15 Psychological Disorders WHEN ADAPTATION BREAKS DOWN Slides prepared by Matthew Isaak

Learning Objectives LO 15.1 Identify criteria for defining mental disorders. LO 15.2 Describe conceptions of diagnoses across history and cultures. LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. LO 15.4 Describe the many ways people experience anxiety

Learning Objectives LO 15.5 Identify the characteristics of different mood disorders. LO 15.6 Describe major explanations for depression and how life events can interact with characteristics of the individual to produce depression symptoms. LO 15.7 Identify common myths and misconceptions about suicide. LO 15.8 Identify the characteristics of borderline and psychopathic personality disorders.

Learning Objectives LO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. LO 15.10 Recognize the characteristic symptoms of schizophrenia. LO 15.11 Explain how psychosocial, neural, biochemical, and genetic influences create the vulnerability to schizophrenia. LO 15.12 Describe the symptoms and debate surrounding disorders diagnosed in childhood.

Lecture Preview Conceptions of mental illness Anxiety-related disorders Mood disorders and suicide Personality and dissociative disorders Schizophrenia Childhood disorders

What is Mental Illness. LO 15 What is Mental Illness? LO 15.1 Identify criteria for defining mental disorders. Psychopathology (mental illness) is often seen as a failure of adaptation to the environment. Failure analysis approach tries to understand mental illness by examining breakdowns in functioning Mental disorder does not have a clear cut definition. LO 15.1

What is Mental Illness. LO 15 What is Mental Illness? LO 15.1 Identify criteria for defining mental disorders. Many different conceptions of mental illness, each with pros and cons: Statistical rarity Subjective distress Impairment Societal disapproval Biological dysfunction LO 15.1

Historical Views of Mental Illness LO 15 Historical Views of Mental Illness LO 15.2 Describe conceptions of diagnoses across history and cultures. During Middle Ages, mental illnesses were often viewed through a demonic model. Odd behaviors were the result of evil spirits inhabiting the body. Exorcisms and witch hunts were common during this time. LO 15.2

Historical Views of Mental Illness LO 15 Historical Views of Mental Illness LO 15.2 Describe conceptions of diagnoses across history and cultures. During the Renaissance, the medical model saw mental illness as a physical disorder needing treatment. Began housing people in asylums – but they were often overcrowded and understaffed Treatments were no better than before (bloodletting and snake pits). LO 15.2

Historical Views of Mental Illness LO 15 Historical Views of Mental Illness LO 15.2 Describe conceptions of diagnoses across history and cultures. Reformers like Phillippe Pinel and Dorothea Dix pushed for moral treatment. Treated patients with dignity, respect, and kindness Still no effective treatments, though, so many continued to suffer with no relief LO 15.2

Modern Era LO 15.2 Describe conceptions of diagnoses across history and cultures. In early 1950s, a drug was developed called chlorpromazine (Thorazine). Moderately decreased symptoms of schizophrenia and similar problems With advent of other medications, policy of deinstitutionalization was enacted LO 15.2

Figure 15. 1 Decline in Psychiatric Inpatients Figure 15.1 Decline in Psychiatric Inpatients. Over the past several decades, the number of hospitalized psychiatric patients has gradually declined. (Source: www.ahrq.gov/legacy/about/annualconf09/vandivort_mark_owens/slide4.jpg)

Modern Era LO 15.2 Describe conceptions of diagnoses across history and cultures. Deinstitutionalization had mixed results. Some patients returned to almost normal lives but tens of thousands had no follow-up care and went off medications. Community mental health centers and halfway houses attempt to help this problem. LO 15.2

Diagnosis Across Cultures LO 15 Diagnosis Across Cultures LO 15.2 Describe conceptions of diagnoses across history and cultures. Certain conditions are culture-bound. Koro involves believing your genitals are shrinking and receding into your abdomen. Amok is marked by episodes of intense sadness and brooding followed by uncontrolled behavior and violence. LO 15.2

Diagnosis Across Cultures LO 15 Diagnosis Across Cultures LO 15.2 Describe conceptions of diagnoses across history and cultures. Taijin kyofushu is a fear of offending others by saying something offensive or body odor. Many severe mental disorders (schizophrenia, alcoholism, psychopathy) appear to be universal across cultures. LO 15.2

