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

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1 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 to work or get along with others; or endangers others or the community. This is the defini3on of: A. Insanity B. Mental disorders C. Both of the above Your turn Psychopaths (APD) are ojen happy, func3onal 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: A. causes a person to suffer, is self- destruc<ve. B. seriously impairs the person s ability to work or get along with others. C. endangers others or the community. 1

Diagnostic and Statistical Manual (DSM-IV) Axis I: Primary clinical problem Axis II: Personality disorders Axis III: General medical condi3ons Axis IV: Social and environmental stressors Axis V:

2 Diagnostic and Statistical Manual (DSM-IV) Axis I: Primary clinical problem Axis II: Personality disorders Axis III: General medical condi3ons Axis IV: Social and environmental stressors Axis V: Global assessment of overall func3oning Explosion of mental disorders Supporters of new categories answer that it is important to dis3nguish disorders precisely. Cri3cs point to economics: diagnoses are needed for insurance reasons for therapists to be compensated. Concerns about the DSM The danger of over- diagnosis The power of diagnos3c labels! Confusion of serious mental disorders with normal problems The illusion of objec3vity 2

3 Advantages of the DSM When the manual is used correctly and diagnoses are made with valid objec3ve tests, the DSM improves the reliability of and agreement between clinicians. Culture and DSM Culture- bound syndromes Sets of symptoms specific to the culture in which they occur Example Na<ve American tribes Ghost sickness: Preoccupa<on with death and the dead, with bad dreams, fain<ng, appe<te loss, fear, hallucina<ons, etc. Projective tests Projec3ve tests Psychological tests used to infer a person s mo<ves and conflicts, on the basis of the person s interpreta<on of ambiguous s<muli. Rorschach inkblot test A projec<ve personality test that asks respondents to interpret abstract, symmetrical inkblots. 3

4 Objective tests Inventories Standardized objec<ve ques<onnaires requiring wrilen responses Typically include scales on which people are asked to rate themselves Inventories are generally more reliable and valid than either projec<ve methods or subjec<ve clinical judgments. Minnesota Multiphasic Personality Inventory A widely used personality instrument Mostly used in clinical sexngs Measures aspects of personality that, if extreme, suggest a problem For example, extreme suspiciousness Characteristics of MMPI Has several different scales Scales thought to measure different kinds of psychological disorders Scale scores indicate how you compare with others Overall assessment is interpre3ve Inspect profile of different scales. 4

5 MMPI validity scales Four scales designed to determine whether respondent is presen3ng self accurately For example: L scale ( Fake good ) trying too hard to present self in a posi3ve light I smile at everyone I meet True I read every editorial every day True Learning objectives 15.5 The difference between ordinary anxiety and an anxiety disorder 15.6 Why the most disabling of all phobias is known as the fear of fear 15.7 Why some people recover quickly ajer a trauma whereas others develop post- trauma stress disorder Generalized anxiety disorder State of excessive anxiety marked by feelings of worry and dread, apprehension, difficul3es in concentra3on, and signs of motor tension Gene3c predisposi3on Genes may be involved in causing abnormali<es in the amygdala and the prefrontal cortex. Experience Some chronically anxious people have a history, star<ng in childhood, of being unable to control or predict their environments. 5

Posttraumatic stress disorder An anxiety disorder in which a person who has experienced a trauma3c or life- threatening event has symptoms such as psychic numbing, reliving the trauma, and increased

panic aeacks Panic a'ack: a feeling of impending doom or death, accompanied by physiological symptoms such as rapid breathing and dizziness What do you know?

6 Posttraumatic stress disorder An anxiety disorder in which a person who has experienced a trauma3c or life- threatening event has symptoms such as psychic numbing, reliving the trauma, and increased physiological arousal Diagnosed only if symptoms persist for one month or longer May immediately follow event or occur later Panic disorder An anxiety disorder in which a person experiences recurring panic aeacks Panic a'ack: a feeling of impending doom or death, accompanied by physiological symptoms such as rapid breathing and dizziness What do you know? When Charlie takes a test, his heart begins pounding, his palms begin to sweat, and he has a difficult 3me breathing. Charlie worries that he is about to have a heart aeack. Which type of disorder does Charlie have? A. Generalized anxiety disorder B. Panic disorder C. PTSD 6

7 Phobias Phobia An exaggerated, unrealis<c fear of a specific situa<on, ac<vity, or object Social phobia Individuals become extremely anxious in situa<ons in which they will be observed by others ea<ng in a restaurant, speaking in public, having to perform for an audience Agoraphobia A set of phobias, oten set off by a panic alack, involving the basic fear of being away from a safe place or person Obsessive-compulsive disorder (OCD) An anxiety disorder in which a person feels trapped in repe33ve, persistent thoughts (obsessions) and repe33ve, ritualized behaviors (compulsions) designed to reduce anxiety Person usually understands that the ritual behavior is senseless but guilt mounts if the behavior is not performed. Depression Major depression A mood disorder involving disturbances in emo<on (excessive sadness), behavior (loss of interest in one s usual ac<vi<es), cogni<on (thoughts of hopelessness), and body func<on (fa<gue and loss of appe<te), which last at least two weeks 7

