CHAPTER 23
Mental Health
Mental Health Overview
• Mental health
– Relative state of mind in which the person
who is healthy is able to cope with and
adjust to the recurrent stresses of everyday
living in an acceptable way
2
Mental Health Overview
• Mental disorders
– Disturbances of emotional stability, as
manifested in maladaptive behavior and
impaired functioning
• Defense mechanisms
– Body’s unconscious reaction to protect itself
from conflicts or anxieties
3
Mental Health Overview
• Psychology
– Study of behavior and processes of the
mind as it relates to the individual’s social
and physical environment
• Psychologist
– Professional who specializes in the study
of the structure and function of the brain
and related mental processes
• Not a medical doctor
• MA or PhD degree
4
Mental Health Overview
• Psychiatry
– Branch of medicine that deals with the
causes, treatment, and prevention of
mental, emotional, and behavioral
disorders
• Psychiatrist
– Medical doctor who specializes in
diagnosing, preventing, and treating mental
disorders
• Many subspecialties
5
Defense Mechanisms
• Compensation
– Effort to overcome, or make up for, real or
imagined inadequacies
• Denial
– Refusal to admit or acknowledge the reality of
something, thus avoiding emotional conflict or
anxiety
6
Defense Mechanisms
• Displacement
– Process of transferring a feeling or emotion
from the original idea or object to a substitute
idea or object
• Introjection
– Individual unconsciously identifies with
another person or with some object
• Individual assumes the supposed feelings and/or
characteristics of the other personality or object
7
Defense Mechanisms
• Projection
– Act of transferring one’s own unacceptable
thoughts or feelings on to someone else
• Rationalization
– Attempting to make excuses or invent logical
reasons to justify unacceptable feelings or
behaviors, most commonly used defense
mechanism
8
Defense Mechanisms
• Regression
– Response to stress in which the individual
reverts to an earlier level of development
and comfort measures associated with that
level of functioning
• Repression
– Involuntary blocking of unpleasant feelings
and experiences from one’s conscious mind
9
Defense Mechanisms
• Sublimation
– Rechanneling or redirecting one’s
unacceptable impulses and drives into
constructive activities
• Suppression
– Voluntary blocking of unpleasant feelings and
experiences from one’s mind
10
Classification
of Mental Disorders
• DSM-IV-TR Multiaxial Classification
System
– Sixteen major diagnostic classifications
– Each classification includes several disorders
– Disorders are grouped based on shared
features
– Includes five axes for classification
11
Classification of Mental Disorders
• Axis I
– Clinical Disorders
– Other conditions that may be a focus of
clinical attention
• Axis II
– Personality Disorders
– Mental retardation
12
Classification of Mental Disorders
• Axis III
– General Medical Conditions
• Axis IV
– Psychosocial and Environmental Problems
• Axis V
– Global Assessment of Functioning
13
SPECIFIC
MENTAL DISORDERS
Mental Health
Cognitive Disorders
• Cognitive disorders
– Those that affect the individual’s ability to
perceive, think, reason, and remember
– Organic mental disorders
– Includes:
• Amnesia disorders
• Delirium
• Dementia
15
Amnesia Disorders
• Pronounced
– (am-NEE-zee-ah)
• Defined
– Characterized by short-term and long-term
memory deficits
• Have normal attention but are unable to learn
new information
• Unable to recall previously learned information
16
Delirium
• Pronounced
– (dee-LEER-ee-um)
• Defined
– Frenzied excitement that occurs rapidly and is
characterized by difficulty maintaining and
shifting attention
• Individual is easily distracted and must be
constantly reminded to focus attention
17
Dementia
• Pronounced
– (dee-MEN-she-ah)
• Defined
– Progressive, organic mental disorder
characterized by chronic personality
disintegration, confusion, disorientation,
stupor, deterioration of intellectual capacity
and function, and impairment of control of
memory, judgment, and impulses
18
Substance-Related Disorders
• Associated with the use of drugs
– Characteristics:
• Psychological dependence on the substance
• Daily use
• Frequent intoxication by ingestion of the
substance
• Inability to control use of substance
• Physical dependence involves serious withdrawal
symptoms
19
Substance-Related Disorders
• Drugs of substance-related disorders
– Central nervous system depressants
