Psychological Disorders PDF - Chapter 13

Chapter 13 Psychological Disorders Res. Assist. Selen Eltan Çıldır 1 Overview Anxiety Somatic Perspectives Mood Disorders Disorders Disorders...

Chapter 13 Psychological Disorders Res. Assist. Selen Eltan Çıldır 1 Overview Anxiety Somatic Perspectives Mood Disorders Disorders Disorders Personality Schizophrenic Childhood Sexual Disorders Disorders Disorders Disorders Culture and Gender 2  Enduring Issues Mind- Diversity- Stability- Body Person- Universality Change Nature- Situation Nurture 3  Normal vs. Abnormal ◦ Abnormality is defined as ◦ deviation from the average (statistical and social norms) ◦ creating a sense of personal discomfort ◦ the inability to function effectively (in social, academic or occupational life) ◦ a legal concept 4  Perspectives on Abnormality ◦ Supernatural view - abnormal behavior as the work of evil spirits, demons, gods, or witches who took control of the person. ◦ Hippocrates - rejecting the idea of demonic possession; mental disorders were akin to physical disorders and had natural causes. ◦ During the Middle Ages - methods such as exorcism, flogging, prayer, the touching of relics, chanting, visiting holy sites, and holy water were used to rid the person of the Devil’s influence. In extreme cases, the afflicted were confined, beat, and even executed. ◦ Renaissance – the rise of humanism ◦ Moral Treatment Movement (18th to 19th Centuries) - importance of affording the mentally ill respect, moral guidance, and humane treatment ◦ Mental Hygiene Movement 5 Medical/Biological Perspective Physiological causes (biochemical malfunctions, heredity) Psychoanalytic Perspective Unconscious mental conflicts stem from childhood or infancy Behavioral Perspective Learned maladaptive responses Cognitive Perspective Cognitive distortions and faulty beliefs Humanistic Perspective people’s responsibility for their own behavior, need to self-actualize Sociocultural Perspective behavior is shaped by family, society, and culture Diathesis-Stress Model: Mental disorders develop when a diathesis (biological predispositon to the disorder) is triggered by a stressful circumstance Systems Theory (Biopsychosocial Model): Biological risks, psychological stresses, and social pressures and expectations combine to produce psychological disorders 6  Classifying Psychological Disorders ◦ The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the most widely used system to classify and define psychological disorders ◦ The shortcomings of DSM 2022 ◦ Disorders classified as diseases – too medically oriented ◦ E.g. Premenstrual dysphoric disorder ◦ Lists of symptoms – dehumanizing 2013 ◦ The stigma of labeling ◦ E.g. Gender dysphoria 7  Prevalence of Psychological Disorders ◦ Prevalence → frequency with which a given disorder occurs at a given time ◦ Incidence → number of new cases that arise in a given period 8 In a 2014 survey ◦ 17.6% of respondents were identified as meeting criteria for a common mental disorder during the 12-months preceding assessment ◦ 29.2% of respondents were identified as having experienced a common mental disorder at some time during their lifetimes ◦ Gender differences ◦ males were more likely to experience an alcohol or other substance use disorder. ◦ women having higher rates of mood and anxiety disorders Steel, Z., Marnane, C., Iranpour, C., Chey, T., Jackson, J. W., Patel, V., & Silove, D. (2014). The global prevalence of common mental disorders: A systematic review and meta-analysis 1980-2013. International Journal of Epidemiology, 43(2), 476–493. https://doi.org/10.1093/ije/dyu038 9  Mental Illness and the Law Insanity – legal term not a psychological one Those people are not considered responsible for their criminal actions lacked substantial capacity to appreciate the criminality of their actions (to know right from wrong) or to conform to the requirements of the law (to control their behavior) 10 MOOD DISORDERS 11 ◦ Characterized by disturbances in mood or prolonged emotional state ◦ Mood disorders are the second most common category