Psychological Disorders
Psychological Disorders•Psychopathology—scientific study of theorigins, symptoms, and development ofpsychological disorder...
DiagnosisDiagnostic and Statistical Manual of  Mental Disorders (DSM-IV-TR)—  describes specific symptoms and  diagnostic ...
Some DSM-IV-TR CategoriesCategory              Features              ExamplesInfancy, childhood,   Symptoms          Autis...
Prevalence• Approximately 48% of adults experienced  symptoms at least once in their lives• Approximately 80% who experien...
Anxiety Disorders• Primary disturbance is distressing,persistent anxiety or maladaptivebehaviors that reduce anxiety• Anxi...
Pathological AnxietyThree features distinguish normal anxiety from pathological anxiety  – Irrational--perceived threats a...
Generalized Anxiety Disorder          (GAD)• More or less constant worry about  many issues• The worry seriously interfere...
Panic Disorder• Panic attacks—sudden episode of  helpless terror with high physiological  arousal• Very frightening—suffer...
Cognitive-behavioral Theory of Panic              Disorder• Sufferers tend to misinterpret the physical  signs of arousal ...
PhobiasIntense, irrational fears that may focus   on• Natural environment—heights, water,  lightning• Situation—flying, tu...
It is not phobic to simply be anxious                         about something                                     Study of...
Some Unusual Phobias•   Ailurophobia—fear of cats•   Algobphobia—fear of pain•   Anthropophobia—fear of men•   Monophobia—...
Social Phobias• Social phobias—fear of failing or being  embarrassed in public  – public speaking (stage fright)  – fear o...
Development of Phobias• Learning Theory  – Classical conditioning--associate object    with frightening event  – Operant c...
Posttraumatic Stress Disorder           (PTSD)• Follows events that produce intense horror  or helplessness (traumatic epi...
Obsessive-Compulsive Disorder           (OCD)• Obsessions—irrational, disturbing  thoughts that intrude into  consciousnes...
Development of OCDSeems that biological factors play a role  – Deficiency of serotonin seems to be    associated with OCD ...
Mood DisordersA category of mental disorders in which  significant and persistent disruption in  mood is the predominant s...
Major DepressionA mood disorder characterized by extreme  and persistent feelings of despondency,   worthlessness and hope...
Symptoms of Major Depression• Emotional—sadness, hopelessness, guilt,  turning away from others• Behavioral—tearfulness, d...
– Prolonged, very severe symptoms– Passes without remission for at least 2  weeks– Global negativity and pessimism– Very l...
Dysthymic Disorder• Chronic, low-grade depressed feelings  that are not severe enough to be major  depression• May develop...
Seasonal Affective Disorder• Episodes of depression occur in fall  and winter then subside in spring and  summer• Seasonal...
Prevalence and Course of           Depression• Most common of psychological disorders• Women are twice as likely as men to...
Bipolar Disorders• Cyclic disorder (manic-depressive  disorder)• Mood levels swing from severe  depression to extreme euph...
Cyclothymic DisorderCyclothymic—mood disorder characterized  by moderate but frequent mood swings  that are not severe eno...
Prevalence and Course• Onset usually in young adulthood (earlytwenties)• Mood changes more abrupt than in majordepression•...
Explaining Mood Disorders• Neurotransmitter theories  – Dopamine  – Norepinephrine  – Serotonin  – Glutamate (implicated i...
Situational Bases for             Depression• Positive correlation between stressful  life events and onset of depression ...
Personality Disorders    Inflexible, maladaptive pattern of   thoughts, emotions, behaviors, andinterpersonal functioning ...
Antisocial Personality Disorder• Used to be called psychopath or sociopath• Evidence often seen in childhood (conduct  dis...
Borderline Personality            Disorder• Chronic instability of emotions, self-  image, relationships• Self-destructive...
Dissociative Disorders• What is dissociation?  – literally a dis-association of memory  – person suddenly becomes unaware ...
Dissociative AmnesiaMargie and her brother were recently victims of a robbery. Margie was not injured, but her brother was...
Dissociative Amnesia• Also known as psychogenic amnesia• Memory loss the only symptom• Often selective loss surrounding tr...
Dissociative FugueJay, a high school physics teacher in New York City, disappeared three days after his wife unexpectedly ...
Dissociative Fugue• Also known as psychogenic fugue• Global amnesia with identity replacement  –   leaves home  –   develo...
Dissociative Identity Disorder            (DID)Norma has frequent memory gaps and cannot account for her whereabouts durin...
Dissociative Identity Disorder• Originally known as “multiple personality  disorder”• 2 or more distinct personalities man...
Dissociative Identity Disorder• Pattern typically starts prior to age 10  (childhood)• Most people with disorder are women...
Causes of Dissociative         Disorders?• Repeated, severe sexual or physical  abuse• However, many abused people do not ...
The DID Controversy• Some curious statistics  – 1930–60: 2 cases per decade in USA  – 1980s: 20,000 cases reported  – many...
What is Schizophrenia?• Comes from Greek meaning “split” and  “mind”  – ‘split’ refers to loss of touch with reality  – no...
Symptoms of Schizophrenia• Positive symptoms  – hallucinations  – delusions• Negative symptoms  – absence of normal cognit...
Symptoms of Schizophrenia• Delusions of persecution  – ‘they’re out to get me’  – paranoia• Delusions of grandeur  – “God”...
Symptoms of Schizophrenia• Hallucinations  – hearing or seeing things that aren’t there  – contributes to delusions  – com...
Symptoms of Schizophrenia• Disorganized behavior and affect  – behavior is inappropriate for the situation     • e.g., wea...
Frequency of positive and negative symptoms in individuals at the time they werehospitalized for schizophrenia. Source: Ba...
Types of Schizophrenia• Paranoid type  – delusions of persecution, believes others are spying    and plotting  – delusions...
Schizophrenia and GeneticsRisk increases with genetic similarity                    40    Lifetime risk   30  of developin...
Other Factors in Development of          Schizophrenia• Difficult birth (e.g., oxygen deprivation)• Prenatal viral infecti...
The Dopamine Theory• Drugs that reduce dopamine reduce  symptoms• Drugs that increase dopamine produce  symptoms even in p...
Other Biological Factors• Brain structure and function  – enlarged cerebral ventricles and reduced    neural tissue around...
Family Influences on        Schizophrenia• Parental communication that is  disorganized, hard-to-follow, or highly  emotio...
Summary of Schizophrenia• Many biological factors seem involved  – heredity  – neurotransmitters  – brain structure abnorm...
Ch13 dp3
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  • Discovering Psy2e slides (Shulman)
  • The caudate nucleus is located in the basal ganglia and is associated with initiation of learned, habitual motor activities Using drugs that increase Serotonin reduces the activity of the caudate nucleus and leads to a reduction in the obsessions and compulsions - people who recover from OCD using behavioral and cognitive therapies also show a reduction in activity in the caudate nucleus
  • Fig 13.3 p 514 DP3
  • Picture from Hockenbury Presentation Manager CD p.. 489 of the text
  • neurotransmitters are associated with motivation and arousal drugs that augment NE or Serotonin have been found effective in treating depression Prozac is a serotonin reuptake inhibitor, making more Serotonin available
  • Keywords: definition of dissociation Some psychologists use the term repression for dissociative amnesia A problem is that we need to distinguish between normal forgetting and the extreme case of dissociative amnesia. Just because you can’t remember something from your past very well doesn’t mean you are dissociating. Amnesia can also be caused by a head injury or by drugs. This isn’t considered dissociative amnesia How can we tell other kinds of forgetting from dissociation? Sudden onset, related to emotional trauma absence of brain injury, drugs
  • Keywords: dissociative amnesia example
  • Keywords: dissociative amnesia
  • keywords: dissociative fugue example
  • keywords: dissociative fugue
  • keywords: dissociative identity disorder example
  • keywords: dissociative identity disorder, symptoms
  • keywords: dissociative identity disorder, characteristics
  • keywords: causal theories of dissociative disorders
  • keywords: dissociative identity disorder, controversy over Spanos asked college students to pretend they were accused murderers being examined by a psychiatrist. When given hypnotic therapy the students often expressed a second personality which claimed to be the murderer. This raises the question of whether DID might arise in some cases as a strategy or ploy by the patient, not just to avoid prosecution for crimes but perhaps to avoid other negative situations. It is not suggested that all DID cases arise in this way, but perhaps the large increase in diagnosis can be accounted for in this way. The increase in incidence in the 1980s was preceded by heightened awareness of the the stories of THE THREE FACES OF EVE and SYBIL which became known in the 1960’s
  • keywords: schizophrenia, definition
  • keywords: schizophrenia, symptoms, types
  • keywords: schizophrenia, symptoms, delusions
  • keywords: schizophrenia, symptoms, hallucinations, disorganized speech
  • keywords: schizophrenia, symptoms, disorganized behavior, disorganized affect
  • p. 528 dp3 Figure 13.5
  • keywords: schizophrenia, subtypes
  • keywords: genetics of schizophrenia Discovering Psy2e slides, Shulman Discovering Psy2e Slides (Shulman)
  • keywords: schizophrenia, congenital influences Increased risk has been observed for those born in a country where there was a flu epidemic during their gestation. The months of above average risk births are reversed between the northern and southern hemispheres, as are the flu seasons.
