Psych Disorders

they regarded abnormal behavior as the work of evil spirits

an ancient operation in which a stone instrument was used to cut away a circular section of the skill, perhaps to treat abnormal behavior

thought that abnormal behavior was caused by an imbalance of four fluids, or humors, that flowed through the body: yellow bile, black bile, blood, and phlegm.

there was a growing distrust of science and many believed that demons were to blame for psychological disfunctioning; exorcisms were a main form of treatment

care of people with mental disorders improved and an asylum is a type of institution that provided care for persons with mental disorders. most became virtual prisoners

moral treatment: emphasized moral guidance and humane and respectful treatment. decline of moral treatment: there were not enough people to care for them in this way, and state hospitals were prevalent: state-run public institutions

• somatogenic perspective: the view that abnormal psychological functioning has physical causes. stemmed from Hippocrates’ view that abnormal behavior resulted from brain disease and an imbalance of humors
• psychogenic perspective: the view that the chief causes of abnormal functioning are psychological. psychoanalysis: either the theory or the treatment that emphasizes unconscious psychological forces as the cause of psychotherapy

current drugs that mainly affect the brain and reduce many symptoms of mental dysfunctioning. after the discovery of these medications, mental health professionals followed a policy of deinstitutionalization: the practice, beginning in the 1960s, of releasing hundreds of thousands of patients from public mental hospitals

a system of health care coverage in which the insurance company largely controls the nature, scope, and cost of services

a research procedure used to determine the “co-relationship” between variables. correlation is the degree to which events or characteristics vary with each other. a positive correlation is when variables change the same way and they are said to have a positive direction. a negative correlation is when the value of one variable increases as the value of another variable decreases. variables may also be unrelated, meaning that there is no consistent relationship between them. the magnitude is the strength, or how closely the variables respond. the correlation coefficient can vary from +1.00 to -1.00. you test correlations with a statistical analysis by calculating how likely it is that the study’s particular findings have occurred by chance

• reveal the incidence and prevalence of a disorder in a particular population.
• incidence is the number of new cases that emerge during a given period of time.
• prevalence is the total number of cases in the population during a give time period (includes both existing and new cases): these studies help detect groups atrisk for certain disorders

researchers observe the same individuals on many occasions over a long period of time

a research procedure in which a variable is manipulated and the effect of the manipulation is observed. the manipulated variable is called the independent variable and the variable being observed is called the dependent variable

• confounds are variables other than the independent variable that may also be affecting the dependent variable. to guard against it, they have 3 important features in their experiment:
• 1. control group: a group of research participants who are not exposed to the independent variable under investigation but whose experience is similar to that of the experimental group, the participants who are exposed to the independent variable
• 2. random assignment: any selection procedure that ensures that every participant in the experiment is as likely to be placed in one group as the other
• 3. blind design: experimenters prevent participants from finding out which group they’re in

researchers induce laboratory participants—either animals or humans—to behave in ways that seem to resemble real-life abnormal behavior and then conduct experiments on the participants in the hope of shedding light on the real-life abnormality

• proposes that a full understanding of a patient’s thoughts, emotions, and behaviors must therefore include an understanding of their biological basis and the most effective treatment with be biological ones
• views abnormal behavior as an illness brought about my malfunctioning parts of the organism
• typically, they point to problems in the brain anatomy or brain chemistry as the cause of such behavior

• 1. genes: chromosome segments that control the characteristics and traits we inherit. studies suggest that this inheritance also plays a part in mood disorders, schizophrenia, and other mental disorders. this has become much clearer because of the Human Genome Project, where scientists mapped, or sequenced, all of the genes in the human body in great detail
• 2. evolution: many of the genes that contribute to abnormal functioning are actually the result of normal evolutionary principles. example: the capacity for fear was and is normal and adaptive, but some people are more prone to it, which can cause anxiety disorders, etc.
• 3. viral infections: example: schizophrenia may be related to exposure to certain viruses during childhood or before birth. studies have found that the mothers of many of these individuals had influenza or related viruses during their pregnancies

• 1. psychotropic medications: drugs that primarily affect the brain and reduce many symptoms of mental dysfunctioning. 4 types: 1. antianxiety drugs: also called minor tranquillizers or anxiolytics, help reduce tension and anxiety 2. antidepressant drugs: help improve the mood of people who are depressed 3. antibipolar drugs: also called mood stabilizers, help steady the mood of those with a bipolar disorder, a condition marked by mood swings from mania to depression 4. antipsychotic drugs: help reduce the confusion, hallucinations, and delusions of psychotic disorders marked by a loss of contact with reality
• 2. electroconvulsive therapy (ECT): used primarily in depressed patients; two electrodes are attached to a patient’s forehead and an electrical current is passed briefly through the brain which causes a brain seizure that lasts up to a few minutes. after 7-9 session, spaced 2-3 days apart, many patients feel considerably less depressed
• 3. psychosurgery (neurosurgery): in a lobotomy, a surgeon would cut the connections between the brain’s frontal lobes and the lower regions of the brain. these are done only after certain severe disorders have continued for years without responding to any other forms of treatment

a person’s behavior, whether normal or abnormal, is determined largely by underlying psychological forces of which he or she is not consciously aware. these internal forces are described as dynamic: they interact with one another, and their interaction gives rise to behavior, thoughts, and emotions. abnormal symptoms are viewed as the result of conflicts between these forces. psychological conflicts are tied to early relationships and to traumatic experiences that occurred during childhood: deterministic assumption: no symptom or behavior is “accidental”

