Psychological Disorders Chapter 15

Abnormal Behavior Historical aspects of mental disorders The medical model What is abnormal behavior? 3 criteria Deviant Maladaptive Causing personal distress A continuum of normal/abnormal The medical model proposes that it is useful to think of abnormal behavior as a disease…Thomas Szasz and others argue against this model, contending that psychological problems are “problems in living,” rather than psychological problems. In determining whether a behavior is abnormal, clinicians rely on the following criteria: 1. Is it deviant, or does it violate societal norms, 2. Is it maladaptive, that is, does it impair a person’s everyday behavior, and 3. Does it cause them personal distress? All three criteria do not have to be met for a person to be diagnosed with a psychological disorder…diagnoses involve value judgments. Antonyms such as normal vs. abnormal imply that people can be divided into two distinct groups, when in reality, it is hard to know when to draw the line.

Prevalence, Causes, and Course Epidemiology Prevalence Lifetime prevalence Diagnosis Etiology Prognosis Epidemiology: study of the distribution of mental or physical disorders in the population Prevalence: % of population that displays the disorder during a specific period Lifetime: % of people who have ben diagnosed w/ a disorder at any point in their lives Diagnosis: distinguishing one disease form another Etiology: apparent causation and development history of illness

Psychodiagnosis: The Classification of Disorders American Psychiatric Association – published first taxonomy in 1952 Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - IV) Multiaxial system 5 axes or dimensions – F 14.3 Axis I – Clinical Syndromes Axis II – Personality Disorders or Developmental Disorders Axis III – General Medical Conditions Axis IV – Psychosocial and Environmental Problems Axis V – Global Assessment of Functioning DSM A taxonomy of mental disorders was first published in 1952 by the American Psychiatric Association - the DSM. This classification scheme is now in its 4th revision, which uses a multiaxial system for classifying mental disorders. The remaining axes are used to record supplemental information. A person’s physical disorders are listed on Axis III, and the types of stress they have experienced in the past year on Axis IV. Axis V estimates the individual’s current level of adaptive functioning. The goal of this multiaxial system is to impart information beyond a traditional diagnostic label.

Figure 14.4 – Example multiaxial evaluation

Two Major Classifications in the DSM Neurotic Disorders Psychotic Disorders Distressing but one can still function in society and act rationally. Person loses contact with reality, experiences distorted perceptions.

Axis I Clinical Syndromes and Axis II Personality Disorders Anxiety Disorders Somatoform Disorders Dissociative Disorders Mood Disorders Schizophrenic Disorders Eating Disorders Axis II – Personality Disorders

Clinical Syndromes: Anxiety Disorders Generalized anxiety disorder “free-floating anxiety” Phobic disorder Specific focus of fear Panic disorder and agoraphobia Physical symptoms of anxiety/leading to agoraphobia Obsessive compulsive disorder Obsessions Compulsions PTSD A group of conditions where the primary symptoms are anxiety or defenses against anxiety The patient fears something awful will happen to them They are in a state of intense apprehension, uneasiness, uncertainty, or fear GAD: high level of anxiety not tied to anything Phobia: no realistic danger ( hydrophobia, claustrophobia and acrophobia) Panic disorder: recurrent attacks of overwhelming anxiety that occur suddenly and unexpectedly - physical symptoms (chest pain, choking) - may eventually be afraid of going out in public - studies show that patients had experienced a traumatic increase in stress in the past month D) OCD: persistent, uncontrolled E) PTSD: flashbacks or nightmares following a persons involvement in or observation of an extremely stressful event. Memories of the event cause anxiety -re-experiencing the traumatic event in the form of nightmares and flashbacks, emotional numbing, alienation, problems in social relations, and elevated arousal, anxiety and guilt

Etiology of Anxiety Disorders Biological factors Genetic predisposition, anxiety sensitivity GABA circuits in the brain Conditioning and learning Acquired through classical conditioning or observational learning Maintained through operant conditioning Cognitive factors Judgments of perceived threat Personality Neuroticism Stress A precipitator Twin studies suggest a moderate genetic predisposition to anxiety disorders. They may be more likely in people who are especially sensitive to the physiological symptoms of anxiety. Abnormalities in neurotransmitter activity at GABA synapses have been implicated in some types of anxiety disorders, and abnormalities in serotonin synapses have been implicated in panic and obsessive-compulsive disorders. Many anxiety responses, especially phobias, may be caused by classical conditioning and maintained by operant conditioning. Parents who model anxiety may promote the development of these disorders through observational learning. Cognitive theories hold that certain styles of thinking, overinterpreting harmless situations as threatening, for example, make some people more vulnerable to anxiety disorders. The personality trait of neuroticism has been linked to anxiety disorders, and stress appears to precipitate the onset of anxiety disorders.

Clinical Syndromes: Somatoform Disorders Somatization Disorder Conversion Disorder Hypochondriasis Etiology Reactive autonomic nervous system Personality factors Cognitive factors The sick role Occur when a person manifests a psychological problem through a physiological symptom. No physical explanation Not just faking that would be malingering They occur mostly in women and often coexist with depression and anxiety disorders. Report the existence of severe physical problems with no biological reason. Ex. Blindness or paralysis Excessive preoccupation w/ health concerns and worry about developing physical illness. Usually believe that the minor issues (headache, upset stomach) are indicative are more severe illnesses. - Etiology: Somatoform disorders often emerge in people with highly suggestible, histrionic personalities and in people who focus excess attention on their physiological processes. They may be learned avoidance strategies, reinforced by attention and sympathy.

Quick Write Ellie, a new student at Skinner High School, is determined to make friends. When she attends the first psychology club meeting she finds herself in the room with twenty strangers who seem to know each other well. She plans to attend a few more meetings before deciding whether she will join.   A. Demonstrate how each of the following could HELP play a role in Ellie’s quest for friendship. You may use a different example for each concept. Definitions will not score. Operant conditioning Locus of control B. Demonstrate how each of the following could HINDER Ellie’s quest for friendship. You may use a different example for each concept. Definitions will not score. HINDER  Agorapohia Circadian rhythm Narcissitic Personality Disorder

Clinical Syndromes: Dissociative Disorders Dissociative amnesia Dissociative fugue Dissociative identity disorder Etiology severe emotional trauma during childhood Controversy Media creation? Sybil Repressed memories These disorders involve a disruption in the conscious process Lose contact with portions of their consciousness or memory resulting in disruptions in their sense of identity Most controversial Relatively uncommon Amnesia: sudden loss of memory for important personal info that is too extensive to be due to normal forgetting. Can last for one single traumatic event or for an extended period of time around the vent. ex. Car accident, rape etc 2. Dissociative fugue is when people lose their memory for their entire lives along with their sense of personal identity…forget their name, family, where they live, etc., but still know how to do math and drive a car. 3. Dissociative identity disorder (formerly multiple personality disorder) involves the coexistence in one person of two or more largely complete, and usually very different, personalities. - DID is related to severe emotional trauma that occurred in childhood, although this link is not unique to DID, as a history of child abuse elevates the likelihood of many disorders, especially among females. - Some theorists believe that people with DID are engaging in intentional role playing to use an exotic mental illness as a face-saving excuse for their personal failings and that therapists may play a role in their development of this pattern of behavior, others argue to the contrary. In a recent survey, only ¼ of American psychiatrists in the sample indicated that they felt there was solid evidence for the scientific validity of DID.

Clinical Syndromes: Mood Disorders Major depressive disorder Dysthymic disorder Bipolar disorder (manic-depressive disorder) Cyclothymic disorder Seasonal Affective Disorder Etiology Age of onset Genetic vulnerability Neurochemical factors Cognitive factors Interpersonal roots Precipitating stress MDD: Also known as unipolar depression Unhappy for at least two weeks with no apparent cause Depression is the common cold of psychological disorders 7-18% of people have this disorder (15 million in the US, this is increasing and is twice as high for women) Bipolar: A) fomarlly known as manic depression Involves periods of depression and manic episodes Manic episodes involve feelings of high energy but they differ a lot Engage in risky behavior during the manic episode Manic episode is followed by a period of depression 1 – 2% of population suffers from this disorder (about 5 million in US, equal among men and women)

Clinical Syndromes: Schizophrenia General symptoms Delusions and irrational thought Deterioration of adaptive behavior - avolition Hallucinations – any modality but usually auditory Disturbed emotions – 66% Prognostic factor Gradual onset Sudden onset About 1 in every 100 people are diagnosed with schizophrenia Disturbed thoughts are the core In mood disorders its disturbed emotions

Subtyping of Schizophrenia 4 subtypes Paranoid type Catatonic type Disorganized type Undifferentiated type New model for classification Positive vs. negative symptoms paranoid: someone is out to get them Catatonic: impaired motor movement Disorganized: comes from a breakdown in selective attention- they cannot filter out info. Fragmented and bizarre thoughts with false beliefs - delusions of grandeur: when people think they are famous or important - delusions of prosecution: someone's out to get me.

Etiology of Schizophrenia Genetic vulnerability Neurochemical factors – Dopamine hypothesis Structural abnormalities of the brain – prefrontal lobe and ventricles The neurodevelopmental hypothesis Expressed emotion Precipitating stress – stress-vulnerability model

Figure 14.19 The dopamine hypothesis as an explanation for schizophrenia

Neurological Changes in Schizophrenia

Figure 14.21 – Neurodevelopment hypothesis of schizophrenia Figure 14.22 – Expressed emotion and relapse rates in schizophrenia

Slide 33 – The stress-vulnerability model of schizophrenia

Personality Disorders Anxious-fearful cluster Avoidant, dependent, obsessive- compulsive Dramatic-impulsive cluster Histrionic, narcissistic, borderline, antisocial Odd-eccentric cluster Schizoid, schizotypal, paranoid Etiology Genetic predispositions, inadequate socialization in dysfunctional families Prognosis Personality disorders: a) Well-established, maladaptive ways of behaving that negatively affect people’s ability to function b) Dominates their personality. -

Psychological Disorders and the Law Insanity M’naghten rule The insanity defense Involuntary commitment – varies by states danger to self danger to others in need of treatment Culture and pathology

Eating Disorders Issues of weight Anorexia nervosa Criteria and subtypes: restrictive and binge/purge Bulimia nervosa Binge eating History and prevalence Age onset Etiology Genetics Personality – perfectionism Cultural issues - “perfect” body type and digital photograph Family role Cognitive factors

Figure 14.25 - Age of anorexia nervous in the United States – Lucas et al. (1991)