Psychological Disorders:Part 1 Music: “Crazy” By Seal By Seal“Crazy” By Gnarles Barkley

Agenda 1. What is Abnormal? 1. What is Abnormal? Criteria / Classification Criteria / Classification 2. Anxiety Disorders: 2. Anxiety Disorders: Generalized Anxiety/ Phobias/ Obsessive Compulsive Disorders Generalized Anxiety/ Phobias/ Obsessive Compulsive Disorders 3. Somatoform Disorders 3. Somatoform Disorders Somatization Disorders/ Hypochondriasis Somatization Disorders/ Hypochondriasis 4. Dissociative Disorders 4. Dissociative Disorders Multiple Personality Disorder Multiple Personality Disorder 5. Mood Disorders 5. Mood Disorders Depression/ Bipolar Disorders /Suicide Depression/ Bipolar Disorders /Suicide 6. Tutorial 6. Tutorial

1. What IS Abnormal??  Criteria:  1) Distress is present:  Person is suffering, unhappy, afraid  2) Behaviour is maladaptive Impaired functioning Impaired functioning Inability to meet responsibilities Inability to meet responsibilities  3) Socially Deviant  Behaviour is unusual, “not normal”  Classification  DSM-IV, p. 580  Why Classify? Simplify and create order Simplify and create order Research Research Plan treatment Plan treatment

Criteria for Abnormality  Fig p. 578

1. Classification (cont’d)  Older Distinction:  Neurotic vs. Psychotic  Neurotic:  Distressing problem but person is still coherent and can function socially (once acute phase of disorder is treated).  E.g. most disorders discussed today  Psychotic:  More bizarre, involving delusions or halucinations. Individual has impaired thought processes and cannot function socially. Treatment is long term  E.g. schizophrenia (next week)

2. Anxiety Disorders Anxiety: Anxiety: Fear in situations that pose no objective threat Fear in situations that pose no objective threat 3 components: 3 components: A) Cognitive: A) Cognitive: Extreme/chronic worry; fear of harm Extreme/chronic worry; fear of harm B) Physiological: B) Physiological: Muscle tension, increased heart rate and blood pressure Muscle tension, increased heart rate and blood pressure C) Behavioural: C) Behavioural: Shaking, jumpiness, pacing, avoidance Shaking, jumpiness, pacing, avoidance Generalized Anxiety Disorders (5%) Generalized Anxiety Disorders (5%) Symptoms of anxiety felt continuously for at least 6 months Symptoms of anxiety felt continuously for at least 6 months Excessive worry, restlessness, sleep disturbance that are difficult to control Excessive worry, restlessness, sleep disturbance that are difficult to control

2. Anxiety Disorders (cont’d) Panic Disorders: (2-3%) Panic Disorders: (2-3%) Presence of recurrent, and unexpected panic attacks: Presence of recurrent, and unexpected panic attacks: Intense dread, shortness of breath, chest pain, choking, fear of going crazy or losing control or dying, shaking, sweating, nausea… Intense dread, shortness of breath, chest pain, choking, fear of going crazy or losing control or dying, shaking, sweating, nausea… May lead to Agoraphobia (fear of open spaces) May lead to Agoraphobia (fear of open spaces) Phobic Disorders: (10%) Phobic Disorders: (10%) Fear of a particular object, animal or context which is irrational Fear of a particular object, animal or context which is irrational Is causing distress and impairment in functioning Is causing distress and impairment in functioning Social Phobia: (3-13%) Social Phobia: (3-13%) Fear of social or performance situations Fear of social or performance situations Public speaking; Public speaking; Eating, drinking, writing in public Eating, drinking, writing in public

2. Anxiety Disorders (cont’d) Obsessive-Compulsive Disorders (2%) Obsessive-Compulsive Disorders (2%) Obsessions: Obsessions: Persistent, uncontrollable thoughts Persistent, uncontrollable thoughts Compulsions: Compulsions: Rituals, behaviours that reduce anxiety Rituals, behaviours that reduce anxiety Interfere with functioning Interfere with functioning Thoughts and behaviours are not under voluntary control Thoughts and behaviours are not under voluntary control

3. Somatoform Disorders Somatization Disorder: Somatization Disorder: (1-2% women) (1-2% women) History of diverse physical complaints for which there is NO organic basis History of diverse physical complaints for which there is NO organic basis Long medical history of treatments for minor physical ailments Long medical history of treatments for minor physical ailments Hypochondriasis: Hypochondriasis: 4-9% in medical practice 4-9% in medical practice Inordinate preoccupation with health and illness Inordinate preoccupation with health and illness excessive anxiety about having a disease excessive anxiety about having a disease

4. Dissociative Disorders Multiple Personality Disorder (very rare) Multiple Personality Disorder (very rare) Presence of at least 2 distinct personalities within the same individual Presence of at least 2 distinct personalities within the same individual Leads to sudden changes in identity and consciousness Leads to sudden changes in identity and consciousness Each personality has its unique style and may unaware of the existence of the other personalities Each personality has its unique style and may unaware of the existence of the other personalities Often related to severe abuse in early childhood Often related to severe abuse in early childhood

5. Mood Disorders Depression Depression Lifetime prevalence rates Lifetime prevalence rates 20% in women; 10% in men 20% in women; 10% in men Why more common in women? Why more common in women? Cost of caring Cost of caring Greater burden due to nurturing roles Greater burden due to nurturing roles Also more affected by disruptions in relational ties Also more affected by disruptions in relational ties Ruminative cognitive style Ruminative cognitive style as opposed to distraction or taking action as opposed to distraction or taking action Perpetuates negative mood Perpetuates negative mood More likely to report symptoms More likely to report symptoms Seasonal Affective Disorders (SAD) Seasonal Affective Disorders (SAD) Depressive symptoms related to physiological consequences of shorter winter days Depressive symptoms related to physiological consequences of shorter winter days Treatable with light therapy Treatable with light therapy

5. Theories of Depression Biological predisposition Biological predisposition Concordance rates in twins: Concordance rates in twins: Identical: 65% Identical: 65% Fraternal: 15% Fraternal: 15% Cognitive Perspective Cognitive Perspective Beck: Negative (dysfunctional) attitudes Beck: Negative (dysfunctional) attitudes Seligman: Attribution Theory Seligman: Attribution Theory How do you explain your circumstances? How do you explain your circumstances? Internal vs external Internal vs external Stable vs unstable Stable vs unstable Global vs specific Global vs specific Depression: internal, stable, global attributions for negative events Depression: internal, stable, global attributions for negative events Diathesis-stress models Diathesis-stress models Depression results from an interaction between personality and negative life events Depression results from an interaction between personality and negative life events Dependency and vulnerability to loss Dependency and vulnerability to loss Self-Criticism/Perfectionism and vulnerability to perceived failure Self-Criticism/Perfectionism and vulnerability to perceived failure

Cognitive Risk and Depression Featured Study p. 596 Featured Study p. 596 Those with dysfunctional attitudes and depressive attributional style were more likely to become depressed over 2 year period. Those with dysfunctional attitudes and depressive attributional style were more likely to become depressed over 2 year period.

5. Mood Disorders (cont’d) Bipolar Disorders: Bipolar Disorders: Periods of depression alternate with manic episodes Periods of depression alternate with manic episodes Mania: Mania: abnormally elevated mood, inflated self-esteem, pressure of speech, increased energy, decreased need for sleep, over- activity, lack of inhibition and impaired judgment abnormally elevated mood, inflated self-esteem, pressure of speech, increased energy, decreased need for sleep, over- activity, lack of inhibition and impaired judgment Prevalence rates: Prevalence rates: 1% in men and women 1% in men and women Strong genetic component Strong genetic component Understood as a primarily biological disorder Understood as a primarily biological disorder Unlike unipolar depression which has cognitive, interpersonal and environmental determinants Unlike unipolar depression which has cognitive, interpersonal and environmental determinants

Comparison of symptoms of depression and mania (p. 592)

5. Suicide University students: University students: 40-50% have had suicidal thoughts 40-50% have had suicidal thoughts 15% attempt suicide 15% attempt suicide Major Risk Factors: Major Risk Factors: Drug or alcohol use including cigarette smoking Drug or alcohol use including cigarette smoking A prior attempt A prior attempt Depression/ hopelessness (pessimism) Depression/ hopelessness (pessimism) Aggressiveness or impulsivity Aggressiveness or impulsivity Family history Family history Shame, humiliation, failure or rejection Shame, humiliation, failure or rejection

5. Suicide (cont’d) How to help: How to help: 1) Establish communication 1) Establish communication Talk about suicidal wishes Talk about suicidal wishes 2) Identify needs that have been frustrated 2) Identify needs that have been frustrated Search for love, recognition, respect? Search for love, recognition, respect? 3) Broaden suicidal person’s perspective 3) Broaden suicidal person’s perspective Impermanence of feelings Impermanence of feelings It won’t last It won’t last Other solutions? Other solutions?

6. Tutorial Until next week: Until next week: