DISORDERS AND TREATMENT Review Session 10

What is Abnormal?  Common characteristics  1) It is maladaptive (harmful) and disturbing to the individual Agoraphobia- afraid of public places do unable to leave home  2) It is disturbing to others Zoophilia- sexually aroused by animals  3) It is unusual; based on culture! Seeing visions  4) It is irrational Depressed when your family moves- rational

The DSM-IV  Insane-not a medical term but a legal term The DSM-IV: Diagnostic and Statistical Manual of Mental Disorders Used to Diagnose Patients (I) CLINICAL SYNDROMES (II) PERSONALITY DISORDERS (III) GENERAL MEDICAL CONDITIONS (IV) PSYCHOSOCIAL STRESSORS (V) GLOBAL ASSESSMENT OF FUNCTIONING

Causes by Perspective

Categories of Disorders  6 Categories  Anxiety  Somatoform  Dissociative  Mood/Affective  Schizophrenic  personality

Anxiety Disorders- Phobias  Specific Phobia  Intense unwarranted fear of a situation or object Claustrophobia, Arachnophobia, etc.  Agoraphobia  a fear of open, public spaces  Social Phobia  fear of embarrassing oneself in public  Contact with the feared object or situation results in anxiety

Anxiety Disorders  Generalized Anxiety Disorder (GAD)  Constant, low level anxiety  Constantly feels nervous and our of sorts  Panic Disorder  Acute episodes of intense anxiety without any provocation  Often suffer anxiety due to anticipating the attacks

Anxiety Disorders  Obsessive-Compulsive Disorder (OCD)  Persistent, unwanted thoughts- obsessions  Feeling the need to engage in a particular action- compulsions  Obsessions result in anxiety that is reduced when the compulsive behavior is performed  Post-Traumatic Stress Disorder (PTSD)  Flashbacks or nightmares following a person’s involvement in or observation of an extremely troubled event (wars, disasters, etc.)  Memories cause anxiety

Causes of Anxiety Disorders Psychoanalyt ic Result of conflicts between the id, ego, and superego Behaviorist Learned through classical or operant conditioning Cognitive Result from dys- functional ways of thinking/ irrationality

Somatoform Disorders  A person manifests a psychological problem through a physiological symptom  Physical problem without a physical cause  Hypochondriasis  Frequent physical complaints with no medical cause  May believe minor problems are severe physical illness  Conversion Disorder  Report a severe physical problem such as paralysis or blindness with no physical reason

Causes of Somatoform Disorders Psychodynamic Outward manifestations of unresolved unconscious conflicts Behaviorist Continue because people are reinforced for their behavior (attention)

Dissociative Disorders  Involve a disruption in conscious processes  Psychogenic Amnesia  When a person cannot remember things for no physiological reason  Psychogenic Fugue  Not only have psychogenic amnesia but also find themselves in an unfamiliar environment  Dissociative Identity Disorder (Multiple Personalities)  A person has several personalities rather than one integrated personality  Personalities may have different ages, sexes  Commonly have a history of sexual abuse or childhood trauma

Causes of Dissociative Disorders Psychoanalytic Result of an extremely traumatic event so strongly repressed that a split in consciousness results Behaviorism People who have experienced trauma find reward in not thinking about it Social Rare outside the US, where numbers have increased along with publicizing Role play disorder inadvertenly

Mood or Affective Disorders  Major Depression  Most common  Remain unhappy for more than two weeks with no clear reason  Loss of appetite, fatigue, sleep changes, feeling worthless  Seasonal Affective Disorder (SAD)  Only depressed during certain types of year  Use of phototherapy

Mood or Affective Disorders  Bipolar Disorder  Manic Depression- involves both depressed and manic episodes  Depressed- depression symptoms  Manic- feelings of high energy Some have a heightened sense of confidence and power, others just feel anxious and irritable Usually engage in risky behavior

