Psychological Disorders
History <ul><li>1.  Demonology </li></ul><ul><li>belief that abnormal behavior is caused by supernatural forces </li></ul>...
History <ul><li>Excess of black bile caused depression </li></ul><ul><li>Too much yellow bile associated with anxiety </li...
History <ul><li>Introduction of Humane Care </li></ul><ul><li>16 th  Century </li></ul><ul><li>Realization that people nee...
History <ul><li>Renewed Interest in Physiological Explanations </li></ul><ul><li>1950s French chemists were working on ant...
Identifying Psychological Disorders <ul><li>History </li></ul><ul><li>Diagnostic system was introduced by the American Psy...
5 Axes of the DSM <ul><li>Axis I:  Clinical Syndromes: </li></ul><ul><li>Contains all major disorders (mood, anxiety, schi...
Mood Disorders <ul><li>Psychological dx’s characterized by swings in emotional states that are much more extreme & prolong...
Depressive Disorder <ul><li>Very common </li></ul><ul><li>Affects men or women more? </li></ul><ul><li>Reasons there is a ...
Bipolar Disorder <ul><li>WAS called “manic-depressive dx” </li></ul><ul><li>Depression is referred to as  unipolar  (depre...
Causes of Depression <ul><li>Physiological Explanations </li></ul><ul><ul><li>Low levels of neurotransmitters ( serotonin ...
Causes of Depression <ul><li>Selective Recall </li></ul><ul><ul><li>“ Are depressed indiv’s more likely to recall negative...
Suicide <ul><li>Act of taking one’s own life </li></ul><ul><li>30,000 people in US commit suicide each year </li></ul><ul>...
Myths about Suicide <ul><li>People who talk about suicide won’t commit suicide. </li></ul><ul><li>Only very depressed pers...
Anxiety Disorders <ul><li>Anxiety  </li></ul><ul><li>Increased arousal accompanied by generalized feelings of fear or appr...
Attention Deficit/Hyperactivity Disorder <ul><li>A:  Six or more of the following symptoms of inattention have been presen...
Cause of Anxiety <ul><li>Psychoanalytic Explanation: </li></ul><ul><li>Believed anxiety is result of  intrapsychic conflic...
Phobias <ul><li>Persistent, irrational fears of a specific object, activity or situation. </li></ul><ul><li>Have no justif...
3 Groups of Phobias <ul><li>Agoraphobia  </li></ul><ul><li>Intense fear of specific situations in which individuals suspec...
Some specific phobias… <ul><li>Acrophobia </li></ul><ul><li>Astraphobia </li></ul><ul><li>Claustrophobia </li></ul><ul><li...
Obsessive-Compulsive Disorder (OCD) <ul><li>Recurrent obsessions or compulsions or both </li></ul><ul><li>Obsessions  – pe...
OCD:  Explanations <ul><li>Physiological Explanations: </li></ul><ul><li>OCD symptoms can be controlled using  antidepress...
Post-Traumatic Stress Disorder (PTSD) <ul><li>Re-experiencing of a traumatic event & numbing of responsiveness </li></ul><...
Why do PTSD symptoms develop? <ul><li>Study (1992), Hurricane Andrew </li></ul><ul><li>3 Factors lead to development of PT...
Somatoform Disorders <ul><li>Physical symptoms such as pain, paralysis, blindness or deafness for which there is no demons...
Somatoform Disorders <ul><li>Somatization Disorders  -  numerous, recurrent & long lasting somatic complaints that are not...
Somatoform Disorders <ul><li>Conversion Disorders  – one or more major physical symptom that greatly impairs fx’ing, but a...
Somatoform Disorders <ul><li>Glove anesthesia  –IS a conversion disorder </li></ul><ul><li>Individual loses  feeling in th...
Are Somatoform Symptoms Real or Fake? <ul><li>Malingering  – faking disorders to avoid responsibilities. </li></ul><ul><li...
Dissociative Disorders <ul><li>Separation of personality fx’s so that the individual is not aware of, or loses contact wit...
Dissociative Disorders <ul><li>Dissociative Amnesia  – sudden inability to remember impt info or events </li></ul><ul><li>...
Dissociative Disorders <ul><li>Depersonalization </li></ul><ul><li>A temporary, episodic loss or distortion of self. </li>...
Sexual Disorders <ul><li>Sexual Dysfunctions </li></ul><ul><li>Absence or failure of the sexual response at some point dur...
3 Dysfunction Disorders Associated with Sexual Response Cycle:  <ul><li>Desire Disorder –  associated with appetitive phas...
Paraphilias <ul><li>Term paraphilias is derived from para meaning “deviant” & philia meaning “attraction” </li></ul><ul><l...
Types of Paraphilias: <ul><li>Exhibitionism –  exposure of genitals to a stranger in attempt to achieve sexual arousal.   ...
Psychodynamic Explanations: <ul><li>Sexual Sadism –  based on Freud’s idea that 2 instincts (aggression & sex) & energies ...
Gender Identity Disorder <ul><li>Physiological Sex Identification –  objective knowledge of whether you are male or female...
