Chapter 12 Psychological Disorders

Chapter 12Psychological Disorders

What is Normal? • Psychopathology: Scientific study of mental, emotional, and behavioral disorders • Subjective Discomfort: Feelings of discomfort, unhappiness, or emotional distress • Statistical Abnormality: Having extreme scores on some dimension, such as intelligence, anxiety, or depression • Social Nonconformity: Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior

Figure 12.1 FIGURE 12.1 The number of people displaying a personal characteristic may help define what is statistically abnormal.

What Is Normal? (cont'd) • Situational Context: Social situation, behavioral setting, or general circumstances in which behavior takes place • Is it normal to walk around strangers naked? If you are in a locker room and in the shower area, yes! • Cultural Relativity: Judgments are made relative to the values of one’s culture

Clarifying and Defining Abnormal Behavior (Mental Illness) • Maladaptive Behavior: Behavior that makes it difficult to function, to adapt to the environment, and to meet everyday demands • Mental Disorder: Significant impairment in psychological functioning

Clarifying and Defining Abnormal Behavior (Mental Illness) • Psychotic Disorder: Severe psychiatric disorder characterized by hallucinations and delusions, social withdrawal, and a move away from reality • Organic Mental Disorder: Mental or emotional problem caused by brain pathology (i.e., brain injuries or diseases) • Mood Disorder: Disturbances in affect (emotions), like depression or mania • Anxiety Disorder: Feelings of fear, apprehension, anxiety, and distorted behavior

Clarifying and Defining Abnormal Behavior (Mental Illness) • Somatoform Disorder: Physical symptoms that mimic disease or injury (blindness, anesthesia) for which there is no identifiable physical cause • Dissociative Disorder: Temporary amnesia, multiple personality, or depersonalization (like being in a dream world, feeling like a robot, feeling like you are outside of your body) • Personality Disorder: Deeply ingrained, unhealthy, maladaptive personality patterns • Sexual and Gender Identity Disorder: Problems with sexual identity, deviant sexual behavior, or sexual adjustment

Clarifying and Defining Abnormal Behavior (Mental Illness) • Substance Related Disorders: Abuse or dependence on a mind or mood-altering drug, like alcohol or cocaine • Person cannot stop using the substance and may suffer withdrawal symptoms if they do • Neurosis: Archaic; once used to refer to excessive anxiety, somatoform, dissociative disorders, and some kinds of depression

General Risk Factors for Contracting Mental Illness • Biological Factors: Genetic defects or inherited vulnerabilities; poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disability • Psychological Factors: Low intelligence, stress, learning disorders________________ • Social Conditions: Poverty, homelessness, overcrowding, stressful living conditions • Family Factors: Parents who are immature, mentally ill, abusive, or criminal; poor child discipline; severe marital or relationship problems • Other sources of psychological stress

Figure 12.11 FIGURE 12.11 A combination of vulnerability and stress may produce psychological problems. The top bar shows low vulnerability and low stress. The result? No problem. The same is true of the next bar down, where low vulnerability is combined with moderate stress. Even high vulnerability (third bar) may not lead to problems if stress levels remain low. However, when high vulnerability combines with moderate or high stress (bottom two bars) the person “crosses the line” and suffers from psychopathology.

Anxiety-Based Disorders • Anxiety: Feelings of apprehension, dread, or uneasiness • Adjustment Disorders: When ongoing stressors cause emotional disturbance and push people beyond their ability to effectively cope • Usually suffer sleep disturbances, irritability, and depression • Examples: Grief reactions, lengthy physical illness, unemployment can be some triggers for anxiety

Anxiety-Based Disorders (cont'd) • Anxiety Disorders: When stress seems greatly out of proportion to the situation at hand …usually accompanied by some form of avoidance • 3 Main Types • Generalized Anxiety Disorder (GAD): Duration of at least six months of chronic, unrealistic, or excessive anxiety • Panic Disorder (w/ or w/o agoraphobia) • Phobia