• 1. the id: denotes instinctual needs, drives, and impulses. it operates in accordance with the pleasure principle—it always seeks gratification and all tend to be sexual
• 2. the ego: it also seeks gratification but does so in accordance with the reality principle—the knowledge we acquire through experience that it can be unacceptable to express our id impulses outright
• ego defense mechanisms: basic strategies the ego develops to control unacceptable id impulses and avoid or reduce the anxiety they arouse. most basic mechanism=repression
• 3. the superego: grows from the ego (just how ego grows from id); represents a person’s values and ideals (our conscience)
• fixation: a condition in which the id, ego, and superego do not mature properly and are frozen at an early stage of development. all future development will suffer, and the individual will be stuck in that phase of development

• 1. ego theory: emphasize the role of the ego and consider it a more powerful and independent force than Freud did
• 2. self theory: give the greatest attention to the role of the self: the unified personality: basic human motive is to strengthen the wholeness of the self
• 3. object relations theory: people are motivated mainly by a need to have relationships with others and that severe problems in the relationships between children and their caregivers may lead to abnormal development

• all seek to uncover past traumas and the inner conflicts that have resulted from them. therapists must subtly guide discussions so that the patients discover their underlying problems fro themselves
• 1. free association: the patient describes any thought or feeling that comes to mind, even if it seems unimportant
• 2. therapist interpretation: listen as patients talk, looking for clues, drawing tentative conclusions, and sharing interpretations when they think the patient is ready to hear them. 3 interpretations are particularly important: 1. resistance: when patients show unconscious refusal to participate fully in therapy 2. transference: the redirection toward the psychotherapist of feelings associated with important figures in the patient’s life, whether now or in the past 3. dreams: Freud thought that our defense mechanisms operate less when we sleep and can reveal unconscious instincts and needs. 2 types of dream content: a. manifest content: the consciously remembered dream; b. latent content: its symbolic meaning
• 3. catharsis: a reliving of past repressed feelings to settle internal conflicts and overcome problems
• 4. working through: the patient and therapist must examine the issues and go through interpretation and catharsis many times, each with greater clarity to change the way a person functions

our actions are determined largely by our experiences in life; but concentrates on behaviors, the responses an organism makes to its environment. behaviors can be external or internal. conditioning: simple forms of learning where researchers used stimuli and rewards and observed how the manipulations affected the responses of their research participants

• 1. operant conditioning: humans and animals learn to behave in ways as a result of receiving rewards whenever they do so
• 2. modeling: individuals learn responses simply by observing other individuals and repeating their behaviors
• 3. classical conditioning: learning occurs by temporal association: when 2 events repeatedly occur close together in time, they become fused in a person’s mind, and soon the person responds the same way to both events. an unconditioned stimulus elicits the unconditioned response (the natural response). a conditioned stimulus is a previously neutral stimulus and when the new response is produced by the conditioned stimulus rather than the unconditioned stimulus, it is called the conditioned response

• aim to identify the behaviors that are causing a person’s problems and then tries to replace them with more appropriate ones by applying the principles of operant conditioning, classical conditioning, or modeling. therapist is more of a teacher than a healer
• systematic desensitization: clients with phobias learn to react calmly instead of with intense fear to the objects or situations they dread

cognitive processes are at the center of our behaviors, thoughts, and emotions and that we can best understand abnormal functioning by looking to cognition. clinicians must ask questions about the assumptions and attitudes that color a person’s perceptions, the thoughts running through their mind, and the conclusions to which they are leading

• some people make assumptions and adopt attitudes that are disturbing and inaccurate.
• illogical thinking processes are another source and can lead to self-defeating conclusions.
• overgeneralization is the drawing of broad negative conclusions on the basis of a single insignificant event

• people can overcome their problems by developing new, morefunctional ways of thinking. therapists help clients recognize the negative thoughts, biased interpretations, and errors in logic that dominate their thinking and cause them to feel depressed
• acceptance and commitment therapy: help clients to accept many of their problematic thoughts rather than judge them, act on them, or try fruitlessly to change them

• problemscan be understood only in the light of complex goals such as self-awareness, strong values, a sense of meaning in life, and freedom of choice.
• humanists: believe that human beings are born with a natural tendency to be friendly, cooperative, and constructive. people are drive to self-actualize: to fulfill this potential for goodness and growth. they can only do so if they accept their weaknesses.
• existentialists: agree that human beings much have an accurate awareness of themselves and live meaningful (authentic) lives in order to be psychologically well; people are not naturally inclined to live positively

• we all need unconditional (nonjudgmental), positive regard from important people in our lives, primarily our parents. if we receive that at a young age we will develop something positive
• client-centered therapy: clinicians try to help clients by conveying acceptance, accurate empathy, and genuineness

• guide clients toward self-recognition and self-acceptance and often try to achieve this goal by challenging and even frustrating their clients.
• skill frustration: gestalt therapists refuse to meet their clients’ expectations or demands. this is meant to help people see how often they try to manipulate others into meeting their needs

• psychological dysfunctioning is caused by self-deception in which people hide from life’s responsibilities and fail to recognize that it is up to them to give meaning to their lives
• existential therapy: people are encouraged to accept responsibility for their lives and for their problems. therapists try to help clients recognize their freedom so that they may choose a different course and live with greater meaning

abnormal behavior is best understood in light of the broad forces that influence an individual

• clinical theorists should concentrate on those broad forces that operate directly on an individual as he or she moves through life: family relationships, social interactions, and community events. 3 factors
• 1. social labels and roles: when people stray from the norms of society, the society calls them deviant and “mentally ill” and overtime someone can adopt this role even if it wasn’t fitting in the first place
• 2. social networks and support: there are ties between deficiencies in social networks and a person’s functioning; people who are isolated and lack social support are more likely to become depressed and remain depressed longer
• 3. family structure and communication: according to the family systems theory, the family is a system of interacting parts who interact in a consistent way and follow rules unique to each family member. the structure and communication patterns of some families actually force individual members to behave in a way that otherwise seems abnormal

• 1. group therapy: a group of people with similar problems meet together with a therapist to work on those problems. there are also self-help groups (or mutual help groups) where people with similar problems come together to discuss them without the leadership of a professional clinician
• 2. family therapy: the therapist meets with all members of a family and helps them to change in therapeutic ways. even if one member has a clinical diagnosis, it is the whole family that is under treatment. structural family therapy: therapists try to change the family power structure, the roles each person plays, and the relationships between members. conjoint family therapy: therapists try to help members recognize and change harmful patterns of communication
• 3. couple therapy: (marital therapy): the therapist works with two individuals who are in a long-term relationship; focuses on the structure and communication patterns occurring in the relationship. behavioral couple therapy: uses techniques from the behavioral practice. investigative couple therapy: helps partners accept behaviors that they cannot change and embrace the whole relationship nonetheless
• 4. community mental health treatment: allow clients to receive treatment in familiar social surroundings as they recover; clinicians actively reach out to clients rather than waiting for them to seek treatment. primary prevention: efforts to improve community attitudes and policies and prevent psych disorders altogether. secondary prevention: identifying and treating psych disorders in early stages, before they come serious. tertiary prevention: provide effective treatment as soon as it is needed so that moderate or severe disorders do not become long-term problems

• studies show that members of ethnic and racial minorities tend to show less improvement in clinical treatment. 2 features can improve therapy effectiveness: 1. greater sensitivity to cultural issues; 2. inclusion of cultural morals and models of treatment, especially in therapies for children and adolescents
• culture-sensitive therapies: approaches that seek to address the unique issues faced by members of minority groups
• gender-sensitive therapies: approaches geared to the pressures of being a woman in Western society, also called feminist therapies

• an understanding of the behavior of a particular individual. to gather this information, clinicians use assessment and diagnosis:
• assessment: the process of collecting and interpreting relevant information about a client or research participant. broken into 3 categories: clinical interviews, test, and observations (these tools must be standardized and have reliability and validity)
• standardization: the process in which a test is administered to a large group of people whose performance than serves as a standard or norm against which any individual’s score can be measured
• reliability: refers to the consistency of a test or research results. an assessment tool has high test-test reliability: it yields the same results every time it is given to the same people. it also shows high interrater (or interjudge) reliability: different judges independently agree on how to score and interpret it
• validity: it must accurately measure what it is supposed to measure. face validity: when an assessment tool appears to be valid simply because it makes sense and seems reasonable. predictive validity: a tool’s ability to predict future characteristics or behavior. concurrent validity: the degree to which the measures gathered from one tool agree with the measures gathered from other assessment techniques

• psychodynamic: interviewers try to learn about the person’s needs and memories of past events and relationships
• behavioralists: try to pinpoint information about the stimuli that trigger responses and their consequences
• cognitive: interviewers try to discover assumptions and interpretations that influence the person
• humanistic: clinicians ask about the person’s self-evaluation, self-concept, and values
• biological: clinicians look for signs of biochemical or brain dysfunction
• sociocultural: interviewers ask about the family, social, an cultural environments
• unstructured interview: clinician asks open-ended questions
• structured interview: clinicians ask prepared questions. many include mental status exams: a set of questions and observations that systematically evaluate the client’s awareness, orientation with regard to time and place, attention span, memory, judgment and insight, thought content and process, mood, and appearance

