Psychological Disorders

1. Psychological Disorders PSYCHOLOGY Mr. Noble 2008-09 A special thanks to my former student teacher--Ms. Sharon Mohr--for her diligent research, insightful professional expertise, and valuable thoughtful effort in compiling much of the information included in this overview of Psychological Disorders.

2. Defining Abnormality • Difficult to define… • 3 Criteria… • Deviance • Distress • Disability/Maladaptive Behavior • Symptom/Behavior Continuum: _----_________________ normal range__ __________________+++ Abnormal Abnormal

3. Ancient Perspective • Perceived Causes • movements of sun or moon • lunacy- full moon • evil spirits • Ancient Treatments • exorcism, caged like animals, beaten, burned, mutilated, blood replaced with animal’s blood

4. Biological (chemistry, brain) Psychological ( learned helplessness, negative perceptions and memories) Sociocultural (Societal expectations, definition of normality and disorder) Bio-psycho-social Model • assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders

5. Medical Model • Diagnosis • Label for a set of symptoms • Prognosis • Prediction or forecast for the course of a D/O • Etiology • Suspected cause of a disorder

6. Classifying Disorders • DSM-IV-TR • Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision • Published by the American Psychiatric Association • 2000…(most recent update 2004) • Next major revision (DSM-V) anticipated for 2011. • Provides for reliable classification and description of all mental illnesses • Allows for better communication

7. DSM’s Multi-axial Diagnosis • Axis I Major Clinical Disorders • Axis II Mental Retardation & Personality Disorders • Axis III General Medical Conditions • Axis IV Psychosocial/Environmental Stressors • Axis V Global Assessment of Functioning • # between 1 and 100 • Current and Highest in past year

8. Labeling Issues • Reasons to Label/Diagnose: • Needed for communication • Guide treatment • Insurance reimbursement • Arguments against Labeling: • Creates a stigma • Creates a self-fulfilling prophecy • Fail to see the person behind the disorder

9. Major Classes of Disorders • Anxiety Disorders • Mood Disorders • Somatoform Disorders • Dissociative Disorders • Schizophrenia • Substance Use Disorders • Other Axis I Disorders • Personality Disorders (Axis II)

10. I. Anxiety Disorders • Characterized by generalized apprehension, worry, and a variety of physical symptoms • Generalized Anxiety Disorder • Phobias • Panic Disorder • Obsessive-Compulsive Disorder • Post-traumatic Stress Disorder

11. Generalized Anxiety Disorder • Experiencing a continuous, generalized feeling of anxiety (reaction to vague or imagined dangers) – 6 months or more • Anxiety in many different areas of life • Accompanied by physical symptoms… muscle tension, trouble sleeping, irritability, lack of concentration, headaches, fatigue, inability to relax, twitching/trembling, etc.

12. Specific Phobia Severe anxiety is focused on a specific object or situation Examples: Enclosed spaces Snakes Spiders Heights Flying Social Phobia Fear of embarrassing oneself in a social situation Speaking, eating, using bathroom in public Agoraphobia “fear of the marketplace” Associated with panic disorder Phobias

13. 100 90 80 70 60 50 40 30 20 10 0 Percentage of people surveyed Snakes Being in high, exposed places Mice Flying on an airplane Being closed in, in a small place Spiders and insects Thunder and lightning Being alone In a house at night Dogs Driving a car Being In a crowd of people Cats Afraid of it Bothers slightly Not at all afraid of it PHOBIAS http://www.phobialist.com/reverse.html • Common and uncommon phobias

14. PHOBIAS Treatment Exposure Treatment Flooding Counter-Conditioning Systematic Desensitization (1) training the patient to physically relax (2) establishing an anxiety hierarchy of the stimuli (3) counter-conditioning relaxation responding to ea. feared stimulus Biofeedback Modeling

15. “Nothing is so much to be feared as Fear” ---Henry David Thoreau Panic Disorder • Frequent Panic Attacks or fear of them: • Sudden and unexplainable attacks of intense fear • Come on without warning • Not associated with a stimulus • Individual fears that he/she is about to die • Physical symptoms…choking, tightness in chest, difficulty breathing, nausea, dizziness • Commonly occurs with Agoraphobia

16. OBSESSIONS Intrusive and uncontrollable thoughts Contamination, safety, etc. COMPULSIONS Ritualistic and purposeless actions Cleaning, washing, checking, etc. O and C are usually related… compulsions help to decrease the anxiety caused by the obsession This pattern begins to interfere with functioning Obsessive-Compulsive Disorder

