INTRODUCTION TO PSYCHOLOGY Chapter 16 Psychopathology.

INTRODUCTION TO INTRODUCTION TO PSYCHOLOGYPSYCHOLOGY

Chapter 16Chapter 16

PsychopathologyPsychopathology

At the end of this Chapter you At the end of this Chapter you should be able to:should be able to:

Learn about Psychodynamic approachLearn about Psychodynamic approach Learn different conceptions of Mental Learn different conceptions of Mental

DisorderDisorder Difference between psychosis and Difference between psychosis and

neurosisneurosis Psychodynamic approachPsychodynamic approach Defense MechanismsDefense Mechanisms Learn about SchizophreniaLearn about Schizophrenia Learn about Mood DisordersLearn about Mood Disorders Learn about Anxiety DisordersLearn about Anxiety Disorders Learn about Dissociative DisordersLearn about Dissociative Disorders

The psychodynamic approach: The psychodynamic approach: Probing the depthsProbing the depths

Examines Examines motivesmotives underlying underlying our behaviorour behavior Motives can be consciousMotives can be conscious

But…But… Motives may also be poorly Motives may also be poorly

understood understood May be completely hidden from May be completely hidden from

our own view/comprehensionour own view/comprehension

Psychoanalytic Thought: Psychoanalytic Thought: From hypnosis to “the talking From hypnosis to “the talking cure”cure” Freud:Freud: treated patients first as treated patients first as

neurologist physicianneurologist physician Noted disorders of conversion, or Noted disorders of conversion, or

hysteriahysteria Symptoms were implausible or Symptoms were implausible or

impossible: impossible: Examined other explanations for Examined other explanations for

patients’ symptomspatients’ symptoms Troubling memories at the foundation of Troubling memories at the foundation of

the symptomsthe symptoms

Techniques of analysisTechniques of analysis

Hypnosis at first; Freud abandoned Hypnosis at first; Freud abandoned early and used early and used free association free association

Free associationFree association: : a way at getting a way at getting at thoughts that were typically at thoughts that were typically “repressed”“repressed”

Freud’s assumption: ideas and Freud’s assumption: ideas and thoughts are associated with each thoughts are associated with each other other Therefore…eventually you will “say” Therefore…eventually you will “say”

something associated with the forgotten something associated with the forgotten or repressed memoryor repressed memory

One problem….One problem….

““Resistance”Resistance” Anxiety arises: we worry about the Anxiety arises: we worry about the

consequences of rememberingconsequences of remembering Patients “resist” talking about their Patients “resist” talking about their

memoriesmemories Freud’s underlying belief: when Freud’s underlying belief: when

conflict was revealed, and when conflict was revealed, and when memories were uncovered, neurotic memories were uncovered, neurotic and hysterical symptoms would and hysterical symptoms would subsidesubside

Models of mindModels of mind

Levels of processing: Levels of processing: Conscious: currently being thought Conscious: currently being thought

aboutabout Preconscious: easily available to usPreconscious: easily available to us Unconscious: unavailable to our (willed) Unconscious: unavailable to our (willed)

thoughtthought Structures of personality: Structures of personality:

IdId EgoEgo Super-egoSuper-ego

Structures of PersonalityStructures of Personality

Id:Id: all other aspects of personality all other aspects of personality emerge from this basic, primitive, emerge from this basic, primitive, pleasure seeking part of our pleasure seeking part of our personalitypersonalityEgo:Ego: deals with reality and its deals with reality and its demands; copes with demands demands; copes with demands from Id and …from Id and …Superego:Superego: society’s rules and society’s rules and parents’ rules, internalized and parents’ rules, internalized and imposed on the egoimposed on the ego

Conflict and defenseConflict and defense

Interplay of the three structures and Interplay of the three structures and the three levels of processing: the the three levels of processing: the dynamicsdynamics of this theory of this theory

Avoiding anxiety is prime directiveAvoiding anxiety is prime directive Defense mechanisms are in place to Defense mechanisms are in place to

protect the personality from anxiety protect the personality from anxiety that may feel overwhelmingthat may feel overwhelming

Defense mechanismsDefense mechanisms

RepressionRepression: Keeping distressing : Keeping distressing thoughts & feelings buried in the thoughts & feelings buried in the unconsciousunconsciousExample: A child who witnessed a Example: A child who witnessed a parent being shot has no recollection parent being shot has no recollection of the event.of the event.

