Psychological Disorders

Transcription

1 Psychological Disorders Key Question: What is Psychological Disorder Core Concept: The medical model takes a disease view, while psychology sees psychological disorder as an interaction of biological, cognitive, social, and behavioral factors. What is Psychological Disorder? Three classic signs suggest severe psychological disorder v Hallucinations v Delusions v Severe affective (emotional) disturbances Part of a continuum ranging from absence of disorder to severe disorder Figure 14.2 Normality and abnormality as a continuum Changing Concepts of Psychological Disorder: Historical Roots Ancient World v Supernatural powersv Possession by demons and spirits 400 B. C. v Physical causesv Hippocrates-imbalance of humors Middle Ages v Medieval church v Demons and witchcraft 18 th Century v Mental disorders are diseases of the mind v Similar to other physical diseases v Objective causes requiring specific treatments Changing Concepts of Psychological Disorder: The Psychological Model Behavioral perspective Abnormal behaviors can be acquired through behavioral learning operant and classical conditioning Page 1 of 16

2 Cognitive perspective Abnormal behaviors are influenced by mental processes how people perceive themselves and their relations with others Social-cognitive-behavioral approach v Combines psychology s 3 major perspectives v Behavior, cognition, and social/environmental factors all influence each other Recognize the influence of biology Indicators of Abnormality Distress: Does the individual show unusual or prolonged levels of unease or anxiety? Maladaptiveness: Does the person act in ways that make others fearful or interfere with his or her wellbeing? Irrationality: Does the person act or talk in ways that are irrational or incomprehensible to others? Unpredictability: Does the individual behave erratically and inconsistently at different times or form one situation to another; experiencing a loss of control? Unconventionality and Undesirable Behavior: Does the person behave in ways that violate social norms? Key Question: How are Psychological Disorders Classified? Core Concept: The DSM-IV, most widely used system, classifies disorders by their mental and behavioral symptoms. Overview of DSM-IV Classification System DSM-IV TR (2000): v Fourth edition of the Diagnostic and Statistical Manual of Mental Disorders v Includes 300 disorders Figure Lifetime prevalence of psychological disorders Developmental Disorders Can appear at any age, but often first seen in childhood Autism Marked by impoverished ability to read other peoples, use language, and interact socially Dyslexia A reading disability, thought by some experts to involve a brain disorder Page 2 of 16

3 Attention-deficit hyperactivity disorder Disability involving short attention span, distractibility, and extreme difficulty in remaining inactive for any period Axis I Clinical Syndromes Anxiety Disorders Mood Disorders Addictive Disorders Somatoform Disorders Dissociative Disorders Schizophrenic Disorders Clinical Syndromes: Anxiety Disorders The anxiety disorders are a class of disorders marked by feelings of excessive apprehension and anxiety. Generalized anxiety disorder is marked by a chronic, high level of anxiety that is not tied to any specific threat free-floating anxiety. Panic disorder is characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly. These paralyzing attacks have physical symptoms. After a number of these attacks, victims may become so concerned about exhibiting panic in public that they may be afraid to leave home, developing agoraphobia or a fear of going out in public. Phobic disorder is marked by a persistent and irrational fear of an object or situation that presents no realistic danger. Particularly common are acrophobia fear of heights, claustrophobia fear of small, enclosed places, brontophobia fear of storms, hydrophobia fear of water, and various animal and insect phobias. Obsessive-compulsive disorder (OCD) is marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions). Obsessions often center on inflicting harm on others, personal failures, suicide, or sexual acts. Common examples of compulsions include constant handwashing, repetitive cleaning of things that are already clean, and endless checking and rechecking of locks, etc. PTSD involves enduring psychological disturbance attributed to the experience of a major traumatic event seen after war, rape, major disasters, etc. Symptoms include re-experiencing the traumatic event in the form of nightmares and flashbacks, emotional numbing, alienation, problems in social relations, and elevated arousal, anxiety, and guilt. Generalized anxiety disorder free-floating anxiety Panic disorder and agoraphobia Phobic disorder Specific focus of fear Obsessive compulsive disorder Page 3 of 16

