Psychological Disorders and Their Treatment

1
Psychological Disorders
2
Prevalence of Psychological Disorders

• In a year in the U.S.
• 20 of persons experience psychological problems
  severe enough to adversely affect their daily
  living.
• 40 of persons experience at least mild mental
  health problems.
• About 2.1 million people are admitted to
  hospitals due to serious psychological problems.
• Worldwide
• About 400 million people are afflicted with
  psychological disorders.

3
How Should We Understand Psychological Disorders?

• The medical model proposes that psychological
  disorders have a biological basis and can be
  classified into discrete categories and are
  analogous to physical diseases.

4
How Should We Understand Psychological Disorders?

• Although not agreeing that all mental health
  problems have a biological basis, mainstream
  psychology has adopted the medical models
  terminology.
• Symptom a sign of a disorder
• Diagnosis distinguishing one disorder from
  another
• Etiology a disorders apparent causes and
  developmental history
• Prognosis prediction about the likely course of
  a disorder

5
Defining Psychological Disorders

• A pattern of atypical behavior
• Results in personal distress or
• Significant impairment in a persons social or
  occupational functioning

6
Numerous Theoretical Explanations

• Five primary perspectives to understand mental
  illness
• Psychodynamic Disordered behavior is controlled
  by unconscious forces shaped by childhood
  experiences.
• Behavioral Disordered behavior is caused by
  identifiable factors in the persons environment
  and results from learning.
• Cognitive ineffective or inaccurate thinking is
  the root cause of mental illness

7
Numerous Theoretical Explanations

• Five primary perspectives to understand mental
  illness
• Sociocultural Mental illness is the product of
  broad social and cultural forces .
• Biological Disordered behavior is caused by
  biological conditions, such as genetics, hormone
  levels, or neurotransmitter activity in the
  brain.

8
Combined Models

• Diathesis-stress model a predisposition to a
  given disorder (diathesis) that combines with
  environmental stressors to trigger a
  psychological disorder
• Bio-psycho-social model. Takes into account
  predispositions, personal experience, and life
  circumstances.

9
The Diathesis-Stress Model
10
Psychological Disorders

• Bio-psycho-social Perspective
• assumes that biological, sociocultural, and
  psychological factors combine and interact to
  produce psychological disorders

11
Models from Outside Psychology

• Spirit Possession
• Trephining
• Lunacy
• Curses
• Family/generational
• Occult (voodoo, witchcraft)
• Sin
• Guilt
• Unforgiveness, bitterness

12
Risks of Using Diagnostic Labels

• David Rosenhan demonstrated diagnostic labels
  biasing effects.
• Misdiagnosis of insanity by hospital personnel
  due to their bias toward calling a healthy person
  sick
• Diagnostic labels can harm patients in several
  ways.
• Label may dehumanize patients by encouraging
  mental health practitioners to treat them as
  labels rather than as unique individuals with
  problems.
• Labeled individuals may experience discrimination
  and may cause people to expect those labeled to
  behave abnormally and thus to misperceive normal
  behavior as disordered.

13
Benefits of Using Diagnostic Labels

• Despite ethical concerns, diagnostic labels are
  used because they serve several important
  functions
• Summarize patients symptoms or problems, and
  thus, communicate great deal of information with
  a single word
• Convey information about possible causes of the
  disorder
• Convey information about the patients prognosis

14
DSM Classification System

• Diagnostic and Statistical Manual of Mental
  Disorders (DSM) use to diagnose mental disorders
• Published by the American Psychiatric
  Association.
• Since 1980, DSM has been updated several times
  and is now in its fourth edition, text revision,
  or DSM-IV-TR.

15
DSM Classification System

• DSM classification system is descriptive rather
  than explanatory, meaning that
• it is not based on a particular theory concerning
  the cause(s) of psychological disorders.
• diagnoses are based mainly on observable
  symptoms.
• DSM provides clearer directions concerning
  number, duration, and severity of symptoms
  necessary to assign a diagnosis.
• By recognizing that two patients with same
  disorder may substantially differ from one
  another, clinicians much more likely to
  acknowledge uniqueness of all patients.

