Psychological Disorders Chapter Outline

Chapter 16, Psychology by David Meyers, 7th Edition

At various moments we all get anxious, depressed, withdrawn, suspicious, deluded, or antisocial the way disturbed people feel, think, and act most of the time just less intensely and more briefly. 450 million people worldwide suffer psychological disorders No known culture is free from depression or schizophrenia Mental disorders have accounted for 15.4% of the years of life lost due to death or disability.

-Perspectives on Psychological DisordersI. Defining 1. Psychological Disorder a harmful dysfunction in which behavior is judged to be atypical, disturbing, maladaptive, and unjustifiable. Being different from most other people in ones culture To be considered disordered, an atypical behavior must also be one that other people find disturbing Standards of acceptability vary with culture as well as time Atypical and disturbing behaviors are more likely to be considered disordered when judged harmfully. Maladaptiveness is a key element of defining a disorder: behaviors must be distressing or disabling or put one at greatly increased risk of suffering or death Abnormal behavior is most likely to be considered disordered when others find it rationally unjustifiable. II. Understanding People in earlier times first thought that puzzling behavior was forces the movement of the starts, godlike powers, or evil spirits at work. The cure was to get rid of evil forces by placating the great powers or exorcising the demon. Mad people were caged in zoo-like conditions, sometimes beaten, burned, or castrated. Philippe Pinel opposed brutal treatment; insisted that madness was a sickness of the mind caused by severe stress and/or inhumane conditions. Moral Treatment: boosting patients morale by unchaining them, talking with them, replacing brutality with gentleness, isolation with activity, and filth with clean air and sun. 2. Medical Model the concept that diseases have physical causes that can be diagnosed, treated, and, in most cases, cured. When applied to psychological disorders, the medical model assumes that theses mental illnesses can be diagnosed on the basis of their symptoms and cured through therapy, which may include treatment in a psychiatric hospital. Mental Illness is also called psychopathology

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All behavior, normal or disordered, arises from the interaction of nature and nurture. The presumption that a person is mentally ill attributes the condition solely to an internal problem, maybe there is a growth blocking difficulty in the persons environment, in the persons current interpretation of events, or the persons bad habits and poor social skills. Some major disorders, such as depression, occur worldwide; others are culture bound. Disorder Anorexia Nervosa and Bulimia Susto Culture Western Latin America Symptoms Starvation / Purging Severe anxiety, restlessness, fear of black magic Social anxiety of ones appearance with readiness to blush, fear of eye contact

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Such disorders may share and underlying dynamic (anxiety) while differing in the symptoms manifested in a particular culture. Most mental health workers assume that disorders are influenced by genetic predispositions and physiological states, psychological dynamics, social and cultural circumstances. 3. Bio-psycho-social Perspective a contemporary perspective which assumes that biological, psychological, and sociocultural factors combine and interact to produce psychological disorders The mind and body are inseparable Example: Stress and negative emotions contribute to physical illness and physical abnormalities contribute experiences of pain or malaise III. Classifying In psychiatry and psychology, classification orders and describes symptoms Aims to not only describe a disorder, but also to predict its future course, imply appropriate treatment, and simulate research into its causes Current authoritative scheme for classifying is: 4. DSM-IV The American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), a widely used system for classifying psychological disorders. Presently distributed in an updated text revision (DSMIV-TR) Updated to DSM-V in 2010 Developed in coordination with the World Health Organizations International Classification of Diseases (ICD-10) Some practitioners not enthralled with terminology such as diagnosing, symptoms, and illness but most find DSM-IV a helpful and practical tool. CAMERONPHILLIPS2012

