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Psychological Disorders
Dysfunctional Behavior • Dysfunctional or abnormal behavior is any behavior judged to be disturbing, atypical, maladaptive
or unjustifiable • It can be irrational, unpredictable and unconventional • The person can feel distress and discomfort from their behaviors • It is different from insanity which is a legal defense
• insanity means that the individual could understanding the difference between right and wrong, and is unable to control their actions
• confidentiality—patient confidentiality can come into play in legal investigations • insanity defense—not understanding the difference between right and wrong
Major Perspectives
• There are four perspectives on psychopathology or the study of dysfunctional behavior: • medical (or biological) model: dysfunctional behavior is the result of an organic cause
• Philippe Pinel and Emil Kraepelin created two of the first medical classification systems for psychological disorders
• behavioral model: abnormal behavior is the result of maladaptive learning (reinforcement) • cognitive model: dysfunctional behavior is the result of irrational or distorted thinking that leads to emotional problems and maladaptive behaviors
• psychodynamic model: dysfunctional behavior is the result of internal, unconscious conflicts and motives
Other Perspectives
• Also considered are these perspectives: – humanistic model: abnormal behavior is the result of roadblocks that people encounter on the path to self-‐actualization whereby people become detached from their true selves and adopt a distorted self-‐image which leads to emotional problems
– ethical model: dysfunctional behavior is the result of a lack of or improper ethical values – sociocultural model: abnormal behavior is the result the stress involved in coping with poverty and other social ills such as unemployment and racism
– interactionist (or biopsychosocial) perspective: dysfunctional behavior is the result of a complex interaction between biological processes and genetic predispositions, psychological dynamics and social influences
– evolutionary perspective—dysfunctional behavior is a result of any or all of a variety of factors: psychological defenses, side effects of genetics, the frequency by which behaviors are carried out by existing genetic codes, absence or malfunctioning of a particular biological system, a mismatch between the current environment and other environments one has previously mastered, or extremes in the distribution of traits influenced by more than one gene
Reasons for Classification • Psychological disorders have been classified for four main reasons:
1. describe the disorder 2. predict the course it will take in the future 3. render appropriate treatment 4. prompt further research into its causes and treatments
DSM-‐V
• In the United States, the DSM-‐V (or Diagnostic and Statistical Manual for Mental Disorders, 5th edition) is considered the authoritative source on diagnosing and treating psychological disorders
Neurosis versus Psychosis • neurotic disorders which are affective (or emotional) disorders • psychotic disorders which are affective and cognitive (or thinking) disorders
Medical Student Syndrome
• One caution in examining both mental and physical disorders is a phenomenon called medical student syndrome
• In this, students who study specific disorders begin to convince themselves that they are suffering from that disorder because they may have one or more general symptoms
• Typically this is not the case and worry shifts from the current disorder being studied to the next
Determining “Normal” • Who determines what's "normal?"
• you: individuals constantly assess the normalcy of their behaviors • society: society imposes labels of normal and abnormal behavior • the experts: applying their skill and knowledge in diagnosing and treating psychological
disorders • Psychologists have established six criteria in determining the distinction between normal and
abnormal behavior: • unusualness • social deviance • emotional distress • maladaptive behavior • dangerousness • faulty perceptions or interpretations of reality.