16
Anxiety Disorders Distressing, Persistent
Anxiety, Maladaptive Behavior

• Characterized by distressing, persistent anxiety
  or maladaptive behavior
• About 25 percent of the population will
  experience this disorder in our lifetime.
• Anxiety disorders occur across the life span and
  commonly co-occur with many other disorders, such
  as depression and substance abuse.

17
Anxiety Disorders Distressing, Persistent
Anxiety, Maladaptive Behavior

• Five major anxiety disorders
• Panic disorder brief episodes of intense anxiety
  with no apparent reason
• Phobic disorder strong irrational fears of
  specific objects or situations, called phobias
• Generalized anxiety disorder (GAD) a constant
  state of moderate anxiety

18
Anxiety Disorders Distressing, Persistent
Anxiety, Maladaptive Behavior

• Five major anxiety disorders
• Obsessive-compulsive disorder repetitive,
  unwanted, and distressing actions and/or thoughts
  
• Post-traumatic stress disorder occurs among
  individuals who have experienced or witnessed
  traumatic events
• Later reexperience the event through nightmares,
  flashbacks, and avoid situations or persons that
  trigger flashbacks

19
Anxiety Disorders
20
Anxiety Disorders

• PET Scan of brain of person with obsessive/
  compulsive disorder
• High metabolic activity (red) in frontal lobe
  areas involved with directing attention

21
Etiology of Anxiety Disorders

• Genetic and biological factors
• Genetic heritage may predispose us to more easily
  develop phobic reactions or to respond intensely
  to stressful events.
• Behavioral or conditioning factors
• Classical conditioning may instill conditioned
  emotional responses, and operant conditioning may
  reinforce and maintain the persons avoidance
  responses.
• Cognitive factors
• People suffering from panic disorder closely
  monitor their physiological reactions, and often
  exaggerate the significance of their
  physiological symptoms.

22
Mood Disorders Emotional Extremes

• Characterized by emotional extremes that cause
  significant disruption in daily functioning.
• To qualify as a mood disorder, emotional extremes
  must persist for a long time.
• Most common mood disorder is depression
• Characterized by extreme and persistent negative
  moods and the inability to experience pleasure by
  participating in activities one previously
  enjoyed (Kramlinger, 2001)

23
Mood Disorders Emotional Extremes

• Depressed individuals
• Often experience physiological problems such as
  lack of appetite, weight loss, fatigue, and sleep
  disorders
• Often experience behavioral symptoms, such as
  slowed thinking and acting, social withdrawal,
  and decreased activity
• Exhibit cognitive symptoms, such as low
  self-esteem, thinking about death and/or suicide,
  and having little hope for the future

24
Mood Disorders-Depression

• The vicious cycle of depression can be broken at
  any point

25
Hostile Pessimistic Persons Are More Reactive
to Stressors

• Pessimistic explanatory style
• tendency to explain cause of negative
  uncontrollable events as ones own stable
  personal qualities affecting all aspects of life
• Associated with health problems and premature
  death
• Optimistic explanatory style
• tendency to explain cause of uncontrollable
  negative events as temporary, external factors
  that do not affect other aspects of ones life
• Associated with good health and longevity

26
Mood Disorders-Depression
27
Mood Disorders Emotional Extremes

• Bipolar disorder characterized by swings between
  the emotional extremes of mania and depression
• Less common than major depressive disorder,
  occurring in about 1 percent of the population
• Unlike major depression, this disorder occurs
  about equally in men and women and tends to occur
  earlier than major depression

28
Mood Disorders Emotional Extremes

• Bipolar disorder
• Bipolar patients depressive episodes differ from
  the depressive episodes in major depression in
  that they tend to be more severe, are accompanied
  by higher suicide risks, and have a distinct
  pattern of brain activity during sleep.

29
Mood Disorders-Bipolar

• PET scans show that brain energy consumption
  rises and falls with emotional swings

30
Suicide

• A major danger of depression is suicide.
• As many as 30 of people with severe mood
  disorders die from suicide.
• In the U.S. suicide rates are higher among
• Men than women
• Elderly adults than younger adults
• Unemployed ( retired) adults than employed
  persons
• Widowed adults than married adults
• Native European Americans than Asian. Hispanic,
  and African Americans.

