Psychological Disorders Chapter 15 - PowerPoint Presentation

1. Psychological DisordersChapter 15AP PsychologyAlice F. ShortHilliard Davidson High School

2. Chapter PreviewDefining/Explaining Abnormal BehaviorAnxiety DisordersMood DisordersDissociative DisordersSchizophreniaPersonality DisordersPsychological Disorders and Health and Wellness

3. Abnormal Behaviorabnormal behavior - behavior that is…deviant (atypical)example: washing hands 4x an hourmaladaptive (dysfunctional)example: believing that you can hurt people by breathing and hiding away and avoiding peoplepersonally distressing (despair)example: feeling extreme shame or guilt… over a relatively long period of timeNOTE: context matters!

4. Theoretical ApproachesBiological Approach: Medical Modeldisorders with biological origins Psychological Approachexperiences, thoughts, emotions, personalitySociocultural Approachsocial contextBiopsychosocial Modelinteraction of biological, psychological and sociocultural factors

5. Theoretical ApproachesBiological Approach: Medical Modelmedical model – the view that psychological disorers are medical diseases with biological origindisorders with biological origins abnormalities = mental illnessespatients = afflicted individualsdoctors = people who treat the patients

6. Theoretical Approaches:Psychological Approachpsychological approach – focuses on experiences, thoughts, emotions, personalityin the development and course of psychological disorders

7. Theoretical Approaches:Sociocultural ApproachSociocultural Approachsocial contextincludes: gender, ethnicity, socioeconomic status, family relationships, culture, technological aspects of culture, religious aspects of culturesocioeconomic status = greater impact than ethnicityliving conditions of poverty = stressful

8. Theoretical Approaches:Biopsychosocial ModelBiopsychosocial Modelinteraction of biological, psychological and sociocultural factorsbiological factors (such as genes)psychological factors (such as childhood experiences)sociocultural factors (such as gender)

9. DSM-V Classification SystemAdvantagesprovides a common basis for communicationhelps clinicians make predictionsnaming the disorder can provide comfortDisadvantagesstigma (shame, negative reputation)medical terminology implies internal causefocus on weaknesses ignores strengthDISUCSSION: Which do you think is more significant—the advantages or disadvantages?

10. Critical Controversy: Psychological Disorders – Real or Myth?Szasz & Cruisephrase “mental illness” is presumptuousmedication of mental illnesses is presumptuousResponse of Medical Professionalsmental illnesses are real medical conditionsdrugs effectively alleviate symptomsADHD: over-diagnosed or non-medical?should prescription drugs be used to treat ADHD?

11. Critical Controversy:A SHORT Time to PonderWhen do you think it is appropriate to label someone as having a psychological disorder?When do you think medical treatments for psychological disorders are appropriate?If a teacher suggested that your child be tested for ADHD, what do you think you would do? Why?

12. DSM-V-TR AxesMultiaxial SystemAxis I and II: Psychological DisordersAxis III: Another Medical ConditionsAxis IV: Psychosocial/Environmental ProblemsAxis V: Current Level of Functioning

13. Axis I DisordersMajor Categories:disorders usually first diagnosed in infancy, childhood, or adolescence and communication disordersanxiety disorderssomatoform disordersfactitious disordersdissociative disordersdelirium, dementia, amnesia, and other cognitive disordersmood disordersschizophrenia and other psychotic disorderssubstance-related disorderssexual and gender identity disorderseating disorderssleep disordersimpulse control disorders not elsewhere classifiedadjustment disorders

14. Axis II DisordersMajor Categories:intellectual disabilitypersonality disordersother conditions that may be a focus of clinical attention

15. Anxiety Disordersanxiety disorders - uncontrollable fears that are disproportionate to the actual danger and disruptive to ordinary life (Axis I) generalized anxiety disorderpanic disorderphobic disorderseparation anxiety disorderselective mutism obsessive-compulsive disordernow in the obsessive-compulsive and related disorderspost-traumatic stress disordernow in the trauma- and stressor-related disorderssequential order of chapter reflects close relationship

16. Generalized Anxiety DisorderDiagnosis and Symptomspersistent anxiety for at least 6 monthsinability to specify reasons for the anxietyEtiology – the causes or significant preceding conditionsbiological factorsgenetic predisposition, GABA deficiency, sympathetic nervous system activity, respirationpsychological and sociocultural factors harsh self-standards, critical parents, automatic negative thoughts, history of uncontrollable trauma (like an abusive parent)

