the nature and causes of mental disorders classification and diagnosis what is abnormal? departure...

The Nature and Causes of Mental Disorders

Classification and Diagnosis

• What is abnormal?• Departure from the norm

• Causes stress, discomfort, and interferes in lives

Perspectives on the Causes

• Psychodynamic Perspective• Originate from intra-psychic conflict

• Produced by Id, Ego, and Superego

• Therapists make clients more aware of conflict

• Medical Perspective• Originate from abnormalities in the brain and

nervous system

• Treated with drugs

• Cognitive-Behavioral Perspective• Learned maladaptive behavior patterns• Focus on environmental factors, and person

perception of these patterns• Therapists want client to replace with more

adaptive behaviors

• Humanistic Perspective• Originates from thinking one must earn positive

regard from others• Therapists urge to achieve own potential, no

matter what

• Sociocultural Perspective• Cultures play a role

• Perceive actions as abnormal, or normal

• Culture-Bound Syndromes• Mental disorders only seen in certain cultures

– Southeast Asians and Koro

• Treated using folklore

• Diathesis-Stress Model• Previous perspectives combined into one• Genetics and early experience yields

predispositions• Only develop if person has stressor that they

can’t cope with.

DSM-IV Classification• Diagnostic and Statistical Manual IV

• Reliable and universal set of categories to describe a patients psychological condition.

• Assessed on four Axes• Axis I – Major disorders requiring clinical attention• Axis II – Personality disorders• Axis III – Physical disorders• Axis IV – Severity of stress encountered• Axis V – Persons overall level of functioning

– Ratings on 100 pt. Global Assessment of Functioning (GAF) scale

Problems With Classification

• Looks more from the medical perspective

• Questionable reliability

• Langer & Abelson's study• Patients or job applicant

• Assessed patient as worse off

Need For Classification

• Thomas Szasz – no need for classification

• Benefits to patient• Recognition precedes development of treatment

• Different disorders respond to different treatment

• Good prognosis, bad prognosis

Clinical Method vs. Actuarial Method

• Judgments based on an experts experiences

• Knowledge of previous symptoms, and applies to present symptoms

• Applying empirically derived rules

• Relate particular outcomes with particular indications

Which Method (Actuarial or Clinical) is More

ACCURATE?

Actuarial Method

• Reliability is Higher

• Decision is based on a precise formula

• Goldberg (1970)• Studied patients released from mental

institutions

• Found that actuarial method was more accurate

60% – 70% of the time

Anxiety, Somatoform, and Dissociative Mental Disorders

• Neuroses – anxious, fearful, depressed, and generally unhappy

• Almost all realize that they have a problem

Anxiety Disorders• Panic Disorders (description)

• Episodic attacks of acute anxiety

• Physical symptoms

• Anticipatory anxiety – fear of more panic attacks

• Panic Disorders (Causes)• Genetic – appears to be hereditary

• Cognitive - sensitive to risk or danger in environment

Anxiety Disorders

• Phobic Disorders (description)• Irrational fears of specific objects and situations

• Fear makes life difficult

• Agoraphobia – fear of open spaces

• Social Phobia – fear of possible scrutiny or embarrassment

• Specific Phobia – all other phobias

• Early onset more likely to leave

Phobic Disorders (Causes)

• Psychoanalytic theory – stress caused by intolerable unconscious impulses

• Classical Conditioning• Direct – when they are present in an unpleasant

situation

• Vicarious – observing another show fear to an object or animal.

• Some objects more likely to be feared

Phobic Disorder (causes) cont.

• Genetic Causes• Reflective of our evolution

• Chimpanzees are afraid of snakes even though they had never seen them before

• Simple and social families do not run in families

• Stable families with overprotective mothers

Obsessive-Compulsive Disorder (description)

Obsessions

• Thoughts that won’t leave

• Two principle types• Doubt or Uncertainty

• Fear of doing something prohibited

Compulsions

• Behaviors can’t keep from doing

• Four Categories• Counting

• Checking

• Cleaning

• Avoidance

Obsessive-Compulsive Disorder (Causes)

Cognitive Causes

• Reduce anxiety caused by fear of being perceived as incompetent

• Behaviors replace fear or anxiety, thus more fear, more behavior

Genetic Causes

• Associated with Tourette’s Syndrome

• Produced by same gene as previous

• Sometimes occurs after brain damage

Somatoform Disorders

• Somatization disorder (description)• Complaints of physical problems that have no

biological basis

• It is often chronic lasts for decades

• DSM-IV requires a history of complaints

• Hypochondriasis – fear of having major illness

Somatization Disorder (causes)

• Common in poorly educated women in low economic status

• Runs in families

• Closely associated with Antisocial personality disorder

Conversion Disorder (description)

• Physical complaints of neurological problems that have no real basis

• DSM - IV • Must be response to stimulus, avoid activity, or

get sympathy

• Not Faking Illnesses (malingering)• Enjoy talking about illness• Change with time, and knowledge

Conversion Disorder (causes)

• Psychoanalytic – unresolved conflicts displaced into physical symptoms

• Learned – most have already suffered from the disease they are then complaining about

Dissociative DisordersDisruptions in Consciousness

• Freud and massive repression• Psychogenic Amnesia

• Forgets all of past, and starts new one

• Psychogenic Fugue• Leaves home and starts a new life somewhere

• Multiple Personality Disorder• Two or more separate people within one person• Form of self-hypnosis

Dissociative Disorders Causes

• Responses to severe conflicts or guilt

• Usually advantageous to person

Personality DisordersAbnormalities that impair social functioning

• Antisocial Personality Disorder (psychopaths or sociopath)• Failure to conform to social norms: lying,

stealing, failure at relationships, lack of guilt

• DSM-IV - evidence of three types of Antisocial behavior before fifteen

• Pattern of antisocial behavior where another person was violated

Antisocial Personality Causes

• Physiological causes and learning• Lower signs of fear, unresponsive autonomic

nervous system

• Do not learn to avoid an aversive stimuli, but do learn to avoid a loss of appetitive stimulus

• Genetic – somewhat hereditable

Antisocial Personality Causes

• Environmental• Parenting – ignoring or leaving children

unsupervised develop delinquency

• Cognitive• View world different than well behaved kids

• See others as being hostile

• May be biologically predisposed

Psychoactive Substance Use Disorders

• Psychoactive Substance Dependence and Abuse

• Drug addiction a serious problem• Alcohol – car accidents, fetal alcohol

syndrome, cirrhosis of the liver, increased heart rate of cerebral hemorrhage

• Cocaine – causes psychosis, brain damage, and death

Substance Use Causes

• Genetic and Physiological causes• Susceptibility comes from inability to

metabolize alcohol, or difference in brain

• Brain of steady drinker has under sensitive punishment mechanism

• Binge drinkers have an oversensitive punishment mechanism

• Cognitive Causes

• Develop heavy drug use, by what they believe about the benefit of the drug

• Use is negatively reinforced by the escape it gives to people

Schizophrenic Disorders• Most common psychosis

• Distortions of thought, perception, and emotion; bizarre behavior, and social withdrawal

• Two categories of symptoms• Positive – make known by presence (thought disorders,

hallucinations, and delusions)• Delusions of Persecution, Grandeur, and Control

• Negative – absence of normal behaviors (flattened emotional response, no speech, no pleasure, withdrawal

Types of Schizophrenia• Undifferentiated

• Have delusions, hallucinations, and disorganized behavior, but are not he other types of schizophrenia

• Catatonic• Motor disturbances (catatonic postures, and waxy

flexibility); are aware of what is going on

• Paranoid• Delusions of persecutions, grandeur and control

• Disorganized• Disturbances of thought, word salad (a jumble of words)

Early signs of Schizophrenia

• Bleuler (1950) divided disorder• Reactive – those with a good history of mental

health. Reaction to stressor. Recover.

• Process – those diagnosed as having a mental illness early in life.

• Predictors – being “different” than everyone else.

Possible Causes

• Genetic Causes• Heritability is firmly established. Have tendency

towards illness

• Predisposition towards having schizophrenia

• Physiological Causes (Dopamine Hypothesis)• Over-activity of dopamine synapses using

dopamine as transmitter substance

• Cocaine users

Possible Causes (cont.)

• Physiological causes (neurological disorders)• Drugs alleviate positive symptoms, and not negative• Weinberger and Wyatt (1982) ventricles in brains,

twice as large• Pfefferbaum (1988) sulci were wider• Positive symptoms – dopamine: negative – loss of

brain tissue• Damage may be viral (multiple sclerosis)• Births during winter months; trauma

Possible Causes (cont)

• Cognitive and Environmental Causes• Being raised by a mentally healthy family may

protect against onset

• Raised by dominating, overprotective, rigid, and insensitive to the needs of others type of household.

• Double-blind parent – verbally accepting, rejecting

• Rate of recovery affected by how family deals

Mood Disorders

• Disorders of emotion; affect normal perceptions, thoughts and behaviors

• Bipolar Disorder• Alternating periods of mania (wild excitement)

and depression

• Major Depression• Persistent feelings of sadness, worthlessness, and

changes in behavior, appetite, and sleeping

• Mania• Wild, exuberant, unrealistic activity• Have delusions and hallucinations• Person with mania always has bi-polar

• Depression• Sad, and filled with self-directed guilt, can’t

always say why they are depressed• Five symptoms

• A sad apathetic mood• Feelings of worthlessness and hopelessness• A desire to withdraw from other people• Sleeplessness and a loss of appetite and sexual desire• Change in activity level to laziness, or agitation

Possible Causes

• Cognitive• Caught in a vicious cycle

• Distortion in perception of reality

• Beck’s Cognitive Triad• Negative thoughts about self, present, and future

• Attributional style• Negative to self, positive to others

Possible Causes (cont)• Genetic

• First degree relatives ten times more likely to get a mood disorder

• Physiological (Biochemical Factors)• Electro-convulsive therapy, antidepressant drugs

• Biochemical abnormalities in brain – less activity of serotonin-secreting neurons

• Decrease in activity of 5-HT and NE related to depression, antidepressants increase activity

Possible Causes (cont)

• Physiological (Sleep Cycle)• Enter REM sleep sooner and spend more time

in it during last part of sleep

• Depression triggered environmentally through zeitgeber

• A stimulus synchronizing biological rhythms

• Seasonal Affective Disorder• Depressed in winter seasons

• Sleep depravation helps