Psychological Disorders

Psychological Disorders

Specific Disorders for ourBIG “Landscape” Notes

Created by Andy FilipowiczOcean Lakes High School, 2008

Definitions of Mental Disorder

1- Mental disorders as a violation of cultural standards or atypical

2- Mental disorder as maladaptive or harmful behavior

3- Mental disorder as a disturbing emotional distress.

4- Mental disorder as unjustifiable

Psychological Disorders

According to the LawM’Naghten Rule

1) must not know what you are doing is wrong OR2) must not understand the nature of the act

Stats on “legal insanity”…Discuss: Are the mentally insane more dangerous?Several articles on “legal

insanity” and more

Discussion Day 59• Why do we diagnose people with

psychological disorders? What exactly is the purpose of this

anyway?• What might be some potential benefits? Potential negatives/side

effects of such a diagnostic system?

Let’s discuss a few ideas…

Diagnostic & Statistical Manual of Mental

Disorders• DSM-IV (1994) contains more

than 300 mental disorders. (DSM-V to be released in May 2012)

• Provides diagnostic categories• Does not provide information on

causes• Does not provide information on

treatment• It is organized in 5 axes

The Five Axes• I = Categories of Psychological

Disorders • II = Personality & Developmental

Disorders• III = Medical Conditions• IV = Rating of Recent Social &

Environmental Stress• V = Global Assessment of Functioning

(GAF) from 1-100 (1 = severe dysfunction)

Discussion• What are some remaining issues stemming

from this system of classification?

• Boundary btwn normal / abnormal• Cut-offs for number of symptoms seems

random and arbitrary• How are specific time periods for symptom

duration chosen?• Auxiliary axes (premorbid history, quality of

relationships, work and family functioning)

Understanding Psychological

DisordersThe Biomedical ModelPsychological disorders are

sicknesses and can be diagnosed, treated, and even cured.

The Bio-Psycho-Social ModelHow biological, psychological, and

social factors interact to produce specific psychological disorders.

Anxiety Disorders• 1- Panic Disorder• 2- Generalized Anxiety Disorder

(GAD)• 3- Posttraumatic Stress Disorder

(PTSD)• 4- Phobias (fears)• 5- Obsessive-Compulsive Disorder

(OCD)

1 – Panic Disorder• Symptoms

– “recurrent, unexpected”– acute episode of intense anxiety without any apparent

provocation• Can’t breathe, heart pounding ,sweat, shake, feel like you’re

losing your mind– Additional anxiety comes from anticipating future attacks

this is actually what the disorder is (panic attacks are actually separate from the disorder; can have 1 without the other! (Abnormal book Pg. 117 Gretchen Attacked by Panic)

• Cause – based on perspective– NOT caused by a stressful event– LIKELY original cause physiological event (out of breath) and

then an unrelated troublesome thought (death of mother)– Increase in frequency following 1st panic attack– Low levels of GABA = inc anxiety – Genes tendency to be tense/uptight– Smoking incs likelihood of developing anxiety disorders

Panic Attack

1 – Panic Disorder – Stats and Treatment

• With or without agoraphobia (5.3% have this by itself)?– Fear and avoidance of situations in which they would feel

unsafe in the event of a panic attack or symptoms– Abnormal book pg. 126 (Mrs. M – Self-Imprisoned)

• 3.5% some point in their lives• 2/3 women

– Men drink– Women develop this agoraphobia

• Onset mid-teens to 40– Puberty is best predictor

• Less pervasive in elderly• Benzodiazepines/SSRIs = Prozac, Paxil, Xanax

2 – Generalized Anxiety Disorder (GAD)

• (abnormal book pg. 121 – Irene)• A general feeling of impending doom• Continually tense / jittery (from constant high-levels

of anxiety)– Muscle fatigue, tension common

• Worried that bad, horrible things might happen• Autonomic System Arousal

– racing heart, clammy hands, stomach butterflies, sleeplessness, twitching eyelids, fidgeting

• Cause: no specific cause– Genes: tendency to be tense– Learning: important events in life are

uncontrollable/dangerous– Stress makes them apprehensive, vigilant

2 – GAD Stats• 5% at some point• 2/3 female• Gradual onset, though first appears following a major

life change beginning in early adulthood (leaving home, getting a new job, having a baby, etc.)

• Chronic• Very prevalent in elderly• Treatment: Hardest of the Anxiety Disorders to treat

– Valium, Librium– Cognitive Behavioral Therapy purposefully confront

anxiety-provoking images and thoughts…develop strategies for dealing with these

3 – Posttraumatic Stress Disorder (PTSD)

• SYMPTOMS: flashbacks, nightmares, intrusive thoughts, intense physiological reactivity

• CAUSES:• When people are in danger, they produce high levels of natural

opiates, which can temporarily mask pain. They also produce stress hormones.

• People with PTSD tend to continue producing these hormones.• Norepinephrine is higher than normal. It activates the

hippocampus, which is involved with memory and long term memory.

• At high levels, stress hormones can become toxic and can damage the brain.

• Triggered by a life threatening trauma– Men: War– Women: Rape

• 25% of those experiencing a life threatening event develop PTSD

3—PTSD – Stats / Treatment

• Group therapy helps us to mimic normal relationships again

• Behavioral therapy experience the conditioned stim/response as NOT always together or anxiety will always persists– Systematic Desensitization

4 – Phobias• Acrophobia: fear of heights• Brontophobia: fear of thunder• Astraphobia: fear of lightning• Claustrophobia: fear of closed places• Porphyrophobia: fear of the color purple• Mysophobia: fear of dirt and germs• Agoraphobia: fear of being away from a safe

place. • Triskaidekaphobia: fear of number 13• Phobophobia

4 – Phobias – 3 Classes

• Specific (over 700, but not in DSM)– Search for Phobias

• Social – avoidance of social situations – 13.3% of pop at some point (35mil)– 1.4F: 1M– Peak onset = 15yrs

• Agoraphobia• Cause:

– Inherited = falling, loud noises, social seen in infants 4 months old

– Behavioral = observation, vicarious (latent) experience

Moving Images: 24:

Intensive Exposure Therapy

5 – Obsessive-Compulsive Disorder

(OCD)• Obsessions = Recurrent, persistent,

unwished-for thoughts or images.– Example: repetitive thoughts about killing

a child or becoming contaminated by shaking hands.

• Compulsions = Repetitive, ritualized behaviors that the person feels must be carried out to avoid disaster.– Example: hand washing, counting, &

checking (door locked, curling iron off)

5 – OCD – Causes • Video Moving Images: 22 OCD or OCD VHS• 2.6% at some point• 55-60% female (in kids though, ratio is

reversed)• Onset around 20, doesn’t show up past 30

– Boys develop OCD earlier• Article Strep throat!• High activity in front lobe just above the eyes• Freud = Anal Retentive• NT = lack of serotonin• Link to Tourette syndrome and Dopamine• Organic = brain tumors, injuries, stress,

viruses• 1918 flu epidemic spiked encephalitis also

increased OCD cases• Brain = abnormally high levels of activity in

the caudate nucleus, part of the basal ganglia known to be involved in initiation of learned behavior

Somatoform Disorders

• Defined = psychological problem manifested in a physiological symptom (see overhead slides)

• A - Conversion Disorder• B - Hypochondriasis• C – Body Dysmorphic Disorder

Conversion Disorder• NOT FAKING IT• Paralysis of a limb (most common)• Total paralysis• Weakness • Insomnia• Blurred vision, deafness, other

sensory effects• Pain – back, abdominal• Peak onset = mid-late 30s • “Shell shock” during WWI/II

• The patient has one or more symptoms or deficits affecting the senses or voluntary movement that suggest a neurological or general medical disorder. 

• The onset or worsening of the symptoms was preceded by conflicts or stressors in the patient's life. 

• The symptom is not faked or produced intentionally. • The symptom cannot be fully explained as the result of a

general medical disorder, substance intake, or a behavior related to the patient's culture. 

