Psychological Disorders

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Chapter 14

• Psychological Disorders

• PowerPoint Presentation
• by Jim Foley

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A Psychological disorder is

• A significant dysfunction in an individuals
  cognitions, emotions, or behaviors.

More Understandings about disorders

• Disorders are diagnosed when there is
  dysfunction, behaviors which are considered
  maladaptive because they interfere with ones
  daily life
• Disorders are diagnosed when the symptoms and
  behaviors are accompanied by Distress, suffering.
  
• New definition (DSM 5) a disturbance in the
  psychological, biological, or developmental
  processes underlying mental functioning.

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The Medical Model
The discovery that the disease of syphilis causes
mental symptoms (by infecting the brain)
suggested a medical model for mental illness.

• Psychological disorders can be seen as
  psychopathology, an illness of the mind.
• Disorders can be diagnosed, labeled as a
  collection of symptoms that tend to go together.
• People with disorders can be treated, attended
  to, given therapy, all with a goal of restoring
  mental health.

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The Biopsychosocial Approach
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Classifying Psychological Disorders

• The Diagnostic and Statistical Manual
• Its easier to count cases of autism if we have a
  clear definition.
• Versions DSM-IV-TR, DSM-V (May 2013)
• The DSM is used to justify payment for treatment.
• Its consistent with diagnoses used by medical
  doctors worldwide.

• Why create classifications of mental illness?
  What is the value of talking about diagnoses
  instead of just talking about individuals?
• Diagnoses create a verbal shorthand for referring
  to a list of associated symptoms.
• Diagnoses allow us to statistically study many
  similar cases, learning to predict outcomes.
• Diagnoses can guide treatment choices.

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The Five Axis of Diagnosis
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Anxiety Disorders Our self-protective,
risk-reduction instincts in overdrive

• Generalized Anxiety Disorder Painful worrying
• Panic Disorder Fear of the next attack
• Phobias Dont even show me a picture
• OCD I know it doesnt make sense, but I cant
  help it
• PTSD Stuck Re-experiencing Trauma

• Causes of Anxiety Disorders
• Fear Conditioning
• Observational Learning
• Genetic/Evolutionary Predispositions
• Brain involvement

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GAD Generalized Anxiety Disorder

• Emotional-cognitive symptoms include worrying,
  having anxious feelings and thoughts about many
  subjects, and sometimes free-floating anxiety
  with no attachment to any subject. Anxious
  anticipation interferes with concentration.
• Physical symptoms include autonomic arousal,
  trembling, sweating, fidgeting, agitation, and
  sleep disruption.

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Panic Disorder Im Dying

• A panic attack is not just an anxiety attack.
  It may include
• many minutes of intense dread or terror.
• chest pains, choking, numbness, or other
  frightening physical sensations.
• a feeling of a need to escape.
• Panic disorder refers to repeated and unexpected
  panic attacks, as well as a fear of the next
  attack.

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Specific Phobia

• A specific phobia is more than just a strong fear
  or dislike. A specific phobia is diagnosed when
  there is an uncontrollable, irrational, intense
  desire to avoid the some object or situation.
  Even an image of the object can trigger a
  reaction--GET IT AWAY FROM ME!!!--the
  uncontrollable, irrational, intense desire to
  avoid the object of the phobia.

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Some Fears and Phobias

• Which varies more, fear or phobias? What does
  this imply?

Some Other Phobias
Agoraphobia is the avoidance of situations in
which one will fear having a panic attack.
Social phobia an intense fear of being watched
and judged by others, often showing as a fear of
possibly embarrassing public appearances.
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Obsessive-Compulsive Disorder OCD

• Obsessions are intense, unwanted worries, ideas,
  and images that repeatedly pop up in the mind.
• A compulsion is a repeatedly strong feeling of
  needing to carry out an action, even though it
  doesnt feel like it makes sense.
• When is it a disorder?
• Distress when you are deeply frustrated with not
  being able to control the behaviors
• or
• Dysfunction when the time and mental energy
  spent on these thoughts and behaviors interfere
  with everyday life

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Common OCD Behaviors
Percentage of children and adolescents with OCD
reporting these obsessions or compulsions

• Common pattern RECHECKING Although you know that
  youve already made sure the door is locked, you
  feel you must check again. And again.