• a test consisting of ambiguous material that people interpret or respond to. they help asses unconscious drives and conflicts that psychodynamic therapists believe to be the root of abnormal functioning
• Rorschach test: clinicians present one inkblot at a time and ask what the patients see
• thematic apperception test: people are shown 30 black and white pictures in individuals in vague situations and are asked to make up a dramatic story about each card; people usually identify with one character and stories are thought to reflect the individuals’ own circumstances, needs and emotions
• sentence completion test: asks people to complete a series of unfinished sentences
• drawings: assumes that a drawing tells us something about its creator; clients draw human figures and talk about them; evaluations are based on details and shape of drawing, solidity of the pencil line, location of the drawing on paper, size of the figures…etc

• asks respondents a wide range of questions about their
• behavior, beliefs, and feelings; individuals indicate whether each of a long list of statements applies to them
• Minnesota Multiphasic Personality Inventory: consists of more than 500 self-statements to be labeled “true” “false” or “cannot say” and then they are assessed on 10 clinical scales:
• 1 .hypochondriasis: items showing abnormal concern with bodily functions
• 2. depression: items showing extreme pessimism and hopelessness
• 3. hysteria: items suggesting that the person may use physical or mental symptoms as a way of unconsciously avoiding conflicts and responsibilities
• 4. psychopathic deviate: items showing a repeated and gross disregard for social customs and an emotional shallowness
• 5. masculinity-femininity: items that are thought to separate male and female respondents
• 6. paranoia: items that show abnormal suspiciousness and delusions of grandeur or persecution
• 7. psychasthenia: items that show obsessions, compulsions, abnormal fears, and guilt and indecisiveness
• 8. schizophrenia: items that show bizarre or unusual thoughts or behaviors
• 9. hypomania: items that show emotional excitement, overactivity, and flight of ideas
• 10. social introversion: items that show shyness, little interest in people, and insecurity

• ask people to provide detailed information about themselves, but these tests focus on one specific area of functioning
• affective inventories: measure the severity of such emotions as anxiety, depression, and anger
• social skills inventories: ask respondents to indicate how they would react in a variety of social situations
• cognitive inventories: reveal a person’s typical thoughts and assumptions and they can uncover counterproductive patterns of thinking

measure physiological responses as possible indicators of psychological problems. one test is the polygraph: (lie detector): detects changes in breathing, perspiration, and heart rate while the individual answers questions

• neurological tests: designed to measure brain structure and activity directly. one is the electrocephalogram which records brain waves, the electrical activity taking place within the brain as a result of neurons finding
• neuroimaging, or brain scanning, techniques: includes CT scans (X rays of the brain’s structure are taken at different angles and combined; PET scans (a computer-produced motion picture of chemical activity throughout the brain; MRI (a procedure that use the magnetic property of certain atoms in the brain to create a detailed picture of the brain’s structure
• neuropsychological tests: measure cognitive, perceptual, and motor performances on certain tasks and interpret abnormal performances as an indicator of underlying brain problems

• the capacity to judge well, to reason well, and to comprehend well
• intelligence is an inferred quality rather than a specific physical process, it can be measured only indirectly
• consists of a series of tasks requiring people to use various verbal and nonverbal skills. the general score
• derived from this and later intelligence tests is termed an intelligence quotient (or IQ)

• in addition to interviewing and testing people, clinicians may systematically observe their behavior
• naturalistic and analog observations: usually take place in homes, schools, institutions such as hospitals and prisons, or community settings. often observations are made by participant observers, key persons in the client’s environment, and reported to the clinician
• self-monitoring: people report their own feelings, behaviors, or cognitions and record the frequency of certain behaviors, thoughts or feelings as they occur over time

• clinicians use this information from interviews, tests, and observations to construct an integrated picture of the factors that are causing and maintaining a client’s disturbance sometimes known as a clinical picture
• diagnosis: a determination that a person’s problems reflect a particular disorder
• classification system: a list of disorders, along with descriptions of systems and guidelines for making appropriate diagnoses
• syndrome: a cluster of symptoms that usually occur together

• Diagnostic and Statistical Manual of Disorders: most widely used classification system in the US
• lists around 400 disorders
• clinicians evaluate a client’s condition on 5 axes (branches of information)
• the newest DSM is generally reliable, but there are 2 issues:
• 1. the assumption it makes that clinical disorders are qualitatively different than normal behavior
• 2. there is criticism on the use of discrete diagnostic categories, with each category ofpathology considered to be separate from all the others

