Features of Mental Disorders Behavior is judged abnormal by others Behavior generates distress in those

afflicted Behavior is maladaptive—interferes with

ability to function normally

DSM-IV (Diagnostic & Statistical Manual of Mental Disorders) Axis I: includes mental disorders Axis II: personality disorders & mental

retardation—stable and incurable Axis III: general medical conditions related to

disorder Axis IV: psychosocial and environmental factors Axis V: global assessment of current functioning

Symptoms of Depression Feeling profoundly sad most of the time for

the last 2 weeks No interest in eating, sex, family, friends,

hobbies Dramatic weight loss or gain Sleep too much or too little Must have at least 5 of these symptoms

during 2-week period to be diagnosed

Statistics about Depression Very common disorder, but almost twice

as common in women than men (21.3% of women; 12.7% of men)

People with depression suffer 5-6 episodes in their lives

There is a genetic component to depression; it runs in families

Treatment of Depression Treatment usually takes 6 months to 1 year Antidepressants are the first choice

(MAOIs, tricyclics, SSRIs, SSNRIs) Therapy, especially cognitive-behavioral

therapy, is effective Best approach is to combine medications

with therapy

Bipolar Disorder (manic depression) Wide mood swings over periods of time, going

from deep depression to wild mania Mania: extreme excitement, elation, energy,

decreased need for sleep, going from one idea to another, engaging in silly or destructive behaviors

Varying degrees of bipolar disorder, from mild to severe; some forms may mimic attention-deficit-disorder (ADD/ADHD), depression, or anxiety

Treated with lithium or Depakote, along with therapy

Living with Bipolar Disorder http://www.youtube.com/watch?v=sl95tsiL

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Causes of mood disorders Appears to be interaction between genetic

and environmental factors Both occur more in females; bipolar

disorder tends to skip a generation Abnormalities in brain chemistry

Serotonin and norepinepherine deficiencies; drugs target these neurotransmitters

More causes of mood disorders Learned helplessness (thinking you have

no control over anything); therapy is particularly effective here

Negative self-schemas (thinking of yourself in the harshest ways; start to feel worthless); therapy also very effective

Anxiety Disorders Phobias Panic disorder with and without

agoraphobia Generalized anxiety disorder Obsessive-compulsive disorder

Phobias Specific, intense, and irrational fears of objects or

events; interferes with daily life Most common phobia is social phobia—afflicts

13% of Americans (fear of situations in which you might be evaluated or embarrassed; e.g., public speaking)

Root of most phobias is classical conditioning Systematic desensitization is the treatment (recall

from Learning section)

Panic disorder Periodic unexpected attacks of intense, terrifying

anxiety People with panic attacks often end up in the ER,

thinking they’re having a heart attack. Symptoms include racing heart, sweating,

dizziness, nausea, trembling, palpitations, fear of losing control, fear of dying, chills, tingling, numbness

Agoraphobia Intense fear of specific situations in which

the person suspects help will not be available in case of a panic attack

Basically, it’s the fear of being afraid (i.e., having a panic attack) in public.

Causes people to not want to leave their homes.

Causes of panic disorder Genetic component; over 50% of those who have

it have relatives who have it PET scans show enlarged locus coreuleus (LC) in

the brain stem of those with panic disorder, which acts as a primitive “alarm system” alerting people to danger

Learning also plays a part. People learn to fear having another panic attack, leading to more anxiety and agoraphobia.

Treatment of panic disorders Benzodiazepines (Xanax, Klonopin,

Ativan)—anti-anxiety drugs that are highly effective but extremely addictive

SSRIs are also used to treat anxiety; becoming the treatment of choice because of addiction potential of benzodiazepines

Generalized anxiety disorder (GAD) Generalized fear and heightened anxiety

about everything in general Can’t pinpoint anxiety to any one

particular stimulus; everything produces nervousness

Usually no outright panic attacks, but often feel sick at stomach, nauseated, headaches, trouble sleeping. Heart may race, palms sweat for no good reason.

Treatment of GAD Therapy is considered more effective than

drugs, but SSRIs are used extensively for treatment.

Drug called BuSpar also helps many people with GAD,without the side effects or addiction potential of other drugs.

Obsessive-compulsive disorder (OCD) Recurrent disturbing thoughts (obsessions) that a

person can’t stop unless they perform specific behaviors (compulsions)

Common obsessions: fear of dirt or germs, touching infected people, disgust with bodily wastes, irrational concern about not having done a job well, fear of having antireligious or sexual thoughts, or fear of death or loved one dying

Common compulsions: repetitive hand washing, checking things, counting, hoarding things,

More about OCD People with OCD develop severe anxiety over

their obsessions/compulsions and feel powerless to stop them. Complex rituals take over their day.

Compulsions relieve anxiety when performed, so the person learns through conditioning to continue doing them.

Males and females are equally afflicted with OCD, but females are more likely to be compulsive hand washers.

OCD: Ritual Handwashing Video http://www.youtube.com/watch?v=tPFQM

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Somatoform Disorders When the symptoms of physical health

have psychological causes Somatization disorder Hypochondriasis Somatoform pain disorder Conversion disorder All seem to have roots in anxiety.

