Chapter 14Psychological Disorders

“I felt the need to clean my room at home in Indianapolis every Sunday and would spend four to five hours at it. I would take every book out of the bookcase, dust and put it back. At the time I loved doing it. Then I didn’t want to do it anymore, but I couldn’t stop. The clothes in my closet hung exactly two fingers apart.… I made a ritual of touching the wall in my bedroom before I went out because something bad would happen if I didn’t do it the right way. I had a constant anxiety about it as a kid, and it made me think for the first time that I might be nuts.”

Marc, diagnosed with obsessive-compulsive disorder (from Summers, 1996)

Obsessive Compulsive Disorder

Possible causes of Depression:◦ Disease ◦ Death of a loved once◦ Divorce ◦ Loss of job◦ A break-up

Depression

Nearly 450 million people suffer from mental or behavioral disorders

Disorders account for 15.4% of years lost due to death or disability

World Health Organization

Psychological Disorders: Deviant, distressful, and dysfunctional behavior patterns.

Remember the 3D’s

Psychological disorders

Schizophrenia Depression

Most Universal Disorders

ADHD : a psychological disorder marked by the appearance by age7 of one or more of three key symptoms; extreme inattention, hyperactivity, and impulsivity.

Attention Deficit Hyperactivity Disorder

Mostly males are diagnosed with ADHD In the past 20 years the number of

diagnoses have tripled Some doubt the legitimacy of the disorder

due to this

ADHD Prevalence

ADHD is potentially heritable Ritalin and Adderall are stimulants used to

treat ADHD symptoms

Treating ADHD

Children with ADHD appear to have delayed pruning but when it occurs, however, kids can mature later into normal adults.

Children with ADHD

Over the last two centuries, the mentally ill were caged, beaten, castrated, got holes drilled in their skull, had teeth removed, and more.

The mistreatment of the mentally ill

Insisted mental disorders were sickness of the mind caused by stress and inhumane conditions, not demons

Made great strides to help serve justice to the mentally ill

Phillippe Pinel

Medical Model : the concept that diseases, in this case psychological, can be diagnosed, treated, and in most cases, cured, often through treatment in a hospital.

The Medical Model

Biopsychosocial approach contends that all behaviors are an interaction of genetics and experiences

Biopsychosocial

Susto: a condition marked by severe anxiety, restlessness, and a gear of black magic. It is prevalent in Latin America.

Taijin Kyofusho: Social anxiety about one’s appearance combined with a readiness to blush and a fear of eye contact Commonly Found in Japan.

Cultural Disorders

Types of Disorders

DSM-IV-TR: The American Psychiatric Association’s diagnostic and statistical mauel of mental disorders, fourth edition, with an updated “text revision”; a widely used system for classifying psychological disorders.

Goal: to describe and classify disorders, it does not explain why they occur or how they can be treated.

DSM-IV-TR

Criticisms of the DSM:◦ Casts too wide of a net for possible diagnosis ◦ The number of disorder categories has swelled

considerably

Criticisms

Six clusters of 24 strengths: wisdom and knowledge, courage, love, justice, temperance, and transcendence. ◦ Seligman came up with this

Strengths According to Seligman

Labels create preconceptions that guide our perceptions and our interpretations.

David Rosenhan experiment: Rosenhan and 7 other perfectly healthy men went to a hospital claiming they heard voices in their heads. They answered follow up questions truthfully and normally, yet all were misdiagnosed with a disorder.

Rosenhan Experiment

Pros of labeling disorders: health professionals can use labels to communicate about their cases and to discern treatment.

Cons: can create bias and self-fulfilling prophecy

Labels

The majority of individuals with psychological disorders are not violent.

16% of US jai land prison inmates have sever mental disorders

Andrea Yates

Jail or hospital? Two weeks after being taken off antipsychotic medication by her psychiatrist, Andrea Yates drowned her five children, ages 7, 5, 3, 2, and 6 months, in her bathtub, apparently believing she was sparing them “the fires of hell.” Although she was psychotic, one jury rejected the insanity defense, believing Yates still could have discerned right from wrong. On retrial, a second jury found her not guilty by reason of insanity.AP Photo

Anxiety disorders: psychological disorders characterized by distressing, persistent anxiety, or maladaptive behaviors that reduce anxiety.

5 anxiety disorders: Generalized anxiety disorder Panic disorder Phobias Obsessive compulsive disorder Post traumatic stress disorder

Generalized anxiety disorder: a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal. ◦ 2/3 of those with this disorder are women◦ May lead to high blood pressure or ulcers

Generalized Anxiety Disorder

Panic attack: a minutes-long episode of intense fear that something horrible is going to happen.◦Tremble◦Dizziness◦Choking sensation◦May be perceived as

A heart attack

Panic Attacks

Phobia: an intense, irrational fear of something.

Agoraphobia: a fear or avoidance of situations in which escape might be difficult or help unavailable.

Phobias

Anxiety Disorders Common and uncommon fears

Anxiety Disorders

PET Scan of brain of person with Obsessive/ Compulsive disorder

High metabolic activity (red) in frontal lobe areas involved with directing attention

Post-Traumatic Stress Disorder: PTSD, is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened that comes with…..depression, anxiety, paranoia, mood swings

Possible causes: rape, war, torture, kidnapping, attacks etc. After 9/11 8.5% of Manhattan residents has PTSD Heavy combat Vietnam survivors had 32% PTSD A sensitive limbic system makes one more susceptible to

PTSD On the other hand: holocaust survivior became more

empathetic, responsible, and developed larger capacities for caring after their traumatic experiences “Post Traumatic Growth”

Post Traumatic Stress Disorder

Using classical conditioning, researchers created anxious, ulcer-prone rats by giving them unpredictable electric shocks

Stimulus generalization: attacked by one dog but fear all different breeds of dogs

Naturally selected fears: spiders, snakes, closed spaces, darkness storms, heights.

Genes affect fears due to temperament; identical twins usually have the same anomocity of fear and feared subjects.

Characteristics of Phobias

Somatoform disorder: a psychological disorder in which the symptoms take a somatic form with out apparent physical cause. ◦ Vomiting◦ Dizziness◦ Blurred vision◦ Prolonged pain

Somatoform Disorder

Conversion disorder: a person experiences very specific genuine physical symptoms for which no physiological basis can be found ◦ Real physical symptoms◦ Blindness◦ Inability to swallow

Conversion Disorder

Hypochondriasis: a person interprets normal physical sensations as symptoms of a disease.

Hypochondriasis

I have a headache ..is it cancer?

Dissociative disorders: disorders in which conscious awareness becomes separated dissociated from previous memories, thoughts, and feelings ◦ Forget previous experiences ◦ Often in response to stress

Dissociative Disorders

Dissociation is not rare Comparable to an “out of body” experience Freud might call this phenomenon

repression

Dissociation: to become separate

D.I.D: A rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Formerly called multiple personality disorder◦ Each personality may have its own distinct qualities◦ Individuals are not aware or this personality switch

Dissociative Identity Disorder

Kenneth Bianchi the “Hillside Strangler” was accused of the rape and murder of 10 women in California in 1984

Faked a Dissociative IdentityDisorder in court to attempt to escape a jail sentence

The faults in his act were seen; he was figured out

and was convicted

The Hillside Strangler

Asked college students to pretend they were accused murderers being examined by psychiatrist.

Most spontaneously expressed a second personality

“Are dissociative identitiessimply a more extreme versionof our capacity to vary the‘selves’ we present? “

Nicholas Spanos

In the 1980’s the number of DID diagnosis skyrocketed to nearly 20,000

Number of personalities mushroomed: 3% to 12% per patient

Outside North America this disorder is almost non existent

DID is overly diagnosed

These therapists have detected that shifting visual activity and eye muscles balance as people switched personalities

Heightened brain activity in brain areas for control and inhibition of traumatic memories

Some therapists “fish” for multiple personalities

Ophthalmologists

Psychoanalysts see DID as defenses against the anxiety caused by the eruption of unacceptable impulses