Denial:Denial: Refusing to recognize some Refusing to recognize some anxiety arousing event/piece of anxiety arousing event/piece of information.information.Example: Example: although her husband keeps although her husband keeps beating her, his wife doesn’t accept it. beating her, his wife doesn’t accept it.

3.

Defense mechanismsDefense mechanisms, cont’d.., cont’d..

Rationalization:Rationalization: Creating false but Creating false but plausible excuses to justify unacceptable plausible excuses to justify unacceptable behaviorbehaviorExample: A student watches TV instead Example: A student watches TV instead of studying, claiming "additional studying of studying, claiming "additional studying won’t help anyway".won’t help anyway".

Displacement:Displacement: Diverting emotional Diverting emotional feelings from their original course to a feelings from their original course to a safer substitute target.safer substitute target.Example: After getting a speeding ticket Example: After getting a speeding ticket you take your anger out on your you take your anger out on your passenger rather than the state trooper.passenger rather than the state trooper.

Defense mechanismsDefense mechanisms, cont’d.., cont’d..

Reaction Formation:Reaction Formation: Behaving in a way Behaving in a way that is exactly opposite of one’s true that is exactly opposite of one’s true feelingsfeelingsExample: A parent who unconsciously Example: A parent who unconsciously resents a child spoiling that child with resents a child spoiling that child with lavish gifts.lavish gifts.

Projection:Projection: Attributing one’s own Attributing one’s own thoughts, feelings or desires to someone thoughts, feelings or desires to someone elseelseExample: Deep down you hate your Example: Deep down you hate your brother (but are unaware of this) - brother (but are unaware of this) - instead you feel your brother hates you.instead you feel your brother hates you.

Defense mechanismsDefense mechanisms, cont’d.., cont’d..

Regression:Regression: Reverting to immature Reverting to immature patterns of behavior.patterns of behavior.Example: A six year old renews his Example: A six year old renews his thumb-sucking when a new sibling is thumb-sucking when a new sibling is born.born.

Windows into the Windows into the UnconsciousUnconscious ““Psychopathology of everyday life”Psychopathology of everyday life”

Slips of the tongueSlips of the tongue : : error in error in speech, memory or physical speech, memory or physical action that is believed to be action that is believed to be caused by the unconscious mind caused by the unconscious mind

e.g. a woman accidentally calling her e.g. a woman accidentally calling her husband by the name of another husband by the name of another man she loves more and with whom man she loves more and with whom she is having an affairshe is having an affair with. with.

Windows into the Windows into the UnconsciousUnconscious DreamsDreams

Freud thought dreams represented Freud thought dreams represented unconscious wish fulfillment.unconscious wish fulfillment.

When people are awake wishes are not When people are awake wishes are not usually acted on (the ego and superego usually acted on (the ego and superego stop this happening)stop this happening)

Dreams are often strange because Dreams are often strange because iin n dreams the dreams the forbidden forbidden ideas are disguised. ideas are disguised.

Myths, legends, fairy-tales: stories of Myths, legends, fairy-tales: stories of mankind’s wishes, hopes, and fearsmankind’s wishes, hopes, and fears

““Normal” versus “Abnormal”Normal” versus “Abnormal”

Concept of “abnormal” not sufficient Concept of “abnormal” not sufficient or necessary to be mentally or necessary to be mentally disordereddisordered - It is - It is notnot “normal” to be very joyous, but “normal” to be very joyous, but

this mental state, while “not normal,” is this mental state, while “not normal,” is not mentally ill eithernot mentally ill either

On the other hand…On the other hand…- It It is is “normal” to have cavities in teeth “normal” to have cavities in teeth

occasionally, but doesn’t mean that’s occasionally, but doesn’t mean that’s healthy / preferredhealthy / preferred

The term “normal” therefore is very The term “normal” therefore is very problematicproblematic

Early views of Early views of psychopathologypsychopathology

Psychological viewpoint: the Psychological viewpoint: the physical body as the source for physical body as the source for some mental disorders some mental disorders explained some but not all explained some but not all symptomssymptoms

The modern conception The modern conception of mental disorderof mental disorder

What best explains the cause, What best explains the cause, or source, of mental disorders?or source, of mental disorders?

