Chapter 14 Psychological Disorders

Table of Contents 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

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Prevalence, Causes, and Course Epidemiology Prevalence - % of population that displays the disorder during a specific period Lifetime prevalence – Diagnosis Etiology – causes Prognosis

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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 –Axis I – Clinical Syndromes –Axis II – Personality Disorders or Mental Retardation –Axis III – General Medical Conditions –Axis IV – Psychosocial and Environmental Problems –Axis V – Global Assessment of Functioning Example Figure DSM V – to be published in

Table of Contents Fig. 14-3, p. 555 Figure 14.3 – DSM-IV overview

Table of Contents Example multiaxial evaluation The DSM multiaxial system

Table of Contents 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 –

Table of Contents Clinical Syndromes: Anxiety Disorders Generalized anxiety disorder –“free-floating anxiety” Phobic disorder –Specific focus of fear Panic disorder and agoraphobia (definition issue) –Physical symptoms of anxiety/leading to agoraphobia Obsessive compulsive disorder –Obsessions –Compulsions

Table of Contents 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

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Clinical Syndromes: Somatoform Disorders Somatization Disorder Conversion Disorder – Figure Hypochondriasis –Etiology Reactive autonomic nervous system Personality factors Cognitive factors The sick role

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Clinical Syndromes: Dissociative Disorders Dissociative amnesia Dissociative fugue Dissociative identity disorder –Etiology severe emotional trauma during childhood –Controversy Media creation? Sybil Repressed memories

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Clinical Syndromes: Mood Disorders Major depressive disorder –Dysthymic disorder Bipolar disorder (manic-depressive disorder) –Cyclothymic disorder Etiology –Age of onset – –Genetic vulnerability – –Neurochemical factors –Cognitive factors – negative thinking – –Interpersonal roots –Precipitating stress

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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

Table of Contents Subtyping of Schizophrenia 4 subtypes –Paranoid type – most common subtype - John Nash –Catatonic type –Disorganized type –Undifferentiated type New model for classification –Positive vs. negative symptoms

Table of Contents 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 –

Table of Contents – Genetic vulnerability - schizophrenia

Table of Contents The dopamine hypothesis as an explanation for schizophrenia

Table of Contents Neurological Changes in Schizophrenia

Table of Contents – Neurodevelopment hypothesis of schizophrenia – Expressed emotion and relapse rates in schizophrenia

Table of Contents The stress-vulnerability model of schizophrenia

Table of Contents Personality Disorders Next slide– description and male/female percents 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

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

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John Hinkley, Jr. – assassination attempt of President Reagan in 1981

Table of Contents 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

Table of Contents Age of anorexia nervous in the United States – Lucas et al. (1991)

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