Psychological disorders
• Abnormal vs. normal
– The 4 D’s
– The 3 C’s plus norms, zeitgeist
• Explanations
– various psychological and personality theories
• Classifying psychological disorders
– History
– Diagnostic and statistical Manual
• Major psychological disorders
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Anxiety
Somatoform & dissociative
Mood
Psychotic
Personality disorders
Abnormal vs. normal
• Dialectic thinking
– Opposite concepts define each other (thesis –
antithesis)
• The 4 D’s
– Deviance (statistical, not judgmental)
– Distress
– Danger
– Dysfunction
Abnormal vs. normal
• The 3 C’s
– Contents (what a person does, maladaptive,
irrational, unpredictable)
– Context (When and where a BX occurs )
– Consequences (Distress or suffering)
– Norms (Age gender culture historical period)
Theoretical explanations for
psychological disorders
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Biological
Psychodynamic
Behavioral
Cognitive
Humanistic – existential
Social cultural
Bio-psycho-social
Theories, continued
• Diathesis- stress model
– Also known as the vulnerability – stress model
– Assumes a predisposition that will only present
with sufficient and disorder specific stress
– Classic example in biology is heart disease
– Psychology examples include cognitive models of
depression
• For example relationship oriented vs. achievement
oriented
Cultural issues
• Constructivist vs Objectivist definitions
– Definitions of normality to a large degree are
based on cultural traditions.
Epidemiology
• Study of prevalence and cause of disease
– Etiology : study of cause
– Prevalence
• Point
• Lifetime
Point
Lifetime
Source
Schizophrenia
0.3–0.7%
Wikipedia
2012
Bipolar
1.0%
Wikipedia
2012
17%
Wikipedia
2012
•
Depression
3-6% ♂
8-10% ♀
DSM History
• DSM stands for The Diagnostic & Statistical Manual of
mental disorders
• DSM I 1952
• DSM II
• Homosexuality removed as a disorder, 1973
• DSM III 1980
– Descriptive vs theoretical (atheoretical)
• DSM III-R 1989
• DSM-IV 1994
• DSM- V 2013
– Major overhaul
Classification
DSM IV
• 5 Axes
– Axis I Major Mental disorders
– Axis II notes personality disorders and mental
retardation
– Axis III reflect any relevant physical conditions
– Axis IV records any psychosocial or environmental
problems
– Axis V has a rating of one's current level of
psychological social functioning
DSM
• Benefits
– Increased interrelater reliability
• Criticisms
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Reliability improved for some, not all
Validity improved for some, not many
Qualitative differences between health/non-health
Discrete categories
• vs dimension (or 3rd variable, eg, “negative emotionality”)
– Same sx in different categories
– Subjectivity inherent
DSM-V
• are they more like theoretical constructs or more
like diseases;
• how to reach an agreed definition;
• whether the DSM-V should take a
cautious/conservative approach;
• the role of practical rather than scientific
considerations;
• the issue of use by clinicians or researchers;
• and whether an entirely different diagnostic
system is required
Anxiety Disorders
• Biological factors
– Some people appear to have inherited
predispositions
– norepinephrine, serotonin may be factors
• Psychological factors
– People with anxiety disorders may exaggerate
dangers of some stimuli while underestimating
their own ability to deal with them
Anxiety Disorders
• Key commonality is physiological: heart rate,
breathing, sweating, dry mouth, sense of
dread
• Fear/anxiety
– phobia
– generalized anxiety disorder
– Panic disorder
– obsessive compulsive disorder
– PTSD
Phobia
• Often phobias are experienced as irrational
• Simple or specific
– Classic, typically afraid of a specific object or situation:
• Spiders, Heights, Etc.
