Chapter 14: Psychological Diagnosis and Disorders Rob Cramer, M.A. Department of Psychology & Psychology Trainee- The Counseling Center.

Chapter 14: Psychological Diagnosis and Disorders

Rob Cramer, M.A.

Department of Psychology &

Psychology Trainee-

The Counseling Center

Psychological Diagnosis and The Psychological Diagnosis and The Medical ModelMedical Model

–Medical Model categorizes behavior Medical Model categorizes behavior as abnormalas abnormal

–What is abnormal? (3 criteria)What is abnormal? (3 criteria)

• DeviantDeviant

• MaladaptiveMaladaptive

• Causing personal distressCausing personal distress

–Behavioral continuum from Behavioral continuum from abnormal-normalabnormal-normal

• Diagnostic Schemes: The Diagnostic and Statistical Manual– Current version is DSM-IV-TRCurrent version is DSM-IV-TR– 1980: DSM-III added multi-axial assessment 1980: DSM-III added multi-axial assessment

schemescheme

Axis I: Clinical SyndromesAxis I: Clinical Syndromes

Axis II: Personality Disorders and Mental Axis II: Personality Disorders and Mental RetardationRetardation

Axis III: General Medical ConditionsAxis III: General Medical Conditions

Axis IV: Psychosocial and Environmental Axis IV: Psychosocial and Environmental ProblemsProblems

Axis V: Global Assessment of FunctioningAxis V: Global Assessment of Functioning

• What do you think about diagnosis?What do you think about diagnosis?– Do disorders exist?Do disorders exist?– Stigma?Stigma?

““She’s depressed”She’s depressed”

““He’s on medication”He’s on medication”

““He was hospitalized for schizophrenia”He was hospitalized for schizophrenia”

What comes to your mind?What comes to your mind?

• Anxiety DisordersAnxiety Disorders– Generalized anxiety disorderGeneralized anxiety disorder

– Phobic disorderPhobic disorder

– Social PhobiaSocial Phobia

– Panic disorder and agoraphobiaPanic disorder and agoraphobia

– Obsessive compulsive disorderObsessive compulsive disorder

– Post-Traumatic Stress DisorderPost-Traumatic Stress Disorder

Causes of Anxiety DisordersCauses of Anxiety Disorders• Biological factorsBiological factors

– Genetic predisposition, anxiety sensitivityGenetic predisposition, anxiety sensitivity– GABA circuits in the brainGABA circuits in the brain

• Conditioning and learningConditioning and learning– Acquired through classical conditioning or Acquired through classical conditioning or

observational learningobservational learning– Maintained through operant conditioningMaintained through operant conditioning

• Cognitive factorsCognitive factors– Judgments of perceived threatJudgments of perceived threat

• PersonalityPersonality– NeuroticismNeuroticism

• StressStress– A precipitatorA precipitator

• Example of Maintenance of Anxiety: Phobia

Activity Time!!!Activity Time!!!• The good doctor is still The good doctor is still

locked away!! Help his locked away!! Help his patients out by patients out by identifying the type of identifying the type of anxiety they have.anxiety they have.

Case 1• Johnny is a 20-year-old college student who has had

recent problems with grades and friends. He has reported feeling nervous and fearful about taking exams, making his friends happy, and many other areas of his life. Johnny sought therapy for his problem. During early therapy sessions, Dr. Relax learned that Johnny’s symptoms began several months ago after a musical performance in which he froze and was laughed off stage. Since that time, Johnny avoids playing his guitar or going on stage. He also told Dr. Relax that his grades began to drop and friendships suffered because of trouble concentrating, trouble sleeping, and feeling tired. What type(s) of anxiety disorders does Johnny have?

Case 2• Lisa was involved in a plane crash more than

six months ago. Shortly after the crash, she began having nightmares and flashbacks about the event. Since that time, Lisa has also become easily startled by any loud sound and she often wakes during the night. Lisa presented for therapy with Dr. Relax because her job requires her to fly to a conference in Florida next week, but she is experiencing tremendous anxiety and trying to avoid having to fly. What type(s) of anxiety disorders does Lisa have?

• Depression and SuicideDepression and Suicide

• What do you know?What do you know?

• What do you want to know?What do you want to know?

Depression FactsDepression Facts1.1. 33rdrd most common disorder most common disorder

2.2. 1 in 5 people will suffer an MDD episode across 1 in 5 people will suffer an MDD episode across the lifetimethe lifetime

3.3. Almost twice as common in womenAlmost twice as common in women

4.4. Costs businesses an estimated $33 billion in Costs businesses an estimated $33 billion in salary productivity per year salary productivity per year

5.5. Most common in young adults and older adultsMost common in young adults and older adults

6.6. Expressed differently by culture and ageExpressed differently by culture and age• E.g., Chinese – somatic complaintsE.g., Chinese – somatic complaints• E.g, Children – anger/irritabilityE.g, Children – anger/irritability

Major Depressive DisorderMajor Depressive DisorderTwo weeks of 5 or more of the following:Two weeks of 5 or more of the following:

1. Depressed mood and/or1. Depressed mood and/or

2. Loss of interest2. Loss of interest

3. Weight loss or gain3. Weight loss or gain

4. Insomnia or hypersomnia4. Insomnia or hypersomnia

5. Psychomotor agitation or retardation (e.g., 5. Psychomotor agitation or retardation (e.g., restless) restless)

6. Loss of energy6. Loss of energy

7. Worthlessness/guilt7. Worthlessness/guilt

8. Concentration/indecision8. Concentration/indecision

9. Recurrent thoughts of death9. Recurrent thoughts of death

Dysthymia

Two or more of the following are present or at Two or more of the following are present or at least 2 years:least 2 years:

1.1. Poor appetite or overeatingPoor appetite or overeating

2.2. Insomnia or hypersomniaInsomnia or hypersomnia

3.3. Low energyLow energy

4.4. Low Self-esteemLow Self-esteem

5.5. Poor concentration/indecisionPoor concentration/indecision

6.6. Feelings of hopelessnessFeelings of hopelessness

- MDD episode cannot be present in these 2 - MDD episode cannot be present in these 2 yearsyears

Differences between MDD and Differences between MDD and DysthymiaDysthymia

1.1. IntensityIntensity

2.2. Time requirementsTime requirements

3.3. Symptom presentationSymptom presentation• Thoughts of deathThoughts of death• Weight issues Weight issues • psychomotor effectspsychomotor effects

4.4. Presentation for treatmentPresentation for treatment• MDD more likelyMDD more likely

Factors Associated with DepressionFactors Associated with Depression1.1. Cognitive StylesCognitive Styles

• Locus of ControlLocus of Control• Learned HelplessnessLearned Helplessness• Hopelessness TheoryHopelessness Theory

2.2. StressStress• Chronic stressChronic stress• Major life events – can precipitate both typesMajor life events – can precipitate both types

3.3. PersonalityPersonality• Five-Factor- associationsFive-Factor- associations

4.4. Biological underpinningsBiological underpinnings• Neurotransmitter dysfunctionNeurotransmitter dysfunction

Treatments:Treatments:1.1. Cognitive/Cognitive-behavioral TherapyCognitive/Cognitive-behavioral Therapy

• Belief testingBelief testing• Thought RecordThought Record

2.2. Dynamic TherapyDynamic Therapy• BibliotherapyBibliotherapy• Assertiveness trainingAssertiveness training

3.3. Psychopharmacological TherapiesPsychopharmacological Therapies• SSRIsSSRIs

Warning signs• 1. Changes in activity level1. Changes in activity level

• 2. Physical changes (e.g., weight)2. Physical changes (e.g., weight)

• 3. Emotional pain3. Emotional pain

• 4. Mood change (e.g., irritable, down, self-4. Mood change (e.g., irritable, down, self-critical)critical)

• 5. Changes in thought patterns 5. Changes in thought patterns (concentration, decision making)(concentration, decision making)

• 6. Thoughts/mention of death6. Thoughts/mention of death

Scenario:Scenario:Fred is your roommate. Lately, he has been Fred is your roommate. Lately, he has been

sleeping a lot more, feeling down, and sleeping a lot more, feeling down, and pulling away from others. He makes pulling away from others. He makes statements like “it would be better if I statements like “it would be better if I wasn’t here” and “I don’t care about wasn’t here” and “I don’t care about anything anymore.” anything anymore.”

