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Psychological Disorders
Chapter 11
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Psychological Disorders Defining and diagnosing disorder. Anxiety disorders. Mood disorders. Personality disorders. Drug abuse and addiction. Dissociative identity disorder. Schizophrenia.
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Defining and Diagnosing Disorder
Dilemmas of definition. Dilemmas of diagnosis. Dilemmas of measurement.
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Dilemmas of Definition Possible Models for Defining Disorders:
Mental disorder as a violation of cultural standards. Mental disorder as maladaptive or harmful behavior. Mental disorder as emotional distress.
Mental Disorder Any behavior or emotional state that causes an
individual great suffering or worry, is self-defeating or self-destructive, or is maladaptive and disrupts the person’s relationships or the larger community.
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Diagnostic and Statistical Manual Axis I: Primary clinical problem Axis II: Personality disorders Axis III: General medical conditions Axis IV: Social and environmental stressors Axis V: Global assessment of overall
functioning
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Explosion of Mental Disorders Supporters of new
categories answer that is important to distinguish disorders precisely.
Critics point to an economic reason: diagnoses are needed for insurance reasons so therapists will be compensated.
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Concerns About Diagnostic System The danger of overdiagnosis. The power of diagnostic labels. Confusion of serious mental disorders with
normal problems. The illusion of objectivity and universality.
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Advantages of the DSM
When the manual is used correctly and diagnoses are made with valid objective tests, the DSM improves the reliability of and agreement among clinicians.
The DSM-IV included for the first time a list of culture-bound syndromes, disorders specific to a particular culture.
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Projective Tests Projective Tests
Psychological tests used to infer a person’s motives, conflicts, and unconscious dynamics on the basis of the person’s interpretations of ambiguous stimuli.
Rorschach Inkblot Test A projective personality test
that asks respondents to interpret abstract, symmetrical inkblots.
A sample inkblot
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Objective Tests Inventories
Standardized objective questionnaires requiring written responses; they typically include scales on which people are asked to rate themselves.
Minnesota Multiphasic Personality Inventory (MMPI) A widely used objective personality test.
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Anxiety Disorders Anxiety and panic. Fears and phobias. Obsessions and compulsions.
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Anxiety and Panic Generalized Anxiety Disorder
A continuous state of anxiety marked by feelings of worry and dread, apprehension, difficulties in concentration, and signs of motor tension.
Panic Disorder An anxiety disorder in which a person experiences
recurring panic attacks, feelings of impending doom or death, accompanied by physiological symptoms such as rapid breathing and dizziness.
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Panic Disorder An anxiety disorder in which a
person experiences: recurring panic attacks, periods of intense fear, and feelings of impending doom or
death; accompanied by physiological
symptoms such as rapid heart rate and dizziness.
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Posttraumatic Stress Disorder (PTSD) An anxiety disorder in which a person who
has experienced a traumatic or life-threatening event has symptoms such as psychic numbing, reliving the the trauma, and increased physiological arousal.
Diagnosed only if symptoms persist for 6 months or longer.
May immediately follow event or occur later.
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Obsessions and Compulsions Obsessive-Compulsive Disorder (OCD)
An anxiety disorder in which a person feels trapped in repetitive, persistent thoughts (obsessions) and repetitive, ritualized behaviors (compulsions) designed to reduce anxiety.
Person understands that the ritual behavior is senseless but guilt mounts if not performed.
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Fears and Phobias Phobia
An exaggerated, unrealistic fear of a specific situation, activity, or object.
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Agoraphobia A set of phobias, often set off by a panic
attack, involving the basic fear of being away from a safe place or person.
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Theoretical Explanations: Freudian
Little Hans, for instance Behaviorist
Mowrer’s two-factor theory, for instance Social-Cognitive
“Vicarious learning,” we learn to fear by watching others experience pain
Biological We are genetically predisposed to fear anything that
might have been dangerous to our ancestors
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Mood Disorders Depression and Bipolar Disorder. Theories of Depression.
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Depression Major Depression
A mood disorder involving disturbances in emotion (excessive sadness), behavior (loss of interest in one’s usual activities), cognition (thoughts of hopelessness), and body function (fatigue and loss of appetite).
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Symptoms of Depression
Depressed mood. Reduced interest in almost all activities. Significant weight gain or loss, without dieting. Sleep disturbance (insomnia or too much sleep). Change in motor activity (too much or too little) . Fatigue or loss of energy. Feelings of worthlessness or guilt. Reduced ability to think or concentrate. Recurrent thoughts of death / suicide
DSM IV Requires 5 of these within the past 2 weeks
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Gender, Age, & Depression
Women are about twice as likely as men to be diagnosed with depression. True around the
world
After age 65, rates of depression drop sharply in both sexes.