<ul><li>Does sex reassignment surgery result in improved gender identity adjustment?  </li></ul><ul><li>Findings:  (of sev...
Eating Disorders <ul><li>Anorexia Nervosa:  Primary Symptoms: </li></ul><ul><li>Refusal to maintain body weight </li></ul>...
Explanations/Psychodynamic: <ul><li>Based on Freud’s idea that eating can be a substitute for sex </li></ul><ul><li>Anorex...
Personality Disorders: <ul><li>3 FACTORS: </li></ul><ul><li>Consistently use the behavior(s) in questions </li></ul><ul><l...
Antisocial Personality Disorder: <ul><li>Mood Symptoms: </li></ul><ul><li>Lack of anxiety or quilt </li></ul><ul><li>Hedon...
Avoidant Personality Disorder <ul><li>Exceptionally sensitive to potential social rejection & the humiliation that goes wi...
Histrionic Personality Disorder <ul><li>3 CHARACTERISTICS: </li></ul><ul><li>Usually attractive, charming, appealing & sex...
Narcissistic Personality Disorder <ul><li>Archetype is Narcissus, character in Greek mythology, who fell in love with his ...
Substance-Related Disorders: <ul><li>Substance abuse  – not dependent on drug, but uses the drug repeatedly, which leads t...
Types of Drugs: <ul><li>Depressants – reduce physiological arousal & psychological tension </li></ul><ul><li>3 Types: alco...
Explanations for Substance Dependence & Abuse <ul><li>Exposure – necessary for dependence, not sufficient to explain depen...
Schizophrenia <ul><li>Affects 1-2% of the population </li></ul><ul><li>Cognitive Symptoms: </li></ul><ul><li>Hallucination...
Phases of Schizophrenia <ul><li>Prodromal – intellectual & interpersonal functioning begins to deteriorate </li></ul><ul><...
Positive vs. Negative Symptoms: <ul><li>Positive Symptoms –  hallucinations, delusions, thought disorders & bizarre behavi...
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Phsychological Disorders

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Phsychological Disorders

  1. 1. Psychological Disorders
  2. 2. History <ul><li>1. Demonology </li></ul><ul><li>belief that abnormal behavior is caused by supernatural forces </li></ul><ul><li>Expelled demons by “persuading” them to leave </li></ul><ul><ul><li>Stoning, flogging </li></ul></ul><ul><li>Physiological Explanations </li></ul><ul><li>1 st attempt made by Hippocrates </li></ul><ul><li>Taught brain is responsible for mental dx’s </li></ul><ul><li>Believed behavior to be governed by 4 humors </li></ul><ul><ul><li>Black bile </li></ul></ul><ul><ul><li>Yellow bile </li></ul></ul><ul><ul><li>Phlegm </li></ul></ul><ul><ul><li>Blood </li></ul></ul>
  3. 3. History <ul><li>Excess of black bile caused depression </li></ul><ul><li>Too much yellow bile associated with anxiety </li></ul><ul><li>High levels of phlegm = dull, sluggish temperament </li></ul><ul><li>Excess blood = mood swings </li></ul><ul><li>Treatment = balancing of humors; draining fluids; altering diet; exercising; altering alcohol intake </li></ul><ul><li>Return to Demonology </li></ul><ul><li>Religion was at forefront </li></ul><ul><li>Physiological approach was abandoned </li></ul><ul><li>Life was viewed as a struggle between good & evil </li></ul><ul><li>Disturbed persons accused of being agents of the Devil & labeled as witches </li></ul>
  4. 4. History <ul><li>Introduction of Humane Care </li></ul><ul><li>16 th Century </li></ul><ul><li>Realization that people needed care NOT exorcism </li></ul><ul><li>Early tx = prison; chained to a wall </li></ul><ul><li>Philippe Pinel (1792) directed patients I his Paris hospital to be unchained </li></ul><ul><li>Introduction of Psychological Explanations </li></ul><ul><li>Franz Anton Mesmer </li></ul><ul><li>Believed abnormal behavior result of imbalance of “magnetic fluids” in body </li></ul><ul><li>Tx =baquet was &quot;an oaken tub specially designed to store and transmit magnetic fluid. The tub, some four or five feet in diameter and one foot in depth, had a lid constructed in two pieces. At the bottom of the tub, arranged in concentric circles, were bottles, some empty and pointing towards the center, some containing magnetized water and pointing out towards the circumference. There were several layers of such rows. The tub was filled with water to which iron filings and powdered glass were added. Iron rods emerging through holes in the tub's lid were bent at right angles so that the ends of the rods could be placed against the afflicted areas of the patient's body. A number of patients could use the baquet at one time. They were encouraged to augment the magnetic fluid by holding hands, thus creating a circuit.&quot; - &quot;From Mesmer to Freud&quot; by Adam Crabtree, Yale University, (1993) pp. 13-14. </li></ul><ul><li>Believed he was changing people physically </li></ul>
  5. 5. History <ul><li>Renewed Interest in Physiological Explanations </li></ul><ul><li>1950s French chemists were working on antihistamines used for tx’ing allergies and asthma </li></ul><ul><li>Strong version of antihistamines were given to indiv’s with schizophrenia—they became calm; their cognitive confusion was reduced & their behavior became stabilized. </li></ul><ul><li>Antipsychotic drugs / psychotropic medications revolutionized hospitals </li></ul><ul><li>Before drugs huge #’s in hospitals (750,000)– after drugs, less than half </li></ul><ul><li>Psychopharmacology = investigates the effects of drugs on brain & behavior </li></ul>
  6. 6. Identifying Psychological Disorders <ul><li>History </li></ul><ul><li>Diagnostic system was introduced by the American Psychiatric Association in 1952 </li></ul><ul><li>Name of diagnostic system = Diagnostic & Statistical Manual of Mental Disorders (DSM) </li></ul><ul><li>Most recent revision DSM-IV-TR (2000) </li></ul><ul><li>Next revision anticipated in 2010 </li></ul><ul><li>2 Purposes of the DSM: </li></ul><ul><li>Enables us to communicate information about clients to other professionals (i.e., “major depressive disorder” conveys more information than “abnormal” behavior) </li></ul><ul><li>Helps us decide how to treat an individual </li></ul>
  7. 7. 5 Axes of the DSM <ul><li>Axis I: Clinical Syndromes: </li></ul><ul><li>Contains all major disorders (mood, anxiety, schizophrenia) </li></ul><ul><li>Axis II: Personality Disorders </li></ul><ul><li>Also includes mental retardation diagnosis </li></ul><ul><li>Axis III: General Medical Conditions: </li></ul><ul><li>Any medical condition relevant to the tx of the clinical dx </li></ul><ul><li>Axis IV: Psychosocial & Environmental Prob’s (death of a loved one, economic prob’s, legal prob’s </li></ul><ul><li>Axis V: Global Assessment of Functioning </li></ul><ul><li>Overall judgment of indiv’s fx’ing at present & highest level of fx’ing in past </li></ul>
  8. 8. Mood Disorders <ul><li>Psychological dx’s characterized by swings in emotional states that are much more extreme & prolonged than most people </li></ul><ul><li>Depressive Dx’s: </li></ul><ul><li>311 Depressive dx NOS </li></ul><ul><li>300.4 Dysthymic Dx </li></ul><ul><li>296.36 MDD, recurrent, in full remission </li></ul><ul><li>296.31 MDD, mild </li></ul><ul><li>296.32 MDD, moderate </li></ul><ul><li>296.34 MDD, severe with psychotic features </li></ul><ul><li>Criteria used for reaching a diagnosis: </li></ul><ul><li>Profound unhappiness most of the time </li></ul><ul><li>Loss of interest in usually pleasurable activities </li></ul><ul><li>Major loss of energy (everything is an effort) </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Sleep disturbances </li></ul><ul><li>Difficulties in thinking </li></ul>
  9. 9. Depressive Disorder <ul><li>Very common </li></ul><ul><li>Affects men or women more? </li></ul><ul><li>Reasons there is a gender difference? </li></ul><ul><li>Children & depression… </li></ul><ul><ul><li>Family history </li></ul></ul><ul><ul><li>Medication </li></ul></ul><ul><ul><li>Other issues? </li></ul></ul>
  10. 10. Bipolar Disorder <ul><li>WAS called “manic-depressive dx” </li></ul><ul><li>Depression is referred to as unipolar (depression is the primary symptom) </li></ul><ul><li>Bipolar involves swings of mood between mania & depression </li></ul><ul><li>Manic Symptoms: </li></ul><ul><li>Rapid speech </li></ul><ul><li>Decreased need for sleep </li></ul><ul><li>“ jump” from one idea or activity to another </li></ul><ul><li>High interest in potentially harmful activities </li></ul>
  11. 11. Causes of Depression <ul><li>Physiological Explanations </li></ul><ul><ul><li>Low levels of neurotransmitters ( serotonin & norepinephrine) found in indiv’s with depression </li></ul></ul><ul><ul><li>High levels= mania </li></ul></ul><ul><ul><li>Support for this explanation found in drug rx: </li></ul></ul><ul><ul><ul><li>Drugs that increase certain neurotransmitters reduce depression </li></ul></ul></ul><ul><ul><ul><li>Increase neurotransmitters in “normal” = mania </li></ul></ul></ul><ul><ul><ul><li>Decrease neurotransmitters in “normal” = depression </li></ul></ul></ul><ul><li>Cognitive Explanations: </li></ul><ul><ul><li>Learned Helplessness </li></ul></ul><ul><ul><ul><li>Indiv’s learn that they cannot control future negative outcomes </li></ul></ul></ul><ul><ul><ul><li>Indiv’s feel helpless – leads to depression </li></ul></ul></ul><ul><ul><li>Negative Cognitions </li></ul></ul><ul><ul><ul><li>“ Do negative cognitions cause depression, or are they the result of depression?” </li></ul></ul></ul><ul><ul><ul><li>Study: Ss read sad statements = increases in mild depression </li></ul></ul></ul><ul><ul><ul><ul><li>Sad statements = “I’m discouraged & unhappy about myself” “I feel worn out.” </li></ul></ul></ul></ul><ul><ul><ul><ul><li>When compared to indiv’s who read happy statements, indiv’s who read sad statements </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Reported higher levels of depression </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Performed worse on intelligence tests </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Wrote more slowly </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Preferred solitary or inactive activities </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Depression generated by sad statements was not “deep”; did not last more than a few minutes </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Findings do not support negative cognitions result in clinical depression </li></ul></ul></ul></ul></ul>
