chapter 9 psychological disorders and their treatments
TRANSCRIPT
Chapter 9
Chapter 9
Psychological Disorders and Their Treatments
Chapter 9
Outline
Perspectives on Psychological DisordersMood DisordersAnxiety DisordersPsychosomatic, Somatoform, and Dissociative DisordersSchizophrenic DisordersOther Common DisordersPsychotherapiesBiological TreatmentsChallenges in Therapy
Chapter 9
Outline
Perspectives on Psychological DisordersMood DisordersAnxiety DisordersPsychosomatic, Somatoform, and Dissociative DisordersSchizophrenic DisordersOther Common DisordersPsychotherapiesBiological TreatmentsChallenges in Therapy
Chapter 9
Defining Abnormality
Mental health professionals asses abnormality by looking for:– Maladaptive personality traits– Psychological discomfort regarding a particular behavior– Evidence that the behavior is preventing the person from
functioning well in life
Identifying abnormal behavior is also a matter of degree
Chapter 9
Models of Abnormality
The Biological ModelThe Psychoanalytic ModelThe Cognitive-Behavioral ModelNewer Theoretical Approaches
Chapter 9
The Biological Model
The Biological Model– View the psychological disorders have a biochemical or
physiological basis– Often stem from hereditary factors
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The Psychoanalytic Model
The Psychoanalytic Model– View that psychological disorders result from unconscious
internal conflicts– Most become aware that the source of their problems lies
in their childhood and infancy to resolve their problems effectively
Chapter 9
The Cognitive-Behavioral Model
The Cognitive-Behavioral Model– View that psychological disorders result from learning
maladaptive ways of thinking and behaving– Maladaptive behaviors can be learned and unlearned– Stresses both internal and external learning processes in
development and treatment
Chapter 9
Newer Theoretical Approaches
Diathesis-Stress Model– View that people biologically predisposed to a mental
disorder will tend to exhibit that disorder when particularly affected by stress
– Diathesis– Biological predisposition
Systems Approach– View that biological, psychological and social risk factors
combine to produce psychological disorders– Also known as the biopsychosocial model of psychological
disorders
Chapter 9
Prevalence of Psychological Disorders
Prevalence– The frequency with which a given disorder occurs at a
given time
Incidence– Refers to the number of new cases that arise in a given
period
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Prevalence of Psychological Disorders
2001 APA study of more than 20,000 people found:– 15% of the population was found to be experiencing a clinically
significant disorder– 6% was experiencing a significant substance abuse disorder– Most common mental disorders:
– Anxiety Disorders– Phobias– Mood Disorders
– Schizophrenia was found to afflict 1% of the population, or over 2 million people
– Substance abuse problems were found in 6% of the population– Alcohol abuse 3x more prevalent than abuse of all other drugs
combined
Chapter 9
Classifying Abnormal Behavior
Diagnostic and Statistical Manual of Mental Disorders (DSM)– Manual that lists and describes the various kinds of
psychological disorders– The manual provides careful descriptions of symptoms of
different disorders to improve consistent diagnosis– Generally silent on cause and treatment
Chapter 9
Outline
Perspectives on Psychological DisordersMood DisordersAnxiety DisordersPsychosomatic, Somatoform, and Dissociative DisordersSchizophrenic DisordersOther Common DisordersPsychotherapiesBiological TreatmentsChallenges in Therapy
Chapter 9
Mood Disorders
Mood Disorders– Disturbances in mood or prolonged emotional state,
sometimes referred to as affect
Most people have a wide emotional range, but in some people with mood disorders, this range is greatly restrictedThey seem stuck at one or the other end of the emotional spectrum, or they may alternate back and forth between periods of mania and depression
Chapter 9
Depression
Depression– A mood disorder characterized by overwhelming feelings
of sadness, lack of interest in activities, and perhaps excessive guilt or feelings of worthlessness
Most common mood disorderMajor depressive disorder– An episode of intense sadness that may last for several
months
Dysthymia – Involves less intense sadness but persists with little relief
for a period of two years or more
Chapter 9
Suicide
Nearly 30,000 people in the US commit suicide each year - 11th leading cause of deathMore women than men attempt suicide, but more men succeedSuicide rates among American adolescents and young adults have been rising– Suicide is the third leading cause of death among
adolescents
A common feeling associated with suicide is hopelessness, which is also typical of depression
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Gender and Race Differences in the Suicide Rate Across the Life Span
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Suicide Myths
Myth: Someone who talks about committing suicide will never do it– Fact: Most people who kill themselves have talked about it.
Such comments should always be taken seriously
Myth: Someone who has tried suicide and failed is not serious about it– Fact: Any suicide attempt means that the person is deeply
troubled and needs help immediately. They may try again, picking a more deadly method the second or third time
Myth: Only people who are life’s losers – those who have failed in the careers and in the personal lives – commit suicide– Fact: Many people who kill themselves have prestigious
jobs, conventional families and a good income
Chapter 9
Mania
Mania– A mood disorder characterized by euphoric states, extreme
physical activity, excessive talkativeness, distractedness and sometimes grandiosity
Bipolar Disorder– A mood disorder in which periods of mania and depression
alternate (each lasting from a few days to a few months), sometimes with periods of normal mood intervening
– Occurs equally in men and women– More strongly linked to heredity and is often treated with
drugs
Chapter 9
Causes of Mood Disorders
Most psychologists now believe that mood disorders result from a combination of– Biological factors– Psychological factors– Social factors
Chapter 9
Outline
Perspectives on Psychological DisordersMood DisordersAnxiety DisordersPsychosomatic, Somatoform, and Dissociative DisordersSchizophrenic DisordersOther Common DisordersPsychotherapiesBiological TreatmentsChallenges in Therapy
Chapter 9
Anxiety Disorders
Anxiety Disorders– Disorders in which anxiety is a characteristic feature or the
avoidance of anxiety seems to motivate abnormal behavior– The person doesn't know why he or she is afraid or– The anxiety is inappropriate to the circumstances
Normal fear – Caused by something identifiable– Subsides with time
Chapter 9
Phobias
Specific Phobia– Anxiety disorder characterized by intense, paralyzing fear
of something
Social Phobia– Anxiety disorder characterized by excessive, inappropriate
fears connected with social situations or performances in front of other people
Agoraphobia– Anxiety disorder characterized that involves multiple,
intense fears of crowds, public places, and other situations that require separation from a source of security such as the home
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Panic Disorder
Panic Disorder– An anxiety disorder characterized by recurrent panic
attacks in which the person suddenly experiences intense fear or terror without any reasonable cause
– Leave a dread of future panic attacks that can last for days or weeks
– Can lead to agoraphobia in an attempt to prevent another panic attack
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Other Anxiety Disorders
Generalized Anxiety Disorder– An anxiety disorder characterized by prolonged vague but
intense fears that are not attached to any particular object or circumstance
Obsessive-Compulsive Disorder (OCD)– An anxiety disorder in which a person feels driven to think
disturbing thoughts (obsessions) or to perform senseless rituals (compulsions)
– If someone else tries to stop them, they experience severe anxiety
– Seems to have developed to keep anxiety under control
Chapter 9
Outline
Perspectives on Psychological DisordersMood DisordersAnxiety DisordersPsychosomatic, Somatoform, and Dissociative DisordersSchizophrenic DisordersOther Common DisordersPsychotherapiesBiological TreatmentsChallenges in Therapy
Chapter 9
Psychosomatic, Somatoform & Dissociative Disorders
Psychological disorders that involve symptoms that mimic those commonly associated with neurological disorders
Chapter 9
Mind-Body Disorders
Psychosomatic Disorders – Disorders in which there is real physical illness that is
largely caused by psychological factors such as stress and anxiety
– Caused by muscle contractions brought on by stress
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Mind-Body Disorders
Somatoform Disorders – Characterized by physical symptoms without any
identifiable physical cause – The symptoms are real to them and are not under
voluntary control– Conversion Disorders
– Complaints of paralysis, blindness, deafness, seizures, loss of feeling, or pregnancy
– Hypocondriasis– Interprets small symptoms as a sign of a serious disease
– Body Dysmorphic Disorders– Imagined ugliness where people because so preoccupied with
their looks they cannot lead a normal life
Chapter 9
Dissociative Disorders
Dissociative Disorders– Disorders in which some aspect of the person's personality
seems separated from the rest – Usually involves amnesia and a complete, though
generally temporary, change in identity
Types of Dissociative Disorders– Dissociative amnesia– Dissociative fugue– Dissociative identity disorder
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Dissociative Amnesia
A dissociative disorder characterized by loss of memory for past events without organic causeDissociative amnesia may result from an intolerable experience
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Dissociative Fugue
A dissociative disorder that involves flight from home and the assumption of a new identity, with amnesia for past identity and eventsDissociative fugue is rare
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Dissociative Identity Disorder
A dissociative disorder in which a person has several distinct personalities that emerge at different times– Also known as multiple personality disorder
Extremely rare although the number of cases appears to be increasing
Chapter 9
Outline
Perspectives on Psychological DisordersMood DisordersAnxiety DisordersPsychosomatic, Somatoform, and Dissociative DisordersSchizophrenic DisordersOther Common DisordersPsychotherapiesBiological TreatmentsChallenges in Therapy
Chapter 9
Schizophrenic Disorders
Schizophrenic Disorders – Severe disorders in which there are disturbances of
thoughts, communications, and emotions, including delusions and hallucinations
Psychotic (psychosis)– Behavior characterized by a loss of touch with reality
Insanity– Legal term for mentally disturbed people who are not
considered responsible for their criminal behavior
Chapter 9
Symptoms of Schizophrenia
Hallucinations– Sensory experience in the absence of external stimulation– Usually take the form of hearing voices that are not really
there
Delusions– False beliefs about reality that have no basis in fact– Typically delusions are paranoid – someone is out to harm
them
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Subtypes of Schizophrenia
Disorganized Schizophrenia– Bizarre and childlike behaviors are common
Catatonic Schizophrenia– Disturbed motor activity is prominent
Paranoid Schizophrenia– Marked by extreme suspiciousness and complex, bizarre
delusions– The presence of delusions differentiates this disorder from
paranoid personality disorder
Undifferentiated Schizophrenia – There are clear schizophrenic symptoms that do not meet
the criteria for another subtype of the disorder
Chapter 9
Causes of Schizophrenia
GeneticsFaulty regulation of the neurotransmitters dopamine and glutamatePathology in various structures of the brainEarly prenatal disturbanceEnvironmentCombination of biological, psychological and social factors (Systems Model)
Chapter 9
Outline
Perspectives on Psychological DisordersMood DisordersAnxiety DisordersPsychosomatic, Somatoform, and Dissociative DisordersSchizophrenic DisordersOther Common DisordersPsychotherapiesBiological TreatmentsChallenges in Therapy
Chapter 9
Other Common Disorders
Sexual and Gender-Identity DisordersPersonality DisordersChildhood Disorders
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Sexual and Gender-Identity Disorders
Sexual Dysfunction– Loss or impairment of the ordinary physical responses of
sexual function
Erectile Disorder (ED)– The inability of a man to achieve or maintain an erection
Female Sexual Arousal Disorder– The inability of a woman to become sexually aroused or to
reach orgasm
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Sexual and Gender-Identity Disorders
Paraphilias– Sexual disorders in which unconventional objects or
situations cause sexual arousal
Fetishism– A paraphilia in which a nonhuman object is the preferred or
exclusive method of achieving sexual excitement
Pedophilia– Desire to have sexual relations with children as the
preferred or exclusive method of achieving sexual excitement
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Sexual and Gender-Identity Disorders
Gender-Identity Disorders– Disorders that involve the desire to become, or the
insistence that one really is, a member of the other biological sex
Gender-identity disorder in children– Rejection of one’s biological gender in childhood, along
with the clothing and behavior society considers appropriate to that gender
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Personality Disorders
Personality Disorders– Disorders in which inflexible and maladaptive ways of
thinking and behaving learned early in life cause distress to the person or conflicts with others
Antisocial Personality Disorder– Personality disorder that involves a pattern of violent,
criminal, or unethical and exploitative behavior and an inability to feel affection for others
Chapter 9
Major Personality Disorders
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Childhood Disorders
Childhood Disorders– Disorders usually first diagnosed in infancy, childhood, or
adolescence
