Transcript Psychological Disorders PSYCHOLOGY Mr. Noble 2008-09

Psychological Disorders
PSYCHOLOGY
Mr. Noble
2008-09
A special thanks to my former student teacher--Ms. Sharon Mohr--for her diligent
research, insightful professional expertise, and valuable thoughtful effort in
compiling much of the information included in this overview of
Psychological Disorders.
Defining Abnormality
Difficult to define…
3 Criteria…
Deviance
 Distress
 Disability/Maladaptive Behavior

Symptom/Behavior Continuum:
_----_________________
Abnormal
normal range__ __________________+++
Abnormal
Ancient Perspective
Perceived Causes
 movements
 lunacy-
 evil
of sun or moon
full moon
spirits
Ancient Treatments
 exorcism,
caged like animals, beaten, burned,
mutilated, blood replaced with animal’s blood
Bio-psycho-social Model
Biological
(chemistry, brain)
Sociocultural
(Societal expectations,
definition of normality
and disorder)
Psychological
( learned helplessness,
negative perceptions
and memories)
assumes that
biological,
sociocultural, and
psychological
factors combine
and interact to
produce
psychological
disorders
Medical Model
Diagnosis
 Label
for a set of symptoms
Prognosis
 Prediction
or forecast for the course of a
D/O
Etiology
 Suspected
cause of a disorder
Classifying Disorders
DSM-IV-TR
Diagnostic and Statistical Manual of Mental
Disorders, 4th edition, Text Revision
 Published by the American Psychiatric Association
 2000…(most recent update 2004)
 Next major revision (DSM-V) anticipated for 2011.

Provides for reliable classification and description
of all mental illnesses
Allows for better communication
DSM’s Multi-axial Diagnosis
Axis I Major Clinical Disorders
Axis II Mental Retardation & Personality Disorders
Axis III General Medical Conditions
Axis IV Psychosocial/Environmental
Stressors
Axis V Global Assessment of Functioning
# between 1 and 100
 Current and Highest in past year

Labeling Issues
Reasons to Label/Diagnose:
Needed for communication
 Guide treatment
 Insurance reimbursement

Arguments against Labeling:
Creates a stigma
 Creates a self-fulfilling prophecy
 Fail to see the person behind the disorder

Major Classes of Disorders
Anxiety Disorders
Mood Disorders
Somatoform Disorders
Dissociative Disorders
Schizophrenia
Substance Use Disorders
Other Axis I Disorders
Personality Disorders (Axis II)
I. Anxiety Disorders
Characterized by generalized
apprehension, worry, and a variety of
physical symptoms
Generalized Anxiety Disorder
Phobias
Panic Disorder
Obsessive-Compulsive Disorder
Post-traumatic Stress Disorder
Generalized Anxiety Disorder
Experiencing a continuous, generalized
feeling of anxiety (reaction to vague or
imagined dangers) – 6 months or more
Anxiety in many different areas of life
Accompanied by physical symptoms…
muscle tension, trouble sleeping, irritability,
lack of concentration, headaches, fatigue,
inability to relax, twitching/trembling, etc.
Phobias
Specific Phobia


Severe anxiety is
focused on a specific
object or situation
Examples:
 Enclosed spaces
 Snakes
 Spiders
 Heights
 Flying
Social Phobia


Fear of embarrassing
oneself in a social
situation
Speaking, eating,
using bathroom in
public
Agoraphobia


“fear of the
marketplace”
Associated with panic
disorder
PHOBIAS
http://www.phobialist.com/reverse.html
Common and uncommon phobias
100
Percentage 90
of people 80
surveyed
70
60
50
40
30
20
10
0
Snakes
Being Mice Flying Being Spiders Thunder Being Dogs
in high,
on an closed in, and
and
alone
exposed
airplane in a
insects lightning In a
places
small
house
place
at night
Afraid of it
Bothers slightly
Not at all afraid of it
Driving Being
Cats
a car
In a
crowd
of people
PHOBIAS
Treatment
Exposure Treatment
Flooding
Counter-Conditioning
Systematic Desensitization
(1) training the patient to physically relax
(2) establishing an anxiety hierarchy of the stimuli
(3) counter-conditioning relaxation responding to ea. feared stimulus
Biofeedback
Modeling
“Nothing is so much to be feared as Fear”
Panic Disorder
---Henry David Thoreau
Frequent Panic Attacks or fear of them:
Sudden and unexplainable attacks of
intense fear
 Come on without warning
 Not associated with a stimulus
 Individual fears that he/she is about to die
 Physical symptoms…choking, tightness in
chest, difficulty breathing, nausea, dizziness
 Commonly occurs with Agoraphobia

Obsessive-Compulsive Disorder
OBSESSIONS
Intrusive and
uncontrollable
thoughts
 Contamination,
safety, etc.

COMPULSIONS
Ritualistic and
purposeless
actions
 Cleaning, washing,
checking, etc.

O and C are
usually related…
compulsions help
to decrease the
anxiety caused by
the obsession
This pattern
begins to interfere
with functioning
OCD
Common Obsessions and Compulsions Among
People With Obsessive-Compulsive Disorder
Thought or Behavior
Percentage*
Reporting Symptom
Obsessions (repetitive thoughts)
Concern with dirt, germs, or toxins
40
Something terrible happening (fire, death, illness)
24
Symmetry order, or exactness
17
Compulsions (repetitive behaviors)
Excessive hand washing, bathing, tooth brushing,
or grooming
85
Repeating rituals (in/out of a door,
up/down from a chair)
Checking doors, locks, appliances,
car brake, homework
51
46
Post-traumatic Stress Disorder
Common among veterans of combat,
survivors of accidents and disasters, victims
of crimes, etc.
Feel long-lasting after-effects of trauma
Flashbacks, nightmares, insomnia, mood
symptoms, stimulus generalization
Symptoms last more than 1 month… up to
years later
II. Mood Disorders
Mental disorders characterized by
disturbances of mood that are intense and
persistent enough to be maladaptive
Normal range of mood…
 Major
Depressive Disorder
 Bipolar Disorder
Major Depressive Disorder
Clinical depression/Major Depression
Unipolar depression
Single-episode or recurrent episodes
Symptoms must occur for at least 2 weeks
Subtypes:
Post-partum onset
 S.A.D.

Secondary symptoms…
Depression…symptoms
Sleep disturbance
Interest 
Guilt/worthlessness
Energy  = fatigue
Concentration 
Appetite disturbance/weight gain/loss
Psychomotor agitation/retardation
Suicidal/thoughts of death
Causes of Depression
Genetic Predisposition

+ stressful life events
Neurotransmitters
Serotonin
 Norepinephrine

Cognitive Theories

Beck & Seligman
Behavioral Theories
Bipolar Disorder
Previously known as Manic-Depression
Experience both manic and depressive
episodes