• Social
– Major fear his of humiliation and/embarrassment
• Avoids opportunities that could put them into a position of
ridicule:
– Eating in public, public restrooms, public speaking
• Agora
– Fear of being separated from a safe place or person
Generalized Anxiety Disorder
• A nonspecific experience of anxiety, worry
– This excessive worry often interferes with daily
functioning, as individuals suffering GAD typically
anticipate disaster, and are overly concerned
about everyday matters such as health issues,
money, death, family problems, friend problems,
relationship problems or work difficulties.
– Often comorbid with dysthymia
Panic Disorder
• Attack vs Disorder
• Terror and fear of death, going crazy
• Often experienced as coming from out of the
blue
• Hyper sensitivity to physiological changes
• Cognitive tendency to catastrophize those
changes
OCD
• Obsessive compulsive disorder is
characterized by obsessions and compulsions
• Obsessions are thoughts the create anxiety
– The thoughts made be about germs dirt or
graphically violent thoughts
• Compulsions temporarily reduce that anxiety
PTSD
• Trauma defined
• Acute vs. post
• Acute occurs within 30 days of trauma, post
occurs after
• Symptoms include avoidance of anything that
could remind a person of trauma
• Flashbacks and nightmares
Somatoform Disorders
• Physical ailments without physical cause
• Earliest forms were targeted by Freud
– (Anna O)
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Conversion
Hypochondriasis
Somatization (Briquettes)
Pain Disorder
Somatoform
• Over the course of the 20th century numerous
studies convinced medical and clinical
researchers that psychological factors, such as
stress, worry, and perhaps even unconscious
needs, can contribute to bodily illness
Somatoform
 Sometimes when physicians cannot find a
medical cause for a patient’s symptoms, he or
she may suspect other factors are involved.
 Patients may malinger, intentionally fake illness to
achieve external gain (e.g., financial
compensation, military deferment)
 Patients may be manifesting a factitious disorder intentionally producing or faking symptoms simply
out of a wish to be a patient
Somatoform
• Known popularly as Munchausen syndrome,
people with a factitious disorder often go to
extremes to create the appearance of illness
– Many secretly give themselves medications to
produce symptoms
– Patients often research their supposed ailments
and are impressively knowledgeable about
medicine
Somatoform
 Conversion disorder often is hard to distinguish
from genuine medical problems
 It is always possible that a diagnosis of conversion
disorder is a mistake and the patient’s problem has an
undetected medical cause
 Physicians sometimes rely on oddities in the
patient’s medical picture to help distinguish the
two
 For example, conversion symptoms may be at odds with the
known functioning of the nervous system, as in cases of
glove anesthesia
Somatoform
 People with a somatization pattern experience
many long-lasting physical ailments that have
little or no organic basis
 Also known as Briquet’s syndrome
 A sufferer’s ailments often include pain
symptoms, gastrointestinal symptoms, sexual
symptoms, and neurological symptoms
 Patients usually go from doctor to doctor in search
of relief
Somatoform
 Predominant pain pattern
 If the primary feature of somatic symptom disorder is
pain, the individual is said to have a predominant pain
pattern
 Although the precise prevalence has not been
determined, this pattern appears to be fairly common
 The pattern often develops after an accident or illness that
has caused genuine pain
 The pattern may begin at any age, and more women
than men seem to experience it
Somatoform Tx
• Difficult to treat
• Controversial: maybe not psychological but we
don’t have the tech to dx
• Hypochondriasis tx includes recommendation
to Doctors to being open and setting the stage
for the next doctor to do the same. Be
honest, sincere, and supportive, but don’t
feed the client’s anxieties or demands.
