Mental Health CHAPTER 23. 2 Mental Health Overview Mental health –Relative state of mind in which...

Mental Health

CHAPTER 23

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Mental Health Overview

• Mental health– Relative state of mind in which the person

who is healthy is able to cope with and adjust to the recurrent stresses of everyday living in an acceptable way

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• Mental disorders– Disturbances of emotional stability, as

manifested in maladaptive behavior and impaired functioning

• Defense mechanisms– Body’s unconscious reaction to protect itself

from conflicts or anxieties

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• Psychology– Study of behavior and processes of the

mind as it relates to the individual’s social and physical environment

• Psychologist– Professional who specializes in the study

of the structure and function of the brain and related mental processes• Not a medical doctor • MA or PhD degree


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• Psychiatry– Branch of medicine that deals with the

causes, treatment, and prevention of mental, emotional, and behavioral disorders

• Psychiatrist– Medical doctor who specializes in

diagnosing, preventing, and treating mental disorders• Many subspecialties


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Defense Mechanisms

• Compensation– Effort to overcome, or make up for, real or

imagined inadequacies• Denial

– Refusal to admit or acknowledge the reality of something, thus avoiding emotional conflict or anxiety

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Defense Mechanisms

• Displacement– Process of transferring a feeling or emotion

from the original idea or object to a substitute idea or object

• Introjection– Individual unconsciously identifies with

another person or with some object• Individual assumes the supposed feelings and/or

characteristics of the other personality or object

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Defense Mechanisms

• Projection– Act of transferring one’s own unacceptable

thoughts or feelings on to someone else• Rationalization

– Attempting to make excuses or invent logical reasons to justify unacceptable feelings or behaviors, most commonly used defense mechanism

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Defense Mechanisms• Regression

– Response to stress in which the individual reverts to an earlier level of development and comfort measures associated with that level of functioning

• Repression– Involuntary blocking of unpleasant feelings

and experiences from one’s conscious mind

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Defense Mechanisms

• Sublimation– Rechanneling or redirecting one’s

unacceptable impulses and drives into constructive activities

• Suppression– Voluntary blocking of unpleasant feelings and

experiences from one’s mind

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Classification of Mental Disorders

• DSM-IV-TR Multiaxial Classification System– Sixteen major diagnostic classifications– Each classification includes several disorders– Disorders are grouped based on shared

features– Includes five axes for classification

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• Axis I– Clinical Disorders– Other conditions that may be a focus of

clinical attention• Axis II

– Personality Disorders– Mental retardation


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• Axis III– General Medical Conditions

• Axis IV– Psychosocial and Environmental Problems

• Axis V– Global Assessment of Functioning


SPECIFIC MENTAL DISORDERS

Mental Health

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Cognitive Disorders

• Cognitive disorders– Those that affect the individual’s ability to

perceive, think, reason, and remember– Organic mental disorders– Includes:

• Amnesia disorders• Delirium• Dementia

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Amnesia Disorders

• Pronounced– (am-NEE-zee-ah)

• Defined– Characterized by short-term and long-term

memory deficits• Have normal attention but are unable to learn

new information • Unable to recall previously learned information

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Delirium

• Pronounced– (dee-LEER-ee-um)

• Defined– Frenzied excitement that occurs rapidly and is

characterized by difficulty maintaining and shifting attention• Individual is easily distracted and must be

constantly reminded to focus attention

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Dementia

• Pronounced– (dee-MEN-she-ah)

• Defined– Progressive, organic mental disorder

characterized by chronic personality disintegration, confusion, disorientation, stupor, deterioration of intellectual capacity and function, and impairment of control of memory, judgment, and impulses

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Substance-Related Disorders• Associated with the use of drugs

– Characteristics:• Psychological dependence on the substance• Daily use• Frequent intoxication by ingestion of the

substance• Inability to control use of substance• Physical dependence involves serious withdrawal

symptoms

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• Drugs of substance-related disorders– Central nervous system depressants

• Slow activity of the CNS, causing impaired motor activity, judgment, and concentration

