Psychological Disorders

Chapter 8

What Are Psychological What Are Psychological Disorders?Disorders?

Range from mild disorders (such as adjustment disorders) to more severe and chronic disorders, such as schizophrenia and bipolar disorder.

Adjustment disorder: ◦ A maladaptive reaction to an identified stressor◦ occurs shortly following exposure to the

stressor ◦ Characterized by academic, occupational, or

social problems that exceed those normally caused by stressor.

◦ Resolved if person learns how to cope or stressor is removed

◦ Examples: (end of relationship, life transitions,

Criteria for Determining Criteria for Determining “Abnormal” Behavior“Abnormal” Behavior

1. Unusualness

2. Faulty perception or interpretation of reality

3. Significant personal distress

4. Self-defeating behavior

5. Dangerousness

6. Social unacceptability in a given culture

Classifying Psychological Classifying Psychological DisordersDisorders

Psychological disorders are classified via the Diagnostic and Statistical Manual 4th Edition –Text Revision (DSM-IV-TR).

The DSM-IV-TR uses a multiaxial system of assessment. It provides information about a person’s overall functioning (not just a diagnosis).

5 Axis of DSM-IV-TR5 Axis of DSM-IV-TRAxis 1: Clinical

Syndromes/Psychological Disorders that Impair Functioning

Axis II: Personality DisordersAxis III: Medical ConditionsAxis IV: Psychosocial and

environmental factorsAxis V: Global assessment

functioning (GAF)

Anxiety DisordersAnxiety DisordersPhobias

◦Specific Phobia◦Social Phobia◦Agoraphobia

Panic DisorderGeneralized Anxiety DisorderObsessive Compulsive DisorderPost-Traumatic Stress DisorderAcute Stress Disorder

PHOBIASPHOBIASSpecific Phobia: an excessive, irrational

fear of a specific object or situation, such as snakes or heights. Examples include claustrophobia (fear of tight or enclosed spaces) and acrophobia (fear of heights).◦Example (Arachnophobia):◦ http://www.youtube.com/watch?

v=5ksMw4MJgn0&feature=related

Social Phobia: Also called Social Anxiety Disorder, a social phobia is a persistent fear of social interactions in which one might be scrutinized or judged negatively by others.

Agoraphobia: Fear of open or crowded places.

Panic DisorderPanic Disorder

Panic Disorder: Recurrent experiencing of attacks of extreme anxiety in the absence of external stimuli that usually elicit anxiety.

Attacks seem to come “out of the blue” but may become associated with certain cues over time.

Strong physical symptoms: shortness of breath, heavy sweating, tremors, and pounding of the heart.

Investigators estimate that 1% to 4% of the adult population is affected by panic disorder at some point in their lives.

Generalized Anxiety Generalized Anxiety DisorderDisorder

Disorder involving persistent feelings of worry accompanied by states of bodily tension and heightened arousal.

The anxiety is not focused on a specific object, situation or activity.

Symptoms may include motor tension, autonomic overarousal, feelings of dread and foreboding and excessive worrying and vigilance.

Example (What About Bob):◦

http://www.youtube.com/watchv=RfrueeBmfXo&feature=related (0-1:33)

Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder

Obsessive-Compulsive Disorder: A disorder characterized by the presence of obsessions, compulsions or both.

Obsession: A recurring thought or image that seems beyond one’s ability to control.

Compulsion: An apparently irresistible urge to repeat an act or engage in ritualistic behavior such as hand washing.

Example (As Good As It Gets): ◦ http://www.youtube.com/watch?

v=44DCWslbsNM&feature=PlayList&p=F2B05F841C319A34&playnext=1&playnext_from=PL&index=34

Posttraumatic Stress Disorder and Posttraumatic Stress Disorder and Acute Stress DisorderAcute Stress Disorder

Posttraumatic Stress Disorder (PTSD): A prolonged maladaptive reaction to a traumatic event that is characterized by intense fear, avoidance of stimuli associated with the event, and re-living of the event.◦Example (Law and Order – SVU): ◦ http://www.youtube.com/watch?

v=Ddi86i3vF6E&feature=PlayList&p=C460C4EF4209FF71&index=25 (0-1:20)

Exposure to trauma in the form of physical attacks, combat, medical emergencies, accidents, terrorist attacks or witnessing a death can lead to PTSD.