Psychological sourcesPsychological sources Biological sourcesBiological sources Learning sources Learning sources

… … all contribute important all contribute important explanatory power explanatory power

Diathesis-Stress ModelsDiathesis-Stress Models

Two factor modelTwo factor model An event + a diathesis An event + a diathesis

Event occurs which is stressfulEvent occurs which is stressful Combines with a genetic, biological, or Combines with a genetic, biological, or

other structural/physical factor other structural/physical factor When both occur, depression, for When both occur, depression, for

example, may resultexample, may result Helps address why some identical Helps address why some identical

events do not produce same events do not produce same outcome in different peopleoutcome in different people

Multi-causal modelsMulti-causal models

Factors may be more diverse than Factors may be more diverse than the two-factor model of the diathesis the two-factor model of the diathesis stress modelstress model

Biopsychosocial model:Biopsychosocial model: Biological factors (more than one)Biological factors (more than one) Psychological factors (also more than Psychological factors (also more than

one)one) Social/cultural factors (again, more than Social/cultural factors (again, more than

one)one)… … more complex, more inclusive, more more complex, more inclusive, more

difficult to investigatedifficult to investigate

NeurosisNeurosis

A term no longer used medicallyA term no longer used medically Diagnosis for a relatively mild Diagnosis for a relatively mild

mental or emotional disorder mental or emotional disorder that may involve anxiety or that may involve anxiety or phobias but does not involve phobias but does not involve losing touch with reality. losing touch with reality.

NeurosisNeurosis

A neurotic disorder can be any A neurotic disorder can be any mental imbalance that causes or mental imbalance that causes or results in distress. In general, results in distress. In general, neurotic conditions do not impair or neurotic conditions do not impair or interfere with normal day to day interfere with normal day to day functions, but rather create the very functions, but rather create the very common symptoms of depression, common symptoms of depression, anxiety, or stress. It is believed that anxiety, or stress. It is believed that most people suffer from some sort of most people suffer from some sort of neurosis as a part of human nature. neurosis as a part of human nature.

NeurosisNeurosis

One with a neurosis is aware of One with a neurosis is aware of his disorderhis disorder

Can differentiate between what Can differentiate between what is real and what is notis real and what is not

NeurosisNeurosis

DepressionDepression HisteriaHisteria PhobiasPhobias Obsessif Compulsive disordersObsessif Compulsive disorders HipocondriasisHipocondriasis Traumatic StressesTraumatic Stresses

NeurosisNeurosis

According to DSM classification:According to DSM classification: Anxiety DisordersAnxiety Disorders

Panic attacksPanic attacks PhobiasPhobias Obsessive CompulsiveObsessive Compulsive Generalized AnxietyGeneralized Anxiety Post Traumatic Stress DisordersPost Traumatic Stress Disorders

NeurosisNeurosis

Somatoform DisordersSomatoform Disorders Conversion DisordersConversion Disorders HipocondriaHipocondria

Dissociative DisordersDissociative Disorders Dissociative AmnesiaDissociative Amnesia Dissociative Identity DisorderDissociative Identity Disorder

Personality DisordersPersonality Disorders Paranoid Paranoid SchizoidSchizoid BorderlineBorderline

PsychosisPsychosis

As a psychiatric term, As a psychiatric term, psychosispsychosis refers to any mental state that refers to any mental state that impairs thought, perception, and impairs thought, perception, and judgement. judgement.

A psychotic person loses A psychotic person loses contact with reality and contact with reality and experiences hallucinations or experiences hallucinations or delusions. delusions.

PsychosisPsychosis

The three primary causes of The three primary causes of psychosis are:psychosis are: Functional (mental illnesses such as Functional (mental illnesses such as

schizophrenia and bipolar disorder), schizophrenia and bipolar disorder), Organic (stemming from medical, Organic (stemming from medical,

non-psychological conditions, such non-psychological conditions, such as brain tumors or sleep as brain tumors or sleep deprivation) deprivation)

Psychoactive drugs (eg barbituates, Psychoactive drugs (eg barbituates, amphetamines, and hallucinogens).amphetamines, and hallucinogens).

Psychosis vs. NeurosisPsychosis vs. Neurosis

Psychotic people use:Psychotic people use: Regression, Repression, Regression, Repression,

Projection, Dissociation, Denial as Projection, Dissociation, Denial as “defence mechanisms”;“defence mechanisms”;

Where as neurotic people use:Where as neurotic people use: Displacement, Rationalization, Displacement, Rationalization,

Reaction Formation as “Defense Reaction Formation as “Defense Mechanisms”Mechanisms”

SchizophreniaSchizophrenia

““Abnormal disintegration of mental Abnormal disintegration of mental functions” – Eugene Bleulerfunctions” – Eugene Bleuler Problematic description; term still usedProblematic description; term still used

1-2% of population exhibits this 1-2% of population exhibits this disorderdisorder Higher (or lower) in many populations; Higher (or lower) in many populations;

variations not well understoodvariations not well understood Usual onset: late adolescence/early Usual onset: late adolescence/early

adulthoodadulthood

Signs/SymptomsSigns/Symptoms

““Positive symptoms” Positive symptoms” ((too much of something)too much of something) Delusions (fixed idea or belief, obviously Delusions (fixed idea or belief, obviously

untrue or unlikely) untrue or unlikely) Hallucinations (seeing or hearing Hallucinations (seeing or hearing

something others don’t)something others don’t) Disorganized speech/behaviorsDisorganized speech/behaviors

Negative symptoms Negative symptoms ((not enough of not enough of something)something) Blunted/limited emotionBlunted/limited emotion Poverty of speechPoverty of speech Poverty of languagePoverty of language Unable to persist in tasks Unable to persist in tasks

Other symptomsOther symptoms

Pronounced social withdrawalPronounced social withdrawal May begin at a very young age, well May begin at a very young age, well

before other symptomsbefore other symptoms Idiosyncratic “inner world” – Idiosyncratic “inner world” –

extremely difficult for others to extremely difficult for others to access / understandaccess / understand

Difficulty communicatingDifficulty communicating… … all seem to result in less social all seem to result in less social

contact and fewer friends as years contact and fewer friends as years go bygo by

The roots of schizophreniaThe roots of schizophrenia

Heredity/genetics:Heredity/genetics: Examined by looking at Examined by looking at concordance rates, concordance rates, Ex: Consider 100 families, all of whom have Ex: Consider 100 families, all of whom have

identical twins; one twin of each pair of identical twins; one twin of each pair of twins has schizophreniatwins has schizophrenia-- the concordance rate tells us how many -- the concordance rate tells us how many of the “co-twins” have it as wellof the “co-twins” have it as well-- Identical twins CR: up to 50%-- Identical twins CR: up to 50%-- Fraternal twins CR: about 25%-- Fraternal twins CR: about 25%-- Sibling CR: about 8%-- Sibling CR: about 8%

As genetic “overlap” increases, As genetic “overlap” increases, rates of schizophrenia increaserates of schizophrenia increase

Prenatal environmentPrenatal environment

Why is CR not 100%? Why is CR not 100%? Environment plays an important role; Environment plays an important role;

environment is not identical even if environment is not identical even if genetic material is identicalgenetic material is identical Birth complications?Birth complications? Viral exposure?Viral exposure? Time of birth (i.e., season)?Time of birth (i.e., season)?

Many environmental factors point to Many environmental factors point to schizophrenia being a schizophrenia being a neurodevelopmental disorderneurodevelopmental disorder

Social and Psychological Social and Psychological EnvironmentEnvironment Stressors from much later in life Stressors from much later in life

may play a role may play a role Stress from poverty, racism, Stress from poverty, racism,

poor/absent educationpoor/absent education Parent or parents who also suffer Parent or parents who also suffer

from mental disorder from mental disorder Schizophrenia, other psychotic Schizophrenia, other psychotic

disordersdisorders May be undiagnosed or ‘sub-clinical’ May be undiagnosed or ‘sub-clinical’

but may change environment for but may change environment for child in subtle wayschild in subtle ways

Mood DisordersMood Disorders

Bipolar and UnipolarBipolar and UnipolarEach pole: a different mood stateEach pole: a different mood state At “manic” pole: feelings of “ease, At “manic” pole: feelings of “ease,

intensity, power, well-being, financial intensity, power, well-being, financial omnipotence and euphoria” (Kay omnipotence and euphoria” (Kay Redfield Jamison, 1995, p. 67)Redfield Jamison, 1995, p. 67)

Hypomania: milder form of mania; Hypomania: milder form of mania; hard to sustainhard to sustain

Mania: unable to function, loss of Mania: unable to function, loss of one’s ability to maintain rationality, or one’s ability to maintain rationality, or to complete goal-directed activity, to complete goal-directed activity, fear/paranoia set in.fear/paranoia set in.

At the other pole…At the other pole…

Depressive states:Depressive states: Guilt, shame, dreadGuilt, shame, dread Hopelessness, loss of interest and Hopelessness, loss of interest and

pleasure in lifepleasure in life Sleeping / eating problems (too little or Sleeping / eating problems (too little or

too much)too much) Thoughts of death, dying, suicide; plans Thoughts of death, dying, suicide; plans

or attempts or completed suicideor attempts or completed suicide Alternating between Mania and Alternating between Mania and

Depression: Bipolar Disorder (from Depression: Bipolar Disorder (from one pole to the other)one pole to the other)

The roots of mood disordersThe roots of mood disorders

HeredityHeredity Concordance rates (CR) for Depression: Concordance rates (CR) for Depression:

2x higher in identical twins compared to 2x higher in identical twins compared to fraternal twinsfraternal twins

CR for Bipolar Disorder: Identical CR for Bipolar Disorder: Identical twins, CR = 60%; fraternal twins, CR = twins, CR = 60%; fraternal twins, CR = 12%12%

Risk for other aspects (suicide, other Risk for other aspects (suicide, other forms of depression) increases as forms of depression) increases as genetic overlap increasesgenetic overlap increases

Psychological risk factorsPsychological risk factors

… … How does one How does one think aboutthink about one’s own one’s own symptoms, situation, mood?symptoms, situation, mood?

Beck: depressed people more likely Beck: depressed people more likely to display a to display a negative cognitive negative cognitive schemaschema explains onset of depression; more explains onset of depression; more

difficult to explain spontaneous remissiondifficult to explain spontaneous remission Helplessness/HopelessnessHelplessness/Hopelessness

Seligman’s “learned helplessness” as Seligman’s “learned helplessness” as model for depressogenic thinking; model for depressogenic thinking; “explanatory style”“explanatory style”

Social and cultural contexts of Social and cultural contexts of depressiondepression World Health Organization: World Health Organization:

Depression is 4Depression is 4thth leading cause of leading cause of disability / inability to work and disability / inability to work and function normallyfunction normally

Prevalence across different cultures Prevalence across different cultures and countries: varies widelyand countries: varies widely

More common in women More common in women Genetics? Genetics? Coping style? Coping style?

Anxiety DisordersAnxiety Disorders

““MoodMood” here is anxiety” here is anxiety Overwhelming feelings of fear/ Overwhelming feelings of fear/

anxiety/ apprehension and anxiety/ apprehension and incomplete or unsuccessful incomplete or unsuccessful attempts to deal with thisattempts to deal with this

Most common clinical diagnosisMost common clinical diagnosis Found in both genders; but, Found in both genders; but,

higher prevalence overall in higher prevalence overall in women compared to menwomen compared to men

PhobiasPhobias Social phobia:Social phobia: fear of public scrutiny or fear of public scrutiny or

public judgment, emerges most public judgment, emerges most commonly in adolescencecommonly in adolescence Avoid many common social/public Avoid many common social/public

experiencesexperiences Common to use/abuse substances to Common to use/abuse substances to

manage fearmanage fear Specific phobia:Specific phobia: irrational fear of some irrational fear of some

object, situation, event: bridges, heights, object, situation, event: bridges, heights, spidersspiders

Blood/injury/injection:Blood/injury/injection: Sight of blood Sight of blood loss of blood pressureloss of blood pressure, , fainting not fainting not uncommon uncommon

Panic disorder and Panic disorder and agoraphobiaagoraphobia Panic attacksPanic attacks: sudden onset of full : sudden onset of full

fight/flight symptoms, including …fight/flight symptoms, including … feelings of choking, dizziness, feelings of choking, dizziness,

lightheadednesslightheadedness heart pounding, sweating, heart pounding, sweating, dread, “need” to run or escapedread, “need” to run or escape Panic attacks not uncommon in general Panic attacks not uncommon in general

public!public! In panic disorder, one experiences In panic disorder, one experiences

panic attacks either out of the blue, or panic attacks either out of the blue, or unpredictably in response to certain unpredictably in response to certain stressors/eventsstressors/events

Panic Disorder, cont.Panic Disorder, cont.

