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13 Psychological Disorders

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  • As we will see, the person who is ill may not be distressed with their symptoms, but others may be. Just as in Alzheimer’s disease, the stress isn’t so much on the person with it but the caretakers or those affected by it. Note also that what is culturally appropriate or socially appropriate may vary. In one culture for example a person may be possessed by evil spirits and NOT have schziophrenia. Not in ours. Other illnesses may cause personal distress but not bother anyone else. I don’t care if you are depressed. If you are seriously depressed, you’d probably not be here but at home shut in your room.
  • Oldest human writings about beh circa 1750 B.C. Abnormal behavior thought to be caused by evil spirits. Treatment was to pray or ingest horrible things in order to vomit them out. If this didn’t work, usually killed the person. NOTE: this has not completely disappeared. In Greeley, some psychiatrists work with brujas to attempt to cure the patient. Biological-Hippocrates 5 th century B.C. thought abnormal beh was caused by an imbalance in the 4 important body fluids (don’t say but keep in case they ask: blood, phlegm, black bile, yellow bile). Later in neurobiology realized link between some abnormal beh and brain problems. Ex. Syphillis which is a bacterial infection can eat your brain and cause problems. Roadside test now used to detect drinking was originally to detect syphilis. Psych-ancient Greece Pythagoras bel. That pysch problems were caused by things like stress. Put the disturbed into temples to rest, some success with this.
  • Describes about 250 ways to go crazy. Have to meet the criteria for the disorder or you don’t have it. This was one way ADD was originally problematic. 38 symptoms proposed and only had agreement on 1. Keep in mind, these are not what you took in the last section. These are abnormal. There is some cultural shaping on these as well. DSM used to include homosexuality, not realize that it isn’t a disease. Since they couldn’t cure it, just as well, eh?
  • 50% chance of developing major depression for smokers, 17% chance for those who don’t. In adolescents, smoking predicted depression rather than the other way around.
  • Can be adaptive to respond to potential or actual threat if it is realistic. Fear and anxiety both are at the core of the disorders we are going to talk about today.
  • In contrast to phobias which are in the book, panic disorders and gad are not associated with a specific stimuli. This is a persistent feeling of anxiousness. Constantly plagued by exaggerated worries: I might get sick, my husband might get sick, I might lose my job, etc. Keep in mind, this is exaggerated, persistent, uncontrollable and interferes with daily life. People w/ it may sweat, have a pounding heart, diarrhea, cold clammy hands, dry mouth, shortness of breath, etc. Just the way you might feel before a final you had not prepared for. People w/ GAD feel that way all the time.
  • Thnk for a minute why it might lead to phobias. Have the attack in a particular situation, and then via classical conditioning fear that situation. Or from last section, the attitude is lead by the behavior, if the beh is a stressful feeling, develop bad attitude toward whatever situation. So, if in social setting may become a social phobic. IN a public place, may become agoraphobic, or at a specific loc might develop a fear of that thing. Give Liz and the bridge phobia panic attack.
  • NT in brain may be boosted with drugs and therefore help. Drugs that block GABA lead to an increase in anxiety.
  • Rescue workers, emergency service personnel can develop PTSD symptoms. Sometimes witnessing the death or injury to others can bring on PSTD. About 2x as many women experience PTSD after trauma. May be related to emphathy. Children can exp PTSD: ex of children who witnessed their father killed in a car wreck. Children at Waco had elevated heart rates 15 plus beats a min a year after the event.
  • Person may replay the event in their mind. In #2, may experience numbing of emotional responsiveness. 3. May be easily startled, exp. Sleep disturbances, have problems concentration or remembering.
  • Try not to have a thought. Give penguin example. Try not to think of penguins. Very hard not to. This is what these people struggle with. Compulsions are not relatistically connected to its intended purpose. Usually fear dire consequences if action is not performed. EX. step on a crack, break your mother’s back. Think of Jack Nicolson in As Good As It Gets. Where he taps over his slippers, has to sit in the same place in the restaurant, etc. Now: two levels of this disorder. We all may know someone who has this on a lower level such as a person who overscrubs the tub, for ex. Or my office mate who sprayed the phone after each foreign use. These people go well beyond that. Counting obsession: count the number of steps in a day so it is exactly the same. Or everything they do, they do 6 times. One man had to count all the corners of every object in the room to make sure the objects were evenly distributed so that the total corners in each room was evenly divisible by 16. Washing obsession is hard on relationships because they can’t touch anyone for fear of germs.
