Post on 08-Jul-2015
Psychological Disorders
Understanding Abnormal Behavior
✔Medical Model– Useful to think about abnormal behavior as a
disease– Prior to medical model in 18th century:
• Abnormal behavior was based on superstition:– possessed by demons, witches, victims of God’s
punishment
– Medical model resulted in more sympathy and better treatment
– Criticism of Szasz - abnormal behaviors are “problems of living” not disease processes
Medical Model Today
✔Medical concepts have remained prominent– Diagnosis
• distinguishing one illness from another
– Etiology• refers to the apparent causation and developmental
history of an illness
– Prognosis• a forecast about the probable course of an illness
What is “Abnormal” Behavior✔General criteria for abnormal behavior
– Deviance• the behavior is different from societal norms of what
is acceptable and normal
– Maladaptive Behavior• when the behavior interferes with one’s social or
occupational functioning
– Personal Distress• many may not exhibit deviant or maladaptive
behavior, but experience personal discomfort associated with symptoms
Psychodiagnosis: The Classification of Disorders
✔Diagnostic and Statistical Manual of Mental Disorders (DSM)– Classification system published by the
American Psychiatric Association– First published in 1952– Currently in 4th edition
• DSM-IV-TR (Text Revision)
– Criteria and research has improved with each edition
Multiaxial System of Classification
✔ Axis I– Clinical syndromes, psychological disorders
✔ Axis II– Personality disorders, mental retardation
✔ Axis III– General medical disorders/conditions
✔ Axis IV– Psychosocial/Environmental Stressors
✔ Axis V– Global Assessment of Functioning (1-100 rating)
Anxiety Disorders✔Generalized Anxiety Disorder
– marked by a chronic, high level of anxiety that is not tied to any specific event
– “free-floating” anxiety– ruminative over decisions and minor matters
✔Phobic Disorder– marked by persistent and irrational fear of an
object or situation that presents no realistic danger
– most recognize their own phobias are irrational
Anxiety Disorders
✔Panic Disorder– characterized by recurrent panic attacks
• panic attack – rush of overwhelming anxiety, thoughts that one is dying/
going crazy, increased heart rate, numbing in hands
– typically occurs suddenly and unexpectedly
– after experiencing multiple panic attacks, patient may worry about where they will be when “next one hits”
– agoraphobia - fear of going into public places
Anxiety Disorders
✔Obsessive-Compulsive Disorder (OCD)– obsessions
• thoughts that repeatedly intrude one’s consciousness in a distressing way
– compulsions• actions that one feels forced to carry out; typically
to reduce anxiety brought on by obsessions
– OCD is marked by persistent, uncontrollable intrusions of unwanted thoughts and urges to engage in senseless rituals
Anxiety Disorders
✔Posttraumatic Stress Disorder– person experienced, witnessed, or was
confronted with an event that involved actual or threatened death/injury, or threat to physical integrity of self/others
– response marked by intense fear, helplessness– Symptoms:
• reexperiencing the event • persistent avoidance/numbing • hyperarousal
Anxiety Disorders: Etiology
✔ Biological Factors– Rates are highest among identical twins– Anxiety sensitivity - some are “tuned” to respond to
lower levels of physical anxiety
✔ Conditioning and Learning– a stimulus may be paired with a frightening event
resulting in an learned anxiety response
✔ Cognitive Factors– people misinterpret threat (internal or external), focus
excessive attention on threat, and tend to recall information that seems threatening
Anxiety Disorders: Etiology✔Personality
– Certain personality traits are positively correlated with anxiety disorders
• Neuroticism: – self-conscious, nervous, jittery, insecure, guilt-prone
– This finding may be related to third variable:• genetic predisposition
✔Stress– Those with anxiety disorder tend to experience
more stressors in prior month
Somatoform Disorders
✔Somatoform vs. Psychosomatic– Somatoform Disorders
• physical ailments that cannot be fully explained by organic conditions and are largely due to psychological factors
