Psychology 100
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LectureSlidesWeek10_online1.pptxPsychological Disorders
Chapter 14
According to psychologists and psychiatrists, psychological disorders are marked by a “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior” (American Psychiatric Association, 2013).
Such thoughts, emotions, or behaviors are dysfunctional or maladaptive.
They interfere with normal day-to-day life.
The dysfunctional person is often distressed.
Basic Concepts of Psychological Disorders
In earlier times, abnormal behavior attributed to strange forces (movement of the stars, godlike powers, evil spirits).
During the Middle Ages, it was commonly believed that abnormal people were possessed by devils.
“Therapy” often involved physical and mental torture.
Philippe Pinel (1745–1826) recognized abnormal behavior as sickness of the mind.
Opposed barbaric treatments of patients.
Introduced and encouraged reforms and humane treatments.
Basic Concepts of Psychological Disorders Understanding Psychological Disorders
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.
It looks doubtful that this patient would have survived the “cure.”
YESTERDAY’S “THERAPY”
The Medical Model
By the 1800s the search began for physical causes of mental disorders and for curative treatments.
With the medical model of mental disorders, mental illness is to be diagnosed on the basis of symptoms and treated through therapy, often in a psychiatric hospital.
Reinvigoration of the medical model has come from recent research in genetically influenced brain abnormalities in brain structure and biochemistry.
Basic Concepts of Psychological Disorders Understanding Psychological Disorders
Medical model: The concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and, in most cases, cured, often through treatment in a hospital.
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The Biopsychosocial Approach
General approach positing that biological, psychological, and social-cultural factors all play a significant role in human functioning in the context of disease or illness.
Some symptoms of disorders are culture-related, which points to environmental influences.
For example, the eating disorders anorexia nervosa and bulimia nervosa occur mostly in food-abundant cultures.
Depression and schizophrenia occur worldwide.
Basic Concepts of Psychological Disorders Understanding Psychological Disorders
Classification orders and describes symptoms
Diagnostic classification in psychiatry and psychology attempts to:
Predict the disorder’s future course
Suggest appropriate treatment
Prompt research into its causes
Basic Concepts of Psychological Disorders Classifying Disorders—and Labeling People
Attention-deficit/hyperactivity disorder (ADHD): Marked by extreme inattention and/or hyperactivity and impulsivity
11 percent American 4- to 17-year-olds receive this diagnosis after displaying its key symptoms; 2.5 percent adults have ADHD symptoms.
Critics fear this disorder is overdiagnosed, leading to overuse of prescription drugs.
Those who say ADHD is overdiagnosed argue:
Symptoms displayed sound like the “disorder” of having a Y chromosome; ADHD is three times more prevalent in boys than girls.
ADHD may in effect be marketed by companies that offer drugs for its treatment (Thomas, 2015).
Energetic child + boring school = ADHD diagnoses?
ADHD—Normal High Energy or Disordered Behavior?
Alternate view of those arguing that ADHD is not overdiagnosed:
More frequent diagnoses due to increased awareness of disorder
Scientific community agrees ADHD is a real neurobiological disorder
Coexists with learning disorders
Is heritable
It is treatable with medications
There is debate over the safety of long-term use of these stimulant medications in treating ADHD.
ADHD—Normal High Energy or Disordered Behavior?
Psychological disorders usually strike by early adulthood (first symptoms by age 24 in most cases)
Symptoms arrive at the following median ages:
Antisocial personality disorder (age 8)
Phobias (age 10)
Alcohol use disorder (near age 20)
Obsessive-compulsive disorder (near age 20)
Schizophrenia (near age 20)
Major depressive disorder (age 25)
Basic Concepts of Psychological Disorders Rates of Psychological Disorders
PERCENTAGE OF AMERICANS REPORTING SELECTED PSYCHOLOGICAL DISORDERS IN THE PAST YEAR
Table 14.2
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What Increases Vulnerability to Mental Disorders?
Table 14.3 Risk and Protective Factors for Mental Disorders
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Anxiety is a part of life for all of us.
Some of us are more prone to notice and remember information perceived as threatening, and the brain’s danger-detection system becomes hyperactive.