Attention-Deficit/Hyperactivity Disorder (ADHD)– A childhood disorder characterized by inattention,
impulsiveness, and hyperactivity– Affects nearly 5% of all school-age children– More common in boys than girls– Is present at birth, but becomes a serious problem after
the child starts school
Chapter 9
Attention-Deficit/Hyperactivity Disorder
Most frequent form of treatment is a drug called psychostimulant– Do not work by “slowing down” hyperactive children– Increase the ability to focus attention so that they can
attend to the task at hand– Often produce only short-term benefits– Use is controversial
Chapter 9
Childhood Disorders
Autistic Disorder– A childhood disorder characterized by lack of social
instincts and strange motor behavior– Children fail to form normal attachments to parents,
remaining distant and withdrawn in their own separate worlds
– May even show distress when picked up or held
Echolalia– A speech pattern displayed by some autistic children in
which they repeat the words said to them
Chapter 9
Outline
Perspectives on Psychological DisordersMood DisordersAnxiety DisordersPsychosomatic, Somatoform, and Dissociative DisordersSchizophrenic DisordersOther Common DisordersPsychotherapiesBiological TreatmentsChallenges in Therapy
Chapter 9
Psychotherapies
Psychotherapy– The use of psychological techniques to treat personality
and behavior disorders
Types– Insight Therapies– Behavior Therapies– Cognitive Therapies– Group Therapies
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Insight Therapies
Insight therapy– A variety of individual psychotherapies designed to give
people a better awareness and understanding of their feelings, motivations and actions in the hope that this will help them adjust
Three examples of insight therapies:– Psychoanalysis – Client-Centered Therapy– Short-Term Psychodynamic Therapy
Chapter 9
Psychoanalysis
Psychoanalysis– The theory of personality Freud developed as well as the
form of therapy he invented– Designed to bring hidden feelings and motives to
conscious awareness so that the person can deal with them more effectively
Free association– A technique encouraging the person to talk without
inhibition about whatever thoughts or fantasies come to mind
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Psychoanalysis
Transference– The patient’s carrying over to the analyst feelings held
toward childhood authority figures– Positive Transference is when the person feels good about
the analyst
Insight– Awareness of previously unconscious feelings and
memories and how they influence present feelings and behavior
Chapter 9
Psychoanalysis
Only a handful of people who seek therapy go into traditional psychoanalysisRequires great motivation to change and ability to deal with whatever analysis uncoversMay take five years or more with three, sometimes five, sessions a week– Many want immediate help
Generally not effective with severe disorders
Chapter 9
Client-Centered Therapy
Client-Centered (or Person-Centered) Therapy– Nondirectional form of therapy developed by Carl Rogers
that calls for unconditional positive regard of the client by the therapist with the goal of helping the client become fully functioning
– People’s defensiveness, rigidity, anxiety and other signs of discomfort stem from their experiences of what he called conditional positive regard
Chapter 9
Short-Term Psychodynamic Therapy
Short-Term Psychodynamic Therapy– Insight therapy that is time limited and focused on trying
to help clients correct the immediate problems in their lives
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Behavior Therapies
Behavior Therapies– Based on the belief that all behavior, normal and
abnormal, is learned and that the objective of therapy is to teach people new, more satisfying ways of behaving
For behaviorists, the focus of psychotherapy should be the problem behaviors themselves, not some deeper, underlying conflicts that are presumably causing those behaviors
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Therapies Based on Classical Conditioning
Systematic desensitization– A behavioral technique for reducing fear and anxiety by
gradually associating a new response (relaxation) with stimuli that have been causing the fear and anxiety
Flooding– A behavioral technique for desensitization through intense
and prolonged exposure to anxiety-producing stimuli
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Therapies Based on Operant Conditioning
Behavior Contracting– Form of operant conditioning therapy in which the client
and therapist set behavioral goals and agree on reinforcements that the client will receive on reaching those goals.
