psychology discussion paper, 6 hours due time!

PSYCHOLOGICAL DISORDERS

Key Question

What is Psychological Disorder?

The medical model takes a “disease” view, while psychology sees psychological disorder as an interaction of biological, cognitive, social, and behavioral factors.

What is Psychological Disorder

Three classic signs suggest severe psychological disorder

• Hallucinations • Delusions • Severe affective (emotional) disturbances

Part of a continuum ranging from absence of disorder to severe disorder

Figure 14.2 Normality and abnormality as a continuum

Changing Concepts of Psychological Disorder: Historical Roots

Ancient World •Supernatural powers- •Possession by demons and spirits

400 B. C. •Physical causes- •Hippocrates-imbalance of humors

Middle Ages •Medieval church •Demons and witchcraft

18th Century •Mental disorders are diseases of the mind •Similar to other physical diseases •Objective causes requiring specific treatments

Changing Concepts of Psychological Disorder: The Psychological Model

Behavioral perspective – Abnormal behaviors can be acquired through behavioral learning – operant and classical conditioning

Cognitive perspective – Abnormal behaviors are influenced by mental processes – how people perceive themselves and their relations with others

Changing Concepts of Psychological Disorder: The Psychological Model

Social-cognitive-behavioral approach • Combines psychology’s 3 major perspectives

• Behavior, cognition, and social/environmental factors all influence each other

• Recognize the influence of biology

Indicators of Abnormality

Distress

Maladaptiveness

Irrationality

Unpredictabilty

Unconventionality and undesirable behavior

Indicators of Abnormality

Distress

Maladaptiveness

Irrationality

Unpredictabilty

Unconventionality and undesirable behavior

Does the individual show unusual or prolonged levels of unease or anxiety?

Indicators of Abnormality

Distress

Maladaptiveness

Irrationality

Unpredictabilty

Unconventionality and undesirable behavior

Does the person act in ways that make others fearful or interfere with his or her well- being?

Indicators of Abnormality

Distress

Maladaptiveness

Irrationality

Unpredictabilty

Unconventionality and undesirable behavior

Does the person act or talk in ways that are irrational or incomprehensible to others?

Indicators of Abnormality

Distress

Maladaptiveness

Irrationality

Unpredictabilty

Unconventionality and undesirable behavior

Does the individual behave erratically and inconsistently at different times or from one situation to another; experiencing a loss of control?

Indicators of Abnormality

Distress

Maladaptiveness

Irrationality

Unpredictabilty

Unconventionality and undesirable behavior

Does the person behave in ways that violate social norms?

Key Question

How are Psychological Disorders Classified?

The DSM-5, most widely used system, classifies disorders by their mental and behavioral symptoms.

Overview of DSM-5 Classification System

DSM-5 – (2013): • Fourth edition of the Diagnostic and Statistical Manual

of Mental Disorders

• Includes hundreds of disorders

Figure 14.5 Lifetime prevalence of psychological disorders

Developmental Disorders

Can appear at any age, but often first seen in childhood Autism –

Marked by impoverished ability to “read” other peoples, use language, and interact socially

Dyslexia – A reading disability, thought by some experts to involve a brain disorder

Attention-deficit hyperactivity disorder – Disability involving short attention span, distractibility, and extreme difficulty in remaining inactive for any period

Types of Clinical Syndromes

Anxiety Disorders

Mood Disorders

Addictive Disorders

Somatoform Disorders

Dissociative Disorders

Schizophrenic Disorders

Anxiety, Compulsive, and Stress Disorders

Generalized anxiety disorder “free-floating anxiety”

Panic disorder and agoraphobia Phobic disorder

Specific focus of fear Obsessive compulsive disorder

Posttraumatic Stress Disorder

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

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.

Fears and Phobias

Phobia An exaggerated, unrealistic fear of a specific situation, activity, or object.

Figure 14.7 Conditioning as an explanation for phobias

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.

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.

Posttraumatic Stress Disorder (PTSD)

• An anxiety disorder in which a person who has experienced a traumatic or life-threatening event has symptoms such as re- experiencing, avoidance, negative alterations in cognition and mood and increased physiological arousal.

• Diagnosed only if symptoms persist for 6 months or longer.

• May immediately follow event or occur later. Watch Videos in this Module

What is PTSD? (03:26) Mental Distress of War Veterans (04:12) War Veterans and PTSD (03:31)

Etiology of Anxiety Disorders

Biological factors Genetic predisposition, anxiety sensitivity GABA circuits in the brain

Conditioning and learning Acquired through classical conditioning or observational learning Maintained through operant conditioning

Cognitive factors Judgments of perceived threat

Personality Neuroticism

Stress—a precipitator

Figure 14.6 Twin studies of anxiety disorders

Clinical Syndromes: Mood Disorders

Major depressive disorder Dysthymic disorder

Bipolar disorder Cyclothymic disorder

Figure 14.11 Episodic patterns in mood disorders

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).

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.

DSM 5 Requires 5 of these within the past

2 weeks.