• Slow activity of the CNS, causing impaired
motor activity, judgment, and concentration
– Central nervous system stimulants
• Increased activity of CNS, causing elevated
blood pressure, heightened behavioral activity
and alertness
– Hallucinogens
• Create perceptual distortions of the mind
20
Schizophrenia
• Pronounced
– (skiz-oh-FREN-ee-ah)
• Defined
– Any of a large group of psychotic disorders
characterized by gross distortion of reality,
disturbances of language and
communication, withdrawal from social
interaction, and disorganization and
fragmentation of thought, perception, and
emotional reaction
21
Schizophrenia
• Characteristic symptoms
– Hallucinations
• Person perceives something that does not exist in
the external environment
– Delusions
• Person firmly holds to a persistent abnormal belief
or perception despite evidence to the contrary
22
Schizophrenia
• Characteristic symptoms
– Disorganized speech
• Person may move rapidly from one topic to
another, making little sense
– Disorganized or catatonic behavior
• Person may alternate between agitation and nonpurposeful or random body movements to little or
no behavioral response to the environment
– Flattened affect
• Individual shows little or no emotional response to
the environment
23
Paranoid Schizophrenia
• Pronounced
– (PAIR-ah-noyd skiz-oh-FREN-ee-ah)
• Defined
– Condition characterized by the individual
being overly suspicious of others and having
hallucinations and delusions
24
Mood Disorders
• Group of psychiatric disorders characterized by
disturbances in physical, emotional, and
behavioral response patterns
• Extreme elation and agitation to extreme
depression with suicidal potential
– Includes:
• Bipolar disorders
• Cyclothymic disorder
• Major depressive disorder
25
Bipolar Disorders
(Manic-Depressive)
• Pronounced
– (by-POHL-ar dis-OR-der)
• Defined
– Psychological disorder characterized by
episodes of mania, depression, alternating
between the two, or a mixture of the two
moods simultaneously
26
Bipolar Disorders
(Manic-Depressive)
• Characteristics of mania
– Extreme excitement, hyperactivity
– Agitation, overly talkative
– Flight of ideas, fleeting attention
– Sometimes violent, destructive, and selfdestructive behavior
– May have decreased need for sleep and
seemingly limitless energy
27
Bipolar Disorders
(Manic-Depressive)
• Characteristics of depression
– Symptoms are inappropriate and out of
proportion with reality
– Exaggerated feelings of sadness
– Discouragement
– Hopelessness
28
Anxiety Disorders
• Individual feels increased tension,
apprehension, a painfully increased sense
of helplessness, a feeling of uncertainty,
fear, jitteriness, and worry
– Includes:
•
•
•
•
•
Generalized anxiety disorder
Panic disorder
Phobic disorder
Obsessive-compulsive disorder
Posttraumatic stress disorder
29
Anxiety Disorders
• Observable signs of anxiety
– Includes but not limited to:
•
•
•
•
•
•
•
Restlessness
Poor eye contact
Glancing about
Facial tension
Dilated pupils
Increase perspiration
Constant focus on self
30
Generalized Anxiety Disorder
• Pronounced
– (generalized ang-ZY-eh-tee dis-OR-der)
• Defined
– Disorder characterized by chronic, unrealistic,
and excessive anxiety and worry
• Symptoms have usually existed for at least six
months or more
• Symptoms have no relation to any specific cause
31
Panic Disorder
• Pronounced
– (PAN-ik dis-OR-der)
• Defined
– Characterized by recurrent panic attacks that
come on unexpectedly, followed by at least
one month of persistent concern about having
another panic attack
32
Panic Disorder
• Characteristics
– Intense apprehension, fear, or terror, often
associated with feelings of impending doom
– Person may experience:
•
•
•
•
•
Dyspnea
Dizziness
Sweating
Trembling
Chest pain or palpitations of the heart
33
Phobic Disorder
• Pronounced
– (FOH-bik dis-OR-der)
• Defined
– Anxiety disorder characterized by an
obsession, irrational, and intense fear of a
specific object, of an activity, or of a
physical situation
– Phobia disorder
34
Phobic Disorder
• Classifications of phobias
– Acrophobia
• Fear of high places that results in extreme anxiety
– Aerophobia
• Morbid fear of fresh air or drafts
– Agoraphobia
• Fear of being in an open, crowded, or public place,
such as a field, congested street, or busy
department store, where escape may be difficult
35
Phobic Disorder
• Classifications of phobias
– Arachnophobia
• Fear of spiders
– Claustrophobia
• Fear of closed spaces
– Nyctophobia
• Obsessive, irrational fear of darkness
– Zoophobia
• Persistent, irrational fear of animals, particularly
dogs, snakes, insects, and mice
36
Obsessive-Compulsive Disorder
• Pronounced
– (ob-SESS-iv kom-PUHL-siv dis-OR-der)
• Defined
– Disorder characterized by recurrent
obsessions or compulsions that are severe
enough to be time consuming, (they take more
than one hour a day), or to cause obvious
distress or a notable handicap
37
Obsessive-Compulsive Disorder
• Obsessions
– Repeated, persistent thoughts or impulses that
are irrational and with which the mind is
continually and involuntarily preoccupied
• Compulsions
– Irresistible, repetitive, irrational impulses to
perform an act
• Behavior patterns that are intended to reduce
anxiety, not to provide pleasure or gratification
38
Posttraumatic Stress Disorder
• Pronounced
– (post-trah-MAT-ik Stress dis-OR-der)
• Defined
– Individual experiences characteristic
symptoms following exposure to an extremely
traumatic event
• Individual reacts with horror, extreme fright, or
helplessness to the event
39
Somatoform, Sleep,
and Factitious Disorders
• Somatoform disorders
– Any group of neurotic disorders
characterized by symptoms suggesting
physical illness or disease
– No demonstrable organic causes of
physiologic dysfunctions
40
Somatoform, Sleep,
and Factitious Disorders
• Sleep disorders
– May be related to stress, anxiety, or
physiological problems
• Factitious disorders
– Characterized by physical or psychological
symptoms that are intentionally produced or
feigned to assume the sick role
41
Somatoform, Sleep,
and Factitious Disorders
• Malingering
– Willful and deliberate faking of symptoms of a
disease or injury to gain some consciouslydesired end
– Malingering
• Of the conscious mind
• Results in secondary gain
– Somatoform disorder
• Unconscious
• Results in reduction of anxiety
42
Somatoform, Sleep,
and Factitious Disorders
• Examples:
– Conversion disorder
– Hypochondriasis
– Munchausen syndrome (by proxy)
– Narcolepsy
– Pain disorder
43
Conversion Disorder
• Pronounced
– (kon-VER-zhun dis-OR-der)
• Defined
– Disorder in which the individual represses
anxiety experienced by emotional conflicts by
converting the anxious feelings into physical
symptoms that have no organic basis, but are
perceived to be real by the individual
44
Hypochondriasis
• Pronounced
– (high-poh-kon-DRY-ah-sis)
• Defined
– Chronic, abnormal concern about the health
of the body characterized by:
• Extreme anxiety, depression
• Unrealistic interpretation of real or imagined
physical symptoms as indications of a serious
illness or disease despite rational medical
evidence that no disorder is present
45
Munchausen Syndrome
(By Proxy)
• Pronounced
– (mun-CHOW-zen SIN-drom by PROCKSsee)
• Defined
– Somewhat rare form of child abuse in which a
parent of a child falsifies an illness in a child
by fabricating or creating the symptoms, and
then seeks frequent medical attention for the
child
46
Narcolepsy
• Pronounced
– (NAR-coh-lep-see)
• Defined
– Sleep disorder that is characterized by
repeated, uncontrollable desire to sleep,
often several times a day
• Attacks must occur daily over a period of at least
three months to establish the diagnosis
47
Pain Disorder
• Pronounced
– (pain dis-OR-der)
• Defined
– Psychological disorder in which the patient
experiences pain in the absence of
physiologic findings
48
Dissociative Identity Disorders
• Emotional conflicts that are so repressed
into the subconscious mind that a
separation or split in personality occurs
– Results in an altered state of consciousness or
a confusion identity
– Includes:
• Dissociative amnesia
• Dissociative fugue
• Dissociative identity disorder
49
Dissociative Amnesia
(Formerly: Psychogenic Amnesia)
• Pronounced
– (diss-SOH-see-ah-tiv am-NEE-zee-ah)
• Defined
– The individual is unable to recall important
personal information, usually of a traumatic or
stressful nature
• Loss of memory is more than simple forgetting
50
Dissociative Fugue
(Formerly: Psychogenic Fugue)
• Pronounced
– (diss-SOH-see-ah-tiv FYOOG)
• Defined
– The individual separates from a past life and
associations, wanders away for a period of
time, and returns with no recollection of the
disappearance
51
Dissociative Identity Disorder
(Formerly Multiple Personality)
• Pronounced
– (diss-SOH-see-ah-tiv identity dis-OR-der)
• Defined
– Presence of two or more distinct personalities
within one individual
• At some point in time, each personality takes
complete control of the person’s behavior