Labeling
• Experts caution that labeling individuals with certain disorders can predispose them to certain self-‐fulfilling prophesies and cause those around them to perceive them differently based on stereotypical beliefs
Anxiety Disorders
• Anxiety disorders involve: • behaviors the surround overwhelming anxiety • attempts to reduce this anxiety through maladaptive means
• Anxiety disorders are among the most common psychological disorders treated by professionals
Generalized Anxiety Disorder • Generalized anxiety disorder (GAD) is one in which the individual feels continually and
unexplainable tense or anxious, worries that bad things might happen • This anxiety occurs consistently for at least six months • The individual typically can hide these symptoms but physical symptoms such as insomnia or
racing heart) may occur • Freud called this a "free-‐floating" anxiety because the individual cannot identify what's causing
their anxiety; this makes it hard to control it • Lifetime prevalence: 5%
Panic Attack
• A panic attack or panic disorder is a condition in which a person suffers a period of intense anxiety
• Physical reactions include disorientation, tunnel vision, a feeling a disconnectedness, increased blood pressure, increase heart rate, shortness of breath
• Panic attacks typically begin in the mid-‐20s • Agoraphobia is an intense fear of situations with no escape or help in the event of a panic attack • panic attacks are acute and short in duration, whereas GAD is less intense for a longer period of
time • Lifetime prevalence: 1-‐4%
Phobias
• A phobia is an intense irrational fear • The individual usually actively avoids the situation or object of their phobia • Specific phobias involve fear and avoidance of specific objects or situations • Social phobias involve fear and avoidance of social situations or performance situations • Lifetime prevalence: specific phobia 7-‐11%, social phobia 3-‐13%.
Obsessive-‐Compulsive Disorder
• An obsession is an uncontrollable thought • A compulsion is an uncontrollable act • These frequently go together in the form of an obsessive-‐compulsive disorder (OCD) • This disorder is characterized by a combination of repetitive thoughts and uncontrollable acts • The onset of this disorder occurs in childhood or adolescence • Research now indicates that there is a biological link to OCD • Part of the problem lies in the pathway between the basal ganglia and the frontal lobe • Research indicates that four structures in the brain are linked along a circuit to promote OCD
behaviors: • the amygdala • the orbital frontal cortex • the caudate nucleus • the thalamus
• This circuit is abnormally active in individuals with OCD • Research also indicates genetic markers on six sites in five chromosomes in children of family
members with OCD • A seventh gene, located on the ninth chromosome, appears to regulate the brain chemical
glutamate • Excessive amounts of glutamate stimulate the alarm centers in the brain which facilitates the
obsessive-‐compulsive behavior • Drug medication that regulates an individual's serotonin level has shown great success in two-‐
thirds of patients • The most common obsessions are dirt or germs (40%), that something terrible will happen
(24%), symmetry or order (17%) and religious obsessions (13%) • The most common compulsions are ritualized hand washing and showering (85%), repeating
rituals (51%), checking (46%), removing contaminants from contacts (23%) and touching (20%) • Lifetime prevalence: 2-‐3%.
• The most common expressions of OCD: • Relationship substantiation—searching for tiny but disqualifying flaws in someone else • Fear of injuring others-‐-‐a preoccupation of losing control and injuring or killing someone else • Responsibility anxiety-‐-‐a fear of negligently hurting others • Scrupulosity-‐-‐intolerance of disorder or asymmetry • Contamination anxiety-‐-‐compulsive hand-‐washing and fear of contamination from other objects
• Sexual-‐orientation fears-‐-‐fear of homosexual stirrings in people who have no moral or social objections to it
• Obsessive hypochondria-‐-‐fear of illness in the face of evidence to the contrary and the tendency to reject that opinion of experts
• Hoarding disorder—persistent difficulty in getting rid of or parting with possessions • There is a perceived need to save them • Individuals feel distress at parting with these possessions
Post-‐Traumatic Stress Disorder • Posttraumatic stress disorder (PTSD) involves overwhelming anxiety, flashbacks and troubling
recollections of a highly traumatic event • veterans who have seen heavy combat duty and women who have been raped or assaulted may suffer from this
• The individual attempts to avoid situations or objects that might trigger the disorder • Other symptoms include reduced involvement in the external world, hyperaltertness, and
concentration difficulties • Success of treatment depends on:
• whether the individual had any psychological disorders prior to PTSD • their social support group • whether the individual is currently experiencing any other psychological disorders.
