Ch15_Disorders.ppt

Psychopathology WARNING!!! •Psychopathology field concerned with the nature and development of abnormal behavior, thoughts, and feelings •the domain of abnormal psychology, clinical psychology, counseling psychology and psychiatry Defining Abnormal Behaviour •Statistical infrequency •Violat...

Psychopathology WARNING!!! •Psychopathology field concerned with the nature and development of abnormal behavior, thoughts, and feelings •the domain of abnormal psychology, clinical psychology, counseling psychology and psychiatry Defining Abnormal Behaviour •Statistical infrequency •Violation of norms •Personal distress •Disability or Dysfunction •None of these by themselves yield a fully satisfactory definition What is Abnormal? What is (Ab)Normal? The Five D’s of Abnormality •Deviance Norms and averages Culture •Distress Suffering •Dysfunction Disruptions in daily functioning •Dangerosity Threat to oneself or others What is Normal? •Not easy to define the line b/t what is normal and what is abnormal isn’t always clear-cut and easy to specify an arbitrary line! •Mental disorder is best viewed as a continuum No Disorder Mild Disorder Moderate Disorder Severe Disorder Psychological disorders are: patterns of thoughts, feelings, or actions that are deviant, distressful, and dysfunctional. Terms from the Definition  Disorder refers to a state of mental/behavioral ill health.  Patterns refers to finding a collection of symptoms that tend to go together, and not just seeing a single symptom.  For there to be distress and dysfunction, symptoms must be sufficiently severe to interfere with one’s daily life and well being.  Deviant means differing from the norm. Insanity •Tends to be confused with mental illness -legal term only •Insanity defense infrequently used; generally unsuccessful when it is •“not criminally responsible on account of mental disorder” Insanity and Responsibility  Jared Loughner shot many people, including a U.S. Representative, in 2011.  Loughner had schizophrenia and substance abuse problems, a combination associated with increased violence. To what degree, if any, should he be held responsible for his actions? What is the appropriate consequence? Objectivity •A Psychological Dysfunction Associated With Distress or Impairment in Functioning That is not a Typical or Culturally Expected Response Objectivity •Meaning of behavior is jointly determined by its content and context •Judgments about where the line between normal and abnormal should be drawn differ depending on the time and culture American physician Samuel A. Cartwright •Judgments of abnormality have often been made by individuals to preserve their moral or political power •Soviet Socialist Realism •1940s “career woman” •It is current practice in China to institutionalize members of the Falun Gong religion Cultural Influences on Disorders Culture-bound syndromes are disorders which only seem to exist within certain cultures; they demonstrate how culture can play a role in both causing and defining a disorder. Examples: Bulimia Nervosa: binging/purging, in the United States Running amok: violent outbursts, in Malaysia Hikikomori: social withdrawal, in Japan Culture-bound syndromes WHAT IS NORMAL??? •If definitions of mental illness and abnormality vary across cultures can we really speak of mental illness at all? Mental Illness as Social Construction •Emile Durkheim, 1895, The Rules of Sociological Method •Ruth Benedict, 1934, Anthropology and the Abnormal - Shamanism The Myth of Mental Illness Sociological Model of Mental Illness - In the mind of the beholder •Thomas Szasz (1961) mental illness as myth - doesn’t exist •what we call “mental illness” is really a contrivance of the medical community, government, and organized religion to “The term ‘mental illness’ is a metaphor. Bodily illness stands in the same relation to mental illness as a defective television set stands to a bad television programme. [...] It is as if the television viewer were to send for a TV repairman because he dislikes the programme he sees on the screen.” (Szasz (1971) The Manufacture of Madness) Pharmacracy (2001) continues his long quest to “comfort the afflicted and afflict the comfortable” www.pfizer.com “Depression is a real medical condition. Everyone has times when they're feeling down. If you have depression, this sad mood along with other symptoms can last weeks, months, or even years if not treated. Depression isn't a sign of weakness or a character flaw. It's a real medical condition, but there are ways to successfully treat depression”. Labeling Theory •Diagnosis is a way to stigmatize people a society considers deviant labeling is dangerous people into patients