Psychological Disorders WHEN ADAPTATION BREAKS DOWN

1. 15 Psychological Disorders WHEN ADAPTATION BREAKS DOWN Slides prepared by Matthew Isaak

2. Learning Objectives LO 15.1 Identify criteria for defining mental disorders. LO 15.2 Describe conceptions of diagnoses across history and cultures. LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. LO 15.4 Describe the many ways people experience anxiety

3. Learning Objectives LO 15.5Identify the characteristics of different mood disorders. LO 15.6 Describe major explanations for depression and how life events can interact with characteristics of the individual to produce depression symptoms. LO 15.7 Identify common myths and misconceptions about suicide. LO 15.8Identify the characteristics of borderline and psychopathic personality disorders.

4. Learning Objectives LO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. LO 15.10 Recognize the characteristic symptoms of schizophrenia. LO 15.11 Explain how psychosocial, neural, biochemical, and genetic influences create the vulnerability to schizophrenia. LO 15.12 Describe the symptoms and debate surrounding disorders diagnosed in childhood.

5. Lecture Preview • Conceptions of mental illness • Anxiety-related disorders • Mood disorders and suicide • Personality and dissociative disorders • Schizophrenia • Childhood disorders

6. What is Mental Illness?LO 15.1 Identify criteria for defining mental disorders. • Psychopathology (mental illness) is often seen as a failure of adaptation to the environment. • Failure analysis approach tries to understand mental illness by examining breakdowns in functioning • Mental disorder does not have a clear cut definition.

7. What is Mental Illness?LO 15.1 Identify criteria for defining mental disorders. • Many different conceptions of mental illness, each with pros and cons: • Statistical rarity • Subjective distress • Impairment • Societal disapproval • Biological dysfunction

8. Historical Views of Mental IllnessLO 15.2 Describe conceptions of diagnoses across history and cultures. • During Middle Ages, mental illnesses were often viewed through a demonic model. • Odd behaviors were the result of evil spirits inhabiting the body. • Exorcisms and witch hunts were common during this time.

9. Historical Views of Mental IllnessLO 15.2 Describe conceptions of diagnoses across history and cultures. • During the Renaissance, the medical model saw mental illness as a physical disorder needing treatment. • Began housing people in asylums – but they were often overcrowded and understaffed • Treatments were no better than before (bloodletting and snake pits).

10. Historical Views of Mental IllnessLO 15.2 Describe conceptions of diagnoses across history and cultures. • Reformers like Phillippe Pinel and Dorothea Dix pushed for moral treatment. • Treated patients with dignity, respect, and kindness • Still no effective treatments, though, so many continued to suffer with no relief

11. Modern EraLO 15.2 Describe conceptions of diagnoses across history and cultures. • In early 1950s, a drug was developed called chlorpromazine (Thorazine). • Moderately decreased symptoms of schizophrenia and similar problems • With advent of other medications, policy of deinstitutionalization was enacted

12. Figure 15.1 Decline in Psychiatric Inpatients. Over the past several decades, the number of hospitalized psychiatric patients has gradually declined. (Source: www.ahrq.gov/legacy/about/annualconf09/vandivort_mark_owens/slide4.jpg)

13. Modern EraLO 15.2 Describe conceptions of diagnoses across history and cultures. • Deinstitutionalization had mixed results. • Some patients returned to almost normal lives but tens of thousands had no follow-up care and went off medications. • Community mental health centers and halfway houses attempt to help this problem.

14. Diagnosis Across CulturesLO 15.2 Describe conceptions of diagnoses across history and cultures. • Certain conditions are culture-bound. • Koro involves believing your genitals are shrinking and receding into your abdomen. • Amok is marked by episodes of intense sadness and brooding followed by uncontrolled behavior and violence.

15. Diagnosis Across CulturesLO 15.2 Describe conceptions of diagnoses across history and cultures. • Taijin kyofushu is a fear of offending others by saying something offensive or body odor. • Many severe mental disorders (schizophrenia, alcoholism, psychopathy) appear to be universal across cultures.

16. Psychiatric Diagnosis TodayLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Evidence largely contradicts common misconceptions concerning psychiatric diagnosis, such as: • Psychiatric diagnosis is simply pigeonholing. • Psychiatric diagnoses are unreliable. • Psychiatric diagnoses are invalid. • Psychiatric diagnoses stigmatize people.

17. Psychiatric Diagnosis TodayLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Diagnostic and Statistical Manual of Mental Disorders (DSM) is a system that contains the criteria for mental disorders. • Currently on fifth edition (DSM-5) • Has 18 different classes of disorders

18. The DSM-5LO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Provides list of diagnostic criteria and a set of decision rules for each condition • Warns to "think organic" (rule out physical causes of symptoms first) • Contains information on prevalence and adopts a biopsychosocial approach

19. DSM CriticismsLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Some diagnoses may be invalid • High level of comorbidity • Medicalizes normality • Reliance on categorical model of psychopathology • Vulnerable to political and social influences

20. Mental Illness and the LawLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Overwhelming majority of people with schizophrenia are not aggressive or violent

21. Mental Illness and the LawLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Insanity defense requires people to either: • Not know what they were doing at time of crime, or • Not know what they were doing was wrong. • Less than 1% of criminal cases use the defense successfully.

22. Mental Illness and the LawLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Involuntary commitment is a procedure for protecting us from certain people with mental disorders and protecting them from themselves.

23. Mental Illness and the LawLO 15.3 Identify common misconceptions about psychiatric diagnoses, and the strengths and limitations of the current diagnostic system. • Can only be committed against their will if they: • Pose a clear and present threat to themselves or others. • Are so impaired they can't care for themselves.

24. Anxiety DisordersLO 15.4 Describe the many ways people experience anxiety. • Most anxieties are transient and can be adaptive. • They can, though, spin out of control and become excessive and inappropriate. • One of the most prevalent and earliest-onset of all classes of disorders.

25. Anxiety DisordersLO 15.4 Describe the many ways people experience anxiety. • Can also see inappropriate anxiety in other disorders and problems • Somatic symptom disorder entails anxieties about physical symptoms that interfere with daily living. • Illness anxiety disorder is the preoccupation that one has a serious undiagnosed disease.

26. Generalized Anxiety DisorderLO 15.4 Describe the many ways people experience anxiety. • Continual feelings of worry, anxiety, physical tension, and irritability about many areas • About 3% of the population; 1/3 develop it after major stressor or life change • More prevalent in females and Caucasians

27. Panic DisorderLO 15.4 Describe the many ways people experience anxiety. • Repeated, unexpected panic attacks, along with either: • Persistent concerns about future attacks, or • A change in personal behavior in an attempt to avoid them. • Can be associated with specific situation or come "out of the blue"

28. PhobiasLO 15.4 Describe the many ways people experience anxiety. • Intense fear of an object or situation that's greatly out of proportion to its actual threat • Most common anxiety disorder (11%) • Comes in different forms, such as: • Agoraphobia • Specific or social phobia

29. Posttraumatic Stress DisorderLO 15.4 Describe the many ways people experience anxiety. • Marked emotional disturbance after you experience or witness a severely stressful event • Symptoms include: • Flashbacks and recurrent dreams • Avoiding reminders of the trauma • Increased physiological arousal

30. Obsessive-Compulsive DisorderLO 15.4 Describe the many ways people experience anxiety. • Marked by obsessions - persistent ideas, thoughts, or impulses that are unwanted and inappropriate and cause marked distress

31. Obsessive-Compulsive DisorderLO 15.4 Describe the many ways people experience anxiety. • This distress is relieved by compulsions – repetitive behaviors or mental acts. • Related disorders include body dysmorphic disorder and Tourette's syndrome

32. Explanations for Anxiety DisordersLO 15.4 Describe the many ways people experience anxiety. • Learning models focus on acquiring fears via classical conditioning, then maintaining them through operant conditioning. • Can also learn fears by observing others or by hearing misinformation from others.

33. Explanations for Anxiety DisordersLO 15.4 Describe the many ways people experience anxiety. • Anxious people tend to think about the world in different ways from non-anxious people. • Catastrophic thinking - predicting terrible events despite low probability • Anxiety sensitivity – a fear of anxiety-related symptoms • Many anxiety disorders are genetically influenced through level of neuroticism.