Causes of Anxiety Disorders
• The causes of anxiety disorders depend on the model of psychopathology: – biological: disorders are the result of organic causes; neurotransmitter imbalances (anxiety, mood and schizophrenic disorders) and hereditary genetics (schizophrenia) cause the disorder; GAD is treated with benzodiazepines because it’s associated with too little inhibitory neurotransmitters in the brain; OCD and panic disorders are treated with antidepressants associated with low levels of serotonin
– behavioral: behaviors result from prior reinforcement or conditioning of the maladaptive behavior: rewarding avoidance behaviors can contribute to phobias; relieve from anxiety (negative reinforcement) reinforces OCD ; anxiety disorders are acquired through classical conditioning and maintained through operant conditioning
– cognitive: anxiety is based on incorrect reasoning, a distortion of real events and unrealistic expectations; misinterpretation of minor changes in bodily sensations promotes anxiety and panic attacks; social phobias may occur because of an obsessive fear of social embarrassment or negative judgments
– evolutionary: enhanced vigilance occurs even in the absence of a real threat – psychodynamic: anxiety disorders are the result of an unconscious conflict or fear; desire to avoid a previously abrasive experience can generate ritualistic behaviors to reduce anxiety (OCD); phobias may be a result of childhood traumas that have been repressed
Psychosomatic Disorders • Psychosomatic (or psychophysiological) disorders are where there are real physical disorders but
no organic or biological cause • These illnesses are brought on by psychological not physiological factors • The two most common types of psychosomatic disorders are migraine headaches and stomach
ulcers • These are usually brought on by overwhelming stress
Somatoform Disorders
• Somatoform disorders are where there is an apparent physical illness but no organic or biological cause.
• Individuals are usually seen in medical settings and complain of a variety of physical symptoms • Those afflicted complain of anxiety, and maladaptive feelings, thoughts and behaviors.
Somatoform Disorders • Somatic symptom disorder (SSD) is a disorder where the person has vague physical symptoms and
repeatedly seeks medical treatment but no organic cause is found for the illness – The individual has repeatedly seen physicians, taken medicine and changed his or her
lifestyle – Duration of symptoms: 6 months
• Conversion disorder is a disorder where the person suffers from paralysis, blindness, deafness, seizures. loss of feeling or false pregnancy but with no physiological reason for it
• Symptoms persist as long as the anxiety exists – in about 80% of suspected cases, the cause turns out to be medical – this disorder is rare
• Illness anxiety disorder (IAD) is a disorder where a person takes insignificant physical symptoms
and interprets them as a sign of a serious illness despite a lack of evidence of any organic cause. • Formerly called hypochondriasis • Duration of symptoms: 6 months • Body dysmorphic disorder is a disorder in which a person become preoccupied with his or her
imagined physical ugliness that makes normal life impossible
Causes of Somatoform Disorders • The causes of somatoform disorders depend on the model:
• biological: there is no biological argument since there are no biological reasons for these disorders
• behavior: believe the disorder allows the person to avoid the anxiety-‐producing situation (see psychodynamic explanation); further reinforcement for the disorder comes in the form of sympathy and support from others for having the physical ailment
• cognitive: people are misinterpreting and exaggerating minor bodily sensations as signs of serious illness
• psychodynamic: these disorders are an outward sign of an unconscious conflict; in stopping the expressions of the id by the ego, leftover sexual or aggressive energy is converted into a physical symptom • the symptom itself is symbolic of the underlying struggle (e.g. immobilization of the arm would prevent the person from carrying out a violent act)
• the symptom has the secondary gain of preventing the person from having to confront the conflict
• socio-‐cognitive: SSD patients focus too much on internal rather than external experiences which leads to incorrect cognitive conclusions
Organic/Neurocognitive Disorders • The DSM-‐V calls these neurocognitive disorders • The World Health Organization’s International Statistical Classification of Diseases and Related
Health Problems (ICD-‐10) calls these organic disorders • These are disorders in which medical conditions produce a psychological disorder • There can be a loss of attention ability, learning, memory impairments, deficits in language, motor
skills or social skills • Specific diseases or brain damage an be the cause • For example, a brain injury or thyroid disorder may directly produce a mood disturbance • All of these can result in dementia—the loss of mental ability • Alzheimer’s disease—degenerative neurological disease that is ultimately fatal
– characterized by loss of memory, loss of control of bodily movements, and learning and memory impairment
• Delirium—impaired attention and lack of awareness of the surrounding environment – characterized by memory loss, and disturbances in language and perception
Dissociative Disorders • Dissociative disorders involve a separation (or dissociation) of conscious awareness of the world
around the individual and previous thoughts and memories • This can cause a sudden memory loss or even the person may not be able to remember their own
identity • Stress is so extreme that the individual blocks out part of their memory to reduce their anxiety • The causes of dissociative disorders may involve an attempt to disconnect from consciousness to
avoid awareness of traumatic or painful experiences • It may be an attempt to protect the self from this trauma • Severe and continual physical or sexual abuse as a child is a prominent precursor to dissociative
identity disorders.
