Psychological Disorders
INTRO PSYCH
Modules 36-37
Apr30-May5, 2010
Class #40-42
Module 36:
Some definitions of abnormality…
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Words you’ll see in the literature…
Harmful dysfunctions
 Atypical
 Maladaptive
 Disturbing
 Psychotic
 Unjustifiable
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A Little History of Mental Illness…
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Some were considered witches…
 Submerged into water – if they drowned it was felt
they weren’t really witches
 Thousands of women were killed in this manner
during 13th-16th century
A Little History of Mental Illness…
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Physiological Treatment
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Bleeding
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Fear
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Excessive blood in the brain
Put in coffin-like box and submerged in water until
bubbles from the patient’s breathing had ceased to come
to the surface at which point the person was revived…
Drugs
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The use of alcohol, opium, and marijuana were used to try
to cure these individuals
A Little History of Mental Illness…
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Asylums
During this time (late 1300’s), places where the
mentally ill were cared for began to surface
 Before this, these people were treated as criminals
and put in jails or prisons
 A medical model where psychological disorders were
considered to be sicknesses that could be cured
through therapy at a psychiatric hospital became the
prevailing viewpoint
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Bedlam
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Hospital of St. Mary of Bethlehem (established
officially in 1500’s)
 Bedlam – “lunatics” were treated cruelly…if they
became too excited they were chained out of harm’s
way and often beaten or doused with water
 Visitors would pay a small fee to be allowed to go in
and ridicule the patients for entertainment purposes
 The crowds would often become very noisy and
disorderly themselves – hence, the name
Removing the chains…
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Philippe Pinel
Institutes a medical model – that these
psychological disorders were sicknesses
 That psychopathology needs to be diagnosed on the
basis of its symptoms and cured through therapy
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Bio-psycho-social Perspective
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Mental disorders are seen as caused by the combination
and interaction of:
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Biological Factors: Includes physical illnesses and
disruptions of bodily processes that may in part be due to
genetic predispositions
Psychological Factors: Includes psychological processes
such as our wants, needs, and emotions; our learning
experiences; and our way of looking at the world
Sociocultural Factors: Includes the social and cultural
context that form the background of the abnormal behavior
Diagnostic and Statistical Manual
(DSM-IV)
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The behavior pattern of all psychological
disorders were not clearly described until the
publication of the APA’s first diagnostic and
statistical manual (DSM-I) in 1952
DSM-IV defines 17 major categories of mental
disorder
Purposes of Diagnostic System
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Designed to determine nature of client’s
problems
Once characteristics are understood, problem’s
probable course can be predicted and most
appropriate method of treatment can be
administered
Problems With Diagnostic System
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Some critics believe that now there are too many
behaviors are considered to be within “the compass of
psychiatry” – only about 60 in DSM-I and now about
400
People’s problems often do not fit neatly in one
category
The same symptoms appear as part of more than one
disorder
Possibility of personal bias due to the somewhat
subjective nature of diagnostic judgments – some feel
these are “value judgments masquerading as a science”
Labeling people may be dehumanizing
Anxiety Disorders – Module 37
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Deciding when anxiety is so severe that it is
a disorder depends on several variables, and
physicians differ in making the diagnosis…
If anxiety is very distressing, interferes with
functioning, and does not stop spontaneously within
a few days, an anxiety disorder is present and merits
treatment
 Diagnosis of a specific anxiety disorder is based
largely on its characteristic symptoms and signs
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Anxiety Disorders
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Generalized Anxiety Disorder
Panic Disorder
Phobias
Obsessive-Compulsive Disorder
Generalized Anxiety Disorder
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Symptoms and Issues
Anxiety that is constantly present
 Distractibility, fatigue, muscle tension, sleep disturbances
 Chronic unrealistic or excessive worry
 To be diagnosed, the worry must last six months and
not be limited to a single life circumstance
 Always apprehensive even when things seem to be going
well
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Symptoms and Issues
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Trouble making decisions – agonize over them –
then once they finally make the decision…
Sex difference: Women 6.6% Men 3.6%
Onset: anytime
Complications
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High risk for development of substance abuse
or dependence
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Self-medicating
Physiological Explanation: Chemical imbalances
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GAD is associated with irregular levels of
neurotransmitters caused partly by an
underactivity of inhibitory neurons
GABA – too low levels
Serotonin – too low levels
Norepinephrine – too high levels
This makes sense…
Medications
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Antidepressants and anti-anxiety drugs
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Valium, Xanax, etc.
These fast-acting drugs increase GABA activity
Minor Tranquilizers
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These increase the activity of the inhibitory neurons so that the
excitatory neurons will be less active
Prognosis
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Not very good…can be long-standing and
difficult to treat
Obsessive-Compulsive Disorder
(OCD)
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To be diagnosed with OCD, a person must have
recurrent obsessions and compulsions that are
disabling
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Significantly interfere with a person’s routine,
making it difficult to work, or to have a normal
social life or relationships
Prevalence and Onset
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Prevalence
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Life-time prevalence
 Afflicts 2%-3% of population some time in their lives
Group differences
 No sex differences
 Knows no geographic, ethnic, or economic
boundaries
Onset
About two-thirds develop the disorder before they are
25 years old and only 15% after the age of 35
 Onset after 40 is very rare
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Obsessions
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Constant, intrusive, unwanted thoughts causing
distressing emotions such as anxiety or disgust
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Examples:
 Thoughts of violence (person feels he/she will
hurt someone)
 Thoughts of contamination (germs)
 Thoughts of uncertainty (did I lock the door?)
Compulsions
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Compulsions are urges to do something to
lessen discomfort
Rituals are the behaviors in which these people
engage in to accomplish this
Common OCD Compulsions
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Cleaning
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Repeating
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Feel harm will occur if they don't
Completing
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Fear of germs, etc.
Exact order until perfection
Being meticulous
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Exact place for things (ex: appearance of room, etc.)
OCD Compulsions
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Avoiding
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Counting
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Constant collection of useless items
Slowness
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Compelled to count things (like how many steps it takes to get
somewhere)
Hoarding
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Exaggerated avoidance of anxiety producing stimuli
Tasks done extremely slowly
Excessive and Ritualized praying
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May pray literally all day long in a ritualized manner
Behavioral Explanation
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Operant conditioning explanation
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Problems:
 Even after receiving drugs, etc. that reduce
anxiety levels – they still continue obsessions and
compulsions
Physiological Explanations
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Scarcity of serotonin
In certain brain structures there are high levels
of brain activity (orbital frontal, etc.)
Brain damage
Genetics
Common Treatments for OCD
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Cognitive-Behavioral Therapy
Antidepressant Medications
Cognitive-Behavioral Therapy
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This type of therapy is based on learning
(reconditioning specific behaviors) and changing the
beliefs (thinking processes) of the individual suffering
from OCD…
 Systematic
 Expose
desensitization
them to what is making them anxious at
increasing intervals…the idea here is that by
facing the thing that they fear a little at a time they
will eventually conquer the fear
 May have to start some off by having them
imagine the situation
Cognitive-Behavioral Therapy
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Response prevention
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Preventing the person from doing the compulsion or
mental act
Relaxation techniques
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Cognitive techniques such as self-talk are often
combined with the above techniques
Cognitive-Behavioral Therapy
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Effectiveness:
 60-80% of those using the cognitivebehavioral treatments improve (show at least
a partial reduction in symptoms)
Antidepressant Medications
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Drugs that influence (increase) serotonin levels have been used
effectively
 Prozac, Zoloft, Paxil, Anafranil, etc.
 Drawbacks:
 High doses of these drugs may be required in the
treatment of OCD
 It can take several weeks to feel their beneficial effects
 Additionally, there are potential side effects to
consider
Prognosis
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The disease is chronic for most people even
with drug treatment
Most take medication indefinitely, and about
85% of people relapse within one or two
months after discontinuing usage
Panic Disorder
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Usually brief periods of intense anxiety
Usually unexpected and do not appear to be
provoked by the situation the person is
responding to
Prevalence and Onset
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Lifetime prevalence:
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Approximately 3% to 5% of the general population
Sex difference:
Females 5 %
 Males 2%
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Onset
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Usually before age 25
Symptoms
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Racing HR
Chest pain
Choking sensation
Excessive sweating
Dizziness and Nausea
Chills, shaking, etc.