• 1. Axis 1: list of clinical syndromes that cause significant impairment. anxiety disorders: people may experience general feelings of anxiety and worry (general anxiety disorder), anxiety centered on a specific situation or object (phobias), periods of panic (panic disorder), persistent thoughts or repetitive behaviors (OCD), or lingering anxiety reactions to unusually traumatic events (acute stress disorder and posttraumatic stress disorder) mood disorders: people feel excessively sad or elated for long periods of time. it includes major depressive disorder and bipolar disorders
• 2. Axis 2: includes long-standing problems that are frequently overlooked in the presence of disorders on Axis 1 (only 2 groups of disorders) (people may also receive diagnoses from both axes) mental retardation: people display significantly subaverage intellectual functioning and poor adaptive functioning by 18 years of age. personality disorders: people who display a very rigid maladaptive pattern of inner experience and outward behavior that has continued for many years
• 3. Axis 3: asks for information concerning relevant general medical conditions from which the person is currently suffering
• 4. Axis 4: asks about special psychosocial or environmental problems the person is facing such as schooling or housing problems
• 5. Axis 5: requires clinician to make a global assessment of functioning (GAF), which is to rate the person’s psychological, social and occupational functioning as well

• empirically supported/evidence-based treatment: proponents seek to identify which therapies have received clear research support for each disorder, to propose corresponding treatment guidelines, and to spread information to clinicians
• rapprochement movement: tries to identify a set of common strategies that may run through the work of all effective therapists, regardless of the clinicians’ particular orientation
• psychopharmacologist: a psychiatrist who primarily prescribes medication

• a very rigid pattern of inner experience and outward behavior. the pattern is seen in most of the person’s interactions, continues for years, and differs markedly from the experiences and behaviors usually expected of people
• DSM checklist for a personality disorder: 1. pattern of inner experience…etc (above) with at least 2 of the following areas affected: cognitive, affectivity, interpersonal functioning, impulse control; 2. pattern is inflexible and pervasive across a broad range of personal and social settings; 3. pattern is stable and long-lasting, and its onset can be traced back at least to adolescence or early adulthood; 4. significant distress or impairment
• comorbidity: when a person with a personality disorder also displays an acute disorder (on Axis I)

paranoid, schizoid and schizotypal disorders. people display odd or eccentric behaviors that are similar but not as extensive as those seen in schizophrenia, including extreme suspiciousness, social withdrawal, and peculiar ways of thinking and perceiving things

• people deeply distrust other people and are suspicious of their motives. because they believe that everyone intends them harm, they shun close relationships
• psychodynamic theories trace the pattern to early interactions with demanding parents, particularly distant, rigid fathers and over controlling, rejecting mothers

• people persistently avoid and are removed from social relationships and demonstrate little in the way of emotion. they do not have close ties with other people; they avoid contact because they genuinely prefer to be alone
• psychodynamic theorists propose that it has its roots in an unsatisfied need for human contact
• cognitive theories think they suffer from a deficiency in their thinking; most make limited or no progress in therapy

• people display a range of interpersonal problems marked by extreme discomfort in close relationships, very odd pattern of thinking and perceiving, and behavioral eccentricities. they feel anxious around others and most feel intensely lonely
• symptoms may include: ideas of reference: beliefs that unrelated events pertain to them in some important way; and bodily illusions: such as sensing an external “force” or presence
• researchers think that similar factors work in both schizotypal disorder and schizophrenia; could be linked to family conflicts and psych disorders in parents

antisocial, borderline, histrionic, and narcissistic personality disorders. behaviors are so dramatic, emotional, or erratic that it is almost impossible for them to have relationships that are truly giving and satisfying

• people persistently disregard and violate others rights. this is most closely related to adult criminal behavior. most lie repeatedly, are absent from their jobs or quit altogether; careless with money; impulsive without thinking of consequences; they are irritable, aggressive, and quick to start fights and are very reckless
• psychodynamic theorists propose that it begins with an absence of parental love during infancy, leading to a lack of basic trust; behavioral theorists suggest that antisocial symptoms may be learned through modeling or imitation; treatments are typically ineffective, but some atypical antipsychotic drugs are somewhat effective

• people display great instability, including major shifts in mood, an unstable self-image, and impulsivity. they swing in and out of very depressive, anxious, and irritable states that last anywhere from a few hours to a few days or more. many engage in self-destructive activities such as cutting
• psychodynamic theorists: look to early parental relationships as the source. object relations theorists propose that an early lack of acceptance by parents may lead to a loss of self-esteem, increased dependence, and an inability to cope with separation
• biosocial theory: the disorder results from a combo of internal forces (ex: difficulty identifying and controlling one’s arousal levels and emotions) and external forces (ex: an environment in which a child’s emotions are punished or disregarded). many people also display an eating disorder
• sociocultural theorists: suggest that these cases are likely to emerge in cultures that undergo rapid change
• therapy can sometimes be helpful; new integrative treatment. dialectical behavioral therapy (DBT) includes homework assignments, psychoeducation the teaching of social skills, therapist modeling, clear goal setting, and collaborative examinations by client and therapist of the client’s ways of thinking