discrimination self-fulfilling prophecy •Rosenhan (1973) classic study: Being sane in an insane place Labeling Theory Judgment of all admissions patients as to the likelihood that they are pseudo patients On Being Deceitful •Critics argued that the study led to some very dramatic but largely incorrect conclusions •Clearly, labeling has grains of truth but... The DSM-IV •Diagnostic and Statistical Manual of Mental Disorders, APA (1994, 2000) 1st published in 1952 •a descriptive, atheoretical aid to diagnosis •assumes the disease model •groups psychological disorders into categories The DSM-IV The DSM-IV • when making a diagnosis clinician must describe patient’s condition according to each Axis • Axes I and II make up the mental disorders per se (state and trait disorders) • Axis III lists any physical disorders believed to bear on the mental disorder • Axis IV indicates psychosocial and environmental problems (stressors) • Axis V rates person’s current level of adaptive functioning (GAF) Global Assessment of Functioning •90 - Absent or minimal symptoms, good functioning in all areas •10 - Persistent danger of severely hurting self or others Example of a multiaxial evaluation. A multiaxial evaluation for a depressed man with a cocaine The DSM-IV •Naming and describing disorders facilitates communication, treatment, and research •DSM-1 (1952) - 100 diagnoses •DSM-4 (1994) - almost 300 diagnoses - need to distinguish disorders precisely to treat them properly, or - insurance companies require clinicians to assign clients appropriate DSM code # https://tinyurl.com/2bjkt8p4 Problems with the DSM •danger of overdiagnosis •power of labels •confusion with normal problems Problems with the DSM •DSM-5 •“Oppositional Defiant Disorder” •“Relational disorders” •“Compulsive shopping” •“Self-defeating personality disorder” Problems with the DSM •ever-growing list of psychiatric disorders and their overly inclusive symptoms, including bad handwriting, impulsive A Diagnostic & Statistical Manual of Mental Disorders Pathology OF THE DSM-5 TASK FORCE MEMBERS, 69% REPORT HAVING TIES TO THE PHARMACEUTICAL INDUSTRY COSGROVE, L. & DRIMSKY, L. (2012). Poor Mental Health or Mental Illness? “The DSM is not called the ‘Diagnostic and Statistical Manual of Mental Disorders and a Whole Bunch of Everyday Problems in Living.’ It is marked simply as a manual of mental disorders.” From, “They Say You’re Crazy” Paula J. Caplan, Ph.D. William Glasser, M.D. “Few, if any, mental health professionals embrace mental health as an entity” From, “Defining Mental Health as a Public Health Problem” www.wglasser.com • Canadian Institute for Health Information, 2005-06 • people who are homeless are more likely to experience mental illness or poor mental health, but which comes first - the illness or the homelessness -- is more difficult to determine • people with mental illness and/or substance abuse problems are over-represented among the homeless • biggest increase occurred in the 1990s when many provinces lowered welfare rates and limited investment in social housing Problems with the DSM •Internet Addiction Disorder? - pathological Internet use similar to pathological gambling insofar as it also involves a failure of impulse control without involving an intoxicant • Preoccupation with the Internet (thinking about it while offline) • Inability to control Internet use • Using the Internet to escape problems • Going through withdrawal when offline • Staying online longer than originally intended • https://www.macleans.ca/society/life/i s-she-a-brat-or-is-she-sick/ Anxiety Disorders Anxiety Disorders GAD: Generalized Anxiety  Emotional-cognitive Disorder symptoms include worrying, having anxious feelings and thoughts about many subjects, and sometimes “free-floating” anxiety with no attachment to any subject. Anxious anticipation interferes with concentration.  Physical symptoms include autonomic arousal, trembling, sweating, fidgeting, agitation, and sleep disruption. Anxiety Disorders Panic Disorder: “I’m Dying” A panic attack is not just an “anxiety attack.” It may include: many minutes of intense dread or terror. chest pains, choking, numbness, or other frightening physical sensations. Patients may feel certain that it’s a heart attack. a feeling of a need to escape. Panic disorder refers to repeated and unexpected panic attacks, as well as a fear of the next attack, and a change in behavior to avoid panic attacks. Anxiety Disorders Specific Phobia A specific phobia is more than just a strong fear or dislike. A specific phobia is diagnosed when there is an uncontrollable, irrational, intense desire to avoid the some object or situation. Even an image of the object can trigger a reaction--“GET IT AWAY FROM ME!!!”