Learning theorists think it is a type of reinforcement

Views of DID

Mood disorders are marked by emotional extremes

◦ People are mostSusceptible to Depression in the winter

Mood Disorders

Major Depressive Disorder a mood disorder in which a person, for no apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities

Major Depressive Disorder

Symptoms:

◦ Discouraged about the future

◦ Dissatisfied with life

◦ Socially isolated

44% college kids reportBeing depressed

Depression

Depression is the leading cause of disability world wide

Depression is usually a response to past and current loss

1 in 4 people who are depressed are ismply struggling with normal emotional impact of a significant loss

Depression Characteristics

Major Depressive Disorder a mood disorder in which a person, for no apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities

Mood Disorders-Depression

Canadian depression rates

Mood Disorders- Suicide

Manic Episodea mood disorder marked by a hyperactive, wildly optimistic state

Bipolar Disordera mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania

formerly called manic-depressive disorder

Bipolar Disorder

Mood Disorders-Bipolar PET scans show that brain energy

consumption rises and falls with emotional switches

Depressed state Manic state Depressed state

40% fold increase in diagnosis's for individuals under 19 from 1994-2003

Mostly males are diagnosed; 2/3 of those diagnosed

Composers, artists, poets,Novelists, and entertainers Are more prone to bipolar

Bipolar disorder facts

A mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities.

Major Depressive Disorder

Negative outcomes: inactive, unmotivated, more often recall negative memories

Women internalize depression while men externalize it

“women get sadder, men get madder” Most people with major depression

eventually return to normal without professional health

Depression

Most people with major depressive disorder usually return to normal on their own

Depression

Generally depression results more often from a pile up of stresses than from a single loss of failure

Events that typically precede depression: family members death, job loss, marital crisis, or physical assault

Possible causes

Freud's hypothesis: depression often occurs when significant losses evoke feelings associated with losses experienced in childhood

Psychoanalytic theory

Mood disorders tend to run in families If one identical twin is depressed, there is a

50% chance the other twin will develop depression too

Kendler estimates that heritability of major depression is 35-40%

Genetic Influence

Geneticists examine DNA from affected and unaffected family members looking for differences

Linkage Analysis

Nearly 1million people commit suicide a year

European suicide rates are higher than American suicide rates

In the united states whites are 2 times more likelyto commit suicide than blacks

Women attempt suicide more often, but men succeed more often

Suicide

Study: 13 elite Canadian swimmers watched Olympic videos where they failed to make the team . Their fmri’s appeared to be similar to a patient in a depressed mood

Brain Scan Study

The left frontal lobe which is active during positive emotions, is likely to be inactive during depressed states

In people with severe depression, fMRI’s show frontal loves are 7% smaller than normal

Physiological signs

Prozac, zolof, and paxil are drugs that relieve depression by blocking reuptake of nor epinephrine and serotonin, or their chemical breakdown

Antidepressants

Repetitive physical exercise reduces depression as it increases serotonin

Physical exercise

More common in women than in men Research shows self-defeating beliefs and

negative explanatory style feeds depression and its vicious cycle

Learned Helplessness

Outlooks on depression

The majority of college students have claimed to have felt depressed at come point

Students who have optimism as they begin college develop more social support and have lower risks of depression

Students with Depression

The Vicious Cycles of Depression

Figure 14.8  The vicious cycle of depressed thinking Cognitive therapists attempt to break this cycle, as we will see in Chapter 15, by changing the way depressed people process events. Psychiatrists attempt to alter with medication the biological roots of persistently depressed moods.

Schizophrenia: a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions.