8 Symptoms of depression Depressed mood Reduced interest in almost all ac3vi3es Significant weight gain or loss Sleeping too much or too liele Fa3gue 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 Bipolar disorder A mood disorder in which episodes of depression and mania (excessive euphoria) occur What do you know? Serena some3mes feels absolutely on top of the world. She feels ecsta3c for no apparent reason, and everything around her seems to be wonderful and beau3ful. However, ajer a few weeks of feeling great, Serena becomes horribly upset, begins sleeping 12 hours a day, and constantly crying. Which disorder might Serena have? A. Clinical depression B. Bipolar disorder 8

9 Vulnerability-stress model Origins of depression Gene3c predisposi3ons Violence and parental neglect Losses of important rela3onships Cogni3ve habits Violence and parental neglect Repeated experiences with violence Domes3c violence Children who are neglected are at an increased risk. 9

Relationship loss History of separa3ons and losses Insecure aeachment Rejec3on by parents or peers Cognitive habits Cogni3ve explana3ons emphasize habits of thinking and ways of interpre3ng events.

10 Relationship loss History of separa3ons and losses Insecure aeachment Rejec3on by parents or peers Cognitive habits Cogni3ve explana3ons emphasize habits of thinking and ways of interpre3ng events. Depressed people believe their situa3on is permanent and uncontrollable. Rumina3on Brooding about nega<ve aspects of one s life Personality disorders Personality disorders Rigid, maladap<ve personality palerns that are beyond the expecta<ons of one s culture and cause personal distress or an inability to get along with others. Most are being restructured for DSM- V die out in 2014! Including Narcissis3c & Borderline personality disorders, (exaggerated sense of self- importance and self- absorp<on or extreme reac<ons to perceived abandonment in rela<onships and inability to calmly and consistently deal with important others in empathic ways). An3social personality disorder (APD) Characterized by a lifelong palern of irresponsible, an<social behavior such as lawbreaking, violence, and other impulsive, restless acts 10

11 Causes of APD Abnormali3es in the central nervous system Impaired frontal- lobe func3oning Gene3c influences Environmental Biology and addiction The biological model holds that addic3on is due primarily to a person s neurology and gene3c predisposi3on. Evidence comes from twin studies. Learning, culture, and addiction Addic3on paeerns vary according to cultural prac3ces. Policies of total abs3nence tend to increase addic3on rates rather than reduce them. Not all addicts have withdrawal symptoms when they stop taking a drug. Addic3on does not depend on proper3es of the drug alone but also on the reasons for 11

12 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 dis3nct personali3es, each with its own name and traits Commonly known as Mul<ple Personality Disorder (MPD) MPD debate First view MPD is common but oten unrecognized as such. Starts in childhood as a means of coping. Trauma produced a mental spliyng. Second view Created through pressure and sugges<on by clinicians. ShiT from handfuls of diagnoses to ten thousand diagnoses since

13 MPD explained MPD is an extreme form of our ability to present many aspects of our personali3es to others. MPD is a socially acceptable way for some troubled people to make sense of their problems. Therapists looking for MPD may reward pa3ents with aeen3on and praise for revealing more and more personali3es. Symptoms of schizophrenia Bizarre delusions Hallucina3ons and heightened sensory awareness Disorganized, incoherent speech Grossly disorganized and inappropriate behavior Impaired cogni3ve abili3es Delusions and hallucinations Delusions False beliefs that oten accompany schizophrenia and other psycho<c disorders Hallucina3ons Sensory experiences that occur in the absence of actual s<mula<on 13

What do you think? If you have an iden3cal twin who has been diagnosed with schizophrenia, there is almost a 50% chance that you will develop the disorder as well. A. True B.

14 What do you think? If you have an iden3cal twin who has been diagnosed with schizophrenia, there is almost a 50% chance that you will develop the disorder as well. A. True B. False Genetic vulnerability The risk of developing schizophrenia increases as the gene3c relatedness with a diagnosed schizophrenic increases. Prenatal or birth complications Damage to the fetal brain increases chances of schizophrenia and other mental disorders. May occur as a func<on of maternal malnutri<on or illness. May also occur if brain injury or oxygen depriva<on occurs at birth. 14

15 Brain events during adolescence 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. Also associated with stress model with some extreme stressor as the an ini<a<ng event. Mental Illness and Community Importance of community ac3on and organiza3ons such as NAMI. Are prison s the new Asylums? 15

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

16 Overview! 16 Mental disorder! Psychological disorders! Dilemmas of definition! Your turn! Psychological disorders! Overview! Defining and diagnosing disorder Anxiety disorders Mood disorders Personality disorders Drug abuse and addiction Dissociative identity disorder Schizophrenia Dilemmas