Chapter 14 Psychological

Disorders: Part 1Music: “Crazy”

Gnarls Barkley

“Insane in the Brain”

Today’s Agenda

• 1. What is Abnormal?– Criteria / Classification

• 2. Anxiety Disorders:– Generalized Anxiety/ Phobias/ Obsessive

Compulsive Disorders

• 3. Somatoform Disorders– Somatization Disorders/ Hypochondriasis

• 4. Dissociative Disorders– Multiple Personality Disorder

• 5. Mood Disorders– Depression/ Bipolar Disorders /Suicide

1. What IS Abnormal??

Criteria: 1) Distress is present:

Person is suffering, unhappy, afraid 2) Behaviour is maladaptive

• Impaired functioning • Inability to meet responsibilities

3) Socially Deviant Behaviour is unusual, “not normal”

Classification DSM-IV, p. 580 Why Classify?

• Simplify and create order• Research• Plan treatment

Criteria for Abnormality

Fig. 14.2 p. 608

Where is the dividing line between normal and abnormal behavior?

• Deviation from statistical average

• Deviation from cultural/societal average

1. Classification (cont’d)

Older Distinction: Neurotic vs. Psychotic

Neurotic: Distressing problem but person is still coherent and can

function socially (once acute phase of disorder is treated).

E.g. most disorders discussed today Psychotic:

More bizarre, involving delusions or halucinations. Individual has impaired thought processes and cannot function socially. Treatment is long term

E.g. schizophrenia (next week)

2. Anxiety Disorders

• Anxiety:– Fear in situations that pose no objective threat– 3 components:

• A) Cognitive:– Extreme/chronic worry; fear of harm

• B) Physiological:– Muscle tension, increased heart rate and blood pressure

• C) Behavioural:– Shaking, jumpiness, pacing, avoidance

• Generalized Anxiety Disorders (5%)– Symptoms of anxiety felt continuously for at least 6 months– Excessive worry, restlessness, sleep disturbance that are

difficult to control– More details from clip:

• http://www.youtube.com/watch?v=dRmBJhtys9g 

2. Anxiety Disorders (cont’d)

• Panic Disorders: (2-3%)– Presence of recurrent, and unexpected panic attacks:

• Intense dread, shortness of breath, chest pain, choking, fear of going crazy or losing control or dying, shaking, sweating, nausea…

– May lead to Agoraphobia (fear of open spaces)

• Phobic Disorders: (10%)– Fear of a particular object, animal or context which is irrational– Is causing distress and impairment in functioning

• Social Phobia: (3-13%)– Fear of social or performance situations

• Public speaking; • Eating, drinking, writing in public

2. Anxiety Disorders (cont’d)

• Obsessive-Compulsive Disorders (2%)– Obsessions:

• Persistent, uncontrollable thoughts

– Compulsions:• Rituals, behaviours that reduce anxiety• Interfere with functioning

– Four different themes: • Obsessions and checking• Symmetry and order• Cleanliness and washing• Hoarding

– Case examples: • Illustration from movie “As Good as it Gets”

– http://www.youtube.com/watch?v=48jD-ZEuB0I  • Howie Mandel: Germaphobic & Hypochondriac

3. Somatoform Disorders

– Hypochondriasis:• 4-9% in medical practice• Inordinate preoccupation with health and illness• excessive anxiety about having a disease

– Somatization Disorder: • (1-2% women)• History of diverse physical complaints for which

there is NO organic basis• Long medical history of treatments for minor

physical ailments

4. Dissociative Disorders

• Multiple Personality Disorder (very rare)– Presence of at least 2 distinct personalities

within the same individual– Leads to sudden changes in identity and

consciousness– Each personality has its unique style and may

unaware of the existence of the other personalities

– Often related to severe abuse in early childhood

5. Mood Disorders• Depression

– Lifetime prevalence rates• 20% in women; 10% in men

– Why more common in women?• Cost of caring

– Greater burden due to nurturing roles– Also more affected by disruptions in relational ties

• Exposure to higher levels of stress– Victimization, abuse

• Ruminative cognitive style– as opposed to distraction or taking action– Perpetuates negative mood

• More likely to report symptoms

• Seasonal Affective Disorders (SAD)– Depressive symptoms related to physiological consequences of

shorter winter days– Treatable with light therapy

5. Theories of Depression• Biological predisposition

– Concordance rates in twins:• Identical: 65%• Fraternal: 15%

– G X E models (interaction of genetic and environmental contributors)• Cognitive Perspective

– Beck: Negative (dysfunctional) attitudes– Seligman: Attribution Theory

• How do you explain your circumstances?– Internal vs external– Stable vs unstable– Global vs specific

• Depression: internal, stable, global attributions for negative events– Diathesis-stress models

• Depression results from an interaction between personality and negative life events

– Dependency and vulnerability to loss– Self-Criticism/Perfectionism and vulnerability to perceived failure

Cognitive Risk and Depression

• Featured Study p. 629

– Those with dysfunctional attitudes and depressive attributional style were more likely to become depressed over 2 year period.

5. Mood Disorders (cont’d)

• Bipolar Disorders:– Periods of depression alternate with manic episodes– Mania:

• abnormally elevated mood, inflated self-esteem, pressure of speech, increased energy, decreased need for sleep, over-activity, lack of inhibition and impaired judgment

– Prevalence rates: • 1% in men and women• Strong genetic component

– Understood as a primarily biological disorder » Unlike unipolar depression which has cognitive, interpersonal

and environmental determinants

– Case Example: Vincent Van Gogh

Comparison of symptoms of depression and mania (p. 592)

5. Suicide

• University students:– 40-50% have had suicidal thoughts – 15% attempt suicide

• 3rd leading cause of death among 15-24 year-olds

• Major Risk Factors:– Feelings of isolation; withdrawal from friends and family– Having a serious mental or physical illness

• Including mood disorder (42%)/ depression and feelings of hopelessness

– Experiencing a major loss or stressor• Leading aggression or feelings of shame, humiliation, failure, rejection• History of child abuse (leading to self-harm in women)

– Abuse of drugs or alcohol/ impulsivity (40%)– Talking about wanting to hurt oneself/ Having a plan– Feeling trapped, like there is no way out

5. Suicide (cont’d)

• How to help:– 1) Establish communication

• Talk about suicidal wishes

– 2) Identify needs that have been frustrated• Search for love, recognition, respect?

– 3) Broaden suicidal person’s perspective• Impermanence of feelings

– This too will pass

– Give yourself the chance to experience a better future

• Provide support for treatment

Resources

• Mental Health Service Information Ontario – 1-866-531-2600 http://www.mhsio.on.ca

• Mood Disorders Association of Ontario– 416-486-8049 http://www.mooddisorders.on.ca

• Until next week: