Psychological Disorders PDF

CHAPTER 16 Psychological Disorders 1 Abnormal Psychology in Everyday Life mental disorders are common 1 out of every 5 Canadians suffer from a mental disorder (Clifford et al., 1996) 1 in 5 are hospitalized because of a psychiatric disorder (Public Health Agenc...

CHAPTER 16 Psychological Disorders 1 Abnormal Psychology in Everyday Life mental disorders are common 1 out of every 5 Canadians suffer from a mental disorder (Clifford et al., 1996) 1 in 5 are hospitalized because of a psychiatric disorder (Public Health Agency, 2002) Possibly under reported – up to 46.4% (Kessler et al., 2005) abnormal states occur in all of us - language of abnormal psychology permeates everyday conversation 2 Psychosis/Psychotic Insanity Nervous Breakdown Delusional Panic Attack Schizophrenic So what is everyday and what is abnormal? 3 What is Common or Abnormal??  A student drinking until she passes out A man kissing another man on the lips A parent slapping a child Believing that and acting like Jesus Christ A woman refusing to eat for several days A man barking like a dog Feeling really sad An elderly woman kicking others and screaming in the hospital 4 What is Abnormal? Discontinuity hypothesis  Only strong terms can accurately portray true nature of abnormal behavior Continuity hypothesis  Insanity and mental illness terms should not be used  Mental disorder best viewed as continuum that varies between mental health to mental illness No single “abnormal” criteria 5 “I should like to make clear, therefore, that although I consider the concept of mental illness to be unserviceable, I believe that psychiatry could be a science. I also believe that psychotherapy is an effective method of helping people – not to recover from an ‘illness’ but rather to learn about themselves, others and life.” Thomas Szasz 6 Objectivity & Abnormality Important for mental health judgments to be objective Consideration of content and context Reliability & Validity is key People improperly labelled as “abnormal” due to norms and values (i.e., individual, cultural, group) Labels used to interpret later behaviour David Rosehan & being “sane in insane places” Given diagnoses – bipolar, schizophrenia (even upon discharge) 7 What is Abnormal? 1) Distress or 5. Unconventionality Disability/dysfunction and statistical rarity (social, cognitive, (e.g.,IQ) occupation) 6. Observer discomfort 2) Maladaptiveness – (or distress – like #1) hinderance based on behaviour or thoughts 7. Violation of moral and ideal standards 3) Irrationality – e.g., (deviance) (personal hearing voices values of the 4) Unpredictability diagnostician – (2, 3, & 4 examine culture – e.g., dysfunction) homosexuality) 8 Psychological Disorders Psychopathological functioning Involves disruptions in emotional, behavioural, or thought processes that lead to personal distress or that block one’s ability to achieve important goals Abnormal/Clinical psychology Area of psychological investigation most directly concerned with understanding the nature of individual pathologies of mind, mood, and behaviour 9 Etiology of Disorders Vulnerability Stress/Diathesis Stress Model Diathesis (vulnerability) + STRESS = disorder Stress (environmental stimulus) triggers psychopathology Stressors: loss of job, divorce, death in family, being stuck in traffic Neither a diathesis or a stress alone is sufficient to cause disorder 10 Historical Views Psychological theories psychological factors like stress caused problems Freud revived the theory; able to compete with supernatural and biological approaches Model of unconscious conflicts – id, ego, superego 11 Historical Views Supernatural theories Early views linked psychological disorders with evil (demonological view) Resulted in more harmful treatments like exorcism, drinking foul concoctions, witches put to death (mostly women), trephining Biological theories Ancient Greece: four humors of body – excess black bile leads to depression, excess yellow bile leads to irratibility (blood letting) 12 Historical Classifications View that disorders reflected disease or sickness Philippe Pinel & classification of disorders by patterns of symptoms – thought, behaviour, mood Classification systems given medical basis Emil Kraepelin Made effective drug therapies possible Paresis, melancholia, dementia, epilepsy (1880) 13 Etiology of Disorders Etiology The factors that cause or contribute to the development of psychological and medical problems Biological