• characterized by a pattern of excessive emotionality and attention seeking (once called hysterical personality disorder). they are always “on stage,” using theatrical gestures and mannerisms and grandiose language to describe ordinary events; they rely on approval and praise; they are vain, self-centered and demanding and overreact to any minor event that gets in the way of their quest for attention
• psychodynamic theorists: as children they experienced unhealthy relationships in which cold and controlling parents left them feeling unloved and afraid of abandonment
• cognitive theorists: look at people as being self-focused and emotional and that they hold a general assumption that they are helpless
• sociocultural theorists: believe that it is produced in part by cultural norms and expectations

• people are generally grandiose, need much admiration, and feel no empathy with others. convinced of their own great success, power, or beauty, they expect constant attention and admiration from those around them. they take advantage of others to fulfill their own needs and believe their problems are unique
• psychodynamic theorists: problem starts with cold, rejecting parents, some people with this background spend their lives defending against feeling unsatisfied, rejected, unworthy, and wary of the world
• object relations: it’s a way for people to convince themselves that they are totally self-sufficient and without need of relationships
• cognitive-behavioral therapists: it may develop when people are treated too positively early in life. it is one of the most difficult to treat because clients are unable to acknowledge weakness

avoidant, dependent, and obsessive-compulsive disorders. people with these patterns display anxious and fearful behavior

• people are very uncomfortable and inhibited in social situations, overwhelmed by feelings of inadequacy, and extremely sensitive to negative evaluation. they withdraw from situations not necessarily because of poor social skills as much as a dread of criticism, disapproval, or rejection. it is similar to social phobia and many similarities include a fear of humiliation and low confidence. people w/ a social phobia primarily fear social circumstances, while people w/ the personality disorder tend to fear close social relationships
• theorists assume that it has the same cause as anxiety disorders...early traumas, conditioned fears, upsetting beliefs, or biochemical abnormalities but research has not tied the two directly
• psychodynamic theorists: focus on the general sense of shame which some trace to childhood.
• cognitive theorists: focus on the person’s fears of being judged by others
• behavioral theorists: people fail to develop normal social skills which maintains the disorder

• people have a persistent, excessive need to be taken care of, which makes them clinging and obedient, fearing separation from a parent, spouse, or other close relationship and cannot make even small decisions themselves
• Freudian theorists: unresolved conflicts during the oral stage of development can give rise to a lifelong need for nurturance
• object relations: early parental loss or rejection may prevent normal experiences of attachment and separation
• cognitive theorists: identify two attitudes which help produce and maintain the disorder: 1. “I am inadequate and helpless to deal with the world” and 2. “I must find a person to provide protection so I can cope”

• people are so preoccupied with order, perfection, and control that they lose all flexibility, openness, and efficiency. they set unreasonably high standards for themselves and others and can never be satisfied with their performance. clinicians believe that obsessive-compulsive personality disorder and obsessive-compulsive disorder (the anxiety disorder) are closely related...people w/ the personality disorder are more likely to suffer from either major depressive disorder, generalized anxiety disorder, or a substance-related disorder
• Freudian theorists: people are anal aggressive because of their overly harsh toilet training during the anal stage—they become filled w/ anger and are fixated at this stage
• psychodynamic theorists: any early struggle with parents over control and independence can ignite aggressive impulses
• cognitive theorists: have little to say but they do think that illogical thinking processes help keep it going

• 1. some of the criteria used to diagnose the disorders cannot be observed directly
• 2. clinicians differ widely in their judgments about when a normal personality style crosses the line and qualifies for designation as a personality disorder
• 3. the personality clusters w/in a DSM cluster are very similar so it is common for people to meet the criteria of multiple disorders
• 4. people w/ quite different personalities may qualify for the same personality disorder diagnosis
• 5. the diagnostic categories for personality disorders have changed a number of times. ex; DSM dropped passive-aggressive personality disorder which is a pattern of negative attitudes and passive resistance to the demands of others, because research failed to show that this was more than a single trait

• the basic structure of personality may consist of five “supertraits” (factors): neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness
• proponents argue that it would be best to describe all people w/ personality disorders as being high, low, or in between the 5 supertraits and to drop the DSM’s current use of personality disorder categories altogether

Johnathan Shedler and Drew Weston identify 12 broad factors instead of 5 specific ones, and they are statements such as “the individual tends to elicit liking in others” and 200 of those are rated on a scale of 0-7 to make up a comprehensive description of personality

• people who previously functioned well or at least acceptably, who deteriorate into an isolated wilderness of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities. they experience psychosis, a loss of contact with reality; their ability to perceive and respond to the environment becomes so disturbed that they may not be able to function; they may have hallucinations (false sensory perceptions) or delusions (false beliefs)
• downward drift theory: schizophrenia causes its victims to fall from a higher to lower socioeconomic level or to remain poor because they are unable to function effectively