17. Panic DisorderDiagnosis and Symptomsrecurrent, sudden onsets of intense terror that often occur without warningpanic attacks: can produce sever palpitations, extreme shortness of breath, chest pains, trembling, sweating, dizziness and a feeling of helplessnesstypes changed to unexpected panic attack and expected panic attackpanic disorder and agoraphobia are unlinkedEtiologybiological factors: genetic predispositionpsychological factors: misinterpret arousalsociocultural factors: gender differencesAmerican women = 2x as likely to suffer from a panic disorderFUN FACT: Charles Darwin had a panic disorder

18. Phobic DisorderDiagnosis and Symptomsan irrational, overwhelming, persistent fear of a particular object or situation social anxiety disorder social phobia – an intense fear of being humiliated or embarrassed in social situationsdeletion of requirement that individuals over age 18 years recognize that their anxiety is excessive or unreasonable6-month duration expanded to include all agespanic disorder and agoraphobia are unlinked“generalized” specifier has been deleted and replaced with a “performance only” specifier (fear of speaking/performing in front of an audience)Etiologybiological factors: genetic dispositionneural circuit: thalamus, amygdala and cerebral cortexpsychological factors: learned classical conditioning / learned associations

19. Examples of Phobic Disordersphobic disorders – it is no longer a requirement that individuals over age 18 years must recognize that their fear and anxiety are excessive or unreasonable

20. Social Anxiety Disorders in the USsocial anxiety disorder (formerly called social phobias)

21. Obsessive Compulsive and Related DisordersDiagnosis and Symptomspersistent anxiety-provoking thoughts and/or urges to perform repetitive, ritualistic behaviors to prevent or produce a situationcognitive perspective: inability to turn off negative, intrusive thoughts by ignoring or effectively dismissing themobsession – recurrent thoughtscompulsions – recurrent behaviorsmost common: excessive checking, cleansing, countingEtiologybiological factors: genetic predispositionmore activity in frontal cortex, basal ganglia, thalamussmaller amygdala (counter-intuitive)lower levels of serotonin and dopaminepsychological factors: life stress

22. Obsessive-Compulsive and Related Disordersnew disorders:hoarding disorderexcoriation (skin-picking) disordersubstance-/medication induced obsessive-compulsive and related disorderobsessive-compulsive related disorder due to another medical conditionfrom impulse-control disorderstrichotillomania (hair-pulling) disordernew specifiers“with poor insight”… “fair”… “good”… “absent insight/delusional”

23. Post-Traumatic Stress Disorder (PTSD)Diagnosis and SymptomsSymptoms develop as a result of exposure to a traumatic event--oppressive situation, natural or unnatural disasters—that have overwhelmed the person’s abilities to copeflashbacks  reliving eventavoidance of emotional experiences/talking with othersconstricted ability to feel emotionsexcessive arousal  inability to sleep, exaggerated startle responsedifficulties with memory and concentrationfeelings of apprehensionimpulsive outbursts4 major symptom clusters: reexperiencing, avoidance, persistent negative alteration in cognitions and mood, arousal

24. Post-Traumatic Stress DisorderEtiologystressor criterion: requires being explicit to whether qualifying traumatic events were experienced directly, witnessed, or experienced indirectlysubjective reaction (removed) traumacombat and war-relatedsexual abuse and assaultnatural and unnatural disasters (plane crashes, terrorists attacks)vulnerabilityprevious history of traumaconditions: abuse, psychological disordersgenetic predispositions

25. Mood Disordersmood disorder - disturbance of mood that affects entire emotional state (Axis I Disorder)depressive disordersmajor depressive disorderdysthymic disorderbipolar disorderscorrelate: suicideSymptoms may includecognitive, behavioral, or physical symptomsinterpersonal difficulties

26. Diagnosis and Symptomssignificant depressive episode that lasts for at least two weeksdefined by presence of at least 5 out of 9 symptomsdepressed mood most of the dayreduced interest or pleasure in all or most activitiessignificant weight loss or gain or significant decrease or increase in appetitetrouble sleeping or sleeping too muchpsychological and physical agitation, or, in contrast, lethargyfatigue or loss of energyfeeling worthless or guilty in an excessive or inappropriate mannerproblems thinking, concentrating, or making decisionsrecurrent thoughts of death and suicideno history of manic episodes (periods of euphoric moods)daily functioning is impairedthe coexistence of within a major depressive episode of at least three manic symptoms (insufficient to satisfy criteria for a manic episode) is now acknowledged by the specifier “with mixed feature”  increases likelihood illness exists in bipolar spectrumbereavement exclusion removed - was an exclusion applied to depressive symptoms lasting less than 2 months following the death of a loved oneMajor Depressive Disorder (MDD)