  12. 12. Causes of Depression <ul><li>Selective Recall </li></ul><ul><ul><li>“ Are depressed indiv’s more likely to recall negative events than nondepressed indiv’s?” </li></ul></ul><ul><ul><li>YES!!!!!!!!! </li></ul></ul><ul><ul><li>Easily recall things such as failures, being left out of groups, criticized by teachers or employers </li></ul></ul><ul><li>Mood-dependent Memory </li></ul><ul><ul><li>Depressed indiv’s tend to notice, store & remember information consistent with their negative moods </li></ul></ul>
  13. 13. Suicide <ul><li>Act of taking one’s own life </li></ul><ul><li>30,000 people in US commit suicide each year </li></ul><ul><li>Twice as many women than men </li></ul><ul><li>Men are more likely to succeed…why? </li></ul><ul><li>Highest rate of suicide—elderly & which profession? </li></ul><ul><li>Can suicide be predicted? </li></ul><ul><li>Predictors: </li></ul><ul><li>Elderly </li></ul><ul><li>High-status occupation </li></ul><ul><li>More financial resources </li></ul><ul><li>Depression </li></ul><ul><li>Bisexual, homosexual </li></ul><ul><li>More sleep per night </li></ul><ul><li>Ideas of persecution </li></ul><ul><li>Improvement of depression---WHY? </li></ul>
  14. 14. Myths about Suicide <ul><li>People who talk about suicide won’t commit suicide. </li></ul><ul><li>Only very depressed persons commit suicide. </li></ul><ul><li>Suicidal tendencies run in families. </li></ul><ul><li>Suicide rates are higher in rainy than sunny months. </li></ul>
  15. 15. Anxiety Disorders <ul><li>Anxiety </li></ul><ul><li>Increased arousal accompanied by generalized feelings of fear or apprehension </li></ul><ul><li>Panic Attack DX </li></ul><ul><ul><li>Brief periods of INTENSE spontaneous anxiety </li></ul></ul><ul><ul><li>Occurrence is unpredictable </li></ul></ul><ul><ul><li>Physical symptoms: </li></ul></ul><ul><ul><ul><li>Shortness of breath </li></ul></ul></ul><ul><ul><ul><li>Heart palpitations </li></ul></ul></ul><ul><ul><ul><li>Chest pains </li></ul></ul></ul><ul><ul><ul><li>Sweating </li></ul></ul></ul><ul><ul><ul><li>Often mistake symptoms for a heart attack </li></ul></ul></ul>
  16. 16. Attention Deficit/Hyperactivity Disorder <ul><li>A: Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level: </li></ul><ul><li>Inattention </li></ul><ul><li>Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. </li></ul><ul><li>Often has trouble keeping attention on tasks or play activities. </li></ul><ul><li>Often does not seem to listen when spoken to directly. </li></ul><ul><li>Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). </li></ul><ul><li>Often has trouble organizing activities. </li></ul><ul><li>Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). </li></ul><ul><li>Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools). </li></ul><ul><li>Is often easily distracted. </li></ul><ul><li>Is often forgetful in daily activities </li></ul><ul><li>B: Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level: </li></ul><ul><li>Hyperactivity </li></ul><ul><li>Often fidgets with hands or feet or squirms in seat. </li></ul><ul><li>Often gets up from seat when remaining in seat is expected. </li></ul><ul><li>Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless). </li></ul><ul><li>Often has trouble playing or enjoying leisure activities quietly. </li></ul><ul><li>Is often &quot;on the go&quot; or often acts as if &quot;driven by a motor&quot;. </li></ul><ul><li>Often talks excessively. </li></ul><ul><li>Impulsivity </li></ul><ul><li>Often blurts out answers before questions have been finished. </li></ul><ul><li>Often has trouble waiting one's turn. </li></ul><ul><li>Often interrupts or intrudes on others (e.g., butts into conversations or games). </li></ul><ul><li>Some symptoms that cause impairment were present before age 7 years. </li></ul><ul><li>Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home). </li></ul><ul><li>There must be clear evidence of significant impairment in social, school, or work functioning. </li></ul><ul><li>The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder </li></ul>
