Chapter 16 – Psychological Disorders 10.doc

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Chapter 16 – Psychological Disorders 10.doc

  1. 1. Chapter 16 – Psychological Disorders ‘10 All of us… where to draw the line? Psych disorders: deviant, distressful, dysfunctional How to Understand / treat? vs. past…  medical model: needed reform; universal, cultural, bio-psycho-social perspective -ADD, ADHD, issues: Classifying – DSM-IV (DSM-IV-TR): 16 major categories, neurotic, psychotic, reliability, axes Labeling: Rosenhan, Toronto exp, (Temerlin): self-fulfilling prophecy “Insanity”: I. Anxiety Disorders: 1. generalized anxiety disorder (GAD) 2. panic disorder 3. phobias 4. obsessive-compulsive disorder 5. post-traumatic stress disorder (PTSD) -explaining anxiety disorders: learning -- generalization, reinforcement, observational; biological: natural selection, genes, physiology
  2. 2. II. Dissociative Disorders: 1. dissociative identity disorder (DID) / multiple personality disorder (MPD) – The Three Faces of Eve, Sybil; issues, controversy: III. Mood (Affective) Disorders: 1. seasonal affective disorder (SAD) 2. depressive disorders: dythsymic disorder / dysthymia, major depressive disorder 3. bipolar disorder: mania -explaining: sex difference, cognitive, stress, dramatic increase…; bio: genetics – linkage analysis, brain differences; socio-cognitive: self-defeating attributions / learned helplessness / little self-serving bias -- stable, global, internal  with pessimism, rumination, failure… the vicious cycle: -suicide: cultural, racial, gender, age, other group differences, social suggestion, rates -loneliness: IV. Schizophrenia: symptoms: delusions, word salad, paranoia, hallucinations, inappropriate emotions / AFFECT, catatonia, subtypes: chronic / process / negative symptoms, acute / reactive / positive symptoms, paranoid, disorganized, catatonic, undifferentiated, residual; AUTISM?!? -explaining: brain abnormalities: dopamine, tissue loss:
  3. 3. genetic factors: psychological factors: others: V. Personality Disorders: definition, types: avoidant, schizoid, histrionic, narcissistic, borderline, antisocial AKA psychopath, sociopath; factors: Rates of Disorders: (and gender, racial differences), risks, protective factors Chp. 16 – Abnormal Psych (Thomas Szasz – no such thing as mental illness…) -nosology: medical diagnosis; -etiology: history / underlying cause(s); prognosis – probable course diathesis-stress: looking at all the components as factors Reactive AKA neurotic; psychotic – debilitating madness / schizophrenia DSM-IV axes: 5, current symptoms (1), history (2), other relevant medical conditions (3), current stress level (4), past- year adaptive functioning – social, occupational, recreational (5) Psychosomatic AKA somatoform, psychogenic -(subtypes conversion disorders, hypochondriasis: seeing nonexistent disorders in yourself, body dysmorphic disorder – overpreoccupation with a physical defect), factitious – self-injury or pills to produce symptoms mood disorders AKA affective disorders -bipolar II – severe bipolar swings - cyclothymia – less extreme bipolar; unipolar: one or the other Developmental disorders: ADD / ADHD, autism, Tourette’s – tics, motor and vocal, eating disorders - Autism: schizophrenic-like attention problems, but early-onset (by 3), mostly male, not in families, much less chance) – not currently viewed as a subtype of schizophrenia Dissociation AKA depersonalization -other subtypes: amnesia: not organic but psychogenic (retro-, anterograde), fugue (amnesia with flight) Schizophrenias (dementia): "neologisms" -- words that have meaning only to them; clang associations: nonsense rhyming ; -other subtypes: disorganized AKA hebephrenic (“childlike’): incoherent, inappropriate / silly giggling, babbling; -double binds: schizophrenia caused by childhood stress of no-win situations with parents Personality disorders: paranoid – continual unjustified suspicion, mistrust; schizotypal: strangeness in thinking, but not s severe as schizophrenic; dependent –extreme need to be cared for / helplessness
  4. 4. psychosexual: fetish – sexual arousal by objects [or body parts as objects]; zoophilia; by animals; voyeur: by watching; masochist: by hurting self; sadist: by hurting others; -homosexuality was taken off sex. Disorders in ‘70s Substance use disorders: addictive / chemical dependent types (some are more genetically prone than others) -Chromosomes disorders: Turner's Syndrome (X female) - short, immature features; very feminine in gender role, sterile; Klinefelter's Syndrome (XXY male) - some breast development, unusually high voice, little facial hair;sterile, with some intellectual impairment; Double Y Syndrome (XYY "supermale") - tall, more prone to violence?? (At least a higher % in prison -- lower intelligence, so more get caught...)