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Post-Traumatic Stress Disorder PTSD
About 10 to 35 percent of people who experience
trauma not only have burned-in memories, but also
four weeks to a lifetime of

• repeated intrusive recall of those memories.
• nightmares and other re-experiencing.
• social withdrawal or phobic avoidance.
• jumpy anxiety or hypervigilance.
• insomnia or sleep problems.

• Which people develop PTSD?
• Those with sensitive emotion-processing limbic
  systems
• Those who are asked to relive their trauma as
  they report it
• Those previously traumatized

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Observational Learning and Anxiety

• Experiments with humans and monkeys show that
  anxiety can be acquired through observational
  learning. If you see someone else avoiding or
  fearing some object or creature, you might pick
  up that fear and adopt it even after the original
  scared person is not around.
• In this way, fears get passed down in families.

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Cognition and Anxiety

• Cognition includes worried thoughts, as well as
  interpretations, appraisals, beliefs,
  predictions, and ruminations.
• Cognition includes mental habits such as
  hypervigilance (persistently watching out for
  danger). This accompanies anxiety in PTSD.
• In anxiety disorders, such cognitions appear
  repeatedly and make anxiety worse.

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Mood Disorders

• Major depressive disorder MDD is
• more than just feeling down.
• more than just feeling sad about something.

• Bipolar disorder is
• more than mood swings.
• depression plus the problematic overly up mood
  called mania.

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Criteria of Major Depressive Disorders
Major depressive disorder is not just one of
these symptoms. It is one or both of the first
two, PLUS three or more of the rest.

• Depressed mood most of the day, and/or
• Markedly diminished interest or pleasure in
  activities
• Significant increase or decrease in appetite or
  weight
• Insomnia, sleeping too much, or disrupted sleep
• Lethargy, or physical agitation
• Fatigue or loss of energy nearly every day
• Worthlessness, or excessive/inappropriate guilt
• Daily problems in thinking, concentrating, and/or
  making decisions
• Recurring thoughts of death and suicide

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Depression is Everywhere

• Depression shows up in people seeking treatment
• Phobias are the most common (frequently
  experienced) disorder, but depression is the 1
  reason people seek mental health services.
• Depression appears worldwide
• Per year, depressive episodes happen to about 6
  percent of men and about 9 percent of women.
• Over the course of a lifetime, 12 percent of
  Canadians and 17 percent of USA residents
  experience depression.

• Depression The Common Cold of Disorders?
• Although both are common (occurring frequently
  and pervasively), comparing depression to a cold
  doesnt work.
• Depression
• is more dangerous because of suicide risk.
• has fewer observable symptoms.
• is more lasting than a cold, and is less likely
  to go away just with time.
• is much less contagious.
• Anddepressive pain is beyond sniffles.

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Bipolar Disorder

• Bipolar disorder was once called
  manic-depressive disorder.
• Bipolar disorders two polar opposite moods are
  depression and mania.

Mania refers to a period of hyper-elevated mood
that is euphoric, giddy, easily irritated,
hyperactive, impulsive, overly optimistic, and
even grandiose.
Contrasting Symptoms Contrasting Symptoms
Depressed mood stuck feeling down, with Mania euphoric, giddy, easily irritated, with
exaggerated pessimism social withdrawal lack of felt pleasure inactivity and no initiative difficulty focusing fatigue and excessive desire to sleep exaggerated optimism hypersociality and sexuality delight in everything impulsivity and overactivity racing thoughts the mind wont settle down little desire for sleep
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Understanding Mood Disorders

• Why are mood disorders so pervasive, especially
  among women?

