Psychological Disorders

PSYCHOLOGYMr. Noble2008-09

A special thanks to my former student teacher--Ms. Sharon Mohr--for her diligent research, insightful professional expertise, and valuable thoughtful effort in compiling much of the information included in this overview of Psychological Disorders.

Defining Abnormality

Difficult to define…

3 Criteria… Deviance Distress Disability/Maladaptive Behavior

Symptom/Behavior Continuum:_----_________________ normal range__ __________________+++

Abnormal Abnormal

Ancient Perspective

Perceived Causes movements of sun or moon

lunacy- full moon evil spirits

Ancient Treatments exorcism, caged like animals, beaten, burned,

mutilated, blood replaced with animal’s blood

Bio-psycho-social Model

assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders

Biological(chemistry, brain)

Psychological( learned helplessness, negative perceptions

and memories)

Sociocultural(Societal expectations, definition of normality

and disorder)

Medical Model

Diagnosis Label for a set of symptoms

Prognosis Prediction or forecast for the course of a

D/O

Etiology Suspected cause of a disorder

Classifying Disorders

DSM-IV-TR Diagnostic and Statistical Manual of Mental

Disorders, 4th edition, Text Revision Published by the American Psychiatric Association 2000…(most recent update 2004) Next major revision (DSM-V) anticipated for 2011.

Provides for reliable classification and description of all mental illnessesAllows for better communication

DSM’s Multi-axial Diagnosis

Axis I Major Clinical Disorders

Axis II Mental Retardation & Personality Disorders

Axis III General Medical Conditions

Axis IV Psychosocial/Environmental Stressors

Axis V Global Assessment of Functioning # between 1 and 100 Current and Highest in past year

Labeling Issues

Reasons to Label/Diagnose: Needed for communication Guide treatment Insurance reimbursement

Arguments against Labeling: Creates a stigma Creates a self-fulfilling prophecy Fail to see the person behind the disorder

Major Classes of Disorders

Anxiety DisordersMood DisordersSomatoform DisordersDissociative DisordersSchizophreniaSubstance Use DisordersOther Axis I DisordersPersonality Disorders (Axis II)

I. Anxiety Disorders

Characterized by generalized apprehension, worry, and a variety of physical symptoms

Generalized Anxiety DisorderPhobiasPanic DisorderObsessive-Compulsive DisorderPost-traumatic Stress Disorder

Generalized Anxiety Disorder

Experiencing a continuous, generalized feeling of anxiety (reaction to vague or imagined dangers) – 6 months or moreAnxiety in many different areas of lifeAccompanied by physical symptoms…muscle tension, trouble sleeping, irritability, lack of concentration, headaches, fatigue, inability to relax, twitching/trembling, etc.

Phobias

Specific Phobia Severe anxiety is

focused on a specific object or situation

Examples: Enclosed spaces Snakes Spiders Heights Flying

Social Phobia Fear of embarrassing

oneself in a social situation

Speaking, eating, using bathroom in public

Agoraphobia “fear of the

marketplace” Associated with panic

disorder

PHOBIAS http://www.phobialist.com/reverse.html

Common and uncommon phobias

Afraid of it Bothers slightly Not at all afraid of it

Beingclosed in,

in a smallplace

Being alone

In a house

at night

Percentageof peoplesurveyed

100

90

80

70

60

50

40

30

20

10

0Snakes Being

in high,exposedplaces

Mice Flyingon an

airplane

Spidersand

insects

Thunderand

lightning

Dogs Drivinga car

Being In a

crowdof people

Cats

PHOBIAS Treatment

Exposure Treatment

Flooding

Counter-Conditioning

Systematic Desensitization (1) training the patient to physically relax (2) establishing an anxiety hierarchy of the stimuli (3) counter-conditioning relaxation responding to ea. feared stimulus

Biofeedback

Modeling

Panic Disorder

Frequent Panic Attacks or fear of them: Sudden and unexplainable attacks of

intense fear Come on without warning Not associated with a stimulus Individual fears that he/she is about to die Physical symptoms…choking, tightness in

chest, difficulty breathing, nausea, dizziness Commonly occurs with Agoraphobia

“Nothing is so much to be feared as Fear”

---Henry David Thoreau

Obsessive-Compulsive Disorder

OBSESSIONS Intrusive and

uncontrollable thoughts

Contamination, safety, etc.