--the uncontrollable, irrational, intense desire to avoid the object of the phobia. Anxiety Disorders Anxiety Disorders Obsessive-Compulsive [OCD]  ObsessionsDisorder are intense, unwanted worries, ideas, and images that repeatedly pop up in the mind.  A compulsion is a repeatedly strong feeling of “needing” to carry out an action, even though it doesn’t feel like it makes sense.  When is it a “disorder”?  Distress: when you are deeply frustrated with not being able to control the behaviors or  Dysfunction: when the time and mental energy spent on these thoughts and behaviors interfere with everyday life Common OCD Behaviors Percentage of children and adolescents with OCD reporting these obsessions or compulsions: Common pattern: RECHECKING Although you know that you’ve already made sure the door is locked, you feel you must check again. And again. Anxiety Disorders • Excoriation (skin picking) disorder • Trichotillomania, now termed trichotillomania disorder (hair pulling), moved to OCD chapter; • No longer classified as an impulse control disorder • DSM-5 includes conditions in this chapter such as: • Body-focused repetitive behavior disorder – other than excoriation and trichotillomania i.e. nail biting, lip chewing Post-Traumatic Stress Disorder [PTSD] About 10 to 35 percent of people who experience trauma not only have burned-in memories, but also four weeks to aintrusive lifetime of: repeated recall of those memories.  nightmares and other re-experiencing.  social withdrawal or phobic avoidance.  jumpy anxiety or hypervigilance. Which People get PTSD?  Those with less control in the     situation Those traumatized more frequently Those with brain differences Those who have less resiliency Those who get re-traumatized Resilience and Post-Traumatic Growth Resilience/ recovery after trauma may include: some lingering, but not overwhelming, stress. finding strengths in yourself. finding connection with others. finding hope. seeing the trauma as a challenge that Biology and Anxiety: An Evolutionary Perspective 1. Human phobic 2. Similar but non- objects: phobic objects: Snakes Fish Heights Low places Closed spaces Open spaces Bright light 3. Dangerous Darkness yet non-phobic subjects: We are likely to become cautious about, but not phobic about: Guns Electric wiring Cars  Evolutionary psychologists believe that ancestors prone to fear the items on list #1 were less likely to die before reproducing.  There has not been time for the innate Preparedness Hypothesis • This theory suggests that we carry an innate biological tendency, acquired through natural selection, to respond quickly and automatically to stimuli that posed a survival threat to our ancestors. – May explain why we develop phobias for snakes and lightning much more easily than automobiles and electrical outlets • The Greeks called depression melancholia, meaning “black bile” Mood Disorders  Involve dramatic changes in a person’s emotional mood that are excessive and unwarranted Major Major Depressive Depressive Disorder Disorder Bipolar Bipolar Disorder Disorder prevalence of MDD during a lifetime is 16.6 percent WHO BECOMES DEPRESSED? • Studies show that depression rates are higher in women. The difference may be in the way men and women handle emotional situations. – Women tend to be introspective: • Think about their feelings and what may be causing them. – Men, on the other hand, try to distract themselves from the depressed feelings. • This suggests the more ruminative response of women increases their vulnerability to depression. – Depression breeds depression • may occur in a milder form called persistent depressive disorder (or dysthymia) • Nonspecific descriptions may be used for some symptoms of depressive disorders – For example, “changes in body weight” Bipolar Disorder  Bipolar disorder was once called “manic-depressive disorder.”  Bipolar disorder’s two polar opposite moods are depression and mania. Mania refers to a period of hyperelevated mood that is euphoric, giddy, easily irritated, hyperactive, impulsive, overly Contrasting Symptoms optimistic, and even Depressed mood: stuck Mania: euphoric, giddy, grandiose. feeling “down,” with: easily irritated, with: exaggerated pessimism social withdrawal lack of felt pleasure inactivity and no initiative  difficulty focusing  fatigue and excessive desire to sleep      exaggerated optimism  hypersociality and sexuality  delight in everything  impulsivity and overactivity  racing thoughts; the mind won’t settle down  little desire for sleep PET scans show that brain energy consumption rises and falls with emotional swings  The incidence of bipolar disorder is the same in men and women  occurs in