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Psychological Disorders

Psychological Disorders

Behavior patterns or mental processes that cause serious personal suffering or interfere with a person’s ability to cope with daily life

What Is Abnormality?

No biological test

Judgment call

Heavily influenced by

– Social norms

– Person’s characteristics

– Context

What Is Abnormality?

Current consensus:

1. Deviance

2. Dysfunction

3. Distress

What Is Abnormality?

Deviance

– Statistically uncommon

Wearing beekeeper’s outfit

…in the shower.

What Is Abnormality?

Deviance

“Talking” to a baseball to psych yourself up

…and hearing it talk back.

What Is Abnormality?

Not recycling cans

…for 8 years.

…and having 70,000 of them in your apartment.

What Is Abnormality?

Dysfunctional

– Interferes with day-to-day life

Avoiding people b/c they make you anxious

…so you haven’t left the house in 2 years.

Defining Abnormal Behavior

Distress (to self or others)

– Negative emotions

Crying a lot whenyou’re sad► …every day

for months.

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Mental Disorder Rates, 18+

0%

10%

20%

30%

40%

50%

Lifetime 1 Year 1 Year - Serious

46%

26%

6%

Mental Disorder Rate, People 18+(Percent in a Given Year)

26.0%

18%

9.5%

1%

ALL ANXIETY MOOD SCHIZ

Facts About Mental Illness

Average age at onset = 14

Most people recover

Few are violent

Most suffer quietly and privately

Diagnosing Mental Disorders:The DSM

Diagnostic and Statistical Manual of Mental Disorders

– Current version: DSM-IV-TR(DSM 5 comes out in May)

– Diagnose disorders, improve reliability/consistency

– 17 categories

DSM Categories of Disorders

Anxiety Disorders

Mood Disorders

Schizophrenia

Personality Disorders

Adjustment Disorders Delirium, Dementia, and Amnestic

and Other Cognitive Disorders Disorders Usually First Diagnosed

in Infancy, Childhood, or Adolescence

Dissociative Disorders Eating Disorders Factitious Disorders Impulse-Control Disorders Mental Disorders Due to a Medical

Condition Psychotic Disorders Sexual and Gender Identity

Disorders Sleep Disorders Somatoform Disorders Substance-Related Disorders

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DSM Multiaxial Diagnosis

Axis I: Clinical disorders Axis II: Personality disorders/mental

retardation Axis III: Current medical conditions Axis IV: Psychosocial/environmental

problems Axis V: Global assessment of

functioning

Examples of Multiaxial DiagnosisAnxiety Disorders

What Is Anxiety?

– Fear of future danger or misfortune, accompanied by emotional and/or physical tension

May be related to specific object or situation

About 75% before age 22 (avg = 11)

"I always thought I was just a worrier. I'd feel keyed up and unable to relax. At times it would come and go, and at times it would be constant. It could go on for days. I'd worry about what I was going to fix for a dinner party, or what would be a great present for somebody. I just couldn't let something go."

"I'd have terrible sleeping problems. There were times I'd wake up wired in the middle of the night. I had trouble concentrating, even reading the newspaper or a novel. Sometimes I'd feel a little lightheaded. My heart would race or pound. And that would make me worry more. I was always imagining things were worse than they really were: when I got a stomachache, I'd think it was an ulcer."

Generalized Anxiety Disorder

3% of population Ongoing anxiety on most days for at

least 6 months Anxiety difficult to control No specific trigger Muscle tension, inability to relax “Vigilance” Fatigue and sleep problems

"For me, a panic attack is almost a violent experience. I feel disconnected from reality. I feel like I'm losing control in a very extreme way. My heart pounds really hard, I feel like I can't get my breath, and there's an overwhelming feeling that things are crashing in on me."

"It started 10 years ago, when I had just graduated from college and started a new job. I was sitting in a business seminar in a hotel and this thing came out of the blue. I felt like I was dying."

"In between attacks there is this dread and anxiety that it's going to happen again. I'm afraid to go backto places where I've had an attack. Unless I get help, there soon won't be anyplace where I can go and feel safe from panic."

Panic Disorder

3% of population

Panic attacks

– Sweating, dizziness, numbness or tingling

– No obvious trigger for attacks

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Panic Disorder Phobic Disorders

Excessive, irrational fear & avoidance of specific object or situation

May be maintained by relief of escaping feared situation

“When I think about flying, I picture myself losing control, freaking out, and climbing the walls, but of course I never did that. I'm not afraid of crashing or hitting turbulence. It's just that feeling of being trapped. Whenever I've thought about changing jobs, I've had to think, "Would I be under pressure to fly?" These days I only go places where I can drive or take a train. My friends always point out that I couldn't get off a train traveling at high speeds either, so why don't trains bother me? I just tell them it isn't a rational fear."

Phobic Disorders

A. Specific Phobia

9% of population

Usually begins in childhood

Fear of specific object/situation

Avoidance of what is feared

Phobic Disorders

A. Specific Phobia

Most common phobias:

animals and insects

Other common phobias

hydrophobiaacrophobia

claustrophobia

waterheightsclosed-in places

Some Unusual Phobias

Alektorophobiachickens

Geniophobiachins

Some Unusual Phobias

long words

Peladophobiabald people

Hippopotomonstrosesquippedaliophobia

Hexakosioihexekontahexaphobiathe number 666

Some Unusual PhobiasAutomatonophobia

ventriloquist's dummiesTriskaidekaphobia

Arachibutyrophobiapeanut butter sticking to

the roof of the mouth

Phobic DisordersB. Agoraphobia 1% of population Fear of being in a place where escape

isn’t easy Avoid

– Being alone outside home– Traveling by car, airplane– Crowded places

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"In any social situation, I felt fear. I would be anxious before I even left the house, and it would escalate as I got closer to a college class, a party, or whatever. I would feel sick in my stomach - it almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being removed from myself and from everybody else.

"When I would walk into a room full of people, I'd turn red and it would feel like everybody's eyes were on me. I was embarrassed to stand off in a corner by myself, but I couldn't think of anything to say to anybody. It was humiliating. I felt so clumsy, I couldn't wait to get out."

Phobic Disorders

C. Social Phobia

7% of population

fear and anxiety of being judged and evaluated by other people

Situations to avoid

– Eating in public

– Public speaking–Center of attention

–Talking to people

"I was in a car accident when I was 25 years old in which my girlfriend died. For a long time, I spoke about it as though it was something that happened to someone else. I was very aware that it had happened to me, but there was just no feeling."

"Then I started having flashbacks. They kind of came over me like a splash of water. I would be terrified. Suddenly I was reliving the accident. Every instant was startling. I wasn't aware of anything around me, I was in a bubble, just kind of floating. And it was scary. Having a flashback can wring you out."

“It happened the week before the Fourth of July, and I can't believe the anxiety and fear I feel every year around the anniversary date. It's as though I've seen a monster. I can't relax, can't sleep, don't want to be with anyone. I wonder whether I'll ever be free of this terrible problem."

Post-Traumatic Stress Disorder

3.5% of population

30% of Vietnam vets

Extreme anxiety after event that almost anyone would find stressful

Car/plane crashMuggingExtreme abuseWar

FlashbacksAvoid things that remind of event

"I'm scared to death of flying, and I never do it anymore. I used to start dreading a plane trip a month before I was due to leave. It was an awful feeling when that airplane door closed and I felt trapped. My heart would pound, and I would sweat bullets. When the airplane would start to ascend, it just reinforced the feeling that I couldn't get out.”

"I couldn't do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn't add up to a 'bad' number."

"I knew the rituals didn't make sense, and I was deeply ashamed of them, but I couldn't seem to overcome them until I had therapy."

"Getting dressed in the morning was tough, because I had a routine, and if I didn't follow the routine, I'd get anxious and would have to get dressed again. I always worried that if I didn't do something, my parents were going to die. I'd have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me."

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Obsessive-Compulsive Disorder

1% of population Either obsessions, compulsions, or both Obsession

– Unwanted thought that a person can’t stop thinking about

Compulsion– Ritualistic behavior that person feels

they must do

Obsessive-Compulsive Disorder

Common obsessions:– Dirt, germs– Something terrible happening– Order, exactness– Religious obsessions

Obsessive-Compulsive Disorder

Common rituals:– Cleaning– Repeating – Checking

“Self-Portrait”“The Old Guitarist”

“The Tragedy”

Picasso’s “Blue Period” Mood Disorders

What Is Mood?

– A long-lasting emotion that affects how one perceives the world

Median age = 30

Range of Emotions

Extremesadness

“Neutral”emotions

Mildsadness

Mildhappiness

Extremeelation

Brain chemistry

Brain chemistry

Mental processes

Mental processes

MoodMood

Breakup with romantic partner

Stable“I’ll never get over this.”

Global“Without her, I’m nothing.”

Internal“It was all my fault.”

Depression

Temporary“It’s hard, but I’ll get over it.”

Specific“I miss her, but I have family

and friends.”

External“It wasn’t meant to be.”

Successful coping

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Major Depressive Disorder

“Common cold” of mental illness

Leading cause of disability in U.S. for ages 15-44

Lifetime rates:

– 21-24% for women

– 12-15% for men

Major Depressive Disorder

Groups most likely to meet criteria: 45-64 years Women < HS education Unemployed or unable to work Divorced No health insurance

Major Depressive Disorder

1. Depressed mood

2. Loss of pleasure

3. Weight loss

4. Sleep changes

5. Restlessness or being slowed down

6. Loss of energy7. Worthlessness or

guilt8. Poor concentration9. Thoughts of death

5 or more symptoms in 2 week period

Beck Depression Inventory Dysthymic Disorder

1. Depressed mood most days for 2+ years

2. Changes in eating

3. Changes in sleeping

4. Fatigue

5. Low self-esteem

6. Poor concentration

7. Hopelessness

2 or more

Seasonal Affective Disorder(SAD)

Symptoms of major depression during fall and winter

– Related to light

– Higher latitudes show higher rates

SAD Rates in the U.S.

10.2%

5.8%

3.6%

1.4%

8%

Light Treatment for SAD Bipolar Disorder

3%

“Manic-depression”

Severe mood swings

– mania and depression

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Manic vs. Depressed Brain Activity

Depressed state Manic state Depressed state

Bipolar DisorderA. At least 1 week of abnormally

elevated, expansive, irritable mood

B. 3 or more of following:

1.Inflated self-esteem

2.Decreased need for sleep

3.More talkative4.Racing thoughts

5.Distractibility6.Psychomotor

agitation7.Risky activities

A Typical Bipolar Cycle

Mo

od

Mania

Depression

1 2 3 4Years

1 cycle overseveral years

Bipolar Disorder - Rapid Cycling

Mo

od

Mania

Depression

4 or more cycles

per year

1 Year

Suicide Facts

About 15% with depression commit suicide 32,439 in 2004 Fewest = winter, most = spring Women 3x more likely to attempt Men 4x more likely to die from suicide 3rd leading cause of death for 15-24s

– 86% male Highest rate = 80+

Suicide Risk Factors

depression, other mental disorders, or a substance-abuse disorder prior suicide attempt family history of mental disorder or

substance abuse family history of suicide family violence firearms in the home incarceration exposure to the suicidal behavior of others

Gender Differences in Suicide Method

56%

24%

13%

30%

21%

40%

0%

10%

20%

30%

40%

50%

60%

Firearms Suffocation Poisoning

Men

Women

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“New Mexico Republicans schizophrenic since November election.”Farmington Daily Times, 4/5/13

“The Blue Devils schizophrenic season comes to an end.”Bleacher Report, 3/31/13

"The story of England's schizophrenic winter in numbers.” Yahoo! UK, 3/27/13

Schizophrenia Loss of contact with reality 1% of population

– Men - late teens to early 20s– Women – 20s to early 30s

Strong genetic link– If parents have it, risk = 10%– When 1 identical twin has it,

risk around 50%

History

Probably has been with humans forever

Emile Kraeplin used “dementia praecox” in 1887

Eugen Bleuler coined “schizophrenia” in 1911

Schizophrenia and “The Rule of Thirds”

FullRecovery

SomeImprovement

No Improvement

Schizophrenia: Symptoms

Two or more of the following, during a 1-month period:

1. delusions

2. hallucinations

3. disorganized speech

4. disorganized or catatonic behavior

5. “negative” symptoms

1. Delusions

False beliefs

A. Delusions of Persecution

B. Delusions of Reference

C. Delusions of Grandeur

Bizarre vs non-bizarre

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2. Hallucinations

False perceptions

Any of the senses

Most common = hearing voices

3. Disorganized Speech Seen as sign of disorganized thinking

A. Loose associations Thoughts unrelated

B. Poverty of content Many words, little meaning

C. Clanging Words that rhyme or sound similar

D. Word salad Words jumbled together

A. Loose Associations

Normal 1: Both are salmon colored. This one, however, is more pink. Normal 2: My God, this is hard. They

are both about the same, except this one must be redder. Normal 3: They are both either the

color of canned salmon or clay. This one here is the pinker one.