When this occurs, we are at greater risk for an anxiety disorder, or for two other disorders that involve anxiety:
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)
Anxiety Disorders, OCD, and PTSD
OCD and PTSD were formerly classified as anxiety disorders, but the DSM-5 now classifies them separately.
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HOW DO GENERALIZED ANXIETY DISORDER, PANIC DISORDER, AND PHOBIAS DIFFER?
Anxiety disorders are marked by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety; include:
Generalized anxiety disorder: Person is unexplainably and continually tense and uneasy.
Panic disorder: Person experiences panic attacks, sudden episodes of intense dread, and fears the next episode’s unpredictable onset.
Phobia: Person is intensely and irrationally afraid of a specific object, activity, or situation.
Anxiety Disorders, OCD, and PTSD Anxiety Disorders
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Generalized anxiety disorder: Person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.
Worry continually, often jittery, on edge, and sleep deprived
Lack of concentration on a task
Two-thirds women
Anxiety is free-floating (not linked to a specific stressor or threat)
Often seen with depression, but usually debilitating even on its own
May lead to physical problems (high blood pressure)
Anxiety Disorders Generalized Anxiety Disorder
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Panic disorder: An anxiety disorder marked by unpredictable, minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Often followed by worry over a possible next attack.
Panic attacks: Sudden episodes of intense dread
Physical symptoms accompany the attack:
Irregular heartbeat, chest pains, shortness of breath, choking, trembling, dizziness
Agoraphobia: Fear or avoidance of public situations from which escape may be difficult (should a panic attack occur).
Anxiety Disorders Panic Disorder
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Phobia: Anxiety disorder marked by a persistent and irrational fear of a specific object, activity, or situation.
Specific phobias include a fear of particular animals, insects, heights, blood, or closed spaces.
Social anxiety disorder (formerly called “social phobia”) is an intense fear of other people’s negative judgments.
People with this disorder avoid social situations (speaking up in a group, eating out, going to parties), and if unable to avoid them, may experience strong symptoms of their anxiety.
Anxiety Disorders Phobias
See Figure 14.3 for some common and uncommon specific fears.
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WHAT IS OCD?
Obsessive-compulsive disorder (OCD)
Characterized by persistent and repetitive thoughts (obsessions), actions (compulsions), or both
Occurs when obsessive thoughts and compulsive behaviors persistently interfere with everyday life and cause distress
Is more common among teens and young adults than older people
Twin studies reveal that OCD has a strong genetic basis
Anxiety Disorders, OCD, and PTSD Obsessive-Compulsive Disorder (OCD)
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COMMON OBSESSIONS AND COMPULSIONS AMONG CHILDREN AND ADOLESCENTS WITH OBSESSIVE-COMPULSIVE DISORDER
Table 14.4
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WHAT IS PTSD?
Post traumatic stress disorder (PTSD)
Is 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 involves military veterans (7.6 percent of combatants; 1.4 of noncombatants among American military personnel in Afghanistan) and survivors of accidents, disasters, and violent and sexual assaults (including an estimated two-thirds of prostitutes).
Women at higher risk (1 in 10) than men (1 in 20) of developing this disorder, following a traumatic event.
Most men and women display impressive survivor resiliency.
Anxiety Disorders, OCD, and PTSD Posttraumatic Stress Disorder (PTSD)
Symptoms of posttraumatic stress disorder (PTSD) include four or more weeks of haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or sleep problems following some traumatic experience.