COMPULSIONS Ritualistic and

purposeless actions

Cleaning, washing, checking, etc.

O and C are usually related… compulsions help to decrease the anxiety caused by the obsessionThis pattern begins to interfere with functioning

OCD

Common Obsessions and Compulsions AmongPeople With Obsessive-Compulsive Disorder

Thought or Behavior Percentage*Reporting Symptom

Obsessions (repetitive thoughts)

Concern with dirt, germs, or toxins 40

Something terrible happening (fire, death, illness) 24

Symmetry order, or exactness 17

Excessive hand washing, bathing, tooth brushing, 85or grooming

Compulsions (repetitive behaviors)

Repeating rituals (in/out of a door, 51up/down from a chair)Checking doors, locks, appliances, 46car brake, homework

Post-traumatic Stress Disorder

Common among veterans of combat, survivors of accidents and disasters, victims of crimes, etc.

Feel long-lasting after-effects of trauma

Flashbacks, nightmares, insomnia, mood symptoms, stimulus generalization

Symptoms last more than 1 month… up to years later

II. Mood Disorders

Mental disorders characterized by disturbances of mood that are intense and persistent enough to be maladaptive

Normal range of mood…

Major Depressive Disorder Bipolar Disorder

Major Depressive Disorder

Clinical depression/Major Depression

Unipolar depression

Single-episode or recurrent episodes

Symptoms must occur for at least 2 weeks

Subtypes: Post-partum onset S.A.D.

Secondary symptoms…

Depression…symptoms

SSleep disturbance

IInterest GGuilt/worthlessness

EEnergy = fatigue

CConcentration AAppetite disturbance/weight gain/loss

PPsychomotor agitation/retardation

SSuicidal/thoughts of death

Causes of Depression

Genetic Predisposition + stressful life events

Neurotransmitters Serotonin Norepinephrine

Cognitive Theories Beck & Seligman

Behavioral Theories

Bipolar Disorder

Previously known as Manic-Depression

Experience both manic and depressive episodes Mania = emotional state characterized by

intense and unrealistic feelings of excitement and euphoria, along with impulsivity

Cycles…not mood swings

High rate of suicide

Mood Disorders-Bipolar

PET scans show that brain energy consumption rises and falls with emotional swings

Depressed state Manic state Depressed state

Mood Disorders & Suicide

Not all people who commit suicide are depressed; Not all depressed people commit suicide

Associated with mood disorders, especially bipolar disorder (also schizophrenia)

Warning Signs…

Risk factors…

Prevention…

Males•Suicide is the eighth leading cause of death for all U.S. men.•Males are four times more likely to die from suicide than females. •Suicide rates are highest among Whites and second highest among American Indian and Native Alaskan men. •Of the 24,672 suicide deaths reported among men in 2001, 60% involved the use of a firearm.Females•Women report attempting suicide during their lifetime about three times as often as men.

SUICIDE: Male v. Female

•Overall rate of suicide among youth has declined slowly since ‘92.

•However, rates remain unacceptably high.

•Adolescents and young adults often experience stress, confusion, and depression from situations occurring in their families, schools, and communities.

•Such feelings can overwhelm young people and lead them to consider suicide as a “solution.”

•Few schools and communities have suicide prevention plans that include screening, referral & crisis intervention programs for youth.

SUICIDE: Youth

•Suicide is the third leading cause of death among young people ages 15 to 24.

•Of the total number of suicides among ages 15 to 24 in 2001, 86% were male and 14% were female.

•American Indian and Alaskan Natives have the highest rate of suicide in the 15 to 24 age group.

•In 2001, firearms were used in 54% of youth suicides.

SUICIDE: Youth

•Previous suicide attempt(s) •History of mental disorders, particularly depression •History of alcohol and substance abuse •Family history of suicide •Family history of child maltreatment •Feelings of hopelessness •Impulsive or aggressive tendencies •Barriers to accessing mental health treatment

SUICIDE: Risk FactorsThe first step in preventing suicide is to identify and understand the risk factors.