  17. 17. Cause of Anxiety <ul><li>Psychoanalytic Explanation: </li></ul><ul><li>Believed anxiety is result of intrapsychic conflict </li></ul><ul><li>Freud identified three types of anxiety: </li></ul><ul><li>Objective anxiety - anxiety stemming from threats from the external world. (i.e., illnesses, financial probs & failues) </li></ul><ul><li>Moral anxiety - anxiety resulting from internal conflict over the expression of id impulses. </li></ul><ul><li>Neurotic anxiety - anxiety about the fear that the superego will not be effective in restraining the id & unacceptable beh will break through. </li></ul><ul><li>Physiological Explanations: </li></ul><ul><li>Genetic component </li></ul><ul><li>In 1967, discovered injections of sodium lactate caused panic attacks in some individuals </li></ul><ul><li>When sodium lactate was terminated = panic attacks subsided </li></ul><ul><ul><li>Don’t understand why this happens </li></ul></ul>
  18. 18. Phobias <ul><li>Persistent, irrational fears of a specific object, activity or situation. </li></ul><ul><li>Have no justification in reality (fear of open spaces) OR, fears are greater than what is justified (fear of flying, needles) </li></ul><ul><li>Disrupts Behavior in 2 Ways: </li></ul><ul><li>If feared object or situation can be avoided easily, the avoidance may result in unfortunate consequences </li></ul><ul><li>If cannot avoid feared stimulus may experience overwhelming fear & panic </li></ul>
  19. 19. 3 Groups of Phobias <ul><li>Agoraphobia </li></ul><ul><li>Intense fear of specific situations in which individuals suspect that help will not be available. </li></ul><ul><li>Fear of being in a crowd; standing in a line; leaving home. </li></ul><ul><li>2. Social Phobia </li></ul><ul><li>Irrational fear that s/he will behave in an embarrassing way & then be criticized by others. </li></ul><ul><li>Primarily a fear of criticism </li></ul><ul><li>Specific Phobia </li></ul><ul><li>Irrational fear about an object or situation other than crowds & personal criticism. </li></ul>
  20. 20. Some specific phobias… <ul><li>Acrophobia </li></ul><ul><li>Astraphobia </li></ul><ul><li>Claustrophobia </li></ul><ul><li>Hematophobia </li></ul><ul><li>Pathophobia </li></ul><ul><li>Zoophobia </li></ul><ul><li>Monophobia </li></ul><ul><li>Arachibutyrophobia </li></ul>
  21. 21. Obsessive-Compulsive Disorder (OCD) <ul><li>Recurrent obsessions or compulsions or both </li></ul><ul><li>Obsessions – persistent idea, thought, image or impulse that an individual cannot get out of his/her mind. </li></ul><ul><li>Compulsion – behavior that is performed over and over in a stereotyped fashion. </li></ul><ul><li>Designed to achieve some goal. </li></ul>
  22. 22. OCD: Explanations <ul><li>Physiological Explanations: </li></ul><ul><li>OCD symptoms can be controlled using antidepressant drugs (reduces obsessions & compulsions) </li></ul><ul><li>Anxiolytic drugs only reduced the anxiety associated with the obsessions & compulsions </li></ul><ul><li>How do antidepressants reduce symptoms associated with OCD? </li></ul><ul><ul><li>Blocks reuptake of neurotransmitter, serotonin </li></ul></ul><ul><ul><li>Increases levels of serotonin at synapse </li></ul></ul><ul><ul><li>Study that increased levels of serotonin = Ss displayed OCD symptoms </li></ul></ul>
  23. 23. Post-Traumatic Stress Disorder (PTSD) <ul><li>Re-experiencing of a traumatic event & numbing of responsiveness </li></ul><ul><li>Re-experiencing can take many forms: </li></ul><ul><ul><li>Memories </li></ul></ul><ul><ul><li>Dreams/nightmares </li></ul></ul><ul><ul><li>Flashbacks </li></ul></ul><ul><ul><ul><li>Individual relives event & behaves as though experiencing the event at that moment </li></ul></ul></ul><ul><li>Numbing: </li></ul><ul><ul><li>diminished interest in usual activities </li></ul></ul><ul><ul><li>Feelings of detachment </li></ul></ul><ul><ul><li>Blunted affect </li></ul></ul><ul><li>Symptoms: </li></ul><ul><ul><li>Hypervigilance </li></ul></ul><ul><ul><li>Sleep problems </li></ul></ul><ul><ul><li>Shame (about surviving) </li></ul></ul><ul><ul><li>Trouble concentrating </li></ul></ul><ul><ul><li>Avoidance of activities that could arouse memories </li></ul></ul>
  24. 24. Why do PTSD symptoms develop? <ul><li>Study (1992), Hurricane Andrew </li></ul><ul><li>3 Factors lead to development of PTSD: </li></ul><ul><li>Exposure to the hurricane (life felt threatened) </li></ul><ul><li>Social support (or lack of) </li></ul><ul><li>Coping strategies (negative = PTSD) </li></ul>
  25. 25. Somatoform Disorders <ul><li>Physical symptoms such as pain, paralysis, blindness or deafness for which there is no demonstrable physical cause. </li></ul><ul><li>Stem from psychological causes </li></ul><ul><li>Psychosomatic disorders – the causes are psychological & the symptoms are physical. </li></ul><ul><li>Psychosomatic = physical damage (ulcers; damage to lining of stomach) </li></ul><ul><li>Somatoform = no physical damage (stomach pain, yet no physical damage) </li></ul>
