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PSYCHOLOGICAL DISORDERS (INTRO) To be classified as “abnormal behavior,” it must have the following characteristics:DeviantDistressfulDysfunctionalDangerousPerspectives on AbnormalityMedical – believes that there are physiological causes at the root of psychological problemsPsychoanalytic – believes that psychological disorders stem from unresolved childhood conflictsBehavioral – believes that behaviors are learned responsesCognitive – ?believes that cognitions (thoughts and beliefs) are the root of psychological problemsHumanistic – ?believes that people are responsible for their own behavior, even abnormal behaviorSociocultural – ?believes that abnormal behavior is shaped by family, society and cultureClassifying Abnormal BehaviorDSM-V (Diagnostic and Statistical Manual of Mental Disorders, FIFTH EDITION) – used by most U.S. mental health professionals to diagnose and classify abnormal behaviorit keeps psychologists all on the same page…and using the specific criteria in the DSM, most psychologists will diagnose the same person with the same disorderCriticisms of the DSMCategories are too wide and make many behaviors psychologicalLabels are arbitrary and value judgmentsBottom line…what truly constitutes abnormal behavior is a fine and fuzzy line!ANXIETY DISORDERSAnxiety – involves worry, fear, apprehension, intrusive thoughts, physical symptoms, and feelings of tensionGeneralized Anxiety Disorder (GAD)Prolonged, vague, unexplained…but intense…fears that do not seem to be attached to any particular object Clinical features:Excessive anxiety and worry occurring for at least 6 monthsInability to control the worryPresence of 3 or more of the following:Restlessness; feeling on edgeBeing easily fatiguedDifficultly concentrating; mind goes blankIrritabilityMuscle tensionSleep disturbancesConsiderable distress or impairment in social, occupational or other important areas in lifePanic DisorderIndicators are similar to those of GAD, except that they are greatly magnified and usually have a sudden onsetClinical featuresRecurrent, unexpected panic attacks and at least 1 month of persistent concern over having them againSymptoms of a panic attack:Shortness of breath/feeling smotheredDizziness, unsteadiness or faintnessTrembling, shaking or seatingRacing heartChoking, nausea or stomach painNumbness or tinglingChest pain or discomfortSense of “strangeness” Fear of going crazy, losing control or dyingPhobiasIntense, irrational fear, panic, dread or frightTypes of phobiasSpecific phobia: ?miscellaneous category of marked, persistent, irrational fearsSocial phobia: ?characterized by fear and embarrassment in dealing with othersAgoraphobia: ?fear of entering certain fear-evoking or unfamiliar situations, which often accompanies panic attacksObsessive- Compulsive Disorder (OCD)Recurrent obsessions (persistent thoughts, ideas or images that can’t get rid of ) and/or compulsions (repetitive acts or series of acts one feels compelled to do) that are severe enough to be time-consuming, cause marked distress or cause significant impairment to lifeOCD CyclePosttraumatic Stress Disorder (PTSD)Involves an extreme experience, such as war or natural catastrophe, whose effect may be extended over a long period of timeSymptoms are similar to those experience in GAD or Panic Disorder – except for fact that often person has tendency to re-experience the event SOMATOFORM DISORDERSSomatoform Disorders – characterized by physical symptoms that seem to suggest a physical disorder, yet have no physical causes or evidence suggests that symptoms are linked to psychological factorsConversion disorder: ?unexplained symptoms or deficits affecting voluntary motor or sensory function that suggest a medical condition, yet no medical condition exists Common symptoms are…la belle indifference (beautiful indifference) Hypochondriasis: ?preoccupation with the idea that one has or might get a serious disease, along with misinterpretation of bodily symptoms/functionsDo not recognize concern to be excessive3 major characteristics…Physiological arousal Bodily focus Behaviors designed to avoid or check for physical illness Body dysmorphic disorder: ?preoccupation with an imagined or exaggerated defect in personal appearanceEssential feature of BDD is belief in an imagined defect in appearanceExperience marked distress over supposed deformityTypically becomes evident in adolescenceDEVELOPMENTAL DISORDERSDevelopmental Disorders – group of disorders that involve distortions in the development of basic psychological functions that are involved in social skills, language, perception or motor behaviorAutism (Autistic disorder): ?typically show an unusual pattern of social and cognitive development beginning in childhood, with marked difficulties in social interaction and communicationCharacteristics of autistic disorderImpairment in social