  • keywords: schizophrenia, the dopamine theory A problem for the theory: Drugs that reduce dopamine do reduce Sz symptoms, but the effects on dopamine function in the brain and on behavior have different time courses. On treatment with dopamine blocking drugs receptor function in the brain is affected almost immediately but reduction of symptoms is delayed by days or weeks. Some drugs that increase dopamine and that may induce sz-like positive symptoms include amphetamines and cocaine. When drug therapy first became available it was regarded as a major breakthrough in the treatment of mental disease by medical means
  • keywords: schizophrenia, brain structure, behavioral precursors
  • keywords: schizophrenia, family variables
  • keywords: schizophrenia, summary
  • Ch13 dp3

    1. 1. Psychological Disorders
    2. 2. Psychological Disorders•Psychopathology—scientific study of theorigins, symptoms, and development ofpsychological disorders•Psychological disorder--a pattern ofbehavioral and psychological symptoms thatcauses significant personal distress, impairsthe ability to function in one or more importantareas of daily life, or both
    3. 3. DiagnosisDiagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)— describes specific symptoms and diagnostic guidelines for psychological disorders – Provides a common language to label mental disorders – Comprehensive guidelines to help diagnose mental disorders
    4. 4. Some DSM-IV-TR CategoriesCategory Features ExamplesInfancy, childhood, Symptoms Autistic disorderor adolescence usually diagnosed Tourette’s in childhood disorderSubstance-related Effects of seeking Substance abuse or using drugsEating disorders Disturbances in Anorexia nervosa body image, Bulimia nervosa eatingImpulse-control Inability to resist Kleptomania,disorders actions that may pyromania be harmful
    5. 5. Prevalence• Approximately 48% of adults experienced symptoms at least once in their lives• Approximately 80% who experienced symptoms in the last year did NOT seek treatment• Most people seem to deal with symptoms without complete debilitation• Women have higher prevalence of depression and anxiety• Men have higher prevalence of substance abuse and antisocial personality disorder
    6. 6. Anxiety Disorders• Primary disturbance is distressing,persistent anxiety or maladaptivebehaviors that reduce anxiety• Anxiety—diffuse, vague feelings offear and apprehension
    7. 7. Pathological AnxietyThree features distinguish normal anxiety from pathological anxiety – Irrational--perceived threats are exaggerated or nonexistent, response is out of proportion – Uncontrollable--cannot be “turned off” even when the person wants to – Disruptive--anxiety interferes with everyday activities
    8. 8. Generalized Anxiety Disorder (GAD)• More or less constant worry about many issues• The worry seriously interferes with functioning• Physical symptoms – headaches – stomach aches – muscle tension – irritability
    9. 9. Panic Disorder• Panic attacks—sudden episode of helpless terror with high physiological arousal• Very frightening—sufferers live in fear of having them• Agoraphobia often develops as a result
    10. 10. Cognitive-behavioral Theory of Panic Disorder• Sufferers tend to misinterpret the physical signs of arousal as catastrophic and dangerous• This interpretation leads to further physical arousal, tending toward a vicious cycle• After the attack the person is very apprehensive of another attack
    11. 11. PhobiasIntense, irrational fears that may focus on• Natural environment—heights, water, lightning• Situation—flying, tunnels, crowds, social gathering• Injury—needles, blood, dentist, doctor• Animals or insects—insects, snakes, bats, dogs
    12. 12. It is not phobic to simply be anxious about something Study of normal anxieties 100Percentage 90 of people 80 surveyed 70 60 50 40 30 20 10 0 Snakes Being Mice Flying Being Spiders Thunder Being Dogs Driving Being Cats in high, on an closed in, and and alone a car in exposed airplane in a insects lightning in a crowd places small a house of people place at night Afraid of it Bothers slightly Not at all afraid of it