•Loss (relational, social, work or financial) •Physical illness •Easy access to lethal methods •Unwillingness to seek help due to stigma•Local epidemics of suicide •Isolation - feeling cut off from other people

The first step in preventing suicide is to identify and understand the risk factors.

SUICIDE: Risk Factors

•Effective clinical care•Easy access to clinical interventions & support•Family and community support •Medical & mental health care relationships•Problem solving, conflict resolution skills•Cultural & religious beliefs/support

SUICIDE: Protective FactorsProtective factors buffer people from the risks associated with suicide. A number of protective factors have been identified:

III. Somatoform Disorders

Also know as Hysteria (Freud)

Conditions involving physical complaints or disabilities that occur without physical pathology

NOT psychosomatic disorders…

Conversion Disorder Hypochondriasis

Conversion Disorder

Conversion of emotional difficulties into the persistent loss of a physiological function

Paralysis, loss of feeling, exceptional sensitivity, mutism, blindness, deafness

Not faking a physical problem

Cannot be explained physically

Hypochondriasis & Somatization Disorders

HypochondriasisPreoccupation with fear that he/she has a serious disease Based on the misinterpretation of bodily symptomsMountain out of a molehillNo evidence of illness

Somatization DisorderHistory of diverse physical complaints of all varieties (all body systems)

Focus on numerous symptoms

Many trips to doctor, many medications, no root cause found

IV. Dissociative Disorders

Dissociation…the human mind’s capacity to mediate complex mental activity in channels split off from or independent of conscious awareness

A way of managing anxiety and stress…Psychogenic/Dissociative Amnesia & Fugue

Dissociative Identity Disorder

Amnesia & Fugue

PSYCHOGENIC AMNESIA Inability to recall

certain personal information, which is still know at the unconscious level

Loss in episodic memory, not procedural or semantic

PSYCHOGENIC FUGUE Loss of memory

accompanied by an actual flight from one’s present life situation to a new environment

May take on a new identity

Dissociative Identity Disorder

Previously known as Multiple Personality Disorder

Individual manifests at least two or more distinct systems of identityHost personality + Alter identities (15)Associated with childhood abuseRare disorder; Popular in mediaCan be faked or influenced by therapist

V. Schizophrenia

Characterized by confused and disordered thoughts and perceptionsMost debilitating of the mental disorders; Deterioration of adaptive behaviorSubtypes: Paranoid Disorganized Catatonic Undifferentiated

Schizophrenia…symptoms

BBizarre behaviors (catatonia, others)

AAffect (inappropriate, flat)

DDelusions

SSpeech (disorganized, incoherent)

HHallucinations

IInability to care for self or function

NNegative symptoms

Positive vs. Negative Sx

POSITIVE SYMPTOMS Presence of something abnormal Examples:

NEGATIVE SYMPTOMS Absence of something normal Examples:

Schizophrenia…

DELUSIONS False beliefs maintained in the face of contrary

evidence Types: Grandeur Identity

Persecution Reference

HALLUCINATIONS Sensations in the absence of external stimuli Types: visual, auditory, tactile, olfactory,

gustatory

Causes of Schizophrenia

Genetic Predisposition Twin study evidence

Neurotransmitters Dopamine hypothesis

Brain Structure & Function

Family & Interactions Double-bind theory Schizophrenogenic mother

VI. Substance Use Disorders

Substance AbuseSubstance Dependence Psychological dependence + Addiction Alcoholism = Alcohol Dependence

Important terms… Tolerance Withdrawal

VII. Other Axis I Disorders

Eating DisordersSleep DisordersDisorders of childhood and adolescence Autism, ADHD, Tourette’s, Conduct Disorder

Sexual and Gender Identity DisordersCognitive DisordersImpulse Control DisordersAdjustment Disorders

VIII. Personality Disorders

Diagnosed on Axis IIStem from the gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of relating to the world

Ego-syntonic…not a problem for the person A problem for others

Resistant to treatment (only behavioral)

