CHAPTER 12Psychological Disorders

WHAT IS PSYCHOLOGICAL DISORDER?

• Psychopathology: Any pattern of emotions, behaviors, or thoughts inappropriate to the situation and leading to personal distress or the inability to achieve important goals

• Synonymous terms include:• Mental illness• Mental disorder• Psychological disorder• Abnormal psychology

Atypical Maladaptiveness

Disturbing Unjustifiable

INDICATORS OF ABNORMALITY

• Three classic signs suggest a severe psychological disorder • Hallucinations• Delusions• Severe affective (mood) disturbances

• Other signs of a disorder are more subtle, and a diagnosis depends heavily on clinical judgment

CHANGING CONCEPTS OFPSYCHOLOGICAL DISORDER

• Medical Model: Diseases of the mind; objective causes & require specific treatments• Disadvantages: Encourages patient to be passive,

psychologists not as important as psychiatrists, overmedicating

• Psychological Models• Behavioral perspective: Abnormal behaviors can be

acquired through behavioral learning• conditioning (class/operant) - fears, anxiety

• Cognitive perspective: Abnormal behaviors are influenced by mental processes• how people perceive themselves and relations with others• locus of control, coping mechanisms

• Both have a social component as well!• Social-Cognitive-Behavioral Approach

THE BIOPSYCHOLOGY OF MENTAL DISORDER

• Although there is reservation about the medical model, psychologists do not deny the influence of biology on thought and behavior• Biopsychology – influence of biology on

thought and behavior• Biopsychosocial Model: combination!!!

• Diathesis-stress hypothesis: Genetic factors place the individual at risk, but environmental stress factors transform this potential into an actual disorder

OVERVIEW OF DSM-IV CLASSIFICATION SYSTEM

• DSM-5: Diagnostic and Statistical Manual of Mental Disorders• Most accepted classification system in US• Closely tied to medical model• Avoids endorsing theories of cause or

treatment• Statistics data

SOMATIC SYMPTOM AND RELATED DISORDERS

• Somatic Symptom Disorders: Prominence of somatic symptoms associated with distress and impairment.• Somatic Symptom Disorder: distressing

somatic symptoms plus abnormal thoughts, feelings and behaviors in response to them• Illness Anxiety Disorder: Preoccupation with

having or acquiring a serious illness without somatic symptoms.• Conversion disorder: Altered voluntary motor

or sensory functions without physical cause (paralysis, weakness, or loss of sensation) – video

PERSONALITY DISORDERS• Personality disorders: Enduring pervasive and

inflexible pattern of inner experience and behavior that deviates from one’s culture and is stable over time• Personality traits to an excessive degree and

in rigid ways that undermine their adjustment• Handout – focus on middle column (Cluster B)• Antisocial, Borderline, Histrionic, Narcissistic

FEEDING AND EATING DISORDERS

• Persistent disturbance of eating or related behavior resulting in altered consumption or absorption of food that impairs health or functioning• The following involve undue influence of weight

or shape on self-evaluation• Anorexia Nervosa: restriction of energy

intake that leads to significantly low weight with a fear of gaining weight• Bulimia Nervosa: recurrent episodes of

binge eating and behaviors to prevent weight gain

• Pica, Rumination, Avoidant, Binge Eating

ANXIETY DISORDERS• Share features of excessive fear, anxiety and

related behavioral disturbances(survey)• Fear: emotional response to real/perceived threat• Anxiety: anticipation of future of threat

• Specific Phobia: Marked fear of a specific object or situation• Significantly interferes with daily routine, occupation,

or social life.• Animal, Enviro, Situational, Injury/blood/inject• Preparedness hypothesis: innate tendency to respond

quickly and automatically to stimuli that posed a survival threat to our ancestors

ANXIETY DISORDERS (CONT’D)• Social Anxiety Disorder: A persistent fear of

1+ social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. • Fears that he or she will act in a way that will be

embarrassing and humiliating.

• Generalized anxiety disorder: Excessive anxiety and worry about a number of things without any real external cause• Panic disorder: Recurrent, unexpected panic

attacks followed by worry of another• http://www.youtube.com/watch?v=WWngA_ZMCD4

ANXIETY DISORDERS• Agoraphobia: Fear of being in places where it

may be difficult or embarrassing to get out quickly or where you may have a panic attack and can't get help

• Avoid places where you think you may have a panic attack or panic-like symptoms.