Causes of Mood Disorders Psychoanalyst Product of anger directed inward, early childhood lose, or an overactive superego Cognitive Aaron Beck- Cognitive Triad Negative thoughts about 1) themselves 2) their world 3) their future Attributions- explaining causes Internal vs. external Global vs. specific Stable vs. unstable Cognitive- Behavioral Learned Helplessness (Seligman) Biological Low levels of serotonin- unipolar Low levels of acetylcholine- bipolar Low levels of norepinephrine Genetic Component

Schizophrenic Disorders  Tends to strike people as young adults  Disordered, distorted thinking often demonstrated through delusions and hallucinations  Delusions- beliefs that have no basis in reality  Delusions of persecution- believing people are out to get you  Delusions of grandeur- belief that you enjoy greater power and influence than you do  Hallucinations- perceptions in the absence of any sensory stimulation  Schizophrenics DO NOT have split personalities  Positive Symptoms- excesses of behavior  Negative Symptoms- correspond to deficits of behavior

Types of Schizophrenia Paranoid Delusions of persecution Belief that others are “out to get you” Disorganized Odd uses of language Make up own words String together nonsense words that rhyme Inappropriate affect- wrong emotion at the wrong time Flat affect- no emotional response Catatonic Odd movements Remain in strange positions for hours at a time Will allow their body to be moved into any shape and will hold the new pose Increasingly rare Undifferentiated Exhibit disordered thinking but no symptoms of one of the other types

Causes of Schizophrenic Disorders Biological Perspective Dopamine Hypothesis- high levels of dopamine are associated with schizophrenia Antipsychotic drugs used to treat schizophrenia result in lower dopamine levels Extensive use causes negative side effects- dyskinesia (muscle tremors and stiffness) L-dopa, given to Parkinson’s patients, can cause schizophrenic symptoms in excess Enlarged brain ventricles and brain asymmetry Genetic predisposition- possible abnormality on 5 th chromosome Identical twins more likely to both have than fraternal

Causes of Schizophrenic Disorders Cognitive-Behavioral Certain kinds of environments may cause or increase the likelihood Double binds- a person is giving contradictory messages People who live in environments full of conflicting messages may develop distorted ways of thinking Diathesis-Stress Model Environmental stressors can provide the circumstances under which a biological predisposition for illness can express itself Can explain other disorders as well

Personality Disorders  Generally less serious  Well-established, maladaptive ways, of behaving  Antisocial Personality Disorder- have little regard for other people’s feelings (often criminals)  Dependent Personality D/o- depend too much on others  Histrionic Personality Disorder- overly dramatic

Other Psychological Disorders  Paraphilias/Psychosexual Disorders- sexual attraction to an object, person, or activity not usually seen as sexual  Eating Disorders- Anorexia and Bulimia  Substance Abuse Disorder  Autism- atypical social development  ADHD

The Rosenhan Study (1978)  David Rosenhan and his associates sought admission to mental hospitals, claiming that they had been hearing voices; all were admitted as suffering from schizophrenia  At that time, they ceased reporting any unusual symptoms and behaved as usual  None were exposed, all leftwith the diagnosis of schizophrenia in remission  Should people who were once diagnosed carry it the rest of their lives?  To what extent are disorders the product of the environment?  What is the level of institutional care available of the imposters could go undetected for weeks?

Types of Therapy- Generally Effective Psychotherapy Treating the mind PsychoanalyticBehavioralCognitiveHumanistic Somatic Treating the body Biomedical

Psychoanalytic Therapy  Cause of disorders in unconscious conflicts; must identify the underlying cause  Symptom substitution- happens in other types of therapy when the underlying problem is not addressed; person will have a new psychological problem  Hypnosis- an altered state of consciousness where people are less likely to repress troubling thoughts

Psychoanalytic Theory  Free Association- saying whatever comes to mind, we cannot constantly sensor everything we say  Dream Analysis- the ego’s defenses are relaxed during sleep  Manifest content- what a patient reports about their dream  Latent content- the hidden content revealed by interpretive work

Psychoanalytic Theory  Resistance- disagreeing with their therapist’s interpretations  Strongly voiced- close to getting at the actual problem  Transference- having strong feelings toward their therapist  Love, hate, etc.  Psychodynamic- after Freud (Adler, Horney etc.)