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Major depressive disorder is a prolonged state of hopeless depression
Bipolar disorder (formerly called “manic-depressive disorder”) alternates between depression and overexcited hyperactivity
Symptoms for these disorders may have a seasonal pattern
Depression protects us from dangerous thoughts and feelings, letting us slow down
Reassessing life may redirect our energy in promising ways, and even mild sadness can be helpful sometimes
Depression can be seriously maladaptive and disabling
Major Depressive Disorder and Bipolar Disorder
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Major depressive disorder: A disorder in which a person experiences two or more weeks with five or more symptoms, at least one of which must be:
Depressed mood or
Loss of interest or pleasure
These symptoms present themselves in the absence of drugs or another medical condition
Phobias are more common, but depression is the number one reason people seek mental health services
United States: 7.6% experience moderate or severe depression (CDC, 2014)
Worldwide: 3.95% men and 7.2% women have a depressive episode (Global, 2015)
Major Depressive Disorder and Bipolar Disorder Major Depressive Disorder
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DIAGNOSING MAJOR DEPRESSIVE DISORDER
Table 14.6
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Bipolar disorder: A 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
Mild mania fuels creativity
Strikes more often among those who rely on emotional expression and vivid imagery
Much less common than major depressive disorder, but often more dysfunctional
Americans twice as likely as people elsewhere to be diagnosed with this disorder
New to DSM-5: Disruptive mood dysregulation disorder
Major Depressive Disorder and Bipolar Disorder Bipolar Disorder
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Any theory of depression must explain at least the following six phenomena:
Behaviors and Thoughts Change With Depression
Negative aspects on environment consume the depressed
Nearly half of people diagnosed with depression also display symptoms of another disorder (anxiety or substance abuse)
Depression Is Widespread
Found worldwide; causes must also be common
Major Depressive Disorder and Bipolar Disorder Understanding Major Depressive Disorder and Bipolar Disorder
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Women’s Risk of Major Depressive Disorder Is Nearly Double Men’s
Women experience depression 1.7 times more often than men (CDC, 2014)
Women’s disorders are generally more internal (depression, anxiety, inhibited sexual desire)
Men’s disorders are more external (alcohol use disorder, antisocial conduct, lack of impulse control)
Most Major Depressive Episodes End on Their Own
Therapy often helps and tends to speed recovery, but even without most people recover
Recovery more likely if first episode strikes later in life, there were few previous episodes, and there is minimal stress and a strong social support system
Understanding Major Depressive Disorder and Bipolar Disorder
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Negative Thoughts and Negative Moods Interact
Learned helplessness may exist with self-defeating beliefs, self-focused rumination, and self-blaming and pessimistic explanatory style.
Found more often in women than men, who may tend to respond more strongly to stress
Rumination: Compulsive fretting; overthinking about our problems and their causes
Can divert us from thinking about other life tasks
Can increase negative moods
Critics note a chicken-and-egg problem in the social-cognitive explanation of depression. Which comes first, the pessimistic explanatory style or the depressed mood?
Understanding Major Depressive Disorder and Bipolar Disorder The Social-Cognitive Perspective
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EXPLANATORY STYLE AND DEPRESSION
Figure 14.8 After a negative experience, a depression-prone person may respond with a negative explanatory style.
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Depression’s vicious cycle—pieces of the depression puzzle:
Stressful events are interpreted through
A brooding, negative explanatory style, that
Creates a hopeless, depressed state, that
Hampers the way the person thinks and acts
These thoughts and actions, in turn, fuel 1), and the cycle continues.
Understanding Major Depressive Disorder and Bipolar Disorder The Social-Cognitive Perspective
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Understanding Major Depressive Disorder and Bipolar Disorder The Social-Cognitive Perspective
THE VICIOUS CYCLE OF DEPRESSED THINKING
Figure 14.9 Therapists recognize this cycle, and they work to help depressed people break out of it, by changing their negative thinking, turning their attention outward, and engaging them in more pleasant and competent behavior.
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Worldwide, 800,000 people annually take their own lives.
At least five times higher risk for suicide with diagnosis of depression, and ironically it may especially occur when people are beginning to rebound (when they become capable of following through).
Is more likely to occur when people feel disconnected from or burden to others, or when they feel defeated and trapped by an inescapable situation.
Understanding Major Depressive Disorder and Bipolar Disorder Suicide and Self-Injury
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Comparing the suicide rates of different groups, researchers have found:
National differences
Racial differences
Gender differences
Age differences and trends
Other group differences
Day of the week differences
Understanding Major Depressive Disorder and Bipolar Disorder Suicide and Self-Injury
Only 1 in 25 attempts in the United States are successful
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How to help a family member or friend who is talking suicide? Three tips:
Listen, offering sincere empathy (rather than arguments for why suicide is not the answer)
Connect, by doing your best to link those at risk with a helpline or with campus health services
Protect, by seeking help right away (doctor, emergency room, or 911) and removing potential tools for suicide (weapons, medications) for anyone appearing in immediate risk
Understanding Major Depressive Disorder and Bipolar Disorder Suicide and Self-Injury
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Nonsuicidal Self-Injury
Nonsuicidal self-injury (NSSI) includes cutting, burning, hitting oneself, inserting objects under nails or skin, and self-administered tattooing. These self-injuries are painful but not fatal.