• Often leads to not wanting to leave your home (video)

• Causes of Anxiety Disorders:• Genetics• Abnormal neurotransmitters• Environment• Learning

TRAUMA AND STRESSOR RELATED DISORDERS

• Post-Traumatic Stress Disorder: Recurrent, involuntary, and intrusive distressing memories of traumatic events• Actual or threatened death, serious injury,

sexual violence• Direct experience, witness, learning about,

extreme exposure• Avoid associated stimuli, negative cognitions/

moods, alterations in arousal/reactivity

OBSESSIVE-COMPULSIVE AND RELATED DISORDERS

• Obsessive-compulsive disorder: Presence of obsessions and /or compulsions• Obsession: Intrusive, persistent thought, image,

or urge• Compulsion: Repetitive behavior or mental act

one feels driven to do in response to an obsession• Take up more than 1 hour of the day• Handout, video clips, survey• http://www.youtube.com/watch?v=44DCWslbsNM (AGAIG)• http://www.youtube.com/watch?v=Rn1OYlYzgm8 (Spokesperson)

OBSESSIVE-COMPULSIVE AND RELATED DISORDERS

• Body Dysmorphic Disorder: Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others•Hoarding: Persistent difficulty discarding or parting with possessions regardless of their value• Trichotillomania, Excoriation

DISSOCIATIVE DISORDERS• Dissociative disorders: Disruption in the

integration of consciousness, memory, identity, emotion, perception, and behavior• Intrusion into awareness or inability to access

information/control mental functions• Extreme stress – consciousness becomes

dissociated (split) from previous thoughts and memories• Trouble integrating dimensions of

consciousness• They remain split and operate independently

of each other

DISSOCIATIVE DISORDERS

• Dissociative Amnesia: A psychologically induced inability to recall biographical information, usually of traumatic or stressful nature• May be localized, selective or generalized• May involve fugue – purposeful traveling or

bewildered wandering• Dissociative Identity Disorder: Disruption of identity

characterized by 2+ distinct personality states• Marked discontinuity in sense of self• Recurrent gaps in everyday events, personal info• 90%+ have history of childhood abuse and neglect• http://www.youtube.com/watch?v=YXuG2zI39yA&feature= related

DEPRESSIVE DISORDERS• Sad, empty, or irritable mood, accompanied by somatic

& cognitive changes that significantly affect functioning• Major depression: Form of depression that has clear

cut changed in affect, cognition, and behavior with inter-episode remissions• A change in previous functioning for a 2 week period• Must have a depressed mood or loss of interest or pleasure

along with 4+ other symptoms• Symptoms slide…• With Seasonal Pattern: Onset and remission of MD episodes

at characteristic times of year

• Persistent Depressive Disorder (Dysthymia): Depressed mood for most of the day, more days than not, for at least two years; symptoms not as severe as MDD

• Causes of DDs: Genetics, chemical (serotonin) environment, cognitions

BIPOLAR DISORDER AND RELATED DISORDERS

• Bipolar disorder: Periods of elevated mood (mania) and periods of depression• Manic Episodes:

• Excessively “high,” overly good, euphoric, maybe angry• Increased energy, activity, irritability, restlessness • Racing thoughts, talking very fast, can’t concentrate well • Little sleep needed, poor judgment, spending sprees • Unrealistic beliefs in one’s abilities• Increased sexual drive, abuse of drugs, denial of problem

• Bipolar I: Typically severe mania and depression• Bipolar II: Typically hypomania and severe

depression• Cyclothymic: Typically hypomania with less

severe depression

SCHIZOPHRENIC DISORDERS

• Schizophrenia: Abnormalities in 1+ of the following: delusions, hallucinations, disorganized thinking, abnormal motor behavior, and negative symptoms; reality falls apart• Delusion: false belief that a person maintains

in the face of contrary evidence• Reference – everything related to you• Persecution – everybody plotting against/harm• Grandeur – more important, powerful, wealthy

• Hallucination: sensory perception w/ no external cause usually auditory; related to delusions

SYMPTOMS OF SCHIZOPHRENIA

Positive

•Any form in which the person displays active symptoms

•Excess or distortion of normal functions

•Delusions, hallucinations, word salads

•Responds to anti-psychotic meds

Negative

•Any form distinguished by deficits

•Loss of normal functioning

•Alogia, avolition, decreased emotional expression (flat affect)

•Does not usually respond to anti-psychotic meds

•Catatonia

POSSIBLE CAUSES OF SCHIZOPHRENIA• Variety of factors - genetics, abnormal brain

structure, and biochemistry• Fundamentally a brain disorder• Dopamine Hypothesis – caused by over-active dopamine system in brain• Drugs that block dopamine reduce positive

symptoms• Diathesis-stress model