1 Anxiety, Dissociative, Somatoform and Personality Disorders Module 37

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3 Psychological Disorders Anxiety Disorders Overview  Generalized Anxiety Disorder  Panic Disorder  Phobias  Obsessive-Compulsive Disorder  Post-Traumatic Stress Disorder  Explaining Anxiety Disorders

4 Anxiety Disorders Feelings of excessive apprehension and anxiety. You don’t have to write this… 1.Generalized anxiety disorder 2.Panic disorder 3.Phobias 4.Obsessive-compulsive disorder 5.Post-traumatic stress disorder

5 Generalized Anxiety Disorder 1.Persistent and uncontrollable tenseness and apprehension. 2.Autonomic arousal. 3.Inability to identify or avoid the cause of certain feelings. Symptoms

6 Panic Disorder Minutes-long episodes of intense dread which may include feelings of terror, chest pains, choking, or other frightening sensations. link Symptoms

7 Phobias Marked by a persistent and irrational fear of an object or situation that disrupts behavior.

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10 Kinds of Phobias Phobia of blood.Hemophobia Phobia of closed spaces Phobia of closed spaces Link. Claustrophobia Phobia of heights link.Acrophobia Phobia of open places.Agoraphobia Arachnophobia at National Geographic Link

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13 Obsessive-Compulsive Disorder Persistence of repetitive thoughts (obsessions) and urges to engage in repetitive behaviors (compulsions) that cause distress. Clip Clip

14 A PET scan of the brain of a person with Obsessive- Compulsive Disorder (OCD). High metabolic activity (red) in the frontal lobe areas are involved with directing attention. LinkLink 45:08 Brain Imaging Brain image of an OCD

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16 Post-Traumatic Stress Disorder Four or more weeks of the following symptoms constitute post-traumatic stress disorder (PTSD): 1.Haunting memories 2.Nightmares 3.Social withdrawal 4.Jumpy anxiety 5.Sleep problems Bettmann/ Corbis

17 Resilience to PTSD Only about 10% of women and 20% of men react to traumatic situations and develop PTSD. Holocaust survivors show remarkable resilience to traumatic situations. All major religions of the world suggest that surviving a trauma leads to the growth of an individual.

18 Explaining Anxiety Disorders Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety. There are 2 main perspectives, Learning and Biological. LinkLink 58:32

19 The Learning Perspective Learning theorists suggest that fear conditioning leads to anxiety. When anxiety then becomes associated with other objects or events (stimulus generalization) and is reinforced. John Coletti/ Stock, Boston

20 The Learning Perspective Fear responses may be initiated through observational learning. Young monkeys develop fear when they watch other monkeys who are afraid of snakes.

21 The Biological Perspective Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias.

22 The Biological Perspective Generalized anxiety, panic attacks, and even OCD are biologically measurable and linked with brain circuits like the anterior cingulate cortex. Anterior Cingulate Cortex of an OCD patient. S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action monitoring in obsessive-compulsive disorder. Psychological Science, 14,

23 Somatoform Disorders Somatoform Disorders Overview  Somatoform Disorders  Conversion Disorder  Hypochondriasis

24 Somatoform Disorders Psychological problems in which there are symptoms of a physical disorder with NO physical cause.

25 Conversion Disorder A somatoform disorder in which a person displays blindness, deafness, or other symptoms of sensory or motor failure without a physical cause.

26 Glove Anesthesia A conversion disorder in which a person can’t feel their hand (B). Neurologically this is impossible because the sensory nerves of the hand and arm are organized as shown in (A) rather than (B).

