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Psychological Disorders
Psychological Disorders
Behavior patterns or mental
processes that cause serious
personal suffering or interfere with a
person’s ability to cope with daily life
What Is Abnormality?
No biological test for mental
disorders; it’s a judgment call
Heavily influenced by
– Social norms
– Person’s characteristics
– Context
What Is Abnormality?
Current consensus:
1. Deviance
2. Dysfunction
3. Distress
What Is Abnormality?
Deviance
– Statistically uncommon
Wearing beekeeper’s
outfit
…to a restaurant.
Talking to a baseball
…and hearing it talk back.
What Is Abnormality?
Never recycling cans
…for 8 years.
…and having 70,000
of them in your
apartment.
What Is Abnormality?
Dysfunctional
– Interferes with day-to-day life
Avoiding people b/c
they make you anxious
…so you haven’t left
the house in 2 years.
Defining Abnormal Behavior
Distress (to self or others)
– Negative emotions
Crying because
you’re sad
► …every day
for months.
Mental Disorder Rates, 18+
0%
10%
20%
30%
40%
50%
Lifetime 1 Year 1 Year - Serious
46%
26%
6%
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Facts About Mental Illness
Most can be treated
Most suffer privately
Few are violent
Diagnosing Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Current version: DSM-IV-TR
Lists of symptoms, with required symptoms, and required number
17 categories
Categories of Disorders
Anxiety Disorders
Mood Disorders
Schizophrenia
Adjustment Disorders
Delirium, Dementia, and Amnestic and Other Cognitive Disorders
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Dissociative Disorders
Eating Disorders
Factitious Disorders
Impulse-Control Disorders
Mental Disorders Due to a Medical Condition
Personality Disorders
Psychotic Disorders
Sexual and Gender Identity Disorders
Sleep Disorders
Somatoform Disorders
Substance-Related Disorders
Anxiety Disorders
What is anxiety?
How does it affect your behavior?
Can anxiety ever be healthy or helpful?
Anxiety Disorders
What Is Anxiety?
– Fear of future danger or
misfortune, accompanied by
emotional and/or physical tension
May be related to specific object or
situation
About 75% before age 22
"I always thought I was just a
worrier. I'd feel keyed up and unable
to relax. At times it would come and
go, and at times it would be constant.
It could go on for days. I'd worry about
what I was going to fix for a dinner
party, or what would be a great present
for somebody. I just couldn't let
something go."
"I'd have terrible sleeping problems.
There were times I'd wake up wired in
the middle of the night. I had trouble
concentrating, even reading the
newspaper or a novel. Sometimes I'd
feel a little lightheaded. My heart
would race or pound. And that would
make me worry more. I was always
imagining things were worse than they
really were: when I got a stomachache,
I'd think it was an ulcer."
1. Generalized Anxiety Disorder
3% of population; median age 31
Ongoing anxiety on most days for at least 6 months
Anxiety difficult to control
No specific trigger
"For me, a panic attack is almost a violent
experience. I feel disconnected from
reality. I feel like I'm losing control in a
very extreme way. My heart pounds really
hard, I feel like I can't get my breath, and
there's an overwhelming feeling that things
are crashing in on me."
"It started 10 years ago, when I had just
graduated from college and started a new
job. I was sitting in a business seminar in a
hotel and this thing came out of the blue. I
felt like I was dying."
3
"In between attacks there is this
dread and anxiety that it's going to
happen again. I'm afraid to go back
to places where I've had an attack.
Unless I get help, there soon won't be
anyplace where I can go and feel safe
from panic."
2. Panic Disorder
3% of population; median age 24
Panic attacks
– No obvious trigger for attacks
– Sweating, dizziness, numbness or
tingling
"I was in a car accident when I was 25
years old in which my girlfriend died. For a
long time, I spoke about it as though it was
something that happened to someone
else. I was very aware that it had happened
to me, but there was just no feeling."
"Then I started having flashbacks. They
kind of came over me like a splash of water.
I would be terrified. Suddenly I was reliving
the accident. Every instant was startling.
“I wasn't aware of anything around me, I was
in a bubble, just kind of floating. And it was
scary. Having a flashback can wring you out.
“It happened the week before the Fourth
of July, and I can't believe the anxiety and
fear I feel every year around the anniversary
date. It's as though I've seen a monster. I
can't relax, can't sleep, don't want to be
with anyone. I wonder whether I'll ever be
free of this terrible problem."
3. Post-Traumatic Stress
Disorder
3.5% of population; median age 23
20% of Vietnam vets
Extreme anxiety after event that
almost anyone would find stressful
Car/plane crash Mugging
Extreme abuse War
Flashbacks
Avoid things that remind of event
4. Phobias
From phobos, Greek for “fear”
Three kinds
1. Specific phobia
2. Agoraphobia
3. Social phobia
Excessive, irrational fear & avoidance
of specific object or situation
"I'm scared to death of flying, and I
never do it anymore. I used to start
dreading a plane trip a month before I
was due to leave. It was an awful
feeling when that airplane door closed
and I felt trapped. My heart would
pound, and I would sweat bullets. When
the airplane would start to ascend, it
just reinforced the feeling that I couldn't
get out.”
“When I think about flying, I picture myself
losing control, freaking out, and climbing
the walls, but of course I never did that. I'm
not afraid of crashing or hitting turbulence.
It's just that feeling of being trapped.
Whenever I've thought about changing jobs,
I've had to think, "Would I be under pressure
to fly?" These days I only go places where I
can drive or take a train. My friends always
point out that I couldn't get off a train
traveling at high speeds either, so why don't
trains bother me? I just tell them it isn't a
rational fear."
4. Phobic Disorders
A. Specific Phobia
9% of population; median age 7
Usually begins in childhood
Fear of specific object/situation
Avoidance of what is feared
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4. Phobic Disorders
A. Specific Phobia
Most common phobia:
Other common phobias
hemophobia
acrophobia
claustrophobia
animals & insects
heights
closed-in places
blood
zoophobia
Some Unusual Phobias
Alektorophobia chickens
Geniophobia chins
Some Unusual Phobias
long words
Peladophobia bald people
Hippopotomonstrosesquippedaliophobia
Hexakosioihexekontahexaphobia the number 666
Some Unusual Phobias
Automatonophobia ventriloquist's dummies
Triskaidekaphobia
Arachibutyrophobia peanut butter sticking to
the roof of the mouth
4. Phobic Disorders
B. Agoraphobia
1% of population; median age 20
Fear of being not being able to escape if anxiety gets too high
Avoid
– Being alone outside home
– Traveling by car, airplane
– Crowded places
"In any social situation, I felt fear. I
would be anxious before I even left the
house, and it would escalate as I got
closer to a college class, a party, or
whatever. I would feel sick in my
stomach - it almost felt like I had the
flu. My heart would pound, my palms
would get sweaty, and I would get this
feeling of being removed from myself
and from everybody else.
"When I would walk into a room full
of people, I'd turn red and it would feel
like everybody's eyes were on me. I
was embarrassed to stand off in a
corner by myself, but I couldn't think of
anything to say to anybody. It was
humiliating. I felt so clumsy, I couldn't
wait to get out."
4. Phobic Disorders
C. Social Phobia
7% of population; median age 13
fear and anxiety of being judged and
evaluated by other people
Situations to avoid
– Eating in public
– Public speaking
– Center of attention
– Talking to people
"I couldn't do anything without rituals. They
invaded every aspect of my life. Counting really
bogged me down. I would wash my hair three
times as opposed to once because three was
a good luck number and one wasn't. It took me
longer to read because I'd count the lines in a
paragraph. When I set my alarm at night, I had
to set it to a number that wouldn't add up to a
'bad' number."
"I knew the rituals didn't make sense, and
I was deeply ashamed of them, but I couldn't
seem to overcome them until I had therapy."
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"Getting dressed in the morning was
tough, because I had a routine, and if I didn't
follow the routine, I'd get anxious and
would have to get dressed again. I always
worried that if I didn't do something, my
parents were going to die. I'd have these
terrible thoughts of harming my parents.
That was completely irrational, but the
thoughts triggered more anxiety and more
senseless behavior. Because of the time I
spent on rituals, I was unable to do a lot of
things that were important to me."
5. Obsessive-Compulsive
Disorder
1% of population; median age 19
Either obsessions, compulsions, or both
Obsession
– Unwanted thought that person can’t stop thinking about
Compulsion
– Ritualistic behavior that person feels they must do; reduces anxiety
Obsessive-Compulsive Disorder
Common obsessions:
– Dirt, germs
– Something terrible happening
– Order, exactness
– Religious obsessions
Common Obsessions Table Obsessive-Compulsive Disorder
Common rituals:
– Cleaning
– Repeating
– Checking
Common Compulsions Table
“Self-Portrait” “The Old
Guitarist”
“The Tragedy”
Picasso’s “Blue Period” Mood Disorders
Mood
– Long-lasting emotion that affects
how one perceives the world
Median age = 30
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Range of Emotions
Extreme
sadness “Neutral”
emotions
Mild
sadness Mild
happiness
Extreme
elation
Brain
chemistry Cognition
Mood
Breakup with romantic partner
Stable
“I’ll never get over this.”
Global
“Without her, I’m nothing.”
Internal
“It was all my fault.”
Depression
Temporary
“It’s hard, but I’ll get over it.”
Specific
“I miss her, but I have family
and friends.”
External
“It wasn’t meant to be.”
Successful coping
1. Major Depressive Disorder
“Common cold” of serious mental illness
Leading cause of disability in U.S. for
ages 15-44
Lifetime rates:
– Around 25% for women
– Around 13% for men
Major Depressive Disorder
Groups most likely to meet criteria:
45-64 years
Women
< HS education
Unable to work or unemployed
Divorced
No health insurance
1. Major Depressive Disorder
1.Depressed mood
2.Loss of pleasure
3.Weight loss
4.Sleep changes
5.Restlessness or being slowed down
6.Loss of energy
7.Worthlessness or guilt
8.Poor concentration
9.Thoughts of death
5 or more symptoms in 2 week period
2. Dysthymic Disorder
1. Depressed mood most days for
2+ years
2. Changes in eating
3. Changes in sleeping
4. Fatigue
5. Low self-esteem
6. Poor concentration
7. Hopelessness
2 or more
Seasonal Affective Disorder
(SAD)
Symptoms of major depression during
fall and winter
– Related to light
– Higher latitudes show higher rates
SAD Rates in the U.S.
10.2%
5.8%
3.6%
1.4%
8%
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Light treatment for SAD 3. Bipolar Disorder
3%
Severe mood swings
– mania and depression
“Manic-depression”
3. Bipolar Disorder Manic Episode
A. At least 1 week of abnormally elevated,
expansive, irritable mood
B. 3 or more of following
1. Inflated self-esteem
2.Decreased need for
sleep
3.More talkative
4.Racing thoughts
5.Distractibility
6.Psychomotor
agitation
7.Excessive risky
pleasurable
activities
Manic vs. Depressed
Brain Activity
Depressed state Manic state Depressed state
A Typical Bipolar Cycle
Mo
od
Mania
Depression
1 2 3 4 Years
1 cycle over
several years
Bipolar Disorder - Rapid Cycling
Mo
od
Mania
Depression
4 or more
cycles
per year
1 Year
Suicide Facts
About 15% with depression commit suicide
32,439 in 2004
Fewest = winter, most = spring
Women 3x more likely to attempt
Men 4x more likely to die from suicide
3rd leading cause of death for 15-24s
– 86% male
Highest rate = 80+
Suicide Risk Factors
depression, other mental disorders, or a substance-abuse disorder
prior suicide attempt
family history of mental disorder or substance abuse
family history of suicide
family violence
firearms in the home
incarceration
exposure to the suicidal behavior of others
Gender Differences in
Suicide Method 56%
24%
13%
30%
21%
40%
0%
10%
20%
30%
40%
50%
60%
Firearms Suffocation Poisoning
Men
Women
8
Rates of Suicide By Sex and Age, All Races 2004
0
5
10
15
20
25
30
35
40
45
50
10-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age
Ra
tes
Males
Females
Jennifer Lawrence admits she’s
“schizophrenic” when it comes to fashion.
Showbiz Spy, 3/1/12
"The Jets are schizophrenic, and that should
be no surprise to the legions of genuinely long-
suffering fans that follow them."
Yahoo! Sports, 3/21/12
"Schizophrenic weather aside, we're finally
starting to see signs of spring, which has most of
us daring to daydream of summer fun.”
Boise Weekly, 3/14/12
Schizophrenia
1% of world population
#1 reason for being in mental hospital
Same rates by gender, different age of onset
– Men – 18-25
– Women – 26-45
Strong genetic link
– If parents have it, risk = 10%
– When 1 identical twin has it, risk around 50%
Schizophrenia and
“The Rule of Thirds”
Full
Recovery
Some
Improvement
No Improvement
Schizophrenia: Symptoms
Two or more of the following, during a
1-month period:
1. delusions
2. hallucinations
3. disorganized speech
4. disorganized or catatonic behavior
5. “negative” symptoms
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Schizophrenia: Symptoms
Two or more of the following, during a
1-month period:
1. delusions
2. hallucinations
3. disorganized speech
4. disorganized or catatonic behavior
5. “negative” symptoms
1. Delusions
False beliefs
A. Delusions of Persecution
B. Delusions of Reference
C. Delusions of Grandeur
Bizarre vs non-bizarre
2. Hallucinations
False perceptions
Any of the senses
Most common = hearing voices
3. Disorganized Speech
Seen as sign of disorganized thinking
A. Loose associations
Thoughts are unrelated
A. Loose Associations
Normal 1: Both are salmon colored. This one, however, is more pink.