of psychiatric disorders after anxiety disorders 12  Depression ◦ Most common form of mood disorders ◦ Symptoms ◦ Overwhelming feelings of sadness ◦ Lack of interest in activities and sex ◦ Significant weight loss or gain ◦ Sleep and eating disturbances ◦ Trouble in concentrating and thinking ◦ Excessive feelings of guilt, hopelessness, worthlessness ◦ Suicidal thoughts and suicide attempts 13 ◦ 2 forms of depression ◦ Major depressive disorder A severe form of depression that intenferes with concentration, decision making, and sociability May last for several months ◦ Dysthymia Less intense depressive symptoms but may last for periods of two years or more 14  Mania ◦ Not as common as depression ◦ Symptoms ◦ Racing thoughts ◦ Highly distractible ◦ Emotional heights (euphoria) ◦ Sometimes aggressive and hostile ◦ Extreme physical activity ◦ Grandiosity (believing they will ◦ Excessive talkativeness succeed at anything they attempts, feeling of infinite power) ◦ Decreased need for sleep ◦ Acting recklessly and impulsively 15  Bipolar Disorder ◦ Sequentially experiencing periods of mania and depression ◦ Swings between highs and lows may occur a few days apart or may alternate over a period of years ◦ Periods of depression usually longer than periods of mania ◦ Creativeness vs. recklessness 16  Causes of Mood Disorders Biological Biological Factors Factors Twin studies demonstrate that genetic factors play a role in development of mood disorders Psychological (stronger evidence for bipolar disorder) Factors Several neurotransmitters play a role in mood disorders (alterations in the functioning of serotonin and norepinephrine in the brain) Social Factors 17 Psychological Factors Psychoanalytic approaches see depression as the result of feeling of loss (real or potential) Behavioral theories argue that depression is a way of receiving attention (positive reinforcers) Cognitive factors Martin Seligman suggests that depression is largely response to learned helplessness. Aaron Beck has proposed that negative cognitions underlie people’s depressed feelings. Evolutionary psychology view depression as an adaptive response to attainable goals. 18 Social Factors Depression is linked to troubled close relationships Women > men More stressful lifestyle and social expectations from a woman Women have a greater risk for physical and sexual abuse, earn lower wages etc. Different coping mechanism 19  SUICIDE Gender Paradox in suicide ◦ More women than men attempt suicide, but more men succeed ◦ Crying for help ◦ Gender roles prevents males from seeking help ◦ Men use more lethal methods as compared to women 20  It is also known that minorities in a societies (i.e., LGBTQ people, racial and ethnic minorities) are at the risk groups at face of suicide due to the fact that they experience extensive discrimination and exclusion from the society. They may not search for the suitable medical care and obtain support. 21 22 ANXIETY DISORDERS 23 Anxiety is a normal reaction to stress. Some anxiety is needed to be motivated to study hard and spend long hours at our jobs. YET The occurrence of anxiety without an obvious external cause and inappropriate to the circumstances affects daily functioning = ANXIETY DISORDER 24 ◦ Specific Phobias Phobias ◦ Intense, irrational fears of specific objects or situations ◦ Common phobias include animals, heights, closed places, needles ◦ Social Phobias ◦ Fear of being judged or embarrassed by others ◦ Intense fear of public speaking and performances in front of other people ◦ Agoraphobia ◦ Fear of places, such as unfamiliar or crowded spaces, where help might not be available in case of emergency ◦ Person becomes housebound; experiencing panic like symptoms 25  Panic Disorder ◦ Recurrent and unpredictable panic attacks with an intense fear of terror ◦ Unconnected to any specific stimulus ◦ They believe they are going to die or are going crazy ◦ Physical symptoms (heart palpitations, shortness of breath, sweating, faintness and dizziness, gastric sensations etc.) ◦ Can lead people to avoid certain situations ◦ Sometimes with agoraphobia 26 Generalized Anxiety Disorder (GAD) ◦ The experience of long-term, persistent anxiety and worry ◦ Intense fears not attached to any particular object or circumstances = free-floating anxiety ◦ Their lives become centered on their worry (unable to relax) ◦ Their anxiety is often accompanied by physiological symptoms (muscle tension, headaches, dizziness, heart palpitations, insomnia) In DSM-5-TR, OCD is a separate category Obsessive-Compulsive Disorder (OCD) ◦ A disorder characterized by obsessions (persistent and unwanted thoughts) and compulsions (irresistible urge to repeatedly carry out some act that seems strange and unreasonable) ◦ Carrying out rituals may lead to some immediate reduction of anxiety; in the long run the anxiety returns. 27 In DSM-5-TR, separate category Trauma and Stressor-Related Disorders o Highly stressful events can also lead to elevation in anxiety. oIf the anxious reactions occurs 3 days to 1 month after trauma, the diagnosis is acute stress disorder. oIf the symptoms occur even after a one month, the diagnosis is post-traumatic stress disorder (PTSD). 28  Causes of Anxiety Disorders ◦ Genetic Factors GABA ◦ Twin studies and certain chemical deficiencies in the brain ◦ Overactive autonomic nervous system – overstimulation of limbic system ◦ Acc. to evolutionary view, we are predisposed by evolution to associate certain stimuli with intense fears (e.g. Snakes and spiders) ◦ Anxiety is a response to stress (traumatic events) ◦ Classical conditioning (e.g. Little Albert) and observational learning ◦ Cognitive Perspective ◦ People’s maladaptive thoughts about the world and feelings of not being in control 29 PSYCHOSOMATIC AND DISSOCIATIVE DISORDERS 30 ◦ A real physical illness ◦ Partially has a psychological cause ◦ Stress, anxiety, and prolonged emotional arousal might lead to alterations in immune system 31  Somatic Symptom and Related Disorders Formerly called as Somatoform Disorders Psychological difficulties that take on a physical (somatic) form, but for which there is no medical cause Person experiences symptoms as real Somatization Disorder : recurrent vague somatic complaints without a physical cause. Common symptoms are back pain, dizziness and abdominal pain Conversion Disorder : Involves an actual physical disturbances, such as inability to use a sensory organ or the complete or partial inability to move an arm or leg. e.g., Glove anesthesia 32 ◦ Hypochondriasis : The patient interprets even small symptoms such as a cough, bruise as a sign of a serious physical illness ◦ Body Dysmorphic Disorder : The individual is excessively concerned about, and preoccupied by, a perceived defect in his or her physical features. 33  DSM-IV DSM-5 and DSM-5-TR Somatization Disorder Somatic Symptom Disorder (SSD) Hypochondriasis Illness Anxiety Disorder Under the category of Obsessive- Body Dysmorphic Disorder Compulsive and Related Disorders Functional Neurological Symptom Conversion Disorder Disorder 34 Causes of Somatic Symptom and Related Disorders Freud physical symptoms often related to traumatic experiences buried in patient’s past Cognitive Behavioral Perspective Investigates how symptomatic behavior rewarded (secondary gain) Biological Perspective May be real physical illnesses that are misdiagnosed or overlooked 35 Dissociative Disorders some aspect of personality seems separated from rest group of disorders involving memory loss, complete (generally temporary) change in identity Dissociative Amnesia : Characterized by an inability to recall autobiographical information. This amnesia may be localized (i.e., an event or period of time), selective (i.e., a specific aspect of an event), or generalized (i.e., identity and life history). Dissociative Fugue : Flight from home/leaves the home and the assumption of a new identity with amnesia for past identity and events-very unusual 36 Dissociative Identity Disorder : Person displays characteristics of two or more distinct personalities (multiple personality disorder) Depersonalization/Derealization