Psychological disorders of humans

1. Abnormal Psychology: Disorders
and Treatment
NATIA BADRIDZE,MD

2. Psychological disorders are:
patterns of thoughts, feelings, or actions
that are deviant, distressful, and
dysfunctional.
 Disorder refers to a state of
mental/behavioral ill health.
 Patterns refers to finding a collection
of symptoms that tend to go together,
and not just seeing a single
symptom.
 For there to be distress and
dysfunction, symptoms must be
sufficiently severe to interfere with
one’s daily life and well being.
 Deviant means differing from the
norm.
Terms from the Definition

3. Understanding the Nature of
Psychological Disorders
 One reason to diagnose a disorder is to make
decisions about treating the problem.
 To treat a disorder, it helps to understand the
nature/cause of the psychological symptoms.
 Based on older understanding of
psychological disorders,
treatments have included:
exorcising evil spirits, beatings,
caging/restraint, and

4. The Medical
Model
 Psychological disorders can be seen as
psychopathology, an illness of the mind.
 Disorders can be diagnosed, labeled as a
collection of symptoms that tend to go
together.
 People with disorders can be treated,
attended to, given therapy, all with a
goal of restoring mental health.
The discovery that the disease of
syphilis causes mental symptoms
(by infecting the brain) suggested a
medical model for mental illness.

5. Mental disorders can arise in the
interaction between nature and
nurture caused by biology, thoughts,
and the sociocultural environment.
The Biopsychosocial Approach

6. Categories of
Diagnoses

7. Anxiety Disorders

8. GAD: Generalized
Anxiety Disorder
 Emotional-cognitive
symptoms include worrying,
having anxious feelings and
thoughts about many
subjects, and sometimes
“free-floating” anxiety with no
attachment to any subject.
Anxious anticipation
interferes with concentration.
 Physical symptoms include
autonomic arousal, trembling,
sweating, fidgeting, agitation,
and sleep disruption.

9. Panic Disorder:
“I’m Dying”
A panic attack is not just an
“anxiety attack.” It may include:
many minutes of intense dread or
terror.
chest pains, choking, numbness, or
other frightening physical
sensations. Patients may feel
certain that it’s a heart attack.
a feeling of a need to escape.
Panic disorder refers to repeated
and unexpected panic attacks, as
well as a fear of the next attack, and
a change in behavior to avoid panic
attacks.

10. Specific Phobia
A specific phobia is more than just
a strong fear or dislike. A specific
phobia is diagnosed when there is
an uncontrollable, irrational,
intense desire to avoid the some
object or situation. Even an image
of the object can trigger a
reaction--“GET IT AWAY FROM
ME!!!”--the uncontrollable,
irrational, intense desire to avoid
the object of the phobia.

11. Agoraphobia is the
avoidance of situations in
which one will fear having a
panic attack, especially a
situation in which it is
difficult to get help, and from
which it difficult to escape.
Social phobia refers to an intense
fear of being watched and judged by
others. It is visible as a fear of public
appearances in which
embarrassment or humiliation is
possible, such as public speaking,
eating, or performing.
Some Other Phobias

12. Obsessive-Compulsive Disorder [OCD]
 Obsessions are intense, unwanted
worries, ideas, and images that
repeatedly pop up in the mind.
 A compulsion is a repeatedly strong
feeling of “needing” to carry out an
action, even though it doesn’t feel
like it makes sense.
 When is it a “disorder”?
 Distress: when you are deeply
frustrated with not being able to
control the behaviors
or
 Dysfunction: when the time and
mental energy spent on these
thoughts and behaviors interfere
with everyday life

13. Common OCD Behaviors
Common pattern: RECHECKING
Although you know that you’ve already
made sure the door is locked, you feel
you must check again. And again.
Percentage of children and adolescents with OCD reporting
these obsessions or compulsions:

14. Post-Traumatic
Stress Disorder
[PTSD]
About 10 to 35 percent of people who experience
trauma not only have burned-in memories, but
also four weeks to a lifetime of:
 repeated intrusive recall of
those memories.
 nightmares and other re-
experiencing.
 social withdrawal or phobic
avoidance.
 jumpy anxiety or
hypervigilance.
 insomnia or sleep problems.

15. Which People get PTSD?
 Those with less control in the
situation
 Those traumatized more frequently
 Those with brain differences
 Those who have less resiliency
 Those who get re-traumatized
Resilience and Post-
Traumatic Growth
Resilience/recovery
after trauma may
include:
some lingering, but
not overwhelming,
stress.
finding strengths in
yourself.
finding connection
with others.
finding hope.
seeing the trauma as
a challenge that can
be overcome.
seeing yourself as a
survivor.

