PSYC

Psychological Disorders

PSYCHOLOGY David G. Myers C. Nathan DeWall Twelfth Edition

Chapter 15

Chapter Overview

 Introduction to Psychological Disorders  Anxiety Disorders, OCD, and PTSD  Depressive Disorders, Bipolar Disorder, Suicide,

and Self-Injury  Schizophrenia  Dissociative, Personality, and Eating Disorders

Introduction to Psychological Disorders (part 1)

 According to psychologists and psychiatrists, psychological disorders are marked by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior (APA, 2013).

 Disturbed or dysfunctional thoughts, emotions, or behaviors are maladaptive.

Yesterday’s “Therapy”

Through the ages, psychologically disordered people have received brutal treatments, including the trephination evident in this Stone Age skull. Drilling skull holes like these may have been an attempt to release evil spirits and cure those with mental disorders. Did this patient survive the “cure”?

Introduction to Psychological Disorders (part 2)  The medical model

 1800s: Search for physical cause of mental disorders and for curative treatments

 Mental illness diagnosed on basis of symptoms and treated through therapy

 Credibility gained from recent research in genetically influenced brain abnormalities in brain structure and biochemistry

 The biopsychosocial approach  General approach positing that biological, psychological, and

social-cultural factors play significant roles in human functioning in the context of disease or illness

 Epigenetics also informs our understanding of disorders

Biopsychosocial Approach to Psychological Disorders

Introduction to Psychological Disorders (part 3)

 Diagnostic classification in psychiatry and psychology  Predicts the disorder’s

future course  Suggests appropriate

treatment  Prompts research into its

causes

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Diagnostic and Statistical Manual of Mental Disorders (DSM-5)  DSM-5  American Psychiatric Association-Fifth edition  Describes disorders and estimates their occurrence

Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (part 2)

 DSM-5 criticism  Antisocial personality disorder and generalized

anxiety disorder did poorly on field trials.  DSM-5 contributes to pathologizing of everyday life.  System labels are society’s value judgments.

 DSM-5 benefits  System helps mental health professionals

communicate and is useful in research

Does Disorder Equal Danger?

 Mental disorders seldom lead to violence and clinical prediction of violence is unreliable.  When they do, moral and ethical questions are raised

about whether society should hold people with disorders responsible for their violent actions?

 Most people with disorders are nonviolent and are more likely to be victims than attackers.

Rates of Psychological Disorders

 Psychological disorder rates vary, depending on the time and place of the survey.

 Poverty is a risk factor.  Conditions and experiences

associated with poverty contribute to the development of psychological disorders.

 Some disorders, such as schizophrenia, can drive people into poverty.

Percentage of Americans Reporting Selected Psychological Disorders in the Past Year

Psychological Disorder Percentage

Depressive disorders or bipolar disorder 9.3

Phobia of specific object or situation 8.7

Social anxiety disorder 6.8

Attention-deficit/hyperactivity disorder (ADHD)

4.1

Posttraumatic stress disorder (PTSD) 3.5

Generalized anxiety disorder 3.1

Schizophrenia 1.1

Obsessive-compulsive disorder 1.0

What Increases Vulnerability to Mental Disorders?

Risk Factors Protective Factors

Academic failure Birth complications Caring for those who are chronically ill or who have a neurocognitive disorder Child abuse and neglect Chronic insomnia Chronic pain Family disorganization or conflict Low birth weight Low socioeconomic status Medical illness Neurochemical imbalance Parental mental illness Parental substance abuse Personal loss and bereavement Poor work skills and habits Reading disabilities Sensory disabilities Social incompetence Stressful life events Substance abuse Trauma experiences

Aerobic exercise Community offering empowerment, opportunity, and security Economic independence Effective parenting Feelings of mastery and control Feelings of security High self-esteem Literacy Positive attachment and early bonding Positive parent-child relationships Problem-solving skills Resilient coping with stress and adversity Social and work skills Social support from family and friends

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es Anxiety Disorders, OCD, and PTSD

 Phobias Persistent, irrational fear and avoidance of a specific object, activity, or situation

 Anxiety disorders are marked by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.

 Panic disorder Sudden episodes of intense dread and often lives in fear of when the next attack might strike

 GAD (General Anxiety Disorder) Excessive Anxiety and pervasive worry about everyday life events

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Specific Phobias irrational fear toward something specific

Social Anxiety Disorder Fear & anxiety of being judged or evaluated by others

Eating or drinking in front of others

Writing or working in front of others

Being the center of attention

Dating or going to parties

Some Common and Uncommon Specific Fears

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Obsessive-Compulsive Disorder (OCD)

 Characterized by unwanted repetitive thoughts (obsessions), actions (compulsions), or both

 Compulsive behaviors are responses to obsessive thoughts.  Become a disorder when obsessive thoughts:

 Persistently interfere with everyday life  Cause distress

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Obsessive-Compulsive Disorder (OCD)

 Characterized by persistent and repetitive thoughts (obsessions), actions (compulsions), or both

Thought or Behavior

Percentag e Reporting Symptom

Obsessions (repetitive thoughts)

Concern with dirt, germs, or toxins Something terrible happening (fire, death, illness) Symmetry, order, or exactness

40 24 17

Compulsions (repetitive behaviors)

Excessive hand washing, bathing, toothbrushing, or grooming Repeating rituals (in/out of a door, up/down from a chair) Checking doors, locks, appliances, car brakes, homework

85 51 46

Posttraumatic Stress Disorder (PTSD)

 Posttraumatic stress disorder  Characterized by haunting memories, nightmares,

social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia lingering for four weeks or more after a traumatic experience

 Often affects battle-scarred veterans (7.6 percent of combatants; 1.4 percent of noncombatants) and survivors of accidents, disasters, and violent and sexual assaults (two-thirds of prostitutes)

 Women are at higher risk

Understanding Anxiety Disorders, OCD, and PTSD (part 1)

 Conditioning  Classical conditioning research helps explain how

panic-prone people associate anxiety with certain cues.

 Stimulus generalization research demonstrates how a fearful event can later become a fear of similar events.

 Reinforcement (operant conditioning) can help maintain a developed and generalized phobia.

Understanding Anxiety Disorders, OCD, and PTSD (part 2)

 Cognition  Observing others can contribute to

development of some fears.  Olsson and colleagues: Wild monkey research

findings

 Interpretations and expectations shape reactions.  Hypervigilance

Understanding Anxiety Disorders, OCD, and PTSD (part 3)

 Biology  Genes: Genetic predisposition to anxiety, OCD, and

PTSD  The brain: Trauma linked to new fear pathways,

hyperactive danger detection, impulse control, and habitual behavior areas of brain

 Natural selection: Biological preparedness to fear threats; easily conditioned and difficult to extinguish

An Obsessive-Compulsive Brain

Depressive Disorders

 Major depressive disorder  Person experiences, in the absence of drugs or another

medical condition, two or more weeks with five or more symptoms, at least one of which must be either (1) depressed mood or (2) loss of interest or pleasure

 Persistent depressive disorder  Person experiences mildly depressed mood more often

than not for at least two years, along with at least two other symptoms.

 For some people, depressive symptoms may have a seasonal pattern.

Bipolar Disorder

 Bipolar disorder  Disorder in which a person alternates between the

hopelessness and lethargy of depression and the overexcited state of mania; formerly called manic- depressive disorder

 Mania  A hyperactive, wildly optimistic state in which dangerously

poor judgment is common

 Bipolar disorder is much less common than major depressive disorder, but is often more dysfunctional

 Potent predictor of suicide

Understanding Depressive Disorders and Bipolar Disorder (part 1)  Findings that any theory of depression must

explain:  Behavioral and cognitive changes accompany depression.  Depression is widespread.  Women’s risk of major depression is nearly double men’s.  Most major depressive episodes end on their own.  Stressful events related to work, marriage, and close

relationships often precede depression.  With each new generation, depression is striking earlier in

life and affecting more people.

Gender and Major Depressive Disorder

Genetic Influences

 Risk increases if family member has disorder

 Twin studies: Estimated heritability of major depression as 37 percent

 Linkage analysis points to “chromosome neighborhood”

 Many genes work together and produce interacting small effects that increase risk for depression

Understanding Depressive Disorders and Bipolar Disorder (part 2)

 The depressed brain  Brain activity slows during depression  Left frontal lobe is less active  Norepinephrine and serotonin levels decline

The Ups and Downs of Bipolar Disorder (part 1)

 PET scans show that brain energy consumption rises and falls with the patient’s emotional switches. Red areas show where the brain is using energy most rapidly.

 During depression:  Slowed brain activity  Less active left frontal lobe  Scarcity of norepinephrine and serotonin

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Depressive Disorders and Bipolar Disorder

 The depressed brain  Brain activity slows during depression  Left frontal lobe less active  Scarcity of norepinephrine and serotonin

Understanding Depressive Disorders and Bipolar Disorder (part 3)

 Nutritional effects  People who eat a heart-healthy “Mediterranean diet”

(heavy on vegetables, fish, and olive oil) have a comparatively low risk of developing heart disease, stroke, late-life cognitive decline, and depression—all of which are associated with inflammation (Kaplan et al., 2015; Psaltopoulou et al., 2013; Rechenberg, 2016).

 Excessive alcohol use is correlated with depression risk.

Understanding Depressive Disorders and Bipolar Disorder (part 4)

 Psychological and social influences: social- cognitive perspective  Depressed people view self

and world negatively

 Learned helplessness may coexist with self-defeating beliefs, self-focused rumination, and self-blaming and pessimistic explanatory style

Understanding Depressive Disorders and Bipolar Disorder (part 5)

 Social-cognitive perspective  Explores how people’s assumptions and expectations

influence their perceptions  Self-defeating beliefs and a negative explanatory

style contribute to the cycle of depression  Views depression as an ongoing cycle of stressful

experiences (interpreted through negative beliefs, attributions, and memories) which lead to negative moods and actions and fuel new stressful experiences

Explanatory Style and Depression

The Vicious Cycle of Depressed Thinking

Suicide and Self-Injury (part 1)

 Suicide  Affects 1 million people worldwide  Higher risk with diagnosis of depression but may

occur with rebound  More likely to occur when people feel disconnected

from or as if they are a burden to others

 Nonsuicidal self-injury (NSSI)  Cutting, burning, hitting oneself, pulling out hair,

inserting objects under nails or skin, self-administered tattooing

Suicide and Self-Injury (part 2)

 Research into the suicide rates of different groups shows:  National differences  Racial differences  Gender differences  Age differences and trends  Other group differences  Day of the week differences

Why Do People Who Engage in Nonsuicidal Self-Injury Hurt Themselves?

 Reasons for engaging in NSSI  Gain relief from intense negative thoughts through the

distraction of pain  Ask for help and gain attention  Relieve guilt by self-punishment  Get others to change their negative behavior

(bullying, criticism)  Fit in with a peer group

U.S. Rates of Nonfatal Self-Injury

Schizophrenia Psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression

 Symptoms – positive and negative  Positive – presence of something undesirable  Negative – the absence of something desirable  Disturbed perceptions (hallucinations)  Disorganized thinking and speech DELUSION of GRANDURE PARANOIA  Diminished and inappropriate emotions and actions

FLAT AFFECT CATATONIA SENSLESS ACTS

Schizophrenia: Onset and Development

 Chronic schizophrenia (also called process schizophrenia)  Form of schizophrenia in which symptoms usually appear by late

adolescence or early adulthood

 As people age, psychotic episodes last longer and recovery periods shorten.

 Acute schizophrenia (also called reactive schizophrenia)  Form of schizophrenia that can begin at any age, frequently

occurs in response to an emotionally traumatic event, and has extended recovery periods

Risk of Developing Schizophrenia

Dissociative, Personality, and Eating Disorders

 Dissociative disorder  Conscious awareness becomes separated

(dissociated) from previous memories, thoughts, and feelings

 Dissociative identity disorder (DID)  Rare dissociative disorder in which a person exhibits

two or more distinct and alternating personalities  Formerly called multiple personality disorder

Personality Disorders (part 1)

 Personality disorder  Disruptive, inflexible, and enduring behavior patterns

that impair social functioning.  Disorder forms three clusters, characterized by:

 Anxiety

 Eccentric or odd behaviors

 Dramatic or impulsive behaviors

Personality Disorders (part 2)

 Antisocial personality disorder  Lack of conscience for wrongdoing, even toward

friends and family members; impulsive, fearless, irresponsible; some genetic tendencies, including low arousal

 Genetic predispositions may interact with the environment to produce the altered brain activity associated with antisocial personality disorder

Murderous Minds

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Eating Disorders • Anorexia nervosa

– Characterized by self-starvation to being 85% or less of healthy body weight

• Starvation can destroy body organs and cause death. • Medical emergencies require hospitalization (2/3 of ideal

weight or less). – Menstruation ceases – Distorted body image

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When Kesha was deep in her eating disorder, she thought “being hungry to the point of feeling almost faint was a positive thing. The worse it got, the more positive feedback I was getting. Inside I was really unhappy, but outside, people were like, ‘Wow, you look great.’” When her therapist helped her realize how big of a problem it was, she called her mom and went to rehab where she learned how food is a great thing—not something to fear.

Kesha

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Troian Bellisario

Troian Bellisario, who starred in Pretty Little Liars, used the eating disorder she had as a teenager as a way to punish herself. “I started self-harming when I was a junior. I would withhold food or withhold going out with my friends, based on how well I did that day in school,” “I didn’t know what was right and what was wrong, so I think I created this bizarre system of checks and balances to create order in my world. But it really backfired.”

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Eating Disorders • Bulimia nervosa

– Characterized by at least biweekly cycles of binging and purging

• In addition to forced vomiting, purging may include taking laxatives and/or diuretics, fasting, and excess exercise.

– Major consequences • Mouth sores, loss of tooth enamel (gray teeth), esophageal

ulcers, esophageal cancer

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Lady Gaga

“I used to throw up all the time in high school. So I’m not that confident,” she said. “I wanted to be a skinny little ballerina but I was a voluptuous little Italian girl whose dad had meatballs on the table every night.” At one point, her bulimia started to affect her singing. “It made my voice bad, so I had to stop.”

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What causes these conditions?

• Strong hereditary component, especially in girls

• Temperamental tendency – to be anxious, – to have low self-efficacy, – to have a great need for

approval, – and an inability to

express legitimate needs.

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es Understanding Eating Disorders  People with anorexia nervosa continue to diet and exercise

excessively because they view themselves as fat.  People with bulimia nervosa secretly binge and then

compensate by purging, fasting, or excessive exercise.  People with binge-eating disorder binge but do not follow

with purging, fasting, and exercise.  Cultural pressures, low self-esteem, and negative emotions

interact with stressful life experiences and genetics to produce eating disorders.