Most North American Health insurance companies require a DSM diagnosis before they will pay for therapy. 5. Neurotic Disorder a psychological disorder that is usually distressing but that allows one to think rationally and function socially. 6. Psychotic Disorder a psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions. DSM uses diagnostic guidelines: asks clinicians a series of objective questions about observable behavior. Critics of DSM fault the manual for being too broad and bringing almost any kind of behavior within the compass of psychiatry Another fundamental complaint: these labels are arbitrary and do not represent science IV. Labeling Labels create preconceptions that guide our perceptions and our interpretations. David Rosenhan along with seven others went to mental hospitals complaining of hearing voices that were saying empty, hollow and thud. Aside from that they answered all the other questions truthfully, all were diagnosed as mentally ill. When they were released (an average of 19 days) the patients exhibited no further symptoms, yet the clinicians were able to discover the causes of their disorders after analyzing their (quite normal) life histories. Ellen Langer and her colleagues had people rate an interviewee they thought was either normal (a job applicant) or out of the ordinary (a psychiatric or cancer patient) They all watched an identical videotape, those acting as the control saw them as normal, those labeled as patients were viewed as different from most people Stewart Page called 180 people in Toronto who were advertising furnished rooms for rent. When asked if available, nearly always said yes. When mentioned that they were about to be released from jail or a mental hospital, the answer was no 3 out 4 times. The power of labels stigmatizes peoples view of the mentally ill. The media influences peoples stereotypes of the mentally ill 9 out of 10 people with disorders are not dangerous; instead they are anxious, depressed, and withdrawn. o If they steer clear of alcohol and drugs, no more dangerous than your neighbor. Labels can change reality if you are classified, you might act differently and create a self-fulfilling prophecy. Benefits of diagnostic labels. o Enables medical professionals to:

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a) Communicate with each other about the subject matter of their concern b) Comprehend the pathological processes involved in psychiatric illness c) Control psychiatric outcomes. -Anxiety Disorders Anxiety is a part of life, any one of us might feel anxious 7. Anxiety Disorders psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety. 8. Generalized Anxiety Disorder (GAD) an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal. Symptoms of this disorder are commonplace; their persistence is not. Two-thirds of sufferers are women. Continually jittery and tense, worried about bad things that might happen, plagued by muscular tension, agitation and sleeplessness. Shows through slight physical actions furrowed brows, twitching Concentration is difficult Cannot identify, therefore cannot deal with or avoid the cause of anxiety. Freud the anxiety is free floating 9. Panic Disorder an anxiety disorder marked by a minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Terrifying panic attack After several attacks, the individual develops a Panic Disorder o Come to fear the fear itself and avoid situations where the panic strikes Agoraphobia fear or avoidance of situations in which escape might be difficult or help unavailable when panic strikes. o Causes people to avoid being outside the home; being in a crowd. 10. Phobias an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object or situation. o Common psychological disorder that many people accept and live with; however, some specific phobias are incapacitating. Social Phobia an intense fear of being scrutinized by others, the anxious person will avoid potentially embarrassing social situations. 11. Obsessive-Compulsive Disorder an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsion) o Engage in compulsive, rigid, behavior checking ordering, cleaning, hoarding. o Cross the line between normality and disorderly when actions become persistent; so they interfere with the way we live.

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o Checking to see if the door is locked is normal; checking 10 times is not. Anxiety disorders all engage out anticipation of future events, about which older adults, it seems, are less apprehensive I. Explaining Anxiety Disorders Anxiety is both a feeling and a cognition Freud Psychoanalysis assumed that, beginning in childhood, people repress intolerable impulses, ideas, and feelings. This submerged mental energy sometimes produces mystifying symptoms such as anxiety. Today we focus on Learning and Biological explanations. Learning Perspective A. Fear Conditioning When bad events happen unpredictably and uncontrollably, anxiety often develops Classical conditioning of fear responsible for general anxiety Anxiety swells with any reminder of their trauma o Explains why anxious people are hyper attentive to possible threats, and how panic prone people come to associate anxiety with certain cues B. Stimulus Generalization Conditioned fears remain long after we have forgotten the experiences that produced them. New fears arise from generalization of old fears. Heights = Airplane C. Reinforcement When phobias and compulsions arise, reinforcement helps maintain them. Avoiding or escaping the feared situation reduces anxiety, ergo reinforcing the phobic behavior Compulsive behaviors reduce anxiety. D. Observational Learning We might learn fear by observing others fear. Parents transmit their fear to children. Biological Perspective A. Natural Selection Biologically prepared to face fears faced by our ancestors. Most of our phobias focus on objects: animals; closed spaces and heights; storms and darkness. It is easy to condition, but hard to extinguish such stimuli. Our compulsive acts typically exaggerate behaviors that contributed to our species survival. B. Genes Some people genetically predisposed to particular fears and high anxiety. Studies on twins show both of them, being raised separately, developing anxiety disorders Pair a traumatic event with a sensitive, high-strung temperament and the result may be a new phobia.