52
Sexual and
Gender Identity Disorders
• Sexual Dysfunctions
– Disturbance in sexual desire and sexual response
– Cause marked distress and interpersonal difficulty
• Gender Identity Disorders
– Strong and persistent cross-gender identification
accompanied by persistent discomfort with one’s
assigned sex
• Paraphilias
53
Paraphilias
• Paraphilias
– Recurrent, intense sexual urges, fantasies, or
behaviors that involve unusual objects,
activities, or situations
– Includes:
•
•
•
•
•
Exhibitionism
Fetishism, transvestic
Frotteurism
Pedophilia
Sexual sadism/sexual masochism
54
Exhibitionism
• Pronounced
– (egs-hih-BIH-shun-izm)
• Defined
– Sexual disorder involving exposure of one’s
genitals to a stranger
55
Fetishism,Transvestic
• Pronounced
– (FEH-tish-izm, trans-VESS-tik)
• Defined
– Sexual disorder in which the focus of the
fetish involves cross-dressing
• Male usually keeps a collection of female clothing
that he intermittently uses to cross-dress
56
Frotteurism
• Pronounced
– (FROH-chur-izm)
• Defined
– Sexual disorder in which the person gains
sexual stimulation or excitement by rubbing
against a non-consenting person
• Sexual arousal is achieved through the act of
rubbing and/or touching, which includes fondling
57
Pedophilia
• Pronounced
– (pee-doh-FILL-ee-ah)
• Defined
– Sexual disorder in which the individual is
sexually aroused and engages in sexual
activity with children (generally age 13 or
younger)
• Person is known as a pedophile
58
Sexual Sadism
Sexual Masochism
• Pronounced
– (SEKS-yoo-al SAY-dizm)
– (SEKS-yoo-al MASS-oh-kism)
• Defined
– Sexual disorder that involves the act (real, not
simulated) of being humiliated, beaten,
bound, or otherwise made to suffer, or the act
of inflicting psychological or physical suffering
on the victim
59
Sexual Sadism
Sexual Masochism
• Examples
– Restraining by holding down or tying down
– Slapping
– Spanking
– Blindfolding
– Beating
– Burning
– Rape
– Cutting and torturing
60
Eating Disorders
• Characterized by severe disturbances in
eating behavior
– Individuals have a morbid fear of gaining
weight
– Includes:
• Anorexia nervosa
• Bulimia nervosa
61
Anorexia Nervosa
• Pronounced
– (an-oh-REK-see-ah ner-VOH-suh)
• Defined
– Disorder characterized by an emotional
disturbance concerning body image,
prolonged refusal to eat followed by extreme
weight loss, amenorrhea, and a lingering,
abnormal fear of becoming obese
• Seen primarily in adolescent girls
62
Bulimia Nervosa
• Pronounced
– (boo-LIM-ee-ah ner-VOH-suh)
• Defined
– An uncontrollable craving for food, often
resulting in eating binges, followed by
vomiting to eliminate food from stomach
• Individual may feel depressed, go through a period
of self-deprivation, followed by another eating
binge, and the cycle continues
63
Personality Disorders
• Rigid, inflexible, and maladaptive patterns
of behavior that impair a person’s ability to
function well in society due to a limited
ability to adapt
– Includes:
•
•
•
•
•
Antisocial personality disorder
Borderline personality disorder
Narcissistic personality disorder
Paranoid personality disorder
Schizoid personality disorder
64
Antisocial Personality Disorder
• Pronounced
– (an-tih-SOH-shal per-son-AL-ih-tee dis-ORder)
• Defined
– Characterized by repetitive behavioral patterns
that lack moral and ethical standards, keeping
the individual in continuous conflict with
society
• Individual demonstrates socially irresponsible,
guiltless behavior
65
Borderline
Personality Disorder
• Pronounced
– (BOR-der-line per-son-AL-ih-tee dis-OR-der)
• Defined
– Extensive pattern of instability of interpersonal
relationships, self-image, and marked
impulsivity that begins by early adulthood and
is present in a variety of contexts
66
Narcissistic Personality Disorder
• Pronounced
– (nar-sih-SISST-ik per-son-AL-ih-tee dis-ORder)
• Defined
– Abnormal interest in oneself, especially in
one’s own body and sexual characteristics
• Individual has an exaggerated sense of self-worth,
lacks empathy, appears to lack humility, and tends
to exploit others to fulfill his or her own needs and
desires
67
Paranoid
Personality Disorder
• Pronounced
– (PAIR-ah-noyd per-son-AL-ih-tee dis-ORder)
• Defined
– Generalized distrust and suspiciousness of
others, so much so that the individual blames
them for his or her own mistakes and failures
68
Schizoid
Personality Disorder
• Pronounced
– (SKIZ-oyd per-son-AL-ih-tee dis-OR-der)
• Defined
– Characterized by inability to form social
relationships
