psychology

psychopathology

psychological disorder/ mental disorder

• Diagnostic
• and Statistical Manual of Mental Disorders (DSM-IV-TR)—describes specific symptoms and diagnostic guidelines for psychological disorders

–Provides a common language to label mental disorders

–Comprehensive guidelines to help diagnose mental disorders

..

• •Primary disturbance is distressing, persistent anxiety or maladaptive behaviors
• that reduce anxiety

• • Anxiety—diffuse,
• vague feelings of fear and apprehension

•More or less constant worry about many issues

• •The worry seriously interferes with
• functioning

•Physical symptoms


–headaches

–stomach aches

–muscle tension

–irritability

• •GAD has some genetic component
• •Related genetically to major depression
• •Childhood trauma also related to GAD
• 

• •Panic attacks—sudden
• episode of helpless terror with high physiological arousal

• •Very frightening—sufferers live in fear
• of having them

• •Agoraphobia often
• develops as a result

• •Sufferers tend to
• misinterpret the physical signs of arousal as catastrophic and dangerous

• •This interpretation
• leads to further physical arousal, tending toward a vicious cycle

• •After the attack the
• person is very apprehensive of another attack

• Intense, irrational fears that
• may focus on:

• •Natural
• environment—heights, water, lightening

• •Situation—flying,
• tunnels, crowds, social gathering

• •Injury—needles, blood,
• dentist, doctor

• •Animals or
• insects—insects, snakes, bats, dogs

•Anemophobia: fear of wind

• •Aphephobia: fear of being touched
• by another person

• •Catotrophobia: fear of breaking a
• mirror

•Gamophobia: fear of marriage

• •Phonophobia: fear of the sound of
• your own voice

• •Fear of panic attacks in
• public places

• •Avoid situations that
• might provoke a panic attack or where there may be no escape or help if a panic
• attack were to come

• •Not everyone with panic
• disorder develops agoraphobia

• •Social phobias—fear
• of social situations. Also called social anxiety disorder. Stems from
• irrational fear of being embarrassed or judged by others in public

• –public speaking
• (stage fright)

• –fear of crowds,
• strangers

–meeting new people

–eating in public

• •Considered phobic if
• these fears interfere with normal behavior

• •More prevalent among
• women than men

•Classical conditioning model


–problems:

• •often no memory of a traumatic
• experience

• •traumatic experience may not
• produce phobia

•Preparedness theory—phobia serves to enhance survival

• •Follows events that produce intense horror or
• helplessness (traumatic episodes)

•Core symptoms include:

• –Frequent recollection of traumatic event, often intrusive
• and interfering with normal thoughts

–Avoidance of situations that trigger recall of the event

–Increased physical arousal associated with stress

• •Obsessions—irrational, disturbing thoughts that intrude into
• consciousness

•Compulsions—repetitive actions performed to alleviate obsessions

• •Often accompanied by an irrational belief that failure to perform ritual
• action will lead to catastrophe

•Checking and washing most common compulsions

• A category of mental
• disorders in which significant and chronic disruption in mood is the predominant symptom, causing impaired cognitive, behavioral, and physical
• functioning

–Major depression

–Dysthymic disorder

–Bipolar disorder

–Cyclothymic disorder

A mood disorder characterized by extreme and persistent feelings of despondency, worthlessness,and hopelessness


–Prolonged, very severe symptoms

–Passes without remission for at least 2 weeks

–Global negativity and pessimism

–Very low self-esteem

•Emotional—sadness, hopelessness, guilt, turning away from others

• •Behavioral—tearfulness, dejected facial expression, loss of interest in
• normal activities, slowed movements and gestures, withdrawal from social
• activities

• •Cognitive—difficulty thinking and concentrating, global negativity,
• preoccupation with death/suicide

• •Physical—appetite and weight changes, excess or diminished sleep, loss
• of energy, global anxiety, restlessness

•Most common of psychological disorders

• •Women are twice as likely as men to be
• diagnosed with major depression

• •Untreated episodes can become recurring and
• more serious

• •Seasonal affective disorder (SAD)—onset with
• changing seasons

• •Chronic, low-grade depressed feelings
• that are not severe enough to be major depression

•May develop in response to trauma, but does not decrease with time

•Can have co-existing major depression

•Cyclic severe depression and elevated mood

•Seasonal regularity

•Unique cluster of symptoms

–intense hunger

–gain weight in winter

–sleep more than usual

–depressed more in evening than morning

•Cyclic disorder (manic-depressive disorder)

•Mood levels swing from severe depression to extreme euphoria (mania)

•No regular relationship to time of year (SAD)

•Must have at least one manic episode

–Supreme self-confidence

–Grandiose ideas and movements

–Flight of ideas

• Cyclothymic—mood disorder characterized by moderate but
• frequent mood swings that are not severe enough to qualify as bipolar disorder

•Onset usually in young adulthood (early twenties)

• Mood changes more abrupt than in major depression

• No gender differences in rate of bipolar disorder

• Commonly recurs every few years

• Can often be controlled by medication (lithium)

•Neurotransmitter theories


–dopamine

–norepinephrine


–serotonin


•Genetic component

• –more closely related people
• show similar histories of mood disorders

• •Positive correlation between stressful life events and onset of
• depression

• –Does life stress cause
• depression?