Token Economies– An operant conditioning therapy in which patients earn
tokens (reinforcers) for desired behaviors and exchange them for desired items or privileges
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Therapies Based on Social Learning
Modeling– A behavior technique in which the person learns desired
behaviors by watching others perform those behaviors– Has helped schizophrenics to learn and use appropriate
behavior both inside and outside the hospital– Used to teach people with mental retardation job skills and
independent living
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Cognitive Therapies
Cognitive Therapies– Therapy that depends on identifying and changing
inappropriately negative and self-critical patterns of thought
Cognitive therapies focus not so much on maladaptive behaviors as on maladaptive ways of thinkingBy changing people's distorted, self-defeating ideas about themselves and the world, cognitive therapists hope to encourage better coping skills and adjustment
Chapter 9
Stress-Inoculation Therapy
Trains clients to cope with stressful situations by learning a more useful pattern of self-talkThe client is taught to suppress any negative, anxiety-evoking thoughts and to replace the with positive, “coping” thoughtsWorks by turning the client’s own thought patterns into a kind of vaccine against stress-induced anxiety
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Rational-Emotive Therapy (RET)
A directive cognitive therapy based on the idea that clients’ psychological distress is caused by irrational and self-defeating beliefs and the therapist’s job is to challenge such dysfunctional beliefsIrrational/self-defeating beliefs involve absolutes, for example “musts” and “shoulds” that allow no room for mistakes
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Beck’s Cognitive Therapy
Depends on identifying and changing inappropriately negative and self-critical patterns of thoughtTherapists try to help clients examine each dysfunctional thought in a supportive but objectively scientific manner
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Group Therapies
Clients meet regularly to interact and help one another achieve insight into their feelings and behaviorBased on the idea that psychological problems are at least partly interpersonal and are therefore best approached in a group
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Family Therapy
The family is seen as partly responsible for the individual’s problemsFamily therapy seeks to change all family members’ behaviors to the benefit of the family unit as well as the troubled individual
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Couple Therapy
A form of group therapy intended to help troubled partners improve their problems of communication and interactionEmpathy Training– Each person is taught to share inner feelings and to listen
to and understand the partner’s feelings before responding to them
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Effectiveness of Psychotherapy
Most researchers agree that psychotherapy helps about two-thirds of the people treatedMany people who do not receive formal therapy get therapeutic help from friends, clergy, physicians and teachersAlthough there is some debate over how many untreated people also recover, the consensus is that those who get therapy are generally better off than those who don't
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Effectiveness of Psychotherapy
Works best for relatively mild psychological problemsGreatest benefits to people who really want to changeGreater improvement among people who have undergone long-term therapy
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Duration of Therapy and Improvement
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Effectiveness of Psychotherapy
In general, there isn’t much difference in effectiveness based on the form of psychotherapy– All forms of psychotherapy provide people with an
explanation for their problems– Most forms of psychotherapy offer people hope– All major types of psychotherapy engage the client in a
therapeutic alliance with a therapist
Chapter 9
Outline
Perspectives on Psychological DisordersMood DisordersAnxiety DisordersPsychosomatic, Somatoform, and Dissociative DisordersSchizophrenic DisordersOther Common DisordersPsychotherapiesBiological TreatmentsChallenges in Therapy
Chapter 9
Biological Treatments
A group of treatment approaches including medication, electroconvulsive therapy, and psychosurgery that are sometimes used to treat psychological disorders in conjunction with, or instead of, psychotherapySelect biological treatments because– People may be too agitated, disorientated, or unresponsive
to be helped by psychotherapies– Biological treatment is virtually always used for disorders
that have a strong biological component– Biological treatment is often used for people who are
dangerous to themselves and others
Chapter 9
Drug Therapies
Two major reasons for widespread use of drug therapies– Development of several very effective psychoactive
medications– Drug therapies can cost less than psychotherapy
Critics contend that drugs are used because of our society’s “pill mentality”, or belief that medication can fix any problem
Chapter 9
Types of Psychoactive Drugs
Drugs used to treat mental disorders work by regulating the action of specific neurotransmitter mechanisms in the brainOrganized into general categories based on the types of disorders for which they are effective
Chapter 9
Categories of Drug Therapies
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How Do SSRIs Work?
