Chapter 14 Psychological Disorders. Abnormal Behavior, continued The medical model applied to...

Chapter 14 Psychological Disorders

Abnormal Behavior, continued The medical model applied to abnormal behavior The medical model proposes that it is useful to think of abnormal behavior as a disease and has become the main way of thinking about mental illness today. This view is in stark contrast to how mental illness used to be perceived (see Figure 14.1). Thus, the medical model has brought much needed improvement in patient care.

Figure 14.1. Historical conceptions of mental illness. Throughout most of history, psychological disorders were thought to be caused by demonic possession, and the mentally ill were candidates for chains and torture.

The medical model, continued Diagnosis involves distinguishing one illness from another. Etiology refers to the apparent causation and developmental history of an illness. Prognosis is a forecast about the probable course of an illness. Abnormal Behavior, continued

Criteria of Abnormal Behavior 1.Deviance the behavior must be significantly different from what society deems acceptable. 2.Maladaptive behavior the behavior interferes with the persons ability to function. 3.Personal distress the behavior is troubling to the individual.

Psychodiagnosis: The Classification of Disorders The American Psychological Association (A.P.A.) uses the Diagnostic and Statistical Manual (now in its fourth revision and referred to as the DSM-IV) to classify disorders. It provides detailed information about various mental illnesses that allows clinicians to make more consistent diagnoses.

Classification of Disorders, continued The multiaxial system The DSM has five axes or components 1.Axis I: criteria for diagnosing most disorders. 2.Axis II: specific to personality disorders. 3.Axis III: patients general medical condition. 4.Axis IV: psychosocial and environmental problems. 5.Axis V: global assessment of functioning.

Classification of Disorders, continued Controversies surrounding the DSM Some argue that The categorical approach to pathology should be replaced by a dimensional approach. The DSM medicalizes everyday problems into disorders. e.g. difficulty controlling gambling becomes pathological gambling disorder.

Prevalence of Psychological Disorders Epidemiology is the study of the distribution of mental or physical disorders in a population. Prevalence refers to the percentage of the population that exhibits a disorder during a specified time period. Research suggests that there has been a real increase in the prevalence in disorder (see Figure 14.4). The most common classes are substance use, anxiety, and mood disorders.

Figure 14.4. Lifetime prevalence of psychological disorders. The estimated percentage of people who have, at any time in their life, suffered from one of four types of psychological disorders or from a disorder of any kind (top bar) is shown here. Prevalence estimates vary somewhat from one study to the next, depending on the exact methods used in sampling and assessment. The estimates shown here are based on pooling data from Wave 1 and 2 of the Epidemiological Catchment Area studies and the National Comorbidity Study, as summarized by Regier and Burke (2000) and Dew, Bromet, and Switzer (2000). These studies, which collectively evaluated over 28,000 subjects, provide the best data to date on the prevalence of mental illness in the United States.

Anxiety Disorders, continued Anxiety disorders are a class of disorders marked by feelings of excessive apprehension and anxiety. Generalized anxiety disorder is marked by a chronic, high level of anxiety that is not tied to any specific threat. Phobic disorder is marked by a persistent and irrational fear of an object of situation that presents no realistic danger.

Anxiety Disorders, continued Panic disorder is characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly (see following animation sequence). [Insert Video: Panic Disorder: Symptoms. From CDROM CB 9 th edition] Agoraphobia is a fear of going out to public places. Agoraphobia may result from severe panic disorder, in which people hide in their homes out of fear of the outside world.

Anxiety Disorders, continued Obsessive-compulsive disorder (OCD) is marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions). Common obsessions include fear of contamination, harming others, suicide, or sexual acts. Compulsions are highly ritualistic acts that temporarily reduce anxiety brought on by obsessions.

Anxiety Disorders, continued Obsessive -compulsive disorder, continued OCD disorders occur in approximately 2.5% of the population. Most cases of OCD emerge before the age of 35.

Anxiety Disorders, continued Etiology of anxiety disorders Biological factors Inherited temperament may be a risk factor for anxiety disorders. Anxiety sensitivity theory posits that some people are more sensitive to internal physiological symptoms of anxiety and overreact with fear when they occur.

Anxiety Disorders, continued Etiology of anxiety disorders, continued The brains neurotransmitters, or chemicals that carry signals from one neuron to another, may underlie anxiety. In particular, drugs that affect the neurotransmitter GABA (e.g., Valium) suggest that these chemical circuits may be involved in anxiety disorders.

Anxiety Disorders, continued Etiology of anxiety disorders, continued Conditioning and learning Classical conditioning may cause one to fear a particular object or scenario. Then, avoiding the fear stimulus is negatively reinforced, through operant conditioning, by making the person feel less anxious. Seligman (1971) adds we are biologically prepared to fear some things more than others, however.

Anxiety Disorders, continued Etiology of anxiety disorders, continued Cognitive factors Some people are more likely to experience anxiety disorders because they Misinterpret harmless situations as threatening. Focus excess attention on perceived threats. Selectively recall information that seems threatening.

Anxiety Disorders, continued Etiology of anxiety disorders, continued Stress as a factor Finally, anxiety disorders may be linked to excessive stress. Specifically, research (Brown, 1998) has found that people with anxiety disorders were more likely to have experienced severe stress one month prior to the onset of their disorder. Thus, stress may precipitate the onset of anxiety disorders.

Somatoform Disorders, continued Somatoform disorders are physical ailments that cannot be fully explained by organic conditions and are largely due to psychological factors. Somatization disorder is marked by a history of diverse physical complaints that appear to be psychological in origin. It occurs mostly in women. Symptoms seem to be linked to stress.

Somatoform Disorders, continued Conversion disorder is characterized by a significant loss of physical function with no apparent organic basis, usually in a single organ system. Common symptoms include Partial or total loss of vision or hearing. Partial paralysis. Laryngitis or mutism (inability to speak). Seizures or vomiting. Loss of function in limbs.

Somatoform Disorders, continued Hypochondriasis (or hypochondria) is characterized by excessive preoccupation with health concerns and incessant worry about developing physical illnesses. People with hypochondria are convinced their symptoms are real and often become frustrated with the medical establishment. Hypochondria often occurs along with anxiety disorders and depression.

Somatoform Disorders, continued Etiology of somatoform disorders Personality factors Somatoform disorders are more common in people with histrionic personalities (those who thrive on the attention that illness brings). Neuroticism also seems to elevate ones predisposition to somatoform disorders.

Somatoform Disorders, continued Etiology of somatoform disorders, continued Cognitive factors Some people focus excessive attention on bodily sensations and amplify them into perceived symptoms of distress. They also have unrealistically high standards of good health. Thus, any deviation from perfect health is seen as a sign of illness.

Somatoform Disorders, continued Etiology of somatoform disorders, continued The sick role Some people learn to like being sick because It allows one to avoid challenging tasks. Demands arent placed on sick people. It provides an excuse for failure. Being sick elicits attention from others.

Dissociative Disorders, continued Dissociative disorders are a class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity.

Dissociative Disorders, continued Dissociative amnesia & fugue Dissociative amnesia is a sudden loss of memory for important personal information that is too extensive to be due to normal forgetting. It often occurs after a single traumatic event or an extended period of severe trauma or stress.

Dissociative Disorders, continued Dissociative amnesia & fugue, continued Dissociative fugue is a disorder in which people lose their memory for their sense of personal identity. People suffering from this disorder often wander away from home, do not know who they are, where they live, or who they know.

Dissociative Disorders, continued Dissociative identity disorder (DID) involves the coexistence in one person of two or more largely complete, and usually very different, personalities. Also known as multiple personality disorder, in which each personality has its own name, memories, traits, and physical mannerisms. Transitions between identities can be sudden and the differences between them can be extreme (e.g., different races or genders).

Dissociative Disorders, continued Etiology of dissociative disorders Psychogenic amnesia and fugue are usually the result of extreme stress. Dissociative identity disorder is a fascinating and bizarre disorder, and its causes are largely unknown. However, many clinicians suspect that DID may result from severe emotional trauma that occurs in childhood.

Mood Disorders, continued Mood disorders are a class of disorders marked by emotional disturbances that may spill over to disrupt physical, perceptual, social, and thought processes. Major depressive disorder is one in which people show persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure. Onset can occur at any time, but most cases occur before age 40. The majority of people with depression (75- 95%) will experience a repeat episode.

