131 Chapter 13 Psychological Disorders3061

8/10/2019 131 Chapter 13 Psychological Disorders3061

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Chapter 13

PsychologicalDisorders

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Defining and Classifying

Historical Explanations ofAbnormal Behaviors

Demonic possession Physical diseases

Products of psychological

conflicts Learned maladaptive behaviors

Distorted perceptions of the

world


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Vulnerability-Stress Model

Each of us has vulnerability fordeveloping a psychological

disorder

Stress plays a role in

development


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Criteria for abnormality

Distress

Dysfunction Deviance


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Distress

Judgments of abnormality

most likely when distress is

disproportionately acute orlong-lasting


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Dysfunctionality

Either for individual or for

society


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Deviance

From cultural norms


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What is Abnormal Behavior?

Behavior that is so:

Personally distressful

Personally dysfunctional

Culturally deviantthat others judge it as

inappropriate or maladaptive


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Diagnosing Psychological

Disorders

Reliability

Clinicians should show high

levels of agreement in their

diagnostic decisions

C i h Th M G Hill C i I P i i i d f d i di l


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Diagnosing PsychologicalDisorders

Validity

Diagnostic categories shouldaccurately capture essentialfeatures of disorders

C i ht Th M G Hill C i I P i i i d f d ti di l


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DSM-IV

Diagnostic and StatisticalManual of Mental Disorders,

Fourth Edition

Most widely used classification

system in U.S.

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DSM-IV Axes

Axis I: Primary clinical

symptoms Axis II: Long-standing

personality or developmental

disorders Axis III: Relevant physical

conditions



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DSM-IV Axes cont.

Axis IV: Intensity ofenvironmental stressors

Axis V: Coping resources as

reflected in recent adaptive

functioning



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Consequences of Diagnostic

Labeling

Social

Personal Legal

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Social Consequences ofDiagnostic Labeling

Becomes too easy to acceptlabel as description of the

individual



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Personal Consequences of

Diagnostic Labeling

May accept the new identity

implied by the label

May develop the expected role

and outlook



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Legal Consequences of

Diagnostic Labeling

Involuntary commitment to

mental institutions

Loss of civil rights

Indefinite detainment

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Legal Concepts

Competency

Defendants state of mind atthe time of a judicial hearing Insanity

Presumed state of mind ofdefendant at time crime wascommitted



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Copy g t e cG a Co pa es, c e ss o equ ed o ep oduct o o d sp ay

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Anxiety Disorders

Definition

Frequency and intensity ofanxiety responses are out ofproportion to the situations

that trigger them Anxiety interferes with daily

life



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Anxiety Disorders

Components of Anxiety

Responses

Subjective-emotional

Cognitive

Physiological

Behavioral



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py g p q p p y

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Anxiety Disorders

Phobias

Strong and irrational fears

of certain objects orsituations



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Anxiety Disorders

Agoraphobia: Fear of open and

public spaces from whichescape would be difficult

Social phobias: Fear ofsituations in which evaluationmight occur



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Anxiety Disorders

Specific phobias: Fear of

specific objects such asanimals or situations



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Anxiety Disorders

Generalized Anxiety Disorder

Chronic state of diffuse, free-floating anxiety

Anxiety not attached to

specific objects or situations



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Anxiety Disorders

Panic Disorder

Panic occurs suddenly and

unpredictably

Much more intense thantypical anxiety



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Anxiety Disorders

Obsessive-Compulsive Disorder

Obsessions

Repetitive and unwelcomethoughts, images, orimpulses

CompulsionsRepetitive behavioralresponses



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Anxiety Disorders

Posttraumatic Stress

Disorder

Severe anxiety disorder

Can occur in peopleexposed to extreme trauma



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Anxiety Disorders

Symptoms of PTSD

Severe symptoms of anxiety,

arousal, and distress Reliving of trauma in

flashbacks

Numb to world and avoidanceof reminders

Intense survivor guilt



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Anxiety Disorders

Biological Factors in Anxiety

Overreactive autonomic

nervous system Overreactive neurotransmitter

systems involved in emotional

responses Overreactive right hemisphere

sites involved in emotions



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Anxiety Disorders

Evolutionary Explanations

Biological preparedness

Makes it easier for us to learnto fear certain stimuli



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Anxiety Disorders

Psychodynamic Theory

Neurotic anxiety

Occurs when unacceptable

impulses threaten tooverwhelm the egosdefenses



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Anxiety Disorders

Cognitive Factors

Maladaptive thought

patterns and beliefs

Exaggeratedmisinterpretations of stimuli



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Anxiety Disorders

Learned Responses

Result of emotionalconditioning (hman, 2000;Rachman, 1998)

Classically conditioned fear

Observational learning



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Anxiety Disorders

Culture-Bound Disorders

Occur only in certain

locales

e.g., Anorexia Nervosa,Taijin Kyofushu



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Somatoform Disorders

Involve physical complaints

that suggest a medicalproblem

But no biological cause



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Hypochondriasis

Great alarm about physical

symptoms

Convinced of seriousillness



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Pain Disorder

Experience of intense pain outof proportion to medical

conditions

No physical basis for



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Conversion Disorder

Serious neurological

disorders suddenly occur

e.g., paralysis, loss ofsensation, blindness



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Glove Actual nerve

anethesia innervation



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Predispositions

May involve combinations ofbiological and psychologicalvulnerabilities

Genetics, environmentallearning, and socialreinforcement for bodilysymptoms (Trimble, 2003)



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Incidence (Tanaka-Matsumi &Draguns, 1997)

Higher in cultures that:

Discourage open discussionof emotions

Stigmatize psychological

disorders



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Dissociative Disorders

Breakdown of normal personality

integration

Results in alterations to

memory or identity



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Psychogenic Amnesia

Response to stressful event

with extensive but selectivememory loss



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Psychogenic Fugue

Loss of all sense of

personal identity

Establishment of newidentity in a new location



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Dissociative Identity Disorder(DID)

Formerly called multiplepersonality disorder

Two or more separatepersonalities coexist in thesame person



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Causes of DID

Trauma-Dissociation Theory

Development of personalities

is a response to severe

stress



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Criticisms of DID

Large increase in cases inrecent years

Are personalitiesunintentionally implantedby overzealous therapists?



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Mood (Affective) Disorders

Involve depression and

mania

Most frequently experienced

(with anxiety disorders)psychological disorders



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Major Depression

Intense depressed state

Leaves people unable to

function effectively in theirlives



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Dysthymia

Intense form of depression Less dramatic effects on

personal and occupational

functioning More chronic than major

depression



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Symptoms of Depression

Negative mood Cognitive symptoms

Motivational symptoms Somatic (physical)

symptoms



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Negative Mood in Depression

Sadness, misery, loneliness

Loss of capacity forpsychological, biologicalpleasures



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Cognitive Symptoms ofDepression

Difficulty concentrating andmaking decisions

Low self-esteem Feelings of inferiority

Blame selves for failures

Pessimism and hopelessness



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Motivational Symptoms of

Depression

Inability to get started on task

Inability to perform behaviors

leading to pleasure oraccomplishment



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Somatic (Bodily) Symptoms of

Depression

Loss of appetite and weight

loss in moderate and severe

depression Weight gain in mild depression


( ff )


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Bipolar Disorder

Depression alternates withperiods of mania

Mania = Highly excitedmood and behavior


M d (Aff i ) Di d


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Prevalence of Mood Disorders

1 in 20 Americans is severelydepressed (Narrow et al., 2002)

1 in 5 Americans will have a

depressive episode of clinicalproportions during lifetime(Hamilton, 1989)


M d (Aff ti ) Di d


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Gender Differences

Women about twice as

likely to suffer fromunipolar depression


M d (Aff ti ) Di d


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Biological Explanations for

Gender Differences in

Depression

Genetic factors

Biochemical differences

Premenstrual depression


M d (Aff ti ) Di d


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Environmental Explanations for