  26. 26. Somatoform Disorders <ul><li>Somatization Disorders - numerous, recurrent & long lasting somatic complaints that are not due to any apparent, physical cause. </li></ul><ul><li>Individuals reject the notion that symptoms are caused by psychological factors </li></ul><ul><li>Hypochondriasis – unrealistic concern & anxiety about potential physical problems </li></ul><ul><ul><li>Individuals interpret minor physical sensations as abnormalities that will inevitably lead to serious diseases </li></ul></ul><ul><ul><li>Differs from somatization disorder because hypochondriacs show anxiety about one or two specific compliants versus a wide variety of physical complaints </li></ul></ul>
  27. 27. Somatoform Disorders <ul><li>Conversion Disorders – one or more major physical symptom that greatly impairs fx’ing, but an organic basis for the symptoms cannot be found </li></ul><ul><li>Usually occurs in musculoskeletal or sensory systems (paralysis, seizures, anesthesia—loss of feeling; or paresthesia – prickling or tingling sensation of the skin </li></ul><ul><li>Symptoms are closely related to the individuals activities or occupation </li></ul><ul><ul><li>Pilot develops night blindness </li></ul></ul><ul><li>1/3 show little to no concern over what appears to be a serious medical condition </li></ul>
  28. 28. Somatoform Disorders <ul><li>Glove anesthesia –IS a conversion disorder </li></ul><ul><li>Individual loses feeling in the hand up to the point at which a glove would stop </li></ul><ul><li>Such a pattern of insensitivity is impossible </li></ul>
  29. 29. Are Somatoform Symptoms Real or Fake? <ul><li>Malingering – faking disorders to avoid responsibilities. </li></ul><ul><li>Factitious Disorders - disorders that are consciously faked </li></ul><ul><li>Symptoms can be real </li></ul><ul><li>Best evidence = placebo effect </li></ul><ul><li>Individual is given a tx that has no therapeutic value </li></ul><ul><li>The individual believes the tx will work and shows the expected change </li></ul><ul><li>Placebo effect is relevant for understanding somatoform symptoms because placebos can be used to induce, as well as reduce, symptoms </li></ul>
  30. 30. Dissociative Disorders <ul><li>Separation of personality fx’s so that the individual is not aware of, or loses contact with important aspects of his/her personality. </li></ul><ul><li>4 Types: </li></ul><ul><li>Dissociative Amnesia </li></ul><ul><li>Dissociative Fugue </li></ul><ul><li>Dissociative Identity Disorder </li></ul><ul><li>Depersonalization </li></ul>
  31. 31. Dissociative Disorders <ul><li>Dissociative Amnesia – sudden inability to remember impt info or events </li></ul><ul><li>Usually occurs following a severe stress </li></ul><ul><li>Dissociative Fugue – individual suddenly & unexpectedly travels to a new locale, assumes a new identity & is amnesic for his/her previous identity. </li></ul><ul><li>When fugue ends, individual returns to original life & has no memory of what took place during the fugue. </li></ul><ul><li>Dissociative Identity Disorder </li></ul><ul><li>Used to be “Multiple Personality Dx” </li></ul><ul><li>Two or more distinctly different personalities; each of which is dominant at different times </li></ul><ul><li>Usually sharp contrast between at least two of the personalities </li></ul><ul><li>90% of individuals are female </li></ul><ul><li>Usually the result of severe trauma, abuse </li></ul>
  32. 32. Dissociative Disorders <ul><li>Depersonalization </li></ul><ul><li>A temporary, episodic loss or distortion of self. </li></ul><ul><li>Individual’s feels as if </li></ul><ul><ul><li>their extremities have changed in size </li></ul></ul><ul><ul><li>they were in a dream </li></ul></ul><ul><ul><li>they were out of their bodies & viewing themselves from a distance </li></ul></ul><ul><li>Distinguished from schizophrenia because depersonalization believes the skin is rubber and knows that’s crazy </li></ul>
  33. 33. Sexual Disorders <ul><li>Sexual Dysfunctions </li></ul><ul><li>Absence or failure of the sexual response at some point during the sexual response cycle. </li></ul><ul><li>4 Phases of Sexual Response Cycle: </li></ul><ul><li>Appetitive Phase- individual has fantasies about sexual activity & develops a desire for sexual activities </li></ul><ul><li>Excitement Phase- subjective sexual pleasure & physiological changes </li></ul><ul><li>Orgasm Phase- peaking of subjective sexual pleasure with heightened physical change. </li></ul><ul><li>Resolution Phase- sense of general relaxation & well-being & a low level of physical arousal </li></ul>
  34. 34. 3 Dysfunction Disorders Associated with Sexual Response Cycle: <ul><li>Desire Disorder – associated with appetitive phase and involves lack of sexual desire. </li></ul><ul><li>Arousal Disorder – associated with excitement phase and involves insufficient physiological arousal, despite the presence of desire. </li></ul><ul><li>Orgasm Disorder – associated with orgasm phase and involves either failure to achieve orgasm, despite presence of desire or premature orgasm. </li></ul>