  5. 5. Chapter 16 Notes: • Objective 1: Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions. When behavior is deviant, distressful, and dysfunctional, they label it disordered. Standards for deviant behavior vary by culture and context. In some cultures, it is okay to be naked and war can be considered as heroic. Olympic gold medalists deviate from the norm in their physical abilities, but we honor them. So, deviant behavior has to cause the person distress. Dysfunction is the key to defining a disorder: an intense fear of spiders may be deviant but if it doesn’t impair your life, you don’t have a disorder. ADHD – three key symptoms – inattention, hyperactivity, and impulsivity (distraction, fidgeting, interrupting). It is diagnosed two to three times more often in boys than girls. ADHD has nearly quadrupled, so is it really not a disorder? Some adults are taking the drug too, for their lack of self – discipline. It seems to be heritable and neurological disorder. It is treatable with medications such as Ritalin and Adderall, which are stimulants but calm the hyperactivity. Also, psychological therapies help. Extreme inattention, hyperactivity, and impulsivity can derail social, academic, and vocational achievements, and these symptoms can be treated with stimulant drugs. But the debate continues over whether it is too often diagnosed a disorder and that there is a cost to the long term damage of these drugs. • Objective 2: Until the last two centuries, mad people were caged in zoolike conditions, or given therapies appropriate to a demon. They were treated very harshly. In opposition to this, Philippe Pinel in France insisted that madness was not demon possession but a sickness of the mind caused by stress and inhumane conditions. They wanted to boost their morale, being gentle, and being in activities and being outside. Medical model – that psychological disorders are sicknesses – provided the impetus for further reform as hospitals replaced asylums. A mental illness needs to be diagnosed on the basis of its symptoms and cured through therapy, which may include treatment in a hospital. Today’s psychologists content that all behavior arises from the interaction of nature and nurture. To say that someone is mentally ill, a sickness must be found and cured. Most health workers assume that disorders are influenced by genetics and physiological states, by inner dynamics, and social and cultural circumstances. In some countries, some diseases are more common than others and vice versa, example eating disorders in western cultures. To get the whole picture, you need to use the biopsychosocial approach, mind and body are inseparable. • Objective 3: Diagnostic classification aims not only to describe a disorder but also to predict its future, imply appropriate treatment, and stimulate research into the causes. Diagnostic and Statistical Manual of mental Disorders (DSM – IV – helpful and practical tool and financially necessary. It defines a diagnostic process and 16 clinical syndromes, describes various disorders and lists their prevalence. They are reliable; the chances are very good that two psychologists will give the same diagnosis. For 83 percent of the patients, the two opinions agreed without knowing about the first diagnosis. But, some believe that there are too many disorders and some are included that do not realty have any disorder symptoms (went up from 40 to 400 today). • Objective 4: Once we label a person, we view them differently. Labels create preconceptions that guide our perceptions and our interpretations. David Rosenhan and seven others went to mental hospitals complaining of hearing voices and all eight were diagnosed as mentally ill. That these normal people were misdiagnosed is unsurprising. Labels affect how we perceive people. Those who watched unlabeled interviewees perceived them as normal; those who watched supposed patients perceived them as different from most people. Also, when asked if there was room, the answer was yes, but if told that you were getting out of the mental hospital, the answer was no ¾ of the time. Public figures are coming out with their problems that they had with these disorders and people are becoming more accepting. Too often, people see people with disorders as freaks or homicidal. If they do not use drugs or alcohol, they have the same violence rate as their neighbors. But, there are benefits to labeling – to understand the causes and to pick treatment programs. • Objective 5:
  6. 6. INSANITY – People have been using the insanity plea to get out of the charges that they have inflicted. Who is responsible for this? Does it create a social basis for evading responsibility? Anxiety Disorders – marked by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety. Generalized anxiety disorder – in which a person is unexplainably and continually tense and uneasy. The symptoms of this disorder are commonplace; their persistence is not. People who have this disorder (2/3 is women), are continually tense and jittery, worried about bad things that could happen, and plagued by muscular tension and sleeplessness. The tension can leak through furrowed brows, twitching eyelids, trembling, sweating, and fidgeting. The person cannot identify or deal with the cause. The anxiety is free – floating, and the disorder is often accompanied by depression, and can lead to ulcers and high blood pressure. Panic Disorder – experiences sudden episodes of intense dread. It strikes suddenly and then leaves. Heart palpitations, shortness of breath, choking sensations, trembling, or dizziness typically accompany the panic, which may be perceived as a heart attack. People come to fear the fear itself and to avoid situations where the panic has struck before. Agoraphobia is fear or avoidance of situations in which escape might be difficult or help unavailable when panic strikes. Ergo, can avoid being outside, in group gatherings, etc. Phobias – focus anxiety on a specific object, activity, or situation. It is an irrational fear that disrupts behavior. Social phobia – an intense fear of being scrutinized by others. The anxious person may avoid speaking up, eating out, or going to parties or will sweat and tremble when doing so. Obsessive Compulsive disorder (OCD) – in which a person is troubled by repetitive thoughts or actions. Checking the door 10 times, washing your hands so that your hand becomes raw = not normal. Howard Hughes had it, afraid of germs, made everyone wear gloves when handing him a document. Post Traumatic Stress Disorder – characterized by lingering symptoms including haunting memories and nightmares, a numbled social withdrawal, jumpy anxiety, and insomnia. The more frequent and severe the assault experiences, the more adverse the long – term outcomes tend to be. A sensitive limbic system also increases vulnerability. Many combat veterans, accident and disaster survivors, sexual assault victims, have experienced these symptoms. Their sense of basic trust erodes, and hopelessness increases. This learned helplessness makes them more vulnerable to PTSD. Combat stress doubled a veteran’s risk of alcohol abuse, depression, or anxiety. The more torture they suffered, the greater its psychological toll. Dose response relationship- the greater one’s emotional distress during a trauma, the higher the risk for post – traumatic symptoms. Some psychologists think that PTSD is overdiagnosed. They also point to the impressive survivor resiliency most people display. EX. a boy who survived the Holocaust under conditions of privation while his mother died. Post – traumatic growth= leads people later to report an increased appreciation for life, more meaningful relationships, increased personal strength, changed priorities, and a richer spiritual life. • Objective 10: In childhood, people repress intolerable impulses, ideas, and feelings and that this submerged mental energy sometimes produced mystifying symptoms such as anxiety. People have linked general anxiety with classical conditioning of fear. Conditioned fear may remain long after we have forgotten the experiences that produced them. Stimulus generalization occurs, for example, when a person fears heights after a fall and later develops a fear of flying in an airplane without ever having flown. Reinforcement helps maintain them. Avoiding or escaping the feared situation reduces anxiety, which reinforces the phobias. We also learn fear through observing others’ fears. (like monkeys). We humans seem biologically prepared to fear threats faced by our ancestors such as spiders, snakes, and other animals, closed spaces and heights, storms and darkness. Fear of flying – comes from our biological past, which predisposes us to fear confinement and heights. Our compulsive acts typically exaggerate behaviors that contributed to our species survival. Washing up becomes ritual hand washing; checking territorial boundaries become checking and rechecking a locked door. Also, some people are more genetically predisposed to particular fears and high anxiety. Vulnerability to anxiety disorders rises when the afflicted relative is an identical twin. In those people with OCD, the anterior cingulated cortex, a brain region that monitors our actions and checks for errors, seems to be hyperactive. Amygdala has the fear circuits. • Objective 11: Dissociative Disorders – a person appears to experience a sudden loss of memory or changes in identity. When a situation becomes very stressful, people are said to dissociate themselves from it. This is sometimes good, it helps a person from being overwhelmed with emotion. Dissociative Identity Disorder (DID) – said
  7. 7. to have two or more distinct identities that alternately control the person’s behavior, with memory impairment across the different personality states. The person can be proper one moment and loud the next. There have been cases where the personalities are the good and the bad. Nicholas Spanos asked college students to pretend they were accused murderers being examined by a psychiatrist. When five the same hypnotic treatment, most spontaneously expressed second personality. – Is it only just role playing or something more? The numbers have doubled in the number of cases. Also, psychiatrists can start a second personality by asking question about a part of the person that that person cannot control. MID – Multiple personality disorder, example Sybil, who was told to have 17 personalities or so. Three Face of Eve – good and bad. – one of the earliest books on DID. • Objective 12: Mood Disorders – major depressive disorder or bipolar disorder. Major depressive disorder – person experiences prolonged hopelessness and lethargy until usually rebounding to normality. Bipolar – the person alternates between depression and mania – an overexcited, hyperactive state. Depression is the common cold of psychological disorders – an expression that effectively describes its pervasiveness but not is seriousness. It helps to not take risks and slow our bodies down, but it is bad when it is major. MDD – occurs when signs of depression last two weeks or more and are not caused by drugs or medical condition. The difference between a blue mood and depressive disorder is being short of breath after a mile run and being constantly short out of breath. Dysthmic disorder – a down in the dumps mood that fills most of the day, nearly every day, for two years or more. Tend to experience chronic low energy and self – esteem, have difficulty concentrating or making decision, and sleep and eat too much or too little. During the manic phase of bipolar disorder, the person is over talkative, overactive, and elated, has little need for sleep, and fewer sexual inhibitions. You have self – esteem and optimism, which leads to reckless decisions, spending sprees and unsafe sex. A lot of creative people (authors, etc) have bipolar and this mania state increased creativity. What goes up must come down, so mania goes down into depression. • Objective 13: Many behavioral and cognitive changes accompany depression – inactive and feel unmotivated, and very sensitive. Depression is widespread and so must its causes. Compared with men, women are nearly twice as vulnerable to major depression. Men are more likely for alcohol abuse and lack of impulse control. Most major depressive episodes self – terminate. Stressful events related to work, marriage and close relationships often precede depression. With each new generation, the rate of depression is increasing and the disorder is striking earlier (late teens). It may reflect today’s young adults’ greater willingness to disclose depression, as well as our tendency to forget many negative experiences over time. • Objective 14: If one identical twin has MDD, 50% chance the other twin has it too. Bipolar – 70% chance. Adopted people who suffer a mood disorder often have close biological relatives who suffer mood disorders, become dependent on alcohol, or commit suicide. They are using linkage analysis to find out which genes are implicated. First, they find families that have had the disorder across several generations. Then, they draw blood from both affected and unaffected family members. Many small genes have small effects that can combine with one another and with nongenetic factors put some people at greater risk. Norepinephrine, increases arousal and boosts moods, is scarce during depression and overabundant during mania. Serotonin, also scarce during depression. Drugs that relieve depression tend to increase norepinephrine or serotonin supplies by blocking either their reuptake or their chemical breakdown. People with depression have also recently been observed to have lower levels in their diet and blood count of omega -3 fatty acid, believe to enhance brain function. Japan – who have these fatty acids, have low depression levels. Left frontal lobe is likely to be inactive during depressed states. Severe depression – their left frontal lobes are 7% smaller. Hippocampus is sensitive to stress – related damage. Depressed people view life through dark glasses. Their intensely negative assumptions about themselves, their situation, and their future lead them to magnify bad experience and minimize good ones. Self – defeating beliefs may arise from learned helplessness. Depressed people tend to explain bad events in terms that stable, global, and internal. Depression is common among young Westerners because of epidemic hopelessness stemming from the rise of individualism and the decline of commitment to religion and family. They have to take responsibility and have nothing to fall back
