Psychological Disorders Chapter 12 Psychological Disorders Copyright © Allyn & Bacon 2007

What are Psychological Disorders? The medical model takes a “disease” view, while psychology sees psychological disorders as an interaction of biological, cognitive, social, and behavioral factors. Copyright © Allyn & Bacon 2007

What are Psychological Disorders? Psychopathology – Any pattern of emotions, behaviors, or thoughts inappropriate to the situation and leading to personal distress or the inability to achieve important goals. Also referred to as: Mental illness Mental disorder Psychological disorder Copyright © Allyn & Bacon 2007

What are Psychological Disorders? Three classic signs suggest severe psychopathology: 1. Hallucinations -false sensory experiences that may suggest mental disorder. 2. Delusions -persistent false beliefs. 3. Severe affective disturbances -emotion or mood. Copyright © Allyn & Bacon 2007

Indicators of Abnormality Other signs of a disorder are more subtle, and a diagnosis depends heavily on clinical judgment. Distress Maladaptiveness Irrationality Unpredictability Unconventionality and undesirable behavior Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 The Medical Model The view that mental disorders are diseases that, like ordinary physical diseases, have objective physical causes and require specific treatments. Mental disorders are best treated with drug therapy. Copyright © Allyn & Bacon 2007

The Cognitive-Behavioral Approach Behavioral perspective – Abnormal behaviors can be acquired through behavioral learning – operant and classical conditioning. Cognitive perspective – Abnormal behaviors are influenced by mental processes – how people perceive themselves and their relations with others. Copyright © Allyn & Bacon 2007

The Social-Cognitive-Behavioral Approach A psychological alternative to the medical model that views psychological disorder through a combination of the social, cognitive, and behavioral perspectives. Cognition Environment Behavior Copyright © Allyn & Bacon 2007

How are Psychological Disorders Classified? The most widely used system, found in the DSM-5, classifies disorders by their mental and behavioral symptoms. Copyright © Allyn & Bacon 2007

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Copyright © Allyn & Bacon 2007 DSM-5 Neurodevelopmental Disorders Schizophrenia Spectrum and Other Psychotic Disorders Bipolar and Related Disorders Depressive Disorders Anxiety Disorders Obsessive-Compulsive and Related Disorders Trauma and Stressor-Related Disorders Dissociative Disorders Somatic Symptoms and Related Disorders Feeding and Eating Disorders Elimination Disorders Sleep-Wake Disorders Sexual Dysfunctions Gender Dysphoria Disruptive, Impulsive-Control, and Conduct Disorders Substance-Related and Addictive Disorders Neurocognitive Disorders Personality Disorders Paraphilic Disorders Other Mental Disorders Copyright © Allyn & Bacon 2007

Neurodevelopmental Disorders Typically begin early in development; characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning.

Neurodevelopmental Disorders Intellectual Disabilities (ID) Communication Disorders Autism Spectrum Disorder Attention-Deficit/Hyperactivity Disorder (ADHD) Specific Learning Disorder Motor Disorders Copyright © Allyn & Bacon 2007

Neurodevelopmental Disorders Autism Spectrum Disorder – Persistent deficits in social communication and social interaction. Deficits in social-emotional reciprocity Deficits in nonverbal communicative behaviors used for social interaction Deficits in developing, maintaining, and understanding relationships Copyright © Allyn & Bacon 2007

Neurodevelopmental Disorders Attention-Deficit/Hyperactivity Disorder (ADHD)– A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning of development.                           Copyright © Allyn & Bacon 2007

Schizophrenia Spectrum and Other Psychotic Disorders Schizotypal (Personality) Disorder Delusional Disorder Brief Psychotic Disorder Schizophreniform Disorder Schizophrenia Schizoaffective Disorder Copyright © Allyn & Bacon 2007

Schizophrenia Spectrum and Other Psychotic Disorders Defined as abnormalities in one or more of the following domains: Delusions Hallucinations Disorganized thinking (speech) Abnormal motor behavior (catatonia) Negative symptoms Copyright © Allyn & Bacon 2007

Major Types of Schizophrenia Disorganized Catatonic Paranoid Undifferentiated Residual Copyright © Allyn & Bacon 2007

Major Types of Schizophrenia Features incoherent speech, hallucinations, delusions, and bizarre behavior. Disorganized Catatonic Paranoid Undifferentiated Residual Type Copyright © Allyn & Bacon 2007

Major Types of Schizophrenia Disorganized Catatonic Involves a spectrum of motor dysfunctions: catatonic stupor and catatonic excitement. Paranoid Undifferentiated Residual Type Copyright © Allyn & Bacon 2007

Major Types of Schizophrenia Disorganized Catatonic Paranoid Prominent feature: delusions of persecution and grandiosity. Undifferentiated Residual Type Copyright © Allyn & Bacon 2007