Acute Stress Disorder: Characterized by feelings of intense anxiety and feelings of helplessness during the first month following exposure to a traumatic event.

Causal Factors in Anxiety Causal Factors in Anxiety Disorders.Disorders.

Psychological Views: ◦classical conditioning and by observational learning.

◦unconscious conflicts originating in childhood.

◦anxiety is maintained by exaggerating the consequences of threatening events.

Biological Views: Genetic factors◦genetics may cause predisposition but

development of disorder depends on many other factors (such as a warm and loving family, level of stressful events, coping ability, etc.).

Dissociative and Dissociative and SomatoformSomatoformDissociative Disorders: A class of

psychological disorders involving changes in consciousness or self-identity.

Somatoform Disorders: A class of psychological disorders in which people have physical complaints that cannot be explained medically or attribute their physical problems to grave causes despite lack of medical evidence.

Role of disorders is to shield self from anxiety.

Dissociative and Dissociative and Somatoform DisordersSomatoform DisordersDissociative Disorders

◦Dissociative Amnesia◦Dissociate Fugue◦Dissociative Identity Disorder◦Depersonalization Disorder

Somatoform Disorders◦Conversion Disorder◦Hypochondirasis

Dissociative DisordersDissociative DisordersDissociative Amnesia: Loss of personal memories

or self-identity; skills and general knowledge are usually retained. The loss of memory is not due to an organic problem (such as a blow to the head). ◦ Ex. a soldier who, following a stressful combat experience,

cannot remember what happened for several hours.

Dissociative Fugue: Dissociative disorder in

which one experiences amnesia, then flees to a new location. The new personality is often more outgoing than the “real” identity. Following recovery, the events are not recalled.

Example of Dissociative Amnesia and Fugue (Nurse Betty): ◦ http://www.youtube.com/watch?v=8p4nK1RE5M0&feature=related (0-2:00

and 4:15-4:40 and 5:38-6:20)

Dissociative DisordersDissociative DisordersDissociative Identity Disorder (DID): a

person appears to have two or more distinct identities which may alternate in controlling them. Some psychologists feel that people with DID have constructed these alternate personalities as roles they play to act out confusing emotions.◦Example (Sybil):

http://www.youtube.com/watch?v=1vANyDFgjZU

Depersonalization Disorder: one experiences persistent or recurrent feelings that one is not real or is detached from one’s own experiences or body.

Causal Factors in Dissociative Causal Factors in Dissociative DisordersDisorders

Suffered terrible sexual or physical abuse in childhood, usually before the age of 5.

Psychodynamic theorists: dissociative disorders are a result of massive repression

Learning theorists: learned to

redirect their thinking away from troubling memories in order to avoid feelings of shame, anxiety and guilt.

Somatoform DisordersSomatoform DisordersConversion Disorder: A disorder in which

anxiety or unconscious conflicts are “converted” into physical symptoms that often have the effect of helping the person cope with anxiety or conflict.

Example (The Piano)◦ http://www.youtube.com/watch?

v=k3jUcEOWJO0&feature=related (0:38)

Hypochondriasis: A disorder

characterized by the persistent belief that one has a serious medical disorder despite lack of medical finding.◦ Example (Donald Duck cartoon): ◦ http://www.youtube.com/watch?v=WjOrFV13ylY

(2:20-4:25)

Causal Factors in Somatoform Causal Factors in Somatoform DisordersDisorders

Psychodynamic theory: Hysterical symptoms symbolize underlying psychological conflict.

Learning theory: Conversion symptoms represent learned responses that are reinforced by avoidance of painful or anxiety-evoking situations.

Cognitive factors: Evidence is emerging that points to cognitive factors such as distorted thinking patterns.

Mood DisordersMood DisordersMajor Depression

Major Depression with Psychotic Features

Bipolar Disorder

Mood DisordersMood DisordersMajor Depression: A mood disorder in

which the person may have a dampened mood, changes in appetite and sleep patterns, and lack of interest or pleasure. In extreme cases, people suffering from major depression may experience psychotic behaviors.

Psychotic: Relating to a break with reality, as manifested by delusional thinking or hallucinations.

Example (Girl Interrupted) : http://www.youtube.com/watch?v=CPt42e5ZKDw (1:45-3:15)

Mood DisordersMood DisordersWomen are two times more likely to be

diagnosed with depression than men.

