Psychological Disorders

1
Psychological Disorders
Chapter 14
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Characteristics of Abnormality

• Distressing (Subjective Discomfort)
• causes distress or anxiety in that individual
• Problem is that people may not be feeling stress
  about their bizarre behaviors
• Dysfunction
• Inability to function effectively and adapt to
  the demands of society
• Problem is that this definition does not consider
  personal choice

• Atypical (Deviation from Average)
• Behavior is statistically rare
• Problem is that not all rare behaviors (e.g.
  genius) are abnormal
• Socially unacceptable (Deviation from Ideal)
• Behavior violates social norms
• Problem is that norms change over time and people
  do not agree on ideal behavior

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Mental Illness and the Law

• Insanity
• Legal term for mentally disturbed people who are
  not considered responsible for their criminal
  actions
• Competency
• Is the individual fit to stand trial?
• Those found insane often spend more time in
  mental institutions than they would have in prison

4
Historical Views of Psychological Disorders

• Supernatural view, where mysterious behavior was
  attributed to supernatural powers, likely
  dominated early societies
• Naturalistic View, where abnormality is
  attributed to medical problems.
• Mental hospitals and asylums were used more like
  prisons to keep the afflicted away from society
• Church dominance over culture in Middle Ages and
  lack of scientific knowledge caused the
  supernatural view to dominate through the 17th
  century.

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Historical Views of Psychological Disorders

• Enlightenment and the Triumph of Human Rights
  ALL PEOPLE HAVE RIGHTS!
• Philippe Pinel Used more humane approaches to
  treating patients in France.
• Dorothea Dix Brought these humane ideas about
  mental healthcare to the U.S.
• Deinstitutionalization of the mid-20th century
• Advent of Drug Therapies allowed people to be
  more functional in the real world.
• Rosenhan Study (1973) institutionalization not
  necessarily effective!
• Brief Film Clip tracing the history of
  understanding mental illness

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Models of the Causes of Psychological Disorders

• Humanistic-Existential Model
• Abnormal behaviors result from failure to fulfill
  ones self-potential and faulty self-image
• Client-centered and Gestalt therapies are used to
  increase self acceptance.
• Cognitive Model
• Faulty or negative thinking can cause depression
  or anxiety.
• Focus of treatment is on changing
  faulty/irrational thinking
• Diathesis-Stress model
• Biological predisposition to disorder which is
  triggered by stress
• Systems theory (biopsychosocial model)
• Model in which biological, psychological, and
  social risk factors combine to produce
  psychological disorders

• Biological model (Medical)
• Underlying cause (etiology) of mental disorders
  is biological
• Medication or medical therapies are used as
  treatments
• Learning model
• Abnormal behaviors are learned the same way as
  normal ones, through conditioning,
  reinforcements, imitation, etc. and are not
  considered symptoms of some underlying disease
  the behaviors themselves are the problem.
• Treatments consist of retraining and
  reconditioning
• Psychodynamic Model
• Abnormal behaviors represent unconscious motives
  and conflicts
• Psychoanalysis is used as treatment

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Classifying Psychological Disorders

• Diagnostic and Statistical Manual of Mental
  Disorders published by the American Psychiatric
  Association
• Describes more than 300 specific mental disorders
  and is used by most professionals
• DSM First edition published in 1952
• DSM-II Revised in 1968 to reflect changing
  culture
• DSM-III Revised in 1977 to describe mental
  disorders in greater detail
• DSM-III-R clarified and updated DSM-III
• DSM-IV Published in 1994 with revisions
• DSM-IV-TR Released in 2000, text revision
• Criticisms
• Disorders classified as diseases
• Many of the symptoms have nothing to do with
  mental illness
• Stereotypes and expectations based on labels can
  be damaging

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Classifying Psychological Disorders

• DSM-IV evaluates individuals according to five
  dimensions or axes, thus rendering it a
  multiaxial system of classification.
• Axis I Mental disorder or learned disorder that
  might be present (Anxiety Disorders)
• Axis II Personality disorder or mental
  retardation that might be present
• Axis III Physical or medical disorders that
  might be present, such as diabetes, hypertension,
  or arthritis
• Axis IV Rates the severity of psychosocial
  stressors such as school or housing issues in the
  individuals life during the past year
• Axis V Assess the level of adaptive functioning
  currently and during the past year on Global
  Assessment of Functioning Scale (GAF) 0-100.

