Disorders

Neurotic aka Anxiety Disorders Generalized Anxiety Panic Disorder Phobias Obsessive-Compulsive Disorders PTSD

Characterized by Fear – emotional response to a perceived threat or imminent threat Anxiety – an emotional response to a perceived future threat

Generalized Anxiety Disorder Persistent and excessive anxiety over areas of school, work, social or private life (various) domains which the individual finds difficult to control or “turn off” 1 st recognized as a disorder by the APA in Prior to this a general diagnosis of “stress” or “nerves” was given

Causes Specific Causes are unknown however some demographics are more likely than others to have GAD More prevalent in individuals of European Descent and developed countries suggesting cultural and genetic components 1/3 of the risk factors are genetic (runs in families) Females experience more than males (approximately 2/3’s)

Diagnosing criteria / characteristics Excessive worry occurring more days than not over a period of 6 months or more Worry is difficult to control or escape 3 or more of the following symptoms (more days than not) Restlessness (edginess) Easily fatigued Difficulty concentrating Sleep disturbance Muscle tension Irritability The worry causes impairment in social occupation or personal functioning Not attributed to drug or substance abuse or another mental disorder

Treatment / Therapy Cognitive Behavioral Therapy Antidepressents (SSRI’s aka selective serotonin reuptake inhibitors have been demonstrated to reduce anxiety)

Vignette Jennifer is a 30 year-old accountant who recently started her first job after graduating honors. She has always been an anxious person and describes herself as a "worry bug" Her friends and family often tell her she worries too much. During school she found it very difficult to control her worry about being on time for class or appointments, her grades, losing her friends, getting her parents angry, her appearance, whether her teachers liked her, and which university she would attend. Since then she has also worried excessively about whether her current boyfriend will leave her, her work performance, her weight, and having enough time in the day to get everything done. Jennifer has great difficulty controlling these worries and they often intrude when she is trying to relax alone at the end of each day, during down time at work, and when out with friends. She notices that she is frequently irritable (e.g., snaps at her roommate and boyfriend inappropriately). Jennifer can't remember when she last felt relaxed as she always feels jumpy, tense, and on guard for something bad to happen. For the past 6 months she hasn't been sleeping very well. She often lies in bed worrying for several hours, wakes frequently during the night, or wakes up too early and can't fall back asleep. On days when her worrying is really problematic she has difficulty concentrating at work and several friends have commented that she often seems distracted. Jennifer knows her worry is a problem but she is concerned that without her worrying everything would fall apart or get worse.

9 Panic Disorder Episodes of intense dread which may include feelings of terror, chest pains, choking, or other frightening sensations. Anxiety is a component of both disorders. It occurs more in the panic disorder, making people avoid situations that cause it. Symptoms

10 Phobia Marked by a persistent and irrational fear of an object or situation that disrupts behavior.

11 Kinds of Phobias Phobia of blood.Hemophobia Phobia of closed spaces.Claustrophobia Phobia of heights.Acrophobia Phobia of open places.Agoraphobia

12 Obsessive-Compulsive Disorder Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress.

13 A PET scan of the brain of a person with Obsessive-Compulsive Disorder (OCD). High metabolic activity (red) in the frontal lobe areas are involved with directing attention. Brain Imaging Brain image of an OCD

14 Post-Traumatic Stress Disorder Four or more weeks of the following symptoms constitute post-traumatic stress disorder (PTSD): 1.Haunting memories 2.Nightmares 3.Social withdrawal 4.Jumpy anxiety 5.Sleep problems Bettmann/ Corbis

15 Resilience to PTSD Only about 10% of women and 20% of men react to traumatic situations and develop PTSD. Holocaust survivors show remarkable resilience against traumatic situations. All major religions of the world suggest that surviving a trauma leads to the growth of an individual.

16 Explaining Anxiety Disorders Psychoanalytic perspective Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety.

17 Mood Disorders Emotional extremes of mood disorders come in two principal forms. 1.Major depressive disorder 2.Bipolar disorder 3.Dysthemia

18 Major Depressive Disorder Depression is the “common cold” of psychological disorders. In a year, 5.8% of men and 9.5% of women report depression worldwide (WHO, 2002). Chronic shortness of breath Gasping for air after a hard run Major Depressive DisorderBlue mood

19 Major Depressive Disorder Major depressive disorder occurs when signs of depression last two weeks or more and are not caused by drugs or medical conditions. 1.Lethargy and fatigue 2.Feelings of worthlessness 3.Loss of interest in family & friends 4.Loss of interest in activities Signs include:

20 Bipolar Disorder Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder. Multiple ideas Hyperactive Desire for action Euphoria Elation Manic Symptoms Slowness of thought Tired Inability to make decisions Withdrawn Gloomy Depressive Symptoms

21 The Depressed Brain PET scans show that brain energy consumption rises and falls with manic and depressive episodes. Courtesy of Lewis Baxter an Michael E. Phelps, UCLA School of Medicine

22 Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase. Whitman WolfeClemensHemingway Bettmann/ Corbis George C. Beresford/ Hulton Getty Pictures Library The Granger Collection Earl Theissen/ Hulton Getty Pictures Library