  35. 35. Paraphilias <ul><li>Term paraphilias is derived from para meaning “deviant” & philia meaning “attraction” </li></ul><ul><li>Sexual arousal occurring with the presence of unusual imagery or acts </li></ul><ul><li>In order for diagnosis to be made behavior must have resulted in “recurrent, intense sexual urges & sexually arousing fantasies” for a period of at least six months. </li></ul>
  36. 36. Types of Paraphilias: <ul><li>Exhibitionism – exposure of genitals to a stranger in attempt to achieve sexual arousal. </li></ul><ul><li>Fetishism – use of nonhuman objects to obtain sexual arousal </li></ul><ul><li>Frotteurism – rubbing against or touching nonconsenting individual </li></ul><ul><li>Pedophilia – sexual attraction to children </li></ul><ul><li>Sexual Masochism – individual derives sexual pleasure from being abused or from suffering </li></ul><ul><li>Sexual Sadism – flip side of sexual masochism. Derives sexual pleasure from causing others to suffer or from fantasies about making others suffer. </li></ul>
  37. 37. Psychodynamic Explanations: <ul><li>Sexual Sadism – based on Freud’s idea that 2 instincts (aggression & sex) & energies from these instincts are interchangable, so that aggression can trigger sexual arousal & sex can give rise to aggression. Incidence of sadism is higher in men, because they have higher innate levels of aggression. </li></ul><ul><li>Masochism- posed a problem for Freud </li></ul><ul><li>Freud asserted humans were driven by pleasure principle </li></ul><ul><li>Masochism involves seeking of pain </li></ul><ul><li>Freud suggested that masochism might be manifestation of death instinct or defense mechanism turning into self </li></ul><ul><li>Exhibitionism – is an attempt to deny possibility of castration </li></ul>
  38. 38. Gender Identity Disorder <ul><li>Physiological Sex Identification – objective knowledge of whether you are male or female based on type of genitalia </li></ul><ul><li>Psychological Gender Identity- subjective feeling of being a male or female </li></ul><ul><li>Major Symptoms: </li></ul><ul><li>-persistent & intense distress about one’s physiological sex identification </li></ul><ul><li>-children with disorder may insist they are of the opposite sex </li></ul><ul><li>-some individuals dress as members of the opposite sex b/c they are more comfortable in those clothes, not for sexual gratification </li></ul><ul><li>Sex Reassignment Surgery: </li></ul><ul><li>-aka: sex-change operation </li></ul><ul><li>-1953 > 1 st operation of Christine Jorgensen </li></ul><ul><li>-female-to-male change is more difficult than male-to-female </li></ul>
  39. 39. <ul><li>Does sex reassignment surgery result in improved gender identity adjustment? </li></ul><ul><li>Findings: (of several studies) </li></ul><ul><li>2/3 report improved adjustment </li></ul><ul><li>Female-to-male surgery is psychologically more effective </li></ul><ul><li>7% of operations result in psychotic episodes, hospitalizations, suicide, or request of reversal of surgery </li></ul>
  40. 40. Eating Disorders <ul><li>Anorexia Nervosa: Primary Symptoms: </li></ul><ul><li>Refusal to maintain body weight </li></ul><ul><li>Intense fear of gaining weight </li></ul><ul><li>Distortion of body image </li></ul><ul><li>Absence of at least 3 consecutive menstrual cycles </li></ul><ul><li>Bulimia Nervosa: Primary Symptoms: </li></ul><ul><li>Binging – individual consumes very large amounts of food in short periods of time </li></ul><ul><ul><li>Usually done in secret and carefully planned </li></ul></ul><ul><ul><li>Accompanied by feeling of lack of control over eating behavior </li></ul></ul><ul><ul><li>Binge ends when one cannot eat anymore & develops abdominal pain </li></ul></ul><ul><li>Purging – induces vomiting </li></ul><ul><ul><li>Used to reduce abdominal pain </li></ul></ul><ul><ul><li>Also uses laxatives, diuretics, diets or exercise to control weight </li></ul></ul><ul><ul><li>Secondary Symptoms: sore throat, swollen salivary glands, destruction of tooth enamel, and depression </li></ul></ul>
  41. 41. Explanations/Psychodynamic: <ul><li>Based on Freud’s idea that eating can be a substitute for sex </li></ul><ul><li>Anorexia reflects adolescents anxiety about emerging sexual urges </li></ul><ul><ul><li>Women are symbolically avoiding sexuality by avoiding eating </li></ul></ul><ul><li>Starvation can retard sexual development & can inhibit sexual drive </li></ul><ul><li>Bulimia related to CSA </li></ul>
  42. 42. Personality Disorders: <ul><li>3 FACTORS: </li></ul><ul><li>Consistently use the behavior(s) in questions </li></ul><ul><li>Show a more extreme level of the behavior </li></ul><ul><li>Behavior results in serious & prolonged problems with functioning or happiness </li></ul>