relationshipsImpaired speechVery narrow range of interests and activitiesSameness and routine very importantAsperger’s Disorder: ?results in impairment of social interaction, restricted interests, and repetitive behavior, yet no significant delays in language or cognitive developmentCharacteristics of Asperger’s disorderInterest in objects rather than people – impairment in social interactionRoutine oriented No general delay in language, yet some problems with social use of languageMotor clumsiness – awkward way of walking, trouble throwing/catching balls and trouble with fine motor skills like tying shoesAttention-Deficit Hyperactivity Disorder (ADHD): ?developmental disability involving short attention span, distractibility, and extreme difficulty in remaining inactive for any period3 subtypes…Predominantly hyperactive-impulsivePredominantly inattentive Combined hyperactive-impulsive and inattentiveSymptoms of ADHDInattentionHyperactivityImpulsivityCausesResearch points to a combination of genetic and environmental factorsTreatment often involves administering stimulant drugs like Adderal, Ritalin, ConcertaIndividuals with ADHD often have other disorders such as a learning disability, oppositional defiant disorder, conduct disorder, anxiety disorders, depression or bipolar disorderMOOD DISORDERSMood Disorder – disturbances in emotional feelings strong enough to interfere with everyday livingMajor DepressionSymptoms (must last for 2 weeks without cause) – for those who are grieving symptoms must last for 2 months:Either depressed mood or loss of interest/pleasure in almost all activitiesAt least four of the following:Weight gain/lossSleep disturbancesAgitated behaviorFatigueInability to think clearlyFeelings of worthlessnessFrequent thoughts of death/suicideCausesBiological – lack or insufficient amounts of neurotransmittersSocial-Cognitive – negative thoughts influence negative behaviors that influence the situation and in turn influence thought patternsDepression Cycle:Bipolar DisordersAlternate between depression and maniaMania = racing thoughts, elevated/irritable mood, inflated self-esteem, decreased need for sleep, increased talkativeness, distractibility, increased activity, etc. lasting at least a weekTypes of Bipolar DisorderBipolar I – experience manic episodes and usually major depressive episodesBipolar II – experience mania to a lesser degree (called hypomania) Cyclothymic Disorder – have hypomanic and depressive symptoms for at least 2 years yet not constitute full “major depressive episode” or “mania”CausesBiological – evidence for inherited predisposition very strong Are some psychosocial factors in triggering new episodes or preventing themfound that stressful events often trigger manic episodesSCHIZOPHRENIA“split mind” – a split from reality that shows itself in disorganized thinking, disturbed perceptions and inappropriate emotions/actionsdisorganized thinking: thoughts spill out in no logical order and are often fragmented, bizarre and distorted by false beliefs (delusions)disturbed perceptions: ?may perceive things that aren’t there (hallucinations)inappropriate emotions and actions: ?emotions/actions are inappropriate to the situationSymptoms Positive symptoms: ?reflect a distortion or excess of normal functions and tend to be most frequent in the first stages or early episodes of schizophreniaDelusionsHallucinationsDisordered speechDisorganized behavior Negative symptoms: ?behavioral deficits or the lost or decrease of normal functionsFlat affect Poverty of speechLack of directedness Subtypes of SchizophreniaDisorganized: ?disorganized speech or behavior and/or flat or inappropriate emotionsParanoid: ?preoccupations with delusions or hallucinationCatatonic: ?at least two of the following – extreme motor inability; purposely excessive motor activity; extreme negativism (motionless resistance to all instructions) or mutism (refusing to speak); peculiar or bizarre voluntary movement; echolalia or echopraxia (parrot-like repeating of another’s speech or movement)Undifferentiated: ?many and varied symptoms…not fit into other categoriesResidual: ?experience at least one episode of schizophrenia, but currently does not have prominent positive symptoms…yet continues to show negative symptoms and milder variation of positive symptoms Development of SchizophreniaSometimes it occurs gradually (process or chronic schizophrenia) and sometimes it develops rapidly (acute or reactive schizophrenia)Brain abnormalitiesDopamine – excess of D4 dopamine receptorBrain anatomyAbnormally low activity in frontal lobesHallucination = much activity in the thalamusGreater the shrinkage of hippocampus and amygdala, the worse the disorderThalamus small = greater difficulty in filtering informationCauses of SchizophreniaAppears to be a genetic predisposition for schizophrenia No environmental causes YET if predisposed genetically there