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C. Physiology GAD, Panic Attacks and even obsessions and compulsions are biologically measurable as an over arousal of brain areas involved in impulse control and habitual behaviors. High activity in area of the frontal lobes just above the eyes. When the distorted brain detects that something is amiss, it generates a mental hiccup of repeating thoughts or actions. Fear-learning experiences can traumatize the brain by soldering fear circuits in the amygdala. -Mood Disorders-

12. Mood Disorders psychological disorders characterized by emotional extremes. See Major Depressive Disorder, Manic Episode, and Bipolar Disorder. 13. Major Depressive Disorder a mood disorder in which a person, for no apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities. Symptoms more likely in the dark months of winter Can be brought on by social stresses [break up] Depression is the common cold of psychological disorders; however still very serious Number one reason people seek mental help services; leading cause of disability worldwide Depression is often a response to past and current loss Depression is a sort of psychic hibernation: It slows us down, avoids attracting predators, restrains futile effort, and evokes support. Provides opportunity to reassess ones life when feeling threatened, redirect energy in more promising ways. Dysthymic Disorder condition where a down-in-the-dumps mood fills most of the day, nearly every day, for two years or more. o Chronic low energy and self-esteem, have difficulty concentrating or making decisions, and sleep and eat too much or too little. 14. Manic Episode - A mood disorder marked by a hyperactive, wildly optimistic, euphoric state. A rebound to the opposite emotional extreme of depression. 15. Bipolar Disorder a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania. (Formerly called manic-depressive disorder) Person usually over talkative, overactive, elated Maladaptive symptom is grandiose optimism and self-esteem leads to reckless investments, spending sprees, and unsafe sex. Individuals in this state need protection from their own judgment In mild forms, can stimulate creativity Explaining Mood Disorders

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Peter Lewinsohn summarized the facts that any theory of depression must explain: 1. Many behavioral and cognitive changes accompany depression. People are inactive and unmotivated Especially sensitive to negative happenings and expect negative outcomes. 2. Depression is widespread. Its causes must be common. 3. Compared with men, women are twice as vulnerable to major depression, even more so if they have been depressed before. Women more vulnerable to passive disorders internalized states such as depression and anxiety. Mens disorders are more active alcohol abuse, antisocial conduct, lack of impulse control. 4. Most major depressive episodes self-terminate. Therapy can speed recovery, but most people return to normal without professional help. The plague of depression comes and goes. 5. Stressful events related to work, marriage, and close relationships often precede depression. Early loss of a parent due to death or separation increases later vulnerability to depression. As with anxiety, with each new generation, the rate of depression is increasing, as well as striking earlier. Freud depression occurs when significant losses evoke feelings associated with losses experienced in childhood. Unresolved anger toward ones parents might be turned inward against the self. Bio-psycho-social perspective replacing Freudian explanation. I. The Biological Perspective Depression is a whole-body disorder. It involves genetic predispositions, biochemical imbalances, melancholy mood, and negative thoughts. A. Genetic Influences: Risk of major depression and bipolar disorder increases if you have a depressed parent or sibling Twins show strong relationship between disorders being genetic Researchers use Linkage Analysis to search for which genes are implicated with bipolar disorder first by searching for families that have had the gene across several generations, then drawing blood from affected and unaffected family members, examining for differences. Many genes have small effects that can combine to put some people at greater risk for depression. B. The Depressed Brain Norepinephrine neurotransmitter that increases arousal and boosts mood- is overabundant during mania and scarce during depression. Correlation between smoking and depression. CAMERONPHILLIPS2012