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Bipolar Disorder Bipolar Disorder:
A mood disorder in which episodes of depression and mania (excessive euphoria) occur.
Commonly known as “manic depression” or “manic depressive disorder” Mood
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The Two Sides of the Coin: Manic and Depressive Phases
Manic: Increased energy and
activity Little need for sleep Euphoria, sometimes
excessive Lack of concentration Poor judgment Distractible; racing
thoughts Denial of problems
Depressive: Lasting sad, anxious,
empty mood Pessimistic outlook,
feelings of guilt Decreased energy Sleep disturbance Loss of pleasure in old
favorite activities Change in eating habits Restlessness or irritability
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The Bipolar Brain Bipolar disorder can
have rapid mood swings
These wild changes are shown in brain activity (right)
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Theories of Depression Biological explanations emphasize genetics and brain
chemistry. Social explanations emphasize the stressful
circumstances of people’s lives. Attachment explanations emphasize problems with
close relationships. Cognitive explanations emphasize particular habits of
thinking and ways of interpreting events. “Vulnerability-Stress” explanations draw on all four
explanations described above.
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Vulnerability-Stress Model
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Personality Disorders Problem Personalities. Antisocial Personality Disorder.
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Problem Personalities
Personality Disorder Rigid, maladaptive patterns that cause personal
distress or an inability to get along with others.
Narcissistic Personality Disorder A disorder characterized by an exaggerated sense of
self-importance and self-absorption.
Paranoid Personality Disorder A disorder characterized by habitually unreasonable
and excessive suspiciousness and jealousy.
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Antisocial Personality Disorder (APD) A disorder characterized by antisocial
behavior such as lying, stealing, manipulating others, and sometimes violence; and a lack of guilt, shame and empathy. Used to be called psychopathy or sociopathy
Occurs in 3% of all males and 1% of all females.
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DSM Criteria for APD Must have 3 of these criteria and a history of behaviors
Repeatedly break the law. They are deceitful, using aliases and lies to con others. They are impulsive and unable to plan ahead. They repeatedly get into physical fights or assaults. They show reckless disregard for own safety or that of
others. They are irresponsible, failing to meet obligations to others. They lack remorse for actions that harm others.
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Emotions and Antisocial Personality Disorder People with APD were
slow to develop classically conditioned responses to anger, pain, or shock.
Such responses indicate normal anxiety.
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Causes of APD Abnormalities in central nervous system. Genetically influenced problems with impulse
control. Brain damage.
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Drug Abuse and Addiction Biology and addiction. Learning, culture, and addiction. Debating the causes of addiction.
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Biology and Addiction The biological model holds that addiction,
whether to alcohol or other drugs is due primarily to: a person’s biochemistry, metabolism, and genetic predisposition,
Most evidence comes from twin studies.
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Learning, Culture, and Addiction
Addiction patterns vary according to cultural practices and the social environment.
Policies of total abstinence tend to increase addiction rates rather than reduce them.
Not all addicts have withdrawal symptoms when they stop taking a drug.
Addiction does not depend on the properties of the drug alone, but also on the reason for taking it.
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Failure of the Addiction Prediction 75% of US Soldiers who tested
“drug positive” in Vietnam reported being addicted during their tour.
Fewer reported post-Vietnam drug use (blue bar).
Even fewer still showed dependency (green bar).
This contradicts what the biomedical model of addiction would predict.
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Debating the Causes of Addiction Problems with drugs are more likely when:
A person has a physiological vulnerability to a drug. A person believes she or he has no control over the drug. Laws or customs encourage people to take the drug in
binges, and moderate use is neither tolerated nor taught. A person comes to rely on a drug as a method of coping
with problems, suppressing anger or fear, or relieving pain.
Members of a person’s peer group use drugs or drink heavily, forcing the person to choose between using drugs or losing friends.
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Dissociative Identity Disorder Defining identity disorders. The MPD controversy. The sociocognitive explanation.
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The Four Dissociative Disorders Dissociative amnesia – loss of memory or
personal information, usually of a stressful nature Dissociative fugue – rare; person suddenly leaves
and travels; will be confused about identity; will have hazy memories of the event
Depersonalization disorder – recurrent feelings of detachment or distance from one’s own body, experience, or self
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Dissociative Identity Disorder (DID) A controversial disorder marked by the
appearance within one person of two or more distinct personalities, each with its own name and way of relating to the world or self; commonly known as “Multiple Personality Disorder (MPD).” Different from schizophrenia (note: no one
calls it “split personality” any more), and not the same as bipolar disorder
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More About DID Different personalities recurrently take
control of the subject’s behaviors Subject exhibits inability to recall
important personal information to an extent that is more than ordinary forgetfulness
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History of DID Virtually unknown 35
years ago Became more
common in past 20 years
Why would this be?
Fewer than 100 documented cases by mid-20th Century (Taylor and Martin, 1944)
About 40,000 new cases documented between 1985 and 1995
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The MPD Controversy First viewpoint – It’s real!
MPD is common but often unrecognized or misdiagnosed.
The disorder starts in childhood as means of coping. Trauma produced a mental splitting.
Second viewpoint – Most cases are fake! Created through pressure and suggestions by
clinicians. Handfuls to tens of thousands since 1980.
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Sociocognitive Explanation DID is an extreme form of our ability to present
many aspects of our personalities to others. DID is a socially acceptable way for some
troubled people to make sense of their problems. Therapists looking for DID may reward patients
with attention and praise for revealing more and more personalities.
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The Case of Sybil Case of DID, popularized in a novel and two
movies Real name was Sybil Isabel Dorsett Set the standard for DID as being rooted in child
abuse About 16 different personalities, all with uniquely
different personalities and attributes (religious, party girl, British accent, skilled pianist, baby); two were male!
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DID in Court – What legal problems can you see?
Billy Mulligan – accused of robberies and rape; by the time of trial, 10 of his 23 personalities had surfaced: one had a British accent, one could write fluently in Arabic, one was 16, one was 8…
Juanita Maxwell – bludgeoned an elderly woman to death with a lamp, but had no memory of the crime; during trial, the violent alter manifested
Critics say that the vast majority of subjects were misdiagnosed, are faking it, or were unwittingly pressured into the state by a too-eager clinician
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Psychosis Symptoms of psychotic disorders:
Hallucinations Delusions Formal thought disorders
Psychotic disorders: Mania or depression with psychosis
(Schizoaffective disorder) Drug-induced psychosis Schizophrenia
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Schizophrenia Defining schizophrenia and psychosis. Symptoms of schizophrenia. Theories of schizophrenia.
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Symptoms of Schizophrenia Bizarre delusions. Hallucinations and heightened sensory
awareness. Disorganized, incoherent speech. Grossly disorganized and inappropriate
behavior.
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Delusions and Hallucinations Delusions
False beliefs that often accompany schizophrenia and other psychotic disorders.
Hallucinations Sensory experiences that occur in the absence
of actual stimulation Hallucinations are usually tactile, auditory, or
visual
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Positive Symptoms Cognitive, emotional, and behavioral
excesses Examples of Positive Symptoms
Hallucinations. Bizarre delusions. Incoherent speech. Inappropriate/Disorganized behaviors.
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Negative Symptoms Cognitive, emotional, and behavioral
deficits Examples of Negative Symptoms
Loss of motivation Emotional flatness Social withdrawal Slowed speech or no speech, even catatonia
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Theories of Schizophrenia Genetic predispositions Structural brain abnormalities Neurotransmitter abnormalities Prenatal abnormalities
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Genetic Vulnerability to Schizophrenia
The risk of developing schizophrenia (i.e., prevalence) in one’s lifetime increases as the genetic relatedness with a diagnosed schizophrenic increases.
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Structural Brain Abnormalities Several abnormalities exist, especially when
schizophrenia is characterized by primarily negative symptoms: Decreased brain weight. Decreased volume in temporal lobe or
hippocampus. Enlargement of ventricles.
About 25% do not have these observable brain deficiencies
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Neurotransmitter Abnormalities Include serotonin, glutamate, and
dopamine. Many schizophrenics have high levels of
brain activity in brain areas served by dopamine as well as greater numbers of particular dopamine receptors.
Similar neurotransmitter abnormalities are also found in depression and alcoholism.
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Prenatal Problems or Birth Complications Damage to the fetal brain increases
chances of schizophrenia and other mental disorders. May occur as a function of maternal
malnutrition, maternal illness. May also occur if brain injury or oxygen
deprivation occurs at birth.
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Adolescent Abnormalities in Brain Development Normal pruning of excessive synapses in
the brain occurs during adolescence. In schizophrenics, a greater number of
synapses are pruned away. Many explain why first episode occurs in
adolescence or early adulthood.
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The Question of Drugs
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Cautions About Drug Treatment
Placebo effect High Relapse and dropout rates. Dosage problems. Long-term risks
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Kinds of Psychotherapy Psychodynamic therapy. Behavioral and Cognitive therapy. Humanist and Existential therapy. Family therapy.