Notice the decreased neural activity in the depressed brain (shown by less warm colors at the front of the brain). The frontal cortex is largely responsible for active thinking and planning ahead. This lack of frontal activity would result in a depressed person having trouble concentrating was well as to many of the other symptoms of depression.

Causal Factors in Depression

Etiology

• Genetic vulnerability • Neurochemical factors • Cognitive factors • Interpersonal roots • Precipitating stress

Gender, Age, & Depression

Women are about twice as likely as men to be diagnosed with depression. True around the world.

Bipolar Disorder

Bipolar Disorder: A mood disorder in which episodes of depression and mania (excessive euphoria) occur.

Mood

The Bipolar Brain

Bipolar disorder can have rapid mood swings

These wild changes are shown in brain activity (right)

Figure 14.15 Negative thinking and prediction of depression

Figure 14.13 Twin studies of mood disorders

Substance Use Disorders

Behaviorism and Addiction

The behavioral model is very important in addiction. • You can’t become addicted if you don’t use. • People use substances and are rewarded by getting high, so

they use the drug again and again, and may become dependent.

• Once addicted quitting leads to withdrawal symptoms which are punishing so the person is likely to discontinue that behavior = quit quitting and relapse.

Biology and Addiction

The biological model holds that addiction, whether to alcohol or other drugs is due primarily to: • biochemistry • metabolism • genetics

Most evidence comes from twin studies.

Clinical Syndromes: Somatoform Disorders

Somatic Symptom Disorder Conversion Disorder

Illness Anxiety Disorder

Etiology Reactive autonomic nervous system Personality factors Cognitive factors The sick role

Figure 14.10 Glove anesthesia

Clinical Syndromes: Dissociative Disorders

• Dissociative amnesia

• Dissociative fugue

• Dissociative identity disorder

Dissociative Identity Disorder

A controversial disorder marked by the appearance within one person of two or more distinct personalities, each with its own name and traits; commonly known as “Multiple Personality Disorder (MPD).”

The DID Controversy

First View • MPD is common but often unrecognized or misdiagnosed. • The disorder starts in childhood as means of coping with severe

abuse • Trauma produced a mental splitting.

2nd View • Created through pressure and suggestions by clinicians. • Handfuls of diagnoses to 10000 since 1980.

Symptoms of Schizophrenia

Delusions False beliefs that often accompany schizophrenia and other psychotic disorders.

Hallucinations Sensory experiences that occur in the absence of actual stimulation.

Grossly disorganized and inappropriate behavior. Disorganized, incoherent speech. Negative symptoms

Positive Symptoms

Cognitive, emotional, and behavioral excesses

Examples of Positive Symptoms:

• Hallucinations. • Bizarre delusions. • Incoherent speech. • Inappropriate/Disorganized behaviors.

The slide below shows an MRI image of the brains of identical twins. The brain on the left belongs to the healthy twin and looks normal. The brain on the right belongs to the twin with schizophrenia. Notice the large “holes” in the center of the brain, these are called “ventricles.” Having larger ventricles means you also have less brain volume because there is more empty space inside the skull. Enlarged ventricles are particularly associated with the negative symptoms of schizophrenia, which should highlight why negative symptoms are harder to treat than positive symptoms. Medications change neurotransmitter levels, but do not dramatically change brain structure.

Negative Symptoms

Cognitive, emotional, and behavioral deficits.

Examples of Negative Symptoms:

• Loss of motivation. • Emotional flatness. • Social withdrawal. • Slowed speech or no speech.

Theories of Schizophrenia

Diathesis-Stress Model Need biological (genetic vunerability)

AND Need environmental stress to trigger

Genetic predispositions Structural brain abnormalities Neurotransmitter abnormalities Prenatal abnormalities

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.

Neurotransmitter Abnormalities

Many schizophrenic patients have high levels of brain activity in brain areas served by dopamine as well as greater numbers of particular dopamine receptors.

Figure 14.18 The dopamine hypothesis as an explanation for schizophrenia

Personality Disorders

Anxious-fearful cluster Avoidant, dependent, obsessive-compulsive

Dramatic-impulsive cluster Histrionic, narcissistic, borderline, antisocial

Odd-eccentric cluster Schizoid, schizotypal, paranoid

Etiology Genetic predispositions, inadequate socialization in dysfunctional families

Table 14.2 Personality Disorders

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.

• Sometimes called psychopathy or sociopathy

• Occurs in 3% of all males and 1% of all females.

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.

Psychological Disorders and the Law

• Involuntary commitment § Danger to self § Danger to others § Unable to care for self

Key Question

What are the Consequences of Labeling People?

Ideally, accurate diagnoses lead to proper treatments, but diagnoses may also become labels that depersonalize individuals and ignore the social and cultural contexts in which their problems arise.

The Plea of Insanity

Insanity –

A legal term, not a psychological or psychiatric one, referring to a person who is unable, because of a mental disorder or defect, to conform his or her behavior to the law.

Figure 14.22 The insanity defense: public perceptions and actual realities