approximately 1% of the population Understanding Mood Disorders: The SocialCognitive Perspective Discounting positive Low SelfEsteem information and assuming the worst about self, situation, and the future Depression is associated with: Ruminatio n Learned Helpless ness Depressi ve Explanat ory Style Stuck focusing on what’s bad Self-defeating beliefs such as assuming that one (self) is unable to cope, improve, achieve, or be happy Depressive Explanatory Style How we analyze bad news predicts mood. Problematic event: Assumptions about the problem The problem is: The problem is: The problem is: Mood/result that goes along with these Depression’s Vicious Cycle A depressed mood may develop when a person with a negative outlook experiences repeated stress. The depressed mood changes a person’s style of thinking and interacting in a way that makes stressful experience more likely. Personality Disorders Dramatic and Emotional  Histrionic  Colorful, dramatic, extremely extroverted   Like a peacock Cannot develop deep, long-lasting relationships   Excitable, but shallow emotionally Everyone must see them   Personality Disorder Everything is skin deep Respond only to external success measures   Money, physical beauty Spend time with plastic surgeons Dramatic and Emotional  Narcissistic  Heightened sense of self importance   For absolutely no reason Grandiose about abilities, attractiveness    Personality Disorder Feel unique in someway Need to associate with other high status persons Unempathic  Step over anyone, anytime Borderline Personality Disorder  Pervasive pattern of poor impulse control and instability in mood, interpersonal relationships, and self-image  BPD’s  The central feature is that of instability way that people with BPD relate to others is termed “splitting”  Antisocial  personality disorder "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.”  history of conduct disorder  sociopath and psychopath  one study of 22,790 prisoners  47% of men and 21% of women were diagnosed with APD  less activity in amygdala and hippocampus to words that elicit fear in non-APD Antisocial PD ≠ Criminality Many career criminals do show empathy and selflessness with family and friends. Many people with A.P.D. do not commit crimes. Biosocial Roots of Crime: The Brain People who commit murder seem to have less tissue and activity in the part of the brain that suppresses impulses. Other differences include: less amygdala response when viewing violence. an overactive dopamine reward-seeking system. Dissociative Disorders Dissociation A disruption in the normally integrated functions of identity, consciousness, memory, and perception  Not due to the effects of a substance or a general medical condition  Results in amnesia, depersonalization, and/or multiple personalities in the same individual Common Dissociative Experiences in Everyday Life            Daydreaming Missing parts of conversations Vivid fantasizing Forgetting part of drive home Calling one number when intending to call another Driving to one place when intending to drive elsewhere Reading an entire page & not knowing what you read Not sure whether you’ve done something or only thought about doing it Seeing oneself as if looking at another person Remembering the past so vividly you seem to be reliving it Not sure if an event happened or was just a dream Possible Causes of Dissociation Fatigue  Sleep deprivation  Stress  Binge drinking  Drug use  Confronting a new environment  Feeling preoccupied or conflicted  Engaging in certain religious or cultural rituals or events   Dissociation refers to a separation of conscious awareness from thoughts, memory, bodily sensations, feelings, or even from identity.  Dissociation can serve as a psychological escape from an overwhelmingly stressful situation.  A dissociative disorder refers to dysfunction and distress caused by chronic and severe dissociation. Loss of memory with no known physical Dissociati ve Disorders Examples: Dissociative Amnesia: cause; inability to recall selected memories or any memories Dissociative Fugue “Running away” state; wandering away from one’s life, memory, and identity, with no memory of these Dissociative Identity Disorder (D.I.D.) Development of separate personalities Dissociative Identity Disorder Dissociative Identity Disorder (D.I.D.) formerly “Multiple PersonalityAlternative Disorder” In the rare actual cases of D.I.D., the personalities: are distinct, and not present in consciousness at the same time. may or may not appear to be aware of each other. Explanations for D.I.D. Dissociative “identities” might just be an extreme form of playing a role. D.I.D. in North America might be a recent cultural construction, similar