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Psychological Disorders Psychological Disorders

I felt the need to clean my room … spent four to five hour at People are fascinated by the exceptional, the it … At the time I loved it but then didn't want to do it any unusual, and the abnormal. This fascination may be more, but could not stop … The clothes hung … two fingers caused by three reasons: apart …I touched my bedroom wall before leaving the house … I had constant … I thought I might be nuts. . During various moments we feel, think, and act like an Marc, diagnosed with abnormal individual. obsessive-compulsive disorder . Psychological disorders may bring unexplained physical (from Summers, 1996) symptoms, irrational , and suicidal thoughts. . A reminder of our species’ fragility. http://www.youtube.com/watch?v=Rn1OYlYzgm8&feature=related

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Psychological Disorders Defining Psychological Disorders

To study the abnormal is the best way of workers view psychological disorders understanding the normal. as persistently harmful thoughts, feelings, and William James (1842-1910) actions.

. There are 450 million people suffering from When behavior is deviant, distressful, and psychological disorders (WHO, 2004). [current dysfunctional psychiatrists and psychologists label it population of US is 307 million] as disordered (Comer, 2004).

. Depression and exist in all cultures of the world.

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1 Deviant, Distressful & Dysfunctional Understanding Psychological Disorders

. Deviant behavior (going Ancient Treatments of psychological disorders include naked) in one culture may be considered normal, trephination, exorcism, being caged like animals, while in others it may lead being beaten, burned, castrated, mutilated, or to arrest. transfused with animal’s blood. . Deviant behavior must Carol Beckwith

accompany distress to be John W. Verano a disorder.

. If a behavior is In the Wodaabe tribe men wear dysfunctional it is clearly costumes to attract women. In a disorder. Western society this would be considered abnormal.

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Medical Perspective Medical Model

Philippe Pinel (1745-1826) from France, insisted that When physicians discovered that syphilis led to mental madness was not due to demonic possession, but an disorders, they started using medical models to review the ailment of the mind. physical causes of these disorders. George Wesley Bellows, 1. Etiology: Cause and development of the disorder.

Dancer in a Madhouse 2. Diagnosis: Identifying (symptoms) and distinguishing one from another. , 1907. © 1997 The Art Institute of Chicago 3. Treatment: Treating a disorder in a psychiatric hospital. 4. Prognosis: Forecast about the disorder.

Dance in the madhouse. 9 10

Biopsychosocial Perspective Classifying Psychological Disorders

Assumes that biological, socio-cultural, and The American Psychiatric Association rendered a psychological factors combine and interact to Diagnostic and Statistical Manual of Mental produce psychological disorders. Disorders (DSM) to describe psychological disorders. The most recent edition, DSM-IV-TR (Text Revision, 2000), describes 400 psychological disorders compared to 60 in the 1950s.

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2 Multiaxial Classification Multiaxial Classification

Is a Clinical Syndrome (cognitive, anxiety, mood Note 16 syndromes in Axis I Axis I disorders [16 syndromes]) present? Is a Personality Disorder or Mental Retardation Axis II present? Is a General Medical Condition (diabetes, Axis III hypertension or arthritis etc) also present? Are Psychosocial or Environmental Problems Axis IV (school or housing issues) also present? What is the Global Assessment of the person’s Axis V functioning?

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Multiaxial Classification Goals of DSM

Note Global Assessment for Axis V 1. Describe (400) disorders. 2. Determine how prevalent the disorder is.

Disorders outlined by DSM-IV are reliable. Therefore, diagnoses by different professionals are similar.

Others criticize DSM-IV for “putting any kind of behavior within the compass of .”

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Labeling Psychological Disorders Labeling Psychological Disorders

1. Critics of the DSM-IV argue that labels may 2. Labels may be helpful for healthcare stigmatize individuals. professionals when communicating with one another and establishing therapy. N. N. Tomes, Elizabeth Eckert, Middletown, NY. From L. Gamwell and BUT, Rosenhan’s “study” - self- Madness in Madness America, perpetuating aspects of labels

1995. Cornell University Press. Graduate students, during psychiatric assessment, claimed to be hearing voices that were often unclear, but which seemed to pronounce the words "hollow", "empty", and "thud." Asylum baseball team (although comprised of hospital staff, observers saw psychological 17 18 symptoms in these players)

3 Labeling Psychological Disorders Anxiety Disorders

3. “Insanity” labels Feelings of excessive apprehension and anxiety. raise moral and ethical questions about how society 1. Generalized anxiety disorders should treat people 2. who have disorders and have committed Elaine Thompson/ AP Photo 3. Panic disorders crimes. 4. Obsessive-compulsive disorders NGRI, GBI??

Theodore Kaczynski 19 20 (Unabomber)

Generalized

Symptoms Symptoms

1. Persistent and uncontrollable tenseness and Minute-long episodes of intense dread which may apprehension. include feelings of terror, chest pains, choking, or 2. Autonomic arousal. other frightening sensations. 3. Inability to identify or avoid the cause of certain feelings. Anxiety is a component of both disorders. It occurs more in the panic disorder, making people avoid situations that cause it.

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Phobia Kinds of Phobias

Marked by a persistent and irrational of an object of open places. or situation that disrupts behavior.

Acrophobia Phobia of heights.

Claustrophobia Phobia of closed spaces.

Hemophobia Phobia of blood.

http://phobialist.com/

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4 Obsessive-Compulsive Disorder Dylan’s OCD Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress.

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Brain Imaging Post-Traumatic Stress Disorder

A PET scan of the brain of Four or more weeks of the following symptoms a person with Obsessive- constitute post-traumatic stress disorder (PTSD): Compulsive Disorder (OCD). High metabolic activity (red) in the frontal 1. Haunting memories lobe areas are involved with directing attention. 2. Nightmares 3. Social withdrawal

Red means a difference between the group in 4. Jumpy anxiety Bettmann/ Corbis question (in this case, those with OCD) and a control or comparison group. (yellow does, too, 5. Sleep problems but to a lesser extent) Brain image of an OCD 27 28

Resilience to PTSD Explaining Anxiety Disorders

• Only about 10% of women and 20% of men react to Freud suggested that we repress our painful and traumatic situations and develop PTSD. intolerable ideas, feelings, and thoughts, resulting in anxiety. • Holocaust survivors show remarkable resilience against traumatic situations.

• All major religions of the world suggest that surviving a trauma leads to the growth of an individual. – Does this expectation help or hurt individuals?

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5 The Learning Perspective The Learning Perspective

Learning theorists Investigators believe that fear responses can also be suggest that fear acquired through observational learning. Young conditioning leads to monkeys develop fear when they watch other anxiety. This anxiety then monkeys who are afraid of snakes. becomes associated with other objects or events Hmm, maybe I (stimulus generalization) should be John Coletti/John Stock, Boston frightened of and is reinforced. snakes…

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The Biological Perspective The Biological Perspective monitoring in obsessive-compulsive disorder. Ursu, S. V.A. Stenger, Shear, M.K. &Carter Jones, C.S. M.R. (2003). Overactive action Natural Selection has led our ancestors to learn to Generalized anxiety, fear snakes, spiders, and other animals. Therefore, panic attacks, and even fear preserves the species. OCD are linked with brain circuits like the Psychological Science, 14, anterior cingulate cortex. Twin studies suggest that our genes may be partly 347-353. responsible for developing fears and anxiety. Twins Maybe Jung would say are more likely to share phobias. these genes that make us Anterior Cingulate Cortex naturally fearful are part of an OCD patient. of our “collective unconscious?” 33 34

Dissociative Disorder Dissociative Identity Disorder (DID)

Conscious awareness becomes separated Is a disorder in which a person exhibits two or more (dissociated) from previous memories, thoughts, and distinct and alternating personalities, formerly called feelings. multiple personality disorder.

Symptoms

1. Having a sense of being unreal. Lois Bernstein/ Gamma Liason 2. Being separated from the body. 3. Watching yourself as if in a movie.

Chris Sizemore (DID) 35 36 On whom “Three Faces of Eve” was based. Herschel Walker (DID)

6 DID Critics Mood Disorders

Critics argue that the diagnosis of DID increased in Emotional extremes of mood disorders come in two the late 20th century. And, DID has not been found in principal forms. other countries.

Critics’ Arguments 1. Major depressive disorder 1. Role-playing by people open to a 2. therapist’s suggestion. 2. Learned response that reinforces reductions in anxiety and avoidance of responsibility. 37 38

Major Depressive Disorder Major Depressive Disorder

In terms of frequency, depression is the “common Major depressive disorder occurs when signs of cold” of psychological disorders. In a year, 5.8% of depression last two weeks or more and are not men and 9.5% of women report depression caused by drugs or medical conditions. worldwide (WHO, 2002).