    13. 13. Some Unusual Phobias• Ailurophobia—fear of cats• Algobphobia—fear of pain• Anthropophobia—fear of men• Monophobia—fear of being alone• Pyrophobia—fear of fire
    14. 14. Social Phobias• Social phobias—fear of failing or being embarrassed in public – public speaking (stage fright) – fear of crowds, strangers – meeting new people – eating in public• Considered phobic if these fears interfere with normal behavior• Equally often in males and females
    15. 15. Development of Phobias• Learning Theory – Classical conditioning--associate object with frightening event – Operant conditioning--avoidance behavior is reinforced – Observation learning--model other’s behavior• Preparedness theory—phobia serves to to enhance survival
    16. 16. Posttraumatic Stress Disorder (PTSD)• Follows events that produce intense horror or helplessness (traumatic episodes)• Core symptoms include: – Frequent recollection of traumatic event, often intrusive and interfering with normal thoughts – Avoidance of situations that trigger recall of the event – Increased physical arousal associated with stress
    17. 17. Obsessive-Compulsive Disorder (OCD)• Obsessions—irrational, disturbing thoughts that intrude into consciousness• Compulsions—repetitive actions performed to alleviate obsessions• Checking and washing most common compulsions• Heightened neural activity in caudate nucleus
    18. 18. Development of OCDSeems that biological factors play a role – Deficiency of serotonin seems to be associated with OCD – Possible dysfunctions in frontal lobes, the area of the brain that directs thinking and planning – Possible dysfunction in caudate nucleus, area of the brain that has a role in regulating movements
    19. 19. Mood DisordersA category of mental disorders in which significant and persistent disruption in mood is the predominant symptom, causing impaired cognitive, behavioral, and physical functioning – Major depression – Dysthymic disorder – Bipolar disorder – Cyclothymic disorder
    20. 20. Major DepressionA mood disorder characterized by extreme and persistent feelings of despondency, worthlessness and hopelessness that disturb everyday functioning
    21. 21. Symptoms of Major Depression• Emotional—sadness, hopelessness, guilt, turning away from others• Behavioral—tearfulness, dejected facial expression, loss of interest in normal activities, slowed movements and gestures, withdrawal from social activities• Cognitive—difficulty thinking and concentrating, global negativity, preoccupation with death/suicide• Physical—appetite and weight changes, excessive or diminished sleep, loss of energy, global anxiety, restlessness
    22. 22. – Prolonged, very severe symptoms– Passes without remission for at least 2 weeks– Global negativity and pessimism– Very low self-esteem
    23. 23. Dysthymic Disorder• Chronic, low-grade depressed feelings that are not severe enough to be major depression• May develop in response to trauma, but does not decrease with time• Can have co-existing major depression• Usually does not severely impair functioning
    24. 24. Seasonal Affective Disorder• Episodes of depression occur in fall and winter then subside in spring and summer• Seasonal regularity• More common among women• More common in northern latitudes where there is less sunlight
    25. 25. Prevalence and Course of Depression• Most common of psychological disorders• Women are twice as likely as men to be diagnosed with major depression• Untreated episodes can become recurring and more serious
    26. 26. Bipolar Disorders• Cyclic disorder (manic-depressive disorder)• Mood levels swing from severe depression to extreme euphoria (mania)• No regular relationship to time of year (SAD)• Must have at least one manic episode – Supreme self-confidence – Grandiose ideas and movements
    27. 27. Cyclothymic DisorderCyclothymic—mood disorder characterized by moderate but frequent mood swings that are not severe enough to qualify as bipolar disorder. Sufferers are often perceived as moody, inconsistent, and unpredictable.