  • Usually developed between 10-25.
  • Many relatives of OCD people have some other form of anxiety disorder.
  • Keep in mind this important difference in the two: depressives cycle between prolonged periods of hopelessness and normality the other between depression and mania (which is an active, elevated mood state).
  • Other things as well: lack of energy, loss of interest in former interests, future looks bleak and have neg opinion of self and others.
  • Dysthymia is described as a chronic blue mood. The difference between blue mood after bad news and a mood disorder is like the difference between gasping for breath for a few minutes after a hard run and being chronically short of breath”. We all have these at some time in our lives but if it stays, its this disorder. Think of Eeyore. You say good morning Eyeore and he says “if it is a good morning, which I doubt”.
  • In major depression, the person usually goes back to their normal pattern. Not excessively happy. In one case I knew of with this disorder, when she came back she painted her house a bright bright yellow. We characterized it as “I’m so happy!”.
  • Disorder is common among creative artists many believe Handel suffered a mild form of bipolar disorder and composed his nearly 4 hour long Messiah during 3 weeks of intense creative energy. About 1% of population Can get into trouble with reckless spending, investment sprees, wild optimism. Disorder typically occurs in the person’s 20s.
  • NOT the big 5 traits. These are disorders. Impair functioning, like keeping a relationship going, ability to keep a job. Long standing inflexible and maladaptive traits. IMPORTANT: these do not involve a break with reality.
  • Keep in mind that people can have some of these traits and not be abnormal. IT is only when they get to the extreme that it is a personality disorder. I brought this one up so as to emphasize that. Some normals in odd occupations have elevated rates of this. For ex, cops have extreme scores on this and one psychiatrist remarked that ordinarily that level of elevation would warrant a disease but since they all had and were functioning fine, oh well. This is also why I suggested you not fake good on psy tests. Some of them may want you to look like the others and the others are not normal. Consider how adapative this is. Do you want cops who say oh that guy carrying a TV is not a burglar, he’s just moving. Do you want cops who see a man playing with a child in the middle of the day who say that’s just her dad, not a stranger approaching her. And so on.
  • This is the disorder known as Psychopathy or sociopaths. The Md sniper probably has this disorder as most serial killers do. Not everyone w/ disorder is a serial killer thankfully. Think of slick car salesman, politicians. People may be impulsive and not plan ahead. Run up debts and never pay them back, borrows from everyone in siht. About 4% of Am males have this, 1% of women. 75-80% of criminals meet the criteria for ASP. BE SURE TO DESCRIBE DIFFERENCE BETWEEN ASOCIAL AND ANTISOCIAL.
  • Closely linked to ASO but refers more to psychopath’s psych Lack of positive emotions leads them to behave irresponsibly toward others. Neg emotions means they don’t learn from their mistakes. Don’t feel embarrassed by what they have doen. Seldom are anxious. No sense of share. 2 major clusters of psychopaths: selfish, remorseless, exploitative. And those with an antisocial lifestye.
  • Keep in mind these are very tenative. We mostly know what we know from the ones who got caught…so it may be the study of inept psychopaths not all of them. There is a higher rate of psychopathy in bio relatives of psychopaths. EEG abnormalities-show slow-wave activity widespread thorught the brain which is typical of infants and young children but not normal adutls. Possibly related to dysfunction of inhibitory mechanicisms? Pretty tenative. Usually look back to family and see some problems there. But keep in mind we don’t know how many of other people had similar backgrounds. In social psy I give out backgrounds and have people try to pick out known serial killers backgrounds from that of poets, saints, and highly successful people and they are unable to. Maya Angelou and Aileen Wuronos are almost identical, so…
  • It is unusual when clinicians agree and they do agree that treating psychopaths is impoosible. Their very nature makes this impossible. They lie almost w/out knowing it, appear not to have any motivation to obey laws, live for the pesent, and can’t form trusting, honest relationships. This is why prison is the best method for treatment. They usually grow less disruptive with age but it isn’t really known why.
  • One of the ex in the book about driving somewhere and not knowing how you got there may also be explained by hypnosis. Very controversial area. We will see why in a minute. Some dissociations may be adaptive. People in the hospital may begin being detached from their body, as if they are doing it to someone else. Only when prolonged and severe are they a problem.