Mood Disorders, continued Major depressive disorder, continued Depression is one of the most common mental illnesses (the lifetime prevalence is 16.2%). However, prevalence is tied to gender. Women are twice as likely to be diagnosed with depression. This does not appear to be tied to biological differences between men and women and could result from greater stress and abuse that women experience.

Mood Disorders, continued Bipolar disorder (once known as manic- depressive disorder) is marked by the experience of both depressed and manic periods. Manic periods are characterized by bouts of extreme exuberance and a feeling of invincibility. However, this state of elation alternates, sometimes suddenly, with periods of depression (see Figure 14.10).

Figure 14.10. Common symptoms in manic and depressive episodes. The emotional, cognitive, and motor symptoms exhibited in manic and depressive illnesses are largely the opposite of each other. From Sarason, I.G., & Sarason, B. R. (1987). Abnormal psychology: The problem of maladaptive behavior (5 th ed., p. 283). Englewood Cliffs, NJ: Prentice-Hall. 1987 Prentice-Hall. Reprinted by permission of Prentice-Hall, Inc.

Mood Disorders, continued Mood disorders and suicide 90% of people who complete suicide suffer from some type of psychological disorder. Suicide rates are highest for people with mood disorders, who account for 60% of completed suicides. Lifetime risk for those with bipolar disorder is 15-20%; it is 10-15% in those who have had depression.

Mood Disorders, continued Etiology of mood disorders Genetic vulnerability Concordance rates, or the percentage of twin pairs or other pairs of relatives that exhibit the same disorder, suggests there is a genetic basis for mood disorders. Concordance rates for identical twins is 65-72%, whereas it is only 14-19% for fraternal twins who share fewer genes but the same environment.

Mood Disorders, continued Etiology of mood disorders, continued Neurochemical & neuroanatomical factors Mood disorders are correlated with low levels of two neurotransmitters in the brain: 1.Norepinephrine. 2.Seratonin. However, it is unclear whether changes in these chemicals are the cause, or the result, of the onset of mood disorders.

Mood Disorders, continued Etiology of mood disorders, continued Neuroanatomical factors, continued Depression is also correlated with reduced hippocampal volume. The hippocampus, is 8-10% smaller in depressed, than in normal, subjects (see Figure 14.12). New theories suggest that neurogenesis may play a central role in the regulation of mood and depression.

Figure 14.12. The hippocampus and depression. This graphic shows the hippocampus in blue. The photo inset shows a brain dissected to reveal the hippocampus in both the right and left hemispheres. It has long been known that the hippocampus plays a key role in memory, but its possible role in depression has only come to light in recent years. Research suggests that shrinkage of the hippocampal formation due to suppressed neurogenesis may be a key causal factor underlying depressive disorders.

Mood Disorders, continued Etiology of mood disorders, continued Cognitive factors Seligman (1974) proposes that depression is caused by learned helplessness, in which people become passive and give up in times of difficulty. Learned helplessness is also related to a pessimistic explanatory style in which people attribute setbacks to personal flaws.

Mood Disorders, continued Etiology of mood disorders, continued Nolen-Hoeksema (1991, 2000) also asserts that those who ruminate about problems put themselves at risk for depression. Finally, depression may be caused by negative thinking, as shown in Lauren Alloys (1999) studies (see Figure 14.14).

Figure 14.14. Negative thinking and prediction of depression. Alloy and colleagues (1999) measured the explanatory style of first-year college students and characterized them as being high risk or low risk for depression. This graph shows the percentage of these students who experienced major or minor episodes of depression over the next 2.5 years. As you can see, the high-risk students, who exhibited a negative thinking style, proved to be much more vulnerable to depression. (Data from Alloy et al., 1999)

Mood Disorders, continued Etiology of mood disorders, continued Interpersonal roots Depression has also been correlated with interpersonal factors, such as poor social skills. It is unclear what the direction of cause and effect is, with regard to this correlation. Precipitating stress There is also a link between stress and the onset of mood disorders.

