The study of psychological disorders

Psychological Disorders

A prolonged or recurring problem that seriously interferes with a person’s ability to live a satisfying personal life & function adequately within society.

Abnormal/normal continuum

Often the degree and duration of disruption distinguishes "normal" from "abnormal"

Diagnostic & Statistical Manual of Mental Disorders - IV

American Psychiatric Association’s guide to diagnosing and classifying mental disorders

Major Clinical Syndromes

Anxiety disorders

Dissociative disorders

Mood disorders

Schizophrenic disorders

Generalized Anxiety Disorder

Panic Disorder

Phobias

Obsessive-Compulsive Disorder

Post-Traumatic Stress Disorder

Person is generally nervous, tense, always worrying more than necessary

Impairs functioning; physical complaints associated with anxiety are common

Used to be called "free-floating anxiety"

Affects about 1 in 20 adults (5%)

Treated with therapy with or without drugs; 40-50% are still ok 1 yr later

Recurrent unpredictable attacks of intense physical terror plus continual worry about having the next attack

Attacks include 4 or more of these: pounding heart, sweating, trembling, breathless, choking feelings, nausea, chest pain, dizzy, feeling out of control

Limits person’s activities

4% of adults, 2-3 X as many women

Biological differences (it runs in families, there is evidence that those with panic disorder may be chemically different and may be more sensitive to body feedback)

Artificially causing body changes (e.g. with caffeine) can trigger a panic attack

Social cognitive approach - a difference in the cognitive interpretation of bodily signs

Persistent intense irrational fear of particular situations or things

Fear leads to avoidance that interferes with normal activities

75% are linked to traumatic experiences; all 3 types of learning can be involved

Most common is social phobia (13% of adults)

acrophobia - fear of heights

claustrophobia - fear of closed spaces

zoophobia - fear of animals

xenophobia - fear of strangers/unfamiliar

Some phobias may have a biological basis - we may be biologically prepared to fear things that were dangerous to us in our evolutionary past

Fear of going out will cause panic attacks

Person may avoid particular situations (shopping, public transportation, large crowds) or may be totally house-bound

Repetitive intrusive thoughts (obsessions") + repetitive behavioral rituals ("compulsions")

Feel driven to engage in those behaviors - otherwise experience intense anxiety.

Anxiety & feelings of helplessness after an extreme trauma - keep thinking about trauma, tend to become emotionally unresponsive

Anxiety causes difficulty concentrating, irritability, memory problems, sleep problems, sometimes flashbacks, physical symptoms

May occur quite a while after the trauma

serious, persistent disturbances in a person’s emotions that causes psychological distress and/or impairment of the ability to function

Major depression ("unipolar depression")

Bipolar disorder

SAD

Dysthymic and cyclothymic disorders

sadness, feel helpless, hopeless, worthless

no energy, apathetic, nothing matters

can’t make decisions, complete tasks

lose appetite for food & sex, disordered sleep, move & talk slowly

suicidal thoughts or actions

Chronic low-level depression for 2 years or more, with intervals of normal mood not lasting longer than a few weeks or months. Symptoms like depression but not as debilitating. Individuals tend to accept being "down in the dumps" as just a fact of life.

Often referred to as Manic Depression

Involves periods of incapacitating depression alternating with periods of extreme euphoria and excitement.

A sudden, rapidly escalating emotional state characterized by extreme euphoria, excitement, physical energy, and rapid thoughts and speech.

Immediately precedes or follows a bout with major depression

Symptoms of Manic Episode

Emotional: Elated, euphoric, very talkative, impatient

Cognitive: Racing thoughts, flight of ideas, desire for action, Impulsive behavior, self-confident; unrealistic view of capabilities; some delusions of grandeur

Motor: Hyperactive, tireless, increased sex drive and fluctuating appetite

Emotional: Gloomy, hopeless, socially withdrawn, irritable

Cognitive: Slowness of thought processes, obsessive worrying, inability to make decisions, negative self-image, self-blame, and delusions of guilt and disease

Motor: Less active, tired, difficulty in sleeping, decreased appetite

Approximately 2 million Americans suffer from bipolar disorder

No sex differences

The risk for developing bipolar disorder is about 1 percent for both men and women

Genetics

Neurotransmitters

Stress

Twin studies show that if one identical twin suffers from bipolar disorder, the other twin has about a 70% chance of developing the disorder

If a person has bipolar disorder his/her immediate family members are 3x more likely to have a mood disorder

Serotonin and norepinephrine play a role in depression

Antidepressants that increase the availability of these neurotransmitters are highly effectivein alleviating the symptoms of depression

Lithium is used to treat bipolar disorder

Some evidence that stressful life events play a role in bipolar disorder

Moderate but frequent swings in mood for 2 years or more

Depressive symptoms that cycle with the seasons, with depression typically occurring in the fall/winter and disappearing when the days get longer in the spring.

Characterized by lack of energy, oversleeping, overeating as well as depressed, irritable mood

Biological factors (genetic, neurological)

Depression seems to be linked to underactivity of serotonin and/or NE

Psychological factors (stresses, life events)

Cognitive factors (pessimism, negative thinking, learned helplessness)

Another DSM category of disorders which seem to be caused by extreme stress/psychological trauma

Conscious awareness is separated or dissociated from previous memories, feelings,or experiences

Amnesia for personal information and events that does not have an organic basis

Usually associated with stressful or traumatic events

Recovery possible (unlike most organic cases)

Psychogenic amnesia or confusion about your identity paired with sudden, unexpected travel or fleeing to a new location

May start up a new life with no recollection of your past

Individual shows 2 or more distinct personality states, each with its own manner of thinking & behaving, and appearing at different times.

1. Mental "splitting" was a way of coping with severe childhood abuse.

2. Public awareness of cases of DID led to this behavior becoming a way to express frustration/distress or to manipulate others.

Huge recent increase in reported cases

Increase limited to the USA

Majority of recent cases had a wide range of chronic psychiatric problems

Certain therapists may over-diagnose or "suggest" DID

Serious mental disorder lasting >6 months with at least 2 of the following interfering with their functioning:

Delusions (misbeliefs about reality)

Hallucinations (most often hearing voices)

Disorganized speech, disorganized thought, jumping to loosely associated ideas

Grossly disorganized behavior

Decreased emotional expression

Paranoid- delusions of being plotted against/persecuted; delusions of grandeur (that they’re important)

Disorganized- childish behavior, bizarre ideas, inappropriate & changeable emotions, often extreme neglect of personal hygiene

Catatonic- periods of rigid, prolonged immobility alternating with periods of wild motor activity

Those not clearly fitting any of the above categories are called "undifferentiated".

Those with positive (+) symptoms (hallucinations, delusions have been "added" to their behavior) have a better chance of responding to meds & recovery

Those with negative (-) symptoms  (normal behaviors that have disappeared or decreased, like the loss of normal emotional responses, loss of normal social interactions, decreased speech) are less likely to respond to meds & show recovery

Acute vs chronic schizophrenia - although perhaps 25% may suffer a single psychotic episode and have little problem after that, it is much more common for schizophrenia to be a chronic condition with some symptoms all of the time and periods when the symptoms worsen and hospitalization may be necessary.

Inherited predisposition

Overactive DA theory -

Brain Changes (larger ventricles, smaller thalamus,  abnormalities in limbic system, decreased activity in the frontal lobe)

Prenatal virus/trauma - the children of mothers who had the flu or other viral infection during pregnancy, or who had prenatal complications
    are at higher risk of developing schizophrenia. This association is strongest in cases where there is no family history of psychosis.

Diathesis Stress Theory - genetic predisposition interacts with life stressors to determine risk/vulnerability  to schizophrenia or if, when, & how severe psychotic episodes may be