16. Cognition and
Anxiety
 Cognition includes worried
thoughts, as well as
interpretations, appraisals,
beliefs, predictions, and
ruminations.
 Cognition includes mental
habits such as hypervigilance
(persistently watching out for
danger). This accompanies
anxiety in PTSD.
 In anxiety disorders, such
cognitions appear repeatedly
and make anxiety worse.

17. Examples of Cognitions that can
Worsen Anxiety:
Cognitive errors, such as believing that we
can predict that bad events will happen
Irrational beliefs, such as “bad things don’t
happen to good people, so if I was hurt, I
must be bad”
Mistaken appraisals, such as seeing aches as
diseases, noises as dangers, and strangers as
threats
Misinterpretations of facial expressions and
actions of others, such as thinking “they’re
talking about me”

18. Biology and Anxiety: Genes
 Studies show that
identical twins, even
raised separately,
develop similar phobias
(more similar than two
unrelated people).
 Some people seem to
have an inborn high-
strung temperament,
while others are more
easygoing.
 Temperament may be
encoded in our genes.
Genes and
Neurotransmitters
Genes regulate levels of
neurotransmitters.
People with anxiety have
problems with a gene associated
with levels of serotonin, a
neurotransmitter involved in
regulating sleep and mood.
People with anxiety also have a
gene that triggers high levels of
glutamate, an excitatory
neurotransmitter involved in the
brain’s alarm centers.

19. Biology and Anxiety: The Brain
 Traumatic
experiences can burn
fear circuits into the
amygdala; these
circuits are later
triggered and
activated.
 Anxiety disorders
include overarousal
of brain areas
involved in impulse
control and habitual
behaviors.
The OCD brain shows extra
activity in the ACC, which
monitors our actions and checks
for errors.
ACC = anterior cingulate gyrus

20. Mood Disorders
Major depressive disorder [MDD] is:
 more than just feeling “down.”
 more than just feeling sad
about something.
Bipolar disorder is:
 more than “mood swings.”
 depression plus the problematic
overly “up” mood called “mania.”

21. Criteria of Major Depressive Disorders
 Depressed mood most of the day, and/or
 Markedly diminished interest or pleasure in activities
 Significant increase or decrease in appetite or weight
 Insomnia, sleeping too much, or disrupted sleep
 Lethargy, or physical agitation
 Fatigue or loss of energy nearly every day
 Worthlessness, or excessive/inappropriate guilt
 Daily problems in thinking, concentrating, and/or
making decisions
 Recurring thoughts of death and suicide
Major depressive disorder is not just one of these
symptoms.
It is one or both of the first two, PLUS three or more
of the rest.

22. Bipolar Disorder
 Bipolar disorder was once called
“manic-depressive disorder.”
 Bipolar disorder’s two polar opposite
moods are depression and mania.
Mania refers to a period of
hyper-elevated mood that
is euphoric, giddy, easily
irritated, hyperactive,
impulsive, overly optimistic,
and even grandiose.
Contrasting Symptoms
Depressed mood: stuck feeling
“down,” with:
Mania: euphoric, giddy, easily
irritated, with:
 exaggerated pessimism
 social withdrawal
 lack of felt pleasure
 inactivity and no initiative
 difficulty focusing
 fatigue and excessive desire to
sleep
 exaggerated optimism
 hypersociality and sexuality
 delight in everything
 impulsivity and overactivity
 racing thoughts; the mind
won’t settle down
 little desire for sleep

23. Why Does Depression Have so
Many Symptoms?

24. Understanding Mood Disorders
Biological aspects and
explanations
Social-cognitive aspects
and explanations
Evolutionary
Genetic
Brain /Body
Negative thoughts and
negative mood
Explanatory style
The vicious cycle

25. Biology of Depression: Genetics
Evidence of genetic influence on depression:
1.DNA linkage analysis reveals depressed gene regions
2.twin/adoption heritability studies

26. Biology of Depression: The Brain
 Brain activity is diminished in depression and increased in mania.
 Brain structure: smaller frontal lobes in depression and fewer
axons in bipolar disorder
 Brain cell communication (neurotransmitters):
 more norepinephrine (arousing) in mania, less in depression
 reduced serotonin in depression

27. Preventing or Reducing Depression:
Using Knowledge of the Biology of Depression
1. Adjust
neurotransmitters
with medication.
2. Increase serotonin
levels with
exercise.
3. Reduce brain
inflammation with
a healthy diet
(especially olive
and fish oils).
4. Prevent excessive
alcohol use .

28. Depressive
Explanatory
Style
Low Self-
Esteem
Learned
Helplessness
Rumination
Discounting positive
information and assuming the
worst about self, situation,
and the future Self-defeating
beliefs such as
assuming that
one (self) is
unable to cope,
improve, achieve,
or be happy
Depression is
associated with:
Stuck focusing on
what’s bad
Understanding Mood Disorders:
The Social-Cognitive Perspective

29. Depressive Explanatory Style
Mood/result that
goes along with
these views:
How we analyze bad news predicts mood.
Assumptions about
the problem
The problem is:
The problem is:
The problem is:
Problematic event:

30. Depression’s Vicious Cycle
A depressed mood may develop when a person with a
negative outlook experiences repeated stress.
The depressed
mood changes a
person’s style of
thinking and
interacting in a
way that makes
stressful
experience
more likely.

31. Schizophrenia:
the mind is split from reality, e.g.
a split from one’s own thoughts
so that they appear as
hallucinations.
Psychosis refers
to a mental split
from reality and
rationality.
Schizophrenia
symptoms include:
disorganized
and/or delusional
thinking.
disturbed
perceptions.
inappropriate
emotions and
actions.

32. Positive +
presence of
problematic
behaviors
Negative -
absence of
healthy
behaviors
 Hallucinations (illusory
perceptions), especially
auditory
 Delusions (illusory
beliefs), especially
persecutory
 Disorganized thought and
nonsensical speech
 Bizarre behaviors
 Flat affect (no emotion
showing in the face)
 Reduced social
interaction
 Anhedonia (no feeling of
enjoyment)
 Avolition (less motivation,
initiative, focus on tasks)
 Alogia (speaking less)
 Catatonia (moving less)
Positive and Negative Symptoms of
Schizophrenia

33. Schizophrenia Symptoms:
Problems in Thinking and Speaking
 Disorganized speech, including the
“word salad” of loosely associated
phrases
 Delusions (illusory beliefs), often
bizarre and not just mistaken; most
common are delusions of grandeur
and of persecution
 Problems with selective attention,
difficulty filtering thoughts and
choosing which thoughts to believe
and to say out loud
? ! ? !
? ! ? !

34.  People with schizophrenia often experience
hallucinations, that is, perceptual experiences not
shared by others.
 The most common form of hallucination is hearing
voices that no one else hears, often with
upsetting (e.g. shaming) content.
 Hallucinations can also be visual, olfactory/smells,
tactile/touch, or gustatory/taste.
You’re evil!
Am I evil?
Schizophrenia Symptoms:
Disturbed Perceptions

35.  Odd and socially inappropriate
responses such as looking bored
or amused while hearing of a
death
 Flat affect: facial/body
expression is “flat” with no
visible emotional content
 Impaired perception of
emotions, including not
“reading” others’ intentions and
feelings
Schizophrenia Symptoms:
Inappropriate Emotions

36. Odd and socially inappropriate
behavior can be caused by symptoms
such as:
errors in social perception.
disorganized, unfiltered thinking.
delusions and hallucinations.
The schizophrenic body exhibits
symptoms such as:
repetitive behaviors such as rocking
and rubbing.
catatonia, such as sitting motionless
and unresponsive for hours.
Schizophrenia Symptoms:
Inappropriate Actions/Behavior

37. Onset and
Development of
Schizophrenia
 Onset: Typically, schizophrenic symptoms
appear at the end of adolescence and in
early adulthood, later for women than for
men.
 Prevalence: Nearly 1 in 100 people develop
schizophrenia, slightly more men than
women.
 Development: The course of schizophrenia
can be acute/reactive or chronic.
Course of
Schizophrenia
Acute/Reactive Schizophrenia
In reaction to stress, some
people develop positive
symptoms such as
hallucinations.
– Recovery is likely.
Chronic/Process Schizophrenia
develops slowly, with more
negative symptoms such as flat
affect and social withdrawal.
– With treatment and
support, there may be
periods of a normal life,
but not a cure.
– Without treatment, this
type of schizophrenia
often leads to poverty and
social problems.

38. Subtypes of Schizophrenia

39. What’s going on in
the brain in
schizophrenia?
 Too many dopamine/D4 receptors
help to explain paranoia and
hallucinations; it’s like taking
amphetamine overdoses all the time.
 Poor coordination of neural firing in
the frontal lobes impairs judgment
and self-control.
 The thalamus fires during
hallucinations as if real sensations
were being received.
 There is general shrinking of many
brain areas and connections between
them.
Abnormal brain
structure and
activity
Understanding Schizophrenia

40. Understanding Schizophrenia
Are there biological risk factors
affecting early development?
 low birth weight
 maternal diabetes
 older paternal age
 famine
 oxygen deprivation during delivery
 maternal virus during mid-pregnancy
impairing brain development
Biological Risk Factors
Schizophrenia is more
likely to develop in
babies born:
during and after flu
epidemics.
in densely populated
areas.
a few months after flu
season.
after mothers had the
flu during the second
trimester, or had
antibodies showing
viral infection.
The lesson is to:
Schizophrenia is somewhat more
likely to develop when one or more of
these factors is present:
get flu shots
with early fall
pregnancies.