23 Explaining Mood Disorders Since depression is so prevalent worldwide, investigators want to develop a theory of depression that will suggest ways to treat it. Lewinsohn et al., (1985, 1995) note that a theory of depression should explain the following: 1.Behavioral and cognitive changes 2.Common causes of depression

24 Theory of Depression 3.Gender differences

25 Theory of Depression 4. Depression is increasing, especially in the teens. Post-partum depression Desiree Navarro/ Getty Images

26 Suicide The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide. 1.National differences 2.Racial differences 3.Gender differences 4.Age differences 5.Other differences Suicide Statistics

27 Biological Perspective Genetic Influences: Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%). Linkage analysis and association studies link possible genes and dispositions for depression. Jerry Irwin Photography

28 Neurotransmitters & Depression Post-synaptic Neuron Pre-synaptic Neuron Norepinephrine Serotonin A reduction of norepinephrine and serotonin has been found in depression. Drugs that alleviate mania reduce norepinephrine.

29 Social-Cognitive Perspective The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles.

30 Example Explanatory style plays a major role in becoming depressed.

31 Depression Cycle 1.Negative stressful events. 2.Pessimistic explanatory style. 3.Hopeless depressed state. 4.These hamper the way the individual thinks and acts, fueling personal rejection.

Dissociative Disorders

33 Dissociative Identity Disorder (DID) Is a disorder in which a person exhibits two or more distinct and alternating personalities, formerly called multiple personality disorder. An interview with DID patient KimKim

34 DID: Criticism Critics argue that the diagnosis of DID increased in the late 20 th century. DID has not been found in other countries. 1.Role-playing by people open to a therapist’s suggestion. 2.Became a trendy disorder which caught the public’s imagination

Dissociative Disorders Dissociative Amnesia- partial loss of personal information due to stressful event Usually memory loss is for the time period surrounding this event and is isolated to this time period Dissociative Fugue- loss of personal information from all previous experience, formation of new identity, involves unexpected travel Dissociative Fugue-

36 Schizophrenia If depression is the common cold of psychological disorders, schizophrenia is the cancer. Nearly 1 in a 100 suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease (WHO, 2002). Schizophrenia strikes young people as they mature into adults. It affects men and women equally, but men suffer from it more severely than women.

37 Symptoms of Schizophrenia The literal translation is “split mind.” A group of severe disorders characterized by the following: 1.Disorganized and delusional thinking. 2.Disturbed perceptions. 3.Inappropriate emotions and actions.

38 1. Disorganized & Delusional Thinking Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and bizarre thoughts).

39 2. Disturbed Perceptions A schizophrenic person may perceive things that are not there (hallucinations). Frequently such hallucinations are auditory and lesser visual, somatosensory, olfactory, or gustatory. L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign

40 3. Inappropriate Emotions & Actions *A schizophrenic person may laugh at the news of someone dying or show no emotion at all (apathy). *Patients with schizophrenia may continually rub an arm, rock in a chair, or remain motionless for hours (catatonia).

Sometimes disorganized speech Clanging Example: “He went in entry in trying tieing sighing dying ding- dong dangles dashing dancing ding-a-ling!” Word Salad Unintelligible combinations fo familiar phrases or words Unintelligible combinations fo familiar phrases or words

42 Positive and Negative Symptoms Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, deluded ways) that are not present in normal individuals (positive symptoms). Schizophrenics also have an absence of appropriate symptoms (apathy, expressionless faces, rigid bodies) that are present in normal individuals (negative symptoms).

43 Subtypes

44 Understanding Schizophrenia: Brain Abnormalities Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain.

45 Abnormal Brain Activity Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients. Adolescent schizophrenic patients also have brain lesions. Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health

46 Abnormal Brain Morphology Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles. Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC

47 Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated

48 Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries.

49 Psychological Factors Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed. Genain Sisters The genetically identical Genain sisters suffer from schizophrenia. Two more than others, thus there are contributing environmental factors. Courtesy of Genain Family

50 Warning Signs Early warning signs of schizophrenia include: Birth complications, oxygen deprivation and low-birth weight. 2. Short attention span and poor muscle coordination. 3. Poor peer relations and solo play.6. Emotional unpredictability.5. Disruptive and withdrawn behavior.4. A mother’s long lasting schizophrenia.1.

Personality Disorders Some examples: Avoidant – social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation Dependent – a pattern of submissive and clinging behavior and a need to be taken care of Schizoid - a pattern of detachment from social relationships and a restricted range of emotional expressions Paranoid – a pattern of distrust and suspiciousness / others motives interpreted as malevolent Histrionic - a pattern of excessive emotionality and attention seeking Narcissistic – need for admiration, pattern of grandiosity, lack of empathy Borderline - pattern of instability in interpersonal relationships, self-image, and marked impulsivity.

52 Antisocial Personality Disorder A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, even toward friends and family members. Formerly, this person was called a sociopath or psychopath.

53 Understanding Antisocial Personality Disorder Like mood disorders and schizophrenia, antisocial personality disorder has biological and psychological reasons. Young people, before committing a crime, respond with lower levels of stress hormones than others do at their age.

54 Understanding Antisocial Personality Disorder PET scans of 41 murderers with antisocial personality disorder revealed reduced activity in the frontal lobes. In a follow-up study repeat offenders had 11% less frontal lobe activity compared to normal. Normal Murderer Courtesy of Adrian Raine, University of Southern California