4 Obsessions Compulsions Posttraumatic Stress Disorder Anxiety and Panic Generalized Anxiety Disorder A continuous state of anxiety marked by feelings of worry and dread, apprehension, difficulties in concentration, and signs of motor tension. Panic Disorder An anxiety disorder in which a person experiences recurring panic attacks, feelings of impending doom or death, accompanied by physiological symptoms such as rapid breathing and dizziness. Panic Disorder An anxiety disorder in which a person experiences: v recurring panic attacks, v periods of intense fear, and v feelings of impending doom or death, v accompanied by physiological symptoms such as rapid heart rate and dizziness. Fears and Phobias Phobia: an exaggerated, unrealistic fear of a specific situation, activity, or object. Page 4 of 16

5 Agoraphobia A set of phobias, often set off by a panic attack, involving the basic fear of being away from a safe place or person. Obsessions and Compulsions Obsessive-Compulsive Disorder (OCD) v An anxiety disorder in which a person feels trapped in repetitive, persistent thoughts (obsessions) and repetitive, ritualized behaviors (compulsions) designed to reduce anxiety. v Person understands that the ritual behavior is senseless but guilt mounts if not performed. Posttraumatic Stress Disorder (PTSD) v An anxiety disorder in which a person who has experienced a traumatic or life-threatening event has symptoms such as re-experiencing, avoidance, and increased physiological arousal. v Diagnosed only if symptoms persist for 6 months or longer. v May immediately follow event or occur later. Etiology of Anxiety Disorders Twin studies suggest a moderate genetic predisposition to anxiety disorders. They may be more likely in people who are especially sensitive to the physiological symptoms of anxiety. Abnormalities in neurotransmitter activity at GABA synapses have been implicated in some types of anxiety disorders, and abnormalities in serotonin synapses have been implicated in panic and obsessive-compulsive disorders. Page 5 of 16

6 Many anxiety responses, especially phobias, may be caused by classical conditioning and maintained by operant conditioning. Parents who model anxiety may promote the development of these disorders through observational learning. Cognitive theories hold that certain styles of thinking, overinterpreting harmless situations as threatening, for example, make some people more vulnerable to anxiety disorders. The personality trait of neuroticism has been linked to anxiety disorders, and stress appears to precipitate the onset of anxiety disorders. Biological factors Genetic predisposition, anxiety sensitivity GABA circuits in the brain 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: Mood Disorders Figure 14.6 Twin studies of anxiety disorders Mood disorders are a class of disorders marked by emotional disturbances of varied kinds that may spill over to physical, perceptual, social, and thought processes. Major depressive disorder is marked by profound sadness, slowed thought processes, low self-esteem, and loss of interest in previous sources of pleasure. Major depression is also called unipolar depression. Research suggests that the lifetime prevalence rate of unipolar depression is between 7 and 18%. Evidence suggests that the prevalence of depression is increasing, particularly in more recent age cohorts, and that it is 2X as high in women as in men. Dysthymic disorder consists of chronic depression that is insufficient in severity to justify diagnosis of major depression. Bipolar disorder (formerly known as manic-depressive disorder) is characterized by the experience of one or more manic episodes usually accompanied by periods of depression. In a manic episode, a person s mood becomes elevated to the point of euphoria. Page 6 of 16