27 Conversion disorders Appear when a person is under severe stress. Help reduce that stress by allowing the person to avoid unpleasant or threatening situations. The person shows remarkably little concern about what is apparently a rather serious problem. The symptoms may be neurologically impossible or improbable

28 Hypochondriasis A somatoform disorder involving strong, unjustified fear of having (VS getting) physical illness.

29 Psychological Disorders Dissociative and Personality Disorders Overview  Dissociative Disorders  Personality Disorders

30 Dissociative Disorders Conscious awareness becomes separated (dissociated) from or unaware of previous memories, thoughts, and feelings. Symptoms 1.Having a sense of being unreal. 2.Being separated from the body. 3.Watching yourself as if in a movie.

31 Dissociative Disorders Dissociative/Psychogenic Fugue –New identity –New location Dissociative Amnesia –Sudden loss of memory

32 Dissociative Identity Disorder (DID) A disorder in which a person exhibits two or more distinct and alternating personalities, formerly called multiple personality disorder. LinkLink Chris Sizemore (DID) Lois Bernstein/ Gamma Liason

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34 DID Critics Critics argue that the diagnosis of DID increased in the late 20 th century. DID has not been found in other countries. Critics’ Arguments 1.Role-playing by people open to a therapist’s suggestion. 2.Learned response that reinforces reductions in anxiety.

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37 Personality Disorders Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. Link 58:55 Link

38 Antisocial Personality Disorder A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, even toward friends and family members. LinkLink 6:29 Formerly, this person was called a sociopath or psychopath.

“Psychiatrists, like the rest of us, have also been fascinated with psychopaths. Clinicians have written about psychopaths since the birth of psychiatry in the early 1800s.“ 39

Fact: There are over 29,000,000 psychopaths worldwide. The Psychopath Whisperer: The Science of Those Without Conscience by Kent A. Kiehl PhD 40

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42 "I have no desire whatever to reform myself. My only desire is to reform people who try to reform me, and I believe the only way to reform people is to kill 'em. My motto is: Rob 'em all, rape 'em all, and kill 'em all.“ »Carl Panzram

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Psychopath assessment The one thing that was known was that psychopaths were at very high risk to reoffend. An inmate who scored high on the Psychopathy Checklist was four to eight times more likely than an inmate who scored low to reoffend in the next five years. 46

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Dr. Robert D. Hare is now known as the modern father of the field of psychopathy. In 2010, he was awarded the Order of Canada, one of the highest civilian honors bestowed by the country, for his scientific and community efforts developing the Psychopathy 48

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Spree Killers are psychopaths right? For the vast majority of spree killer cases, the answer is no—the offender was not a psychopath. Most killing sprees are committed by individuals who suffer from psychosis, not psychopathy. Recall that psychosis is a fragmentation of the thinking processes in the brain that leads to symptoms like hallucinations and delusions. Kent A. Kiehl PhD 50

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“As there are persons who cannot distinguish certain colours, having what is called colour blindness, and others who, having no ear for music, cannot distinguish one tune from another, so there are some few who are congenitally deprived of moral sense.” –Henry Maudsley 52

He was so nice, I can’t imagine why he is in prison” or “If that guy was on the outside, I’d get a beer with him.” The psychopath often comes off as quick witted, even likable, but the listeners’ “gut” feelings detect that there is something not quite right about the individual. 53

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A psychopath would! Selling cigarettes to pregnant women…. 55

56 Understanding Antisocial Personality Disorder Like mood disorders and schizophrenia, antisocial personality disorder has biological and psychological connections. Link Link The brain of a serial killer

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58 Understanding Antisocial Personality Disorder PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study, violent repeat offenders had 11% less frontal lobe tissue than normal (Raine et al., 1999; 2000). Normal Murderer Courtesy of Adrian Raine, University of Southern California

“One of the most telling aspects of the letters is that none of the children are described as normal from birth. Parents say they noticed something different, odd, or abnormal about the child from the very beginning.“ –Kent A. Kiehl PhD 59

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Wade and Tavris © 2005 Prentice Hall Emotions and Antisocial Personality Disorder People with APD were slow to develop classically conditioned responses to anger, pain, or shock. Such responses indicate normal anxiety.