CHAPTER 15 PSYCHOLOGICAL DISORDERS Abnormal vs Normal Behavior more than 1 1 Personal distress 2 Violation of social normal 3 Harmful dysfunction 4 Impairment BELIEFS ABOUT DISORDERS Ancient Greeks The gods punished humans by causing madness Hippocrates suggested a link to the brain Middle Ages The Demonic Model possession by the devil Punishment for sin Witches Renaissance Medical Model Asylums most likely a placebo effect Moral treatment The Modern Era 1950 s Dramatic change in treatment of mentally ill Deinstitutionalization Community mental health centers CULTURE BOUND DISORDERS Certain conditions are culture bound o Remain poorly researched May be variants of conditions in western culture o ex Social anxiety Individualistic vs collectivistic Many mental disorders appear to be universal across cultures o ex Schizophrenia alcoholism MISCONCEPTIONS Psychiatric diagnosis is nothing more than pigeonholing Psychiatric diagnoses are unreliable Psychiatric diagnoses are invalid o Robins and Guze criteria for validity Diagnoses usually distinguish themselves from other diagnoses ruling out other things in the process The diagnose do predict performance on laboratory tests Predicts what happens to the individual over time Predicts response to treatment Psychiatric diagnoses stigmatize people CLASSIFICATION Psychodynamic Diagnostic Manual PDM DSM IV TR Diagnostic and Statistical Manual o multiaxial system o diagnostic criteria o warns to think organic o gives prevalence rates DSM IV 5 Axes o I Clinical Syndromes mood anxiety learning o II Personality Disorders narcissistic anti social o III Medical Conditions diabetes glaucoma o IV Social and Environmental Problems financial difficulties lack of social support o V Global Assessment of Functioning Criticisms o High level of comorbidity ex Major depression and anxiety go hand in hand o Reliance on categorical rather than dimensional model of psychopathology All or none in categorical Spectrum in dimensional o Vulnerable to political an social influences ex Homosexuality used to be seen as disorder but b c of social influence is no longer MENTAL ILLNESS AND THE LAW Overwhelming majority of people with schizophrenia are no aggressive or violent Insanity defense requires people to o Not know what they were doing at the time of the crime o Not know what they were doing was wrong Less than 1 of criminal cases use this successfully Involuntary commitment Can only be committed against their will if o Threat to themselves or others o Are so impaired they can t care for themselves PERSPECTIVES Biological Psychological o Psychodynamic o Cognitive o Behavioral Sociocultural Biopsychosocial combination DIATHESIS STRESS MODEL Psychological theory that attempts to explain behavior as predisposition vulnerability together with stress from life experiences o Diathesis B P or S Stressor B P or S Disorder AXIS I CLINICAL SYNDROMES Developmental disorders Learning attention disorders Mood disorders Anxiety disorders Schizophrenia Somatoform disorders Dissociative disorders AXIS II PERSONALITY DISORDERS Deeply ingrained maladaptive ways of perceiving others and behaviors that are stressful Narcissistic Antisocial Paranoid Boarderline OCD and OCPD Dependent AXIS II GENERAL MEDICAL CONDITIONS AXIS IV GLOBAL AND ENVIRONEMENTAL ISSUES AXIS V GLOBAL ASSESSMENT OF FUNCTIONING AXIS I CLINICAL SYNDROMES ANXIETY DISORDERS Most prevalent of all disorders o 29 of us will meet criteria for an anxiety disorder at some point in our lives o Average age of onset 11 years Generalized Anxiety Disorder Panic Disorder Phobias OCD PTSD GAD o o o o o o Broad spectrum worry Feelings of impending negative events Many topics Physical symptoms GI problems ulcers headaches May be specific or nonspecific Arousal of sympathetic nervous system Panic Disorder o Abrupt attacks of acute anxiety o Panic Attacks o Repeated and unexpected o Feels like a heart attack o Feel of dying or going crazy o May last minutes or hours o Symptoms tend to peak in 10 minutes o choking racing heart numbness sweatiness shortness of breath nausea o Feeling like it s all in their head o Some are associated with specific situations Panic Disorder w or w out agoraphobia o Fear of being in a place or situation in which escape is difficult o misconception is that agoraphobia is the fear of crowds or public places Phobias o Intense IRRATIONAL sometimes debilitating fear of specific objects or situations o situations avoided or endured with great distress o agoraphobia claustrophobia etc Social Phobia o Fear of public situations and scrutiny leading to embarrassment or humiliation o Public speaking o Eating in front of others o Writing in front of others o Recognizing fear as excessive or unreasonable o Might lead to panic attack o Avoidance o Can be generalized if includes multiple situations OCD o If I don t do bad things will happen o Obsessions recurrent persistent anxiety provoking thoughts images experienced as intrusive and causes marked distress o Have I locked the door are my hands clean etc o Compulsions ritualistic repetitive behaviors or mental acts that reduce the anxiety connected with obsessions Aimed at reducing distress o Checking doors washing hands PTSD o o o o o o o Begins with a life threatening event Flashbacks reliving Intense fear Avoidance Nightmares Overall anxiety Defensive or aggression ROOTS OF ANXIETY o Learned response Acquired habits o Observing others engage in fearful behaviors o Operant Conditioning relies on reinforcement and punishment e g feeling rejected o Classical Conditioning fear of small furry animals Little Albert o Biological Influences o Twin studies show that anxiety is genetically influenced o OCD 2x as likely to develop OCD than people w out OCD to inherit overactive gene Related to serotonin THEORETICAL VIEWS o Psychodynamic o Anxiety as difficulty repressing primitive impulses o Behaviorists o Conditioned avoidance of feared stimuli reinforced by reduced anxiety o Cognitive o Anxiety maintained by distorted cognitions I won t be able to handle it o Biological o Anxiety runs in families o Evolutionary o Predisposed to fear stimuli that might be life threatening MOOD DISORDERS Major Depressive Disorder Systhymia Seasonal affective disorder Postpartum Depression Bipolar Disorder o Bipolar I o Bipolar II o Cycothymia o o o o o Nothing more than society trying to control our behaviors Myth about mental illness MAJOR DEPRESSIVE DISORDER o Chronic and recurrent o Low