Disorder: The person suddenly feels changed or feels different in an unusual way e.g. as if lefting the body, behaviors becoming mechanic VIDEO: https://www.youtube.com/watch?v=KR-oZ3s-0Jk 37 Causes of Dissociative Disorders Seems to involve unconscious processes A response to childhood traumas May related to biological factors (memory impairments with normal aging; dissociation with use of drugs such as LSD) 38 SEXUAL DISORDERS 39  Sexual Dysfunctions ◦ Loss or impairment of the ordinary physical responses of sexual activity ◦ Problem with sexual desire, sexual arousal, or the pleasure associated with sex or orgasm ◦ Erectile Dysfunction Inability to achieve and maintain erection during sexual intercourse ◦ Female Sexual Arousal Disorder Inability to become sexually aroused/excited or to reach orgasm ◦ Sexual Desire Disorders Lack of sexual interest or active distaste/aversion for sex 40 ◦ Orgasmic Disorders Inability to reach orgasm in a person who has sexual desire and can maintain arousal ◦ Premature Ejaculation Male’s inability to inhibit orgasm as long as desired ◦ Vaginismus Involuntary muscle spasm in the outer part of the vagina making intercourse impossible 41 Paraphilic Disorders (in DSM-5 and DSM-5-TR) Paraphilias ◦ Atypical sexual interests; use of unconventional sex objects or situations to obtain sexual arousal Fetishism non-human objects such as shoes, underwear to achieve sexual excitement Voyeurism Sexual arousal is achieved by watching other people having sex or when they are naked Exhibitionism Exposing one’s genital publicly in inappropriate situations to achieve sexual arousal Frotteurism 42 Sexual arousal by touching or rubbing against a non-consenting person Transvestic Fetishism Wearing clothing of the opposite sex to achieve sexual arousal Sexual Sadism Sexual excitement is achieved by inflicting pain to others Sexual Masochism The inability to enjoy sex without accompanying emotional or physical pain Pedophilia Preffered desire to have sex with children 43 Gender Dysphroia ◦ «Gender identity disorder» in DSM-IV ◦ refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender ◦ Gender dysphoria manifests itself differently in different age groups. ◦ A strong preference for cross-dressing, for the toys, games, or activities stereotypically used or engaged in by the other gender ◦ A strong desire to be treated as the other gender / be of the other gender ◦ A strong dislike of one’s sexual anatomy ◦ Many also wish for gender reassignment surgery 44 PERSONALITY DISORDERS 45 ◦ A disorder characterized by a set of inflexible, maladaptive behavior patterns that keep a person from functioning appropriately in society. ◦ Cause distress to person or conflicts with others ◦ Learned early in life 46  Cluster A - odd or eccentric behavior Schizoid is a pattern of detachment from social relationships and a restricted range of emotional expression Paranoid is a pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent Schizotypal is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. 47  Cluster B - dramatic, emotional, or erratic behavior Antisocial a pattern of violent, criminal, or unethical and exploitative behavior and an inability to feel affection for others Borderline by marked instability in self-image, mood, and interpersonal relationships/self-destructive manipulative Narcissistic an exaggerated sense of self-importance and needs constant admiration/feels superior to others Histrionic is a pattern of excessive emotionality and attention seeking 48  Cluster C - anxious or fearful behavior Avoidant is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation Dependent is a pattern of submissive and clinging behavior related to an excessive need to be taken care of Obsessive-compulsive is a pattern of preoccupation with orderliness, perfectionism, and control 49 SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS 50 ◦ Severe disorders that characterized by disturbances of thought, communication and emotions ◦ Chronic and recurrent disorder Negative Symptoms Positive Symptoms Decline