A. Loose Associations

Schiz 1: A fish swims. You call it a salmon. You cook it. You put it in a can. You open the can. You look at it in this color. Salmon fish.

Schiz 2: This is a stupid color of a ------ bowl of salmon. Mix it with mayonnaise. Then it gets tasty. Leave it alone and puke all over the ------place. Puke fish.

Schiz 3: Make-up. Pancake make-up. You put your face on it and the think guys run after you. Wait a second! I don’t put it on my face and guys don’t run after me. Girls put it on them.

B. Poverty of Content

I am writing on paper. The pen which I am using is from a factory called “Perry & Co.” The factory is in England. I assume this. Behind the name of Perry & Co. the city of London is inscribed. But not the city. The city of London is in England. I know this from my school days. Then, I always liked geography. My last teacher in that subject was Professor August A. he was a man with black eyes. There are also blue eyes and gray eyes and other sorts, too. I have heard it said that snakes have black eyes.

C. ClangingDr: How are things going today, Ernest?Patient: OK for a flump.Dr: What is a flump?Pt: A flump is a gump.Dr: What do you mean by that?Pt: Well, when you go to the next planet from the

planet beyond the planet that landed on the danded and planded on the standed.

Dr: Wait a minute. I didn’t follow any of that.Pt: Well, when we was first bit on the slit on the rit

and the man on the ran or the pan on the ban on the can on the man on the fan on the pan.

Dr: What’s all that hitting your head for. And waving your arms?

Pt: That’s to keep the boogers from eating the woogers.

D. Word SaladIt’s all over for a squab true tray and there ain’t no music, there ain’t no nothing besides my mother and father who stand alone on the Island of Capri where there is no ice, there is no nothing but changers, changers, changers. That comes in like first and last names, so that thing does. Well, it’s my suitcase sir. I’ve got to travel to keep my energy alive.

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4. Disorganized or CatatonicBehavior

Disorganized

A. Problems in goal-directed behavior

B. Inappropriate sexual behavior

C. Unpredictable agitation

4. Disorganized or CatatonicBehavior

Catatonic Behavior

A. Catatonic posturing

B. Catatonic rigidity

C. Waxy flexibility

D. Catatonic stupor

5. Negative Symptoms

Absence of certain normal behaviors

1. Emotions

2. Speech

3. Goal-directed behavior

Schizophrenia Subtypes

1. Paranoid Schizophrenia− Delusions, auditory hallucinations

2. Disorganized Schizophrenia− Disorganized speech/behavior,

emotions absent or inappropriate3. Catatonic Schizophrenia− Catatonic symptoms

4. Undifferentiated Schizophrenia− Don’t fit another subtype

Understanding Schizophrenia

1. Brain Abnormalities

– Excessive dopamine levels

– Abnormal brain activity

– Tissue loss

Understanding Schizophrenia

2. Prenatal Environment

– Maternal viral infections

– Born during winter & spring

Reversed below equator

Possible Risk Factors

Prenatal malnutrition

Fathers’ age at birth, esp. 50+

Family history of epilepsy

Twice as common in unmarried or divorced people

Personality DisordersA. What is a personality disorder?

– Ongoing pattern of inner experience and behavior that differs from cultural expectations

– Inflexible

– Cause distress or social/occupational impairment

– Stable over time traced to adolescence

What Are Personality Disorders?3 Clusters• Based on similarities1. Odd or eccentric

• Paranoid, Schizoid, Schizotypal2. Dramatic, emotional, or impulsive

• Borderline, Histrionic, Narcissistic, Antisocial

3. Anxious or fearful• Dependent, Avoidant,

Obsessive-Compulsive

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VII. How Are Violence and Mental Disorders Related?

A. Diagnoses Associated with Violence– More serious disorders

– Delusions

– Manic phase of bipolar disorder

– Paranoid schizophrenia

• Those with substance problems alone more violent than those with schizophrenia alone

– Antisocial personality disorder