• Individual may appear as emotionally cold or
indifferent
69
DEVELOPMENTAL
DISORDERS AND
LEARNING DISABILITIES
Mental Health
Attention-Deficit
Hyperactivity Disorder (ADHD)
• Pronounced
– (ah-ten-shun-DEF-ih-sit –
HIGH-per-ak-tiv-ih-tee diss-OR-der)
• Defined
– Persistent inattention and
hyperactivity, impulsivity, or both
• Formerly known as attention-deficit disorder (ADD)
71
TREATMENTS
AND THERAPIES
Mental Health
Treatments and Therapies
• Behavior therapy
– Psychotherapy that seeks to modify
observable, maladjusted patterns of
behavior by substituting new responses to
given stimuli
– Behavior modification
73
Treatments and Therapies
• Drug therapy
– Psychotropic drugs to treat mental disorders
• Drugs prescribed for their effects in relieving
symptoms of anxiety, depression, or other mental
disorders, such as schizophrenia
– Include:
• Antianxiety agents
• Antidepressants
• Antipsychotic drugs
74
Treatments and Therapies
• Electroconvulsive Therapy (ECT)
– Process of passing an electrical current
through the brain to create a brief seizure,
much like a spontaneous seizure from some
forms of epilepsy
– Shock therapy
75
Treatments and Therapies
• Family therapy
– Psychotherapy that focuses treatment on the
process between family members that
supports and sustains symptoms
• Group therapy with family members composing the
group
76
Treatments and Therapies
• Group therapy
– Application of psychotherapeutic
techniques within a small group of
people who experience similar
difficulties
– Also known as encounter groups
77
Treatments and Therapies
• Hypnosis
– Passive, trancelike state of existence that
resembles normal sleep during which
perception and memory are altered, resulting
in increased responsiveness to suggestion
• Used in psychotherapy, medicine, and in some
criminal investigations
78
Treatments and Therapies
• Play therapy
– Psychotherapy in which a child plays in a
protected and structured environment with
games and toys provided by a therapist,
who observes the behavior, effect, and
conversation of the child to gain insight into
thoughts, feelings, and fantasies
79
Treatments and Therapies
• Psychoanalysis
– Psychotherapy that analyzes the individual’s
unconscious thought, using free association,
questioning, probing, and analyzing
– Therapist uses a technique known as free
association
• Allows individual to say aloud anything that comes
to mind no matter how minor or embarrassing
80
Personality
and Intelligence Tests
• Draw-A-Person (DAP)
– Personality test that is based on the
interpretation of drawings of human figures of
both sexes
– Individual is asked to draw human figures and
talk about them
81
Personality
and Intelligence Tests
• Minnesota Multiphasic Personality
Inventory (MMPI)
– Self-report personality inventory test that
consists of 550 statements that can be
answered “true,” “false,” or “cannot say”
• Statements vary widely in content and are
sometimes repeated in various ways throughout
the test
82
Personality
and Intelligence Tests
• Rorschach inkblot
– Personality test that involves the use of 10
inkblot cards, half black and white, and half in
color
• Cards are shown to the individual, one at a time
• Person is asked to describe what he or she sees in
the card
83
Personality
and Intelligence Tests
• Thematic Apperception Test (TAT)
– To elicit stories that reveal something about
an individual’s personality
– Series of 30 black-and-white pictures, each
on an individual card
• When cards are shown, individual is asked to tell a
story about each picture, providing all background
information and details
84
Personality
and Intelligence Tests
• Intelligence testing
– Designed to measure an individual’s ability to
adapt and constructively solve problems in
the environment
– First successful test of intelligence developed
by Alfred Binet, a French psychologist
85
Personality
and Intelligence Tests
• Intelligence test scoring
– Mental Age (MA)
• Age level at which one functions intellectually
– Chronological Age (CA)
• Age of the individual, expressed as time beyond
birth
– Intelligence Quotient (IQ)
• Numeric expression of an individual’s intellectual
level
– MA divided by CA multiplied by 100 = IQ
86
Personality
and Intelligence Tests
• Intelligence test used to measure IQ
– Stanford-Binet Intelligence Scale
– WAIS III: Wechsler Adult Intelligence Scale –III
– WISC-III: Wechsler Intelligence Scale for
Children-III
– WPPSI-R: Wechsler Preschool and Primary
Scale of Intelligence-R
87