Dissociative
• Based on the Defense Mechanism
– Think of your safe place rather than be present
– Similar to hypnosis
– Common in childhood (make believe friend)
• Amnesia (not biological)
• Fugue
• Dissociative Identity Disorder
– (DID, FKA Multiple Personality Disorder)
Dissociative
• The key to our identity – the sense of
who we are and where we fit in our
environment – is memory
• In dissociative disorders, one part of the
person’s memory typically seems to be
dissociated, or separated, from the rest
Dissociative
• There are several kinds of dissociative
disorders, including:
– Dissociative amnesia
– Dissociative identity disorder (multiple personality
disorder)
– Depersonalization-derealization disorder
• These disorders are often memorably
portrayed in books, movies, and television
programs
Dissociative
• People with dissociative amnesia are unable
to recall important information, usually of a
stressful nature, about their lives
– The loss of memory is much more extensive than
normal forgetting and is not caused by physical
factors
– Often an episode of amnesia is directly triggered
by a specific upsetting event
Dissociative
• Dissociative amnesia may be:
– Localized – most common type; loss of all memory
of events occurring within a limited period
– Selective – loss of memory for some, but not all,
events occurring within a period
– Generalized – loss of memory beginning with an
event, but extending back in time; may lose sense
of identity; may fail to recognize family and friends
– Continuous – forgetting continues into the future;
quite rare in cases of dissociative amnesia
Dissociative
• All forms of the disorder are similar in that the
amnesia interferes mostly with a person’s
memory for personal material
– Memory for abstract or encyclopedic information
– usually remains intact
• Clinicians do not known how common
dissociative amnesia is, but many cases seem
to begin serious threats to health and safety
Dissociative
• An extreme version of dissociative amnesia is
called dissociative fugue
– Here persons not only forget their personal
identities and details of their past, but also flee to
an entirely different location
• For some, the fugue is brief – a matter of hours or days
– and ends suddenly
• For others, the fugue is more severe: people may travel
far from home, take a new name and establish new
relationships, and even a new line of work; some
display new personality characteristics
DISSOCIATIVE IDENTITY DISORDER
• A person with dissociative identity disorder
(DID, or multiple personality disorder)
develops two or more distinct personalities,
called “subpersonalities”, each with a unique
set of memories, behaviors, thoughts, and
emotions
DISSOCIATIVE IDENTITY DISORDER
• At any given time, one of the subpersonalities
dominates the person’s functioning
– Usually one of these subpersonalities – called the
primary, or host, personality – appears more often
than the others
– The transition from one subpersonality to the next
(“switching”) is usually sudden and may be
dramatic
DISSOCIATIVE IDENTITY DISORDER
• Most cases are first diagnosed in late
adolescence or early adulthood
– Symptoms generally begin in childhood after
episodes of abuse
• Women receive the diagnosis three times as
often as men
DISSOCIATIVE IDENTITY DISORDER
• How do subpersonalities interact?
– The relationship between or among
subpersonalities varies from case to case
• Generally there are three kinds of relationships:
– Mutually amnesic relationships – subpersonalities have no
awareness of one another
– Mutually cognizant patterns – each subpersonality is well
aware of the rest
– One-way amnesic relationships – most common pattern;
some personalities are aware of others, but the awareness is
not mutual
» Those who are aware (“co-conscious subpersonalities”)
are “quiet observers”
DISSOCIATIVE IDENTITY DISORDER
• How do subpersonalities interact?
– Investigators used to believe that most cases of
the disorder involved two or three
subpersonalities
• Studies now suggest that the average number is much
higher – 15 for women, 8 for men
– There have been cases of more than 100!
DISSOCIATIVE IDENTITY DISORDER
• How do subpersonalities differ?
– Subpersonalities often display dramatically
different characteristics, including:
• Identifying features
– Subpersonalities may differ in features as basic as age, sex,
race, and family history
• Abilities and preferences
– Although encyclopedic information is not usually affected by
dissociative amnesia, in DID it is often disturbed
– It is not uncommon for different subpersonalities to have
different abilities, including being able to drive, speak a
foreign language, or play an instrument
DISSOCIATIVE IDENTITY DISORDER
• How do subpersonalities differ?
– Subpersonalities often display dramatically
different characteristics, including:
• Physiological responses
– Researchers have discovered that subpersonalities may have
physiological differences, such as differences in autonomic
nervous system activity, blood pressure levels, and allergies
DISSOCIATIVE IDENTITY DISORDER
• How common is DID?
