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1

PsychologicalDisorders

2

PsychologicalDisorders

PerspectivesonPsychologicalDisorders DefiningPsychologicalDisorders

UnderstandingPsychologicalDisorders

ClassifyingPsychologicalDisorders

LabelingPsychologicalDisorders

3

PsychologicalDisorders

AnxietyDisorders GeneralizedAnxietyDisorderandPanicDisorder

Phobias

ObsessiveCompulsiveDisorders

PostTraumaticStressDisorders

AnxietyDisorderExplanation

4

PsychologicalDisorders

MoodDisorders MajorDepressiveDisorders

BipolarDisorder

MoodDisorderExplanation

Schizophrenia SymptomsofSchizophrenia

SubtypesofSchizophrenia

5

PsychologicalDisorders

Schizophrenia UnderstandingSchizophrenia

PersonalityDisorders

RatesofPsychologicalDisorders

6

PsychologicalDisorders

IfelttheneedtocleanmyroomspentfourtofivehoursatitAtthetimeIloveditbutthendidntwanttodoitanymore,butcouldnotstopTheclotheshungtwofingersapartItouchedmybedroom

wallbeforeleavingthehouseIhadconstantanxietyIthoughtImightbenuts.

Marc,diagnosedwithobsessivecompulsivedisorder

(fromSummers,1996)

7

PsychologicalDisorders

Peoplearefascinatedbytheexceptional,theunusual,andtheabnormal.Thisfascination

maybecausedbytworeasons:

1. Duringvariousmomentswefeel,think,andactlikeanabnormalindividual.

2. Psychologicaldisordersmaybringunexplainedphysicalsymptoms,irrationalfears,andsuicidalthoughts.

8

PsychologicalDisorders

Tostudytheabnormalisthebestwayofunderstandingthenormal.

1. Thereare450millionpeoplesufferingfrompsychologicaldisorders(WHO,2004).

2. Depressionandschizophreniaexistinallculturesoftheworld.

WilliamJames(18421910)

9

DefiningPsychologicalDisorders

Mentalhealthworkersviewpsychologicaldisorders aspersistentlyharmfulthoughts,

feelings,andactions.

Whenbehaviorisdeviant,distressful,anddysfunctional psychiatristsandpsychologists

labelitasdisordered(Comer,2004).

10

Deviant,Distressful&Dysfunctional

1. Deviant behavior(goingnaked)inoneculturemaybeconsiderednormal,whileinothersitmayleadtoarrest.

2. Deviantbehaviormustaccompanydistress.

3. Ifabehaviorisdysfunctional itisclearlyadisorder.

IntheWodaabetribemenwearcostumestoattract

women.InWesternsocietythiswouldbeconsidered

abnormal.

Carol B

eckwith

11

UnderstandingPsychologicalDisorders

AncientTreatmentsofpsychologicaldisordersincludetrephination,exorcism,beingcagedlike

animals,beingbeaten,burned,castrated,mutilated,ortransfusedwithanimalsblood.

Trephination(boringholesintheskulltoremoveevilforces)

John W. V

erano

12

MedicalPerspective

PhilippePinel(17451826)fromFrance,insistedthatmadnesswasnotduetodemonicpossession,

butanailmentofthemind.

Danceinthemadhouse.

George W

esley Bellow

s, Dancer in a M

adhouse, 1907. 1997 The A

rt Institute of Chicago

13

MedicalModel

Whenphysiciansdiscoveredthatsyphilisledtomentaldisorders,theystartedusingmedicalmodelstoreviewthephysicalcausesofthesedisorders.

1. Etiology: Causeanddevelopmentofthedisorder.

2. Diagnosis: Identifying(symptoms)anddistinguishingonediseasefromanother.

3. Treatment: Treatingadisorderinapsychiatrichospital.

4. Prognosis: Forecastaboutthedisorder.

14

BiopsychosocialPerspective

Assumesthatbiological,sociocultural,andpsychologicalfactorscombineandinteractto

producepsychologicaldisorders.

15

ClassifyingPsychologicalDisorders

TheAmericanPsychiatricAssociationrenderedaDiagnosticandStatisticalManualofMentalDisorders(DSM)todescribepsychological

disorders.

Themostrecentedition,DSMIVTR(TextRevision,2000),describes400psychological

disorderscomparedto60inthe1950s.

