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Anxiety, Dissociative, Somatoform

and Personality Disorders

Module 37

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Psychological Disorders

Anxiety Disorders Overview Generalized Anxiety Disorder

Panic Disorder

Phobias

Obsessive-Compulsive Disorder

Post-Traumatic Stress Disorder

Explaining Anxiety Disorders

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Anxiety DisordersFeelings of excessive apprehension and anxiety.

1. Generalized anxiety disorder2. Panic disorder3. Phobias4. Obsessive-compulsive disorder5. Post-traumatic stress disorder

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Generalized Anxiety Disorder

1. Persistent and uncontrollable tenseness and apprehension.2. Autonomic arousal.

3. Inability to identify or avoid the cause of certain feelings.

Symptoms

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Panic Disorder

Minutes-long episodes of intense dread which may include feelings of terror, chest

pains, choking, or other frightening sensations.

Anxiety is a component of both disorders. It occurs more in the panic disorder, making

people avoid situations that cause it. link

Symptoms

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PhobiasMarked by a persistent and irrational fear of an

object or situation that disrupts behavior.

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Kinds of Phobias

Phobia of blood.Hemophobia

Phobia of closed spaces Link .

Claustrophobia

Phobia of heights link.

Acrophobia

Phobia of open places.Agoraphobia

Arachnophobia at National Geographic Link

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Obsessive-Compulsive DisorderPersistence of repetitive thoughts (obsessions)

and urges to engage in repetitive behaviors (compulsions) that cause distress. Clip

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A PET scan of the brain of a person with

Obsessive-Compulsive Disorder (OCD).

High metabolic activity (red) in the frontal lobe areas are involved with

directing attention.

Link 45:08

Brain Imaging

Brain image of an OCD patient

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Post-Traumatic Stress Disorder

Four or more weeks of the following symptoms constitute post-traumatic

stress disorder (PTSD):

1. Haunting memories

2. Nightmares3. Social withdrawal

4. Jumpy anxiety

5. Sleep problems

Bettmann/ Corbis

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Resilience to PTSD

Only about 10% of women and 20% of men react to traumatic situations and develop PTSD.

Holocaust survivors show remarkable resilience to traumatic situations.

All major religions of the world suggest that surviving a trauma leads to the

growth of an individual.

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Explaining Anxiety Disorders

Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety.

There are 2 main perspectives, Learning and Biological.

Link 58:32

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The Learning Perspective

Learning theorists suggest that fear

conditioning leads to anxiety.

When anxiety then becomes associated with other objects or

events (stimulus generalization) and is

reinforced.

John Coletti/ Stock, B

oston

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The Learning Perspective

Investigators believe that fear responses are initiated through observational learning.

Young monkeys develop fear when they watch other monkeys who are afraid of snakes.

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The Biological Perspective

Natural Selection has led our ancestors to learn to fear snakes, spiders, and

other animals. Therefore, fear preserves the species.

Twin studies suggest that our genes may be partly responsible for developing fears

and anxiety. Twins are more likely to share phobias.

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The Biological Perspective

Generalized anxiety, panic attacks, and even

OCD are biologically measurable and linked with brain circuits like the anterior cingulate

cortex.

Anterior Cingulate Cortexof an OCD patient.

S. U

rsu, V.A

. Stenger, M

.K. S

hear, M.R

. Jones, & C

.S. Carter (2003). O

veractive action m

onitoring in obsessive-compulsive disorder. P

sychological Science, 14, 347-353.

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Somatoform Disorders

Somatoform Disorders Overview Somatoform Disorders

Conversion Disorder

Hypochondriasis

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Somatoform Disorders• Psychological problems in which there are

symptoms of a physical disorder without a physical cause.

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Conversion Disorder• A somatoform disorder in which a person

displays blindness, deafness, or other symptoms of sensory or motor failure without a physical cause.

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Conversion disorders

• Tend to appear when a person is under severe stress.

• Often help reduce that stress by allowing the person to avoid unpleasant or threatening situations.

• The person may show remarkably little concern about what is apparently a rather serious problem.

• Finally, the symptoms may be neurologically impossible or improbable

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Hypochondriasis

• A somatoform disorder involving strong, unjustified fear of having (VS getting) physical illness.

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Psychological Disorders

Dissociative and Personality Disorders Overview Dissociative Disorders

Personality Disorders

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Dissociative Disorders

Conscious awareness becomes separated (dissociated) from previous memories,

thoughts, and feelings.

Symptoms

1. Having a sense of being unreal.

2. Being separated from the body.

3. Watching yourself as if in a movie.

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Dissociative Identity Disorder (DID)

A disorder in which a person exhibits two or more distinct and alternating personalities,

formerly called multiple personality disorder. Link

Chris Sizemore (DID)Lois Bernstein/ Gamma Liason

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DID Critics

Critics argue that the diagnosis of DID increased in the late 20th century. DID has not been found in other countries.

Critics’ Arguments

1. Role-playing by people open to a therapist’s suggestion.

2. Learned response that reinforces reductions in anxiety.

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Personality DisordersPersonality disorders are characterized by inflexible and enduring behavior patterns

that impair social functioning. Link 58:55

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Antisocial Personality DisorderA disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, even toward friends

and family members.Link 6:29

Formerly, this person was called a sociopath or psychopath.

Fact: There are over

29,000,000 psychopaths worldwide.

The Psychopath Whisperer: The Science of Those Without Conscience by

Kent A. Kiehl PhD

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• "I have no desire whatever to reform myself. My only desire is to reform people who try to reform me, and I believe the only way to reform people is to kill 'em. My motto is: Rob 'em all, rape 'em all, and kill 'em all.“

»Carl Panzram

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Psychopath assessment

• The one thing that was known was that psychopaths were at very high risk to reoffend.

• An inmate who scored high on the Psychopathy Checklist was four to eight times more likely than an inmate who scored low to reoffend in the next five years.

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Spree Killers are psychopaths right?

• For the vast majority of spree killer cases, the answer is no—the offender was not a psychopath. Most killing sprees are committed by individuals who suffer from psychosis, not psychopathy. Recall that psychosis is a fragmentation of the thinking processes in the brain that leads to symptoms like hallucinations and delusions. Kent A. Kiehl PhD

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• “As there are persons who cannot distinguish certain colors, having what is called color blindness, and others who, having no ear for music, cannot distinguish one tune from another, so there are some few who are congenitally deprived of moral sense.”

– Henry Maudsley56

• He was so nice, I can’t imagine why he is in prison” or “If that guy was on the outside, I’d get a beer with him.”

• The psychopath often comes off as quick witted, even likable, but the listeners’ “gut” feelings detect that there is something not quite right about the individual.

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Understanding Antisocial Personality Disorder

Like mood disorders and schizophrenia,

antisocial personality disorder has biological and

psychological basis.

Link The brain of a serial killer

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Understanding Antisocial Personality Disorder

PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up

study, violent repeat offenders had 11% less frontal lobe tissue than normal (Raine et al.,

1999; 2000).

Normal Murderer

Courtesy of A

drian Raine,

University of Southern C

alifornia

• “One of the most telling aspects of the letters is that none of the children are described as normal from birth. Parents say they noticed something different, odd, or abnormal about the child from the very beginning.“

–Kent A. Kiehl PhD62

• Insanity is a concept discussed in court to help distinguish guilt from innocence. It's informed by mental health professionals, but the term today is

primarily legal, not psychological. There's no "insane" diagnosis listed in the DSM.

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Insanity is a LEGAL concept

• Insanity: mental illness of such a severe nature that a person cannot distinguish fantasy from reality, cannot conduct her/his affairs due to psychosis, or is subject to uncontrollable impulsive behavior.

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“Mens Rea”

• In the U.S., a person cannot be held responsible for a crime if he/she did not possess a “guilty mind” (mens rea) at the time the criminal act was committed.

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• In the thirteenth century, Bracton, the first medieval jurist to deal with the subject of insanity and crime, stated, "For a crime is not committed unless the will to harm be present.“

• The earliest documented case of a jury acquittal on grounds of unsound mind occurred in 1505

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NGRI

• Not Guilty by Reason of Insanity.

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NGRI

• ….female defendants were more likely to be found NGRI than men (38.5% vs. 26.9%).

• The explanations for this finding are not immediately obvious…

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End

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