Feelings of unreality (detached from one’s body)
Specific Characteristics
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Brevity of attacks (usually reach maximum
intensity within a minute or so)
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Marked intensity of stark terror
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In very rare cases the attacks can last several hours or days
This terror lingers on long after the episode has ended – they
“fear the fear”
People often have a fear of dying or going crazy
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Note: Some individuals will fear having a panic attack in
public so much that they will rarely leave home…if their
avoidance of public places becomes this extreme the
individual may be diagnosed as suffering from panic disorder
with agoraphobia
Phobias
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Fear has no justification in reality
Fear is greater than is justified
Individual is aware of irrationality of fear
Dissociative Identity Disorder
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Commonly referred to as Multiple Personality Disorder (name of
this illness was officially changed in DSM-IV)
Very rare: Less than 1%.
A person alternates between two or more distinct personality
systems
Each personality system has a distinct, well-developed emotional
and thought process
Usually there is a main or basic personality
Sex difference: F > M (9 to 1 ratio)
Probably the #1
“Hollywood Disorder”
Symptoms
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The individual may change from one personality to
another in a matter of a few minutes to several years
(shorter time frames are more common)
The personalities are often dramatically different
Depression…often suicidal
Mood swings (alter shifts?)
Treatment and Prognosis
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Treatment
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Psychoanalysis
Therapists try to give therapy to the main personality who
"knows" the others
 This is not always possible
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Prognosis
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Not good
Important Note…
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Until 1970's extremely rare with few reported
cases (about 100) but since then its
prevalence has increased dramatically…
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Why this dramatic increase???
Antisocial Personality Disorder
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Probably a universal disorder
Sex Difference:
3% males
 1% females
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Occurs about equally in all ethnic groups,
cultures, historical periods
Most research with criminals, but it may occur in
non-forensic populations
Characteristics In Adolescence
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Seem to have little feeling for anyone
Fear no one
Lack of conscience apparent by age 15
Compulsive liars
Stealing
Fighting
Unrestrained sexual behavior
Animal cruelty connection
Clinical Description of the Psychopath
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Egocentric, arrogant, deceitful, shallow, impulsive
individuals who callously use and manipulate others
with very little or no sense of shame, guilt, remorse
Often violent
Unguided by dictates of "conscience"
Lack of empathy; only an abstract, intellectual
awareness of others feelings
No loyalty to any person, group, code, organization, or
philosophy; self-interest
Not psychotic or intellectually dull
Clinical Description of the Psychopath
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Human predators
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Look for places where there is opportunity for easy
money, power, control, prestige
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Others exist only as emotional, psychical, and financial prey
with no rights of their own
Prey on the vulnerable
Psychopathy is associated with pleasure and thrillseeking behavior
Clinical Description of the Psychopath
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They put on a good show, wear many masks
Performance diverts us away from what they are saying
Intense eye contact
Invade personal space
Effective deceivers
Seem to have little feeling for anyone
Fear no one
No regret over committing a crime – its forgotten the
next day
What to look for…
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Very intelligent and charming
Spontaneously likeable at first
“My mom thinks he’s a wonderful guy”
But they have many social problems…
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See next slide
Ted Bundy:
The classic example
Social Problems
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Unable to keep a job
Always seem to have “new” friends
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No long term friendships
“He’s a good friend of mine” – NOT!
Irresponsible marital and parental behavior
Seem to live in a series of present moments with no
consideration for the future (“the pleasure principle” of
the id)
Much criminal activity
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Record of assaults
Physiological Explanations
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Hare (1968)
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Deficient Arousal Activity
 Relative immunity to stimulation
 Stressful situations are nothing to them
Behavioral Explanations
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Family Relationships
Early parental loss
 Parental rejection
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Medical Treatment
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Treatment with medications such as antidepressants has
not been helpful