• THIS IS NOT DELIBERATE FAKING
– Psychosomatic Diseases• genuine physical ailments caused in part by
psychological factors, especially emotional distress• ulcers, asthma, high blood pressure
Somatoform Disorders✔Somatization Disorder
– marked by a history of diverse physical complaints that appear to be psychological in origin
– unlikely combination of symptoms (gastrointestinal, pulmonary, neurological)
✔Conversion Disorder– significant loss of physical function (with no
apparent organic basis)– loss of sight/hearing, mutism, paralysis
Somatoform Disorders
✔Hypochondriasis– characterized by excessive preoccupation with
one’s health and worry about developing physical illness
– tend to “doctor shop” and think professionals are incompetent
– over-interpret ANY sign of illness
Somatoform Disorders: Etiology
✔Personality– Histrionic - self-centered, suggestible, overly
dramatic, highly emotional, thrive on attention
✔Cognitive Factors– “amplify” normal bodily sensations and draw
catastrophic conclusions
✔Sick Role– some grow fond of “perks” of being sick (avoid
responsibility, attention from others)
Dissociative Disorders✔ Loss of contact with portions of memory or
consciousness resulting in disruption of one’s sense of identity
✔ Dissociative Amnesia– sudden loss of memory for important personal
information– common after disasters, accidents, combat stress,
physical abuse, rape, witnessing a violent death
✔ Dissociative Fugue– People lose their memory for their entire lives along
with their sense of personal identity
Dissociative Disorders
✔Dissociative Identity Disorder (DID)– “multiple personality disorder”– NOT schizophrenia– coexistence in one person of two or more
largely complete, and usually very different, personalities
– experiences of one “personality” are typically not known by others
Dissociative Disorders: Etiology
✔Psychogenic amnesia and fugue:– excessive stress
✔DID– SEVERE emotional trauma during childhood– Criticisms:
• intentional role playing• therapist subtly “create” DID in patients through
suggestion
Mood Disorders
✔Major Depressive Disorder– persistent feelings of sadness/despair and a loss
of interest in previous sources of pleasure, lack of energy, hopelessness, suicidal ideation
– in adolescents, may manifest as agitation– average duration: 5 months– 75%-95% who suffer one episode of depression
will suffer another– affects 7% of population at some point
Mood Disorders
✔Bipolar Disorder– “manic-depressive disorder”– marked by experience of both depressed and
manic periods• mania
– marked by euphoria, hyperactivity, impaired judgement, extravagance, impulsivity, insomnia
– may have uneasiness, irritability that may be disturbing
– affects about 1% of the population
Mood Disorders: Etiology✔Genetic Vulnerability
– heredity may create a predisposition to mood disorders
✔Neurochemical Factors– Norepinephrine and serotonin appear important
in development of depression
✔Cognitive Factors– “Learned helplessness” Martin Seligman
• passive “giving up” response to uncontrollable situations
Mood Disorders: Etiology✔Cognitive Factors
– Pessimistic explanatory style• attribute setbacks to personal flaws instead of
situational factors• draw global generalizations about their inadequacies
– Rumination• those who continue to worry about their depression
tend to remain depressed longer than those who distract themselves
✔Interpersonal Roots– lack social “finesse,” tend to be depressing
Mood Disorders: Etiology
✔Stress-vulnerability models– vulnerability to a disorder is influenced by
heredity– stress from one’s environment results in
potential manifestation of vulnerability– If a person has a genetic predisposition to
develop a disorder, stress from the environment may increase the likelihood that the disorder will appear
Schizophrenic Disorders✔Term meaning “split mind” was coined by
Eugen Bleuler in 1911– refers to fragmentation of thought processes– not “split personality” associated with MPD
✔Class of disorders marked by delusions, hallucinations, disorganized speech, and deterioration of adaptive behavior
✔1% - 1.5% of population – 3-4 million people in U.S.
Schizophrenic Disorders
✔General Symptoms– Irrational Thought
• Delusions - false beliefs that are maintained even though they clearly are out of touch with reality
– thought broadcasting
– ideas being injected into one’s mind against one’s will
– delusions of grandeur
• Train of thought deteriorates– becomes less logical and linear and more chaotic
– loosening of associations
Schizophrenic Disorders✔General Symptoms
– Deterioration of adaptive behavior• impairment of work, social relations, personal care
– Distorted perception• Hallucinations - sensory perceptions that occur in
the absence of a real, external stimulus or gross distortions of perceptual input
– visual or auditory (auditory more common)
– Disturbed emotion• Flattening of emotions (little emotional response)• Emotionally volatile and inapproapriate
Schizophrenic Disorders✔Subtypes
– Paranoid • dominated by delusions of persecution and
delusions of grandeur
– Catatonic• marked by striking motor disturbances, ranging
from muscular rigidity to random motor activity
– Disorganized• severe deterioration of adaptive behavior
– Undifferentiated• marked by a mix of symptoms
Schizophrenic Disorders✔Positive Versus Negative Symptoms
– with criticism of subtype classification, this scheme was devised
– Negative Symptoms• behavioral deficits, such as flattened emotions,
social withdrawal, apathy, impaired attention, poverty of speech
– Positive Symptoms• behavioral excesses or peculiarities, such as
hallucinations, delusions, bizarre behavior, and wild flights of ideas
Schizophrenic Disorders: Etiology✔ Genetic “vulnerability”
– concordance rate for identical twins is 48%
✔ Neurochemical factors– Excess dopamine
✔ Structural abnormalities in the brain– chronic schizophrenic disturbance is associated with
enlarged brain ventricles
✔ Expressed emotion– degree to which family displays highly critical or
emotionally overinvolved attitudes (critical comments, resentment, overprotective)
Schizophrenic Disorders: Etiology✔Neurodevelopmental Hypothesis
– disruptions in normal maturation processes of brain before or at birth
• viral infections during prenatal development– study of 1957 flu epidemic in Finland: Schizophrenia
rates elevated among individuals who were in their second trimester of prenatal development during epidemic
• malnutrition during prenatal development• obstetrical complications during birth process
✔Precipitating Stress– stress can trigger onset or relapses
Eating Disorders✔Severe disturbances in eating behavior
characterized by preoccupation with weight concerns and unhealthy efforts to control it– Anorexia nervosa
• intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, and dangerous measures to lose weight
– Bulimia nervosa• habitually engaging in out-of-control overeating
followed by unhealthy compensatory efforts, such as self-induced vomiting, fasting, laxatives
Eating Disorders: Etiology
✔Genetic Vulnerability✔Personality Factors
– anorexia• obsessive, rigid, neurotic, emotionally restrained
– bulemia• impulsive, overly sensitive, low self-esteem
✔Cultural Values– Western society’s emphasis on “attractive”
Eating Disorders: Etiology✔The Role of the Family
– Overly involved parents turn normal adolescent drive for independence into unhealthy struggle
• in response, child may seek extreme control over body and eating behavior
– Parents may endorse society’s messages about body image
✔Cognitive Factors– rigid, all-or-none thinking, maladaptive beliefs,
obsessive, ruminative
Psychology and the Law✔Insanity
– NOT a diagnosis– a legal concept indicating that a person cannot
be held responsible for his/her actions because of mental illness
– used with people that admit they committed the crime but claim that they lacked intent
✔Involuntary commitment– people are hospitalized in psychiatric facilities
against their will
Culture and Psychopathology✔ Relativistic View
– criteria for mental disorders vary across cultures– no universal standards of “normal” or “abnormal”
✔ Pancultural view– basic standards of normality are universal– most serious psychological disorders (schizophrenia,
depression, bipolar disorder) are found in all cultures
✔ Culture-bound disorders– abnormal syndromes found only in a few cultural groups
• koro - obsesive fear that penis will retract into abdomen (Southern Asia)