approaches assume structural abnormalities, biochemical processes, and genetic influences Psychological approaches focus on personal experiences, traumas, conflicts, and environmental factors as roots of disorders Psychodynamic, behavioural, cognitive, & sociocultural perspectives 14 Classifying Disorders  Psychological diagnosis  A label given to an abnormality by classifying and categorizing the observed behaviour pattern into an approved diagnostic system  Diagnostic systems should involve … a) Common shorthand language b) Understanding of causality c) Treatment plan 15  Classifying Disorders DSM-IV-TR (2000) Diagnostic and Statistical Manual of Mental Disorders Classifies, defines, describes over 200 disorders First DSM was published in 1952, DSM-V published in 2013 Divided into axes Comorbidity = the co-occurrence of diseases, most common with anxiety, mood disorders, alcohol/drug abuse/dependence Prevalence rates listed in Report on Mental Illness in Canada International Classification of Diseases (ICD-10) 16 Classifying Disorders 17 Classifying Disorders  DSM 5 (May, 2013)  Add dimensional assessments – not just presence of symptom, but also severity rating  Removal of multi-axial system  Chapters organized based on similarities in disorders underlying vulnerabilities (but not a one size fits all – ex. pg. 634)  Chapters reorganized and new diagnoses (Hoarding D/O, Skin Picking D/O 18 Anxiety Disorders Anxiety disorders Class of disorders that involves anxiety that interferes with ability to function effectively Disorders differ in extent that anxiety is experienced, severity of anxiety, and situations that trigger disorders 5 major categories of anxiety disorders Share emotional (fear - apprehension), physiological (heart racing), cognitive (I to afraid to come to class), and behavioural symptoms (avoidance) 19 Types of Anxiety Disorders Generalized Anxiety Disorder  Feelings of anxiety and worry most of the time without specific threats or danger  Must also display physical and cognitive symptoms of impairment  Restless, muscle tension, easily fatigue, concentration issues  Majority of the day for 6 months Panic Disorder  Experience of unexpected and severe panic attacks that are brief in duration  Include intense psychological and physical symptoms  Palpitations, trembling, sweating, chest pain, choking 20 Types of Anxiety Disorders 1) Phobias  Suffering from a persistent and irrational fear of a specific object, activity, or situation that is excessive and unreasonable given the reality of the threat  Social phobias = public situations involving being observed by others  Specific phobias = related to types of objects or situations  animal, natural environment, blood-injection-injury, situational , not otherwise specified 21 Types of Anxiety Disorders Obsessive-Compulsive Disorder (OCD)  Obsessions = thoughts, images, impulses that recur despite efforts to suppress them and cause distress  Compulsions = repetitive and purposeful acts performed according to certain rules or in a ritualized manner in response to an obsession (used to reduce discomfort) 22 Types of Anxiety Disorders Post-Traumatic Stress Disorder (PTSD)  Disorder characterized by persistent re-experience of traumatic events through distressing recollections, dreams, hallucinations, or flashbacks  Often comorbid with other disorders (e.g., depression, substance abuse) 23 Causes of Anxiety Disorders Biological - evolutionary preparedness, neurotransmitter GABA, neuroimagining Psychodynamic - anxiety stems from underlying psychic conflicts or are substitutions for forbidden impulses Behavioural - anxiety linked to reinforcement or conditioning, disorder may be maintained by reinforcement contingencies Cognitive - focus on perceptual processes, attitudes, interpretations that distort estimates of danger or fear 24  Mood Disorders Major Depressive Disorder Severity of symptoms differ Share emotional, motivational, cognitive, and somatic symptoms 25 Mood Disorders 26  Mood Disorders Bipolar Disorder Characterized by periods of severe depression alternating with manic episodes Manic episode – involve feelings and actions that are unusually elated, expansive, and often excessive (e.g., decreased need for sleep) Also associated with unwarranted optimism and risk-taking Goals are blocked or thwarted Depression sets in when dealing with damage of frenzy Duration vary from person to person – some people experience short manic and depressive episodes Some individuals