• The symptom is severe enough to interfere with the patient's schooling, employment, or social relationships, or is serious enough to require a medical evaluation. 

• The symptom is not limited to pain or sexual dysfunction, does not occur only in the context of somatization disorder , and is not better accounted for by another mental disorder.

Hypochondriasis

Body Dysmorphic Disorder

• “distorted body image”– Size, shape, form– Perception of physical appearance

• 50% get plastic surgery• Equal gender ratios• Onset: late childhood, early

adolescence (avg age is 17)

Dissociative Disorders

• ?- Amnesia

• @- Fugue

• #- Dissociative Identity Disorder (Multiple Personality Disorder)

?- Dissociative Amnesia

• Unable to recall important personal information or past events (name, origin, relationships, job, etc.)– General amnesia is anything at all (procedural stuff

is fine though ride a bike, how to talk, etc.)– Selective amnesia is specific traumatic events (war)

• Cause (all Dissociative Disorders): attempt to escape from traumatic event (past or present)

• Abnormal book: 179: The Woman who Lost Her Memory

@- Fugue• Memory loss is accompanied by an

unexpected trip• Confusion about personal identity• 0.2% of pop• Therapy: Psychotherapy to deal

with original traumatic event• Prognosis: A few months• Abnormal book: 180: The

Misbehaving Sherif

#- Dissociative Identity Disorder(Multiple Personality Disorder)

• IT IS NOT SCHIZOPHRENIA; IT’S TOTALLY DIFFERENT!!!!!!!! THIS WAS AN AP ESSAY QUESTION!

• Loss of time• Onset = 2-12 yrs old• At least 2 personalities, 10 is avg• Personalities have different names, sexes,

ages, voices, facial expressions, handwriting, physical problems– Often at least 1 is quite violent, aggressive

(FIGHT CLUB!)

#- Dissociative Identity Disorder(Multiple Personality Disorder)

• Almost non-existent outside of North America– India, Japan entirely nonexistent

• Self-multilation• EXCELLENT MEMORY!!! (when not in the alter egos)• Some can function in a “normal” life• Cause: physical, sexual, psychological abuse (not all who

are abused will develop it, but it’s a good place to look for a cause if someone has it)

• Video: Brain 23 Multiple Personality • May involve role playing as normal subjects under

hypnosis will express 2nd personality if instructed to do so by the psychologist/hypnotist

• 85% are female (http://skepdic.com/mpd.html)

Mood Disorders• - Major Depression (think Unipolar)

• & Bipolar Disorder aka Manic Depression

MIND 32: Mood Disorders: Hereditary Factors

Symptoms of Depression

Psychological Symptoms• Feeling of despair, hopelessness,

worthlessness, intense sadness #1 symptom

• Exaggerating minor failings and ignoring positive events

• Interpreting losses as signs of personal failures and concluding that happiness is not possible.

Physiological Symptoms• Insomnia/Hypersomnia, lack of appetite

trouble/ overeating, trouble concentrating, early morning wakeups

• DEBILITATING can’t go to work/schoolVIDEO: Moving Images: 23: Depression

Pg. 195 (Katie)

Causes / Stats of Depression• 1 more thing about symptoms: to be clinical

depression, symptoms must persist for at least 2 weeks in the absence of a clear reason

• If only during winter months (no sunlight = more melatonin = sleepy), SAD = Seasonal Affective Disorder

• Neurotransmitters: lack of serotonin, norepinephrine

• Lower activity in left frontal lobe• Freud: “anger turned inward”• Onset: mean = 25-29, though age of onset is

going down [3 month olds (207)]• Average duration of 1st episode = 6-9 months• 70% are women• Dysthmyic Disorder = chronic, lasting at least

2 years, not episodes, its chronic! But less severe…(not debilitating) (Double Depression = Dysthymic Disorder with occasional bouts of depression

• + common than bipolar, - common than phobias

Moving Images 23: Mike Wallace

NT Causes of...MANIA

• Excessive production of 1 or 2 NTs:–1-Norepinephrine

–2-Serotonin

DEPRESSION• Low levels of 1 of 2 NTs:

• 1-Norepinephrine–2-Serotonin

Mind: 31: Mania & Depression

Mania• An abnormally high state of exhilaration• Extreme pleasure in every activity (cleaning,

shopping, etc.)• Flight of ideas – lots at once• Excessive energy• Irrational decisions• Feeling of excessive hopefulness• Speaking rapidly and dramatically• Excessive feeling of ambition / grandiosity• Inflated self esteem

Pg. 202 abnormal book – Billy

Stages of Mania• 1-HypomaniaPatients are energetic, extroverted,

and assertive• 2-ManiaLoss of judgment• 3-Delusion with Paranoid

ThemesSpeech is generally rapid and

hyperactive behavior may lead to violence.

Bipolar DisorderManic-Depressive

• When people alternate between episodes of depression and one or more episodes of mania.

• Occurs equally in both sexes.• Mean onset is between 18-22, though 1/3

of cases actually begin in adolescence• 50/50 M/F• Those who have rapid cycling may

experience more episodes of mania and depression that succeed each other without a period of remission.

• Less common than depression

Bipolar DisorderManic-Depressive

• Cyclothymic Disorder =

People Who Had Bipolar

• Abraham Lincoln Edgar Allan Poe• Van Gough Virginia Wolf• Vivian Lee Walt Whitman• Charles Dickens Ernest

Hemingway• Isaac Newton• Mark Twain

Mind 34: ECT for Depression

SAD• Seasonal Affective Disorder• 5% of North Americans

– 2% of Floridians– 10% of New Hampshirians

Schizophrenia• Overall must have at least 2 of the

following 5:– Delusions (+)– Hallucinations (+)– Disorganized Speech (mostly +)– Disorganized Behavior (inappropriate or

ineffective behavior) (mostly +)– Negative Symptoms

Schizophrenia – General Characteristics

• delusions = – Delusions of Persecution (CIA watching)

• “the doctor is out to get me” “that picture is meant for me” Beautiful Mind: codes in the newspaper

– Delusions of Grandeur (God-like, the president, Nobel Prize winner, savior of the world, etc.)

– Capgras Syndrome: someone you know replaced by a double

– Cotard’s Syndrome: thinks a part of the body has changed in some impossible way

Schizophrenia – General Characteristics

• Disturbed Perceptions = Hallucinations– Seeing / hearing / feeling usually

• Somatic hallucinations – “snakes are crawling around on me”

• Hearing voices (auditory hallucinations – most common)– interestingly, we find problems in Broca’s area (NOT

wernicke), so it’s not language composition, but as if one’s own produced language is repeated in the head as other people’s voices & the person can’t tell the diff

Schizophrenia – General Characteristics

• Disorganized speech & Thought– Lack insight, awareness of problem– Jump from topic to topic, talk illogically– Tangentiality, loose association– Overinclusion (word associations guide speech

“For dinner we had veal cutlets, tossed salad, and French fries, with lots of German, Polish, Spanish, and the United Snakes)

– Paralogic: “President Bush is a Texan. I come from Houston, TX. I’m the President.”

– Thought insertion or withdrawal

Schizophrenia – General Characteristics

• Disorganized behavior = Inappropriate or ineffective behaviors– Ex: wearing winter clothing on a hot

day– Ex: crying, laughing at inappropriate

times– Catatonia – no movement (- symptom)

OR rigid fixed behaviors– Flat Affect – no emotion (- symptom)

Negative Symptoms• Affective Flattening (2/3 have this) = don’t

show emotion in situations where you’d expect it

• Anhedonia = inability to feel pleasure; indifference

• Alogia = lack of meaningful speech• Avolition = lack of motivation• Cessation of personal hygiene

Other symptoms• Dissociative symptoms• Anosognosia• High rates of substance abuse

disorders• High risk of suicide• High rate of OCD / Panic Disorder• Downward drift