  43. 43. Antisocial Personality Disorder: <ul><li>Mood Symptoms: </li></ul><ul><li>Lack of anxiety or quilt </li></ul><ul><li>Hedonistic (pleasure seeking) </li></ul><ul><li>Shallowness of feelings </li></ul><ul><li>Lack of emotional attachment to others </li></ul><ul><li>Cognitive Symptoms: </li></ul><ul><li>Very intelligent </li></ul><ul><li>Verbal & social skills </li></ul><ul><li>Ability to rationalize (often use rationalizations in their excuses) </li></ul><ul><li>Unable to benefit from punishment (regardless of severity) </li></ul><ul><li>Will engage in same behavior over & over </li></ul>
  44. 44. Avoidant Personality Disorder <ul><li>Exceptionally sensitive to potential social rejection & the humiliation that goes with it </li></ul><ul><li>Avoid relationships unless guaranteed uncritical acceptance </li></ul>
  45. 45. Histrionic Personality Disorder <ul><li>3 CHARACTERISTICS: </li></ul><ul><li>Usually attractive, charming, appealing & sexually seductive </li></ul><ul><li>Center of attention > overly dramatic and emotional </li></ul><ul><li>Emotionally very shallow (despite great “shows” of emotion) </li></ul><ul><li>Often outgoing individuals </li></ul><ul><li>Can become egocentric, inconsiderate & manipulative if things do not go their way </li></ul>
  46. 46. Narcissistic Personality Disorder <ul><li>Archetype is Narcissus, character in Greek mythology, who fell in love with his own reflection in a pond </li></ul><ul><li>Individual’s have a grandiose sense of own importance </li></ul><ul><li>Preoccupied with fantasies about their success, power, brilliance or beauty </li></ul><ul><li>In end, Narcissus because so absorbed with self, spurned the love of Echo, who then went off to die alone in a cave </li></ul>
  47. 47. Substance-Related Disorders: <ul><li>Substance abuse – not dependent on drug, but uses the drug repeatedly, which leads to serious impairment of individual functioning. </li></ul><ul><li>Substance dependence – Symptoms: </li></ul><ul><li>Need for higher level of drug to achieve desired effects </li></ul><ul><li>Presence of withdrawal when substance is reduced </li></ul><ul><li>Unsuccessful attempts to cut down or stop </li></ul><ul><li>Reduction of participation in social, occupational or recreational activities </li></ul>
  48. 48. Types of Drugs: <ul><li>Depressants – reduce physiological arousal & psychological tension </li></ul><ul><li>3 Types: alcohol, barbiturates, and benzodiazepines </li></ul><ul><li>Narcotics – often used to refer to legal drugs </li></ul><ul><li>Types: opium, morphine, and heroin </li></ul><ul><li>Stimulants – increase arousal & cause states of euphoria </li></ul><ul><li>Types: Amphetamines, cocaine, caffeine, and nicotine </li></ul><ul><li>Hallucinogens – distort sensory experiences </li></ul><ul><li>Types – Marijuana and LSD </li></ul>
  49. 49. Explanations for Substance Dependence & Abuse <ul><li>Exposure – necessary for dependence, not sufficient to explain dependence </li></ul><ul><li>Situational Factors – Vietnam, wars, trauma </li></ul><ul><li>- but not everyone involved in stress turns toward drugs </li></ul><ul><li>- not sufficient to explain </li></ul><ul><li>Family Characteristics – poor role models </li></ul><ul><li>- lack of discipline </li></ul><ul><li>- family disorganization </li></ul><ul><li>- shared genes </li></ul><ul><li>Personality – originally though substance abusers </li></ul>
  50. 50. Schizophrenia <ul><li>Affects 1-2% of the population </li></ul><ul><li>Cognitive Symptoms: </li></ul><ul><li>Hallucinations – perceptual experiences with no basis in reality </li></ul><ul><li>Delusions – erroneous beliefs despite strong evidence to the contrary </li></ul><ul><li>Disturbed Thought Process – spin off into irrelevant thoughts </li></ul><ul><li>Cognitive Flooding – excessive broadening of attention </li></ul>
  51. 51. Phases of Schizophrenia <ul><li>Prodromal – intellectual & interpersonal functioning begins to deteriorate </li></ul><ul><li>- peculiar behavior appears </li></ul><ul><li>- emotions become inappropriate </li></ul><ul><li>- unusual perceptual experiences </li></ul><ul><li>- lasts few days to many year </li></ul><ul><li>Active – symptoms are prominent </li></ul><ul><li>- behavior becomes grossly disorganized </li></ul><ul><li>Residual – similar to prodromal phase </li></ul><ul><li>- symptoms are less prominent </li></ul><ul><li>- flat affect </li></ul><ul><li>- decline in intellectual performance </li></ul>
  52. 52. Positive vs. Negative Symptoms: <ul><li>Positive Symptoms – hallucinations, delusions, thought disorders & bizarre behaviors </li></ul><ul><li>- active symptoms </li></ul><ul><li>Negative Symptoms – flat affect, poverty of speech, inability to experience positive feelings </li></ul><ul><li>- reflects defects or lacks </li></ul><ul><li>* Individuals can have both positive and negative symptoms </li></ul>

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