1. PSYC 1000 Lecture 53

2. Etiology What causes psychological disorders? –For many disorders there is no general consensus Compromises one of the bases of the DSM-IV-TR classification scheme. –Major approaches Psychodynamic – Focus on unresolved conflicts, often subconscious, and maladaptive defense mechanisms Behavioural – Understand the conditioning (classical or operant) that maintains the behaviour and modify. Cognitive – Target the rationale behind actions and address incorrect or maladaptive reasoning. Maladaptive processing may also be unconscious. Biological – What are the neural substrates that are different in clinical populations? Restore function through pharmacological or physiological manipulation.

3. Anxiety Disorders –Distressing, persistent anxiety –Or maladaptive behaviors that reduce anxiety Generalized Anxiety Disorder –Person is tense, apprehensive, and in a state of autonomic nervous system arousal –Unable to identify cause, “free floating” Panic Disorder –Minutes-long episode of intense dread in which person experiences terror and accompanying chest pain, choking, or other frightening sensation –Perceived as heart-attack, come to fear fear itself

4. Geneeralized Anxiety Disorder A. At least 6 months of "excessive anxiety and worry" about a variety of events and situations. Generally, "excessive" can be interpreted as more than would be expected for a particular situation or event. Most people become anxious over certain things, but the intensity of the anxiety typically corresponds to the situation. B. There is significant difficulty in controlling the anxiety and worry. If someone has a very difficult struggle to regain control, relax, or cope with the anxiety and worry, then this requirement is met. C. The presence for most days over the previous six months of 3 or more (only 1 for children) of the following symptoms: 1. Feeling wound-up, tense, or restless 2. Easily becoming fatigued or worn-out 3. Concentration problems 4. Irritability 5. Significant tension in muscles 6. Difficulty with sleep D. The symptoms are not part of another mental disorder. E. The symptoms cause "clinically significant distress" or problems functioning in daily life. "Clinically significant" is the part that relies on the perspective of the treatment provider. Some people can have many of the aforementioned symptoms and cope with them well enough to maintain a high level of functioning. F. The condition is not due to a substance or medical issue

5. Phobia –Persistent, irrational fear of a specific object or situation –Some common and uncommon fears

7. Obsessive-Compulsive Disorder –Unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

8. Post- Traumatic Stress Disorder Four or more weeks of following symptoms –Haunting memories –Nightmares –Social withdrawal –Jumpy anxiety –Sleep problems Associated with –More intense trauma –Closer proximity (e.g., 9/11) Concerns about PTSD –Overdiagnosed? –Trauma counseling ineffective or harmful in some cases –Resilience of survivors

9. Explaining Anxiety Disorders Learning Perspective –Fear Conditioning: 58% of people with social phobia experienced disorder after traumatic event Horley et al (2004): Social Phobics avoid looking at eyes of angry faces (above, early experiences?) –Stimulus Generalization –Avoidance or Escape behaviors: Negative Reinforcement –Observational Learning

10. Biological Perspective –Natural Selection: predispositions to fear certain kinds of objects and events (snakes, confinement) and engage in certain ritual behaviors (hand-washing) –Genes: higher prevalence of anxiety in identical twins –Reduced GABA levels: GABA is inhibitory neurotransmitter –Physiology: over-arousal of frontal lobe areas involved in directing attention and impulse control, as in PET Scan of brain of person with Obsessive/ Compulsive disorder (top); high metabolic activity (red) in frontal lobe areas; or over-activity of brain region involved in error checking (bottom)

11. Cognitive Perspective –Attentional and other cognitive processes play role in anxiety (and other psychological disorders) –Emotional Stroop task: name ink color of words that are either Threatening or Non-Threatening –Study with Adolescents who also completed Beck Anxiety Inventory (BAI). Measured time (sec) to read Stroop card. WordsLow BAIHigh BAI Non-threatening63.268.3 Threatening65.376.6 Difference 2.1 8.3* –Interference index calculated by subtracting time to read colors of threat words from time to read colors of neutral words: r with BAI = +.42

12. Mood Disorders –Characterized by emotional extremes –Two variants: Major Depressive Disorder and Bipolar Disorder Major Depressive Disorder –Mood disorder in which person, for no apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities –Symptoms

13. Depression: Five (or more) of following symptoms present during same 2-week period –Depressed mood most of day, nearly every day –Markedly diminished interest in most activities most of day –Significant weight loss when not dieting or weight gain –Insomnia or Hypersomnia nearly every day –Psychomotor agitation or retardation nearly every day –Fatigue or loss of energy nearly every day –Feel worthless or excessive guilt nearly every day –Diminished ability to think or concentrate, or indecisiveness, nearly every day –Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without specific plan, or suicide attempt or specific plan for committing suicide

14. Bipolar Disorder –Mood disorder in which person alternates between hopelessness and lethargy of depression and overexcited state of mania –Formerly called manic-depressive disorder Manic Episode –Mood disorder marked by hyperactive, wildly optimistic state –Symptoms

15. Manic Episode: Three (or more) of following symptoms present during same 1-week period –Inflated self-esteem or grandiosity –Decreased need for sleep (feels rested after three hours sleep) –More talkative than usual or pressure to keep talking –Flight of ideas or subjective experience that thoughts are racing –Distractibility –Increase in goal-directed activity or psychomotor agitation –Excessive involvement in pleasurable activities that have high potential for painful consequences (sexual indiscretions, foolish business investments)

16. Explaining Mood Disorders Facts to be explained by theory –Many associated behaviors and cognitions: lack motivation, recall negative events, negative expectations, … –Stressful events often precede depression: Incidence of 1% if 0 stressful events, 24% for 3 or more –Major Depressive Episodes often Self-Terminate –Increase in rates of depression (and other disorders), and also earlier onset –Widespread –More common in women –Affects all ages, but especially young –Also suicide facts (later slides)

20. Next Class Suicide Personality Disorders