Psychological Disorders 1917 (22) WWI (1914-1918) DSM 1-1952 (106) WWII (1939-1945) DSM II-1968 Vietnam (1955-1975) DSMIII-1980 DSMIV-1994 (297) DSMIVR-2000 DSM V-2013
Abnormal Behavior The APA uses the medical model as defined by the DSM. What is abnormal behavior? 3 criteria-not gender specific Deviant-violate social norms/atypical bx Maladaptive-impaired functioning Causing personal distress/disturbing bx A continuum of normal/abnormal-doesn t really exist as black and white. Depends on role fulfillment
Prevalence, Causes, and Course Epidemiology-distribution of population Prevalence- % of population Lifetime prevalence-% over time (44%) Diagnosis Etiology-cause Prognosis-forecast
Causes of Mental Disorders Combination of these reasons Table EXIT of Contents
The Classification of Disorders American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM - IVR) Multiaxial system 5 axes or dimensions Axis I Clinical Syndromes Axis II Personality Disorders or Mental Retardation Axis III General Medical Conditions Axis IV Psychosocial and Environmental Problems Axis V Global Assessment of Functioning scale 100-1.
Clinical Syndromes: Anxiety Disorders Generalized anxiety disorder free-floating anxiety is a state of intense apprehension, uneasiness, uncertainty, or fear. Phobic disorder Specific focus of fear (CC) Panic disorder and agoraphobia Physical symptoms of anxiety more days than not for 6 months. agoraphobia (fear of going out) Obsessive compulsive disorder Obsessions (thoughts) Compulsions (BX)
Common Examples of OCD Common Obsessions: Common Compulsions: Contamination fears of germs, dirt, etc. Washing Imagining having harmed self or others Repeating Imagining losing control of aggressive urges Checking Intrusive sexual thoughts or urges Excessive religious or moral doubt Forbidden thoughts A need to have things "just so" A need to tell, ask, confess Touching Counting Ordering/arranging Hoarding or saving Praying
Etiology of Anxiety Disorders Biological factors Genetic predisposition, anxiety sensitivity GABA circuits in the brain & serotonin Conditioning and learning Acquired through classical conditioning or observational learning Maintained through operant conditioning Cognitive factors Judgments of perceived threat Personality Neuroticism Stress A precipitator
Clinical Syndromes: Somatoform Disorders Somatization Disorder- physical ailments no explanation. Psychosomatic- real physical caused by psychological problems. Conversion Disorder-loss of physical function ex. blindness Hypochondriasis Etiology Reactive autonomic nervous system Personality factors, Cognitive factors The sick role
Clinical Syndromes: Dissociative Disorders Dissociative amnesia-emotional trauma NOT a result from other medical trauma (e.g. a blow to the head). Dissociative fugue-an individual in a fugue state is unaware of or confused about his identity, and in some cases will assume a new identity (although this is the exception). They often take journeys Dissociative identity disorder (MPD)-rare Etiology severe emotional trauma during childhood Controversy Media creation?
Clinical Syndromes: Mood Disorders- Psychological Disorders characterized by emotional extremes. Major depressive disorder-more common in females Dysthymic disorder Bipolar disorder (manic-depressive disorder) Cyclothymic disorder Etiology Genetic vulnerability Neurochemical factors Cognitive factors Interpersonal roots Precipitating stress
Major Depressive Disorder A person, for no apparent reason, experiences two or more weeks of depressive moods. Includes feelings of worthlessness and diminished interest or pleasure in most activities.
Bipolar Disorder Person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.
Bipolar Brain
Depression
Clinical Syndromes: Schizophrenia General symptoms Delusions and irrational thought Deterioration of adaptive behavior Hallucinations-sensory perceptions Disturbed emotions and perceptions Disorganized thinking Inappropriate emotions/affect. Prognostic factors 1% or higher of the population.
Subtyping of Schizophrenia 4 subtypes Paranoid type-someone s out to get me. Catatonic type-frozen or weird movements or speech patterns Disorganized type-severe bx deterioration in regards to speech, bx, and affect Undifferentiated type-varied symptoms but not paranoid New model for classification Positive vs. negative symptoms
Etiology of Schizophrenia Genetic vulnerability Neurochemical factors Dopamine (too much) Structural abnormalities of the brain The neurodevelopmental hypothesis Expressed emotion Precipitating stress Drugs/alcohol- including marijuana
Personality Disorders-Psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning. Lacks conscience, guilt, empathy, very self-absorbed. Etiology Genetic predispositions, inadequate socialization in dysfunctional families Difficult to treat-often people end up in prison.
Paranoid Personality Disorder Paranoid personality disorder is characterized by a distrust of others and a constant suspicion that people around you have sinister motives. They search for hidden meanings in everything and read hostile intentions into the actions of others. They are quick to challenge the loyalties of friends and loved ones and often appear cold and distant to others. They usually shift blame to others and tend to carry long grudges.
Antisocial Personality Disorder Characterized by a lack of conscience, guilt, and empathy. Psychopaths People with this disorder are prone to criminal behavior, believing that their victims are weak and deserving of being taken advantage of. They tend to lie and steal. They are often aggressive and are much more concerned with their own needs than the needs of others. They do not care about consequences Deceitfulness, impulsivity, lack of remorse
Borderline Personality Disorder Characterized by mood instability and poor selfimage, poor relationships. People with this disorder are prone to constant mood swings and bouts of anger. They will take their anger out on themselves, causing themselves injury. Different from bipolar in that they lack empathy, guilt, consciousness. They fake it. They undermine themselves with selfdefeating bx.
Histrionic Personality Disorder Constant attention seekers They need to be the center of attention all the time, often interrupting others in order to dominate the conversation. They may dress provocatively or exaggerate illnesses in order to gain attention. Very emotional
Narcissistic Personality Disorder Characterized by selfcenteredness They exaggerate their achievements, expecting others to recognize them as being superior Picky, disregards others feelings.
Schizoid Personality Disorder People with schizoid personality disorder avoid relationships and do not show much emotion They genuinely prefer to be alone and do not secretly wish for popularity.
Obsessive Compulsive Personality Disorder Characterized by a general psychological inflexibility, rigid conformity to rules and procedures, perfectionism, and excessive orderliness. People with OCPD tend to stress perfectionism above all else, and feel anxious when they perceive that things aren't "right".
Avoidant personality disorder Characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and extreme sensitivity to negative evaluation. Consider themselves to be socially inept or personally unappealing, and avoid social interaction for fear of being ridiculed or humiliated.
Schizotypal Personality Disorder Characterized by a need for social isolation, odd behavior and thinking, and often unconventional beliefs such as being convinced of having extra sensory abilities. Some people believe that schizotypal personality disorder is a mild form of schizophrenia. Magical thinking Odd, eccentric or peculiar bx. Lack of close friends
Psychological Disorders and the Law Insanity-legal concept M naghten rule (right from wrong) Involuntary commitment (Baker Act) 72 hours danger to self danger to others in serious need of treatment
Culture and Pathology Cultural variations Culture bound disorders Koro-obsessive fear penis to abdomen, Asia Windigo-craving for flesh, Indian Anorexia nervosa, western The International Classification of Diseases is published by the World Health Organization (WHO) 66 countries
Some of the Missing Illnesses Childhood disorders: Pica, ADHD, Sexual and gender identity disorders Eating disorders Sleep disorders Impulse control disorders Adjustment disorders Learning disorders Communication disorders Tic disorders Delirium & dementia Autism & Aspergers Alcohol related disorders Drug related disorders Elimination disorders