FOCUS Antisocial, Narcissistic, OCPD

OCPD symptoms tend to appear early in adulthood and are defined by inflexibility, close adherence to rules, anxiety when rules are transgressed, and unrealistic perfectionism. A person with obsessive compulsive personality disorder exhibits several of the following symptoms:

•abnormal preoccupation with lists, rules, and minor details

•excessive devotion to work, to the detriment of social and family activities

•miserliness or a lack of generosity

•perfectionism that interferes with task completion, as performance is never good enough

•refusal to throw anything away (pack-rat mentality)

•rigid and inflexible attitude towards morals or ethical code

•unwilling to let others perform tasks, fearing the loss of responsibility

•upset and off-balance when rules or routines disrupted.

Symptoms of Obsessive Compulsive Personality

Disorder

Psychopathology & The Law

Competence to Stand Trial Can individual participate in own defense at

time of trial?

Involuntary Civil Commitment Should individual be hospitalized against their

will due to imminent danger? Suicidal or homicidal Decided by doctor, then court; need evidence

More Legal Issues…State-level

Insanity Plea Should individual not be held accountable due

to their mental state at the time of the crime? Could not determine right from wrong

Determined by judge before actual trial Difficult to prove, but prevalent in media Sent for treatment, then released

*Insanity is a LEGAL term…!

More Legal Issues…State-level

Guilty but Mentally Ill Alternative to insanity plea in some states Adopted by Pennsylvania… 1st trial determines guilt or innocence 2nd trial determines sanity or insanity Sent for treatment, then to prison to complete

sentence…get treatment as well as punishment

•Cognitive therapy identifies habitual ways in which patients distort information (e.g. automatic thoughts) and teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs, using a variety of techniques to change thinking, mood, and behavior. Cognitive therapy is a structured, goal oriented, problem focused, and time limited intervention.

TYPES OF PSYCHOTHERAPY — A number of types of psychotherapy are used to treat psychological disorders:

•Behavioral therapy attempts to alter behavior by systematically changing the environment that produces the behavior. Behavioral changes are believed to lead to changes in thoughts and emotions.

•Exposure-based behavioral treatments utilize gradual, systematic, repeated exposure to the feared object or situation to allow patients with anxiety disorders to become desensitized to the feared stimulus.

TYPES OF PSYCHOTHERAPY

•Cognitive Behavioral therapy (CBT) combines principles of both behavioral and cognitive therapy, focusing simultaneously on the environment, behavior, and cognition. Cognitive behavioral therapy is also structured, goal directed, problem focused. Patients learn how their thoughts contribute to symptoms of their disorder and how to change these thoughts. Increased cognitive awareness is combined with specific behavioral techniques.

TYPES OF PSYCHOTHERAPY

•Problem Solving therapy, a short-term, cognitive behavioral intervention, teaches a systematic method for solving current and future problems. Patients acquire new skills for successfully resolving interpersonal difficulties. These skills include the following sequential steps: 1) Problem definition; 2) Goal setting; 3) Generating, choosing, and implementing solutions; and 4) Evaluating outcomes.

TYPES OF PSYCHOTHERAPY

•Interpersonal therapy addresses issues such as grief, role transitions, interpersonal role disputes, and interpersonal deficits as they relate to the patient's current symptoms.

•Family therapy attempts to correct distorted communications and relationships as a means of helping the entire family, including the identified patient. In patients with serious mental illness, such as schizophrenia, family therapy helps family members learn about the disorder, solve problems, and cope more constructively with the patient's illness.

TYPES OF PSYCHOTHERAPY

•Psychoeducation provides patients with information about their diagnosis, its treatment, how to recognize signs of relapse, relapse prevention, and strategies to cope with the reality of prolonged emotional or behavioral difficulties.

•The goal of psychoeducation is to reduce distress, confusion, and anxiety within the patient and/or the patient's family to facilitate treatment compliance and reduce the risk of relapse.

•Psychoeducation is often particularly helpful for patients and the families of patients with chronic, severe psychiatric disorders such as schizophrenia and bipolar disorder.

TYPES OF PSYCHOTHERAPY