    28. 28. Prevalence and Course• Onset usually in young adulthood (earlytwenties)• Mood changes more abrupt than in majordepression• No sex differences in rate of bipolar disorder• Commonly recurs every few years• Can often be controlled by medication(lithium)
    29. 29. Explaining Mood Disorders• Neurotransmitter theories – Dopamine – Norepinephrine – Serotonin – Glutamate (implicated in bipolar disorder)• Genetic component – more closely related people show similar histories of mood disorders
    30. 30. Situational Bases for Depression• Positive correlation between stressful life events and onset of depression – Does life stress cause depression?• Most depressogenic life events are losses – spouse or companion – long-term job – health – income
    31. 31. Personality Disorders Inflexible, maladaptive pattern of thoughts, emotions, behaviors, andinterpersonal functioning that are stable over time and across situations, and deviate from the expectations of the individual’s culture
    32. 32. Antisocial Personality Disorder• Used to be called psychopath or sociopath• Evidence often seen in childhood (conduct disorder)• Manipulative, can be charming, can be cruel and destructive• Seems to lack “conscience”• More prevalent in men than women
    33. 33. Borderline Personality Disorder• Chronic instability of emotions, self- image, relationships• Self-destructive behaviors• Intense fear of abandonment and emptiness• Possible history of childhood physical, emotional, or sexual abuse• 75% of diagnosed cases are women
    34. 34. Dissociative Disorders• What is dissociation? – literally a dis-association of memory – person suddenly becomes unaware of some aspect of their identity or history – unable to recall except under special circumstances (e.g., hypnosis)• Three types are recognized – dissociative amnesia – dissociative fugue – dissociative identity disorder
    35. 35. Dissociative AmnesiaMargie and her brother were recently victims of a robbery. Margie was not injured, but her brother was killed when he resisted the robbers. Margie was unable to recall any details from the time of the accident until four days later.
    36. 36. Dissociative Amnesia• Also known as psychogenic amnesia• Memory loss the only symptom• Often selective loss surrounding traumatic events – person still knows identity and most of their past• Can also be global – loss of identity without replacement with a new one
    37. 37. Dissociative FugueJay, a high school physics teacher in New York City, disappeared three days after his wife unexpectedly left him for another man. Six months later, he was discovered tending bar in Miami Beach. Calling himself Martin, he claimed to have no recollection of his past life and insisted that he had never been married.
    38. 38. Dissociative Fugue• Also known as psychogenic fugue• Global amnesia with identity replacement – leaves home – develops a new identity – apparently no recollection of former life – called a ‘fugue state’• If fugue wears off – old identity recovers – new identity is totally forgotten
    39. 39. Dissociative Identity Disorder (DID)Norma has frequent memory gaps and cannot account for her whereabouts during certain periods of time. While being interviewed by a clinical psychologist, she began speaking in a childlike voice. She claimed that her name was Donna and that she was only six years old. Moments later, she seemed to revert to her adult voice and had no recollection of speaking in a childlike voice or claiming that her name was Donna.
    40. 40. Dissociative Identity Disorder• Originally known as “multiple personality disorder”• 2 or more distinct personalities manifested by the same person at different times• VERY rare and controversial disorder• Examples include Sybil, Trudy Chase, Chris Sizemore (“Eve”)• Has been used as a criminal defense
    41. 41. Dissociative Identity Disorder• Pattern typically starts prior to age 10 (childhood)• Most people with disorder are women• Most report recall of torture or sexual abuse as children and show symptoms of PTSD
    42. 42. Causes of Dissociative Disorders?• Repeated, severe sexual or physical abuse• However, many abused people do not develop DID• Combine abuse with biological predisposition toward dissociation? – people with DID are easier to hypnotize than others – may begin as series of hypnotic trances to cope with abusive situations
    43. 43. The DID Controversy• Some curious statistics – 1930–60: 2 cases per decade in USA – 1980s: 20,000 cases reported – many more cases in US than elsewhere – varies by therapist—some see none, others see a lot• Is DID the result of suggestion by therapist and acting by patient?
