1. Chapter 14 Psychological Disorders: Part 1 Music “I’ll Go Crazy if I Don’t Go Crazy” U2 “Mad World” Adam Lambert

2. Today’s Agenda 1. What is Abnormal? 1. What is Abnormal? Criteria / Classification 2. Anxiety Disorders: Generalized Anxiety/ PTSD/ Obsessive Compulsive Disorders 3. Somatoform Disorders Somatization Disorders/ Hypochondriasis 4. Dissociative Disorders Multiple Personality Disorder 5. Mood Disorders Depression/ Bipolar Disorders /Suicide

3. 1. What IS Abnormal??  Criteria:  1) Distress is present:  Person is suffering, unhappy, afraid  2) Behaviour is maladaptive Impaired functioning Inability to meet responsibilities  3) Socially Deviant  Behaviour is unusual, “not normal”  Classification  DSM-IV, p. 580 text  Why Classify? Simplify and create order Research Plan treatment

4. Criteria for Abnormality  Fig. 14.2 p. 608

5. Where is the dividing line between normal and abnormal behavior? Deviation from statistical average Deviation from cultural/societal average

6. 1. Classification (cont’d)  Older Distinction:  Neurotic vs. Psychotic  Neurotic:  Distressing problem but person is still coherent and can function socially (once acute phase of disorder is treated).  E.g. most disorders discussed today  Psychotic:  More bizarre, involving delusions or hallucinations. Individual has impaired thought processes and cannot function socially. Treatment is long term  E.g. schizophrenia (next week)

8. 2. Anxiety Disorders Anxiety: Fear in situations that pose no objective threat 3 components: A) Cognitive:  Extreme/chronic worry; fear of harm B) Physiological:  Muscle tension, increased heart rate and blood pressure C) Behavioural:  Shaking, jumpiness, pacing, avoidance Generalized Anxiety Disorders (5%) Symptoms of anxiety felt continuously for at least 6 months Excessive worry, restlessness, sleep disturbance that are difficult to control http://www.youtube.com/watch?v=dRmBJhtys9g

9. 2. Anxiety Disorders (cont’d) Panic Disorders: (2-3%) Presence of recurrent, and unexpected panic attacks: Intense dread, shortness of breath, chest pain, choking, fear of going crazy or losing control or dying, shaking, sweating, nausea… May lead to Agoraphobia (fear of open spaces) Post-Traumatic Stress Disorder Re-experiencing traumatic event (e.g. dreams, flashbacks, reliving the experience) Avoidance of stimuli associated with the trauma (thoughts, feelings, people, places) Difficulties with sleep, concentration, irritability Is causing distress and impairment in functioning http://movieclips.com/e7Xc-born-on-the-fourth-of-july-movie-the-homecoming-speech / http://movieclips.com/e7Xc-born-on-the-fourth-of-july-movie-the-homecoming-speech / Social Phobia: (3-13%) Fear of social or performance situations Public speaking; Eating, drinking, writing in public

10. 2. Anxiety Disorders (cont’d) Obsessive-Compulsive Disorders (2%) Obsessions: Persistent, uncontrollable thoughts Compulsions: Rituals, behaviours that reduce anxiety Interfere with functioning Four different themes: Obsessions and checking Symmetry and order Cleanliness and washing Hoarding Case examples: Illustration from movie “As Good as it Gets”  http://www.youtube.com/watch?v=48jD-ZEuB0I http://www.youtube.com/watch?v=48jD-ZEuB0I Howie Mandel: Germaphobic & Hypochondriac

11. 3. Somatoform Disorders Hypochondriasis: 4-9% in medical practice Inordinate preoccupation with health and illness excessive anxiety about having a disease http://www.youtube.com/watch?v=lkIQ39538Ig&feature=related http:// www.youtube.com/watch?v=tV_ORdpOK3g http:// www.youtube.com/watch?v=tV_ORdpOK3g Somatization Disorder: (1-2% women) History of diverse physical complaints for which there is NO organic basis Long medical history of treatments for minor physical ailments

12. 4. Dissociative Disorders Multiple Personality Disorder (very rare) Presence of at least 2 distinct personalities within the same individual Leads to sudden changes in identity and consciousness Each personality has its unique style and may unaware of the existence of the other personalities Often related to severe abuse in early childhood

13. 5. Mood Disorders Depression Lifetime prevalence rates 20% in women; 10% in men Why more common in women? Cost of caring  Greater burden due to nurturing roles  Also more affected by disruptions in relational ties Exposure to higher levels of stress  Victimization, abuse Ruminative cognitive style  as opposed to distraction or taking action  Perpetuates negative mood More likely to report symptoms Seasonal Affective Disorders (SAD) Depressive symptoms related to physiological consequences of shorter winter days Treatable with light therapy

14. 5. Theories of Depression Biological predisposition Concordance rates in twins: Identical: 65% Fraternal: 15% G X E models (interaction of genetic and environmental contributors) Cognitive perspective Beck: Negative (dysfunctional) attitudes Seligman: Attribution Theory How do you explain your circumstances?  Internal vs external  Stable vs unstable  Global vs specific Depression: internal, stable, global attributions for negative events Diathesis-stress models Depression results from an interaction between personality and negative life events Dependency and vulnerability to loss Self-Criticism/Perfectionism and vulnerability to perceived failure

15. Cognitive Risk and Depression Featured Study p. 629 Students with dysfunctional attitudes and depressive attributional style were more likely to become depressed over 2 year period.

16. 5. Mood Disorders (cont’d) Bipolar Disorders: Periods of depression alternate with manic episodes Mania: abnormally elevated mood, inflated self-esteem, pressure of speech, increased energy, decreased need for sleep, over- activity, lack of inhibition and impaired judgment http://www.youtube.com/watch?v=3mJoHqmtFcQ Prevalence rates: 1% in men and women Strong genetic component  Understood as a primarily biological disorder  Unlike unipolar depression which has cognitive, interpersonal and environmental determinants Case Example: Vincent Van Gogh

17. 5. Suicide University students: 40-50% have had suicidal thoughts 15% attempt suicide 3 rd leading cause of death among 15-24 year-olds Major Risk Factors: Feelings of isolation; withdrawal from friends and family Having a serious mental or physical illness Including depression and feelings of hopelessness Experiencing a major loss or stressor Leading aggression or feelings of shame, humiliation, failure, rejection History of child abuse (leading to self-harm in women) Abuse of drugs or alcohol/ impulsivity Talking about wanting to hurt oneself/ Having a plan Feeling trapped, like there is no way out

18. 5. Suicide (cont’d) How to help: 1) Establish communication Talk about suicidal wishes 2) Identify needs that have been frustrated Search for love, recognition, respect? 3) Broaden suicidal person’s perspective Impermanence of feelings  This too will pass  Give yourself the chance to experience a better future Provide support for treatment

19. Resources Mental Health Service Information Ontario 1-866-531-2600 http://www.mhsio.on.cahttp://www.mhsio.on.ca Mood Disorders Association of Ontario 416-486-8049 http://www.mooddisorders.on.cahttp://www.mooddisorders.on.ca Until next week: