Psychological Disorders and Treatments8-10% and 7-9% (A combined 15-19% of the exam)

Questions to Consider

• How should we define psychological disorders?• How should we understand disorders? – Do underlying biological factors contribute to

disorders?– How do troubling environments influence our well-

being?– How do nature and nurture interact?

• How should we classify psychological disorders? And can we do so in a way that allows us to help people without stigmatizing them with labels?

Defining Psychological Disorders

• According to the American Psychiatric Association….

–Psychological Disorder- a syndrome marked by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior

–Disturbed behaviors are maladaptive—they interfere with everyday life

Understanding Psychological Disorders

The Medical Model

• Psychological disorders are diseases that have physical causes that can be diagnoses, treated, and in most cases, cured, often through hospitalization

• Does not account for environmental factors

The Biophychosocial Approach

• Includes the influences of both nature and nurture

• Bio- psycho- social

Psychological

Disorder

Biological Influences EvolutionGenetics

Brain structure

and chemistry

Social-Cultural

InfluencesRoles

ExpectationsDefinitions

of normality and disorder

Psychological InfluencesStress

TraumaLearned helplessness

Mood-related perception and memory

The Diathesis Stress ModelNO STRESS STRESS

NO GENETIC PREDISPOSITION

GENETIC PREDISPOSITION

Classifying Psychological Disorders

• American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (5th Edition)

• DSM-V

• Guides medical diagnoses and defines who is eligible for treatments, including medication

The Pros and Cons of Diagnostic Labels

• The Rosenhan StudyPros Cons

Clearing Up Some Terminology

• Psychologist vs. Psychiatrist

• People with psychological disorders vs. insanity

• Schizophrenic Person vs. Person with Schizophrenia

Prevalence of Psychological Disorders

• 26% of American Adults– Immigrants experience better mental health than their native US

counterparts

• 75% Experience Symptoms before Age 24

• Poverty plays a large role in psychological disorders

Risk Factors- Nature or Nurture

Psychological Disorders and Treatments

• Organization: – Name and classification (when applicable) of the disorder

(How is it classified in the DSM-V?)– Diagnostic criteria (How is it diagnosed? What are the

common symptoms? – Understanding the disorder (how do the different

perspectives contribute to the understanding of the disorder and how it is formed?)

Anxiety Disorders- ClassificationAnxiety Disorders

Generalized Anxiety Disorder

Panic Disorders

Specific Phobias

Social Anxiety Disorder

Agoraphobia

Anxiety Disorders- Diagnostic Criteria

• Distressing, persistent anxiety or maladaptive behaviors that reduce quality of life

• Duration of 6 months or more

Generalized Anxiety Disorder- Diagnostic Criteria• Continually tense, apprehensive, and in a state of

autonomic nervous system arousal

• Worry continuously, jittery, agitated, and sleep-deprived

• May cause a depressed mood and lead to physical problems such as high blood pressure

• Debilitating- interferes with normal functioning

Panic Disorders- Diagnostic Criteria

• Marked by unpredictable, minutes-long episodes of intense dread in which a person experiences terror, accompanying chest pain, choking , or other frightening sensations

Specific Phobia- Diagnostic Criteria

• Irrational fears cause the person to avoid some object

• Individual become incapacitated by their efforts to avoid the fearful situation

Social Anxiety Disorder- Diagnostic Criteria

• Intense fear of being scrutinized by others, avoiding potentially embarrassing social situations, such as speaking up, eating out, or going to parties

• Fear of performance situations is a specialized subset

Agoraphobia- Diagnostic Criteria

• Fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control or panic

Obsessive Compulsive Disorder- Diagnostic Criteria• Characterized by unwanted repetitive thoughts

(obsessions) and or actions (compulsions)

• Persistently interfere with everyday living and causes distress

• Onset occurs in the late teens or 20s; effects 2-3 percent of the population

OCD in Mrs. Lallemand’s Favorite Movie

Crash Course- Anxiety and OCD

Posttraumatic Stress Disorder- Diagnostic Criteria• Classified under Trauma and Stress Related Disorders

• 4 Diagnostic Criteria– Re-experience (through dreams or thoughts)– Avoidance (of situations or people)– Persistent Negative Alterations in Cognition and Mood

(numbing of mood, persistent negative emotional state)

– Alteration in Arousal and Reactivity (includes irritability, aggressive behavior, reckless or self-destructive behavior)

Analysis of Anxiety Disorders, OCD, and PTSD How do they Form? • From the behavioral perspective – Classical conditioning– Operant conditioning– Observational learning

• Biological perspective– Natural selection– Genes– The brain

Mood Disorders-Classification

Mood Disorders (Not a DSM-V Term)

Major Depressive Disorder

Bipolar Disorder

Psychological disorders characterized

by emotional extremes

Major Depressive Disorder-Diagnosis

• The presence of at least five of the following symptoms over a two week period of time

– Depressed mood most of the day

– Markedly diminished interest or pleasure in activity most of the day

– Significant weight loss or gain when not dieting, or significant decrease or increase in appetite

– Insomnia or sleeping too much

Major Depressive Disorder-Diagnosis

• The presence of at least five of the following symptoms over a two week period of time

– Physical agitation or lethargy

– Fatigue or loss of energy

– Feeling worthless, or excessive or inappropriate guilt

– Problems in thinking, concentrating, or making decisions

– Recurrent thoughts of death or suicide

Bipolar Disorder- Diagnostic Criteria

• Mania- a mood disorder marked by hyperactive, widely optimistic state

• Individuals with bipolar disorder alternate between depression and mania (from week to week, not day to day)

Understanding Mood Disorders

• Some facts about depression….– Many behavioral and cognitive changes accompany

depression

– Depression is widespread

– Women’s risk of major depression is double that of men’s

– Most major depressive episodes self-terminate

Understanding Mood Disorders

• Some facts about depression…– Stressful events related to work, marriage, or relationships

often precede depression

– With each new generation, depression is striking earlier, affection more people, with the highest rates in developed countries

– Depression has 37% heritability, bipolar disorder 80%

Understanding Mood Disorders

The Biological Perspective

• Mood disorders run in families

– Heritability of depression is 37%

– Heritability of bipolar disorder is 80%

The Biological Perspective

• The Depressed Brain

• Lower levels of serotonin and dopamine

PET Scan of Depressed vs. Bipolar Brain

• Review: How does a PET scan work? What can it show us?• PET scans show that energy consumption in the brain goes

up during manic episodes of bipolar disorder

The Social-Cognitive Perspective

• Learned helplessness- when faced with adverse events, an individual (animal or human) may begin to believe that they have no control over situations and begin to feel hopeless

• Rumination- staying focused on a problem

– Adaptive when trying to solve an external problem or overcome a challenge

– Problematic when self-focused

The Social-Cognitive Perspective

• Depression prone people tend to respond to bad events in an especially self-focused, self-blaming way

• Think about it from a mindset perspective…

Crash Course- Depression and Bipolar Disorder

Schizophrenia-Classification

• Means “split mind”– NOT THE SAME AS MULTIPLE PERSONALITY DISORDER OR

SPLIT BRAIN RESEARCH!!– Split, as in split from reality

• Classified under Schizophrenia Spectrum and Other Psychotic Disorders

• Psychosis- a psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions

Schizophrenia- Diagnosis and Symptoms

• Individual exhibits two of the following symptoms – Delusions– Hallucinations– Disorganized speech and behavior – Other symptoms that cause social and occupational

dysfunction (often diminished or inappropriate emotion)

• Symptoms present for 6 months with at least 1 month of active symptoms

Delusions vs. Hallucinations

• Delusions- false thoughts– Often about grandeur or persecution– Can manifest as paranoia- fear based delusions

• Hallucinations- false sensory experiences– Seeing, hearing, smelling, or tasting something

that is not actually there– Auditory hallucinations are common, hearing

voices, often persecuting or ordering

Anderson Cooper Schizophrenia Simulation

Inappropriate Emotions and Disorganized Behaviors • Emotions

– Expressed emotions are utterly inappropriate – Anger for no reason, laughing when others are crying– May exhibit flat affect- expressing no emotions at all– Most have difficulty perceiving facial emotions and

exhibiting empathy

• Behaviors– Senseless, compulsive acts such as continually rocking or

rubbing arms– Catatonic (motionless for hours), followed by becoming

agitated

Onset and Development

• Strikes as young people are maturing into adulthood

• Affects 1 in 100 people

• All cultures are susceptible

• Effects both men and women, thought men seem to get it earlier and it strikes more severely

Onset and Development

• Can appear suddenly in reaction to stress (easier to treat)

• Can develop gradually- typically individuals with a history of social inadequacy and poor school performance (harder to treat)

• Positive Symptoms- hallucinations, disorganized talking, inappropriate emotions

• Negative Symptoms- toneless voice, expressionless faces, mute rigid bodies

Understanding Schizophrenia- Biological Perspective

Neurotransmitters

• Dopamine over activity

• Brains of deceased schizophrenics show a six fold increase in dopamine receptors

• Intensified hallucinations and paranoia

Abnormal Brain Anatomy and Activity

Review…what are the functions of the following brain structures?

• Thalamus-

• Amygdala-

• Corpus callosum-

• Cerebrum/ cortex/ cerebral cortex-

• Frontal Lobe (a portion of the cortex)-

Abnormal Brain Anatomy and Activity

Review…what are the functions of the following brain structures?

• Thalamus- filters incoming sensory information and relays it to the proper area of the cortex for processing and storage

• Amygdala- fear processing center

• Corpus callosum- connection between the two hemispheres of the brain

• Cerebrum/ cortex/ cerebral cortex- where sensory information is processed, memories are stored, and higher order thinking occurs

• Frontal Lobe (a portion of the cortex)- reasoning, planning, and problem solving

Abnormal Brain Anatomy and ActivityConsidering the function of each part of the brain and the symptoms of schizophrenia, try to predict how the brains of schizophrenic patients may differ from a nonschizophrenic individual.

Abnormal Brain Anatomy and Activity

• Thalamus- PET scans show increased activity during hallucinations

• Amygdala- PET scans show increased activity during paranoid episodes

• Increased fluid and smaller brain regions (cortex, thalamus, and corpus callosum) slows neural firing and interrupts coordination of neural signaling

• Frontal Lobe (a portion of the cortex)- a noticeable decline in the brain waves

Genetic Factors

• Twin studies show an increased risk 60-70% of identical twins both being diagnosed with schizophrenia vs. 10-30% for fraternal twins

Nature via Nurture

• Low birth weights, maternal diabetes, older paternal age, and oxygen deprivation during delivery

• Brain fully develops during midpregancy (2nd trimester)

• Viral infections during pregnancy– Increased risk if the country experiences a flue epidemic – Increased risk if you are born in more densely populated

area– Increased risk if you were born in the spring or summer – Increased risk if your mother was sick while pregnant

Nurture- Risk Factors

• A mother whose schizophrenia was severe or long-lasting

• Birth complication, often involving oxygen deprivation and low birth weight

• Short attention span and poor muscle coordination

• Disruptive or withdrawn behavior

• Emotional unpredictability

• Poor peer relations and solo play

Other DisordersO

ther

Dis

orde

rs

Somatic Symptom and Related Disorders

Somatic Symptom Disorder

Illness Anxiety Disorder

Dissociative Disorders Dissociative Identity Disorder

Eating Disorders

Anorexia nervosa

Bulimia nervosa

Binge Eating Disorder

Personality Disorders Antisocial Personality Disorder

Somatic Symptom Disorder• Psychological disorder in which the symptoms take a somatic

(bodily) form without apparent physical cause

• Vomiting, dizziness, blurred vision, difficulty in swallowing, prolonged pain

• Can be strongly influenced by culture

• Diagnostic Criteria: – Persistently symptomatic (at least 6 months)– Significantly distressing or disruptive to daily life and must

be accompanied by excessive thoughts, feelings, or behaviors

Illness Anxiety Disorder

• Formerly known as hypochondria

• Disorder in which the individual interprets normal physical sensations as symptoms of a serious disease

• Diagnostic Criteria: heightened bodily sensations, are intensely anxious about the possibility of an undiagnosed illness, or devote excessive time and energy to health concerns, often obsessively researching them

Dissociative Identity Disorder

• A rare disorder in which a person has two or more distinct and alternating personalities

• Diagnostic Criteria– Two or more distinct personality states must be present,

each with their own way of being– Recurrent gaps in the recall of everyday events, important

personal information, and/or traumatic events that are inconsistent with ordinary forgetting

– No substance abuse problems

Dissociative Disorder Controversy- is it a real disorder?• Disorder is localized in

time and space

• We are all capable of presenting a different version of ourselves

• Hillside strangler case

• Individuals diagnosed show heightened brain activity in brain areas associated with the control and inhibition of traumatic memories

• Psychodynamic theory and learning theory support a possible mechanism

Crash Course!

Eating Disorders

• You have notes about this! Look in the motivation and emotion unit!

Personality Disorders

• A collection of psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning

• Divided into three “clusters” with key characteristics

Personality Disorders

• Cluster A- Eccentric or odd behaviors– Paranoid– Schizoid– Schizotypal

• Cluster B- dramatic or impulsive behaviors– Antisocial – Borderline (I love you, I hate you, Please don’t leave me)– Histrionic (attention seeking)– Narcissistic (intense love of self)

• Cluster C- Fearful sensitivity to rejection – Avoidant– Dependent– Obsessive-compulsive

Antisocial Personality Disorder-Diagnosis

• Significant impairments in personality functioning manifest by impairments in self-functioning and interpersonal functioning.

• Self-Functioning: – Identity: Ego-centrism; self-esteem derived from personal gain, power, or

pleasure. – Self-direction: Goal-setting based on personal gratification; absence of

prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behavior.

• Impairments in interpersonal functioning (a or b): – Empathy: Lack of concern for feelings, needs, or suffering of others; lack

of remorse after hurting or mistreating another. – Intimacy: Incapacity for mutually intimate relationships, as exploitation is

a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.

Antisocial Personality Disorder

• The most troubling and heavily research of the personality disorders

• Sociopath/psychopath

• Male that shows symptoms before age 15

• Criminality is not an essential component, but about 50% participate in criminal behavior

• Behave impulsively and then feel and fear little

Understanding Antisocial Personality Disorder• Specific genes associated with antisocial personality disorder

have been identified

• Individuals with the disorder show little fear and little autonomic nervous system arousal, low levels of stress hormones

• If channeled it may lead to adventurousness, heroism, and athleticism

• The genes that put individuals at risk for antisocial personality disorder also put them at risk for substance abuse problems

Understanding Antisocial Personality Disorder• Decreased brain activity in the frontal lobe and the area of the

cortex that helps control impulses

• Deficits in frontal lobe functions such as planning, organization, and inhibition

• Respond poorly to the facial displays of those in distress

• Inability to feel empathy

Crash Course!