  • Dissociative fugue involves memory loss and also wandering and change in identity. Otherwise, could be diss amnesia. Usually involves fleeing one’s home and identity for days, months, even years. When found those experiencing this initially seem confused and may deny recognizing spouse, family. Later awaken from fugue state and remember their old identities but not what happened during fugue state. Author Agatha Christie did this once. Still has no real explanation for it. Thought to be publicity stunt at first, but later it was believed she actually did this for a time.
  • Even more mysterious and controversial…massive dissociation of self from ordinary consciousness in those w/ MPD. Now called DID. One personality is usually restrained and dull, another more impulsive and uninhibited; may be prim and proper on minute, loud and flirtatious the next. Each personality has its own mannerism and voice, the original one typically denies the awareness of the other or others. 3 Faces of Eve. Book writne by a woman claiming 22 distinct personalities: 2 main ones were the Good Eve and the Bad Eve. Sybil had 16 personalities in the course of 42 years. Of course, very rare condition…what may cause it?
  • Average number of personalities per case has increased from 3 to 12 per patient. Most clinicians have never seen a person with DID. Almost nonexistent outside U.S. Text reports that is rising, but then, aren’t they getting our movies now? Fishing for it- do you feel that another part of you does things you can’t control? Does this part have a name? Can I talk to that angry part of you? Per real skeptics it is no coincidence that mult personality studies began among hypnotists.
  • Believed to be brought on by stress and that it is a way to avoid responsibility, not face life. May be brought on by therapists asking to talk to other personalities. Interestingly, has seen dramatic increase in this behavior since popular movies popularized it during the last 20 years. Also virtually unknown outside our culture. Most controversial of all diagnoses.
  • Means “split mind”. Dos not mean DID obvisously. It does mean a split from reality.
  • Cluster of disorders that have some common features. Excesses means hallucinations, delusions, bizarre beh. Negative symptoms means lack of emotional affect, inability to experience pleasure, lack of social interaction, speech deficits. There is no essential feature that needs to be present for a diagnosis of schizophrenia.
  • Grandeur: mostly exaggerated sense of their own importance. They receive messages from God. They usually are God, Jesus, Moses, Napoleon. Part of the reason they don’t like to take their meds is that they aren’t special anymore. Who wouldn’t rather be Joan of Arc than Laura Manuel? A lot fo them have perscution complexes because they are so important to the world. I know no one is following me: I am not important enough to bother with. Thought broadcasting: believe that people may have listening devices that allow them to hear the schizos thoughts. Mention the guy with the tin foil put everywhere to keep the demons away and the thoughts from getting in. Or the one with the pans on his roof that was going to translate color into sound and get rich. Someone broke in and stole his tape of his work. Hallucination is an important distinction: schizos hear things. 74% are auditory hallucinations. Now what if they have visual ones? May be schizo but more likely you just took some wonderful drug and are now seeing things. Likewise schizos feel an imbalance in their bodies, their legs may distort or there may be tingling. That is also possible with dope. Emotions: may laugh when they hear someone died, may become angry for no reason.
  • People w/ Sch vary in their symptoms. Some exhibit most symptoms, some only a few. Paranoid-have basic symptoms like on last page. Compared to the others, this one has better chance of recovery. Some w/ mild forms can live mostly ok. Remain constantly suspicious. Doesn’t run in families the same way as other types. Disorganized-sill or childlike behavior, may have incoherent speech. Extreme lack of social relationships. Catatonic-movement disorder. Affected person may go through periods of extremely rapid repetitive activity, may imitate another person ormay sit in a totally rigid way. May resist attempts to change their posture (very rare type). Undifferentiated-basic symptoms. Don’t fit into other types. I think everyone I have ever met was in the paranoid category. Want to meet one? Go to the smoking section of an all night restaurant after Midnight.
  • Drugs that work on schzos generally decrease dopamine. MRI scans show they have enlarged ventricles and a corresponding shrinkage of cerebal tissue. The greater the shrinkage, the worse the disorder tends to be.
  • May inherit predisposition which is then encouraged or discouraged by environment. Adopted children still show elevated risk if biological parent has schizo.