Psychiatric Diagnosis Today LO 15 Psychiatric Diagnosis Today LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. Evidence largely contradicts common misconceptions concerning psychiatric diagnosis, such as: Psychiatric diagnosis is simply pigeonholing. Psychiatric diagnoses are unreliable. Psychiatric diagnoses are invalid. Psychiatric diagnoses stigmatize people. LO 15.3

Psychiatric Diagnosis Today LO 15 Psychiatric Diagnosis Today LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. Diagnostic and Statistical Manual of Mental Disorders (DSM) is a system that contains the criteria for mental disorders. Currently on fifth edition (DSM-5) Has 18 different classes of disorders LO 15.3

The DSM-5 LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. Provides list of diagnostic criteria and a set of decision rules for each condition Warns to "think organic" (rule out physical causes of symptoms first) Contains information on prevalence and adopts a biopsychosocial approach LO 15.3

DSM Criticisms LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. Some diagnoses may be invalid High level of comorbidity Medicalizes normality Reliance on categorical model of psychopathology Vulnerable to political and social influences LO 15.3

Mental Illness and the Law LO 15 Mental Illness and the Law LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. Overwhelming majority of people with schizophrenia are not aggressive or violent LO 15.3

Mental Illness and the Law LO 15 Mental Illness and the Law LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. Insanity defense requires people to either: Not know what they were doing at time of crime, or Not know what they were doing was wrong. Less than 1% of criminal cases use the defense successfully. LO 15.3

Mental Illness and the Law LO 15 Mental Illness and the Law LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. Involuntary commitment is a procedure for protecting us from certain people with mental disorders and protecting them from themselves. LO 15.3

Mental Illness and the Law LO 15 Mental Illness and the Law LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. Can only be committed against their will if they: Pose a clear and present threat to themselves or others. Are so impaired they can't care for themselves. LO 15.3

Anxiety Disorders LO 15.4 Describe the many ways people experience anxiety. Most anxieties are transient and can be adaptive. They can, though, spin out of control and become excessive and inappropriate. One of the most prevalent and earliest-onset of all classes of disorders. LO 15.4

Anxiety Disorders LO 15.4 Describe the many ways people experience anxiety. Can also see inappropriate anxiety in other disorders and problems Somatic symptom disorder entails anxieties about physical symptoms that interfere with daily living. Illness anxiety disorder is the preoccupation that one has a serious undiagnosed disease. LO 15.4

Generalized Anxiety Disorder LO 15 Generalized Anxiety Disorder LO 15.4 Describe the many ways people experience anxiety. Continual feelings of worry, anxiety, physical tension, and irritability about many areas About 3% of the population; 1/3 develop it after major stressor or life change More prevalent in females and Caucasians LO 15.4

Panic Disorder LO 15.4 Describe the many ways people experience anxiety. Repeated, unexpected panic attacks, along with either: Persistent concerns about future attacks, or A change in personal behavior in an attempt to avoid them. Can be associated with specific situation or come "out of the blue" LO 15.4

Phobias LO 15.4 Describe the many ways people experience anxiety. Intense fear of an object or situation that's greatly out of proportion to its actual threat Most common anxiety disorder (11%) Comes in different forms, such as: Agoraphobia Specific or social phobia LO 15.4

Posttraumatic Stress Disorder LO 15 Posttraumatic Stress Disorder LO 15.4 Describe the many ways people experience anxiety. Marked emotional disturbance after you experience or witness a severely stressful event Symptoms include: Flashbacks and recurrent dreams Avoiding reminders of the trauma Increased physiological arousal LO 15.4

Obsessive-Compulsive Disorder LO 15 Obsessive-Compulsive Disorder LO 15.4 Describe the many ways people experience anxiety. Marked by obsessions - persistent ideas, thoughts, or impulses that are unwanted and inappropriate and cause marked distress LO 15.4

Obsessive-Compulsive Disorder LO 15 Obsessive-Compulsive Disorder LO 15.4 Describe the many ways people experience anxiety. This distress is relieved by compulsions – repetitive behaviors or mental acts. Related disorders include body dysmorphic disorder and Tourette's syndrome LO 15.4

Explanations for Anxiety Disorders LO 15 Explanations for Anxiety Disorders LO 15.4 Describe the many ways people experience anxiety. Learning models focus on acquiring fears via classical conditioning, then maintaining them through operant conditioning. Can also learn fears by observing others or by hearing misinformation from others. LO 15.4

