Psychological Disorders Instructional Objectives History 1. Definition of Normal Behaviour 2. Perspectives 3. Diagnostic labeling – common disorders 4. Causal factors of disorders. History During the middle ages (1600’s), mental illness was interpreted from a religious point of view and people with mental illnesses were seen as influenced by the devil, practicing witchcraft and possessed with demons If accused of witchcraft all possessions, property and money confiscated Initially professional theologians identified witches – movement called Inquisition Criteria for witches in Malleus Malficarauum: birthmarks, witches float, feeling a prick from a dull object Criteria so loose many people were identified as witches People became very afraid – afraid to cross neighbours, to speak up against ideas, etc. Treatment included execution, exorcism, drilling holes in skulls, beatings, being burned, drowned, castrated In the 1800,s, medical understandings developed for many mental illnesses and hospitals started to replace asylums - this was a great period of reform: Philipe Pinel (1745-1826); Thomas Szaz; RD Lang; David Cooper These people saw the mentally ill as having problems with living and felt that treatment should involve treating them as individuals in need of help, rather than dumping them in institutions and throwing away the key 1 Disorder - Definition Mental health workers label behavior psychologically disordered when it is atypical, disturbing, maladaptive, unjustifiable, and producing personal distress, or endangering others In most instances several of these criteria need to be met in order for a person to be considered abnormal. But there are no necessary symptoms – usually the greater the number of symptoms, the more likely one is to have a disorder Note: It’s common for students studying mental disorders for the first time to think that they are afflicted by many of them – this is completely natural – the same happens to medical students Atypical – deviating form statistical norms At least once in each person’s life, they will be able to be classified as having a mental disorder Having a mental disorder means 1) having abnormal experiences/perceptions (may be very difficult for normal people to imagine what constitutes an abnormal experience) 2) a person’s behaviour must also be significantly different from the social norms seen in the population Note: 1) What is considered normal in one society/culture may be considered abnormal in another – e.g. members of some African cultures think it’s normal to hear voices, to talk with them and to see visions 2) The concept of normality within a culture can change over time – e.g. homosexuality used to be considered a disorder, as well as near nudity on a beach and smoking pot Problems of labeling as a self-fulfilling prophecy and stigmas associated with labels (latter in reference for example to schizophrenia) Disturbing Behaviour deviates from the norm sufficiently that others find it disturbing Schizophrenics talking to themselves Street people hassling you for money Maladaptive That the behaviour brings on detrimental physical change in the individual or in relation to the social group Substance abuse Behaviour disruptive to daily life 2 Unjustifiable That there is no apparent reason for the individual’s e.g. paranoid behaviour Example of spy who was wrongly diagnosed as paranoid Personal Distress If an individual is suffering e.g. anxiety, depression, agitation, insomnia What is Normal We think of mental disorder relative to our own experiences (probably we are being very inaccurate) We also use our cultural norms as benchmarks for judging abnormal behaviour Legal definitions include 1) being able to take care of yourself 2) not destructive to yourself or others Efficient perception of reality Ability to exercise voluntary control over behaviour Self-esteem and self acceptance Feelings of worthlessness, alienation and lack of acceptance are common in abnormal persons An ability to form affectionate relationships Productivity: a productive contributing individual in society 3 Perspectives on Mental Disorders Medical (organic or endogenous) Sickness, genetic/biological cause: tumors, toxins (alcohol, drugs, environmental exposure), blood chemistry, CNS problems with aging Treatment: medication, surgery, therapy, ECT Critics argue that disorders are socially, not medically, defined and that the labels the medical model assigns may be self-fulfilling. Functional or Psychological (exogenous) Psychologists who reject the "sickness" idea typically contend that all behavior arises from the interaction of nature (genetic and physiological factors) and nurture (past and present experiences) No physical cause, lack of knowledge, motivation, result from strong fears, early childhood experiences, life experiences Psychodynamic (Psychotherapy) Freud: disorder is early childhood experience, psychosexual stages of development Behavioural: Skinner Life experience – history of reinforcement – classical conditioning and operant learning – treatment: behaviour can be reconditioned Cognitive: Thinking patterns are maladaptive and can be changed with appropriate training Social Cognitive: Thinking patterns in relation to social experience Bio-psycho-social: genetic factors, physiological states, inner psychological dynamics, and social circumstances Phenomenological: Rogers, Maslow, Interrelationship with acquiring life goals (humanistic therapy)- reaction to mechanistic behavioural viewpoint Emphasis on one’s own existence – getting in touch with emotions – individual identification of meaning of life (phenomenological) – persons responsible for their own lives and can choose how to interpret situations – behaviour not determined by past experience but by the choices we make Various perspectives have implications for cause and type of therapy – also combinations of explanations and therapies are used 4 Identifying and Describing Disorders The Diagnostic and Statistical Manual of Mental Disorders North America: A descriptive approach to classification heavily based on medical perspective - Most recent update: 2010 Purpose: Classify Communicate Define treatment approaches Define research directions In Europe ICD Instrumental Classifications of Disease – in this, disorders are considered a subcategory of diseases – unlike DSM4 (strictly disorders) (DSM-IVTR) provides an authoritative classification scheme. It assumes the medical model and groups some 230 psychological disorders and conditions into 17 major categories of "mental disorder." DSM-IVTR describes disorders and their prevalence without presuming to explain their causes Although diagnostic labels may facilitate communication and research, they can also bias our perception of people's past and present behavior and unfairly stigmatize them. Criteria or axis of diagnosis: Primary diagnosis (physical) Personality type Physical history (e.g. ulcers) Recent stress Recent history of social functioning – family history Some of the labels Those who suffer an anxiety disorder may for no reason feel uncontrollably