16

MultiaxialClassification

ArePsychosocial orEnvironmentalProblems(schoolorhousingissues)alsopresent?AxisIV

WhatistheGlobalAssessment ofthepersonsfunctioning?AxisV

IsaGeneralMedicalCondition (diabetes,hypertensionorarthritisetc)alsopresent?AxisIII

IsaPersonalityDisorder orMentalRetardationpresent?AxisII

IsaClinicalSyndrome (cognitive,anxiety,mooddisorders[16syndromes])present?AxisI

17

MultiaxialClassificationNote16syndromesinAxisI

18

MultiaxialClassificationNoteGlobalAssessmentforAxisV

19

GoalsofDSM1. Describe(400)disorders.2. Determinehowprevalentthe

disorderis.

DisordersoutlinedbyDSMIVarereliable.Therefore,diagnosesbydifferentprofessionalsaresimilar.

OtherscriticizeDSMIVforputtinganykindofbehaviorwithinthecompassofpsychiatry.

20

LabelingPsychologicalDisorders

1. CriticsoftheDSMIVarguethatlabelsmaystigmatizeindividuals.

Asylumbaseballteam(labeling)

Elizabeth Eckert, Middletow

n, NY

. From L. G

amw

ell and N

. Tomes, M

adness in America, 1995. C

ornell University Press.

21

LabelingPsychologicalDisorders

2. Labelsmaybehelpfulforhealthcareprofessionalswhencommunicatingwithoneanotherandestablishingtherapy.

22

LabelingPsychologicalDisorders

3. Insanity labelsraisemoralandethicalquestionsabouthowsocietyshouldtreatpeoplewhohavedisordersandhavecommittedcrimes.

TheodoreKaczynski(Unabomber)

Elaine Thompson/ A

P Photo

23

AnxietyDisorders

Feelingsofexcessiveapprehensionandanxiety.

1. Generalizedanxietydisorders2. Phobias3. Panicdisorders4. Obsessivecompulsivedisorders

24

GeneralizedAnxietyDisorder

1. Persistentanduncontrollabletensenessandapprehension.

2. Autonomicarousal.3. Inabilitytoidentifyoravoidthecauseof

certainfeelings.

Symptoms

25

PanicDisorder

Minutelongepisodesofintensedreadwhichmayincludefeelingsofterror,chestpains,choking,orotherfrighteningsensations.

Anxietyisacomponentofbothdisorders.Itoccursmoreinthepanicdisorder,making

peopleavoidsituationsthatcauseit.

Symptoms

26

Phobia

Markedbyapersistentandirrationalfearofanobjectorsituationthatdisruptsbehavior.

27

KindsofPhobias

Phobiaofblood.Hemophobia

Phobiaofclosedspaces.Claustrophobia

Phobiaofheights.Acrophobia

Phobiaofopenplaces.Agoraphobia

28

ObsessiveCompulsiveDisorder

Persistenceofunwantedthoughts(obsessions)andurgestoengageinsenselessrituals

(compulsions)thatcausedistress.

29

APETscanofthebrainofapersonwith

ObsessiveCompulsiveDisorder(OCD).Highmetabolicactivity(red)inthefrontallobeareas

areinvolvedwithdirectingattention.

BrainImaging

BrainimageofanOCD

30

PostTraumaticStressDisorder

Fourormoreweeksofthefollowingsymptomsconstituteposttraumaticstressdisorder

(PTSD):

1. Hauntingmemories2. Nightmares3. Socialwithdrawal4. Jumpyanxiety

5. Sleepproblems

Bettm

ann/ Corbis

31

ResiliencetoPTSD

Onlyabout10%ofwomenand20%ofmenreacttotraumaticsituationsanddevelopPTSD.

Holocaustsurvivorsshowremarkableresilienceagainsttraumaticsituations.

Allmajorreligionsoftheworldsuggestthatsurvivingatraumaleadstothegrowthofan

individual.

32

ExplainingAnxietyDisorders

Freudsuggestedthatwerepressourpainfulandintolerableideas,feelings,andthoughts,

resultinginanxiety.

33

TheLearningPerspective

Learningtheoristssuggestthatfear

conditioning leadstoanxiety.Thisanxiety

thenbecomesassociatedwithotherobjectsorevents

(stimulusgeneralization)andis

reinforced.

John Coletti/ Stock, B

oston

34

TheLearningPerspective

Investigatorsbelievethatfearresponsesareinculcatedthroughobservationallearning.

Youngmonkeysdevelopfearwhentheywatchothermonkeyswhoareafraidofsnakes.

35

TheBiologicalPerspective

NaturalSelection hasledourancestorstolearntofearsnakes,spiders,andotheranimals.

Therefore,fearpreservesthespecies.

Twinstudiessuggestthatourgenes maybepartlyresponsiblefordevelopingfearsand

anxiety.Twinsaremorelikelytosharephobias.

36

TheBiologicalPerspective

Generalizedanxiety,panicattacks,andevenOCDarelinkedwithbrain circuitsliketheanteriorcingulatecortex.

AnteriorCingulateCortexofanOCDpatient.

S. Ursu, V

.A. Stenger, M

.K. Shear, M

.R. Jones, &

C.S. C

arter (2003). Overactive action

monitoring in obsessive-com

pulsive disorder. Psychological Science, 14, 347-353.

37

DissociativeDisorder

Consciousawarenessbecomesseparated(dissociated)frompreviousmemories,

thoughts,andfeelings.

Symptoms

1. Havingasenseofbeingunreal.2. Beingseparatedfromthebody.3. Watchingyourselfasifinamovie.

38

DissociativeIdentityDisorder(DID)

Isadisorderinwhichapersonexhibitstwoormoredistinctandalternatingpersonalities,

formerlycalledmultiplepersonalitydisorder.

ChrisSizemore(DID)

Lois Bernstein/ G

amm

a Liason

39

DIDCritics

CriticsarguethatthediagnosisofDIDincreasedinthelate20th century.DIDhas

notbeenfoundinothercountries.

CriticsArguments

1. Roleplayingbypeopleopentoatherapistssuggestion.

2. Learnedresponsethatreinforcesreductionsinanxiety.

40

MoodDisorders

Emotionalextremesofmooddisorders comeintwoprincipalforms.

1. Majordepressivedisorder2. Bipolardisorder

41

MajorDepressiveDisorder

Depressionisthecommoncold ofpsychologicaldisorders.Inayear,5.8%ofmen

and9.5%ofwomenreportdepressionworldwide(WHO,2002).

Chronicshortnessofbreath

Gaspingforairafterahardrun

MajorDepressiveDisorderBluemood

42

MajorDepressiveDisorder

Majordepressivedisorderoccurswhensigns ofdepressionlasttwoweeksormoreandarenot

causedbydrugsormedicalconditions.

1. Lethargyandfatigue2. Feelingsofworthlessness3. Lossofinterestinfamily&friends4. Lossofinterestinactivities

Signsinclude:

43

DysthymicDisorder

Dysthymicdisorderliesbetweenabluemoodandmajordepressivedisorder.Itisadisordercharacterizedbydailydepressionlastingtwo

yearsormore.

MajorDepressiveDisorder

BlueMood

DysthymicDisorder

44

BipolarDisorder

Formerlycalledmanicdepressivedisorder.Analternationbetweendepressionandmania

signalsbipolardisorder.

MultipleideasHyperactive

DesireforactionEuphoriaElation

ManicSymptoms

SlownessofthoughtTired

InabilitytomakedecisionsWithdrawnGloomy

DepressiveSymptoms

45

BipolarDisorder

Manygreatwriters,poets,andcomposerssufferedfrombipolardisorder.Duringtheirmanicphasecreativitysurged,butnotduring

theirdepressedphase.

Whitman Wolfe Clemens Hemingway

Bettm

ann/ Corbis

George C

. Beresford/ H

ulton Getty Pictures Library

The Granger C

ollection

Earl Theissen/ Hulton G

etty Pictures Library

46

ExplainingMoodDisorders

Sincedepressionissoprevalentworldwide,investigatorswanttodevelopatheoryof

depressionthatwillsuggestwaystotreatit.

Lewinsohnetal.,(1985,1995)notethatatheoryofdepressionshouldexplainthefollowing:

1. Behavioralandcognitivechanges2. Commoncausesofdepression

47

TheoryofDepression

3. Genderdifferences

48

TheoryofDepression

4. Depressiveepisodesselfterminate.5. Depressionisincreasing,especiallyin

theteens.

Postpartumdepression

Desiree N

avarro/ Getty Im

ages

49

Suicide

Themostsevereformofbehavioralresponsetodepressionissuicide.Eachyearsome1million

peoplecommitsuicideworldwide.

1. Nationaldifferences2. Racialdifferences3. Genderdifferences4. Agedifferences5. Otherdifferences

SuicideStatistics

50

BiologicalPerspective

GeneticInfluences: Mooddisordersruninfamilies.Therateofdepressionishigherinidentical(50%)thanfraternaltwins(20%).

Linkageanalysis andassociationstudies linkpossiblegenesand

dispositionsfordepression.

Jerry Irwin Photography

51

Neurotransmitters&Depression

PostsynapticNeuron

PresynapticNeuron

Norepinephrine Serotonin

Areductionofnorepinephrine andserotonin hasbeenfoundindepression.

Drugsthatalleviatemaniareduce

norepinephrine.

52

TheDepressedBrain

PETscansshowthatbrainenergyconsumptionrisesandfallswithmanicanddepressive

episodes.

Courtesy of Lew

is Baxter an M

ichael E.Phelps, U

CLA

School of Medicine

53

SocialCognitivePerspective

Thesocialcognitiveperspectivesuggeststhatdepressionarisespartlyfromselfdefeatingbeliefs andnegativeexplanatorystyles.

54

DepressionCycle

1. Negativestressfulevents.2. Pessimisticexplanatory

style.3. Hopelessdepressedstate.4. Thesehamperthewaythe

individualthinksandacts,fuelingpersonalrejection.

55

Example

Explanatorystyleplaysamajorroleinbecomingdepressed.

56

Schizophrenia

Ifdepressionisthecommoncoldofpsychologicaldisorders,schizophreniaisthe

cancer.

Nearly1ina100sufferfromschizophrenia,andthroughouttheworldover24millionpeople

sufferfromthisdisease(WHO,2002).

Schizophreniastrikesyoungpeopleastheymatureintoadults.Itaffectsmenandwomenequally,butmensufferfromitmoreseverely

thanwomen.

57

SymptomsofSchizophreniaTheliteraltranslationissplitmind.Agroup

ofseveredisorderscharacterizedbythefollowing:

1. Disorganizedanddelusionalthinking.

2. Disturbedperceptions.3. Inappropriateemotionsand

actions.

58

Otherformsofdelusionsinclude,delusionsofpersecution(someoneisfollowingme)or

grandeur(Iamaking).

Disorganized&DelusionalThinking

ThismorningwhenIwasatHillside[Hospital],Iwasmakingamovie.IwassurroundedbymoviestarsImMarryPoppins.Isthisroompaintedbluetogetmeupset?Mygrandmotherdiedfourweeksaftermyeighteenthbirthday.

(Sheehan,1982)

Thismonologueillustratesfragmented,bizarrethinkingwithdistortedbeliefscalleddelusions

(ImMaryPoppins).

59

Disorganized&DelusionalThinking

Manypsychologistsbelievedisorganizedthoughtsoccurbecauseofselectiveattentionfailure(fragmentedandbizarrethoughts).

60

DisturbedPerceptionsAschizophrenicpersonmayperceivethingsthatarenotthere(hallucinations).Frequentlysuchhallucinationsareauditoryandlesser

visual,somatosensory,olfactory,orgustatory.

L. Berthold, U

ntitled.The Prinzhorn Collection, U

niversity of Heidelberg

August N

atter, Witches H

ead.The Prinzhorn Collection, U

niversity of Heidelberg

Photos of paintings by Krannert M

useum, U

niversity of Illinois at Urbana-C

hampaign

61

InappropriateEmotions&Actions

Aschizophrenicpersonmaylaughatthenewsofsomeonedyingorshownoemotionatall

(apathy).

Patientswithschizophreniamaycontinuallyrubanarm,rockachair,orremainmotionless

forhours(catatonia).

62

SubtypesofSchizophrenia

Schizophreniaisaclusterofdisorders.Thesesubtypessharesomefeatures,butthereareothersymptomsthatdifferentiatethese

subtypes.

63

PositiveandNegativeSymptoms

Schizophrenicshaveinappropriatesymptoms(hallucinations,disorganizedthinking,deluded

ways)thatarenotpresentinnormalindividuals(positivesymptoms).

Schizophrenicsalsohaveanabsenceofappropriatesymptoms(apathy,expressionlessfaces,rigidbodies)thatarepresentinnormal

individuals(negativesymptoms).

