Chapter 12

Defining Psychological Disorders

• Psychological Disorder

  • Mental (cognitive) processes and/or behavior patterns that cause emotional distress and/or substantial impairment in functioning.

  • Oftentimes, a person suffering from a psychological disorder displays or exhibits abnormal behavior.

What is Considered Abnormal Behavior?

• Is the behavior considered strange within the person’s own culture or age group?

• Does the behavior cause personal distress?

• Is the behavior maladaptive? Does it interfere or impair functioning?

• Is the person a danger to self or others?

• Is the person legally responsible for his or her actions?

Defining Psychological Disorders: Classifying and Tracking Psychological DIsorders

• Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

  • latest (5th) edition released in 2013

  • contains descriptions of about 300 specific psychological disorders

  • lists criteria that must be met in order to make a particular diagnosis

  • organizes disorders into categories

Psychological Disorders: Statistics

• Each year, 26 percent, or more than 44 million adults, are diagnosed with a mental disorder or condition.

• About 50 percent of Americans will be diagnosed with a mental disorder sometime in their lives

• Mental disorders represent personal misery for individuals and lost productivity for society

Understanding the basis of Psychological Disorders

• Biological Perspective (nature/ genetics/ heredity)

  • Abnormal behavior arises form a physical/ physiological cause

  • Biological treatments, such as drug therapy, are favored.

  • Psychiatric approach including pharmacological.

Development of Psychological Disorders

• Biopsychosocial perspective

  • Disorders result from a combination of biological, psychological, and social factors

  • Drug and psychotherapy are employed as treatment.

Psychological Disorders: Psychodynamic

• Psychodynamic Perspective (Freudian)

  • Disorders stem from traumatic childhood experiences, unresolved unconscious conflicts.

  • Treatment involves extensive psychoanalysis (not frequently practiced due to time constraints and other factors.)

Psychological Disorders: Learning Perspective

• Learning Perspective

  • Abnormal thoughts and behaviors are learned and sustained like any other behaviors (most often unknowingly).

  • Treatment may include classical and operant conditioning and modeling to decrease/eliminate maladaptive behavior and increase more productive and beneficial behavior.

Psychological Disorders: Cognitive Perspective

• Cognitive Perspective

  • Faulty/ illogical thinking and distorted perceptions can cause psychological disorders.

  • Treatment tries to change faulty, dysfunctional, irrational, and/or negative thinking.

Note: counseling is also referred to as psychotherapy ro “talk therapy”

Anxiety Disorders

• Disorders characterized by frequent, fearful thoughts about what might happen in the future, excessive worrying (cognitive).

• The most common category of psychological disorders

  • Anxiety disorders account for more than 4 million visits to doctors’ offices in the US each year.

Anxiety Disorders Types

• Two types of anxious feelings for which people often seek professional help:

  • Panic attacks

  • Agoraphobia

  • Anxiety disorders usually have both a biological/physiological and psychological basis

Note: Chronic worrying is a cognitive activity often arising from increased physiological/physical anxiety (biological basis). Re: sympathetic nervous system activation

Anxiety Disorders, Phobias, OCD, and other disorders

• People oftentimes unknowingly contribute to the development of certain disorders through reinforcement of irrational/illogical, dysfunctional and maladaptive thoughts and behaviors.

• Overthinking, excessive thinking (obsessions)

Anxiety Disorders: Panic Attacks

• Panic Attack

  • An episode of overwhelming anxiety, fear, or terror

  • The brain responds to normal changes in the body as if they were life-threatening

    • Attacks may occur cued or uncles: brought about by a dysfunction in the sympathetic nervous system’s fight-or-flight system.

Anxiety Disorders; Panic Disorders: Panic Disorder

• Panic Disorder

  • Recurring, unpredictable episodes of overwhelming anxiety, fear, or terror.

  • Sometimes, the person associates the occurrence of a panic attack with an object or place (Re: conditioned behavior).

  • Avoidance behavior may develop because it enables the individual to escape from the unpleasant sensations that are associated with anxiety

  • can lead to the development of agoraphobia

Anxiety Disorders: Agoraphobia

• Agoraphobia

  • Intense fear of being in situation from which escape is not possible

  • often begins with repeated panic attacks

  • People with agoraphobia sometimes plan their entire lives around avoiding feared situations.

  • Panic disorder with agoraphobia is among the most debilitating of all psychological disorders

  • Related to claustrophobia which is an irrational fear of being confined

Generalized Anxiety Disorder

• Generalized Anxiety Disorder (GAD)

  • disorder involving chronic, excessive worry for 6 months or more

  • The worry is either unfounded or greatly exaggerated: difficult to control.

  • Affects twice as many women as men

  • What should we worry about?

Anxiety Disorders: Phobias

• Explaining Generalized Anxiety Disorder and Phobias

  • Brown (2007) argues that GAD and social phobia are manifestations of the Big Five personality trait of neuroticism

  • Neuroticism is also a risk factor for the development of specific phobias (Beinvenu et al., 2007)

Phobias

What’s a phobia? Fears inadvertently grown out of proportion through self-reinforcement

• Social Phobia

  • irrational fear and avoidance of any social or performance situation

  • fear of embarrassing or humiliating oneself in front of others by appearing clumsy, weak, stupid, foolish, or incompetent

  • may take the specific form of performance anxiety

Specific Phobias

• Specific Phobia

  • fear of a specific object or situation

  • general label for any phobia other than agoraphobia or social phobia

  • categories of specific phobias:

    • situational phobias

    • Fear of the natural environment

    • Animal phobias

    • Blood, injection, injury phobias

Anxiety Disorders: Obsessive-Compulsive Disorder

• Recurrent obsessions and/or compulsions

• Obsession

  • Persistent, involuntary thought, image, or impulse that causes great distress

  • Excessive and overwhelming cognitions

• Compulsion: engaging in excessive and overwhelming behaviors

  • persistent, irresistible, and irrational urge to perform an act or ritual repeatedly.

  • Compulsions often involve cleaning and washing, counting, checking, touching object, hoarding, or excessive organizing.

Obsessive Compulsive Disorder: Etiology

• Explaining Obsessive-Compulsive Disorder

  • Autoimmune system diseases, strep infection, and brain changes causes by other infections (biological factors).

  • Genetic anomalies affecting serotonin functioning are suspected of contributing to the development of OCD

  • Traumatic experiences, high degree of anxiety, learned behavior patterns, faulty thinking.

OCD

The behavior becomes a psychological problem only if the person cannot resist performing it; if it is very time consuming, and if it causes dysfunction in the person’s normal activities and relationships with others.

Mood Disorders: Major Depressive Disorder

• Mood Disorders

  • Disorders characterized by extreme and unwarranted disturbances in emotion

• Major Depressive Disorder

  • Sufferers feel an overwhelming sadness, despair, and hopelessness

  • usually lose their ability to experience pleasure

Mood Disorders: Major Depressive Disorder Prognosis

• Major Depressive Disorder

  • one year after initial diagnosis

    • Forty percent are without symptoms

    • Forty percent still suffering from a disorder

    • Twenty percent are depressed

  • The risk of recurrence is greatest for females (Winokur et al., 1993) and for individuals with an onset of depression before age 15

Mood Disorders: Bipolar Disorder

• Manic episodes alternating (cycling0 with periods of depression, usually with relatively “normal” periods in between.

• Manic Episodes:

  • Periods of excessive euphoria, inflated self-esteem, wild optimism, and hyperactivity, little to no sleep!

  • often accompanied by delusions of grandeur and by hostility if activity is blocked

  • noticeable increase in risky/ dangerous behavior 9sexual, financial, recklessness, etc…)

Mood Disorders: Bipolar Disorder 1 and 2

• Symptoms can be managed with lithium and divalproex

• Bipolar 1: manic episodes with self-destructive behavior and being out of touch with reality (delusions)

• Bipolar 2: milder manic (hypomanic) episodes that do not necessarily lead to dysfunctional behavior. Bipolar 2 however, may become chronic.

Explaining Mood Disorders: Biological Perspective

• Neurological Correlatesof Modd DIsorders

  • PET scans have revealed abnormal patterns of brain activity in people with mood disorders.

  • Area of brain tissue in lower prefrontal cortex is 40 to 50 percent smaller in people with major depression.

  • Abnormal production, transport, and reuptake patterns for dopamine, GABA, and norepinephrine

Explaining Mood Disorders

• A high degree of Neuroticism (Re: OCEAN) is associated with depression and abnormal serotonin levels.

• Heredity

  • Fifty percent of the identical twins of bipolar sufferers have also been diagnosed with a mood disorder (compared to only seven percent of fraternal twins).

Explaining Mood Disorders: Sociocultural Perspective

• Stressors

  • The majority of first episodes of depression strike after major life stress

• Culture

  • Lifetime risk for developing depression varies greatly around the world.

  • in most countries, the rate of depression in females is about twice that for males.

Suicide Risk Factors

• Risk factors for suicide:

  • Mood disorders

  • Schizophrenia

  • Substance abuse

  • Ineffective/dysfunctional coping strategies

  • Unhealthy self-esteem

  • Major life stressors

  • Untreated psychological/ psychiatric conditions

  • Chronic debilitating medical conditions

Suicide and Race. Gender. and Age

• In the United States, older white males commit suicide at rates higher than members of other races or age groups.

• Women are more likely to attempt suicide; men are more likely to succeed.

Schizophrenia

Characterized by extremes in behavior, thinking, mood and cognitive/perceptual distortions

• Positive Symptoms (over and above)

  • Additional: abnormal, bizarre, disorganized, exaggerated behaviors

  • Hallucinations: audible, visual (psychosis)

  • Delusions: irrational, illogical, false beliefs

  • Derailment: totally disorganized speech and grossly disorganized behavior

  • Inappropriate affect (emotional expression)

Symptoms of Schizophrenia

• Negative Symptoms: noticeably diminished or absent behavior

  • social withdrawl

  • Apathy/loss of motivation

  • Flat affect

    • showing little or no emotional repsonse

  • Limited speech and slow movements

  • Poor hygiene and grooming

People experiencing negative symptoms seem to have the poorest outcome