Attempts to Attempts to avoid any further panic avoid any further panic attacksattacks are hallmark of the disorder are hallmark of the disorder the “fear of fear”the “fear of fear”

Over time, increased attention to Over time, increased attention to symptoms develops; this increases symptoms develops; this increases number of attacksnumber of attacks ““Agoraphobia” then may resultAgoraphobia” then may result

Generalized Anxiety DisorderGeneralized Anxiety Disorder

Continuous anxious feelingContinuous anxious feeling No real trigger; trivial worries No real trigger; trivial worries

can intensifycan intensify Symptoms: constant sense of Symptoms: constant sense of

dread; gut/intestinal upset; inability dread; gut/intestinal upset; inability to focus; increased heart rate; to focus; increased heart rate; excessive sweating; constant excessive sweating; constant worryworry

Common disorder; around 3% Common disorder; around 3% of populationof population

Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder Obsessions:Obsessions: unwanted, intrusive unwanted, intrusive

thoughts (“If I step on this crack I will thoughts (“If I step on this crack I will cause my mother to die”)cause my mother to die”)

Compulsions:Compulsions: irresistible urges to irresistible urges to engage in certain behaviors (“I must engage in certain behaviors (“I must repeat this phrase 20 times to keep repeat this phrase 20 times to keep my mother from dying”)my mother from dying”)

Usually, thoughts increase anxiety; Usually, thoughts increase anxiety; compulsions feel as though they will compulsions feel as though they will directly decrease the anxietydirectly decrease the anxiety Typically, compulsions decrease anxiety Typically, compulsions decrease anxiety

only only temporarilytemporarily

Predispositions for OCD?Predispositions for OCD?

Again, genetic: CR higher for Again, genetic: CR higher for identical than fraternal twinsidentical than fraternal twins Separate inheritance paths for different Separate inheritance paths for different

types of OCD: e.g., cleaning or types of OCD: e.g., cleaning or hoarding may be uniquely transmitted, hoarding may be uniquely transmitted, but not other forms (checking or but not other forms (checking or washing)washing)

Stress disordersStress disorders

Occur in response to events that Occur in response to events that threatened one’s lifethreatened one’s life directly, or directly, or threatened integrity of one’s life (or threatened integrity of one’s life (or someone else’s life)someone else’s life)

Often marked by acute feelings of Often marked by acute feelings of distance/estrangement from – distance/estrangement from – “dissociation”“dissociation”

Alternates with intense “reliving” of Alternates with intense “reliving” of the event: nightmares, flashbacks, the event: nightmares, flashbacks, intrusive thoughtsintrusive thoughts

Post-traumatic stress disorderPost-traumatic stress disorder

Diagnosed only after one month has Diagnosed only after one month has passedpassed

Other symptoms: Other symptoms: increased startle reflex, increased startle reflex, inability to focus/concentrate; inability to focus/concentrate; problems with memory and attention; problems with memory and attention; intense irritability; intense irritability; avoidance of memories of event; avoidance of memories of event; continued problems with flashbacks and continued problems with flashbacks and

nightmaresnightmares However… However… of those who experience of those who experience

trauma, only about 5 – 12% develop PTSDtrauma, only about 5 – 12% develop PTSD

Better prognosis if…Better prognosis if…

Trauma less severe Trauma less severe ““Preparation” or training was in place Preparation” or training was in place

(so, police and firefighters trained to (so, police and firefighters trained to deal with frightening situations less deal with frightening situations less likely to develop PTSD than ordinary likely to develop PTSD than ordinary citizens facing same situation)citizens facing same situation)