64

ChronicandAcuteSchizophrenia

Whenschizophreniaisslowtodevelop(chronic/process)recoveryisdoubtful.Suchschizophrenicsusuallydisplaynegative

symptoms.

Whenschizophreniarapidlydevelops(acute/reactive)recoveryisbetter.Suchschizophrenicsusuallyshowpositive

symptoms.

65

Subtypes

66

UnderstandingSchizophrenia

Schizophreniaisadiseaseofthebrainexhibitedbythesymptomsofthemind.

DopamineOveractivity:Researchersfoundthatschizophrenicpatientsexpresshigherlevelsof

dopamineD4receptorsinthebrain.

BrainAbnormalities

67

AbnormalBrainActivity

Brainscansshowabnormalactivityinthefrontalcortex,thalamus,and amygdala of

schizophrenicpatients.Adolescentschizophrenicpatientsalsohavebrainlesions.

Paul Thompson and A

rthur W. Toga, U

CLA

Laboratory of Neuro

Imaging and Judith L. R

apport, National Institute of M

ental Health

68

AbnormalBrainMorphology

Schizophreniapatientsmayexhibitmorphologicalchangesinthebrainlikeenlargementoffluidfilledventricles.

Both Photos: C

ourtesy of Daniel R

. Weinberger, M

.D., N

IH-N

IMH

/ NSC

69

ViralInfection

Schizophreniahasalsobeenobservedinindividualswhocontractedaviralinfection

(flu)duringthemiddleoftheirfetaldevelopment.

70

GeneticFactors

Thelikelihoodofanindividualsufferingfromschizophreniais50%iftheiridenticaltwinhas

thedisease(Gottesman,1991).

01020304050Identical

BothparentsFraternal

OneparentSibling

NephewornieceUnrelated

71

GeneticFactors

Thefollowingshowstheprevalenceofschizophreniainidenticaltwinsasseenin

differentcountries.

72

PsychologicalFactors

Psychologicalandenvironmentalfactorscantriggerschizophreniaiftheindividualis

geneticallypredisposed(Nicols&Gottesman,1983).

GenainSisters

ThegeneticallyidenticalGenain

sisterssufferfromschizophrenia.Twomorethan

others,thustherearecontributingenvironmental

factors.

Courtesy of G

enain Family

73

WarningSigns

Earlywarningsignsofschizophreniainclude:

Birthcomplications,oxygendeprivationandlowbirthweight.

2.

Shortattentionspanandpoormusclecoordination.

3.

Poorpeerrelationsandsoloplay.6.Emotionalunpredictability.5.

Disruptiveandwithdrawnbehavior.4.

Amotherslonglastingschizophrenia.1.

74

PersonalityDisorders

Personalitydisordersarecharacterizedby

inflexibleandenduringbehaviorpatternsthatimpairsocialfunctioning.Theyareusuallywithoutanxiety,depression,ordelusions.

75

AntisocialPersonalityDisorder

Adisorderinwhichtheperson(usuallymen)exhibitsalackofconscienceforwrongdoing,eventowardfriendsandfamilymembers.Formerly,thispersonwascalledasociopath orpsychopath.

76

UnderstandingAntisocialPersonalityDisorder

Likemooddisordersandschizophrenia,antisocialpersonalitydisorderhasbiologicalandpsychological

reasons.Youngsters,beforecommittingacrime,respondwithlowerlevelsofstresshormonesthanothers

doattheirage.

77

UnderstandingAntisocialPersonalityDisorder

PETscansof41murderersrevealedreducedactivityinthefrontallobes.Inafollowupstudyrepeatoffendershad11%lessfrontallobeactivitycomparedtonormals(Raineetal.,1999;2000).

Normal Murderer

Courtesy of A

drian Raine,

University of Southern C

alifornia

78

UnderstandingAntisocialPersonalityDisorder

Thelikelihoodthatonewillcommitacrimedoubleswhenchildhoodpovertyiscompoundedwith

obstetricalcomplications(Raineetal.,1999;2000).

79

RatesofPsychologicalDisorders

80

RatesofPsychologicalDisorders

Theprevalenceofpsychologicaldisordersduringthepreviousyearisshownbelow(WHO,2004).

81

RiskandProtectiveFactors

Riskandprotectivefactorsformentaldisorders(WHO,2004).

82

RiskandProtectiveFactors