are some psychological triggers…like possibly stress and/or parental relationshipDISSOCIATIVE and PERSONALITY DISORDERSDissociative DisordersCharacterized by separation of critical parts of the personality (like memory, consciousness or identity) that are normally integrated and work togetherDissociative Identity Disorder (multiple personality disorder)Condition in which a person appears to have 2 or more distinct personality, each which speaks, acts and writes in a different wayDifferent identities also seem to have their own memories, wishes and impulses (often the impulses of one identity conflict with those of the others)How do dissociative disorders develop?Psychoanalytic – massive repression of unwanted impulses or memories create “new person” who acts out otherwise unacceptable impulses or recalls otherwise unbearable memoriesBehaviorists – everyone capable of acting in different ways in different situations…this disorder is the extreme variation of acting so different that you “feel” like a different person Actually evaluating the true causes of D.I.D. has been difficult due to the rarity of the disorderHowever, most clinicians believe that the root cause of the disorder is some sort of abuse during childhood Personality disordersLong-standing, inflexible personality traits that impair social functioningSeem to be more “styles of life” rather than severe mental disorders…in other words, the people with these disorders feel little distress and frequently lead seemingly normal livesMost well-known personality disorder – Antisocial Personality Disorder ?Exhibit a long-term pattern of irresponsible, impulsive, unscrupulous, even criminal behaviorbehavior often begins in childhood or early adolescenceUsually individuals with this disorder are intelligent and even likableLack any feelings of guilt, anxiety or remorse for their behaviorsCauses of antisocial personality disorderSome studies have suggested a genetic predisposition Others believe that environmental factors like broken homes, rejection by parents, poor discipline, lack of good parental models, lack of attachment to early caregivers, impulsivity, conflict-filled childhoods and poverty play a role in the behavior exhibited by antisocial individualsOther personality disordersParanoid – tense, guarded, suspicious; holds grudgesSchizoid – socially isolated, with restricted emotional expressionSchizotypal –peculiarities of thought, appearance and behaviors that are disconcerting to others – emotionally detached and isolatedHistrionic – seductive behavior, needs immediate gratification and constant reassurance, rapidly changing moods and shallow emotionsNarcissistic – self-absorbed, expects special treatment and adulation and envious of attention to othersBorderline – cannot stand to be alone, intense & unstable moods & personal relationships, chronic anger and drug/alcohol abuseAvoidant – easily hurt or embarrassed, few close friends, sticks to routines to avoid new possibly stressful experiencesDependent – wants others to make decisions, needs constant advice & reassurance and fears being abandonedEVALUATING PSYCHOTHERAPIESDoes therapy work?Most psychotherapists and their clients believe in the effectiveness…but confirming this belief with research has been challenging and controversialReasons why difficult…How to measure improvementBroad range of clients, therapists and treatments involvedMeta-analysis (statistical combination of the results of large number of different studies) shown that overall people who received treatment were better off that 80% of trouble people who did notWhich therapies work best for which disorders?Again hard to answer because it depends on the individual personality of client and degree of disorderhowever, an APA task force looked at empirically supported therapies (ESTs) – ones that have been validated by controlled experimental research – and found the following to be “superior” to no treatmentDepression -- behavior, cognitive-behavioral, interpersonal Specific phobia –- exposure Agoraphobia/panic disorder/generalized anxiety –- cognitive-behavioral The client-therapist relationship plays a consistent role in the success of ALL forms of treatmentCultural factors in psychotherapyCultural differences, including religious differences and collectivist/individualism, can create enough miscommunication or mistrust to threaten the quality of the client-therapist relationshipRules and Rights in the therapeutic relationshipEthical standards are in place to ensure the relationship does not harm the clientIncluding…no intimate relationship between client & therapist during therapy or for 2 years laterconfidentiality (so much so that information revealed in therapy is privileged communication)Clients have rights too – cannot be casually committed to a mental hospital by their therapist ................
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