Normal 2: My God, this is hard. They are both about the same, except this one must be redder.
Normal 3: They are both either the color of canned salmon or clay. This one here is the pinker one.
A. Loose Associations
Schiz 1: A fish swims. You call it a salmon. You
cook it. You put it in a can. You open the can.
You look at it in this color. Salmon fish.
Schiz 2: This is a stupid color of a ------ bowl of
salmon. Mix it with mayonnaise. Then it gets
tasty. Leave it alone and puke all over the ------
place. Puke fish.
Schiz 3: Make-up. Pancake make-up. You put
your face on it and the think guys run after you.
Wait a second! I don’t put it on my face and guys
don’t run after me. Girls put it one them.
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3. Disorganized Speech
B. Poverty of content
Many words, little meaning
B. Poverty of Content
I am writing on paper. The pen which I am using is from a factory called “Perry & Co.” The factory is in England. I assume this. Behind the name of Perry & Co. the city of London is inscribed. But not the city. The city of London is in England. I know this from my school days. Then, I always liked geography. My last teacher in that subject was Professor August A. he was a man with black eyes. There are also blue eyes and gray eyes and other sorts, too. I have heard it said that snakes have black eyes.
3. Disorganized Speech
C. Clanging
Words that rhyme or sound
similar
C. Clanging
Dr: How are things going today, Ernest?
Patient: OK for a flump.
Dr: What is a flump?
Pt: A flump is a gump.
Dr: What do you mean by that?
Pt: Well, when you go to the next planet from the planet beyond the planet that landed on the danded and planded on the standed.
Dr: Wait a minute. I didn’t follow any of that.
Pt: Well, when we was first bit on the slit on the rit and the man on the ran or the pan on the ban on the can on the man on the fan on the pan.
Dr: What’s all that hitting your head for. And waving your arms?
Pt: That’s to keep the boogers from eating the woogers.
3. Disorganized Speech
D. Word salad
Words jumbled together
D. Word Salad
It’s all over for me now and there ain’t no
music, there ain’t no nothing besides my
mother and father who stand alone on the
Island of Capri where there is no ice, there is
no nothing but changers, changers,
changers. That comes in like first and last
names, so that thing does. Well, it’s my
suitcase sir. I’ve got to travel to keep my
energy alive.
4. Disorganized or Catatonic
Behavior
Disorganized
A. Problems in goal-directed behavior
B. Inappropriate sexual behavior
C. Unpredictable agitation
D. Inappropriate emotions
4. Disorganized or Catatonic
Behavior
Catatonic Behavior
A. Catatonic posturing
B. Rigidity
C. Waxy flexibility
D. Stupor
5. Negative Symptoms
Absence of certain normal behaviors
1. Emotions
2. Speech
3. Goal-directed behavior
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Schizophrenia Subtypes
1. Paranoid Schizophrenia
− Delusions, auditory hallucinations
2. Disorganized Schizophrenia
− Disorganized speech/behavior, emotions absent or inappropriate
3. Catatonic Schizophrenia
− Catatonic symptoms
4. Undifferentiated Schizophrenia
− Don’t fit another subtype
Understanding Schizophrenia
1. Brain Abnormalities
– Excessive dopamine levels
– Abnormal brain activity
– Tissue loss
Understanding Schizophrenia
2. Prenatal Environment
– Maternal viral infections
– Born during winter & spring
Reversed below equator
Possible Risk Factors
Prenatal malnutrition
Fathers’ age at birth, esp. 50+
Family history of epilepsy
Twice as common in unmarried or
divorced people
"I couldn't do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn't add up to a 'bad' number."
"I knew the rituals didn't make sense, and I was deeply ashamed of them, but I couldn't seem to overcome them until I had therapy."
"Getting dressed in the morning was tough, because I had a routine, and if I didn't follow the routine, I'd get anxious and would have to get dressed again. I always worried that if I didn't do something, my parents were going to die. I'd have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me."