to the idea of being possessed by evil spirits. Cases of D.I.D. might be created or worsened by therapists encouraging people to the mind is split from reality, e.g. a split from Schizophrenia: one’s own thoughts so that they appear as hallucinations. Psychosis refers to a mental split Schizophrenia from reality symptoms and include: rationality. disorganized and/or delusional thinking. disturbed perceptions. inappropriate emotions and actions. Schizophrenia Symptoms: Problems in Thinking and Speaking  Disorganized speech, including the “word salad” of loosely associated phrases  Delusions (illusory beliefs), often bizarre and not just mistaken; most common are delusions of grandeur and of persecution  Problems with selective attention, difficulty filtering thoughts and choosing which thoughts to believe and to say out loud ?!?! ?!?! Schizophrenia Symptoms: Disturbed Perceptions  People with schizophrenia often experience hallucinations, that is, perceptual experiences not shared by others.  The most common form of hallucination is hearing voices that no one else hears, often with upsetting (e.g. shaming) content.  Hallucinations can also be visual, olfactory/smells, tactile/touch, or gustatory/taste. Am I evil? You’re evil! Schizophrenia Symptoms: Inappropriate Emotions  Odd and socially inappropriate responses such as looking bored or amused while hearing of a death  Flat affect: facial/body expression is “flat” with no visible emotional content  Impaired perception of emotions, including not “reading” others’ intentions and feelings Schizophrenia Symptoms: Inappropriate Actions/Behavior Odd and socially inappropriate behavior can be caused by symptoms such as: errors in social perception. disorganized, unfiltered thinking. delusions and hallucinations. The schizophrenic body exhibits symptoms such as: repetitive behaviors such as rocking and rubbing. catatonia, such as sitting motionless and unresponsive for hours. • Catatonia • Wavy Flexibility Subtypes of Schizophrenia Development of Schizophreni a  Onset: Typically, schizophrenic symptoms appear at the end of adolescence and in early adulthood, later for women than for men.  Prevalence: Nearly 1 in 100 people develop schizophrenia, slightly more men than women.  Development: The course of schizophrenia can be acute/reactive or chronic. Course of Schizophrenia Acute/Reactive Schizophrenia In reaction to stress, some people develop positive symptoms such as hallucinations. – Recovery is likely. Chronic/Process Schizophrenia develops slowly, with more negative symptoms such as flat affect and social withdrawal. – With treatment and support, there may be periods of a normal life, but not a cure. Positive and Negative Symptoms of Schizophrenia Positive + presence of problema tic behaviors    Hallucinations (illusory perceptions), especially auditory Delusions (illusory beliefs), especially persecutory Disorganized thought and nonsensical speech Negativ eabsence of healthy behaviors     Flat affect (no emotion showing in the face) Reduced social interaction Anhedonia (no feeling of enjoyment) Avolition (less motivation, 09_05 KH2F0905 60 First-Degree Relative 50 46% Second-Degree Relative 48% Third-Degree Relative 40 Percentage 30 of Risk Unrelated Person 20 17% 13% 10 1% 2% 2% 2% 5% 4% 6% 6% 9% 0 Spouse First Cousin General Population Grandchild Half Sibling Uncle or Aunt Nephew or Niece Parent Offspring of One Schizophrenic Parent Offspring of Two Schizophrenic Parents Sibling Relationship to Schizophrenic Person Fraternal Twin Identical Twin But nearly 80% of people with a greater risk for developing the disorder never do ….so there must be other factors Hypofrontality Understanding Schizophrenia Are there biological risk factors affecting early development? Biological Risk Factors Schizophrenia is somewhat more likely to develop when one or more of these factors is present:  low birth weight  maternal diabetes  older paternal age  famine  oxygen deprivation during delivery  maternal virus during midpregnancy impairing brain Schizophrenia is more likely to develop in babies born: during and after flu epidemics. in densely populated areas. a few months after flu season. after mothers had the flu during the second trimester, or had antibodies showing viral infection. Theget lesson is to: flu shots with early fall pregnancies. Neurodevelopmental Hypothesis Diathesis-Stress Model  Diathesis   Stress   Predisposition (e.g., genetic) for disorder Triggers disorder Both diathesis (risk) and stress must be present for disorder The Biopsychosocial Approach Mental disorders can arise in the interaction between nature and nurture caused by biology, thoughts, and the sociocultural environment.