Smoking may precede depression, but may also be a means of selfmedicating as it temporarily increases norepinephrine and boosts mood. Serotonin is scarce during depression. Anti-Depressants [Prozac, Zoloft] relieve depression by blocking either their reuptake or their chemical breakdown. Repetitive exercise, such as jogging, increases serotonin. Brain found to be less active among depressed people; the left frontal lobe [active during positive emotions] likely to be inactive in depressed state. Serotonin increases hippocampus neuron growth II. Social-Cognitive Perspective Self-Defeating Beliefs feed vicious cycle of negative assumptions that leads to magnifying bad experiences and minimizing good ones. Women more prone to stress; therefore more prone to anxiety and depression Depressed people explain bad events in terms that are stable, global, and internal. Pessimistic, overgeneralized, and self-blaming attributions results in a depressing sense of hopelessness. If you temporarily put people in a bad or sad mood, their memories, judgments, and expectations suddenly become more pessimistic. Women tend to think; men tend to act. When things arent going our way, it may seem as though they never will. If you have an optimistic way of interpreting events, a failure or stress is unlikely to provoke depression. Martin Seligman a recipe for severe depression is preexisting pessimism encountering failure Edward Hirt demonstrated that even small losses could sour our thinking. Susan Nolen-Hoeksema and Jannay Morrow those who tended to brood over negative events showed more symptoms of depression after the 1989 San Francisco earthquake. Lauren Alloy monitored college students and found that those with positive outlooks were not likely to get depressed. Depression causes self-focused negative thinking; Self-focused, selfblaming style of explaining events puts one at risk for depression when bed events strike. Penn Optimism Program for children 9 to 13 who are targeted as at risk for depression. Puts the children through 12 small group sessions, each lasting 2 hours, in which hey learn to tune into their thoughts when facing tough situations and to imagine alternatives to negative thoughts. The training halved the proportion of children suffering depression for up to 2 years

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Stephen Strack and James Coyne depressed persons induced hostility, depression, and anxiety in others and got rejected Misery may love anothers company, but company does not love anothers misery 16. Dissociative Disorders disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. Occurs when a situation is overwhelmingly stressful. Patients have a sense of being unreal, of being separated from their body, or watching themselves in a movie. During trauma, can protect a person from being overwhelmed by emotion. 17. Dissociative Identity Disorder a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Also called multiple personality disorder. Each voice has its own voice and mannerisms, with the original one denying the existence of the other ones. Skepticism of whether it is real or not; some say a cultural phenomenon. To relieve anxiety. - Schizophrenia 1 in 100 people will develop schizophrenia Typically strikes as young people are maturing into adulthood 18. Schizophrenia a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions. I. Symptoms A. Disorganized Thinking Schizophrenic patients thinking is fragmented, bizarre and distorted by delusions. 19. Delusions false beliefs, often of persecution or grandeur, that may accompany psychotic disorders. Ideas can change mid-sentence creating a word salad Those with paranoid tendencies are particularly prone to delusions of persecution. Disorganized thoughts result from a breakdown in selective attention. Have trouble clearing their memory of distracting information and irrelevant material. B. Disturbed Perceptions Perceive things that are not there. Usually auditory hallucinations voices that make insulting statements or give orders C. Inappropriate Emotions and Actions Emotions utterly inappropriate

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Some victims lapse into the flat affect a zombielike state of apparent apathy. Motor behaviors may also be inappropriate Disrupts social relationships. II. Subtypes of Schizophrenia Schizophrenia is a cluster of disorders that share common features, but also have some distinguishing symptoms. Positive symptoms hallucinations, disorganized and deluded, inappropriate laughter, tears, or rage. Negative toneless voices, expressionless faces, mute or rigid bodies. Positive is the presence of inappropriate behavior; negative the absence of appropriate behaviors. Sometimes schizophrenia develops gradually from a long history of social inadequacy; other times it appears suddenly, semmingly as a reaction to stress. When schizophrenia is a slow-developed process (chronic, or process) recovery is doubtful. When in reaction to particular life stresses, a previously well adjusted person develops schizophrenia rapidly (acute, or reactive) recovery is much more likely. Subtypes of Schizophrenia Paranoid Preoccupation with delusions or hallucinations, often with themes of persecution or grandiosity. Disorganized Disorganized speech or behavior, or flat or inappropriate emotion. Catatonic Immobility (or excessive, purposeless movement), extreme negativism, and/or parrot-like repeating of anothers speech or movements Undifferentiated Many and varied symptoms. Residual Withdrawal, after hallucinations and delusions have disappeared. III. Understanding Schizophrenia Schizophrenia is a disease of the brain exhibited in symptoms of the mind. A. Brain Abnormalities Schizophrenia symptoms might have a biochemical key. Dopamine receptors in schizophrenic patients are six times that of a normal person. This intensifies brain signals in schizophrenic patients, causing hallucinations and paranoia. o Drugs that block dopamine receptors often lessen the symptoms, but have little effect on persistent negative symptoms of withdrawl.

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Glutamate chemical that directs neurons to pass along an impulse research found that street drugs can interfere with receptors and produce schizophrenic-like negative symptoms. Schizophrenic patients have abnormally low brain activity in the frontal lobes. While hallucinating increased activity in the thalamus. Large fluid filled areas within brain corresponding with shrinkage of cerebral tissue. Greater the shrinkage, the greater the thoughts disorders tend to be Low birth weight and birth complications such as oxygen deprivation are known risk factors for schizophrenia. Questions about mid-pregnancy viral infections and their affect on brain development. Are people at increased risk of schizophrenia if, during the middle of their fetal development, their country experiences a flu epidemic? Yes. Are people born in densely populated areas, where viral diseases spread more readily, at greater risk for schizophrenia? Yes. Are those born during the winter and spring months after the fallwinter flu season also at increased risk? Yes. In the Southern Hemisphere, where the seasons are the reverse of the Northern Hemisphere, are the months of above-average schizophrenia similarly reversed? Yes. Are mothers who report being sick with influenza during pregnancy more likely to bear children who develop schizophrenia? Yes. Does blood drawn from pregnant women whose offspring develop schizophrenia show higher-than-normal levels of antibodies that suggest a viral infection? Yes. B. Genetic Factors Some people inherit a predisposition to certain brain abnormalities. Twins who share the same placenta are more likely to experience the same prenatal viruses. Influenced by multiple genes of small effects Susan Nicol and Irving Gottesman concluded that some people have a genetic disposition to the disorder, but that this predisposition by itself is not sufficient for the development of schizophrenia C. Psychological Factors Not sure of the psychological triggers for schizophrenia Bio-psycho-social = the traffic between brain biochemistry and psychological experiences runs both ways. CAMERONPHILLIPS2012

Warning Signs: A mother whose schizophrenia was severe and long-lasting Birth complications, often involving oxygen deprivation and low birth weight Separation from parents Short attention span and poor muscle coordination Disruptive or withdrawn behavior Emotional unpredictability Poor peer relations and solo play -Mood Disorders20. Personality Disorders psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning. Avoidant Personality Disorder a cluster of disorders that expresses anxiety, such as fearful sensitivity to rejection Schizoid Personality Disorder expresses eccentric behaviors, such as social disengagement Histrionic Personality Disorder displays shallow, attention-getting emotions and goes to great lengths to gain others praise and reassurance. Narcissistic Personality Disorder exaggerate their own importance, aided by success fantasies. Find criticism hard to accept, often reacting with rage or shame. Borderline Personality Disorder have an unstable identity, unstable relationships, and unstable emotions. 21. Antisocial Personality Disorder a personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. May be aggressive and ruthless or a clever con artist. Formerly known as being a Sociopath or a Psychopath Half of antisocial children become antisocial adults When the antisocial personality combines a keen intelligence with amorality, the result may be a charming and clever con artist or worse. Most criminals DO NOT fit the description of antisocial personality disorder. Antisocial people feel little and fear little results can be horrifyingly tragic. Both genetic and psychological factors lead to ASPD When a known adverse event is about to care, ASPD individuals show little autonomic nervous system arousal. Those affected have marked deficits in frontal lobe cognitive functions, such as planning, organization, and inhibition. Rates of Psychological Disorders

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Summarizing the NIMH study and a later government survey, William Narrow and his colleagues estimate that 1 in 6 Americans suffers clinically significant mental disorders. Britains Office of National Statistics (2002) recently reported a similar 1 in 6 rate of active disorders. An Australian government survey of 10,600 adults found that in any 12 months, slightly less than 1 in 6 have a mental disorder. Another Australian government study of 4500 children and adolescents concluded that 1 in 7 had mental health problems

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