Onset of Schizophrenia• Chronic / Process schizophrenia

– Slow developing process– Recovery doubtful

• Acute / reactive schizophrenia– Previously well-adjusted person, in

reaction to life’s stresses, rapidly develops schizophrenia; recovery more likely

Onset statistics• Average age of onset = 15-30

– Men = usually younger than 25– Women = 26-45

• 1 % worldwide• EQUAL M/F

– Men likelihood of onset decreases with age (possible after even age 75)

– Women lower likelihood until age 36, then higher• Kids do show abnormal signs

– (more -, less +) • 78% have several episodes, not just 1• In US, Af-Am are diagnosed at a higher rate than

whites. WHY?• Could be a bias in who is tested

Neurotransmitters dopamine

• Over-activity of DA (impaired attention)• Over-sensitivity of DA receptors• Drugs mimicking DA (amphetamines,

cocaine intensify symptoms b/c they too increase DA levels)

• Anti-psychotic drugs reduce symptoms by blocking receptors for DA

Brain issues• Thalamus smaller than normal (could

explain hallucinations?)• Low activity in frontal lobes (judgment,

planning of behavior)– Major site of Dopamine activity

• Vesicles (fluid filled) larger (mostly only in men) = shrinkage of brain tissue

Prenatal factors• Pregnant women:• Exposed to the influenza virus

during 2nd trimester• Poor nutrition• Exposed to a variety of teratogens• Born in winter = greater chance

Genetic factors• 1% worldwide• 8% with sibling• 12% with 1 afflicted parent (30-40% when 2

parents have it)• 18% with Fraternal Twin• 50% with afflicted identical twin• Smooth-pursuit eye movement – watching a

pendulum swing isn’t as smooth for schizos• Most resistent to treatment of all psych

disorders (more resistant = more of a genetic factor)

Family factors• Schizophrenogenic Parenting Style –

mom who is cold, dominant, rejecting nature

• Double bind = punish for following directions OR confusing messages– Mother responds coolly to a child’s

embrace, then says “Don’t you love me anymore?” when the child withdraws…child is thinking what the heck??

• Families with high criticism, hostility, over emotional involvement

Potential causes• Big thing to know…• DIATHESIS-STRESS MODEL• 1) Genetic predisposition inherited (multiple genes)

– Tendency to exhibit certain traits / behaviors / neurological makeup, etc.

• ***Prenatal issues*** likely have some effect in here• 2) Stress (really like a trigger)

– People in war combat display temporary symptoms resembling schizophrenia

– Family factors• Schizophrenogenic mother• Double bind

Brain 27: Etiology

Sub-types of schizo• Paranoid• Disorganized• Catatonic• Undifferentiated

• See handout “Types of Schizophrenia”

Paranoid• Delusions of persecution or

grandeur. The individual may trust no one and may be anxious or angry about supposed tormenters

• Delusions, hallucinations stand out• Cognitive skills, affect in tact

Disorganized• disorganized behavior, disorganized

speech, and flat affect.  Involving a disturbance in behavior, communication, and thought. There is a lacking of any consistent theme. 

• Disruption of speech & behavior, inappropriate affect

• Self-absorbed• Delusions• More likely to be chronic

Catatonic• Odd mannerisms with bodies,

faces• Echolalia – mimic words of others• Echopraxia – mimic movement of

others

• Undifferentiated = everything else

Residual• Have had 1 episode but now no

longer have any major symptoms

Journal: Day 63• If you had to pick just 1, which of the

personality disorders best describes you? Give several general & specific reasons why you chose this answer.

• DO NOT REVEAL TO ANYONE!

Personality Disorders

• 20% of pop has at least 1• 50% of those treated for a psychiatric

disorder also have a personality disorder

• 10 PDs…2 ways to learn them…choose what works best for you

• DAN HAS BOPS• Or…• The 3 Cluster Format

NEW STUFF...Look at to Update these!