from a previous level of functioning Hallucinations (sensory experiences without Flat affect (no emotion showing in the face) external stimulation) Social withdrawal Delusions (false beliefs about reality) Catatonia Disorganized behavior and speech Anhedonia Inappropriate affect ◦ Cognitive symptoms (problem in attention, working memory, decision making)51  Age of Onset Males earlier than females Adolescent through young adulthood 52  Types Disorganized Schizophrenia ◦ Bizarre symptoms of schizophrenia such as giggling, grimacing, frantic gesturing ◦ A childish manner disregarding social conventions ◦ May urinate and/or defecate at inappropriate places and times ◦ May engage in incoherent speech Catatonic Schizophrenia ◦ Motor activity is severely disturbed ◦ Might remain immobile and mute even for years ◦ May alternate between catatonic and overly active state (hyperactive and violent) 53 Paranoid Schizophrenia ◦ Extremely suspicious ◦ Become aggressive if their paranoid ideas are questioned e.g. French government follows me because I have learnt great secrets about the country Undifferentiated Schizophrenia ◦ Clear symptoms of schizophrenia that do not meet criteria for any other subtypes. Note: These subtypes are no longer included in DSM-5 and DSM-5-TR. Diagnosis is now based on the assessment of symptom severity. 54  Causes of Schizophrenia Biological Perspectives ◦ The closer genetic links between two people, the greater the likelihood that if one experiences schizophrenia, so will the other sometime during his or her lifetime Risk of developing schizophrenia for unrelated person 1%, sibling 9%, identical twin 48% ◦ Biochemical imbalance or structural abnormalities of brain (excessive levels of dopamine) Environmental Perspectives ◦ Drug use (e.g. LSD may trigger episodes in vulnerable people) ◦ Family interaction and life stress ◦ Social class 55 CHILDHOOD DISORDERS 56 ◦ DSM-5 Neurodevelopmental Disorders ◦ Intellectual Disabilities ◦ Communication Disorders ◦ Autism Spectrum Disorder ◦ Attention Deficit-Hyperactivity Disorder ◦ Specific Learning Disabilities ◦ Motor Disorders ◦ Other Neurodevelopmental Disorders 57 Attention Deficit-Hyperactivity Disorder (ADHD) ◦ Marked by inattention, impulsiveness, a low tolerance for frustration and hyperactivity ◦ VIDEO: https://www.youtube.com/watch?v=Dm_q2lIF30g&ab_channel=Psych2Go ◦ Cause not fully understood YET explained by the dysfunctions in the nervous systems ◦ Misdiagnosis or overdiagnosis (gender and cultural differences!!) ◦ Psychostimulants 58  Autism Spectrum Disorder (ASD) ◦ Usually appears in the first three years and typically continues throughout life ◦ Impairments in children's ability to communicate and relate to others ◦ Difficulty in both verbal and nonverbal communication ◦ May avoid social contact and make little eye contact ◦ Delayed speech ◦ Show interest in a limited number of objects and attached to some objects strictly ◦ Repetitive behavior patterns 59 ◦ VIDEO: https://www.youtube.com/watch?v=RbwRrVw-CRo ◦ Increase in prevalence – actual rise in the incidence or better reporting?? ◦ Male-to-female ratio approximately 4:1 – underdiagnosed or diagnosed later compared to boys?? Causes ◦ Genetic (e.g. heredity, abnormalities in the brain structure or function) ◦ Environmental risk factors (e.g. increased parental age, uncontrolled maternal fever during pregnancy, birth complications, mercury exposure) 60 ◦ More women than men are treated for mental disorders ◦ WOMEN ARE MORE LIKELY TO SEEK FOR PROFESSIONAL HELP ◦ Men: Antisocial personality disorder and alcohol dependence ◦ Women: Depression and anxiety disorders ◦ Separated, divorced, or never married men > women of the same marital status or married men. ◦ Married women have higher rates than married men. ◦ There are no marked gender differences in the rates of severe mental disorders like schizophrenia and bipolar disorder that affect less than 2% of the population. 61 e.g., Taijin Kyofusho 62 Next Class: ◦ Treatment of Disorders Chapter ◦ Discussion Session: The Three Faces of Eve 63