Gender Differences in Depression

(Nolen-Hoeksma, 1990)

Female passivity and

dependency

Distraction by physical activity

and drinking in males


M d (Aff ti ) Di d


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Patterns After Depressive

Episodes

No recurrence of clinical

depression

Recovery with recurrence

No recovery


M d (Aff ti ) Di d


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Genetic Factors

67% concordance rate foridentical twins; only 15% forfraternal twins (Gershon et al.,1989)

Genetic predisposition tomood disorder



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M d (Aff ti ) Di d


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Brain Chemistry Factors

Underactivity ofnorepinephrine, dopamine, andserotonin in depression(Davidson, 1998)

Overactivity ofneurotransmitters in mania?


M d (Aff ti ) Di d


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Psychological Factors

Early traumatic losses orrejections create vulnerability

(e.g. Abraham, 1911; Freud,

1917, Brown and Harris, 1978)


M d (Aff ti ) Di d


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Humanistic Factors

Definition of self-worth interms of individual attainment

React more strongly tofailures; view failures as due toinadequacies

Experience ofmeaninglessness


M d (Aff ti ) Di d


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Depressive Cognitive Triad

(Wenzlaff et al., 1988)

Negative thoughts concerning:

The world

Oneself

The future


M d (Aff ti ) Di d


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Depressive Attributional Pattern

Attributing success to factorsoutside self

Attributing negative outcomes

to personal factors



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Learned Helplessness Theory(Abramson et al., 1978; Seligman& Isaacowitz, 2000)

Depression occurs whenpeople expect that bad eventswill occur and they think thatthey cant cope with them




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Environmental Factors(Hammen, 1991)

Poor parenting

Many stressful experiences

Failure to develop good coping

skills Failure to develop positive self-

concept




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Sociocultural Factors

Prevalence of depressivedisorders less in Hong Kongand Taiwan than in the West

Feelings of guilt andinadequacy are highest inNorth America and WesternEurope




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Sociocultural Factors cont.

Gender difference not found

in developing countries


Suicide


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Suicide

Willful taking of ones life

Second most frequent cause ofdeath among high school andcollege students

Women attempt more suicides;men are more likely to kill selves



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Suicide


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Suicide

Warning Signs of Suicide

Verbal or behavioral threat tokill self

History of previous attempts

Detailed plan that involves alethal method


Suicide


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Suicide

Suicide Prevention

Talk about it with theperson

Provide social support andempathy


Suicide


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Suicide

Suicide Prevention cont.

Help the person to considerpositive future possibilities

Stay with the person and helphim or her to seek professionalassistance


Schizophrenia


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Schizophrenia

Severe disturbances in (Herz &Marder, 2002):

Thinking

Speech

Perception Emotion

Behavior


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Schizophrenia


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Schizophrenia

Diagnosis of Schizophrenia cont.

Strange or inappropriatecommunication

Neglect of personal grooming

Disorganized behavior


Schizophrenia


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Schizophrenia

Delusions

False beliefs that are sustainedin the face of contrary

evidence normally sufficient to

destroy them


Schizophrenia


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Schizophrenia

Hallucinations

False perceptions that have acompelling sense of reality

Can be auditory or visual


Schizophrenia


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Schizophrenia

Types of Affect

Flat: No emotions at all

Inappropriate


Schizophrenia


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Schizophrenia

Subtypes of Schizophrenia

Paranoid

Delusions of persecutionand grandeur


Schizophrenia


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Schizophrenia


Disorganized

Confusion and incoherence

Severe deterioration ofadaptive behavior


Schizophrenia


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Schizophrenia


Catatonic

Motor disturbances from

muscular rigidity to randomor repetitive movements


Schizophrenia


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Schizophrenia


Undifferentiated

Do not show enough specific

criteria to be classified asparanoid, disorganized, orcatatonic


Schizophrenia


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Schizophrenia

Positive Symptoms

Bizarre behaviors such asdelusions, hallucinations, anddisordered speech, thinking