– Central nervous system stimulants• Increased activity of CNS, causing elevated

blood pressure, heightened behavioral activity and alertness

– Hallucinogens• Create perceptual distortions of the mind

Substance-Related Disorders

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Schizophrenia• Pronounced

– (skiz-oh-FREN-ee-ah)• Defined

– Any of a large group of psychotic disorders characterized by gross distortion of reality, disturbances of language and communication, withdrawal from social interaction, and disorganization and fragmentation of thought, perception, and emotional reaction

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Schizophrenia

• Characteristic symptoms– Hallucinations

• Person perceives something that does not exist in the external environment

– Delusions• Person firmly holds to a persistent abnormal belief

or perception despite evidence to the contrary

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Schizophrenia• Characteristic symptoms

– Disorganized speech• Person may move rapidly from one topic to

another, making little sense– Disorganized or catatonic behavior

• Person may alternate between agitation and non-purposeful or random body movements to little or no behavioral response to the environment

– Flattened affect• Individual shows little or no emotional response to

the environment

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Paranoid Schizophrenia

• Pronounced– (PAIR-ah-noyd skiz-oh-FREN-ee-ah)

• Defined– Condition characterized by the individual

being overly suspicious of others and having hallucinations and delusions

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• Group of psychiatric disorders characterized by disturbances in physical, emotional, and behavioral response patterns

• Extreme elation and agitation to extreme depression with suicidal potential– Includes:

• Bipolar disorders• Cyclothymic disorder• Major depressive disorder

Mood Disorders

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• Pronounced– (by-POHL-ar dis-OR-der)

• Defined– Psychological disorder characterized by

episodes of mania, depression, alternating between the two, or a mixture of the two moods simultaneously

Bipolar Disorders (Manic-Depressive)

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• Characteristics of mania– Extreme excitement, hyperactivity– Agitation, overly talkative– Flight of ideas, fleeting attention– Sometimes violent, destructive, and self-

destructive behavior– May have decreased need for sleep and

seemingly limitless energy


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• Characteristics of depression– Symptoms are inappropriate and out of

proportion with reality– Exaggerated feelings of sadness– Discouragement– Hopelessness


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• Individual feels increased tension, apprehension, a painfully increased sense of helplessness, a feeling of uncertainty, fear, jitteriness, and worry– Includes:

• Generalized anxiety disorder• Panic disorder• Phobic disorder• Obsessive-compulsive disorder• Posttraumatic stress disorder

Anxiety Disorders

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Anxiety Disorders

• Observable signs of anxiety– Includes but not limited to:

• Restlessness• Poor eye contact• Glancing about• Facial tension• Dilated pupils• Increase perspiration• Constant focus on self

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Generalized Anxiety Disorder• Pronounced

– (generalized ang-ZY-eh-tee dis-OR-der)• Defined

– Disorder characterized by chronic, unrealistic, and excessive anxiety and worry• Symptoms have usually existed for at least six

months or more • Symptoms have no relation to any specific cause

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Panic Disorder

• Pronounced– (PAN-ik dis-OR-der)

• Defined– Characterized by recurrent panic attacks that

come on unexpectedly, followed by at least one month of persistent concern about having another panic attack

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• Characteristics– Intense apprehension, fear, or terror, often

associated with feelings of impending doom– Person may experience:

• Dyspnea• Dizziness• Sweating • Trembling• Chest pain or palpitations of the heart

Panic Disorder

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Phobic Disorder

• Pronounced– (FOH-bik dis-OR-der)

• Defined– Anxiety disorder characterized by an

obsession, irrational, and intense fear of a specific object, of an activity, or of a physical situation

– Phobia disorder

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• Classifications of phobias– Acrophobia

• Fear of high places that results in extreme anxiety

– Aerophobia• Morbid fear of fresh air or drafts

– Agoraphobia• Fear of being in an open, crowded, or public place,

such as a field, congested street, or busy department store, where escape may be difficult

Phobic Disorder

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• Classifications of phobias– Arachnophobia

• Fear of spiders– Claustrophobia

• Fear of closed spaces– Nyctophobia

• Obsessive, irrational fear of darkness– Zoophobia

• Persistent, irrational fear of animals, particularly dogs, snakes, insects, and mice

Phobic Disorder

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Obsessive-Compulsive Disorder• Pronounced