7 Bipolar disorder affects a little over 1%-2% of the population and is equally as common in males and females. People are given the diagnosis of cyclothymic disorder when they exhibit chronic but relatively mild symptoms of bipolar disturbance. Evidence suggests genetic vulnerability to mood disorders. These disorders are accompanied by changes in neurochemical activity in the brain, particularly at norepinephrine and serotonin synapses. Cognitive models suggest that negative thinking contributes to depression. Learned helplessness and a pessimistic explanatory style have been proposed by Martin Seligman as predisposing individuals to depression. Hopelessness theory, the most recent descendant of the learned helplessness model of depression, proposes a sense of hopelessness as the final pathway leading to depression not just explanatory style, but also high stress, low self-esteem, and other factors combine in the development of depression. Current research also implicates ruminating over one s problems as important in the maintenance of depression, extending and amplifying individuals episodes of depression. Interpersonal inadequacies and poor social skills may lead to a paucity of life s reinforcers and frequent rejection. Stress has also been implicated in the development of depressive disorders. Major depressive disorder Dysthymic disorder Bipolar disorder Cyclothymic disorder Depression Figure Episodic patterns in mood disorders Major Depression A mood disorder involving disturbances in emotion (excessive sadness), behavior (loss of interest in one s usual activities), cognition (thoughts of hopelessness), and body function (fatigue and loss of appetite). Page 7 of 16

8 Symptoms of Depression v Depressed mood. v Reduced interest in almost all activities. v Significant weight gain or loss, without dieting. v Sleep disturbance (insomnia or too much sleep). v Change in motor activity (too much or too little). v Fatigue or loss of energy. v Feelings of worthlessness or guilt. v Reduced ability to think or concentrate. v Recurrent thoughts of death. Causal Factors in Depression Etiology v Genetic vulnerability v Neurochemical factors v Cognitive factors v Interpersonal roots v Precipitating stress Gender, Age, & Depression Women are about twice as likely as men to be diagnosed with depression. True around the world. Figure from Wade, C., & Tavris, C. (2002). Invitation to Psychology, 2 nd Ed. Upper Saddle River, NJ: Prentice Hall. Bipolar Disorder Bipolar Disorder: A mood disorder in which episodes of depression and mania (excessive euphoria) occur. Page 8 of 16

9 The Bipolar Brain Bipolar disorder can have rapid mood swings These wild changes are shown in brain activity (below) Figure from Wade, C., & Tavris, C. (2002). Invitation to Psychology, 2 nd Ed. Upper Saddle River, NJ: Prentice Hall. Figure Negative thinking and prediction of depression Figure Twin studies of mood disorders Addictive Disorders Substance Abuse Substance Dependence No Use à Social Use à Abuseà Dependence Behaviorism and Addiction Page 9 of 16

10 The behavioral model is very important in addiction. v You can t become addicted if you don t use. v People use substances and are rewarded by getting high, so they use the drug again and again, and may become dependent. v Once addicted quitting leads to withdrawal symptoms which are punishing so the person is likely to discontinue that behavior = quit quitting and relapse. Behaviorism and Addiction The biological model holds that addiction, whether to alcohol or other drugs is due primarily to: v biochemistry v metabolism v genetics Most evidence comes from twin studies. Clinical Syndromes: Somatoform Disorders Somatoform disorders are physical ailments that cannot be explained by organic conditions. They are not psychosomatic diseases, which are real physical ailments caused in part by psychological factors. (Recall from chapter 13 that psychosomatic disease as a category has fallen into disuse). Individuals with somatoform disorders are not simply faking an illness, which would be termed malingering. Somatization disorder is marked by a history of diverse physical complaints that appear to be psychological in origin. They occur mostly in women and often coexist with depression and anxiety disorders. Conversion disorder is characterized by a significant loss of physical function (with no apparent organic basis), usually in a single organ system loss of vision, partial paralysis, mutism, etc glove anesthesia, for example, is neurologically impossible. Hypochondriasis is characterized by excessive preoccupation with health concerns and incessant worry about developing physical illnesses. Somatoform disorders often emerge in people with highly suggestible, histrionic personalities and in people who focus excess attention on their physiological processes. They may be learned avoidance strategies, reinforced by attention and sympathy. Somatization Disorder Conversion Disorder Hypochondriasis Etiology Reactive autonomic nervous system Personality factors Cognitive factors The sick role Page 10 of 16

11 Figure Glove anesthesia Clinical Syndromes: Dissociative Disorders Dissociative disorders are a class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity. Dissociative amnesia is a sudden loss of memory for important personal information that is too extensive to be due to normal forgetting. Memory loss may be for a single traumatic event or for an extended time period around the event. Dissociative fugue is when people lose their memory for their entire lives along with their sense of personal identity forget their name, family, where they live, etc., but still know how to do math and drive a car. Dissociative identity disorder (formerly multiple personality disorder) involves the coexistence in one person of two or more largely complete, and usually very different, personalities. DID is related to severe emotional trauma that occurred in childhood, although this link is not unique to DID, as a history of child abuse elevates the likelihood of many disorders, especially among females. Some theorists believe that people with DID are engaging in intentional role playing to use an exotic mental illness as a face-saving excuse for their personal failings and that therapists may play a role in their development of this pattern of behavior, others argue to the contrary. In a recent survey, only ¼ of American psychiatrists in the sample indicated that they felt there was solid evidence for the scientific validity of DID. v Dissociative amnesia v Dissociative fugue v Dissociative identity disorder Dissociative Identity Disorder A controversial disorder marked by the appearance within one person of two or more distinct personalities, each with its own name and traits; commonly known as Multiple Personality Disorder (MPD). The DID Controversy Page 11 of 16

12 First view v MPD is common but often unrecognized or misdiagnosed. v The disorder starts in childhood as means of coping with severe abuse v Trauma produced a mental splitting. 2nd view v Created through pressure and suggestions by clinicians. v Handfuls of diagnoses to since Symptoms of Schizophrenia Delusions False beliefs that often accompany schizophrenia and other psychotic disorders. Hallucinations Sensory experiences that occur in the absence of actual stimulation. Grossly disorganized and inappropriate behavior. Disorganized, incoherent speech. Negative symptoms Positive Symptoms Cognitive, emotional, and behavioral excesses Examples of Positive Symptoms: v Hallucinations. v Bizarre delusions. v Incoherent speech. v Inappropriate/Disorganized behaviors. Negative Symptoms Cognitive, emotional, and behavioral deficits. Examples of Negative Symptoms: v Loss of motivation. v Emotional flatness. v Social withdrawal. v Slowed speech or no speech. Theories of Schizophrenia Diathesis-Stress Model Genetic predispositions Structural brain abnormalities Neurotransmitter abnormalities Prenatal abnormalities Diathesis-Stress Model Need biological (genetic vunerability) Page 12 of 16

13 AND Need environmental stress to trigger (onset in late adolescent early adulthood) Genetic Vulnerability to Schizophrenia The risk of developing schizophrenia (i.e., prevalence) in one s lifetime increases as the genetic relatedness with a diagnosed schizophrenic increases. Figure from Wade, C., & Tavris, C. (2002). Invitation to Psychology, 2 nd Ed. Upper Saddle River, NJ: Prentice Hall. Neurotransmitter Abnormalities Many schizophrenic patients have high levels of brain activity in brain areas served by dopamine as well as greater numbers of particular dopamine receptors. Subtyping of Schizophrenia Currently, in the DSM-IV, there are 4 subtypes of schizophrenia. Paranoid schizophrenia is dominated by delusions of persecution, along with delusions of grandeur. Catatonic schizophrenia is marked by striking motor disturbances, ranging from muscular rigidity to random motor activity. In disorganized schizophrenia, a particularly severe deterioration of adaptive behavior is seen incoherence, complete social withdrawal, delusions centering on bodily functions. People who clearly have schizophrenia, but cannot be placed in any of the above subtypes, are given the diagnosis of undifferentiated schizophrenia. There are many critics of the current subtyping system for schizophrenia. Some theorists argue that the disorder should be conceptualized along two categories, positive symptoms behavioral excesses or peculiarities, such as hallucinations, delusions, bizarre behavior, and wild flights of ideas; and negative symptoms behavioral deficits, such as flattened emotions, social withdrawal, apathy, impaired attention, and poverty of speech. 4 subtypes Page 13 of 16