Schizophrenic Disorders, continued Schizophrenia literally means split mind. Schizophrenic disorders are a class of disorders marked by disturbances in thought that spill over to affect perceptual, social, and emotional processes. Prevalence is quite low, with only about 1% of the population suffering from this class of disorders. Schizophrenia is a severe disorder that usually has an early onset and a poor prognosis.

Schizophrenic Disorders, continued General symptoms 1.Irrational thought Delusions are false beliefs that are maintained even though they clearly are out of touch with reality. A common delusion is the belief that ones mind is being controlled by an external source. Delusions of grandeur are irrational beliefs that one is extremely important or famous.

Schizophrenic Disorders, continued General symptoms, continued 2.Deterioration of adaptive behavior (e.g., inability to function at work or home.) 3.Distorted perception Auditory hallucinations sensory perceptions that occur in the absence of a real external stimulus or that represent gross distortions of perceptual input are common symptoms. 4.Disturbed emotion (either flat affect or inappropriate emotions for a situation).

Schizophrenic Disorders, continued Subtypes 1.Paranoid type Paranoid schizophrenia is dominated by delusions of persecution along with delusions of grandeur. People with this type often believe others are watching and plotting against them. 2.Catatonic type Catatonic schizophrenia is marked by striking motor disturbances, ranging from muscular rigidity to random motor activity.

Schizophrenic Disorders, continued Subtypes of schizophrenia, continued 3.Disorganized type In disorganized schizophrenia, a particularly severe deterioration of adaptive behavior is seen. Major symptoms include Emotional indifference. Incoherence. Severe social withdrawal. Aimless giggling and babbling. Delusions centered on bodily functions.

Schizophrenic Disorders, continued Subtypes of schizophrenia, continued 4.Undifferentiated type Undifferentiated schizophrenia is marked by idiosyncratic mixtures of schizophrenic symptoms. Essentially, symptoms do not fit neatly into one of the subtypes.

Schizophrenic Disorders, continued Positive versus negative symptoms An alternative to dividing schizophrenia into four subtypes has been proposed by Andreasen (1990) and others. There are only two subtypes with this approach: 1.Schizophrenias with negative symptoms (behavioral deficits, such as flat affect). 2.Schizophrenias with positive symptoms (hallucinations, delusions, & bizarre behavior).

Schizophrenic Disorders, continued Course and outcome Schizophrenia usually emerges during adolescence or early adulthood. Its course is variable, with three likely outcomes: 1.Patients with milder versions who experience a full recovery. 2.Patients who experience a partial recovery and who are in and out of treatment facilities. 3.Patients whose symptoms are persistent and severe, and who require permanent hospitalization.

Schizophrenic Disorders, continued Course and outcome, continued Patients with a favorable prognosis Have a sudden onset of the disorder. Experience onset at a later age. Were well adjusted before the onset. Have a low proportion of negative symptoms. Do not have a loss of cognitive function. Show good adherence to treatment. Have a relatively healthy, supportive family environment to return to.

Schizophrenic Disorders, continued Etiology of schizophrenia Genetic vulnerability Concordance in identical twins is 48%, versus 17% in fraternal twins, suggesting a genetic basis for the disease (see Figure 14.17). Neurochemical factors Schizophrenia is also linked with excess activity in the transmitter Dopamine.

Figure 14.17. Genetic vulnerability to schizophrenic disorders. Relatives of schizophrenic patients have an elevated risk for schizophrenia. This risk is greater among closer relatives. Although environment also plays a role in the etiology of schizophrenia, the concordance rates shown here suggest that there must be a genetic vulnerability to the disorder. These concordance estimates are based on pooled data from 40 studies.

Schizophrenic Disorders, continued Etiology of schizophrenia, continued Structural abnormalities in the brain CT and MRI (brain-imaging) scans have shown that patients with schizophrenia have enlarged brain ventricles (see Figure 14.18). It is unclear, however, whether this abnormality is the cause, or the result, of the disorder.

Figure 14.18. Schizophrenia and the ventricles of the brain. Cerebrospinal fluid (CSF) circulates around the brain and spinal cord. The hollow cavities in the brain filled with CSF are called ventricles. The four ventricles in the human brain are depicted here. Studies with modern brain-imaging techniques suggest that an association exists between enlarged ventricles in the brain and the occurrence of schizophrenic disturbance.