Clusters• Cluster A = odd, eccentric

– paranoid, schizoid, schizotypal• Cluster B = dramatic, emotional,

erratic– antisocial, borderline, histrionic,

narcissistic• Cluster C = anxious, fearful

– avoidant, dependent, OCPD

Paranoid• Suspicious, mistrustful, interprets

others motives as malevolent, don’t pay attention to facts that contradict thoughts

• Argumentative, complains, hostile• Refusal to go with the group in debates,

doesn’t like authority figures, fears passive surrender

• Cause: compensating for feelings of weakness– Think self is weak, so sees threats

everywhere– (2:1 M:F)

• Jake: Abnormal 411

Cluster A = odd, eccentricparanoid, schizoid, schizotypal

Schizoid• loner-type, lacks feelings for others, indifferent to

others, detached• Dopamine (too much) issues• 3.5:1 M:F• Mr. Z: 413

Schizotypal• socially isolated, behaves in unusual

ways, suspicious, odd beliefs, detached, eccentric (half-crazy), magical thinking (but not illogical)

• Ideas of reference = insignificant events relate directly to them

• Dresses strangely/unusually • A Phenotype of the schizophrenic

Genotype• About even M/F• Mr. S: 415

Cluster A = odd, eccentric

paranoid, schizoid, schizotypal

Antisocial• THE MOST COMMON (4:1 M:F; 3%,

1%)• Sociopath, violates rights of others

without remorse, immoralistic, just don’t care about hurting others

• frequently breaks the law • irritable, aggressive, manipulative• charming con-artist• little desire for the truth• If <18, called “Conduct Disorder”• Cause:

– low cortical arousal or insufficient development – cortex is childlike, impulsive

– Higher threshold for experiencing fear

• Cluster B = dramatic, emotional, erratic

– antisocial, borderline, histrionic, narcissistic

Mind 35: Mind of the Psychopath

Ryan: 417

Borderline• Instability in interpersonal relationships, mood, & self-image

• “Girl Interrupted”• Theory = abandonment depression (live

in fear of being abandoned), so they distract themselves with alternative destructing actions

• 25% have major depression; 10% have bipolar disorder (cause = link to mood disorders)

• Uses splitting see others as either awesome or horrible (idealization vs. devaluation)

• 2% of pop; (2:1 F:M)• 10% of people with this commit suicide

by age 30• Claire: 426

• Cluster B = dramatic, emotional, erratic

– antisocial, borderline, histrionic, narcissistic

Histrionic• Overly dramatic (almost acting) Excessive emotionality,

need for attention• shallow, vain, self-centered, uncomfortable if not in the

limelight, seductive in appearance/behavior• seeks reassurance/approval constantly• Angry when others don’t attend to them or praise them• Impulsive, great difficulty delaying gratification• Tend to say everything they think• Focused on repression – while seductive, represses

sex/aggression (disgusted if blatant sex appears in a movie)

• 5:1 F/M• Pat: 429

• Cluster B = dramatic, emotional, erratic

– antisocial, borderline, histrionic, narcissistic

Narcissistic• Exaggerated self-regard, self-

importance, needs constant admiration

• Lack sensitivity/compassion for others

• Grandiosity• Actually has low self-esteem,

insecure, inferiority complex underlies all thoughts

• Can be good empathizers (reciprocity desires)

• 2:1 M:F

• Cluster B = dramatic, emotional, erratic

– antisocial, borderline, histrionic, narcissistic

Avoidant• Sensitive to rejection, so avoid relationships

• Equal M/F• Jane: 432

• Cluster C = anxious, fearful

Dependent• Excessive need to be taken care

of, • Unable to make choices and

decisions independently• Overly cooperative, submissive• Yield and placate, not assertive,

clingy• Fear of abandonment• 2.5:1 F:M• Karen: 434

avoidant, dependent, OCPD

Obsessive-Compulsive

• Opposite of histrionic• highly focused thinking• attention to details• Cause: fears a lack of control

b/c something bad could happen

• Inflexible• About even M/F• Daniel: 435

• Cluster C = anxious, fearful

avoidant, dependent, OCPD

Reactive Attachment Disorder

• http://www.youtube.com/watch?v=DcAuYRp2dJs