17. Common Obsessions and Compulsions Among People With Obsessive-Compulsive Disorder Thought or Behavior Percentage* Reporting Symptom Obsessions (repetitive thoughts) Concern with dirt, germs, or toxins 40 Something terrible happening (fire, death, illness) 24 Symmetry order, or exactness 17 Compulsions (repetitive behaviors) Excessive hand washing, bathing, tooth brushing, 85 or grooming Repeating rituals (in/out of a door, 51 up/down from a chair) Checking doors, locks, appliances, 46 car brake, homework OCD

18. Post-traumatic Stress Disorder • Common among veterans of combat, survivors of accidents and disasters, victims of crimes, etc. • Feel long-lasting after-effects of trauma • Flashbacks, nightmares, insomnia, mood symptoms, stimulus generalization • Symptoms last more than 1 month… up to years later

19. II. Mood Disorders • Mental disorders characterized by disturbances of mood that are intense and persistent enough to be maladaptive • Normal range of mood… • Major Depressive Disorder • Bipolar Disorder

20. Major Depressive Disorder • Clinical depression/Major Depression • Unipolar depression • Single-episode or recurrent episodes • Symptoms must occur for at least 2 weeks • Subtypes: • Post-partum onset • S.A.D. • Secondary symptoms…

21. Depression…symptoms Sleep disturbance Interest  Guilt/worthlessness Energy  = fatigue Concentration  Appetite disturbance/weight gain/loss Psychomotor agitation/retardation Suicidal/thoughts of death

22. Causes of Depression • Genetic Predisposition • + stressful life events • Neurotransmitters • Serotonin • Norepinephrine • Cognitive Theories • Beck & Seligman • Behavioral Theories

24. Bipolar Disorder • Previously known as Manic-Depression • Experience both manic and depressive episodes • Mania = emotional state characterized by intense and unrealistic feelings of excitement and euphoria, along with impulsivity • Cycles…not mood swings • High rate of suicide

25. Depressed state Manic state Depressed state Mood Disorders-Bipolar • PET scans show that brain energy consumption rises and falls with emotional swings

26. Mood Disorders & Suicide • Not all people who commit suicide are depressed; Not all depressed people commit suicide • Associated with mood disorders, especially bipolar disorder (also schizophrenia) • Warning Signs… • Risk factors… • Prevention…

27. SUICIDE:Male v. Female • Males • Suicide is the eighth leading cause of death for all U.S. men. • Males are four times more likely to die from suicide than females. • Suicide rates are highest among Whites and second highest among American Indian and Native Alaskan men. • Of the 24,672 suicide deaths reported among men in 2001, 60% involved the use of a firearm. • Females • Women report attempting suicide during their lifetime about three times as often as men.

28. SUICIDE:Youth • Overall rate of suicide among youth has declined slowly since ‘92. • However, rates remain unacceptably high. • Adolescents and young adults often experience stress, confusion, and depression from situations occurring in their families, schools, and communities. • Such feelings can overwhelm young people and lead them to consider suicide as a “solution.” • Few schools and communities have suicide prevention plans that include screening, referral & crisis intervention programs for youth.

29. SUICIDE:Youth • Suicide is the third leading cause of death among young people ages 15 to 24. • Of the total number of suicides among ages 15 to 24 in 2001, 86% were male and 14% were female. • American Indian and Alaskan Natives have the highest rate of suicide in the 15 to 24 age group. • In 2001, firearms were used in 54% of youth suicides.

31. SUICIDE:Risk Factors The first step in preventing suicide is to identify and understand the risk factors. • Previous suicide attempt(s) • History of mental disorders, particularly depression • History of alcohol and substance abuse • Family history of suicide • Family history of child maltreatment • Feelings of hopelessness • Impulsive or aggressive tendencies • Barriers to accessing mental health treatment

32. SUICIDE:Risk Factors The first step in preventing suicide is to identify and understand the risk factors. • Loss (relational, social, work or financial) • Physical illness • Easy access to lethal methods • Unwillingness to seek help due to stigma • Local epidemics of suicide • Isolation - feeling cut off from other people

33. SUICIDE:Protective Factors Protective factors buffer people from the risks associated with suicide. A number of protective factors have been identified: • Effective clinical care • Easy access to clinical interventions & support • Family and community support • Medical & mental health care relationships • Problem solving, conflict resolution skills • Cultural & religious beliefs/support

34. III. Somatoform Disorders • Also know as Hysteria (Freud) • Conditions involving physical complaints or disabilities that occur without physical pathology • NOT psychosomatic disorders… • Conversion Disorder • Hypochondriasis

35. Conversion Disorder • Conversion of emotional difficulties into the persistent loss of a physiological function • Paralysis, loss of feeling, exceptional sensitivity, mutism, blindness, deafness • Not faking a physical problem • Cannot be explained physically

36. Hypochondriasis Preoccupation with fear that he/she has a serious disease Based on the misinterpretation of bodily symptoms Mountain out of a molehill No evidence of illness Somatization Disorder History of diverse physical complaints of all varieties (all body systems) Focus on numerous symptoms Many trips to doctor, many medications, no root cause found Hypochondriasis & Somatization Disorders

37. IV. Dissociative Disorders • Dissociation…the human mind’s capacity to mediate complex mental activity in channels split off from or independent of conscious awareness • A way of managing anxiety and stress… • Psychogenic/Dissociative Amnesia & Fugue • Dissociative Identity Disorder

38. PSYCHOGENIC AMNESIA Inability to recall certain personal information, which is still know at the unconscious level Loss in episodic memory, not procedural or semantic PSYCHOGENIC FUGUE Loss of memory accompanied by an actual flight from one’s present life situation to a new environment May take on a new identity Amnesia & Fugue

39. Dissociative Identity Disorder • Previously known asMultiple Personality Disorder • Individual manifests at least two or more distinct systems of identity • Host personality + Alter identities (15) • Associated with childhood abuse • Rare disorder; Popular in media • Can be faked or influenced by therapist

40. V. Schizophrenia • Characterized by confused and disordered thoughts and perceptions • Most debilitating of the mental disorders; Deterioration of adaptive behavior • Subtypes: • Paranoid • Disorganized • Catatonic • Undifferentiated

41. Schizophrenia…symptoms Bizarre behaviors (catatonia, others) Affect (inappropriate, flat) Delusions Speech (disorganized, incoherent) Hallucinations Inability to care for self or function Negative symptoms

42. Positive vs. Negative Sx • POSITIVE SYMPTOMS • Presence of something abnormal • Examples: • NEGATIVE SYMPTOMS • Absence of something normal • Examples:

43. Schizophrenia… • DELUSIONS • False beliefs maintained in the face of contrary evidence • Types: Grandeur Identity Persecution Reference • HALLUCINATIONS • Sensations in the absence of external stimuli • Types: visual, auditory, tactile, olfactory, gustatory

44. Causes of Schizophrenia • Genetic Predisposition • Twin study evidence • Neurotransmitters • Dopamine hypothesis • Brain Structure & Function • Family & Interactions • Double-bind theory • Schizophrenogenic mother

45. VI. Substance Use Disorders • Substance Abuse • Substance Dependence • Psychological dependence + Addiction • Alcoholism = Alcohol Dependence • Important terms… • Tolerance • Withdrawal

46. VII. Other Axis I Disorders • Eating Disorders • Sleep Disorders • Disorders of childhood and adolescence • Autism, ADHD, Tourette’s, Conduct Disorder • Sexual and Gender Identity Disorders • Cognitive Disorders • Impulse Control Disorders • Adjustment Disorders

47. VIII. Personality Disorders • Diagnosed on Axis II • Stem from the gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of relating to the world • Ego-syntonic…not a problem for the person • A problem for others • Resistant to treatment (only behavioral) • FOCUSAntisocial, Narcissistic, OCPD

48. Symptoms of Obsessive Compulsive Personality Disorder • OCPD symptoms tend to appear early in adulthood and are defined by inflexibility, close adherence to rules, anxiety when rules are transgressed, and unrealistic perfectionism. A person with obsessive compulsive personality disorder exhibits several of the following symptoms: • abnormal preoccupation with lists, rules, and minor details • excessive devotion to work, to the detriment of social and family activities • miserliness or a lack of generosity • perfectionism that interferes with task completion, as performance is never good enough • refusal to throw anything away (pack-rat mentality) • rigid and inflexible attitude towards morals or ethical code • unwilling to let others perform tasks, fearing the loss of responsibility • upset and off-balance when rules or routines disrupted.

49. Psychopathology & The Law • Competence to Stand Trial • Can individual participate in own defense at time of trial? • Involuntary Civil Commitment • Should individual be hospitalized against their will due to imminent danger? • Suicidal or homicidal • Decided by doctor, then court; need evidence

50. More Legal Issues…State-level • Insanity Plea • Should individual not be held accountable due to their mental state at the time of the crime? • Could not determine right from wrong • Determined by judge before actual trial • Difficult to prove, but prevalent in media • Sent for treatment, then released *Insanity is a LEGAL term…!