– (ob-SESS-iv kom-PUHL-siv dis-OR-der)• Defined

– Disorder characterized by recurrent obsessions or compulsions that are severe enough to be time consuming, (they take more than one hour a day), or to cause obvious distress or a notable handicap

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• Obsessions– Repeated, persistent thoughts or impulses that

are irrational and with which the mind is continually and involuntarily preoccupied

• Compulsions– Irresistible, repetitive, irrational impulses to

perform an act• Behavior patterns that are intended to reduce

anxiety, not to provide pleasure or gratification

Obsessive-Compulsive Disorder

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Posttraumatic Stress Disorder

• Pronounced– (post-trah-MAT-ik Stress dis-OR-der)

• Defined– Individual experiences characteristic

symptoms following exposure to an extremely traumatic event• Individual reacts with horror, extreme fright, or

helplessness to the event

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• Somatoform disorders– Any group of neurotic disorders

characterized by symptoms suggesting physical illness or disease

– No demonstrable organic causes of physiologic dysfunctions

Somatoform, Sleep, and Factitious Disorders

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• Sleep disorders– May be related to stress, anxiety, or

physiological problems• Factitious disorders

– Characterized by physical or psychological symptoms that are intentionally produced or feigned to assume the sick role


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• Malingering– Willful and deliberate faking of symptoms of a

disease or injury to gain some consciously- desired end

– Malingering• Of the conscious mind• Results in secondary gain

– Somatoform disorder• Unconscious• Results in reduction of anxiety


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• Examples:– Conversion disorder– Hypochondriasis– Munchausen syndrome (by proxy)– Narcolepsy– Pain disorder


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Conversion Disorder

• Pronounced– (kon-VER-zhun dis-OR-der)

• Defined– Disorder in which the individual represses

anxiety experienced by emotional conflicts by converting the anxious feelings into physical symptoms that have no organic basis, but are perceived to be real by the individual

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• Pronounced– (high-poh-kon-DRY-ah-sis)

• Defined– Chronic, abnormal concern about the health

of the body characterized by: • Extreme anxiety, depression• Unrealistic interpretation of real or imagined

physical symptoms as indications of a serious illness or disease despite rational medical evidence that no disorder is present

Hypochondriasis

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Munchausen Syndrome (By Proxy)

• Pronounced– (mun-CHOW-zen SIN-drom by PROCKS-

see)• Defined

– Somewhat rare form of child abuse in which a parent of a child falsifies an illness in a child by fabricating or creating the symptoms, and then seeks frequent medical attention for the child

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• Pronounced– (NAR-coh-lep-see)

• Defined– Sleep disorder that is characterized by

repeated, uncontrollable desire to sleep, often several times a day• Attacks must occur daily over a period of at least

three months to establish the diagnosis

Narcolepsy

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Pain Disorder

• Pronounced– (pain dis-OR-der)

• Defined– Psychological disorder in which the patient

experiences pain in the absence of physiologic findings

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• Emotional conflicts that are so repressed into the subconscious mind that a separation or split in personality occurs– Results in an altered state of consciousness or

a confusion identity– Includes:

• Dissociative amnesia• Dissociative fugue• Dissociative identity disorder

Dissociative Identity Disorders

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• Pronounced– (diss-SOH-see-ah-tiv am-NEE-zee-ah)

• Defined– The individual is unable to recall important

personal information, usually of a traumatic or stressful nature• Loss of memory is more than simple forgetting

Dissociative Amnesia(Formerly: Psychogenic Amnesia)

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• Pronounced– (diss-SOH-see-ah-tiv FYOOG)

• Defined– The individual separates from a past life and

associations, wanders away for a period of time, and returns with no recollection of the disappearance

Dissociative Fugue(Formerly: Psychogenic Fugue)

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• Pronounced– (diss-SOH-see-ah-tiv identity dis-OR-der)

• Defined– Presence of two or more distinct personalities

within one individual• At some point in time, each personality takes

complete control of the person’s behavior

Dissociative Identity Disorder (Formerly Multiple Personality)

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• Sexual Dysfunctions– Disturbance in sexual desire and sexual response– Cause marked distress and interpersonal difficulty

• Gender Identity Disorders– Strong and persistent cross-gender identification

accompanied by persistent discomfort with one’s assigned sex

• Paraphilias

Sexual and Gender Identity Disorders

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Paraphilias• Paraphilias

– Recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations

– Includes:• Exhibitionism• Fetishism, transvestic• Frotteurism• Pedophilia• Sexual sadism/sexual masochism

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Exhibitionism

• Pronounced– (egs-hih-BIH-shun-izm)

• Defined– Sexual disorder involving exposure of one’s

genitals to a stranger

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Fetishism,Transvestic

• Pronounced– (FEH-tish-izm, trans-VESS-tik)

• Defined– Sexual disorder in which the focus of the

fetish involves cross-dressing• Male usually keeps a collection of female clothing

that he intermittently uses to cross-dress

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Frotteurism

• Pronounced– (FROH-chur-izm)

• Defined– Sexual disorder in which the person gains

sexual stimulation or excitement by rubbing against a non-consenting person• Sexual arousal is achieved through the act of

rubbing and/or touching, which includes fondling

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Pedophilia

• Pronounced– (pee-doh-FILL-ee-ah)

• Defined– Sexual disorder in which the individual is

sexually aroused and engages in sexual activity with children (generally age 13 or younger)• Person is known as a pedophile

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• Pronounced– (SEKS-yoo-al SAY-dizm)– (SEKS-yoo-al MASS-oh-kism)

• Defined– Sexual disorder that involves the act (real, not

simulated) of being humiliated, beaten, bound, or otherwise made to suffer, or the act of inflicting psychological or physical suffering on the victim

Sexual Sadism Sexual Masochism

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• Examples– Restraining by holding down or tying down– Slapping– Spanking– Blindfolding– Beating– Burning – Rape – Cutting and torturing

Sexual Sadism Sexual Masochism

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Eating Disorders

• Characterized by severe disturbances in eating behavior– Individuals have a morbid fear of gaining

weight– Includes:

• Anorexia nervosa• Bulimia nervosa

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• Pronounced– (an-oh-REK-see-ah ner-VOH-suh)

• Defined– Disorder characterized by an emotional

disturbance concerning body image, prolonged refusal to eat followed by extreme weight loss, amenorrhea, and a lingering, abnormal fear of becoming obese• Seen primarily in adolescent girls

Anorexia Nervosa

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• Pronounced– (boo-LIM-ee-ah ner-VOH-suh)

• Defined– An uncontrollable craving for food, often

resulting in eating binges, followed by vomiting to eliminate food from stomach• Individual may feel depressed, go through a period

of self-deprivation, followed by another eating binge, and the cycle continues

Bulimia Nervosa

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• Rigid, inflexible, and maladaptive patterns of behavior that impair a person’s ability to function well in society due to a limited ability to adapt– Includes:

• Antisocial personality disorder• Borderline personality disorder• Narcissistic personality disorder• Paranoid personality disorder• Schizoid personality disorder

Personality Disorders

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Antisocial Personality Disorder• Pronounced

– (an-tih-SOH-shal per-son-AL-ih-tee dis-OR-der)

• Defined– Characterized by repetitive behavioral patterns

that lack moral and ethical standards, keeping the individual in continuous conflict with society• Individual demonstrates socially irresponsible,

guiltless behavior

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Borderline Personality Disorder

• Pronounced– (BOR-der-line per-son-AL-ih-tee dis-OR-der)

• Defined– Extensive pattern of instability of interpersonal

relationships, self-image, and marked impulsivity that begins by early adulthood and is present in a variety of contexts

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• Pronounced– (nar-sih-SISST-ik per-son-AL-ih-tee dis-OR-

der)• Defined

– Abnormal interest in oneself, especially in one’s own body and sexual characteristics• Individual has an exaggerated sense of self-worth,

lacks empathy, appears to lack humility, and tends to exploit others to fulfill his or her own needs and desires

Narcissistic Personality Disorder

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Paranoid Personality Disorder

• Pronounced– (PAIR-ah-noyd per-son-AL-ih-tee dis-OR-

der)• Defined

– Generalized distrust and suspiciousness of others, so much so that the individual blames them for his or her own mistakes and failures

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SchizoidPersonality Disorder

• Pronounced– (SKIZ-oyd per-son-AL-ih-tee dis-OR-der)

• Defined– Characterized by inability to form social

relationships• Individual may appear as emotionally cold or

indifferent

Mental Health

DEVELOPMENTAL DISORDERS AND

LEARNING DISABILITIES

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Attention-Deficit Hyperactivity Disorder (ADHD)

• Pronounced– (ah-ten-shun-DEF-ih-sit –

HIGH-per-ak-tiv-ih-tee diss-OR-der)• Defined

– Persistent inattention and

hyperactivity, impulsivity, or both• Formerly known as attention-deficit disorder (ADD)

TREATMENTSAND THERAPIES

Mental Health

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Treatments and Therapies• Behavior therapy

– Psychotherapy that seeks to modify observable, maladjusted patterns of behavior by substituting new responses to given stimuli

– Behavior modification

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Treatments and Therapies• Drug therapy

– Psychotropic drugs to treat mental disorders• Drugs prescribed for their effects in relieving

symptoms of anxiety, depression, or other mental disorders, such as schizophrenia

– Include:• Antianxiety agents• Antidepressants• Antipsychotic drugs

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Treatments and Therapies• Electroconvulsive Therapy (ECT)

– Process of passing an electrical current through the brain to create a brief seizure, much like a spontaneous seizure from some forms of epilepsy

– Shock therapy

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Treatments and Therapies• Family therapy

– Psychotherapy that focuses treatment on the process between family members that supports and sustains symptoms• Group therapy with family members composing the

group

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• Group therapy–Application of psychotherapeutic

techniques within a small group of people who experience similar difficulties

–Also known as encounter groups

Treatments and Therapies

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• Hypnosis– Passive, trancelike state of existence that

resembles normal sleep during which perception and memory are altered, resulting in increased responsiveness to suggestion• Used in psychotherapy, medicine, and in some

criminal investigations


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• Play therapy– Psychotherapy in which a child plays in a

protected and structured environment with games and toys provided by a therapist, who observes the behavior, effect, and conversation of the child to gain insight into thoughts, feelings, and fantasies


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• Psychoanalysis– Psychotherapy that analyzes the individual’s

unconscious thought, using free association, questioning, probing, and analyzing

– Therapist uses a technique known as free association• Allows individual to say aloud anything that comes

to mind no matter how minor or embarrassing


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Personality and Intelligence Tests

• Draw-A-Person (DAP) – Personality test that is based on the

interpretation of drawings of human figures of both sexes

– Individual is asked to draw human figures and talk about them

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• Minnesota Multiphasic Personality Inventory (MMPI)– Self-report personality inventory test that

consists of 550 statements that can be answered “true,” “false,” or “cannot say”• Statements vary widely in content and are

sometimes repeated in various ways throughout the test

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• Rorschach inkblot – Personality test that involves the use of 10

inkblot cards, half black and white, and half in color• Cards are shown to the individual, one at a time• Person is asked to describe what he or she sees in

the card

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• Thematic Apperception Test (TAT)– To elicit stories that reveal something about

an individual’s personality– Series of 30 black-and-white pictures, each

on an individual card• When cards are shown, individual is asked to tell a

story about each picture, providing all background information and details

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• Intelligence testing– Designed to measure an individual’s ability to

adapt and constructively solve problems in the environment

– First successful test of intelligence developed by Alfred Binet, a French psychologist

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• Intelligence test scoring– Mental Age (MA)

• Age level at which one functions intellectually– Chronological Age (CA)

• Age of the individual, expressed as time beyond birth

– Intelligence Quotient (IQ)• Numeric expression of an individual’s intellectual

level– MA divided by CA multiplied by 100 = IQ

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• Intelligence test used to measure IQ– Stanford-Binet Intelligence Scale– WAIS III: Wechsler Adult Intelligence Scale –III– WISC-III: Wechsler Intelligence Scale for

Children-III– WPPSI-R: Wechsler Preschool and Primary

Scale of Intelligence-R

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Mental Health CHAPTER 23. 2 Mental Health Overview Mental health –Relative state of mind in which...

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