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PSY 150A1 With Prof. Lazarewicz Lecture Notes Chapter 15: Psychological Disorders  Psychological disorder – characterized as deviant, distressful, & dysfunctional patterns of thoughts, feelings, & behaviors o Deviant – violation of norms, or rules in society that are defined as “right & wrong”  Ex: personal space o Distressful  Judge own normality  No distress = no disorder  Problem: lack of distress does not equal harmless behavior  Behavior can still be harmful even if not causing distress o Ex: alcoholism o Dysfunctional – disrupts life & routine  Ex: compulsive hand-washing  Explaining Psychological Disorders o Ancient societies  Ancient Egypt was the first known culture that made metal health a priority  First known psychiatric test, mental hospital, mental physicians, etc.  Ancient Greece & Hippocrates (460-360 BC)  Mental illness due to natural causes o Middle ages  Witchcraft th th  Mid 15 to end of 17 centuries: 100,000 “witches” executed in European witch-hunts  Possession/evil spirits  Exorcisms o Thought torture would make the body an inhabitable place for a spirit so they would leave o Trepanation – drilling holes into the skull to allow the evil spirit to escape  When people survived these (most cases), they would be changed  (wouldn’t happen to do with the fact that they were just basically tortured and drilled into without anesthesia)  Big holes … not small  Motivation to act differently o Medical model  Return to a more medicinal approach by the 1800’s  Physical causes for mental disorders  Asylums (psychiatric hospitals) – institutions that offered shelter & support to the mentally ill o Often had very poor living conditions and excluded from the rest of society PSY 150A1 With Prof. Lazarewicz  Overcrowding, lack of resources & care, etc.  Terminology – mental health/illness, diagnosis, symptoms, cures, therapy, treatment, etc.  Classifying Psychological Disorders o Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – lists of all symptoms & diagnostic criteria for all disorders  Most common diagnostic tool in clinical psychology  Disorders organized into categories (anxiety, mood, etc.)  Pros:  Standardized (diagnosis & treatment)  Fairly reliable  Cons:  More disorders = more mental illnesses o 60 categories in 1950s DSM; 400 today o Nearly 30% of adults qualify for at least one disorder  Diagnostic criteria include everyday behaviors… at what point is it considered a disorder then  Labeling problem – labeling people as a person with disorders and only considering them by that  David Rosenhan (1973): On Being Sane in Insane Places  Can 8 psychologically healthy people fake way into mental hospitals What happens if they do o 3 psychologists, 1 psychiatrist, 1 psychology graduate student, 1 pediatric, 1 painter, 1 home maker  Present selves at separate hospital (5 states)  3 lies told:  False names  False careers for psychologist & psychiatrists  Hearing voices  All 8 admitted with schizophrenia  No further voices, any other abnormal behavior  Behaviors seen as consistent with mental illness  Ex: note talking: “Patient engaging in pathological writing behavior”  Fooled doctors, but patients were the ones to challenge them  Challenged by a different mental hospital  can’t fool us!  Rosenhan to send at least 1 imposter over a 3- month span  Admitted 193 patients o 41 considered imposters, another 42 considered suspicious PSY 150A1 With Prof. Lazarewicz o 0 sent by Rosenhan  Anxiety disorders o Anxiety – state of fear (behavioral, subjective experience with psychological reactions)  Can be adaptive  Anxiety disorder – deviant, distressful, & dysfunctional anxiety o Generalized anxiety disorder (GAD)  Symptoms  Persistent state of anxiety  Continually waiting for something bad to happen  Restless, jittery, insomnia  Difficulty concentration, irritable  Increased heart rate & muscle tension, easily tired  Secondary anxiety – anxiety about their anxiety o Only makes it worse  Groups at risk  2/3 of diagnoses are female o Women more likely to seek help than men  All ages o Panic disorder  Symotoms  Repeated un-cued panic attacks o Panic attack – sudden period of intense fear  Often short of breath, heart palpitations, sweating, dizziness  exhaustion after attack  Usually only a few minutes o Cued – situationally bound in response to a trigger  Ex: phobias o Un-cued – unexpected, random, “out of the blue”, not connected to a trigger  Agoraphobia – fear of future attacks in public  Fear of inescapable situations where help may not be available  May tend to stay close to home, only leave with companions (or don’t leave home at all)  Complication of panic disorder & own disorder o Agoraphobics without panic disorder, panic disorder without agoraphobia  Both can be the case  Bottom line: panic attacks can cause agoraphobia, but are not a prerequisite  Groups