Schizophrenia

Includes delusions: false beliefs, often of persecution or grandeur, that may accompany psychotic disorders

“word salad” jumbled ideas Unable to utilize selective attention

Characteristics

Sensory experiences without sensory stimulations ◦ Most common form: auditory

Hallucinations

Hallucinations Disorganized speech Inappropriate emotions Over-the-top actions

Positive symptoms

The flat effect: an emotionless state Catatonia: motionless for hours and then

become agitated after Toneless voice Mute Rigid bodies

Negative syptoms

Types of Schizophrenia

Men are more likely to get it more than women

It is one of the most researched disorders The development of schizophrenia over a

long period of time is easier to treat rather than if it is contracted very rapidly

Facts about Schizophrenia

Schizophrenics have excess dopamine receptors, drugs that increase dopamine amplify symptoms

Schizophrenics have low brain activity in the frontal lobes but access activity in the amygdala

Physiological characteristics

More likely to contract schizophrenia if…◦ Ones country experienced a flu epidemic while

pregnant ◦ Live in densely populated area◦ Born during winter and spring

Risks of Schizophrenia

If a parent or sibling has it, there is a 1 in 10 chance of them too

If and identical twin has it, it becomes 1 in 2 Twins who shared placenta have a

heightened chance of both contracting schizophrenia

Genetic influence

Followed 163 teens and people in their early 20’s who had relatives with schizophrenia(2005) ◦ 20% developed schizophrenia ◦ These subjects became socially withdrawn

Johnstone's study on Schizophrenia

May develop in the early 20’s if…◦ Mother with severe schizophrenia ◦ Birth complications involving low oxygen◦ Separation from parents◦ Short attention span◦ Disruptive or withdrawn behavior ◦ Emotionally unpredictable

Warning signs of schizophrenia

Personality disorders: psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning

Personality disorders

Avoidant personality disorder: an unusually fearful sensitivity to rejection

personality disorders

Narcissistic personality disorder: to be overly focused and self inflating

Schizoid personality disorder:emotionless disengagement

Personality disorders

Antisocial personality disorder: a person, usually a man, exhibits a lack of conscience for wrong doing, even towards friends and family. ◦ Former names: sociopath,psychopath

Antisocial personality disorder

Lying, stealing, fighting, displaying unrestrained sexual behavior

About ½ of children who show these characteristics become antisocial adults

Characteristics of antisocial personality disorder

Early signs have been observed in 3-6 year olds

◦ They are impulsive, uninhibited, unconcerned with social rewards, and low in anxiety

Antisocial personality disorder

Satistics

Figure 14.10  Cold-blooded arousability and risk of crime Levels of the stress hormone adrenaline were measured in two groups of 13-year-old Swedish boys. In both stressful and non-stressful situations, those later convicted of a crime (as 18- to 26-year-olds) showed relatively low arousal. (From Magnusson, 1990.)

PET scans of 41 murderers showed reduced activity in their frontal loves and repeat offenders had 11% less frontal lobe tissue than normal

The Brain of an Antisocial Person

“Perhaps a biologically based fearlessness, as well as early environment, helps explain the reunion of long-separated sisters Joyce Lott, 27, and Mary Jones, 29—in a South Carolina prison where both were sent on drug charges. After a newspaper story about their reunion, their long-lost half-brother Frank Strickland called. He explained it would be a while before he could come see them—because he, too, was in jail, on drug, burglary, and larceny charges (Shepherd et al., 1990). According to a 2004 U.S. Justice Department report, 48 percent of 2 million state prison inmates say they have had incarcerated relatives (Johnson, 2008).”

Relatives in Jail

Biopsychosocial Perspective of Crime

Figure 14.12  Biopsychosocial roots of crime Danish male babies whose backgrounds were marked both by obstetrical complications and social stresses associated with poverty were twice as likely to be criminal offenders by ages 20 to 22 as those in either the biological or social risk groups. (From Raine et al., 1996.)

Compared to 1960, you are 2x more likely to be murdered, 4x more likely to be robbed, and 5x more likely to be assaulted

Crime

14.12 Does a full moon trigger “madness” in some people? James Rotton and I. W. Kelly (1985) examined data from 37 studies that related lunar phase to crime, homicides, crisis calls, and mental hospital admissions. Their conclusion: There is virtually no evidence of “moon madness.” Nor does lunar phase correlate with suicides, assaults, emergency room visits, or traffic disasters (Martin et al., 1992; Raison et al., 1999).•

About 26% of adult Americans suffer diagnosable mental disorders in a given year

Understanding Mental Disorders

Mood disorders are most common, phobias too

Incidence of serious psychological disorders is doubly high among those below the poverty line

Mental Disorder Facts