Somatization disorder Intensely and chronically uncomfortable

psychological conditions that involve numerous symptoms of bodily illness without physical causes

Much more common in women Involve frequent, dramatic complaints of things

like memory problems, blackouts, numbness, problems walking, nausea, menstrual problems, lack of enjoyment of sex

Can lead to addictions to alcohol/drugs and unnecessary surgeries

Hypochondriasis A milder form of somatization disorder Person has excessive concern over health, but not as

pervasive or intense as in somatization disorder Hypochondriacs don’t experience side effects, such

as depression, drug addiction, or unnecessary surgeries that people with somatization disorder do.

Lives are dominated by excessive concern over health, attempt to avoid germs, or avoiding cancer-causing agents

Conversion disorder Most dramatic somatoform disorder Freud coined the term—anxiety has been

“converted” into physical symptoms Dramatic symptoms experienced—sudden

blindness, paralysis, deafness, muteness, seizures, etc.

Person acts as if h/she doesn’t care about being afflicted with this; called the beautiful indifference; gets them out of responsibilities and allows dependence on others

Somatoform pain disorder Similar to conversion disorders, but the primary

symptom is pain with no physical cause Difficult to diagnose; must rule out true physical

pain that has biological cause Somatoform pain usually occurs at times of high

stress; generally beneficial in some way (disability payments, getting out of school/work)

Dissociative disorders Involve disruptions in person’s memory,

consciousness, or identity; often experienced on a temporary basis

Depersonalization disorder Dissociative fugue Dissociative identity disorder

Depersonalization Disorder Feeling of detachment from oneself Experienced by 70% of “normal” people but on a

very fleeting basis; true depersonalization disorder is longer-lasting

More common in females Cause is unknown Sometimes linked to drug use—marijuana, Ecstasy,

acid Associated with high IQ, analytical thought about

oneself

Dissociative fugue A person suddenly leaves his home and

travels somewhere else where he has no memory of previous life

Like amnesia but with no medical basis Person often simply makes a new life for

himself and never recovers old identity or memory

Dissociative Identity Disorder (DID) Formerly known as multiple personality disorder Fragmenting of the personality into 2 or more

separate but coexisting personalities One personality is the “host” and the others are

“alters.” Host may not know about the alters, but the alters usually know about the host and at least some of the other alters.

Person “switches” between personalities; occurs in response to anxiety brought on by memories of past traumatic experiences

More about DID Develops early in childhood and is associated

with extreme childhood abuse Before 1950s and publication of The Three Faces

of Eve, diagnosis was extremely rare, but then it exploded.

Now it’s considered extremely controversial. Some experts don’t believe it exists; others believe it exists but is extremely rare. It’s almost certain that it’s overdiagnosed now.

A man with DID http://www.youtube.com/watch?v=7iHJfIH

20TY

Schizophrenia: Definition Complex disorder characterized by

hallucinations, delusions, speech disturbances, and other symptoms

Schizophrenics are “out of touch with reality” and often can’t function in society

NOT the same thing as “split personality” Basic psychological functions (attention,

perception, thoughts, emotions, behavior are fragmented; person misperceives things around him

Heather: A Schizophrenic Patient http://www.youtube.com/watch?v=kvdw4b

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Two types: Type I and Type II Type I: involves mostly “positive” symptoms

(symptoms are added that aren’t usually present)—hallucinations, delusions, bizarre behaviors

Hallucinations—hearing voices or seeing things; present in 70% of schizophrenics

Delusions—firmly held beliefs that have no basis in reality Delusion of persecution (someone’s after me) Delusion of grandeur (someone famous) Delusion of control (someone’s controlling thoughts)

Type II schizophrenia Involves negative symptoms, or an asence

of normal behavior Zombie-like Flat affect—total lack of emotion; glazed

look Avolition—showing no motivation or will Alogia—lack of speech

Causes of schizophrenia No evidence that a single gene is involved, but it does

run in families Probably a combination of many genetic and

environmental factors Brain differences between schizophrenics and non-

schizophrenics: ventricles are larger in schizophrenics, which may produce abnormalities in cerebral cortex. Also excessive amounts of dopamine in schizophrenia.

Psychological factors—harsh, critical families more relapses

Treatment No cure; goal is to control symptoms as much as

possible Antipsychotic meds—Thorazine, clozapine,

haloperidol, Novartis, Zeneca Tardive dyskinesia—bad side effect of

antipsychotics; loss of motor control, especially in the face. Doesn’t show up until you’ve taken drug for several years. Then it’s irreveresible.

More about treatment Drugs are better at controlling Type I symptoms;

not good with negative symptoms, so patient remains somewhat flat

New drugs are being tested that target negative symptoms and don’t have tardive dyskinesia side effects

Psychotherapy is sometimes used to help person function better.

Personality disorders An Axis II diagnosis Considered incurable because they’re a

basic part of personality; present from early childhood

Involve extreme and inflexible personality traits that may be distressing to people who have them or cause problems at work/home;relationships

Borderline personality disorder More common in females Characterized by extremely unstable

relationships, self-image, or mood swings Associated with self-mutilation (cutting or

burning self, pulling hair out, etc.) Physical pain of mutilation reduces

psychological pain

Becky: Borderline Personality http://www.youtube.com/watch?v=eOphg

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Antisocial personality disorder Also known as “sociopath” or “psychopath” People are extremely manipulative and callous;

seem to have no morals Ignore social rules/laws, behave impulsively,

don’t seem to learn from punishment, show no remorse. Seemingly have no conscience.

May become criminals, politicians, or con artists.