16 Overview! 16 Mental disorder! Psychological disorders! Dilemmas of definition! Your turn!

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Emmeline Baker
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1 Psychological disorders! Overview! Defining and diagnosing disorder Anxiety disorders Mood disorders Personality disorders Drug abuse and addiction Dissociative identity disorder Schizophrenia Dilemmas of definition! Mental disorder! Possible models for defining disorders As the violation of cultural standards As emotional distress As maladaptive or harmful behavior Any behavior or emotional state that causes a person to suffer, is self-destructive; seriously impairs the person s ability to work or get along with others; or endangers others or the community Your turn! Your turn! Psychopaths are often happy, functional people, but they manipulate and harm others without conscience. On what basis are psychopaths said to have a mental disorder? A mental disorder is any behavior or mental state that (1) causes a person to suffer, is self-destructive; (2) seriously impairs the person s ability to work or get along with others; (3) or endangers others or the community. Psychopaths are often happy, functional people, but they manipulate and harm others without conscience. On what basis are psychopaths said to have a mental disorder? A mental disorder is any behavior or mental state that (1) causes a person to suffer, is self-destructive; (2) seriously impairs the person s ability to work or get along with others; (3) or endangers others or the community.

Explosion of mental disorders! Supporters of new categories answer that it is important to distinguish disorders precisely.

2 Diagnostic and Statistical Manual! Axis I: Primary clinical problem Axis II: Personality disorders Axis III: General medical conditions Axis IV: Social and environmental stressors Axis V: Global assessment of overall functioning Explosion of mental disorders! Supporters of new categories answer that it is important to distinguish disorders precisely. Critics point to economics: diagnoses are needed for insurance reasons for therapists to be compensated. Concerns about diagnostic system! The danger of over-diagnosis The power of diagnostic labels Confusion of serious mental disorders with normal problems The illusion of objectivity and universality Advantages of the DSM! When the manual is used correctly and diagnoses are made with valid objective tests, the DSM improves the reliability of and agreement between clinicians. The DSM-IV included for the first time a list of culture-bound syndromes. Projective tests! Objective tests! Projective tests Psychological tests used to infer a person s motives, conflicts, and unconscious dynamics on the basis of the person s interpretation of ambiguous stimuli Inventories Standardized objective questionnaires requiring written responses Typically include scales on which people are asked to rate themselves Rorschach inkblot test A projective personality test that asks respondents to interpret abstract, symmetrical inkblots

3 Minnesota Multiphasic Personality Inventory! Most widely used personality instrument Now the MMPI-2 Clinical and employment settings Measures aspects of personality that, if extreme, suggest a problem E.g., extreme suspiciousness Long test 567 questions! Characteristics of MMPI-2! Has several different scales Scales thought to measure different kinds of psychological disorders Scale scores indicate how you compare with others Overall assessment is interpretive From inspecting profile of different scales MMPI score profile! MMPI validity scales! Four scales designed to determine whether respondent is presenting self accurately E.g., L scale ( Fake good ) trying too hard to present self in a positive light I smile at everyone I meet True I read every editorial every day True Generalized anxiety disorder! Continuous state of anxiety marked by feelings of worry and dread, apprehension, difficulties in concentration, and signs of motor tension Posttraumatic stress disorder! An anxiety disorder in which a person who has experienced a traumatic or lifethreatening event has symptoms such as psychic numbing, reliving the trauma, and increased physiological arousal Diagnosed only if symptoms persist for six months or longer May immediately follow event or occur later

4 Panic disorder! Fears and phobias! An anxiety disorder in which a person experiences recurring panic attacks Panic attack: a feeling of impending doom or death, accompanied by physiological symptoms such as rapid breathing and dizziness Phobia An exaggerated, unrealistic fear of a specific situation, activity, or object Agoraphobia! A set of phobias, often set off by a panic attack, involving the basic fear of being away from a safe place or person. Obsessive-compulsive disorder! An anxiety disorder in which a person feels trapped in repetitive, persistent thoughts (obsessions) and repetitive, ritualized behaviors (compulsions) designed to reduce anxiety Person understands that the ritual behavior is senseless but guilt mounts if the behavior is not performed. Your turn! Your turn! If you have the persistent thought that gremlins are sabotaging any airplane you are on or will be on, then you have a. If you cannot stop asking for more water during flights, then you have a. 1. Obsession; compulsion 2. Compulsion; obsession 3. Phobia; obsession 4. Plane ticket; pet camel If you have the persistent thought that gremlins are sabotaging any airplane you are on or will be on, then you have a. If you cannot stop asking for more water during flights, then you have a. 1. Obsession; compulsion 2. Compulsion; obsession 3. Phobia; obsession 4. Plane ticket; pet camel

(fatigue and loss of appetite) Depressed mood Reduced interest in almost all activities Significant weight gain or loss Sleeping too much or too little Fatigue Feelings of worthlessness or guilt

5 Depression! Symptoms of depression! Major depression A mood disorder involving disturbances in emotion (excessive sadness), behavior (loss of interest in one s usual activities), cognition (thoughts of hopelessness), and body function (fatigue and loss of appetite) Depressed mood Reduced interest in almost all activities Significant weight gain or loss Sleeping too much or too little Fatigue Feelings of worthlessness or guilt Reduced ability to think, concentrate Recurrent thoughts of death DSM IV requires 5 of these within the past 2 weeks Gender, age, and depression! Women are about twice as likely as men to be diagnosed with depression. True around the world After age 65, rate of depression drops sharply for both sexes. Bipolar disorder! A mood disorder in which episodes of depression and mania (excessive euphoria) occur. The bipolar brain! Bipolar disorder can have rapid mood swings. These wild changes are shown in brain activity. Biological theories of depression! Studies of adopted children support genetic explanations of depression 5-HTT is a gene that is present in either a long or short form. 17% of individuals with the long form become severely depressed. 43% of individuals with 2 copies of the short form become depressed. Genetics may also influence levels of serotonin and other neurotransmitters.