  • People are at increased risk of schiz if their moms got flue in the middle of the 2 nd trimester. Flu interupts neuronal migration and it appears the cells don’t get to where they are supposed to be. People born during the winter and spring months after the flu season have a 5-15% increased risk of schiz. In the southern hemisphere, this is reversed. Increased risk of schiz if malnourished during preg. People conceived during the Dutch wartime famine later had double the rate of schiz.
  • By themselves, genetics will not do it. Also by themselves schiz can not be environ caused. However, may trigger it in predisposed people.
  • Example: Kurt Vonnegut’s biological son Mark Twain Vonnegut had one psychotic break and then became a dr. No other breaks. The book is called The Eden Express describes the disease but not as well as I Never Promised You a Rose Garden. Ok, lets try a few brief diagnoses to see if you are getting them. I will show you a picture and you can attempt some diagnoses.
  • Transcript

    • 1. Psychological Disorders Anxiety disorders Mood disorders Personality Disorders
    • 2. Psychological disorder
      • A pattern of behavioral & psychological symptoms that causes
      • significant personal distress
      • impairs ability to function
      • or both
    • 3. Historical Perspective
      • Supernatural causation-possessed by evil spirits
      • Biological-some imbalance in the body/brain
      • Psychological-****not until Freud did psych compete with the supernatural & biological theories
    • 4. DSM-IV-TR
      • Diagnostic & Statistical Manual of Mental Disorders, 4 th edition
      • 5 dimensions (axes) 1-V
      • Rate the person on 5 dimensions.
    • 5. Prevalence of Psychological Disorders
      • About half of us experience a psy disorder during our lifetime
      • About 30% in one survey in the last year
      • Depression esp. common in college
      • about 25% will experience it in college
      • Smokers more likely to develop major depression
    • 6. Smoking and psych disorders
      • People w/ mental illnesses are likely to be heavy smokers
      • 41% of those w/ a current mental disorder are smokers compared to 22% not diagnosed
      • 54% of all cigs smoked in the U.S. are consumed by people w/ mental disorders
    • 7. Anxiety Disorders GAD-generalized anxiety disorder PTSD-post traumatic stress Obsessive-compulsive disorder
    • 8. Fear vs. Anxiety
      • Fear: response to specific danger
      • Anxiety: response to diffuse or nonexistent danger
      • Fear & anxiety can be normal and adaptive
    • 9. Generalized Anxiety Disorder
      • Persistent anxiousness
      • Chronic, uncontrollable worry
      • Unable to identify cause
    • 10. Panic Disorder
      • Constant amount of moderate anxiety
      • Sudden attacks of increased HR, chest pains, difficulty breathing, feelings of terror, etc.
      • May lead to phobias
    • 11. Causes of GAD & Panic attacks
      • Biological
      • genetic (twin studies)
      • low levels of GABA (inhibitory NT)
      • Psychological
      • cognitive: perception of lack of control
      • fear of fear hypothesis
      • (misinterpret physiological sensations)
    • 12. Posttraumatic Stress Disorder
      • Extreme anxiety & intrusive thoughts (like OCD)
      • Long lasting response to EXTREME phsyical or psych trauma
      • Most commonly related to military combat situations
    • 13. PTSD
      • 3 core symptoms 1. recall the event frequently
      • 2. person avoids situations that trigger the memories
      • 3. person experiences increased physical arousal associated with anxiety
    • 14. Obsessive-Compulsive Disorder
      • Obsession: repetitive, unwelcome stream of thought
      • e.g. fear of germs
      • Compulsion: repetitive, irresistible action
      • e.g. collecting, counting, cleaning, checking
    • 15. OCD
      • Have some insight into the problem
      • Affects 2-3% of people in the U.S.
      • Sudden or gradual onset
    • 16. Causes of OCD
      • Biological: genetic & low serotonin
      • Cogntive-Behavioral Theories
      • checkers don’t trust their own memory
      • compulsion reduces anxiety
    • 17. Mood Disorders
      • Two major types:
      • major depressive disorder
      • bipolar disorder (formerly known as manic-
      • depressive disorder).