Generalized Anxiety Disorder • Extreme anxiousness and worry for at least 6 months • Anxiousness/anxiety do not fade when life circumstances get better • Multiple topics of worry

Panic Disorders • Panic Disorder (without Agoraphobia): A chronic state of anxiety with brief moments of sudden, intense, unexpected panic (panic attack) • Panic Attack: Feels like one is having a heart attack, going to die, or is going insane • Symptoms include vertigo, chest pain, choking, fear of losing control • Panic Disorder (with Agoraphobia): Panic attacks and sudden anxiety still occur, but with agoraphobia

Agoraphobia • Agoraphobia (withPanic Disorder): Intense, irrational fear that a panic attack will occur in a public place or in an unfamiliar situation • Intense fear of leaving the house or entering unfamiliar situations • Can be very crippling • Literally means fear of open places or market (agora) • Agoraphobia (withoutPanic Disorder): Fear that something extremely embarrassing will happen away from home or in an unfamiliar situation.

Specific Phobias • Irrational, persistent fears, anxiety, and avoidance that focus on specific objects, activities, or situations • People with phobias realize that their fears are unreasonable and excessive, but they cannot control them.

Social Phobia • Intense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e.g., shyness, eating, or speaking in public)

Review: 3 Anxiety Disorders • 1. Phobia—objects, situation, social • Causes: not only experience…also inherit tendencies (prepared fears) • 2. Generalized Anxiety—constant anxiety and worry • 3. Panic Disorder—discrete panicky episodes

Obsessive-Compulsive Disorder (OCD) • Extreme preoccupation with certain thoughts and compulsive performance of certain behaviors • Obsession: Recurring images or thoughts that a person cannot prevent • Cause anxiety and extreme discomfort • Enter into consciousness against the person’s will • Most common: Being dirty or wondering if you performed an action (turned off the stove)

Compulsions • Compulsion: Irrational acts that person feels compelled to repeat against his/her will • Help to control anxiety created by obsessions • Checkers and cleaners

Table 16.2 Obsessive-Compulsive Tendencies

Anxiety • Feelings of tension, uneasiness, apprehension, worry, and vulnerability • We are motivated to avoid experiencing anxiety

Figure 10.6 FIGURE 10.6 The approximate relationship between the id, ego, and superego, and the levels of awareness.

Theoretical Causes of Anxiety Disorders: Psychodynamic • Psychodynamic (Freud): Anxiety caused by conflicts among id, ego, and superego. • Forbidden id impulses for sex or aggression are trying to break into consciousness and thus influence behavior; person fears doing something crazy or forbidden. • Superego creates guilt in response to these impulses. • Ego gets overwhelmed and uses defense mechanisms to cope.

Other Theoretical Causes of Anxiety Disorders • Humanistic-Existential: Unrealistic self-image conflicts with true self

Other Theoretical Causes of Anxiety Disorders • Behavioristic: Anxiety symptoms and behaviors are learned, like everything else • Conditioned emotional responses generalize to new situations • Anxiety Reduction Hypothesis: When reward of immediate relief from anxiety perpetuates self-defeating avoidance behaviors • Cognitive: When distorted thinking causes people to magnify ordinary threats and failures, leading to anxiety and distress

Mood Disorders • Major disturbances in emotion, such as depression or mania • Depressive Disorders: Sadness or despondency are prolonged, exaggerated, or unreasonable • Bipolar Disorders: Involve both depression, and mania or hypomania • Seasonal Affective Disorder (SAD): Depression that only occurs during fall and winter. • May be related to reduced exposure to sunlight • Phototherapy: Extended exposure to bright light to treat SAD

Major Mood Disorders • Lasting extremes of mood or emotion and sometimes with psychotic features (hallucinations, delusions) • Major Depressive Disorder: A mood disorder where the person has suffered one or more intense episodes of depression; one of the more serious mood disorders. • Bipolar I Disorder: Extreme mania and deep depression; one type of manic-depressive illness. • Mania: Excited, hyperactive, energetic, grandiose behavior • Bipolar II Disorder: Person is mainly sad but has one or more hypomanic episodes (mild mania)

