Psychological Disorders. Chapter 14

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1 Psychological Disorders Chapter 14

2 Identifying Psychological Disorders: What Is Abnormal? Medical model: the conceptualization of psychological disorders as diseases that, like physical diseases, have biological causes, defined symptoms, and possible cures Diagnosis of symptoms underlying a syndrome DSM provides a reliable way of classifying (operationalizing) mental disorders: psychiatrists and psychologists all want to able to arrive at the same diagnosis. (Its validity is another issue).

3 Problems with DSM Strong medical orientation; only half of 290+ diagnoses have a concrete medical component. Can be misleading: causing overprescription of drugs and victimization of I have depression. Reification & naming something is not the same as explaining it. Labeling can be damaging: stigmatization, Rosenhan study: On Being Sane in Insane Places.

5 Physiognomy and Phrenology

6 Classification of Disorders Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; 4 th ed., text revision): a classification system that describes the features used to diagnose each recognized mental disorder and indicates how the disorder can be distinguished from other similar problems Involves disturbances in behavior, thoughts, or emotions Causes significant distress or impairment. Stem from internal dysfunction (biological and/or psychological). Global Assessment of Functioning (GAF score) Comorbidity: the co-occurrence of two or more disorders in a single individual

7 Table 14.1 Main DSM-IV-TR Categories of Mental Disorders

8 Table 14.2 Global Assessment of Functioning (GAF) Scale

9 Figure 14.1 Comorbidity of Depression and Anxiety Disorders

10 Causation of Disorders and the Dangers of Labeling An integrated perspective incorporates biological, psychological, and environmental factors. Different individuals may experience a similar psychological disorder for different reasons. Diathesis-stress model: suggests that a person may be predisposed for a mental disorder that remains unexpressed until triggered by stress The intervention-causation fallacy assumes treatment addresses the cause of the disorder. The brain is likely not the only cause. Stigmas are likely attached to labeling people with psychological disorders. Roughly 70% of sufferers do not seek treatment. Education does not dispel the stigma. May result in unnecessary incarceration May lead to low self-esteem

11 The Diathesis Stress Model

12 Culture and Community Can people in different parts of the world have different mental disorders? The DSM-IV-TR includes a description of culture-bound syndromes that appear only in some cultures. Ataque de nervios, ghost sickness, koro, mal de ojo

13 Anxiety Disorders Fears & Phobias Panic Disorder Generalized Anxiety Disorder Obsessive Compulsive Disorder

14 Anxiety Disorders and GAD Anxiety disorder: the class of mental disorder in which anxiety is the predominant feature Anxiety can be adaptive or maladaptive, when it is disproportionate to real threats and challenges. Generalized anxiety disorder (GAD): a disorder characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance Roughly 5% of North Americans suffer Occurs more in lower SES groups

15 Phobic Disorders Phobic disorders: disorders characterized by marked, persistent, and excessive fear and avoidance of specific objects, activities, or situations Specific phobia: a disorder that involves an irrational fear of a particular object or situation that markedly interferes with an individual s ability to function Social phobia: a disorder that involves an irrational fear of being publicly humiliated or embarrassed Preparedness theory: the idea that people are instinctively predisposed toward certain fears; proposed by Martin Seligman (1942- ) Evolution, heritability, and temperament argue for biological predispositions. Phobias can also be classically conditioned.

16 Phobias: Lifetime Prevalence

17 No Acrophobia Here

Panic Disorder Panic disorder: a disorder characterized by the sudden occurrence of multiple psychological and physiological symptoms that contribute to a feeling of stark terror;

18 Panic Disorder Panic disorder: a disorder characterized by the sudden occurrence of multiple psychological and physiological symptoms that contribute to a feeling of stark terror; panic attacks Approximately 22% of the U.S. population reports having at least one panic attack. Agoraphobia: an extreme fear of venturing into public places; correlates with panic disorder

19 Obsessive Compulsives Obsessions Reduce Compulsions Anxiety

20 Obsessive-Compulsive Disorder Obsessive-compulsive disorder (OCD): a disorder in which repetitive, intrusive, thoughts (obsessions) and ritualistic behaviors (compulsions) designed to fend off those thoughts interfere significantly with an individual s functioning Roughly 1.3% of the population suffers Moderate heritability