• excess of thought, emotion, and behavior
• delusions: ideas that people believe wholeheartedly but have no basis in fact. delusions of persecution are the most common; people believe they are being plotted or discriminated against, spied on, slandered, threatened, attacked, or deliberately victimized. delusions of reference; people attach special and personal meanings to the actions of others or to various objects or events. delusions of grandeur; people believe themselves to be great inventors, religious saviors, or other specially empowered persons. delusions of control; people believe their feelings, thoughts, and actions are being controlled by other people
• disorganized thinking and speech: they may not be able to think logically and speak in peculiar ways.
• formal thought disorders: a disturbance in the production and organization of thought. loose associations (derailment): (most common formal thought disorder): people rapidly shift from one topic to another, believing that the their incoherent statements make sense. neologisms: made-up words that typically have meaning only to the person using them. perseveration: they repeat their words and statements again and again. clang: using rhyme to express yourself
• heightened perceptions and hallucinations: perception and attention seems to intensify. hallucinations: perceptions that occur in the absence of external stimuli
• inappropriate affect: display of emotions that are unsuited to the situation. in some cases, these emotions may be a response to other features of the disorder

• deficits of thought, emotion, and behavior
• poverty of speech: people display alogia, which is a reduction in speech or speech content. some people think and say very little, and others say quite a bit but still convey little meaning
• blunted and flat affect: they show less anger, sadness, joy and other feelings than most people. some show no emotion at all, called flat affect (their faces are still, eye contact is poor, voices are monotonous)
• loss of volition: many experience avoliton, or apathy, feeling drained of energy and of interest in normal goals and unable to start or follow through on a course of action. some display ambivalence, or conflicting feelings, about most things
• social withdrawal: attend only to their own ideas and fantasies

unusual movements or gestures. these symptoms may take certain extreme forms, collectively called catatonia. people in a catatonic stupor stop responding to their environment, remaining motionless and silent for long periods of time. catatonic rigidity is when people maintain a rigid, upright posture for hours and resist efforts to be moved. catatonic posturing is assuming awkward, bizarre positions for long periods of time. catatonic excitement is when they move excitedly, sometimes with a wild waving of arms and legs

• it usually first appears between late teens and mid 30s. most go through 3 phases:
• 1. prodromal phase: symptoms are not yet obvious, but the individuals are beginning to deteriorate. they may withdraw socially, speak in odd ways, develop strange ideas, or express little emotion
• 2. active phase: symptoms become apparent, sometimes it is triggered by stress
• 3. residual phase: they return to a prodromal-like level of functioning; the strinking symptoms of active phase lessen, but some negative symptoms, such as blunted emotions, may remain (about 25% completely recover from schizophrenia and a fuller recovery is more likely in persons whose disorder was initially triggered by stress, came on abruptly, developed during middle age, or in people who functioned quite well before the disorder (good premorbid functioning)

• the DSM calls for a diagnosis only after 6 months or more of symptoms, a deterioration of work, social relations and ability to care for themselves. 5 types:
• 1. disorganized: symptoms are confusion, incoherence and flat or inappropriate affect. attention and perception problems, extreme social withdrawal, and odd mannerisms or grimaces are common
• 2. catatonic: psychomotor disturbance; some spend time in a catatonic stupor, others in catatonic excitement
• 3. paranoid: organized system of delusions and auditory hallucinations that may guide their lives
• 4. undifferentiated: those who do not fall neatly into one of the other categories; it is a wide assortment of unusual patterns over many years
• 5. residual: when the symptoms lessen in strength and number, yet remain in the residual form; people may continue to display blunted or inappropriate emotions as well as social withdrawal, eccentric behavior, and some illogical thinking

• some people inherit the predisposition and develop it when they face extreme stress
• relative studies: it is common among relatives: the more closely related the relatives, the greater the likelihood of developing the disorder
• twin studies: if twins have a particular trait, they are said to be concordant for that trait…so identical twins have a higher concordance rate for this disorder than fraternal twins. there is a 48% chance that a twin will develop it if one does in identical twins, and only a 17% chance in fraternal twins
• adoption studies: biological relatives are more likely to experience the disorder than their adoptive relatives
• genetics and molecular biology: there are possible gene defects on certain chromosomes, which predispose people to the disorder; different types may be linked to different genes; a polygenic disorder is caused by a combo of gene defects

• dopamine hypothesis: certain neurons that use the neurotransmitter dopamine fire too often and transmit too many messages. antipsychotic drugs: medications that help remove the symptoms of schizophrenia. the first group of these meds are the phenothiazines: originally used as antihistamines, but failed, and reduced schizophrenic symptoms. but these drugs often have side effects that mimic Parkinson’s disease: people w/ Parkinson’s have low levels of dopamine, and if those people take medicine to raise their dopamine some have schizophrenic symptoms
• new group of antipsychotic drugs: atypical antipsychotic drugs: more effective than traditional ones; bind not only to D-2 dopamine receptors but also to many D-1 receptors and to receptors for others such as serotonin