tense (generalized anxiety disorder), may have a persistent irrational fear (phobic disorder), or may be troubled by repetitive thoughts and actions (obsessivecompulsive disorder). Somatoform disorders involve a bodily symptom that has no apparent physical cause. In hypochondriasis, people interpret normal sensations as symptoms of a dreaded disease. Dissociative disorders take the form of amnesia, fugue, or even multiple personality. Under extreme stress, conscious awareness becomes separated from previous memories, thoughts, and feelings. Mood disorders (Affective) include major depressive disorder and bipolar disorder. Current research on depression is exploring (1) genetic and 5 biochemical influences and (2) cyclic self-defeating beliefs, learned helplessness, negative attributions, and aversive experiences. The symptoms of schizophrenia include disorganized thinking, disturbed perceptions, and inappropriate emotions. Researchers have linked certain forms of schizophrenia to brain abnormalities. Studies also point to a genetic predisposition that may work in conjunction with environmental factors. Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. The most common is the remorseless and fearless antisocial personality. Dependent, obsessive compulsive, passive aggressive Disorders in Depth Anxiety Disorders Generalized anxiety disorder is an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal. The anxiety can escalate into a panic attack an episode of intense dread, usually lasting several minutes. A phobic disorder is an anxiety disorder marked by a persistent, irrational fear of a specific object or situation. An obsessive-compulsive disorder is an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions – person can’t control these – checking doors, under beds, is the stove turned off, repetitive behaviours -–counting fence posts, heart beats Causes The psychoanalytic perspective views anxiety disorders as the discharging of repressed impulses. The learning perspective sees them as a product of learned helplessness or fear conditioning. The biological perspective emphasizes evolutionary, genetic, and physiological influences. Somatoform Disorders Both conversion disorder and hypochondriasis are Somatoform disorders in which symptoms take a bodily form without apparent physical cause. The conversion disorder, more common in Freud's day than ours, is marked by very specific physical symptoms, such as paralysis, blindness, or an inability to swallow, for which no physiological basis can be found – common in war time (bombardiers become blind). Hypochondriasis is a more common disorder in which a person interprets normal physical sensations such as a headache as symptoms of a dreaded disease. 6 Dissociative Disorders Amnesia, a Dissociative disorder, is selective memory loss often brought on by extreme stress. Fugue is a Dissociative disorder in which flight from one's home and identity accompanies amnesia. Multiple personality is a rare Dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Causes Psychoanalysts see these disorders as defenses against the anxiety caused by the eruption of unacceptable impulses. Disorders are viewed as hypnotic like states into which people lapse as a protective response to traumatic childhood experiences. For example, most people diagnosed as multiple personality are women, many of whom suffered physical, sexual, or emotional abuse as children. Learning theorists see them as behaviors reinforced by anxiety reduction. Mood Disorders In major depressive disorder, a person without apparent reason descends for weeks or months into deep unhappiness, lethargy, and feelings of worthlessness before rebounding to normality. Poor appetite, insomnia, and loss of interest in family, friends, and activities are often other important symptoms. Bipolar disorder is a mood disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania (a hyperactive, wildly optimistic state). Causes The psychoanalytic perspective suggests that depression occurs when significant losses evoke feelings associated with losses experienced in childhood. For example, loss of a loved one may evoke the anger once felt toward parents who were similarly "abandoning" or "rejecting." The unacceptable anger is turned inward toward the self and, combined with the sense of loss, produces depression. The biological perspective emphasizes the importance of genetic and biochemical influences. Mood disorders run in families, and certain neurotransmitters seem to be scarce in depression. The social-cognitive perspective sees depression as a vicious cycle in which (1) stressful events are interpreted though (2) a pessimistic explanatory style, creating (3) a hopeless, depressed state that (4) hampers the way a person thinks and acts. This, in turn, fuels (1) more negative experiences. 7 Schizophrenia Disorders Schizophrenia is a group of severe psychotic disorders characterized by disorganized and deluded thinking (including delusions and hallucinations), disturbed perceptions, and inappropriate emotions and actions Inability to maintain a train of thought Can’t concentrate for long periods of time Social withdrawal Schizophrenia patients with positive symptoms are disorganized and deluded in their talk or prone to inappropriate laughter, tears, or rage - overly emotional Those with negative symptoms - loss of emotional responsiveness -have toneless voices, expressionless faces, or mute and rigid bodies. Catatonic – rock, motionless, oblivious, waxy (let you mold limbs) Chronic, or process, schizophrenia develops gradually, emerging from a long history of social inadequacy. Acute, or reactive, schizophrenia develops rapidly in response to particular life stresses – Paranoid schizophrenia Researchers have linked certain forms of schizophrenia with brain abnormalities, such as enlarged, fluid-filled cerebral cavities or increased receptors for the neurotransmitter dopamine. A possible cause of these brain abnormalities in the fetus is a mid-pregnancy viral infection. Twin and adoption studies also point to a genetic predisposition (44%) that, in conjunction with environmental factors, may bring about a schizophrenia disorder. Personality Disorders Personality disorders are psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning. Although they sometimes coexist with one of the other psychological disorders, they need not involve anxiety, depression, or loss of contact with reality. The most frequent of these disorders is the antisocial personality disorder in which a person (usually a man) exhibits a lack of conscience for wrong-doing, even toward friends and family members. This person may be aggressive and ruthless or a clever con artist. 8 Other Labels Substance Abuse Disorders (Psychoactive substance) Psychosexual disorders – gender identity Paraphilias (arousal to situations or sexual objects not considered to usually be part of a sexually arousing situation sexual dysfunction – no desire for sex pedophilia sexual masochism sexual sadism transvestic fetishism necrophilia zoophilia telephone scatolgia 9