Major Types of Schizophrenia Disorganized Catatonic Paranoid Undifferentiated Persons displaying a combination of symptoms that do not clearly fit in one of the other categories. Residual Type Copyright © Allyn & Bacon 2007

Major Types of Schizophrenia Disorganized Catatonic Paranoid Undifferentiated Residual Type Individuals who have had a past episode of schizophrenia but are free of symptoms. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Schizophrenia Positive Symptoms Any form in which the person displays active symptoms (e.g. delusions, hallucinations) Negative Symptoms Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Schizophrenia Positive Symptoms Negative Symptoms Any form distinguished by deficits, such as withdrawal and poverty of thought processes Copyright © Allyn & Bacon 2007

Possible Causes of Schizophrenia Evidence for the causes of schizophrenia has been found in a variety of factors including genetics, abnormal brain structure, and biochemistry. Diathesis-stress hypothesis – Genetic factors place the individual at risk, but environmental stress factors transform this potential into an actual schizophrenic disorder.

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Bipolar and Related Disorders Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Copyright © Allyn & Bacon 2007

Bipolar and Related Disorders Bipolar Disorder - A condition in which a person alternates between periods of depression and periods of mania (excessive elation or excitement). Copyright © Allyn & Bacon 2007

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Copyright © Allyn & Bacon 2007 Depressive Disorders Disruptive Mood Dysregulation Disorder Major Depressive Disorder Persistent Depressive Disorder Premenstrual Dysphoric Disorder Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Depressive Disorders Major Depressive Disorder - Affects how you feel, think and behave causing persistent feelings of sadness and loss of interest in previously enjoyed activities. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Depressive Disorders Five or more of the following symptoms must be present during the same 2 week period AND at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure: -depressed mood -diminished pleasure in most activities -significant weight loss or weight gain -insomnia or hypersomnia -psychomotor agitation -fatigue or loss of energy -feelings of worthlessness or guilt -diminished ability to think or concentrate -recurrent thoughts of death Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Depressive Disorders Seasonal Affective Disorder (SAD) A condition in which people become seriously depressed in one season of the year; usually winter. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Anxiety Disorders Separation Anxiety Disorder Selective Mutism Specific Phobia Social Anxiety Disorder Panic Disorder Agoraphobia Generalized Anxiety Disorder (GAD) Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Anxiety Disorders Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Anxiety Disorders Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Anxiety Disorders Specific Phobias– Marked by fear or anxiety about a specific object or situation. Specify if: - animal - natural environment - blood-injection injury - situational - other Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Anxiety Disorders Preparedness hypothesis – Notion that we have an innate tendency, acquired through natural selection, to respond quickly and automatically to stimuli that posed a survival threat to our ancestors. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Anxiety Disorders Panic disorder – Marked by recurrent, unexpected panic attacks. Panic attack - an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. Symptoms include: heart palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, and dizziness. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Anxiety Disorders Agoraphobia – Fear of public places/open spaces. Marked fear or anxiety about at least two of the following situations: Using public transportation Being in open spaces Being in enclosed places Standing in line or being in a crowd Being outside of the home alone Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Anxiety Disorders Generalized anxiety disorder – Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of activities (such as work or school performance). Copyright © Allyn & Bacon 2007

Obsessive-Compulsive and Related Disorders Obsessive-Compulsive Disorder (OCD) Body Dysmorphic Disorder Hoarding Disorder Trichotillomania Excoriation Disorder Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 OCD Obsessive-compulsive disorder – Characterized by obsessions (recurrent and persistent thoughts) and compulsions (repetitive behaviors). The 3 C’s Copyright © Allyn & Bacon 2007

Trauma and Stressor-Related Disorders Reactive Attachment Disorder (RAD) Disinhibited Social Engagement Disorder Post-Traumatic Stress Disorder (PTSD) Acute Stress Disorder Adjustment Disorders Copyright © Allyn & Bacon 2007

Trauma and Stressor-Related Disorders PTSD – Exposure to actual or threatened death, serious injury, or sexual violence that causes the person to involuntarily re-experience emotional, cognitive, and behavioral aspects of past trauma. Copyright © Allyn & Bacon 2007

Dissociative Disorders Dissociative Identity Disorder (DID) Dissociative Amnesia Specify if: with dissociative fugue Depersonalization/ Derealization Disorder Copyright © Allyn & Bacon 2007

Dissociative Disorders Dissociative disorders – Group of pathologies involving “fragmentation” of the personality. Dissociative amnesia Dissociative fugue Depersonalization disorder Dissociative identity disorder Copyright © Allyn & Bacon 2007

Dissociative Disorders Dissociative amnesia A psychologically induced loss of memory for personal information. Dissociative fugue Depersonalization disorder Dissociative identity disorder Copyright © Allyn & Bacon 2007

Dissociative Disorders Dissociative amnesia Dissociative fugue Dissociative amnesia with the addition of “flight” from one’s home, family, and job. Depersonalization disorder Dissociative identity disorder Copyright © Allyn & Bacon 2007

Dissociative Disorders Dissociative amnesia Dissociative Fugue Abnormality involving the sensation of mind and body having separated. Depersonalization disorder Dissociative identity disorder Copyright © Allyn & Bacon 2007

Dissociative Disorders Dissociative amnesia Dissociative Fugue Depersonalization disorder Condition in which the individual displays multiple identities. Dissociative identity disorder Copyright © Allyn & Bacon 2007

Somatic Symptoms and Related Disorders Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Factitious Disorder Somatoform Disorders – Psychological problems appearing in the form of bodily symptoms or physical complaints. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Somatic Symptoms Conversion disorder – Altered voluntary motor or sensory function that can’t be explained through neurological or medical conditions. A person may experience blindness, paralysis, or other nervous system symptoms that cannot be explained by medical evaluation. Copyright © Allyn & Bacon 2007

Feeding and Eating Disorders Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Copyright © Allyn & Bacon 2007

Disruptive, Impulse-Control, and Conduct Disorders Oppositional Defiant Disorder (ODD) Intermittent Explosive Disorder Conduct Disorder Antisocial Personality Disorder Pyromania Kleptomania Copyright © Allyn & Bacon 2007

Oppositional Defiant Disorder Pattern lasting 6 or more months: Angry/irritable mood Argumentative/defiant behavior Vindictiveness

Intermittent Explosive Disorder Behavioral outbursts representing a failure to control aggressive impulses manifested through verbal or physical aggression.

Conduct Disorder Repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. Four main groupings: 1) Aggression to people and animals 2) Destruction of property 3) Deceitfulness or theft 4) Serious violation of rules Can be childhood onset or adolescent onset. Comorbid with ADHD and Oppositional Defiant Disorder. Once person is age 18, diagnosis may be given of Antisocial Personality Disorder.

Pyromania Deliberate and purposeful fire setting on more than one occasion.

Kleptomania Failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.

Neurocognitive Disorders Delirium Major of Mild Neurocognitive Disorders Copyright © Allyn & Bacon 2007

Personality Disorders Cluster A: Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Cluster B: Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder Cluster C: Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder Copyright © Allyn & Bacon 2007

Personality Disorders Personality disorders – An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. Copyright © Allyn & Bacon 2007

Personality Disorders Cluster A: Individuals with these disorders often appear odd or eccentric. Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Copyright © Allyn & Bacon 2007

Personality Disorders Cluster B: Individuals with these disorders often appear dramatic, emotional, or erratic. Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder Copyright © Allyn & Bacon 2007

Personality Disorders Antisocial Personality Disorder – A pattern of disregard for and violation of the rights of others, occurring since 15 years old. Copyright © Allyn & Bacon 2007

Antisocial Personality Disorder Indicated by 3 (or more) of the following: Failure to conform to social norms with respect to lawful behaviors. Deceitfulness (repeated lying, use of aliases, or conning others for profit or pleasure) Impulsivity or failure to plan ahead Irritability and aggressiveness (repeated physical fights or assaults) Reckless disregard for the safety of others Consistent irresponsibility (failure to sustain consistent work behavior or honor financial obligations) Lack of remorse (indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another) The individual must be at least 18 years of age. There is evidence of Conduct Disorder with onset before age 15. Copyright © Allyn & Bacon 2007

Personality Disorders Borderline Personality Disorder – A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. page 663 in DSM Copyright © Allyn & Bacon 2007

Personality Disorders Narcissistic Personality Disorder A pattern of grandiosity, need for admiration, and lack of empathy. (page 669 in the DSM) Copyright © Allyn & Bacon 2007

Personality Disorders Cluster C: Individuals with these disorders often appear anxious or fearful. Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder Copyright © Allyn & Bacon 2007

Other Conditions That May Be a Focus of Clinical Attention Mild depression Marital problems Physical complaints Academic problems Parent-child problems Job problems Bereavement Physical/Sexual abuse Copyright © Allyn & Bacon 2007

What are the Consequences of Labeling People? Ideally, accurate diagnoses lead to proper treatments, but diagnoses may also become labels that depersonalize individuals and ignore the social and cultural contexts in which their problems arise. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 A defendant is not criminally responsible if, at the time of committing an unlawful act, the person was laboring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing; or if he did know it, that he did not know he was doing wrong. Daniel M‘Naghten Prime Minister Sir Robert Peel Edward Drummond M’Naghten Rule Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 The Plea of Insanity “Not guilty by reason of insanity” Insanity – A legal term, not a psychological one, referring to a person who is unable, because of a mental disorder or defect, to confirm his or her behavior to the law. Copyright © Allyn & Bacon 2007