People engage in NSSI to:
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
Typically are suicide gesturers, not suicide attempters.
Understanding Major Depressive Disorder and Bipolar Disorder Suicide and Self-Injury
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Self-injury rates peak higher for females than for males (CDC, 2009).
RATES OF NONFATAL SELF-INJURY IN THE U.S.
Figure 14.10
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Schizophrenia: A psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression.
The word itself means “split” (schizo) “mind” (phrenia).
Schizophrenia is the chief example of a psychotic disorder, which is marked by irrationality, distorted perceptions, and lost contact with reality.
With treatment and a supportive environment, over 40 percent of people with schizophrenia will have periods of a year or more with normal life experience. But just 1 in 7 of those diagnosed will make a complete and enduring recovery.
Schizophrenia and Other Disorders Schizophrenia
Positive symptoms: Presence of inappropriate behavior
Negative symptoms: Absence of appropriate behavior
Disturbed Perceptions
Hallucinations: Seeing, feeling, tasting, smelling things that exist only in the mind
Disorganized Thinking and Speech
Delusions: False beliefs
May have paranoid tendencies
Word salad (senseless speech) and a breakdown in selective attention
Schizophrenia and Other Disorders Schizophrenia Symptoms of Schizophrenia
Diminished and Inappropriate Emotions
Flat affect: Emotionless, a state of no apparent feeling
Impaired theory of mind: Difficulty reading other peoples’ facial emotions and states of mind
Emotional deficiencies occur early in illness and have a genetic basis
Inappropriate motor behavior, with motionless catatonia or senseless, compulsive actions
Schizophrenia and Other Disorders Schizophrenia Symptoms of Schizophrenia
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
Often positive symptoms that respond to drug therapy
Schizophrenia and Other Disorders Schizophrenia Onset and Development of Schizophrenia
Dissociative disorders
Controversial, rare disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings
Dissociative identity disorder (DID) (formerly called multiple personality disorder)
Rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities
Other Disorders Dissociative Disorders
Skeptics note that dissociative identity disorder, formerly known as multiple personality disorder, increased dramatically in the late twentieth century; is rarely found outside North America; and may reflect role playing by people who are vulnerable to therapists’ suggestions. Others view this disorder as a manifestation of feelings of anxiety, or as a response learned when behaviors are reinforced by anxiety-reduction.
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Understanding Dissociative Identity Disorder
Increased dramatically in the late twentieth century.
Is rarely found outside North America.
DID may reflect role playing by people who are vulnerable to therapists’ suggestions.
Some psychodynamic theorists view this disorder as a manifestation of feelings of anxiety.
Some learning theorists view this disorder as a response learned when behaviors are reinforced by anxiety-reduction.
Some clinicians include dissociative disorders under the umbrella of posttraumatic stress disorder.
Other Disorders Dissociative Disorders
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Personality disorders: Inflexible and enduring behavior patterns that impair social functioning.
These disorders forms three clusters, characterized by:
anxiety, that predisposes the withdrawn avoidant personality disorder
eccentric or odd behaviors, such as the emotionless disengagement of schizotypal personality disorder
dramatic or impulsive behaviors as seen in borderline personality disorder, narcissistic personality disorder, and antisocial personality disorder
Other Disorders Personality Disorders
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Antisocial Personality Disorder
A person with antisocial personality disorder displays:
Lack of conscience for wrongdoing, even toward friends and family members
Often impulsiveness, fearlessness, irresponsibility
Criminality is not an essential component of antisocial behavior—and many criminals do not fit the description of antisocial personality disorder (since they show responsible concern for their friends and family members).
Other Disorders Personality Disorders
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Other Disorders Personality Disorders
Antisocial Personality Disorder
Understanding Antisocial Personality Disorder
Biological relatives of people with antisocial and unemotional tendencies are at increased risk for antisocial behavior.
Some specific genes identified as more common in those with antisocial personality disorder; these genes also increase the risk for substance use disorder, and these disorders often appear in combination.
Low autonomic nervous system arousal in situations others would find unnerving.
Genetic predispositions may interact with the environment to produce the altered brain activity associated with antisocial personality disorder.