Negative Symptoms

Absence of normal reactions

e.g., emotional expression,motivation, normal speech


Schizophrenia


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Schizophrenia

Positive Symptoms

Better prognosis for later

recovery


Schizophrenia


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Schizophrenia

Biological Causes

Genetic predisposition Destruction of neural tissue

(neurodegenerativehypothesis)

Atrophy in brain regions thatinfluence cognitions,emotions


Schizophrenia


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Schizophrenia

Dopamine hypothesis

Overactivity of the dopamine

system in brain areasregulating emotions,

motivations, and cognitions


Schizophrenia


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Schizophrenia

Psychological Factors

Freud: extreme example ofregression

Retreat from painfulintrapersonal world

Chaotic sensory input

Deficits in frontal lobeexecutive functions


Schizophrenia


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Schizophrenia

Environmental Factors

Stressful life events

Family dynamics

Home environments high in

expressed emotion (Vaughn &

Leff, 1976)


Schizophrenia


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Schizophrenia

Expressed Emotion

High levels of criticism High levels of hostility

Overinvolvement in personslife


Schizophrenia


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Schizophrenia

Sociocultural Factors

Highest in lowersocioeconomic populations

Causal or correlational?


Schizophrenia


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Schizophrenia

Social Causation Hypothesis

Higher prevalence ofschizophrenia due to higher

levels of stress

Social Drift Hypothesis

Deterioration of social andpersonal functioning causesdrift into poverty


Personality Disorders


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Stable, ingrained, inflexible, andmaladaptive ways of thinking,

feeling, and behaving

Increase likelihood of acquiring,maintaining several Axis Idisorders




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Three Clusters:

Dramatic and impulsivebehaviors

Anxiety and fearfulness

Odd and eccentricbehaviors


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Biological Causes of Antisocial

Personality Disorder

Genetic predisposition

Dysfunction in brain structures

that govern self-control andemotional arousal?




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Psychological Causes ofAntisocial Personality Disorder

Psychodynamic view: lack of asuperego

Inability to developconditioned fear responseswhen punished leads to poorimpulse control




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Psychological Causes ofAntisocial PersonalityDisorder cont.

Modeling of aggression

Parental inattention tochildrens needs (Rutter,1997)




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e so a ty so de s

Psychological Causes ofAntisocial Personality Disordercont.

Exposure to deviant peers

Consistent failure to thinkabout or anticipate long-termnegative consequences of acts


Childhood Disorders


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Over 20% of children aged 2-5diagnosed with DSM-IV disorder(Lavigne et al., 1996)

Only about 40% of children withbehavior disorders receive

professional attention (Satcher,1999)


Childhood Disorders


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Externalizing Disorders

Disruptive and aggressive

behaviors e.g., ADHD


Childhood Disorders


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ADHD (AttentionDeficit/Hyperactivity Disorder)

Attentional difficulties

Hyperactivity-impulsivity

Most common childhooddisorder (7-10% of U.S.children)


Childhood Disorders


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Causes of ADHD

Genetic predispositions Brain scans show no

differences with normals

Environmental factors


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Childhood Disorders


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Internalizing Disorders

Involve maladaptive thoughtsand emotions

Include anxiety and mooddisorders


Dementia in Old Age


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g

Gradual loss of cognitiveabilities

Accompanies brain deterioration

e.g., Alzheimers, Parkinsons,Huntingtons, Creutzfeldt-JakobDiseases


Dementia in Old Age


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g

Senile Dementia

Dementia that begins after age65

2:1 female-male ratio

Onset is typically gradual Over 1/2 cases resemble

schizophrenia


Dementia in Old Age


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Alzheimers Disease 60% of senile dementias

Caused by deterioration infrontal and temporal lobes ofbrain

Plaques in brain

Destruction of cells thatproduce acetylcholine

131 Chapter 13 Psychological Disorders3061

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Transcript of 131 Chapter 13 Psychological Disorders3061