– Traditionally, DID was believed to be rare
• Some researchers even argue that many or all cases are
iatrogenic; that is, unintentionally produced by
practitioners
– These arguments are supported by the fact that many cases of
DID first come to attention only after a person is already in
treatment
» Not true of all cases
DISSOCIATIVE IDENTITY DISORDER
• The psychodynamic view
– Psychodynamic theorists believe that dissociative
disorders are caused by repression, the most basic
ego defense mechanism
• People fight off anxiety by unconsciously preventing
painful memories, thoughts, or impulses from reaching
awareness
DISSOCIATIVE IDENTITY DISORDER
• The psychodynamic view
– In this view, dissociative amnesia is a single
episode of massive repression
– DID is thought to result from a lifetime of
excessive repression, motivated by very traumatic
childhood events
DISSOCIATIVE IDENTITY DISORDER
• The behavioral view
– Behaviorists believe that dissociation grows from
normal memory processes and is a response learned
through operant conditioning:
• Momentary forgetting of trauma leads to a drop in anxiety,
which increases the likelihood of future forgetting
• Like psychodynamic theorists, behaviorists see dissociation
as escape behavior
– Also like psychodynamic theorists, behaviorists rely
largely on case histories to support their view of
dissociative disorders
• Moreover, these explanations fail to explain all aspects of
these disorders
DISSOCIATIVE IDENTITY DISORDER
• State-dependent learning
– If people learn something when they are in a
particular state of mind, they are likely to
remember it best when they are in the same
condition
• This link between state and recall is called statedependent learning
• This model has been demonstrated with substances
and mood and may be linked to arousal levels
DISSOCIATIVE IDENTITY DISORDER
• Self-hypnosis
– Although hypnosis can help people remember
events that occurred and were forgotten years
ago, it can also help people forget facts, events,
and their personal identity
• Called “hypnotic amnesia,” this phenomenon has been
demonstrated in research studies with word lists
• The parallels between hypnotic amnesia and
dissociative disorders are striking and have led
researchers to conclude that dissociative disorders may
be a form of self-hypnosis
DISSOCIATIVE IDENTITY DISORDER
• People with dissociative amnesia often
recover on their own
– Only sometimes do their memory problems linger
and require treatment
• In contrast, people with DID usually require
treatment to regain their lost memories and
develop an integrated personality
– Treatment for dissociative amnesia tends to be
more successful than treatment for DID
DISSOCIATIVE IDENTITY DISORDER
• How do therapists help people with dissociative
amnesia?
– The leading treatments for these disorders are
psychodynamic therapy, hypnotic therapy, and drug
therapy
• Psychodynamic therapists guide patients to search their
unconscious and bring forgotten experiences into
consciousness
• In hypnotic therapy, patients are hypnotized and guided to
recall forgotten events
• Sometimes intravenous injections of barbiturates are used
to help patients regain lost memories
– Often called “truth serums,” the key to the drugs’ success is their
ability to calm people and free their inhibitions
DISSOCIATIVE IDENTITY DISORDER
• How do therapists help individuals with DID?
– Therapists usually try to help the client by:
• Recognizing the disorder
– Once a diagnosis of DID has been made, therapists try to bond
with the primary personality and with each of the
subpersonalities
– As bonds are forged, therapists try to educate the patients
and help them recognize the nature of the disorder
» Some use hypnosis or video as a means of presenting
other subpersonalities
– Many therapists recommend group or family therapy
DISSOCIATIVE IDENTITY DISORDER
• How do therapists help individuals with DID?
– Therapists usually try to help the client by:
• Recovering memories
– To help patients recover missing memories, therapists use
many of the approaches applied in other dissociative
disorders, including psychodynamic therapy, hypnotherapy,
and drug treatment
» These techniques tend to work slowly in cases of DID