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The Prevalence of Psychological Disorders

• In a 2001 survey, 14.9 of respondents reported
  experiencing some type of clinically significant
  mental disorder
• Six percent were suffering from substance abuse
• Most common disorders were anxiety, phobias, and
  mood disorders

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Anxiety Disorders
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Anxiety Disorders
Defining Anxiety Anxiety is a general feeling of
fear and apprehension that may be related to an
object or event and is often accompanied by
increased physiological arousal.
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Causes of Anxiety Disorders

• Conditioning
• For example, phobias can be learned through
  classical conditioning
• Feelings of not being in control can lead to
  anxiety
• Predisposition to anxiety disorders may be
  inherited (genetic)
• Displacement or repression of unacceptable
  thoughts or impulses can lead to anxiety

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Types of Anxiety DisordersGeneralized Anxiety
Disorder

• Prolonged vague but intense fears not attached to
  any particular object or circumstance
• Often results from Free-Floating Anxiety
  anxiety not attached to any particular event or
  object
• Difficult to treat

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Types of Anxiety Disorders Panic Disorder

• Recurrent panic attacks in which the person
  experiences intense terror without cause
• Person is often left with fear of having another
  panic attack
• Can lead to agoraphobia

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Types of Anxiety Disorders Phobic Disorders

• Intense fear of specific situations or objects
• Agoraphobia
• Intense fear of crowds and public places or other
  situations that require separation from source of
  security, such as the home
• Social phobia
• Excessive fear of social situations
• Fear of scrutiny of others
• Specific Phobia
• Common phobias include animals, heights, closed
  places, needles

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Types of Anxiety DisordersObsessive Compulsive
Disorder

• Driven to disturbing thoughts (obsessions) and/or
  performing senseless rituals (compulsions)
• Individual recognizes behavior is excessive but
  cannot stop without experiencing anxiety.
• Washers and Checkers
• Hoarding Touching

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Types of Anxiety DisordersPost-Traumatic Stress
Disorder

• Psychologically distressing experience continues
  to plague individual after the fact and causes
  anxiety.
• Could result from either personally experiencing
  or witnessing a life-threatening situation
• Often linked with combat or rape

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Psychosomatic and Somatoform Disorders
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Somatoform Disorders

• Somatoform Disorders
• Physical symptoms without any physical cause
• Person experiences symptoms as real
• Contrast with Psychosomatic Disorders
• Real physical illness with psychological causes
  such as stress or anxiety
• Tension headaches, for example
• Research indicates that most, if not all,
  illnesses may have a psychosomatic component

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Causes of Somatoform Disorders

• Freud
• Symptoms related to traumatic experience in the
  past
• Cognitive-behavioral
• Examines ways in which the behavior is being
  rewarded, either tangibly or mentally
• Biological perspective
• May be real physical illnesses that are
  misdiagnosed or overlooked

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Types of Somatoform Disorders

• Somatization Disorder vague, recurrent physical
  symptoms plentiful and unrelated and
  unresponsive to medical treatment (back pain,
  dizziness, stomach pains, etc.)
• Conversion Disorder sudden but temporary loss
  of physical functions triggered by psychological
  factors.
• La belle indifference apathy over loss of
  functioning.
• Glove anesthesia lack of feeling in hand only
  neurologically impossible.
• Hypochondriasis without physical evidence,
  individual believes they have a serious illness
• Body Dysmorphic Disorder preoccupation with a
  minor physical anomaly to the point of
  dysfunction.

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Somatoform

• Somatization disorder- Vague, recurring physical
  symptoms with no cause (back pain, dizziness,
  stomach pains, etc.)
• Conversion Disorder -Conversion of emotional
  difficulties into the loss of a specific
  physiological function
• If stuck with a pin, a limb will have no feeling
• glove anesthesia- lack of feeling from the hand
  down
• Hypocondriasis - A person who is in good health
  becomes preoccupied with imaginary ailments (a
  cough becomes a serious disease
• BDD- Body Dysmorphic Disorder- imagined ugliness

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Dissociative Disorders
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Dissociative Disorders

• Disorders in which conscious awareness becomes
  separated from previous memories, thoughts and
  feelings.
• Dissociative disorders are characterized by a
  sudden but temporary alteration in consciousness,
  identity, sensory/motor behavior, or memory.
• These disorders are relatively rare, but quite
  noticeable.

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Causes of Dissociative Disorders

• Seems to involve unconscious processes
• Memory impairments may also include biological
  factors such as normal aging and Alzheimers
  disease
• Dissociation is common with use of some drugs
  such as LSD
• Trauma is often involved

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Dissociative Disorders

• Dissociative amnesia
• Loss of memory without a physical cause
• Dissociative fugue
• Involves flight from home and adoption of a new
  identity and amnesia for past events
• Depersonalization disorder
• Person suddenly feels strangely changed or
  different outside self
• Dissociative identity disorder
• Person has several distinct personalities that
  emerge at different times
• Previously called multiple personality disorder

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Sexual Disorders
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Sexual Disorders

• Include a range of sexual problems typically
  divided into two categories
• sexual dysfunctions
• sexual desire disorders, known as paraphilias.
• Difficult to diagnose!
• Sexuality is a private thing
• Difficult to label acts as abnormal or normal
  
• Kinseys research?
• Additionally, must people be diagnosed for desire
  or for acts or both?
• Key factor in definition of sexual disorders it
  causes the individual stress and anxiety. This
  is a sign that something is wrong, no matter how
  acceptable or unacceptable the desire or behavior
  may be to the rest of society.

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Sexual Dysfunction

• Sexual dysfunctions involve an impairment of
  normal sexual functioning.
• This can refer to an inability to perform or
  reach an orgasm, painful sexual intercourse, a
  strong repulsion of sexual activity, or an
  exaggerated sexual response cycle or sexual
  interest. 
• A medical cause must be ruled out prior to making
  any sexual dysfunction diagnosis and the symptoms
  must be hindering the person's everyday
  functioning.

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Sexual Dysfunction

• Erectile disorder
• Inability of a man to achieve or maintain an
  erection
• Female sexual arousal disorder
• Inability of a woman to become sexually aroused
  or reach orgasm
• Sexual aversion disorders
• Lack of sexual interest or active distaste for sex

• Orgasmic disorders
• Inability to reach orgasm in a person who has
  sexual desire and can maintain arousal
• Premature ejaculation
• Males inability to inhibit orgasm as long as
  desired
• Vaginismus
• Involuntary muscle spasms in the outer part of
  the vagina making intercourse impossible

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Sexual Dysfunction
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Paraphilias

• Paraphilias all have in common distressing and
  repetitive sexual fantasies, urges, or
  behaviors. 
• Must occur for a significant period of time
• Must interfere with either satisfactory sexual
  relations or everyday functioning if the
  diagnosis is to be made. 
• There is also a sense of distress within these
  individuals
• Typically recognize the symptoms as negatively
  impacting their life
• Feel as if they are unable to control the symptoms

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Paraphilias

• Transvestic fetishism
• Wearing clothing of the opposite sex to achieve
  sexual arousal
• Sexual sadism
• Obtain sexual gratification by humiliating or
  physically harming a sex partner
• Sexual masochism
• Inability to enjoy sex without physical or
  emotional pain
• Pedophilia
• Preferred desire to have sex with children

• Fetishism
• Non-human object is preferred method of sexual
  excitement
• Voyeurism
• Desire to watch others having sex or undressing
• Exhibitionism
• Compulsion to expose ones genitals to achieve
  sexual arousal
• Frotteurism
• Touching or rubbing against a non-consenting
  person in public

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Gender-Identity Disorders

• Involves a desire to become, or insistence that
  one really is, a member of the other sex
• Usually begins in childhood
• Most develop normal gender identity in adulthood
• Sex reassignment surgery is an option for adults
  who have this disorder
• Causes are not known

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Mood Disorders
Woh woh.
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Mood Disorders

• Mood disorders are characterized by ongoing,
  dysfunctional emotional patterns
• Mood disorders are also referred to as affective
  disorders
• An affect is another word for an emotion
• Mood disorders come in two general categories,
  depressive disorders and bipolar disorders

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Causes of Mood Disorders

• Biological factors
• Twin studies suggest genetic factors play a role
• Mood disorders may be linked to chemical
  imbalances in the brain
• Psychological factors
• Cognitive distortions Maladaptive response to
  early negative life events that leads to feelings
  of incompetence and unworthiness
• These responses are reactivated whenever a new
  situation arises that resembles the original
  events
• Social factors
• Depression is linked to troubled close
  relationships
• May explain greater incidence of depression in
  women, who tend to be more relationship-oriented
• Depressed people can evoke anxiety and hostility
  in others, who then withdraw, which in turn can
  intensify feelings of depression

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Treatment of Mood Disorders

• In most cases, mood disorders are treated with a
  combination of drug therapy and talk therapy.
• In some extreme cases when these methods do not
  work, ECT has been effective.
• used rarely if all other treatments fail
• Used if suicide is a threat
• Not as heinous as depicted in films
• Many more women are diagnosed with mood disorders
  than men.
• Psychologists have been researching both
  biological and cultural causes for this.

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Suicide

• 19,000 people commit suicide in the U.S. every
  year, the 11th leading cause of death
• More women than men attempt suicide, but more men
  succeed

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Depression

• General Symptoms
• Overwhelming feelings of sadness
• Lack of interest in activities
• Excessive guilt or feelings of worthlessness
• Types
• Major depressive disorder
• Intense symptoms that may last for several months
• Dysthymic Disorder
• Less intense, but may last for periods of two
  years or more
• Seasonal Affective Disorder (SAD)
• symptoms of depression triggered by weather
  patterns (melatonin hypersensitivity)

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Bipolar Disorder

• Characterized by alternating between depression
  and mania
• Manic-Depressive Disorder (Kelsey and Chase)
• Periods of normal mood may come between bouts of
  depression and mania
• Symptoms of Mania include
• Feelings of euphoria
• Extreme physical activity
• Excessive talkativeness
• Grandiosity
• Mania rarely occurs alone it is typically part
  of manic-depressive disorder
• Much less common than depression
• Stronger biological component than depression
• Cyclothemia less intense mood swings

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Personality Disorders
43
Personality Disorders

• Disorders in which maladaptive ways of thinking
  and behaving learned early in life cause distress
  in the person and/or conflicts with others
• Axis II in DSM
• Rate among prisoners is close to 50
• They are often easy to identify in others, but
  difficult to treat
• Personality disorders are grouped by the DSM into
  three groups or clusters

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Types of Personality Disorders The Three
Clusters

• Cluster A Odd or Eccentric Behavior
• Paranoid
• Very suspicious of others
• Schizoid
• Withdrawn and lacks feelings for others

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Types of Personality Disorders The Three
Clusters

• Cluster B Dramatic or Erratic Behavior
• Histrionic (Hysterical)
•  Attention-hungry
• drama-queen
• Narcissistic
• exaggerated sense of self-importance
• Antisocial - Ted Bundy
• Violates social norms
• Enjoys harming others
• Conduct Disorder
• Borderline
• Unpredictable, impulsive and sometimes
  destructive behavior
• Chaotic relationships

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Types of Personality Disorders The Three
Clusters

• Cluster C Anxious or Inhibited Behavior
• Avoidant
• Fearful of social interactions
• Feels inferior 
• Dependent
• Uncomfortable being alone
• Uncomfortable making decisions  
• Obsessive-Compulsive
• Obsessed with order, lists, organizing
• Need for control over all aspects of life 

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Spotlight Causes of Antisocial Personality
Disorder

• Combination of biological predisposition, adverse
  psychological experiences, and an unhealthy
  social environment
• Also possible link to damaged frontal lobe during
  infancy
• Emotional deprivation during childhood may lead
  to antisocial tendencies

I enjoy long walks on the beach, soft music, oh,
and killing people.
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Schizophrenia
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Schizophrenic Disorders

• Schizophrenia is the most debilitating and
  complex of all the psychological disorders.
• Diverse symptoms one common denominator
  psychoticism
• Being psychotic means that the individual is
  suffering from a break with reality that inhibits
  their ability to function.
• Additionally, there is ongoing evidence of
  deteriorating social and intellectual
  functioning.
• The diagnosis must be made before age 45 and
  symptoms must persist for at least 6 months.
• The Schizophrenic Experience

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Schizophrenic Disorders

• Most cases of schizophrenia are treated with
  antipsychotic medication.
• When these medications first were introduced,
  they only treated some of the symptoms of the
  disorder
• Tardive dyskinesia in long-term patients
• Medications used now better treat both the
  positive and negative symptoms of the disease.
• Positive symptoms are symptoms people with
  schizophrenia experience, but normal people do
  not
• Hallucinations, delusions, disorganized thought,
  movements
• Negative symptoms are behaviors that occur
  normally, but do not in schizophrenics
• Flat affect, minimal speech

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Schizophrenic Disorders Symptoms

• Symptoms have further been categorized by the
  effect they have on functioning disturbances of
  thought, perception, and emotions
• Thought Disturbances
• Delusions - False beliefs about reality
• Language Disturbances
• Clang rhyming speech pattern (The run sun done
  the gun don't drink drown down, brown gown." )
• Neologism making up new words
• Loose Association words dont hold together
  language does not make sense ("I need to go to
  the store to buy some band-aids. I read an
  article about how expensive AIDS drugs are.
  People take too many street drugs. The streets
  should be clean from the rain today, etc" )
• Echolalia repeating words over and over
• Perceptual Disturbances 
• Hallucinations - Sensory experiences without
  external stimulation
• Emotional Disturbances
• Flat Affect having no emotion
• Ambivalent Affect having erratic emotional
  responses

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Causes of Schizophrenia

• Biological predisposition to schizophrenia may be
  inherited
• Twin studies show genetic link
• Excessive levels of dopamine lead to psychotic
  symptoms
• Abnormalities of brain structures
• Abnormal patterns of connections between brain
  cells
• May involve family relationships and social class

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Types of Schizophrenic Disorders

• Disorganized schizophrenia
• Bizarre and childlike behavior
• May engage in incoherent conversations
• Catatonic schizophrenia
• Can alternate between a catatonic state (mute and
  immobile) and an overly active state (overly
  excited and shouting)

• Paranoid schizophrenia
• Marked by extreme suspiciousness and complex
  delusions
• Undifferentiated schizophrenia
• Clear symptoms of schizophrenia that do not meet
  criteria for other subtypes
• Cases
• Gerald 1
• Gerald 2
• Heather

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Childhood Disorders
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Defining Childhood Disorders

• Disorders Usually First Diagnosed in Infancy,
  Childhood, or Adolescence
• Example Categories
• Mental Retardation
• Pervasive Developmental Disorder (Autism,
  Aspergers)
• Disruptive Behavior Disorders (AD/HD, Conduct
  Disorder, ODD)
• Tic Disorders (Tourettes)
• Feeding Disorders (Pica, Rumination Disorder)

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Childhood Disorders Developmental Disorders

• Autistic Disorder
• Qualitative impairment in social interaction
• Qualitative impairments in communication
• Restricted repetitive and stereotyped patterns of
  behavior, interests, and activities 
• Aspergers Disorder
• Qualitative impairment in social interaction
• Restricted repetitive and stereotyped patterns of
  behavior, interests, and activities
• No language or cognitive limitations limitation
  is mostly social

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Childhood DisordersDisruptive Behavior
Disorders

• AD/HD (Attention Deficit/Hyperactivity Disorder)
• 6 month history of behaviors involving multiple
  symptoms of inattention, impulsivity and
  hyperactivity that disrupt normative development
• Use of psychostimulants for treatment (Ritalin,
  Adderall)
• ODD (Oppositional Defiant Disorder)
• A pattern of negativistic, hostile, and defiant
  behavior lasting at least 6 months
• Impairs social, academic, or occupational
  functioning
• Conduct Disorder
• A repetitive and persistent pattern of behavior
  in which the basic rights of others or major
  age-appropriate societal norms or rules are
  violated
• Aggression to people and animals
• Destruction of property
• Deceitfulness or theft
• Serious violations of rules
• Antisocial disorder?

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Childhood DisordersTic Disorder Feeding
Disorders

• Tic Disorders
• A tic is a sudden, rapid, recurrent, nonrhythmic,
  stereotyped motor movement or vocalization
• The tics occur many times a day (usually in
  bouts) nearly every day or intermittently
  throughout a period of more than 1 year
• Example Tourettes Disorder (includes motor and
  vocal tics)
• Feeding Disorders
• Pica
• Persistent eating of nonnutritive substances for
  a period of at least 1 month. 
• The eating of nonnutritive substances is
  inappropriate to the developmental level (older
  than 18-24 mos)
• clay, dirt, sand, stones, pebbles, hair, feces,
  lead, laundry starch, vinyl gloves, plastic,
  pencil erasers, ice, fingernails, paper, paint
  chips, coal, chalk, wood, plaster, light bulbs,
  needles, string, cigarette butts, wire, and burnt
  matches.
• Rumination Disorder
• Repeated regurgitation and rechewing of food for
  a period of at least 1 month following a period
  of normal functioning. 
• The behavior is not due to an associated
  gastrointestinal or other general medical
  condition (e.g., esophageal reflux). 

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Trends in Psychological Disorders
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Gender Differences

• More women are in treatment for psychological
  disorders
• Men who are divorced or separated, or who never
  married, have a higher rate of mental disorders
• Married women have higher rates than married men
• Women have higher rates of anxiety disorders and
  depression

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Cultural Differences

• Many disorders occur only in particular cultural
  groups
• Prevalence of some disorders among
  males/females/children differs markedly by culture

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Prevalence of Mental Disorders