Women have greater stress than men (multiple demands of childbearing, childrearing and financial support of the family).

Hormonal differences can also contribute to the differences between men and women.

Societal norms for gender roles may also impact our ability to detect depression in men and children (ex. Irritability and anger rather than sadness).

Mood DisordersMood Disorders Bipolar Disorder: A mood

disorder in which mood alternates between two extreme poles (elation or manic and depression).

In the manic phase, the person may show excessive excitement or silliness, engage in risky behaviors, experience a flight of ideas and speak very rapidly.

Example (Mr. Jones):◦ http://www.youtube.com/watch?

v=UZyVOXge-L0&feature=PlayList&p=E193ED4256E8A24F&index=92 (4:08 – 6:54)

In the depression phase, people have a downcast mood, often sleep more than usual, and feel lethargic.◦ Example:

http://www.youtube.com/watch?v=0wWWOTH1h4E&feature=PlayList&p=E193ED4256E8A24F&index=95(0-1:44)

In order to avoid the depressive phase, some people suffer from bipolar disorder may attempt suicide when the mood shifts from elation towards depression.

Causal Factors in Mood Causal Factors in Mood DisordersDisorders

Psychological Factors: ◦ Psychodynamic perspective - depression is anger

turned inward.◦ Learning theorists - depressed people lack

sufficient reinforcement in their lives to maintain their mood and behavior.

◦ Cognitive theorists - ways we interpret life events leads to emotional disorders such as depression.

Biological Factors: Genetic factors in major depression and bipolar disorder. ◦ Irregularities in the use of serotonin in the brain

(Prozac works to increase the level of serotonin in the brain).

SchizophreniaSchizophrenia Schizophrenia: A severe and persistent psychological

disorder characterized by a break with reality, disturbances in thinking, and a disturbed behavior and emotional responses.

About 2.5 million Americans are diagnosed with schizophrenia, with about 1 in 3 requiring hospitalization. 1% of population in US and worldwide.

People with schizophrenia have problems with memory, attention and communication. Their thinking becomes unraveled and their speech jumbled.

Many people with schizophrenia have delusions. Others may enter a stuporous state or become wildly agitated.

Example (A Beautiful Mind): ◦ http://www.youtube.com/watch?

v=mLhv18rfe2k&feature=related

SchizophreniaSchizophreniaParanoid Schizophrenia

Disorganized Schizophrenia

Catatonic Schizophrenia

SchizophreniaSchizophreniaParanoid Schizophrenia: A type of schizophrenia

characterized primarily by delusions—commonly of persecution—and by vivid hallucinations.

Example (Donnie Darko):◦ http://www.youtube.com/watch?

v=YfwWMsOp5EU&NR=1(1:55)

Disorganized Schizophrenia: A type of schizophrenia characterized by incoherent speech, disorganized or fragmentary delusions, and vivid hallucinations.

Catatonic Schizophrenia: A type of schizophrenia characterized by striking impairment of motor activity. These individuals may show waxy flexibility and/or mutism

Example for Disorganized and Catatonic (Patch Adams):◦ http://www.youtube.com/watch?v=KbdlzXPJV7U (0-

0:38)

Causal Factors in Causal Factors in SchizophreniaSchizophrenia

Genetic Factors: Heredity plays a key role in schizophrenia. The more closely related two people are by blood, the more likely they are to share the disorder.

Other Biological Factors: Complications during childbirth, being born during the winter (predictive of viral infection) and poor maternal nutrition are also linked to schizophrenia.

Dopamine Theory: According to the dopamine theory, people with schizophrenia overutilize the neurotransmitter dopamine.

Personality DisordersPersonality Disorders

Personality Disorders: Enduring patterns of maladaptive behaviors that are sources of distress to the individual or others. Diagnosed after age 18.

Personality disorders cause difficulties in social, personal or occupational functioning.

The DSM-IV-TR lists 10 specific types of personality disorders that are organized in three clusters: Odd or eccentric (Cluster A) behavior, behavior that is overly dramatic, emotional or erratic (Cluster B) and behavior that is anxious or fearful (Cluster C).

Cluster A: Personality Cluster A: Personality Disorders Disorders Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

Features: Odd or eccentric behavior.