31
Etiology of mood disorders

• Genetic/ biological influence?
• Bipolar patients show imbalances in neural
  circuits using serotonin, norepinephrine, etc.?
  Enlarged amygdala?
• Major depressive disorder Family, twin, and
  adoption studies indicate at least a moderate
  genetic influence on depression.
• Cognitive contributions
• Depressed persons have negative views and they
  misinterpret daily experiences so that their
  negative outlook is supported.
• Behavioral psychologists propose that depression
  results from low social reinforcement.

32
Gender Mood Disorders

• Why is depression more common among women?
• May due to biological factors.
• Sociocultural factors Women have fewer
  educational and occupational opportunities,
  receive less money for their work, and experience
  more violence due to their gender than men.
• Difference in diagnosis?
• Women may be diagnosed more frequently because
  they are more likely to seek help for their
  problems.
• Gender bias among mental health professionals may
  result in women and men with identical symptoms
  being diagnosed differently, i.e., women labeled
  as depressed and men diagnosed with other
  conditions

33
Dissociative Disorders Loss of Contact with
Consciousness or Memory

• Characterized by disruptions in consciousness,
  memory, sense of identity, or perception
• Dissociative amnesia a sudden loss of memory of
  ones identity and other personal information
• Dissociative fugue a sudden departure from home
  or work, combined with loss of memory of identity
  and the assumption of a new identity

34
Dissociative Disorders Loss of Contact with
Consciousness or Memory

• Dissociative identity disorder (DID)
  characterized by the presence of two or more
  distinct identities or personalities, which take
  turns controlling the persons behavior (also
  known as multiple personality disorder)

35
Etiology of Dissociative Disorders

• Psychodynamic theory results from the
  individuals attempt to repress some troubling
  event
• Biological explanation patient may have a
  neurological problem that has not yet been
  detected
• Cognitive perspective individuals learn to
  dissociate as a way to cope with intense distress

36
Schizophrenia Disturbances in Almost All Areas
of Psychological Functioning

• Characterized by severe impairment in thinking,
  including hallucinations, delusions, or loose
  associations
• Diagnosed when symptoms persist for at least six
  months, are not due to some other condition, and
  cause significant impairment in daily functioning
  
• Schizophrenics often cannot work, manage a home
  or apartment successfully, or care for their
  basic needs.

37
Schizophrenia

• Delusions
• false beliefs, often of persecution or grandeur,
  that may accompany psychotic disorders
• Hallucinations
• false sensory experiences such as seeing
  something without any external visual stimulus

38
Risk of Developing Schizophrenia
39
Personality Disorders Inflexible Behavior
Patterns That Impair Social Functioning

• Personality disorders general styles of living
  that are ineffective and lead to problems for the
  person and for others
• Ten personality disorders in the DSM-IV-TR.

40
Personality Disorders Inflexible Behavior
Patterns That Impair Social Functioning

• Three common personality disorders are
• Paranoid personalities habitually distrustful
  and suspicious of others motives
• Histrionic personalities excessively emotional
  and attention seeking, often turning minor
  incidents into full-blown dramas
• Narcissistic personalities desire constant
  admiration from others  

41
Personality Disorders Inflexible Behavior
Patterns That Impair Social Functioning

• The personality disorder that receives the most
  attention is the antisocial personality disorder.
• Exhibit a persistent pattern of disregard for and
  violation of the rights of others
• Repeatedly exhibit antisocial behavior across all
  realms of life, lying, cheating, stealing, and
  manipulating others
• When caught, they take no responsibility and feel
  no remorse.

42
Personality Disorders
Those with criminal convictions have lower levels
of arousal
15 10 5 0
Adrenaline excretion(ng/min)
Nonstressful situation
Stressful situation
No criminal conviction
Criminal conviction
43
Personality Disorders
PET scans illustrate reduced activation in a
murderers frontal cortex
44
Etiology of Personality Disorders

• A genetic component related to abnormal brain
  development or chronic underarousal of both the
  autonomic and central nervous systems
• May be caused by the interaction of both
  biological and environmental factors.
• Children in chaotic households who have a
  biological predisposition for this disorder may
  not learn to control their impulses, and so
  behave in ways to maximize their benefit even if
  this means violating social rules.