•Most depressogenic life events are losses


–spouse or companion

–long-term job

–health

–income

•Aaron Beck: depressed people hold pessimistic views of


–themselves

–the world

–the future

•Depressed people distort their experiences in negative ways


–exaggerate bad experiences

–minimize good experiences

• •Anorexia Nervosa-characterized by excessive weight loss, irrational fear
• of gaining weight, and distorted body self-perception

• •Bulimia Nervosa-characterized by binges of extreme overeating followed
• by self-induced vomiting, misuse of laxatives, or other methods to purge

• •Perfectionism, rigid
• thinking, poor peer relations, social isolation, low self-esteem associated
• with anorexia

• •Genetic factors
• implicated in both

• •Both involve decrease in
• serotonin

• Inflexible, maladaptive pattern
• of thoughts, emotions, behaviors, and interpersonal functioning that are stable
• over time and across situations, and deviate from the expectations of the
• individual’s culture

• •Pervasive mistrust and suspiciousness of others are the main
• characteristics

•Distrustful even of close family and friends

•Reluctant to form close relationships

•Tend to blame others for their own shortcomings

•Occurs in about 3 percent of population, more frequent in men

•Pathological jealousy seen in intimate relationships

•Used to be called psychopath or sociopath

• •Evidence often seen in childhood (conduct
• disorder)

• •Manipulative, can be charming, can be cruel
• and destructive

•Seems to lack “conscience”

•More prevalent in men than women

•Chronic instability of emotions, self-image, relationships

•Self-destructive behaviors

•Intense fear of abandonment and emptiness

•Possible history of childhood physical, emotional, or sexual abuse

•75% of diagnosed cases are women

• What is dissociation?

–literally a dis-association of memory

• –person suddenly becomes
• unaware of some
• aspect of their identity or history

• –unable to recall except under
• special circumstances (e.g., hypnosis)

•Three types are recognized

–dissociative amnesia

–dissociative fugue

–dissociative identity disorder

•Also known as psychogenic amnesia

•Memory loss the only symptom

•Often selective loss surrounding traumatic events

• –person still knows identity
• and most of their past

•Can also be global

• –loss of identity without
• replacement with a new one

•Also known as psychogenic fugue

•Global amnesia with identity replacement

–leaves home

–develops a new identity

• –apparently no recollection of
• former life

–called a ‘fugue state’

•If fugue wears off

–old identity recovers

• –new identity is totally
• forgotten

• •Originally known as “multiple personality
• disorder”

• •2 or more distinct personalities manifested
• by the same person at different times

•VERY rare and controversial disorder

• •Examples include Sybil, Trudy Chase, Chris
• Sizemore (“Eve”)

•Has been tried as a criminal defense

• •Pattern typically starts
• prior to age 10 (childhood)

• •Most people with
• disorder are women

• •Most report recall of
• torture or sexual abuse as children and show symptoms of PTSD

• •Repeated, severe sexual
• or physical abuse

• •However, many abused
• people do not develop DID

• •Becomes a pathological
• defense mechanism to cope with intense feelings of rage and anger

–‘split’ refers to loss of touch with reality

–not dissociative state

–not ‘split personality’

•Positive symptoms

–hallucinations

–delusions

• •Negative symptoms
• –absence of normal cognition or
• affect (e.g., flat affect, poverty of speech)

•Disorganized symptoms

• –disorganized speech (e.g.,
• word salad)

–disorganized behaviors

•Hallucinations

• –hearing or seeing things that
• aren’t there

–contributes to delusions

–command hallucinations: voices giving orders

•Disorganized speech

• –Over-inclusion—jumping from
• idea to idea without the benefit of logical association

• –Paralogic—on the surface, seems
• logical, but seriously flawed

•Disorganized behavior and affect

–behavior is inappropriate for the situation

•e.g., wearing sweaters and overcoats on hot days

–affect is inappropriately expressed

flat affect—no emotion at all in face or speech

•inappropriate affect—laughing at very serious things,crying at funny things

–catatonic behavior

•unresponsiveness to environment, usually marked by

immobility for extended periods

Paranoid type

–delusions of persecution

• •believes others are spying and
• plotting

–delusions of grandeur

• •believes others are jealous,
• inferior, subservient

• Catatonic type—unresponsive to surroundings, purposeless movement,
• parrot-like speech

•Disorganized type

• –delusions and hallucinations
• with little meaning

• –disorganized speech, behavior,
• and flat affect

•Drugs that reduce dopamine reduce symptoms

• •Drugs that increase dopamine produce symptoms even in people without the
• disorder

•Theory: Schizophrenia is caused by excess dopamine

•Dopamine theory not enough; other neurotransmitters involved as well

•Other congenital influences

–difficult birth (e.g., oxygen deprivation)

–prenatal viral infection

•Brain chemistry

–neurotransmitter excesses or deficits

–dopamine theory

•Brain structure and function

• –enlarged cerebral ventricles
• and reduced neural tissue around the ventricles

• –PET scans show reduced frontal
• lobe activity

•Early warning signs

• –nothing very reliable has been
• found yet

• –certain attention deficits can
• be found in children who are at risk for the disorder

• •Father’s age—older men are at higher risk for fathering a child with
• schizophrenia

Family variables

• –parental communication that is disorganized, hard-to-follow,
• or highly emotional

–expressed emotion

• • highly critical,
• over-enmeshed families

•Many biological factors seem involved

–heredity

–neurotransmitters

–brain structure abnormalities

•Family and cultural factors also important

•Combined model of schizophrenia

• –biological predisposition
• combined with psychosocial stressors leads to disorder

• –Is schizophrenia the
• maladaptive coping behavior of a biologically vulnerable person?