Suicide: Major Risk Factors • Drug or alcohol abuse • Prior suicide attempt • Depression or other mood disorder • Availability of a firearm • Severe anxiety or panic attacks • Family history of suicidal behavior • Shame, humiliation, failure or rejection

Figure 12.15 FIGURE 12.15 Suicidal behavior usually progresses from suicidal thoughts, to threats, to attempts. A person is unlikely to make an attempt without first making threats. Thus, suicide threats should be taken seriously

Common Characteristics of Suicidal Thoughts and Feelings (Shneidman) • Escape • Unbearable Psychological Pain: Emotional pain that the person wishes to escape • Frustrated Psychological Needs: Such as searching for love, achievement, or security • Constriction of Options: Feeling helpless and hopeless and deciding that death is the only option left

Psychosis • Psychosis: Loss of contact with reality marked by hallucinations, delusions, disturbed thoughts and emotions, and personality disorganization

Delusions • Delusions: False beliefs that psychotic individuals insist are true, regardless of overwhelming evidence against them • Common forms: • Erotomanic • Grandiose • Jealous • Persecution • Somatic

Hallucinations • Hallucinations: Imaginary sensations, such as seeing, hearing, or smelling things that do not exist in the real world • Most common psychotic hallucination is hearing voices • Note that olfactory hallucinations sometimes occur with seizure disorder (epilepsy)

Schizophrenia: The Most Severe Mental Illness • Psychotic disorder characterized by hallucinations, delusions, apathy, thinking abnormalities, and “split” between thoughts and emotions • Does NOTrefer to having split or multiple personalities

Some More Psychotic Symptoms • Flat Affect: Lack of emotional responsiveness • Inappropriate emotions: • Disturbed Verbal Communication: Garbled and chaotic speech; word salad • Personality Disintegration: Uncoordinated thoughts, actions, and emotions…a “split” between thought and emotion • Withdrawal and apathy • Breakdown of personal habits • Problems with selective attention

The Four Subtypes of Schizophrenia • Disorganized Schizophrenia: Incoherence, grossly disorganized behavior, bizarre thinking, and flat or grossly inappropriate emotions • Catatonic Schizophrenia: Marked by stupor where victim may hold same position for hours or days; also unresponsive • Paranoid Schizophrenia: Preoccupation with delusions of grandeur or persecution; also involves hallucinations that are related to a single theme, especially grandeur or persecution • Undifferentiated Schizophrenia: Any type of schizophrenia that does not have paranoid, catatonic, or disorganized features or symptoms

Causes of Schizophrenia • Psychological Trauma: Psychological injury or shock, often caused by an environment of violence, abuse, or neglect • Disturbed Family Environment: Stressful or unhealthy family relationships, communication patterns, and emotional atmosphere • Deviant Communication Patterns: Cause guilt, anxiety, anger, confusion, and turmoil • Heredity—if one identical twin becomes schizophrenic then the other twin has about 50% chance • Stress-Vulnerability Hypothesis: Combination of environmental stress and inherited susceptibility cause psychotic disorders

Figure 12.7 FIGURE 12.7 Lifetime risk of developing schizophrenia is associated with how closely a person is genetically related to a schizophrenic person. A shared environment also increases the risk.

Biochemical Causes of Schizophrenia • Biochemical Abnormality: Disturbance in brain’s chemical systems or in the brain’s neurotransmitters • Dopamine: Neurotransmitter involved with emotions and muscle movement • Works in limbic system • Dopamine overactivity in brain may be related to schizophrenia • Glutamate may also be related to schizophrenia

Figure 12.8 FIGURE 12.8 Dopamine normally crosses the synapse between two neurons, activating the second cell. Antipsychotic drugs bind to the same receptor sites as dopamine does, blocking its action. In people suffering from schizophrenia, a reduction in dopamine activity can quiet a person’s agitation and psychotic symptoms.

Chapter 12 Psychological Disorders