Psychological disorders

I. Defining and diagnosing disorders

Mental disorder Any behavior or emotional state that: causes a person to suffer causes a person to suffer is self-destructive is self-destructive seriously impairs the person’s ability seriously impairs the person’s ability to work or get along with others to work or get along with others endangers others or the community endangers others or the community chapter 11

Diagnostic and Statistical Manual [DSM] Axis I: Primary clinical problem Axis II: Personality disorders Axis III: General medical conditions Axis IV: Social and environmental stressors Axis V: Current and past levels of overall functioning

Explosion of mental disorders Supporters of new categories answer that it is important to distinguish disorders precisely. Critics point to economics: diagnoses are needed for insurance reasons for therapists to be compensated.

Projective tests Psychological tests used to infer a person’s motives, conflicts, and unconscious dynamics on the basis of the person’s interpretation of ambiguous stimuli Rorschach inkblot test A projective personality test that asks respondents to interpret abstract, symmetrical inkblots

Objective tests Inventories Standardized objective questionnaires requiring written responses Typically include scales on which people are asked to rate themselves “Evaluating Whether You Are Depressed”

II. Mood disorders

Symptoms of depression Major depression A mood disorder involving disturbances in: emotion (depressed mood, excessive sadness) emotion (depressed mood, excessive sadness) behavior (reduced interest in one’s usual activities) behavior (reduced interest in one’s usual activities) cognition (thoughts of hopelessness, feelings of worthlessness or guilt, reduced ability to concentrate, recurrent thoughts of death) cognition (thoughts of hopelessness, feelings of worthlessness or guilt, reduced ability to concentrate, recurrent thoughts of death) body function (fatigue, loss of appetite, significant weight loss or gain, sleeping too much or too little) body function (fatigue, loss of appetite, significant weight loss or gain, sleeping too much or too little) chapter 11 DSM IV requires 5 of these within the past 2 weeks

Bipolar disorder A mood disorder in which episodes of depression and mania (excessive euphoria) occur. AKA: manic-depressive disorder

Genetic factors in depression Studies of adopted children support genetic explanations of depression. 5-HTT is a gene that is present in either a long or short form. 17% of individuals with the long form become severely depressed. 43% of individuals with 2 copies of the short form become depressed. Genetics may also influence levels of serotonin and other neurotransmitters. Biomedical therapy is common for depression. Major depression: Antidepressant medication Major depression: Antidepressant medication Bipolar disorder: Lithium (also antidepressants, antipsychotics) Bipolar disorder: Lithium (also antidepressants, antipsychotics)

Life experiences and circumstances Social explanations emphasize the stressful circumstances in people’s lives. Loss of or problems with important relationships Loss of or problems with important relationships Women are less satisfied with work and family and more likely to live in poverty. Women are less satisfied with work and family and more likely to live in poverty. A health psychologist might emphasize stress reductionA health psychologist might emphasize stress reduction

Cognitive habits Cognitive explanations emphasize habits of thinking and ways of interpreting events. Depressed people believe their situation is permanent, uncontrollable. Rumination Brooding about negative aspects of one’s life Cognitive therapy is often effective in treating depression

III. Anxiety disorders

Generalized anxiety disorder Continuous state of anxiety marked by feelings of worry and dread, apprehension, difficulties in concentration, and signs of motor tension

Panic disorder An anxiety disorder in which a person experiences recurring panic attacks Panic attack: a feeling of impending doom or death, accompanied by physiological symptoms such as rapid breathing and dizziness

Fears and phobias Phobia An exaggerated, unrealistic fear of a specific situation, activity, or object

Agoraphobia A set of phobias, often set off by a panic attack, involving the basic fear of being away from a safe place or person.

Posttraumatic stress disorder An anxiety disorder in which a person who has experienced a traumatic or life- threatening event has symptoms such as psychic numbing, reliving the trauma, and increased physiological arousal Diagnosed only if symptoms persist for six months or longer May immediately follow event or occur later

Obsessive-compulsive disorder An anxiety disorder in which a person feels trapped in repetitive, persistent thoughts (obsessions) and repetitive, ritualized behaviors (compulsions) designed to reduce anxiety

Treatment of anxiety disorders Biomedical therapy (antidepressant and antianxiety medication) Biomedical therapy (antidepressant and antianxiety medication) Cognitive therapy Cognitive therapy Behavior therapy Behavior therapy

IV. Dissociative disorders

Dissociative amnesia Involves memory loss caused by extensive psychological stress

Dissociative identity disorder A controversial disorder marked by the appearance within one person of two or more distinct personalities, each with its own name and traits Commonly known as Multiple Personality Disorder

The MPD controversy First view MPD is common but often unrecognized as such. MPD is common but often unrecognized as such. Starts in childhood as a means of coping Starts in childhood as a means of coping Trauma produced a mental splitting. Trauma produced a mental splitting. Second view Created through pressure and Created through pressure and suggestion by clinicians suggestion by clinicians Handfuls to 10,000 since 1980 Handfuls to 10,000 since 1980

Sociocognitive explanation MPD is an extreme form of our ability to present many aspects of our personalities to others. MPD is a socially acceptable way for some troubled people to make sense of their problems. Therapists looking for MPD may reward patients with attention and praise for revealing more and more personalities.

V. Personality disorders

Problem personalities Personality disorder Rigid, maladaptive patterns that cause personal distress or an inability to get along with others Narcissistic personality disorder Characterized by an exaggerated sense of self- importance and self- absorption

Criminals and psychopaths Antisocial personality disorder Characterized by a lifelong pattern of irresponsible, antisocial behavior such as lawbreaking, violence, and other impulsive, restless acts

VI. Schizophrenia

Schizophrenia A psychotic disorder marked by: Delusions Delusions Hallucinations Hallucinations Disorganized, incoherent speech Disorganized, incoherent speech Inappropriate behavior Inappropriate behavior Impaired cognitive abilities Impaired cognitive abilities Typical onset: adolescence to early adulthood

Delusions and hallucinations Delusions False beliefs that often accompany schizophrenia and other psychotic disorders Hallucinations Sensory experiences that occur in the absence of actual stimulation

Genetic vulnerability The risk of developing schizophrenia increases as the genetic relatedness with a diagnosed schizophrenic increases.

Structural brain abnormalities Several abnormalities exist: Decreased brain weight Decreased volume in temporal lobe or hippocampus Enlargement of ventricles About 25% do not have these observable brain deficiencies.

Neurotransmitter abnormalities Many schizophrenics have high levels of brain activity in areas served by dopamine, and greater numbers of dopamine receptors. Abnormalities may also involve serotonin, glutamate Biomedical therapy: antipsychotic medication

Prenatal or birth complications Damage to the fetal brain increases chances of schizophrenia and other mental disorders. Damage may occur as a function of: maternal malnutrition maternal malnutrition maternal illness maternal illness brain injury brain injury oxygen deprivation at birth oxygen deprivation at birth