27. Persistent Depressive Disorder:Dysthymic Disorder (DD)Diagnosis and Symptomschronic depressionunbroken depressed mood lasting at least two years (adult) or one year (child)adult: less than two months regular mood still = diagnosis fewer symptoms than MDDdefined by presence of 2 out of 6 symptomspoor appetite or overeatingsleep problemslow energy or fatiguelow self-esteempoor concentration or difficulty making decisionsfeelings of hopelessnessdysthymic disorder now falls in category of persistent depressive disorder (along with chronic major depressive disorder)

28. Major Depressive Disorder (MDD)Etiologybiological factors: genetic dispositionunderactive prefrontal cortexregulation of neurotransmittersserotoninnorepinephrinepsychological factors: learned helplessnessruminating on negative, self-defeating thoughtspessimistic attribution sociocultural factorspovertywomen head of householdsminoritiesgender differences (women = 2x likely)

29. Childhood DepressionDevelopmental Psychopathologyrisk factors for depressionparental psychopathologygeneticsprotective factorssupportive adult role model, or strong extended familygenetics

30. Mood Disorder: Bipolar DisorderCharacterized by extreme mood swingsBipolar I (more severe)hallucinations – seeing or hearing things that are not theremania – an overexcited, unrealistically optimistic statenew specifier of “with mixed features” (meeting full criteria for both has been removed) Bipolar IIless extreme level of euphoriamanic and hypomanic episodes now include an emphasis on changes in activity and energy as well as moodFrequency and separation of episodesusually separated by 6 months to a yearEtiologystrong genetic componentswings in metabolic activity in cerebral cortexlevels of neurotransmittershigh levels of norepinephrine, glutamatelow levels of serotonin

31. SuicidePrevalenceover 32,000 in year 2004one completion for every 8 to 25 attempts3rd leading cause of death in early adolescence 10-1413-19

32. SuicideBiological factorslow levels of serotonin 10x likely to try againpoor healthPsychological Factorsmental disorders90 percenttrauma (recent/immediate and highly stressful)sexual abuseloss of a job/flunking out of school/unwanted pregnancysubstance abuseSociocultural Factorschronic economic hardshipcultural and religious normsnorms against suicide = lower rateseastern Europe, Japan, South Korea gender differences

33. When Someone is Threatening Suicideattempters: connection to otherswomen 3x morel likely to attemptcompleters: disconnected / burden on othersmen 4x more likely to complete suicide; more likely to use a firearmhighest suicide rate is among non-Latino men aged 85+

34. Dissociative Disorderdissociative disorder - sudden loss of memory or change in identity due to the dissociation (separation) of the individual’s conscious awareness from previous memories and thoughtsDissociation protection from extreme stress or shockproblems integrating emotional memoriesTypesdissociative amnesiadissociative fugue * is now a specifier of dissociative amnesia rather than a separate diagnosis dissociative identity disorder (DID)

35. Dissociative DisordersDissociative Amnesiaindividuals experience extreme memory loss caused by extensive psychological stressonly aspects of their own identity and autobiographical experiences are forgottenExample: sodium pentathol “truth serum”  stressDissociative Fuguedissociative fugue * is now a specifier of dissociative amnesia rather than a separate diagnosis individuals experience amnesia, unexpectedly travel away, and sometimes assume a new identitytendency to run away*

36. Dissociative Identity Disorder (DID)formerly known as multiple personality disordermost dramatic, least common, most controversial dissociative disorder Diagnosis and Symptomsthe same individual possesses two or more distinct personalitiessymptoms of disruption may be reported as well as observedeach personality has unique memories, behaviors, and relationshipsonly one personality is dominant at a timepersonality shifts (and gaps in recall) occur under distress and everyday (not just traumatic events)* “experiences of pathological possession in some cultures are included in the description of identity disruption”Etiologyextraordinarily severe abuse in early childhood (70%)social contagionmostly womenruns in familiesindividual compartmentalizes different aspects of the self into independent identities

37. Schizophreniahighly disordered thoughtthought disorder – refers to the unusual, sometimes bizarre thought processes that are characteristic positive symptoms of schizophreniasplit from reality (psychotic)typically diagnosed in early adulthoodhigh suicide risk (8x general population)categories of symptoms:positive symptomshallucinationsdelusionsthought disordersdisorders of movementnegative symptoms

38. Symptoms of SchizophreniaPositive Symptoms hallucinations – sensory experiences in the absence of real stimuliauditory and visual = more commonsmells or tastes = less common delusions – false, unusual, and sometimes magical beliefs that are not part of an individual’s culturebelieving you’re Jesus Christ, Muhammad, etc.that your thoughts are being broadcast over the radio, etc.disorganized speech * in DSM-V must have one of these core positive symptomsthought disorder“word salad”; neologisms – making up new wordsreferential thinking – ascribing personal meaning to completely random events – traffic light turned red because YOU’RE in a hurrydisorders of movement – unusual mannerisms, body movements, facial expressions, may repeat certain motions over and overcatatonia – state of immobility and unresponsiveness lasting for long periods of time (all contexts require 3 catatonic symptoms (of 12); may be diagnosed as specifier for depressive, bipolar, psychotic disorders) Negative Symptoms flat affect – the display of little or no emotion (common)Cognitive Symptomsattention difficulties and memory problemsimpaired ability to interpret information and make decisionssubtypes of schizophrenia are removed in DSM-V (paranoid, disorganized, catatonic, undifferentiated, residual, etc.)

39. Etiology of SchizophreniaBiological Factorsgenetic predispositionstructural brain abnormalities (no glial cells  prenatal)enlarged ventricles (fluid-filled spaces) in brain  indicates deterioration in other brain tissuesmaller and less active prefrontal cortexregulation of neurotransmittersexcess dopamine production (or overactivation of pathways)bizarre beliefs continue after dopamine regulation  may disappear only after experience demonstrates that such schemas no longer carry their explanatory power Psychological Factorsdiathesis-stress model – view of schizophrenia emphasizing that a combination of biogenetic disposition and stress causes the disorderdiathesis – physical vulnerability or predisposition to a particular disorderSociocultural Factorsinfluence how disorder progresses (course)developing, non-industrialized countries have better results

40. Personality Disorderspersonality disorder - chronic maladaptive cognitive-behavioral patternsantisocial personality disorderborderline personality disorder Antisocial Personality DisorderDiagnosis and Symptomsguiltless lawbreaking, violence, deceitimpulsive, irritable, reckless, irresponsibleexploitative, lacks empathypsychopaths – remorseless predators who engage in violence to get what they want (examples: John Wayne Gacy, Ted Bundy)“successful psychopaths” and “unsuccessful psychopaths”Etiologybiological factors genetic heritablebrain: less prefrontal activation, structural abnormalities in amygdala and hippocampus underaroused ANS (autonomic nervous system) differencestestosterone – hormone most associated with aggressive behaviormore common in men

41. Personality DisordersBorderline Personality DisorderDiagnosis and Symptomsinstability in interpersonal relationships & self-imageimpulsive, insecure, unstable & extreme emotionsvery sensitive to treatment of othersparanoia – a pattern of disturbed thought featuring delusion of grandeur or persecutiondissociative symptomsrecurrent suicidal behavior, gestures, or threats or self-mutilating behaviorscutting – insuring oneself with a sharp object but without suicidal attemptsplitting – thinking style of seeing things in black or whiteEtiologygenetic (40% heritability)childhood abuse, neglect – suggests diathesis-stress explanationirrational belief one is powerless, unacceptable, and that others are hostilehypervigilance – the tendency to be constantly on the alert, looking for threatening information in the environment75% women

42. Psychological Disorders and Health and WellnessStereotypes and StigmaRosenhan’s study - fake psychiatric patients3-52 days hospitalization for (FAKE) schizophrenianegative attitudes toward mentally illphysical health risk successfully functioning individuals with mental illness reluctant to “come out”

43. Chapter SummaryDiscuss the characteristics, explanations, and classifications of abnormal behavior.Distinguish among the various anxiety disorders.Compare the mood disorders and specify risk factors for depression and suicide.Describe the dissociative disorders.Characterize schizophrenia.Identify behavior patterns typical of personality disorders.Explain the impact of the stigma associated with mental illness.

44. Chapter SummaryAbnormal Behaviordeviant, maladaptive, or personally distressingTheoretical Approachesbiological, psychological, and socioculturalbiopsychosocial Classifying Abnormal BehaviorDSM-IV-TR Axesadvantages and disadvantages

45. Chapter SummaryAnxiety Disordersgeneralized anxiety disorder panic disorderphobic disorderobsessive-compulsive disorderpost-traumatic stress disorder

46. Chapter SummaryMood Disordersmajor depressive disorder dysthymic disorderbipolar disordersuicideDissociative Disordersdissociative amnesiadissociative fuguedissociative identity disorder

47. Chapter SummarySchizophreniapositive, negative and cognitive symptomsetiology (biological, psychological, sociocultural)Personality Disordersantisocial personality disorderborderline personality disorderPsychological Disorders and Health & Wellnessstigmas and stereotypes