XII. Psychological Disorders

A. Who is mentally ill? What is “disordered” behavior? Psychological disorder: typically includes constellation of cognitive, emotional, and behavioral symptoms that create significant stress (impair work, relationships, etc.) 1. Characteristics of disordered behavior. – Atypical, but... – Disturbing, but particularly worrisome when... – Maladaptive – Unjustifiable – Involuntary

A. Who is mentally ill? What is “disordered” behavior? 2. Diagnosing disordered behavior. – 230 possible diagnoses. a. Development of the DSM (Diagnostic and Statistical Manual for Mental Disorders) First edition 1952: too subjective. Third edition 1980: created objective criteria. Today - Fourth Edition - How it is used Important today for insurance.

A. Who is mentally ill? What is “disordered” behavior? ii. The DSM and labeling. - Can giving people a label be problematic? - Rosenhan et al., (1973) - Stigma associated with mental illness.

B. Why are people mentally ill? 1. Historically ( ’s): – Supernatural, witch craft. – Treatment? Bleeding, magic, drill holes in skull Institutions like zoos

B. Why are people mentally ill? 2. Medical Model – In reaction to maltreatment. – First scientific approach to disorders. Psychological disorders are caused by physical conditions that can be cured. (disease not depravity).

B. Why are people mentally ill? 3. Bio-Psycho-Social Perspective - More contemporary. - Considers more influences. - Biological (genes, brain chemistry) – Environment (stress, roles, expectations) – Culture - Reflects the nature/nurture perspective.

C. Anxiety Disorders 1. General Description – experience extreme/intense fear, panic, anxiety – most treatable, best prognosis 2. Generalized Anxiety Disorder – Unfocused, free-floating anxiety – 5% of N. Americans experience disorder at some point in life. – Symptoms: physiological psychological visual **Must occur for more days than not for 6 month period.

C. Anxiety Disorders 2. Generalized Anxiety Disorder Causes: Genetic predisposition Hyper-vigilance/Over-arousal in brain Environment Can lead to panic attacks, panic disorder.

C. Anxiety Disorders 3. Phobias - Focus anxiety on specific source. - Examples… - Causes: Learning approach: Classical conditioning Observational learning Genetic (amygdala) Freud

C. Anxiety Disorders 4. Obsessive Compulsive Disorder - Trapped in endless cycle of repetitive thoughts (obsessions) and actions (compulsions). - Possibly 4 million people have OCD at one time in life. - Examples...

C. Anxiety Disorders - Symptoms: - Severe, prolonged, disrupts normal living - Consumes more than one hour a day. - Causes similar to generalized anxiety. - Post-Traumatic Stress Disorder – see text.

D. Dissociative Disorders 1. General Description - Most controversial of disorders. - Experience sudden loss of memory or change identity. - “Dissociate” in response to stressful event.

D. Dissociative Disorders 2. Dissociative Amnesia - Selective memory loss in response to intolerable psychological stress. - Cannot remember distant/recent past name, identity

D. Dissociative Disorders 3. Dissociative Fugue - Flight from one’s home and identity accompanies memory loss. (take on complete new identity in different place).

D. Dissociative Disorders 4. Dissociative Identity Disorder - Previously called multiple personality. - People have two or more distinct personalities that alternately control behavior. - Why is this disorder so controversial?

D. Dissociative Disorders Causes: - natural, protective response - often women who were abused as kids - may be encouraged by inborn, biological capacity Or - contrived fantasy? Or - created by therapist?

E. Schizophrenia 1. General Description and Symptoms. - Accounts for higher % of patient population in mental hospitals than any other disorder.

E. Schizophrenia 1. Symptoms: Disorganized Thinking: no organization, fragmented, includes delusions. Disturbed Perceptions: perceive things that aren’t there, hallucinations. (typically auditory “hear voices”) Inappropriate Emotions & Actions: Strike out, cry when should laugh, flat affect, movement - rocking, rubbing, motionless

E. Schizophrenia 2. Types of Schizophrenia Positive - disorganized, deluded, acting out Negative - mute, catatonic, expressionless Chronic or Process - develops gradually, long history, recovery doubtful. Acute or Reactive - develops in reaction to life stress, recovery more likely.

E. Schizophrenia Causes: Genetic: Many genes involved Brain: Excess number of dopamine receptors. Abnormal brain tissue. Low brain activity in frontal lobes. Environment?: need to have predisposition.

F. Mood Disorders Mood: Prolonged emotional state that colors many (or all) aspects of thoughts & behavior. Spans from severe sad/bad (depression) to unbridled elation, happiness (mania). Depression: - Number one reason people seek mental health services.

F. Mood Disorders 1. Depression Symptoms: focused on negative absence of pleasure, hopelessness self-blame, worthlessness affects sleep, speech, movement, eating

F. Mood Disorders 1. Major Depressive Disorder - 2 levels: Dysthymic Disorder - sad mood, low energy, difficulty concentrating. Major Depressive Disorder - more disabling, possibly with suicidal thoughts.

F. Mood Disorders 1. Major Depressive Disorder Causes - Brain: neurotransmitters - Genetic: twin studies

F. Mood Disorders 1. Major Depressive Disorder Causes: - Socio-Cognitive Perspective Influence of interpreting events & coping. Attribution process for negative events: internal, stable, global Ruminate, develop hopelessness and learned helplessness.

F. Mood Disorders 2. Bipolar Disorder - Was manic depressive disorder. - Alternate between hopelessness (dep) and overexcitedness (mania). Symptoms: overtalkative, easily irritated, little need for sleep, loud speech, high opinion of self, reckless, fewer sexual inhibitions

F. Mood Disorders 2. Bipolar Disorder Causes: - genetic: 7 in 10 chance for twins. - brain: neurotransmitters abundant during mania - environmental influence unclear.

Disorders – rates are increasing – 1 in 6 Americans – Symptoms by age 24

G. Personality Disorders – see text Inflexible and enduring patterns of behavior that impair one’s social functioning. 1. Histrionic: shallow, attention-getting 2. Narcissistic: unwarranted sense of self- importance, cannot accept criticism, demand for constant attention.

G. Personality Disorders 3. Antisocial: socio or psychopath. Typically male, lack of conscience. Lie, steal, fight, unrestrained sexual behavior, fear and feel for few, no guilt. 4. Borderline: unstable identity, relationships, and emotions.

C. Anxiety Disorders 5. Posttraumatic Stress Disorder – see text - Only anxiety disorder directly tied to experiencing or witnessing traumatic event(s). - Symptoms: nightmares, reliving events sleeplessness, irritability, guilt emotional numbing, depression - Importance of social support/genetics.