14 v Paranoid type v Catatonic type v Disorganized type v Undifferentiated type New model for classification: Positive vs. negative symptoms Figure The dopamine hypothesis as an explanation for schizophrenia Personality Disorders Personality disorders are a class of disorders marked by extreme, inflexible personality traits that cause subjective distress or impaired social and occupational functioning. Anxious-fearful cluster: Avoidant excessively sensitive to potential rejection, humiliation or shame, Dependent excessively lacking in self-reliance and self-esteem, Obsessive-compulsive preoccupied with organization, rules, schedules, lists, and trivial details. Odd-eccentric cluster: Schizoid defective in capacity for forming social relationships, Schizotypal social deficits and oddities in thinking, perception, and communication, Paranoid pervasive and unwarranted suspiciousness and mistrust. Dramatic-impulsive cluster: Histrionic overly dramatic, tending to exaggerate expressions of emotion, Narcissistic grandiosely self-important, lacking interpersonal empathy, Borderline unstable in selfimage, mood, and interpersonal relationships, Antisocial chronically violating the rights of others, nonaccepting of social norms, inability to form attachments. Specific personality disorders are poorly defined, and there is much overlap among them some theorists propose replacing the current categorical approach with a dimensional one. Page 14 of 16

15 Research on the etiology of personality disorders has been conducted primarily on antisocial personality disorder. Genetic vulnerability has been suggested, along with autonomic reactivity, inadequate socialization, and observational learning. Anxious-fearful cluster Avoidant, dependent, obsessive-compulsive Dramatic-impulsive cluster Histrionic, narcissistic, borderline, antisocial Odd-eccentric cluster Schizoid, schizotypal, paranoid Etiology Genetic predispositions, inadequate socialization in dysfunctional families Table 14.2 Personality Disorders Antisocial Personality Disorder (APD) v A disorder characterized by antisocial behavior such as lying, stealing, manipulating others, and sometimes violence; and a lack of guilt, shame and empathy. v Sometimes called psychopathy or sociopathy v Occurs in 3% of all males and 1% of all females. DSM Criteria for APD Must have 3 of these criteria and a history of behaviors v Repeatedly break the law. v They are deceitful, using aliases and lies to con others. v They are impulsive and unable to plan ahead. v They repeatedly get into physical fights or assaults. v They show reckless disregard for own safety or that of others. v They are irresponsible, failing to meet obligations to others. Page 15 of 16

16 v They lack remorse for actions that harm others. Psychological Disorders and the Law Insanity is not a diagnosis, it is a legal concept. Insanity is a legal status indicating that a person cannot be held responsible for his or her actions because of mental illness. The M naghten rule holds that insanity exists when a mental disorder makes a person unable to distinguish right from wrong. Involuntary commitment occurs when people are hospitalized in psychiatric facilities against their will. Rules vary from state to state, but generally, people are subject to involuntary commitment when they are a danger to themselves or others or when they are in need of treatment (as in cases of severe disorientation). In emergency situations, psychiatrists and psychologists can authorize temporary commitment only for a period of hours. Long-term commitments must go through the courts and are usually set up for renewable six-month periods. v Involuntary commitment v danger to self v danger to others v Unable to care for self Key Question: What are the Consequences of Labeling People? Core Concept: Ideally, accurate diagnoses lead to proper treatments, but diagnoses may also become labels that depersonalize individuals and ignore the social and cultural contexts in which their problems arise. The Plea of Insanity Insanity A legal term, not a psychological or psychiatric one, referring to a person who is unable, because of a mental disorder or defect, to conform his or her behavior to the law. Page 16 of 16