  8. 8. on for hope. Self – defeating beliefs, negative attributions, and self blame surely do support depression. But, do they cause it? When watching videos of people, unhappy saw the other people as negative also, positive people saw it as positive and happy. Depression is brought on by stressful experiences. It can be adaptive, time for lying low and gaining insights. Depression – prone people respond to bad events in an especially self – focused, self – blaming way. When down, their brooding amplifies their negative feelings, which in turn trigger depression’s other cognitive and behavioral symptoms. This cycle helps explain women’s doubled risk of depression. Men tend to act, and women tend to think – and often to overthink. None of is immune to this. Being withdraw, self – focused, and complaining can elicit rejection. Negative stressful events interpreted through a ruminating pessimistic explanatory style create a hopeless depressed state that hampers the way the person thinks and acts. Churchil – called depression a black dog. • Objective 16: Schizophrenia – split mind, a split form reality that shows itself in disorganized thinking, disturbed perceptions, and inappropriate emotions and actions. The thinking of a person with schizophrenia is fragmented, bizarre and distorted by false beliefs (delusions). Those with paranoid tendencies are prone to delusions of persecution. Jumping from one idea to another may occur within sentences, creating a “word salad” It results from a breakdown in selective attention. We give our undivided attention to one voice in a party; people with the disorder cannot do that. Hallucinations (sensory experiences without sensory stimulation) are usually auditory and often take the form of voices making insulting statements or giving orders. You can also have inappropriate emotions, such as laughing at the death of a grandma. Other victims of this disorder lapse into flat affect a state of apparent apathy (zombie). Motor behavior can also be inappropriate, rubbing an arm continuously. Those who exhibit catatonia may maintain motionless for hours on end and then become agitate. They disrupt social relationships and make it hard to keep a job. They live in a private world. Those with negative symptoms have toneless voices, expressionless faces, or mite and rigid bodies. Thus, positive symptoms are the presence of inappropriate behaviors, and negative symptoms are the absence of appropriate behaviors. When schizophrenia is a developing process (chronic or process), recovery is doubtful. When it is developed rapidly (acute, reactive), recovery is much more likely. Those with chronic schizophrenia have the negative symptoms of withdrawal. • Objective 18: In people with schizophrenia, there is an excess for the D4 dopamine receptors. So, it creates positive symptoms such as hallucinations and paranoia. Drugs that block dopamine loosen these activites. People with chronic schizophrenia have abnormal activity in the frontal lobes, which are critical for reasoning, planning and problem solving. When people were expecting hallucinations, the brain becomes active in core regions. Many studies have found enlarged, fluid filled area and a corresponding shrinkage of cerebral tissue. The greater the shrinkage, the more severe the disorder is. Low birth weight and birth complications are known risk factors for the disorder. Also, the risks are if the country is having a flu epidemic when the child is in the womb, born during spring and winter months, and have higher than normal amount of antibodies. • Objective 19-20 Schizophrenia is genetic, there is more of a risk if your twin has it or a sibling. Scientists are looking for the genes that code for proteins. Some early warning signs are short attention span and poor muscle coordination, disruptive or withdrawn behavior, emotional unpredictability, and poor peer relations and solo play. • Objective 21-22 Personality disorders – inflexible and enduring patterns of behavior that impair one’s social functioning. Avoidant personality disorder – fear of rejection that predisposes the withdrawn. Schizoid Personality Disorder – eccentric behaviors, emotional disengagement. Histrionic disorder – dramatic or impulsive behaviors, shallow attention getting emotions and always tries to please people. Narcissistic – exaggerates own importance, success fantasies. Borderline – unstable everything. Antisocial personality disorder – typically a male whose lack of conscience becomes plain before 15, as person begins to lie, steal, or fight. Called psychopaths or sociopaths. Antisocial – feel and fear little, the results can be horrific. When they await aversive events, they have very little autonomic nervous system arousal. They also read with lower levels of stress. As young children, they are
  9. 9. impulsive, uninhibited, unconcerned with society, and low in anxiety. They find reduced activity in the person’s frontal lobes. Genetics could be a reason, but not the whole story. Nature and nurture interact. 1 in 7 Americans suffered a mental disorder during the prior year. Britain – 1 in 6. Shang Hai – lowest amount of mental disorders and U.S. – the highest amount of mental disorders. The predictor of mental disorder can be poverty and both of them cause a circle and both cause it. Schizophrenia leads to poverty but the stress of poverty can also make the disorder more severe. Median age of 8 & 10 – go through phobias. Major depression can hit at the age of 25. The risk factors can be academic failure, birth complications, caring for chronically ill patients with dementia, child abuse and neglect, chronic insomnia, chronic pain, family disorganization or conflict, low birth weight, or low socioeconomic status.

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