Mania = emotional state characterized by
intense and unrealistic feelings of excitement
and euphoria, along with impulsivity
Cycles…not mood swings
High rate of suicide
Mood Disorders-Bipolar
PET scans show that brain energy consumption rises and
falls with emotional swings
Depressed state
Manic state
Depressed state
Mood Disorders & Suicide
Not all people who commit suicide are
depressed; Not all depressed people commit
suicide
Associated with mood disorders, especially
bipolar disorder (also schizophrenia)
Warning Signs…
Risk factors…
Prevention…
SUICIDE:
Male v. Female
Males
•Suicide is the eighth leading cause of death for all U.S. men.
•Males are four times more likely to die from suicide than females.
•Suicide rates are highest among Whites and second highest among
American Indian and Native Alaskan men.
•Of the 24,672 suicide deaths reported among men in 2001, 60%
involved the use of a firearm.
Females
•Women report attempting suicide during their lifetime about three
times as often as men.
SUICIDE:
Youth
•Overall rate of suicide among youth has declined slowly since ‘92.
•However, rates remain unacceptably high.
•Adolescents and young adults often experience stress, confusion,
and depression from situations occurring in their families, schools,
and communities.
•Such feelings can overwhelm young people and lead them to
consider suicide as a “solution.”
•Few schools and communities have suicide prevention plans that
include screening, referral & crisis intervention programs for
youth.
SUICIDE:
Youth
•Suicide is the third leading cause of death among
young people ages 15 to 24.
•Of the total number of suicides among ages 15 to
24 in 2001, 86% were male and 14% were female.
•American Indian and Alaskan Natives have the
highest rate of suicide in the 15 to 24 age group.
•In 2001, firearms were used in 54% of youth
suicides.
SUICIDE:
Risk Factors
The first step in preventing suicide is to identify and
understand the risk factors.
•Previous suicide attempt(s)
•History of mental disorders, particularly depression
•History of alcohol and substance abuse
•Family history of suicide
•Family history of child maltreatment
•Feelings of hopelessness
•Impulsive or aggressive tendencies
•Barriers to accessing mental health treatment
SUICIDE:
Risk Factors
The first step in preventing suicide is to identify and
understand the risk factors.
•Loss (relational, social, work or financial)
•Physical illness
•Easy access to lethal methods
•Unwillingness to seek help due to stigma
•Local epidemics of suicide
•Isolation - feeling cut off from other people
SUICIDE:
Protective Factors
Protective factors buffer people from the risks associated
with suicide. A number of protective factors have been
identified:
•Effective clinical care
•Easy access to clinical interventions & support
•Family and community support
•Medical & mental health care relationships
•Problem solving, conflict resolution skills
•Cultural & religious beliefs/support
III. Somatoform Disorders
Also know as Hysteria (Freud)
Conditions involving physical complaints or
disabilities that occur without physical
pathology
NOT psychosomatic disorders…
 Conversion
Disorder
 Hypochondriasis
Conversion Disorder
Conversion of emotional difficulties into
the persistent loss of a physiological
function
Paralysis, loss of feeling, exceptional
sensitivity, mutism, blindness, deafness
Not faking a physical problem
Cannot be explained physically
Hypochondriasis & Somatization
Disorders
Hypochondriasis
Preoccupation with
fear that he/she has a
serious disease
Based on the
misinterpretation of
bodily symptoms
Mountain out of a
molehill
No evidence of illness
Somatization Disorder
History of diverse
physical complaints of
all varieties (all body
systems)
Focus on numerous
symptoms
Many trips to doctor,
many medications, no
root cause found
IV. Dissociative Disorders
Dissociation…the human mind’s capacity to
mediate complex mental activity in
channels split off from or independent of
conscious awareness
A way of managing anxiety and stress…
Psychogenic/Dissociative Amnesia & Fugue
Dissociative Identity Disorder
Amnesia & Fugue
PSYCHOGENIC
AMNESIA
Inability to recall
certain personal
information,
which is still know
at the unconscious
level
 Loss in episodic
memory, not
procedural or
semantic

PSYCHOGENIC
FUGUE
Loss of memory
accompanied by
an actual flight
from one’s present
life situation to a
new environment
 May take on a new
identity

Dissociative Identity Disorder
Previously known as
Multiple Personality
Disorder
Individual manifests at least two or more
distinct systems of identity
Host personality + Alter identities (15)
Associated with childhood abuse
Rare disorder; Popular in media
Can be faked or influenced by therapist
V. Schizophrenia
Characterized by confused and disordered
thoughts and perceptions
Most debilitating of the mental disorders;
Deterioration of adaptive behavior
Subtypes:
Paranoid
 Disorganized
 Catatonic
 Undifferentiated

Schizophrenia…symptoms
Bizarre behaviors (catatonia, others)
Affect (inappropriate, flat)
Delusions
Speech (disorganized, incoherent)
Hallucinations
Inability to care for self or function
Negative symptoms
Positive vs. Negative Sx
POSITIVE SYMPTOMS
Presence of something abnormal
 Examples:

NEGATIVE SYMPTOMS
Absence of something normal
 Examples:

Schizophrenia…
DELUSIONS
False beliefs maintained in the face of contrary
evidence
 Types:
Grandeur
Identity

Persecution
Reference
HALLUCINATIONS
Sensations in the absence of external stimuli
 Types: visual, auditory, tactile, olfactory,
gustatory

Causes of Schizophrenia
Genetic Predisposition

Twin study evidence
Neurotransmitters

Dopamine hypothesis
Brain Structure & Function
Family & Interactions
Double-bind theory
 Schizophrenogenic mother

VI. Substance Use Disorders
Substance Abuse
Substance Dependence
Psychological dependence + Addiction
 Alcoholism = Alcohol Dependence

Important terms…
Tolerance
 Withdrawal

VII. Other Axis I Disorders
Eating Disorders
Sleep Disorders
Disorders of childhood and adolescence

Autism, ADHD, Tourette’s, Conduct Disorder
Sexual and Gender Identity Disorders
Cognitive Disorders
Impulse Control Disorders
Adjustment Disorders
VIII. Personality Disorders
Diagnosed on Axis II
Stem from the gradual development of inflexible
and distorted personality and behavioral
patterns that result in persistently maladaptive
ways of relating to the world
Ego-syntonic…not a problem for the person
 A problem for others
Resistant to treatment (only behavioral)
FOCUS Antisocial, Narcissistic, OCPD
Symptoms of Obsessive Compulsive
Personality Disorder
OCPD symptoms tend to appear early in adulthood and are defined by inflexibility,
close adherence to rules, anxiety when rules are transgressed, and unrealistic
perfectionism. A person with obsessive compulsive personality disorder exhibits
several of the following symptoms:
•abnormal preoccupation with lists, rules, and minor details
•excessive devotion to work, to the detriment of social and family activities
•miserliness or a lack of generosity
•perfectionism that interferes with task completion, as performance is never good
enough
•refusal to throw anything away (pack-rat mentality)
•rigid and inflexible attitude towards morals or ethical code
•unwilling to let others perform tasks, fearing the loss of responsibility
•upset and off-balance when rules or routines disrupted.
Psychopathology & The Law
Competence to Stand Trial

Can individual participate in own defense at
time of trial?
Involuntary Civil Commitment
Should individual be hospitalized against their
will due to imminent danger?
 Suicidal or homicidal
 Decided by doctor, then court; need evidence

More Legal Issues…State-level
Insanity Plea

Should individual not be held accountable due
to their mental state at the time of the crime?

Could not determine right from wrong
Determined by judge before actual trial
 Difficult to prove, but prevalent in media
 Sent for treatment, then released

*Insanity is a LEGAL term…!
More Legal Issues…State-level
Guilty but Mentally Ill
Alternative to insanity plea in some states
 Adopted by Pennsylvania…
 1st trial determines guilt or innocence
 2nd trial determines sanity or insanity
 Sent for treatment, then to prison to complete
sentence…get treatment as well as punishment

TYPES OF PSYCHOTHERAPY — A number
of types of psychotherapy are used to treat
psychological disorders:
•Cognitive therapy identifies habitual ways
in which patients distort information (e.g.
automatic thoughts) and teaches patients to
identify, evaluate, and respond to their
dysfunctional thoughts and beliefs, using a
variety of techniques to change thinking,
mood, and behavior. Cognitive therapy is a
structured, goal oriented, problem focused,
and time limited intervention.
TYPES OF PSYCHOTHERAPY
•Behavioral therapy attempts to alter
behavior by systematically changing the
environment that produces the behavior.
Behavioral changes are believed to lead to
changes in thoughts and emotions.
•Exposure-based behavioral treatments
utilize gradual, systematic, repeated
exposure to the feared object or situation to
allow patients with anxiety disorders to
become desensitized to the feared stimulus.
TYPES OF PSYCHOTHERAPY
•Cognitive Behavioral therapy (CBT)
combines principles of both behavioral and
cognitive therapy, focusing simultaneously on
the environment, behavior, and cognition.
Cognitive behavioral therapy is also
structured, goal directed, problem focused.
Patients learn how their thoughts contribute
to symptoms of their disorder and how to
change these thoughts. Increased cognitive
awareness is combined with specific
behavioral techniques.
TYPES OF PSYCHOTHERAPY
•Problem Solving therapy, a short-term,
cognitive behavioral intervention, teaches a
systematic method for solving current and
future problems. Patients acquire new skills
for successfully resolving interpersonal
difficulties. These skills include the following
sequential steps: 1) Problem definition; 2)
Goal setting; 3) Generating, choosing, and
implementing solutions; and 4) Evaluating
outcomes.
TYPES OF PSYCHOTHERAPY
•Interpersonal therapy addresses issues
such as grief, role transitions, interpersonal
role disputes, and interpersonal deficits as
they relate to the patient's current
symptoms.
•Family therapy attempts to correct
distorted communications and relationships
as a means of helping the entire family,
including the identified patient. In patients
with serious mental illness, such as
schizophrenia, family therapy helps family
members learn about the disorder, solve
problems, and cope more constructively with
the patient's illness.
TYPES OF PSYCHOTHERAPY
•Psychoeducation provides patients with
information about their diagnosis, its treatment, how
to recognize signs of relapse, relapse prevention, and
strategies to cope with the reality of prolonged
emotional or behavioral difficulties.
•The goal of psychoeducation is to reduce distress,
confusion, and anxiety within the patient and/or the
patient's family to facilitate treatment compliance and
reduce the risk of relapse.
•Psychoeducation is often particularly helpful for
patients and the families of patients with chronic,
severe psychiatric disorders such as schizophrenia and
bipolar disorder.