    • 18. Depression Symptoms
      • Physical
      • Change in appetite
      • persistent fatigue
      • low energy
      • sleep disturbances
      • immune system impairment
    • 19. Depression symptoms
      • Cognitive
      • feelings of guilt & worthlessness
      • difficulty concentrating
      • self-criticism
      • difficulty making decisions
      • suicidal thoughts/attempts
    • 20. Major Depressive Disorder
      • Not just a “bad mood”
      • Persists
      • Interferes with daily life, work, interactions with others
    • 21. Bipolar disorder
      • Cycles between depression and mania
      • Equal number of males and females
    • 22. Manic symptoms
      • Elevated mood
      • Unlimited energy, high activity level
      • Little or no sleep (don’t need it)
      • Risk taking
      • Short attention span
      • Hypersexuality (indiscriminate)
      • Grandiose plans, inflated self esteem
    • 23. Biological Theories
      • Genetic influences: Twin Studies
      • Mz twins more similar
      • Chemical Influences
      • low serotonin (Treatment: Prozac)
      • low dopamine
      • In bipolar: Norepinepherine
      • high in mania, low in depressive phase
    • 24. Personality Disorders
      • Persistent, maladaptive traits
      • Impairment of social and occupational functioning
      • No impairment of contact with reality
    • 25. Paranoid Personality Disorder
      • Unwarranted distrust & suspiciousness
      • Assumes others want to deceive & exploit
    • 26. Antisocial Personality Disorder
      • Conduct disorder prior to 15
      • Irresponsible & antisocial behavior
      • e.g. breaking laws
      • Impulsive
      • No remorse
    • 27. Psychopathy
      • Poverty of emotions
      • Both negative & positive
      • Superficially charming
      • Manipulative & selfish
    • 28. Causes of psychopathy
      • Biological
      • -genetic: adoption studies
      • -slow-wave brain activity
      • Early experience
      • -parental rejection, lack of affection
    • 29. Therapy for Psychopathy
      • There isn’t one.
      • Often settle down in middle age.
    • 30. Dissociative Disorders
      • Sudden loss of memory and identity
      • --dissociative fugue
      • --dissociative identity disorder (aka Multiple
      • Personality Disorder)
    • 31. Dissociative Fugue
      • Period of “wandering” with memory loss and identity change
    • 32. Dissociative Identity Disorder
      • Exhibits 2 or more distinct & alternating personalities
    • 33. DID Skeptics say
      • Regional difference: North America
      • diagnoses rose from 2 cases per decade in
      • the 30-60’s to
      • 20,000 in the 1980s
      • Role of therapists
      • may be fishing for this
    • 34. Causes of DID
      • Who knows? We surely do not.
      • No widely accepted biological tie.
      • Some studies report differences in HR, RR, PET scans, EEG activity
      • which people acting as if they had DID
      • could not imitate
    • 35. Schizophrenia Symptoms 3 Types Causes
    • 36. Schizophrenia
      • NOT multiple personalities
      • Affects 1% of the population
      • Affects males & females equally
      • Onset in adolescence or young adulthood
    • 37. Behavioral Symptoms
      • Positive: excesses
      • Negative: deficits
    • 38. Symptoms
      • Delusions: bizarre, distorted beliefs
      • delusions of grandeur
      • delusions of persecution
      • thought broadcasting
      • Hallucinations
      • primarily hearing voices
      • Inappropriate emotions
    • 39. Types
      • Paranoid-delusions, hallucinations.
      • Disorganized-disorganized speech or behavior
      • Catatonic-movement disorder
      • Undifferentiated
    • 40. Causes
      • Old theory: schizophrenicgenic mother
      • Different types may have different causes
      • Theories
      • biological
      • psychological
      • environmental
    • 41. Brain abnormalities
      • Dopamine overactivity (treat by decreasing it)
      • Enlarged ventricles
      • Other areas as well
    • 42. Genetic influence
      • Risk increases with genetic closeness to relative w/ schizophrenia
      • Genetics alone won’t cause it
      • identical twins 50% concordance
    • 43. Environmental Factors
      • Prenatal environment
      • viral infection midpregnancy
      • malnourishment during pregnancy
    • 44. Psychological Factors
      • Genetic predisposition plus stress may “trigger” schizophrenia
    • 45. Treatment
      • No cure, can only decrease symptoms
      • Thorazine: decreases dopamine activity
      • Rule of fourths
      • 25% get well and stay well
      • 25% do well on meds & live independently
      • 25% do ok on meds & live in group home
      • 25% do very poorly