• many people have enlarged ventricles, brain cavities that contain cerebrospinal fluid
• they usually display more negative and fewer positive symptoms and have poorer social adjustment and greater cognitive disturbances. some also have smaller temporal and frontal lobes and abnormal blood flow

brain abnormalities may result from exposure to viruses before birth; large # are born during the winter

• psychodynamic explanation: Freud says it develops from 2 psychological responses: 1. regression to a pre-ego stage and 2. effort to reestablish ego control. when their world is harsh or withholding people develop it to regress to the earliest point in their development to a state of primary narcissism
• Frieda Fromm-Reichman said that the mothers of those with the disorders are cold, domineering, and uninterested in their children’s needs and called them schizophrenogenic mothers
• cognitive explanation: during hallucinations, the brain is producing strange and unreal sensations, triggered by biological factors

• multicultural factors: rates of the disorder appear to differ btwn racial and ethnic groups. 2.1% of Af. Am. have the diagnosis vs 1.4% of white Americans. it may be because of bias in diagnosing, or because they are at an economic disadvantage and the stress of poverty can trigger it. the overall prevalence of it is stable across the world, but the course and outcome vary considerably—those in developing countries have better recovery rates
• social labeling: many think the features of schizophrenia are influenced by the diagnosis itself and society labels those who think differently as schizophrenic
• family dysfunctioning: it is maybe linked to family stress. parents of those with the disorder often: 1. display more conflict, 2. have greater difficulty communicating w/ one another, 3. are more critical of and over involved w/ their children
• certain families are high in expressed emotion: members frequently express criticism, disapproval, and hostility toward each other and intrude on one another’s privacy

• milieu therapy: institutions can help individuals by creating a social climate (or milieu) that builds protective activity, self-respect and a sense of responsibility; patients can make their own decisions and run their own lives
• the token economy: based on discoveries that the application of operant conditioning techniques used in hospital wards could help change behaviors of patients w/ schizophrenia and other severe disorders; programs were called token economy programs: patients are rewarded when they behave acceptably and are not rewarded when they behave unacceptably, creating a “token economy” through the rewards

• they eliminate many of its symptoms and are almost always part of the treatment today. neuroleptic drugs are conventional drugs that often produce undesired movement effects similar to the symptoms of neurological diseases. they reduce symptoms in at least 65% of patients. they generally reduce positive symptoms more than negative ones
• extrapyramidal effects: disturbing movement problems that appear to be caused by the drugs’ impact on the extrapyramidal areas of the brain which help control motor activity. most common are Parkinson’s symptoms. at least half experience muscle tremors/rigidity. tardive dyskinesia: (means late-appearing movement disorder): appears after a year of drug use; includes involuntary writhing or ticklike movements of the tongue, mouth, face or whole body, the longer they are on the drug the worse it is and harder to reverse
• new antipsychotic drugs: “atypical drugs” have been developed; their biological operation differs from conventional meds; they are received at fewer dopamine D-2 receptors and more D-1, D-4 and serotonin receptors than the others; appear to be more effective; help around 85% of people and reduce positive and negative symptoms; cause fewer extrapyramidal symptoms

• 1. cognitive-behavioral therapy: seeks to change how people react to their hallucinatory experiences; if people can be guided to interpret such experiences in a more accurate way, they will not suffer the fear and confusion produced by delusions. some techniques: 1. education about biological causes of hallucinations, 2. learn about comings and goings of delusions and what triggers voices in their heads, 3. challenge inaccurate ideas about the power of their hallucinations, 4. teach them to more accurately interpret hallucinations, 5. coping w/ unpleasant sensations
• 2. family therapy: over 50% live w/ families; those who feel positively toward their relatives do better in treatment; it provides family members with guidance, training, practical advice, psychoeducation, and emotional support and empathy
• 3. social therapy: treatment should address social and personal difficulties in clients’ lives; helps keep people out of the hospital

• 1. coordination of patient services: community mental health center: treatment facility that would supply medication, psychotherapy, and inpatient emergency care to people w/ severe disturbances; can be very helpful
• 2. short-term hospitalization: after outpatient therapy fails, this lasts a few weeks. when they improve, they are released for aftercare: follow-up care and treatment in the community
• 3. partial hospitalization: some communities offer day centers or day hospitals which are all-day programs w/ supervised activities, therapy, and programs to improve social skills
• 4. supervised residencies: people who do not require hospitalization but cannot live alone or with families live in halfway houses: staffed by paraprofessionals (people who receive training and supervision from mental health professionals); usually run with milieu therapy that emphasizes mutual support, resident responsibility…etc
• 5. occupational training: paid employment provides income, independence, and the stimulation of working with others. many people receive it in a sheltered workshop: a supervised workplace for employees who are not ready for competitive or complicated jobs

• 1. poor coordination of services: various mental health agencies fail to communicate w/ one another. now many community therapists have become case managers who offer a full range of services including therapy, advice, medication, guidance, and protection of patients’ rights
• 2. shortage of services: there are not enough centers and most don’t treat as many w/ severe disorders