21 Mood Disorders and Depressive Disorders Mood disorders: mental disorders that have mood disturbances as their predominant feature Major depressive disorder: a disorder characterized by a severely depressed mood that lasts 2 wks. or more and is accompanied by feelings of worthlessness and lack of pleasure, lethargy, and sleep and appetite disturbances Dysthymia: a disorder that involves the same symptoms as in depression only less severe, but the symptoms last longer, persisting for at least 2 yrs Double depression: a moderately depressed mood that persists for at least 2 yrs. and is punctuated by periods of major depression Seasonal affective disorder: depression that involves recurrent depressive episodes in a seasonal pattern Women experience depression at twice the rate of men, as in postpartum depression

22 Gender & Depression (Data from Kessler, et al., 1994)

23 Prognosis (1 year) (APA Data, 1994)

24 Questions What is the difference between depression and sadness? Why do more women than men experience depression?

25 Biological and Psychological Factors Heritability estimates for major depression range from 33% to 45%. Depression may involve norepinephrine and serotonin, and/or diminished activity in the left prefrontal cortex and increased activity in the right prefrontal cortex. Aaron Beck (1921- ) noted dysfunctional attitudes and negative mood states in depressed individuals. Helplessness theory: the idea that individuals who are prone to depression automatically attribute negative experiences to causes that are internal, stable, and global Depressed individuals tend to have depressive biases in thinking and memory.

26 Figure 14.2 Brain and Depression

27 Seasonal Affective Disorder (After Wurtman & Wurtman,1989)

The Real World: Suicide Risk and Prevention Suicide is the 11 th leading cause of death in the U.S. (and third among high school and college students).

28 The Real World: Suicide Risk and Prevention Suicide is the 11 th leading cause of death in the U.S. (and third among high school and college students). 50% of those who commit suicide do so during a depressive episode. There exist a variety of motives for suicide. May be biological and/or contagious (the Werther effect) Prediction and prevention is difficult, however warning signs are abundant.

29 Suicide Attempts

30 Suicide Deaths

31 Suicide Methods

32 Suicide Methods

33 Bipolar Disorder Bipolar disorder: an unstable emotional condition characterized by cycles of abnormal, persistent high mood (mania) and low mood (depression) Approximately 1.3% of people suffer Rapid cycling bipolar disorder Bipolar disorder has the highest heritability (polygenic) among the psychological disorders. Biological causes (specific neurotransmitters) are difficult to substantiate. Stressful life experiences often precede episodes.

34 Dissociative Disorders: Going to Pieces Dissociative disorder: a condition in which normal cognitive processes are severely disjointed and fragmented, creating significant disruptions in memory, awareness, or personality that can vary in length from a matter of minutes to many years Dissociative identity disorder (DID): the presence within an individual of two or more distinct identities that at different times take control of the individual s behavior.5% - 1% of the population suffers; female to male prevalence 9:1 Dissociative amnesia: the sudden loss of memory for significant personal information Dissociative fugue: the sudden loss of memory for one s personal history, accompanied by an abrupt departure from home and the assumption of a new identity Dissociative amnesia and fugue usually occur later in life and memory loss may be temporary.

35 Schizophrenia: Losing the Grasp on Reality Schizophrenia: a disorder characterized by the profound disruption of basic psychological processes, a distorted perception of reality, altered or blunted emotion, and disturbances in though, motivation, and behavior Occurs in about 1% of the population Delusion: a patently false belief system, often bizarre and grandiose, that is maintained in spite of its irrationality. Hallucination: a false perceptual experience that has a compelling sense of being real despite the absence of external stimulation Disorganized speech: a severe disruption of verbal communication in which ideas shift rapidly and incoherently from one to another unrelated topic Grossly disorganized behavior: behavior that is inappropriate for the situation or ineffective in attaining goals, often with specific motor disturbances Catatonic behavior: a marked decrease in all movement or an increase in muscular rigidity and overactivity Negative symptoms: emotional and social withdrawal, apathy, poverty of speech, and other indications of the absence or insufficiency of normal behavior, motivation, and emotion Subtypes include: paranoid, catatonic, disorganized, undifferentiated, and residual

36 Catatonic Schizophrenia

37 Table 14.3 Types of Schizophrenia

38 Onset Timing AGE Period of greatest susceptibility

39 Biological and Psychological Factors Concordance rates increase greatly with biological relatedness. Prenatal and perinatal environments may also have effects. Dopamine hypothesis: the idea that schizophrenia involves an excess of dopamine activity Effects and treatments related to neurotransmitters have yet to be completely determined. Neuroimaging has revealed enlarged ventricles and progressive tissue loss in many cases of schizophrenia. Disturbed family environment may affect development and recovery of schizophrenia.

40 Strikes 1/100 Incidence Schizophrenic (1%)

41 Figure 14.3 Average Risk of Developing Schizophrenia

42 Figure 14.4 Enlarged Ventricles in Schizophrenia

43 Hot Science: Autism and Childhood Disorders Early onset disorders are recognized in the DSM, and some resolve into adulthood while others do not. Autistic disorder involves abnormal or impaired development of communication and social interaction, and a markedly restricted repertoire of activities/interest. Recent increased prevalence Variations of the disorder lie along a spectrum, including Asperger s syndrome. Individuals with the disorder may display unique, gifted talents. Temple Grandin as an example

44 Personality Disorders: Going to Extremes Personality disorder: disorder characterized by deeply ingrained, inflexible patterns of thinking, feeling, or relating to others or controlling impulses that cause distress or impaired functioning Organized into three clusters: odd/eccentric, dramatic/erratic, and anxious/inhibited 14.8% of the population has a personality disorder. Common feature is failure to take others perspectives Diagnosis is controversial and complicated. Peer nomination measures may be more valid assessments.

45 Table 14.4 Clusters of Personality Disorders

46 Antisocial Personality Disorder Antisocial personality disorder(apd): a pervasive pattern of disregard for and violation of the rights of others that begins in childhood or early adolescence and continues into adulthood 3.6% of the population suffers; males outnumber females 3:1 Individuals typically have a history of conduct disorder and many commit crimes. Sociopathology and psychopathology describe people with APD. Newer theories suggest internal (biological) causes. Less sensitive to fear in the brain.

47 Antisocial Personality Disorder Marked by a lack of empathy, chronic underarousal, willingness to lie, cheat, steal, and break the law

48 Where Do You Stand: Genetic Tests for Risk of Psychological Disorders In the future, diagnosis of potential psychological disorders may be as simple as providing a saliva sample. A genetic diagnosis may provide a nice explanation for a yet unlabelled problem. Would you want to know about a predisposition even if it never manifests? This could present added stress or a self-fulfilling prophecy.

Thomas Szasz: The Myth of Mental Illness The concept of "mental illness" is a myth; i.e., these do not exist in reality, but only as a type of explanation for abnormal behavior.

49 Thomas Szasz: The Myth of Mental Illness The concept of "mental illness" is a myth; i.e., these do not exist in reality, but only as a type of explanation for abnormal behavior."abnormal" behavior is a normative judgment: the only consistent definition of abnormality is one that refers to the average members of a community as a frame of reference.

50 The Myth of Mental Illness People behave abnormally because either they CANNOT abide by cultural norms, or they CHOOSE not to abide by these norms..the concept of mental illness is incorrect for two reasons:."problems in living" do not have a medical cause, hence are not illnesses, even though such problems may result in physiological changes (eg., stress)..reification of mind; mind/body dualism is a false dichotomy: a disease of the brain may have psychological effects, but that does not mean the mind is some separate thing that has diseases.

51 The Myth of Mental Illness Szasz also asks "Whose agent is the psychiatrist?"--- on whose behalf is the therapist acting? The client/patient, the community, the medical profession, the government?.szasz argues that psychiatry and psychology should be concerned with problems in living NOT illness per se..the concept of mental illness is harmful and unethical, in so far as it is used as a rationale for medical treatments and institutionalization

Agoraphobia. An anxiety disorder marked by fear of being in situations in which escape may be difficult or impossible.

Agoraphobia. An anxiety disorder marked by fear of being in situations in which escape may be difficult or impossible. Agoraphobia An anxiety disorder marked by fear of being in situations in which escape may be difficult or impossible. (See page 634) Antisocial personality disorder (APD) A personality disorder marked