Schizophrenic Disorders, continued Etiology of schizophrenia, continued The neurodevelopmental hypothesis posits that schizophrenia is caused in part by various disruptions in the normal maturational processes of the brain before or at birth (Brown, 1999). Potential disruptions could include Prenatal exposure to a flu virus. Severe famine. Birth trauma.

Schizophrenic Disorders, continued Etiology of schizophrenia, continued Expressed emotion (EE) is the degree to which a relative of a schizophrenic patient displays highly critical or emotionally overinvolved attitudes toward the patient. A familys EE is a good predictor of the course of a schizophrenics illness. Patients who return to families high in EE are three to four times more likely to relapse because they add stress.

Schizophrenic Disorders, continued Etiology of schizophrenia, continued Precipitating stress itself may trigger the onset of schizophrenia in someone who is already vulnerable to the disease.

Application: Eating Disorders, continued Types of eating disorders Eating disorders are severe disturbances in eating behavior characterized by preoccupation with weight and unhealthy efforts to control weight. There are three main types: Anorexia nervosa. Bulimia nervosa. Binge-eating disorder.

Application: Eating Disorders, continued Types of eating disorders, continued Anorexia nervosa involves intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, and dangerous measure to lose weight. This is usually achieved by severely limiting caloric intake or by using laxatives and excessive exercise to eliminate food and/or burn calories.

Application: Eating Disorders, continued Anorexia nervosa, continued Medical complications from anorexia are serious and can include Amenorrhea (ceasing of menstrual cycles). Gastrointestinal problems. Dental problems. Osteoporosis (loss of bone density). Low blood pressure. Metabolic disturbances that can trigger cardiac arrest.

Application: Eating Disorders, continued Types of eating disorders, continued Bulimia nervosa involves habitually engaging in out-of-control overeating followed by unhealthy compensatory efforts, such as self-induced vomiting, fasting, abuse of laxatives and diuretics, and excessive exercise. Unlike with anorexia, patients with bulimia usually maintain a normal weight. However, they do risk medical problems such as cardiac arrythmias, dental problems, metabolic, and gastrointestinal problems.

Application: Eating Disorders, continued Types of eating disorders, continued Binge-eating disorder involves distress- inducing eating binges that are not accompanied by the purging, fasting, and excessive exercise seen in bulimia. Patients with this disorder are often overweight and disgusted with their bodies. Excessive overeating is often triggered by stress.

Application: Eating Disorders, continued History and prevalence Anorexia has existed throughout history, but became more common in the middle of the 20 th century. Bulimia appears to be a new disorder. Young women are much more likely to develop eating disorders, and the gender gap is likely due to the unrealistic cultural standards for weight in Western societies. Still, these are rare conditions, with about 1% developing anorexia and 2-3% developing bulimia.

Application: Eating Disorders, continued Etiology of eating disorders Genetic vulnerability Twin studies show higher concordance rates for identical twins than fraternal twins, suggesting a genetic predisposition for the disease. However, many other factors influence the development of eating disorders.

Application: Eating Disorders, continued Etiology of eating disorders, continued Personality factors Victims of anorexia tend to be rigid, neurotic, emotionally restrained, and obsessive. Perfectionism is a risk factor for anorexia. In contrast, bulimia is associated with impulsiveness, being overly sensitive, and low self-esteem.

Application: Eating Disorders, continued Etiology of eating disorders, continued Cultural values In Western society, young women are socialized to believe they must be very thin in order to be attractive and the desirable weight, as seen in models and actresses, has decreased in recent decades.

Application: Eating Disorders, continued Etiology of eating disorders, continued The role of the family In families where parents are overly involved in childrens lives, adolescents may use anorexia as a way to control the one aspect of their life they feel they can exert control over their body. Some mothers even contribute to eating disorders by endorsing societys obsession with being thin.

Application: Eating Disorders, continued Etiology of eating disorders, continued Cognitive factors Individuals with eating disorders often display all-or-none, irrational thinking, and hold beliefs such as I must be thin to be accepted. If I am not in complete control, I will lose all control. If I gain one pound, I will become obese.

Chapter 14 Psychological Disorders. Abnormal Behavior, continued The medical model applied to...

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