Women are less satisfied with work and family and more likely to live in poverty. Cognitive habits! Cognitive explanations emphasize habits of thinking and ways of interpreting events.

6 Life experiences and circumstances! Social explanations emphasize the stressful circumstances in people s lives. Loss of or problems with important relationships Psychologists investigating sex differences in depression have ruled out hormones and genetics and are now investigating life circumstances. Women are less satisfied with work and family and more likely to live in poverty. Cognitive habits! Cognitive explanations emphasize habits of thinking and ways of interpreting events. Depressed people believe their situation is permanent, uncontrollable. Rumination Brooding about negative aspects of one s life Problem personalities! Personality disorder Rigid, maladaptive patterns that cause personal distress or an inability to get along with others Paranoid personality disorder Characterized by habitually unreasonable and excessive suspiciousness and jealousy Narcissistic personality disorder Characterized by an exaggerated sense of self-importance and self-absorption Borderline personality disorder Characterized by a history of intense but unstable relationships in which they alternate between idealizing the partner and then devaluing the partner, Today may be changed to Complex-PTSD to avoid stigma and acknowledge gender issues. Criminals and psychopaths! Antisocial personality disorder Characterized by a lifelong pattern of irresponsible, antisocial behavior such as lawbreaking, violence, and other impulsive, restless acts Psychopathy Characterized by a lack of remorse, empathy, anxiety, and other social emotions; the use of deceit and manipulation, and impulsive thrill seeking Causes of APD and psychopathy! Abnormalities in the central nervous system Impaired frontal-lobe functioning Genetic influences Biology and addiction! The biological model holds that addiction is due primarily to a person s biochemistry, metabolism, and genetic predisposition. More evidence comes from twin studies.

7 The addicted brain! Learning, culture, and addiction! Addiction patterns vary according to cultural practices and the social environment. Policies of total abstinence tend to increase addiction rates rather than reduce them. Not all addicts have withdrawal symptoms when they stop taking a drug. Addiction depends on both the drug and the reason for taking it. Problems with drugs are more likely when a person...! has a physiological vulnerability to a drug. believes he or she has no control over the drug. is encouraged to take the drug in binges, and moderate use is neither tolerated nor taught. comes to rely on the drug as a method of coping with problems, suppressing anger or fear, or relieving pain. has a peer group using drugs or drinking heavily. Dissociative identity disorder! A controversial disorder marked by the appearance within one person of two or more distinct personalities, each with its own name and traits Commonly known as Multiple Personality Disorder The MPD controversy! Sociocognitive explanation! First view MPD is common but often unrecognized as such. Starts in childhood as a means of coping Trauma produced a mental splitting. Second view Created through pressure and suggestion by clinicians Handfuls to ten thousand since 1980 MPD is an extreme form of our ability to present many aspects of our personalities to others. MPD is a socially acceptable way for some troubled people to make sense of their problems. Therapists looking for MPD may reward patients with attention and praise for revealing more and more personalities.

8 Symptoms of schizophrenia! Bizarre delusions Hallucinations and heightened sensory awareness Disorganized, incoherent speech Grossly disorganized and inappropriate behavior Impaired cognitive abilities Delusions and hallucinations! Delusions False beliefs that often accompany schizophrenia and other psychotic disorders Hallucinations Sensory experiences that occur in the absence of actual stimulation Genetic vulnerability! The risk of developing schizophrenia increases as the genetic relatedness with a diagnosed schizophrenic increases. Structural brain abnormalities! Several abnormalities exist, especially when disease has primarily negative symptoms. Decreased brain weight Decreased volume in temporal lobe or hippocampus Enlargement of ventricles About 25% do not have these observable brain deficiencies. Neurotransmitter abnormalities! Include serotonin, glutamate, dopamine Many schizophrenics have high levels of brain activity in areas served by dopamine, and greater numbers of dopamine receptors. Similar abnormalities are found in depression and alcoholism. Prenatal or birth complications! Damage to the fetal brain increases chances of schizophrenia and other mental disorders. May occur as a function of maternal malnutrition or illness May also occur if brain injury or oxygen deprivation occurs at birth

9 Adolescent abnormalities in brain development! Normal pruning of excessive synapses in the brain occurs during adolescence. In schizophrenics, a greater number of synapses are pruned away. May explain why first episode occurs in adolescence or early adulthood

Psychological (Emotional/Mental) Disorders. Mental disorder. Your turn 11/30/11

Psychological (Emotional/Mental) Disorders Mental disorder Any ongoing behavior or psychological emo3onal state that causes a person to suffer, is self- destruc3ve; seriously impairs the person s ability