    44. 44. What is Schizophrenia?• Comes from Greek meaning “split” and “mind” – ‘split’ refers to loss of touch with reality – not dissociative state – not ‘split personality’• Equally split between genders, males have earlier onset – 18 to 25 for men – 26 to 45 for women
    45. 45. Symptoms of Schizophrenia• Positive symptoms – hallucinations – delusions• Negative symptoms – absence of normal cognition or affect (e.g., flat affect, poverty of speech)• Disorganized symptoms – disorganized speech (e.g., word salad) – disorganized behaviors
    46. 46. Symptoms of Schizophrenia• Delusions of persecution – ‘they’re out to get me’ – paranoia• Delusions of grandeur – “God” complex – megalomania• Delusions of being controlled – the CIA is controlling my brain with a radio signal
    47. 47. Symptoms of Schizophrenia• Hallucinations – hearing or seeing things that aren’t there – contributes to delusions – command hallucinations: voices giving orders• Disorganized speech – Over-inclusion—jumping from idea to idea without the benefit of logical association – Paralogic—on the surface, seems logical, but seriously flawed • e.g., Jesus was a man with a beard, I am a man with a beard, therefore I am Jesus
    48. 48. Symptoms of Schizophrenia• Disorganized behavior and affect – behavior is inappropriate for the situation • e.g., wearing sweaters and overcoats on hot days – affect is inappropriately expressed • flat affect—no emotion at all in face or speech • inappropriate affect—laughing at very serious things, crying at funny things – catatonic behavior • unresponsiveness to environment, usually marked by immobility for extended periods
    49. 49. Frequency of positive and negative symptoms in individuals at the time they werehospitalized for schizophrenia. Source: Based on data reported in Andreasen &Flaum, 1991.
    50. 50. Types of Schizophrenia• Paranoid type – delusions of persecution, believes others are spying and plotting – delusions of grandeur, believes others are jealous, inferior, subservient• Catatonic type—unresponsive to surroundings, purposeless movement, parrot-like speech• Disorganized type – delusions and hallucinations with little meaning – disorganized speech, behavior, and flat affect
    51. 51. Schizophrenia and GeneticsRisk increases with genetic similarity 40 Lifetime risk 30 of developing schizophrenia for relatives of 20a schizophrenic 10 0 Fraternal Children Identical General Siblings twin of two twin population Children schizophrenia victims
    52. 52. Other Factors in Development of Schizophrenia• Difficult birth (e.g., oxygen deprivation)• Prenatal viral infection• Risk highest for people living in urban areas and born during February and March• Age of the father--incidence of schizophrenia increases with the age of the father
    53. 53. The Dopamine Theory• Drugs that reduce dopamine reduce symptoms• Drugs that increase dopamine produce symptoms even in people without the disorder• Theory: Schizophrenia is caused by excess dopamine• Dopamine theory not enough; other neurotransmitters involved as well
    54. 54. Other Biological Factors• Brain structure and function – enlarged cerebral ventricles and reduced neural tissue around the ventricles – PET scans show reduced frontal lobe activity• Early warning signs – nothing very reliable has been found yet – certain attention deficits can be found in children who are at risk for the disorder
    55. 55. Family Influences on Schizophrenia• Parental communication that is disorganized, hard-to-follow, or highly emotional• Expressed emotion • highly critical, over-enmeshed families• Psychologically unhealthy families may contribute to schizophrenic development in genetically predisposed children.
    56. 56. Summary of Schizophrenia• Many biological factors seem involved – heredity – neurotransmitters – brain structure abnormalities• Family and cultural factors also important• Combined model of schizophrenia – biological predisposition combined with psychosocial stressors leads to disorder – Is schizophrenia the maladaptive coping behavior of a biologically vulnerable person?

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