41. Understanding Schizophrenia
Are there genetic risk factors? If so, we
would see more similar schizophrenia
risk shared between identical twins than
fraternal twins (graph below). Do we?
Having adoptive
siblings (or parents)
with schizophrenia
does not increase the
likelihood of
developing
schizophrenia.
Genetic Factors
If one twin has
schizophrenia, the
chance of the other
one also having it are
much greater if the
twins are identical.

42. Are there
psychological
causes?
 Research does not support the idea
that social or psychological factors
(such as parenting) alone can cause
schizophrenia.
 However, there may be factors such
as stress that affect the onset of
schizophrenia.
 Until we find a mechanism of
causation, all we may have is a list of
factors which correlate with
increased risk.
Social-
Psychological
Factors
Understanding Schizophrenia

43. Other
Disorders
Dissociative
Disorders
Eating
Disorders
Personality
Disorders

44.  Dissociation refers to a separation of
conscious awareness from thoughts,
memory, bodily sensations, feelings,
or even from identity.
 Dissociation can serve as a
psychological escape from an
overwhelmingly stressful situation.
 A dissociative disorder refers to
dysfunction and distress caused by
chronic and severe dissociation.
Dissociative
Disorders
Loss of memory with no known physical cause;
inability to recall selected memories or any memories
“Running away” state; wandering away from one’s
life, memory, and identity, with no memory of these
Development of separate personalities
Dissociative
Amnesia:
Dissociative
Fugue
Dissociative
Identity
Disorder
(D.I.D.)
Examples:

45. Dissociative Identity Disorder (D.I.D.)
formerly “Multiple Personality Disorder”
In the rare actual cases of
D.I.D., the personalities:
are distinct, and not present
in consciousness at the same
time.
may or may not appear to be
aware of each other.
Alternative Explanations
for D.I.D.
Dissociative “identities”
might just be an extreme
form of playing a role.
D.I.D. in North America
might be a recent cultural
construction, similar to the
idea of being possessed by
evil spirits.
Cases of D.I.D. might be
created or worsened by
therapists encouraging
people to think of different
parts of themselves.

46. D.I.D., or DID Not?
Evidence that D.I.D. is Real
Different personalities have
involved:
different brain wave
patterns.
different left-right
handedness.
different visual acuity and
eye muscle balance patterns.
Patients with D.I.D. also show
heightened activity in areas
of the brain associated with
managing and inhibiting
traumatic memories.
Explaining fragmentation
of personality from
different perspectives
Psychoanalytic perspective:
diverting id
Cognitive perspective:
coping with abuse
Learning perspective:
dissociation pays
Social influence:
therapists encourage

47. Definition Prevalence
Anorexia
Nervosa
Compulsion to lose weight,
coupled with certainty about
being fat despite being 15 percent
or more underweight
0.6 percent
meet criteria at
some time
during lifetime
Bulimia
Nervosa
Compulsion to binge, eating large
amounts fast, then purge by losing
the food through vomiting,
laxatives, and extreme exercise
1.0 percent
Binge-Eating
Disorder
Compulsion to binge, followed by
guilt and depression 2.8 percent
These may involve:
unrealistic body image and extreme
body ideal.
a desire to control food and the
body when one’s situation can’t be
controlled.
cycles of depression.
health problems.
Eating
Disorders
Anorexia nervosa
Bulimia nervosa
Binge-eating disorder

48. Eating Disorders: Associated Factors
Family factors:
having a mother focused on her
weight, and on child’s appearance and
weight
negative self-evaluation in the family
for bulimia, if childhood obesity runs
in the family
for anorexia, if families are
competitive, high-achieving, and
protective
Cultural factors:
unrealistic ideals of body appearance

49. Personality disorders
are enduring patterns of
social and other
behavior that impair
social functioning.
There are three “clusters”/categories of personality
disorders.
Anxious: e.g., Avoidant P.D., ruled by fear of social
rejection
Eccentric/Odd: e.g. Schizoid P.D., with flat affect, no
social attachments
Dramatic: e.g. Histrionic, attention-seeking;
narcissistic, self-centered; antisocial, amoral
Personality
Disorders

50. Antisocial Personality Disorder [APD]
Antisocial personality
disorder refers to acting
impulsively or fearlessly
without regard for
others’ needs and
feelings.
The diagnostic criteria
include a pattern of
violating the rights of
others since age 15,
including three of these:
Deceitfulness
Disregard for safety of self or
others
Aggressiveness
Failure to conform to social
norms
Lack of remorse
Impulsivity and failure to plan
ahead
Irritability
Irresponsibility regarding jobs,
family, and money

51. THANK YOU