Personality DisordersPersonality Disorders

Paranoid personality disorder: A personality disorder characterized by persistent suspiciousness, but not involving the disorganization of paranoid schizophrenia.◦ Example (Conspiracy Theory)

Schizoid personality disorder: A personality disorder characterized by social detachment or isolation.◦ Example (Punch Drunk Love):

http://www.youtube.com/watch?v=v6GkbiPTIKs&feature=player_embedded (4:10)

Schizotypal personality disorder: A personality disorder characterized by difficulty forming close relationships and oddities of thought and behavior, but not involving bizarre behaviors associated with schizophrenia.

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Cluster B: Personality Cluster B: Personality DisordersDisordersBorderline Personality Disorder

Histrionic Personality Disorder

Narcissistic Personality Disorder

Anti-Social Personality Disorder

Features: Overly dramatic, emotional or erratic behaviors

Personality DisordersPersonality Disorders Borderline Personality Disorder: A personality

disorder characterized by failure to develop a stable self-image, by a pattern of tumultuous moods and stormy relationships with others, and by difficulties controlling impulsive behaviors.

Example (Fatal attraction): http://www.youtube.com/watch?v=xfiA-Rb7UR4 (0:30-1:47).

Histrionic Personality Disorder: A personality disorder characterized by overly dramatic and emotional behavior; by excessive needs to be the center of attention; and by constant demands for reassurance, praise, and approval.

Example (Jessica Rabbit):◦ http://www.youtube.com/watch?

v=C79tfgiiXDI&feature=related

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Personality DisordersPersonality DisordersNarcissistic Personality Disorder: A

personality disorder characterized by an inflated or grandiose self-image and extreme needs for admiration.

Example (Charles Manson): http://www.youtube.com/watch?v=f9jRDHGabp8&feature=player_embedded

Antisocial Personality Disorder: A personality disorder characterized by a pattern of antisocial and irresponsible behavior, a flagrant disregard for the interests and feelings of others, and lack of remorse for wrongdoing.

Example (Silence of The Lambs):◦ http://www.youtube.com/watch?

v=Eqr_XkhBaXc&feature=PlayList&p=89AED546E3952DAB&playnext=1&playnext_from=PL&index=1 (5:35-7:10)

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Cluster C: Personality Cluster C: Personality DisordersDisordersAvoidant Personality Disorder

Dependent Personality Disorder

Obsessive-Compulsive Personality Disorder

Features: Anxious and fearful behaviors

Personality DisordersPersonality Disorders Avoidant personality disorder: A personality

disorder in which the person is generally unwilling to enter relationships without assurance of acceptance because of extreme fears of rejection and criticism.

Example (UP): http://www.youtube.com/watch?v=SDkt-LdwAkk (0-0:48)

Dependent personality disorder: A personality disorder characterized by excessive dependence on others and difficulties making independent decisions.

Obsessive-compulsive personality disorder: A personality disorder described by excessive needs for attention to detail and demands for orderliness, as well as perfectionism and highly rigid ways of relating to others.

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Causal Factors in Personality Causal Factors in Personality DisordersDisorders

Most of the theoretical explanations come from the psychodynamic model. Traditional Freudian theory focuses upon faulty resolution of the Oedipal complex.

Learning theorists suggest the childhood experiences can contribute to maladaptive ways of relating to others in adulthood.

Cognitive theorists find that antisocial adolescents interpret social information in ways the bolster their misdeeds.

Genetic factors are implicated in some personality disorders such as schizoid personality disorder.

Preventing SuicidePreventing Suicide

Suicide is the 8th leading cause of death in the United States.

Most suicides are linked to mood disorders, especially depression and bipolar disorder. Other factors include feelings of hopelessness, serious medical illness and schizophrenia.

High risk groups include teenagers and young adults, college students, women, European Americans (versus African Americans), Native-American teenagers and older people who are separated or divorced.

Tips if a person refuses to seek Tips if a person refuses to seek help:help:

Keep the person talking.Be a good listener.Suggest that something other than suicide

might solve the problem, even if it is not evident at the time.

Emphasize as concretely as possible how the person’s suicide would be devastating to you and to other people who care.

Ask how the person intends to commit suicide.Do not tell people threatening suicide that

they’re acting stupid or crazy.Suggest that the person go with you to obtain

professional help now.