34. Mood DisordersLO 15.5 Identify the characteristics of different mood disorders. • Over 20% of Americans will experience a mood disorder. • Major Depressive Disorder (MDD) is the most common, at 16%. • More prevalent in females, most likely to develop in 30s

35. Mood DisordersLO 15.5 Identify the characteristics of different mood disorders. • Depression symptoms can develop gradually or suddenly, but are often recurrent. • Average episode lasts 6 months to 1 year; most people experience 5-6 episodes • Can cause extreme functional impairment across all areas

36. Sample MDD SymptomsLO 15.5 Identify the characteristics of different mood disorders. • Feeling blue or irritable • Sleep difficulties • Fatigue and loss of energy • Weight changes • Thoughts of death or suicide

37. Explanations for MDDLO 15.6 Describe major explanations for depression and how life events can interact with characteristics of the individual to produce depression symptoms. • Complex interplay of biological, psychological, and social influences • Life events such as loss of something that is dearly valued can set stage for depression. • Depression can create interpersonal problems, which cause lack of social support.

38. Explanations for MDDLO 15.6 Describe major explanations for depression and how life events can interact with characteristics of the individual to produce depression symptoms. • Behavioral model sees depression resulting from a low rate of positive reinforcement in the environment. • Beck's cognitive model holds that depression is caused by negative beliefs and expectations. • Cognitive triad, negative schemas, cognitive distortions

39. Explanations for MDDLO 15.6 Describe major explanations for depression and how life events can interact with characteristics of the individual to produce depression symptoms. • Learned helplessness - tendency to feel helpless in the face of events we can't control • People with depression attribute failure internally and have global, stable attributions. • Genes exert a moderate influence on MDD; role of serotonin, norepinephrine, and dopamine

40. Bipolar DisorderLO 15.5 Identify the characteristics of different mood disorders. • Both depressive and manic episodes • Elevated mood, lowered need for sleep, high energy, talkativeness, inflated self-esteem • Also show highly irresponsible behavior • Equally common in men and women

41. Bipolar DisorderLO 15.5 Identify the characteristics of different mood disorders. • Produces serious problems in social and occupational realms • Very heavily genetically influenced, but stressful life events can cause episode onset • These can be negative or positive events

42. SuicideLO 15.7 Identify common myths and misconceptions about suicide. • Major depression and bipolar disorder – higher risk for suicide than most disorders • More than 30,000 people commit suicide in US each year (11th leading cause of death). • Risk factors include previous suicide attempts and feelings of hopelessness

43. Table 15.5 Common Myths and Misconceptions About Suicide.

44. Personality DisordersLO 15.8 Identify the characteristics of borderline and psychopathic personality disorders. • Should only be diagnosed when: • Personality traits first appear by adolescence • Traits are inflexible, stable, and expressed in a wide variety of situations • Traits lead to distress or impairment • Show substantial comorbidity with other psychological disorders, like mood and anxiety disorders

45. Borderline Personality DisorderLO 15.8 Identify the characteristics of borderline and psychopathic personality disorders. • Mainly women; about 2% of population • Marked by instability in mood, identity, and impulse control; self-destructive tendencies • In sociobiological model, individuals with BPD overreact to stress and experience lifelong difficulties with regulating their emotions.

46. Psychopathic PersonalityLO 15.8 Identify the characteristics of borderline and psychopathic personality disorders. • Condition marked by superficial charm, dishonesty, manipulativeness, self-centeredness, and risk taking • Overlaps with antisocial personality disorder • Primarily males; about 25% of the prison population qualifies

47. Psychopathic PersonalityLO 15.8 Identify the characteristics of borderline and psychopathic personality disorders. • Causes are largely unknown, but may stem in part from a deficit in fear • Alternatively, they may be perpetually underaroused and experiencing stimulus hunger.

48. Dissociative DisordersLO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. • Involve disruptions in consciousness, memory, identity, or perception • Examples include depersonalization disorder, derealization disorder, dissociative amnesia, and dissociative fugue.

49. Dissociative Identity DisorderLO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. • Characterized by presence of two or more distinct identities (alters) • Intriguing differences between alters shown, but could be easily explained in other ways • Primary controversy surrounds issue of posttraumatic vs sociocognitive models

50. Dissociative Identity DisorderLO 15.9 Explain the controversies surrounding dissociative disorders, especially dissociative identity disorder. • Little evidence to support the posttraumatic model • Support for sociocognitive model includes: • Most DID patients don't show alters prior to therapy