Women, starting in adolescence, appear to
ruminate more, have deeper sadness then men,
encounter more stressors, and report their
depression more readily.
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Biology of Depression Genetics

• Evidence of genetic influence on depression
• DNA linkage analysis reveals depressed gene
  regions
• twin/adoption heritability studies

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Biology of Depression The Brain

• Brain activity is diminished in depression and
  increased in mania.
• Brain structure smaller frontal lobes in
  depression and fewer axons in bipolar disorder
• Brain cell communication (neurotransmitters)
• more norepinephrine (arousing) in mania, less in
  depression
• reduced serotonin in depression

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Understanding Mood Disorders The
Social-Cognitive Perspective
Discounting positive information and assuming the
worst about self, situation, and the future
Self-defeating beliefs such as assuming that one
(self) is unable to cope, improve, achieve, or be
happy
Depression is associated with
Stuck focusing on whats bad
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Depressive Explanatory Style
How we analyze bad news predicts mood.
Problematic event
Assumptions about the problem
The problem is
The problem is
The problem is

• Mood/result that goes along with these views

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Depressions Vicious Cycle

• A depressed mood may develop when a person with a
  negative outlook experiences repeated stress.

The depressed mood changes a persons style of
thinking and interacting in a way that makes
stressful experience more likely.
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Schizophrenia

• the mind is split from reality, e.g. a split from
  ones own thoughts so that they appear as
  hallucinations.

Psychosis refers to a mental split from reality
and rationality.

• Schizophrenia symptoms include
• disorganized and/or delusional thinking.
• disturbed perceptions.
• inappropriate emotions and actions.

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Positive and Negative Symptoms of Schizophrenia
Positive presence of problematic behaviors
Negative - absence of healthy behaviors

• Flat affect (no emotion showing in the face)
• Reduced social interaction
• Anhedonia (no feeling of enjoyment)
• Avolition (less motivation, initiative, focus on
  tasks)
• Alogia (speaking less)
• Catatonia (moving less)

• Hallucinations (illusory perceptions), especially
  auditory
• Delusions (illusory beliefs), especially
  persecutory
• Disorganized thought and nonsensical speech
• Bizarre behaviors

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Schizophrenia SymptomsProblems in Thinking and
Speaking

• Disorganized speech, including the word salad
  of loosely associated phrases
• Delusions (illusory beliefs), often bizarre and
  not just mistaken most common are delusions of
  grandeur and of persecution
• Problems with selective attention, difficulty
  filtering thoughts and choosing which thoughts to
  believe and to say out loud

? ! ? !
? ! ? !
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Schizophrenia SymptomsDisturbed Perceptions
Youre evil!
Am I evil?

• People with schizophrenia often experience
  hallucinations, that is, perceptual experiences
  not shared by others.
• The most common form of hallucination is hearing
  voices that no one else hears, often with
  upsetting (e.g. shaming) content.
• Hallucinations can also be visual,
  olfactory/smells, tactile/touch, or
  gustatory/taste.

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Schizophrenia SymptomsInappropriate Emotions
and Actions

• Odd and socially inappropriate responses such as
  looking bored or amused while hearing of a death
• Flat affect facial/body expression is flat
  with no visible emotional content
• Impaired perception of emotions, including not
  reading others intentions and feelings
• The schizophrenic body exhibits symptoms such as
  
• repetitive behaviors such as rocking and rubbing.
  
• catatonia, such as sitting motionless and
  unresponsive for hours.

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Onset and Development of Schizophrenia

• Course of Schizophrenia
• Acute/Reactive Schizophrenia In reaction to
  stress, some people develop positive symptoms
  such as hallucinations.
• Recovery is likely.
• Chronic/Process Schizophrenia develops slowly,
  with more negative symptoms .
• With treatment and support, there may be periods
  of a normal life, but not a cure.
• Without treatment, this type of schizophrenia
  often leads to poverty and social problems.

• Onset Typically, schizophrenic symptoms appear
  at the end of adolescence and in early adulthood,
  later for women than for men.
• Prevalence Nearly 1 in 100 people develop
  schizophrenia, slightly more men than women.
• Development The course of schizophrenia can be
  acute/reactive or chronic.