Explanations for Anxiety Disorders LO 15 Explanations for Anxiety Disorders LO 15.4 Describe the many ways people experience anxiety. Anxious people tend to think about the world in different ways from non-anxious people. Catastrophic thinking - predicting terrible events despite low probability Anxiety sensitivity – a fear of anxiety-related symptoms Many anxiety disorders are genetically influenced through level of neuroticism. LO 15.4

Mood Disorders LO 15.5 Identify the characteristics of different mood disorders. Over 20% of Americans will experience a mood disorder. Major Depressive Disorder (MDD) is the most common, at 16%. More prevalent in females, most likely to develop in 30s LO 15.5

Mood Disorders LO 15.5 Identify the characteristics of different mood disorders. Depression symptoms can develop gradually or suddenly, but are often recurrent. Average episode lasts 6 months to 1 year; most people experience 5-6 episodes Can cause extreme functional impairment across all areas LO 15.5

Sample MDD Symptoms LO 15.5 Identify the characteristics of different mood disorders. Feeling blue or irritable Sleep difficulties Fatigue and loss of energy Weight changes Thoughts of death or suicide LO 15.5

Explanations for MDD LO 15 Explanations for MDD LO 15.6 Describe major explanations for depression and how life events can interact with characteristics of the individual to produce depression symptoms. Complex interplay of biological, psychological, and social influences Life events such as loss of something that is dearly valued can set stage for depression. Depression can create interpersonal problems, which cause lack of social support. LO 15.6

Explanations for MDD LO 15 Explanations for MDD LO 15.6 Describe major explanations for depression and how life events can interact with characteristics of the individual to produce depression symptoms. Behavioral model sees depression resulting from a low rate of positive reinforcement in the environment. Beck's cognitive model holds that depression is caused by negative beliefs and expectations. Cognitive triad, negative schemas, cognitive distortions LO 15.6

Explanations for MDD LO 15 Explanations for MDD LO 15.6 Describe major explanations for depression and how life events can interact with characteristics of the individual to produce depression symptoms. Learned helplessness - tendency to feel helpless in the face of events we can't control People with depression attribute failure internally and have global, stable attributions. Genes exert a moderate influence on MDD; role of serotonin, norepinephrine, and dopamine LO 15.6

Bipolar Disorder LO 15.5 Identify the characteristics of different mood disorders. Both depressive and manic episodes Elevated mood, lowered need for sleep, high energy, talkativeness, inflated self-esteem Also show highly irresponsible behavior Equally common in men and women LO 15.5

Bipolar Disorder LO 15.5 Identify the characteristics of different mood disorders. Produces serious problems in social and occupational realms Very heavily genetically influenced, but stressful life events can cause episode onset These can be negative or positive events LO 15.5

Suicide LO 15.7 Identify common myths and misconceptions about suicide. Major depression and bipolar disorder – higher risk for suicide than most disorders More than 30,000 people commit suicide in US each year (11th leading cause of death). Risk factors include previous suicide attempts and feelings of hopelessness LO 15.7

Table 15.5 Common Myths and Misconceptions About Suicide. LO 15.7

Personality Disorders LO 15 Personality Disorders LO 15.8 Identify the characteristics of borderline and psychopathic personality disorders. Should only be diagnosed when: Personality traits first appear by adolescence Traits are inflexible, stable, and expressed in a wide variety of situations Traits lead to distress or impairment Show substantial comorbidity with other psychological disorders, like mood and anxiety disorders LO 15.8

Borderline Personality Disorder LO 15 Borderline Personality Disorder LO 15.8 Identify the characteristics of borderline and psychopathic personality disorders. Mainly women; about 2% of population Marked by instability in mood, identity, and impulse control; self-destructive tendencies In sociobiological model, individuals with BPD overreact to stress and experience lifelong difficulties with regulating their emotions. LO 15.8

Psychopathic Personality LO 15 Psychopathic Personality LO 15.8 Identify the characteristics of borderline and psychopathic personality disorders. Condition marked by superficial charm, dishonesty, manipulativeness, self-centeredness, and risk taking Overlaps with antisocial personality disorder Primarily males; about 25% of the prison population qualifies LO 15.8

Psychopathic Personality LO 15 Psychopathic Personality LO 15.8 Identify the characteristics of borderline and psychopathic personality disorders. Causes are largely unknown, but may stem in part from a deficit in fear Alternatively, they may be perpetually underaroused and experiencing stimulus hunger. LO 15.8

Dissociative Disorders LO 15 Dissociative Disorders LO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. Involve disruptions in consciousness, memory, identity, or perception Examples include depersonalization disorder, derealization disorder, dissociative amnesia, and dissociative fugue. LO 15.9

Dissociative Identity Disorder LO 15 Dissociative Identity Disorder LO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. Characterized by presence of two or more distinct identities (alters) Intriguing differences between alters shown, but could be easily explained in other ways Primary controversy surrounds issue of posttraumatic vs sociocognitive models LO 15.9

Dissociative Identity Disorder LO 15 Dissociative Identity Disorder LO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. Little evidence to support the posttraumatic model Support for sociocognitive model includes: Most DID patients don't show alters prior to therapy LO 15.9

Dissociative Identity Disorder LO 15 Dissociative Identity Disorder LO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. Support for sociocognitive model includes: Treatment reinforces idea person has alters Treatment tends to increase number of alters seen LO 15.9

Schizophrenia LO 15.10 Recognize the characteristic symptoms of schizophrenia. Severe disorder of thought and emotion associated with a loss of contact with reality Symptoms include disturbances in attention, thinking, language, emotion, and relationships. Less than 1% of population, but over half of people in mental institutions LO 15.10

Schizophrenia LO 15.10 Recognize the characteristic symptoms of schizophrenia. Symptoms include: Delusions – strongly held, fixed beliefs with no basis in reality (a psychotic symptom) Hallucinations – sensory perceptions in the absence of external stimuli Disorganized speech (word salad) and behavior (echolalia, catatonia) LO 15.10

vulnerability to schizophrenia. LO 15.11 Explain how psychosocial, neural, biochemical, and genetic influences create the vulnerability to schizophrenia. Psychosocial factors play a role in schizophrenia, but only trigger it in persons with genetic vulnerabilities. Family members can influence whether patients relapse (expressed emotion). LO 15.11

Schizophrenia LO 15.11 Explain how psychosocial, neural, biochemical, and genetic influences create the vulnerability to schizophrenia. Brain abnormalities: Enlarged ventricles Increased sulci size Hypofrontality Neurotransmitter differences in dopamine, norepinephrine, glutamate, and serotonin Significant genetic element LO 15.11

Figure 15. 5 Schizophrenia Risk and the Family Figure 15.5 Schizophrenia Risk and the Family. The lifetime risk of developing schizophrenia is largely a function of how closely an individual is genetically related to a person with schizophrenia. (Source: Feldman, 1991) 15.11

Vulnerability to Schizophrenia LO 15 Vulnerability to Schizophrenia LO 15.11 Explain how psychosocial, neural, biochemical, and genetic influences create the vulnerability to schizophrenia. Diathesis-stress models propose that disorder is a joint product of a genetic vulnerability (diathesis) and stressors that trigger it Early warning signs of schizophrenia vulnerability: Social withdrawal Thought and movement problems Lack of emotions, decreased eye contact LO 15.11

Autism Spectrum Disorders LO 15 Autism Spectrum Disorders LO 15.12 Describe the symptoms and debate surrounding disorders diagnosed in childhood. Autistic disorder and less severe Asperger's disorder Autistic disorder – severe deficits in language, social bonding, and imagination; often accompanied by mental retardation Dramatic increase in prevalence since early 1990s reflects more liberal diagnostic criteria. LO 15.12

Figure 15. 6 The Autism Epidemic in America from 1992 to 2008 Figure 15.6 The Autism Epidemic in America from 1992 to 2008. The fact that autism diagnoses have been skyrocketing isn't controversial—but the reasons for the increase are. LO 15.12

ADHD and Early-Onset Bipolar Disorder LO 15 ADHD and Early-Onset Bipolar Disorder LO 15.12 Describe the symptoms and debate surrounding disorders diagnosed in childhood. Primary problems include inattention, impulsivity, and hyperactivity Diagnosable in 3-7% of school children; more males than females (3:1) Related to numerous functional problems in both children and adults LO 15.12

ADHD and Early-Onset Bipolar Disorder LO 15 ADHD and Early-Onset Bipolar Disorder LO 15.12 Describe the symptoms and debate surrounding disorders diagnosed in childhood. Highly genetically influenced; can be successfully treated with stimulant meds Rates of "early-onset bipolar disorder" have skyrocketed over last 20 years. 0.42% to 6.67% from 1990 to 2003 Most likely reflects severe ADHD symptoms, not bipolar disorder LO 15.12