An Analogy: Signs include: Blue mood Major Depressive Disorder 1. Lethargy and fatigue Is to: as Is to: 2. Feelings of worthlessness Gasping for air after a Chronic shortness of 3. Loss of interest in family & friends hard run breath 4. Loss of interest in activities

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Dysthymic Disorder Bipolar Disorder

Dysthymic disorder lies between a blue mood and Formerly called manic-depressive disorder. An major depressive disorder. It is a disorder alternation between depression and signals characterized by daily depression lasting two years bipolar disorder. or more. Depressive Symptoms Manic Symptoms

Gloomy Elation Blue Dysthymic Major Depressive Withdrawn Euphoria Disorder Inability to make decisions Desire for action Tired Hyperactive Slowness of thought Multiple ideas 41 42

7 Bipolar Disorder Explaining Mood Disorders

Many great writers, poets, and composers suffered Since depression is so prevalent worldwide, from bipolar disorder. During their manic phase investigators want to develop a theory of depression creativity surged, but not during their depressed that will suggest ways to treat it. phase. George C. Beresford/ Hulton Getty Pictures Library Earl Theissen/ Hulton Getty Pictures Library Lewinsohn et al., (1985, 1995) note that a theory of depression should explain the following: The Granger Collection

Bettmann/ Corbis 1. Behavioral and cognitive changes 2. Common causes of depression Whitman Wolfe Clemens Hemingway

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Theory of Depression Theory of Depression

3. Gender differences 4. Depressive episodes self-terminate. 5. Depression is increasing, especially in the teens. Desiree Navarro/ Getty Images

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Suicide New Theory of Depression The most severe form of behavioral response to • Allen & Badcock (2003, Psych Bulletin) depression is suicide. Each year some 1 million – “Social Risk Hypothesis” people commit suicide worldwide. • Depressive state evolved as alerting mechanism when at risk of social exclusion, necessary since Pleistocene period, because social exclusion would equal death. Suicide Statistics • Mechanism works to minimize social exclusion by changing th social perception and social behavior in response to others’ 1. National differences (39 ) behavior 2. Racial differences – This theory could address those points, but one problem with this theory is that the depressive mechanism seems 3. Gender differences to shut person down rather than energize them to 4. Age differences improve their inclusionary status. 5. Other differences 47 48

8 Biological Perspective Neurotransmitters & Depression

Genetic Influences: Mood disorders run in families. A reduction of The rate of depression is higher in identical (50%) norepinephrine and than fraternal twins (20%). serotonin has been Pre-synaptic found in depression. Neuron Serotonin Linkage analysis and Norepinephrine association studies link Drugs that alleviate

possible genes and dispositions Jerry Irwin Photography Post-synaptic for depression. mania reduce Neuron norepinephrine.

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The Depressed Brain Social-Cognitive Perspective

PET scans show that brain energy consumption rises The social-cognitive perspective suggests that and falls with manic and depressive episodes. depression arises partly from self-defeating beliefs and negative explanatory styles. Phelps, UCLA School of Medicine Courtesy of Lewis Baxter an Michael E.

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Depression Cycle Example

1. Negative stressful events. 2. Pessimistic explanatory style. 3. Hopeless depressed state. 4. These hamper the way the individual thinks and acts, fueling personal rejection.

Explanatory style plays a major role in becoming depressed. 53 54

9 Schizophrenia Symptoms of Schizophrenia

The literal translation is “split mind.” A group of If depression is the common cold of psychological severe disorders characterized by the following: disorders, schizophrenia is the cancer.

. Disorganized and delusional Nearly 1 in a 100 suffer from schizophrenia, and thinking. throughout the world over 24 million people suffer from this disease (WHO, 2002). . Disturbed perceptions. . Inappropriate emotions and Schizophrenia strikes young people as they mature actions. into adults. It affects men and women equally, but men suffer from it more severely than women.

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Disorganized & Delusional Thinking Disorganized & Delusional Thinking

This morning when I was at Hillside [Hospital], I was making Many psychologists believe disorganized thoughts a movie. I was surrounded by movie stars … I’m Marry occur because of selective attention failure Poppins. Is this room painted blue to get me upset? My (fragmented and bizarre thoughts). grandmother died four weeks after my eighteenth birthday.”

(Sheehan, 1982)

ThisOther monologue forms of illustrates include, fragmented, delusions bizarre of (disorganizedpersecution) thinking (“someone with is distorted following beliefs me”) calledor delusionsgrandeur (“I’m (“I Maryam a king”).Poppins”).

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Disturbed Perceptions Inappropriate Emotions & Actions

A schizophrenic person may perceive things that are not A schizophrenic person may laugh at the news of there (hallucinations). Frequently such hallucinations are someone dying or show no emotion at all (apathy). auditory and to a lesser extent visual, somatosensory, olfactory, or gustatory. August Natter,August L. Berthold, Photos of paintingsPhotos by Krannert Museum, University of Illinois at Urbana-Champaign Witches Head. Untitled.

The Prinzhorn Collection, University of Heidelberg Patients with schizophrenia may The Prinzhorn Collection, University of Heidelberg continually rub an arm, rock a chair, or remain motionless for hours ().

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10 Positive (present) and Negative (absent) Subtypes of Schizophrenia Symptoms Schizophrenia is a cluster of disorders. These Schizophrenics have inappropriate symptoms subtypes share some features, but there are other (hallucinations, disorganized thinking, deluded symptoms that differentiate these subtypes. ways) that are not present in normal individuals (positive symptoms).

Schizophrenics also have an absence of appropriate symptoms (apathy, expressionless faces, rigid bodies) that are present in normal individuals (negative symptoms).

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Chronic and Acute Schizophrenia Subtypes

When schizophrenia is slow to develop (chronic/ process) recovery is doubtful. Such schizophrenics usually display negative symptoms.

When schizophrenia rapidly develops (acute/ reactive) recovery is better. Such schizophrenics usually show positive symptoms.

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Understanding Schizophrenia Abnormal Brain Activity

Schizophrenia is a disease of the brain exhibited by the Brain scans show abnormal activity in the frontal symptoms of perception, affect, and cognition. cortex, thalamus, and of schizophrenic patients. Adolescent schizophrenic patients also have brain lesions. Imaging and Judith L. Rapport, National Institute of Mental Health Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Brain Abnormalities Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain.

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11 Abnormal Brain Morphology Viral Infection

Schizophrenia patients may exhibit morphological Schizophrenia has also been observed in individuals changes in the brain like enlargement of fluid-filled who contracted a viral infection (flu) during the ventricles. middle of their fetal development. Both Photos: Courtesy of Daniel R. Weinberger, NSC NIH-NIMH/ M.D.,

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Genetic Factors Genetic Factors

The likelihood of an individual suffering from The following shows the prevalence of schizophrenia is 50% if their identical twin has the schizophrenia in identical twins as seen in different disease (Gottesman, 1991). countries.

0 10 20 30 40 50 Identical Both parents Fraternal One parent Sibling Nephew or niece

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Psychological Factors Warning Signs

Psychological and environmental factors can trigger Early warning signs of schizophrenia include: schizophrenia if the individual is genetically predisposed (Nicols & Gottesman, 1983). 1. A mother’s long lasting schizophrenia. 2. Birth complications, oxygen deprivation and low- birth weight. The genetically identical Genain 3. Short attention span and poor muscle coordination. sisters suffer from schizophrenia. Two of them suffered more than the Courtesy of Genain Family other two; thus there are contributing 4. Disruptive and withdrawn behavior. environmental factors. 5. Emotional unpredictability. 6. Poor peer relations and solo play. Genain Sisters 71 72

12 Personality Disorders Antisocial Personality Disorder

Personality disorders are A disorder in which the person (usually men) exhibits a characterized by lack of conscience for wrongdoing, even toward friends inflexible and enduring and family members. These characteristics are also behavior patterns that referred to as sociopaths or psychopaths. impair social functioning. They are usually without anxiety, depression, or delusions.

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Understanding Antisocial Personality Understanding Antisocial Personality Disorder Disorder Like mood disorders and PET scans of 41 murderers revealed reduced activity in schizophrenia, antisocial the frontal lobes. In a follow-up study repeat offenders personality disorder has had 11% less frontal lobe activity compared to normal biological and psychological individuals (Raine et al., 1999; 2000). reasons. Youngsters with antisocial personality characteristics, (even before committing any crimes), respond with lower levels of University of Southern California Courtesy of Adrian Raine, stress hormones than others do at their age.

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Cultural Influences Matter, Too. Understanding Antisocial Personality Rates of Psychological Disorders Disorder The likelihood that one will commit a crime doubles when childhood poverty is compounded with obstetrical complications (Raine et al., 1999; 2000).

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13 Rates of Psychological Disorders Risk and Protective Factors

The prevalence of psychological disorders across Risk and protective factors for mental disorders (WHO, different countries (WHO, 2004). 2004).

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Risk and Protective Factors

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