Humanistic Theory  Focuses on helping people understand and accept themselves and strive to self-actualize  People are innately good and possess free will- capable of controlling their own destinies (opposite of determinism)  Carl Rogers (Client Centered Therapy)  The therapist provides the patient with unconditional positive regard (support no matter what)  Essential to healthy development

Humanistic Therapy  Non-directive- do not tell client what to do, but seek to help clients choose the best course of action for themselves  Active listening- clarify feelings for client- (“So what I’m hearing you say is…”)  Gestalt Therapy (Perls)- encourage client to get in touch with their whole selves  Body position, minute actions  Stress importance of the present

Behavioral Therapy  Counterconditioning- a kind of classical conditioning in which an unpleasant conditioned response is replaced with a pleasant one  Give Bentley a treat when he is put in his cage  Systematic Desensitization- teaching the client to replace the feelings of anxiety with relaxation  Teach the client to relax  Create an anxiety hierarchy- rank ordered list of what the client fears and tackle each one

Behavioral Therapy  Flooding- address the most frightening scenario first to realize fears are irrational  Modeling- learning by observing the behavior of others  Aversive conditioning- pairing a habit one wishes to break with an unpleasant stimulus  Token Economy- identify desired behaviors and reward them for tokens that can be exchanged

Cognitive Therapy  Changing unhealthy thought patterns  Attributional Style- healthy views failures as external, specific, and temporary (vs. unhealthy)  Aaron Beck- Cognitive Therapy (used to treat depression)  Cognitive Triad Depression- Caused by Irrational: Beliefs about themselves Beliefs about their world Beliefs about their futures

Cognitive Behavioral Therapies (CBT)  Rational Emotive (REBT)- Albert Ellis  Expose and confront the dysfunctional thoughts of their clients  Question the likelihood of an event occurring and the impact that would result  Goal is to show the client that failure is an unlikely occurrence but that even if it did occur, its not that big of a deal

Somatic Therapy  Pharmacology/Chemotherapy- Drug Treatment Type of DisorderTreatmentType of DrugDrug Names Anxiety DisordersDepress CNS activity Barbiturates, Benzodiazepines Miltown, Zanax, Valium Unipolar DepressionIncrease SerotoninMAOIs, Tricyclic Antidepressants, serotonin-reuptake inhibitors Zoloft, Prozac Bipolar DepressionLower manic phaseLithium SchizophreniaBlock dopamine receptor sites Antipsychotics, Neuroleptics Haldol

Somatic Therapy  Electroconvulsive Therapy (ECT)  Passing electric current through the brain, causing a brief seizure  Can result in memory loss  Used as a last resort for severe depression  Not completely understood  Psychosurgery  Prefrontal lobotomies- calmed patients to a vegetative state

Practice Questions  1) All schizophrenics suffer from  Depression  Multiple personalities  Flat affect  Distorted thinking  Delusions of persecution

 2) Juan hears voices that tell him to kill people. Juan is experiencing  Delusions  Obsessions  Anxiety  Hallucinations  Compulsions

 3) Depression is associated with low levels of  Acetylcholine  Epinephrine  Serotonin  Dopamine  GABA

 4) What kind of psychologist would be most likely to describe depression as the result of an unconscious process in which anger is turned inward?  Biomedical  Psychoanalytic  Cognitive  Behavioral  Sociocultural

 5) Coretta’s therapist says little during their sessions and never makes any recommendations about what Coretta ought to do. What kind of therapy does Coretta’s therapist most likely practice?  Psychdynamic  Behavioral  Cognitive  Biomedical  Humanistic

 6) Maria has been in analysis for over a year. Recently, she has begun to suspect that she has fallen in love with Dr. Chin, her analyst. When she confesses her feelings, Dr. Chin is likely to tell Maria that she is experiencing  Resistance  Transference  A breakthrough  Irrational expectations  Unconditional positive regard