Major Dissociative Disorders • Major dissociative disorders include the following:
• Dissociative amnesia involves partial or total memory loss • This is usually caused by overwhelming stress • Amnesia is usually limited to memories associated with anxiety-‐producing or traumatic events that result in a strong, negative emotional reaction
• This disorder is rare • Dissociative fugue (or generalized amnesia) involves memory and identity loss
• The individual may forget their home and past life for days to years • This is extremely rare
• Dissociative identity disorder (DID) was previously called multiple personality disorder or MPD • This involves the two or more distinct personalities inhabiting the same body • Identities can be either sex and handedness sometimes switches • Brain studies indicate that eye-‐muscle balance and visual acuity are different in the different personalities • this study was compared to subjects pretending to be have multiple identities in which there were no differences in these factors
• This disorder is extremely rare
Opinions on DID • There is still some skepticism regarding the existence of DID • Only a few cases were reported prior to 1970; thousands have been reported in the 1990s • Some psychologists believe DID is a legitimate disorder; others believe it is a form of attention-‐
seeking role playing • Others believe these alternate personalities are a result of therapy • To help deal with a history of abuse, therapists promote the enactment of alternate personalities
to cope with these feelings; patients identify too closely with this role and it becomes reality to them
Depressive Disorders
• Depressive disorders (also called affective or mood disorders) involve extremes in emotion.
Depressive Disorders • Major mood disorders include the following:
• Major depressive disorder involves feelings of worthlessness, a depressed mood and a reduction in pleasure from most activities for a period of at least two weeks
• There is typically a change in eating and sleeping patterns • Low self-‐esteem, pessimism, negativity and slow thought processes are also accompanying
symptoms – this is an extreme depression, not to be confused with feeling blue from time to time. – Lifetime prevalence: 10-‐25% for women and 5-‐12% for men
• Seasonal affective disorder (SAD) is a pattern of severe depression in the fall and winter, and elevated moods in the spring and summer – this has been successfully treated with artificial light therapy
• Dysthymic disorder is a mild, chronic depression for long period of time, typically five years or more – Lifetime prevalence: 6%
• Premenstrual dysphoric disorder—occurs in women who are between menarche and menopause – Symptoms include (must have at least five of these) mood swings, sensitivity to rejection,
increased irritability, increased interpersonal conflicts, a depressed mood, marked anxiety, decrease in energy, changes in appetite, insomnia, and feelings of being “out of control”
Causes of Depressive Disorders
• The causes of depression are explained from different perspectives: • biological: disorders are the result of organic causes, particularly levels of serotonin and
norepinephrine • behavioral: feelings result from lack of positive reinforcement and an overabundance on
punishment – this is an imbalance between behavioral output and reinforcement input – this becomes a viscous cycle as behavior diminishes and reinforcement is consequently absent
• cognitive: feelings are caused by negative thinking, pessimistic views of self and the world – this becomes a distorted thinking pattern and a mental filter that bias people toward
exaggerating events and conflicts • psychodynamic: anxiety disorders are the result of an unresolved childhood emotions and
unconscious conflicts – Freud believed depression was anger turned inward against one's self
Additional Causes • Additionally, the learned helplessness model believes that people become depressed when they
believe they cannot control the reinforcement in their lives • This is combined with attributional style which refers to where people place the cause of events:
internal or external factors, global or specific factors, and stable or unstable factors • Depressive attributional style consists of internal, global and stable attributions; this means the
person thinks that negative situation are because: – they are at fault (internal) – they don't possess the abilities to deal with the issue (global) – they'll never learn to cope with them (stable)
Bipolar and Related Disorders
• Mania is a period of hyperactivity where the individual has unrealistic hope and dreams – it is an wildly optimistic, euphoric state
• When this manic behavior is coupled with depression, the individual experiences bipolar disorder – this is extreme mood swings between both mania and depression – bipolar disorder is rare – lifetime prevalence: .4-‐1.6%
• Cyclothymic disorder is a milder form of bipolar disorder, with less severe swings in mood
– unlike unipolar depression which is more common in women, bipolar and cyclothymic disorder are equally common among both men and women
Schizophrenia
• Schizophrenia is a collection of several disorders that are characterized by: – disorganized thinking and language – delusions (or false beliefs) – hallucinations (or false sensory experiences) – grossly inappropriate behavior
• Schizophrenic has a flattened affect (or lack of emotional dynamic) and tend to become withdrawn from social settings
• Life prevalence: 1%
Causes of Schizophrenia • The causes of schizophrenia fall predominantly around the biological model • Freud did not have any good explanation for schizophrenia
• In terms of genetic factors, one stands a 13% chance of developing schizophrenia if one of his or
her parents is schizophrenic, and a 45-‐ 50% chance if his or her identical twin suffers from the disorder
• If heredity was the sole factor, it would be expected that fraternal twins would have a 100% chance of both being schizophrenic
• In fraternal twins there is about a 17% chance if one has schizophrenia that the other will as well • These statistics have been supported through adoption studies as well • Biochemical factors involve overreactivity or overabundance of dopamine levels in the brain • The brain does not have more dopamine, rather schizophrenia patients seem to have more
dopamine receptors and these may be overly sensitive • Excess dopamine promotes hallucinations and delusional thinking • Antipsychotic drugs such as Thorazine and Mellaril reduce dopamine activities • Tardive dyskinesia can result from long-‐term use of dopaminergic anatogonist medications—
muscle tremors and stiffness can result
• Parkinson’s disease has similar muscle tremors and stiffness – treated with L-‐dopa to increase dopamine levels – excessive L-‐dopa can cause schizophrenic-‐like symptoms
• Brain abnormalities also seem to contribute to schizophrenia • These abnormalities develop during certain critical prenatal periods • Areas that are most effected are the prefrontal cortex (thought formation and organization) and
the limbic system (memory and emotion) • Brain asymmetries and an abnormality on the fifth chromosome may be associated with
schizophrenia • The diathesis-‐stress model suggests that stress works with genetic factors in bringing on
schizophrenia in genetically vulnerable individuals • Sources of stress include early brain trauma, dysfunctional family environments and negative life
events • It is suggested that these factors combine to produce brain abnormalities and disturbances in
thinking, memory and perception
Schizophrenia and DID • Schizophrenia is frequently confused with dissociative identity disorder because the word
"schizophrenia" literally means "split mind" • This is because their is a break with reality and a disintegration of personality • Because of this, schizophrenic disorders are considered psychotic disorders
Characteristics
• Schizophrenia is usually diagnosed in the late teens or early twenties and occurs in only 1% of the population
• There is a fairly strong genetic link to schizophrenia and recent research believes the limbic system is involved in the disorder.
• 25% of those who experience a schizophrenic episode fully recover • 50% have reoccurrences which can be controlled through medication • 25% show little to no sign of recovery
Process v. Reactive
• Schizophrenia can be one of two types: – process (or chronic) schizophrenia develops gradually over time – reactive (or acute) schizophrenia comes on suddenly, usually in response to environmental
cues • Prognosis is worse for process schizophrenia and better for reactive schizophrenia.
Positive Symptoms
• Some schizophrenic patients have positive symptoms which include: – excessive laughing and emotional outbursts – disorganized speech and thinking
• Those exhibiting these symptoms tend to have: – normal brain structures – excessive amounts of dopamine – show overactivity and aggressive behavior during adolescence – have a greater prognosis for treatment
Negative Symptoms • Other patients have negative symptoms which include:
– rigid bodies – lack of emotional response – faces with no expression
• Those exhibiting these symptoms tend to have: – more abnormal brain structures – more frontal and parietal lobe deficits – are more clearly genetically linked – have lower educational levels – have a poorer prognosis for treatment
Types of Schizophrenia
• The major types of schizophrenia are: – paranoid: fear or persecution is present, as are delusions of grandeur, or feelings of extreme
self-‐importance as the reason they are being singled out for persecution – disorganized: disorganized thinking and speech patterns accompanied by flat emotions
and/or grossly inappropriate behavior – catatonic: a freezing up of the body in response to overwhelming stress accompanied by
extreme negativism and/or mimicking of language patterns or body movements – undifferentiated (residual): schizophrenic symptoms that do not fit one of the specific types
listed above Personality Disorders
• Personality disorders involve enduring, inflexible behavior patterns that impair social functioning • These are usually first identified in adolescence • 10-‐20% of the population has one type of personality disorder • The DSM-‐V classifies three types of personality disorder
Odd/Eccentric Disorders
• paranoid personality disorder: extreme suspiciousness and mistrust of others based on unjustified reasoning
• schizoid personality disorder: indifference or lack of interpersonal relationships • schizotypal personality disorder: generally odd thinking, showing suspicion and mistrust
Dramatic/Emotionally Problematic • narcissistic personality disorder: an overexaggeration of self-‐importance and love of one's self
– requires constant attention and admiration • antisocial personality disorder: exercises his or her own needs or wants over the feelings of
others – hedonistic (seeks self-‐gratification); no emotional reaction to others' suffering – commonly called a psychopath or sociopath
• histrionic personality disorder: over-‐dramatizes situations and behaviors – blows things out of proportion and overreacts to situations
• borderline personality disorder: unpredictable and impulsive, irritable and emotionally unstable
Chronic Fearfulness/Avoidant • dependent personality disorder: overly dependent on others due to low self-‐esteem and lack of
confidence • avoidant personality disorder: avoids relationships because of an exaggerated fear of rejection • obsessive-‐compulsive personality disorder: too serious, emotionally insensitive, too preoccupied
with structure and rules
AP Check AP students in psychology should be able to do the following: – Describe contemporary and historical conceptions (p. 642) of what constitutes psychological
disorders. – Recognize the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM)
published by the American Psychiatric Association as the primary reference for making diagnostic judgments.
– Discuss the major diagnostic categories, including anxiety and somatoform disorders, mood disorders, schizophrenia, organic disturbance, personality disorders, and dissociative disorders, and their corresponding symptoms.
– Evaluate the strengths and limitations of various approaches to explaining psychological disorders: medical model, psychoanalytic, humanistic, cognitive, biological, and sociocultural.
– Identify the positive and negative consequences of diagnostic labels (e.g. the Rosenhan study). – Discuss the intersection between psychology and the legal system (e.g. confidentiality,
insanity defense).