at risk  Panic disorder: o 3.5% of US  7% have experienced a panic attack PSY 150A1 With Prof. Lazarewicz  Agoraphobia: o 5.3% of US o More common in women o Median average of onset = 24 o Phobias – intense, persistent fear of an object/situation, avoidance of it, cued panic attacks  Specific phobias  Top 10 most common o Heights o Enclosed spaces o Injection/needles o Thunder/lightning o The number 13 o The dark o Snakes o Spiders o Disease o Germs  Social phobia  Symptoms o Anxiety in social situations or thinking about them o Fear of embarrassment & humiliation  avoid certain situations  Ex: public speaking, eating in public, using the public restrooms  Social phobia vs. agoraphobia  Social phobia o Afraid of social disapproval, embarrassment o Comforted by avoiding others  Agoraphobia o Afraid of the anxiety itself, not having help o Comforted by being with others  Groups at risk  Specific phobias o Average onset age is 11-17 o 9-10% of people o 2x as common in women  Social phobia o Usually early adolescence is the average onset age o 13% of people o No sex differences o Obsessive compulsive disorder – uncontrollable anxiety due to obsessions compulsions  Obsessions – unwanted, repetitive thoughts  Ex: dirt/germs, something bad happening, order/symmetry  Compulsions – unwanted, repetitive behaviors  Ex: excessive washing, repeating behaviors, checking PSY 150A1 With Prof. Lazarewicz  Groups at risk  2-3% of people  Median onset age: 23  Men & women at equal risk o Men  checking o Women  cleaning o Post-traumatic stress disorder (PTSD)  Symptoms  Haunting memories of trauma  Easily startled  Irritability  Nightmares  Social withdrawal  Insomnia  4+ weeks after a traumatic event (incubation period)  War, terrorism, natural disasters, accidents, abuse, etc. o The closer were are to the event, the more traumatizing it is…  Groups at risk  5-8% of people  Certain jobs (military, EMTs)  Females 2x that of men o Possible causes of anxiety disorders: Nature vs. Nurture  Nurture  Fear conditioning o Ex: phobias, PTSD o Ex: little Albert o Ex: OCD handwashing germs  Learned behavior o Anxiety runs in families  Modeled behavior  Nature  Genes o Runs in families o Twin studies o The brain  OCD: hyperactivity in the anterior cingulate cortex  Region of the frontal lobe that monitors our actions – defects errors & mistakes  Panic disorder: hyperactivity in the locus ceraleus  Controls norepinephrine (fight-or-flight)  Mood disorders o Mood disorder – significant increase or decrease in mood o Major depressive disorder (MDD) PSY 150A1 With Prof. Lazarewicz  Depressive episodes  5+ of these symptoms & must have one of top two o Low mood o Loss of interest in activities o Feeling worthlessness o Sleep: insomnia/hypersomnia o Difficulty concentrating o Appetite: weight loss/gain o Sluggishness, fatigue, low energy o Thoughts of death, suicide  Dysthymia – low mood & two other symptoms listed above  15 million Americans  15% of college students  1 in 5 in their lifetime  Who is at risk  Women 2x as likely  At any given time o 4% men o 6% women  Rates of depression are rising worldwide  Seasonal affective disorder (SAD) – depressive symptoms that arise in late autumn & winter  Majority are females  Ex: Finland 9.5% & Alaska 8.9%  May be related to less light exposure o Affects circadian rhythm o Body shows down as if it is nighttime  Treatment o Light therapy – exposure to artificial light for several hours a day  75% improvement o Bipolar disorder – group of disorder marked by mania  Subsyndromal symptoms = 24.9%  Symptoms  Elevated/euphoric or irritable mood  High energy  Decreased need for sleep  Grandiosity  Racing thoughts, short attention span  Reckless/risky behavior  Manic episodes – these symptoms occur most of the day, nearly every day for 1 week  Hypomanic episode – these symptoms occur most of the day nearly every day, for 4 days PSY 150A1 With Prof. Lazarewicz  Bipolar 1 – 1+ manic episode (may or may not involve depressive episode)  Bipolar 2 – 1+ depressive episode & 1+ hypomanic episode  Cyclothymia – manic & depressive episodes that do not meet full DSM criteria— subtler than bipolar 1 or 2  Possible causes  1. Biological influences o Genes o Neurotransmitters  Depression: low levels of serotonin, norepinephrine  Mania: high levels of norepinephrine o Area 25: smaller than normal = higher risk of depression  2. Psychological/cognitive influences o Self-defeating beliefs  Negative assumptions about self, present, and future o Explanatory style  How we interpret & explain an event to ourselves  3. Environmental influences o Negative experiences  Traumatic events  Stressful environment  Stressful experiences o Vulnerability-stress model  Vulnerability (diathesis): predisposition  Stressor: life even or series of events  Vicious cycle  Stressful experience  negative explanatory style  depressed mood  cognitive & behavioral changes  stressful experience (& repeat)  Schizophrenia – distortion of thoughts, moods, perceptions, & weird behaviors o Approx. 