Better social support prior to traumaBetter social support prior to trauma No adverse/traumatic experiences in No adverse/traumatic experiences in

childhoodchildhood Lack of PTSD in parent’s Lack of PTSD in parent’s

backgroundbackground

Dissociative DisordersDissociative Disorders

DissociationDissociation:: distancing of the self distancing of the self from what is occurring; dissociation from what is occurring; dissociation between an on-going event from one’s between an on-going event from one’s sense that one is experiencing it; sense that one is experiencing it; sense of “watching from a distance”sense of “watching from a distance” As a defense mechanism: effective in As a defense mechanism: effective in

many waysmany ways Over the long term: dissociation Over the long term: dissociation

associated with poorer outcomes associated with poorer outcomes This response is the defining feature This response is the defining feature

of dissociative disordersof dissociative disorders

Dissociative disordersDissociative disorders

Dissociative amnesiaDissociative amnesia Inability to remember discrete Inability to remember discrete

period of one’s life, one’s identity, period of one’s life, one’s identity, aspects of one’s biographyaspects of one’s biography

OrOr One wanders away from home for One wanders away from home for

a time, then suddenly “comes a time, then suddenly “comes back to one’s senses” with no back to one’s senses” with no memory for that period of timememory for that period of time

Dissociative disordersDissociative disorders, cont’d.., cont’d..

Dissociative identity disorderDissociative identity disorder Two or more distinct personalities can be Two or more distinct personalities can be

identified or take action in one’s lifeidentified or take action in one’s life Can differ by gender, age, SES, interests, Can differ by gender, age, SES, interests,

etc.etc. Controversial diagnosis; given with cautionControversial diagnosis; given with caution

Factors underlying Dissociative Factors underlying Dissociative Disorders:Disorders: Ability to dissociate: trait aspects, some Ability to dissociate: trait aspects, some

easily able to dissociate, others unable to easily able to dissociate, others unable to dissociatedissociate

Intense/abusive/traumatic stress as a Intense/abusive/traumatic stress as a trigger?trigger?

Case Study 1Case Study 1

34 year old, male34 year old, male Talks to himself loudlyTalks to himself loudly Lives in the streets, doesn’t have any Lives in the streets, doesn’t have any

relativesrelatives Does not take care of himself / does Does not take care of himself / does

not clean himself, dirtynot clean himself, dirty Looks, talks and laughs at things that Looks, talks and laughs at things that

does not existdoes not exist Can not identify realityCan not identify reality Sees hallucinationsSees hallucinations His interpersonal relations are very His interpersonal relations are very

weakweak

Case Study 1Case Study 1

What is the diagnosis?What is the diagnosis?

PSYCHOTIC?PSYCHOTIC?

NEUROTIC?NEUROTIC?

Case Study 1Case Study 1

Probable diagnosis would be;Probable diagnosis would be;

PSYCHOTICPSYCHOTIC

SCHIZOPHRENIASCHIZOPHRENIA

Case Study 2Case Study 2

27 years old, female, housewife27 years old, female, housewife Very captious since childhoodVery captious since childhood Married 6 years ago, has 2 Married 6 years ago, has 2

daughtersdaughters Constantly cleans the houseConstantly cleans the house Whenever guests leave the house, Whenever guests leave the house,

she cleans the house for hoursshe cleans the house for hours Life becomes unbearable for her Life becomes unbearable for her

familyfamily Stays in the bathroom for at least 2 Stays in the bathroom for at least 2

hours, finishing one block of soaphours, finishing one block of soap

Case Study 2Case Study 2

She says “I know what I am doing is She says “I know what I am doing is ridiculous, but I can’t help it”ridiculous, but I can’t help it”

Her relations with people other than Her relations with people other than her family, are very positiveher family, are very positive

Admits she has a disorder, goes and Admits she has a disorder, goes and asks for help from a doctor, willinglyasks for help from a doctor, willingly

Doesn’t lose contact with realityDoesn’t lose contact with reality Uses reaction formation and Uses reaction formation and

rationalization as defence rationalization as defence mechanisms to avoid from anxietymechanisms to avoid from anxiety

Case Study 2Case Study 2

What is the diagnosis?What is the diagnosis?

PSYCHOTIC?PSYCHOTIC?

NEUROTIC?NEUROTIC?

Case Study 2Case Study 2

Probable diagnosis would be;Probable diagnosis would be;

NEUROTICNEUROTIC

Obsessive Compulsive DisorderObsessive Compulsive Disorder