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Impact of Psychoactive Drugs
Antipsychotic drugs are valuable in treating schizophrenia They do not cure the disorder, but they reduce its symptoms, although side effects can be severeDrugs are of little value in treating the problems of social adjustment faced outside of institutional setting
Chapter 9
Deinstitutionalization
Policy of treating people with severe psychological disorders in the larger community or in small residential centers such as halfway houses, rather than large public hospitalsDeinstitutionalization has created serious problems– Discharged people often find poorly funded community
mental health centers– Suicide rate among deinstitutionalized patients is
increasing– Some surveys indicate that about 40% of the homeless
people in the US are mentally ill
Chapter 9
Electroconvulsive Therapy (ECT)
A mild electrical current is passed through the brain for a short period, often producing convulsions and temporary coma Used to treat severe, prolonged depressionThe reason ECT works remains unknownUsually considered a “last-resort” treatment when all other methods have failed
Chapter 9
Psychosurgery
Brain surgery performed to change a person’s behavior and emotional stateExample: prefrontal lobotomy– The prefrontal lobes of the brain are severed from the
deeper centers beneath them
This therapy is rarely used today
Chapter 9
Outline
Perspectives on Psychological DisordersMood DisordersAnxiety DisordersPsychosomatic, Somatoform, and Dissociative DisordersSchizophrenic DisordersOther Common DisordersPsychotherapiesBiological TreatmentsChallenges in Therapy
Chapter 9
Client Diversity and Treatment
Given that human beings differ as much as they do, it isn't surprising that a one-size-fits-all concept isn't always appropriate in the treatment of psychological problemsIn recent years the special needs of women and people from other cultures have particularly occupied the attention of mental health professionals
Chapter 9
Matching Treatments to Individuals
Therapy should reflect the person’s preferences as well as the type of problem being treatedMany of the most severe mental disorders probably involve a biological dimensionSuccess can often be improved by providing psychotherapy
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Major Perspectives on Therapy
Chapter 9
Chapter Review
Perspectives on Psychological Disorders– How does a mental health professional define a
psychological disorder?– How have the biological, psychoanalytic, cognitive-
behavioral, diathesis-stress, and systems models each attempted to explain psychological disorders?
Mood Disorders– How does clinical depression differ from ordinary sadness?– What factors are related to a person’s likelihood of
committing suicide?– What is mania, and how is it involved in bipolar disorder?– What causes some people to experience extreme mood
changes?
Chapter 9
Chapter Review
Anxiety Disorders– Into what categories are phobias usually grouped?– How does a panic attack differ from fear?– How do generalized anxiety disorder and obsessive-
compulsive disorder differ from specific phobias?
Psychosomatic, Somatoform, and Dissociative Disorders– What are the differences among Psychosomatic,
Somatoform, and Dissociative Disorders
Chapter 9
Chapter Review
Schizophrenic Disorders– How is Schizophrenia different from multiple-personality
disorder?– How do subtypes of Schizophrenia differ from each other?– Is Schizophrenia inherited?
Other Common Disorders– What are the three main types of sexual disorders?– Which personality disorder creates the most significant
problems for society?– Why do stimulants appear to slow down hyperactive
children and adults?
Chapter 9
Chapter Review
Psychotherapies– What do insight therapies have in common?– What do behaviorists believe should be the focus of
psychotherapy?– What are some advantages of group therapies?– How much better off is a person who receives
psychotherapy than one who gets no treatment at all?
Chapter 9
Chapter Review
Biological Treatments– What are some of the drugs used to treat psychological
disorders?– How is electroconvulsive therapy of today different from
that of the past?– What is psychosurgery ad how is it used?
Challenges in Therapy– Are there particular groups of people who may require
special approaches in the treatment of psychological problems?
– How should individuals evaluate which therapy is best for them?