1 in 100 people o Incredibly universal  Men afflicted earlier, more severely, and slightly more often than women o Symptoms  Detachment from reality  Hallucinations  Delusions  Actions don’t reflect understanding o 3 types of symptoms  1. Distortions to thought & language  Delusions – false beliefs, firmly held with no basis in reality o Ex: some types of delusions  Persecution  Control  Sin & guilt  Reference PSY 150A1 With Prof. Lazarewicz  Nihilistic  Grandeur  Bizarre hypochondriacally  Thought insertion  Thought withdrawal  Thought broadcasting o Thought tampering  Broadcasting – “people can hear everything I’m thinking”  Insertion – “they put it in my mind”  Withdrawal – “they took it from my mind”  Word salad – jumble of words all together that doesn’t make much sense with little to no coherence o Like someone threw a bunch of word magnets at a fridge and read it  Clanging – rhyming of words or sounds while talking, sentences don’t make much sense  Poverty of content – more like a grammatically correct stream of consciousness without any rhyme or reason as to why they are talking or what the purpose of them talking is  Neologisms – combination of regular words to create new ones or sayings that aren’t common or associated in society o Possible schizophrenics who demonstrate this know what they are trying to say, but don’t know how to say it  2. Perception – breakdown of selective attention  Hallucinations – sensory experiences without sensory input o Mind creates images or noises without there actually being such o Any sense b auditory most common (70% of schizophrenics) o Some are aware of the hallucinations, others are not and cannot tell or are not aware that they have a problem  Which are the real voices, and which are imaginary  PET scans show activity in Broca’s area while hearing voices  3. Inappropriate emotions & behaviors – reduced emotional responsiveness  Blunt affect – showing little emotion  Flat affect – showing no emotion o Dimensions of schizophrenia  1. Reactive vs. process schizophrenia  Reactive – rapid development, often in response to stress o Recovery fairly likely  Process – more gradual onset, slow development o Recovery doubtful  2. Positive vs. negative symptoms  Positive – presence of inappropriate behaviors PSY 150A1 With Prof. Lazarewicz o Ex: hallucinations, word salad, inappropriate emotions o Usually respond well to medication o Type I schizophrenia  Negative – absence of appropriate behaviors o Ex: flat affect, toneless voice, rigid body o Harder to treat o Usually not as responsive to medication o Type II schizophrenia o Possible causes: Nature vs. Nurture  Nature  Genetics o The more closely related to a schizophrenic you are the more likely you are to be schizophrenic as well o If a genetic predisposition likely exists, may not be sufficient enough to be schizophrenic though  Brain abnormalities o 1. Excess dopamine receptors  6x as many in schizophrenics  Intensifies neural signals  positive symptoms (hallucinations  Medications block symptoms o 2. Shrinking in brain  Tissue loss in the cortex thalamus  Environmental factors o Flu during pregnancy  4x higher risk of schizophrenia  Higher rate in urban areas (faster viral spread)  Born during winter & spring (after fall-winter flu season) = 5-8% increased risk  Southern hemisphere: flipped months PSY 150A1 With Prof. Lazarewicz Textbook Notes  Abnormal behavior – causes distress and prevents daily functioning  Medical perspective – cause of abnormal behavior rooted in individual possibly due to hormone imbalance, chemical deficiency, or brain injury  Psychoanalytic perspective – abnormal behavior stems from childhood conflicts over opposing wishes regarding sex and aggression  Behavioral perspective – rewards and punishments in the environment which influence and determine abnormal behavior  Cognitive perspective – central part of people’s abnormal behavior is from thoughts and beliefs  Humanistic perspective – people responsible for own behavior  Sociocultural perspective – society shapes people’s behaviors  Illness anxiety disorder – people fear illness and are preoccupied with their health  Conversion disorder – physical disturbance of a somatic symptom disorder  Dissociative disorders – dysfunctional characteristics of a person’s personality  Dissociative identity disorder – multiple personalities displayed within a single person  Dissociative amnesia – significant selective memory loss  Dissociative fugue – leaving home and assuming a new identity suddenly  Narcissistic personality disorder – exaggerated sense of self importance  Attention-deficit hyperactivity disorder – low tolerance for frustration, inattention, easily distracted, impulsive, and decent amount of inappropriate activity