1.1. What is wrong with Fred?What is wrong with Fred?

2.2. How would you handle this situation?How would you handle this situation?

3.3. What if he has a plan?What if he has a plan?

Suicide Facts1.1. 88thth leading cause of death overall, 3 leading cause of death overall, 3rdrd for for

adolescents and young adultsadolescents and young adults2.2. Most prevalent in adolescents and older Most prevalent in adolescents and older

adultsadults3.3. Twice as common in college students than Twice as common in college students than

non-college counterpartsnon-college counterparts4.4. Accounts for 30,000 deaths annuallyAccounts for 30,000 deaths annually5.5. Women more likely to attempt, men more Women more likely to attempt, men more

likely to completelikely to complete6.6. Suicidal thoughts and attempts difficult to Suicidal thoughts and attempts difficult to

countcount

Associated Risk Factors/Causes• 1. Mood disorder1. Mood disorder

• 2. Gender2. Gender

• 3. Negative Life Event3. Negative Life Event

• 4. Neuroticism4. Neuroticism

• 5. Low self-esteem5. Low self-esteem

• 6. Low social support6. Low social support

• 7. Personality Disorder7. Personality Disorder

• **Most likely completed when mood is **Most likely completed when mood is improvingimproving

Warning Signs1. Talking about dying1. Talking about dying2. Recent loss2. Recent loss3. Depressive symptoms3. Depressive symptoms4. Talking about loss of control/harming self 4. Talking about loss of control/harming self

or othersor others5. Withdrawal from relationships5. Withdrawal from relationships6. Hopelessness6. Hopelessness7. Previous attempt**7. Previous attempt**8. “Finalizing behavior” (e.g., Giving things 8. “Finalizing behavior” (e.g., Giving things

away, tying up relationships, making out away, tying up relationships, making out wills)wills)

Suicide Assessment• Question: Imminent risk of death vs. non-fatal Question: Imminent risk of death vs. non-fatal

attempts?attempts?• 1. Allow person to discuss their problem for 5-10 1. Allow person to discuss their problem for 5-10

minutesminutes• 2. Assess negative psychological effects of 2. Assess negative psychological effects of

problem (e.g., hopeless, depressed)problem (e.g., hopeless, depressed)• 3. Assess thoughts of suicide uninterrupted 3. Assess thoughts of suicide uninterrupted

thoughts at the moment, plan, meansthoughts at the moment, plan, means• 4. Assess thoughts of death- active or passive?4. Assess thoughts of death- active or passive?• 5. Ask about carrying out plan/taking other with 5. Ask about carrying out plan/taking other with

them them

What should you do to help?• 1. Educate yourself on warning signs1. Educate yourself on warning signs• 2. Be direct2. Be direct• 3. 3. NEVERNEVER leave the person alone leave the person alone• 4. Assess immediacy of threat – plan and means? 4. Assess immediacy of threat – plan and means?

Remove if neededRemove if needed• 5. GET HELP!!!5. GET HELP!!!

– University Counseling CenterUniversity Counseling Center• 348-3863348-3863

– University Psychological ClinicUniversity Psychological Clinic• 348-5000348-5000

– 1-800-SUICIDE1-800-SUICIDE– 1-800-273-TALK1-800-273-TALK– DIAL 911 DIAL 911

A helping hand for Fred…Recall that Fred has Recall that Fred has

exhibited depressive exhibited depressive symptoms and talked symptoms and talked about death. How about death. How might you go about might you go about helping him?helping him?

I need a volunteer for a I need a volunteer for a role play!!! role play!!!