cycle back and forth (some rapidly) 27  Causes of Mood Disorders Biological – neurotransmitters of serotonin and norepinephrine linked to depression (reduced levels) and mania (increased levels) Twin studies on mood d/o – 67% identical, 20% fraternal Psychodynamic – unconscious conflicts and hostile feelings originating in early childhood are transferred to adult symptoms – turned inward Behavioural – focuses on positive reinforcements (lacking) and punishments (in excess) Cognitive – cognitive triad (Beck) – negative view of self, negative view of ongoing experiences - the world, and negative view of future and learned helplessness - people believe bad things are going to happen and can’t do anything about it Seligman's Attribution theory = internal-stable-global vs. external, unstable, specific) 28 Mood Disorders & Gender Depression rate for women is 2x more than men Greater likelihood of negative experiences – sexual abuse, poverty, single parent, taking care of parents Internal-global-explanatory style Rumination on causes & implications – learned helplessness (people believe bad things are going to happen and can’t do anything about it). Depression linked to suicide attempts Women make 3x more attempts than men Men are more likely to commit suicide Suicide most common in Canadian youth aged 15-24, especially in northern provinces and territories (Dr. David Danto's Research) 29 Final stage of inner turmoil  Somatoform Disorders Somatic Disorders Physical illnesses or complaints that cannot be fully explained by actual medical conditions Anxiety Illness Disorder/Hypochondriasis – preoccupation & belief they are physically ill or will get physically ill despite medical reassurances – often go from doctor to doctor Somatic Symptom Disorder/Somatization disorder/Pain Disorder – long history of physical complaints that are not medically explained They cross many medical categories – must have 4 pain symptoms (eg. headaches/stomach aches), 2 gastrointestinal (eg. Nausea), 1 sexual symptom, and 1 neurological (eg. Double vision) Conversion disorder/functional neurological symptom disorder – loss of motor or sensory functioning not explained by nervous system or physical 30  Dissociative Disorders Dissociative disorders Disturbance in the integration of identity, memory, or consciousness – often a survival mechanism from traumatic past Dissociative amnesia – forgetting of important personal experiences caused by psychological experiences in the absence of any organic dysfunction Dissociative Fuge - period of “wandering” that involves a loss of memory and a change of identity Dissociative identity disorder (DID) – disorder in which two or more distinct personalities exist within the same individual (unique behavioural patterns) Formerly called multiple personality disorder or split personality Three Faces of Eve, Sybil 31  Schizophrenia Schizophrenic disorder Severe form of psychopathology in which personality seems to disintegrate, thought and perception are distorted, and emotions are blunted Symptoms can involve illogical thinking, hallucinations, delusions, language problems, flat emotions, psychomotor disturbances Existence of both positive (hallucinations, delusions, disorganization – type 1) and negative symptoms (flat affect – type 2) Relatively rare – 1% of the population Some experience a few episodes, while others it is life long 32 Schizophrenia Uncommon disorder affecting more men than women Can appear gradually or with sudden break – men experience the break on average younger than women Characterized by 3 types of serious problems Delusions and hallucinations Disorganized thinking, emotions, behavior Reduced enjoyment and interests 33 Delusions False beliefs that distort reality. Hallucinations False perceptual experiences that distort reality. 34 Types of Schizophrenia 35  Causes of Schizophrenia Biological factors ⇧ genetic relatedness = ⇧ risk – both parents (46%) or identical twins (48%) Biological markers – brain abnormalities in ventricles, (flow of cerebrospinal fluid) which impacts support/stability, chemical balances, loss of cortical tissue and activity in frontal & temporal lobe Environmental conditions Diathesis-stress hypothesis – genetic factors place individuals at risk but environmental factors trigger the manifestation of the disorder – lack of support (empathy), housing/safety Deviations in parental interactions may play a role (expressed emotion) – emotionally overinvested, critical, 36 hostile