat because there is no obvious source ofthe anxiety
Panic attack
I felt hot as though I couldn't breath. Myheart was racing and I started to sweat andtremble and I was sure I was going to faint.
Then my fingers felt numb and tingly andthings seemed unreal. It was so bad I
wondered if I was dying and asked myhusband to take me to the emergency room.By the time we got there the worst of theattack was over and I just felt washed out
Panic Attack
Sudden episodes of overwhelming terror
Over-activity of sympathetic nervous system heart palpitations
shortness of breath
perspiration muscle tremors
faintness
nausea
fear of dying or going crazy
Can start to fear the fear itself
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Persistent and irrational fear of an object or situation thatpresents no realistic danger
Anxiety experienced in response to a specific stimulus Specific (simple) phobias Animals (snakes, spiders, rats) Situations (high places, enclosed spaces, doctors office) Things (blood, waters, clowns)
Social phobia - fear of public scrutiny Public speaking
Agoraphobia - fear of being in public places Fear is that something bad might happen and youll be
trapped
Not labeled a phobia unless it disrupts a persons daily life
Example of panic/agoraphobia (DVD - Clip)
Phobia
How do phobias develop?
Classical Conditioning Remember Little Albert
Social Learning Principles E.g., modeling
Phobias often persist because of avoidance Cannot learn that anxiety response is unnecessary
Usually treated with exposure therapy Expose the person to the object that arouses fear
When nothing bad happens the phobia fades
OCD
(Howard Hughes)
Hughes compulsively dictated the samephrases over and over again. Under stress,he developed a phobic fear of germs, which
led to compulsive behaviors. Hughes becamereclusive and insisted his assistants carry outelaborate hand-washing rituals and wearwhite gloves when handling any document hewould later touch. He ordered tape arounddoors and windows and forbade his staff totouch or even look at him.
Obsessive - Compulsive Disorder
Obsessions persistent and irrational intrusions or
unwelcome thoughts or images
Try it - The white bear
Compulsions irresistible urges to carry out certain acts or
rituals DVD example
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OCD: Cleaners vs. Checkers
Sex Distribution:
Dominant Emotion:
Speed of onset:
Length of behavior:
Feel better after?
Cleaners Checkers
Mostly female
Anxiety
Usually rapid
Less 1 hour at a time
Yes
Equal
Guilt and Shame
More often gradual
Some go on indefinitely
Usually not
Causes of OCD
Operant conditioning
anxiety paired to event and to behavior to reduce
anxiety
Biological
Abnormalities of the frontal lobes
organizing behaviors and planning.
Abnormality of the basal ganglia
involved in routine behaviors, like grooming, and thefrontal lobes
PTSD
During the Iraq war, Jacks platoon wasrepeatedly under fire. In one ambush, I closestfriends as killed while Jack stood a few feet away.Jack himself killed someone in an assault. Yearslater, images of theses event still intrude on his asflashbacks and nightmare. He still jumps at thesound of a firecracker or the backfire of a car.When annoyed by his family or friends, he lashesout in ways he seldom did before Iraq. To calmhis continuing anxiety, he drinks more than heshould.
Post-Traumatic Stress Disorder
Experiencing or witnessing severely threatening andtraumatic experiences Eg. War veterans, rape victims, accident survivors
Symptoms include:
Flashbulb memories Hypervigilance
Intrusive thoughts
Startle response
Nightmares
Insomnia
Social withdrawal
(Example: Carl Vietnam Vet if there is time)
Schizophrenia
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Dysfunction in social, emotional, cognitive, and
perceptual processes
Afflicts 1% of the general population Account for 30% of all hospital beds
Peak incidence occurs adolescence or early adulthood Onset can be sudden or gradual
Course of schizophrenia is variable
Effects may wax and wane across time
40% successfully treated
Best predictor pre-morbid functioning
Schizophrenia
Thought and attention
inability to filter out irrelevant stimuli loose associations (word salad); easily
distracted
delusions
Delusions of grandeur
Thought broadcasting
Thought blocking or withdrawal
Thought insertion
Schizophrenia Symptoms
Perceptual
Hallucinations
Generally auditory
Difficulty distinguishing reality from
imagination
Affective
dysregulated emotion
Flat; inappropriate tears, laughter or anger
Motor deficit in motor processes
Schizophrenia Symptoms (continued)Example
Discovering Psychology
20:19 22-30
Schizophrenia and Biology Dopamine hypothesis
high levels of activity at dopamine receptors in brain
only known treatment are neuroleptic drugs Block receptor sites Basically a tranquilizer
Enlarged cerebral ventricles (fluid-filled spaces) continue to enlarge as the disorder progresses,
signifying brain atrophy (loss of brain tissue)
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Mental disorders expressed in bodily symptoms No apparent physical cause Difficult to diagnose any physical cause must be ruled out
Hyphochondriasis: belief one has specific disease;continually seeks treatment despite no physical evidencefor illness
Somatization disorder: aches and pains inconsistent withany illness
Somatoform pain disorder: chronic pain with no apparentphysical cause
Conversion disorder: dramatic loss of function (numbnessof hand, paralysis) with no physical cause. Referred to as hysteria by Freud Not commonly diagnosed today
Somatoform Disorders
Mood Disorders
Affective (mood) disorders
Extreme disturbances of mood Can disrupt physical, perceptual, social, and thought
processes
Two major types Unipolar extreme at one end of mood continuum
Depression
Bipolar extremes at both ends of the moodcontinuum Major swings between depression and mania
Note each episode (dep or mania last for some time)
NOT Rapid cycling.
Mood Continuum
Extreme Negative Extreme Positive
Normal Range
Unipolar Depression
Bipolar Disorder
Depressive Disorder Persistent feelings of sadness and despair
Loss of interest in previous sources of pleasure
Symptoms also include:
feelings of worthlessness or guilt; low self-esteem
reduced motivation
disturbances of sleep, appetite, sex drive
reduced energy; move sluggishly/talk slowly
difficulties in thinking
recurrent thoughts of suicide
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Major Depression and Suicide
Of suicides, majority had suffered a major depression
250, 000 suicide attempts per year
1 in 8 are successful 8th leading cause of death
Age: highest attempts: 24-44 highest success: 55-65 adolescents: rate tripled in last several decades college students: almost twice the rate of non-college peers
Usually has to do with social relationships
Gender: women 3 times more likely to attempt suicide than men of those who attempt, men 4 times more successful
Men tend to use more effective means
Myths about SuicideMyth 1:
Failed attempts indicate the person is not serious
about dying
75% of those who succeed in committing suicide
have made at least one previous attempt
Myth 2:
Those who talk about suicide seldom make
attempts
70% of suicide victims had communicated their
intention to others
percentage is similar among college students
Myths about SuicideMyth 3:
Depressed people should be steered away from
talking about suicide for fear it will only
strengthen their resolve
letting despondent people talk may actually help
them to overcome those thoughts
Myths about Suicide
Important to get professionalhelp!
Risk of suicide may actually rise for a period
during recovery process
Greater risk during recovery than during depths of
depressive episode
Person may have more energy and control to carry
the suicide out
Mania State of exaggerated elation
Often accompanied by:
feverish activity
great distractibility
emotional high
inflated self-esteem
hyperactivity
reckless behavior
decreased need for sleep
constant talkativeness
flight of ideas
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Bipolar Disorder
Cycling between manic and depressive episodes
Tied to biological causes
Changes in brains approach system:
Highly activated during mania
Low activation during depression
Most often treated with lithium carbonate
Requires careful monitoring of toxicity
Personality Disorders
Personality DisordersClass of disorder marked by inflexible and maladaptive
ways of interacting with the world
Persistent
Antisocial Personality: Typicalattributes
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Antisocial Personality Often called sociopaths or
psychopaths
Show lower physiological
arousal
Less sensitive to peripheral
informational cues
Subjects received a shock at number 8
sociopaths show lower overall skin
conductance response and smaller
responses in anticipation of shockTed Bundy
Practice your understanding
Name that disorder