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Subtypes of Schizophrenia
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Understanding Schizophrenia

• Whats going on in the brain in schizophrenia?

Abnormal brain structure and activity

• Too many dopamine/D4 receptors help to explain
  paranoia and hallucinations its like taking
  amphetamine overdoses all the time.
• Poor coordination of neural firing in the frontal
  lobes impairs judgment and self-control.
• The thalamus fires during hallucinations as if
  real sensations were being received.
• There is general shrinking of many brain areas
  and connections between them.

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Understanding Schizophrenia

• Schizophrenia is more likely to develop in babies
  born
• during and after flu epidemics.
• in densely populated areas.
• a few months after flu season.
• after mothers had the flu during the second
  trimester, or had antibodies showing viral
  infection.
• The lesson is to

• Are there biological risk factors affecting early
  development?

Biological Risk Factors
Schizophrenia is somewhat more likely to develop
when one or more of these factors is present

• low birth weight
• maternal diabetes
• older paternal age
• famine
• oxygen deprivation during delivery
• maternal virus during mid-pregnancy impairing
  brain development

get flu shots with early fall pregnancies.
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Understanding Schizophrenia

• Are there genetic risk factors? If so, we would
  see more similar schizophrenia risk shared
  between identical twins than fraternal twins
  (graph below). Do we?

Genetic Factors
If one twin has schizophrenia, the chance of the
other one also having it are much greater if the
twins are identical.
Having adoptive siblings (or parents) with
schizophrenia does not increase the likelihood of
developing schizophrenia.
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Understanding Schizophrenia
Genetic and Prenatal Causes

• Even in quadruplets, genetics do not fully
  predict schizophrenia.
• This could be because of environmental
  differences.
• First difference twins in separate placentas.

• The Genain quadruplets share genes and all have
  schizophrenia but at different levels of
  severity genes may interact with environment to
  produce this pattern.

Only one of two twins has the enlarged ventricles
seen in schizophrenia.
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• Dissociation a separation of conscious
  awareness from thoughts, memory, bodily
  sensations, feelings, or even from identity.
• Dissociative disorder dysfunction and distress
  caused by chronic and severe dissociation.

Dissociative Disorders
Examples
Dissociative Fugue state
Fugue Running away wandering away from ones
life, memory, and identity, with no memory of them
Dissociative Identity Disorder (D.I.D.)
Development of separate personalities
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Dissociative Identity Disorder (D.I.D.) formerly
Multiple Personality Disorder

• Alternative Explanations for D.I.D.
• Dissociative identities might just be an
  extreme form of playing a role.
• D.I.D. in North America might be a recent
  cultural construction, similar to the idea of
  being possessed by evil spirits.
• Cases of D.I.D. might be created or worsened by
  therapists encouraging people to think of
  different parts of themselves.

• In the rare actual cases of D.I.D., the
  personalities
• are distinct, and not present in consciousness at
  the same time.
• may or may not appear to be aware of each other.

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D.I.D., or DID Not? Evidence that D.I.D. is Real

• Different personalities have involved
• different brain wave patterns.
• different left-right handedness.
• different visual acuity and eye muscle balance
  patterns.
• Patients with D.I.D. also show heightened
  activity in areas of the brain associated with
  managing and inhibiting traumatic memories.

Explaining fragmentation of personality from
different perspectives Psychoanalytic
perspective diverting id Cognitive
perspective coping with abuse Learning
perspective dissociation pays Social
influence therapists encourage
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Eating Disorders

• These may involve
• unrealistic body image and extreme body ideal.
• a desire to control food and the body when ones
  situation cant be controlled.
• cycles of depression.
• health problems.

Anorexia nervosaBulimia nervosaBinge-eating
disorder
Definition Prevalence
Anorexia Nervosa Compulsion to lose weight, coupled with certainty about being fat despite being 15 percent or more underweight 0.6 percent meet criteria at some time during lifetime
Bulimia Nervosa Compulsion to binge, eating large amounts fast, then purge by losing the food through vomiting, laxatives, and extreme exercise 1.0 percent
Binge-Eating Disorder Compulsion to binge, followed by guilt and depression 2.8 percent
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Eating Disorders Associated Factors

• Family factors
• having a mother focused on her weight, and on
  childs appearance and weight
• negative self-evaluation in the family
• for bulimia, if childhood obesity runs in the
  family
• for anorexia, if families are competitive,
  high-achieving, and protective
• Cultural factors
• unrealistic ideals of body appearance

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Personality Disorders
Personality disorders are enduring patterns of
social and other behavior that impair social
functioning.

• There are three clusters/categories of
  personality disorders.
• Anxious e.g., Avoidant P.D., ruled by fear of
  social rejection
• Eccentric/Odd e.g. Schizoid P.D., with flat
  affect, no social attachments
• Dramatic e.g. Histrionic, attention-seeking
  narcissistic, self-centered antisocial, amoral

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Antisocial Personality Disorder APD

• Antisocial personality disorder Persistently
  acting without conscience, without a sense of
  guilt for harm done to others (strangers and
  family alike).
• The diagnostic criteria include a pattern of
  violating the rights of others since age 15,
  including three of these

Deceitfulness Disregard for safety of self or
others Aggressiveness Failure to conform to
social norms Lack of remorse Impulsivity and
failure to plan ahead Irritability Irresponsibilit
y regarding jobs, family, and money
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Which Kids May Develop APD as Adults?

• Biological APD Risk Factors
• Antisocial or unemotional biological relatives
  increases risk.
• ? Some associated genes have been identified.
• Lower levels of stress hormones and low
  physiological arousal in stressful situations
• Fear conditioning is impaired.
• Reduced prefrontal cortex tissue leads to
  impulsivity.
• Substance dependence is more likely.

• About half of children with persistent antisocial
  behavior develop lifelong APD.
• Which kids are at risk? Psychological factors
• those who in preschool were impulsive,
  uninhibited, unconcerned with social rewards, and
  low in anxiety.
• those who endured child abuse, and/or
  inconsistent, unavailable caretaking.

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Antisocial PD ? Criminality
Many career criminals do show empathy and
selflessness with family and friends. Many people
with A.P.D. do not commit crimes.
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Antisocial Crime Associated factors

• Though antisocial personality disorder is not a
  full picture of most criminal activity, what can
  we say about people who commit crime, especially
  violent crime?

Lower levels of physiological arousal (measured
here as adrenaline levels) under stress may
enable taking violent action without feeling
anxiety or panic.
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Biosocial Roots of Crime The Brain

• People who commit murder seem to have less tissue
  and activity in the part of the brain that
  suppresses impulses.

• Other differences include
• less amygdala response when viewing violence.
• an overactive dopamine reward-seeking system.

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How common are psychological disorders?

• Countries vary greatly in the percentage of
  people reporting mental health issues in the past
  year.

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Rates of Psychological Disorders

• This list takes a closer look at the past-year
  prevalence of various mental health diagnoses in
  the United States.

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Vulnerable factors and ages for developing Mental
Disorders

• Age of vulnerability
• Many disorders begin to show symptoms by early
  adulthood.
• Developing on average around age 20 OCD,
  Schizophrenia, Bipolar, Alcohol Dependence.
• Showing some signs earlier Phobias (median age
  10) and antisocial personality disorder (some
  symptoms by age 8)
• Developing later than 20 Major Depressive
  Disorder.

• Who is vulnerable to
• mental disorders?
• Poverty increases the risk of many mental
  disorders including aggression and anxiety.
  Disorders decrease when poverty is lifted.
• Immigrant paradox Despite the stress of
  immigrating, those who immigrate to the U.S.A.
  have a lower risk of disorders than their
  children born in the U.S.A.

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Outcomes for People with Psychological Disorders

• There are risks to be watchful of, obstacles to
  be overcome, and improvements to be made, often
  with the help of with treatment.
• Some people with psychological disorders do not
  recover.
• Some achieve greatness, even with a psychological
  disorder.